Browsing Tag

physio exercises

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

 


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, running, training

Zoom out – Rehabilitation with your eyes open

March 10, 2014 • By

The approach to treatment and rehabilitation is changing and for the better. Gone are the days (going anyway) of just treating the pain and symptoms. This approach lead to :

  • Short term outcomes: Pain relief, symptom relief (muscle spasm etc) and you feeling better.
  • Flare ups and frustration: But the pain kept coming back after these quick fixes.
  • Meaning more money spent in the long-term, more frustration and decreased quality of life.

The reason the quick fix approach doesn’t work for a lot of people is because the cause is not being addressed – The reason behind the pain and injury isn’t being rehabilitated.

When an injury, pain or niggles occurs you need to look above and below the area to find the contributing and causative factors.

Some examples? Here is a couple of common examples:

1. An office worker gets regular headaches that stops them doing what they love, playing on their mind and being very, very frustrating. They have had their neck treated in various ways – acupuncture, massage, trigger point release, joint mobilizations etc. All of these offer release – but they keep coming back!

bad posture and why it causes headachesOften the reason behind this is a rounded thoracic spine (upper back). This rounded spine pushes the head forward in a less than ideal position as you can see in the image to the right. This forward head position, one closes down the joint at the base of the skull and also every centimeter that the head is forward makes the neck muscles work four times harder! This will definitely cause muscle knots and stiff joints at the base of your skull AND headaches. So no matter how much you pull your head back, have the neck treated etc – If you do not treat your spine below the neck – You are going to keep getting headaches.

 

Patellofemoral pain syndrome. self treatment and rehab at home to decrease pain and get you back to it!

2. Another common example that will ring true with a lot of people, particularly runners, is anterior knee pain (Patello-femoral pain). Anterior knee pain is one of the most common running injuries and the pain happens because the knee cap doe not glide in its grove correctly. This is due to increased tension in your quads (particularly the outer quads) – pulling the knee cap laterally (to the outside) causing pain, inflammation and further muscle tension to due it grinding in the wrong place. Studies have shown that runners with PFPS have weak hip abductors and external rotators – This is a huge contributing factor as if these muscle are weak the knee is not controlled, in turns inwards, changing the tracking and position of the knee. So the knee can be treated, taped, dry-needled and exercises etc as much as you like but of hip strength and endurance isn’t improved then this will hang around and really frustrate.

 

 

core strength minimizes lower limb injuryIt is amazing how the body is connected, with no muscles and joints working in isolation. The body is full of synergies, with different muscles and tissues working together to move everything in unison, it really is an awesome machine.

But this is why when one thing goes wrong – multiple other areas can be affected. Other areas help out and work hard to compensate, some parts get more stress through them, leading to pain and niggles, that may bot be where the problem is!

 

This is why you need to rehab with your eyes open. If you have:

Look at your body holistically – Don’t just focus on the pain and getting a quick fix. Health care is changing; less pills, less anti-inflammatories, healthy food and less steroid injections – Become aware of your body and improve it for the long-term and Physioprescription is here to help you do that, giving you the tools, info and exercises to live better!

 

Please share, like and let me know how you get on!

 


Lower limb, running, Shin Pain

Shin Splints Treatment and Exercises

October 14, 2013 • By

runningShin splints is the most common lower limb injury in athletes and can lead to large blocks off training and serious injuries such as stress fractures if ignored. Here you will find out, what it is, what causes it and how to treat and rehab it YOURSELF with effective self treatment methods and exercises.

Shin splints is an Umbrella term that describes pain along the inside border of your tibia(shin) and covers a number of pathologies. The most common and Injury most often associated with Shin splints is Medial Tibial Stress Syndrome.

shin splint painMedail Tibial stress syndrome (MTSS) Is the most common Injury in runners (Lopes et al 2012) affecting 9.5 percent of all runners, coming in just ahead of achilles tendinopathy and plantar fasciitits.  In MTSS pain is felt along the inside border of your shin bone (tibia), it is tender to touch and the tender/ lumpy area is larger than 5cms.

MTSS is caused by repetitive contraction of the calf muscles causing excessive stress on the tibia. The calf muscles (namely the soleus, flexor digitorum longus and tibialis posterior) attach onto the inside border of the tibia, and the repeated pulling from any of these muscles at their attachment causes micro-tears which causes inflammation, pain and excess tissue build up.

Now this generally happens due to one or a number of the following reasons:

  • Sudden increase in training that your body isn’t used to.
  • Change on footwear or training surface, eg. going barefoot (minimalist running) or changing from flats to hill running.
  • Poor hip control causing excessive internal rotation.
  • Over pronated foot type.
  • Poor running form (See Ironing out your running).

 

Differentail Diagnosis:

Stress reaction and stress fracture

These also cause shin pain and can be causes by MTSS or occur by themselves due to over training so it is important to have these ruled out by your Local physio if there is pain when you: tap on your shin bone, jump on your heel or if the pain is localised to one spot on the shin.

 

MTSS is far too often ignored and put aside as calf tightness until it is far worse than is should have got, which means some serious time off training and a lot of money spent on rehab. Below we are going to run through exercises and self-treatment that will both help heal your MTSS/shin splints AND prevent them happening again.

 

Exercises: All of these need to be done 2 x daily if you have shin splints.

calf stretch1. Calf Stretch:  Drop your heel off a step and hold it for 1 minute.

 

 

 

 

 

 

MTSS shin splints self treatment

2. Foam roll your calf: Position as shown in the picture to get as much weight through the roller as you can. Spend 2-3 minutes slowly rolling your whole calf – ignore the pain!

 

Tip: You can also give yourself and self-massage, which is really effective at reducing tension and getting right to the point!

 

 

 

glut and Lat stretch - Hip flexibility

3. Sling stretch for hip range: Hold for 1 minute.

 

 

 

 

 

 

Bridge - increase leg strength, glute activation and decrease back pain.

4. Single leg bridge for hip stability: 

Hold for 5 seconds, 2 x 12 reps each side.

 

 

 

 

 

Single leg Squat, hip stability and strength

5. Single leg squat for lower limb strength and stability: To make it harder and better for lateral stability, keep your free leg out to the side.

Do 2 sets of 12reps each side.

 

 

 

 

 

Make the above exercises a routine even when pain-free!

Self treatment:

The main technique that will benefit you is self deep tissue massage. Check out this post for a easy video demo of this.

 

Tinker with your training:

– Decrease your training load to allow healing to take place

– decrease hill running and running or walking on hard surfaces

– Take a good look at your shoes and consult a Podiatrist of Physio re your foot mechanics.

– Once pain has gone, start SLOWLY building up your training again.

 

 

So there you have it, your guide to Shin Splints Treatment! Take some time to check out some other great posts that will help athletes and runners out a huge amount in preventing lower limb injuries as it is ALWAYS better to prehab!

Iron out your running – run faster, easier and injury free.

Quick balance and stability test.

Glute activation – the missing link

Please Share and like and let me know how you get on!


Health, neck pain

Headaches and Neck Pain – Self trigger pointing to abolish Knots

May 30, 2013 • By

In this post I will tell you how to get relief and get rid of headaches and annoying knot sin your neck yourself! A fantastic tool that everyone needs to know – Don’t rely on drugs, medication and heat packs – treat yourself!

First of all, I would like to say that I really believe that there is such a thing as good pain! Some of my patients may disagree with this at the time of treatment of course but if not immediately, then the day after, you will feel markedly better. A lot of this “Good pain”  is felt during trigger point release and deep massage, when the tissue is released, it feels like a weight has been lifted off your shoulder at times and relieves a lot of pain – namely Headaches and niggly Neck Pain!

Another way to look at this is a little bit of pain for a whole lot of gain!

I am going to run through a couple of techniques that you can utilise YOURSELF along with strengthening exercises to beat headaches and neck pain. These can be performed yourself or you can get someone else to do them for you:

Self-massage:

Starting position – I find that prone lying (on your back) is best as this way it is easier to relax and you aren’t using all the muscles to hold you up. You can also give it a go in sitting or another position you find comfortable.

Motion – using the hand on the same side as you want to massage, bring you hand back and place your three middle fingers on the back of your neck right below your skull. This gives you a good idea of the area you need to be massaging. Now simply using these fingers or just the index and middle gently begin massaging into the muscle using circulatory motions and remembering to keep good contact on the skin. The idea with this is to find the muscle that feels harder, tighter or knotty and work into this to warm it up, stretch it out and increase blood flow.

 If someone else is performing the massage on youlielye on your back with your head supported on a pillow, have this awesome person sit behind your head and place their hands under the upper portion of your neck on each side.

 Trigger point release: I have listed this technique second as it is best to do after light massage when the muscle is warmed up.

In the same position as described above, use your index and middle finger to find the trigger points in your sub-occipital muscles. You will find these at the back of your neck in the at the base of your skull. A trigger point as described in Beating Headaches is basically a point in a tight muscle which is especially hard and sore to touch and often refers pain up into your head.

 When one of these points is found you need to apply pressure to the point with your index finger supported by your middle finger. Apply pressure so that there is mild pain (it needs to be bearable – if you are too aggressive the muscle will bunch up more). Maintain this pressure until the pain begins to subside and at this point you need to more pressure, without taking your fingers off. This increase in pressure should be performed 2-3 times and then the pressure can be taken off. It can take ten seconds to over a minute for the pain to start easing and the muscle to relax so you need to hang in there!

Tip – give the muscle a gentle rub after this to make it feel more normal.

Next – move on to another trigger point if there are any more on the same or other side.

 Image

Note: Trigger point release can at times cause aching and an increase in pain/ headaches but improvements will show the day after.

For further information see: Beating Headaches