To whom it May concern,

Re: Fakher Zia

I first began treating Mr. Zia in May of this year for of bilateral insertional achilles tendinosis. He was
initially referred by an Orthopedic Specialist for Physiotherapy and rehabilitation exercise regime.

Mr. Zia has attended a total of seven Physiotherapy sessions including today. Treatment in this time has
consisted of shockwave therapy for this Achilles tendons, a rehabilitation exercise program and self-
management strategies. This is a total of two months treatment to date.

With conditions and presentations like Fakher’s, it as very much chronic condition. He has had this pain
for two years which means there are chronic and long-term, potentially permanent changes that have
occurred in his heel. I have treated many conditions like this and have found they take a long time to
recover. This ranges anywhere from sex months to two years at times and is normally reflective of the
amount of time suffering the condition and the level of damage sustained.

I have found in treating Mr. Zia that his walking at times is altered to a company pattern, which places
uneven stresses on this knees, hips and lumbar spine and is a very common and very normal compensation
for people with Achilles tendon pain and injuries. This has caused him to develop lower back pain due to
this altered walking pattern and abnormal stress placed on the lumbar spine which is normally eased with
gentle treatment, movement and exercises. Mr. Zia reports sitting for extended periods of time now
causes his back pain to increase considerably and this occurs after approximately 30 minutes of sitting, at
which time he needs to stand up, gently move and walk around to relieve the pain to manageable levels
it is for this reason we feel classroom hours of up to 7 hours a week would be reasonable at this time.

I am continuing to treat Mr. Zia and will do so until has pain and symptoms are more under control, at
which time we will reassess and make necessary changes to these recommendations as required.

Your Sincrely,

Nich Khalifeh

Physiotherapist