Blue Cheese and Caramelised Onion Pizza - Physio Direct NZ

Blue Cheese and Caramelised Onion Pizza


2 flatbread or pizza bread

2 tbsp blue cheese or blue cheese dip

1 cup rocket

1 green pear, sliced

30gm parmesan cheese, sliced

 3 onions

2 tbsp olive oil

1 tbsp brown sugar

¼ cup red wine vinegar


Caramelised Onion:

  1. Fry onions in olive oil until brown and starting to soften. Add brown sugar and red wine vinegar and simmer until onions are soft and caramelised. Can be used immediately or stored in the fridge.


Preheat oven to 180 degrees Celsius.

  1. Spread blue cheese dip over pizza base, cover with caramelised onion and place in oven for 10 minutes. Remove and place sliced pear pieces over pizza and cook for a further 5 minutes.
  2. Remove from oven and place fresh rocket over pizza. Add cracked pepper and parmesan slices to taste.


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ACL Reconstructions - Physio Direct NZ

ACL Reconstructions

A common injury of the knee is a tearing of the ACL (Anterior Cruciate Ligament). This ligament is very important for stability of the knee and often needs to be repaired surgically. The primary function of the ACL is to keep the bottom surface of the knee joint from sliding forwards during movement. An unrepaired knee may feel unstable or give way suddenly.

Not all ACL injuries require surgery and some may heal well with proper rehabilitation, however for those who do need surgery, there is a significant rehabilitation period afterwards.

What does the surgery consist of?

Every surgeon will have a slightly different technique for surgery. The most common approach is the arthroscopic approach, which uses a small camera and allows the surgeon to make only small incisions into the knee. They will then replace the torn ligament with either a graft from a tendon or ligament at another part of the body or using a synthetic graft.

How long does rehabilitation take?

Full rehabilitation following surgery can take up to nine months and rehabilitation is divided into different stages. As all surgeons will have different protocols for their approaches to surgery, time frames will vary for everyone.

Initially after surgery, the graft will be quite weak while a new blood supply is being established. It can take up to 12 weeks before the graft is at its strongest point and evidence shows that it may never have the strength of the original ligament.

In the early stages, rehabilitation will be focused on restoring movement to the joint and strengthening the muscles around the knee without putting any undue stress on the graft.

As the graft begins to heal and strengthen, rehabilitation can progress to include stability and control exercises and gradually build up to a complex program that prepares the knee for a full return to sport.

The path to full rehabilitation from a knee reconstruction can be a long and bumpy one, however there are high success rates with this surgery, particularly when followed up with full physiotherapy rehabilitation.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.


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Three Things Your Physio Wants You To Know - Physio Direct NZ

Three Things Your Physio Wants You To Know

Every profession has a unique perspective of life that can only be achieved from years of experience in that area. Here are three things that experience has taught your physio:

  1. Problems that seem to arise for “no reason” are usually a result of disuse or lack of movement.

It’s common to want to know why pain has occurred; however it’s not always easy to identify a cause. What you come to learn as a physiotherapist is that pain and injury are just as likely to arise from disuse and inactivity as they are to develop from a direct trauma.

Our bodies are made to move and modern day life simply doesn’t allow for enough movement. We certainly shouldn’t be sitting as much as we are. This allows our joints to stiffen, muscles to shorten and weaken, and nerves to become extra sensitive.

There is also evidence that movement is essential for joint health, due to the movement of joint fluid that provides nutrients to the joint structures. The reason physiotherapists are always advocating for more movement is because we see the long-term effects of disuse on a daily basis.

  1. Bad habits are hard to break, but the best time to make a change is today.

Today’s slightly stooped posture is tomorrow’s fixed hump back. It doesn’t happen overnight, but seeing every stage of the progression walk through your door is like seeing evolution in fast forward. It makes you want to address change early, when it is easiest to make a positive effect.

Other habits that should be formed early are incorporating as much exercise into your routine as possible. It’s harder to be fit and active in your 60s if you weren’t active in your 30s. Being active now is arguably one of the most important things you can do to ensure you have a comfortable and healthy later life.

  1. Pain is affected by so much more than just tissue damage.

Your beliefs and attitudes about pain can have a huge impact on how you experience pain. Being fearful and anxious will amplify pain. The worst-case scenario is actually very unlikely and seeking the treatment of a physiotherapist can help to ensure the best outcomes possible.

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Smashed Avocado, Feta and Rocket Bagel - Physio Direct NZ

Smashed Avocado, Feta and Rocket Bagel


1 whole avocado

1 bagel

100g feta cheese

1 cup washed rocket lettuce

1/2 a lemon

1 tbsp olive oil



  1. Cut the bagel in two slices and place under grill on medium until crispy.
  2. Remove avocado flesh and mix into a bowl with feta cheese.
  3. Spread avocado and feta mix over bagel halves. Cover with rocket leaves.
  4. Garnish with half a fresh lemon and drizzle olive oil over top.

Salt and pepper to taste.


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Golfer’s Elbow - Physio Direct NZ

Golfer’s Elbow

Golfer’s elbow is defined as chronic degeneration of the tendon on the inside of the elbow, usually due to overuse. As its name implies, it is a condition common in golfers. However, as with all sporting injuries, this condition can affect anyone. Golfer’s elbow is similar to Tennis elbow, occurring on the inside of the elbow rather than the outside.

What are the symptoms?

Typically, someone suffering from this condition will experience pain on the inside of the elbow, forearm and possibly extending down to the hand. The pain will be worst with activities that require gripping of the hand and movements of the wrist. Less common is the experience of pins and needles in the hand.

How does it happen?

The exact cause of this condition is unknown, however it is generally thought to occur when the forces transmitted through the tendon become too great. This can be due to increased demands on the tendon or reduced quality of the tendon tissues.

As the tendon is attached to muscles that bend the wrist and provide grip strength, activities such as golf, rock climbing or manual work that involve gripping objects can easily create forces that damage the tendon.

Conversely, factors such as poor blood supply or simply the normal processes of aging can reduce the quality of the tendon. If the tissue is not functioning well, then even simple but repetitive movements in an office job can cause Golfer’s elbow.

There are a few other known contributing factors for Golfer’s elbow, such as poor posture, neck dysfunction, a recent change in activity and a history of trauma, such as a fall onto an outstretched hand.

What is the treatment?

Golfer’s elbow usually develops slowly, and healing can be a long process. The first step to effective treatment is accurate diagnosis, as many other conditions have similar symptoms and need to be excluded first by a medical professional.

Once a diagnosis of golfer’s elbow has been confirmed, treatment is aimed at allowing tissues to heal and regenerate. This will require a certain level of rest, and changes to the forces affecting the tissues, sometimes through bracing or taping.

Specific exercises have been shown to assist tissues in coping with and responding to load; these are called “eccentric” exercises. Other treatments include increasing blood flow to the area to promote healing. In chronic and severe cases, injections of corticosteroids are used, and in severe cases surgery may be undertaken.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.


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Surprising Skills That Improve With Age - Physio Direct NZ

Surprising Skills That Improve With Age

Many of us associate aging with a decline of skills and quality of life. However, the truth is not as black and white as this. While certain skills and functions do tend to suffer as we age, surprisingly there are many abilities that actually improve as we grow older.

Recent studies have shown that happiness is U-shaped, proving that the mid-life crisis is real. Ages between 40-60 tend to hold the highest amount of stress and responsibility for adults. It seems that happiness increases steadily after this period, with the average 80 year old reporting themselves to be as happy as the average 20 year old.

There is also evidence that your beliefs about ageing can act as a self-fulfilling prophecy. If you are positive about ageing, then your experience will be more positive than if you believe negatively about it.

It’s not only good news about your mental health though. Studies have also shown that while your short-term memory might decline, other skills such as creativity can actually increase. One of the biggest reasons for a decline in skill and function is the disuse that comes with retirement from work. Keeping active and mentally stimulated can be enough to keep your skills up to speed.

It has also been shown that confidence grows in both genders as we age. Making decisions becomes easier as we know ourselves better and have a wealth of experience to draw on when a tricky situation arises.

Certain physical skills such as strength and agility might decline, however it seems that other aspects of physical ability might increase, including endurance. There are many triathletes who are in their 70s, 80s, and unbelievably even in their 90s. In the absence of any serious disability, it might be the case that age is an excuse rather than an actual hindrance to being active.

Verbal ability and vocabulary are also skills that improve as we age, which may explain why crosswords are so popular with the elderly. Making the most of your abilities at every age is important. So try not to let age be a barrier to trying new things and keeping active.

Physiotherapists are dedicated to helping people stay active at any age and can help you with achieving your goals. Speak to your physiotherapist for more information.


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Grilled Parmesan, Polenta and Rocket Salad - Physio Direct NZ

Grilled Parmesan, Polenta and Rocket Salad


2 cups instant polenta

5 cups water

100g  parmesan cheese

200g crumbled feta cheese

2 cups of rocket lettuce

6 vine ripened tomatoes

3 Tbsp Olive oil.



  1. Place tomatoes onto a baking tray lined with foil and drizzle with olive oil. Bake in a preheated oven at 170 d Celsius for 1hr.
  2. Bring water to the boil, reduce to low heat and slowly add polenta, stirring constantly for 6 minutes until polenta is smooth and thick, stir in Parmesan cheese.
  3. Place polenta onto a chopping board and flatten to 1.5cm height. Place in fridge for 40 minutes to set. Cut into 6cm by 6cm squares and spray both sides with olive oil.
  4. Heat a bbq hotplate and grill to medium heat, cook polenta pieces on each side for 2-3 minutes.
  5. Wash rocket and place on top of baked polenta, cover with feta cheese and drizzle balsamic glaze over top to taste.


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Ankle Sprains - Physio Direct NZ

Ankle Sprains

Ankle sprains are extremely common, however, this doesn’t make them easy to cope with when they happen to you. If you’ve ever spent two weeks hobbling around on crutches after an unfortunate twist, you’ll understand just how painful and difficult they can be.

What are they?

Ankle sprains refer to a tear to the ligament fibres of the ankle. Commonly, a person will roll their ankle inwards and tear the ligament on the outside. Occasionally, the ankle will twist outwards and the ligaments on the inside of the ankle are torn and even less commonly, the fibres of the ligament that hold the two bones of the lower leg together tear (high ankle sprain). A sprained ankle will usually be painful, swollen, bruised, difficult to walk on and in some cases unstable.

How does it happen?

Ankle sprains can occur from something as simple as putting weight onto your leg when you think your foot is flat even though it’s not. The most typical pattern is of a person jumping and landing on the outside of their foot or simply slipping and twisting their ankle. A sprained or twisted ankle is one of the most common injuries presented to emergency departments around the world. This is important as a severely sprained ankle can actually have very similar symptoms to a broken ankle and will need an X-ray.
A medical professional should assess any severe sprain. However, there are some guidelines to help decide if a sprained ankle needs X-ray.

  1. You are unable to put weight on the ankle immediately after the injury.
  2. You are unable to take more than 4 steps immediately after the injury.
  3. Pain on the bony edges of the outer foot and ankle.

How long do sprains take to heal?

Depending on the severity of the tear, from one to six weeks. Your physiotherapist is able to help with recovery and ensure nothing slows down the healing. Following any injury of the body, joints may remain a little stiff and lose strength and control. Even though the injured tissues have healed, the ankle doesn’t move quite the way it used to. This means that your risk of twisting it again is higher than before the injury.

How can physiotherapy help?

Correct rehabilitation can help to prevent recurring injuries. As well as providing support to the unstable ankle, your physiotherapist will help you to strengthen any weak muscles and restore balance and control through exercise. They are also able to correct any abnormal movement of the joint following swelling.

If you’d like to make an appointment with one of our physiotherapists, please click below.

Sprains vs Strains - Physio Direct NZ

Sprains vs Strains

Sprains and strains are words that are used almost interchangeably when describing injuries, however they each actually have quite distinct meanings. The most straightforward explanation is that a “strain” refers to a tear in a muscle or tendon, while a “sprain” refers to a tear in ligament fibers. Below we briefly describe what that means and how we treat a sprain or strain differently.

Ligaments are fibrous tissues that connect and hold bones to other bones. These are very strong parts of your anatomy and, depending on the joint, provide large amounts of support and stability to the body.

Some ligaments are so strong, for example in the shoulder, that sometimes a bone will break before the ligament will tear. When ligament fibers do tear, the nearby joint can actually feel unstable.

Ligament tears will usually swell up and have a normal inflammatory reaction. Pain will be worse with movement or if the ligament is placed under more stress. Occasionally, if a ligament has torn all the way through, there is much less pain than with a less severe injury.

Your physiotherapist is able to grade the severity of a ligament sprain. This will help guide treatment and expected recovery times.

Muscle strains are easy to confuse with ligament sprains, however there are a few telltale differences.  Following a muscle tear, it is more likely that you’ll feel weakness rather than instability. The pain will also be isolated over the muscle or tendon body. An injury to a ligament will be tender over the site of the ligament and special tests can be done to show a laxity due to the injury.

Treatment is also slightly different as sprains will need more support and will sometimes even need to be braced. Muscle strains however will benefit from gentle movements earlier.

In both cases, following the basic principles of rest, ice, compression and elevation is great advice in the early stages of any injury. Heat is not recommended until at least two days after the injury.

It is important to seek professional opinion when recovering from both a strain and a sprain. It is very easy to re-injure an area while it is healing if undertaking strenuous activity too early and without correct rehabilitation. Speak to your physiotherapist for more information.

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Homespun Caesar Salad - Physio Direct NZ

Homespun Caesar Salad


Base Caesar Salad
2 garlic cloves, minced
1 tsp anchovy paste
2 tbsp lemon juice
1 tsp Dijon mustard
1 tsp Worcestershire sauce
1 cup good quality mayonnaise
½ cup fresh grated parmesan cheese
Pinch salt and pepper


  1. Mix salad together in large salad bowl.
  2. Whisk together remaining ingredients in a small bowl to create dressing.
  3. Stir Dressing through salad
  4. Top with chicken or salmon

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Metatarsalgia - Physio Direct NZ


What is Metatarsalgia?

Metatarsalgia is a medical term used to describe pain that occurs in the ball of the foot. This occurs due to rubbing of the long bones of the foot, called metatarsals, causing inflammation.  Build-up of inflammation in the ball of the foot compresses the small nerves that run between the toes and along the foot. Inflammation and compression of these small nerves is painful.

The pain can involve one or more joints of the foot including the big toe, second toe and third toe. It is unlikely to include the fourth or fifth joints.  On occasion, the pain may involve the entire foot, or larger parts of the foot.

The pain or symptoms may be made worse when bearing weight through the foot, such as walking or running. In severe cases, just standing or even wearing tight footwear can affect the foot.

How does it happen?

Metatarsalgia can be caused by a number of things. An abrupt change in posturing of the lower back or pelvis may alter the way the foot is loaded, and cause rubbing of the long bones. Altered loading of the foot may also be caused arthritic conditions that affect the knees, hips or pelvis and carrying extra weight.

Unavoidable factors, which may lead to the development of metatarsalgia, include increased age, and the physical shape of the foot and toe. As your body ages, the ligaments of the foot may loosen or weaken. Therefore, the bones of the foot move differently leading to altered positioning and loading of the foot.

Avoidable factors, which may lead to the development of metatarsalgia, include wearing inappropriately fitting footwear, and the type of exercise performed. Metatarsalgia is more highly associated with high impact-type exercise such as running or gymnastics.

What are the signs and symptoms of Metatarsalgia?

The signs and symptoms of metatarsalgia may vary from person to person. Generally, a complaint of pain is common. This may range from mild to severe, or may be described as burning or shooting pain in the foot or toes. Another common description is a tingling sensation in the foot or toes.

Typically, symptoms worsen when weight bearing and improve once weight is removed from the foot.

How can Physio help?

Your physio will determine the cause of the metatarsalgia pain and assist you with adapting your posture, or improving the loading pattern of your foot. You may be advised to unload the foot by reducing or stopping exercise, changing the shoe you wear, or strengthening certain muscles in your legs.

Electrotherapeutic modalities such as icing, ultrasound or interferential therapy may be of assistance to reduce pain and inflammation in the beginning stages of treatment as well.

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Orthopaedic Surgery And Physiotherapy - Physio Direct NZ

Orthopaedic Surgery And Physiotherapy

Orthopaedic surgery is any surgery performed primarily on the musculoskeletal system of the body. Common orthopaedic surgeries you may have heard of are joint replacements and reconstructions.

Physiotherapists have a large role to play in the recovery of these kinds of surgeries especially in the more extensive operations, such as a total hip or knee replacement.

It is not unusual to wake up in the hospital a few hours post-op knee replacement, hip replacement or shoulder reconstruction to your hospital-based physio asking you to get out of bed for the first time. This may seem daunting and entirely too early, however there is very well researched evidence for why getting out of bed early is so important: your speedy return to normal health and wellbeing!

Hospital-based physiotherapy typically includes re-learning how to walk and making initial improvements on your range of movement and function of the affected joint. The physio will also help you maintain healthy respiratory function by checking your lungs regularly. Drugs administered during surgery change your breathing pattern, which can lead to complications in the days after surgery.

Following your in-patient stay, it is highly likely your surgeon will request for you to continue with outpatient physiotherapy either in an outpatient hospital-based setting or in a private-practice setting.

With your outpatient physio, your recovery will be measured and monitored, goals will be discussed and set, and you will be given an exercise program created to achieve those goals.

Physiotherapists use a variety of treatment methods to assist a post-operative orthopaedic surgery patients achieve their goals. These include soft tissue work, stretching, hydrotherapy, manual therapy and gym-based exercise.

Recovery from orthopaedic surgery can take up to 12-to-18 months to occur. During this time, it is not unusual to experience bouts of pain and swelling; however these episodes should reduce the further into rehabilitation you progress.

Many post-operative orthopaedic surgery patients can expect to return to a normal life following a period of rehabilitation guided by a physiotherapist. This includes return to some sport and regular exercise!

Note: Please seek professional advice prior to beginning a post-operative exercise program.

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Ankle Fractures - Physio Direct NZ

Ankle Fractures

Recognising and Managing Ankle Fractures

Ankle fractures are surprisingly common injuries, both in athletes and the general population. Being able to quickly identify the signs and symptoms of a fracture is extremely important in ensuring quick and effective medical management.

Ankle fractures come in different shapes and forms. For example, a netballer with shin splints may experience a stress fracture, while a soccer player colliding with another player may experience a large break of the bone at the base of the ankle. In either case, bony tissue has been disrupted and must be treated accordingly.

Knowing the signs and symptoms of fracture

Understandably, swelling and bruising will occur when a bony injury to the ankle takes place. Inability to bear weight on the affected leg, along with extreme pain when the affected area is touched are also very common signs of fracture. However, as an ankle sprain will often present with these same symptoms, it can be easy to misdiagnose an ankle fracture as a severe sprain.

Luckily, there are some established rules to follow if you a suspect an ankle fracture. If one or more of the following signs are present, along with a history of trauma, it is recommended that you seek medical advice as soon as possible.

1) Inability to fully bear weight on the affected limb for 4 or more steps.
2) Tenderness to touch along the inner and outer bony aspects at the base of the ankle.
3) Pain to touch at the outer part of the foot.

Following diagnosis of a fracture, the doctor may decide to use a plaster (cast) to protect the bones while they heal. Severe fractures will need to be surgically stabilized. After surgery or time in a cast, ankles can be surprisingly weak and stiff due to disuse, leaving them vulnerable to becoming reinjured.

After removal of a cast, wearing a fabric brace is usually recommended for a few weeks. The brace provides an element of stability while the joint is regaining strength and balance. During this time, it is important to start strengthening and mobilizing the ankle. A physiotherapist can develop a rehabilitation program that involves a gradual return to normal daily activities and eventually sport.

This rehab program will allow your bones to continue healing while adjusting to the increasing stresses being placed on them. You may begin rehab in a non-weight-bearing setting such as the pool, and progress to increased weight-bearing activities such as cycling. Eventually you will be able to start a weight-bearing program on the grass or even on a hard surface to assist with your return to sport.

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Osteitis Pubis - Physio Direct NZ

Osteitis Pubis

What is Osteitis Pubis?

Osteitis Pubis is a medical term used to describe sports-related groin pain. Osteitis means ‘bone inflammation’, while pubis refers to the specific bone that is affected: the pubic bone.  Usually an overuse injury, Osteitis Pubis can sometimes be triggered by a specific event. It is characterized by pain deep within the front of the pubic bone, caused by inflammation. The area of the pubic bone affected is specifically known as the ‘pubic symphisis’.

This type of injury is common in load-bearing athletes such as runners. Other people commonly affected include soccer players and footballers, due to their frequent kicking actions.

How does it happen?

Instability within the pelvic region is the primary cause of Osteitis Pubis, particularly if the instability occurs at the connection between the two sides of the pubic bones at the front of the body. The pelvis carries the weight of the upper body and is responsible for providing stability when walking, running and kicking. This means that the joint can easily become irritated and inflamed.

What are the signs and symptoms of Osteitis Pubis?

Osteitis pubis is aggravated by weight-bearing activities, with running and kicking being the two main culprits. Pain is usually experienced on one side, however both sides can be affected. The pain is usually located at the front of the pelvis, and may progress into the hip and groin area as it becomes more severe.

Sufferers of Osteitis Pubis tend to have a history of previous groin strain, as well as lower back pain. They may also have a history of a sports hernia in the hip area. As with most inflammatory conditions, the pain may be worse when in use, better when resting, and worse overnight into the morning.

How can Physio help?

Your physio is able to help this condition in a number of ways and will hopefully get you back to your pre injury sporting level. During assessment, your physio will look at many different things to determine the cause of the condition. Muscle length, muscle strength and muscle control will all be assessed. Your posture in standing, walking and running will also be assessed to determine any irregularities.

Your physio will ask you to rest from sport for a period of time to allow some bony healing to occur. They will then progress you through a rehab program aimed at getting you back to sport.

This rehab program will retrain your muscles to stabilize the pelvis when walking, running and kicking. The muscles will also need to have relatively equal flexibility to help stabilize the pelvis. Your physio will give you specific exercises to target the strength and flexibility of these muscles. Finally, your physio will progress you to running or kicking, and allow you to gradually return to sport over a 3-to-6-month period of time.

The information in this newsletter is not a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

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Strawberry and Balsamic Bruschetta - Physio Direct NZ

Strawberry and Balsamic Bruschetta


3 strawberries, thinly sliced
2 slices of Ciabatta bread
1 cup rocket salad leaves
Balsamic glaze


1. Toast slices of Ciabatta bread
2. Sautee strawberries for 20 seconds each side over medium heat
3. Top bread with fresh rocket
4. Place sautéed strawberry slicked over rocket
5. Drizzle with balsamic glaze

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