The electrifying truths about sciatica

It’s electrifying, it’s like lightening, it’s not Lightning McQueen though…It’s sciatica. Electric bolts of pain that is really no fun at all.

 

Sciatica is not a diagnosis but a description of symptoms. It is the umbrella term that describes pain, tingling, numbness or weakness felt in the leg with the cause of these symptoms originating in the lower back.

Different issues in the lower back, such as a herniated disc (aka slipped disc) or degenerative disc disease (ie general wear and tear of the discs), can cause sciatica.

An estimated 70-90% of people (pretty much all of us!!) will suffer from lower back pain at some point in our lives, according to the Australian governments’ Australian Institute of Health and Welfare. Back pain plagues our society, so let’s get into learning some more about it!

4 wheely fun facts about Sciatic nerve anatomy

The sciatic nerve:

  • is the largest single nerve in the human body
  • is as thick as a garden hose in the buttock area
  • runs from each side of the lower spine, through the buttock and down the back of the leg all the way down to the foot. It therefore connects the spinal cord with the leg and foot muscles.
  • can be kinked, compressed or irritated at any point along it’s path. This explains why people describe sciatica differently, as it depends on where the pressure on the sciatic nerve occurs.

The sciatic nerve is pictured below:

What’s that about the bolts of lightening again?

Specific sciatica symptoms can be different in location and severity, depending upon the condition causing the sciatica. Typically what patients feel is:

  • A sharp, shooting pain that may make it difficult to stand up or to walk
  • Constant pain in only one side of the buttock or leg (it very rarely occurs in both legs)
  • Pain that is worse when sitting
  • Leg pain that is often described as burning, tingling or searing (versus a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • Sciatic pain can vary from infrequent and irritating to constant and incapacitating.
 

Getting to the mechanic – how to treat sciatica

For most people suffering from sciatica, conservative treatment and regular exercise will go a long way to relieving pain and any neurological symptoms.

For a specific group of sciatica sufferers, surgery may be required to provide pain relief and minimize neurological damage.  (If you have the following symptoms – numbness in the groin or pelvic floor area, loss of bladder/bowell function, sudden loss of motor function in both legs, then you need to present to your nearest Emergency Department as this is not sciatica). 

As most cases don’t need to go down the surgical path though, lets look into the broad range of conservative options available for sciatica treatment, with some of the most common and effective options discussed below.

1. Turn the ignition off

In the first couple of days of having acute and severe sciatic symptoms, treatment is focussed on calming the sciatic nerve irritation down. You can:

  • Take medication – talk to your GP or Sports Physician for the most appropriate medication to take.
  • Rest – don’t go to work, forget cleaning the house, just concentrate on looking after yourself. Rest in bed just while the pain is disabling and severe. This should go on for no more than 2 days, until the medication kicks in and your symptoms ease. Then, as you’ll see below you must get up and about.
  • Heat packs – can be a great natural way to give relief and relax the muscles.
  • When the pain is crippling, it can be more effort than it is worth to get into physio, so just stay at home in this really acute period.

2. Ok, time to slowly turn the ignition on now

After the pain relief has kicked in (after 2-3 days), the focus on treatment will change to help get you up and about slowly. Treatment aspects include:

  • Relative rest – the term relative rest is hugely different to just resting! This means you can start to get up and about a little bit, but just be guided by pain. It is hugely important to try and prevent too much deconditioning by completely resting.
  • Heat packs – continue as needed.
  • Medication – continue, as prescribed by your doctor. For worsening cases, imaging and the possibility of injections may be considered.
  • Physio – now we can start! After making a diagnosis, your physiotherapist will most likely do some hands on treatment. You will always be sent home with exercises.. just make sure you do them!

Your physio will work with you to:

  • Reduce the sciatic pain in the short term and help to give you relief
  • Guide you on conditioning exercises (cardio, strengthening and flexibility exercises appropriate to you) to help prevent future episodes.. Let’s explore the exercises in more detail below!

3. Rev up the engine

When the acute pain subsides, now you must start to gradually and progressively build in some exercises.
(NB these exercises are a guide only. You must consult with a physiotherapist to ensure the exercises are appropriate to your body type and your injury at the time).

A. Stretches
Stretching can help to get things moving again, and may provide relief to spasmed and tight muscle groups. 2  helpful stretches to providing relief from sciatic pain are shown below.

B. Strengthening

What lots of people find quite interesting is that after a bout of back pain, your core muscles turn off. Like a switch. Off. The core completely shuts down.

That is why you need to go back to some basic inner core exercises to reassure to the brain, that it is ok to send a message to the right muscle groups to switch on again. Spend 10 minutes, 2-3 times per day for 2 weeks just activating the deep core and focusing on your breathing. Then you can gradually start to increase the difficulty of the inner core activation exercises.

Have you heard of the 10 000 hour rule? In his book, “Outliers: The Story of Success”, Malcolm Gladwell discusses the need to practice a task for 10 000 hours to train your brain. So, get those inner core activation exercises going!!

Just as you start to wake up your deep core, you will also need to start some buttock muscle activation exercises as well. Similar to the deep core, the buttock muscles also switch off when you have back pain.

How to feel as smooth as a Porsche (injury prevention)

To prevent and manage sciatica and other forms of back pain, our physiotherapists at Physiotonic will help you keep:

  • strong in the right places – that is from the inside out in areas such as your core, pelvic floor and buttock muscles. The correct tone and strength of these muscle groups are imperative to support the spine and provide stability.
  • flexible in areas you are tight
  • good posture

Our classes at Physiotonic, will help you to continually work on these factors to keep your spine healthy and prevent Sciatica…. and of course feel as good as a Porsche!

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6 things you should know about rotator cuff tears

At some time in your life, either you, a family member or a friend will complain about the crippling effects of shoulder pain.

Although there are many ‘things’ in the shoulder that can cause pain, the most common injury in the shoulder is a rotator cuff tear. The pain can be disruptive to your life, can last a long time and treatment can get very expensive. Let alone if you need surgery to help fix the problem.

In this article, we are going to discuss the 6 things you must know about rotator cuff tears and how to keep your shoulders healthy.

1. The rotator cuff is important!

The rotator cuff is a group of 4 muscles and their tendons that run from your shoulder blade and connect to your arm bone. The connection of your shoulder blade and arm bone is a ball and socket joint. The shapes of these bones when together resemble a golf ball balancing on a golf tee, as shown below.

 

One of the main functions of the rotator cuff is to help balance the golf ball (the head of the humerus) on the tee (the socket part of the shoulder blade), in order for your shoulder to be able to move.Therefore, if the rotator cuff is torn or partly torn, this can significantly affect your ability to move your arm. That is why it is so important!

 Above: image of the rotator cuff muscles and tendons around the shoulder

2. The referred pain phenomenon

Have you ever had pain down the upper side of your arm?  And as much as you poke and prod it, you just can’t seem to pin point where the pain is coming from? Welcome to the phenomenon of referred pain.

Torn rotator cuff tendons can cause pain deep in the shoulder, around the shoulder or refer down the upper side of the arm. Unfortunately no amount of poking through the side of your arm will lead you to the source of the pain. Just be aware of this, in case it ever happens to you!


Above: the red markings show the ‘referred’ pain you may feel

3. A direct cause and effect

If you have a torn rotator cuff, you can pinpoint exactly what movements cause pain and feel weak. Common painful and weak movements include:

  • lifting
  • overhead activities such as hanging out the clothes
  • tucking your shirt in as you reach behind your back, and for ladies doing your bra up behind your back
  • combing your hair
  • playing tennis
  • swimming

4. Chances are your shoulders are going to wear out through life!

Rotator cuff tendons are so commonly torn and this is in part due to the limited blood supply of the tendon. It is estimated by the age of 50, 60-70% of people will have a tear shown on ultrasound.

The tear can either happen:

  1. in a single traumatic episode, such as falling onto an outstretched arm.
  2. over time due to repetitive microtrauma.

Let’s look at (b) more closely as it is the most common way people end up with a cuff tear, as it is a normal part of ageing.

Your rotator cuff tendons pass through a small space, called the subacromial space. In a normal shoulder, as you reach your arm overhead there is enough room for your tendons and bursa to pass through this space.

However, with various muscle imbalances, what happens when you reach your arm overhead, is that the tendons and bursa get squashed in this space. As they keep getting squashed, initially micro damage to the tendons occur (which typically happens through your 20’s and 30’s) until eventually the tendons get so worn out that they start to tear (which starts to happen in your 50’s), initially with smaller tears and overtime ultimately with larger tears.

 

5.  Get the right advice

If you start to experience shoulder pain, make sure you see either a:

  • physiotherapist with experience in sports injuries
  • GP with an interest in musculoskeletal medicine
  • Sports Physician
  • Orthopaedic surgeon

Either of these professionals will perform a physical examination to diagnose the problems with your shoulder. They may suggest you get some imaging done to provide further information. Options include:

  • an X-ray – you will most likely need this to asses the integrity and shape of your bones
  • MRI – this is the gold standard and can give you a lot of useful information, but can be expensive
  •  an ultrasound – beware!! not all ultrasound tests are created equally!

A little more information on ultrasounds
Ultrasounds are cheap, non-invasive, quick and free of radiation. However, test results are highly dependant on the person performing them and are notoriously difficult to interpret. Your results may significantly over or under report the damage that is there.

The chances are if we were to repeat the ultrasound on your good, pain-free shoulder, you may have just as many problems on the report for that shoulder. This is because tests can report degeneration and damage but they can’t report where your pain is coming from. Wear and tear is normal. You need a good team of health professionals to interpret any tests you have.

To make the most out of your ultrasound, make sure you are referred to a radiologist who specializes in reporting on the shoulder (there are only a handful in Sydney, so ask us if you ever need a recommendation).

6. You need to keep your shoulder muscles healthy… starting from today!

By coming to Physiotonic classes, we are helping you create a habit of good posture. Research has shown poor posture where the spine is hunched forwards, the shoulders are rounded and the neck pokes out, is linked to shoulder problems. In this poor posture, the muscles at the front of the shoulder such as your pec muscles become very tight and overactive. Meanwhile the muscles at the back of the shoulder become weak.

This simple muscle imbalance exacerbates shoulder problems. So to manage and prevent shoulder and rotator cuff problems, through Physiotonic we  get you to:

  • activate the muscles at the back of your shoulder to help you improve your shoulder posture (which is the shoulder blade setting we talk about during class)
  • continue to work on your deep core activation to help with your overall posture.

Some tips to incorporate in your exercise routine include:

  • do less pushing exercises involving your shoulders such as bench press and chest press
  • do more pulling exercises such as pull downs with the cables,  horizontal pulls and bent over reverse flies.

However, if you are experiencing shoulder pain, you really do need to get yourself to a good sports physio to ensure you are engaging the right muscles, as it is very easy to get it wrong.

In summary, your rotator cuff tendons are important to your shoulder. They are commonly injured, so you need to look after them. Don’t carry a world of pain on your shoulders. It is better to be proactive and do the right exercises for your shoulders, from today.

MINDFULNESS

When an ostrich is scared, the bird apparently buries its head in the sand to avoid danger with the logic, ‘if I can’t see it, it doesn’t exist’. This is the Ostrich effect. Maybe it isn’t as ridiculous as it sounds because humans do it too as we often look away from our problems.We really need to pull our heads out of the sand, face our problems and take life head on to overcome life’s obstacles as we work towards happiness and living a better life.

When I read books to my daughter I notice that it is engrained into us as children that we are all going to live happily ever after. But are we?

Did you know that in Australia, it is estimated that 45 per cent of people will experience a mental health condition in their lifetime? (statistic from Beyond Blue. For more info go to http://www.beyondblue.org.au/the-facts). And as reported in The Lancet, December 2014 , mental ill health is now, staggeringly, the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10–24 years. Wow.

There is only one children’s book I have come across so far that paints a fair and realistic picture of life, encouraging you as the reader to take responsibility and find your own opportunities. That is Dr Seuss’s children’s book ‘Oh, the places you’ll go’.  Don’t get me wrong, fairytales and fantasies certainly do have a role in children’s lives as they plant the seed for us all to dream.

However, it is paramount to be in the right frame of mind, to be truly healthy and happy. Mindfulness is probably a term you have heard thrown around in the media lately, and the talk about it has become as popular as the fashionable vegetable, kale. Mindfulness is the focus of one’s attention on emotions, thoughts and sensations occurring in the present moment. It is used to treat a variety of mental and physical conditions including depression and anxiety.

Physiotonic started the year with the newsletter feature of New Year’s Resolutions. This month our focus is on reflection (by the way how are those NYR’s going?) and to remind you to give some attention to your emotions, thoughts and sensations.

So just how introspective are you? Some questions you could ask yourself are:

  • how healthy are you right now? Where are your aches and pains and what are you doing about it?
  • if you are in a relationship,  what are the relationships’ strengths and weaknesses and what can you do to improve it?
  • how close are you to the rest of your family like your kids, your parents and your siblings? Can you be more active in your relationships with them to feel closer to them?
  • what are your friendships like? Do you surround yourself with energetic, positive, motivated and like-minded people?
  • how much satisfaction and enjoyment does your job bring? Lets face it, you are there probably 50 hours per week, so best to enjoy your time there.
  • are you keeping your mind active by reading and learning about new things?
  • where are your finances up to and what could you be doing better?
  • how well do you sleep? This is an important point as good quality sleep is imperative for your well-being. If you aren’t sleeping well what needs to change? Perhaps you need to avoid screen time 1-2 hours before bed time to improve your sleep, or reduce the amount of caffeine you consume or do a good exercise session during the day to tire you out. We receive great feedback from Physiotonic participants who say they sleep really well after our classes, so perhaps you need to factor in more time to do Physiotonic classes.
Above all, simply ask yourself how am I? Where am I at and what do I need to change to make life happier. Physiotonic is there to help you focus on your:
  • breathing to help you relax, reduce stress and improve your sleep quality
  • strength, tone and flexibility to help you recover and/or manage injuries and reduce your pain (plus the toning exercises will help you look good!)
  • posture to help you feel good and to hold yourself well and with confidence
  • and to remind you about mindfulness… are you feeling introspective yet?!
Take the time to read some of the lines from Dr Seuss’s book ‘Oh the places you’ll go’ written below as we can all learn something from it. And remember… Don’t be an ostrich!“Congratulations! Today is your day. You’re off to Great Places! You’re off and away!

You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You’re on your own. And you know what you know. And YOU are the guy who’ll decide where to go….

You won’t lag behind, because you’ll have the speed. You’ll pass the whole gang and you’ll soon take the lead. Wherever you fly, you’ll be best of the best. Wherever you go, you will top all the rest.

Except when you don’t. Because, sometimes youwont. I’m sorry to say so but, sadly, it’s true that Bang-ups and Hang-ups can happen to you. You can get all hung up in a prickle-ly perch. And your gang will fly on. You’ll be left in a Lurch.

You’ll come down from the lurch with an unpleasant bump, and the chances are, then, that you’ll be in a Slump. And when you’re in a slump, you’re not in for much fun. Un-slumping yourself is not easily done….

You can get so confused that you’ll start in to race down long wiggled roads at break-necking pace and grind on for miles across weirdish wild space, headed, I fear, toward a most useless place… The Waiting Place…

for people just waiting. Waiting for a train to go or a bus to come, or a plane to go or the mail to come, or the rain to go or the phone to ring, or the snow to snow or waiting around for a Yes or No or waiting for their hair to grow. Everyone is just waiting.

Waiting for the fish to bite or waiting for wind to fly a kite or waiting around for Friday night or waiting, perhaps, for their Uncle Jake or a pot to boil, or a better break or a string of pearls, or a pair of pants or a wig with curls, or another chance. Everyone is just waiting.

NO! That’s not for you! Somehow you’ll escape all that waiting and staying. You’ll find the bright places where boom bands are playing.

You’ll get mixed up, of course, as you already know. You’ll get mixed up with many strange birds as you go. So be sure when you step. Step with care and great tact and remember that Life’s a Great Balancing Act. Just never forget to be dexterous and deft. And never mix up your right for with your left.

And will you succeed? Yes! You will, indeed! (98 and ¾ cent guaranteed). KID, YOU’LL MOVE MOUNTAINS!…

Today is your day! Your mountain is waiting. So… get on your way!”

Talking all things tendons

 You would know it takes a ridiculously long time to heal if you have had tendon pain or know someone that has. So what is it with tendon issues being so notoriously slow to heal?

When a muscle tears, the injury takes about 3-4 weeks to heal. When a bone breaks the injury takes about 6 weeks to heal. But when a tendon is irritated, it can take 3 months or longer to settle down. Have you ever heard of rotator cuff issues? Golfers elbow? Tennis elbow? Heel spurs? These are all to do with tendon based pain.

Commonly referred to as tendinitis, its proper name is tendinopathy. When you experience tendon pain, there is breakdown and general wear and tear of the tendon. The older you are, and the more you ignore the injury, the more wear and tear there will be. In a young person who has no tendon issues, the tendon cells align in a compact, neat, parallel fashion, like a brand new rope (pictured below left). As the wear and tear proceeds the cells become loose and disorganized like a frayed, old rope (pictured below right).

 ???????????????????????????????????????????????????????????????????????????????frayed_rope

Common areas for tendinopathies in runners:

  • Patella tendon (pain at the front of the knee).
  • Achilles tendon (pain behind the heel).
  • Gluteal tendons (pain at the side of the hip).
  • Plantar fasciitis (pain under the heel).

 Common causes:

  • Loads. An irritated tendon is a direct reflection that the tendon is not coping with the demands you are placing on it. For example, bringing in an extra sprint session in the week to your training plan, or adding a hill sprint session, can set off a tendon issue.
  • Muscle imbalances: Generally in the tendon that is irritated, its respective muscle has wasted. Other areas in the kinetic chain typically have wasted as well.
    • For example in Achilles tendinopathy, the calf muscle has wasted and sometimes further up the chain, the gluts, quads and hammies have also wasted.
  • Age: the older you get, the more wear and tear you will have in areas such as your tendons.

Symptoms

Tendons have a very interesting way of indicating they are irritated. If you tear a muscle, you know about it at the time of the incident. Versus with an irritated tendon, its symptoms can creep up on you. Symptoms in order of severity of tendon pain:

  • Pain in the area of the tendon after a run
  • Pain at the start and end of a run
  • Pain the next morning after a run, particularly with your first few steps as you get out of bed (for Achilles Tendinopathy) or as you first walk down stairs (for patella tendinopathy).
  • Pain every morning, even without a training day on the previous day.
    • For example in Achilles Tendinopathy, the pain can last for a few minutes as you start to walk around on it in the morning.

Common treatments:

  • Loading:
    • Be guided by your Sports Physiotherapist on how much to reduce your running and how/when to gradually increase running again. A careful, gradual return to running is vital at improving tendon pain as it helps to stimulate the damaged tendon cells and improve their organisation.
    • Some load of the tendon is good.
      • For Achilles Tendinopathy doing some static calf raises is helpful. Holding onto a bench, lift up into a half calf raise. Hold 3x30sec, 3-4 times throughout the day. These static holds can be really great to add into your warm up before a run.
    • Complete rest of the tendon (unless it is severely irritated) is not good.
  • Ice: can be used as a helpful analgesic to relieve pain.
  • Strengthening: the muscle of the affected tendon, and ensuring the rest of the kinetic chain is strong.
    • For Achilles tendinopathy, do calf raises once to twice per day. Your exact dose of calf raises should be prescribed by your physio, depending on how irritated the tendon is. Calf raises will help to re-build calf muscle strength and will help to put some load through the tendon.
  • Maintain your cardio fitness in other ways if you have to reduce your running training loads.
    • For example, if you have an Achilles tendon issue, you can still cycle!
  • Taping and bracing: Can be effective to reduce the pressure on the tendon.
    • Achilles tendon issues – ask your physio about a heel wedge that inserts into your running and work shoes. This lifts the position of the heel and reduces the load on the tendon. However, if your Achilles is really bad, you may need to go into a boot to take the load off it completely.
    • Patella tendon issues – ask your physio about a patella tendon strap that can be worn while running.

5 tips to improve your stretching regime

1. Do some stretches while you are at work

You shouldn’t let hours pass at the desk before you get up and move. Instead, every half hour you should get up and do just one stretch! Your productivity and energy levels will improve. Some simple stretches you can do without moving too far away from your desk include:

extension_standing_exerciseHip-Flexor-Stretching-PicTstand-ham-stretch-male

Left picture: Stand with your hands on your lower back. Keep your knees straight and gently lean your shoulders back over your hips. This ‘extension’ movement helps you to stretch in the opposite direction you are slumped in the chair in! Great for preventing and managing low back pain.

Centre picture: Hip flexor stretch. In the above stance, try to tuck your tail bone under. You should feel the stretch at the front of the hip on the back leg.

Right picture: Hamstring stretch. The leg that is up on a stool should be slightly bent. Make sure you feel the stretch in the muscles at the back of the thigh.

2. Stretch before you put your feet up

Just before you collapse on the couch at the end of the day, get down on the floor and hold stretches for a few minutes. Or in the TV ad breaks, you could get up and stretch. Trust me you will feel better for it. Some great floor stretches include:

back ext stretch pronebuttocksstretch downward-dog-e1337427564175 trunk rotn stretch

3. Factor in 10 minutes of stretching AFTER a cardio workout

Yes studies show that stretching AFTER not BEFORE a cardio workout is best. This is when the muscles are warm and you will get more out of the stretch. Make sure you stretch all your major muscle groups.

4. Vary your cardio

Just varying your cardio can help improve your flexibility. For example, if you sit all day for work then cycle as your main choice of exercise, your body has remained in that same bent forwards position. Just changing your body position for different workouts can help to loosen up tight areas. So if you sit all day for work, jump in the pool and do some freestyle or backstroke to help iron you out! See previous post “Is cycling really good for you?”

5. Get your brain in on the action!

Your stretching will be far more effective if you think about the muscle that you are stretching and ACTIVELY RELAX it. Try not to resist the tightness and hold your muscle stiff and rigid. Instead, allow your muscle to relax into the stretch. Breathe as you hold the stretch and just ‘let it go’.

Tell us your favourite stretch in the comments below!

3 tips to help you train smarter not harder for your running

1. The ‘THREE’ rule

Listen up all you runners out there…. Most runners don’t need to run anymore than 3 times per week. Here is the break up of what you should do:

  • Run 1: A longer run (increasing the distance each week to help you get to your target). Keep in mind that to train for a marathon, you don’t need to run a marathon everyday. Your target distance to reach when training for an event should be about 85% of the race distance. Reach this peak distance a couple of weeks before the event, to allow time for tapering.
  • Run 2: A medium distance run
  • Run 3: A shorter, faster run. This is where you can add in sprints and hill workouts. This session helps improve your anaerobic fitness (i.e. your quick energy stores) which will then help improve your aerobic endurance.

2. Spread it out

Make sure your runs are spread out during the week so you don’t EVER run on consecutive days. By spreading out your running sessions, this allows your soft tissue structures to recover between sessions. If you push through too hard and run on too many consecutive days, then you are exposing yourself to injuries like stress fractures.

3. Vary it

On the “off” days from running, you can definitely still do a cardio session but vary the type of exercise you choose so its completely different to running. Give your joints a break by making sure each session outside of running isn’t high impact exercise. So choose a low impact cardio session such as swimming or cycling.

sport such as basketball, netball, squash or tennis. Instead, get on a bike or into the pool. This will allow you to exercise other parts of your body and give your joints a break at the same time.

Opinion piece – Stand up Australia – sitting is as bad as smoking

Last night, 60 minutes had a story on the devastating effects of sitting. Yes we absolutely need to get talking about how ridiculously sedentary our lives have become but I’m afraid this story failed to truly emphasise what we need to do about it.

dog

The story can be viewed at http://www.jump-in.com.au/show/60minutes/stories/2014/september/stand-up-australia/

The highlights were:

  • A reflection on the catastrophic effects of our sedentary jobs and we were told ‘the latest research says sitting is as bad as smoking’. Yikes! They said sitting can be linked with diabetes, cardiovascular disease and cancer.
  • Their case study, Donna, shed 20kg by doing some big changes around the office. This included getting up hourly to move around the office and standing at her desk.
  • You have a 40% higher risk of early death if you sit on a daily basis for 11 hours or more versus 4 hours
  • You can decrease your blood pressure and improve your energy levels if you stand or light walk around the office while you are working, versus sitting at the office.

Be warned that to loose weight and improve health, it won’t just come from standing at the desk and wandering around the office every now and then throughout the day. People who sit for the doomed 11 hours or more during the day are probably more likely to have sedentary behaviour with most other aspects of their life, don’t exercise and don’t give a hoot about their diet. And this is why the story was so misleading. There are too many variables to make the research they were talking about ‘high quality’. The diseases – cardiovascular disease, cancer and diabetes – aka lifestyle diseases have so many contributing factors and sitting is just one variable – absolutely an important variable but it is just one variable. A healthy lifestyle must also factor in regular exercise, a good diet, not smoking, not drinking and reducing your stress.

We still MUST do our 30 minutes of cardiovascular exercise and in addition, take on board some of these suggestions of how to keep active during the day. Suggestions include:

  • As per the story, I love the idea of doing a ‘walk and talk’ meeting rather than sitting in a board room (see story for full details).
  • Perhaps try a standing desk. If you do, don’t start off by standing all day because if you aren’t used to it, you’ll may end up with a sore back anyway.
  • Get up every 30-60mins and MOVE around the office. You could
    • walk around your floor
    • Do some calf raises (as this gets blood pumping in your legs)
    • Hold a stretch to prevent your joints from getting too stiff
  • Set your alarm to remind you to move every 30 mins because, lets face it, it is so easy to get engrossed in our work and forget about moving
  • Take the stairs not the lift or elevator

For a truly healthy lifestyle, yes we could all improve our incidental movement throughout the day, but don’t forget WE MUST also keep up our exercise and have a good diet!

Is cycling really good for you? A must read for office workers and cyclists.

MAMIL aka middle aged men in lycra. We’ve all heard the phrase before and rightly so since cycling has become a hugely popular sport in recent years. We are seeing less of people going off to have a round of golf and instead people of all ages, shapes and sizes jumping on a bike and going for a ride.

Benefits to cycling

There are huge advantages to cycling especially the cardiovascular benefits. The heart works harder if more major muscle groups are worked during exercise. Therefore cycling is a fantastic cardio work out because the major leg muscles are involved. This makes the heart worker harder and pump more blood, giving you better cardio benefits for the workout.

The other advantage is that it is a form of non impact exercise, to give those creaky joints a break!

 What to watch out for

One issue to be aware of is the position you are in and the problems this contributes to for people with back pain and for office workers. As you are in a bent forward position on the bike, your hip flexor muscle is held in a very short position. This will make the hip flexor tighter.

As with sitting in a chair, your hip flexor muscle is held in a shortened position and again this will make the hip flexor tighter.

iliopsoas-cycling short mm

Anatomy review of the hip flexor

The hip flexor muscle runs from the front side of your lower back, passes through the pelvis and attaches onto the front part of your hip. See the pictures below, looking front on at the hip flexor. As you can imagine, when you sit at work or are on a bike this muscle is held in a shortened position, which over a period of time makes the muscle tight and overactive.

iliopsoas anatomy pic 2iliopsoas anatomy

The issue

The problem with your hip flexor being tight is that it can:

  • contribute to lower back and hip joint stiffness.
  • It will start to cause muscle imbalances. As your hip flexor becomes tighter and more overactive, surrounding muscles such as the buttock and deep core muscles get weaker and start to switch off. This can then place more load and start to cause pain in your hip joint and lower back.

Should you still cycle?

Of course! The cardio benefits of this non impact exercise far outweigh the idea of a muscle getting tight. However, follow the tips below to get the most out of cycling without causing too much tightening of the hip flexor:

  • Stretch the hip flexor EVERYDAY, no matter whether you have cycled or not. As mentioned above, this muscle gets tight even while you are sitting. Stretch 3 times per day for 30-45 sec each side. And after a cycle stretch for longer. psoas-stretch1
  • Lean back! With sitting at work or being on a bike you are in a bent forwards position, so do some stretching EVERYDAY to take you into the opposite position and help iron you out. Do the below standing stretch (pictured on the left) for 30 seconds every 1-2 hours while you are sitting at your desk. Do the prone stretch (pictured on the right) every night for 1-2 minutes. Do either option as well for 1-2 mins immediately after you finish a ride.

extension_standing_exerciseback ext stretch prone

  • Keep strengthening your gluts and deep core to correct any muscle imbalances.
  • Vary your exercise. Don’t just use cycling as your only cardio exercise, but vary your routine so you can place your spine and body in different positions – this can be achieved with adding in some other exercise such as walking, running and swimming.

Happy cycling!

The power of the brain in dealing with pain

Have you ever wandered why after a bad nights’ sleep, you are in an irritated mood or feel more pain? As sports physios working with teams, why is it that when a team wins their game, players have less injuries and complaints versus when the team looses, players have more injuries?

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It used to be believed that when you injured a tissue, a message would travel up to your brain to say the tissue was damaged. The brain would register that information and then signals would be sent back to the tissue saying the area was in pain. But this didn’t explain phantom limb pain. So if someone had an amputated leg, how was it possible they could still feel pain or an itch in the leg that is no longer there?

Scientists and medical professionals have shown that the brain is the powerhouse for understanding your perception of pain and that pain is in fact related to many factors. It isn’t just to do with the amount of tissue damage you may have experienced. Instead, your perception of pain is to do with a huge range of factors. This includes:

  • Sleep – the more pain you have, the poorer your sleep pattern. Poorer quality sleep also makes you feel more pain.
  • Immune system – when you experience ongoing pain, this can weaken your immune system, making you more susceptible to things such as colds. When your immune system is down, you generally feel more achey.
  • Your mood, stress and your environment– the more stress, anxiety and worry you have about anything in your life, the more pain you will have. The more pain you have the more you are going to feel stressed and anxious.
    • For example, your pain may be worse if a relative has just died or you are moving house or you have work pressures.
  • Past experience and your thoughts can dictate your brain’s perception of pain. For example, if you have recurrent episodes of acute low back pain, you may experience either:
    • more pain because you know what is involved to get you better, you may become emotional, frustrated and fear the pain you have had in the past. All these factors can escalate the amount of pain you are experiencing.
    • less pain because you have had a good understanding of your pain in the past and you know what to expect.

pain-in-the-back

Chronic pain is a huge problem in Australia, where 1 in 5 people have it. The brain keeps producing pain even though the tissues are restored and out of danger and any other serious diagnosis have been ruled out.

Note the difference between acute and chronic pain.

  • Acute pain is defined as pain you may experience for less than 3 months. For example, if you sprain your ankle and you make a speedy recovery.
  • Chronic pain is pain that lasts for longer than 3 months and where the ongoing pain is to do less with the structural changes to your body and more to do with sensitivity of the nervous system. That is, the tissue damage is not the main issue.

What should you do about it?

We need to retrain the brain and nervous system. The brain is not fixed. It is PLASTIC. You may have heard the term before, neuroplasticity – where we can retrain your brain (for an interesting read, see Norman Doidge’s book The Brain That Changes Itself). These are the factors to work on:

  • Medical
    • Medication can help to get you going but should be tapered off and ceased as your symptoms settle.
    • Always get a second opinion, especially if you are told to get surgery and you have any doubts.
  • Keep your approach active
    • Learn ways to decrease your stress levels and wind down the nervous system. This can help with your emotional wellbeing and can reduce pain.
  • Diet and lifestyle
    • Our sedentary lifestyle and what we eat contributes to a sensitized nervous system. Take a good look at your diet and lifestyle and make appropriate changes to your drinking and smoking habits, diet and exercise.
  • Explore the deeper meaning of your pain by looking at what was going on in your life around the time the pain developed. Any worrying periods of life can make pain worse so think deeply to recognize your emotions.
  • Physical activity
    • Get moving at comfortable levels without fear. Slowly build back your normal activity levels.

If you want to learn more on this topic:

Pain comes from the brain. The brain can be re-trained. But to re-train the brain, you need to look at a broad perspective and all the factors contributing to your pain.

4 part series on low back pain – Part 4C: The ultimate answer for managing low back pain

For the 80% of us with a grumbly lower back, research is telling us that ultimately an active approach is the most favourable in managing back pain in the long term.

This means you need to:

  • Keep active in your spare time

    • In part 3 of this back pain series, we discussed how our sedentary lives are the major cause to low back pain. So what do you need to do about it? Get up and get moving! 
    • Swimming is a fantastic form of exercise for people with low back pain. While you are at the pool, try some walking in the shallow end – walk forwards because it is fantastic cardio, but try walking backwards as it is a great way to help you engage your buttock muscles. 
    • Get into any other exercise that you enjoy – walking, yoga, Pilates, Physiotonic classes, cross trainer… there is so much variety you can choose from.. and do exactly that – keep the exercise varied.
    • Is cycling a good choice of exercise for low back pain? Maybe not – we’ll discuss this in a separate blog post soon!

  • Keep your weight down
    • Being overweight simply puts too much pressure on your spine. Make some changes to your dietary and exercise habits today! 

  • Work on your core strength
    • Having a strong core that will help you prevent back pain, does not mean you have a six pack and can do 100 sit ups. Your six pack muscles are the outer core and don’t support your back.
    • Instead, the deep core muscle that wraps around your trunk, is the one you need to improve and will help you get a stronger, more stable body. For more reading on your deep core visit:
    • You will need to go through how to activate your inner core with your physio in detail. Or, come along to a Physiotonic class and we will get you sorted. 
  • Work on your flexibility
  • Keep working on your posture
    • You need to learn a skill 10 000 times before your brain changes it pattern. So get cracking on teaching yourself good sitting habits! Improving your posture is a gradual process but just keep working at it! It is never too late to start!  

 

This is the final blog post on this series for low back pain. To help manage back pain in the long term, our message is simple…get moving! Improve your posture, core strength, buttock strength and flexibility today with Physiotonic exercise classes. Visit our website at www.physiotonic.com.au to contact us.