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Pelvic Floor Physical Therapy

Pelvic Floor Physical Therapy for Women

Ladies, let’s have an honest conversation about a topic that often remains hidden behind closed doors: pelvic health. The pelvic floor, a group of muscles and tissues situated at the base of the pelvis, plays a crucial role in supporting vital organs, controlling bladder and bowel function, and enhancing sexual wellness. Unfortunately, issues such as weakened muscles, pain, and incontinence can affect countless women, impacting their quality of life.

What is P-DTR?

Proprioceptive – Deep Tendon Reflex (P-DTR) is a very gentle, non-invasive, and painless method based on the real time manual effect of particular sensory receptors on the human body.


Using a comprehensive system of muscle testing and neural challenges, dysfunctional sensory receptors can be located and corrected, quickly restoring normal function and eliminating pain.

Most therapeutic modalities address only the “hardware” of the body, neglecting the fact that most of the pain and dysfunction we experience is often actually a problem with our “software.”

P-DTR provides access to the software coding of the human nervous system, allowing you to quickly identify and resolve the root causes of pain and dysfunction throughout the entire body.

What is TMJ Pain?

Pain coming from the jaw, also known as the temporomandibular joint (TMJ).

Jaw pain is a small term but can be debilitating and affect other body parts including your sinuses, ears, teeth, or the muscles and bones.

TMJ Pain - ACTThe jaw or temporomandibular joint (TMJ) is a sliding hinge joint responsible for chewing, talking and expressing emotions. Therefore, due to its muscle attachments at the head and neck, you can experience a variety of unpleasant symptoms. The best option for treating TMJ pain is to target the cause of the pain, not just the symptoms.
A thorough examination from a physical therapist may show a number of findings: poor control of the jaw muscles, jaw stiffness, myofascial pain, or neck tightness. These findings, if not addressed lead to persistent TMJ pain, headaches and neck pain. We know that there is no one “cure” for jaw pain, however, a blended approach of differential diagnosis, corrective exercise, joint manipulation, and dry needling have been shown to be effective at alleviating symptoms. Above all, treating the “cause” of the pain will help you find long lasting pain relief.

Advice for Lower Back Pain

Lower back pain is one of the most common and unfortunate body ailments that is experienced by 85% of the people during their lifetime. Be it because of trivial causes like wrong posture or muscle strain or because of systemic illnesses like osteoporosis or arthritis, lower back pain can be really frustrating and distressing. Here, we will discuss some home remedies and some scientifically proven ways of confronting lower back pain.

Improving and maintaining correct posture: Incorrect posture is the most common cause of LBP which can be easily countered by trying to stay in the right posture by keeping our back straight and by straight, we mean naturally straight without any stiffness or tension. Sitting in a bent posture for a long time can have dramatic effects on our vertebral column causing it to change its shape permanently. Our skeleton is designed in a way to keep our shoulders in alignment with our body. A loose body figure can result in forward hunched shoulders which can put excessive stress on our spine. Therefore, we should sit straight with our shoulders in alignment with our pelvic girdle.

Physical exercise: Strong and flexible muscles can improve the endurance and stamina of our body multifold. Stretching and strengthening exercises release stress that is built inside our body due to accumulation of lactic acid. Physical exercise has proven to be effective as it keeps our entire system active which keeps our spinal cord from rest or rigorous and relentless work. This inertia of our vertebral column causes it to stay in a gentle moving state allowing its lubrication.

Physiotherapy/Massage Therapy: “If you’re dealing with back pain, Physiotherapy/massage therapy may be just what the doctor ordered.” Physiotherapy/massage therapy is the natural therapy without any chemical assimilation that brings together the balance of mind and body with utmost expedition and relieves all kinds of physical pain, LBP.

What is the McKenzie Method of MDT?

Imagine you have the power to control your pain, stiffness and ability to do your work or daily activities.

You will not have to spend months in therapy. You will not need to buy or use expensive equipment. You will not have to rely on needles, injections or surgery.

You will use your own skills and resources when you gain knowledge and guidance from a Certified McKenzie Provider.

Q: What is the McKenzie Method of MDT?

A: The McKenzie Method of MDT is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, neck and extremities (i.e., shoulder, knee, ankle etc.), as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. If you are suffering from any such issues, then a MDT assessment may be right for you!

Developed by world-renowned expert physiotherapist Robin McKenzie in the 1950s, this well-researched, exercise-based approach of assessment, diagnosis and treatment uses a comprehensive and clinically reasoned evaluation of patients without the use of expensive diagnostic imaging (e.g. x-rays and MRIs). The treatment principles of the McKenzie Method promote the body's potential to repair itself and do not involve the use of medication, heat, cold, ultrasound, needles, or surgery. McKenzie allows patients to learn the principles and empowers them to be in control of their own symptom management, which can reduce dependency on medical intervention.

If utilized correctly, the achievable goals of the McKenzie Method in a cost- and time-effective manner are to:

  • Accurately understand the patient's presentation and behaviour of symptoms.
  • Determine the most appropriate and effective treatment plan.
  • Eliminate symptoms and restore full function.
  • Empower the patient to self treat and prevent recurrences.
  • Help inform patients if other medical advice or testing is needed.

Q: How does it work?

A: MDT is comprised of four primary steps: assessment, classification, treatment and prevention.

Most musculoskeletal pain is "mechanical" in origin, which means it is not due to a serious pathology like cancer or infection but a result of abnormal or unusual forces or mechanics occurring in the tissue. Further, it means that a position, movement or activity caused the pain to start. If a mechanical force caused the problem then it is logical that a mechanical force may be part of the solution. The MDT system is designed to identify the mechanical problem and develop a plan to correct or improve the mechanics and thus decrease or eliminate the pain and functional problems.

In the simplest and most common instance, this may mean that moving in one direction may provoke and worsen the pain, and moving in the opposite direction may eliminate the pain and restore function.  This is known as Directional Preference. Other patients may have pain just at the end of movement or with certain functional movements like throwing or stair climbing.  The McKenzie assessment explores these different positions and movements, how the patient performs them, and the response to these movements. Interpreting this information, the clinician determines which of the movements and posture becomes the treatment as well as the necessary exercise dosage.


MDT begins with the clinician taking a detailed history about your symptoms and how they behave. You will be asked to perform certain movements and rest in certain positions. The main difference to most other assessments is the use of repeated movements rather than a single movement. How your symptoms and range of movement changes with these repeated movements provides the clinician with information that they can use to categorise your problem.



Each syndrome is addressed according to its unique nature, with specific mechanical procedures, including repeated movements and sustained postures. MDT is a comprehensive classification system, and includes a smaller group of patients that cannot be classified into one of the three Syndromes, but are into the 'Other' Subgroup which includes serious pathologies, non-mechanical causes, true chronic pain etc


McKenzie Method of MDT

Using the information from the assessment, the clinician will prescribe specific exercises and advice regarding postures to adopt and postures to temporarily avoid. If your problem has a more difficult mechanical presentation, a qualified MDT clinician may need to add hands-on techniques until you can self-manage. The aim is to be as effective as possible in the least number of sessions. Treatment that you can perform five or six times a day is more likely to be effective in a shorter period of time than treatment administered by the clinician once or twice per week. The emphasis is on you, the patient, being actively involved. This can minimise the number of visits to the clinic. Ultimately, most patients can successfully treat themselves when provided with the necessary knowledge and tools.


By learning how to self-treat the current problem, you gain knowledge on how to minimise the risk of recurrence. You can also rapidly deal with symptoms if they recur, putting you in control of your treatment safely and effectively. Persisting problems are more likely to be prevented through self-maintenance than by passive care.


Covid-19 and Physiotherapy/ Multidisciplinary rehabilitation

Countries all across the world are in various stages of the pandemic with many countries now entering the "day after" COVID-19/Coronavirus phase.

  • Many people who have suffered from the effects of this disease might now be at risk of long-term impairment and disability.
  • The extent of this impairment and disability is yet unknown, but it is clear from early research that these patients will be in need of rehabilitation/Physiotherapy in all phases of the disease - acute, post-acute, and long-term.
  • Physiotherapists are essential to these rehabilitation efforts in all phases to facilitate early discharge, but even more to support and empower patients.

Benefits of Physiotherapy/Rehabilitation in COVID-19 Patients

• Post-Acute COVID-19 Rehabilitation Phase

  1. Physiotherapists can be very useful in the rehabilitation of patients as they transition from the acute phase to the post-acute phase
  2. The consequences of COVID-19 will be specified in each individual and their rehabilitation needs will be specific to these consequences such as:
    • Long term ventilation
    • Immobilisation-May lead to neck, back pain, and stiffness in the joint
    • Deconditioning- leads to muscle weakness and reduced endurance.
    • Related impairments – respiratory, neurological, musculoskeletal
  3. COVID-19 patients will often present with pre-existing comorbidities and that can also affect their functional recovery, the help of physiotherapist may be needed to overcome it.

The transition from the acute to the post-acute phase needs to be supported through service delivery pathways and the multidisciplinary team will be key to this.

COVID-19 Patient Presentation in the Rehabilitation Unit

Conditions that may arise from lengthy ICU-stays include:

Critical Illness Polyneuropathy (CIP)

Critical Illness Polyneuropathy is a mixed sensorimotor neuropathy that may lead to axonal degeneration and studies have shown that patients hospitalised in ICU with ARDS may present with CIP. Critical illness polyneuropathy (CIP) causes several difficulties such as]:

  • Difficulty weaning from mechanical ventilation
  • Generalized and symmetrical weakness (distal greater than proximal, but does also include diaphragmatic weakness)
  • Distal sensory loss (numbness in fingers)
  • Atrophy and weakness in muscles
  • Decreased or absent deep tendon reflexes

Critical Illness Polyneuropathy is associated with]:

  • Pain
  • Loss of range of motion
  • Fatigue
  • Incontinence
  • Dysphagia
  • Anxiety
  • Depression
  • Post-traumatic Stress Disorder (PTSD)
  • Cognitive loss

Critical Illness Myopathy (CIM)

This condition is present in 48 – 96% of patients in ICU with ARDS. It is a non-necrotising diffuse myopathy with fatty degeneration, fibre atrophy and fibrosis.

CIM is associated with:

  • Exposure to corticosteroids, paralytics and sepsis.

It has a similar clinical presentation to CIP but with more proximal weakness and sensory preservation. Patients recover more completely from myopathies than polyneuropathies, but with both conditions, there are long term consequences to consider such as:

  • Weakness
  • Loss of Function
  • Loss of Quality of Life
  • Poor Endurance

Post Intensive Care Syndrome (PICS)

Characteristics of PICS include:

  • Cognitive Impairments/problems
    • Memory
    • Attention
    • Visuo-spatial
    • Psychomotor
    • Impulsivity
  • Physical Impairment/Problems
    • Dyspnea/ Impaired pulmonary function
    • Reduced inspiratory muscle strength
    • Pain
    • Sexual dysfunction
    • Impaired exercise tolerance
    • Neuropathies
    • Muscle weakness/Paresis
    • Poor upper extremity and grip strength
    • Poor knee extension
    • Severe fatigue
    • Low functional capacity

The neuromuscular complications from PICS often result in poor mobility, falls and even quadriparesis.

How can we help you after COVID-19

A randomised controlled trial from China implemented a respiratory rehabilitation program consisting of 2 sessions of 10 minutes per week for 6 weeks post-discharge from acute care. The study results showed a significant improvement in respiratory function, endurance, quality of life and depression. The respiratory rehabilitation programme included respiratory muscle training with a positive expiratory pressure device, cough exercises, diaphragmatic training, chest stretching and pursed-lip breathing.


  • Muscle and joint range of motion
  • Strength testing
  • Balance
  • Exercise capacity – assess with the 6-minute walking test (continuous oxygen saturation monitoring included)
  • Cardiopulmonary exercise testing
  • Activities of Daily Living (ADL)

Clinical Management for COVID-19 patients:

  • Implement clinical management guidelines and protocols of care related to COVID-19 patients based on the best available evidence
  • Adaptable rehabilitation resources for COVID-19 patients who experience ongoing respiratory and physical deconditioning should be available
  • These may include:
    • Exercise programs with graded exercises
    • Pacing strategies
    • Behavior modification
    • Advice on positioning
  • Recognition of red flags such as signs of medical deterioration
  • Implement systems for tracking COVID-19 patients and remote-follow-up
  • Implement referral pathways and develop contact lists for services required by COVID-19 patients

At ACT Physiotherapy and Health Services our professionals are trained and educated in the post covid recovery program, they can help you with any of your needs regarding making your functional life better.

Chiropractic care

Chiropractic Care

Getting help from a chiropractor can yield many benefits that dramatically improve one’s physical and emotional well-being. Many people think to see a chiropractor only when something has gone wrong, or when they can no longer tolerate their pain symptoms. A chiropractor can help prevent something from going wrong in the first place.

While most people know it is time to see a chiropractor if they are experiencing back pain, there are other clues to keep in mind. Here are 10 things you should see a chiropractor:

  1. Headaches

Chiropractic careHeadaches can be caused by a number of factors, including dehydration, malnutrition, oxygen deprivation, tight joint and muscles or a misalignment in the neck or spine. A chiropractor can help to relieve headaches and improve blood flow, which will increase the amount of oxygen that is supplied to the brain.

Your chiropractor also may recommend a change to your diet to help you improve your overall health.

  1. Chronic Back Pain 

One of the most obvious signs that a chiropractic visit is needed is if you are experiencing chronic back pain. There are multiple factors that can contribute to back pain, such as posture, previous injuries how long you’re on your feet each day, and the type of work that you do.

A chiropractic doctor can provide you with pain relief without the need for invasive surgery or narcotics.

  1. You Were Involved in a Recent Accident

Being involved in an accident, such as a car, work or motorcycle collision, can cause serious injuries that only an experienced chiropractor can help heal. Many chiropractors specialize in car accident injuries, and are able to diagnose and properly treat a multitude of different injuries.

  1. Joint or Muscle Pain 

A chiropractor is trained to make sure your body is functioning as optimally as possible by using spinal manipulations to relieve pain in your joints and muscles. These spinal adjustments will increase blood flow and nerve conductivity to the joints and muscles that are experiencing pain.

  1. Sharp, Shooting Pain in Your Legs 

Chiropractic careIf you are experiencing a sharp, shooting pain in your legs, or tingling and weakness, this could be a sign that you are suffering from a pinched nerve or slipped disc.

A trained chiropractor can diagnose the cause of the pain in your leg and perform a spinal adjustment to alleviate the unwanted pressure that is being placed on the nerve and causing you pain.

  1. Your Job Requires You to Sit for Long Periods of Time 

If your job requires you to sit for long periods of time, especially hunched over a keyboard or phone, it is not uncommon to wind up with very poor posture. Poor posture puts unwanted pressure on the upper back, neck, and shoulders. The pressure can cause the discs and bones to shift enough to cause problems such as a slipped or herniated disc.

A chiropractor can make sure your spine is aligned correctly, so you do not run into any future problems.

  1. Limited Range of Motion 

If you notice that your arms and legs are not as flexible as they used to be, or if your neck won’t turn as far in one direction or the other or you can not bend forward this is a good indication that you need to see your chiropractor.

Chiropractic adjustments realign the bones and joints, relieving pain and increasing the body’s range of motion. Having normal range of motion helps the body to function optimally.

  1. The Soles of Your Shoes Wear Out Differently 

If you begin to notice that the soles of your shoes wear out differently, this is a sign that your body is out of alignment and needs to be adjusted. Uneven wear on your shoes is a very reliable indicator that you are experiencing a subluxation in the spine and need a chiropractic spinal manipulation to realign your spine to ensure the problem does not continue and turn into a chronic issue.

  1. You’re an Active Person

If you have an active lifestyle and spend time working out or playing sports or working on very active jobs your body is subjected to additional strain and pressure. This added stress can cause the spine to become misaligned. After spending time engaging in these activities, the body can become prone to pinched nerves, slipped discs, or other alignment problems.

Seeing a chiropractic doctor on a regular basis helps to keep your body functioning at its prime so you can continue to live the active lifestyle that you love.

  1. You Want to Live a More Health-Conscious Life 

If you want to live a more health-conscious life, or just want to be more aware of how to best take care of your body, your chiropractor is an excellent source of information. Your chiropractor can provide you with exercise routines, nutritional guidance, and specific techniques to help relieve stress. All of this, along with spinal adjustments, will help to improve your physical and emotional well-being.

shoulder pain

Shoulder Pain – Many Causes for Common Pain

The shoulder is a complex ball and socket joint that is able to move in many directions. With this great mobility comes a lack of stability. This lack of stability in the shoulder makes it susceptible to injury and pain. Pain is the most common complaint among patients with shoulder problems. Not only are there several structures within and surrounding the shoulder joint which cause pain, but there are various clinical conditions that can be a cause too.

shoulder painCommon causes of shoulder pain include:

1. Poor posture/Neck origin: Poor posture in sitting or standing can cause shoulder pain. If you have a rounded shoulder posture, the shoulder joint is placed in a position where the bursa, muscles, and tendons in the shoulder can be pinched. Pinched nerves in the neck are the number one cause of shoulder pain and weakness. Many times this weakness gets unnoticed by many for years before it turns into terrible pain.

2. Repetitive activity: While reaching overhead, the space between the shoulder tendon and the shoulder blade decreases. The tendons can then get pinched underneath the bony part of the shoulder blade. This pinching, often called impingement syndrome, can be painful.
Chronic shoulder pain often stems from prolonged, repetitive, or awkward movements. This type of pain is sometimes referred to as repetitive strain injury (RSI) or cumulative trauma disorder. This is common among people who work with their arm above the shoulder level, construction workers, teachers, painters, carpenters, and sports injuries. Sports like shooting a racket in badminton, overhead throwing, etc. will lead to repetitive strain on one group of muscles. Which eventually leads to fraying of those muscles and may cause tears with minor trauma and rarely without trauma also.

3. Trauma: Occasionally, trauma can cause shoulder pain. Falling on an outstretched arm or falling on the side of your arm, fall from two-wheelers, sudden jerky movements while trying to avoid falling, all can lead to sudden injury and can break the bones or injure the tendons and/or ligaments of the shoulder. It also can dislocate the shoulder resulting in shoulder pain.

4. Natural aging or degeneration: Common degenerative conditions are degenerative rotator cuff disease, which involves tendinitis and tear, another common condition is arthritis of the shoulder joint which affects the elderly and is one of the most painful conditions.
Arthritis is a degenerative condition that causes inflammation in any of the joints in the body. It most often occurs in the weight-bearing joints of the body, like the hip and knee. Occasionally, arthritis can occur in the shoulder, causing severe pain and loss of motion.

5. Medical illness – People with conditions like Diabetes, Hypothyroidism, Rheumatoid Arthritis, Peripheral Neuropathy will have more affections in shoulder joints. Diabetes commonly affects the shoulder joint in multiple ways, Adhesive capsulitis or frozen shoulder is the most common shoulder ailment in diabetes. Inflammatory conditions like Rheumatoid Arthritis will cause muscle tendon inflammation of the rotator cuff and biceps and also can cause hypertrophy and inflammation of the subacromial bursa both of which are very painful conditions.

Diagnosis and Treatment:

Early examination by a Physiotherapist or chiropractor will help you to diagnose the root cause of your problem early without further deterioration of the pain, weakness, and stiffness of the joint. A complete physical examination of the neck and shoulder will be helpful. Depending on your condition physiotherapist can recommend some exercises, postural correction tips, self-mobilization, modalities like shockwave therapy, LASER therapy, Ultrasound therapy, acupuncture. Massage therapy can help you to loosen the tissue around the shoulder joint and improve flexibility.

Neck Pain

Neck pain is a highly prevalent condition that leads to considerable pain, disability. Neck pain is most commonly caused by a muscle strain, whiplash injury, poor posture, or abnormal sleeping positions. Neck pain can also be caused due to cervical degenerative disc disease, cervical osteoarthritis, or a cervical herniated disc.

The pain associated with these conditions can range from moderate to severe, but physiotherapy can luckily help ease most (if not all) of the pain. 

How will I be diagnosed?

If you’re experiencing neck pain, it can lead to a loss of productivity, and it is a common cause for disability. Because of this, it is important to seek the assistance of a medical professional immediately if you are suffering from neck pain. A physiotherapist/Chiropractor can examine your mobility, your strength and functional abilities.

How will physiotherapy relieve my pain?

Physiotherapy is an effective treatment for neck pain. The goals and expected outcomes of these treatments include:

Reduction of pain and stiffness. By using passive treatments such as manual therapy, your physiotherapist will help alleviate pain in the affected area and accelerate the healing process.

Development of strength. Your physiotherapist will create a specific exercise plan for your particular needs, which will aid in the strengthening of muscles in the affected area.

Improvement of range of motion. Your physiotherapist will implement flexibility exercises into your treatment plan, which will help increase the range of motion in your neck.

Prevention of further issues. By learning proper body mechanics, you can avoid future injuries and prevent pain from recurring.

Improvement of overall quality of life. Physiotherapy can help you return to your normal routine much quicker, allowing for an overall improvement in quality of life.

Your physiotherapy treatments may include ice and heat therapies, massage therapy, electrotherapy, LASER therapy, Shockwave therapy or ultrasound. These help in relieving pain, stiffness, and inflammation. Active physiotherapy treatments for back and neck pain may include any stretches and exercises that your physiotherapist deems fit for your specific condition. Active therapy helps to increase strength and flexibility, in addition to relieving pain in the spine and affected muscles.

Mechanical Lower Back Pain : Cause, Symptoms & Treatment

What is mechanical lower back pain?
Mechanical lower back pain is a common problem and almost accounts for more than 90% of the lower back pain. Mechanical means that the pain source may be in your spinal joints, discs, vertebrae, or soft tissues. Mechanical back pain may also be called low back pain, lumbago, lumbosacral strain or sprain and sciatica.

What causes mechanical back pain?
It is not possible to find the main cause of the pain right away, but sometimes it starts with being in one particular position or repetitive movement and continues to progress. Weak spinal or core muscles can also be responsible for it.

woman with back painWhat are the symptoms of mechanical back pain?
Most people with mechanical back pain experience pain primarily in their lower back. The pain may spread to your buttocks and thighs on the side or on both sides. Many people may also experience spasms with mechanical back pain. The symptoms of the mechanical lower back pain may include pain on bending, morning pain, stiffness in lower back and hip, weakness in lower extremity and tingling and numbness symptoms.

How is back pain diagnosed?
Best way to diagnose mechanical lower back pain will be by seeing McKenzie trained or certified therapist, who will take a detailed history of pain and function as well as overall health and complete full neurological and repetitive movement examination. Therapists will be able to find out which movement will help and which one will hurt or be harmful. If needed, further investigations will be recommended by the physiotherapist.

How is back pain treated?
Non-surgical treatment with limited rest, over the counter medications and supervised Physiotherapy program for ongoing mechanical pain, may be recommended. Physiotherapy may be an essential part of acute back pain rehabilitation. It is important that you work with a physical therapist trained in this exercise approach to promote rapid healing. Active physical therapy can help shorten recovery time and make you return to work and leisure activities as quickly as possible. Active physical therapy is an exercise program that may require home exercises as frequently as every two hours while you are awake. The exercises generally take about five minutes to do and do not require special equipment, nor do you need to go to a gym to do them.

What is the outlook for people with back pain?
The prognosis for complete recovery is excellent. Most people with acute mechanical back pain respond very rapidly to treatment. About 90% of people with acute low back pain are symptom-free in one to two weeks. Many of the remaining estimated 10% recover within three months.

Recurrences of back pain are common. Continuing your home exercise program may help reduce your risk of another episode.

When can I return to work?
It’s usually recommended that you return to work right away. If you cannot do your regular job, it is in your best interest to return to some kind of modified duty (light or restricted duty). Your healthcare provider can give you a prescription for a limited period of modified work duty.

It is very common to be afraid to promptly return to work and other activities because of fear of re-injury. However, if you are receiving proper treatment, your risk of re-injury should be limited. It is in your best interest to return to a normal lifestyle promptly. Early mobility has been found to directly result in a more rapid recovery. Maintaining a positive mental attitude is also imperative to a quick recovery.