Category Archives: Physio Blog

Elizabeth Orr

Having worked predominantly in private practice since graduating, I have co-owned/operated three practices in New Zealand with my Physio husband.  Additionally we have worked as Physios in the United States (New Orleans) and again in Canada (British Columbia), our home being Gladstone since 2005.  It is here that I opened my fourth practice ‘Elizabeth Orr – Physiotherapy and Acupuncture’ in 2008, operating as my kids grew in a part time, and now full time capacity.

I have a passion to ‘solve the unsolvable’ and love treating chronic and difficult cases alongside the everyday issues.  Though I treat all back and spinal issues as well as sports and musculoskeletal dysfunctions, my many years have enabled me to branch into women’s health (pregnancy, infertility, pre and post menopause) alongside chronic pain and auto-immune disorders. In essence, there is nothing I will not treat!

When you come to me, expect a fast and accurate diagnosis with a treatment focussing strongly on the ’cause’ of your ‘symptom’.  I utilise only hands-on techniques (joint mobilisation and manipulation, fascial/soft tissue release) in conjunction with acupuncture and education.  In conjunction I work strongly with under-pinning issues from hormone irregularity and dominance, to methylation processes, histamine reactions – referring openly and speedily for additional tests and MRI’s.

Aside from loving what I do and having the privilege to work in my area of passion, I have three beautiful children (Josiah, Elisha and Lilah-Rose) who alongside my husband fill my time! I live in Calliope and enjoy cycling and all things outdoor – currently training as a Yoga Instructor.  Additional to this I am a musician – pianist, drummer, singer and a Christian.

Yours in ‘Solving your Unsolved’

Elizabeth Orr

Plantar Faciitis

“Pain with your first steps of a morning?”

The plantar fascia is a thickened fibrous aponeurosis originating from the calcaneus running toward the five metatarsal heads and splitting into five bands of sheath for each digit. Generally, it is split into three parts; medial, central and lateral bands. The central band is most commonly involved in this condition even though it is the thickest and strongest section.

In a normal working foot, the plantar fascia functions in the windlass mechanism of the foot, becoming taught with extension of the great toe during the toe off phase of the gait cycle. This provides stability during both static and dynamic movements, as well as shock absorption. Injury to the plantar fascia is usually due to an underlying biomechanical insufficiency that overloads the tissue causing micro tears. Most commonly this cause is a dropped medial longitudinal arch, or “flat feet”. This stretches the plantar fascia at rest increasing the stress to the tissue once a force is applied to it. This force is 2-3 times your body weight during walking/running, hence it is easy to see how small insufficiencies can quickly build into acute pain.

The most common symptom for this condition is sharp pain during the first steps of a morning, which eases as you continue to walk. This is because overnight your fascia tightens up and becomes very stiff, so that by the time you come to walk and stretch the fascia, it doesn’t react well to it. Of an afternoon or evening the pain often returns due to overuse and inflammation of the fascia. This cycle repeats itself often worsening over days, weeks and months. Pain will usually be felt on the underside of the heel and into the medial arch of your foot.

Differential diagnosis of plantar fasciitis is primarily related to heel spurs, which can co-occur with this condition. However, many heel spurs are asymptomatic in the general population, whereas plantar fasciitis is commonly symptomatic. Diagnosis can be confirmed by an ultrasound scan confirming a thickening of the plantar fascia. An X-Ray can also be used to confirm or decline the incidence of a heel spur.

Treatment of acute plantar fasciitis firstly involves your general RICE principles, although it is difficult to rest your feet to the extent you need to. Other treatment approaches can target the original cause of the condition- biomechanics in most cases. Customised orthotics are usually the best approach to this, via regaining your arch to de-load the plantar fascia from the stretch applied to it. In chronic cases of plantar fasciitis rest alone will not provide sufficient improvement to rid you of your symptoms. Shockwave therapy has been shown to provide effect therapy for tendinopathies and associated conditions. By applying a mechanical force to the tissue it breaks down the scar tissue and adhesive formations, allowing for new and improved tissue to be laid down to replace it. Over a course of sessions this can resolve plantar fasciitis.

If this pattern sounds familiar to you, see a physiotherapist for manual therapy and education on how to improve your condition. Click Here to book your appointment today.

Long Thoracic Nerve Injury

Do you have a winging scapula? Has physio tried to correct your posture with no improvement? You may have a Long Thoracic Nerve Injury.

The long thoracic nerve arises from the lower part of your neck, and supplies to serratus anterior muscle. The serratus anterior muscle is very important in controlling your shoulder blade position, and thus the function of your shoulder. Damage to this nerve may occur from trauma in the neck or shoulder pit region, and can cause excessive winging as shown in the diagram above. As it is a nerve injury, it can take some time to heal, but correct physiotherapy exercises, manual treatment techniques and specific nerve techniques will enable the Long Thoracic Nerve to fire correctly again and thus innervate these important muscles.

If you feel you have a “Winging Scapula” and you need help getting your shoulder function back to normal, give us a call or pop into the clinic to begin your rehab process.

Dupuytren’s Contracture

Have you noticed 1 or more of your fingers have become bent and you are unable to straighten it? You may have a Dupuytren contracture.

A nodule may have developed over the past months or years, and is now causing your finger to bend. If it is now affecting daily life when gripping or trying to use your hand, a physiotherapist can help to maintain range of motion, strength and function of your hand.

Dupuytren contracture typically progresses over the course months or years. This condition most commonly begins with thickening of the skin on the palm, resulting in a puckering or dimpled appearance. As the condition progresses, bands of fibrotic tissue form in the palmar area and may travel toward the fingers. This tightening and shortening eventually leads to the affected fingers being pulled into flexion.

The main treatment for this is by injection or surgical intervention. Physiotherapy is important post intervention in the form of splinting, exercises, oedema and scar interventions to maintain the range of motion that was obtained through the injection or surgical removal of the fibrotic tissue. Functional range of motion of the fingers is imperative to many activities of daily living, making its preservation key.


Are you experiencing widespread heightened pain and fatigue?

Fibromyalgia is a medical condition characterised by multiple symptoms. The primary symptom is widespread heightened pain in multiple regions of the body. It is believed that fibromyalgia amplifies your pain receptors via the mechanism that your brain receives these messages. Interestingly women are more commonly affected than men. Commonly affected areas include the neck with tension headaches, alongside the jaw region with TMJ disorders. The trigger of this condition is unknown, but is believed there are links with onset to post trauma or surgery, along with experiences of psychological stress. If you think you have experienced any of the above, you may suffer from fibromyalgia. Although there is no known cure, medications and physical interventions have been shown to reduce symptoms.

Fibromyalgia is a medical condition characterised by multiple symptoms. These are individual to each person but commonly involve multiple regions of pain and discomfort. If affects roughly 2-5% of the population, with a higher incidence found in women. Although it occurs in all age groups, the most common onset is during middle age.

The causes of fibromyalgia are unknown, but it is more commonly found in people with specific comorbidities:

  • Rheumatoid arthritis
  • Recent illness or physical trauma
  • A family history of fibromyalgia
  • Stress/Depression

The trigger for the onset of this condition is also unknown, however certain environmental factors have been theorised:

  • Weather changes
  • Increased mental stress
  • Infections/allergies

It is believed that fibromyalgia amplifies your pain receptors via the mechanism that your brain receives these messages. Commonly affected areas include the neck through tension headaches, alongside the jaw experiencing TMJ disorders. You can also find an increased responsiveness to sensory stimuli, such as heat or light.

The diagnosis of fibromyalgia involves a process first of ruling out other associated conditions which present with a similar set of symptoms. This is due to there being no known medical procedures to firmly diagnose this condition. One such example is rheumatoid arthritis. Your doctor can send you for a red blood cell sedimentation test, which measures the degree of inflammation in your body. Once such conditions have been ruled out, diagnosis of fibromyalgia is confirmed by a physical examination highlighting multiple tender points in your body, alongside your subjective feedback.

How can Physiotherapy aid this condition?

Although there is no known cure, physiotherapy can aid in the reduction of your symptoms to allow you to live better with the condition. The following are a few examples of the methods physio’s can use to achieve this:

  • Education: through teaching self-management techniques, you can improve your range of motion and strength at affected joints
  • Exercise: light aerobic exercise has been shown to reduce pain, fatigue and sleep disturbance through the release of endorphins, your body’s own “natural high”
  • Stress management/relaxation techniques: through modes such as massage and
    acupuncture, you can allow your body to relax and reduce its tension.

If you would like any further information regarding this condition, or would like to book in for an initial assessment, click to book an appointment.

Cauda Equina

Are you experiencing altered sensation, or severe or progressive weakness or numbness in the lower extremities, urinary or bowel incontinence, lower back pain and sharp stubbing pain in the leg?

Cauda Equina Syndrome is caused by the compression of nerves in the lumbar spine and a narrowing of the spinal
canal. If you are experiencing symptoms such as altered sensation, weakness, numbness in the lower extremities,
together with urinary or bowel incontinence and lower back pain you might have Cauda Equina Syndrome. It is
important that you seek for help ASAP as this condition requires an emergency surgical decompression. If you are
unsure about your symptoms, physiotherapists at Active Physio Health can assist you with a thorough assessment.

Cauda equina syndrome is a relatively rare but serious condition that describes extreme pressure and swelling of the nerves at the end of the spinal cord. It gets its name from Latin, “horse’s tail,” because the nerves at the end of the spine visually resemble a horse’s tail as they extend from the spinal cord down the back of each leg.

Cauda equina syndrome is a serious medical emergency that requires testing and possibly urgent surgical intervention. If patients with cauda equina syndrome do not get treatment quickly, adverse results can include permanent paralysis, impaired bladder and/or bowel control, difficulty walking, and/or other neurological and physical problems.

These are the most common causes of cauda equina syndrome:

  • A severe ruptured disk in the lumbar area (the most common cause).
  • Narrowing of the spinal canal (stenosis).
  • A spinal lesion or malignant tumour
  • A spinal infection, inflammation, haemorrhage, or fracture.
  • A complication from a severe lumbar spine injury such as a car crash, fall,
    gunshot, or stabbing.
  • A birth defect such as an abnormal connection between blood vessels.

Cauda Equina can be diagnosed with a physical examination to assess your strength, reflexes, sensation, stability, alignment, and motion. You may also need blood tests.

Magnetic resonance imaging (MRI) scan or computed tomography (CT scan) are also used by doctors.

Even with treatment, patients may not retrieve full function. It depends on how much damage has occurred. If surgery is successful, you may continue to recover bladder and bowel function over a period of years.

If permanent damage has occurred, surgery cannot always repair it. Your cauda equina syndrome is chronic. You will need to learn ways to adapt to changes in your body’s functioning. You’ll find that both physical and emotional support is essential.

Disc prolapses

“Bending based back pain?”

Lower back pain is the leading cause of lost work productivity each year in Western society. Over a lifetime the incidence of lower back pain is estimated at well over 50%, with a yearly incidence estimated at around 5%. Of new presenting patients to medical professionals, around 15% are reported to be for lower back pain. The intervertebral disc is reported to be a more frequent cause of lower back pain that muscular of ligamentous strain/sprain.

In your lumbar spine there are five intervertebral discs. These function as a load bearer during functional activities and interestingly provide around a third of your spines height. The central nucleus consists of 70-90% water in a healthy adult, allowing optimal function. This is surrounded by an outer sheath of annulus fibrosis, which maintains the nucleus centrally. The annulus only has a nerve supply and therefore injuries to the nucleus only do not usually cause symptoms in the population. Only when the lesion spreads to the annulus do symptoms become clear.

Increased forces are exerted through your disc during flexion based motions of your lumbar spine. This places a primarily anterior directed force to the disc as the anterior aspects of the adjacent vertebrae move closer together. Over a prolonged period, such forces can reduce the load bearing capacity of the disc and reduce the water content of the nucleus. This can result in the nucleus buckling under the load which it can no longer tolerate and push into or completely through the annulus fibrosis into the spinal space.

The vast majority of disc prolapses will be in a posterior direction, due to the mechanism stated above. In this case, the bulge can place to one side or both if large enough, and irritate nerve endings where they exit the spinal cord at the foramina of corresponding vertebrae bilaterally. This irritation causes common symptoms related to lower back pain; lower limb paraesthesia. In a large disc prolapse, the bulge can irritate both nerve endings at a single level causing these symptoms down both lower limbs. Alongside bowel & bladder, saddle anaesthesia and sexual dysfunction, these are red flag symptoms which require immediate examination by a doctor and likely MRI/CT

Primary symptoms therefore for this condition include flexion based symptoms, lower limb paraesthesia and pain with prolonged sitting. Standing will usually be more comfortable than sitting. A medical practitioner will examine you for these symptoms via a neural examination and range of motion tests. Initial treatment for an acute disc prolapse will consist of rest, avoidance of aggravating factors and exercises that promote placing the disc back into its original position. In severe cases where conservative therapy is not enough to improve a person’s symptoms, surgery
can be indicated to remove a herniated part of a disc of to replace a severely damaged disc.

Prognosis for small to moderate disc bulges is generally good, taking 6-8 weeks for a full recovery. Beyond this point, rehabilitation exercises to strengthen your core are crucial to prevent reoccurrence of the same injury. Severe disc bulges can in rare cases cause chronic debilitation and in rarer cases still are a medical emergency if the spinal cord is compressed. If you think these symptoms are similar to what you are experiencing, it is important to be examined by a medical practitioner immediately.

De Quervain’s

The most common injury to occur at your thumb is called De Quervain’s tenosynovitis. A tenosynovitis is an inflammation of the fluid within a sheath that surrounds a tendon. This tendon normally glides up and down the sheath as you use that muscle. With overuse, however, the fluid that surrounds the tendon can become inflamed and thickened.

This causes repetitive friction with the tendon resulting in irritation and pain with use. At the thumb, this occurs in two tendons in particular; abductor pollicus longus, extensor pollicus brevis. Onset of this condition is primarily insidious and builds over the course of a few weeks. Any activity involving repetitive use of the thumb will increase symptoms, such as desk and grip based jobs.

The primary test for this condition is palpation of the appropriate tendons and the Finklestein’s test. If positive, treatment consists of bracing, taping and ultrasound. This will help to reduce the inflammation and rest the condition. With appropriate rest this condition can clear completely within a few weeks. If not addressed however, it will continue to affect you until you do something about it. So don’t wait and hope it will go away, because it won’t!

Colles’ Fracture

One of the most common forms of upper limb fracture is a Colles’ fracture. This occurs at the wrist and is very common after a fall on an outstretched hand.

At your wrist joint you have two bones from your forearm and multiple small bones in your hand. When you fall onto an outstretched hand very commonly the distal end of your radius bone is fractured.

As a result of this your wrist can look a little like a dinner fork due to the displaced bone at the wrist joint. This is the main presentation that can indicate a fracture over a mild sprain or contusion. An X-Ray is required
to confirm a fracture and then whether the fracture is displaced or not. If displaced, an open reduction and internal fixation surgery is required to place the bone in the correct position to allow it to heal properly.

You are then normally placed in a cast and sling for around six weeks to allow the fracture to heal appropriately. Once past this phase, physiotherapy becomes important to regain range of motion and strength, not only at your wrist but also your elbow and shoulder.

This is due to the prolonged period of inactivity. It is very important to complete a course of rehabilitation so that you are not left with residual weakness or limitations in movement at any of these joints, especially your wrist.

Carpal Tunnel

Are you experiencing tingling or numbness in the middle of your hand and fingers especially during the night? You might have the carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity, affecting 2% to 5% of the population, usually involving compression of the median nerve in the wrist region. The prevalence is higher in women than in men, and most commonly the disease onset occurs in the age range between 30 and 60 years. In older patients, the female/male ratio is up to 4:1, and the dominant hand is generally most affected; but bilaterally may occur in up to 50% of cases, making the comparison of images with the contralateral side more difficult, considering that nerve abnormalities may present previously to symptoms onset. The incidence of CTS is higher in
individuals whose professional activity involves repetitive movements or wrist overload.