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Back pain, Core strengthening, Health, physical therapy, physiotherapy

Beating Low Back Pain – Must know Physiotherapy Exercises

July 20, 2017 • By

Don’t put up with low back pain and Sciatica. Below are the best and safest exercises to treat your low back pain yourself.

With 80% of the population experiencing low back pain in their lifetimes, and 84% of those having a recurrence within the same year, this is a huge problem, but a problem that can be helped… alot! As with most other pain and injury, treatment and exercises combined lead to optimal results, so below are five exercises for you

As with most other pain and injury, treatment and exercises combined lead to optimal results, so below are five of the best exercises for you to rehabilitate your low back pain at home.

1. Bridge, level one:

Start by lying on your back on the floor or bed with your knees bent. Squeeze your buttocks together and lift buttocks off the floor until your body is aligned. Hold for 5 seconds, then lower down. Repeat 10 times twice.

Brideg - up

Bridge level 2:

For the next level up if the above is too easy, keep one leg straight out in the air and perform with one leg. 10 reps each side, 2 sets.

For the next level up if the above is too easy, keep one leg straight out in the air and perform with one leg. 10 reps each side, 2 sets.

SL bridge 1SL bridge 2

2. Glute sling stretch:

Our favorite stretch!

glut and Lat stretch - Hip flexibilityglut and Lat stretch - Hip flexibilityglut and Lat stretch - Hip flexibility

 

Start on your hands and knees then bring one knee between your hands. stretch the other leg out behind you and across to the other side. Now slowly walk out over your knee with your hands until you feel a good stretch.

Hold for 1 minute each side.

Tip – If that is too much of a stretch then go down onto your elbows first.

3. Bird-dog: 

Instructions: In four point kneeling slowly raise one arm and leg on opposite sides, making sure to keep your back straight (imagine your dinner is sitting on your hips – it is all about control). Lower down in a controlled manner and repeat, 10 times each side twice.

Beginners: Start by raising one leg only.

birddog 2birddog 1

4: Hip flexor stretch: This is important to unload the Low back and pelvis:

hip flex 1hip flex 2

Tip: to get a good stretch “tuck your bum in” or draw the bones at the front of your pelvis up towards the roof. You should feel it in the front of your hip or top of your thigh.

Hold for 1minute.

5: McGill Curlup

Place your hands down on the floor underneath the natural arch in your lower back (Don’t flatten your back.) Only lift your head and shoulders off the ground – unlike crunches, there should be no movement of your lumbar spine. Your hands are there to make sure your back is not curling off your hands or crushing them.

Once you have good spine control then you can take your hands onto your thighs and slide them to the top of your knees to do the curl-up. It doesn’t feel like you are going far but with repetition, it can get your abs firing well.

Begin with 20 at a time, and build up.

mcgill curl up

The key to all of these exercises is to maintain control and don’t rush them.  Do these exercises twice daily for 6weeks and notice the difference (but don’t stop there!)

Also see Slipped disc: what is it and how to fix it.

And if you want more and harder exercises to strengthen up your low back: Get into some QL strengthening!

 

Please Share, like and comment to let me know how you go.


Health, physical therapy, physiotherapy

Therapeutic Ultrasound – Why is it still used?

May 12, 2016 • By

With therapeutic ultrasound not having a definite mechanism of action on injuries and having no significant evidence behind it  – I ask why ultrasound is still used so much as a treatment for musculoskeletal injuries?

Too often when treating in the clinic I am asked either “do you use ultrasound”, “why don’t you use ultrasound” or “normally my past physio just used ultrasound and a heat pack…”

Now I know everything has its place and its uses but when there are so much better alternatives than therapeutic ultrasound that do actually help more that placebo – why not use them?

Now, here is a little background info on ultrasound:

ultrasoundtherapyWhat it is: Therapeutic ultrasound (US) is a popular electrophysical treatment method that generates mechanical energy which propagates through tissues (1). Among physiotherapists, it is used to treat soft tissue injuries, accelerate the wound’s repair, augment fracture healing, on swellings resolution and to solve some bone and circulatory injuries.

Although many lab‐based studies have demonstrated a number of physiological effects of ultrasound upon living tissue, there is remarkably little evidence for real effect and benefit in the treatment of soft tissue injuries(2).

How much is it used?

Therapeutic US is still used almost daily throughout many countries as a go-to treatment for acute injuries and overuse injuries such as runners knee.

  • In Australia, it is used DAILY by 84% of health professionals
  • in England, it is used in 54% of all interventions in private clinics(1)

There are some countries which are ahead of the game with such as Sweden, where it is used less than 5% of the time and this needs to be followed by other developed countries(3).

EBP triadWhat’s the evidence then?

In most studies, therapeutic ultrasound proved to be no better than Placebo for a wide range of musculoskeletal conditions (4,5), and that there is a lot of variation in parameters used.

I could go into detail but the main point is, therapeutic US has been shown to be no better than placebo or exercises(6), so why would a therapist waste ten minutes of treatment time when they could be doing something else?

Evidence-based practice is becoming increasingly important in physiotherapy as we want to use what works for our patients – So why is US use still so rife in the profession? Is it lack of motivation, education or just plain lazy?

Let me know your thoughts!

 

Extra reading:

Paul Ingrahams post in a similar vein is a great read

 


Health, neck pain, physical therapy, physiotherapy

5 great exercises for neck pain.

June 13, 2013 • By

In this post I want to give you the tools to lay the foundations of a functional and stable, pain free neck. As with all spinal rehabilitation and retraining, there are important aspects that have to be addressed in order to achieve the end result of decreased neck pain and increased movement.

Make sure to check out my post on beating headaches arising from a tight and sore neck.

The first is kinesthetic training. This, in a nutshell, is gaining a better awareness of safe spinal movement and the neutral spine position. This is an important initial building block for the neck because, as mentioned earlier, when in pain we tend to lose proper feeling in the neck and in turn lose control of the stabilising muscles. This leads to unknowingly holding your head in a bad position (and so more neck pain!).

So first we need to discuss the neutral spinal position for the head and neck.

 

As you can see in the picture above, the image on the left is in neutral spinal position, still maintaining gentle curves. Now the image on the right has a typical poor posture of the upper back and neck, with their head jutting forward and their back rounded out. Just remember a good spinal position is not having your spine as straight as a pole or forcing yourself bolt upright!

1.1. Double chin

The first technique we will do is head retractions (I find calling it Double chins makes it far easier to remember). A great way to visualize this exercise is thinking about giving yourself an extra chin, as it has this effect when performed. To do this it is important to keep looking forward while bringing your head backward, making sure not to tilt your head down (it may help to put a finger on your chin to guide your head back).

Hold this position for 5 seconds 5 times. This can be done little and often throughout the day

Now this is an extreme of the position and we do not need to have a head this far back all the time! Rest assured.

 

1.2 Keeping moving

The second easy exercise to start doing is turning nods. This exercise is to start functionally working the core muscles of your neck and help them start feeling normal again. This is a fantastic exercise for neck pain and while at times it may feel like it isn’t doing much, believe me it works wonders on sore necks and headaches, allowing improved neck function and more feeling into the neck.

The added bonus is that it makes you keep the neck moving because as I’m sure you know when in pain we tend to stiffen up and this is not what we want at all.

Turning nods: This involves turning your head to each side and performing 3 nods on each side. These nods need to be small so that you are just moving your head on your neck. An important thing to remember with these exercises is do not push into pain! Also for some people this can feel like an awkward movement to do  or you may struggle to do the small nods – persevere and they will get better, this just shows that the muscles really are weak and lack control. This awesome exercise takes no time at all and can be done little and often throughout the day.

The second aspect is muscle re-training, you can move on to this as early as you like, progressing on as it gets easier.

The specific muscles that we want to retrain are the Deep Neck Flexors.

2. Chin tuck

The best and most used exercise is the chin tuck, which provides the basis for neck stabilization  This exercise can be done in numerous positions, including lying on your back, tummy, in four point kneeling and standing. BUT there are progressions to this exercise and you want to make sure you have each stage down before you move on.

Initial position for learning the chin tuck: lying on your back, knees bent with a towel rolled up under your head as shown so that the thickest part is under the base of your head.

Action: Tuck your chin in causing a fattening of the neck and a downward pressure to be applied to the rolled towel at the base of your neck.

How much? Begin with 10×3 second holds and progress to 10×10 seconds – 2 sets of these twice daily.

 Image

Tips

    1. place your tongue on the top of your mouth and keep your teeth apart. This will help relax the jaw and only utilise the muscles we want, deep in your neck.
    2. Do not force this exercise, it needs to be gentle
    3. Quality over quantity – keep it nice and slow and control it!

 Chin Tuck progression:

Once you have mastered the chin tuck in lying and you can do it easily in a smooth motion without tensing your jaw, then you are ready to move on and do this exercise in the other positions. I recommend progressing to four point kneeling first as this will give you great feedback having to work against gravity. You can also do the exercise in front lying and standing.

The third aspect is unloading the neck by stretching tight muscles:

3. Arm pit stretch: This is a great stretch to unload your neck and shoulder. I call it this as you are pulling your head towards your armpit!

Hold this for at 1 minute and perform 3 times daily. To get a better stretch it may help to hold on to a bench or table with the opposite hand to stop the shoulder rising up.

neck stretch for levator scapulae

4. Ear to shoulder: Keep your head looking forward and this time pull your head towards your shoulder and hold for 1 minute also 3x daily.

 neck stretch for upper trap

Exercise re-cap:

– Double chins

– Turning nods

– Chin tucks

– Arm-pit stretch

– Ear to shoulder stretch

These exercises absolutely don’t take long and can be done LITTLE AND OFTEN throughout the day.

Be sure to keep and eye out for an upcoming post on postural correction for some great self mobilization and correction techniques you can do at home and also my recent post on Self Trigger Pointing.


Core strengthening, physical therapy, physiotherapy, training

Resistance training for an injury free and functional body.

June 12, 2013 • By

Free, Body and weight training – this post is not just for the gym junkies, it is for everyone that wants their body to perform well and likes to look after their body home or the gym.

As a physiotherapist I am a huge fan of functional exercise and so in this post I am going to briefly talk about what type of weight training is best for your body.

Below is a brief description of all three types and a table outlining the pros and cons:

1. Body weight exercises: exercises in which the resistance is provided by your body weight. Eg. push-ups, pull ups, lunges, curl ups, tricep dips.press up training body weight

2. Free weight exercises: exercises where the resistance is applied by a object that is not attached to anything else such as dumbbells, resistance bands, medicine balls.

3. Machine exercises: this is fairly self explanatory but is any exercise where the weight is stabilized by the machine and you just have to apply force in one plane of movement.

Cost

practicality

versatility

Functionality

Difficulty

Muscle mass

Body

none

moderate

moderate

high

moderate

Low – mod

Free

low

high

high

high

moderate

Moderate

Machine

high

low

low

low

low

High

Conclusion: Both free and body weight exercises make your stabilizing muscles work, leading to much greater functionality and cross over into everyday life and I would recommend them over weights machines absolutely any day.  Weights machines are ok if you purely want to build muscle mass, but this has little functionality due do the machine guiding the weight and stabilizing for you.

The best thing to do would be a combination of body and free weight training as you have a much larger range of exercises and workouts available to you and great coss over.

 Why is stability important?

Stability is very, very important, if you do not have a stable base to work off then you are much more likely to get injuries, AND it makes the exercise a lot harder.

Imagine: trying to lift up a heavy object while standing on ice (or mud)(unstable base) and how hard that would be compared to lifting a heavy object with feet firmly planted on a rubber mat (stable base) – what is easier?

This is exactly the same as the following two examples:

    1. Having weak shoulder stabilizers such as your rotator cuff. If these are weak then the shoulder is not stable and so all the muscles working off it will struggle and are much more likely to get injuries such as rotator cuff tears or tendinopathy due to impingement.
    2. Weak core and hip stabilizers:  If you don’t have good strength and endurance in your stabilizers here, you are more likely to injure your back, hips, knees and ankles purely because you are working off an unstable base, leading to poor form and bio-mechanics.

So although weights machines are at times easier – they are not practical the majority of the time, can be costly and do not cross over functionally in to everyday life and sports. If all you want to do is build muscle – then make sure you also do stabilising exercises such as rotator – cuff strengthening for your shoulders in order to reduce the risk of overuse injuries.

And so It is only fair that I give you some great exercises to increase the strength and the endurance of your stabilising mucscles!  These will be for EVERYBODY. Subscribe or stay tuned for these in up-coming posts.


Health, neck pain, physical therapy, physiotherapy

How to get rid of Headaches – All you need to know and do

May 30, 2013 • By

By whatever name you want to call them, tension, stress or cervicogenic Headaches are a huge problem in today’s high demand, high stress world. Here you will find out what your headaches are caused by and most importantly how YOU can improve and get rid of headaches drug-free!

Many have headaches as a common occurrence, simply cannot get rid and have learnt to live with them and for the majority of headaches sufferers, this simply should not and does not need to be the case. This is because a common cause of headaches is the sub-occipital muscles of the cervical spine which in simpler terms are the muscles right at the base of the skull.

Image

And here’s the kicker – THIS CAN BE TREATED.

These headaches are called Cervicogenic headaches, also commonly known as tension headaches. The pain is experienced in the forehead, temples, around the eyes and often gets worse with prolonged postures, stress and neck pain.

Image

Starting to sound familiar? If so read on!

How do these muscles cause headaches?

The pain is essentially caused by trigger points in the muscle referring pain to different points on the head. These  are caused by a number of things, including the following, and often not by one factor in isolation.

The main causes of the trigger points are:

  1. Poor posture: poor posture causes a lot of stress on the posterior structures of the upper neck. Poor posture causes a forward head posture, which closes down of the joints of the upper spine, in turn putting stress on the supporting muscle to hold the head up while out of alignment. This stress causes the sub-occipital muscles to tighten up in order to protect the joints, which if maintained this can cause trigger points and chronic pain.
  2. Stress: when under stress, from any source then you tend to tense up your shoulders, raise your shoulder blades and tense up at the back of your neck causing a forward head posture and over activation of you global muscles. Along with this, the chemical make up in your body changes.
  3. Sports: sports that need a lot of hyper-extension such as diving and climbing and also sports that can injure and put pressure on the neck as these actions close down the joints at the back of your neck and cause muscle guarding and increased tension. Contact sports such as football and rugby also cause jarring and injury which can lead to headaches.
  4. Spinal injury – such as whiplash.
  5. Degenerative spinal disease and arthritis. These diseases cause breakdown of joint surfaces and extra bone growth causing a lot of pain and irritation. Because of this the surrounding muscles tense up to try and protect the joints, this leads to knots in the surrounding muscles which no longer function properly and can cause pain themselves.

Once trigger points are formed and you have the headaches that go untreated then often they stick around due to decreasing muscle function, with a number of factors having effect:

Image

  1. When the sub-occipital muscles tighten and form trigger points, if left untreated, these form a cycle of decreasing muscle function. The trigger points and tight muscles decrease the blood getting into these muscles leading to tighter muscles and more pain.
  2. The second major problem which adds to this cycle is loss of feeling in the neck. When in pain, the proprioceptors in the neck are inhibited, these receptors relay information  to your brain, telling you where your body is in space. Due to pain and tightness, the receptors can no longer effectively sense if your head is in the correct position and this leads to worse neck posture and also decreased movement due to trying to protect the area.
  3. The third point that adds to this cycle just like in low back pain is loss of activation of the deep stabilising muscles. The deep neck flexors are the core of your neck and in pain disorders these stabilising muscles show decreased muscle control and endurance. This leads to less stabilisation which in turn causes large global muscles such as your upper traps and levator scapulae to take of and be a nuisance.

So how do you know if you are getting cervical headaches and not migraines? Here is a quick reference table in oreder to help differentiate between tension headaches and migraines.

Cervicogenic headache

Migraine

Effectiveness of pain killers

Decreasing

Limited response

Description

Dull, aching

Described as an attack

Intensity

Variable

Severe

Effect of migraine drugs

No relief

Relief

Family history

No connection

Family history related

Neck pain

Some neck tenderness or stiffness

none

Quick test: The most significant test I use in practice everyday (if the above matches) is palpation of the offending muscles.

You can do this by feeling the sub-occipital muscles with your index finger, with the middle finger on top of it for support.  Push into the muscles gently and massage(with reasonable force) around the muscles at the base of your skull. When you come across a part of the muscles which feels harder, lumpier of slightly painful, stay there and increase the pressure – if the pain from this refers into the head similar to the headaches you get, then this is most likely a major cause or contributor of your headaches and CAN BE TREATED.

How are cervical headaches treated?

These headaches can be treated very effectively by a Physiotherapist, the aim of treatment is to:

  1. Relax the muscles, mobilize the joints.
  2. Increase muscle stabilization.
  3. Treat the causative factor if possible, such as poor posture or stress.

But as always I want you to help your self and be as independent as a possible! In subsequent posts I will let you in on how to get rid of  headaches at home:

See my posts on these techniques and if you really stick to the above three points and give them a good try, then you will achieve awesome results. Why live with the pain and discomfort if you can do something about it as easy as this. Even spending 10-20 minutes each day doing these self treatments will help! Try it for 6 weeks and you will be sleeping well again.

Let me know how you get on!