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Introduction
Skills and Expertise
Additional affiliations
April 2001 - present
April 2001 - present
February 1994 - March 2001
Publications
Publications (283)
Background
Despite exercise being a fundamental component of musculoskeletal rehabilitation, there is a lack concise, evidence-based recommendations to inform the clinician’s development of rehabilitative exercise programs for patients in a one-on-one rehabilitation setting. Current evidence is widely dispersed throughout the literature, with each...
Background:
The relative value of clinical tests toward identifying cervicogenic headache (CGH) remains under investigated. Whilst certain physical examination findings have been associated with CGH, consensus on which findings provide the strongest association remains elusive.
Objectives:
To determine which cervical musculoskeletal assessment p...
Objective:
The purpose of this study was to determine the feasibility of using detuned laser as a placebo intervention in manual therapy research.
Methods:
We performed a secondary data analysis of a randomized controlled trial. In our analysis, 30 participants with chronic ankle instability (manual therapy group: n = 13, age = 33.1 ± 8.1 years,...
Objective
To investigate if muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS).
Design
Single centre, three-arm, randomised controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up.
Setting
Private osteopathic practice....
Background
Shoulder impingement syndrome (SIS) is the most common form of shoulder pain. Conservative and surgical treatments for SIS are often not effective. One such surgical intervention is subacromial decompression, aimed at widening the subacromial space (SAS). A better understanding of the changes in the SAS may help explain the relative inef...
Objective:
To determine if adding hip treatment to usual low back pain care improved disability and pain for individuals with low back pain (LBP) and a concurrent hip impairment.
Design:
Randomized controlled trial.
Methods:
Seventy-six (76) participants (age ≥ 18, ODI ≥ 20%, NPRS ≥ 2 points) with LBP and a concurrent hip impairment were rando...
Background: Clinically, a discrepancy of fibular position in relation to the tibia has been proposed as a factor in the persistence of chronic ankle instability (CAI). Previous studies have produced conflicting findings, perhaps due to varying radiological methods and measurement of participants in non-weight-bearing positions.
Objectives: To compa...
Background
Data regarding injuries in community-based wheelchair sport athletes is limited and long-term management of injuries and their impact upon participation unexplored. Little data examines benefits and barriers to wheelchair sports participation across the community.
Hypothesis
The prevalence and nature of injuries sustained by wheelchair...
Objective
The purpose of this study was to determine if there is a relationship between pain and movement kinematics during functional tasks, evaluated over time, in individuals with chronic idiopathic neck pain.
Methods
Ten participants with chronic idiopathic neck pain performed 2 functional tasks (overhead reach to the right and putting on a se...
Background
The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and edu...
Background:
Cervical sensorimotor control (CSMC) outcomes have been suggested to be important in the assessment of individuals with neck pain, despite the lack of consistent supporting evidence that CSMC skills are related to neck pain.
Objective:
The aim of this study was to investigate whether CSMC changes over time in individuals with chronic...
Objective:
Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value. We aimed to compare cervical sensorimotor control outcomes between ind...
Background:
Shoulder impingement syndrome (SIS) is the most common form of shoulder pain and a persistent musculoskeletal problem. Conservative and invasive treatments, aimed at the shoulder joint, have had limited success. Research suggests shoulder function is related to thoracic posture, but it is unknown whether thoracic posture is associated...
Purpose:
To investigate the evidence for the effectiveness of MWM's in isolation for ankle sprains.
Materials and methods:
Medline, Embase, CINHAL and SPORTDiscuss were searched. Any RCT or cross-over trial assessing adolescents to adults with grade I/II lateral ankle sprains, and treated with any MWM technique was included. Any conservative int...
Study design:
Case-control study.
Background:
Cervical sensorimotor outcomes have been suggested to be important in the assessment of individuals with neck pain. However, the large variety of sensorimotor control tests used in varying populations makes it difficult to draw conclusions about their clinical value.
Objectives:
To compare cervical...
Background:
Clinical prediction rules (CPRs) are evidence-based tools to aid clinical decision-making, and there are many that are relevant for physiotherapists, especially in the musculoskeletal field. However, a lack of awareness and understanding by physiotherapy clinical educators could limit students' exposure to these potentially valuable to...
Background: Radiographic assessment is frequently used in determining the diagnosis and the management of ankle instability. Anterior positioning of the distal fibula following injury has been proposed as a factor in patients with chronic and recurrent ankle sprains and CAI. Previous radiographic studies of fibular position in such populations have...
Objective:
To systematically review whether there is an association between hip range of motion (ROM) and nonspecific low back pain (NSLBP).
Data sources:
MEDLINE, EMBASE, Cochrane library, PsychINFO, CINAHL and AMED databases were searched from year of inception until October 31st, 2018, using a combination of LBP and hip joint search terms. Co...
Background:
Sensorimotor control is commonly reported in neck pain research and rapidly gaining interest in clinical practice. Joint position error (conventional and torsion), postural balance, subjective visual vertical, head tilt response, The Fly®, smooth pursuit neck torsion and head steadiness are tests that have been reported to assess cervi...
General practitioners (GPs) play a key role in the return-to-work process, and yet their experiences working with workplace Return-to-Work Coordinators (RTWCs) have rarely been studied. The aim of this paper is to provide insights from the GP perspective about their experiences with workplace RTWCs and their preparedness for the role. GPs from Aust...
Objectives:
The main research aims were to investigate whether physical therapists are examining the hip(s) in individuals with a primary complaint of low back pain (LBP) and if so, the interventions being provided that target the hip(s).
Methods:
An anonymous electronic survey was distributed to the membership of the American Physical Therapy A...
Background: There is a growing number of clinical prediction rules (CPRs) relevant to physiotherapy, particularly in the musculoskeletal area, but many students are not learning about them due to lack of awareness or understanding by clinical educators. An educational package specifically designed for physiotherapy clinical educators would aid thei...
Background:
Recent evidence suggests that physical therapy interventions targeting the hips may improve outcomes, including pain and disability, for patients with low back pain (LBP). Currently, there is conflicting data in regard to whether an individual with LBP needs to have a concurrent hip impairment in order to respond to this approach. The...
Objectives:
The purpose of this study was to identify descriptive factors in individuals with a primary complaint of low back pain (LBP) associated with improved pain and function after receiving physical therapy for LBP with or without manual therapy and exercise directed at the femoroacetabular joints.
Methods:
Participants were enrolled in a...
Context:
Scapular taping can offer clinical benefit to some patients with shoulder pain; however, the underlying mechanisms are unclear. Understanding these mechanisms may guide the development of treatment strategies for managing neuromusculoskeletal shoulder conditions.
Objective:
To examine the mechanisms underpinning the benefits of scapular...
Background:
Radiographs are used to monitor thoracic kyphosis in individuals with certain pathologies (e.g. osteoporosis), exposing patients to potentially harmful radiation. Thus, other measures for monitoring the progression of thoracic kyphosis are desirable. The gravity-dependent inclinometer has been shown to be reliable but its validity as a...
Background: Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic whiplash associated disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whet...
We present the first documented case of an ectopic intramedullary hematopoietic niche within a cervical zygapophyseal joint intra-articular meniscoid. The meniscoid was identified in the cervical spine of an 81-year-old male cadaver, located at the dorsal aspect of the right C4-5 zygapophyseal joint, and was noted to be larger and more dense than o...
Objective:
To assess the clinical benefits of joint mobilisation on ankle sprains.
Data sources:
MEDLINE, MEDLINE In Process, Embase, AMED, PsycINFO, CINAHL, Cochrane library, PEDro, Scopus, SPORTDiscus and Dissertations and Thesis were searched from inception to June, 2017.
Study selection:
Studies investigating humans with a grade I or II la...
Background:
Neck pain and injury are common in rugby union. Physical characteristics predisposing players to neck injury are largely unknown. This study aimed to determine physical characteristics associated with neck pain and injury in rugby union players.
Methods:
Semi-professional rugby union players (n=142) underwent pre-season measurements...
Purpose Cervical spine meniscoids are intra-articular folds of synovial membrane that have been theorised to have potential clinical significance in neck pain. Recent anatomical and clinical research has re-visited the pathoanatomical capacity of these structures. The purpose of this review is to discuss cervical spine meniscoid morphology in light...
Objectives:
(1) To identify reported tests used to assess sensorimotor control in individuals with idiopathic neck pain and (2) to investigate whether these tests can quantify differences between individuals with idiopathic neck pain and healthy individuals.
Data sources:
Allied and Complementary Medicine Database, CINAHL, Cochrane Central Regis...
Purpose: Growing demands placed upon healthcare systems require more health professionals to be trained. Clinical placement education is an integral component of health professional training, however accommodating increasing numbers of student placements is a challenge for health services. Personal digital assistants such as iPadsTM may assist in d...
Study Design
Case-control study.
Background
Cervical spine meniscoids are thought to contribute to neck pain and hypomobility in individuals with chronic whiplash-associated disorder (WAD); however, their morphology has not been studied in a clinical population.
Objectives
To investigate cervical spine meniscoid morphology in individuals with chr...
Background: Cervical spine meniscoids are folds of synovial membrane that extend into the joint cavity of cervical zygapophyseal, lateral atlantoaxial and atlanto-occipital joints. It is hypothesised that these structures are potential contributors to pain and hypomobility in chronic whiplash associated disorder (WAD). However, their morphology has...
Conference abstract available at doi:10.1016/j.math.2016.05.041
Background:
Following brief training, an Australian workplace Return to Work (RTW) Coordinator is expected to provide information to the injured worker, liaise with key stakeholders and maintain workplace policies and procedures in accordance with legislative requirements.
Objectives:
The aim of this study was to provide insights into the experi...
Background context:
Innervation of anatomical structures is fundamental to their capacity to generate nociceptive impulses. Cervical spine meniscoids are hypothesized to be contributors to neck pain; however, their innervation is not comprehensively understood.
Purpose:
This study aimed to examine the presence and morphology of nerve fibers with...
Objectives:
Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine...
Question: Can sensorimotor control be identified and quantified in people with insidious onset neck pain compared to healthy individuals?
Design: Systematic review of English and Dutch language observational and intervention studies, identified through searching the databases MEDLINE, CINAHL, EMBASE, AMED and SportDiscus.
Participants: Individuals...
Question: What are the physical characteristics associated with neck injury history and increased risk of sustaining a neck injury in rugby union players?
Design: Prospective cohort study.
Participants: Semi-professional players (n= 142) from six NSW rugby union clubs.
Outcome Measures: Pre-season cervical spine range of motion (ROM), neck muscle s...
Question: Does shoulder taping affect the magnitude and timing of scapular muscle contraction and the corticomotor excitability of the scapular and shoulder muscles?
Design: Pre-post comparison.
Participants: 15 healthy individuals.
Intervention: Rigid strapping tape applied from the anterior glenohumeral joint to the inferior angle of the scapula...
Purpose: Determining the nature of innervation of anatomical structures is central to understanding mechanisms of pain generation. Lateral atlantoaxial (LAA) joints are known to be pain generating as free nerve endings have been identified in joint capsules, however it is unknown whether large diameter, potentially nociceptive nerves exist in LAA c...
Study design:
Cross-sectional case-control study.
Objectives:
To identify risk factors and clinical presentation of individuals with cervical arterial dissection.
Background:
Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is consid...
Background: Populations of patients with low back pain (LBP) are generally considered to be comprised of smaller subgroups who differ in regard to their prognosis and relative response to given interventions. Identifying these subgroups and targeting interventions provides individual and population level benefits. Clinical prediction rules (CPRs) a...
Background: The identification of subgroups of patients with low back pain (LBP) is a priority research area. Significant resources have been invested in the development of clinical prediction rules (CPRs) that function to identify subgroups of patients with LBP who meaningfully differ in regard to their symptomology, prognosis and response to vari...
Manual therapy is effective for reducing cervicogenic dizziness, a disabling and persistent problem, in the short term. This study investigated the effects of sustained natural apophyseal glides (SNAGs) and passive joint mobilisations (PJMs) on cervicogenic dizziness compared to a placebo at 12 months post-treatment. Eighty-six participants (mean a...
Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptio...
Objectives: The role of intra-articular meniscoids in spinal pathology is unclear, and their anatomy not well understood. Spinal meniscoids have been identified in research using dissection and imaging. No previous studies have identified these structures using E12 sheet plastination; such methods of visualising meniscoids are likely of value in re...
Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, an...
Demineralization can facilitate the dissection of soft tissue structures in inaccessible locations by softening surrounding bone so that it can be easily removed without risking damage to the structure of interest. However, it is unclear whether demineralization alters the morphometry of soft tissues if used for this purpose. We have therefore exam...
PURPOSE: Meniscoids are folds of synovial membrane that project into the articular cavities of zygapophyseal joints throughout the cervical spine. These structures have been implicated in musculoskeletal neck pain; however, their anatomy has not been extensively investigated. The purpose of this study was to explore the morphometry and composition...
Evidence is emerging for central nervous system (CNS) changes in the presence of musculoskeletal dysfunction and pain. Motor control exercises, and potentially manual therapy, can induce changes in the CNS, yet the focus in musculoskeletal physiotherapy practice is conventionally on movement impairments with less consideration of intervention-induc...
Objectives: To evaluate patients clinically diagnosed with early stage primary/idiopathic adhesive capsulitis (AC) to determine the existence of any pattern of movement loss and associated pain that may facilitate early recognition.
Design: Cross-sectional study.
Setting: Private upper limb specialty clinic, Newcastle, Australia.
Participants: Fift...
Background
Clinicians commonly assess cervical range of motion (ROM), but it has rarely been critically evaluated for its ability to contribute to patient diagnosis or prognosis, or whether it is affected by mobilisation/manipulation.
Objectives
This review summarises the methods used to measure cervical ROM in research involving patients with cer...
Cervical spine manual therapy has been associated with a small risk of serious adverse neurovascular events, particularly to the vertebral arteries. Sustained end-range rotation is recommended clinically as a pre-manipulative screening tool; however ultrasound studies have yielded conflicting results about the effect of rotation on blood flow in th...
Background:
Cervicogenic headache (CGH) is defined as headache symptoms originating from the cervical spine. Cervical dysfunction from abnormal posture has been proposed to aggravate or cause CGH, but there are conflicting reports as to whether there is an association between posture and CGH.
Objective:
The purpose of this study was to evaluate...