Knee Pain in Children and Adolescents

Brendan Egan and David Thwaites recently attended a professional development course on patellofemoral (knee) pain, run by the La Trobe Sport and Exercise Medicine Research Centre. Here’s a brief summary.

Knee pain is a very common occurrence in children and adolescents, with recent studies putting the number of children aged 15-19 having knee pain at 33%. Within these studies they investigated these children further and found that 7% of the entire group had patellofemoral pain (PFJP). The onset of the symptoms though was generally between 10-14 years. PFJP is more common in girls than boys and generally occurs in children who are very active with their sporting interests.

Strength training is often seen as a core component of any rehab for PFJP.  However a group of researchers in Denmark also found the use of education regarding the child’s activity loads, and activity modification if required, is very important to the child’s recovery. The combination of education and strength training was more beneficial than education alone.

Within this study the researchers also reviewed the amount of times/week the adolescent completed their exercises, and noted that the adolescents who completed 4 or more sessions/week were more likely to have a good result than if they did 3 or less.

In addition to education and strength training, the use of orthotics for short periods of time has also been shown to assist in pain reduction, particularly in the short term. Off the shelf types can be used and so custom-made orthoses are not necessarily required. Your Physiotherapist can advise you on the most appropriate orthoses for your situation.

Your Physiotherapist can also demonstrate a specialised taping technique that is also able to reduce pain, whilst allowing you to commence appropriate strength training.

To learn more about this topic please speak to one of our physiotherapists, who will be pleased to help.

Paul Jackson’s Gym Tips

Spring is a great time of year; we have just switched our clocks forward and the days are getting warmer. I have noticed a lot of new faces at the local gym, which has inspired me to pass on some tips about strength training. If you are keen to get moving for summer and have joined the gym, take a moment to consider how you might optimise your time.

It is important to understand that exercise is similar to medication – doctors determine the correct dosage to optimise the effect of the medication. We are also often advised to avoid alcohol or eat prior to ingesting medication.

Just like medication, in order to develop strength or increase bone density, we need to consider how often we should go to the gym, the correct dosage of exercise for a particular muscle group, and dietary habits pre and post work out. Just as an antibiotic takes a few weeks to take effect, strength gains take approximately 6 weeks.

Here are my tips to optimise your time in the gym:

  1. Start with big muscle groups before small muscles e.g. Lat pulldowns before bicep curls
  2. The dosage to optimise strength is 8 to 12 repetitions. Try doing 3 sets with 1 min rest between sets for each major muscle group. The exercise should become difficult by around the 10th repetition
  3. Make sure you are not hungry prior to your gym workout
  4. Avoid alcohol pre and post gym, as it effects muscle growth
  5. Allow one day’s rest between gym sessions to allow your muscles to repair and grow

It will take 3 sessions of just 30min for 6 weeks to see these strength changes and by this point you are in routine!

Paul Jackson
M Physio B App Sc (Human Movement)

Managing Postural Related Pain At Work

Postural stiffness and pain is one of the most common reasons patients seek treatment from a physiotherapist. Many sedentary working tasks are conducive to prolonged positions that can be sustained for hours at a time and many manual jobs involve persistent, repetitive movements. Due to these factors and more, many people experience significant pain and disability during their occupational tasks. However, there are most definitely strategies that you can put in place to address work related pain.

Pain can take a considerable toll on the health and well-being of an individual. It can be exhausting and significantly affect a person’s mental health. It can also increase perceived work demands, and arguably work performance. A study of nurses from India investigated the relationship between musculoskeletal disorders and perceived work demands. It was found that nurses with lower back and knee pain experienced a feeling of higher working demand and difficulty compared to those who did not experience musculoskeletal disorders. While this may sound obvious, it clearly highlights that managing your occupational pain is a critical factor in your professional performance at work, but also for optimising your own mental health.

A common question asked by patients is, “what exercises can I do to help my pain?”. The answer is not always straightforward, as is depends on the specific demands of your work day.

Physiotherapists can offer an individually structured exercise program to address your work day postural pain after an assessment of the postures you typically undertake at work. These exercises are often made with respect to directional movement and will be realistically completed at your office or worksite without undue inconvenience.

A recent study of building painters investigated the risk of pain associated with hours spent painting. The authors of this study found painting a vertical wall for over 2.5 hours at a time put a worker at an increased risk of injury. This was lengthened to 3 hours if the painter used a painting-roller.

The authors hypothesised that this increased injury risk for prolonged painting was due to excessive stretching of the lumbar and cervical spine into an extended (or backward arching) position. When treating this type of worker a physiotherapist may suggest therapeutic exercise that reverses these prolonged postures so as to periodically unload stressed areas of the spine and preserve normal functional movement.

As you can imagine, the prolonged postures adopted by painters would be significantly different to those used by desk workers who sit for long periods. Hence, the prescribed exercises given by a physiotherapist would likely be dramatically different and focus on spinal extension type movements to reverse forward head and neck postures associated with desk work.

In conclusion, movement exercises can considerably improve your postural pain if appropriately prescribed. Your pain may be further improved with manual therapy techniques or other self management strategies like self-massage, heat packs or ergonomic workplace adjustments. Every occupation presents with different physical demands, and as such are best negated with specifically targeted interventions.

For more information, you can consult one of the many experienced physiotherapists at Clifton Hill Physio/Clifton Hill Pilates and Rehab.


Bill Williams

Physiotherapist and Pilates Instructor

Welcome Rosie Purdue

Clifton Hill Physiotherapy welcomes our newest team member – Rosie Purdue.

Rosie graduated from Charles Sturt University in 2011 and has worked in variety of settings. Over the past five years, Rosie has developed a particular interest in sports and women’s health.

Rosie’s passion for learning has seen her complete additional courses in APPI Pilates, pre and post-natal Pilates, the DMA method, high-level suspension training, women’s health, dry needling and strength and conditioning.

Rosie has worked as a physiotherapist, Pilates Instructor and sports trainer at both international and local levels. Rosie says a highlight of her career was working as a physiotherapist with elite mountain bike riders at the Langkawi International Mountain Bike Challenge as part of the UCI world tour.

Rosie enjoys educating clients about their injuries so that they can make long-term, positive changes for their health. She believes in the importance of developing collaborative goals in order to optimize physiotherapy treatment and rehabilitation. This includes educating clients about the importance of manual treatment in combination with a specific home exercise program and clinical Pilates.

Rosie has travelled extensively and has now settled back home in Melbourne where she grew up. She keeps active with social team sports and playing hockey.

Clinical Pilates – moving beyond core stability for low back pain

For many years Clinical Pilates has been the popular vessel of Physiotherapists to prescribe “core stability” programs for people with low back pain.  Historically, these core stability programs have encouraged clients to engage core muscles and maintain this contraction while they perform a series of movements. Recently, there has been a growing mass of research showing this approach is not as beneficial as we once thought.  A recent systematic review of the literature suggested that in people with low back pain, core stability programs are no more effective than general exercise.  It is even hypothesised that encouraging these heightened contractions and rigid postures can breed unhealthy beliefs around pain and movement, and perpetuate symptoms.  Given this shift in thinking, it is imperative that Physiotherapy, and in particular Clinical Pilates evolves.

Thankfully, Clinical Pilates has the capacity to move beyond this stability approach. Clinical Pilates can be used as a platform to explore movement rather than promoting rigidity.  It can take focus away from isolated contractions and concentrate more on factors science is telling us contributes to pain. I have listed below a few areas in which I believe a modern Pilates approach can be helpful in people with low back pain.

Body Awareness

Altered body schema has been observed in people with low back pain. This manifests as a lack of awareness of body position with movement. Performing movements with tools such as mirrors for visual feedback in various positions can help reconnect with movement and improve movement co-ordination.

 De-threatening movement

The experience of pain with a given movement is linked to the perceived level of danger to the body’s tissues with that movement, not the actual state of the tissues. Meaning, if you subconsciously think a movement will hurt, it probably will, whether there is any damage occurring or not.  This also means that performing a similar movement in a different functional context or position can be completely pain free, as there is no perceived threat by the brain in that scenario.  Exploring these different positions and progressing back towards the original movement can start to diminish the perceived danger with that task.

Tissue loading

Tissue loading with exercise can have an effect on several levels. Firstly, loading muscles, tendons and joints around a painful area can initiate a neurophysiological response, diminishing symptoms for short periods (similar to that of manual therapy). Secondly, mechanical loading can promote tissue repair in muscle, tendon, cartilage and bone through a process called mechanotransduction. Loading tissues appropriately through a variety of targeted mobility and strength based drills can make use of these factors.

In summary, discouraging rigidity and being liberal with movement can contribute to a more modern and evidence based Clinical Pilates approach for low back pain.  As always, chatting to your Physiotherapist about the benefits of exercise for your problem is the best place to start.


David Thwaites

B Physio

Welcome to our new Podiatrist, Sara Fearnside

We’re very excited to announce the appointment of our new Podiatrist to the Clifton Hill Pilates and Rehab team.Sarah

Sara Fearnside consults in all areas of podiatry but has a special interest in Diabetes foot care and prevention of diabetes related foot problems.

Sara initially has appointment availability on Thursday mornings but will be extending her hours in the future.

She looks forward to the opportunity to improve your foot health and general well being in the near future and we warmly welcome Sara to our team.

Sara graduated from Charles Sturt University in 2009. Having completed her graduate year at Caulfield General Medical Centre she gained exposure in all areas of podiatry but particularly in management of the diabetic foot, high risk foot conditions and wound care. After completing her graduate year Sara moved to the United Kingdom where she worked in both private practice and in the public health sector. On returning to Australia Sara completed a short term contract in aged care before taking 12 months maternity leave. Sara has a special interest in Diabetic foot care, paediatrics and treatment of musculoskeletal foot pathologies.

Obetstric Brachial Plexus Palsy

Obstetric Brachial Plexus Palsy (OBPP) is a rare birth injury resulting in reduced movement and sensation of the affected arm. The shoulder(s) of a baby born with OBPP gets caught in the mother’s pelvis during delivery, leading to a stretching of the nerves originating from the neck.

To understand if your child has OBPP, here are common symptoms:

  • A “floppy” looking arm (due to weakness or paralysis). As a result, your child may not use their affected arm as much as their non-affected arm
  • Muscle tightness/joint stiffness
  • A broken collar bone
  • A broken upper arm
  • A drooping of one or both eyelids and a slightly smaller pupil (on the side of the trauma)

The following are risk factors for OBPP:

  • Shoulder dystocia (shoulder becomes stuck in the pelvis during labour)
  • Macrosomia (birth weight greater than 4kg)
  • A narrow maternal birth canal
  • Maternal overweight
  • Breech delivery (buttocks or feet emerge first)

What can be done to treat OBPP?

Treatment depends on the severity of the injury and the specific nerve roots involved. Physiotherapy treatment requires an experienced paediatric physiotherapist and involves assessing and monitoring the severity of the injury. Paediatric physiotherapists can assist in the maintenance and improvement of muscle length and joint range of motion in order to prevent contracture (shortening and hardening of muscles) and dysfunction. Your physiotherapist can teach you gentle exercises for this. Occasionally, surgery may be required to repair the damaged nerves.

When can treatment be commenced?

Treatment may be commenced 10 days post-delivery.

Do I need a referral to see a Paediatric Physiotherapist?

No. Physiotherapists are primary healthcare professionals, which means that no referral is required to make an appointment. At Clifton Hill Physiotherapy we have 2 experienced Paediatric Physiotherapists who can assess your child or answer any concerns. Contact us on 9486 1918 for further information.

Dóra Kónya, APAM

Dóra is a Physiotherapist at Clifton Hill Physiotherapy with a Masters and postgraduate qualifications in Paediatric Physiotherapy.

Andrew Firth’s view on Pilates

Andrew has a long association with disciplined movement. His early sporting exploits are across the board and cover tennis, basketball, cricket, golf and perhaps most successfully athletics, until he became a competitive ballroom dancer in his early adult years which he continues to this day. His focus as a teacher is on rehabilitation through movement and he enjoys challenging his healthier clients with a range of exercises designed to both stretch and strengthen their bodies to their pinnacle. Learning from Andrew will mean a tailored, traditional approach to the Pilates method that will educate your mind and body, allowing you to achieve your personal best. Here Andrew talks about the importance of the body system…

How does one build a strong, flexible and highly functional body? How do we eradicate pain, remove dysfunction, and manage our body in such a way that we remain pain-free?

It’s the system that counts.

The single best thing we can do for our body is to move. Move regularly. Move lots. Move in such a way that each of our joints (and all the muscles in between) receives tender loving care. Yes, going for a walk on a regular basis is good. It’s great in fact, but walking alone isn’t enough. What about our thoracic mobility, our scapula stability, or any other number of undervalued movements that it fails to address?

Again, it’s the system that counts. How well-educated is your system of movement? How varied is it? Does your system account for all of the body’s needs?

Cultivating a healthy body is like planting a crop. Sowing the seeds is only a small part of the job – after that you’ve got to tend to the seeds regularly (and with some degree of know-how), even if you can’t see the sprouts of green poking up through the dirt yet. Sow, cultivate, and then you shall reap…but that doesn’t mean you have to flog yourself. An apple a day keeps the doctor away, and by the same token, a daily dose of educated movement goes a long way to building a healthy body. Regular, well-informed workouts beat the hell out of one massive workout done whenever the blue moon is up.

It’s the system that counts. Pilates has proven time and again to be a valuable addition to many a person’s movement philosophy. Just remember that execution is power – not knowledge. The most intellectual system in the world is useless if never put into action.

Andrew Firth
Pilates instructor


As a physiotherapist I am always assessing and considering the biomechanics and anatomy of various body parts and their relevance to pain and stiffness. I recently attended an interesting and informative lecture run by the Australian Physiotherapy Association on breasts, bras and biomechanics. Breasts have been linked to upper back, neck pain or headaches and should be taken into consideration like any other body parts! Breast hypertrophy has been associated with chronic headaches and musculoskeletal pain is one of the leading reasons women seek reduction mammoplasty.  Furthermore, 17% of women reported breast pain as a barrier to exercise participation, the 4th highest reason. If you have ever experienced exercise induced breast pain you certainly are not alone.

Advances in motion technology have allowed us to study breast movement during various forms of exercise and use this information to improve sports bra technology.  The breast displaces in three dimensions and varies with breast size and intensity or type of exercise.   Biomechanical studies have concluded that breasts should move in a butterfly pattern to reduce strain on supporting structures and technical sports bras have been developed in line with this.  Reduced breast support has also been shown to have an adverse effect on gait or walking pattern.  The effects can include reduced arm swing, altered stride length and foot strike pattern, and increased use of chest muscles to improve support for breast tissue.  These things in combination can lead to further musculoskeletal issues.  Technical sports bras need to be seen as an essential part of exercise equipment.

A technical sports bra can only be defined as such if it has undergone biomechanical testing and is based on current evidence. Technical fabrics may include moisture wicking and heat dissipation properties. Unfortunately, many advertised sports bras are not a technical product and are not readily available on the retail market. She Science in Kew is one of the only stores in Australia stocking technical sports bras who can assist you with specialised fittings using motion technology.  They provide a number of brands and options for breastfeeding mums, post mastectomy populations and active women of all shapes and sizes.

So ladies, if you think lack of breast support may be contributing to your musculoskeletal issues or preventing you from participating in exercise, speak to your physiotherapist and consider having a specialised sports bra fitting today!


Ali Harding


Jess Kostos joins the team

We are excited to announce Jess Kostos has joined our Physiotherapy and Pilates clinics. Jess is an experienced clinician in Private Practice, treating general sporting and musculoskeletal conditions as well as pelvic health for men and women.

Jess completed her degree with Honours at The University of Melbourne, and has since completed post graduate studies in continence and pelvic floor rehabilitation at The University of Melbourne. This enables her to assess and treat any dysfunction of the pelvic floor.

Jess has experience working in both the private and public health sectors, treating a wide range of clientele; however she has a particular interest in the health and wellbeing of women. She has lots of experience teaching clinical Pilates, especially to those in the pre and post-natal period. We are excited to announce that Jess is running a Mums and Bubs Pilates class at our Pilates studio on Wednesdays and Fridays. Get in fast as we expect these to be very popular.

Jess maintains an interest in general sports, musculoskeletal and spinal physiotherapy, and is passionate about helping people of all ages achieve their optimal physical health and well-being.


  • Bachelor of Physiotherapy (Honours) (The University of Melbourne)
  • Graduate Certificate in Continence and Pelvic Floor Physiotherapy (The University of Melbourne)
  • Level 1 – 3 and certified APPI Matwork Pilates instructor
  • Level 1 -4 APPI Equipment Pilates series
  • APA Level 1 Dry Needling

Professional Memberships

  • Australian Physiotherapy Association (APA)
  • Continence and Women’s Health Interest Group (APA)
  • Continence Foundation of Australia
  • Continence Foundation of Australia – Physiotherapy Group


We warmly welcome Jess to our team.