8 Key Points

The way we are taught to do an “initial examination” is neither practical nor effective.  Yes, it covers the important questions for diagnosing a patient’s problem, but it has its drawbacks. The nature of the questioning often leads to an interviewing process which is far too lengthy.

This causes a number of critical problems:

  1. Firstly, it leaves barely enough time to do the rest of the consultation, including an accurate assessment of the problem, explanation of the findings, treatment, advice and even exercise prescription.
  2. Secondly, it can cause the patient to become anxious about time and to begin to lose confidence in you as a therapist.
  3. Furthermore and most importantly, a traditional initial assessment neither facilitates nor allows time to cover the 8 key points.

These 8 key points are important to provide the best quality care for our patients and build long lasting patient rapport.


  1. Am I in the right place?
  2. Can you help me?
  3. What’s wrong?
  4. How long will it take to get better?
  5. How often do I need to come?
  6. What can I do if it doesn’t get better?
  7. What are YOU going to do to help me?
  8. What can I do for myself?

Here at Enhance Physiotherapy, part of putting you first is to answer YOUR questions, not interview you.  We have come up with a unique initial consultation that answers all your questions and helps you get the answers you need to know to know that you have made the right choice.  Here’s what we think…..

These 8 key points are the questions the patient has “buzzing around” in their mind when attending a consultation. It is vital to provide answers to these questions as they are essential for building patient rapport, confidence in you as a practitioner and customer satisfaction.

Chronic Pain

Chronic Pain


By definition, Chronic Pain is persistent pain that lasts longer than 12 weeks. Most people may be new to the notion of chronic pain because we have the common belief that pain goes away when tissues heal after an injury or illness, usually less than 12 weeks. However, this is not the case for 1 in 5 Australians and pain may not lessen even when the healing process is complete.

Chronic pain is complex and can be frustrating because it involves the nerves and nervous systems.  Chronic pain occurs because of changes to the nervous system, which keeps the nerves firing and signaling pain. However, there are likely to be other factors that can contribute to chronic pain, including; genetics, gender and previous episodes of acute pain.  Chronic pain can be intense and unrelenting, and lead to various degrees of disability if it is not well-managed.

Chronic pain refers to the amplification of pain by the central nervous system. Pain itself often modulates the way the central nervous system does, meaning a chronic pain patient can become more sensitive and get more pain with less provocation over time.

Chronic pain is a grey area in health care. Because tissues have healed, however, the alarm system and brain have changed in an effort to protect you, diagnoses based on tissue processes are no longer fit. Patients end up with multiple theories depending on which healthcare practitioner they see.

For people with chronic pain from Fibromyalgia sufferers to a whiplash victim, changes in the spinal cord and the brain may no longer receive accurate information about what is happening in the tissue. In this sensitized state, the brain is being fed information that no longer reflects the true health and abilities of the tissues at the end of the nerve. Brain responses such as movement, thoughts, or autonomic, endocrine and emotional responses, are now based on faulty information about the health of the tissues at the end of the nerve.

Due to the complexity of chronic pain, it is important to be under the care of a healthcare practitioner who thoroughly understands the chronic pain pathways. This ensures that your pain can be properly managed and you can have a better understanding of your body and pain.

At Enhance Physiotherapy we use the latest up-to-date research and treatment techniques to treat chronic pain and we understand the frustrations behind the pain. We are here to plan, treat and offer options for you to lead a life that has pain at a manageable level.

Cervicogenic Headaches and Dizziness

The Global Burden of Disease study ranks headache disorders as the 2nd leading cause of years lived with disability worldwide (Saylor and Steiner 2018). Three common types of headaches exist: migraines, tension-type headaches or cervicogenic headaches.

Cervicogenic headaches are secondary headaches that are related to a disorder in the upper joints of the neck. It is a referred pain, meaning the pain is perceived to be felt in the head, although the source of the pain is the neck. Similarly, cervicogenic dizziness is characterised as dizziness or “vertigo”-like symptoms that are a result of upper neck (cervical spine) dysfunction or injury.

What causes cervicogenic headaches or dizziness?

Because numerous pain sensitive structures exist around the neck (cervical spine) and the back of the head (occipital) region, irritation to structures in this area can result in headaches or dizziness-like symptoms. Working in poor postures or sustained neck positions can cause excessive strain and load to the upper joints of the neck, leading to dysfunctions in the muscles around the neck. Traumatic injuries including motor vehicle accidents, sporting injuries or falls, can also damage these joints. Osteoarthritis, or age-related changes can develop in these joints in older populations, resulting in cervicogenic symptoms.

How do I know if I have a cervicogenic disorder?

A person with cervicogenic headaches will often have reduced neck range of motion, symptom reproduction when touching areas around the neck and associated neck pain. Headaches usually start at the back of the head or neck and can radiate to the front of the head or behind the eyes. Symptoms can be aggravated after being in one position for a prolonged period (i.e. sitting at a desk) or with neck movement. About one third of people with cervicogenic headaches will also report light-headedness, unsteadiness or visual disturbances (APA website). A person with cervicogenic dizziness will similarly have limited neck movement, neck pain, and can report symptoms of unsteadiness, imbalance or disorientation (Reily et al. 2017).

How can Enhance Physiotherapy treatment help?

There is high quality evidence that supports the use of manual therapy and exercise for managing cervicogenic headaches (Gross et al 2015; Hall et al 2007; Jull et al 2002; Racicki et al 2013) and dizziness (Jull et al 2007; Reid and Rivett 2005; Reid et al 2007). Your Enhance Physiotherapist may use different manual therapy techniques, taping, dry needling and prescription of strengthening exercises to help treat your symptoms.

If you believe you may suffer from a cervicogenic disorder, an adequate and thorough assessment by an Enhance Physiotherapist is essential in correctly diagnosing and excluding from other conditions. This is because different headache and dizziness conditions require different treatment and management plans. At Enhance Physiotherapy, our physiotherapists specialize in upper cervical spine disorders and can thoroughly assess your condition, provide a diagnosis with treatment plan or refer you to the appropriate medical practitioner if necessary.

Book your Enhance experience online today or call us on 9583 5165


Saylor and Steiner. The Global Burden of Headache. Semin Neurol 2018:38