My Back's Physio Hints & Tips
7 Tips to Not Develop a Grumpy Back!
Most people in their life have suffered a niggle in the low back. In fact there exists a 50-70% chance that you will succumb to low back pain in your lifetime. Ensuring you apply the following simple but effective tips to your daily activities will lessen your chance of developing a GRUMPY back!
- Exercise! The stronger the bones, muscles, ligaments, discs: the greater their resistance to injury.
- Strengthen both the large movement producing muscles, and deep stabilising muscles of your low back.
- Sleep on your side (increases hydration of discs and promotes disc health).
- Take care in the morning. Avoid heavy lifting, due to increased risk of disc injury.
- Keep your back supple: stretch and get regular massage.
- Lift slowly and with bent knees. Keep the load close to your body, to decrease strain on your back.
- If sore see your physio early! Studies have shown the sooner you settle your pain the less chance you have of developing chronic lower back pain.
Do you Need Orthotics?
Most people are unsure as to whether they should be wearing an orthotic device in their work and or sports shoes. Poor foot positioning can result in a range of lower limb disorders (heel pain, knee pain, hip pain) and can even affect the low back. In fact your feet are true work-horses of your body. Studies show that the average foot undergoes 10,000 contractions per day! If your feet are overly flat standing still, or turned out, or likewise if you over-pronate (roll-in) or supinate (roll-out) when you walk you may be placing adverse loads on your body that may predispose you to an injury.
Our physiotherapists are experts in assessing your foot mechanics and whether you would benefit from an orthotic in your work and or sports shoes. Using GAIT-SCAN technology (force platform scans foot at /min) we can digitally analyse your own foot pattern and compare it to a normal pattern, thereby determining if you are a candidate for orthotics.
Should we deem it necessary to fit you with an orthotic we use a combination of data collected during your GAIT Scan and our clinical notes to prescribe you a custom made orthotic. Furthermore you have the option of choosing models that fit your work shoes, sports shoes, or both.
Mention this article for a complementary GAIT Scan assessment, complete with personalised print-out of results (valued at $39.95)
*note: private health fund holders may receive on average up to $300 for orthotics annually, meaning little or nil out of pocket expense.
Acupuncture- Can It help Me?
Acupucnture has been increasingly incorporaed into physiotherapy practice for t last decade. Acupuncture can be used for great outcomes with lower back, and other joint and soft tissue related conditions. There are 2 philosohies by which acupuncture is practised -Eastern and Western. Physiotherapists typically practice western acupucnture (also referred to at times as dry needling). This form of acupuncture works by releasing adverse muscular tension in areas of muscle tone and tension. Secondary to this effect is the effect of 'desensitising the neural system' and subsequently decreasing pain levels. If you are not sure whether acupuncture can help you-ask one of our exoert practitioners.
Further Back Pain Tips from My Back's Physio
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In our clinics we see a wide range of patients with all manner of pain and injury – however a large part of our work is centred on dealing with low back pain.
Here are some simple tips on overcoming and preventing back pain that will help keep you in good shape and pain free:
If you don’t use it you lose it :
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This is one of the oldest sayings in health and fitness but relates very well to back pain – especially in regards to maintaining movement in your back. We suggest that every day you do a variety of mobility exercises that move your back through a full range e.g.: lie on your back and pull your knees to your chest 10 times, then with your knees at 90 degrees rolling them side to side for 10 reps each side, and finally roll onto your tummy and rest on your elbows for 30 seconds – these simple movements help keep your back moving– if there is any pain when doing these movements make sure you check with your Physio before continuing.
Don’t rest too much with a back injury:
This is a difficult one because many people feel that if they have hurt their back they need to stop moving totally and lie in bed for days on end until the pain settles – whilst this may be the best course of action for a small number of back pain patients - the overwhelming majority of research supports getting moving as soon as possible post injury – be this via swimming, gently walking, or a range of Physio designed exercises.
Stay Fit:
One of the best ways to improve back pain and prevent it in the first place is to keep physically fit – the greater your aerobic fitness the better oxygen delivery to your muscles, the less sensitive you are to pain responses in your back and the better you feel generally – so get out these and move at least 30-40 mins every other day – you will feel great and help your back at the same time.
Don’t stay in the same position for more than 30 mins:
If you spend most of your day sitting in an office chair or driving a car then you are a great risk of getting a stiff and painful back – as we said before the joints in your back love to move and the more they move the healthier they are. Get up and stretch, take a walk or at least move your body position every 30 mins – your back will thank you for it.
If you have a back issue and would like to know what is going on , or if you would like to go over some simple back exercises to keep your back loose and pain free, then call 5572 0133 and we will get you sorted out fast!
How to silence those niggly knees !
Recently while at a family function I was asked to give advice to my Aunty on how settle her knee pain. There are 3 golden rules:
1. Avoid irritating activities (eg stairs especially downhill)
2. Stretch tight structures around the knee (calves, hamstrings, quadriceps). This effectively ‘de-loads the knee joint and lessens pain.
3. Strengthen the inside of the thigh to assist with knee cap correct tracking.
If pain persists consult your physiotherapist for a free injury assessment. There are various pathologies that can create pain and your physio can assess the cause of your pain.
Winter is a time when we see many of our patients presenting with aches and pains (typically joint related-knees, hips, feet, and spinal) that seem ‘stiffer’ and ‘sorer’ over the cooler months.
3 Self-helpstrategies to combat the ‘winter aches’ ....
1. Use a quality heat pack over the affected (decreases muscle tension and aching).
2. Walk for 3-5mins before attempting any lifting 1st thing in the morning.
3. Consider a good quality fish oil and glucosamine supplementation to optimise joint health and decrease aching and stiffness.
What You Should Know About Referred Pain...
Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent or distant from the site of injury. Eg you have a problem with your neck but you feel it in your shoulder. The mechanism behind referred pain is complex. It is believed that where nerves converge in the spinal cord carrying information from the body the brain at times is unable to differentiate signals from 2 body regions, meaning that you feel pain in 2 areas (eg neck + shoulder).
There are many examples of referred pain...often heart attacks can cause arm pain, your neck can cause your headache, and your back can cause your leg to ache.
What it means to you...pain can be a great ‘liar’ and you can easily be confused about what is causing your pain. It is important to have your problem thoroughly assessed so that the correct treatment can be initiated.
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Swim faster and loose that neck
tension on the bike!
Triathlon is a demanding sport that places many stresses on the body. As athletes we tend to be either someone who is very ‘tight & stiff’ or someone who is very ‘mobile and flexible’. Due to the high repetition of movements that occur with triathlon’s swim, bike, and running the vast majority (if not all!) of triathletes tend to be the ‘stiff & tight’ types!
The most deleterious stiffness/tightness pattern that I have seen to be consistent with every triathlete is that of the thoracic spine. The thoracic spine is the mid-section of the spine (ie it separates the neck and lower back). This spinal region is comprised of 12 verterbrae (T1-12) that naturally produce a convex curve forwards (kyphosis). As triathletes this region of the spine is prone to becoming even stiffer than the normal population due to the prolonged periods of time spent in a forwards slumped position on the bike.
When the hours on the bike are coupled with our daily activities such as long hours at a computer, or time spent driving, we have a perfect recipe for ‘pathological’ thoracic spine stiffness’.
What do I mean by pathological? Simply put stiffness beyond a normal and acceptable level inevitably (with time and the repetition of training loads) results in :
· neck strain/tension (yes the type that you feel as though you just need a good neck massage after a long ride).
· Excessive loading of the lower back structures (eg lumbar discs, joints, nerve roots)
· Poor shoulder posturing (ie the shoulders will round more around the rib-cage with greater thoracic spine stiffness) which with time will have a very high likelihood of developing into shoulder impingement.
· Poor posture (yes the stiffer you are the more rounded your shoulders become!)
How do You Know if you are stiff?
This is easy: if you get regular neck tension in the ‘upper traps’ (the muscles that join head to shoulders) or you find it difficult to swim with high elbows than it’s a certainty that you are stiff in your thoracic spine. In the consulting room as physios we conduct a measured thoracic spine extension test (lay on tummy and lift hands/arms to ceiling in a streamlined position whilst head stays on the table/floor. The Australian Institute of Sport recommend a minimal acceptable score of ‘0degs’ ie the arms are in line with the trunk.
However greater than 95% of people we test as physios score in the ‘negatives’ ranging from -30degs to just below 0 degs. To put things in perspective the elite pool swimmers (eg Grant Hackett) score positive 30degs! It is very true that the greater your score the faster swimmer you will be. I recommend that triathletes should aim for 0-10degs positive to allow for an effective swimming stroke and reduce neck strain on the bike.
How Do I improve my thoracic spine mobility and decrease the stiffness?
Reducing thoracic spine stiffness can be achieved by (ideally a combination of the below):
1. Daily stretching over a pilates half foam roller (as shown below). This needs to be
held for 5-10mins minimum and is best performed at the end of the day.
There is no comparable substitute for the pilates foam rollers
(towels, noodles etc whilst having some effect are not as effective).
Place roller between shoulder blades, bend up knees, hands over head if no shoulder pain is felt.
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The rollers retail at $22.00 and would be one of the wisest purchases
you could to better your training.
2. Regular yoga (some yoga asanas or poses target the thoracic
Spine really well!).
3. Physiotherapy treatment: manual (hands on )techniques include joint mobilizations, manipulation, acupuncture and soft tissue remedial massage, trigger point releases.
Time frames to improve your thoracic spine mobility are determined largely by how long you have been ‘stiff’ for. Obviously the longer you have been stiff the longer it will take to improve and the more consistent you will need to be with the above 3 methods of improving your mobility. Unfortunately some people have been stiff for so long (we get progressively stiffer as we age) that there is a’ ceiling’ of how much improvement they will make. As physios we always aim to get people to 0degs however in the aforementioned case of a chronically staff person expectations can be modified.
Take heed middle aged female triathletes
It’s important to also note that rounding in the thoracic spine area can also be contributed to by genetics (eg wedge shaped vertebrae bodies that make the spine more curved) and by osteoporotic crush fractures . As up to 80% of osteoporotic crush fractures of the spine can be pain free many women are not aware that they have osteoporosis. If your physio suspected this as a contributing factor for your thoracic spine stiffness a plain film (bulk-billed) xray will ascertain if any crush fractures are present or not.
If you are curious as to whether or not you are ‘pathologically stiff’ in this area of your spine or you simply want to swim faster and get rid of the neck tension you feel on the bike/at work pop in for your FREE triathlon screening (comprises 10 test that will pin-point any problem areas including the testing of your thoracic spine).
Train smart and stay safe and keep up the great work guys!
Ps. For those who missed the June Running Workshop we will re-run the workshop on Thursday the 29
th July at 7pm. Register your spot to this FREE and informative workshop by email:
b.beer@backinmoton.com.au.
Go and do a PB!
Brad Beer
Senior Physio Back In Motion Mermaid Waters
OFFICE ERGONOMICS-Sit Well!
We spend approximately 60% of our lives at work. For many of us, this involves long hours sitting at a desk in front of a computer. As we use the computer regularly, invariably our posture deteriorates, our shoulders may become hunched, our necks stiff, and we sit in a slumped posture. Add to this the time spent in the car driving to work and then relaxation time reading or watching TV on the couch. With this information alone, it is no surprise that over half of our patients at Back In Motion present with neck and/or low back pain (LBP) directly related to poor sitting posture.
12 TIPS FOR AN ERGONOMIC WORKSTATION
1. Chair must contain lumbar support
2. Top of the monitor should be eye level
3. Use an optical glass anti-glare filter on your computer screen
4. Sit at arm's length from monitor
5. Feet flat on the floor or on a stable footrest
6. Use a document holder, preferably in-line with the computer screen
7. Wrists should be flat and straight in relation to your forearms
8. Make sure your arms and elbows are relaxed and close to your body
9. Centre the monitor and keyboard in front of you
10. Use a negative-tilt keyboard tray with an upper mouse platform
11. Use a stable work surface & keyboard tray
12. Take short, frequent breaks
Hip Flexors-ignore them at your peril!
We have all heard about ‘hip flexors’-but what exactly are they and why do they matter to a triathlete? Do you need to read this article? I strongly encourage you DO read this article, let me explain….
This article is a continuation of the theme from last newsletter’s article where we looked at the importance of the thoracic spine in providing triathletes with ‘free reduced muscular ‘strain’ . Similar to the thoracic spine the hip flexors can also represent a body region that if ‘looked after’ will provide benefits of better technique, less injury risk, and improved performance.
Firstly let’s determine what ‘hip flexors’ are. ‘Hip flexors’ is the ‘umbrella term’ for a grouping of 3 muscles: iliacus, psoas major, and rectus femoris (see image). The psoas major originates off the lower 3 lumbar verterbrae (L3-L5) and combined with the iliacus (originating off the hip rim) join together to insert onto the lesser trochanter of the femur (just on the inside of the groin). The 3rd mucle sof the group is one of the 4 constituents that form the ‘quads’-the rectus femoris-originating off the ASIS (anterior superior iliac spine) and inserting into the top of the knee cap (patella).
The problem with most people (especially triathletes) hip flexors are that they ARE TIGHT! Typically triathletes present in the consulting room with the tightest of hip flexors of all of the patients seen!
Of all 3 legs of triathlon cycling is by far the leg that ‘tightens’ hip flexors the most. Cycling is performed in a ‘hip-flexed’ position (ie the hip is bent through range in a position of flexion). This seated position on the bike coupled with the repetitive loads of cycling and the strain exerted by the quadriceps result in often ‘extreme’ tightness. Running further contributes to tight hip flexor development as do many of our daily activities in particular sitting (caution office workers!).
Irrespective of the degree of hip flexor tightness if they are tight they will cause the following problems:
1. Contribute to lower back pain: tight hip flexors pull the pelvis forwards (anteriorly) and in doing so effectively ‘squash’ up the joints in the lower back. This results in increased pressure on the joints and inevitable pain and stiffness- especially when you jump off the bike and then attempt to run.
2. Contribute to excessive loading of the knee joints- pulls the knee cap like a ‘bow and arrow’ onto the underlying femur bone- increasing likelihood of knee cap pain and worse long term cartilage wear and tear and possible injury.
3. Further stiffen the middle of the back (thoracic spine) resulting in increased neck strain and tightness and lower back pain/tightness (similar to a pregnant females’ posture-ie hips pulled forwards and middle of back rounds).
4. Inefficient and slower running technique as tight hip flexors result in a ‘heel strike position’-resulting in increased injury risk and slower running sped.
5. Inefficient and slower swimming speed-tight hip flexors pull the hips forward resulting in the bottom ‘poking up’ and increasing drag through the water.
How do I know if I have tight hip flexors?
Simple perform the following home test…-lay on a table’s edge with your bottom right to the very edge of the table. Hug one knee into your chest and let the other leg ‘flop’ down.
If the leg flopping down rests in a position above an
imaginary horizontal line (ie it is hitched upwards) then you have
tight hip flexors. Alternately if the thigh of the flopping leg hangs
below the horizontal than you have sufficient length of your
hip flexors. Home hip flexor test.
How do I improve my hip flexor tightness?
Reducing tightness of the hip flexors can be achieved by (ideally a combination of the below):
1. Daily stretching – either kneeling or if you have greater range the gold standard is with your foot on a wall behind you (if you have pain under your knee cap try padding under the knee with a towel or pillow)(as shown below). This needs to be
held for 2-5mins minimum and is best performed at the end of the day.
2. Regular yoga (some yoga asanas or poses target the hip flexors really well).
3. Physiotherapy treatment: manual (hands on) techniques include acupuncture and soft tissue remedial massage, trigger point releases.
Time frames to improve your hip flexor flexibility are determined largely by how long you have been ‘tight’ for. Obviously the longer you have been tight the longer it will take to improve and the more consistent you will need to be with the above 3 methods of improving your flexibility. People can see great changes in as little as 2 weeks if daily stretching is undertaken.
