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.

Cam Walker Fittings

A cam walker is an adjustable orthopaedic device that looks like a boot. “Cam” is an acronym meaning “controlled ankle motion.” Its main purpose is to prevent or limit ankle and foot movement after a serious sprain, surgery or removal of a cast.CamWalker

The boot is commonly used in the treatment of lower limb injuries which require non or partial weight bearing, or a period of complete immobilisation. Physiotherapists use cam boots in the management of a range of orthopaedic conditions, including moderate to severe ankle sprains, fractures of the ankle, foot or lower leg.

A key feature of the cam walker is the joint mechanism. This allows the cam to be adjusted so it can completely immobilise the ankle, or set using small increments to allow the ankle only a specified range of motion. This allows therapy to be very gradual and controlled.

Cam walkers come in several styles to suit a range of needs. Some offer adjustable uprights (the vertical aluminium bars attached to the joints) and the addition of a metal “rocker” to the sole of the plastic form. The boot height can vary, depending on how much of the leg needs to be stabilised.

All Clifton Hill Physiotherapists are trained in the correct fitting technique for cam walkers. Please contact us should you or someone you know need assistance with correct fitting or access to a cam walker.

Welcome Billy Williams

We warmly welcome our newest Physiotherapist and Pilates instructor, Billy Williams.

Billy has recently joined the team at Clifton Hill Physiotherapy and Clifton Hill Pilates and Rehab after spending the last two years working in Victoria’s Northeast in Myrtleford, Bright and at Mt Hotham Village during the ski season.

Billy has worked in private practice and clinical pilates, as well as being the club physiotherapist for the Myrtleford Alpine Saints in the Ovens and Murray Football League. He has a keen interest in working with sporting people and is currently undertaking Post-Graduate studies in Sports Physiotherapy.
With a particular interest in shoulder instability, he is passionate about combining graduated exercise prescription with physiotherapeutic techniques to return an individual to their professional and recreational activities in a safe and timely manner. Billy also enjoys participating in his own competitive football and following sport of all kinds.

What is ‘I love my physio’ all about?

Many people think physiotherapy is limited to helping those with sporting injuries. But each year physiotherapists keep people healthy, mobile and independent through the prevention, maintenance and treatment of a wide variety of injuries and chronic health conditions.

The ‘I Love My Physio’ campaign is designed to spread the word about how physiotherapy can help treat, manage and improve everything from neck and back pain, to soft tissue injuries, to pelvic floor issues and even recovery from accidents that affect the brain, balance and coordination.

So if you have a story about how physiotherapy has helped you, a loved one or a friend, feel free to share your story online at

You can win some great prizes and help to spread the positive word about physiotherapy in the community.

For details go to:

Femoracetabular Impingement

Like all things in life there are trends and fads.  The world of sports medicine is not averse to such things either, with some classic examples being the LARS graft for ACL reconstructions and PRP injections for so many musculoskeletal conditions.  The ‘’fashionable’’ condition in recent years has been Femoroacetabular impingement or FAI.  One of our physiotherapists, Josh Heerey, has recently started a PhD looking into FAI and he took some time to out to talk about his project, and what it will mean for patients who have FAI.

FAI is a bony condition found within the hip joint of both males and females.  It commonly presents as hip or groin pain that occurs during or after exercise or vigorous activity.  Most commonly it is seen in people who put the hip joint in positions that require greater amounts of flexibility that is normally associated with everyday activities like walking, standing or sitting.  To be diagnosed with FAI you need to have two things:

  1. Symptoms reproduction with clinical testing used by physiotherapists
  2. MRI/Xray confirmation of the bony changes commonly seen in FAI

In the last 10 years there has been an exponential increase in the rate of arthroscopic surgery for this condition without a real understanding as to whether conservative management (physiotherapy and exercise) can be used instead to manage FAI.

I am currently undertaking my PhD looking at the natural disease course of FAI.  We are following a group of male and female soccer players for two years who have FAI which is diagnosed with clinical and radiological assessment.  We are interested in seeing what factors such as strength, flexibility and/or movement patterns result in people improving or developing worsening symptoms during the two year period.  As part of this project I will also be looking at the ways that the muscles around the hip joint function in people with FAI.

The project will provide us an understanding about the factors that lead to disease improvement or progression and also give us a better understanding about how to use rehabilitation to improve hip muscle function in people with FAI.

Joshua (Josh) Heerey

B Physio, PhD candidate, La Trobe university

Josh graduated from physiotherapy in 2008.  He completed his Post Graduate Certificate in Sports Physiotherapy in 2013 and has started a PhD in 2015 looking at Femoroacetabular impingement (FAI).  His project is looking at the risks factors associated with progression of FAI, as well as the effectiveness of exercise for FAI.


He has developed clinical expertise in managing hip and groin pain in athletes from his time working in both soccer and VFL.  He also has an interest in acute and chronic shoulder conditions.