Your first step to recovery

We Want You To Understand Your Pain

What is pain?

Pain is the brain giving out a message to protect you . It is part of our bodies natural defense system.

When an event occurs that we need protecting from, our brains response is to increase our pain. Living things detect and respond to stimulus. | Characteristics of living  things, Natural hairstyles for kids, Characteristics

Example: Putting a hand on a hot pan. You feel pain, which is the brain giving you a warning signal to move your hand away.

Pain is all about protection, never about measuring the condition of the tissues in the body.

In this instance we experience a high level of pain to prevent a bigger injury eg. causing a burn.

This is our bodies way of protecting us

So what is happening in our brain?

  • We as human beings are amazingly adaptable. The longer we have pain, the longer our brains learn to produce pain.

  • It hurts in the tissues (back, knee, hand), but the problem is in the nervous system. There is an adaptation within our nervous system.

Long term pain or Chronic pain

Chronic pain is defined as persistent or recurrent pain lasting longer than 3 months

If you have had pain for more than 3 months, your system is now overprotective. Your nervous system and immune systems have learnt.


Movement is medicine: why exercise therapy reduces chronic pain - Hinge  Health


  • With chronic pain the buffer size is increased- therefore pain comes on quicker than before.

  • You get pain when you are not anywhere near being in danger.

Management of chronic pain:

  • Identify why your brain is protecting you – fear, anxiety, quality of movement, posture, injury

  • Reduce the size of your buffer – desensitization, reassurance, progressive load management

  • Understand your pain- know that it may not go completely, but can become more manageable


  • Depending on the type of pain you are experiencing, painkillers/NSAID’s may be beneficial in the short term – speak to your GP/pharmacist

  • Note: the research does not show good outcomes for the long-term use of medication to treat chronic pain.

Occupational Therapy:

  • If you have been off work because of your pain – try to return to work asap. An OT can discuss and plan a gradual return to work plan for you

  • They can also assist by providing aids to helps with daily tasks such as getting out of bed, or putting on shoes.


  • There is no quick fix for persistent pain. We can help guide you along your journey to recovery

  • With persistence and hard work you can learn to adapt and cope with your pain

  • Movement is king – it is critical for retraining the system

  • Movement gradually suppresses the pain system.

  • Finding any form of exercise or movement that you enjoy and gradually increasing the volume over time

  • Moving regularly- on your good days and your bad days

Self Help:

  • Meditation or mindfulness – Apps such as Headspace or Calm are easy to use and will guide you through the process

  • The Pain ToolKit

Do You Have a Healthy Work Station Set Up?

An ergonomically correct workstation has all the best practices to help maintain a healthy posture and improve your health and productivity.

Here are a few helpful tips;

1. Set up your screen

Adjust the monitor height so that the top of the screen is at—or slightly below—eye level. Your eyes should look slightly downward when viewing the middle of the screen. Position the monitor at least 20 inches (51 cm) from your eyes—about an arm’s length distance. If you have a larger screen, add more viewing distance.

2. Set up your chair

  • Height – You should be able to sit with your feet flat on the floor and your thighs roughly parallel to the floor. If you require a taller chair in order to reach the floor you can use a foot rest to ensure you achieve the right angle.

  • Backrest Recline and Tilt – Research has shown that a reclined seat (at least 135 degrees back)  significantly reduces the pressure on your back, and is particularity beneficial for people with back

  • Lumbar support – the shape of the backrest should have a natural curve to support your lower back.

  • Arm rests – Look for armrests that are not just height adjustable and support the entire length of the forearms.

3. Adjust your Desk Height

  • Your legs should fit comfortably under the desk if you are sitting with your feet flat on the floor: you should have enough space to cross your legs.

  • The angle between your forearm and upper arm should be between 90 degrees and 110 degrees while your arms are at rest on the desk.

  • Make your desk organized using storage accessories i.e. Document holders

  • Use an ergonomic mouse pad; to keep your wrists supported.

4. Organizing your Desk space

Organize all the items on the workstation according to their priorities and assign them to the proper ergonomic reach zones.

  • Primary Zone: High use items, easiest access

  • Secondary Zone :Medium use items, comfortable reach

  • Third Zone: Low use items, reduction in efficiency

:sparkles: MOVEMENT IS KEY :sparkles:

Its a simple action step, but mighty! Get up out of your chair and take frequent posture breaks!

When we sit in one position for hours without moving, our performance slowly starts to deteriorate, our body slows down, static loading takes over our muscles and we actually get fatigued even when we aren’t putting in any physical effort. However, when you consciously integrate these microbreaks into your day, you’re giving your body a much-needed refresher and an opportunity to wake up your muscles and replenish blood flow. Research has shown that movement can also help with creativity, or get you ‘unstuck’ so you can approach your work with a different or fresh perspective and energy.

If you think your desk set up could be better, or want us to have a quick look we can do this via a video call. Book in for an appointment www.physiofusion.co.nz or give us a call on (09) 626 6186

Do you experience Cervicogenic Headaches?

What on Earth is a cervicogenic headache??

Headaches happen for lots of reason and can be cause by several sources- both primary and secondary. Once major “red flags” are ruled out, understanding the type of headache is important in order to have it properly addressed.

A cervicogenic headache is a secondary headache arising from a musculoskeletal dysfunction within the cervical spine, and is a disorder that many physiotherapists treat. The main players that are typically involved in generating the pain are the joints, discs, ligaments, nerves and/or muscles found in the upper portion of the neck.

Characteristics of a Cervicogenic Headache:

:sparkles: Pain usually one sided or one side dominant

:sparkles: Pain originates from the back of the neck and radiates along the forehead, orbits around the eye, temple area and ear.

:sparkles: Steady ache or dull, diffuse pain that travels into shoulder region

:sparkles: Limited neck movement especially when turning head

:sparkles: Tenderness to touch at the muscles at the base of the head.

Here are some exercises that would help alleviate your pain:

  1. Cervical side flexion with chin tuck

  • Sit upright in a chair.
    With your shoulders relaxed, relax one arm to your side.
    Drop your opposite ear to your shoulder until a stretch is felt.
    Using your fingers, tuck your chin in, as to resemble a double chin.
    Gently release pressure with your fingers and hold this position.
    Relax and repeat

2. Levator stretch Neck stretch – levator scapula

  • Start in a seated position.
    Place the hand of the side you want to stretch down by your side.
    Tilt your head forwards and to the opposite side at an angle, as if you are trying to
    look at your armpit.
    Keeping your back straight and upright, continue to tilt your head down until you
    feel a stretch from the base of your skull down into your shoulder blade.

3. Neck stretching (Upper trapezius)


  • Stand up straight.
    Take the hand on the symptomatic side and place it behind your back.
    Take your other hand and place it on your head.
    Tilt your ear directly down towards your shoulder and hold this position.
    You should feel a stretch down the side of your neck.

If you believe you experience Cervicogenic Headaches get in touch with us https://physiofusion.co.nz/ for an in-depth assessment and lets knock out those headaches and decrease you dependence on pain meds

Stay safe, Stay fit

Our daily routine has been forced to change during the lockdown and it has never been more important to focus on your physical and mental health. The current situation we’re facing is strange, stressful, emotionally exhausting and there is no surprise that the motivation to keep fit has been a bit of a struggle. It is in these disquieting times that exercise can provide much-needed solace.

Research shows that being physically active helps lower cholesterol and blood pressure and can significantly reduce the risk of heart disease, stroke, and diabetes. Physical activity also maintains mass and bone density, reducing the risk of developing osteoporosis (loss of bone density), Sarcopenia (loss of muscle mass), and helps boost one’s immune system, as it flushes bacteria from the lungs and airways, increases white blood cell circulation and raises body temperature, all of which help the body fight infection.

How much Activity is Recommended?

Be active every day, in as many ways as possible. Aim for at least 2 ½ hours of moderate (or 1 ¼ hours of vigorous physical activity) spread throughout the week. The Ministry of Health outlines how much physical activity New Zealanders need to stay healthy https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/physical-activity/how-much-activity-recommended.

Create a Routine

Whether you are looking to maintain an exercise regime or just stay motivated from one day to the next, as your own four walls start to make you feel a bit stir crazy, many people find that it helps to have a set routine. It portions the day into bite-size chunks and allows you to feel a sense of accomplishment as you tick off the day’s tasks.

Few of us are lucky enough to have an exercise bike/treadmill at home. Fortunately, there are plenty of simple exercises that you can do around the house or with household objects that will work instead. If you do not have your own weights at home there are some surprising substitutes you can utilize instead i.e bags of rice or flour, a tin of beans and bottled water can be used, if you need something heavier you can always fill a carrier bag with a few items inside.

1. Squats


Lie on the floor and rest on your back. Ensure that your knees are bent, and your feet are touching the floor.

Put your hands behind your head and then lift both your chest and your legs slightly but leave a gap between them.

Go back to the starting position and repeat.

2. Crunches

Crunches are another important exercise for your abs to strengthen your body core.


Widen your feet parallel to your shoulder and extend your arms in front of you.

Bend your knees and your hips slightly and then do the traditional squat position.

Push up using your heels and repeat.

3. Stationary Lunge


Stand up straight and put your right leg forwards and your left leg backward. It should look like you’re preparing to run.

Place your hands on your hips. Bend your right leg, leaving a little gap between the floor and the knee.

Then, switch your legs and do the same.

These bodyweight exercises are a great way to start your day and get the blood pumping in your body.


Safety during exercise outside

If you’re working from home, getting outside for physical activity will do wonders for your physical and mental health. Regular walking, running or cycling is a great way to stay active and healthy during lockdown, but it is important to keep your distance and stay more than two metres away from others. Plan your route when you’re thinking of heading out for a cycle/jog. If possible try to think of roads, neighborhoods, and parks that will be quieter and less congested. Follow the latest advice about whether you will also need to wear a mask.

Take a Bit of You Time

Fill your own cup first…Being healthy is not just about maintaining an exercise regime and eating right, it is also about staying mentally healthy too. If you are in isolation with your family, it is easy to spend the day making sure they are happy and entertained, but don’t forget to take a bit of time for you. Do a quick meditation or yoga routine while the kids are watching TV or maybe just go into the garden and take a few deep breaths to relieve some stress!

During this time of uncertainty, something we can take control of is our health and well-being. So, whatever your situation, try to keep active, eat healthily, and stay hydrated.

Ngā mihi and stay safe


Exercise not only changes your body. It changes your mind, your attitude and your mood

We all have days where we plan to do our workouts and we know we should however when it’s time to put your shoes on and go… You simply just don’t want to go.

How many times have you said this to yourself?

  • I don’t feel like exercising
  • I’m too tired to exercise
  • I’ve lost my motivation to exercise
  • I’m not in the mood to exercise

What if we told you that exercise is not just about burning calories, regular exercise plays a vital role in cognitive function and mental acuity which helps support a positive outlook on life.

What we know about Exercise and Mood

Research has long supported the benefits of exercise, from weight control to reducing the risks of cardiovascular disease, type 2 diabetes, and even cancer. Regular exercise strengthens our muscles, bones, increases your flexibility and helps you stay fit and active for longer.

What can exercise do for my mood? Exercise can have an enormous impact on your mood. In fact, it is thought that exercise can be just as effective as anti-depressants in treating mild-to-moderate depression.

What we do know is:

  • Exercise can help treat people with depression who have partially responded to anti-depressants
  • both aerobic exercise (such as walking, cycling or running) and strength training (such as weight lifting) can help treat depression
  • Improved mood
  • Improved self-esteem
  • Reduced stress as well as an improved ability to cope with stress
  • Improved confidence in your physical abilities
  • Builds your coping and resilience
  • Can help distract from negative thoughts
  • Gives you a sense of accomplishment

Exercise and Depression

As mentioned previously, studies show that exercise can treat mild to moderate depression as effectively as antidepressant medication a recent study done by the Harvard T.H. Chan School of Public Health found that running for 15 minutes a day or walking for an hour reduces the risk of major depression by 26%. In addition to relieving depression symptoms, research also shows that maintaining an exercise schedule can prevent you from relapsing.

Exercise and Anxiety

Exercise is a natural and effective anti-anxiety treatment. It relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins. A systematic review by Aylett, E., Small, N. & Bower, 2018 assessed the use of exercise versus waiting list control groups in the treatment of anxiety and also the benefit of high intensity exercise vs low intensity exercise. The intervention was any aerobic exercise programme carried out for at least two weeks, and the comparison groups were either a waiting list control group or low intensity exercise (stretching/walking). This study concluded that higher intensity exercise have an advantage over lower intensity exercise in bringing about an improvement in anxiety scores. The study also confirmed that exercise represents an effective treatment and should be more available for referral from General Practice.

Exercise and Stress

Studies have found that stress contributes to 50% of all illnesses and that two-thirds of GP visits were for stress-related illnesses. Wang, C., Chan, C.H., Ho, R.T. et al. 2014 conducted a systematic review that assessed examining the effect of exercise on stress reduction or anxiety relief among healthy adult and found that exercise does in fact relieve anxiety and reduce stress. There is a great number of studies that have typically focused on aerobic exercises. There have been consistent findings that people report feeling calmer after a 20- to 30-minutes of aerobic exercise, and the calming effect can last for several hours after exercise.

Exercise and Enhancing Brain Function

Exercise also plays a vital role in improving brain function as it leads to increased blood flow and oxygen to the brain. Exercise can help generate new nerve cells and improve cognition, memory and learning. Regular exercises can even help to prevent Parkinson’s Disease, Stroke and Alzheimer’s Disease (Cotman & Engesser-Cesar, 2002). Brain-derived neurotrophic factor (BDNF) is important in brain function, neuronal transmission, and plasticity (Ferris, Williams & Shen, 2007). This process is known as neurogenesis or neuroplasticity. A study conducted by Ferris et al. (2007), studied BDNF to help confirm the relationship between exercise and brain function. Fifteen participants rode a bicycle for 30 minutes, one ride at moderate intensity. After exercise, BDNF values were increased and intensity dependent which supports the positive effect that exercise can have on brain function.

Are you maximizing your exercise routine? Are you unsure if the exercise you’re doing is right? Are you struggling with motivation to get moving again?

If you’re reading this and think any or all mentioned above sounds familiar, then we can definitely help you. Based on specializing in exercise progressions and exercising ourselves, we can help assess, adjust and progress your routine. Everyone’s needs are different so during our consultation with you, we ensure that we draw on the combination that will best serve you. We strive to ensure our clients are performing exercises correctly and efficiently, in order to maximize results.

So, what are you waiting for? Enquire with us to discuss how we can help you get started and achieve your goals!

If you are in a bad mood go for a walk. If you are still in a bad mood go for another walk.


Aylett, E., Small, N. & Bower, P. Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Serv Res 18, 559 (2018). https://doi.org/10.1186/s12913-018-3313-5

Wang, C., Chan, C.H., Ho, R.T. et al. Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials. BMC Complement Altern Med 14, 8 (2014). https://doi.org/10.1186/1472-6882-14-8

Cotman, C.W. & Engesser-Cesar, C. (2002). Exercise enhances and protects brain function. Exercise and Sport Sciences Reviews, 30 (2), 75-79.

Ferris, L.T., Williams, J.S., & Shen, C.L. (2007). The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Medicine and Science in Sports and Exercise, 39 (4), 728-734.

Hearing, C. M., Chang, W. C., Szuhany, K. L., Deckersbach, T., Nierenberg, A. A., & Sylvia, L. G. (2016). Physical Exercise for Treatment of Mood Disorders: A Critical Review. Current behavioral neuroscience reports3(4), 350–359. https://doi.org/10.1007/s40473-016-0089-y

Robertson, R., Robertson, A., Jepson, R., & Maxwell, M. (2012). Walking for depression or depressive symptoms: A systematic review and meta‐analysis. Mental Health and Physical Activity5( 1), 66– 75. https://doi.org/10.1016/j.mhpa.2012.03.002


What does the shoulder look like inside?

The shoulder is made up of two joints. These are the acromioclavicular joint (collar bone meets shoulder blade) and the glenohumeral joint (upper arm meets shoulder blade). The shoulder is protected by ligaments (joining bone to bone) and muscles known as the rotator cuff. These muscles form tendons (joining muscle to bone) and play a major role is stabilising the shoulder. Under some of these muscles and tendons, there are small fluid filled sacs ((known as bursae) to allow easy gliding of muscles over bone.  The upper arm also joins the shoulder blade with the help of the Labrum (soft tissue around the glenoid cavity). Finally, this is all surrounded by a fluid filled sac which lubricates the shoulder joint for better movement known as the shoulder capsule.


History taking and assessment

You can expect questions regarding the history of your shoulder injury from your physiotherapist such as:

  • How the injury happened
  • Where the pain is in your shoulder
  • Whether you have a ‘dead arm’ feeling
  • If you feel a different sensation from the other side or some weakness
  • Aggravating and easing activities
  • Past history and family history of shoulder injuries or pain

Once these questions have been asked and answered, your physiotherapist will proceed to perform an assessment of you and your shoulder. This can range from:

  • Posture assessment
  • Strength and sensation testing
  • Testing of ROM (movement of the shoulder)
  • Special testing to check joint stability, muscle integrity and possible signs of shoulder damage



Based on your history and examination findings, your clinician will suggest the best possible investigation for you.

In most cases, initial X – rays are done to rule out broken bones.

Ultrasounds can be used to diagnose some ligament and tendon damage such as rotator cuff tears.

MRI is the best form of imaging but this does come at a higher cost and higher exposure to radiation. The MRI scan can identify bone, ligament and tendon injuries in the shoulder.

A CT scan is not usually performed in cases of the shoulder.


Possible injuries to the shoulder


If you have dislocated your shoulder in the past or continue to experience shoulder dislocations, you may have some instability of the shoulder. Normally you may develop a “dead arm”. You may also feel a sense of heaviness, numbness or an inability to move the arm which persists for a few minutes. If you are experiencing these episodes more frequently with less force, it is advised that you see your healthcare professional.


Non-surgical management involves a period of rest with a parallel shoulder strengthening program for stability. This is done when the injury is acute and non-recurrent.

Surgical management is opted for when there has been damage to the ligament and Labrum as well as ongoing recurrence of shoulder dislocation. Surgery is associated with a reduced rate of recurrence.


Rotator cuff:

The four muscles that make up the rotator cuff are Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. Rotator cuff injuries are one of the most common disorders of the shoulder. It is believed that most of these injuries are caused by overuse of the shoulder. Often heavy lifting, sports involving the shoulder and repetitive shoulder movements are associated with rotator cuff pathology. These injuries cause pain and stiffness with overhead activity (eg: throwing a ball or putting a shirt on) and pain is worse at night. You may also feel some weakness in your injured arm because of pain.


A partial thickness tear in the rotator cuff can heal with non-surgical management. These are managed with physiotherapy exercises, corticosteroid (cortisone) injections and most importantly, time. It is important to know that the pain will improve over time.

A Full thickness tear in the rotator cuff will normally be managed with surgery. This is followed by immobilisation of the arm for up to 6 weeks in a sling. After these 6 weeks, you should begin a physiotherapy program in order to aid your recovery.

Acromioclavicular joint (ACJ):

This is a fairly common injury and normally occurs in athletes involved in contact sport or when falling directly onto the point of the shoulder. You may experience some pain and swelling in the upper shoulder. This pain can sometimes occur with no reason at all and it is important to voice this to your clinician.


You will be treated surgically or non-surgically according to the severity of your injury.

Non-surgical management includes a brief spell of rest and sling use for protection and healing. This is followed by early mobilisation of the shoulder and a subsequent strengthening program. Your physiotherapist can also assist you with taping in order to return to activity.

Surgical management is followed by a physiotherapy program as outlined by the shoulder surgeon. This is normally done for a quicker return to play in contact sports or when pain is severe and a trial non-surgical management has not worked.


These normally occur as a result of direct trauma to the arm such as a fall. They can be very painful and are usually associated with a lot of swelling around the area.


Depending on where and how severe the injury is, the doctor may opt for surgical or non-surgical management.

In either of these cases, you will undergo a period (6 weeks maximum) of immobilisation of the upper limb to allow for healing. At the end of this period, it is important to see your physiotherapist to begin rehabilitation of your arm.


What to expect


Acute phase:

Immediately following an injury, you should be offered adequate pain relief. A sling can be very effective and can be combined with simple analgesia, anti-inflammatory medications and ice therapy.

Passive range-of-motion (ROM) exercises, including pendulum and active-assisted exercises, should be considered. You will be encouraged to maintain fitness (if comfortable) using a stationary bike or general walking.


Early Rehabilitation phase:

When your pain has settled and your ROM has improved to 60-70% of the unaffected side, you can progress with rehabilitation.

Exercises that might be useful in this phase include:

  • Stretch of the shoulder
  • Progressive ROM exercises with the goal of achieving full ROM
  • Strengthening of the rotator cuff and scapular stabilisers




Late Rehabilitation phase:

You will progress to this phase when you have a normal (full and painless) ROM and 75% strength of the unaffected side.

The types of exercises that might be useful in this phase include:

  • Progressive multi-planar exercises
  • The addition of further resistance exercises, including weights and the use of medicine balls and more functional activity
  • Plyometric exercises


Return to sport:

When you have a normal range of motion and more than 90% strength of the uninjured side, you can progress to return to sport. This should be done in a gradual manner.

A return-to-sport programme may involve:

  • Initial unopposed training
  • Opposed training in a controlled setting
  • Match practice
  • Return to sport when this full progression has occurred


In conclusion:

Your shoulder injury will be treated and tailored to you. With most shoulder injuries, physiotherapy can be helpful in operative and non-operative management.

Early management or rehabilitation of your injury could go a long way in speeding up your recovery process and avoiding re-injury in the future.