Index

Many of our patients at West Pennant Hills Physiotherapy and Sports Injuries Centre come to us to seek relief from back pain.

Back pain can be incredibly debilitating, and yet it’s very common. It’s estimated that 70-90 per cent of people will suffer from back pain at some point in their lives.

Back pain can range from mild aching and stiffness to acute, sharp pain. Back problems may interfere with your daily activities, and it’s one of the most common reasons for taking sick leave from work.

There are many different factors that can cause back pain, including:

  • Sprains and strains caused by lifting a heavy object, poor lifting technique, or overstretching
  • Poor posture or sitting at a desk for long periods with a non-ergonomic desk setup
  • Poor sleeping position or sleeping on an uncomfortable mattress
  • Back injuries caused by a fall, playing sports, or a car accident, which may damage muscle, ligaments, or tendons, or compress the spine, causing disc injuries
  • Degeneration of the discs in the spine due to age
  • Inflammatory diseases such as arthritis
  • Pregnancy, which causes looser ligaments, coupled with increased weight and posture changes

Mild back pain will often go away on its own in a few weeks, but if it doesn’t seem to be improving, you should seek medical advice.

Physiotherapy for back pain can help to speed up recovery from back injuries and uses techniques and exercises to help relieve the symptoms of chronic back problems.

How Does Physio Help Back Pain?

So, how can physio help with back pain exactly? When you visit our centre, one of our physiotherapists will ask you questions and examine your back and posture.

We’ll develop a customised treatment plan designed specifically to treat both the causes and symptoms of your back pain. These are some of the different types of treatments we use at West Pennant Hills Physiotherapy and Sports Injuries Centre.

1. Massage

Massage is helpful for back pain for two main reasons.

Firstly, as you’ll know if you’ve ever enjoyed a massage, it is a very effective technique for reducing muscle pain. It relaxes the muscle tissues, reducing tension and preventing painful spasms.

Secondly, remedial massage promotes the body’s own healing process by stimulating blood flow and speeding up tissue repair.

Remedial massage is particularly effective for treating sports injuries, muscle cramps, and the symptoms of inflammatory diseases such as arthritis.

2. Joint Mobilisation

Joint mobilisation techniques are known to be effective for treating chronic low back pain and spinal compression. The relief from this type of treatment is often immediate.

With this type of treatment, your physiotherapist will manually move your joints using carefully targeted pressure in specific directions. This will help to reduce stiffness, improve your range of motion, and reduce pain.

3. Ultrasound

Ultrasound is a common treatment for soft tissue injuries. With this type of treatment, a handheld device is used to deliver painless high-frequency sound waves to the muscles and tissues under the skin.

This causes micro-vibrations within the tissues, increasing heat and promoting healing.

4. Heat Packs

Heat can ease pain and assist muscle recovery by increasing blood flow and oxygen. Your physiotherapist may apply heat packs to provide instant relief from back pain and to make massage and other treatments more effective.

5. TENS

TENS is a medical device that delivers a low-voltage current to the body. This stimulates the nerves in the spine, creating a tingling sensation and instant relief of back pain.

6. Individually Tailored Exercises

Exercises can help to reduce back pain, improve core strength to support your back, mobilise the back, and reduce muscle stiffness.

Your physio will give you a programme of exercises you can do at home to speed up recovery from a back injury and help to prevent further injury.

7. Lifestyle Advice

Back pain is often caused or made worse by lifestyle factors, such as being overweight, poor posture, lack of exercise, and work environment.

Your physio can give you advice on how to create an ergonomic work or study environment, improve your posture, sleep better, and live a healthier lifestyle overall.

8. Regular Classes

At West Pennant Hills Physiotherapy and Sports Injuries Centre, we run regular weekly and twice-weekly classes designed to improve fitness, core strength, and flexibility. These include:

  • Fitness circuit classes
  • Matwork and core classes
  • Stretch and flexibility classes
  • Balance and falls prevention classes

9. Fitting Orthotics

Orthotics are devices that are fitted into your shoes to adjust and support the foot. They can help to reduce discrepancies in leg length and improve your gait and posture. If your back pain is caused by poor alignment or skeletal irregularities, orthotics may help.

Does Physiotherapy Work for Back Pain Caused by Health Conditions?

If your back pain is caused by a long-term disease or health condition you suffer from rather than a one-off injury, physiotherapy can be a great option to help reduce your pain and improve your quality of life.

Physio is a helpful therapy for several health conditions, including:

  • Arthritis
  • Osteoporosis
  • Sciatica
  • Scoliosis
  • Spinal stenosis
  • Osteomyelitis
  • Skeletal irregularities
  • Parkinson’s Disease

How Effective Is Physiotherapy for Back Pain?

It depends on the cause of your back pain, but physiotherapy can be a very effective treatment. Many patients get immediate relief from pain after a session, and physiotherapy can also help to reduce chronic back pain when it is a symptom of a permanent health condition.

Get in Touch to Book Your Appointment

Don’t suffer with back pain any longer. If you’re wondering, “Does physiotherapy work for back pain?” the answer is yes! Contact us to make an appointment with one of our physiotherapists today. You can call us on 98753760 or email info@wphphysio.com.au.

The shoulder is the most mobile joint in the body, allowing us to have a very wide range of motion. However, this means it is not very stable and can be easily injured. We rely on our shoulder to do a number of activities, whether it be reaching for an object, lifting boxes, gardening, or throwing a ball.

Who is most susceptible to shoulder injuries?

  • Young sportspeople, especially those involved in throwing sports such as softball, baseball or cricket
  • Those who have had an accident such as a fall or skiing injury
  • Older age groups due to age-related degenerative changes. It takes less to injure the structures in our shoulder as they become weaker and stiffer as we age.

Common ways to injure the shoulder

  • Lifting something too heavy or at an awkward angle
  • Lifting a heavy object away from the body or above shoulder height
  • Repetitive motions that place great stress on the shoulder
  • Reaching behind the backseat of your car to lift or place heavy items

Common signs of a shoulder injury

  • Pain at night and difficulty sleeping on the affected side
  • Feelings of stiffness in the shoulder
  • Discomfort with overhead activities, or reaching behind your back
  • Feeling as if the shoulder could pop out of its socket
  • Problems with everyday activities due to lack of shoulder strength or flexibility

Some of the most common shoulder injuries are explained below.

Shoulder Instability

Shoulder instability is common in young people and athletes. The shoulder becomes unstable when the muscles and ligaments that hold it together are stretched beyond their normal limits.

Certain motions used in tackling, throwing, pitching or bowling can put great force on the shoulder, which can stretch the ligaments. Pain can arise quickly or over time, and people often describe feeling that the shoulder is loose, or feels weak.

If the ligaments are too loose or completely tear, a shoulder subluxation or dislocation can occur. This is often caused by falling onto an outstretched hand, a violent twisting motion, or a contact with arms overhead.

Rotator Cuff Tear

The rotator cuff is a group of muscles surrounding the shoulder that act to support and stabilise the joint. An injury to the rotator cuff often occurs from repetitive overhead work (e.g. painters, carpenters), sport (e.g. tennis, baseball), or general wear and tear as we get older. It can also happen when trying to lift a heavy object with an extended arm, trying to catch a falling object, or it can occur after a fall.

As people age and are less active, tendons start to degenerate and lose strength, and hence can be torn more easily. Tendons have a poor blood supply which also makes it harder for them to fix and maintain themselves.

Rotator cuff tears can result in a dull, deep ache in the shoulder and painful reduced range of motion, making day to day tasks difficult such as combing your hair or putting your hand behind your back.

Frozen shoulder

Frozen shoulder is a painful condition characterised by stiffness and limited range of motion. It may be triggered by trauma, postoperatively, or a previous shoulder injury, but can also arise without warning. The joint capsule tightens and becomes inflamed. Scar tissue then forms, causing adhesions which result in a stiff and painful shoulder. This condition can take up to 2-3 years to completely resolve. Physiotherapy treatment aims to speed up the recovery by massaging to loosen up the muscles around the shoulder, gentle mobilisation of the shoulder joint, range of motion stretches, and strength work once the pain subsides.

Imaging for shoulders

Generally scans of the shoulder are only helpful if you have had a history of trauma (eg falling directly onto the shoulder), a history of dislocation or cancer, or if symptoms are worsening despite treatment.

Abnormalities found on scans are found just as commonly on people with no shoulder pain. There is no correlation between the size of a tendon tear shown on MRI or ultrasound, and the duration or amount of pain. Most changes seen on scans are normal age-related changes.

Treatment

  • Anti-inflammatory medication to help reduce pain and swelling
  • Apply a hot pack for 20minutes before bed to help relax the muscles
  • Activity modification: avoid repetitive overhead activities, rest from sport etc
  • Physiotherapy involves massage to alleviate the muscle tightness and joint mobilisations to restore the pain
  • Ultrasound, heat and TENS for pain relief
  • Comprehensive exercise program to address the underlying muscle tightness and weakness to help prevent recurrence
  • Important advice on posture, desk setup, and sleeping positions

Examples of exercises

Pendulums

Lean forward with your uninjured arm supported. Relax the injured arm and allow it to hang. Slowly begin to swing your arm in circles by moving your body. Repeat, this time moving your body to allow your arm to swing in a line forwards and backwards. Complete 30 repetitions

Theraband Rows

Hook the resistance band around a door handle. Begin standing with arms outstretched holding each end of the band. Squeeze shoulder blades together and pull back until your elbows are inline with your trunk. Complete 3 sets of 10 repetitions

External Rotation

Begin standing with your elbows bent to 90 degrees by your side, holding a 1-2kg weight in each hand. Rotate your forearms away from the body, keeping your elbows by your side. Complete 3 sets of 10 repetitions

If you are suffering from shoulder pain and would like more information or help please call us on 9875 3760 or email us on info@wphphysio.com.au. We would be more than happy to assist you in your recovery.

The shoulder joint, or glenohumeral joint, is a ball and socket joint between the humerus (upper arm) and the scapula (shoulder blade). It is a very mobile joint and relies heavily on the rotator cuff muscles to hold the shoulder in the socket. The shoulder is often involved in lots of repetitive work and heavy lifting. If the muscles, ligaments or tendons are not working well together or coordinating properly, we can get pain and inflammation in the muscles, tendons, bursa and the joint itself.

Our previous blog post looked more generally at shoulder pain. This month we will be looking in more detail at the most common sports that cause shoulder injuries.

Tennis

Shoulder injuries are common in tennis, often caused by the forceful motion of serves or smashes. The motion of the tennis serve carries an increased risk of overloading various structures around the shoulder, especially if there is tightness or weakness causing muscle imbalances. This can occur with a muscle strain, or during growth spurts in children as the muscles can become tight as the bones are lengthening. Frequent overuse of the rotator cuff muscles can also cause the bursa (a fluid filled sac), to get impinged between the muscles and the bony prominence of the shoulder, leading to inflammation and pain.

During the early stages of injury, pain limits an athlete’s ability to serve at a maximal level, as well as perform a smash. Forehand and backhand strokes may also be impaired in later stages. Most people complain of pain during tennis, and stiffness after having cooled down. They may also have feelings of instability or clicking sensations with movement.

Physiotherapy aims to reduce pain and swelling with gentle massage, ultrasound, ice and TENS. We can also provide a sling or tape the shoulder if appropriate. Gentle shoulder stretches are prescribed to help maintain the range of motion, and strengthening exercises begin once the pain starts to settle.

It is important that strengthening exercises focus on the muscles that rotate the shoulder outwards (external rotators) as they are generally much weaker than the muscles that rotate the shoulder inwards (internal rotators), which are assisted by the bigger muscle groups in your chest. All tennis strokes involve some external rotation and strong external rotator muscles will prevent future overuse injuries which cause chronic inflammation or tendon tears.

To reduce the risk of injury, a thorough assessment should be performed to identify any muscle imbalances or weaknesses. A physiotherapist can then prescribe you with an individually tailored exercise program to target your strength deficits as well as work on flexibility, stability and endurance. We can also provide advice on your training load, as any increases in the amount of training or competition must be gradual to avoid overloading the shoulder. For example, repetitions of a serve should be increased gradually to allow the body to adapt to the increased workload.

Cricket

Shoulder pain is common in cricket due to the forceful, repetitive motion of throwing the ball. In most cases the pain is caused by inflammation of the rotator cuff tendons, often due to overuse. Pain can refer down into the upper arm, as well as around the shoulder blade. You may have difficulty lying on the injured side which can affect your sleep.

Treatment initially aims to reduce pain and swelling, and will involve resting the shoulder and taking anti-inflammatory medication. Physiotherapy helps to restore movement with massage, gentle joint mobilisations and a progressive program that will target strength, flexibility, and endurance, in order to restore the function of the shoulder.

It is important to strengthen the back of the shoulder to balance the front rotator cuff muscles, which often tend to be stronger. Shoulder stabilisation exercises are important to help prevent damage and reduce your risk of injury. Ensuring you have correct throwing and bowling techniques are essential in preventing injury. Any increases in training or competition must be gradual, particularly bowling and fielding practice, to allow time for the rotator cuff tendons to adapt.

Rotator cuff tears respond well to physiotherapy, but a small percentage may require surgical intervention. Physiotherapy is essential before and after surgery to get the best outcome possible. Treatment before surgery helps to improve strength and flexibility to speed up recovery, and after surgery to get you ready to return to sport.

Swimming

Swimmers can suffer from rotator cuff tendinitis (inflammation of the tendon) or tears, as well as impingement (catching) when the arm is lifted overhead. Causes of swimming injuries can include overtraining without adequate rest, poor stroke mechanics, overtraining in one stroke, poor breathing technique, poor flexibility or range of motion, decreased strength and stability.

Swimming with poor stroke mechanics or decreased flexibility and strength can cause an overuse injury. It is important to vary which strokes you are doing, and not just stick to one stroke eg freestyle as this can contribute to developing muscle imbalances and weaknesses. Backstroke and breaststroke help in opening up the shoulder. Take caution with butterfly as this can sometimes cause trauma due to the forceful nature of the overhead motion.

Preventing shoulder injuries in swimming is best done by adequate warm ups, and taking part in preseason strength and conditioning programs. It is important to gradually increase the intensity and length of swims to avoid overtraining. Adequate rest periods between training sessions and competitions are vital to allow the body to heal and recover.

Physiotherapy is aimed at easing the pain and swelling with gentle massage, ultrasound, ice and taping, or providing a sling. We do gentle shoulder stretches to help correct the range of motion of the shoulder, and strengthening exercises once the pain starts to settle. It is important to restore the shoulder biomechanics to prevent future damage to the shoulder tendons. We also can liaise with your swim coach to discuss training and stroke correction.

Preventative exercises

Doorway pectoral stretch

  • Elbows bent to 90* and arms lifted until shoulders are 90*.
  • Feet level with the door frame.
  • Lean forward gently until you can feel a stretch in the front of the shoulders.
  • Hold for 60 seconds.

External rotation

  • Begin by lying on the opposite side to your injured shoulder
  • With a 1-2kg in your hand, rotate your forearm up towards the ceiling, making sure to keep your elbow tucked into your side
  • Complete 3 sets of 10 repetitions

Theraband rows

  • Hook a resistance band around a door handle
  • Begin standing with arms outstretched holding each end of the band.
  • Squeeze shoulder blades together and pull the band backwards until your elbows are inline with your trunk.
  • Complete 3 sets of 10 repetitions

If you are suffering from a shoulder injury and would like more information or help please call us on 9875 3760 or email us at info@wphphysio.com.au. We would be more than happy to assist you in your recovery.

Do you find you often feel achy and stiff by the end of the workday? Work-related neck and shoulder pain is a common problem for office workers, especially with an upward trend for computer and smartphone use. But why is this such a common problem?

ERGONOMICS

Many work-related factors such as awkward postures, duration of sitting and repetitive hand and finger movements have been identified as being associated with a high incidence of neck or shoulder pain. Sitting most of the day is detrimental to your health and studies have identified that sitting work for more than 95% of the working day is a risk factor for neck pain. Similarly, those who change from a more active job to sitting for more than 75% of the working day are at a higher risk for neck or shoulder pain.


Working at a desk is a common cause of neck and shoulder pain, as often you accommodate to your workstation rather than the other way around. It is important to ensure your workspace is designed to encourage well-aligned posture, and this may vary between individuals. For instance, many people strain to see a computer monitor that is too far away, too low or too high, or spend extended periods looking down at their phones. But what effect does this have on your neck and shoulders?

The average human head weighs almost 5.4kg. For every inch the head is held forwards, an additional 4.5kg of force is exerted on the neck. Therefore when holding the head forward craning to see a computer that is too far away, up to 19kg of stress can be exerted through the neck. Similarly, when your neck is bent to 45 degrees, for example if looking down at your phone, your head exerts nearly 23kg of force on your neck.

WHAT DOES THIS DO TO YOUR NECK?

This change in posture can leads to a change in alignment between the spine and the line of gravity, causing an overload on muscles and connective tissues. The posterior neck muscles are then working overtime in the opposite direction to prevent the head from falling forwards. This additional, constant stress leads to an imbalance and strains the joints and muscles in your neck and shoulders leading to fatigue and pain. This long-term muscle tension can also lead to headaches, neck pain, and can even lead to referred nerve pain down the arm. 



As we continue to be reliant on technological devices, this shift in our resting postures—head down or forward repeatedly each day for lengthy periods of time—may cause long-term muscular adaptations and degeneration of the cervical spine. Maintaining a constant posture with excessive neck bending can cause weakening of the deep muscles of the neck and shoulder blades, and tension or tightness in the front or top of your shoulders.



POSTURE AND YOUR SPINE

This unnatural, forward positioning of the head and cervical spine places additional stress on the intervertebral discs (which provide shock absorption for the spine), vertebrae and joints. As the body naturally ages, it is normal for some degenerative spinal changes to occur, however long-term forward head posture may increase the risk for accelerated degenerative spinal changes. Additionally, this forward positioning of the head increases stretching and tension on the spinal cord and nearby nerve roots, which can lead to numbness or pins and needles into the arm or hand.

POSTURE AND EMOTIONS

Research also shows a close connection between posture and emotions, and the pressure from poor posture can also affect your breathing and mood. A Harvard University study found that people who slouched in their seats had 10% less testosterone and 15% more cortisol than those who adopted more “powerful” postures. This means that those who slouched generally had lower self-esteem and higher levels of stress. Furthermore, sitting in a slumped, closed off posture also has negative effects on breathing. Rounded shoulders and a forward head posture cause the muscles around the chest to tighten. That tightening limits the ability of the rib cage to expand and causes people to take more rapid, shallow breaths, which causes the heart to strain more during breathing, forcing it to pump faster. Sitting with good posture improves our breathing which, in turn, allows more oxygen to reach the brain, further improving our concentration. Adopting an upright seated posture in the face of stress can maintain self-esteem, reduce negative mood, and increase positive mood compared to a slumped posture. It also helps people feel less fatigued and have more positive emotions.

IN SUMMARY

Good posture is important to decrease abnormal wearing of joints, reduce stress on the ligaments of the spine and surrounding muscles and prevent fatigue and pain. In addition, good posture boosts your energy levels and can also increase your self-esteem.

Is your posture causing you pain?

Come in for a visit and we will be able to conduct a full assessment and prescribe an individually tailored exercise program specifically targeting your needs. Give us a call on 9875 376.

References:

1. https://oem.bmj.com/content/59/3/182#ref-42

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296804/

3. https://dash.harvard.edu/bitstream/handle/1/9547823/13-027.pdf?sequence=1

What is plantar fasciitis?

The plantar fascia is a piece of strong connective tissue that runs along the bottom of the foot. It creates the foot’s arch, by connecting the heel bone to the toes, and is very important in assisting with walking.

Plantar fasciitis (or fasciopathy) is inflammation of the plantar fascia, either through overstretching, overuse, or a medical condition. It is also often associated with a heel spur, which is a bony prominence poking out from the heel bone. Many people can have heel spurs without any pain.

Who is at risk of getting plantar fasciitis?

Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles. It is common in people who have just increased their intensity of walking or running, putting additional strain on the plantar fascia.

It is also common in individuals with poor foot biomechanics that stress the plantar fascia, such as flat feet or weak foot arch control muscles. This causes repeated overstretching of the plantar fascia. Ageing and weight gain also places increased stress and tension on the plantar fascia.

Common signs and symptoms

  • Pain under the heel (often in the inside part)
  • Pain is worse in the morning when taking the first few steps
  • Pain after prolonged sitting or standing
  • Symptoms will improve with activity as the foot warms up
  • Pain after, but usually not during, exercise
  • Pain is worse when barefoot on hard surfaces and with stair climbing

Tips to help prevent the onset of plantar fasciitis

  • Maintaining a healthy weight to minimise stress on the plantar fascia
  • Wearing supportive shoes which have good arch support and absorption
  • Avoid going barefoot, especially on hard surfaces
  • Replacing running shoes every 6 months to 1 year before they stop supporting and cushioning the feet
  • Warm up before sport and allow adequate recovery time after training
  • When starting a new activity or exercise program, make sure to gradually ease into it
  • Avoid activities that cause pain

Management

Management of plantar fasciitis initially focuses on reducing pain. This can be done by:

  • Modifying load by adjusting training volume, intensity, frequency etc
  • Modifying footwear. Avoid open-back shoes, sandals, thongs, any shoes without raised heels
  • Avoid going barefoot
  • Wearing orthotics to help distribute the pressure to the feet more evenly, and to stimulate the small foot muscles. Orthotics will provide good arch support, and may also include a heel lift.
  • Taking anti-inflammatories such as ibuprofen to help reduce pain and swelling
  • Taping to offload the plantar fascia and provide extra arch support while allowing the foot to heal
  • Regular icing to help reduce pain and swelling. Apply for 20minutes every couple of hours
  • Stretching of the plantar fascia and calf muscles to relieve pain

Once the pain begins to settle, treatment aims to improve strength and load capacity. Exercises focused on strengthening the calf and small foot muscles are prescribed and gradually progressed as the plantar fascia is able to tolerate more load. Once adequate strength is restored, we aim to work on power by adding speed elements to the strength work.

A physiotherapist will conduct a thorough assessment to determine what factors have contributed to the onset of plantar fasciitis. They will be able to provide expert advice on how to manage the condition, as well as use manual techniques to help release the plantar fascia. They will also provide a detailed exercise program that is tailored to the individual incorporating stretching and strengthening exercises.

For those who are runners, a running assessment would be undertaken to examine your running technique to look for any factors that may be contributing. Corrective strategies would then be taught to address the poor running techniques.

Examples of exercises

Plantar fascia stretch

Start by placing your toes up on the wall with the ball of the foot and heel on the ground. Lean into the wall slowly until you can feel a stretch in the bottom of your foot. Hold for one minute and repeat up to three times.

Calf stretch

Begin by standing in front of a wall with one foot back behind you keeping your knee straight and heel on the floor. Bend your front knee and gently lean forward until the stretch is felt in the calf of the back leg. Hold for one minute.

Calf raise with rolled towel under toes

Fold a towel in half and roll from one end. Stand with the ball of your foot flat on the ground and your toes up on the roll. Slowly raise up onto your toes for 3 seconds, hold at the top for 3 seconds, and then slowly come down for three seconds.

If you are suffering from plantar fasciitis, and would like more information or help please call us on 9875 3760 or email us on info@wphphysio.com.au. We would be more than happy to assist you in your recovery.

How serious is my back pain?

How serious is my back pain?

About 85% of adults experience low back pain at some time in their lives. It is the most common cause of job-related disability and a leading contributor to missed work days. However, only around 10% of people with low back pain have a specific diagnosis. In most of cases, there is no specific disease or spinal abnormality that can be attributed to the pain, we call this non-specific low back pain.

Do I need to know what’s causing my pain?

Research actually suggests it is not always possible or necessary to identify the specific tissue source of pain for effective management non-specific back pain. Over 90% of back pain is mechanical in nature, meaning that there is simply a disruption in the way the components of the back (the spine, muscles, intervertebral discs and nerves) fit together and move.

But why does this cause pain?

It is important to remember that pain does not always equal damage. In the case of back pain, the structures of the spine are sensitised, causing increased pain. Imagine stubbing your toe on the wall, our first reaction is ouch and then a bruise develops. This bruise can become very sensitive and quite sore to touch. We know touching the bruise is not causing further damage, but it is causing increased pain. Why? Increased sensitivity causes protective responses by the body, which increases pain. Following this sensitisation, it is easier for your pain to increase with various activities due to changes in the brain. Even expecting pain may increase pain.

So when should I see my doctor?

Most low back pain is acute, or short term, and lasts only a few days or weeks. The most important thing to remember is to keep moving. Strong evidence shows that people who continue their normal activities following onset of low back pain have better outcomes than those who rested in bed for a week.

However, you should consult your doctor after a week if your pain has not improved, or if your pain:

  • Is constant or intense, especially at night or when you lie down
  • Spreads down one or both legs, especially if the pain extends below your knee
  • Causes weakness, numbness or tingling in one or both legs
  • Occurs with unintended weight loss
  • Occurs with swelling or redness on your back

Should I be taking pain medication?

Painkillers are not recommended as a stand alone treatment for back pain, and are only recommended in addition to active treatments such as exercise and movement to relieve severe pain or to help you start moving more again. The most common medications prescribed are anti-inflammatories, or if other medications don’t work or you’re unable to take anti-inflammatories, you may be prescribed stronger painkillers known as opioids. It is important to remember that anti-inflammatories shouldn’t be taken over a long period of time due to the associated health risks, such as stomach irritation, ulcers, heartburn, diarrhoea and flu retention. Opioids can also have negative side effects such as constipation, nausea, dizziness and tiredness, affecting your ability to drive vehicles. Opioids should be used with care as dependence can also occur with long term use.

Exercise

For many years, the advice given to people with back pain was bed rest. However, current evidence shows that bed rest may actually delay recovery further. Prolonged periods of rest increase stiffness which can actually increase pain. Studies suggest that bed rest alone may make back pain worse and can also lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs.

IN SUMMARY

The most effective way to control your pain is by staying active and moderating your activities. Exercise and movement helps to reduce stiffness, which in turn helps to prevent further injury and pain by stretching and strengthening the muscles that work to support the back.

If you have any further questions, you are more than welcome to come and see us. We will

be able to conduct a full assessment, and prescribe an

individually tailored exercise program specifically targeting your needs.

Give us a call on 9875 3760

References:

NINDS Low Back Pain Fact Sheet. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.

What is lateral hip pain?

Lateral hip pain was previously thought to be caused by inflammation of the bursa, which is a fluid filled sac that provides cushioning and reduces friction between the hip bone and the surrounding muscles and tissue. The term for this condition is Trochanteric Bursitis.

However research has now shown that 90% of cases of lateral hip pain are not in fact Bursitis. The cause of the problem has now been linked to irritation, degeneration or tearing of the hip muscle tendons where they attach to the hip bone. The muscles that are most commonly affected are gluteus medius and gluteus minimus, which act as important stabilisers of the hip joint. This condition is called Gluteal Tendinopathy.

When the tendons are exposed to excessive load, particularly compression, they begin to break down, leading to pain.

Is it arthritis of the hip?

It is important to note that this is different to hip osteoarthritis. Arthritis of the hip is generally felt at the front of the hip in the groin, and can also radiate down to the knee but is rarely felt on the outside of the hip.

Who gets lateral hip pain?

It can occur in young athletes, especially runners as an acute tear to the lateral muscles.

Poor biomechanics with running often contributes to this. For example: knees crossing the midline when running, leg length difference, hip muscle weakness. Training errors such as running on the camber of a road, or always in the same direction around a track can also predispose athletes to this condition.

Lateral hip pain is also common in people over the age of 40, and is more common in women in the perimenopausal age group. This is a more degenerative problem where the muscles and tendons weaken and may tear. It can be caused by biomechanical imbalances, leg length issues or sport.


Common symptoms of lateral hip pain

  • Pain on the outside of the hip
  • Pain when lying on the affected side and can even be sore with sidelying on the good side if the sore leg is stretched right across the body and the muscle is put on stretch.
  • Pain and fatigue with prolonged walking
  • Pain getting out of the car on the affected side
  • Pain walking up hills and climbing stairs
  • Pain with sitting in a low chair or lounge or carseat
  • Pain with sitting crosslegged

What is the best treatment?

Traditionally first line of treatment focused on stretching, however it has been found that this may actually increase the amount of compression on the tendon and therefore irritate it further. Therefore our approach to management of lateral hip pain now has a very large emphasis on strengthening.

Recruiting the deep gluteal muscles is essential in learning to move correctly and is effective in improving pain. It is important to address and correct poor movement patterns, and any underlying muscle weaknesses. Tendons require appropriate gradual loading to become stronger and more resilient.

Examples of exercises:

How about corticosteroid injections?

Corticosteroid injections have traditionally been used as the go-to treatment for gluteal tendinopathy. When injected, corticosteroids aim to reduce inflammation in the nearby area. This can help relieve pain. They have been found to be beneficial in the short term, however their effect on long term outcomes have been shown to be less promising.

A study in 2018 (Mellor et al.) compared the effects of exercise and corticosteroid injection use on pain and overall improvement in individuals with gluteal tendinopathy. There were three different groups: a physiotherapy led education and exercise programme of 14 sessions over eight weights; one corticosteroid injection; and a wait and see approach. They found that the education plus exercise group performed better than the corticosteroid injection group at 8 weeks. At 52 weeks, education plus exercise also lead to better global improvement in terms of function. These results therefore support the use of exercise as an effective management approach for lateral hip pain.

Quick tips to help relieve pain

  • Use a heat pack for 20 minutes before bed
  • Avoid sitting with your legs crossed to reduce the compression on the tendon
  • Avoid stretching the hip muscles too vigorously
  • Sleep on your back with a pillow under your knees, if this is too uncomfortable then sleep on your unaffected side with a pillow between your knees
  • Use a tennis ball to massage through the gluteal muscles to help reduce the tightness
  • Seek guidance from a physiotherapist who will prescribe you with a specific exercise program tailored to your needs to gradually increase strength and endurance of the hip muscles
  • A physiotherapist can also assess and correct any poor movement patterns that may be contributing to your pain

If you would like more information or help with lateral hip pain please call us on 98753760 or email on info@wphphysio.com.au. We would love to help.

References:

https://www.bmj.com/content/361/bmj.k1662

What Is Neck Pain, And How Is It Caused?

Neck pain is a very common problem that physiotherapists can treat. Neck pain and stiffness can be caused by structures such as the muscles, tendons, ligaments, discs and nerves. Neck pain can also originate from or transfer to surrounding areas such as the upper back, shoulders or jaw. It can also travel up into the head, causing headaches at the back of the head, the eyes or around the front of the head and temples. These headaches are called cervicogenic or tension headaches. Physiotherapy for neck pain and headaches is extremely effective, as it works to relieve your pain, and identifies and addresses the underlying cause of your problem to ensure that it does not reoccur in the future.

Common Neck Injuries

Some common neck injuries include acute wry neck, a bulging disc, whiplash and postural neck pain. Physiotherapy management of neck pain is effective in all these conditions. Keep reading below for a description of each injury.

Acute Wry Neck

An acute wry neck is when you are unable to turn your neck or tilt it in one direction. People often wake up with their neck in a ‘locked’ position and experience sharp pain when trying to move. It can be caused by lifting something heavy and straining the neck, or sleeping in an awkward position. The neck muscles spasm on one side and prevent the joints from moving. Physiotherapy for a stiff neck helps to relieve pain through gentle joint mobilisations and massage of the muscles to release the spasms.

Bulging Disc

A bulging disc can occur due to gradual age-related degeneration, poor posture, repetitive activities, heavy lifting or trauma such as a fall or car accident. Sometimes a bulging disc can irritate the nerves nearby which can cause referred pain to the shoulder or down the arm, and in more severe cases can cause pins and needles or numbness. Most patients respond well to physiotherapy for neck pain caused by a bulging disc as it is effective in alleviating pain, and the exercises prescribed will strengthen the neck and shoulder muscles to help support the disc.

Whiplash

A whiplash injury occurs when the head is thrown forcefully forwards and backwards; overstretching the muscles, ligaments, tendons and nerves. Whiplash can cause severe neck pain, stiffness and often headaches. It can also affect the nerves, resulting in pins and needles or numbness down the arm. Whiplash injuries need to be treated early to avoid chronic long term problems. Physiotherapy management of neck pain as a result of whiplash involves massage and joint mobilisations to address muscle spasm and joint stiffness. It also involves stretching and strength work to rebuild your strength and flexibility around the neck and shoulders.

Postural And Work-Related Neck And Shoulder Pain

Postural and work-related neck and shoulder pain is a common problem for office workers.

Many work-related factors such as awkward postures, duration of sitting and repetitive hand and finger movements have been associated with a high incidence of neck pain. People who are sedentary and sit at a desk all day for work are more likely to develop neck pain, as they often don’t consider their workstation set up. For example, many people adopt a head down or head forward position when using their computer or hand-held electronic devices. Maintaining poor posture throughout the day can result in developing weakness in your deep neck muscles and muscles between the shoulder blades, as well as developing tightness in the front or top of your shoulders.

It is important to make sure your workspace is designed to promote well aligned posture. Physiotherapy for neck pain will include education on how to best set up your workstation so that your neck is held in a better position. We give advice on how often you should take breaks at work or when studying, what exercises you can do during the day at work, and the best form of exercise or fitness that you can do to prevent neck pain from returning.

How Can Physiotherapy Help With Neck Pain?

Physiotherapy management of neck pain involves a thorough assessment to look at your range of motion, flexibility and strength. We assess your muscles and joints to identify any areas of stiffness, tightness or weakness. Manual techniques such as massage and joint mobilisations are used to help loosen up the stiff joints and tight muscles, which thereby helps to alleviate pain. Physiotherapy for neck pain also involves ultrasound, heat packs and TENS to help with pain relief. An individually tailored exercise program will be designed by your Physiotherapist to target your specific needs. This will often involve stretches to help restore movement and address your tight muscles, as well as strengthening exercises to rebuild the muscles around the neck and shoulders. If you go to the gym we can also offer you advice on what other exercises you can do at the gym to help prevent the problem from recurring.

Contact Us Today For Neck Pain Advice, Treatment And Help.

If you are suffering from a stiff neck, headaches or neck pain and would like some further advice or treatment, feel free to contact us on info@wphphysio.com.au or call us on 9875 3760. We would be more than happy to help.

With winter sporting season in full swing, one of the most common injuries that you often hear about is a torn ACL. For sportspeople, damage to the ACL means an extended period of time off sport. Those who participate in sports that involve running, jumping, pivoting, or contact, are likely to need a surgical reconstruction to regain full function of the knee and continue playing their sport.

Playing with a torn ACL can lead to multiple episodes of knee instability which can sometimes result in further injury to the knee cartilage and meniscus. An ACL reconstruction involves months of rehabilitation before and after surgery, in order to regain full strength, stability and function of the knee.

So what can be done to avoid tearing your ACL and hence avoid having a reconstruction?

What is the ACL?

The ACL or anterior cruciate ligament is an important ligament in the knee. Its job is to prevent forward movement and control rotation of the tibia (shin bone) in relation to the femur (thigh bone). The ACL is essential for control in twisting movements.

How common are ACL injuries?

ACL injuries are common in sport, particularly soccer, football, basketball, netball and skiing. The ACL can be injured through contact or non-contact. 60-80% of injuries occur in a non-contact situation. For example, landing from a jump, cutting, twisting, changing direction or decelerating suddenly.

The overall incidence of ACL injuries is 81 per 100,000, and is between 2.5 to 10x greater in females compared to males. ACL injuries most commonly occur in combination with other injuries, such as damage to the other ligaments, meniscus and cartilage.

When the ACL is injured, the person often describes hearing a pop or crack, and the knee feeling unstable eg like it’s buckling or giving way. The knee will most likely have large amounts of swelling, and it is often extremely painful, however in some cases it can be painless. Initially the knee has full movement but this can change as the swelling increases and the muscles tighten up to protect the knee. The feelings of instability will also persist if treatment doesn’t commence early.

So how can I avoid injuring my ACL?

There are a number of things you can do at training and pre-game which can greatly reduce the incidence of ACL tears.

Specific prevention programs have been developed for various sports. Such programs have shown to reduce the number of non-contact ACL injuries by as much as 70-90%.

In soccer, the FIFA 11+ program is designed as a warm up incorporating specific exercises and drills to reduce the likelihood of injuries in soccer players. It should be performed as a standard warm-up, at the start of each training session at least twice a week. It should take around 20mins to complete.

Follow the link below to see exactly what it involves.

http://www.yrsa.ca/pdf/Fifa11/english.pdf

Netball Australia has developed the KNEE program which is an on court warm up program designed to enhance movement efficiency and prevent injury in netball players. It needs to be performed at least twice per week and should take no more than 10-12 minutes to complete.

Take a look here for more information https://knee.netball.com.au

What do prevention programs actually involve?

Prevention involves strengthening and coordinating the muscles in the core and legs, training them to keep the legs in a safe position when running and decelerating, and training good knee control. Therefore, exercises addressing jumping and landing, single leg stability, multitasking, agility and cutting are critical. These can include figure 8 running, single leg squats and shuttle runs. It is important that the exercises are completed with correct form and the correct dosage in order to get the most benefit.

Programs may involve plyometric (jumping) exercises with a focus on proper technique and body mechanics. There may also be a component of strength training, as well as neuromuscular training. This may include balance exercises, proprioceptive activities, single leg stability, dynamic joint stability, jumping and landing technique, agility drills and sports specific exercises which all aim to improve postural control and side-to-side imbalances in the leg.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577417/

https://knee.netball.com.au

http://www.f-marc.com/11plus-2/

What is osteoarthritis?

Osteoarthritis (OA) is a chronic condition that commonly affects the knee. It is often characterised by pain, stiffness and swelling, and most frequently occurs in people over the age of 55. Other risk factors include previous joint injury and being overweight or obese.

What do the experts say?

In July 2018, the Royal Australian College of General Practitioners (RACGP) released new guidelines for the management of knee osteoarthritis.

The guidelines “strongly recommend land-based exercise for all people with knee OA to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels”.

This includes: – Muscle strengthening – Stretching – Aerobic conditioning – Neuromuscular/balance training- Cycling – Tai Chi/Yoga – Aquatic exercise/hydrotherapy

Weight management is strongly recommended for people with knee OA. Being overweight/obese is a major risk factor for the onset and progression of OA. A relationship exists between the amount of weight lost and symptomatic benefits. Weight loss is effective because it reduces the load on the joint.

A study looking at walking in obese older adults with OA shows that for every kilo of weight lost, it reduces the force going through the knee by twice the amount. (Aaboe et al., 2011).

What does this mean for me?

Exercise is one of the most effective treatments for OA. It is important to engage in low impact activities so that there is less force or weight going through the joint. Examples of low impact exercise include walking, cycling and swimming. Strengthening exercises, water exercise, and Tai Chi are other forms of exercise that are also recommended.

How does exercise help?

Exercise plays an important role in maintaining and improving your ability to move and function. With osteoarthritis, your joints become really stiff and painful. Stretching and range of motion exercises help maintain the flexibility of your joints. Stretches stop the muscles from pulling too hard on the joint decreasing pain. Strengthening exercises help to support and reduce the load on the joint. They also help to improve the biomechanics and increase smoothness when walking because your muscles are working more efficiently.

How about painkillers and corticosteroid injections?

The evidence for pharmacological interventions such as painkillers and corticosteroid injections is not as strong. Long term use of these interventions can lessen their effects over time as well as having other negative health impacts such as gut irritability and even ulcers. They should only be used sparingly and in conjunction with lifestyle changes (e.g. exercise and weight loss).

Do I need to see a surgeon?

Surgical intervention such as a total joint replacement should only be considered when all appropriate conservative options, delivered over a reasonable period of time, have failed. Referral to an orthopaedic surgeon should be based on a significant decline in quality of life due to end- stage joint arthritis.

To avoid progressing to end-stage joint arthritis and ultimately requiring a total joint replacement, it is vital to adopt lifestyle changes and prioritise regular exercise in order to relieve pain, increase function and improve quality of life.

IN SUMMARY

So what does a typical exercise program look like?

We have put together a general exercise program to give you an idea of what you should be doing. Typically, stretches are to be done twice a day, and strength exercises once per day.

STRETCHES

Quad stretch

  • When standing, use your hand to pull your foot towards your bottom.
  • You should feel a stretch in the front of your thigh.
  • Hold this position for a minute.

Hamstring stretch

  • When standing place your leg on a chair.
  • Keep your leg and your back straight, and bend forwards at the hips.
  • You should feel a stretch at the back of your thigh.
  • Hold this position for a minute.

Calf stretch

  • Start by standing on a step.
  • Bring your foot halfway off the step and drop your heel towards the ground.
  • You should feel a gentle stretch in the back of the calves.
  • Hold this position for a minute.

STRENGTH

Mini Squats:

  • Start with your feet shoulder width apart and keep your toes and knees pointed forward.
  • Slowly bend down 1/4 way then back up.
  • Repeat 10 times for 3 sets.

Lunges

  • Begin by standing with one foot a large step-length in front of your other foot.
  • Make sure both feet are pointing forwards.
  • Slowly bend your knees so that your back knee lowers towards the floor, then come back up.
  • Repeat 10 times for 3 sets.

If you have any further questions, you are more than welcome to come and see us. We will be able to conduct a full strength and biomechanical assessment, and prescribe an individually tailored exercise program specifically targeting your needs.

Give us a call on 9875 3760

References:

Aaeboe, J., Bliddal, H., Messier, SP., Alkjaer, T., Henriksen, M., 2011. Effects of an intensive weight loss program knee joint loading in obese adults with knee osteoarthritis. Osteoarthritis Cartilage.19(7): 822-8. doi: 10.1016/j.joca.2011.03.006.

RACGP Guidelines: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/ guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf

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