Are you part of the 80% of the population who has suffered from low back pain?

Do you want to know how to prevent it from becoming a recurrent chronic problem?

Let’s start with some basic anatomy. Your spine is made up of a sequence of vertebrae, separated by discs. At every level of your spine (there are 5 levels in your low back, 12 in your upper back and 7 in your neck) there are 3 joints. When our back is working correctly this large number of joints allows our spine to move in multiple directions, to bend forwards and backwards, to lean to the side and to twist. Our muscles have two jobs. One job is to move the spine into these varied positions, for example if you lie down and contract your abs your spine will flex forward. Their other job is to stabilise the spine by holding all those joints together and stoping them from getting jammed up like a rusty hinge.

In order to perform these two jobs are body has developed two different types of muscles. The first group, the movers, are our big superficial muscles like our biceps, our quads and our 6-pack muscle. These muscles need to be strong to move our body, carry loads and propel us forward when walking or running. The second group are our deeper stabilising muscles such as our deep tummy muscle that supports our back, our deep neck flexors that support our head and neck and the lower part of our trapezius muscle that keeps our shoulders back and down. These muscles hold us in correct posture and stabilise our joints as we move around. They need to have excellent endurance as they are working in the background all the time.

If we look at the muscles in our back in more detail it can help us to understand what goes wrong when we get low back pain and our how to fix it. We have 3 layers of superficial tummy muscles, the 6 pack muscle and 2 layers of obliques. These muscles are working when we curl our trunk like a sit up, side bend and twist or when we cough or laugh. Your core muscles that protect and stabilise your lower back lie deep in your tummy. Your deep core muscle, called the transversus abdominus, wraps around the abdomen like a corset. When it contracts it sucks everything in like a weight lifters belt to stabilise the lower back.

As well as having a muscle wrapping around the front we also have a deep muscle as the back, known as multifidus, which acts like the lacing on the corset. These two muscles are also helped by our pelvic floor muscles which sit at the bottom of the core like a sling, and our breathing muscle called our diaphrapgm which sits on top like a lid. When all these muscles are working well together our low back is both stable and mobile, allowing us to bend, lift and twist painfree.

We know from clinical trials researching low back pain that when low back pain occurs our brain switches off these deep stabilising muscles and tries to use our superficial mover muscles instead. Hands on treatment from your physiotherapist will help to get your joints moving again and get rid of your pain, but it does not automatically fix the way the muscles are working. To get your deep tummy muscles strong again you need to do specific core muscle exercises. Otherwise your back remains vulnerable to injury and you will find your pain returns. These exercises can be shown to you by your physiotherapist and may seem quite challenging at first, especially if you are not used to using these muscles. They focus on getting the pathway from the brain to these muscles firing again and can require a lot of concentration to start with. Once you have the basic idea of turning these muscles on it is important to progress the exercises to incorporate movements of the arms, legs and torso. This is to make sure the stabilising muscles are working well when we are moving around during the day. Practising these exercises will help to prevent your low back pain becoming a recurrent problem and is particularly important if you have had pain for more than 6-12 weeks.

Many people find it hard to stay motivated to practice these exercises once their pain has gone, or find it difficult to know if they are performing them correctly. However just like going to the gym or changing our diet, if we only do it for a week or two, it is not going to give us any long term benefit. If you are one of those people who struggle to find the time to do the exercises at home or would like regular feedback to ensure you’re exercising correctly Pilates can be the answer.

Why Pilates?

Pilates exercises have a strong focus on the core muscles and are designed to help ensure correct technique. They also increase your flexibility, making sure your back stays supple. Pilates works all areas of the body. This is very helpful for people who have had low back pain because of tightness in their leg or bottom muscles or poor alignment in the knees or ankles. You will also find your posture improves with Pilates, taking pressure off not only your low back but also your neck and shoulders.

What to look for in Pilates class?

Pilates classes with low class numbers will ensure you get adequate attention and individualised feedback. Make sure you are being supervised by a qualified instructor, or even better, someone who is also a physiotherapist, to ensure you get the most benefit out of the exercises and you don’t develop any bad habits. This is particularly important if you still have pain or you have had other injuries. It is also important that people who have experienced low back pain start in a beginner’s class so that you have time to learn the basic exercises first. This way you will have a solid foundation to move from as the difficulty increases.

“If your spine is inflexibly stiff at 30, you are old.  If it is completely flexible at 60 you are young.” Joseph Pilates

With the Sydney Morning Herald Half Marathon coming up on Sunday May 16 now is the time when many people start to feel those niggling injuries resurfacing.

Pilates is a great way to prevent recurrent injuries and correct muscle imbalances that predispose to overuse injuries such as hip pain, knee pain, shin splints and foot problems.

While running is great cardiovascular exercise its repetitive nature means some muscles get a hard workout while others get left behind. Also, regular running without appropriate stretching can lead to tight muscles that go on to give us pain and injuries. Pilates helps to engage and strengthen our deep tummy muscles (our core) that support our back and hips, and will give the body a more stable base to work from. Pilates exercises also focus on mobility and flexibility which is particularly important for runners as they commonly develop tightness through the gluts, hips and legs.

If you are part of the 80% of the population who experience low back pain, it is vital that you have proper rehabilitation, including retraining your core stabilizing muscles, before you return to, or commence, a regular running routine. If you do not work on the strength and endurance of these muscles you will find your pain keeps returning, interrupting your training and slowing you down. Pilates makes strengthening your core and your back easy and fun, and with a qualified instructor you can be confident your technique is spot on.

Improved breathing pattern and control is another area where Pilates can improve your running. Focus on the breath and correct breathing forms part of all Pilates exercises and is vital to promote oxygen exchange and increase stamina when running. Efficient breathing will leave you with more energy to run and avoid tension creeping into your neck and shoulders.

So if you’re a regular runner and want to break out of the injury cycle and improve your performance Pilates is a fun and relaxing way to keep you pounding the pavement painfree!

For more information on Pilates call Precision Physio now on 9280 2322 or email laura.c@precisionphysio.com.au.

“Patience and persistence are vital qualities in the ultimate successful accomplishment of any worthwhile endeavor.”  Joseph Pilates

What is Pilates?

Pilates is a safe, fun and relaxing way of strengthening your back and core, increasing your flexibility and preventing recurrent pain and injuries. Other benefits of Pilates include muscle toning, improved posture, flexibility, balance, coordination, management of chronic pain and improved sporting performance. Pilates also promotes general health and well being and helps to decrease stress and tension.

Precision Pilates involves a series of mat based exercises lead by your physiotherapist Pilates instructor.

At Precision Pilates we offer:

• Smaller class numbers – so you get individual attention and your technique is monitored
• Individual assessments – so we know your history and body type and can tailor the exercises to your needs
• Dual qualified physiotherapist and pilates instructors – specialising in pilates for rehabilitation
• Integrated approach – incorporating the latest scientific research on low back pain, core muscles, injury management and prevention with the time tried and tested methods of Joseph Pilates
• Safety – graded programme that builds your core foundation (and your confidence) first before progressing to more challenging exercises – you won’t be thrown in the deep end
• Health fund rebates – unlike standard Pilates classes, Physiotherapist run Pilates class are usually eligible for a rebate

At Precision Pilates the focus is on your body and your technique.

Who is pilates suitable for?

You don’t have to be flexible to gain the benefits of Pilates – from athletes to officeworkers, the young and the old, Pilates caters for those from all walks of life and can be adapted to suit all levels of ability.

If you have a recent or current injury or pain, speak to your Physio about whether Pilates is suitable for you. In most cases Pilates can be safely started even before your pain has resolved.

Pilates is also suitable for those with no pain or injuries looking to balance their lifestyle with regular strengthening and stretching.

If you are unsure email our Physio and Pilates Instructor Laura at laura.c@precisionphysio.com.au to find out if Pilates will work for you.

All equipment provided – it’s so easy to fit a class in at lunch or after work!

Call Precision Physio now on 9280 2322 or email laura.c@precisionphysio.com.au for more information.

An ankle sprain is a common injury that occurs when the ligaments around the ankle joint are stretched or torn when the ankle is twisted, turned in (inverted) or turned out (everted).

Ligaments are tough bands of tissue that help connect bones together. The most commonly injured ligaments when you ‘roll’ your ankle are the three ligaments on the outside of the ankle. These are called;

• anterior talofibular ligament (ATFL)
• calcaneofibular ligament (CFL)
• posterior talofibular ligament (PTFL)

Normally, the ATFL keeps the ankle from gliding forward & inward, & the CFL keeps the ankle from rolling inward on its side. When the ankle joint is forced into these positions these ligaments are overstretched & can tear.

Initially the ankle joint will become swollen & may bruise. The ankle will be painful to move & depending on the severity of the injury, you may or may not be able to put weight through it. Certain areas, most commonly the outside of your ankle, may be tender to touch.

The best results after an ankle sprain occur when treatment begins straight away. If the ankle ligaments do not heal adequately the ankle may become unstable, causing the ankle to give way & feel untrustworthy on uneven surfaces. This is because the ligaments become weaker after the injury (even when the pain goes away) & without proper rehabilitation re-straining the ankle is very likely. People who have had several mild ankle sprains or one severe sprain may develop irritation & thickening of the ligaments that were sprained causing them to get pinched near the edge of the ankle joint on certain movements.

Studies show that the recurrence of ankle sprains can be as high as 80% & the incidence of developing a chronic ankle sprain between 20-40%. This is important because each sprain creates more scarring & increases the risk of more significant problems such as fractures (broken bones) & cartilage damage, so preventing recurrent sprains is essential. The 2 main reasons for these ongoing problems are;

• persisting weakness in the peritoneal muscles which help stabilise the outer ankle
• a loss of balance feedback (called proprioception) from your ankle to your brain.

Research shows that retraining these 2 components can dramatically reduce the risk of recurrent sprains. Your Physio can help you achieve this, as well as greatly speeding up your recovery from the original pain & inflammation. This lets you get back to your normal sports & activities a lot faster, & also reduces the risk of more inconvenience & damage through repeated injury.

Your knees play a big role in many of your daily activities such as walking, getting in & out of cars, using stairs, & getting up from sitting in a chair. If you have problems with them then they can even make it hard to sleep or sit for long periods. Medical research shows that doing the right exercise can help keep your knees healthy by protecting them from injury & can also significantly improve many common problems that you may already have. Your knees rely a lot on the muscles of your hip, quads (front of thigh), hamstrings (back of thigh) & calf to support them & make them move well. If these muscles get weak then your knee loses some of it’s stability and this can cause pain, increase your risk of developing or aggravating arthritis, & make your leg feel weak like it won’t support your weight. Making sure your muscles are strong and the right length makes your knee stable, prevents injury & reduces pain. This is especially important for your quads & hamstrings to keep the right strength balance between the front & back of your knee. Both aerobic (cardio) & resistance (weights) exercises have been shown to bring many benefits for your knees. These include;

• reducing pain & improving your ability to do daily tasks such as walk, drive & use stairs
• promoting weight loss, which reduces the stress & strain you put on your knees
• improving your balance & strength which helps prevent falls
• helping fight osteoporosis by increasing bone density
• reducing the risk of secondary problems with your ligaments, cartilage & kneecap

If you already have knee problems then exercise can be very good for you however you should consult your trainer or physio to make sure the exercise is right for you. Research shows that in conditions such as knee osteoarthritis the benefits of exercise are further improved when the exercise is done together with physio treatment & appropriate weight loss. The general recommendations for knee exercises for most people are;

• start gently and progress gradually. Have supervision if you are unsure or have any underlying problem or injury. You should not feel any knee pain as you exercise.
• use a mix of cardio & weights exercises
• keep to low-impact exercises initially eg exercise bike, cross-trainer, shallow squats (avoid deep squats as they stress your knee & your kneecap)
• make sure you wear appropriate shoes (trainers) because they absorb shock & help keep your whole leg in the right alignment
• keep the amount of strengthening you do for the back of your knee (eg hamstring curls) in balance with your exercises for the front (eg knee extensions). This balance is important for knee stability & preventing pain.

Following these few simple rules will get you on the right track to enjoying all of the great benefits that regular exercise can bring for your knees.

Why is it sore?

Between 50-80% of pregnant women will report SIJ (pelvis) or lumbar spine pain throughout their pregnancy. This pain is associated with the biochemical and structural changes during pregnancy and throughout postpartum (ie after giving birth) while the mother is still breastfeeding.

When  you are pregnant the hormone relaxin is produced and it continues to rise during the 1st trimester and in the final weeks of pregnancy. This hormone as the name suggests ””””relaxes”””” or loosens the muscles, tendons and ligaments in the body in order to allow the body to accommodate the growing baby. This hormone also breaks down collagen and prevents it from being synthesized.

So what does all this mean?

Well firstly, the increased weight of the belly means your pelvis tilts forward and as a result, your back compensates by arching back further i.e. the curve in your back deepens in order for you to maintain your balance. This ””””hyperlordotic”””” position can then cause the joints in your back to jam up and be irritated as the normal lubrication and movement through them is reduced.

What about the pelvis?

The joint between your pelvis (the illium) & your spine (the sacrum) is called the sacroiliac joint(SIJ). Normally the rough, groove like connecting surfaces of the sacrum and ilium interlock and help stabilise the joint. However when you are pregnant the relaxin hormone loosens and widens the joints at the front and back of the pelvis (SIJ and pubic symphysis) which reduces their stability and changes the efficiency of the muscles which attach around that region. Essentially the joint itself is loose, the ligaments become lax, and the muscles which usually stabilise  the pelvis aren””t able to work as efficiently. When you put all this together with the increased load on the baby you have an unstable pelvis which often causes pain.

Trauma at birth can also tear or loosen some of the ligaments in the pelvis. The pain around the pelvis will typically be a dull ache but can become a sharper pain with activities like standing from a seated position, climbing stairs and getting out of the car. Usually its on one side but can be across both, and the pain can refer down to the buttock or back of the thigh.

What can l do?

• avoid excessive unilateral (ie on one leg weight bearing activities eg excessive twisting, lifting, single leg stance postures, stair climbing.
• Get out of a chair or car with even weight through both feet.
• Sleep on your side with a pillow between your legs and under your pelvis.
• Get a physio to teach you how to train your core muscles as research has shown that these muscles are very important in stabilising your lower back and pelvis (they act like a corset around your low back and pelvic region).
• Avoid lying on your back for long periods of time, particularly after 19 weeks of pregnancy. This is because the weight of the baby and uterus can compress blood vessels & reduce the blood flow to the placenta and baby.
• When standing, maintain a good posture to alleviate the stress in your back and pelvis.
• Stand upright as though someone is pulling on a string attached to the top of your head.
• Keep your abdomen and buttocks pulled in to reduce the curvature in your lower back. Do not hold your breath.
• Keep your knees slightly bent when standing as locking the knees can increase the amount of curvature on your lower back.
• When sitting, choose a good straight backed chair and avoid slouching.
• Bend with your hips and not your back.
• Avoid lifting or carrying heavy objects.
• Reduce your stride length.
• A maternity belt around the pelvis can provide some relief as it re-stabilises your pelvis. Speak to your physio for this.
• Start training you pelvic floor muscles to prevent incontinence happening:
  • try to not go to the toilet on the first urge, but wait till the second urge
  • think of your pelvic floor muscles (muscles that allow you to hold your urine in) as a hammock and gently draw them up towards your belly; perform 10x 10 sec holds daily
  • using those same muscles perform 10 strong contractions (no need to hold these)

Pregnancy can be a tricky time for low back & SIJ pain, and often new mums find problems in these areas once they are caring for their baby as well. There is a lot that can be done to help re-stabilise your low back and pelvis to reduce these problems, and also advice about common daily activities that can help you reduce the strain you put through your back. If you are not sure then please chat to us or your local physio about how we can help you enjoy this exciting time of your life!

Summer is rapidly approaching, and with global climate changes, the summers are getting hotter and what better way to cool down than to hit the beach or pool for a swim!

Unfortunately though, as with many sports there are always associated injuries and in swimming it is often the shoulder. One of the most common conditions that can occur is shoulder impingement.

Lets have a quick chat about the muscles and their function in the shoulder. There are 4 major muscles which make up your rotator cuff. Theses 4 muscles work to stabilise the shoulder as it moves through range.

If one of these 4 muscles are weak or there is tightness in the muscles controlling the shoulder blade then the top of the arm bone (humerus) can jam up under the roof of the shoulder blade (acromion). This can cause the tendons or the bursa (pocket of fluid) to become inflamed and painful.

Shoulder impingement usually occurs when your arm is up close to your ear in backstroke, freestyle, butterfly. It can also be when you are in a streamline position where your arm is slightly rotated inwards (internally rotated).

So think of the shoulder like a canoe and paddle – the swimmers hand is like a paddle and the rotator cuff muscles work like a fulcrum to stabilize the shoulder as the arm comes in and out of the water.

So how does shoulder impingement happen?

Shoulder impingement usually occurs when your arm is up close to your ear in backstroke, freestyle, butterfly. It can also be when you are in a streamline position where your arm is slightly rotated inwards (internally rotated).

This position causes friction of the head (ball) of the arm against the ligaments and the tendons.

This occurs due to:
• Poor swimming technique
• A large amount of training which can cause the muscles to fatigue and therefore work inefficiently or be overworked and fail
• Your hand crossing your bodys midline when it enters the water in freestyle or butterfly
• Your thumb pointing down and the palm facing outwards as your hand enters the water
• Unilateral breathing (ie only breathing on 1 side), as it can cause the opposite shoulder to become overworked
• The use of a kick board and streamline positions with the palm facing out can place the shoulder in a position of impingement
• The use of hand paddles or paddles without holes can increase the pull-through load, again placing increased strain on the shoulder muscles

Here are a few common swimming stroke problems to take note of to help avoid having a painful shoulder this summer!

Things NOT to do!

Butterfly:
• entering the water with your arms too far outside the shoulders or too close together (too close to midline)

Backstroke:
• pulling through with elbows extended (fully straight) which results in a straight arm pull through instead of an S shaped pull through.
• inadequate body roll

Freestyle:
• pulling through beyond the midline
• reaching out too far or aiming for too much length ahead
• inadequate body roll

Breaststroke:
• Excessive elbow straightening in the streamline position.

So have a think about your technique, have a think about the few technical problems mentioned above, and have a safe and painfree swimming season!

Whiplash is the action of a person’s head moving forward and back very quickly and is commonly associated with car accidents. It can occur during any activity that involves a similar forceful movement such as a dive or a fall. Injury results when neck structures are ‘overstretched’- these include ligaments, discs, blood vessels, nerves, muscles and joints. More severe cases can involve broken bones.

WAD

The type of neck problems people experience after a whiplash injury vary greatly and are collectively referred to as Whiplash Associated Disorders (WAD). These problems can range from mild neck stiffness to fracture/dislocation of the neck. Whipllash associated disorders include:

• neck stiffness
• neck pain
• pain in shoulders/arms/upper backheadaches
• dizziness
• double vision
• altered sensations in neck and arms
• weakness in neck and arms

WHAT THE LATEST RESEARCH SAYS ABOUT WAD

• Assuming serious injury such as neck fracture/dislocation has been ruled out a person with WAD can be rest assured that:
• The symptoms are a normal reaction to being hurt but there has been no serious damage. The muscles and joints have been affected but they have a natural ability to restore themselves which is helped by activity.
• Even though symptoms can persist for a while the acute pain will ease off in a few days or weeks, at least to a point where you can get on with your daily activities to some extent.
• Use simple painkillers to control your pain to help increase your activity levels.
• Avoiding daily activities slows recovery. Don’t stay in one position too long, move round before you stiffen up and keep moving!
• Gentle neck exercises are helpful.
• Try not to worry or be frightened of movement or pain. IN this case hurt is not the same as harm.
• Neck collars and rest are unhelpful.

HOW CAN PHYSIO HELP WAD?

Physiotherapy can help people with WAD provided they do not have the most severe WAD ie: fracture/dislocation of the neck for which urgent medical attention is required. Current research shows that people who carry on with their normal activities improve faster than those who limit their activities. Your physiotherapist can assist you in encouraging and promoting mobility in your neck. Working on mobility decreases the chances of the problem persisting into the long-term.

Physiotherapy can help you achieve this by prescribing you with appropriate exercises and progressing these as you improve. Manual techniques may also be used in the early stages to help with mobility of your neck . Your physiotherapist will also advise you about posture as this also plays a role in the path to recovery.
WADs are best treated with gentle movement as soon as possible-physiotherapists being movement specialists are here to help you get better as quickly as possible!