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Health, Spine

Why Does My Back Hurt… Again!

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You might often ask yourself, why does my back hurt? Or, why do I keep hurting my back?

Well, a huge 34% of who have episodes of low back pain will get it again and again. This causes a huge flow on effect with time off work, doctor and physio visits, as well as loss of quality of life during that time. If we can better understand why acute low back pain recurs then we can better manage it.

First of all, this first part of this blog is easy to explain – why do things hurt. Here is a short video from one of the best at explaining pain:

YouTube player

Things hurt due to a combination of our peripheral receptors signaling our brain that they have felt something and importantly how our brain interprets this signal. For more information on pain and the different types, check out this post.

So, with that covered, but we come back to the question of why does my back hurt; do we really know why acute low back pain recurs in over one-third of people?

There is most likely a number of factors and we don’t know them all, that’s for sure. But what we do know is that following an episode of low back pain, activity of your deep back muscles is decreased on the injured side – even once the pain is gone.

Multifidus why does my back hurtIt’s been shown that the multifidus muscle which runs down the side of your spine, supporting, moving and stabilising your vertebrae has different activation to that of a normal back. This shows that even with good management when you have low back pain – the muscles don’t always get back to your normal by themselves, possibly leaving you more prone to another episode of low back pain.(2)

The good thing to remember is that in 90% of cases of low back pain they are pain free and better within 6 weeks and that 85% are classed as non-specific low back pain where there isn’t a diagnosis (you don’t need a label on it saying you have injured your joint, muscle, ligament or disc).

But even with that huge amount improving within 6 weeks – many of those recur again so it is important to ensure your muscles are fully rehabilitated, just like you would if you were returning to sport following a hamstring injury for example. Because if you can get that Multifidis firing better again that is one less thing to worry about and a much better chance of your back pain not coming back.

So if you keep asking yourself “why does my back hurt again!” go see a local physio for some advice and rehab exercises – they do work and the effects do last (1)


Hip pain, Knee pain, Spine

How to Protect and Strengthen Cartilage

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strengthen cartilageWhat if I told you that to keep your joint cartilage strong you need to put load on your joints – Not bike and swim?

Your articular cartilage forms the smooth covering inside your joints and often when someone has degenerated cartilage they are told to decrease loading and get into non-weight-bearing exercise – such as swimming and cycling.

strengthen cartilageIn a way this makes sense in that if you want to preserve and strengthen your cartilage, you wouldn’t run and jump and lift weights, would you? But our body doesn’t work like that, it responds positively to the force we put through it and really lives by the use it or lose it motto.

Recent research shows that:

Through putting load (body weight) on our cartilage we actually promote Transforming growth factor beta (TGFbeta) gene expression which helps to maintain our articular cartilage strength – That is pretty awesome.(1)

So without going into boring detail – By doing exercise which loads and compresses your cartilage, you actually help to strengthen cartilage and maintain homeostasis.

So get out there and walk, run or lift to keep your joints healthy – whether it is your knees, hips, back or any other weight-bearing joint.


Back pain, Core strengthening, Spine

QL Muscle Strengthening: Beat Low Back Pain

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Your Quadratus Lumborum muscle (better knows as your QL muscle) can cause you all sorts of back pain and refer pain into your hip and glutes. Having weakness in your QL muscle can mean recurring and frustrating back pain that can cause way too much trouble

So following on from our previous article on how to treat the QL yourself through an easy muscle release, here is how to strengthen it up and beat low back pain.

Strengthen QLSo, what does your QL muscle do?

Easy, it comes from the top of your pelvis (the iliac crest) and attaches on to the bottom rib and the side of your spine. From there, it acts to help you extend backwards, bend to the side, bend forwards and can help in breathing.

So the QL does rather a lot. Not only that but because it attaches to all your lumbar vertebrae and your pelvis, when it goes into spasm, it can really pull on your spine and can also lift one side of the pelvis – Making it seem like your “back is out”

Strengthen Quadratus lumborumAnd you know what? The QL can be a real pain in the butt.

Literally. As with a lot of muscles in the body which cause you to feel pain elsewhere and not where the real issue is. The QL refers pain into the buttock and side of the hip, making it quite deceiving as to where the pain is actually coming from.

Symptoms of QL muscle dysfunction:

  • Deep, aching in the low back, often worse in sitting or standing
  • Pain with coughing and sneezing
  • Pain rolling to either side when lying on your back
  • Pain can refer to the groin and mimic sciatica symptoms
  • You may have one side of your pelvis lifted higher than the other

Strengthening exercises for the QL:

  1. Side plank

Level 1: Hold

Side plank QL strengthening

Build up your QL endurance by holding a side plank.

Aim for a one minute hold (this is the goal, you may not be able to do it straight away!)

Tip: don’t stick your bum out, tuck it in

.

.

Level 2: Leg lifts

Side plank leg raises

When you can hold a straight side plank comfortably for a minute, step it up.

Lift your hips up into a side plank but now lift your top leg up and down while holding the side plank.

Aim for 3 sets of 10 reps, but you may need to start with less reps!

Tip: don’t let your top leg come forward or toes point up.

2. One sided farmers carry

one sided farmers carry for QL strengthening

Here, the QL muscle on the opposite side to the weight you are carrying is working hard to keep you upright.

Hold onto a dumbbell or kettlebell in one hand and do some laps (e.g. 10 x 10m laps on each side)

Tip: try to stay upright!

And that’s it. Easy. Combine those few exercises into your workout at least 3 x weekly to improve the strength of your QL muscle and help beat back pain.

Looking for more? Download out Complete Low Back Self-Rehab Guide

Tip: This is a great stretch to help unload the low back!


Spine

QL muscle release – Exercise for low back pain

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Your Quadratus Lumborum (QL) muscle is a very common cause of back pain, so being able to treat this yourself, effectively, can be a huge relief. Here is a great self QL muscle release to loosen off your low back and reduce your low back pain.

First of all, here is a bit of information about the QL:

QL release anatomyAnatomy:

This muscle runs down either side of your low back, from the top of your pelvis, all the way to your bottom rib. This is why it can affect your breathing when it is in spasm and it pulls down on the lower rib of yours. It also attaches along the way to the side of your spine.

Purpose:

  • Side flexion/bending of the spine
  • Fixation/stabilization of the low rib

The problem:

QL release trigger pointsWhen muscle knots form in the Ql or it goes into spasm due to overload or injury, then it can give you real grief! Often this is more one-sided than the other also, giving you a real lopsided feeling and can make it seem like you have one leg shorter than the other or that your “pelvis is out” (which can’t really happen). The QL refers pain elsewhere and isn’t always felt at the muscle. The referred pain is generally felt in the outer hip and in the glutes and is often described as a deep ache but can be a sharp pain when moving. The trouble is that this muscle is very hard to stretch – but, it is quite easy to do a QL muscle release!

QL muscle release: Release your low back

QL muscle release1. Position

Lie on your back and place a firm massage ball (or a specific, purpose made tool like what the QL Claw) under your QL muscle, which you will find in-between the top of your pelvis and your bottom rib, off to each side of your spine.

QL muscle release low back and erector spinae2. Action:

Bring the knee on the same side as the ball up towards your chest, which puts pressure on the ball. Once you feel like you have the right spot (you will feel it!), holding onto your knee you can either:

1. Rock your knee out to the side and then in again and repeat, OR

2. Repeatedly bend your knee up and down towards your chest.

Slowly and gently work into it for 1-2 minutes on each side and feel free to move the ball up or down slightly to get the right spots.

Do this great myofascial release once a day for two weeks for longer-lasting results and check out new Complete Low Back Self-Rehab Guide that you can download that is packed with self-treatment advice and exercises for more.

Tip: Help prevent this recurring and giving you ongoing trouble by strengthening your QL and the surrounding muscle so that they can handle everything that is asked of them!

Note: If you have acute low back pain, pain going down your leg, or any neurological symptoms please see your local health professional first.


Back pain, Health, Mobility, Spine

Treat your stiff back and neck with a peanut…

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The peanut - for neck and back stiffnessThe self-treatment tool I use the most, especially while on tour with teams, has got to be the Peanut. This is a handy little tool that you can use to loosen up your stiff back very effectively, and it’s not bad for doing a bit of muscle work too! The great thing it, you can make one at home and I’m going to show you how.

It is perfectly suited to give your spine a good loosen up as it has a nice groove down the middle for your vertebrae to rest in while bulging out to give the muscle down either side of your spine a nice firm massage. You can move it up and down your spine slowly, meaning at each level it;

1. Loosens up the muscles and other soft tissues and

2. Mobilizes your spine at the same time.

Your thoracic spine is very key for pain-free and strong neck and shoulders and is far too often overlooked and missed. So if you have any neck, shoulder or upper back pain or a stiff back – This will be a great exercise for you to try and even better to combine with this myofascial release for tight shoulders.

So, here is how to make your own peanut to mobilize your spine at home:

What you need:

1. Two balls (Mind out of the gutter!) – I prefer to use lacrosse balls but it is up to your preference, tennis balls can do a really good job too.

lacrosse balls

 

2. Tape: A good, strong and durable tape it best. I use strapping tape but that’s just because I have a lot of it! – Use what you have available.

Strapping tape - rigid

 

Put it all together:

Now all you need to do is strap the two balls together – the best way to do it is lengthwise around both balls at once and then around the middle before going around and around where-ever needed to hold them together. In other words, just give it a go, there is no exact way to do it!

Don’t have time to make one yourself? You can pop over to Amazon and buy one Here

How to use it?

It is best used in your upper back, otherwise known as your thoracic spine. Lie on your back and use you knees bent up and feet on the ground to roll it up and down. Stretching your arms over your head or across your chest can help also – experiment and give it a go, you will feel much better for it!

I will be making a video in the coming weeks to show you exactly how to give your upper back a good loosen up so stay tuned or make sure to follow us on Facebook or Twitter.

Good luck and let me know how you go!


Health, Spine

Spondylosis and Back Pain: Scan results aren’t the final say

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MRI spondylosisLow back pain is the most common condition I see, but do x-ray, CT and MRI results that show spondylosis and disc protrusion tell us much? Should you take their results as the be all and end all? Find out here.

Low back pain affects about two-thirds of the population at some point in their lives and often means significant time away from what you love doing (and work!), which is not ideal. As well as this, backs are being investigated by advanced imaging much more. Mainly because:

1. As I have said, back pain is so common

2. It means significant time off work and sport, meaning a large cost to the economy

3. And ultimately, imaging is becoming a lot easier to access and cheaper to do

This ultimately means advanced imaging such as MRI and CT scans are being used more and more.

There scans commonly pick up:

  • Disk degeneration
  • Facet joint hypertrophy
  • Bone spurs
  • Disc protrusion and more

spondylosis MRI findings need to be using smartlyWith most of these able to be grouped under the “spondylosis” label, meaning: degeneration of the spine, often also described as osteoarthritis of the spine.

Far too often (really way too much) these results and findings are taken as THE CAUSE of your back pain, often triggering costly and long medical and surgical interventions. Which don’t always leave you int he condition you would hope for.

So really how much faith can you put in the scan results and how can we make the most of this ever-improving and readily accessible technology? Because it really is great that these investigations are becoming much more accessible – although we have a way to go – because ultimately it does mean better outcomes for you.

Now, here is why we can’t just look at your scan result and say “There is your problem, fetch me the scalpal”without taking your entire clinical presentation into account:

Low back pain prevalence form MRI and CT scan

This table shows the results of imaging findings of over 3000 pain-free individuals – Yes they had these findings and are all asymptomatic, meaning showing no symptoms whatsoever.

Find your age bracket on the table to the left and look down the column and see the prevalence of spondylosis in your peers.

For example:

  • 37% of 20-something year olds have disk degeneration
  • 60% of 50 year olds have disk bulges
  • 50% of 60 year olds have facet joint degeneration (1)

Sobering reading huh? The thing to keep in mind is that the people in this study are asymptomatic – SO findings of spondylosis in scans does not automatically mean that they should be causing you pain.

So what does this mean for your scan results, should you throw them out the window?

NO. WAY.

This is where health professionals need to utilize this great technology and use them as part of their tool belt to our your advantage.

Take away message: Image findings of spondylosis among other things MUST be taken in the context of the patients clinical condition, otherwise you are wasting your time.

MRIThis means that your health professional needs to look at the scan results combined with:

  • Your pain pattern and presentation (night pain, morning stiffness etc)
  • Physical test findings
  • Subjective findings (what you tell us – which is why it is so important that you tell your health pro how it feels and when it hurts etc)
  • Past medical history

And use their clinical reasoning to say “does this scan finding reflect what the patient is presenting with” – That is what a good physio, doctor, specialist etc will do, although all of them should.

2nd take-home message: Unless any red flags are present, low back pain should always have a period of conservative treatment before invasive medical treatment is needed – for most back pain, this will be enough. See this great post to get started on some rehab exercises.

Looking for more? We have compiled all the best info in one, evidence based rehab guide

Feel free to leave a comment, like and share to your heart’s content


Shoulder pain, Spine

Stiff neck – Neck and Shoulder Mobility Exercise

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neck pain sitting at desk - fix it nowIf you experience stiff neck, regular headaches or neck pain, this mobility exercise will help improve this fast.

A stiff neck and tight shoulders are a very real problem for desk workers (plus new moms and others that do a lot of lifting) and people can put up with this for years!

Posture and Tight Neck and Shoulders

This basically happens because we assume a posture where our backs are rounded out and our shoulder roll forward. This causes the muscles running from the top of your shoulder to your neck to be put under a lot of tension and stress causing then to get knotty, weak and angry from overworking – causing you to feel pain, stiffness and headaches.

Mobility Exercise to alleviate Tight Neck and Shoulders

See the video for a simple demo if how to loosen up your stiff neck or check out this link for more info and this link for more info on headaches and how to fix them.

YouTube player

upper traps, self trigger point knots, tension headaches treatmentTry do this mobility exercise daily for two weeks and notice the difference. Your stiff neck will thank you!

You may also like:

Mobilise your-self!

5 Great exercises for neck pain

All you need to know to get rid of headaches


Core strengthening, running, Spine

The importance of Core Stability on injury

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core strength minimizes lower limb injuryHaving a stable core and pelvis has huge benefits through-out the body, including laying a stable base for your legs to work off. This means more bio-mechanical efficiency, less injury AND less pain.

In order to do any lower limb exercise well, including running, squat, weight lifting, tennis etc, you need to be in control of your core. If you don’t have a stable base, everything working off it is going to struggle and compensate. This can lead to tight hip flexors, ITB syndrome, patellofemoral pain, ankle sprains, niggles and more.

Imagine a tennis shot, for example. Your are stepping forward and driving off your back foot while at the same time swinging your raquet forward to strike the ball. If you core isn’t in control then you are losing force between your legs and arms – losing that strength of the drive from your legs.

Core strength makes your body stronger, not just your abs, by conserving and transmitting energy.

Just for clarification, as “core” can mean different things to different people. Core for me is your Lumbo-Pelvic stability. The combined control and strength of your spine and pelvic muscles.

Quick self test: A great way to test and see how good your Lumbo-pelvic stability is yourself is to do the Single Leg Squat Test. If you see your hip dropping or knee tracking inwards, then you are at risk or injury and need to get started strengthening ASAP.

 

Poor core stability can also lead to and contribute to all sorts of injuries and pain, including in your:

  • Low back
  • Shoulder and neck
  • Knee and hip

 

So how do we sort this problem you ask?

Below is an exercise program to get started on that will really make a difference if you stick to it. I also fully recommend finding a good Physio in your area to have your specific deficits assessed to get some manual therapy to speed things up.

Exercises to improve Core stability:


1. Single leg Bridge:Bridge 1 leg - glute activation, leg strength and core stability. the best exercise for hip stabiltiy, great for runners

Position: lying on your back, bend one knee so that your heel is close to your backside and straighten the other leg as above so that your thighs are horizontal. Your arms can be crossed over your chest or down by your side to make it easier.

Action: Pushing through your grounded heel, lift your bum off the ground as above, straighten your back and hold for 30 seconds then lower and repeat on both sides.

 

2. Clam Plus: (Do them right and they are surprisingly hard!)Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength

Position: Side lying  with top elbow on the ground, knees bent, ankles together and importantly the top knee sticking out 1-2 inches further that the bottom knee.

Action: Making sure not to let your pelvis rotate backwards and keeping your ankles together – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 50 reps on each side.

If you have found in the past that normal clams don’t do much for you, try it this way with your hip s rolled forward more to isolate Glute Med better and get less Tensor Fasciae latae activation.

 

3. Double or single leg squatSingle leg Squat, Glut Med activation - hip stability and strength:DL squat
Try performing the Single leg squat, but if you are too unstable (cannot stop your knee going inwards) then start with the double leg squats.

Single leg: 2 sets of 12 reps

Double leg: 3 sets of 12 reps

Tips: stick your bottom out like you are going to sit down and keep your knees out!

 

4. Front Plank: 
plank

Hold this for 60  seconds (if you can, otherwise build up to this).

Tip: do not hang on your hip flexors, tuck your bottom in and bring your hip bones up towards your head.

 

 

 

 

5. Side plank: side plank

Again aim for 60 seconds here, keeping your body straight!

 

Too easy? Add in leg raises to this – Raising the top leg straight up and down, building up to 50.

 

 

Do this short program  DAILY and stick to it for at least 6 weeks -Let me know how you go!

 

You may also be interested in:

Iron out your running – What you never got taught

Get your spine moving

Smash your Glutes


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