Back pain, Core strengthening

Acute Low Back Pain – Getting up and moving

July 3, 2017 • By

Low back pain is an incredibly common condition and is the single most common thing I see in practice every day. Luckily there are some great exercises to do early on to get you up and moving.

The following facts show just how seriously we should take back pain!

The bad

  • Low back pain affects 84% of the population at some point in their lives (1,2)
  •  38% of people have back pain each year (3)
  • Close links with low back pain and neck pain (15 fold increased risk of neck pain)

The Good

  • 50-80% recover within 4-6 weeks
  • This is not uncommon

It may feel really sore and at times disabling but as long as you follow my recommendations below you have a good chance of recovering 100%

In most cases, the majority of low back pain is not serious. What a lot of health professionals do not tell their patients is that 85% of low back pain is categorized as “Non-specific low back pain”. This means that the pain and disability do not have a definitive cause or diagnosis. This non-specific low back pain is what we will be talking about today and I will be giving you the information and exercises to get you walking right and up straight again.

Because 50-80% of people recover in 6 weeks the usual advice is to take painkillers and keep active – but the thing is there is more you can do to speed it along!

First I need to say, yes there is the remaining 15% of back pain that is specific and does have a diagnosis so it is important to have these ruled out and see your doctor – especially if the pain is not improving.

Below I am going to outline a guideline for getting your back to the best it can be when you experience acute low back pain.

Phase 1. Initial inflammatory phase:

This is the stage where most likely it is uncomfortable to walk, bend over etc and you just want to curl up in a ball and stay there (that will not help!). In this phase you need to abide by the Tips below:

  • Number one rule is to keep moving, within reason. This prevents the structures around the spine such as the muscles in spasm from stiffening up too much. This is also very important in order to decrease the loss of stabilizing muscle activity. Now you don’t need to continuously keep moving – just don’t stay in one position for a long period (more than 20 minutes).

Bed rest is one of the worst things for back pain

  • Gentle range of motion exercise: knee rocker – Lying on your back with your knees bent up and feet on the ground – slowly let your knees drop to one side, and then the other. This is a gentle exercise and not to be forced or pushed into pain. Little and often throughout the day.
  • Safe sleeping positions: The best position is in side lying with your knees bent up a little and a pillow between the knees. This position decreases the forces on the spine and allows muscles to relax.
  • If you must sleep on your back then have a pillow under your knees to unload the spine.
  • Stretch to straighten up: when in back pain your hip flexors tighten up and put a shear force through your spine and cause you to have a bent over, shuffling posture.

hip flex 1hip flex 2

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

Hold for 1 minute.

Phase 2. Recovery:

In this phase, the main things causing stiffness and pain are muscles that are tight and in spasm in your hips, glutes and low back.

1. Glute stretch: To get into the below stretch, start in four-point kneeling and bring one knee forward between your hands. then extend you

To get into the below stretch, start in four-point kneeling and bring one knee forward between your hands. Then, extend your other leg out behind you and across to the other side. Lean forward in this until you feel a stretch in your glute region. To add more of a stretch, walk your hands out in front of you. Hold for 1 minute each side

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

2. Hip flexor stretch: as above in phase 1

3. Bird-dog exercise:

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 control and repeat, 10 times each side twice.

Beginners: Start by raising one leg only.

birddog 1birddog 2

4. Bridge, level one:

START POSITION: Lying on your back with your knees bent.
Stabilization: Tighten abdominals.
Squeeze your buttocks together and lift buttocks off the floor until your body is aligned. Hold for 5 seconds and then lower down. repeat 10 times twice.

Brideg - up Brideg 1 legges - up

Phase 3: Strengthening and back stability – and maintain!

To do this make it a routine to do my top five Low back pain exercises daily.

Maintaining core stability is important in preventing flare ups and ensuring you at your best if flare ups do happen, to speed up recovery.

Thanks for reading and remember looking after your back is ALWAYS important, not just when it is sore.


Shoulder pain

Rotator Cuff Rehab: Strengthening exercises

June 13, 2017 • By

Rotator cuff injuries are one of the most common injuries and one of the most feared, but they don’t need to be. With the right rotator cuff rehab exercises, your shoulder can be pain-free and strong again in no time.

There is a huge amount of research coming through that is showing that we have become far too reliant on surgery which often comes with its own risks and can lead to scar tissue and frozen shoulder. Current best practice recommends about 12 weeks of conservative rehab before looking into surgery if not improving. Recent studies have shown:

  • Subacromial impingement and bursitis: Exercise is as effective as surgery AND reduces the need for surgery in 80%
  • Rotator Cuff partial tear: Exercise is as effective as surgery
  • Full Thickness Rotator cuff tears: Exercise reduces the need for surgery by 75%

Rotator cuff rehab physio

That’s some fairly awesome stats from multiple studies and shows that with the right rehab exercises, there is a good chance your shoulder pain will resolve without the risk of surgery, so let’s get into it!

 

Following on from our stage 1 post on early Rotator Cuff Rehab, this is all you need to know to lay a strong base for your shoulder stabilizers.

Stage 2 Rotator Cuff Rehab: Building strength

This stage starts when you can lift your arm up in front of you over shoulder height at least. If you can’t do that, step back to stage 1 or consult your health professional

1. External rotations

  • Lie on your side with your elbow at 90° and holding a small weight – starting with about .5kg can be a good start
  • Then lift the weight, rotating with your shoulder as shown – making sure your elbow stays touching your side the entire time and then lower down
  • Repeat for 3 sets of 10 and increase or decrease weight as needed to fatigue the muscle without pain

Rotator cuff rehab external rotationRotator cuff rehab external rotation

 

2. Overhead rotational press

  • Always start with your knuckles forward and in front of your shoulder and then press up while rotating so that your knuckles are backwards
  • Do 3 sets of 12, starting with a weight that is pain-free (such as a can of beans) and build up from there

Overhead rotational pressOverhead rotational press

3. Lawn mowers

  • Start with your hand in front of your opposite pocket. Leading with your elbow, bring your arm across your body and up to the opposite corner as shown.
  • Start with a weight that is pain-free such as .5kg and build up from there with, performing 3 sets of 12 with an aim of the shoulder being fatigued at the end.

Disco dancer shoulder rehab exerciseDisco dancer shoulder rehab exercise

4. One arm push-up

  • Place your hand on the wall at chest/nipple height. Do a push-up to the wall, keeping back straight and shoulders level.
  • Only go as far as you can control and adjust the distance of your feet from the wall so that it is challenging but not painful.
  • Do 3 sets of 10

One arm push-up shoulder exercise

Tip: If the exercise is sore to do, try and use something lighter (or move closer to the wall for #4) and if you can’t do it without pain, don’t do that one for a couple of weeks – just start with the exercises that you can do. Remember rotator cuff rehab typically takes around 12 weeks on average so patience is key

Get into routine of doing the exercises 5 days a week, combined with other exercise such as walking or biking regularly


Shoulder pain

Rotator Cuff Tear Exercises: Heal Strong and Fast

June 8, 2017 • By

A Rotator cuff tear is one of the most feared injuries but shouldn’t be. Here’s what you need to know about rotator cuff tears to get them stronger, faster.

Just how common are they?

A rotator cuff tear is present in over 20% of the population, but don’t let that number fool you because not 1 in 5 of us actually have painful rotator cuffs. This is because, just like you can and probably do have joint degeneration in your knee that gives you no pain at all, you can have rotator cuff tears that are pain-free (asymptomatic).

So the real number you should be interested in is the number of symptomatic tears; 35% of rotator cuff tears on radiology are symptomatic, which is still very common!(1)

Rotator cuff tearWhat is the rotator cuff?

Put simply, it is a group of muscles which come from the front, back and top of your shoulder-blade and wraps around that ball and socket of your shoulder. Their job is to coordinate between themselves to help keep the ball positioned nicely in the socket while you move your arm.

Rotator cuff tears often happen in the tendon, close to the shoulder joint.

Does a rotator cuff tear need surgery?

Really, it is case by case but most rotator cuff injuries do not need surgery.

As a good guideline, with all rotator cuff tears, it is best to trial 12 weeks of conservative rehab and if that has not much improved the injury, then you look at seeing the surgeon.

A recent study actually showed that there was no difference between surgery and active physiotherapy at 1-year follow-up(2)

Physio Rehab exercises for a rotator cuff tear needs to cover three things:

  • Regaining range of motion and muscle activation
  • Improving strength
  • Regaining full control and function

We are going to cover these stages in three posts and here is Stage 1, which starts after 3-4 days of rest, or more if needed:

Stage 1: Regaining range and muscle activation

1. Pendular circles

2. Regular movement

Using a broomstick or a pulley, this is a great active-assisted exercise for regaining movement and stopping the shoulder stiffening up.

Hold onto the end of the stick with your injured side and help lift it up with the other hand.

Repeat this 20 times 5 times per day without pushing into pain.

Active assisted shoulder flexion Active assisted shoulder flexion

 

isometric rotator cuff strengthening exercise3. Rotator cuff activation

These exercises activate the rotator cuff in a safe way by doing gentle wall pushes. It is essential to load the rotator cuff in a safe way and gently to encourage strong healing and minimizes scar tissue formation.

  1. External rotation
  2. Abduction

 

Read for Stage 2 rotator cuff rehab? Follow this link to the next post in the series.


running

Preventing Running Injuries: The Gold Standard

June 1, 2017 • By

Running is one of the easiest ways to get exercise and improve our health. You don’t need any fancy equipment, gym membership or even a lot of time, you can just get out the door and go. Because of this, running is becoming one of the most popular ways to exercise and with that, we are getting a lot of running injuries.

And do you know what? 60-70% of running injuries and avoidable.

If we asked a bunch of people in the street they would list of a few possible causes of running injuries such as:

  • Shoe type
  • Foot type
  • Flexibility
  • lack of stretching

We hear that all the time right, “foot pain because my feet are too flat”, “back pain because my hamstrings and too tight”, “knee pain because my shoes aren’t supportive enough”.

Well actually, that’s not true at all; there has been no proven link between foot type and injury and the only shoe that prevents injury is the one that is most comfortable to you – it doesn’t matter what foot type you have.

So the real cause of 60-70 of running injuries?

Training Error

Prevent Running Injuries, PhysioThere is no evidence for stretching, running surface, warming up or cooling down in helping with prevent injury but there is a lot of evidence for injuries caused by an imbalance between training and recovery.(1)

So 2/3rd of all running injuries could be possibly avoided if we just had the right amount of recovery time to go with our training. It’s why the British Journal of Sports Medicine showed that we should be training HARDER and SMARTER, meaning that yes, you should push yourself in training as that is how we improve but then you need the time in between for your body to change and improve.

And what is Runnersworld’s simplest strategy for making the biggest difference to performance? not surprisingly, it’s Rest and Recovery.

So there it is, the biggest thing you can do to improve performance isn’t to running and far and as much as you can. It’s training smart, working in rest days around your training and following these tips:

  • Get plenty of sleepThe Oregon Project athletes typically get 10–12 hours of sleep per night, as well as another hour nap most days
  • Fuel your body right. The 30 minutes after a run is the time when your body refuel the best so get some cards and protein in ASAP (ideally at a ratio of 4:1
  • Have training holidays. once or twice a year, have a week off from training to refresh the mind and body. It’s better than being forced to take one due to injury or exhaustion right?
  • Have rest days every week. This doesn’t mean you need full rest, but relative rest, it can be swimming, biking or a core day for example


Back pain, Mobility, neck pain

Exercises to fix iHunch

May 25, 2017 • By

With all great things, there is always an equal and opposite, and with improved technology and greater availability, we now have a new syndrome. The iHunch. Luckily for you, we know the best exercise to straighten your hunch out.

Just like Yin and Yang, most things follow Newton’s third law, where is always and equal and opposite force and now that we have such easy availability of technology, we can easily spend most of our days looking at screens. Whether this is laptops, desktops, tablets, phones or watches, we are forever looking down.

iHunch exercises to fixAnd looking down is the big issue.

Most of our heads are around 6kg but as our shoulders hunch and our head protrudes forward, the load on our neck increases a huge amount as you can see in the picture here

Over time, our body adapts to this posture and our upper back stiffens and loses extension, our pecs tighten and pull the shoulders forward and the muscles in our upper neck cramp up. This then causes pain and can really put you in a bad mood.(1)

 

So here is how you can sort iHunch at home. Stretch out that hunch and maybe even make yourself taller!

1. Thoracic extension stretch

Stretch out you upper back over a Foam Roller or stretch ball. The foam roller can either be across your back or up your spine for a more gentle approach.

Hold the stretch for at least one minute and then move higher, making sure not to put the roller or ball under your low back or neck.

You can also wrap your arms around your chest and roll up and down to massage the muscles

improve your thoracic mobility quick and easy

back stretch thoracic ihunch

2. Pec stretch

Using a doorway, place your forearm against the frame and gently lean forward. Hold the stretch for at least 30 seconds each side

Pec stretch

3. Wall angels

This is one of the best exercises for improving postural strength as if fires up all of your shoulder and spine extensor muscles

Make sure your bum, upper back and head are touching the wall, as well as your knuckles and elbow to start (a). then slide your arms up and down as far as you can without your elbow or hand coming off the wall. You will feel a good burn between your shoulder blades.

Repeat for 3 sets of 15 reps

wall angels, shoulder pain

 

The only other thing you can do to help prevent iHunch is to stop looking down so much! Hold your phone up in front of you, get a stand-up desk and walk more.

And that’s it. Mobilize the spine, stretch the pecs and strengthen your extensors and you will feel much better for it.