Osteitis Pubis- Where did it go? Billy Williams Clifton Hill Pilates & Rehab

Passionate supporters in the AFL community will more than likely be familiar with the once frequently used diagnostic term, ‘osteitis pubis’. In the early 2000s, it seemed every second player was reported to be suffering from this troublesome injury of the hip/groin which was responsible for significant amounts of missed game time and a complex, challenging recovery period.

However, in recent times you may have noticed that it is very rarely being reported in the media by elite sports clubs. But why is this? Are therapists better at managing groin pain in sport? Is the term extinct? The answer might surprise you…..

Leading into 2014, there was a large amount of disagreement and uncertainty regarding the use of diagnostic terms for hip and groin pathology within the sports medicine and physiotherapy industry. Osteitis pubis, or OP, was often used as an umbrella term to describe a number of injuries which were potentially co-existing, and as such became easily recognisable by the public. It was widely accepted that an athlete with OP would require a lengthy rest period and a graded rehabilitation back into training and sport.

In November 2014, 24 experts in groin pain from a number of backgrounds and countries (including surgeons, sports physicians and physiotherapists) attended Qatar for a meeting to discuss the inconsistencies in hip and groin diagnostics. Prior to the meeting, each expert was given the same two case study examples. These included descriptions of relevant clinical symptoms, results of clinical tests and imaging findings for an athlete who was experiencing groin pain. They were then asked to independently provide their expert diagnosis.

For case study one;

NINE different diagnostic terms for primary diagnosis were used!

For case study two;

ELEVEN different diagnostic terms were used!!!

Across the two case studies, 22 different clinical terms were used to describe primary, secondary or tertiary injuries of the same two case studies! This clearly highlighted the need for an agreement on what should be considered accurate terminology when describing hip and groin pain. This would be critical in understanding the anatomical details of each athlete presentation and facilitating clear cross-referral between practitioners.

This meeting is known as the ‘Doha Agreement’. It advocated that long standing groin pain be classified under the following clinical entities;

  • Adductor-related groin pain
  • Iliopsoas-related groin pain
  • Inguinal-related groin pain
  • Pubic-related groin pain
  • Hip-related groin pain
  • Other conditions (including non-musculoskeletal diagnosis)

These clinical entities are often broken down with further more anatomically descriptive terminologies for deeper accuracy. However, many terms, including osteitis pubis, were not recommended for clinical use by the group of experts.

Since the Doha agreement clinicians are gradually becoming less comfortable with using the term osteitis pubis, and as such the public are hearing it less often. It is still occasionally used as it is easily recognisable by many sports fans, and this helps with honest translation of information from clubs to their fans.

Next time you hear OP mentioned in the media, understand that it is likely an injury related to one or more of the many tissues around the hip and groin such as the adductor muscles, the pubic bone, the hip joint or other physiological structures. An accurate and correctly descriptive diagnosis of a hip or groin injury can be obtained by collaborating information from reported symptoms, high quality clinical assessment and then complemented by diagnostic imaging findings. Once an accurate diagnosis is achieved, an appropriate rehabilitation and return to activity plan can be prescribed.

This accurate diagnosis is relevant if you are an athlete, if you enjoy non-competitive exercising or even to improve your ability to complete common daily tasks such as walking or shopping. The fantastic physiotherapists at CHP/CHPR/INP are experienced in working with sporting and non-sporting patients, and are your perfect first stop to work towards getting the answers to your troublesome hip or groin…. Hint; It’s not osteitis pubis.

Billy Williams, APAM

Bachelor of Physiotherapy

Graduate Certificate of Sports Physiotherapy


Weir. A., Brukner. P., Delahunt. E., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 49(12). 768-774.


Are you getting enough sleep?

More and more research is coming out about the importance of sleep, yet almost a third of us get less than 7 hours quality sleep each night. Sleep takes place in three stages and deep sleep actually allows your brain to clean itself. Put scientifically, during deep sleep, the spaces between our brain cells expand by up to 60% allowing cerebral-spinal fluid to remove toxins such as beta-amyloid (a protein that can negatively affect memory). Also, research shows links between poor sleep and increased pain, as well as a correlation between lack of sleep and diseases like stroke, diabetes and depression.

The following tips may help improve your sleeping:

  • Set a nightly routine.
  • Dark, cool room.
  • Warm bed.
  • Relax and prepare for sleep before getting into bed; read a book, listen to calming music, do a puzzle.
  • No smoking and alcohol close to bed time (both can cause waking during the night).
  • No screen time 1-2 hours before bed; this will help your natural body clock.
  • If your partner snores, try different ear plugs.
  • Avoid a heavy dinner/dessert, but a light snack may help if you are hungry.
  • Avoid stimulants in the afternoon and evening.
  • Keep the bedroom for the two S’s.
  • Try practising mindfulness; it can decrease the effort of sleep.
  • If you are having trouble, don’t stay in bed worrying about it, get up but stay in a low-lit room.

If you’d like more help finding ways to improve your sleep quality, I recommend the 21 Day Sleep Programby Smiling Mind. Go to the App store, download the free App, create a login, go to ‘All Programs’ and it will be at the top of the page. Good luck and sleep tight.


Women in Sport – A Growing Force!

Sport Australia recently released the latest AusPlay data which details sports participation across the nation.

Netball has retained its position as the leading team sport for women and girls in Australia, with over 1 million actively participating in netball and choosing netball as the sport they most closely identify with.

It is fantastic to read that female participation is on the rise in many other sports as well- in particular there has been a surge in women participating in AFL since the introduction of AFLW. In the 2017 survey there were 31,542 women participating in AFL once a week .  This number has risen to 59,504 in 2018.  The number of women participating in AFL twice a week or more has risen by 154% growing from 19,005 to 48,225!

We are also seeing an improvement in the professionalism of women’s sport, and it is fantastic to see so many role models emerging.  As young girls are able to see more and more high level women’s sport, hopefully we will continue to see participation rates increase and girls will be more likely to continue playing sport as they grow through adolescence to early adulthood.
Athletes such as Jo Weston (Australian Diamonds netballer), Alyssa Healy (Australian cricket player), Erin Phillips (AFLW player), and Samantha Kerr (captain of the Matildas soccer team), are becoming more familiar names championing women’s sport and demonstrating high performance behaviours for young girls to aspire towards.  The benefits of sport and physical activity are well known, and the more we can foster our young girls and young women to participate the better.

Netball, as a female dominated sport that has been around for a long time, has a well established pathway for participants.  From NetSetGo for 5-10 year olds, through to club netball and pathways for elite performance, there are also avenues for recreational participation for all ages.  There are many social netball competitions around Melbourne as well as Vic Health and Netball Victoria’s “Rock Up Netball” initiative which enables people to play when they like without the weekly commitment of a club or team.

Hopefully over time we begin to see these similar pathways across many other sports to help bring more young girls and women into sport and keep them involved across their lifespan.

Jane Higgs

Physiotherapist and Pilates Instructor


DRAM (Abdominal seperation) – an update from Ali Harding

Abdominal Separation: What is it? Can we prevent it? And what to do about it!


Ali recently headed to Sydney to update her skills and knowledge on DRAM management and the function  of the abdominal wall.

Abdominal separation or DRAM (Diastasis Rectus Abdominal Muscle separation), happens commonly during pregnancy, and, to a degree is a normal change in a woman’s body.  As your baby grows, the increase in abdominal pressure has to be transferred somewhere.  The fascia or Linea Alba (strong tissue holding our six pack abs together) softens and widens and the abdominal muscles elongate and stretch, resulting in these muscles pulling away from the midline and the characteristic ‘separation’.  Research states that up to 66% of women will have a diastasis in the third trimester of pregnancy, and other literature found 100% of women included in their study had a diastasis at 35 weeks!  So – it is certainly common, and to some degree we would expect it.


Why do we care?

Our abdominal muscles are important in maintaining the function and support of our abdominal wall and are involved in all movement of the trunk.  They help to maintain and contribute to intra-abdominal pressure which can affect the pelvic floor and lower back.  This is particularly important during the post-natal recovery phase as our bodies are recovering.

Furthermore, women are often concerned about the appearance of their belly post-natally and we know that treating and undergoing rehab for an seperation can help improve this.  DRAM has been linked to low self body image due to this fact.


We do know that there is a period of natural self recovery in abdominal separation, usually until 12 weeks post-partum.  If your separation remains wide following this time it is a good sign that you should seek an opinion from your women’s health physiotherapist, in order to ensure full functional recovery.

How do we assess it?

Your treating physiotherapist will use the real time ultrasound to visualise and measure the separation, assess superficial and deep abdominal muscle function, strength and endurance, and provide appropriate exercises based on this information.

How do we treat it?

Commonly used and researched treatment methods include, abdominal binding (Such as compression garments or tubigrip, load management, postural education and retraining, and appropriate exercise rehab.  The key to successful management of these conditions is to retrain and improve the function of the abdominal muscles and strengthen the fascia.  This is achieved by exercising the abdominal muscles in the right way and allowing your body time to retrain this function in a safe and load appropriate manner for your recovery.

And finally, can we prevent it?

Maybe, in some cases.  As we mentioned earlier it is most often a normal change that occurs during pregnancy!  However, if we can identify it early, teach postural awareness, load modification and the appropriate type of abdominal exercises, we can often reduce the degree to which a separation will occur!

Ali and all of our female physios are able to help provide assessment and management of these conditions in post-natal women.  If you have any further questions, don’t hesitate to give us a call to discuss further!  

Enjoy a healthy pregnancy – Guidelines for exercise throughout pregnancy

We are constantly being told these days how good exercise is for us. It can improve our physical fitness, our mental health and reduce the risk of numerous chronic diseases such as diabetes and heart disease.

Pregnant women used to be told to rest or take it easy, as it was believed that exercise might be harmful for the mother and /or her baby. These days there are more and more studies showing us that lifestyle behaviours during pregnancy can have a huge effect on the woman’s health and that of her baby. Physical activity is now being proposed as a therapeutic measure to reduce pregnancy complications and optimise maternal-fetal health worldwide.

Some of the suggested benefits of physical activity for pregnant women include:

  • Improved muscular strength and endurance
  • Improved cardiovascular function
  • Reduced back and pelvic pain
  • Reduced fatigue, stress, anxiety and depression
  • Reduced risk of pregnancy-related complications such as pregnancy-induced hypertension or pre-eclampsia
  • Reduction in excessive gestational weight gain with fewer delivery complications, and
  • Prevention and management of urinary incontinence

What exercise should you do during pregnancy?

  • If you were inactive prior to falling pregnant the recommendations are to start being more active by slowly increasing the duration of gentle exercise, such as walking.
  • Pregnant women should accumulate at least 150 minutes of moderate intensity physical activity each week to achieve clinically meaningful reduction in pregnancy complications
  • This physical activity should be accumulated over a minimum of 3 days/week, however being active daily is encouraged.
  • Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding some gentle stretching, such as yoga or pilates may also be beneficial
  • Pelvic floor muscle training exercises should be performed daily, to reduce the odds of urinary incontinence. It is advised to get proper instruction on technique to get maximal benefits.
  • Women who experience light-headedness, nausea or feel unwell lying on their back are recommended to modify their position and avoid exercising in this position. Do. not exercise on your back in the second and third trimesters.

Some safety precautions for exercising whilst pregnant, include:

  • Avoiding activities which involve physical contact or danger of falling, as this may increase the risk of foetal trauma (such as martial arts, horse riding, skiing, hockey, gymnastics, cycling)
  • Avoid scuba diving
  • Avoid physical activity in excessive heat, especially with high humidity
  • Maintain adequate nutrition and hydration – drink water before, during and after physical activity.
  • Know the reasons to stop physical activity and seek medical advice immediately if they occur.

First trimester: Correct pelvic floor exercises, proper technique for core exercises, fix any postural imbalances and continue exercising.

Second trimester: Correct pelvic floor exercises, no exercising on your back, no heavy lifting, no new exercise (except Pilates), prevent pelvic pain, maintain muscle strength, improve deep core strength.

Third trimester: Pelvic floor exercises, no exercising on your back or tummy, maintain fitness and strength.

Post-natal:  Whether you had a natural or caesarean delivery, the first 6 weeks is gentle. Enjoy being a mum and focus on walking, pelvic floor exercises and correct deep core exercises. It is best to get your tummy and pelvic floor muscles checked by a physio before returning to exercise. When your baby is 12 weeks old and you have been cleared by your health professional, you can slowly return to your normal exercise routine.

If you have any concerns regarding exercising whilst pregnant or have any aches and pains during your pregnancy it is probably best to seek some advice from a health practitioner, such as your doctor or physiotherapist.

The team at Clifton Hill Physiotherapy have a lot of experience in helping women to start and continue exercising during their pregnancy by managing any aches and pains you have.

We also run small supervised group exercise classes at our Clifton Hill Rehabilitation and Pilates site. Here we provide a tailored exercise program for you to help you to achieve your exercise goals.


Clare Williamson


Pilates instructor


Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy, British Journal of Sports Medicine 2018; 52: 133-1346


Pilates and health reform -all you need to know.

You may be aware that the Department of Health’s private health insurance reforms for natural therapies will take effect from 1 April 2019. This means private health insurance rebates will no longer be available for a number of natural therapies. Physiotherapists will be the only practitioners who will be eligible to deliver exercises drawn from Pilates within their scope of practice and be eligible for Private Health Insurance rebates.

You are still covered for classes at CHPR when they are conducted by a qualified physiotherapist and you can still claim on your Private Health Insurance as usual.

If you previously claimed private health insurance extras for Pilates classes, you will still be eligible to make a claim for services provided by Physiotherapists at CHPR and nothing will change in that regard.

What will change?
The new rules mean that some wording has to change on receipts and how our classes are described online in MBO and our website, these will now be referred to as  Clinical Exercise Classes. The new rules also make it mandatory for you to have your program reviewed regularly by your physiotherapist. It is essential that you make an individual appointment to have your personal program and goals reviewed at least once every 12 months or sooner as guided by your physio. It is also essential that initial individual assessments are done and programs are designed and taught thoroughly before joining a class or rejoining after a long break or for a new problem.

Not all Private Health Insurers are adopting all the new rules. The reforms can be confusing, and we hope this helps explain the changes and how they may affect you. If you have any further questions, please don’t hesitate to ask us at CHPR.

Kind regards,

The team at CHPR

PROLAPSE- Forget the taboo girls –talk about it and get help!

There is a taboo topic that women are fearful of discussing but should be discussing…something that everyone likes to ignore because it can be embarrassing and a little awkward. The reason we should be discussing prolapse is that 50% of women over the age of 50 that have had a vaginal birth will experience this issue! But it doesn’t just effect women over 50. And there is something we can do about it!

Prolapse of the pelvic organs; commonly known among health professionals as “POP”.

It will affect many women throughout the lifespan and in fact one in four women are currently experiencing one or more prolapse symptoms. These symptoms can include a feeling of heaviness in the vagina, difficulty emptying the bladder or bowel properly, a sense of a lump or bulge in the vagina. What is a prolapse anyway? How does it happen and what are the symptoms? But more importantly how can I prevent it and what can be done for it?

POP means a weakening of the vaginal walls allowing the organs that sit adjacent (bladder, cervix or rectum) to sit lower in the pelvis allowing them to be felt more in the vaginal walls. This issue commonly occurs after a difficult vaginal birth, particularly those involving forceps. It can also occur from long term (years) of straining on the toilet to pass a bowel movement.

POP is commonly the reason that we see women give up sport. The impact of running, jumping, skipping, lifting heavy weights is that is can worsen the symptoms and severity of a prolapse.

The great news is that pelvic floor physiotherapy can help prevent and treat prolapse! We can identify women that are at higher risk to help them understand prevention. We can treat those that are already dealing with prolapse with exercises, lifestyle advice and now a new service at Clifton Hill Physiotherapy – a support pessary.

Issy is credentialed and trained to fit silicone pessaries. This is a product that can allow women to get back to activities which were previously too symptom- provoking or causing concern about worsening their prolapse.

So what is a pessary?

Well it certainly isn’t a new invention although they have come a long way in the past 10 years. They are a soft, silicone device of various shapes; often a ring or a cube which is inserted into the vagina to help support the vaginal walls. Think of it like scaffolding to help support a building. It can be used for sport, lifting toddlers, or every day. When fitted correctly they are completely comfortable and there should be no way of knowing it is even there.

A pessary can be completely transformative. We have fitted them in women who are now back into their running, basketball, cross-fit or general life activities without the worry of making their POP worse. In fact in some women it can actually improve the POP.

If you’re interested in discussing prolapse or a pessary come in and see one of the lovely physiotherapists in the Pelvic health team who can help guide you through the process.

Our Pilates Teachers are familiar with ensuring prolapse-safe exercise , speak to you instructor if you have symptoms.

Isabella Lees-Trinca 

B Physio Grad Cert Continence and Pelvic Floor Rehabilitation


New Bone Health classes at Clifton Hill Pilates and Rehab

Busting the myth of Osteoporosis – Physiotherapy can help more than you think.

Osteoporosis – what does it mean?
Osteoporosis is a condition that affects bone density, due to a depletion of minerals like Calcium. This results in the bones in your body being more brittle and more prone to fractures, even with minor bumps or falls.

How would I know if I have Osteoporosis?
Osteoporosis is very common: it has been found to affect over 1 million Australians! 1 in 3 women, and 1 in 5 men over the age of 50 years old are affected and will suffer an osteoporotic fracture (International Osteoporosis Foundation).

Check you risk factors:
– Age: > 50 years old.
– Gender: Females at greater risks due to hormonal changes through life.
– Family history: Genetic predisposition.
– Calcium intake: low calcium results in lower bone density.
– Vitamin D levels: Vitamin D helps absorb Calcium and can also have an effect on bone density.
– Medical history: corticosteroid medication side effects can include low bone density, digestive  malabsorption disorders and chronic illnesses such as rheumatoid arthritis chronic kidney/liver disease can lead to osteoporosis.
– Lifestyle factors and exercise history: low levels of physical activity or low osteogenic exercise levels result in low bone density. Smoking, excessive alcohol consumption and being overweight have also been shown to increase risks of osteoporosis.

There usually are no symptoms until a fracture occurs, so having regular bone scans past the age of 50 is recommended, in consultation with your GP (Osteoporosis Australia).

What type of exercise should I do if I have Osteoporosis? – Osteogenic Exercises

Osteogenic exercises – quite surprisingly, they are actually impact-based exercise training. Unlike the common belief that patients with osteoporosis should stay away from any impact to protect their bones, controlled impact training actually provides an appropriate stimulus of ground reaction force to help stimulate and promote stronger bone density.
This contradicts the commonly thought myth of having to avoid activities like jumping, running or any other impact type of activities when one has been diagnosed with osteoporosis.

Playing basketball or netball is more osteogenic than swimming or cycling – because the body has to adapt to the jumping and impact landing involved in basketball and netball. In other words, our bone production centres react to the specific type of exercise we perform (stimulus) and adapt to the amount of force our body is exposed to.

That’s where your Physiotherapist can help!

Physiotherapists are experts in exercise rehabilitation and will help tailor an exercise program that will match your physical levels and start some impact and resistance training in a safe way for you to slowly and gradually build up your bone density and lean muscle mass.

Introducing: the “Better Bones Program”

– Based on the research study LIFTMOR from Griffith University, in Queensland, published in 2017: “High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial”.

The LIFTMOR study compared a control group, who performed home-based exercises focused on prevention of falls, to a High Intensity Resistance and Impact Training (HIRIT) group, who performed twice weekly physiotherapist-supervised exercise classes for a period of 8 months.
It was found that the HIRIT group had significant improvements at multiple levels compared to the control group at follow-up.

Benefits shown from the LIFTMOR study:
– Increased bone mineral density, measured at the femoral neck and lumbar spine
– Improvement in height (reduction in thoracic kyphosis)
– Increased back extensor strength which has been associated with a reduced risk of vertebral fractures
– Improved general function

Here at Clifton Hill Physiotherapy, we have decided to apply this evidence into clinical practice and we are excited to announce the launching of Bone Health classes!

Brief overview of the class:

– Targeted for anyone 55 years of age and above

– Involves 4 key exercises based on the LIFTMOR study: 1. Deadlifts
2. Overhead press
3. Back squats
4. Jumping chin-ups with drop landings.
The other exercises will aim at improving balance and core strength, arm and leg strength to achieve better function.

– Performed ideally x2/week as per research recommendations

You will first have an individual consult with one of our Physiotherapists to determine your base starting level of fitness and physical capacity to ensure that the exercise and weights you will use are appropriate and safe. The Physiotherapist will also introduce you to the 4 key exercise components and familiarize yourself to the gym prior to joining classes.

Contact our physiotherapists to enquire for more information and for class registrations.





Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A. and Beck, B. R. (2018), High‐Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res, 33: 211-220. doi:10.1002/jbmr.3284

Adriane Kablyuk


Clare qualified as a physiotherapist in 2000 from the University of the West of England. Since then Clare has worked in the UK, New Zealand and Australia in hospital and private settings. Clare has also completed a Certificate IV in fitness and clinical pilates and recently decided to return to studies and has just completed her Masters in Musculoskeletal Physiotherapy at La Trobe University.

Clare has managed a wide range of acute and chronic musculoskeletal, orthopaedic and sporting conditions over the years and particularly enjoys post-operative rehabilitation of clients.

Clare has experience in hydrotherapy, clinical pilates, and exercise prescription and utilises these skills in combination with hands-on techniques to provide an individualised management plan to promote optimal function and movement, required for returning to work and day-to-day activities. When not working Clare can be found walking the dog, in the gym,  scuba diving in the bay or completing DIY projects around the house.

Professional memberships:

Australian Physiotherapy Association (APA)

Musculoskeletal Physiotherapy Australia

Congratulations Fitzroy Football Club-Premiers 2018

Congratulations to Fitzroy Football Club on another successful season, and especially to the Men’s Senior and Reserve teams who both impressively took out VAFA Premier C Premierships on Saturday at Trevor Barker Oval!!! Both teams have enjoyed spectacular seasons.

In the senior game, Fitzroy were far too strong for Old Geelong and after 8 goals in the first quarter they continued to increase their lead, finishing 15.10.100 to 4.6.30.

The Reserves was a tight game in tough conditions. Fitzroy were able to keep Old Geelong goalless for the first half before surviving a late surge, eventually winning 4.6.42 to 4.9.33.

Team physiotherapists Billy Williams and Lizzy Barnes-Keoghan, along with all of us here, would like to congratulate all teams and thank them for their efforts during the 2018 season.