How Physiotherapy Helps with Rotator Cuff Pathologies

Shoulder pain can be frustrating, especially when it interferes with your ability to lift, reach, or even sleep comfortably. One of the most common culprits? Rotator cuff pathologies. Whether it's a strain, tendinopathy, or a tear, physiotherapy plays a crucial role in recovery and getting you back to pain-free movement.

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint. These muscles work together to stabilize the shoulder and allow a wide range of motion. Injury to any of these tendons can lead to pain, weakness, and limited function.

Common Rotator Cuff Pathologies

  • Tendinopathy – Degeneration or irritation of the rotator cuff tendons, often due to overuse.

  • Partial or Full-Thickness Tears – Small or complete disruptions in one or more of the tendons.

  • Shoulder Impingement – When the tendons are pinched during shoulder movement.

  • Calcific Tendinitis – Calcium deposits within a tendon causing pain and inflammation.

Signs You Might Have a Rotator Cuff Injury

  • Pain in the shoulder, especially when lifting the arm

  • Weakness or fatigue in the arm

  • Difficulty sleeping on the affected side

  • A clicking or popping sensation with movement

  • Reduced range of motion

  • Bursitis (inflammation of the fluid filled sac within the shoulder capsule)

The Role of Physiotherapy

Physiotherapy is often the first line of treatment and can help most people avoid surgery. A well-structured program can:

  1. Reduce Pain and Inflammation
    Manual therapy, taping, ultrasound, shockwave, dry needling, and modalities like heat or ice can ease pain early in treatment.

  2. Restore Range of Motion
    Gentle mobility exercises help improve shoulder flexibility and prevent stiffness.

  3. Strengthen Supporting Muscles
    A progressive strengthening program targets not only the rotator cuff but also the scapular stabilizers to improve shoulder mechanics.

  4. Improve Posture and Movement Patterns
    Poor posture and faulty mechanics can put extra strain on the rotator cuff. Physiotherapists teach better movement habits that protect your shoulder in daily life.

  5. Support Return to Activity
    Whether you’re an athlete or just want to carry groceries without pain, physiotherapy can guide your safe return to activity with sport- or task-specific training.

When to Seek Help

If shoulder pain persists beyond a few days, is getting worse, or is limiting your ability to do everyday tasks, don’t wait. Early intervention with physiotherapy can lead to quicker recovery and better long-term outcomes.

The Place of Imaging

Around 40% of people aged 30+ will have tears on imaging, which can be asymptomatic. When you see a physiotherapist for shoulder pain, majority of the time imaging won’t be recommended straight away. When imaging has been performed, your physiotherapist will combine your imaging results with the results of the in-person assessment to determine what the main pain driver is. It’s important to not take the imaging report as gospel for shoulders!

Final Thoughts

Rotator cuff injuries don’t have to mean the end of your active lifestyle. With the right physiotherapy approach, you can relieve pain, rebuild strength, and return to the things you love — whether that’s tennis, gardening, or simply getting dressed without pain.

 

References:

Lawrence RL, Moutzouros V, Bey MJ. Asymptomatic Rotator Cuff Tears. JBJS Rev. 2019 Jun;7(6):e9. doi: 10.2106/JBJS.RVW.18.00149. PMID: 31246863; PMCID: PMC7026731.

Sciarretta FV, Moya D, List K. Current trends in rehabilitation of rotator cuff injuries. SICOT J. 2023;9:14. doi: 10.1051/sicotj/2023011. Epub 2023 May 23. PMID: 37222530; PMCID: PMC10208043.

Exploring hydrotherapy as a therapeutic tool for recovery.

Introduction

In the world of physiotherapy, innovation often comes from revisiting timeless techniques. One such method that continues to deliver remarkable results is hydrotherapy—the therapeutic use of water to relieve pain, improve mobility, and promote healing. Whether you're a patient recovering from surgery or a someone seeking holistic treatment options, hydrotherapy offers an evidence-based, low-impact alternative that can accelerate recovery and improve quality of life.

What is Hydrotherapy?

Hydrotherapy involves performing exercises or therapeutic movements in a heated pool. The warmth and buoyancy of the water provide a unique environment that reduces stress on the joints, supports the body, and allows greater freedom of movement. It's particularly beneficial for individuals with limited mobility, chronic pain, or post-operative restrictions.

Benefits of Hydrotherapy

  1. Reduced Joint Load and Pain Relief
    The buoyancy of water supports up to 90% of body weight, which significantly reduces joint stress. This makes it ideal for patients with arthritis, joint replacements, or back pain.

  2. Enhanced Circulation and Healing
    Warm water promotes vasodilation, increasing blood flow to injured tissues, which can speed up healing and reduce muscle spasm.

  3. Improved Strength and Endurance
    Water provides natural resistance, helping build muscle strength and endurance without the impact of traditional land-based exercises.

  4. Increased Range of Motion
    The supportive environment encourages a fuller range of motion, allowing for gentle stretching and movement in a pain-free way.

  5. Safe Environment for Neurological Conditions
    Hydrotherapy offers a stable and safe setting for patients with balance or coordination issues, such as those recovering from stroke or managing conditions like Parkinson’s disease or MS.

Who Can Benefit from Hydrotherapy?

  • Post-operative patients (hip/knee replacement, spinal surgery)

  • People with chronic pain or arthritis

  • Individuals with neurological conditions

  • Athletes recovering from injury

  • Older adults looking to maintain mobility and independence

What to Expect in a Hydrotherapy Session

A qualified physiotherapist will guide patients through a series of tailored exercises in a heated hydrotherapy pool. Sessions typically focus on mobility, strength, and balance, and can be customized to meet specific rehabilitation goals. Each program is progressive, ensuring patients build confidence and physical capability over time.

Is Hydrotherapy Right for You?

Hydrotherapy is generally safe, but certain conditions (such as open wounds, infections, or unmanaged cardiovascular issues) may require caution or an alternative approach. A physiotherapy assessment is recommended before beginning hydrotherapy to ensure it’s appropriate and beneficial for the individual.

Conclusion

Hydrotherapy is more than just exercise in water—it's a powerful rehabilitation tool that can transform recovery journeys. For physiotherapists, integrating hydrotherapy into treatment plans offers a dynamic and effective way to support a wide range of patient needs.

If you’re a patient interested in exploring hydrotherapy, or a practitioner looking to refer, our clinic is here to help. Contact us today to learn how hydrotherapy can make a difference.

 

References:

Jenny Geytenbeek. Evidence for Effective Hydrotherapy, Physiotherapy. 2002: 88(9). p. 514-529. https://doi.org/10.1016/S0031-9406(05)60134-4

Mirmoezzi, M., Irandoust, K., H’mida, C. et al. Efficacy of hydrotherapy treatment for the management of chronic low back pain. Ir J Med Sci 190, 1413–1421 (2021). https://doi.org/10.1007/s11845-020-02447-5

G. Sathiyavathi, S. Venkatalakshmi, L. Nivethitha, A. Mooventhan, N. Manavalan. Evidence-based effects of various hydrotherapy on pulmonary function: A systematic review, Advances in Integrative Medicine. 2025; 100501. https://doi.org/10.1016/j.aimed.2025.100501

Tendon Pain and Menopause: What’s the Connection and How Can Physio Help?

Many women are surprised to experience new aches and pains as they approach or go through menopause. Among the most common complaints are tendon-related issues—particularly in the shoulders, hips, elbows, and Achilles tendons. If you're noticing stubborn pain that worsens with activity and doesn’t seem to go away with rest, you’re not alone—and physiotherapy can help.

Why Do Tendon Problems Occur During Menopause?

Menopause brings a significant drop in estrogen levels, which affects many tissues in the body, including tendons. Estrogen plays a role in maintaining tendon health by supporting collagen production and keeping connective tissues supple and strong.

As estrogen declines, tendons can become:

  • Less elastic and more prone to small tears

  • Slower to heal after activity or injury

  • More sensitive to load or strain

These changes can lead to common conditions like:

  • Rotator cuff tendinopathy (shoulder pain)

  • Gluteal tendinopathy (hip pain, often felt when lying on your side or climbing stairs)

  • Tennis or golfer’s elbow (forearm/elbow pain)

  • Achilles tendinopathy (pain at the back of the ankle)

How Can Physiotherapy Help?

While hormonal changes can’t be reversed, tendon pain during menopause is highly treatable—and physiotherapy is one of the most effective ways to manage it.

1. Accurate Diagnosis
A physiotherapist will assess your symptoms and movement patterns to confirm the source of your pain and rule out other causes, such as joint issues or nerve irritation.

2. Targeted Loading Programs
Unlike general stretching or rest, tendons respond best to structured strengthening programs. A physio will guide you through progressive exercises that load the tendon safely, stimulating collagen repair and improving function over time.

3. Hands-On Therapy and Pain Relief
Depending on the area affected, treatment may include soft tissue release, dry needling, taping, or gentle joint mobilisations to support healing and reduce discomfort.

4. Education and Lifestyle Advice
Your physio will also help you manage contributing factors such as biomechanics, posture, footwear, sleep positions, and physical activity levels. Together, these can reduce strain on irritated tendons and prevent flare-ups.

If you’re in or approaching menopause and experiencing lingering tendon pain, don’t wait for it to go away on its own. A physiotherapist can provide the tools, knowledge, and support you need to move comfortably and confidently through this phase of life.

Prolapse? See a Pelvic Floor Physio

Pelvic organ prolapse is a condition where one or more pelvic organs—such as the bladder, uterus, or rectum—descend from their normal position and press into the vaginal wall. It’s a common issue affecting up to 50% of women who have given birth, but it’s often underdiagnosed or misunderstood. While it can feel overwhelming, prolapse is very treatable—especially with the support of a pelvic floor physiotherapist.

Understanding the Role of a Pelvic Floor Physio

Pelvic floor physiotherapists are specially trained to assess and treat conditions affecting the pelvic floor muscles, including prolapse. These muscles play a vital role in supporting the pelvic organs, maintaining bladder and bowel control, and contributing to sexual function.

When these muscles become weak or imbalanced—often due to pregnancy, childbirth, heavy lifting, constipation, or menopause—they may no longer provide adequate support, leading to prolapse symptoms such as pressure, heaviness, bulging, or urinary issues.

Benefits of Pelvic Floor Physiotherapy for Prolapse

1. Personalised Assessment:
A pelvic floor physio will conduct a thorough evaluation of your symptoms, posture, breathing patterns, and pelvic floor function. This ensures your treatment is tailored to your individual needs and goals.

2. Safe, Targeted Exercises:
You’ll learn how to correctly activate and strengthen your pelvic floor muscles through guided exercises. Doing Kegels incorrectly or too often can sometimes worsen symptoms, so professional guidance is crucial.

3. Symptom Relief Without Surgery:
For many women, physiotherapy significantly improves prolapse symptoms and quality of life, reducing the need for surgical intervention. It can also support better outcomes if surgery is eventually chosen.

4. Whole-Body Approach:
Pelvic physios often incorporate breathing techniques, core stability, and lifestyle advice—such as lifting strategies and bowel habits—to reduce intra-abdominal pressure and support long-term recovery.

5. Education and Empowerment:
Understanding your body is key. Physiotherapy helps you feel more confident, informed, and in control of your pelvic health.

If you're experiencing signs of prolapse, don’t suffer in silence. A pelvic floor physio can help you feel stronger, more supported, and empowered to return to the activities you love.

Sever's Disease: Heel Pain in Active Kids

Heel pain is a frequent concern among children, especially those engaged in sports and physical activities. One prevalent cause of this discomfort is Sever's disease, medically known as calcaneal apophysitis.

What Is Sever's Disease?

Sever's disease is an overuse injury that affects the growth plate in the heel bone (calcaneus). It typically occurs in children aged 7 to 14, particularly during growth spurts when bones grow faster than muscles and tendons can adapt. This imbalance leads to increased tension on the heel, resulting in inflammation and pain.

Common Symptoms

Children with Sever's disease may experience:

  • Pain or tenderness at the back or bottom of the heel

  • Swelling or redness in the heel area

  • Discomfort that worsens with physical activity and improves with rest

  • Limping or walking on toes to avoid heel pressure

Risk Factors

Several factors can increase the likelihood of developing Sever's disease:

  • Rapid growth spurts

  • Participation in high-impact sports like running, jumping, or soccer

  • Tight calf muscles or Achilles tendons

  • Flat or high-arched feet

  • Improper or unsupportive footwear

  • Obesity or increased body weight

Management and Treatment

Sever's disease is self-limiting and typically resolves with time. However, certain strategies can alleviate symptoms and promote healing:

  • Activity Modification: Reduce or temporarily halt activities that exacerbate heel pain.

  • Stretching Exercises: Gentle stretching of the calf muscles and Achilles tendon can relieve tension.

  • Footwear Adjustments: Ensure shoes provide adequate support and cushioning. Heel lifts or orthotic inserts may be beneficial.

  • Ice Therapy: Apply ice packs to the affected area for 15-20 minutes to reduce inflammation.

  • Pain Relief: Over-the-counter pain medications, such as ibuprofen, can help manage discomfort.

  • Physiotherapy: A physiotherapist can develop a tailored exercise program to strengthen muscles and improve flexibility.

When to Seek Professional Help

If your child's heel pain persists despite conservative measures, consult a healthcare professional. Early intervention can prevent prolonged discomfort and facilitate a quicker return to normal activities.

Myth-busting During Pregnancy : What You Really Need to Know

Pregnancy often comes with a flood of advice—some helpful, some outdated. Let's clarify some widespread misconceptions and provide evidence-based insights to support a healthy and active pregnancy.

Myth 1: Keep Your Heart Rate Below 140 bpm During Exercise

Fact: There's no need to strictly limit your heart rate to 140 beats per minute while exercising during pregnancy. The Australian Government's Pregnancy Exercise Guidelines recommend engaging in 1.25 to 2.5 hours of vigorous activity per week, even while pregnant. Vigorous activities include those that make you breathe harder, such as brisk walking, swimming, or cycling.

A more practical approach is to monitor your exertion using the Rating of Perceived Exertion (RPE) scale, which ranges from 1 (very light activity) to 10 (maximum effort). Exercise & Sports Science Australia (ESSA) advises pregnant individuals to aim for an RPE of 6 to 7, ensuring the activity is challenging but not overwhelming.

Myth 2: Pregnancy Hormones Loosen the Pelvis, Causing Pain

Fact: While the hormone relaxin does increase ligament flexibility to prepare for childbirth, it doesn't necessarily destabilize the pelvis. Pelvic girdle pain during pregnancy is often due to increased sensitivity in the pelvic area, influenced by factors like muscle tightness or weakness.

Research indicates that early intervention—ideally within two weeks of symptom onset—can significantly improve outcomes. Consulting a physiotherapist can help address muscle imbalances and alleviate discomfort.

Myth 3: Urinary Leakage During or After Pregnancy Is Normal

Fact: While urinary incontinence is common postpartum, it's not considered a normal or inevitable part of pregnancy. The Continence Foundation of Australia reports that 1 in 3 women experience urinary leakage after childbirth.

Pelvic floor exercises can be highly effective in preventing and treating incontinence. A simple technique involves contracting the muscles around the anus, as if trying to prevent passing gas. Start with 10 repetitions of 2-3 second holds, three times daily, gradually increasing to 8-10 second holds. If you're unsure about your technique, consider consulting a women's health physiotherapist for personalized guidance.

References:

  • Continence Foundation of Australia (2024). Pregnancy, childbirth and incontinence. Retrieved from: Continence Foundation

  • Department of Health and Ageing (2021). Physical activity and exercise during pregnancy. Retrieved from: Health.gov.au

  • Pulsifer, Jodie et al. (2022). Reframing beliefs and instilling facts for contemporary management of pregnancy-related pelvic girdle pain. British Journal of Sports Medicine, 56.

All about falls

Every time you take a tumble, realize it's just a chance to bounce back.

A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level. Falling over is something that happens at all stages of life, but why is it that when you hit a certain age the language of falling over shifts to “had a fall”? This is due to how falling affects people across the lifespan, as children tend to bounce but older adults risk more significant injuries.

Why do falls matter:

-          238,005 hospitalisations due to falls in AUS in 2022-2023.

-          43.4% of all injury hospitalisations in AUS in 2022-2023.

-          6,378 deaths in 2022-2023.

-          Most common body parts injured were

o   Head and neck (28.1%)

o   Hip and femur (26.2%)

o   Shoulder and upper arm (22.7%)

-          Females had higher rates of falls hospitalisations (772.4 per 100,000), but males had higher rates of deaths caused by falls (14.8 deaths per 100,000)

-          Females were more likely to fall on stairs or steps, from a bed, or from a chair, while males were more likely to fall from a building, a tree, a ladder, or using objects such as roller skates or scooters.

-          Australians aged 65 and over were almost 12 times more likely to be injured in a fall than adults aged 25-44

Common causes of falls:

-          Medical conditions

o   e.g. Parkinsons disease, peripheral neuropathy, postural hypotension

-          Medication side effects

o   Drowsiness, vision changes, dizziness, confusion, blood pressure changes etc.

-          Taking more than 10 different medications

o   Due to the interactions between different medications, and the combined effect these medications may have on cognition drowsiness, or vision etc.

-          Foot problems, including poor footwear.

-          Reduced muscle strength

o   A natural change from aging (though this can be slowed!)

-          Slowed reaction time

o   A natural change from aging (though this can be slowed!)

-          Poor vision

-          Incontinence

o   Due to a rush to get to the toilet and associated weakness of the leg and trunk muscles.

-          Environmental causes

o   Rugs, walkers out of reach, loose floorboards, cables, clutter, and even pets!

What tools are there predict falls risk?

Five times Sit to Stand: this is a standardised test used to measure how a person transfers from a sitting to standing position (and vice versa). It is a useful quick screen to assess lower limb strength, speed, balance, and coordination. This test has been used in a variety of population groups (seniors, Parkinson’s disease, stroke etc.) and can be used to assess how likely a person is to fall within 12 months. For example, a healthy adult aged 70-79 years should achieve between 6.9s and 13.1s, with a score above 15s indicating an increased risk of falling.

FRAT (Falls risk assessment tool): A 3-part tool that comprises of a falls risk status, a risk factor checklist, and an action plan, developed by Peninsula Health Victoria. This tool is typically administered by a medical practitioner such as a GP or nurse, though some sections can be done without their input. Cognitive status (Part 1, section 4) involves the Abbreviated Mental Test Score, used to assess for delirium or dementia risk, with low scores indicating a need for further cognitive assessment.

These are just two tools out of the hundreds available, if you want to know more feel free to ask your Physiotherapist, Exercise physiologist, or GP.

Can you change your falls risk?

YES!

Falls risk can be reduced by addressing the factors that increase your risk. Some factors can be changed, and some cannot. For example, you can’t change your age, but you can change your vision by using glasses. Speaking to your Physiotherapist or GP about reducing your risk is a helpful way to pinpoint areas to work on.

Participation in physical activity is a great way to reduce your falls risk. Activities such as tai chi, yoga, Pilates, hydrotherapy (or aquarobics), or just general strength and conditioning all have been demonstrated to improve strength, balance, reaction times, and even help with cognition and memory through social engagement. Here at Healesville Physiotherapy and Sports Medicine we run a Falls and Balance class twice weekly under a physiotherapist, or Eastern Health run a 10 week Falls clinic which involves a variety of healthcare disciplines to help get to the root cause of your falling (See link in references for more information). At the end of the day, the best exercise is the one you will consistently do so pick something you enjoy doing!

According to the World Health Organisation, all adults should be aiming to get 150-300 minutes of low to moderate exercise, or 75-150 minutes of moderate to vigorous exercise, AND 1-2 sessions of resistance training per week. This should be a lifelong goal to keep you healthy and active throughout your lifespan.

Help, I’ve fallen! How do I get off the floor?

Here is our handy flow chart of how to safely get off the floor without the assistance of another person. This is difficult and requires a lot of strength, so some people will need assistance either from a bystander or from ambulance staff. This should only be attempted if there are no obvious injuries such as fractures or head wounds.

Version 1: No equipment

Step 1: Take a moment to take some slow deep breaths. Mentally scan your body for any injuries, if there are any areas of significant pain or bleeding, have someone call 000 and do not continue to rise.

Step 2: Bend one leg.

Step 3: Push the bent leg into the floor and bring your arm across your body as you let your knee drop across, this will help roll you into side lying.

Step 4: From side lying, start to push with both arms into half sitting.

Step 5: Continue to roll from half sitting, onto hands and knees.

Step 6: From hands and knees, bring one leg under your body and push your torso upwards with your arms and core. This will bring you into a lunge.

Step 7: Push your arms into your legs (or the floor if you are flexible enough) and push through both legs to start to rise. Continue pushing through this position to finish in standing.

Version 2: Using a chair

Step 1: Take a moment to take some slow deep breaths. Mentally scan your body for any injuries, if there are any areas of significant pain or bleeding, have someone call 000 and do not continue to rise.

Step 2: Bend one leg.

Step 3: Push the bent leg into the floor and bring your arm across your body as you let your knee drop across, this will help roll you into side lying.

Step 4: From side lying, start to push with both arms into half sitting.

Step 5: Continue to roll from half sitting, onto hands and knees.

Step 6: On hands and knees, crawl towards a chair, couch, bed, or other supportive surface.

Step 7: Place both hands on the chair seat (or arm rests as required).

Step 8: Push down through your arms into the chair seat, and bring one leg in front into a lunge position.

Step 9: Continue to push firmly through your arms and leg, as you bring the other leg up to stand. From this position you can stand, or use the back of the chair to help lift your torso.