Why Do Tendon Injuries Take So Long To Heal? - Physio Direct NZ

Why Do Tendon Injuries Take So Long To Heal?

If you have ever suffered from a tendon injury you will know that the recovery can be frustratingly long. Tendons are important tissues of the body, connecting muscles to bones and come in many different shapes and sizes. There are many reasons why tendon injuries can be difficult to treat, as we explain below.

Tendon injuries often develop gradually.

Tendons need to be able to transmit forces from muscles to the bones that they attach, however they respond to changes in strength more slowly than muscles do. As muscles become stronger or take on more load, the tendons can fail to keep up with this increased demand becoming painful and damaged. This process can take a while to occur and often changes to tendon tissue has begun long before the pain is noticed. This means that there are likely to be multiple factors to be assessed, including biomechanics and training regimes before the problem can be resolved.

Tendons have limited blood supply

Tendons do have their own blood supply, however, it is not abundant as muscles and this can be a factor with healing as all tissues require nutrients for health and to heal. Any condition that compromises circulation, such as diabetes, can predispose tendons to injury and delayed healing.

Rest and stretching may not necessarily help.

Our instincts in response to tendon pain may not help with recovery. In some cases, stretching can aggravate symptoms and while rest may reduce symptoms, it will not necessarily help with recovery. The best evidence for promoting healthy tendon growth is through addressing poor biomechanics and a tailored strength and loading program.

Recovery often relies on adherence to a specific rehab program.

One of the biggest barriers to healing tendon pain is that exercises can be easy to do in theory, but hard to do in practice. They can take time and discipline. Your physiotherapist can also help you to find strategies to fit your exercises into your daily routine if you are finding this difficult.Ask your physiotherapist for more information about tendon pain.

A Wrist Injury: Scaphoid Fractures - Physio Direct NZ

A Wrist Injury: Scaphoid Fractures

What is it?

The scaphoid is a small bone in the wrist that connects the radius to the hand, and it is situated near the thumb. Scaphoid fractures are a relatively common wrist injury and are commonly misdiagnosed as the pain can be quite mild even when the bone has been broken. 

Scaphoid fractures are notorious for their high incidence of complications healing due to low blood supply to the area and how easily their diagnosis can be missed. 

How does it happen?

A scaphoid fracture is often caused by a fall on an outstretched hand or a direct blow to the wrist. It is more common in young adults than in children and the elderly.

What are the symptoms?

Symptoms of a broken scaphoid include wrist pain, swelling, bruising or discolouration of the skin over the injured area and difficulty moving the wrist or hand. As the swelling subsides you might notice pain at the base of the thumb when opening jars or gripping objects. There may also be a deep, dull ache in the wrist that doesn’t settle easily.

How is it diagnosed?

If you suspect that you have a scaphoid fracture, you should consult your physiotherapist or GP who will refer you for an X-ray to confirm if the bone is broken. Occasionally scaphoid fractures will not show up on an X-ray, so if the findings are negative yet your medical team still suspect a fracture, they may wait a week then X-ray again or send you for an MRI or CT to double-check. Though these fractures can often be treated without surgery, doctors may recommend surgical intervention for more severe cases. 

How can physiotherapy help?

If you have a scaphoid fracture, your doctor will likely prescribe a splint or cast to ensure the wrist is kept still until healing is complete, usually for a minimum of six weeks. Healing times will vary depending on which part of the bone has been broken. Following the removal of the cast or splint, there is often residual pain, stiffness or muscle weakness. Your physiotherapist can help you restore any deficits as well as resolve any shoulder pain or headaches that may have resulted from altered biomechanics. 

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

Avocado Chocolate Mousse - Physio Direct NZ

Avocado Chocolate Mousse


2 Large Avocados

1/2 cup Cacao Powder

1/2 cup Coconut Milk

1/2 cup Honey

2 tsp Vanilla Extract

1/2 tsp ground chilli

1 tsp Cinnamon

1/2 tsp Cardamom

Fresh Blueberries

Fresh Mint

  1. Peel and pit avocados and scoop flesh into a bowl.
  2. Add cacao powder, coconut milk, vanilla, chilli, cardamom, cinnamon and honey and combine ingredients.
  3. Using either a cake mixer or food processer, blend ingredients until smooth and slightly fluffy.
  4. Put into small containers, sprinkle with berries and coconut. Allow to chill for at least 20 minutes.

Serve chilled with coconut cream.

Strawberry & Parmesan Salad - Physio Direct NZ

Strawberry & Parmesan Salad


4 cups Mixed Salad Greens 

8 Medium Strawberries 

1 Medium Avocado 

4 Tbsp. Roasted Sunflower Seeds 

2 tsp. glazed Balsamic Vinegar 

2 Tbsp. Coconut Oil

1 tbsp. Lemon Juice

50g shaved Parmesan Cheese 

  1. Place greens in a large mixing bowl. Slice strawberries and avocados and add to the bowl along with roasted sunflower seeds. 
  2. Mix coconut oil and lemon juice and spread over salad. Sprinkle Parmesan cheese on top. 
  3. Drizzle balsamic oil over the salad, serve immediately.

Serves two.

Focus: Can Stress Affect My Pain? - Physio Direct NZ

Focus: Can Stress Affect My Pain?

A common fear for patients when discussing pain is the idea that their symptoms are ‘all in their head’ or that they won’t be believed either by friends, family, therapists or workplace. This fear can be worse when there appears to be no obvious cause for their pain or it has been present for a long time.

What is pain?

Many of the models used in the past to explain pain lead us to believe that the intensity of pain will always be proportional to the severity of an injury. The experience of pain is always real and usually distressing. However, pain is a warning system used by our nervous system to alert us to danger, not a direct indicator of damage done. This is a subtle, yet important distinction meaning that the experience of pain can be influenced by many different factors and not exclusively tissue damage.

How can stress impact pain?

Part of the role of your nervous system is to sort through a huge amount of sensory input and interpret it in a meaningful way. When pain is considered to be a serious threat to the body, the intensity of the pain will be worse.

This can happen in many situations, for example:

-The source of the pain is not well understood, leading to fear that the pain might be something very serious.

-The nervous system is in a state of hyper-arousal, such as when you are stressed or tired.

-The pain or injury could have a significant impact on your quality of life, career, relationships or hobbies.

-The injury occurred through a traumatic event such as a car accident.

What does this mean for my treatment?

Along with all our more traditional treatments, we also know that stress reduction strategies, mindfulness and addressing any emotional trauma associated with pain can all help to aid recovery and improve quality of life. Your physiotherapist is a great person to speak to about pain management strategies so you can get the most out of your life while dealing with long-term pain.

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.

Physio Tips for Better Running - Physio Direct NZ

Physio Tips for Better Running

Distance running can be a surprisingly complicated sport. In this article, we offer some words of wisdom from our physiotherapists to help you get the most out of your training and avoid injuries. 

Choose your shoes carefully:

Repeated stress from running long distances will show up any biomechanical flaws in your body relatively quickly. Choosing the wrong shoes can exacerbate an existing problem causing pain and injury. Your physiotherapist can guide you on what style of shoe will best suit you. 

Don’t neglect your upper body:

While running can appear to be a purely leg based activity, increasing the strength and mobility of your upper body can have a surprisingly large impact on your posture, running style, breathing and overall performance. 

Find time to train strength as well as endurance:

Your body is great at finding ways to compensate for weak muscles, however, over time this can lead to overuse injuries of tendons and muscles. Identifying any areas of weakness early and specifically strengthening these muscles can both improve your running and help keep you injury-free.

Pace your progress: 

Entering an event is a great way to set a specific goal and keep you motivated. While trying to increase distances and speed, it is easy to forget to include rest days as a part of your routine. Your body needs time to recover and restore itself, just as much as the active portions of your training program.

Increasing your speed and distances gradually also allows your body to adapt to new demands without breaking down. 

Enjoy your training and listen to your body:

Your body will guide you as to when you need to rest and when you can push a little further. Training will be more enjoyable when you are well-rested and pain-free. Most importantly, if you are able to enjoy your runs, this will help you maintain motivation over a longer period of time, so you can continue for many years to come.

Ask your physiotherapist for more tips on how to reach your running goals while staying injury-free. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for assessment of your individual condition.

Zucchini Parmigiana - Physio Direct NZ

Zucchini Parmigiana


1 Large Fresh Zucchini

2 Cups Pureed Tomatoes

4 Large Fresh Basil Leaves

1 Small Clove of Garlic

50g Parmesan Cheese

100g Mozzarella Cheese

Salt and Pepper

Olive Oil

  1. Preheat oven to 190 degrees Celsius. Wash and cut zucchini into slices approximately 1cm thick.
  2. In a large saucepan add diced garlic, salt and pepper, tomato puree and basil. Cook sauce for about 10-15 minutes, reduce heat and simmer. 
  3. Coat each zucchini slice in oil and cover in parmesan cheese. Fry each side in a frying pan on medium heat. Place in a baking tray and cover in tomato sauce. Sprinkle mozzarella on top.
  4. Bake for 20 minutes or until cheese is melted and golden. Chop basil and sprinkle on top. 

Serve when ready.

Life Hack: Three Stretches for Common Problem Areas - Physio Direct NZ

Life Hack: Three Stretches for Common Problem Areas

Many of us know that office life can wreak havoc on our body. Even with the best intentions, finding time to reverse the pressures of 8 hours a day in a chair can be difficult. Here are three easy stretches to do daily that focus on common problem areas for office workers.

Chest Stretch:

Find a large flat wall and stand facing away from it. You may need to bend your knees slightly or step a few inches forward. Your pelvis, thoracic and base of your head should all be in contact with the wall, with small gaps where the curves of your spine are. If you are unable to keep your head to the wall, you may need to use a towel behind your head to make this position comfortable.

Tuck your chin in gently and keeping your palms facing forward, slide your arms along the wall, as high as you can without your head coming away from the wall.

This will stretch your pectoral muscles and help you to develop a sense of head position alignment with your body.


Kneel on one knee, place your other foot on the floor in front of you and keep your knee bent to 90 degrees. Keeping your hips even, shift your weight forward until you feel a stretch at the front of your hip. Hold for 30seconds to 2 minutes and then swap legs.

This will stretch your Psoas muscles which are often tight from sitting for long periods.

Seated Hamstring Stretch:

Sit on the floor with one leg straight out in front of you. Bend your other leg and tuck your foot in towards your inner thigh. Reach forward and stretch towards your foot on the straightened leg, bending at your hips as much as possible. You should feel a stretch at the back of your thigh, if you feel a pull behind your knee you can point your toes or bend your knee slightly.

Hold for 30 seconds and slowly come back up, change legs and repeat three times on each side.

Check with your physiotherapist if there are other stretches that may benefit you.

Focus: The Broken Collarbone - Physio Direct NZ

Focus: The Broken Collarbone

What is it?

A broken collarbone, also known as the clavicle, is one of the most commonly broken bones in the body.

The collarbone connects the front of the ribcage to the shoulder and is the only bony connection the arm has to the rest of the body. Many muscles attach to the collarbone, including the Deltoid and Pectoralis Major.

How does it happen?

The most common way for this injury to occur is through a fall onto the shoulder. This can happen from a simple fall or sports such as mountain biking or rugby. It is a very common childhood injury but can happen at any age.

What are the symptoms?

Usually, a broken collarbone will cause moderate to severe pain over the broken area. The patient may have heard or felt a popping or cracking at the time of the injury and there may be an ongoing grinding or creaking with movements of the upper arm. If the skin is not broken there may be bruising and swelling over the painful area.

What is the treatment?

While very severe cases can be surgically fixed, more often a broken collarbone will be allowed to heal naturally with rest and monitoring. By supporting the arm in a sling and providing pain relief the arm will mend on its own. As with most fractures, there are also often other injuries that may need to be dealt with at the same time. There are many important structures near the collarbone that can also be damaged

including muscles, nerves and blood vessels. In very severe cases, the lung tissue under the collarbone can be damaged causing the lung to collapse. 

Physiotherapy and recovery:

Once a treatment plan has been decided by your medical team, your physiotherapist can help you to return to your pre injury strength and mobility with a full rehabilitation program.

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.

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…. www.sunsmart.com.au/vitamin-d 

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.