<strong>What Causes Joint and Muscle Stiffness?</strong> - Physio Direct NZ

What Causes Joint and Muscle Stiffness?

Joint and muscle stiffness can be felt in any part of the body. While it may be accompanied by pain, this is not always the case and can have many different causes. Feelings of stiffness can be easy to ignore, however, they can be a sign that you are at increased risk of injury or pain. Here are a few reasons why you might be feeling a little bit less flexible.

Muscle Weakness

Muscle stiffness can be a sign that strength is missing. Our body will prioritise stability over flexibility if our muscles don’t have the ability to provide both. This means that your muscles will be a bit tighter and stiffer to compensate for any weakness. If you are feeling a little tight and sore, your physiotherapist can help to identify any muscles that maybe need strength targeting to help with feelings of tightness.

Delayed Onset Muscle Soreness (DOMS)

Many of us are familiar with post-exercise pain and stiffness. This is a somewhat protective mechanism to help you recover from a bout of increased exercise. This kind of stiffness will be present in muscles that have been used recently and usually lasts for just a day or two. This kind of stiffness usually goes away on its own, although it can be quite uncomfortable, this is usually nothing to be too concerned with. Your physiotherapists can help you with tips to avoid DOMS in your regular workouts.

Lack of movement

Along with muscle weakness, inactivity can lead to joint stiffness. Joints need to move through their full range regularly to maintain their flexibility, as anyone who has kept their joints still in a cast will know. Lack of movement can lead to a reduction of blood flow and nutrients also impacting joint health. Your physiotherapists can help you to identify any joints that are not moving well and advise you on how to restore joint flexibility. Activities such as Pilates aim to help you move all of your joints through their full range safely and maintain flexibility.


Stiffness is the hallmark of arthritis, often noticeable as increased stiffness on waking that progresses gradually over time. Pain and stiffness caused by arthritis can often be helped by a targeted muscle strengthening program to help support the joints.Speak to your physio about any tightness or inflexibility and see how they can help you feel your best.

<strong>Cervicogenic Headache</strong> - Physio Direct NZ

Cervicogenic Headache

What is it?

Headaches are a generic term for any pain in the cranial region. They can be caused by a variety of factors and there are many different types. A severe headache can stop you in your tracks and be severely debilitating. One kind of headache that is commonly treated by physiotherapists is cervicogenic headache or a headache that originates from the neck.

What are the symptoms?

The pain of a cervicogenic headache is usually unilateral (on one side), and often described as a dull or aching pain that can be felt in the neck, head, and sometimes the face. It can also be accompanied by other symptoms such as neck stiffness, limited range of motion in the neck, and tenderness in the neck or scalp.

How does it happen?

Cervicogenic headache is an example of referred pain, where dysfunction of the structures in the neck cause pain to be felt in a different location. The most common reason for this pain to be felt are joint and muscle stiffness around the cervical spine. 

Tight muscles can develop trigger points that refer pain into the cranial region in a typical pattern. Headaches can also be caused by irritated nerves that originate in the spine and travel into the head. Whiplash following a trauma such as a car accident is known to cause ongoing neck-related headaches without treatment.

How is it diagnosed?

Diagnosis of a cervicogenic headache can be difficult as it needs to be differentiated from other forms of headache such as migraine, tension headaches and sinus headaches. Your physiotherapist will perform a thorough assessment to determine the origins of your headaches. Some signs that headaches are caused by cervical dysfunction include muscle tightness, joint limitations, concurrent neck pain and poor posture.

What is the treatment?

Treatment for neck-related headaches is aimed at correcting any dysfunction, restoring movement and flexibility to stiff joints and muscles and addressing any postural vulnerabilities.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your condition. 

<strong>Broccoli, Leek and Bacon Soup</strong> - Physio Direct NZ

Broccoli, Leek and Bacon Soup


2 Tbsp. Extra Virgin Olive Oil

200g Broccoli

1 large Leek, trimmed and sliced

1 Whole Potato, peeled and diced

4 slices Bacon, diced

2 Cup Vegetable Stock

2 cloves Garlic

Chilli Oil

Salt and Pepper

Parsley to Garnish

  1. Place a large soup pot on medium heat. Add olive oil, chill garlic, salt and pepper and chopped leek, and cook for five minutes or until soft, stirring occasionally.
  2. Add broccoli and potato and cover with 2 cups of stock. Simmer until the potato softens or for about 20 minutes.
  3. In a separate pan, cook bacon on medium heat until crispy. Remove from pan and allow oil to drain. Set 1/3 of the bacon aside for garnish and add the remaining bacon to the soup mix.
  4. Once potato pieces are cooked through. Use a handheld blender to blend ingredients until smooth. Add salt and pepper to taste.

Serves two, garnish with crispy bacon and fresh parsley.

Physio Tips for Comfortable Travel

Travel can be one of the most enjoyable aspects of life, however if a trip away comes with the risk of increased pain and soreness, the excitement can be thoroughly diminished. Many people will even avoid travel altogether if their symptoms are exacerbated too much by long seated periods. If you are unlucky enough to fall into this category, here are a few tips from your physiotherapist that might help make long trips a little more comfortable.

Lower back pain is the chief complaint of most travellers. To avoid low back pain, try the following tips:

1) Adjust the seat angle.

If you are able, tilt the seat slightly down towards your feet, not towards your hips. Ideally, your knees should be level with your hips, or even slightly lower. A footrest to lift your knees can also help.

2) Lift the height of the whole seat. This will assist with tip #1 by lifting the whole body away from the floor. When your hips are less bent, it is easier for your back to sit comfortably in an upright position.

3) Use a lower back support.

Many cars nowadays come equipped with in-built lumbar supports. Often this support is a generic design and not fitted for your specific shape or height. A proper lumbar pillow, or even a rolled towel in the small of the back, can be more effective in maintaining the natural arch of your spine. This relieves pressure through your intervertebral discs, spinal ligaments, and spinal muscles.

Neck discomfort is easier to improve when tips for lower back are implemented first. Some very easy tips to reduce neck pain are as follows:

1) Use a travel pillow.

If travelling on an airplane, try wearing the pillow backwards or sideways. This assists in supporting the head in a slightly better position when you rest or sleep, which helps to reduce the stress placed on the muscles, ligaments and joints within the neck.

2) Every hour, perform 10 chin tucks.

This is easiest to perform correctly if you sit tall and press your chin straight backwards, lengthening the back of your neck. Do not tuck the chin to the chest. This exercise stretches the small postural muscles at the base of the skull, relaxing them. The tips above are only suggestions. If you find they are helpful, continue performing them throughout your travels. However, if any of the above tips cause you pain or discomfort, it is advisable to seek your physiotherapist’s opinion.

<strong>Roasted Dates With Almond & Ricotta</strong> - Physio Direct NZ

Roasted Dates With Almond & Ricotta

½ cup of Ricotta Cheese

4 Tbsp. of Almond Nuts, crushed

20 Medjool Dates

1 Tbsp. Extra Virgin Olive Oil

1 Tbsp. Balsamic Vinegar Glaze

  1. Sea Salt to taste
  2. Preheat an oven to 180º Celsius. Bring a medium-sized frying pan to medium heat and add crushed almonds.
  3. Stir almonds frequently, until warm and toasted, removing them from heat as they begin to brown. In a small bowl, mix the ricotta cheese and half of the toasted almonds.
  4. Use a small knife to carefully remove any seeds from the dates, making space for the ricotta mixture. Spoon ¼ teaspoon of the ricotta mixture into each date and place them, evenly spaced, on a foil-lined baking sheet and drizzle with olive oil. Sprinkle dates with remaining almonds and sea salt.
  5. Roast dates for 15-20 minutes until the ricotta is melted.

Remove from oven and immediately drizzle balsamic glaze.

Growing Pains

Are growing pains real?

The short answer is that yes, growing pains are a real and usually harmless part of childhood. Though poorly understood, they are recognized as a common phenomenon occurring most often between the ages of 3 and 12. The pain is commonly felt in both legs, particularly at night with no clear cause of pain. As yet no one is able to explain why they happen but growing pains are thought to be a normal response of a growing body as it adapts to new heights, sizes, strengths and skills. 

Does this mean I can ignore my child’s pain?

Not so fast. While growing pains are harmless and usually transient, there are many childhood illnesses and conditions that do require professional assessment and, if left untreated, can cause serious harm. These include but are not limited to; Juvenile arthritis, childhood cancers (which often first present as knee or jaw pain), developmental hip dysplasia (abnormality of the hip joint), Perthes disease and a variety of other musculoskeletal disorders. 

While it’s true that children are generally more resilient and heal well, they are also

vulnerable to injuries just like adults. All serious strains and sprains should be rehabilitated correctly to ensure no long-term problems occur down the track. Many childhood pains can also be relieved with physiotherapy in the short term even if the child will eventually grow out of the pain. 

How can I tell if pain is abnormal?

Unfortunately, unless you are a trained professional you won’t be able to tell. If there is any doubt in your mind always contact a physiotherapist or doctor. Many clinicians have great respect for a parent’s intuition and acknowledge that parents are usually very good at knowing if something is wrong with their child. 

Even if you’re sure nothing is wrong, there are a few signs and symptoms that you should take particular notice of. pain that is severe, pain that occurs suddenly without an obvious cause, pain that is one sided, pain that affects your child’s activity levels, causes a limp or is associated with signs of general illness/fever. 

Constant, severe and unrelenting pain is a serious sign that should be investigated at any age. If you’re worried, the first step is to consult a physiotherapist or general practitioner. 

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your injury. 

Should You Have a Joint Replacement? - Physio Direct NZ

Should You Have a Joint Replacement?

One of the most impressive healthcare developments in history is the humble joint replacement. Many people are able to take a joint that is extremely painful and dysfunctional and give it a whole new lease on life.

The improvements in this surgery over the last few decades have meant that success rates for joint replacement surgery, particularly hip and knee replacements are even higher than ever. If you are struggling with joint pain related to arthritis, it can be difficult to know when to make the move. Here are a few things to consider before going for that surgical consult.

Don’t assume pain is permanent once you hear the word arthritis

Pain is a complex beast and is usually never caused by one single thing. Most people will have some amount of arthritis in their joints past the age of 50, whether or not this is what is causing your pain will be unclear without first seeking physiotherapy treatment.

Many people have some level of degeneration in their joints without experiencing much discomfort at all. It’s possible that an analysis of biomechanics, strengthening and manual therapy could all improve your symptoms significantly, even if osteoarthritis is present. A trial of physiotherapy treatment is recommended before surgery in most cases.

Pre-surgical strength and fitness are important

This means two things, first of all, your strength or exercise program before surgery will set you up for much better results. The second thing is that choosing when to have the surgery means not necessarily waiting until the pain is unbearable before going ahead, as time spent in significant pain can reduce your overall strength and fitness while also putting more stress on other joints.

Research the risks and side effects

While surgical outcomes are continually improving, no surgery comes without risks and some people will have ongoing pain and stiffness even after their surgery. It is important to make an informed decision about when and if you should have a joint replacement.

If you are considering a joint replacement, speak to your physiotherapist about all the ways they can support you through your journey and help you come to an informed decision about what is right for you.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Olecranon Bursitis - Physio Direct NZ

Olecranon Bursitis

What is it?

Bursae are small sacs of fluid found throughout the body. These bursae produce synovial fluid and act to reduce friction between muscles, tendons, ligaments and bones as they move over each other. Bursae are located at strategic points, typically where there are higher points of stress. If a bursa is injured or irritated, it can become inflamed, painful, red and swollen and this condition is referred to as bursitis.

One bursa that is commonly affected is the olecranon bursa, which sits just over the hard bony process at the base of the elbow. Olecranon bursitis refers to inflammation of the bursa at this point and is a common condition, particularly in men between the ages of 30-60.

What causes it?

Olecranon bursitis has a few different causes including trauma, overuse and infection. A sharp blow to the elbow, through a fall or hit, might damage the bursa leading to bursitis. In other cases, the bursa can be infected by bacteria, which enter the body through a small skin tear. Bursitis can also develop slowly through friction of the nearby muscles that cause the bursa to become irritated and inflamed.

What are the symptoms?

The hallmark of this condition is a painful, red, swollen elbow. Typically pain is worst when resting on the tip of the elbow and/or with elbow movements, particularly when bending or straightening the elbow fully. The pain often lasts a few months and may not go away on its own. The pain may build up gradually, or come on suddenly, depending on the cause. Bursitis caused by infection (septic bursitis) may also be associated with general feelings of illness such as fatigue, fever and body aches.

What is the treatment?

As there are many different causes of this condition, accurate diagnosis is essential. Your physiotherapist is able to distinguish between olecranon bursitis and similar conditions such as rheumatoid arthritis or fibromyalgia. Septic bursitis will need to be treated by a medical professional who will determine the best course of action. All types of bursitis can be managed initially with a RICE protocol to reduce pain and swelling (Rest, ice, compression and elevation). Mechanical causes of bursitis can require more in-depth identification of the factors that may have led to the development of this condition.

Your physiotherapist is able to address these factors plus provide taping support to unload the bursa along with manual therapy and an exercise program. If this is unsuccessful, cortisone injections are often used to reduce pain and inflammation. In severe cases where the pain persists despite all other attempts at treatment, the bursa can be surgically removed in a procedure called a bursectomy. Once the pain has subsided your physiotherapist is also able to help prevent any further recurrence.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Honey, Date & Sesame Brittle - Physio Direct NZ

Honey, Date & Sesame Brittle


1 cup Raw Sesame Seeds

2 Tbsp. Chia Seeds

6 Medjool Dates, diced

¼. cup. Honey

¾. cup. Brown Sugar

2 tsp. Butter

1 Tbsp. Water

¼. tsp. Baking Soda

½ tsp. Vanilla Extract

¼ tsp. Cardamom

¼ tsp. Cinnamon

1.Combine sugar, honey, cardamom, cinnamon and water into a medium-sized saucepan. Bring to medium heat and stir until all ingredients are mixed together.

2.Add sesame seeds, chia seeds and dates and stir often until the mixture is an even consistency and begins to brown slightly. Keep on heat for 5-10 minutes, if you have a candy thermometer, the mixture should reach 150 °C.

3.Remove mixture from heat and stir vanilla extract and butter through. When the butter has completely melted, add baking soda and stir.

4.Spread mixture onto a greased baking tray and allow to cool. Once the mixture has hardened, use a spatula to separate from the tray and break into pieces.

<strong>Pan Fried Gnocchi with Fresh Parsley</strong> - Physio Direct NZ

Pan Fried Gnocchi with Fresh Parsley


500g Potato Gnocchi

1 cup Fresh Parsley

1/2 cup Parmesan Cheese 

1/4 cup Butter

2 cloves crushed Garlic

1 tsp. Cracked Black Pepper

1/2 Fresh Lemon

2 Tbsp. Olive Oil


  1. Heat a medium-sized frying pan to high heat and cover with 2 Tbsp. of olive oil, sprinkle salt and pepper and add 2 cloves of diced garlic. Add gnocchi and fry until lightly crispy. Remove from pan and set aside.
  2. Add butter to pan and allow to melt. Add cracked black pepper and whisk until slightly brown. Add lemon juice. Remove from heat and add gnocchi back to the pan, stirring through butter.
  3. Chop fresh parsley and gently stir through gnocchi. Sprinkle parmesan slices on top.

Add cracked pepper and fresh lemon to garnish. Serves two

<strong>Focus On Improving Your Posture</strong> - Physio Direct NZ

Focus On Improving Your Posture

For most of us, screen time and sitting go hand in hand and both are only increasing as our lives move online. While short periods in any posture aren’t harmful, a lack of movement combined with long periods spent in hunched positions can lead to spinal pain, headaches and even shoulder pain. If you’re noticing yourself needing to spend more time in front of a screen, here are a few tips that can help you to keep flexible and avoid pain.

Set movement breaks

Posture in itself isn’t always a problem. Spending long periods of time in these postures without taking breaks is a little more problematic. When your body is so used to one position, muscles may become shorter and joints a little stiffer, making it harder to move out of this posture and cause pain and discomfort.

You can break up your day by setting a timer to move and take a break every 20-30 minutes. Using these short breaks for movement is a great way to both help focus at work and keep your body more flexible.

Setup your work and home environment properly

Adjusting your work station or setting up a place to relax at home where to you can avoid a hunched posture can help you to reduce time in the same posture. Your physiotherapist can give you tips for how to setup your home and office environment correctly.

Take stock of your time spent sitting

Time in the car, time on your computer and time on the couch can all quickly add up without you realising. By accounting for the amount of time you spend sitting, you can find more ways to move. For example, if you notice that you’re sitting down as soon as you get home, try swapping out watching an episode to relax for a walk while listening to a podcast.

Ask your physio for specific stretches

If you can identify the posture you spend the most time in, your physio can help you to develop a specific exercise and stretching program to counteract these positions most directly and keep you strong and flexible.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

<strong>Common Myths About Back Pain</strong> - Physio Direct NZ

Common Myths About Back Pain

Low back pain is one of the most common conditions treated by physiotherapists and if you are unlucky enough to have been a sufferer, you know that severe back pain can take over your life. With improved understanding, health professionals have come to identify some common myths about back pain that are inaccurate, misleading or even counterproductive.

Myth #1 – Discs can ‘slip’ out of place

Sitting between the vertebrae of the spine are soft discs that provide flexibility and shock absorption to the spine. In the past, many health professionals including doctors and physiotherapists told patients that these discs had ‘slipped’ as a way of explaining their pain to them. While this was helpful to some extent, it is not entirely accurate, as these discs are actually very secure and rarely, if ever ‘slip’ out of place. Discs may bulge slightly or in some cases tear, however more often than not these injuries will heal without any permanent damage and exist in many people without causing any pain at all. Thinking that a part of your spine has permanently ‘slipped’ out of place can cause you to move differently, which can create more pain and dysfunction in itself.

Myth #2 – If you have low back pain, you should stay in bed

When back pain strikes, our natural instinct is to rest, avoid movement and wait for the pain to pass. However, studies have shown that being active and performing targeted, gentle exercises can help improve low back pain. In fact, our impulse to stop moving and protect our spines can actually cause abnormal movement patterns and stress, leading to ongoing pain after the original injury has healed. If you are unsure of what kind of exercises you should be doing, your physiotherapist can help guide you with a targeted exercise program.

Myth #3 – Severe pain means severe damage

Pain that is severe, and strikes suddenly, without warning can be a very scary experience. If this happens to you, you could be forgiven for assuming you must have sustained a very serious injury. The fact is, however, that the spine, being surrounded by nerves is a particularly sensitive area of the body and pain in this area can be very strong without significant damage. A small ligament sprain or muscle tear can actually cause a large amount of pain and it is common for severe pain to settle down quickly, even disappearing within a few days. In many cases, symptoms that last for longer than 2-3 weeks are caused by changes to your movement patterns in response to this pain and not the original injury itself.

If you are suffering from back pain, the best person to see is your physiotherapist. They can help you to recover without any complications or side effects and help you safely return to your usual activities while also ruling out any serious damage that might need further investigation.

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Roasted Carrot, Date & Almond Salad - Physio Direct NZ

Roasted Carrot, Date & Almond Salad


6 Large Fresh Carrots

6 Medjool Dates

1 Handful of Sliced Almonds

1 Garlic Clove

2 Tbsp. Olive Oil

Salt & Pepper

Fresh Parsley for Garnish

  1. Preheat an oven to 180 degrees Celsius and line a baking tray with baking paper. Peel carrots and cut into large sticks. Crush one clove of garlic and add to baking tray along with carrots. Drizzle with olive oil and sprinkle with salt and pepper.
  2. Place the baking tray into the oven and cook for 20 minutes, in the meantime, cut dates into quarters and add to the baking tray. Cook for a further 20 minutes before adding sliced almonds to the baking tray. 
  3. Continue baking for 10 minutes more and remove from oven. Mix ingredients together gently in a large bowl and set aside to cool. 

Garnish with parsley and serve when ready. 

Homemade Apple Crumble - Physio Direct NZ

Homemade Apple Crumble



500g Apples, peeled and chopped

50g Brown Sugar

1 Tbsp. Plain Flour

1 pinch ground Cinnamon

1 tsp. Ginger, finely grated



250g Plain Flour

150g Brown Sugar

200g Rolled Oats

250g Butter, melted

2 Tbsp. Honey

  1. Preheat oven to 180C/350F.
  2. Place flour, sugar, and oats into a mixing bowl. Melt butter and add to bowl, mixing through dry ingredients until well combined.
  3. Place filling ingredients in a saucepan with ½ cup water and cook on medium heat until apples begin to soften.
  4. Grease an ovenproof dish with butter or line with baking paper and spoon in the fruit mixture and cover with crumble mixture. Drizzle honey over the top of mixture.
  5. Place in the preheated oven and cook for 30-40 minutes until browned.
  6. Serve hot, use custard, ice-cream or vanilla yogurt as an optional side.


Ready to serve for four.

LCL Tears - Physio Direct NZ

LCL Tears

What is the LCL?

The knee is one of the largest joints in the body and has only one plane of movement. This means it bends and straightens but does not twist (much) or move from side to side. To keep the knee from moving in other directions, the knee is supported by many strong ligaments, with two of these being found on either side of the knee. The inside ligament is the ‘Medial Collateral Ligament’ (MCL) and the outside one is the ‘Lateral Collateral Ligament’ (LCL). The primary role of the LCL is to prevent the lower leg from moving too far towards the midline in relation to the upper leg.  Both the LCL and MCL are extremely strong ligaments and provide lots of support to the knee during movement however, they are still vulnerable to injury.

How do tears happen?

The LCL is injured less often than the MCL, however tears do still occur. The most common way the ligament is damaged is through a force causing the knee to move inwards in relation to the upper leg, or a twisting of the knee. This can be seen in sports that involve changing directions or with a direct force, such as a rugby tackle. This injury can also occur from a simple fall and as with all sporting injuries, it is not only athletes who can be affected, anyone can tear their LCL in the right circumstances. 

What are the symptoms?

Following an injury to the LCL, common signs and symptoms are a ‘popping’ sound at the time of injury, immediate pain with weight bearing and swelling and a feeling instability. The severity of the injury will impact how much each of these symptoms are felt and LCL tears are classified as either Grade I, II or III, which helps to direct treatment. A grade I tear is where a few fibers of the ligament are stretched and damaged, a grade II is where this a partial rupture of the ligament with some instability of the knee and Grade III is a complete tear.

How are LCL tears diagnosed?

Your physiotherapist is able to perform clinical tests to evaluate if there is any instability of the knee from an LCL tear. An MRI can confirm this diagnosis and an X-ray may be required to rule out any associated fracture. It is possible for nerve damage to occur at the same time as an LCL Tear, which will result in weakness and loss of sensation in the lower leg. Severe injuries are more likely to involve injury to other parts of the knee and your physiotherapist will make a full evaluation of all your injuries on assessment.

Most LCL tears are managed well with just physiotherapy and support of the joint, however severe tears and associated nerve damage may require surgery. Your physiotherapist and medical team will work together to help determine the best course of action for each individual injury.


How can physiotherapy help?

For tears that don’t require surgery, your therapist will advise you on how to best support and protect the injured joint. In the first 48 hours, RICE protocol (Rest, ice, compression, and elevation) is applied to reduce any pain, swelling, and inflammation. Following this period, you will be advised on how best to mobilise the joint whilst preventing any further damage. Return to sport will be dictated by healing times with a full recovery expected by 6-12 weeks.

Following ligament damage, balance, strength, and proprioception are often impacted and your physiotherapist will develop a program to address this, which is an important part of preventing further injury. Tears that are repaired surgically will require a longer program of rehabilitation and close liaison with the medical team.

None of the information in this newsletter is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

If you require professional advice or treatment, please see our range of treatment options, or book an appointment online. Physio Direct has many clinics located throughout New Zealand, with no GP referral required to make an appointment.