Blueberry and Cashew Bliss Balls - Physio Direct NZ

Blueberry and Cashew Bliss Balls



½cup Coconut Oil

½ cup Cacao Powder

¼ cup Honey

½ tsp Vanilla Extract

¼ tsp Salt

¼ cup Cashews, chopped

½ cup Frozen Blueberries

½ cup Dried Coconut

  1. Place coconut oil, cacao powder, honey, vanilla, salt and cashews into a blender. Blend ingredients on high until thoroughly combined.
  1. Once a smooth consistency is reached, add blueberries and continue to blend until combined. Add small amounts of water if the mixture is too dry.
  1. Spoon mixture and roll into small balls. Coat balls in coconut until fully covered.
  1. Place balls in fridge or freezer for half an hour.

Serve when ready.

Anterior Ankle Impingement - Physio Direct NZ

Anterior Ankle Impingement

Anterior ankle impingement, also known as anterior impingement syndrome, is a musculoskeletal condition where repetitive forces compress and damage the tissues at the front of the ankle, causing pain and stiffness. It is a common injury that can affect people of all ages, however is usually seen in athletes of sports involving repetitive or forceful upward movements of the ankle, such as sprinting, landing from long jump, uphill and downhill running.

What are the symptoms?

Pain at the front of the ankle is the primary symptom of anterior ankle impingement. This can be felt as an intense, sharp pain occurring with ankle movements or a dull ache in front of the ankle following periods of exercise. Pain can also be felt when putting weight through the ankle while standing, walking or running. Night-time aching, stiffness, swelling and reduced ankle flexibility are also common symptoms of anterior ankle impingement.

How does it happen?

Anterior ankle impingement is caused by traumatic or repetitive compression to the structures at the front of the ankle as the tibia and talus move towards each other during ankle movements. The tissues that are affected become damaged and inflamed, causing the pain typical of ankle impingement. Chronic inflammation can lead to further stiffness, exacerbating the impingement process.

The most common risk factor for ankle impingement is a previous ankle sprain that was not adequately rehabilitated, as this can result in a stiff or unstable ankle. Another cause of impingement is the growth of small osteophytes or bony spurs around the ankle joint that press against the nearby soft tissues. These can be due to osteoarthritis or grow as a reaction to impingement itself.  Training errors, muscle tightness, unsupportive footwear and a hypermobile ankle have also been shown to be risk factors for anterior ankle impingement.

How can physiotherapy help?

Depending on the cause, mild cases of anterior ankle impingement usually recover in one to two weeks with rest and physiotherapy intervention. For more severe impingement, the ankle may require up to six weeks of rest and rehabilitation to recover. In rare cases, surgical intervention will be required to remove any physical causes of impingement, such as osteophytes to restore impingement free movement of the ankle. Your physiotherapist will first identify the cause of your ankle impingement and help you to choose the best course of action to reduce your symptoms. They are able to advise you on the appropriate amount of rest and provide stretches and exercises to restore strength and flexibility to the ankle.

Mobilization techniques and range of motion exercises can also reduce stiffness of the ankle, restoring normal joint movement. Moreover, balance and proprioception exercises are included to prevent further ankle injury. Balance exercises challenge the way your body reacts to outside forces. With this, your balance will be improved, and you’ll have a more stable ankle.

Ideally, physiotherapy treatment is the first step before considering surgery. If surgery is required, your physiotherapist can help you to make a full recovery with a post-surgical rehabilitation program.

Tips for Finding Your Perfect Exercise Match - Physio Direct NZ

Tips for Finding Your Perfect Exercise Match

Exercise is such an essential part of mental and physical wellbeing, however many of us find it difficult to make time to stay active. Often, when we think of exercise we imagine jogging or the gym. Exercise can be anything that gets you moving, and the trick to reaping the long-term benefits is to find an activity that you love and do often.

Exercise can offer more than just physical benefits, a new activity can be a way to join a new community, improve self-esteem and can even improve brain function. By learning new skills or movements, your brain is laying down new neural pathways, a process known as neuroplasticity. Physical exercise has also been shown to help to improve learning and memory, in some cases even having a slight protective effect against age-related dementia. Here are a few tips to help you find the right exercise for you.

Do a quick personality assessment.

Are you a competitive person? Or do you prefer to focus on your personal improvement of technique? The type of activity that captures your attention and focus will be easier for you to commit to. Matching your activity to your personality will also mean that you meet people who have similar interests to you.

Work with your injuries.

Injuries that stop us from participating in an activity we love can be devastating. However, you can often find another activity that doesn’t aggravate your injury, either as a replacement or to maintain fitness while rehabilitating.

If you are struggling with hip or knee pain with impact sports such as running, switching to swimming or cycling are great options. If you like a little adrenaline, then mountain biking could be more your style. Physiotherapists are able to advise you on which activities will be suitable for your particular condition.

Capitalise on your natural ability. Throwing and catching might not be your thing, but your balance might be exceptional. We all have natural abilities, finding a sport that challenges and develops areas that you find to be strengths is key to enjoying a hobby.

How To Prevent Workplace Injuries - Physio Direct NZ

How To Prevent Workplace Injuries

Why are workplace injuries so common?

The nature of work is that we are often required to complete the same task for hours. We can also find ourselves faced with time constraints and deadlines that lead to lazy postures and taking shortcuts, simply to get the job done.

How can they be prevented?

Workplace injuries can happen suddenly, through an accident like a fall or by lifting something too heavy, however, the vast majority of workplace injuries occur over time due to repetitive tasks. Often these conditions begin slowly and take many months to resolve. Here are a few tips to keep yourself pain free in the workplace.

Moving Items:

It’s important to assess the risk before you start. Do you need to ask for help or use an assistive device? Your legs are the strongest part of your body and ideally, you should use them to power the movement, rather than your arms or back. 

Bending and twisting when lifting is also a common mechanism for injury. It is much safer to lift, then step to turn before putting an object down again. Pushing is a much more efficient movement than pulling and is always preferable if you have a choice. Try to push at waist height and keep forces as close to your body as possible. 

Office Work:

Overuse injuries can occur by using the same side of your body rather than alternating sides. Practise using both left and right hands for taking phone calls and mouse work. 

Be aware of your posture. Good posture isn’t having a rigid and upright spine. It’s about being able to let your spine sit comfortably in its natural curves and be able to move in and out of this easily. Stretching can help to counteract positions you find yourself in for long periods.

Your physiotherapist is a great person to speak to about preventing injuries in your workplace.

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.

How Vitamin D Can Affect Your Life - Physio Direct NZ

How Vitamin D Can Affect Your Life

With so much public education about the dangers of sun damage, the last thing you’ll be expecting to here is that you’re not getting enough sunshine. However, in some countries up to 30% of the population have inadequate vitamin D status, increasing to more than 50% in women during winter and spring. 

What does vitamin D have to do with sunshine? 

Also known as the “sunshine vitamin”, vitamin D is essential for your health. With a typical western diet, most people will get about 10% of their daily vitamin intake through food and the other 90% is processed by the body through exposure to sunshine. 

Why is it important? 

Vitamin D is essential to maintain bone health and muscle function. Deficiencies in children can cause rickets, and over time it can cause osteoporosis in adults. It is also a predictor of falls, due to reduced muscle strength, which coupled with osteoporosis can lead to complicated fractures. Depression has also been linked to vitamin D deficiency. 

Vitamin D has also been shown to have a significant role in preventing respiratory disorders and even reducing their severity. This has been a suggested mechanism for why people with darker skin are more susceptible to COVID infections and suffer more severe infections. 

Think you get enough sunshine? 

You might be surprised at how much sun exposure you need to make enough vitamin D. Unfortunately the answer isn’t straightforward. During winter you’ll need to be in the sun for longer, and the further from the equator you are, the more sun you’ll need. Fair-skinned people are better adapted to process vitamin D and as such need to spend less time outside. 

People who tend to avoid the sun or dress very modestly might be surprised to find that they are vitamin D deficient, along with office workers and those who spend a lot of time indoors, particularly the elderly who are in care. 

Being overweight can also put you at risk of being vitamin D deficient as fat cells absorb vitamin D and prevent it from being released in a way that can be used by the body. Vitamin D deficiency can be diagnosed with a simple blood test. To find out more about how much sun you should be getting and how to balance sun exposure with skin cancer risks go to…. 

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.

Chocolate Pistachio Bars - Physio Direct NZ

Chocolate Pistachio Bars



½cup Coconut Oiil

½ cup Cacao Powder

½ cup Almond Butter

¼ cup Honey

½ tsp Vanilla Extract

¼ tsp Salt

¼ cup Pistachios, chopped

¼ cup dried Raspberries

Chocolate Coating:

150g Chocolate chips

1 tsp Coconut Oil

  1. Add all filling ingredients into a bowl and mix well. Pour into a large tray lined with baking paper, refrigerate for 20 minutes. 
  1. Once set, cut slice into bite-sized bars and set aside. 
  1. Carefully melt the chocolate in a metal bowl sitting above a pan of boiling water. Stir through coconut oil as the chocolate melts to improve consistency. 
  1. Using tongs, dip bars into the chocolate until completely covered and set aside on a tray. Place in the freezer until chocolate has hardened and becomes firm.

Sprinkle with coconut and serve when ready.

Raw Date & Coconut Slice - Physio Direct NZ

Raw Date & Coconut Slice


250g pitted Dates

300g dried Coconut

250g Cashews

zest from one Lemon

juice from one Lemon

1tsp. Honey

1 tsp. Flax Seeds

40 ml water

  1. Place dates and cashew nuts in a blender and blend on high speed for 10 seconds or until chopped into small pieces.
  2. Add lemon juice, honey, water and flax seeds and blend for a further 2 minutes.
  3. Once ingredients are blended evenly, add coconut and mix in a mixing bowl by hand until all ingredients are combined.
  4. Line a baking tray with baking paper and spoon the mixture into the tray. Flatten the mixture out so that it is spread evenly in the tray.
  5. Sprinkle with coconut and refrigerate for at least one hour before serving.

Cut into squares and serve. 

Why Do Joints Become Stiff? - Physio Direct NZ

Why Do Joints Become Stiff?

While pain and stiffness often go together, joint stiffness can occur on its own. Joint stiffness can limit your ability to perform usual tasks, for example turning your neck to check behind you while driving. Stiffness can also be a warning sign that part of the body is vulnerable to future injury. There are many different causes of stiffness and we will explore a few of the reasons why you might not be feeling as flexible as normal. 

1. Disuse and lack of movement

Our bodies are made to move. When we are not regularly moving them through their full range, they can begin to feel ‘tight’. This can be caused by a combination of the capsule that surrounds the joint tightening up and the muscles that surround the joint shortening and losing flexibility. Stiff and tight muscles can cause you to feel as though your joints are stiff, even if it is only the muscle length that is restricting the movement. Joint mobilizations, manipulation and muscle stretches/massage can have a significant effect in improving the symptoms.

The most important way to maintain full movement is to regularly move joints through their full range, which also helps to keep muscles and joints healthy. Your physiotherapist can advise you on how to best approach this with a targeted set of exercises.

2. Osteoarthritis (OA)

OA is a degenerative disease, characterized by a breakdown of the joint surface cartilage and the growth of bony osteophytes around areas of stress. While OA is increasingly common as we age, it is thought that the primary cause is abnormal load and stress to joint surfaces and not simply aging itself. As the joint space between two joint surfaces become uneven, joints affected by OA can feel stiff or even ‘blocked’. 

A person with OA will usually feel stiff for around 15-20 minutes after being still. Physiotherapy programs to strengthen the muscles surrounding the joints, so as to help absorb weight-bearing forces, has been shown to have positive results on OA symptoms. 

3. Inflammatory Related Stiffness

The inflammatory process is characterized by swelling and pain around a specific area. Usually, this is a response to damage by the body. As an area swells, this will allow less space for movement and a sensation of stiffness, as anyone who has had sprained an ankle can attest to. Acute inflammation will cause swelling that increases over 24-48 hours and subsides gradually. Autoimmune disorders can cause the body to mistakenly have an inflammatory reaction where there has been no injury, with resulting pain and stiffness. Rheumatoid arthritis and ankylosing spondylitis are two examples of such disorders. 

Stiffness caused by inflammatory disorders is characterized by a feeling of stiffness after rest, particularly in the morning that can take longer than 30 minutes to subside. Inflammatory disorders unrelated to injuries are complex in cause and require collaboration with medical teams for best treatment outcomes. Acute injuries are best managed by following RICE protocols (Rest, Ice, Compression, Elevation).

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.

MCL Tears - Physio Direct NZ

MCL Tears

What is it?

Your knee moves freely backwards and forwards; however, the thought of it moving from side to side probably makes you cringe. This is because the knee joint has sturdy ligaments either side of it that prevent sideways movement and we instinctively know that a lot of force would be required to shift it in this direction. 

The ligaments on either side of the knee are called the Collateral Ligaments and they each work to provide stability and restrict the knee’s movement into a sideways direction. The Medial Collateral Ligament is found on the inside of the knee and act to prevent the knee bending sideways away from the body.

How does this injury occur?

The typical mechanism for this injury is a force that drives the lower leg sideways away from the upper leg. This can occur from an awkward landing from a height, or when twisting with a foot fixed on the ground or from an external force hitting the outside of the knee, such as with a rugby tackle.

What are the symptoms?

MCL tears distinctively create pain and swelling quite specifically on the inside of the knee. The severity of the pain and swelling will be related to the number of ligament fibres damaged. Larger tears may also make the knee feel unstable or loose. 

A grading system is used to classify the severity of the injury and help to guide treatment. Grade 1 indicates that a few ligament fibres have been torn and grade 3 is used for a complete tear of the ligament with associated joint laxity. Very severe MCL tears often also involve injury to the medial meniscus and ACL and can require surgical repair. However, most MCL sprains can be managed well with physiotherapy. Grade 1 and 2 MCL sprains take between 2-8 weeks to fully heal and a complete rehabilitation program is strongly recommended to prevent future injury.  

How can physiotherapy help?

In the early stages of the injury, treatment is focused on pain and swelling management, while allowing the body to start the healing process through inflammation. This is best managed thought the R.I.C.E. principles (Rest, Ice, Compression and Elevation). 

Following any injury, it is natural for muscles to waste a little and the damaged tissues to lose what we call proprioception, the ability to sense their position in space. This loss of muscle strength and proprioception can contribute to further injury if not restored with a proper rehabilitation program. 

Physiotherapy also aims to restore movement to the joint and support the ligament while healing to ensure that it is strong and healthy, and the scar tissue forms in an organized fashion, which makes the new ligament as strong as it can be and protects against future tears.

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. 

Shoulder Labral Tears - Physio Direct NZ

Shoulder Labral Tears

What is the labrum of the shoulder?

The shoulder is a remarkably mobile joint, however, this flexibility comes with the cost of less stability. The glenohumeral joint, where the upper arm meets with the shoulder blade is a ball and socket type joint. The surface area of the ‘socket’ part of the joint (the glenoid fossa) is much smaller than the ball part of the joint (the head of the humerus). A fibro-cartilaginous ring called a labrum surrounds the edge of the glenoid fossa which acts to increase both the depth and width of the fossa. 

This labrum provides increased stability and is also the attachment for a part of the biceps muscle via a long tendon. The labrum can provide flexibility and stability that a larger glenoid fossa might not be able to, however being a soft structure it is prone to tearing which can be problematic. 

What causes the labrum to tear?

The most common way the labrum is torn is through a fall onto an outstretched arm or through repetitive overhead activities such as throwing or painting as the repeated stress on the labrum can cause it to weaken and tear. 

Suspected labral tears can be diagnosed in a clinic by your physiotherapist through a series of tests, however, an MRI is required to fully confirm the presence of a labral tear. Labral tears are classified into different grades, which are determined by their location and severity. This grading is used as a guide to help determine the correct treatment. 

What are the symptoms of a labral tear?

A labral tear is often associated with other injuries, such as rotator cuff tear, which can make the clinical picture a little confusing. Commonly there will be pain in the shoulder that is difficult to pinpoint and the pain will be aggravated by overhead and behind the back activities.

 Severe labral tears can lead to instability and can also be related to dislocations of the shoulder. 

How Can Physiotherapy Help?

The severity and grade of the labral tear will guide treatment. Smaller tears can be treated with physiotherapy that is aimed at increasing strength and control of the shoulder. Other tears may require surgical repair after which physiotherapy is an important part of treatment to rehabilitate the shoulder.  

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

Mango & Coconut Smoothie Bowl - Physio Direct NZ

Mango & Coconut Smoothie Bowl


1 Cup frozen Mango

1 Frozen Banana

½ Cup frozen Blueberries

½ Tbsp. Honey

1 Cup Fresh Strawberries

2 Tbsp. Chia Seeds

1 Cup Plain Yoghurt

½ Cup Milk

½ Cup Coconut Flakes

  1. Blend mango, banana, milk, yoghurt and honey in a blender on medium speed until smooth and creamy. 
  • Pour mixture into two bowls.
  • Cut strawberries and top smoothie mix with coconut, chia, strawberries, mango and blueberries. 

Serve immediately for a delicious dessert or healthy breakfast.

How Do I Know When My Injury Will Heal? - Physio Direct NZ

How Do I Know When My Injury Will Heal?

When injury strikes, the first thing that most of us want to know is ‘how long will this take to heal?’ Unfortunately, the answer to this can be complicated and requires at least a little understanding of how the different tissues of the body heal. Each of the tissues of the body, including muscles, tendons, ligaments and bone, heal at different speeds and each individual will have some variation on those times as a result of their individual health history and circumstances. 

Understanding the type of tissue injured and their different healing times is an important part of how your physiotherapist approaches treatment and setting goals for rehabilitation. On an individual level, a patient’s age, the location and severity of the injury and the way the injury was managed in the first 48 hours all affect the healing times of an injury. Unfortunately, as we age, injuries do tend to heal more slowly than when we are young. Any medical condition that reduces blood flow to an area, such as peripheral vascular disease, can also reduce the body’s ability to heal at its usual rate. 

There are some guidelines that can be followed when predicting how long an injury will take to heal based on the tissue type affected. Muscles are full of small capillaries, giving them a rich blood supply, and as such, they have a comparatively fast healing time with 2-4 weeks for minor tears. This time will be extended for larger tears and more complicated presentations. 

Ligaments and tendons have less access to blood supply and injury to these tissues generally take longer to heal. Larger or complete tears of all soft tissues, may not be able to heal themselves and in rare cases, surgery may be required for complete healing to occur. Similarly, cartilage, the flexible connective tissue that lines the surface of joints is avascular, which means it has little or no blood supply. To heal, nutrients are supplied to the cartilage from the joint fluid that surrounds and lubricates the joint.  

While the different tissues of the body all have different healing times, they do follow a similar process of healing with three main stages, the acute inflammatory phase, the proliferative stage and finally the remodelling stage. 

The inflammatory stage occurs immediately after an injury and is the body’s primary defence against injury. This stage is identifiable by heat, redness, swelling and pain around the injured area. During this phase, the body sends white blood cells to remove damaged tissue and reduce any further damage. This stage usually lasts for 3-5 days. 

The proliferation stage is the phase where the body starts to produce new cells. Swelling and pain subside and scar tissue is formed that eventually becomes new tissue. This stage usually occurs around days 7-14 following an injury. 

The final stage, known as the remodelling stage is when the body completes healing with the reorganization of scar tissue and the laying down of mature tissue. This stage usually occurs roughly two weeks after the initial injury is sustained. 

At each stage of the healing process, a different treatment approach is required and your physiotherapist can help to guide you through your recovery. Ask your physiotherapist to explain how your injury can be managed best and what to expect in your recovery process. 

Coconut, Date & Apple Cake - Physio Direct NZ

Coconut, Date & Apple Cake


1 ½ cups Flour

1 Tsp. Baking Powder

1/2 cup Honey

1 Egg

1 tsp. Vanilla Extract

1 Cup Milk/Coconut Milk

2 Tbsp. Chia Seeds

1 Cup Dates, diced

2 Apples Sliced

½ Cup Coconut Flakes

125g Butter

Preheat oven to 180 degrees Celsius. Line a medium-sized cake tin with baking paper or grease with butter.

 Pour flour, baking powder, chia seeds, coconut flakes into a large mixing bowl. Create a well in the centre and add egg, honey, vanilla extract, butter and milk. Whisk until a smooth mixture forms, add extra milk if the mixture is too thick.

 Cut the apple into thin slices and remove the core. Fold dates, apples and frozen blueberries into the cake mixture. Pour into cake tin and place a few slices of apple and dates on top.

Place cake tin in the oven for 45 minutes. Allow to cool and serve with coconut cream or butter.

Focus on ACL Reconstructions - Physio Direct NZ

Focus on 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.

Achieving Wellness with Physiotherapy - Physio Direct NZ

Achieving Wellness with Physiotherapy

While being healthy has always been promoted in society, in recent years, the shift towards wellness has been increasing. While the two concepts seem similar, there are some subtle differences between the two. 

Health refers to the state of wellbeing in physical, mental and social terms, rather than just the absence of disease.  Wellnesshowever, encompasses the ability of a person to experience personal growth in emotional, physical, psychological, spiritual, social and intellectual terms. It can be thought of as thriving rather than just surviving.

While you most certainly will notice when your health is failing, it can be harder to be aware that you’ve lost a little wellness. When it comes to physical wellness, this may mean that you have no pain, yet still feel a little stiff, or simply can’t do as much as you would like to. 

While in many ways, health can be measured objectively, wellness is a little more subjective. It is determined by your own goals and aspirations. If you are able to participate in activities you love, this can be vital to emotional and social wellness, not only physical health.

How can physiotherapy help improve wellness?

Your physiotherapist is able to work with you to set goals that are meaningful to you and develop a plan that makes these goals achievable.

Your physiotherapist can also help you to identify factors that may be holding you back from reaching these goals. In some cases, this could be a lack of balance, which reduces confidence in trying something new. Alternatively, an old injury that hasn’t been fully rehabilitated may mean that you are subconsciously avoiding activity.

Little by little, you too can work towards the ultimate goal of total wellness and health. Speak to your physiotherapist about how you can improve your health and wellness.