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groin pain

Back pain

Slipped Disc: What is it and how to fix it

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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!

For a more thorough rehab plan, download our Complete Low Back Self-Rehab Guide

Also see: progressed exercises for keeping back pain away


groin pain, Hip pain, Lower limb

Hip Arthritis: The best self-management exercises

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Hip Osteoarthritis affects 11.5% of men and women and can be an extremely debilitating Hip osteoarthritis self treatment, self help exercises to decrease paindisease for those of you affected. Clinical guidelines for best treatment recommend a combination of conservative non-drug treatment and drug therapies and in particular a focus on “self help and patient driven treatments”. This is what I want to give you today – the information, advice, tools and exercises that you need to decrease the pain and limitations from Hip Arthritis and feel great!

Article layout:

  1. Risk factors for hip OA
  2. Exercise program
  3. Physical activity and weight loss
  4. Physio benefits and self-help tools

Risk factors: Developing arthritis of the hip is due to a combination of factors that add up to increase the load through your hip joint and leading to increased degenerating and bone growth.

Below are the main factors leading to Hip OA:

– Joint shape and past injury

– Predisposition to OA: Gender, age, race, genetics

– Poor muscle function and stability surrounding the hip

Factors adding to OA pain and progression:

– Obesity

– Physical activity levels

– Co-morbidity

– Muscular function.

So: There are definitely some factors there such as joint shape, past injury and age, that we cannot alter, but there is A LOT that we can help with and improve, so in the rest of this post, that is exactly what we are going to do!

Goals of program:

– Unload the hip joint.

– Strengthen and stabilize muscles surrounding the hip.

– Address the contributing and aggravating factors.

Exercise Program:

birddog exercise to muscle coordinatin, glute activation. decrease low back and hip pain

Bird-Dog exercise

Goal: In order to increase muscle coordination and glute activation.

Action: on your hands and knees, slowly extend out your opposite arm and leg, hold for 5 seconds then lower down and repeat 10 times.

Tips: start with just one leg if this is too hard.

 

bridge - glute strenght, decrease back, hip and knee pain.Bridge exercise

Goal: to increase strength and activation of low back and hip extensor muscles.

Action: Lying on your back with knees bent, squeeze your glutes and lift your bottom and low back off the ground. Hold for 5 seconds, lower down and repeat 10 times.

Tip: to advance, cross arms over chest and keep one leg straightened out in the air.

Clam exercise plus - gluteus medius strengthening, pelvic stabilityClam exercise

Goal: to increase hip stability and balance and to reduce hip drop when walking.

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 – lift your top knee up roughly 20cm and lower down in control. Reps: Build up to 30reps on each side.

hip flex 2Hip Flexor stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Action: In the position shown, reach up tot he sky, tuck your bottom underneath you and hold for 1 minute.

Tip: Add a cushion under your knee if sore.

 

 

glut and Lat stretch - Hip flexibilityGlute stretch

Goal: To unload the hip joint, by lengthening tight muscles.

Position: starting on hands and knees, bring one knee in between your hands and straighten the other leg behind you. walk your hands out in front, first onto your elbows and then reaching out if possible.

Tip: take the back leg across to the opposite side.

Advanced exercise:

Single leg Squat, hip stability and strengthDouble and single leg squats: These exercises make the hip stabilizers work in unison and are great for those of you with mild OA.

Start performing Double leg squats and progress to 1 legged, making sure not to work into pain.

Tip: stick your bottom out like you are going to sit down.

 

Do all exercises daily and twice daily if you have the time!

Physical activity and weight loss

Increase load though excess body weight can cause increased pain and disease progression and is something we can definitely do something about! Having a graded exercise program where you gradually increase your activity levels can decrease, pain, increase quality of life and importantly reduce the need for joint replacement in people with hip osteoarthritis.

The best way to do this? set an achievable goal eg. Bike, 10km, walk 3 km, run 20 minutes, swim 500m etc and the time you want to do it in(eg. 2 months) then build slowly towards this! Not only will exercise help your hip arthritis but it will improve your peace of happiness and well-being over-all!

There is a lot of people out there saying to stay off arthritic joints but exercise has been proven to be very beneficial for arthritis so it is a matter of doing what your body can handle – swimming and biking are great as they put less load through the joints.

The Benefits of Physiotherapy:

The benefits of manual therapy are very real and can make a huge difference to your pain and movement. To help out with the great work to you do at home (see exercises above!) I fully recommend consulting a good hand-on Physiotherapist/ Physical Therapist and you won’t be disappointed.

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Quick Stability and Balance test

Glute activation: the missing link


Back pain, foot pain, groin pain, Knee pain, Lower limb, running, training

Quick Stability and Balance test

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Here we discuss an easy test you can do in front of a mirror at home to see why you are having hip, knee or back painGood lower limb stability and control comes straight from your gluteal muscles, and if these aren’t functioning right – your back, hip, knees and feet better watch out!

Stability of the Lower Limb ultimately derives from your hip. The muscles surrounding your hip work to keep your entire body upright on top of your leg and vice versa work to maintain correct alignment of your leg. I see far too many injuries caused by poor hip stability, such as:

  • Patello-femoral pain (knee pain)
  • IT band syndrome
  • Femoral acetabular impingement (hip pain)
  • Iliopsoas tendinopathy (groin pain)
  • Patella tendinopathy
  • and much more hip, knee and foot repetitive strain injuries!

The simple Single Leg Squat is a fantastic test to look at Lower limb biomechanics and control and can easily show you why you are getting pain or tightness down the chain,

The test:

This is best done in front of a mirror or video camera.

Position: Standing on one leg with your arms straight out in front of you (Your other leg can be out in front or bent beside your other leg but never touching the ground or other leg).Single leg Squat, hip stability and strength

Action: squat down like you are going to sit on an imaginary chair behind you. Stop and come back up when you reach your challenge point (before you fall over).

Repeat 10 times (If you can!), then start again on the other leg.

What to look for:

  • Your knee should track straight above your foot, towards your big toe. Typically with poor hip stability you will see the knee going inwards or shaking – If it does this your glutes are not firing or strong enough.
  • No hip drop – your pelvis should stay level (horizontal) if it drops – we have a problem!
  • Your knee bends right forward past your toes – you are relying far too much on your quads and not using your Glutes and so leaving your leg vulnerable.
  • Can’t do 10 reps or you start doing any of the above three towards the end – your Glutes have poor endurance.

 

So, how do we improve your results? See my post on Exercises to Improve Glut activation and strength and re-test every two weeks to check your progress.

 

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