When you have back pain, muscle aches or a sports injury it can be difficult to decide whether to see a physiotherapist, biokineticist, chiropractor or doctor. Gone are the days when heat or ice and bed rest are best. Early movement or exercise is often helpful even with tissue injuries. But knowing that rest isn’t enough still leaves the next question: what should you do, what should you avoid, and who should guide you? Articles like this can easily upset practitioners because we don’t always agree. Still, here is my best-intentioned attempt at how to choose.

Physiotherapy has existed in South Africa for more than 100 years. It has helped millions of people and failed others. Matching the condition to the person’s expertise is however more important than matching it to a profession. Considering the clinician’s strengths relating to your needs rather than picking the ‘best’ profession.

Biokineticists, for example, may be consulted for pain relief. Physiotherapists don’t always love hearing that, perhaps because biokinetics is much younger and it can feel like the profession was duplicated. Even professionals battle to pinpoint the differences: You’ll find both in gyms, both might talk about posture or blame certain muscles not “firing,” and both commonly prescribe rehabilitative exercises to do at home.

A common misconception (which I once believed) is that treating pain falls outside the scope of biokinetics. Conversely, some biokineticists believe physios may not provide final phase rehabilitation. At a recent meeting with the governing board of the Professional Board for Physiotherapy, Podiatry and Biokinetics (PPB) of the HPCSA, it was made clear that the scopes of physiotherapy and biokinetics differ far less than many assume.

What is the difference between a physiotherapist and a biokineticist? There are a few things one profession may do which the other may not.

Biokineticists

• Finger-prick blood tests

Physiotherapists

• The acute management of traumatic injuries
• Manual joint mobilisation
• Manual joint manipulation
• Dry needling
• Electrotherapy beyond exercise-related modalities

To my knowledge, chiropractors and medical doctors have none of these restrictions, but I’m open to correction.

Even so, having access to more treatment options doesn’t necessarily lead to better results. Individual skill varies widely. You may find a physiotherapist better at exercise prescription than the average biokineticist, or a biokineticist better at massage than many physios. The same variation exists with spinal manipulation from chiropractors. So how should you approach this logically?

If you have strong trust in a particular health professional, there’s no harm in seeing them first—even if the condition might technically fall outside their scope. An ethical clinician will recognise those limits and refer you if someone else is better suited to help. The initial appointment may feel wasted, but the directional guidance should be of great value. Otherwise, some general considerations may be helpful:

• If you’ve always had good, lasting results with chiropractic care, there may be no reason to change.
• If you want short-term relief, a GP prescription, a massage may or a quick chiropractic session may temporarily help.
• If your goal is to avoid surgery, starting with a surgeon may not be the best decision.
• Significant bleeding or obvious bony disfigurement, straight to the emergency room.
• Fever with pain, see a medical doctor.
• For general strength and lifestyle changes, biokineticists have ample expertise here.
• If you prefer passive treatment, relief may be short-lived, but chiropractors and some physiotherapists often offer these options.
• If you want the best chance of understanding and managing the condition long term, choose someone who prioritises an accurate assessment and diagnosis (without creating undue fear) over the delivery of some fancy treatment, irrespective of their profession.

Those who know me understand that careful assessment is where my interests lie. I refuse to assume and therefore focus on understanding how symptoms behave so we can identify the cause and the best way to manage it. This mindset began during my physiotherapy training and deepened significantly while I credentialed in the McKenzie Method.

Treating without appropriate assessment can lead to ineffective care or serious problems, which is why my priority is always to understand first. From there, the best or referral options will be clear and the risks appreciated. Consider these concerning scenarios:

• Dry needling where we didn’t know there is a tumour
• Strengthening exercises for unknown vascular compromise or an infection.
• An MRI revealing an incidental finding you can never “unsee”.
• Massage or other passive therapies falling short of addressing the cause, resulting in persistent recurrences.

So, who should you see? Someone who assesses you comprehensively. Not just the painful area, but the person in front of them and the wider factors influencing health because that deeper knowledge is where true value is ultimately uncovered.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

JMPhysio’s Logical Approach to Musculoskeletal care

When you’re in pain, it’s natural to try and diagnose yourself. You might think you’ve “pulled a muscle” or “slipped a disc.” While understandable, these assumptions can inadvertently send you down the wrong path from the start.

Pain is often a complex puzzle. To solve it, we need to be detectives, identifying the root cause rather than just treating the symptom.

Our process begins with a detailed conversation about your history. This helps us rule out potential causes before we even begin moving. We then test your body’s responses to specific movements. We monitor every change in your symptoms, from its location and how it affects your function, to any shift in its intensity. Each one is a crucial data point.

Since our musculoskeletal system is an inherently mechanical structure, it’s no surprise that most pain stems from reversible mechanical problems. These issues often mimic more serious conditions, which is why many receive a vague diagnosis of ‘non-specific’ pain. Others may even end up having surgery but never attain the expected relief or functional restoration.

A comprehensive mechanical assessment (the McKenzie assessment) of this mechanical system provides clear direction, often within just one or two sessions, by identifying which of these paths is right for you:

1. The Path of Independent Healing: For many minor injuries, the body is fully equipped to heal itself. Our role is to confirm this and educate you on how to avoid interfering, saving you time and money on unnecessary treatment.
2. The Path of Active Self-Management: This is the most common outcome. We identify the specific mechanical cause behind your pain. For instance, a muscle doesn’t simply become tense without a reason; it’s likely responding to an underlying nerve or joint issue. By finding the specific movement that releases tension and restores function, we address the cause, not just the effect. This empowers you with a proven strategy for relief, building independence in your recovery and functional capacity, both now and in the future.
3. The Confident Path to a Specialist: If your assessment findings suggest a different underlying condition, our most important role is to provide a swift and informed referral to ensure you see the right expert without delay.
4. The Path of Neural Re-education: Sometimes, the nervous system can develop a hypersensitive alarm system, causing persistent pain. The solution here is not in treating structural damage or mechanical elements, but in carefully guiding your nervous system to recalibrate its response.

Our Promise: Your Results Are Our Priority

Our primary obligation is an accurate diagnosis followed by relevant treatment. You may however opt that we provide hands-on therapy for its comforting value, but we will remain transparent: relying on it alone for musculoskeletal pain often leads to cycles of treatment rather than restored function.

We believe in using the insight from your detailed McKenzie assessment to guide you to the most effective solution. Your long-term recovery is our goal, and we are committed to a path that prioritises your results.

It’s therefore not about one therapy being superior. It’s about the right diagnosis ensuring you get the right care, right from the start.

To better understand your condition and the evidence-based approach we use, a great starting point is: A Patient’s Guide to the McKenzie Method

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Meet Alex, a passionate runner with an opinionated Achilles tendon that always seemed to protest after a big race. One day, having pushed hard for a 21km PB, the pain flared up, sharp and insistent. So, Alex did what seemed logical: she stopped running to let the Achilles injury heal.

Cautiously, Alex returned to running after a few weeks but slowed the pace and cut the distance. To her frustration, the Achilles flared up again, much sooner than what it ever had before! Confused, Alex rested more, waiting for the pain to vanish and even gave it a few days extra before slowly trying again. The same pattern kept repeating, each attempt at running led to another setback, until Alex could barely jog around the block without pain.

This wasn’t just happening to Alex. Mark, a cyclist, battled persistent IT band pain that reappeared every time he upped his mileage, no matter how slowly he progressed the Cradle loop kept causing enough pain to have him sit out for several weeks. And then there was Sarah, a padel player whose elbow throbbed whenever she swung a racket, despite taking weeks off between matches. All of them were trapped in the same cycle: hurt, rest, repeat. Each one believed that pain is the enemy. Each one theorised that they had done too much damage already, that rest is no longer enough and that they would have to stop the activity that brought them such joy for so long.
 

That was until they learnt the truth:

• Tendons don’t heal on rest alone.
• A happy tendon isn’t one that’s been coddled into silence or beaten into submission.
• Happy tendons are steadily conditioned through a gradual exposure to load.
• Tendon recovery can’t be monitored through fading pain levels.
• Medicating the pain while mindlessly pushing on will surely result in a retaliation.
• Building function amidst discomfort or relative pain is the unexpected sweet-spot required to turn a tendon’s declining attitude around.

Take Alex’s comeback: after months of consistent, progressive loading, she could run 8km with the same 3/10 pain that once plagued her within the first 2km. The maximum pain level hadn’t changed, but her capacity had—and that was real progress. She now didn’t even have pain for the initial 6km. Mark’s IT band stopped rebelling when he built tendon resilience with targeted strength and endurance work between Cradle visits. And Sarah’s elbow tolerated longer matches once she stopped fearing every twinge and focused on controlled rehab during practice sessions and on her off-days.
 

The lesson?

• Tendinopathy is a marathon, not a sprint.
• Solving a tendon crisis is not about rest or avoiding pain.
• Avoiding further damage during activity actually fuels the problem.
• It’s also not about fancy and expensive physio machines, or even surgical visits.
• Pain will ebb and flow, but the goal is to train smarter and increase the tendon capacity through continued and gradually progressive exposure.
• Resting a tendon or stopping completely is counterproductive as it reduces the tendon’s capacity for function.

It’s about the tendon outgrowing its limitation, needing only:

• Guidance from someone who understands how tendons work and
• Perseverance from you.

It’s never too late so whenever you’re ready, let’s take this on.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

What is JMP’s fascination with the McKenzie Method?

McKenzie has completely revolutionised how JMPhysio go about assessing and helping people – not because everyone suddenly has mechanical malfunction or that we have an immense love for repetition but because of the McKenzie method’s exceptional reliability in attaining valid answers for the underlying causes of a person’s symptoms. It’s all about pattern recognition and ensuring that we’re aware of what is driving the pain! The reason why repeated movement is valuable in providing answers is because it sets a challenge for the bodily system suspected to be at fault. That system will then either cope with, improve from or retaliate to the various movements tested, and hopefully in a recognisable fashion for which we can provide answers and insight.

The questions we work through before starting any movement testing aims to pick up on patterns in the recent history even if the patient hasn’t noticed any patterns or possible links to other factors up until that point, e.g.:

• Is the pain steadily settling day by day? (This sounds like the body may be effectively healing an injury)
• Is the problem exceptionally consistent? (This sounds structural)
• Is the pain linked to the time of the day or your activity levels? (This could be inflammatory)
• Does the location move around? (This is likely referred from elsewhere)
• Do positions or postures play a role in your symptoms? (This starts sounding mechanical – think movement malfunction)
• Does it have a mind of its own and very inconsistent in its behaviour? (This is highly likely to be mechanical)
• Does the patient have any medical history that is concerning? (Unplanned weight loss or fever? Any personal history of cancer or even new medications known to cause similar symptoms?)

So, after all the questions covering:

• The history of the symptoms
• Your pain’s behaviour,
• Your medical history and
• Anything you’ve tried so far to remedy this…

…we now have information on several possible diagnoses while others have already been ruled out. Your clinician will still have some unanswered questions which may require x-rays or even blood tests but are in most instances best answered directly by the musculoskeletal system. So, unless contraindicated, let the physical and movement testing commence while we keep an eye out for any developing patterns of pain behaviour.

Despite the common approaches which attempt only to relieve pain, we are always interested in what is responsible for the symptoms and if we’re able to control the pain responses going forward because that’s where you get control over the condition. This approach increases the relevance of any treatment, advice and education provided to you.

We haven’t lost the oil, forgotten how to use needles or started fearing strapping tape but we’ve learnt too much from research and experience. So, in spite of change being difficult and even scary at times, we were happy to adapt our approaches to better serve our patients and in the last 3-6 years since adopting and becoming proficient in this approach, we’ve   seen the value it provides in terms of knowledge, empowerment, answers and relief! And we’ve kept the passive options safely hidden inside the practice for select individuals who are not quite ready for this change just yet.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

As physiotherapists, we see this all the time: Someone wakes up with a “stiff neck from sleeping funny,” or an old knee injury flares up after a normal game of tennis. Painful? Absolutely. But here’s the thing: not every ache is an injury, and your best management will have to be matched to the cause of the pain.

For too long, the musculoskeletal health industry has blurred the lines between actual injuries, functional movement problems, and systemic conditions (like neurological or medical issues). Even healthcare professionals sometimes struggle to tell them apart. The problem? Mislabelling pain as an “injury” when there’s no real tissue damage can lead to wasted time, unnecessary rest, unnecessary procedures and delayed recovery of normal function.
 

What Counts as a bona fide Injury?

A true injury involves traumatic tissue damage—think a broken bone or a ripped ligament or muscle. These come with:

• Localised bruising (visible bleeding within the tissues)
• A predictable healing timeline (because cells need time to repair)
• Gradual, consistent improvement (pain decreasing day by day)

In these cases, some relative rest helps protect the area while healing happens and it’s essential to keep the surrounding tissues active and resilient. But here’s the kicker: nothing speeds up biological healing—not massage guns, not ultrasound, not electrical stimulation. Good nutrition, sleep, and avoiding re-injury? Yes. Gimmicky or age-old therapeutic gadgets? No. (And if anyone claims otherwise, I’d love to see quality research!)
 

What can slow healing?

• Poor nutrition
• Smoking
• Diabetes
• Anti-inflammatory use (yes, really!)

 

When It’s Not an Injury

Many painful conditions aren’t tissue damage—they’re mechanical issues, systemic problems, or even neurological conditions. Clues that your pain isn’t an injury requiring simple rest:

• No clear traumatic cause (e.g., “No damaging event”)
• No bruising local to the pain (swelling isn’t unique to injuries)
• Unpredictable symptoms (better one day, worse the next)
• Pain lingers unchanged or worsens with time (instead of fading)
• Worse pain after activity than during (later that day, at night or the next day)
• Pain coinciding with unexplained weight loss (Don’t delay seeing your doctor)

Sometimes, an injury can coincide with a mechanical issue e.g., if you sprain your ankle, the ligament may be injured while the joint movement also stiffened up. The key is tracking how your pain behaves over time because the ligament will heal, and the joint may remain persistently stiff and painful beyond the healing process.
 

Why Does This Matter?

If you treat a functional or systemic problem like an injury (resting endlessly, waiting for “healing”), you waste time while missing the real issue and potentially let it worsen.
 

The takeaway?

• True injuries improve predictably with time and may require modified exercises during healing or in severe cases, may need surgery.
• Non-injury pain needs different approaches depending on the cause: movement retraining / medical investigation / specialist care.

If your pain doesn’t fit the “injury” pattern, it’s worth digging deeper. As physios, our job isn’t to treat pain—it’s to figure out why it’s there in the first place and then advise or treat accordingly.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Image designed by Freepik.com

Whether you’re crushing the spray wall at CityROCK or prepping your next weekend mission to Boven’s epic crags, there’s one golden rule: Don’t be the chop who skips the warm-up. Demanding function from your muscles on sandstone, quartzite or plastic is like trying to braai with wet wood — slow, smoky, and guaranteed to end in frustration. Let’s rather get you lekker warmed up while avoiding any rookie moves.
 

Why Bother?

Managing to climb hard before you pull on. Jumping straight into your project is like driving a bakkie in first gear on the N1 — it’s just not smart. Warming up however, has several benefits:

• Wakes up your tendons: SA rock doesn’t play nice. Cold fingers on Harrismith’s razor crimps? No thanks!
• Gets your head in the game: Zone out mid-climb, and you might just fracture Lightner’s ankle all over again.
• Saves your hips and shoulders: Whether it’s Jhb’s boulder cave or Chosspile’s Lord of the Rings Cave, roofs and drop-knees demand rotator cuffs and glutes which aren’t snoozing.

 

The Two Warm-Up Paths (Match your Mojo)

Option 1: The “Climb Up” Casual Warm-Up

• Perfect for: Social climbers, coffee-addicted humans, and anyone who thinks “dynamic stretching” is a TikTok trend.
• Start stupid easy: Climb 3 – 7 grades below your max. Eyeing a 25? Cruise an 18 first. Focus on flow, not flash.
• Mix it up: Traverse the CityROCK bouldering wall, do laps on the auto-belay, or find a spot for productive mat-work between the comfy sacks.
• Listen to your body: Feel a tweak? Step off, shake it out, and re-assess. No shame in being smart!

 

Option 2: Structured Warm-Up (For the “Type-A” Senders)

• Perfect for: Project chasers, comp kids, and anyone who alphabetises their gear rack.
• Step 1: Get the Blood Flowing (5-10 mins)
  • Light cardio: A jog on the treadmill, a quick cycle or even dancing to CityROCK’s questionable playlist.
  • Dynamic stretches: Arm swings, hip circles, and gentle wrist rolls – pretend you’re swatting away flies or mozzies.
• Step 2: Activate the Climbing Bits (10 mins)
  • Scapular pull-ups: Hang on a pair of jugs and give your shoulder blades 2 good squeezes.
  • Core drills: Dead hangs with knee raises or 30-second planks. A shaky core = wonky heel hooks.
  • Finger prep: Use CityROCK’s spray wall for open-handed grips and slow pulls. Save the campus boarding for after you’re warm!
• Step 3: Climb the Ladder (15 mins)
  • Start low, go slow: Treat each climb like a mini project, utilising crips foot work and ensuring steady breathing. Boulder bunnies, aim 1-2 grades lower. Rope rate, 2-3.
  • Drill a weakness: Practice some balance on the slab or work lock-offs if Superbowl’s steepness haunts your dreams.
• Step 4: Mental Prep (2 mins)
  • Stare down your project. Visualize the crux. Apparently, it helps to sip some green tea but be sure to channel your inner Janja for precision over panic.

Tips to Avoid “Ag, Shame” Moments

• Keep it simple: A 5-minute jog and 3 easy climbs might be all you need. Structured routines aren’t mandatory — just bladdy helpful.
• Crag-specific prep: a good walk to the base goes a long way but if the footing allows, feel free to add a short jog in before you set off or even once you’re there.
• Post-climb care: Stretch while the fire is still too hot to braai. Your boerie roll deserves a body less tight thana lead-fall figure eight.

 

The Bottom Line?

A warm-up should be like a good potjie — low, slow, and worth the wait. Whether you’re a casual CityROCKer or a Boven fanatic, 15-30 minutes of prep keeps your tendons happy, your sends stylish, and your mates from roasting you for being the one who popped a pulley before pitching the tent. Next time you’re tempted to skip the warm-up, ask yourself: Would you lead a climb with just a spotter? Nee wat! So get yourself going and then go crush those climbs in fine style.

P.S. Apparently CityROCK Jhb now has a legendary physio available on select days so grab a card at the front desk if you need tailored advice, targeted rehab or rapid relief.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Let’s talk about pain. Not the simple “I stubbed my toe” kind, but the stubborn, persistent kind that makes you feel like you’ve tried everything. You’ve gone to experts, spent time and money, maybe even blamed yourself when things didn’t work. Sound familiar? It’s a lot like dating: putting yourself out there, risking disappointment, but holding onto hope that this time might be different. 

 

The fear of trying and failing (again)  

Imagine going on blind dates or cheesy setups after a breakup. You’re hopeful while already dreading it, and part of you expects another letdown. Pain relief can feel the same way. Each failed attempt chips away at your confidence. Psychologists refer to the “perseverance loop” of pain – the more you try and fail, the more frustration grows, the more your pain amplifies. It’s like your brain shouts, “Why bother? Nothing works!” But what if giving up means that you’re missing your chance? 

 

Mindset matters: the “nocebo” effect  

You’ve heard of the placebo effect (belief in a treatment helps it work). But the “nocebo” effect is its grumpy cousin: if you expect failure, your body might sabotage success. Ask yourself:  

• Do I truly believe a solution exists?
• Do I trust my therapist’s approach?
• Am I ready to team up with them, not merely show up for appointments?

If you’re thinking, “This won’t work,” you’re already halfway to quitting. Pain is complex and relief is rarely magic – it’s teamwork with shared responsibilities.

 

Red flags (in both pain and love)  

Ever dated someone who seemed more interested in your wallet than your happiness? Sadly, some healthcare providers prioritise repeat visits and temporary relief over real progress even when their patient wants a lasting solution. A good one will educate and empower while celebrating your wins along the way. While some of us accidentally become so focussed on solving the problem in its entirety that we neglect to acknowledge the progress and relief already attained and need a friendly nudge to dial things back because progress can be worth more than perfection.

 

Your pain relief “dating plan”  

Treat this like a high-stakes project:  

Research wisely: Google can help, but it’s like asking a friend for dating advice – take it with a grain of salt.  

Weigh options: Is the solution quick but temporary? Empowering but time-consuming?  

Ask for help: Talk to people who’ve been there but remember – your pain is unique.  

Stay in charge: Speak up if something feels off. You’re the boss of your body.  

Trust, but verify: Lean on experts, but ask questions. Gut feelings matter.  

 

The bottom line  

Yes, trying again is scary. But like love, pain relief often takes a few awkward first dates before finding “the one.” Focus on progress, not perfection. Celebrate small wins. And remember: every failed attempt gets you closer to what works.  

Your pain doesn’t define you – and it certainly doesn’t get the last word.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

I believe it’s crucial to clarify some of the misconceptions around treatment options for nerve, muscle and joint pain. Physiotherapy and other “conservative” treatments are commonly opted for in trying to avoid surgery, as if surgery is the ultimate solution. This potential treatment-overlap is smaller than what we tend to think. Traumatic injuries, which account for only a small portion of both physio and surgical visits, have the potential to be effectively treated with either approach, weighing pros and cons on an individual basis.

However, similar to assuming who is guilty in a murder mystery, for most painful conditions and musculoskeletal complaints three common (and often misguided) scenarios can arise when the ideal profession to address a person’s condition was not consulted from the start:

1. Physiotherapists may unknowingly try to treat structural problems, which could on occasion be alleviated in part but will never be rectified without surgery.
2. Surgeons may operate on non-structural conditions, having assumed that their interpretation of the problem was correct, leading to lengthy recoveries and extensive rehabilitation without the surgery having had the capacity to remedy the true underlying cause of a person’s symptoms.
3. Lastly, conditions exist where neither physiotherapy nor surgery is suited to the problem, often requiring completely different solutions (e.g., rheumatic conditions, cancer, infections, etc) while both physiotherapy and surgery may at times be complementary to the treatment most valuable for that condition.

The quality of care provided to a patient therefore depends greatly on a medical professional’s ability in assessing each person’s history and current presentation in detail. Applying sound clinical reasoning to the information gained in the assessment to ultimately determine the cause behind the symptoms should be non-negotiable. We’re the detectives in the human body’s crime scene but that’s just the start… In addition to a reliable assessment, health professionals should prioritise two key considerations: understanding the nuances of each patient’s presentation and determining the patient’s best interest. This approach should take precedence over financial motivations or professionals justifying treatment within their scope of practice or their area of expertise.

Unfortunately, crime dramas have nothing on health care, due to:

1. Imaging limitations (e.g., incidental findings resulting in misplaced assumptions)
2. Healthcare systems driven by financial and status considerations
3. Overlapping symptoms obscuring the correct diagnosis, and
4. Our professional and personal biases despite our best intentions with patient care

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Photo by cottonbro studio

When are painful exercises / training sessions valuable?

“No pain, no gain” is so over sold that people easily assume it means that your undiagnosed pain will do well from pushing on… Sometimes this pays off and sometimes it backfires in spectacular fashion! But how would you know which one you’re headed for? And when are you wasting your time by avoiding pain?

Avoid these 5 pains:

1. Progressive increases in pain (be that within a training session, outside of training or from one day to the next)
2. Pain limiting your ability to perform or complete a task or an exercise
3. Undiagnosed pain, because your specifics response to different pains are essential
4. Pain demanding medication to keep your sanity (especially if you’re mixing medications, increasing medication strengths or ignoring maximum dosages)
5. Pain that persists and/or doesn’t progressively settle over any 3 consecutive days (tendon rehab being a very special exception to this last rule)

Pain can be a warning sign, sometimes a false alarm, and most certainly may have value in being produced intentionally in several specific scenarios. We often need our patients to produce very precise pain when their condition requires that to resolve the problem, but this is where a skilled health professional’s guidance comes in.

Gain from these 5 pains:

1. Regaining functional movements and range of motion post operatively often require a level of pain but we need to balance that between the risk of disrupting the surgical repair and the requirement of rehabilitating your required function.
2. In centralising referred pain, the production of the more centrally located pain is an excellent cue to confirm you’re being effective – but this pain is typically not the one which brought you to us in the first place.
3. Pain-free tendon rehabilitation is a complete waste of your time (let’s not even talk about the money wasted on massage, needles or strapping for tendon problems) but education on when which level of pain should be present is vital to have you approach this rehabilitation correctly.
4. Gaining strength and gaining fitness (increasing your capacity for load) may involve some pain and you can expect it to be equal on both sides of your body and you may never break rules 1-4 above while doing so.
5. Bonus repeat because it’s so often misunderstood: Proper tendon rehab will require regular (and at times persistent) production of your painful condition within a bona fide tendon rehab programme under the guidance of a skilled professional.

Your health and wellbeing deserve informed, personalised care. For tailored support, please discuss any questions or concerns with your physiotherapist of choice.

Image credit to IG @cottonbro

What is EXPOSS, you ask? This is the abbreviated name given to a research study from Canada based on the McKenzie assessment which showed surprising results in recovery from pain in an arm or a leg. “Extremity Pain Of Spinal Source” or plainly put, when your spine pretends that all is well but simultaneously takes you on a wild goose chase as it raises a complaint somewhere in your arm or leg.

The 2019 publication of Rosedale R, et al. in the Journal of Manual Therapy details how 43.5% of the 369 patients seen during the 16-month study period, had their arm or leg symptoms eradicated through spinal exercises/treatments alone, while they had no spinal symptoms suggesting the need to check the spine.

Each time any joint’s pain responded positively to the tested spinal movements, the data was added to the overall numbers (totalling 43.5%) but also to the data for that particular joint, which provides us with a guide on how often certain joints tend to pretend on behalf of the spine like this (see image above). Perhaps the most remarkable is that when more than 1 of these areas in the arm complained at once, they found that 83% responded positively to the spinal treatments, and in the leg, 72%. Knowing this makes me cringe whenever I see someone post operatively, who has had symptoms in multiple areas in their arm or leg all along. I always wonder if that surgery was ever in the patient’s interest, and the reality is that we’ll likely never know.

The value I take from this study, which I extend to my patients is this:

• Knowing which area to treat means we cut down on symptom-masking around the painful area while getting down to the cause and its symptoms at the same time.
• If a patient dreads a joint replacement or other surgical repair (especially following failed conservative treatments), we have a big chance of still getting good results and avoiding the operation completely when double checking the spine.
• Surgical results will improve if only joints and their surrounding tissues which truly need to be operated on, make it to radiology, a surgical consultation and into theatre.

As seen in the image above, the distribution of joint likelihood identified in this study is not quite linear and perhaps studies digging deeper into this phenomenon will shed further light and value for us all.

Your health and physical wellbeing should be a priority deserving of quality care. Make sure to discuss any concerns you may have directly with your preferred physiotherapist, so that you can receive the appropriate guidance for your unique situation.