Spinach and Ricotta Lasagne - Physio Direct NZ

Spinach and Ricotta Lasagne


16 Lasagne sheets 

680ml Tomato passata sauce 

1 Onion, diced

5 Garlic Cloves, diced 

10 Mushrooms, sliced 

250g Spinach, chopped

500g Ricotta 

1 cup grated Cheese 

1 Egg 

2 Tbsp. Oil

Salt and Pepper

1 tsp. Thyme

1 tsp. Chilli flakes

  1. Preheat oven to 165 degrees Celsius. Sauté onion in a medium-sized pan for 7 minutes. Add garlic and continue to sauté for one minute. Add passata sauce and 2 cups of water, salt, pepper and chilli flakes to taste. 
  2.  In another pan, sauté mushrooms for 10 minutes Add spinach for a few minutes until.
  3. In a bowl stir together 500g ricotta, one egg, salt, pepper, and thyme to taste. 
  4. In a large baking dish, put a ladle full of tomato sauce in the bottom to cover. Cover with three lasagne sheets in a row, cover with tomato sauce, then sauce, then ricotta mixture, then spinach and mushroom. Repeat layering sequence. On the top layer use lasagne sheets, then sauce, then grated cheese. Bake for 40-50 minutes.

Set aside to cool for 10 minutes before serving. Serves 8.

What Is Physiotherapy? - Physio Direct NZ

What Is Physiotherapy?

Many people know the value that physiotherapy brings to their life and their physiotherapist has been with them through the highs and lows of injury and recovery throughout their life. However, for those who have never been to see a physiotherapist before, there can be a question mark over exactly what it is that physiotherapists do. 

What is it that physiotherapists do? 

The answer is tricky because physiotherapists do so much. We might be described as pain management experts, as we work to reduce the pain of our patients, from those who have suffered a new injury, to those who have had pain for several years. We first identify the cause of the pain and then provide manual therapy techniques, education and management strategies to help our patients understand, manage and reduce their pain. 

While pain is usually the first thing that brings patients to see a physiotherapist, this pain has often caused patients to give up activities that they love and can even be getting in the way of everyday tasks. By identifying the cause of your symptoms, we can help to get you back to full function. Physiotherapists are able to do this for people at all activity levels, including elite athletes and those dealing with serious disabilities. 

In fact, physiotherapists have a role to play at practically every stage of life. We can assess infants to monitor their motor skills development and as they grow we help them deal with the pains and vulnerabilities of a growing body. Among other things, we can help to prevent injuries, improve pelvic floor dysfunction and work to prevent falls in the elderly. 

Not just exercises and massage. 

Physiotherapists offer a range of treatments, from self-management strategies, stretches, manual therapies, dry needling, exercises and massage. 

A huge part of recovering from pain and injury comes from understanding what is happening and how to best manage these issues. Rather than create a dependency on their therapist, we aim to empower our patients to improve their health independently as much as possible. 

A physiotherapist’s primary goal is to improve your quality of life and remove any barriers to full participation, whether these barriers are due to pain, weakness or stiffness. 

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

Cycling Tips From Your Physio - Physio Direct NZ

Cycling Tips From Your Physio

There are many reasons to choose biking as a sport. Commuting to work can help you conveniently find time for exercise, save money on transport costs and is a great way to exercise if you suffer from shoulder pain, hip or knee arthritis. Unfortunately, biking injuries are common, but in many cases, preventable. Here are a few tips from us to help you prevent cycling injuries and improve your performance.

Don’t neglect your upper body strength and trunk stability.

While cycling is a sport that predominantly uses the lower legs, it can be a mistake to think that leg strength is the only factor that matters when it comes to biking performance.

Increasing the strength, flexibility and balance of your upper body can actually reduce the amount of effort used to cycle and the efficiency of your pedalling. Focusing on your upper body fitness can both improve your riding stats and help to prevent the neck, back and shoulder pain that comes as a result of maintaining postures for extended periods.

Yoga and Pilates are great complementary activities to help build upper body strength and stability while also counteracting the effects of prolonged flexed postures of the bike.

Don’t skimp on your helmet.

A good quality helmet can mean the difference between a sore head and a life-changing injury. Helmets become less effective with each hit, as they can lose their shock-absorbing capacity, even if they don’t appear to be damaged. If in doubt after a crash, choose to replace your helmet as it may save your life.

Address aches and pains early

Due to the repetitive nature of cycling, overuse injuries are common. Ensuring your bike is set up corrected to minimise stress on your body while riding and paying attention to small niggles can help to identify and resolve issues early so that they can recover quicker.

Speak to your physiotherapist for more information on how to improve your performance and stay injury-free while biking.

Relaxation Tips For Pain Management - Physio Direct NZ

Relaxation Tips For Pain Management

Can prolonged stress affect your pain and healing? There’s a strong suggestion that it can, particularly with chronic pain. If you suffer from ongoing pain you may even have noticed this relationship yourself. Many people know that their pain is worse when they are stressed but they don’t know why.

Stress activates your sympathetic nervous system, this is the state where we move into ‘Fight, Flight or Freeze’ mode. this part of our nervous system is responsible for keeping us safe when we are in danger, however, it can be activated for prolonged periods in modern life and many of us lack skills to return control to our parasympathetic nervous system, which is responsible for helping us to rest and digest.

How would this affect pain?

During this state, muscles become tensed and ready for action, the nervous system is extra sensitive to stimulus, blood pressure is raised and we are more likely to notice and have negative thoughts. Tense muscles can become tired and painful or put extra stress on other structures, causing pain and irritation. Quite often when in a stressed state, our breathing becomes shallow and rapid, particularly when doing work of low exertion, such as while sitting in an office.

Use your breathing to recover.

One way to help your body return control to the parasympathetic nervous system is to consciously change your breathing. One method is to hold your breath for as long as you can, once you relieve your breath your body senses that a threat has passed and can return to a relaxed state.

Another commonly used technique is box breathing. To do this, breathe in for four seconds, hold for four, breathe out for four, hold again for four and repeat. Do this for a few minutes until you start to feel more relaxed and calm.

Show your body that you are safe.

Other activities that can help your body to relax include yoga, going for a swim or having a shower, or doing some intense exercise where your heart rate is raised.Speak to your physiotherapist for more information on this topic and tips to help you relax during the day.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.

Focus On High Ankle Sprains - Physio Direct NZ

Focus On High Ankle Sprains

What are they?

The ankle consists of three bones, the tibia, fibula and talus, all held together by thick fibrous ligaments. The bottom parts of the tibia and fibula join together and surround the talus in such a way that it is able to rock forwards and back while providing stability and restricting the side-to-side movements.

The ligaments holding the tibia and fibula together are large and thick (referred to as a syndesmosis) while a normal ankle sprain is a tear of the ligaments closer to the foot, a syndesmosis tear is called a “high” ankle sprain.

How do they happen?

A high ankle sprain can occur when you twist inwards while your foot is planted on the ground. The foot is typically pushed back and rotated outwards, putting excess pressure on the ligaments that the lower leg bones together. This force can cause the syndesmosis to tear resulting in a gapping of the two bones, which can lead to significant instability of the ankle. This can happen from every-day activities such as a fall, but most commonly while playing sports that involve running and jumping. This is also a common injury for downhill skiers. Patients are often unable to walk on their toes after this injury.

What is the difference between a high and a low ankle sprain?

High ankle sprains are much rarer than lower ankle sprains, accounting for only 1-11% of all ankle injuries. It can be very difficult to tell the two injuries apart. To complicate things, a fracture of the ankle will also have similar symptoms. Your physiotherapist will have a set of physical tests they can perform if they suspect a high ankle sprain. Ultimately imaging may be required to confirm the diagnosis.

Why does correct diagnosis matter?

High ankle sprains can take up to two times longer to heal than normal ankle sprains and require more immediate attention. Syndesmosis tears that are left untreated can result in chronic instability and pain, making them vulnerable to further injury in the future.

What is the treatment?

Severe and unstable tears may require surgery and most syndesmosis tears will need to be put into a supportive boot for 4-6 weeks. Following this period a rehabilitation program of strengthening, mobilization, balance, control and agility will need to be commenced before your ankle will be at its pre-injury function.

Other medical interventions may be recommended in some cases and have been shown to have good results, when accompanied by proper rehabilitation program.

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

Saag Paneer - Physio Direct NZ

Saag Paneer


1 tsp. Turmeric

1/2 tsp. Cayenne Pepper

1 tsp. Salt

3 Tbsp Oil

350g Paneer

400g Spinach

1 Onion, diced

1 thumb Ginger, minced

4 cloves Garlic

1 Green Chilli

1/2 tsp. Garam Masala

2 tsp. ground Coriander

1 tsp ground Cumin

1/2 cup Plain Yoghurt

  1. Whisk turmeric, cayenne pepper, salt and oil together in a small bowl. Add cubed paneer and allow to marinate. Blanch spinach in boiling water, then blend until a paste or sauce forms
  2. Pan-fry marinated paneer on medium heat until browned and set aside.
  3. Sauté onions, garlic, ginger and chilli slowly until caramel coloured Add a little water to soften. Add garam masala, cumin, coriander and cook well.
  4. Add spinach and stir well. Add salt and half a cup of water, simmer with lid off for 10 minutes.
  5. Remove from heat, stir through half a cup of yoghurt then return to heat and cook for a further 5 minutes. Stir through paneer.

Serve with rice or roti bread.

Sweet Potato & Carrot Cake - Physio Direct NZ

Sweet Potato & Carrot Cake


2 cups Plain Flour

1 tsp. Baking Powder

1 cup Sugar

1 Egg

1 Sweet Potato, roasted and mashed

2 Carrots, grated

1 cup Milk

1 tsp. Ground Cinnamon

3 Tbsp. Butter


1/2 cup Icing Sugar

1 cup Plain Greek Yoghurt, strained 

1 tsp. Vanilla Essence

  1. Preheat oven to 180d ℃ and grease a medium-sized cake tin.
  2. Combine butter, cinnamon, carrots, sweet potato, eggs, milk, sugar and baking powder in a medium-sized mixing bowl and mix thoroughly.
  3. Add flour and stir into the mixture until a smooth batter forms.
  4. Add mixture to cake tin and bake for 35-40 minutes. Use a skewer to check when the centre of the cake is cooked.
  5. To make the icing, take strained yoghurt, vanilla essence, butter and sugar and mix with an electric hand mixer until the icing is thick and smooth with no lumps. Place in fridge to set while the cake is baking. 

Allow to cool, cover with icing and serve when ready.

Focus On Hamstring Tears - Physio Direct NZ

Focus On Hamstring Tears

What are they?

The hamstrings are a large group of muscles, located at the back of the thigh. Their job is to bend the knee, move the hip backwards and stabilise the leg. The muscles can be injured at any point but are most vulnerable where the tendon and muscle fibres join together. This is a common injury for players of all sports that involve running, but particularly those that involve quick movements and kicking. 

What are the causes?

As the hamstrings cross two large joints, they need to perform complicated movements, often activating suddenly and with great force. They are often stretched during a fall, large kick or sudden take-off. Factors that increase the chance of a tear, include poor flexibility and neural mobility. Other factors that contribute to hamstring injuries are muscle imbalances, abnormal lower limb biomechanics, fatigue, and inadequate warm-up. It seems, however, the biggest predictor of a future hamstring tear is a previous hamstring injury.

What are the symptoms?

The most common symptom of a torn hamstring is a sharp pain at the back of the thigh, often immediately after intense activity. There may also be swelling, bruising, difficulty walking and pain with knee movements. The symptoms of a hamstring tear are similar to many other conditions, as the lower back often refers pain to the back of the thigh, mimicking a hamstring tear. 

Your physiotherapist can confirm that the pain is due to a torn hamstring and tell you how bad the tear is. Although not usually required, diagnosis can be confirmed by having an MRI or real-time ultrasound scan.

How can physiotherapy help?

Once a diagnosis has been made, the first step is to follow the R.I.C.E protocol (Rest, Ice, Compression, Elevation). During the first 48 hours, you should apply ice for 20 minutes every hour to reduce swelling and bruising. Consultation with your physio will include advice about your recovery, and when it is appropriate to return to sport. Your physiotherapist has many techniques that can promote healing and reduce scar tissue formation, which may include ultrasound, deep tissue therapy, laser, TENS and dry needling.

They will also prescribe an exercise program to return strength, flexibility and control to the muscle, getting you back to your sport quickly and safely. Due to the high chance of recurrence, rehabilitation is very important and usually takes 6-12 weeks. If the muscle is completely torn, surgery may be required before rehabilitation can start. Your physiotherapist will work with you to help you set goals to get you back to your favourite activities as soon as possible.

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. 

Making The Most of Your Physio Treatment - Physio Direct NZ

Making The Most of Your Physio Treatment

Seeing a physiotherapist is an important investment in healing and recovery from injury. Here are a few tips to help get the best outcomes from your treatment time.

Know what your goals are and ask questions.

If you are clear on what you hope to achieve through physiotherapy, this can help you and your therapist to work together to target treatment towards these goals.

Understanding your condition also plays an important part in recovery, it means that you can make better choices to protect and allow your body to heal, plus you will know better how to prevent future injuries. Before each treatment, it can help to take a few moments to prepare some questions and consider what your short and long-term goals might be. 

Do your exercises.

Targeted home exercises are an essential part of your recovery as they help your body to support itself through healing and recovery. Strengthening weak muscles is one way to correct biomechanical imbalances and reduce excess stress on body structures, as well as helping tissues to strengthen as they recover.

Follow your therapist’s recommendations.

Throughout your recovery, your therapist will guide you as to which activities you should avoid and how much rest to take. Return to sport and activity should be gradual, so as not to stress the body too hard when it is still healing. 

Rest is just as important a part of recovery as strengthening. Following the advice given by your therapist can ensure that you don’t injure yourself again and get the most out of your body.

Be patient with your progress.

It can be frustrating waiting for your body to heal. Returning to sport too early or giving up on treatment are common errors that lead to further injury or impaired healing. Recovery takes time, a general rule is that the longer a condition has been present, the longer it will take to resolve. 

If there is a part of your condition or injury that you are struggling to understand, be sure to seek clarification with your physiotherapist. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your condition.

Cauliflower & Blue Cheese Soup - Physio Direct NZ

Cauliflower & Blue Cheese Soup

Cauliflower & Blue Cheese Soup


1 large Cauliflower

2 Tbsp. Butter

4 cups Vegetable Stock or water

100g Blue Cheese

3 Tbsp. chopped Parsley

2 cloves Garlic

2 cup Milk

Salt and Pepper

½ cup Cream

Sliced Almonds

  1. Cut cauliflower into small pieces and place into a roasting dish, drizzle melted butter over top.
  2. Spread pieces in a single layer, add garlic season with salt and pepper and pour 1 cup of stock or water into the base of the dish.
  3. Roast at 180˚C for about 40 minutes until tender and just starting to brown.
  4. Blend cauliflower and juices until smooth then transfer to a large saucepan on medium heat; add the rest of the stock or water, blue cheese, parsley, milk and cream. 
  5. Reduce to low heat, simmer and stir occasionally until the soup is thick and creamy.

Serve while hot and garnish with sliced almonds.

Focus on Ankylosing Spondylitis - Physio Direct NZ

Focus on Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a type of inflammatory, autoimmune arthritis that primarily affects the spine. It is characterised by intermittent pain and progressive stiffness due to the inflammation and eventual hardening of the ligaments that surround the spine. The classic early symptoms of Ankylosing Spondylitis are pain and stiffness of the sacroiliac joints, the large joints connecting the pelvic bones to the sacrum in the lower back. In the final stages of the disease, the entire spine can become fused and rigid, often in a flexed, forward posture.

As this is an inflammatory disorder, many other systems and joints are often also affected. A significant number of people with AS also suffer from irritable bowel syndrome and inflammation of the eye.

What causes it?

The cause of Ankylosing Spondylitis is not clear, however, there are markers and predisposing factors that may contribute to the development of the condition. Genetics, chronic stress and frequent gastrointestinal infections are among the predisposing factors. Men are affected more often than women and symptoms usually begin between the ages of 17 and 45 years.

What are the signs and symptoms?

Intermittent back pain and progressive stiffness are the two most common symptoms of Ankylosing Spondylitis. Other tendons and ligaments may be affected, including those in the hands, feet and ribs. Symptoms tend to be worse following periods of rest, particularly first thing in the morning and improve following periods of activity. It is common for people to experience “flare-ups” and “remissions” of symptoms.

Some people with Ankylosing Spondylitis may experience mild discomfort in the spine from time to time, while others may experience severe and debilitating symptoms at frequent intervals with minimal time in remission from symptoms. Long term issues with AS include breathing difficulties due to thoracic and rib cage stiffness and severe spinal pain and immobility. Medical treatment focuses on reducing inflammation and slowing the disease process.

How can physiotherapy help?

Physiotherapy treatment aims to manage pain during flare-ups and maintain optimal posture as the disease progresses. Your physiotherapist will assess your spinal movement and posture as well as strength. If your hands, feet, hips or shoulders are affected, they will also provide you with specific exercises to help maintain mobility and strength in those joints. Many studies have proven the positive benefits of exercise for those with Ankylosing Spondylitis, such as improved rib cage expansion when breathing, and improved posture of the upper back and neck.

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

5 Reasons to Stay Active - Physio Direct NZ

5 Reasons to Stay Active

The benefits of keeping active may seem obvious, yet it can’t hurt to be reminded of the many ways exercise can improve your life. Here are a few of our favourite reasons to get moving. 

  • Exercise improves energy levels. 

Improving your fitness means your body is capable of achieving more for the same energy expenditure. While doing exercise can make you tired in the short term, regular improvements to your fitness will help you get more out of your body each day.

  • Exercise can help to reduce stress.

If you are stuck in a state of stress or panic, exercise can help you move out of it into a calmer and more relaxed state, improving your mood, concentration and sleep.

  • Exercise and hobbies can help you build connections and community. 

Making new friends as an adult can be surprisingly difficult and the importance of connection and community is being recognised more as being essential for overall wellbeing. Being part of a team, or club is a great way to build confidence, meet friends as well as keeping active. 

  • Exercise keeps your muscles, tendons, joints and bones healthy.

Our bodies are often compared to machinery or car parts. However, there are some crucial differences between our bodies and machines, including the fact that our bodies respond to exercise by becoming stronger and healthier, rather than being worn out. One of the best ways to prevent osteoporosis is through regular high impact activity, which stimulates bone growth. 

  • Exercise can help to reduce injuries.

Similar to the previous point, tissues that are used regularly are stronger, more elastic and are less likely to tear or break when under stress. Regular exercise is the best way to keep your body in a healthy state and prevent injuries.

Finding the right exercise for you can be tricky, your physiotherapist can help you with suggestions based on your ability and skillset. 

Blueberry & Coconut Muffins - Physio Direct NZ

Blueberry & Coconut Muffins


1 Egg

1/2 Coconut Milk

1/2 Cup Coconut Cream

4 Tbsp. Melted Butter

1/2 Cup Sugar or Honey

2 tsp Baking Powder

1 Cup Frozen Blueberries

2 1/2 Cup Flour

  1. Preheat oven to 200 degrees Celsius. Lightly oil a muffin tin and set it aside.
  2. Add eggs, coconut milk, coconut cream and butter into a large bowl and mix well. 
  3. Add sugar or honey, baking powder and flour and blend until a smooth consistency is achieved.
  4.  Gently fold blueberries through the batter and scoop into muffin tins, filling each to 2/3rds. Bake for 15-20 minutes

Makes 12 Muffins

Is Surgery The Right Decision For You? - Physio Direct NZ

Is Surgery The Right Decision For You?

The decision to have surgery following an injury is a serious and complicated one. It can be difficult when navigating the minefield of information you receive to know what is the right pathway for you.

Unfortunately, the answer is not always obvious which can be very confusing. To ensure that surgery is right for you, here are a few questions it pays to ask yourself and your medical team before making a decision. 

How much will surgery cost and will I need to take time off work?

One of the major downsides of surgery is that you will often need to take time off work to recover, resulting in lost income. The cost of the surgery itself may not be completely covered, particularly for elective procedures and you will often need to visit physiotherapy afterwards. The cost of surgery can really add up, and if you can achieve similar results with physiotherapy, you might find yourself in a much better financial situation.

What are the potential complications and success rates for your surgery?

All surgeries come with risks and potential complications, the probability of these will vary depending on the type of surgery, your age and general health. It is also important to compare the success rates of surgery with a period of physiotherapy treatment. Optimal surgical outcomes still often depend on effective post-surgery physiotherapy treatment, which can be an argument for considering physiotherapy first. In some cases, however, healing simply will not occur without surgical intervention and physiotherapy will have little success in resolving the issue.

What are your post-surgical goals?

Not everyone wants to ski down a mountain, but for some, being able to push and trust their bodies is important for both their income and quality of life. Surgery that aims to repair instability might be the right decision for someone who has high athletic demands on their body, but not for another person who isn’t very active. Setting your goals for your body can help to guide your decision making process.

Before making any major decisions, it is important to consult your medical team to ensure you are well educated in all the risks and benefits of choosing surgery. 

Focus on Carpal Tunnel Syndrome - Physio Direct NZ

Focus on Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

The carpal tunnel is a small space base of the hand. This tunnel is covered by a thick ligament and creates a small tunnel where various nerves, arteries and tendons pass through from the forearm into the hand. If anything causes this space to be reduced, these structures can become compressed and damaged, particularly the median nerve. This common condition is referred to as Carpal Tunnel Syndrome (CTS). 

What are the symptoms?

The hallmark symptoms of carpal tunnel syndrome are pain, numbness and weakness in the hand, usually following a typical pattern over the thumb, index and middle finger. There can also be a reduction in grip strength and wasting of the thumb muscles. Symptoms are usually worse on waking or with repetitive hand movements. Patients might also report difficulty holding items, writing or doing up their buttons.

How does it happen?

Carpal tunnel syndrome can be caused by anything that reduces the space in the carpal tunnel, including arthritis, the growth of a cyst or compression from everyday activities. The median nerve is particularly vulnerable to compression and is of the most concern as prolonged compression can cause nerve damage and permanent weakness of the hands. 

How is it treated?

There are a few different treatment options for CTS. Non-surgical treatment is often recommended first, which includes physiotherapy, wearing a splint, cortisone or plasma rich platelet injections to promote nerve healing. The effectiveness of physiotherapy will depend on the cause of your carpal tunnel. If the space of the tunnel has been reduced permanently, such as with arthritis, then surgery is likely to be the most effective treatment. Carpal tunnel surgery is an operation to widen and release the carpal tunnel allowing decompression. This is a common surgery but is not without its risks or complications and requires a period of time off work for recovery.

For non-surgical cases, altered biomechanics of the arm, the mobility of the median nerve and muscle tightness may all be contributing to symptoms. In this case, physiotherapy can be highly effective, along with a period of rest, splinting and a change in daily habits.

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