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

Beating Low Back Pain – Must know Physiotherapy Exercises

• 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 check out our Lower Back Rehab Guide

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.


Back pain, Core strengthening

Acute Low Back Pain – Getting up and moving

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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 the 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.

Looking for a more detailed self-rehab plan? Download our Complete Low Back Self-Rehab Guide


Health, physical therapy, physiotherapy

Therapeutic Ultrasound – Why is it still used?

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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

 


Chronic Pain

Chronic pain – All in my head?

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Your central nervous system plays a massive role in ongoing and chronic pain, Here we will discuss why patients are often told pain is in their head and how you can help it train your brain.

chronic pain - is it in my head? - explained and how to fix itPain is subjective, meaning every single person responds to and feels it differently. This is because the pain receptors (nocioceptors) around your body sense something going on and send the signal up to your brain. How the brain processes/perceives this signal depends on a combination of things:

  • Gender: Hormones can affect perceived pain.
  • Family: How you were taught to react to pain as a child.
  • Past experience: The degree of pain felt in the past and how traumatic it was changes how your brain reacts to pain, for example.
  • Mood: Your mental state can affect how you feel pain. Things such as sadness, depression can increase pain perception. Be aware that it can also happen the other way around!

This is why there is a huge variety of pain tolerances in our society – the varying upbringings and experiences that occur in everyone’s lives.

Chronic pain and you:

Chronic pain is pain that exists after an acute injury has healed or after the normal tissue healing time (generalized to 3 months). For one reason or another reason, the injury does not fully heal (this could be because of some overlooked contributing factor but often for unknown reasons) and the nerve fibers continue to send pain signals up to the brain. With all these signals shooting up to the brain telling it that there is something bad going on, the brain begins to accept these like they are a normal thing, improving the pain pathways, making them more efficient. This results in more pain. Also along with this the chemical messengers that are used in the pain network increase and over time the threshold (how much stimulus is needed) for pain lowers.

Put more simply, with the continued and increased pain signals the brain gets used to them, think of them as normal and becomes more sensitive to them so a smaller and less intense stimulus is needed to feel pain! This is called Central Sensitization.

This is why people are often told that “it is in your head” and yes your brain is definitely contributing to your pain because it has become more sensitive but ALL PAIN IS REAL.

So how can we mitigate the effects of chronic pain and reduce the pain? Try some of these steps:

  1. Relax: Stress and tension will increase pain so practice relaxation techniques – these are easy and can reduce pain by up to 50%. There are multiple options here, find something that works for you! e.g. relaxation.
  2. Keep active: Physical activity boosts endorphins (natural pain-killer), boosts the immune system and helps get your body stronger!
  3. Get serious about rehabbing yourself – find out what you need to do from a Physio that will find your deficits and get to it, regularly and you will improve.
  4. Find appropriate healthcare providers e.g. a doctor that specializes in pain management, a psychologist and a physiotherapist that not only looks at your injury but you as a person.
  5. Eat healthy and don’t over indulge (no overeating, excess alcohol or tobacco consumption).
  6. Drink enough water: Females over 2 litres and men over 2.5 liters.
  7. Get enough sleep: Infants need about 16 hours per day, teenagers need about 9 and for most adults 7 to 8 hours a day is the best amount.
  8. Positive: Get social support by going to events etc that you enjoy(sports, music, dancing etc.) and keep positive people around you, not negative.

Remember all pain is real and everyone experiences it in a different way and most importantly it is NOT something you have to live with. It can be helped and improved.

Please like, share and comment.

 

You may also like:

5 great exercises for neck pain

Mobilise yourself!

 


Health, neck pain, physical therapy, physiotherapy

5 great exercises for neck pain.

• 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.


Health, neck pain

Headaches and Neck Pain – Self trigger pointing to abolish Knots

• 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 and HeadacheProofMe


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