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Knee Cracking: Noisy Knees are No Worry

September 28, 2017 • By

Knee cracking, popping and creaking are very common complaints but are actually nothing to worry about. Today’s post is an explanation of what causes the cracking in your knees, why it is no issue and what you can do to help it if it still gives you or a family member the heebie-jeebies…

knee cracking - what causes itWhat causes knee cracking?

Firstly, in the majority of cases, the cracking IS NOT FROM ARTHRITIS.

The most common cause of knee cracking or crackling are:

  1.  Gas bubbles within the main knee joint. We have a lubricating fluid within our joints called synovial fluid and within this can be gas bubbles. The change in joint pressures with movements of the knee causes these gas bubbles to move and pop – causing the cracking or popping noise
  2. Fluid movement behind the kneecap causes more of a fine crackling noise when bending the knee back and forth
  3. Another common cause of knee cracking is extra-articular (outside the joint) tendons or ligaments snapping back and forth over a knobbly bit of bone.(1)

Either way – these are not usually painful but if you are getting pain with you knee cracking then you should see a physio to get it assessed and treated.

The cracking can happen at any age but is more common as you get older and can be in one or both knees

 

Painful knee cracking

This is far less common but it can be caused by wear and tear (degeneration) of the cartilage and can be treated well with good treatment and rehab exercises – particularly if caught early, so if in doubt, go see your physio.

 

The video below gives a great explanation of crepitus and how it has no correlation to pain or pathology (Watch from 1 minute onwards)

 

How to decrease swelling and support your knee

For those that DO have painful knees, as well as seeing your physio, a compressive knee support can help a lot. There are two main types for you:

  1. A slip on compression sleeve with patella support. Having support for the kneecap at the front helps maintain alignment and compression of the support is key for helping keep the knee warm and decrease fluid from swelling.
  2. For those of you with large thighs, a wrap around knee support can be better fitting and more comfortable as the above braces and more cylindrical in shape and can slip or roll down.

Another great way to support the knee is to get the muscles around it stronger! A great place to start on that is some wall sits, which is a very safe way to lay a base of strength without aggravating any knee pain. Check out more on that here


Back pain

Yoga for Back Pain: The most effective Yoga Poses

September 15, 2017 • By

Many people will suffer from back pain in their lifetime. A recent study found that over 80% of Americans will have back pain at one time in their lives. The costs related to back pain amount to over $100 billion annually. This is due to a decrease in wages and the financial measure of productivity. Our spines and all the supporting factors (muscles, tendons) can only take so much abuse. Yoga for back pain can be very effective in decreasing the need for medication and regaining function.

Lower back pain is caused by many things such as poor posture, constant motion in repetition, or even aging. It’s caused by the discs between vertebrae drying up. They can bulge or rupture as well which presses on the nerves. This is sometimes the pain you’ll experience. It’s been found that stretching daily can prevent this from occurring and relieve symptoms.

Yoga for back pain can help align your spine and pelvis, it allows the muscles to relax which makes your body more resilient. Yoga poses can ease the tension in your back. They also work on the system of muscles that affect posture and the lower spine. This includes easing tension in the hips, inner thighs, and hamstrings.

Yoga for back pain Instead of Medication

The Journal Archives of Internal Medicine found that those who do yoga are twice as likely to stop or cut back on pain medications. For those with severe back pain, yoga probably isn’t the right option unless you’re willing to go through yoga teacher training. You can cause yourself damage by doing poses incorrectly so getting educated on yoga is helpful if you want to take this route.

For those who suffer from everyday soreness due to sitting at a desk, there are postures that can lengthen the spine. This eases the pain while strengthening and stretching the muscle and will promote the alignment of the spine and pelvis.

FOR THE LOWER BACK

Yoga for back pain childs poseChild’s Pose

This gentle pose is great for beginners and quickly calms the mind. It opens up your back and stretches it out while relaxing the muscles.

How to Do Child’s Pose

  • Sitting on your heels, bend your body forward. Your arms should be stretched out in front of you and relaxed on the floor.
  • Bring your belly and head to the mat.
  • Breathe in deeply until you can feel the breath in your back. Stay in this pose for as long as you like.

Pigeon Pose

Pigeon pose offers a deep stretch in the hips which could be causing your back pain. This hip tightness usually occurs from sitting at a desk for too long. When you deeply stretch the hip flexors, you effectively take pressure off your back.

glut and Lat stretch - Hip flexibilityHow to do Pigeon Pose:

  • Start at table top (on your hands and knees)
  • Bring your right knee forward, behind your wrist.
  • Try to place your right ankle in front of your left hip. Where you place your ankle will dictate how deep the stretch is. Feel it out for yourself and adjust when needed.
  • Bring your left leg back so that it’s straight behind you, align your knee with your hip. Point your toes.
  • Another thing to be aware of is that your left knee might want to fall outwards. Make sure the heel is pointed up to the sky.
  • Focus now on keeping the hips square.
  • Bring your upper body down to the ground while keeping hips level. If you need a bolster to support this, go ahead and use it.
  • To get out of the pose, use your hands to push back. Lift your hips and move the legs back to table top.

FOR THE UPPER BACK

Snake Pose

Snake pose helps stretch out your shoulder, upper back, glutes, ankles, and feet. As you open your chest, you counteract the slouching of sitting for long periods.

How to do Snake Pose

  • Lie on your belly with your feet hip-width distance. Your arms should be by your side with your palms towards the sky.
  • Interlace your hands behind your back and press your feet into the mat.
  • Lift your chest on the inhale.
  • Exhale and bring your shoulders back further.
  • Keep your neck long and gradually go deeper into the stretch with a few rounds of breathing. Hold the pose for 5-10 deep breaths through your nose.

FOR THE WHOLE BACK

Downward Facing Dog

The downward facing dog does a lot of stretching in one pose. It is a pose you can do for instant relief and it counteracts any hunching of the back. It also cleanses your organs and helps the upper and lower back. You get a good hamstring stretch which is connected to the lower back. You also give the heart a break because you’re somewhat upside down. When you do downward facing dog daily, you help improve your posture.

You get a good hamstring stretch which is connected to the lower back and is great for taking pressure off.

Steps to do Downward Facing Dog

  • Start at tabletop with palms wide. Your shoulders should be stacked over your wrists.
  • Curl your toes under and walk the palms so they’re slightly in front of your shoulders.
  • Put weight on your palms as you raise your knees off the ground. Focus on trying to bring your stomach to your thighs.
  • Lift your hips high up into the air and imagine that you’re pushing your tailbone to the ceiling.
  • As you slowly make your way into the full stretch of downward facing dog, try to get your heels on the ground. If you’re new to yoga, give it some time but do your best.
  • For maximum benefit, hold this pose for up to 30 seconds and breathe deeply into the areas that you feel.

How often do I do the yoga for back pain?

It’s important to do these poses daily to really experience the results. Ensure that you consult your doctor to see if your type of back pain will be positively affected by a yoga practice. There are plenty of gentle poses that will both relax your mind and your muscles.

 

This is a guest post by Meera Watts

About the author:

Meera Watts is a yoga teacher, entrepreneur, and mom. Her writing on yoga and holistic health has appeared in Elephant Journal, CureJoy, FunTimesGuide, OMtimes and others. She’s also the founder and owner of Siddhi Yoga International, a yoga teacher training school based in Singapore. Siddhi Yoga runs intensive, residential training in India (Rishikesh, Goa and Dharamshala), Indonesia (Bali). You can follow her here:

Website: https://www.siddhiyoga.com/

Facebook: https://www.facebook.com/siddhiyogateachertraining

 


Back pain, Chronic Pain, groin pain, Hip pain

Quadratus Lumborum – Why it hurts and How to fix it

September 4, 2017 • By

Back pain, Quadratus lumborumThe Quadratus Lumborum can cause some real grief through your back, buttock, hip, and groin but with the right management, exercises and self-treatment, you can be pain free – long term.

Where is quadratus lumborum pain felt?

You can see the pain referral patterns below for the deep (closer to the spine) and superficial fibers of the QL muscle. Referral from the quadratus lumborum can vary a lot between people due to this varied referral pattern, in some, it can be a literal pain in the butt and others it is the side of the back, hip or the groin.

Quadratus lumborum pain Quadratus lumborum pain

Quick anatomy

You can easily see from the video below that is the quadratus lumborum tightens up, it can pull at your bottom ribs, vertebrae or pelvis and if this happens one side more than the other, it can lead to some real asymmetry and not just cause back pain but a whole raft of other things.

How can a tight quadratus lumborum effect you?

Apart from being painful, it can also increase the load on quite a few other structures. Often when one side tightens up it can lift that side of your pelvis a little making you feel out of place or out of alignment (even though your back can’t go out of place,1). It can also pull at your ribs, tilting you to the side, limiting your reaching and restricting your breathing. And last but not least if the QL is tight on both sides, you get more compression on your spine.

The QL can also:

  • Cause a sharp stabbing pain in the low back
  • Cause pain and limitation when trying to turn in bed or stand from sitting
  • Make it look like you have a leg shorter than the other by holding one side of your pelvis higher
  • Contribute to a lot of other issues such as patellofemoral pain, trochanteric bursitis and scoliosis due to asymmetrical tension

So how do we fix it?

In three steps:

  1. Ease the pain by decreasing tension by releasing the muscle (stretching often doesn’t help)
  2. Get you back to normal by regaining full range of motion through your back and hips
  3. And finally, treat the cause by improving strength of the QL so that it can handle everything you throw at it

 

1. Ease pain

For this, we need the muscle to relax so the most important thing is reducing aggravating activities and applying heat. Heat can be applied be a wheat bag, hot water bottle, heat rub or anything similar, it will make a big difference. Of course make sure you don’t make it too hot or hurt yourself, by following the instructions.

Also, you can directly release the quadratus lumborum, which is far more specific than stretching. Check out our past blog post to learn how to do a myofascial release for your Quadratus Lumborum.

2. Regain normal range

We need to now get everything back to normal – not just the quadratus lumborum but the muscles that have changed because of the asymmetry that the QL caused. The following stretch is perfect for this, just remember to relax into it and that it isn’t, no pain-no gain.

Gluteal stretch: This will help even you out and regain hip range

3. Strengthen

Now get you quadratus lumborum stronger so that it can handle what you want to be able to do. A stronger QL means less pain and you have more control and power, without having to avoid things constantly.

To load the QL, we need to load the side of your body and the best way to do this is the side planks and the one sided farmers carry:

Side plank Level 1

Hold for up to 1 minute. Once you can do that comfortably, progress to level 2 below.

side plank for core strengthening

Side plank Level 2:

In the side plank, raise your top leg up and down up to 10 times. Repeat 3 times each side.

 

Side plank leg raises

 

one sided farmers carry for QL strengtheningOne sided farmers carry:

Hold onto a dumbbell, kettlebell or anything with a bit of weight to it in one hand and do some laps (e.g. 10 x 10m laps on each side).

Carrying a weight on one side makes the QL and obliques on the opposite side work hard to keep you upright.

Note: Don’t do two sided carry like in the picture!

Tip: try to stay upright!

 

And that’s it.

Heat

Release

Stretch

Strengthen

Work at that most days and notice the results.

On a side note, once you are feeling improved, don’t slack off on the exercises, they are great to do just to maintain yourself in great condition, even if it is just three times per week.

 


Ankle, Health

Ankle pain, The Best 3 Support Braces

August 2, 2017 • By

Our ankles get little reprieve and time to rest so when we get ankle pain we need a way of looking after them while keeping going. We have outlined the best supports and given a guide so that you can find the perfect support for your ankle pain.

Recent research has proven beyond a doubt what the best thing is for ankle pain and it isn’t what everyone would think. In the past, the need for rehab and strengthening ankles up has been pushed as the most important. But actually, what has been shown to be even more effective in recent research, is wearing an ankle brace.(1

Here is a quick summary of the study from YLM Sports Science

Ankle pain support

Why do braces work so well for ankle pain?

They support you, allowing you to keep moving. That is the key.

Often when we have ankle pain, we aren’t as active, we start walking differently and avoid certain activities. But, with the right support, we avoid the muscle dysfunction and stiffness that comes from this. That is why ankle braces and the most popular item in most physical therapy clinics and that is why you have nothing to lose and everything to gain in getting one for yourself.

We have put together a guide for you below of the different types of ankle support to help you decide on what is best for you:

TypeLevel of supportUsed forLink to example product
Compression sleeveMild support- Ankle pain
- Compression in early stage rehab
- Reduction of swelling
- Mild ankle sprains
- mild instability
Support with strapsModerate support- Ankle pain
- Maintaining warmth
- Moderate support
- Mild instability
- Mild and moderate ankle sprains
Lace-up ankle braceComprehensive ankle support- Moderate and severe (grad 2 and 3) ankle sprains
- Moderate to severe ankle instability
- Dynamic sports

For those of you that don’t have a lot of room in your footwear, there are types of low-cut and low profile ankle braces like THIS Mueller brace that are also a great option.

Further information on ankle pain

For those of you that are information orientated, we have decided to go more in-depth into the many causes of ankle pain, why it can hang around and the many more things that you can do to help it as the more we can do to get rid of ankle pain faster, the better right?

Causes of ankle pain:

  • Tendinopathies: Overload injuries to the tendons around your ankle is common, including peroneal tendons, Achilles tendinopathy and more. Note tendonitis is a common term that is still used a lot but research over the last 10 years has shown that the majority of tendon overuse injuries are not inflammatory after the first 1-2 weeks.
  • Broken ankle: Following ankle fractures and subsequent casting you can be left with stiffness and pain for up to a year. An ankle support can really help with this as well as stretching if you don’t have the full range. You can test your range with an easy test in our past blog post here
  • Arthritis: The top two braces above can help a lot with this as they maintain warmth of the joint
  • Plantar fasciitis

The majority of ankle pain can be helped with decreasing the aggravating activity, supporting the area well and strengthening the ankle back again and there are a lot of great exercises in our past blog posts like THIS one that is great for not just ankle sprains but all sorts of issues down below!

Information on ankle sprains

The most common type of sprained ankle is the lateral ankle sprain (85%), and that is what we are going to discuss and sort out today.

Mechanism of injury: The plain and simple is that a sprained ankle is typically when your foot is forced inward (inversion) and down at the same time (often when changing direction, turning and/or on uneven surfaces). This puts the ligaments under too much stress too fast which causes a tear of one or more of your ankle ligaments.

 

sprained ankle - lateral ligamentsQuick anatomy: The lateral (outer) ankle has 3 ligaments supporting, with the weakest of these (and so most often injured) being the ATFL. The ATFL is the Ligament at the front of the ankle shown here and in most simple sprains, this is the one torn with or without the ligament below it.

Sprained ankle recovery time: The general recovery time is 2-6 weeks (if looked after properly) and keep in mind, even if it feels bad now if you do all the right things you will be one of the 95% who returns to sport and activity within 6 weeks.


Back pain

Slipped Disc: What is it and how to fix it

July 21, 2017 • By

Slipped discs are very common, right? Well, to tell you the truth… they don’t actually happen! Find out what a slipped disc really is and how YOU can sort it out yourself.

Slipped disc, Herniated disc, disc bulge and sciatica are all interchangeable and often used to explain the same thing. Now I need to say first of all that intervertebral discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments – Slipped disc is just a colloquial term which has bred a lot of fear over the years but really there is nothing to fear!

The two common sites for herniated discs are the lumbar spine (low back) and the Cervical spine (neck). Today we are going to cover the low back as this is the most common, but stay tuned for self-treatment of herniated discs in the neck!

Discs cannot actually “slip” as they are firmly attached to the vertebrae above and below vertebrae by very strong ligaments

Basic anatomy:

lumbar anatomy - slipped discs and herniation

The spine is made up of vertebrae stacked on top of each other, held together by ligament and muscle. in between each vertebra is an intervertebral disc. Now in the lumbar spine, there are 5 vertebrae and the most common level for disc herniations are L5/S1 – this is the Disc between your lowest lumbar vertebrae and your Sacrum. roughly 80% occur here with the second most at L4/5 above it.

The Lumbar discs are made up of a harder outer layer, holding in a gooey middle.

How does a Disc herniation occur?

When too much force is repeatedly put through the front of the disc (such as bending forward, slouching and lifting heavy objects) the gooey center of the disc is forced forward and eventually (after thousands of bends)it forces through the outer layer.

A lot of Discs are injured doing very simple things light, changing a light bulb or picking up a baby but it is not that action that does it, it is a build up over time and it can take any little thing to tip it over the edge!

Now there is different levels of disc damage as you can see in the picture below:

disc bulge levels herniation - how to fix slipped disc

 

Now, sequestrations are serious and often need surgery but the remaining levels can be and should be treated conservatively (non-surgically) first.

Depending on the level of disc herniation, they can cause symptoms in different places down the leg due to the nerve roots that get annoyed. Keep in mind though that Disc herniations often do not have pain or change on sensation into the legs – there is a very wide range of presentations.

 

Herniated disc symptoms: You can have some or all of these.

  • Pain worse in the morning and cold/bad weather
  • Sciatica – Common back and leg pain caused by irritation to one of the 5 Lumbar spinal nerves. The nerves are irritated by the disc compressing on it or inflammation from the disc herniation. This usually only occurs down one leg.
  • Back spasm – often people are given this as a diagnosis but muscle spasm DOES NOT HAPPEN FOR NO REASON – there is always something behind it. Muscles around your back tighten up and go into spasm to protect your back and try to stabilize it so that no more damage is done.This is called muscle guarding and is a natural mechanism initially but in the following days, it can lead to a lot of discomfort, pain, and limitation.
  • disc bulge, slipped disc, herniation - self treatment physiotherapyAggravated by sitting, prolonged standing, bending and twisting.

Recovery and healing time

Recovery: Up to 80 percent recover within 6 weeks

Healing time: 12-18 months due to poor blood flow into the discs.

 

 

When to go to the hospital or see your Doctor

  • Weakness in your legs
  • Change in bladder or bowel (toileting) function.
  • Constant unremitting pain or pain not improving

If in doubt see your local health professional as this information is not meant to replace the assessment and advice of a health professional.

 

“Slipped disc” Self-treatment

1. keep active: back in the day bed rest was the first port of call, now it is the opposite. keeping relatively active is the best thing for your back and you need to remember that the chances are your back will get better and that over 80% of the population get back pain just like yours!

2. Exercises: to get the right muscles firing again to stabilize your spine and to loosen off the tight muscles (so that you dont feel hunched over and shuffling!) follow this link: Must know exercises for acute low back pain

3. Stiffness in your upper spine puts a huge amount more stress though your low spine and gets worse when in back pain! Here is a great way to mobilise your own spine

4. The greatest exercise for Disc Herniations: this exercise was developed by a top Physiotherapist Robin McKenzie. Repeated Extensions In Lying (REIL) act to centralise the disc and gradually reduce the disc Herniation.

Prone extensions in lying McKenzie exercise for disc low back pain

 

Position: Lying on your Front with your hands in front of you like you are going to do a push up.

Action: Keeping your hips and back relaxed, push your shoulders up. Do not push into pain, so stop when and if you feel pain and hold it for 10 seconds then relax down and repeat 10 times.

 

Initially start on you elbows as shown, then progress to straight arms.

Prone extensions in lying McKenzie exercise for disc low back pain physiotherapy

Reps and sets: 10 x 10 second holds 3 x daily


Remember: if pain worsens with this exercise do not push as far or as hard. If pain continues to worsen then consult a health professional.

 

These easy steps will help you so much, just remember that you WILL have good days and bad days but if you stick to the above 4 things, your Disc pain will get a lot better. Try and persevere with these exercises for 6 weeks at least!

Let me know how you get on and don’t forget to like, share and follow and remember, a slipped disc doesn’t exist!

Also see: progressed exercises for keeping back pain away