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Foot Pain Treatment in Melbourne

Pain Treatment in Melbourne
By Michael Hall

Walking, running and in fact every time you put your feet on the ground, involves a complex interaction of the joints, muscles and nervous system control of your whole body. It stands to reason therefore, that all injuries which involve having your feet on the ground especially foot pain problems and foot pain from walking, must involve an assessment of the activity as a whole as well as an examination of each muscle and joint involved in the process.

This is the physiotherapist advantage.

Physiotherapists can analyze your standing, walking and running as a whole as well as break each movement down to its component parts. Physiotherapists can assess the mobility of your joints, the strength of your muscles and the control of your movements enabling them to determine deficits and analyze causes.

Physiotherapists can then use “hands on” techniques to free up specific joints, loosen specific muscles and mobilize your nervous system, techniques all designed to create the optimal environment for healing. These techniques also make rehabilitative exercise more effective, which makes postural and movement correction more effective. Consequently, all the treatment that we perform at Bodywise Health is not just directed at getting your back, hip or knee better, but importantly directed at getting you back doing the things you love to do whether be hiking in the country, walking in the park or going for a run.

The problem

Up until this stage there have been two problems.

The first problem was that assessments of foot pain problems and foot pain when walking often weren’t optimally objective, often involving observation or even video-taping a person as they walked or ran on a treadmill. These assessments still involved estimates of the biomechanics of the body.

The second was that assessments simply weren’t relevant. A plaster cast was made of the feet in sitting or standing, which had absolutely no relevance to walking or running. Therefore this type of assessment couldn’t adequately provide a solution for leg and body problems associated with these activities.

The solution

Gait scan has now changed all of this. Now assessments of foot pain when walking are both relevant and objective. Gait scan scans each foot, measuring the amount and timing of pressure from each part of the foot at 300 times per second as you stand, squat or walk. This objective data has been validated and verified and an enormous data bank of information has been gathered in the 25 years it has been used in Canada. By comparing your gait scan data with the existing data and combining this with information gained through a clinical examination, accurate, objective clinical findings can be made not just for your foot, but for your knee, hip and even your back.

Gait scan is a fantastic tool for foot pain walking problems as it provides the objective clinical details needed to provide long term orthotic solutions for foot pain problems. These include problems such as plantar fasciitis, heel spurs (pain on the under surface of the foot), hallux valgus (big toe pain), meta-tarsalgia (toe pain), mid-tarsal joint arthritis, chondromalacia patellae (knee cap pain), iliotibial band fasciitis (pain on the outside of the knee) and many others.

Gait scan orthotics permanently change the physical stresses on your body every time you stand. By doing this, they can permanently unload or eliminate the stresses on your painful body part, thereby providing permanent relief. Combined with “hands on” soft tissue and joint techniques as well as precise corrective muscle activation training, balance, walking/running and functional retraining, gait scan orthotics provide the ultimate in long term relief and improved physical performance of many activities.

Experience permanent relief, not just a quick fix

Gait scan orthotics permanently remove the physical stresses on your foot pain problems every time you stand, walk, squat, lunge and run, thereby providing you with permanent relief. Combined with “hands on” soft tissue and joint techniques as well as precise corrective muscle activation training, balance, walking and running retraining, gait scan orthotics provide the ultimate in long term relief from foot pain from walking as well as improved physical performance of many activities.

So if you experience foot pain problems, especially foot pain from walking or have long term foot, ankle, knee, hip or even back problems, gait scan orthotics may be the answer that you are looking for. They may save you months of therapy and years of pain.

For more information or an appointment, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.


Chronic Pain Treatment Melbourne

east brighton physiotherapy
By Michael Hall

Chronic pain is pain that is constant, relentless, draining pain for longer than 12 weeks. Unless you have had it, you can’t imagine it. It may involve back pain, neck pain (whiplash), migraine / headaches, tinnitus (ringing in the ears), phantom limb, fibromyalgia / fibrositis, chronic regional pain syndrome (CRPS) pain.

Chronic pain may affect every part of life, from sleeping, to morning to night. Every posture, movement, every activity, every word, every thought, every moment may be coloured by its presence until it becomes all consuming,

Chronic pain is serious

So pervasive, so invasive is chronic pain that it can wear you down, until it breaks you. Apkarian et al (2004) showed that people with chronic low back pain had lost 5-11% of neocortical brain matter, or 1.3cm3 of brain grey matter for every year of chronic pain. This is equivalent to 10-20 years of normal aging. The seriousness of dealing appropriately with chronic pain could not be more apparent.

Chronic pain is complex

One thing that is clear is that chronic pain is complex involving a complicated interplay of almost every bodily system. The sensations that we experience through our senses (sight, touch, hearing and smell), are transmitted to the spinal cord and then on to the brain. In the case of a severe pain, a response may be initiated from the spinal cord (reflex) directly as in the case of pulling our hand away from a fire. The brain also receives the information and on-sends it to all many different areas for processing, interpretation and the initiation of a response. These responses may affect all systems of the body from the activation of a movement, to changes in the immune system, to changes in the autonomic system. Essentially these responses have to do with either a protective response (fight or flight) or a nurturing growth and repair response.

Fight or Flight Vs Growth and Repair

The response that is activated depends upon how the stimulus is perceived. Our most primitive, automatic response is one of fight or flight. In the case of a perceived pain, threat, or fear, our body is readied to fight or take flight as our awareness is heightened, our heart pumps harder, breathing quickens, perspiration increases, muscles are tautened. At the same time, blood is diverted away from the digestive system and the nervous system is put on alert as the immune system is “deactivated”. In other words, our need to survive is prioritized ahead of every other need of the body, including growth and repair. This survival instinct, in the case of short term threats to our safety, is appropriate to help us stay alive. However, with repeated exposure to this pain, threat or fear, and repeated activation of the fight and flight pathway, our body’s ability to grow and repair may become impaired.

The brain is a computer with no delete button

The brain learns from every experience and may draw on the learning not just of this sensation, but of how the sensation is perceived you felt about this experience in the future. This means, just thinking about the experience is enough to trigger a response, irrespective of whether there is a problem with the body’s tissues or not. Moseley (2008) found that just imagining a body part worse than it is can increase the swelling and perceived pain, whilst imagining it better than it is can reduce the swelling and perceived pain. Maihofner et al (2006) also found that not only could the pain be magnified but that its location couldn’t be accurately identified. And further research has also shown that chronic back pain is experienced in a different location of the brain when compared with acute back pain (Moseley 2008).

Other studies have shown that using the reflection of an unaffected limb has reduced the pain experienced by individuals with their affected limb. Amputees have also been shown to have reduced phantom limb pain when their “legs” are projected walking underneath them on to a screen. What these studies show is that pain may not just be experienced at the local level but that chronic pain changes the brain biochemistry and actually rewires the brain’s neural pathways. This has major implications for the treatment of chronic pain and necessitates a holistic, multidisciplinary approach, if treatment is to be successful.

So where to begin

Given chronic pain’s complexity, chronic pain treatment or chronic pain management must tackle chronic pain on multiple levels, psychologically, physically and socially. Having said this, these levels may fall into two broad categories. The first is to discourage an environment of excessive or abnormal stress which may lead to a fight or flight response. The second is to encourage an environment of healing, repair, growth and building capacity.

Here are 7 guidelines of how chronic pain therapy and chronic pain clinics must deal with chronic pain

  1. The first rule of many chronic pain management clinics is to acknowledge that chronic pain is real. Sometimes not being believed is the most difficult thing to deal with especially as chronic pain can’t be seen, imagined or picked up on a scan.
  2. Have hope that chronic pain can be overcome. Gaining an understanding of the complex mechanisms behind chronic pain can help to give this sense of hope as well as a sense of control and empowerment.
  3. Change your attitude and change your behavior. Easier said than done, it is important to see yourself not as a victim of chronic pain, but as a person who has choices and things that they can control. If you can focus on those things that you have control over and your control them perfectly, many of the things you can’t control will go away.
  4. Create an environment which encourages nurturing, growth and repair. Being supported by and feeling connected with others is important as is sleeping well when most growth repair occurs. Food which reduces inflammation (fish/krill and flaxseed oil, turmeric and ginger) and which assists with growth and repair (vitamin C, Activated B and adequate amounts of protein) may also assist. Relaxation techniques, meditation, prayer or even warm baths can all be used as strategies to help to reduce tension and promote an optimal healing environment.
  5. Whilst there is no evidence that hands on techniques (such as remedial massage and mobilization) and modalities such as heat is of benefit, at Bodywise Health we have found that they may help exercise to be more beneficial by reducing sensitivity and increasing exercise tolerance.
  6. For maximal benefits, exercise should first be directed towards increasing joint mobility, improving muscle length and balance with the objective of correcting and optimizing posture and movement patterns. For these exercises to be effective, they may be performed under the pain cover of heat, cold or electrical stimulation and must start at an intensity which is below pain thresh-hold. Then using the overload principle, this postural exercise program should be increased first in volume and then in intensity, so that a training effect may be experienced which carries over to sustained physical improvement.
  7. Taping or bracing may be used to “unload” hypersensitive body tissues and enable assisted accommodation of correct posture, further reducing physical forces on the body’s structures.

Chronic pain management doctors and the chronic pain specialist in chronic pain management clinics across Melbourne may prescribe non-steroidal anti-inflammatories and opioids to manage chronic pain.

Chronic pain management Melbourne may abide by the evidence which suggests that non-steroidal anti-inflammatory (NSAIDS) medication should be considered as an appropriate treatment for chronic low back pain. However, whilst there are demonstrated benefits, there are also significant side effects that may have meaningful clinical consequences. NSAIDS are favoured over opioids both in terms of cost and safety. (Roelofs et al 2008)

Whilst dealing with chronic pain is extremely challenging, it is important to know that hope is at hand.

With Bodywise Health providing physical, nutritional and psychological services, we are well placed to assist chronic pain sufferers. Whilst medication may have its place, it doesn’t empower you as to how to avoid chronic pain stresses nor build your capacity to tolerate stress. Unless you are enrolled into an appropriate, graduated, progressive and empowering physical, psychological and nutritional training program, it is likely that your ability to cope with everyday life will decrease over time.

Unlike medication which can become a “crutch” upon which the body becomes dependent to cope, Bodywise Health’s philosophy is to empower you, your body and mind, by giving you the knowledge, training and resources that enables you to get stronger, physically, mentally and nutritionally.

Bodywise Health has been providing chronic pain management solutions to the people in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Black Rock, Beaumaris, Elwood Elsternwick and more generally across Melbourne.

Bodywise Health contact details can be found by googling chronic pain management Melbourne, chronic pain management Bayside, chronic pain management Brighton, chronic pain management Hampton or chronic pain management Cheltenham.

Bodywise Health will work with any chronic pain specialist or chronic pain management doctors in Melbourne to ensure that you experience the best results possible.

The Bodywise Health chronic pain management program has had great success in assisting hundreds if not thousands of people over the past 20 years. It can help you too.

For more information or an appointment, please call Bodywise Health on 1 300 BODYWISE (263 994).

You have nothing to lose except your pain.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.


Child Birth Preparation & Exercises During Pregnancy

ergonomic advice
By Michael Hall

Physiotherapists play an important part in the antenatal care of pregnant women and their preparation for labour, birth and parenting. Physiotherapists educate women about the need for good posture during pregnancy and the principles of back care, teaching appropriate lifting skills, lifting and standing postures. Physiotherapists also educate women about the role of the abdominal muscles in supporting the back, and teach exercises to maintain adequate strength for these muscles.

An important role of the physiotherapist is to educate pregnant women about pelvic floor function, correct exercise techniques and the importance of regular exercise. Physiotherapists provide information about general exercise during pregnancy, what can be done safely and what should be avoided, as well as teaching specific exercise techniques to maintain flexibility and strength.

Physiotherapists help to prepare pregnant women and their partners or support people for the physical work of labour. Physical relaxation skills are taught in conjunction with breathing awareness, encouraging women to remain active in labour. Women are taught a variety of labouring positions to allow gravity to assist, but offering comfort and the ability to relax.

They provide information about the use of TENS during labour, giving women the opportunity to use effective analgesia in labour without the risk of the side-effects of drugs.

The final role of the physiotherapist in antenatal education is to prepare couples for the early days in hospital and the first weeks at home with the new baby. The importance of daily rest is emphasised, in conjunction with some gentle exercise to help women return to optimal fitness and physical wellbeing. Couples are taught correct lifting techniques and how correct posture can be maintained when breastfeeding or attending to the needs of the baby. Couples are also informed about baby massage and the importance of the prone position in child development.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.


What’s Better? Running Barefoot or with Shoes? Here’s what the research says

By Michael Hall,

Let’s face it, with all the claims and counter claims that go with barefoot running, it’s difficult if not impossible to know who or what to believe. Runners, especially barefoot runners are passionate people and passionate people tend to be biased people. Discovering the truth however is important as the stakes are high. If you are a runner, the chances are that you have had or will have a running related injury. Running is the 4th most popular activity by participation1 and runners tend to be at high risk of injury. Yet, despite the millions of dollars poured into running research, shoe technology and advanced training programs, the incidence of running related injuries has remained remarkably consistent over the past 40 years.

Up until now, the approach used to prevent injury and tackle running related problems is called Running Shoe Theory (RST), or the prescription of running shoes based on your foot type. Unfortunately this theory has never been adequately tested and is now being called into question by many in the running shoe community.

The barefoot running phenomenon

In recent years, barefoot running (Barefoot Running Theory or BRT) has been proposed as being the answer to reducing running injuries as it allows the foot to work in a way that nature intended it to – something that can’t occur when the foot is put in a running shoe.
Analysis of barefoot running versus running in running shoes reveals that barefoot runners tend to run with a mid or forefoot ground strike (where the mid or ball of the foot hits the ground first) as opposed to shoe runners who land on their heel first in a heel - toe fashion.

Barefoot running – the Pros and Cons

It has been found that using a mid or forefoot strike pattern reduces the impact forces of when your foot hits the ground. However, it also results in a reduced step length and therefore an increase in the number and frequency of steps per given distance.4 So whilst the intensity of the impact stress might be reduced, the frequency and number of these forces actually increases, meaning that the overall effect might be the same.

The impact forces are much greater in heel strike runners being typically 1.5 – 3 times a person’s body weight. Cushioning in the heels of shoes reduces this impact force by about 10% making it more tolerable. Barefoot foot running and using a heel strike pattern actually produce a 7 fold increase in impact forces, thereby placing these runners at much greater risk of injury.

Another difference is that in heel strike runners, much of the impact forces are absorbed through the hip and knee joints as opposed to barefoot and forefoot runners where more of the forces are absorbed through the small mid foot bones and muscles as well as the ankle joints. Whilst a structurally sound and conditioned foot might be able to tolerate these forces, feet which are not biomechanically correct and habituated are more likely to be injured.

Other disadvantages of barefoot running include damage to soles of the feet from running on sharp, jagged, hot or even cold surfaces. To address these problems, running shoe manufacturers have developed minimalist running shoes (or barefoot shoes) which allow the foot to move as naturally as possible whilst offering some protection.

However, a possible advantage of walking or running on grass or at the beach is that of “earthing” where negatively charged electrons are absorbed through your feet providing an anti-inflammatory effect on your body.

Running in bare feet or minimalist shoes also enables better sensory feedback from your feet, thereby facilitating improved body awareness and dynamic balance reactions potentially leading to a reduction in injuries.

However, more recent research is less positive. One study that evaluated claims that minimalist shoes can improve running efficiency and economy found that compared to standard running shoes, minimalist shoes did not decrease running expenditure or improve running economy.

Two other studies have shown that when experienced recreational runners have transitioned to minimalist footwear, there was an increased incidence of injury and of stress reactions in the foot bones.These studies suggest that even despite a careful, slow transition to minimalist footwear, there may still be an increased risk of stress fracture injuries.

Different people have different needs and therefore need different solutions

As can be seen from this article, there is much conflicting evidence as to the advantages and disadvantages of barefoot running. Perhaps this is a reflection that the people unique structural and running styles have not been addressed. If you are overweight, are de-conditioned, have poor core, gluteal, quadriceps and / or calf strength or you have reduced hip, knee and / or ankle mobility, you will be at risk of injury even before you start. Some people have flat feet whilst others have high arched feet. High arched feet tend to needs extra cushioning to absorb shock, whereas flat feet tend to need support to prevent “over stretching” of the foot ligaments and muscles. Therefore, prescribing a generalised, one size fits all approach is inappropriate and fraught with risk. It is therefore advisable that if you are going to take up or increase your running demands, that you get a physical assessment so that you can identify and address potential problems before they become an issue.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE).

Precautions and Advice

On balance, the evidence suggests you need to be wary when trialling minimalist footwear for running. If you have a previous history of plantar fasciitis or stress fractures, you should avoid barefoot or minimalist footwear when running. If you are absolutely determined to run with bare feet or minimalist footwear, you must avoid hills (with the associated greater impacts) and transition from short distances and time periods over a period of at least 3 months. Also, you must acquire a mid or forefoot ground strike pattern.

But does your physiology, biomechanics and speed predispose you to a “best” running style?

Most people run with a heel strike pattern11 which might be a reflection of the speed of ambulation. We are adapted to walk for long distances in a heel strike manner. Underneath the heel of your foot is a fat pad that is designed to absorb shock. Also, the lower calf muscle (soleus) is a postural muscle, which means that it can contract for long periods of time without getting fatigued.

Gradually as our speed ambulation increases, we move to a mid foot landing pattern and then to a forefoot strike pattern with sprinting.12 As the bones of the feet are small and the upper calf muscle (gastrocnemius) is a phasic (powerful but easily fatigue able) muscle, we are adapted to running on the balls of our feet for short amounts of time (e.g. sprinting). Because of these adaptations, running for long distances on your forefeet therefore might be putting you at risk of stress fractures and / or upper calf strains.

Having said this, if you run with a heel strike pattern and have weak gluteal, quadriceps, calf and foot muscles as well as stiff hips and ankles, your legs will tend to move excessively inwards, flattening out your feet (pronation) and setting you up for facet joint syndrome (back pain), gluteus medius tendinopathy (buttock pain), iliotibial fasciitis (outside knee pain), Achilles tendinopathy, ankle sprains and plantar fasciitis (underneath foot pain).

Possibly the best advice is to have a physical and / or running assessment and then once cleared to introduce a small amount barefoot running into your training. We know that repetitive activity can cause injury and running is certainly a repetitive activity. So having been cleared to barefoot run, start slowly and progress slowly at a rate that feels almost too easy for a 6 to 12 week conditioning period.

Following this time, start your sessions with a 5 minute warm up and then begin to gradually build up to 10, 20 second barefoot run throughs on grass or sand at about 80% effort (or more but within comfort limits). Then slow down to an easy jog and get your breath back before beginning the next run through. Do this twice each week and mix your sessions up at least monthly with different rest periods, tempos and drills.

When you run, focus on landing with your knee over your foot (2nd toe to be exact) and contract your buttocks as you push off your toes to stride forward. This will challenge and strengthen your body, helping you to avoid injury and perform better. Alternatively, go for a walk in bare feet at the park (on grass) or at the beach (on sand). It might be just one of the greatest discoveries of sensory stimulation, stress release and freedom that you experience all year.

For a FREE physical health check or injury assessment, please call Bodywise Health on 1 300 263 994 (BODYWISE)

For more information on how Bodywise Health can help you to recover from or prevent running injuries, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:

• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 263 994.


1. ABS data, Australian Health Survey, Participation in Sport and Physical Recreation, Australia, 2011-12

2. Jenkins DW, Cauthon DJ. Barefoot running claims and controversies: a review of the literature. JAPMA 2011; 101: 231

3. Lope A. Hespanhol C. Yeung S. Pena Costa L. What are the main running musculoskelatal injuries: A systematic review. Nature.2010 Jan28;463(7280):531-5

4. Proceedings ISB XXth Congress, America Society of Biomechanics. 29th Annual Meeting Cleveland.2005:553

5. Oschman JL. Can electrons act as antioxidants? A review and commentary. Journal of Alternative and Complementary MedicinE. 2007 Nov; Nov13(9):955-67

6. Squadrone R, Gallozzi C: Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense. J Sports Med Phys Fitness 51: 401, 2011.

7. J Sci Med Sport. 2013 May 24 pii: S1440-2440(13)00102-3

8. Med Sci Sports Exerc.2013 Jul 19.

9. Foot Ankle Int. 2012 Apr; 33(4):262-6

10. Med Sci Sports Exerc: 2013 Jul;45(7):e320-23

11. Sahrmann SA and Associates. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. Elsevier Mosby 2011.

12. Brukner P, Khan K And Collegues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

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Victoria. Australia 3188

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