Author: Michael Ranger

Covid Safe Plan

Covid Safe Plan – Physio Plus

In these currently challenging times we are doing our best to continue to provide the optimal care for everyone while at the same time maintain safety for all patients and staff.

With the recent move to Stage 4 restrictions in metro Melbourne we are doing the following to comply with all current health directives:

Attendance at Physio Plus for staff and patients:
– Masks will be worn by all attending patients and administrative staff. Clinicians will wear both face masks and face shields as directed by the DHHS.

– We are maintaining social distancing by maintaining confined space limits & separating waiting area furniture.

– We are greeting with a smile and a wave rather than shaking hands etc.

– Hand sanitiser is available on entry.

– Email and text reminders to all about symptom and health awareness. Follow up phone calls will be completed to ensure that patients attending are not suffering any symptoms consistent with Covid or awaiting Covid testing results.

– Clinical staff will not attend work should they be suffering any symptoms consistent with Covid or awaiting Covid test results.

– We are constantly cleaning all common surfaces.

– Clinicians will be the only ones touching consultation room door handles to decreased risk of patients touching common surfaces.

– We are asking patients to swipe/tap their own private health/eftpos cards rather than passing their cards to administrative staff.

– No pens will be shared. If you are required to fill out a form, you can keep your pen as a momento.

– Online bookings are still available to patients. Following a booking being made, administrative staff will be in contact with the patient to ensure that they require a face to face consultation and are feeling 100% (apart from their presenting complaint). If deemed appropriate, telehealth appointments will be encouraged.
Distancing measures at Physio Plus:
– Reception furniture has been removed to allow adequate distance between all chairs.
– Patients are asked to only arrive at the time of their appointment and can otherwise wait in their car to be let know when the clinician is ready to take them in.
– One on one consultations only with additional members of the patient’s party currently not allowed into the consultation room except for extenuating circumstances and currently reside or are a family member of the patient.
– All patients attending are required to abide by required distancing rules.
– Where ever possible, telehealth appointments are being utilised to minimise the need for face to face consultations.
Cleanliness and sanitation at Physio Plus:
– All common surfaces will be cleaned between each patient.
– Clinical staff will be the only ones touching their door furniture and they will wipe down anything touched by the previous patient before bringing the next patient in.
– Hand washing protocol print outs take pride of place in the bathrooms with soap and hand towels available for use. Hand sanitiser is available on reception desk for use on entry and exit.
– All payments will be contactless with administrative staff talking each patient through the process of swiping/tapping cards as required on payment.
– There will be no magazines or other common area reading material available.
Working at Physio Plus:
– All staff are required to have completed Department of Health assigned CovidSafe training. Certificates on display at reception.
– All staff will be issued with Permitted Worker Permits that will be available at any time requested by authorities.
– Clinical staff will treat for their entire session/day from the one consultation room. These rooms will then be cleaned thoroughly before use the following session or day.
– Rostering has been arranged to decrease number of clinicians and administrative staff in with the practice at any one time.
– Telehealth will be encouraged for all patients possible to decrease number of patients requiring time in the practice.
– Masks will be worn by all administrative staff. Clinicians will wear both face masks and face shields as directed by the DHHS.
Covid reporting at Physio Plus:
– All patients, as is normal practice, will leave full name and contact details in the event that they need to be contacted should a positive case of Covid occur at Physio Plus.
– In the instance that a staff member or patient reports a positive Covid test result, Physio Plus Footscray will immediately notify DHHS and all staff members.
– Physio Plus Footscray will then carry out the following staged plan as per DHHS direction.
– Should a staff member test positive for Covid then all members of the team will be required to undertake Covid tests themselves before isolating. DHHS protocols will then be used for return to work.
– Should a patient test positive for Covid, the clinician that treated that patient will be required to undertake Covid testing, isolate and following DHHS protocols before returning to work.
– Permitted Worker Permits will only be valid during periods when staff are not in isolation or awaiting Covid test results. Permits will be reissued once all clear guided by DHHS protocols.
Please let any of us know if there is anything you feel we can do better. We are committed to Covid safe practice in the best interest of everyone.

Cycling Injuries and helpful tips – Matt Delaney

Bike photo

With Metropolitan Melbourne now in Lockdown 2.0 exercise has become one of the essential reasons for leaving home. There has been a huge uptake in riders on the roads and we are loving it! Cycling is a fantastic sport and is a great form of cardiovascular exercise. It is beneficial for those after a hip or knee replace due to the low impact on the joints and with such a wide variety of bike set ups achievable it can be adapted to work around most injuries.

Due to the repetitive nature of cycling where most individuals will pedal somewhere between 60-120 rpm for one to four hours it is inevitable you will develop a niggle here and there. We will run through common areas for cycling injuries to develop and what to look for to minimise your risk of developing them.


  • Commonly anterior knee pain (patellofemoral pain, patellar tendinopathy)
  • Arises due to increase or abnormal contact pressures at the knee joint. This can be due to a suboptimal bike fit, rapidly increasing training volume, grinding away in heavier gears with a lower cadence.
  • Important to get a bike fit from a qualified professional and undertake regular strengthening exercises for your glutes and quadriceps outside your cycling sessions.

Lumbar spine

  • Normally arises due to prolonged time spent in a flexed position. Can occur when riding in a more aggressive/aero position than an individual can tolerate.
  • This can be affected again by a suboptimal bike fit and mismanaged training volume.
  • Ensuring regular strengthening exercise is complete for your core, glutes, and lower back will help mitigate this problem.
  • Those individuals with foraminal stenosis (narrowing of the spinal canal) or facet arthropathy will likely tolerate cycling well as these structures are offloaded.


  • Increased time spent in “aero” positions which causes the cervical spine to be forced into extension and protraction.
  • This position tests the endurance of our extensor muscles in our neck. Handlebar position and seat height play a large role this and need to strike a balance between an aerodynamic racing position and rider’s comfort/capacity.
  • Important to remember that for both our neck and lumbar spine if there is any radiating pain into upper and lower limbs, sensation changes or numbness this should be evaluated by a physiotherapist or general practitioner.


If you are experiencing cycling related discomfort but don’t want to stop, book an appointment today with Matt either onsite in Footscray or via telehealth from anywhere in Australia (or the world).

Exercise, workstation optimisation and pain reduction.

This week, Physio Plus Whitsunday Exercise Physiologist extraordinaire Yvette Porter was one of the speakers at an evening designed to empower people with some knowledge and skills in the following catagories:

  • Muscles to target for improved posture
  • Specific exercises for improved strength of postural support muscles
  • Stretches to aide movement and ease of good positions
  • Muscle release techniques to reduce resting tightness and pain
  • Workstation set up including desk and chair optimisation

The session was received very well by all in attendance and was a great collaboration between Maggie from SparkLIFE, Shelley from Proserpine Massage Clinic and our Yvette from the one and only Physio Plus.

For more information on any of the above topics or if you feel that an appointment with Yvette could aide your strength and function, please feel free to contact [email protected] or book online with Yvette following the links on our home page.

Covid19 update

To the Physio Plus Family.

In these currently challenging times we are doing our best to continue to provide the optimal care for everyone.

With recent metro Melbourne changes we are doing the following to comply with directions & maintain the safety of all:

– We are maintaining social distancing by maintaining confined space limits & separating waiting area furniture.

– We are greeting with a smile and a wave rather than shaking hands etc.

– Hand sanitiser and face masks are available on entry. Please ask practitioners to wear a mask/face shield if you feel more comfortable.

– Email and text reminders to all about symptom and health awareness and protecting yourselves and others by not coming to an appointment if you are suffering any symptoms.

– We are constantly cleaning all common surfaces.

– Practitioners are the only ones touching consultation room door handles.

– We are asking patients to swipe/tap their own private health/eftpos cards.

– No pens will be shared. If you are required to fill out a form, you can keep your pen as a momento.

Please let any of us know if there is anything you feel we can do better. We are committed to Covid safe practice. Stay safe and injury free.

Toe running V Heel running


Over the last 2 news posts we have talked about stress fractures, what they are and how training volumes can influence these injuries. Another thing that has been circulating in the research is how our running gait impacts the amount of force that our bones absorb during the act of running. The two main findings of the research have been that toe running and a quicker step rate are the most protective factors whilst running.

Toe running and mid foot running have been proven to create less shock for the bones to absorb as your foot hits the ground. This has been particularly studied through the tibia or shin bone. Toe and mid foot running requires more muscle control of the ankle, which reduces impact through the shin bone. Whereas most of the ground force in heel runners is taken through the bones on the lower leg.

Another suggested change to running gait has been to alter cadence which is a runner’s step rate per minute. It has been shown that increasing cadence by taking shorter steps reduces the amount of time spent on one leg and therefor reduces the shock through the shin and shearing forces as weight is transferred from left to right. Changing running pace is made possible in the everyday runner by using audio cues. A quick way to do this is to match your running playlist’s beats per minute to your desired steps per minute and run to the beat!

There is little study that has investigated how effective changing gait can actually be on reducing a runner’s risk to stress fracture. This is largely because stress fractures pose a multifactorial risk profile which is hard to study. There has also been no study looking into whether changing running gait or pace increases the likelihood of soft tissue injury.

Therefore, there is a lot more to learn! So for now, be aware of the factors that impact boney stress, be mindful of running volumes and if you are still experiencing pain whilst running – see your local physio for some advice!


Written by Physio Plus Footscray Physiotherapist, Monique Rowlands.

Workload ratio

WORKLOAD RATIO’s – Monique Rowlands

Acute to Chronic workload ratios have been heavily utilised in elite sports to reduce the risk of overuse injuries, particularly to muscles and bones. Last week we learnt about stress fractures, this week we will learn how best to structure our running volumes in order to gain the best performance whilst reducing our risk of overload. 

Acute to Chronic workload is a concept that measures this week’s workload against the average of at least 3 weeks workloads. First, you need to determine what you will measure, this is going to be different for each sport/activity. You could measure km’s, speed, time etc. We will use km’s for this example. Then you need to determine how many km’s you are completing each week and look back at these numbers over the last 3-4 weeks. This looks best as a graft. Then you need to find the average of these figures and this gives you your current “tissue tolerance”. Your body’s current capacity for exercise. Whereby your body’s natural ability to repair and recover from exercise is matched with the amount of exercise you are completing.

 This graph is a great way to keep track of what you’re doing each week and can help guide a ramping or rest period. In a healthy state, the body can safely tolerate an increase or decrease in load against your average or current “tissue tolerance” by up to 25%. Meaning, if you stay within this safe zone your risk of overloading is relatively low. Have you ever gone away on holidays for a month, relaxation level 100 and come home, gotten back into your normal running routine and noticed a few weeks down the track this niggling pain that won’t go away? Tracking your exercise even on weeks you’re not doing much is crucial to keeping on track of your body’s exercise tolerance.

If you have any questions regarding workload ratio, contact your physio today.



Bone stress and load management


Which means long distance running season is in full swing, even more so this year with sport and gym’s coming to a grinding halt. Alongside it’s cardiovascular benefits, running is known for helping reduce stress and anxiety levels so it’s no surprise that we are seeing a spike in amateur runners during COVID-19. Running is an excellent way to stay fit and healthy this season, however it does not come without it’s own risk of injuries.


Let’s talk about stress fractures.


Stress fractures are a phenomena that occurs when the volume of impact activity becomes too much for the body’s repair and recovery ability. Micro breakdown is a normal part of exercise, and in a perfect environment, the body regenerates this into stronger tissue for better performance. However, when the body is under pressure to perform this process micro breakdown accumulates and the bone structures become weak. If this process continues for enough time, this weak point in the bone will become a stress fracture. Stress fractures are most common in running athletes, and typically occur in the shin, foot, and hip. Females in their teens and around menopause are most susceptible, however anybody is at risk when running volumes and rest ratios are off.


If you have questions about your running and/or pain that you experience whilst running, talk to your physio today.