Understanding Central Slip Injury: Causes, Symptoms, Treatment, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on FEBRUARY 16, 2024
Central slip injuries, though often underrecognized, have a profound impact on hand function and daily activities. Understanding these injuries is crucial due to their potential to significantly impair finger movement and overall hand dexterity.
A central slip injury occurs when the tendon on the top of the finger, responsible for extending the middle joint, is damaged. This type of injury disrupts the delicate balance of the hand’s extensor mechanism. According to Geoghegan et al. (2019), the central slip plays a critical role in finger extension; its injury can lead to a boutonniere deformity if not properly treated, severely limiting hand function.
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Central slip injuries require precise care to ensure proper healing and to prevent complications such as boutonniere deformity, where the finger may become permanently bent. Immediate and appropriate treatment, often including splinting and controlled exercises, is crucial. According to a study by Geoghegan et al., 2019), timely intervention and appropriate management are essential in preventing long-term dysfunction and deformity. Physiotherapy plays a significant role in both managing and recovering from these injuries, emphasizing its importance in the overall treatment plan (Geoghegan et al., 2019).
What are Central Slip Injuries?
Central slip injuries are a type of tendon injury that occurs in the fingers, most commonly affecting the tendon on top of the middle joint. This tendon is part of the extensor mechanism, which is responsible for straightening the fingers. When the central slip is injured, it disrupts this mechanism, leading to difficulties in fully extending the finger, particularly at the middle joint. This limitation can impair various hand functions, such as grasping, holding, or performing fine motor skills.
The impact of a central slip injury goes beyond just a limited ability to straighten the finger. If left untreated, it can lead to a deformity known as a boutonniere deformity, where the middle joint of the finger bends downwards while the fingertip may hyperextend. The most common mechanism leading to these injuries is a forceful flexion of the extended finger, often occurring during activities where the finger might be struck forcefully, such as while playing sports or due to a fall (Geoghegan et al., 2012). These injuries can also result from lacerations or cuts on the back of the finger, which directly damage the extensor tendon.
Prompt and proper treatment of central slip injuries is critical to prevent long-term complications. Early treatment typically involves immobilization of the affected joint, often with a splint, to allow the tendon to heal properly. Physiotherapy may also be necessary to restore strength and flexibility once the initial healing phase is over. The goal of treatment is to preserve as much function as possible and prevent permanent deformity or stiffness (Debski et al., 2021)
The broader impact on overall well-being should not be underestimated. Hand function is integral to many daily activities, and impairment can lead to frustration, decreased productivity, and even affect mental health. As discussed by Kovacs et al., (2011), the psychological impact of hand injuries, including central slip injuries, can be significant, affecting quality of life and well-being.
Prompt and appropriate treatment is vital to minimize these impacts. Early intervention can help in preventing long-term complications, preserving hand functionality, and maintaining overall quality of life.
Causes and Risk Factors of Central Slip Injuries
Central slip injuries in the fingers can occur due to various reasons, each affecting the extensor tendon mechanism in different ways:
Hyperextension Injuries: One of the most common causes of central slip injuries is hyperextension, where the finger is forcefully bent backwards. This type of injury often occurs in sports when a ball or object strikes the end of an extended finger, causing the central slip to stretch or tear (Debski et al., 2021)
Blunt Trauma: Direct blows to the finger, such as those from falling, crushing incidents, or during contact sports, can also cause central slip injuries. The impact can damage the tendon directly or cause it to detach from its insertion point (Kandam et al., 2024)
Repetitive Stress: Although less common, repetitive stress on the fingers can lead to overuse injuries, including damage to the central slip. This is often seen in occupations or activities that involve repeated finger movements, as noted by (Geoghegan et al., 2019).
Certain activities and professions carry a higher risk for central slip injuries due to their nature and the demands they place on the fingers (Kaminski et al, 2013). Understanding these risk factors can help in adopting preventive strategies and recognizing early signs of injury.
Sports Involving Ball Handling: Athletes participating in sports like basketball, volleyball, and baseball are at an increased risk of central slip injuries. The nature of these sports often involves catching or interacting with a ball, which can lead to hyperextension or direct impact injuries to the fingers.
Occupations Requiring Manual Labor: Jobs that involve manual handling, use of tools, or repetitive finger movements can also pose a risk. Construction workers, mechanics, and those in manufacturing are more likely to experience blunt trauma or repetitive stress injuries to the fingers.
Repetitive Fine Motor Activities: Professions or hobbies that involve repetitive fine motor skills, such as musicians or typists, may also increase the risk of developing overuse injuries in the fingers, potentially leading to central slip damage over time.
Recognizing the Signs of Central Slip Injuries
Central slip injuries are characterized by a specific set of signs and symptoms that are critical for diagnosis and subsequent treatment. These hallmark features include:
Pain: One of the first symptoms of a central slip injury is pain at the site of injury, particularly over the dorsal aspect of the proximal interphalangeal (PIP) joint. The pain is often exacerbated by movement or pressure.
Swelling: Swelling around the PIP joint is common following a central slip injury. This swelling can sometimes extend to the rest of the finger, making it difficult to move.
Boutonniere Deformity: Although this deformity may not be immediately apparent after the injury, it can develop over time if the injury is not properly treated. It is characterized by the bending down (flexion) of the middle joint of the finger and sometimes the straightening (hyperextension) of the end joint.
Difficulty in Straightening the Finger: There is often a noticeable difficulty in fully extending the middle joint of the finger. The patient may be able to straighten the finger only with assistance or not at all, depending on the severity of the injury.
Tenderness: The area around the central slip attachment is typically tender to the touch.
Central slip injuries can sometimes be confused with other hand or finger conditions due to overlapping symptoms. Distinguishing these injuries from similar conditions is vital for effective treatment.
Differentiating from Mallet Finger: Mallet finger involves injury to the tendon at the very tip of the finger, unlike central slip injuries which affect the middle joint. While both present with difficulties in straightening the finger, the location and nature of the deformity differ (Bachoura et al, 2017).
Swan Neck Deformity: This deformity, characterized by hyperextension of the PIP joint and flexion of the distal interphalangeal joint, can be mistaken for a central slip injury.
Joint Dislocations and Fractures: PIP joint dislocations and fractures can present with pain and swelling similar to central slip injuries. However, these conditions often have more pronounced physical deformities (Kaminsky et al., 2013)
Arthritis: Arthritic conditions can cause pain and swelling in the joints of the finger, leading to potential confusion. The chronic nature of arthritis and the pattern of joint involvement usually help in differentiating it from acute central slip injuries.
Consulting a healthcare professional for an accurate diagnosis of central slip injuries is crucial due to the complexity of these injuries and their potential to mimic other hand conditions. A professional diagnosis ensures that the injury is correctly identified and appropriately managed, which is key to preventing long-term complications and ensuring effective recovery.
Expert Evaluation: Healthcare professionals, particularly physiotherapists here at Keilor Road Physiotherapy, have the expertise to evaluate finger injuries accurately. They can distinguish a central slip injury from other conditions like mallet finger, swan neck deformity, or arthritis, which may present with similar symptoms but require different treatments.
Objective Testing: The Elson test is a specific clinical test used to diagnose central slip injuries in the hand. The patient is asked to extend the distal interphalangeal (DIP) joint of the finger against resistance. The test is conducted by observing the movement of the DIP joint.
Normal Result: If the central slip is intact, there will be a lack of extension at the DIP joint due to the tension in the lateral bands. The DIP joint will appear floppy or relaxed.
Positive Sign: If the central slip is injured, the DIP joint will extend or appear tight, as the lateral bands will have shifted and allow extension.
This test is particularly useful because it can help differentiate between a central slip injury and other types of extensor tendon injuries. A positive Elson test suggests a central slip injury, which requires specific management to prevent long-term complications like Boutonnière deformity.
Other tests can include:
Modified Elson Test: This is a variation of the Elson test. In the modified version, the injured digit and a normal counterpart are placed in full proximal interphalangeal (PIP) flexion, with the dorsum of each middle phalanx firmly against each other. A positive sign of central slip injury is visibly better DIP extension in the injured digit compared to the uninjured digit.
Boyes Test: This test involves extending the PIP joint and asking the patient to flex the DIP joint. A positive sign, which is the inability to actively flex the DIP joint, might only become apparent in the later stages of the injury.
Appropriate Imaging: In some cases, imaging tests such as X-rays or ultrasounds may be necessary to confirm a diagnosis and assess the extent of the injury. As noted by Kaminsky et al., (2013), these imaging tests are critical in determining the appropriate course of treatment.
Tailored Treatment Plans: Once accurately diagnosed, healthcare professionals can develop a treatment plan that may include splinting, physiotherapy, and, in some cases, surgery. According to Geoghegan et al., (2019), the success of treatment largely depends on the accuracy of the diagnosis and the specificity of the treatment plan.
Prevention of Complications: Accurate diagnosis is essential in preventing complications such as boutonniere deformity, which can result from untreated or improperly managed central slip injuries. Early and appropriate intervention is key to maintaining hand function and preventing long-term disability.
Prevention Strategies for Central Slip Injuries
Reducing the risk of central slip injuries in daily life involves adopting practical and preventive measures (Kaminsky et al., 2013). Options to help include:
Wear Protective Gear: For athletes and individuals engaged in sports involving ball handling or physical contact, wearing appropriate protective gear like gloves or finger guards is crucial. This equipment can absorb some of the impact and reduce the risk of injury.
Practice Safe Techniques: Whether in sports, work, or everyday activities, using the correct techniques can prevent injuries. For example, learning the proper way to catch, throw, or use tools can significantly decrease the likelihood of finger injuries.
Strengthen and Condition Fingers: Regular exercises that strengthen the muscles of the hand and fingers can improve their resilience against injuries. Simple exercises like squeezing a stress ball or rubber bands can be effective.
Ergonomic Adjustments: For those who perform repetitive tasks, ensuring an ergonomic setup can help. This may involve adjusting the keyboard height, using ergonomic tools, or changing the grip on instruments to reduce strain on the fingers.
Take Regular Breaks: If your occupation or hobby involves repetitive hand movements, take regular breaks to stretch and rest your hands and fingers. This practice can prevent overuse injuries.
Educate and Raise Awareness: Understanding the risks and recognizing the early signs of injury are important. Educating oneself and others about injury prevention, especially in high-risk environments, is beneficial.
Seek Professional Advice: If you’re unsure about the safety of certain activities or need guidance on protective measures and exercises, consult with a healthcare professional or a physiotherapist.
Adopting preventive measures is essential in minimizing the risk of central slip injuries, which can significantly impact hand function. Taking these preventive steps can help maintain hand health and reduce the risk of sustaining central slip injuries (Geoghegan et al., 2019).
Regular hand exercises and stretches play a crucial role in maintaining hand and finger health. These practices are essential not only for preventing injuries but also for enhancing the strength, flexibility, and overall functionality of the hands.
Strengthens Muscles and Joints: Consistent hand exercises help in strengthening the muscles and joints, making them more resilient to injuries. This is particularly important for individuals who engage in activities that put a strain on their hands, whether in sports or occupations involving manual labor.
Improves Flexibility and Range of Motion: Regular stretching exercises increase the flexibility and range of motion of the fingers and hands. Enhanced flexibility can help in preventing injuries caused by overextension and repetitive movements.
Promotes Better Circulation: Hand and finger exercises aid in improving blood circulation to these areas. Good circulation is crucial for maintaining healthy tissue and aids in faster recovery from any injuries.
Reduces Risk of Repetitive Strain Injuries: For those involved in repetitive tasks, such as typing or playing musical instruments, regular exercises can mitigate the risk of conditions like tendonitis or carpal tunnel syndrome.
Aids in Recovery Post-Injury: For individuals recovering from hand or finger injuries, exercises and stretches play a key role in rehabilitation, helping to restore functionality, strength, and mobility.
Treatment Options for Central Slip Injuries
Treating central slip injuries effectively is crucial for preventing long-term complications and ensuring the restoration of finger function. The treatment approach typically depends on the severity of the injury and may include immobilization, splinting, and in more severe cases, surgical intervention.
Immobilization: The first line of treatment for central slip injuries often involves immobilizing the affected finger to allow the tendon to heal. This usually means keeping the finger in an extended position to relieve pressure on the injured tendon. Geoghegan et al. (2019) emphasize the importance of proper immobilization in the initial phase of treatment to facilitate healing.
Splinting: A splint is commonly used to keep the finger in the correct position. The splint supports the joint and keeps it straight to prevent further injury and promote healing. Carruthers et al., (2017) discuss the effectiveness of splinting in treating central slip injuries, noting its role in maintaining proper finger alignment during the healing process.
Splinting for central slip injuries varies depending on the severity and nature of the injury. Acute closed central slip injuries that are less than four weeks old can often be managed conservatively. This involves splinting the injured finger with the PIP in extension, while keeping the DIP, metacarpophalangeal (MCP), and wrist joints free. This splinting is typically followed for 3 to 6 weeks, with additional nighttime splinting for up to 6 weeks.Surgical Intervention: In cases where the injury is severe, such as when the tendon is ruptured or there is a significant deformity, surgical intervention may be necessary. Surgery aims to repair the damaged tendon and restore its function. Lee et al. (2021) highlight the scenarios where surgery is considered, especially in complex or neglected cases. In cases where surgery is required, post-surgical rehabilitation includes different regimes such as PIP joint immobilization followed by isolated PIP flexion-extension exercises, controlled early active short arc motion, and mobilization with a dynamic spring coil finger splint.
Physiotherapy: Post-treatment, physiotherapy plays a crucial role in regaining strength and flexibility in the finger. Tailored exercises and therapy sessions help in restoring the range of motion and preventing stiffness. Rehabilitation exercises, including range of motion exercises and strengthening with Theraputty, are also important components of the treatment plan.
Physiotherapy plays a pivotal role in the recovery process from central slip injuries, particularly in restoring hand function and improving the range of motion of the affected finger. This rehabilitation process is crucial for a full recovery and return to normal hand use.
Restoration of Range of Motion: Physiotherapy focuses on exercises that gradually increase the flexibility and movement of the injured finger. These exercises are designed to restore the normal range of motion, which is often limited following a central slip injury. Downs et al., (2021) emphasize the importance of physiotherapy in regaining joint mobility.
Strengthening Exercises: Alongside flexibility, physiotherapy incorporates strengthening exercises to build up the muscles around the injured tendon. This is essential for regaining the full functionality of the hand and preventing future injuries.
Reducing Stiffness and Preventing Contractures: Regular physiotherapy sessions help in reducing stiffness, a common complication following immobilization. By keeping the joints and tendons moving, physiotherapy aids in preventing contractures (permanent tightening of the muscles, tendons, skin, and other tissues) (Geoghegan et al., 2019).
Customized Rehabilitation Plans: Physiotherapists tailor rehabilitation programs to the specific needs and recovery goals of each patient, ensuring a more effective and patient-centered approach to recovery.
Guidance and Support: Physiotherapists also provide valuable guidance on activity modifications and ergonomics to facilitate a safe return to daily activities and work.
The role of physiotherapy in the treatment of central slip injuries is multifaceted, focusing on restoring range of motion, strengthening the hand, reducing stiffness, and providing customized care for each patient.
The recovery process from central slip injuries or any hand injury greatly benefits from a collaborative approach between patients and physiotherapists. This partnership is essential for successful rehabilitation and involves active patient participation, open communication, and mutual goal-setting. Here's why this collaborative approach is so important:
Active Patient Participation: The success of physiotherapy largely depends on the patient's active involvement in their recovery process. This includes adhering to prescribed exercises, attending therapy sessions regularly, and being proactive in their care. Patients who actively engage with their rehabilitation program often see better and quicker results.
Open Communication: Effective communication between the patient and the physiotherapist is crucial. Patients should feel comfortable discussing their pain levels, difficulties they encounter during exercises, and any concerns they have about their recovery. This open dialogue allows the physiotherapist to adjust the treatment plan as needed to address the patient's specific challenges and preferences.
Mutual Goal-Setting: Recovery goals should be set collaboratively, taking into account the patient's personal objectives, lifestyle, and the functional requirements of their daily activities. By setting realistic and achievable goals together, the patient feels more invested in the treatment process, and the physiotherapist can tailor the therapy to meet these specific goals.
Feedback and Adjustments: Regular feedback from the patient regarding their progress and response to treatment is vital. This feedback allows the physiotherapist to make necessary adjustments to the treatment plan, ensuring that the rehabilitation process remains effective and aligned with the patient's evolving needs.
Education and Empowerment: Physiotherapists also play a key role in educating patients about their condition, the healing process, and ways to prevent future injuries. This educational aspect empowers patients to take control of their recovery and maintain their hand health post-rehabilitation.
The collaborative approach in physiotherapy not only enhances the recovery process but also ensures that the rehabilitation journey is tailored to the individual needs and goals of each patient, leading to more effective and satisfying outcomes.
Restoring Functionality
Keilor Road Physiotherapy utilises a range of techniques to effectively treat central slip injuries, with the goal of restoring functionality and optimizing finger motion. These techniques include therapeutic exercises, manual therapy, and functional training.
Therapeutic Exercises: These exercises are designed to improve strength, increase range of motion, and reduce stiffness in the injured finger. They may include range-of-motion exercises, strengthening exercises, and activities that mimic daily tasks. As highlighted by Geoghegan et al., (2019), therapeutic exercises are a cornerstone of rehabilitation for hand and finger injuries, aiding in the recovery of functionality.
Manual Therapy: This technique involves hands-on manipulation and mobilization of the joints and soft tissue. It helps in alleviating pain, improving circulation, and increasing joint flexibility. Geoghegan et al., (2019), discuss the effectiveness of manual therapy in enhancing joint mobility and reducing stiffness in hand injuries.
Functional Training: As recovery progresses, physiotherapists incorporate functional training into the rehabilitation plan. This training involves activities that mimic daily tasks or specific job-related duties, ensuring that the patient can return to their normal activities safely and effectively. Geoghegan et al., (2019), emphasises the importance of incorporating functional training into rehabilitation programs for finger injuries.
Together, these techniques form a comprehensive approach to rehabilitation, allowing the physiotherapists here at Keilor Road Physiotherapy to focus not only on physical recovery but also on the practical aspects of regaining hand functionality:
Restoration of Hand and Finger Function: Physiotherapy is instrumental in regaining the mobility and strength of the injured finger. Regularly performed exercises tailored to the patient’s specific needs help in restoring the full functionality of the hand. Studies, such as those by Geoghegan et al., (2019), have shown significant improvements in hand function following a structured physiotherapy program.
Reduction of Pain: Effective pain management is a key component of physiotherapy. Techniques such as therapeutic exercises, heat or cold therapy, and manual therapy help in alleviating pain associated with the injury, thereby facilitating a more comfortable and quicker recovery process. Research by Geoghegan et al., (2019), highlights the efficacy of these physiotherapy modalities in pain management.
Enhancing Quality of Life: By restoring hand functionality and reducing pain, physiotherapy significantly improves the quality of life for individuals with central slip injuries. It enables them to return to their normal activities, both occupational and recreational, with greater ease and confidence. The work of Peters et al., (2021) emphasises the positive impact of physiotherapy on the overall quality of life post-hand injuries.
Conclusion
Central slip injuries are specific types of hand injuries that occur at the proximal interphalangeal (PIP) joint, typically as a result of forceful flexion or direct trauma. These injuries can result in the loss of extension at the PIP joint, hyperextension at the distal interphalangeal (DIP) joint, weakened grip, and difficulty manipulating small objects. There may also be swelling and pain at the top of the middle joint of the finger. Early diagnosis and treatment are crucial to prevent long-term deformities such as the Boutonnière deformity, a condition characterized by a flexed PIP joint and a hyperextended DIP joint.
For diagnosing a central slip injury, specific tests such as the Elson Test and Modified Elson Test are often used. These tests help in assessing the integrity of the extensor mechanism of the finger. A positive Elson Test, indicated by a rigid DIP joint, suggests a central slip injury.
Treatment for central slip injuries varies depending on the severity and nature of the injury, from conservative management using splinting and physiotherapy, through to surgery.
It's important to seek professional guidance when dealing with central slip injuries due to the complexity and potential long-term impacts of these injuries. Keilor Road Physiotherapy plays a crucial role in both the conservative and post-surgical management of central slip injuries. We can help tailor a rehabilitation plan to your specific needs, ensuring a more effective and efficient recovery.
Taking proactive steps towards managing your central slip injury, guided by qualified healthcare professionals, can significantly enhance your recovery and prevent long-term complications. Stay positive and committed to your rehabilitation process, and you'll be well on your way to regaining full function of your hand.
References:
Bachoura, A., Ferikes, A. J., & Lubahn, J. D. (2017). A review of mallet finger and jersey finger injuries in the athlete. Current reviews in musculoskeletal medicine, 10(1), 1–9. https://doi.org/10.1007/s12178-017-9395-6
Carruthers, K. H., O'Reilly, O., Skie, M., Walters, J., & Siparsky, P. (2017). Casting and Splinting Management for Hand Injuries in the In-Season Contact Sport Athlete. Sports health, 9(4), 364–371. https://doi.org/10.1177/1941738117700133
Dębski, T., & Noszczyk, B. H. (2021). Epidemiology of complex hand injuries treated in the Plastic Surgery Department of a tertiary referral hospital in Warsaw. European journal of trauma and emergency surgery: official publication of the European Trauma Society, 47(5), 1607–1612. https://doi.org/10.1007/s00068-020-01312-5
Downs, C., Snodgrass, S. J., Weerasekara, I., Valkenborghs, S. R., & Callister, R. (2021). Injuries in Netball-A Systematic Review. Sports medicine - open, 7(1), 3. https://doi.org/10.1186/s40798-020-00290-7
Geoghegan, L., Wormald, J. C. R., Adami, R. Z., & Rodrigues, J. N. (2019). Central slip extensor tendon injuries: a systematic review of treatments. The Journal of hand surgery, European volume, 44(8), 825–832. https://doi.org/10.1177/1753193419845311
Griffin, M., Hindocha, S., Jordan, D., Saleh, M., & Khan, W. (2012). Management of extensor tendon injuries. The open orthopaedics journal, 6, 36–42. https://doi.org/10.2174/1874325001206010036
Kaminski, T. W., Hertel, J., Amendola, N., Docherty, C. L., Dolan, M. G., Hopkins, J. T., Nussbaum, E., Poppy, W., Richie, D., & National Athletic Trainers' Association (2013). National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. Journal of athletic training, 48(4), 528–545. https://doi.org/10.4085/1062-6050-48.4.02
Kankam, H. K. N., Ibrahim, H., Liew, M. S., Hauff, E., Tullie, S., Parthiban, S., & Chester, D. L. (2024). Epidemiology of adult hand injuries presenting to a tertiary hand surgery unit: a review of 4216 cases. The Journal of hand surgery, European volume, 49(1), 48–53. https://doi.org/10.1177/17531934231195499
Kovacs, L., Grob, M., Zimmermann, A., Eder, M., Herschbach, P., Henrich, G., Zimmer, R., Biemer, E., & Papadopulos, N. A. (2011). Quality of life after severe hand injury. Journal of plastic, reconstructive & aesthetic surgery: JPRAS, 64(11), 1495–1502. https://doi.org/10.1016/j.bjps.2011.05.022
Lee, J. K., Lee, S., Kim, M., Jo, S., Cho, J. W., & Han, S. H. (2021). Anatomic Repair of the Central Slip with Anchor Suture Augmentation for Treatment of Established Boutonniere Deformity. Clinics in orthopedic surgery, 13(2), 243–251. https://doi.org/10.4055/cios20170
O'Dwyer, F. G., & Quinton, D. N. (1990). Early mobilisation of acute middle slip injuries. Journal of hand surgery (Edinburgh, Scotland), 15(4), 404–406. https://doi.org/10.1016/0266-7681(90)90079-j
Peters, S. E., Jha, B., & Ross, M. (2021). Rehabilitation following surgery for flexor tendon injuries of the hand. The Cochrane database of systematic reviews, 1(1), CD012479. https://doi.org/10.1002/14651858.CD012479.pub2
Related Links:
Finger Injuries: Types, Causes, Symptoms, Treatment, and the Role of Physiotherapy
Trigger Finger : Causes, Symptoms, Treatment, and the Role of Physiotherapy
Understanding Finger Dislocation: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Mallet Finger: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Understanding Finger Fracture: Causes, Symptoms, Treatment, and the Role of Physiotherapy
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.