Women in sport, footy, ACL prevention-Mel Haberfield

It’s an exciting time to be involved in woman’s sport. In fact, it makes me wish I was a teenager again with the opportunities that our young women have to pursue their dreams of becoming a professional athlete. From the rise of the Matilda’s, to the restructuring of the National Netball League, and of course the introduction of the AFLW. There are more pathways than ever for young female athletes to follow into the professional ranks.

But with this rise in popularity, we have also seen a rise in the rate of serious knee injuries in female athletes.

I am excited to be taking up a role in the AFLW for the upcoming 2019 season as one of the team physiotherapists for North Melbourne Football Club. It will be the inaugural season for North Melbourne in the AFLW. Exciting times for all involved.

The AFLW Injury Report shows that compared to their male counterparts, woman in the AFLW have a 9.2x greater risk of suffering an ACL injury. This figure sits even above the 2-5x greater risk that woman participating in all sports have of rupturing their ACL. Should we be concerned? The reasons for the increased risk in the female athlete are complex and multifactorial – from our genetics/anatomy, to hormonal considerations, to overall strength and conditioning, quality and skill of movement patterns, as well as factors such as footwear. There is much discussion and research occurring around this topic as we speak. Although the injury rates have been high in the first 2 seasons, there is plenty that can be done to reduce injury risk and enhance athletic performance. Injury Reduction Programs (IRP’s) have been shown to be an effective way to reduce the risk of injury by up to 50%!

IRP’s include different components of warm up, preparation, movement quality training, and strengthening exercises for key muscle groups. In the AFLW, teams have all developed programs for the female athletes to undertake at training and before games to help decrease their risk of injury. Professional athletes themselves are becoming more aware of the importance of participating in IRP’s. But there is still much work to be done at the grassroots and community level.

With the massive uptake of sport, especially footy, in girls at the grassroots level, it’s important we begin to educate and talk to our community level athletes about how they too can reduce their risk of injury and enhance their performance. As physio’s we want to encourage our young female athletes to take up sport, and participate fully in their passion of footy, without having an overshadowing fear of impending injury. The benefits of young people participating in sport still far outweigh the risks! The key is for young female (and male) athletes to develop good movement patterns and skills specific to their sport, progressively develop their strength and load capacity as they grow and develop, and be aware of how to prepare their bodies for training and game day with an appropriate warm up. Recovery is also a big key and should be holistic in nature. Gone are the days where recovery is just putting an ice pack on after a game. Recovery should include considerations such as appropriate sleep patterns, nutrition, training load management, general wellness, and self-management strategies.

As a physio, my passion is to not only work with elite athletes in exciting opportunities such as the AFLW, but also with community level and young athletes.

If you or an aspiring young athlete you know want to learn more about what IRP’s involve, or how to recover better, come in and see us at Inner North Physiotherapy. Remember prevention is better than cure!

Mel is part of the Research team at La Trobe University looking at injury prevention in Women’s footy.

Melissa Haberfield


Headshot for CHP (1)


Clare qualified as a physiotherapist in 2000 from the University of the West of England. Since then Clare has worked in the UK, New Zealand and Australia in hospital and private settings. Clare has also completed a Certificate IV in fitness and clinical pilates and recently decided to return to studies and has just completed her Masters in Musculoskeletal Physiotherapy at La Trobe University.

Clare has managed a wide range of acute and chronic musculoskeletal, orthopaedic and sporting conditions over the years and particularly enjoys post-operative rehabilitation of clients.

Clare has experience in hydrotherapy, clinical pilates, and exercise prescription and utilises these skills in combination with hands-on techniques to provide an individualised management plan to promote optimal function and movement, required for returning to work and day-to-day activities. When not working Clare can be found walking the dog, in the gym,  scuba diving in the bay or completing DIY projects around the house.

Professional memberships:

Australian Physiotherapy Association (APA)

Musculoskeletal Physiotherapy Australia


Congratulations Fitzroy Football Club-Premiers 2018




Congratulations to Fitzroy Football Club on another successful season, and especially to the Men’s Senior and Reserve teams who both impressively took out VAFA Premier C Premierships on Saturday at Trevor Barker Oval!!! Both teams have enjoyed spectacular seasons.

In the senior game, Fitzroy were far too strong for Old Geelong and after 8 goals in the first quarter they continued to increase their lead, finishing 15.10.100 to 4.6.30.

The Reserves was a tight game in tough conditions. Fitzroy were able to keep Old Geelong goalless for the first half before surviving a late surge, eventually winning 4.6.42 to 4.9.33.

Team physiotherapists Billy Williams and Lizzy Barnes-Keoghan, along with all of us here, would like to congratulate all teams and thank them for their efforts during the 2018 season.




ACL injuries- Jane Higgs Physiotherapist

What’s the big deal?

ACL – anterior cruciate ligament- is a major stabilising ligament of the knee- it controls the forward sliding motion of the lower leg and provides rotational stability with movement.


Commonly there will be accompanying bone bruising or fracture, possible cartilage or meniscus tears, or damage to other ligaments in the knee.


In the short term, the injury can result in time off work, inability to participate in sport, and prolonged rehabilitation. On average, professional elite athletes require 9 months out of sport and recreational athletes will take 12 months.  Longer term, there is a high risk of osteoarthritis in people who have suffered an ACL injury, particularly if you sustained a concurrent meniscus injury. The cost of primary ACL reconstructive surgery in Australia between 2014-2015 has been estimated at $142 million, which includes surgical costs only and not the rehabilitation, burden of injury or time off work (Zbrojkiewicz, D., Vertullo, C. & Grayson, J., 2018).


How do they occur?

There is a small subgroup of ACL injuries that occur with contact- that is a direct blow to the knee- e.g. another skier collides with your leg resulting in injury.

The vast majority of these injuries however occur in a “non contact” manner.  In other words, because of a landing error or twisting movement.  It may be a movement that you have done countless times before, a small bump in the air prior to landing, or a timing error causing an awkward movement.

What can we do about them?

There is a growing body of evidence that many of these non-contact injuries can be prevented, and with the cost of ACL injury and the rate of injury on the rise it is crucial that we do everything that we can to avoid them.

“Neuromuscular” training programs have been shown to be effective in reducing the rates of ACL injuries.  These programs are warmup routines that include balance, agility, plyometrics and landing control.   Soccer, netball and AFL have all released sport specific programs that are readily available and should become part of your team’s warm up today (see links below).
A 2018 study (Webster & Hewett) showed neuromuscular training programs reduce the overall rates of ACL injuries by 50%, and in females by 67%. The research shows that the more you do these routines, the more effective the programs are at reducing the rate of injury.  They are not only effective at reducing the rate of serious knee injury, but also all lower limb injuries.  And if that’s not enough to get you started they have also been shown to be PERFORMANCE ENHANCING!  Vertical jump and sprinting ability can improve with regular performance of a neuromuscular program (Garrison et al, 2011).

It is essential that we implement these widely from grass roots level up, and that if you’re not already doing them that you start today!


Footy First

Netball Knee

FIFA 11 Soccer


Jane Higgs

Musculoskeletal Physiotherapist

Clifton Hill Physiotherapy



Dargo, L., Robinson, K. & Games, K. (2017). Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review. Journal of Athletic Training, 52 (12), p 1171-1172.


Donnell-Fink, L. et al, (2015). Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLoS ONE 10(12): e0144063.


Garrison, T., Smith, T., Tutalo, S., Barber-Westin, S., Campbell, D. & Noyes, F. (2011). Benefits of neuromuscular training program for knee injury prevention and performance enhancement in high school female basketball players. Journal of Strength and Conditioning Research, 25, pS12-S13.


Ramirez, R., Baldwin, K. & Franklin, C. (2014). Prevention of anterior cruciate ligament injuries in female athletes. Journal of Bone and Joint Surgery, 2 (9): e3.


Shaw, L. & Finch, C. (2017). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015. International journal of environmental research and public health, 14, 599.


Webster, K. & Hewett, T. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of orthopaedic research. doi: 10.1002/jor.24043. [Epub ahead of print]


Zbrojkiewicz, D., Vertullo, C. & Grayson, J. (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. The Medical Journal of Australia, 208 (8): 354-358.



PICK MY PROJECT- educating women in pelvic health

The recent state government initiative is currently in full swing and voting is underway! 30 million dollars worth of funding has been invested to encourage individuals to submit project ideas to benefit their local community and our women’s health physio, Ali has submitted a project!

Ali’s project is aimed at women of all ages and backgrounds. It will involve a quarterly education seminar addressing common concerns and important areas of pelvic health in an interactive manner. The sessions follow the lifespan of women, beginning with adolescent females, through pre & post natal phases and menopause. Common concerns will be addressed for each stage of life, including normal pelvic floor health, good bladder and bowel habits and sexual function.

We know that pelvic floor dysfunction is a common concern and affects up to 1 in 3 women! Here at Clifton Hill and Inner North Physiotherapy we continue to work hard to promote education around pelvic health within our communities. These seminars will be able to reach further audiences and will be presented in a captivating and interactive fashion to inform, educate and provide solutions to these everyday problems. Ali’s project aims to empower women to liberate themselves from the ongoing stigma around pelvic health.

Please check out Ali’s project on the link below, and if you live within 5km of Thornbury register to vote and get voting! There are many excellent community initiatives so have a look through the projects and help someone make a difference! Voting closes September 18th!




Mat pilates is a great opportunity to get a full body work out! It is suitable for all levels, and challenges the individual to work within their own body. The class draws on key pilates principles of breathing, centering, alignment, and core control to improve posture, balance, strength, flexibility and coordination which will have you moving well and feeling fantastic!

Classes are limited to a maximum of 5 participants to ensure that feedback and corrections can be given to promote optimal quality movement. Small pieces of equipment may be used including foam rollers, theraband, balls and magic circles.

Mat classes can be a great compliment to your regular studio pilates sessions and home pilates programme!


These classes are run by Cathy Derham, our Titled Sports Physiotherapist and Polestar Pilates certified Rehab Pilates Instructor.

Get in touch with reception to express your interest and book a spot today!


Cathy Derham

APA Titled Sports Physiotherapist

B Physio (Hons)

M Physio (Sports Physio)



We have been teaching about Endometriosis and Physiotherapy, Gastroenterology Conditions, Sexual pain and Pain education !

Our staff have been busy sharing their knowledge and expertise with Doctors and other Physios.

Issy has been busy presenting on two different topics this month!

Issy was asked to present to a support group of women who suffer with Endometriosis at the Epworth Hospital in East Melbourne. Issy presented on how physiotherapy can help women with pelvic pain and endometriosis. This common and debilitating illness is something our women’s health team sees frequently. They are able to help women with pain and bladder and bowel dysfunction.

The presentation went really well with many women asking questions on how they could be helped by physiotherapy. They were all amazed to hear of the self-help strategies that they could use at home with some simple steps. It was also pleasing to see so many of them came with a friend or partner to assist in managing their condition.

In that same week Issy presented her knowledge of gut focused treatment to a large group of GPs as part of their continuing education. She discussed some case studies of patients with constipation and incontinence and was able to inform the GPs of how they could manage their patients better.

There was lots of interest from the group not only on irritable bowel syndrome but also male pelvic pain and female sexual pain. The group was most interested by how physiotherapists can teach patients to regulate their bowel and be more in-control of their own health. It was exciting to see so many GPs (about 70) come out for this event, which was run by St Vincent’s Private Hospital.

Issy and Jen have also just tutored on a course on Female sexual pain for Physiotherapists and Brendon has just run 3 busy days in Bendigo teaching Health Professionals about Graded Motor Imagery and Explain Pain.

We are always striving to share our knowledge and continue our own learning.

If you have a endometriosis related pain, bladder, bowel or sexual dysfunction, consider coming in to see one of our experienced pelvic health physiotherapists who are able to sensitively navigate a management plan or chat with your GP, help is available.


The use of breath with exercise and Pilates- Cathy Derham

Cath is a very experienced Sports (titled) Physiotherapist and Pilates Instructor and recently ran a workshop for us on the use of breath in exercise and pilates…


Effective breathing while exercising and doing Pilates helps to improve oxygenation to the body, enhance relaxation and engage the mind. Breath is often used to assist with facilitating a muscle, and the coordination of movement patterns. An exhale (breath out) is often used during the more effortful component of a movement (for example lifting or lowering a load, or moving a limb). Breathing can be regressed so that movements always occur on an exhale, with pauses in movements occurring on inhale. As people progress, and are able to achieve greater dynamic stability, breathing patterns can be progressed making movements more fluid. The focus on breath during exercise can be helpful for some to improve timing and coordinate movements. For others it can create too many things to have to attend to in addition to just doing the movement! The important thing is to ensure that you avoid holding your breath during exercise, as this can result in increased blood pressure while exercising.

Breathing also has a significant impact on the mechanics of an exercise. For example, when looking to facilitate extension through the upper back/ trunk we can time these movements with an inhalation (breath in), as the extra air going into the lungs will facilitate this movement. For some we may want to promote more stability with this movement (instead of mobility), and we may cue to do these movements on an exhalation


Figure 1. An inhalation will facilitate getting an increased range of thoracic extension as the trunk goes upwards towards the ceiling during the Swan exercise on the Wunda Chair.

Some words to ponder which draws upon the relationship between breath and its relationship to engaging the mind –

“Breath, prana and mind are mutually and inherently related; cultivate one well and the other two will fall into line. Prana is the energy that drives life, the power that animates the body, enlivens the mind, spurs the soul. Prana is life’s inspiration, its foundation, its tenacity; it is the sure hand on the tiller, the wise voice of good counsel, the urge to health and harmony that craves to turn our bodies into havens where we can take shelter from the storms of the hectic modern world. Prana is at work every instant in every cell of every living organism.” (Robert E. Svoboda, as cited by Polestar Pilates Rehabilitation Series Course Notes, pp. 21).

Cathy Derham



Balance and Control Training College (2012) Foundation Level Manual (pp.42-46)

Norkin CC, and Levangie PK (1992): Joint Structure and Function, (2nd edition), pp.178-192.

Polestar Pilates Education (2012) Studio/ Rehabilitation Series Manual – Principles of Movement, pp. 16-26.



Athletes : the importance of switching on the pelvic floor-Clifton Hill Physiotherapy

CFA Bridge magazine with spoke to former Australian Netball Captain, Sharelle McMahon about incontinence amongst netballers and how she learned how to engage her pelvic floor.

An award-winning research reveals that 30 percent of women netballers experience urinary incontinence while playing Australian women’s most popular team sport. Nearly half of the women that had had babies leaked. They concluded that the prevalence of leakage while participating in netball was similar to other high impact sports and that screening for leakage within netball clubs may assist symptomatic women to receive effective treatment.

Elite netballer, Sharelle McMahon remembers the day well. She was at a training session with the ANZ Championship team, the Melbourne Vixens when a physiotherapist used an external ultrasound to track how well the players were switching on their pelvic floor. “Only one of us in that group was actually activating our pelvic floor correctly, and that one wasn’t me,” said Sharelle. “The team’s physio was quite shocked. When we went through our training we were frequently asked to engage our core and our pelvic floor – that was part of the training program. So while that was a focus, we weren’t actually doing it very well.” The exercise was done about 10 years ago, and prompted Sharelle and her teammates to take action. She said the issues surrounding a weak pelvic floor do not necessarily start after having a child. The ultrasound exercise was used on her team about four years before she had her first child. Sharelle was referred to another physiotherapist, a pelvic floor specialist, who did an internal ultrasound to further identify how she was switching on her pelvic floor, and help her correctly engage the muscles.

Sharelle has participated in the pinnacle of the game, representing Australia in the Commonwealth Games between 1998 and 2010, winning gold in 1998 and 2002, and silver in 2006 and 2010. She played 118 games for Australia, won two World Championships, and was the Australian flag bearer for the opening ceremony of the 2010 Commonwealth Games in Delhi. In 2016, she was inducted into the Australian Sport Hall of Fame. She currently works as a specialist coach for the Melbourne Vixens and commentates on the sport for Channel 9.

Elite athletes such as netballers, basketballers, gymnasts, trampolinists, tennis players and runners are at increased risk of developing pelvic floor problems. This is because of the constant and excessive downward pressure that these sports place on their pelvic floor.

Sharelle believes the prevalence of continence-issues for netballers is likely due to the sport’s high impact activity involving jumping and running. “And the people playing are mostly female, so rather than it being an issue necessarily specific to netball, it’s likely something happening more broadly and it just happens to be that netball by its nature is one of those activities that has those high impact movements and a high number of female players,” she said. Sharelle returned to elite level netball about three months after she had her first child, Xavier. “So I went back into high level training pretty quickly,” she said. “Particularly with training, I had some pain associated with my pelvic floor which presented as pelvic pain and back pain. So in that year after having Xavier, I had a lot of treatment to help relieve the symptoms but also to work on strengthening my pelvic floor in particular. I was wearing a pelvic band to give myself a bit more stability as well.”

Sharelle said her session with a pelvic floor specialist helped her to properly engage her pelvic floor while she was exercising. This resulted in her being able to strengthen her pelvic floor muscles and reduce her symptoms. “You can see it on the screen and get a sense of that’s the feeling when you’re switching it on properly,” she said. Sharelle said she thought it was sad that research showed many affected by continence-related issues just resort to wearing pads or stop playing netball altogether. “For me personally, going to see someone to help in that space was incredibly beneficial. You don’t have to live with the symptoms of a weak pelvic floor. There are people who can really assist in that space,” she said. “It’s something that a lot of people are dealing with and just dealing with the symptoms is not the answer – it can lead to some much worse issues down the track.

Addressing the cause can really help.” She advises anyone going through any continence-related issues, or any issues related to pelvic or back pain to begin with seeing a physiotherapist. “Get advice to ensure you’re switching on the pelvic floor muscles correctly,” she said.

Gill, N.; Jeffrey, S.; Lin, K-Y; Frawley, H The prevalence of urinary incontinence in adult netball players in South Australia. Australian & New Zealand Continence Journal . Summer 2017, Vol. 23 Issue 4, p104-105. 2p. 1 Chart.

Jen Langford taken from article by Bridge magazine | Autumn 2018 |


Welcome Josh Neeft

We warmly welcome Josh Neeft to our team at Clifton Hill Physiotherapy. Josh is a Physiotherapist with over 12 years experience in private
practice. Josh graduated from the University of South Australia with a
Master Of Physiotherapy (Graduate Entry) in 2005 after previously
completing a Bachelor of Podiatry in 2001.
Josh incorporates a distinct focus on manual and exercise therapy and
holistic care, placing great emphasis on having his clients be an
active participant in their therapy to optimise their treatment
Josh has undertaken further training in the fields of Cranio Sacral
Therapy and Visceral Manipulation which looks to address correction of
connective tissue restrictions throughout the body and the
implications they have on dysfunction of the musculo-skeletal,
nervous, vascular, cardio-respiratory, digestive and endocrine
Josh’s special interest areas include pelvic and spinal disorders,
lower-limb problems due to his background in Podiatry, headaches and
migraines, jaw problems and chronic pain syndromes.
In his spare time Josh is an avid music collector, movie watcher and
Adelaide Crows supporter.


For further enquiries email Josh: