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Real Time Ultrasound
Real time ultrasound allows the capturing of real time pictures of structures within the body, using high frequency sound waves that are inaudible to human ears.The sound waves, which are completely safe for human tissue, are sent into the tissues, and the sound waves that are bounced back are used to create the picture. This amazing technology is widely used in medicine for assessing internal organs, blood vessels and developing babies. Ultrasound is also extremely useful for imaging muscles, tendons and ligaments when assessing the consequences of an injury or the cause of persisting musculoskeletal pain. Twenty years ago physiotherapists began using ultrasound not only to look at the size and health of muscles, but to look at activation patterns of muscle groups. There is now a large volume of scientific research confirming the validity, reliability and usefulness of such techniques.
While we can see and palpate the superficial muscles, it is not possible to accurately assess size, quality or activation patterns of deep muscles, as these muscles lay beneath other larger, more superficial muscles. While superficial muscles are generally our power producers for movement, the deeper shorter muscles hug around our joint providing protection, stability and fine control of movement. Researchers have shown that there are often ongoing problems in our deep muscle systems in persisting pain states or recurrent injury. General strengthening programmes in these cases have often failed to normalise function in the deep system, even though the superficial system has become larger and stronger. This can sometimes make the problem worse – if you have larger muscles placing greater loads across joints that are relatively unprotected by an inefficient deep system, worsening pain or re-injury can occur.
Deep muscles are often inhibited and superficial muscles overwork to compensate in persistent pain states or recurrent injuries, resulting in muscle imbalance, pain and stiffness, and reduced efficiency and physical performance.
Deep muscles are particularly prone to inhibition. We know from research that pain inhibits deep muscles, and a lack of weightbearing or poor postures can also negatively influence deep muscles around the spine and pelvis. The superficial muscles have been shown to be much less susceptible to inhibition, so if the deep system is not doing its job the brain ‘upregulates’ the superficial system to ensure you can still get from A to B (hunter & gatherer survival instinct).
However when superficial muscles try to do the ‘stabilising’ job – 1. You become much less efficient using lots more energy for each task (remember you usually only use small muscles to do this task with less metabolic cost) and 2. The underlying joints are exposed to much higher compressive loads and shear forces imposed by the big superficial muscles. This can make you feel tight, rigid or less fluid in your movements, more fatigued, and more painful, and the loss of efficiency may reduce athletic performance.
Real time ultrasound provides an incredible opportunity to assess the health and function of these muscles, not only at rest, but during active movement. No other imaging modality has the same versatility as ultrasound. Physiotherapists can then use ultrasound to train you how to consciously activate your deep muscle systems and protect your joints more effectively prior to and throughout movement. It also helps us to teach you to ‘downregulate’ your superficial system making you less rigid and more efficient in your movements, and then we can strengthen the both systems together in safe and balanced way.
Real time ultrasound provides a unique window into the function of our deep muscles during movement. This level of information cannot be provided by visual assessment, palpation or any other imaging modality to date.
Real time ultrasound and lower back pain
The greatest volume of research surrounds the use of real time ultrasound in the assessment and retraining of muscles around the trunk in those with back and pelvic pain. Ultrasound is used to assess and retrain muscles of the abdominal wall, deep lumbar stabilisers (multifidus), and the pelvic floor musculature. Retraining these muscles with real time ultrasound is often an excellent first step in the recovery of optimal function.
Physio's skilled in RTUS +
Dr Alison Grimaldi
Alison is our Principal Physiotherapist, with 28 years of clinical experience and particular expertise in the management of hip, groin and lumbo-pelvic pain and dysfunction. Alison also has a special interest in the assessment and optimisation of lumbo-pelvic and lower limb biomechanics for running, change of direction and all weightbearing sports, aiming to maximize an athlete’s performance outcomes and minimize risks of injury or re-injury.
Alison completed a Bachelor of Physiotherapy at the University of Queensland in 1990, a Masters of Sports Physiotherapy in 1997, and her Doctorate in Philosophy in the Field of Physiotherapy (PhD) in 2008. Her PhD studies were concerned with improving our understanding of hip muscle function and the relationship with hip joint pathology and weightbearing stimulus. These studies involved research collaboration with the European Space Agency. Alison continues to be passionate about extending our understanding of why we develop problems around the hip and pelvis, and what we can do to most effectively prevent and manage these problems. She is currently involved with research studies through the University of Queensland and University of Melbourne, has co-supervised a number of PhD students, and has pioneered the use of Real Time Ultrasound technology for the assessment and retraining of muscle function around the hip & pelvis. Due to her valuable contributions to research at the University of Queensland, Alison has been awarded the title Adjunct Senior Research Fellow in the School of Health & Rehabilitation Sciences.
It is one of Alison’s core beliefs that research should be relevant to clinical practice and helping the patients we treat every day, and that physiotherapists in the community should have access to this valuable information to allow them to transfer this knowledge into clinical practice as quickly as possible. To this end, Alison continues to publish, present and provide practical workshops for other health professionals. Alison has published a number of papers in scientific journals, has contributed detailed information freely accessible via podcasts by PhysioEdge (itunes) and the British Journal of Sports Medicine (SoundCloud), and has recently contributed to 3 leading physiotherapy and sports medicine text books. Alison is a visiting lecturer at Masters level at Queensland University, and also runs weekend seminars and courses around Australia & overseas with a focus on muscle function, therapeutic exercise, and the use of real time ultrasound in clinical practice. She has presented at many state, national & international conferences as an Invited or Keynote Speaker, and has run international seminars in England, Ireland, Scotland, Wales, France, Belgium, Canada, United States of America, New Zealand, Singapore, Hong Kong and Dubai (UAE).
Alison established Physiotec in 2005 and continues a clinical load, working with patients with complex hip and lumbopelvic conditions, and across a broad spectrum of sports, including elite level triathlon, running, dance, cricket, athletics & swimming. She also spends a considerable amount of time mentoring her excellent staff, ensuring they are up-to-date and able to provide a high level of clinical expertise for management of musculoskeletal problems.
Dr Xiaoqi Chen
Physiotherapist @ drchenphysio.com
Special interests in neck, back, shoulder, arm pain, whiplash, concussion, headaches, cervicogenic dizziness, Hypermobile Spectrum Disorder (HSD) and Hypermobile Ehlers Danlos Syndrome (hEDS)
Chen is from Singapore and has been a physiotherapist since 2009. She completed her PhD at the University of Queensland in 2017, which studied the risk factors associated with neck pain, and the impact of workplace-based interventions on neck pain in office workers (2017). Her passion to bridge the gap between research and clinical practice is manifested in her publications related to exercise and ergonomic interventions for neck pain, and sensorimotor dysfunction in people with chronic neck pain. Altogether, Chen has co-authored 7 publications in the manual therapy, physical therapy, and occupational health journals, with more papers currently in preparation. Chen was also a clinical tutor, examiner, and guest lecturer to physiotherapy students at the University of Queensland from 2014-2018.
Chen’s list of clinical interests are as follows:
- acute/chronic neck, back, shoulder and arm pain
- whiplash and associated disorders (i.e. dizziness, headaches, visual disturbances)
- concussion syndrome
- cervicogenic (i.e. neck-related) dizziness
- nerve impingement, radiculopathies, disc-related pathologies
- thoracic outlet syndrome
- shoulder impingement, bursitis
- work-related injuries (Workcover claims)
- complex, car accident related injuries (Compulsory Third Party, CTP insurance claims)
- Hypermobile Spectrum Disorders (HSDs)
- Hypermobile Ehlers Danlos Syndrome (hEDS)
A combination of advice and education, real time ultrasound (RTUS), electrical muscle stimulation, taping, dry needling, Clinical Pilates, exercise prescription and manual therapy are utilised in her practice. Chen continually improves her practice by keeping up to date with the latest technology, skills, and research.
In her free time, Chen contributes reviews and her digital editing skills to Physio Network, an online platform that allows physiotherapists around the world to keep up with the latest research in physiotherapy. She regularly updates her personal website with the latest information and patient resources at drchenphysio.com. Outside of work, she enjoys reformer Pilates, yoga, hiking, tennis, a good coffee, reading, and playing the piano.
Links to Chen’s publications and media appearances related to her research are listed below:
Honors & Awards:
- 2017 Dean’s Award for Outstanding Higher Degree by Research Theses (University of Queensland)
- 2013-2017 Australian Postgraduate Award Scholarship (Australian Federal Government)
- 2012 University Merit Award (University of South Australia)
- 2012 Three Minute Thesis Finalist (University of Queensland)
Sharon completed her physiotherapy degree, a Bachelor of Physiotherapy with concurrent research-based honours, at the University of Queensland in 1997. In the first five years of her career, Sharon worked in a diverse range of physiotherapy special interest areas including general hospital medical/surgical, intensive care, burns, paediatrics, women’s health, neurology, rheumatology, amputees, orthopaedics, hydrotherapy, inpatient/outpatient neuro-rehabilitation, gerontology, palliative care and musculoskeletal outpatients. Sharon has worked in major teaching hospitals in Brisbane, Australia and London, England as well as smaller rural based clinics and urban practices.
As well as working in various hospital facilities, Sharon worked concurrently in musculo-skeletal outpatients/private practice for the first eight years of her career. In the more recent 12 years of her career she has worked solely in Brisbane in private physiotherapy practices and has been working at PhysioTec with Dr Alison Grimaldi since 2010.
She has extensive experience in the management of hip, pelvic, spinal and shoulder pain and developing targeted rehabilitation programs and teaching pilates, use of real time ultrasound for muscle recruitment training, integrated dry needling approaches and more recently added the Compex muscle stimulator to her rehabilitation strategies.
Sharon has a special passion for treating those with Hypermobility Spectrum Disorder and Hypermobile Ehlers-Danlos Syndrome. She has recently attended Ehlers-Danlos conferences in the USA and Sydney. Her primary aim is to achieve meaningful functional and quality-of-life improvements for patients with individualized and paced exercise programs. Sharon uses a problem-solving approach to achieve goals and improve function in this often-complicated group of individuals. As the Hypermobility Team Leader at PhysioTec, Sharon mentors other team members regarding evidence-informed care for this group of people. She is always interested in fostering relationships with other professionals who have a special interest in this field of connective tissue disorders.
Sharon believes that a broad knowledge base is paramount in understanding her clients who present with a multi-faceted issue. With this in mind, Sharon is very proactive with her approach to regular professional education, reviewing clinical research and adapting her treatment approach appropriately as new evidence emerges.
Annie has always wanted to pursue a career that would allow her to help people make a difference in their lives. Her goal is to help pain sufferers to break their viscous pain cycle and not let it interfere with their lives. She also passionate about helping you set YOUR goals and then guiding you step-by-step to achieve them.
After finishing her Bachelor of Physiotherapy at University of Queensland, she has been keeping up with her learning and always making sure that she has the most up-to-date knowledge and skills. The techniques she has learned throughout the years include exercise therapy, movement re-education including running retraining, pain education, manual therapy including muscle energy and Mulligan techniques, dry-needling and kinesio-taping.
Women’s health is one of Annie’s special interests. She has done numerous courses in the past few years to continue building up her knowledge/skills to treat all women’s health issues including incontinence, over/underactive bladder syndrome, prolapse and antenatal/postnatal care.
Since she started working for PhysioTec, Annie has also been heavily involved in the hypermobility service. She believes that people who are hypermobile can still be strong and live minimally painful lives. Combining her great depth of knowledge on hypermobility conditions and her many years of experience in Clinical Pilates, she is confident in providing hypermobile clients a safe environment in which to exercise, while improving their muscle strength, posture, endurance and working towards their functional goals.
Working together with your other health professionals, Annie will always help you to find a realistic treatment plan that will fit into your lifestyle and help you to achieve your goals.
Her idea of the perfect weekend is watching the sunrise from her bike at the break of dawn, followed by relaxing in a nice café with the company of friends before enjoying a beautiful sunset, bringing the day to a close.
Paul Bosisto graduated from Physiotherapy at Latrobe University in Melbourne in 1989. Paul has worked extensively with neurological disorders and is passionate about the brain and nervous system. More recently, Paul has directed his neurological knowledge to understanding and managing the problems of complex pain states, sensory-motor disorders, disabling fatigue, functional neurological disorders and hypermobility.
Paul has extensive involvement with the Australian Physiotherapy Association. He was Chairperson of the APA National Neurology Group from 2011-2014 and is currently Chairperson of the Qld Chapter of the APA Pain Group. Paul is currently completing a Master of Science in Pain Medicine.
Paul is committed to an approach of finding simple self-management solutions for complex problems. He combines education, cognitive behavioural change, exercise and traditional physiotherapy techniques to restore lifestyle balance and reduce the impact of longstanding difficult to manage problems. Paul’s repertoire includes neurological physiotherapy, vestibular physiotherapy, sensory-motor rehabilitation, pain management, fatigue management, cardiac and respiratory rehabilitation and musculo-skeletal physiotherapy.
Paul is a runner and has completed 9 marathons. Paul is also interested in teaching self-management strategies for running injuries and overtraining syndrome.
Acute and chronic pain management:
Includes complex pain disorders such as CRPS, Neuropathic pain, Fibromyalgia, Complex Regional Pain Syndrome, Back pain, Sciatica, Neck pain, Pelvic pain, Lateral hip pain, Shoulder pain, Ehlers Danlos Syndrome and Headache.
Sensory processing disorders:
Sensory motor disorders, Sensory modulation disorders, Sensory integration disorders.
Functional neurological disorder, Chronic fatigue syndrome, Dystonic disorders, Non-epileptic seizure and POTS syndrome, Neuropathy. Paul can also treat: Stroke, Brain and Spinal cord injury, Multiple Sclerosis & Parkinson’s disease.
Benign positional vertigo. Meniere’s disease, Labyrinthitis/Vestibular neuritis.
Bike Fit Analyst
Eric has been a qualified Physiotherapist since 2004, having worked in a variety of clinical settings from medical centres to holistic health centres before joining Physiotec in 2009. With this many years at Physiotec, Eric is currently our longest serving physiotherapist. For many years, Eric split his time between PhysioTec and providing onsite injury management services to a variety of manual handling industries. In 2018, Eric decided to move from onsite injury management to work with Dr Patrick Weinrauch at Brisbane Hip Clinic. His many years working and training under Dr Alison Grimaldi and now under Dr Weinrauch make him highly qualified in the management of Hip & Groin pain.
His other interests in physiotherapy are neck and upper back pain, cycling related pain and injuries and dry needling. Eric is a competitive cyclist himself, runs his own cycling crew, MIA, and is passionate about all things cycling. He has competed at both Australian and World Track Championships. Eric provides our bike fit service and has a personal and professional interest in strength & conditioning. This experience he brings to our GymStart programs, where Eric can teach, assess and correct your form with gym lifts to ensure you will be safe and gain maximum benefit from your gym program. He has a wealth of knowledge and experience where it comes to balancing optimal performance outcomes and recovery from injury or training fatigue. In his spare time he also enjoys spending quality time with his family and keeping a great looking tropical aquarium.
Gym and Program Coordinator
Colm graduated from the University of Limerick in 2007 with an Honours Degree in Physiotherapy.
Colm has worked in a variety of clinical settings including musculoskeletal practices, MS Ireland and Sports teams. He worked for 6 years with Munster Rugby in Elite Rugby Union in Ireland and Europe.
Within Physiotherapy he has a particular interest in Hip injuries and Gym based rehabilitation for people returning to sport/post-surgery.
Colm moved to Physiotec in 2017 to further his experience and using his experience in Elite Rugby to help implement gym based rehabilitation programs in the clinic. A lifelong Learner, Colm is constantly keen to learn and work at a high level and regularly completes up to date professional development. He is currently completing a Masters in Sports Physiotherapy from the University of Queensland.
Outside of Physiotherapy, Colm is a keen sportsman having played Gaelic Football and Hurling at club level. He also loves to play the guitar and banjo.
Megan completed her post graduate Physiotherapy Masters degree at the University of Sydney and has an undergraduate Bachelor degree in Health and Exercise Science from the University of New South Wales.
Megan’s primary interest area is within Women’s Health and she treats a variety of conditions including pelvic floor weakness and stress/urge incontinence for women of all ages, as well as pre and post-natal women. She has undergone extra training in this field and has presented to community groups regarding Women’s Health issues. Megan is also passionate about restoring optimal movement and function for areas surrounding the hip and pelvis, as well as with running injuries and Hypermobility.
Megan assists Dr Alison Grimaldi with data collation associated with our Hip & Groin rehabilitation programs and her research work at the University of Queensland and is also working with Physio-Network, a company providing online research reviews for physiotherapists to promote evidence-based practice.
Megan enjoys running, touch football and Pilates and she teaches both group and individual Pilates classes here at Physiotec.
Louise has a double Masters having completed her Master of Musculoskeletal Physiotherapy in 2012 and a Master of Sports Physiotherapy in 2013 at the University of Queensland. The Masters of Musculoskeletal Physiotherapy has provided Louise with superior skills in assessing and treating acute and chronic spinal conditions, as well as a broad range of upper and lower limb conditions. The Masters of Sports Physiotherapy has equipped Louise in thorough assessment and treatment of a wide range of sporting injuries with attention to biomechanics, management of injury, and return to participation. Louise has additional training in dry needling techniques and dynamic taping.
Having grown up with a passion for dance, Louise has a special interest in assisting dancers through injury recovery, optimising technique, and assisting in injury prevention. She has attended multiple additional courses for dancers including the treatment of hip, foot and ankle injuries, pre-pointe assessment, and flexibility workshops. She completed her Pilates instructor classes at Dance Medicine Australia, Melbourne.
Louise is currently completing a Masters in Pharmacy which she hopes to combine with her physiotherapy knowledge to better assist those on long-term medication for persistent pain states.
Louise enjoys attending a variety of gym based exercise classes to maintain fitness and general well being. She is also a keen snow skier and has developed our “Snow-Fit” classes to assist snowboarders and skiers prepare for their next snow adventure. If she isn’t in the clinic, Louise will usually be found in a country somewhere enjoying the snow!
Julie Allen – Physiotherapist
Julie Allen is an empathetic, caring and delightful physiotherapist with over 20 years experience in both sports physiotherapy and rehabilitation for chronic neck and back pain. She is passionate about tailoring exercise filled with enjoyment, skills and interests. Her early career was filled with success as a sports physiotherapist who travelled with Australia’s top international sporting teams including the Australian Hockeyroos, Queensland Firebirds, the Brisbane Blades and Queensland Netball State teams. Her passion was rehabilitation after injury, helping athletes recover and return either to full function or transition to life post sport.
Julie is also a survivor of Non Hodgkins Lymphoma and has drawn on both her professional expertise and own cancer experience to develop the Pentimento Project – A physiotherapy approach to post cancer treatment rehabilitation. Julie offers individual tailored rehabilitation options, in addition to group support sessions. Her aim is to assist cancer survivors regain a level of physical and psychological health and wellbeing in a quest for improvement in quality of life.
She obtained her Bachelor of Physiotherapy with first class honours from the University of Queensland in 1994. She is a member of the Australian Physiotherapy Association (APA)and endorsed by the Australian Health Practioner Regulation Authority (AHPRA). She works closely with The Queensland Branch of the Leukaemia Foundation. She also provides service to clients of Haematology Oncology Clinics of Australasia (HOCA) and their clinical network company: Integrated Clinical Oncology Network (ICON).
Visit The Pentimento Project founded by Julie Allen
Kirsty qualified in 1998 as a Bachelor of Physiotherapy with Honours in the UK. Coming to Australia in 2000, she has worked with and treated a multitude of sporting disciplines including triathlon at the Goodwill Games and Brisbane Premiership rugby union.
For 5 years she provided physiotherapy for the Australian Short Track Speed Skating, traveling extensively to World Cups. In 2006 she was selected as a Physiotherapist for the Australian Team at the 2006 Winter Olympics. Having completed her Masters of Sports Physiotherapy at the University of Queensland in 2006, she focused her attentions on tennis and became a Physiotherapist for the Australian Tennis Open, continuing this until present day. Her wide experience with sporting teams has provided her with a high level of expertise in the management of acute and overuse sports injuries.
In addition, she has been involved in teaching, including within the University of Queensland post-grad Physiotherapy courses as well as running courses for Physiotherapists nationally.
Of special interest to Kirsty is the treatment of injuries relating to the hip, shoulder and lower limb complex. Her skills involve screening evaluation to correct muscle imbalances and joint alignment – both in the treatment and prevention of injury – as well as a high level of hands-on treatment skills. Kirsty also has a high level of skill in the use of real time ultrasound for muscles assessment and rehabilitation around the trunk, hip and shoulder.
Real time ultrasound and hip and groin pain
Dr Alison Grimaldi has pioneered the use of real time ultrasound for assessment and retraining of the deep musculature of the hip and groin. She has been using these techniques very successfully for over 10 years, and teaches these techniques to other physiotherapists around Australia and abroad.
Optimal function in the deep trunk and hip musculature is the foundation for optimal weightbearing function and ability to transfer load between the legs and body. These techniques can be useful for almost any musculoskeletal condition of the hip and groin.
Ultrasound retraining of the deep gluteal muscle - gluteus minimus.
Real time ultrasound and the foot intrinsics
Ultrasound is a fantastic tool for assessing and retraining the deep muscles that lie within your foot. These muscles are crucial for support of the arches of your feet and for helping you monitor and adapt to the surface on which you are walking or running. They connect you to the earth and sensors within these muscles provide essential information for your brain and nervous system to help you plan how you should balance your body weight, or where you might place your next foot.
These muscles often become inhibited and atrophied due to lack of stimulus – too much time sitting, not enough time barefoot or on stimulating surfaces (not that you should through off your shoes if you have foot pain – the muscles need to be strengthened first). Like other deep muscles these deep short muscles can be difficult to assess, especially when you are standing.
Ultrasound however allows us to see these muscles and provides feedback on-screen so you can be sure you are activating them properly. This is great for plantar fasciopathy (plantar fasciitis), forefoot pain (metatarsalgia, Mortons neuroma), bunions (hallux valgus), arthritis, tibialis posterior dysfunction/tendinopathy, shins splints (medial tibial stress syndrome MTSS) and many more conditions of the foot, ankle and shins.
Real time ultrasound and patellofemoral pain (PFPS - syndrome)
Dysfunction of the quadriceps, particularly of the Vastus Medialis Oblique (VMO) has been shown to occur in those with pain around the kneecap (patella). The VMO is thought to be important in controlling loads, particularly shear forces, across the patellofemoral joint – where the kneecap slides up and down in a groove in the lower end of the femur.
The VMO has become very inhibited but getting some real time biofeedback with ultrasound can help your brain connect with the muscle, and get it working for you again. Poor function of the hip abductors and rotators has also been closely linked in patellofemoral pain research studies. We also use ultrasound to help optimise muscle function at the hip in patients with patellofemoral pain.
Real time ultrasound and shoulder pain and instability
Real time ultrasound can also be an invaluable tool for managing shoulder pain and instability. It can be used to help you improve function of the muscles that control scapular position and movement, and for retraining of the rotator cuff. This is useful for conditions ranging from postural related pain, to rotator cuff tendinopathy or tears, glenohumeral joint instability or arthritis.