Foot pain

Intrinsic Foot Muscles

Foot intrinsics & intrinsic foot muscles

It is a commonly known “fun fact” that the bones of the feet make up roughly 25% of the total bones in the body. What is not as commonly understood is the complexity of the role the foot plays in the overall function of the body and the importance of the muscles that control the foot. A well functioning foot can adapt shape and both generate and dissipate force depending on the demands placed on it. Just think of a foot walking barefoot on pebbles compared to sprinting at top speed compared to dancing en pointe. The muscles of the foot make all these different activities possible.

When we discuss the muscles of the foot, they are often separated into two groups – intrinsic and extrinsic muscles. Intrinsic means the muscles originate and insert in the foot, while extrinsic means the muscle starts outside the foot (eg somewhere along the shin) but inserts in the foot (think along the lines of your calf muscles). The intrinsic muscles are often somewhat forgotten, but their importance in injury prevention is continuing to emerge in the research.

Foot physio


The intrinsic muscles of the foot are divided into layers. On the bottom (plantar surface) of your foot they are in 4 layers (listed below in order of most superficial to deepest)

  • Plantarfascia (thick fascia that is influenced by the muscles that insert into it)
  • Abductor hallucis, abductor digiti minimi, flexor digitorum brevis
  • Adductor hallucis, flexor hallucis brevis, flexor digiti minimi
  • Plantar interossei

On the top of foot is extensor hallucis brevis, extensor digitorum brevis and the dorsal interossei

Together these muscles control the arch of the foot, help modulate the foot and create the stiffness in the foot that is vital to forward propulsion in walking. Reduced strength and even muscle bulk of the intrinsic foot muscles has been implicated in a number of conditions in the foot and lower leg. 

Below are some exercises that specifically target the intrinsic foot muscles. Even if you are injury free they are fun to try out!

Short foot exercise (doming) – sitting down and keeping the toes flat (ie not curling under), “shorten” the foot by drawing up the arch of the foot

Toe spread – try to separate your toes away from one another

Big toe extension – keeping your smaller toes flat on the floor, lift just the big toe up

Small toe extension – keeping your big toe flat on the floor, lift up toes 2-5

If you have a foot injury or are interested in learning more about intrinsic foot muscles, you can book in to see one of our highly skilled Physiotherapists. Click here to book online now.

Chronic fatigue physiotherapy

The Role of Physiotherapy for Chronic Fatigue Syndrome

Chronic Fatigue is a complex disorder characterised by debilitating fatigue which can’t be explained by any underlying medical or psychological conditions. Therefore, it is often referred to as a diagnosis of exclusion. The symptoms can vary in intensity or range from person to person but often include headaches, nausea, fibromyalgia and sleep disturbances. Physiotherapy for Chronic Fatigue Syndrome can help to manage symptoms. If you, or someone you know is suffering from chronic fatigue, get in touch with Barefoot to learn about our chronic fatigue treatment Brisbane services.

Medically, fatigue is described as ‘ the early onset of tiredness after an activity has been started.’ Chronic fatigue is diagnosed when the fatigue has lasted more than six months. (Sanchez et al, 2005).

There are multiple means of treatment used for Chronic Fatigue but this blog will cover the benefits of Physiotherapy. At Barefoot Physiotherapy whenever a client presents with chronic fatigue we utilise the same treatment plan because it allows us to make tailored treatment programs for every client no matter what they presenting with. Here is a link to our blog explaining the Barefoot Physiotherapy Plan.

In our first session of physiotherapy for chronic fatigue syndrome, we will set realistic and measured goals with the client. These goals can range anywhere from social (ie. wanting to be able to spend 15 minutes at the park with their children without fatigue) to sporting (ie. 20 min walk or jog without fatigue).  Once we have developed a set of goals we then utilise manual therapy techniques to help reduce their discomfort, musculoskeletal or nerve irritation and once their strain is at a minimum we commence an endurance and strength program.

Exercise therapy is essential to improving chronic fatigue as it allows clients to build up their tolerance and endurance to every day tasks.  It is important to utilise a graded exercise program and assess each client’s tolerance level separately.  Exercise therapy should be functional allowing the client to build their strength and endurance whilst carrying out tasks that are utilised in their day to day activity. Exercise built into daily tasks is a great way to maximise adherence and to develop muscle memory and confidence within the individual. For instance, some ideas include, working squats into their day through utilising sit to stand, calf raises while boiling the kettle, step ups at the park with their children or upper body strengthening whilst putting the groceries away.

Once a client’s confidence is restored or improved and they are less intimidated by the prospect of a full exercise program you can introduce a more weighted or structured exercise program to continue building their strength and endurance. It is important to check back in with the clients goals to make sure they are on track to achieve them and if you have it is time to set new ones.  

If you or anyone you know of is experiencing the symptoms of chronic fatigue , muscle, joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. We are open 5 days a week and a couple Saturdays a month. We have early and late appointments available. Please call us at 1300 842 850 or Click here to book an appointment.

physio exercise

Physiotherapy for Menopause

Menopause + exercise

The importance of staying active across our lifespan is well known. However, menopause results in a number of changes including the body’s response to exercise. A shift in the way we workout can help mitigate the negative impacts of menopause and get the most out of exercise.

What is happening during menopause?

Estrogen and progesterone are two hormones that play a key role in normal menstrual cycles (along with luteinising hormone and follicular stimulating hormone). They both influence a number of systems throughout the body. This includes the cardiovascular system, sweating/body temperature, muscle and bone health and the central nervous system.

Quite simply put, menopause is the drop-off of these hormones which results in the cessation of menstrual cycles as well as changes to all the other systems normally affected. This can look like:

  • Loss of bone mass
  • Loss of muscle mass (reduced sensitivity to anabolic stimulus + reduced muscle protein + increased breakdown of muscles)
  • Reduced sensitivity to insulin
  • Increased serotonin and tryptophan (can contribute to ‘brain fog’)
  • Peri-menopausal fluctuations in hormones can contribute to hot flushes, poor sleep and poor cognition

Role of exercise in Menopause

Exercise can be used to help mitigate some of these changes and assist in optimising health. We know that exercise can aid in clearing the mind and assist in getting a good night’s sleep. Regular exercise is also one of the best ways to improve sensitivity to insulin. Any form of exercise is beneficial, so go with what you enjoy most!

On the other hand, more specificity is required to minimise loss of muscle and bone mass. As the body is less sensitive to ‘anabolic stimulus’ (eg resistance/strength training), the stimulus needs to be increased. Likewise, new bone mass is laid down in response to ‘novel stimulus’ so the body needs to be exposed to something new.

Exercise Examples for Menopause

Typically this can look like:

  • Heavier weights – for example swapping out 3 sets of 10 reps for 5 sets of 6 reps at a heavier weight (or adding in weight training if it hasn’t been part of your routine before)
  • Plyometrics (eg squat jumps, bounding, skipping, box jumps etc) – make sure you have an adequate base of strength/control before adding this in!
  • HIIT style training – moving the focus away from slower or ‘steady-state’ exercise and including some short high intensity efforts on short recovery (total session of ~20 minutes)
  • Some slow/steady-state exercise (eg going for a walk, long cycle or run) certainly still has its place. The higher intensity of exercise needs to be balanced with low intensity, easy days and rest days (otherwise everything just ends up at a medium intensity). These sessions also often serve the purpose of nourishing your soul! However, for best outcomes they shouldn’t make up the majority of exercise in the post-menopausal population

If you are interested in optimising your exercise to match your stage of life or just change your routine, make sure you chat to your physio to make sure the changes are done gradually to minimise the risk of injury. To book an appointment with a Barefoot Physiotherapist please click here. If you enjoyed this blog please check out out blog on Women’s Health Physiotherapy and Pelvic Floor Physio is Important for Everyone.

Breath physio

Breath and stress – from a Physio perspective

Written by: Caitlin Sargent

It goes without saying that the respiratory system is essential for life. However it also has an important interplay with musculoskeletal system and stress regulation. Poor breathing patterns can contribute to pain and dysfunction in a number of areas. Likewise, stress, pain and dysfunction can also contribute to poor breathing mechanics.

Normal breathing pattern

A normal breathing pattern sees the diaphragm and pelvic floor muscles lengthen and drop during inhalation. And naturally elevate and gently contract during exhalation. The movement of the diaphragm also encourages rib movement – the ribs gently lift and rotate outwards during a breathe in. As for all our muscles and joints, the body loves movement. So going through a well co-ordinated, full range of movement breath is great for our body. Taking these deep diaphragmatic breaths is usually not suitable or even necessary for the entire day. But we know our bodies love variability. So combining our normal breathing with occasionally slowing down to focus on our breath can work very nicely. 

What about stress?

When we are stressed, we tend to increase our rate of breathing. This increased rate also results in shorter breaths and a higher heart rate. Which can further contribute to our stressed state! The in breath is associated with our sympathetic nervous system (think ‘fight or flight’). While the out breath is linked to our parasympathetic nervous system (think ‘rest and digest’). When we increase our breathing rate, we usually spend more time inhaling than exhaling. As a result we continue to encourage that “fight or flight” response. If we are in a prolonged state of stress (eg big project at work or ill family member), we may subconsciously find ourselves taking slightly shorter and/or quicker breaths. Over a period of time this can have implications as our muscles and joints don’t go through their usual full range. We might see this play a role in back pain, rib pain, neck pain or pelvic floor dysfunction.

What can I do?

To help decrease our stress and encourage our breathing muscles and joints to move through range, we can focus on deep, slow breathes that particularly emphasise the exhale. For example: try taking a breathe in through your nose. Focus on feeling the air enter your nose and travel down your throat and into your lungs and belly. Then as you slowly exhale, follow the air back up to your throat and out your nose. For more relaxation exercises, see Catherine’s blog here.

If you think your breathing pattern might be playing a role in your pain, give us a call to see how a holistic physio approach might be able to help you.

Breath physio

An Introduction to the Anatomy of Breathing (with a focus on post-partum women)

Written by: Brittany Johnstone

One of the areas I’m very passionate about in Physiotherapy is helping women across the lifespan live their best pain free and happy lifestyle. That is why although this blog helps everyone create a better understanding of their breathing, there will be a particular focus on an introduction into considerations for breathing in post-partum women.  

Breathing is the foundation of our system. When we breathe, our diaphragm and pelvic floor move together. Breathing does much more than help us stay alive (although that is very important). It: helps regulate intra-abdominal pressure (to avoid hernias, prolapse, back pain), changes our stress hormones through the parasympathetic nervous system and promotes healing and tissue repair by increasing oxygen in our system.

When you breathe, muscle recruitment depends on the way you breathe and if you are in a resting breathing state (relaxed) or active breathing state (intense exercise etc).

Muscles of Respiration:

  1. Diaphragm (the primary muscle of inspiration (breathing in)
  2. Serratus Anterior (will activate when you take a big breathe in, but not into your neck and shoulders)
  3. Sternocleidomastoid + Scalene (helps with a shallow breathing pattern, breathing into your neck and shoulders)

Note: If your scalenes are tight from a shallow breathing pattern this can put pressure on your brachial plexus (arm nerves) and contribute to neck pain and nerve irritation, one of the reasons assessing breathing pattern is important.

Expanding our Diaphragm

Correct Diaphragm expansion helps to relax our deep hip flexors, lower back muscles and spinal muscles whilst activating our core and pelvic floor evenly. This helps to decrease neck, lower back and sacroiliac (SI) pain, naturally lengthen and strengthen the pelvic floor and resolve rectus diastasis by lengthening and strengthening the abdominals.

Postpartum women

When assessing postpartum women, the following considerations are needed for the core and diaphragm. During pregnancy the diaphragm gets pushed up and ribs gets pushed out, taking a deep breath in or out completely can be difficulty and the back can tighten to offset baby weight. Therefore the goals for the core and diaphragm post-partum are for the ribs to be back at a 90 degree angle, a regain of abdominal control to provide tension for the diaphragm and relearning how to optimize the diaphragm muscle into a deep breathing pattern. 

Want our help?

If this sounds like something you or someone you know needs help with or if you are experiencing any muscle, joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. The clinic is open 5 days a week and a couple Saturdays a month. Please call us at 1300 842 850 or Click here to book an appointment.

Incontinence physio

Pelvic Floor introduction

Written by: Brittany Johnstone

Physiotherapists will often talk to you about your pelvic floor and its importance to your core. If we think about our core as a cylinder we have the deep abdominal muscles which wrap around the cylinder, our deep back muscles which support from behind, our diaphragm on top and then our pelvic floor muscles which yes are essentially the base.

The role of our pelvic floor muscles are:

  • Urinary and faecal continence: The muscle fibres control the actions which allow controlled passing of faeces and urine.
  • Resistance to increasing intrabdominal pressure during daily activities including coughing or lifting objects.
  • Supporting the pelvic organs ie. bladder and bowel.

The pelvic floor is a ‘sling’ of muscles, a bit like a small muscle hammock that runs between the pubic bone in the front, and the tailbone at the back

Thank you for the Continence Foundation of Australia for the use of this image

Throughout your life you pelvic floor can be faced with different stresses that may cause it to become weaker, unable to relax or too relaxed. Whilst the pelvic floor is significant in women especially pre and postnatal it is also a very important structure of the male anatomy and special attention is needed if there have been any prostate surgeries.

Common cues utilised for teaching control of the pelvic floor:

  • Thinking about stopping the flow of urine mid-stream (this helps to contract the pelvic floor and can be a means for strengthening)
  • Thinking of your pelvic floor as an elevator and you are slowly going down the levels until you reach ground and then basement (a cue for relaxing the muscles)

Your physiotherapist can help you determine if you need to increase your pelvic floor strength with targeted exercises, relaxing or contracting the muscles or if you have the sufficient control required for a healthy pelvic floor. 

If you or anyone you know of is experiencing symptoms of muscle, joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. We are open 5 days a week and a couple Saturdays a month. We have early and late appointments available. Please call us at 1300 842 850 or Click here to book an appointment.

Injury recovery

LEA – Low Energy Availability

Written by: Caitlin Sargent

What is Low Energy Availability?

Research is coming to understand more and more about Low Energy Availability (LEA) and its wide-ranging implications on almost all systems of the body. Physiotherapists are well placed to help pick up on these signs to assist in early intervention. As with most conditions, prevention is better than a cure and the earlier treatment starts the better. So what is LEA?

Energy availability is very self-descriptive! It is measured using the equation below

Energy intake (ie food) – energy expenditure (exercise + energy needed for daily life) = energy availability

How can it present?

If there is inadequate energy intake for the activity being undertaken, then energy availability will be low which can have a number of consequences. These can include:

  • Poor immune function
  • Gastrointestinal dysfunction (including increased gut sensitivity)
  • Poor bone health/reduce bone mass
  • Endocrine/thyroid dysfunction
  • Menstrual dysfunction
  • Impacts on growth and development (in younger athletes)
  • Cardiovascular anomalies

As a physiotherapist, we may see:

  • Increased injury rate
  • Poor sleep and recovery, extreme fatigue
  • Decreased co-ordination
  • Irritability, depression or decreased concentration
  • Decreased muscle strength and endurance performance
  • Decreased training response

The science

While this is an evolving area of research, some recent studies suggest that up to 45% of recreational athletes and up to 80% or elite athletes either have or are at risk of LEA. In a sporting context, it is also referred to as relative energy deficiency in sport (RED-S).

It is relevant to note, that while disordered eating can play a role, many people are not purposely restricting their food intake. The combination of heavy training causing appetite suppression and underestimating the caloric demands of life + training is a factor in the high incidence of LEA.

Treatment for LEA/RED-S is usually led by a dietician (+/- psychologist if needed) and consists of fuelling strategies and modified activity until baseline health functions return. Physiotherapists can help play an important role in identifying LEA and managing graduated return to exercise/training.

References

https://bjsm.bmj.com/content/55/1/38

https://pubmed.ncbi.nlm.nih.gov/26841435/#:~:text=Low%20energy%20availability%20(LEA)%20describes,impairing%20health%20and%20athletic%20performance.

https://bjsm.bmj.com/content/bjsports/49/7/421.full.pdf

The Thoracic Ring Approach as incorporated in the Barefoot Physiotherapy Plan

At Barefoot Physiotherapy we utilise techniques from multiple learnings all combined into our unique Barefoot Physiotherapy Plan. These techniques include; LJ Lee’s training in The Thoracic Ring Approach™all of our Bachelor/Masters degrees, Mulligan, Maitland and Ridgway Methods, Western Acupuncture, Dry Needling, and Pain Science/Graded Motor Imagery. We are continually learning and evolving our Framework and an essential part of it is the Thoracic Ring training we have had.

The Thoracic Ring Approach™ is an innovative assessment and treatment technique for the body (treating through the thorax – which is the middle of the back and ribs) based on a broader understanding of how these areas are designed to function optimally. It fits well within our framework of seeing the body as a whole and in the context of whole body movement and optimal health of the whole person.

What is a Thoracic Ring?

A Thoracic ring is the 2 vertebrae and the ribs attached. For example the T4-5 vertebral segment (including disc) and ribs 5 on left and right.

How do you know if the Thoracic Rings are ‘The Driver’?

With the assessment of multiple rings and treatment techniques for them we can facilitate optimal biomechanics and replicate ideal motor control for the Thorax while hands on. If this facilitation/correction improves movements/meaningful tasks we can know that this is a significant area of the body (and potentially a Driver further through the body). We combine this information with the rest of our Clinical Reasoning in our Barefoot Physiotherapy Plan to determine whether the Rings are a true underlying factor of the clients problem (ie the reason they are seeing a physio!). As the LJ Institute states: “The reason this is essential is that it is common for the thorax to be relatively pain-free but dysfunctional; the dysfunctional thorax creates adverse stresses, loads and forces that can cause pain in any other area of the body.”

Treatment of The Thoracic Rings

When we move well we feel good and we move more. But the catch 22 is that we need to have the body feel good enough to move. Our treatment framework is based on getting the body moving through hands on treatment initially and teaching people how to move well – whatever that is for them! This dynamic view of the body means that an essential component of treatment is training optimal muscle activation patterns and muscle balance around the thoracic rings if they are a Driver. Manual techniques, taping, needling and self-release techniques such as “self stack and breathe” are used to treat Thoracic Rings if we have found them to be Drivers or significant in the clients body. What this does is release non-optimal muscle patterns to create a window of opportunity to train new muscle patterns.

If you are interested in seeing a Barefoot Physio trained in Thoracic Ring Approach please call 1300 842 850 or book online by Clicking Here

Physio protectometer

Neuroplasticity introduction

Written by Catherine Mullins

What is Neuroplasticity?

Neuroplasticity is the lifelong ability of the brain to undergo structural and functional changes in response to experiences. The medical world once thought that the brain stops developing in childhood but we now know that ongoing changes occur right up until death.

Information in the brain is transmitted from neuron to neuron via synapses (spaces). This is done through action potentials sending electrical signals along the neurons causing neurotransmitters (chemicals) to be released across synapses, attaching to the next neuron and continuing the process. Each synapse (space) can be linked to multiple neurons, therefore receiving information from a variety of sources. Neuroplasticity looks at the changes that can be made between neurons and synapses.

How does it change

Change can occur through the strengthening of existing connections, elimination of existing connections, or forming of completely new connections. Neuroplasticity is a huge component of rehabilitation following damage from strokes etc but it also very useful in recovering from acute injuries (eg changing balance and reaction times) or from chronic pain (changing movement strategies and functional capacity).

Not all neuroplastic changes are beneficial. Sensitisation of the nervous system can occur with strong or continuous stimulation, release of chemical mediators or by activation of the neuroimmune system.  This can negatively impact the firing of neurons by decreasing the amount of input needed to fire (reduced threshold) or increasing the reaction to a normal level of input (increased responsiveness). This means that things will start to cause a response at a much lower level of input, or with an exaggerated response.  I often use the analogy of a fire alarm.  We need a fire alarm to alert us when there is smoke and fire for our safety (i.e. a cut on the hand from a knife) but when the alarm goes off with burnt toast (i.e. a pen across the back of the hand) or even with steam from the kettle (a feather or clothing on the back of the hand), this is less useful and less accurate for us.

What causes changes

It’s not just physical input that can create change. Most people have heard of stress releasing cortisol into the body which is beneficial for the fight or flight responses but over time excess cortisol in the brain can prevent neuroplastic changes from occurring. Lifestyle factors such as poor sleep/nutrition or under or over exercising can lead to systemic inflammation in the body, increasing chemical mediators that further sensitise the nervous system.  

Deliberate engagement creates stronger connections. In the words of Donald Hebb, “neurons that fire together, wire together”.  The more that you follow a pathway, the stronger that pathway becomes. It’s all about deliberately choosing the pathway you want to follow!

Look out for Catherine’s next blog on Neuroplasticity in Chronic Pain

Physiotherapy Brisbane, Barefoot Physiotherapy

Neuroplasticity in chronic pain

Written by: Catherine Mullins

Chronic pain is defined as the presence of painful sensations that have lasted for more than 3 months and persist without the presence of physical tissue damage or pathology. Up to 20% of the population experience chronic pain at any one time.

What happens in the brain with chronic pain?

Part of the transition from acute to chronic pain involves neuroplastic changes in the central nervous system (brain and spinal cord) (see previous blog on Neuroplasticity for more info on sensitisation) and maladaptive (not useful) changes in body perception and awareness. This can physically result in a measurable change to the thickness of your brain’s grey matter (where majority of neural connections are found).

Two mechanisms that can occur in chronic pain involve the homunculus. The homunculus is the representative map of our bodies (both sensory and motor) within our brains. Each body part is given representation based on how many nerves are in the area and how much information is received/given. This representation map is (mostly) the same across all people.  In people with persistent pain (therefore persistent activation and input), the body area in question can become bigger in this body map, which means even more awareness of this area and an increased perception of pain. People with chronic pain tend to move less, move more slowly, and reduce the variety of movements.  This lack of input can lead to brain smudging in the homunculus and ultimately a reduced awareness around this body part.

Can we improve?

This can be changed again! Ultimately, we want to gradually introduce more variability to movement and postures, helping to remap the brain.  Sometimes we need to start with simply imagining ourselves performing an activity without pain (stimulating mirror neurons). Other times we can gradually return to activity, changing the load, duration and context to allow for pain free (or reduced) function.  We frequently utilise motor control exercises to help bring your awareness to an area and change patterning of muscle activation. Non-specific exercise of moderate intensity has been found to release BDNF (brain-derived neurotropic factor) and IGF (insulin-like growth factor), both of which help support neuroplastic growth.

If you’re experiencing chronic pain and want to know more – get in touch …. we love helping our community. You can book online here