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Lower back pain is by far the most common type of injury we see in our clinics. One of the most common types we see is back pain that radiates down the leg, this is often referred to as sciatica. True sciatica can be difficult to treat but there are some things that can help treat and manage radiating pain. Below are 3 simple things you can try to help manage your lower back pain. Piriformis release. The piriformis muscle is one of the deeper muscles around the back of the hip and is important in stabilising your back, pelvis and hip regions. It is a common muscle that gets tight and irritated with lower back problems and with sciatic pain. Try releasing this muscle using a firm ball (a tennis ball or lacrosse ball works). Lean against the ball on a wall with the ball positioned in the centre of the glute region. Walk your feet away a step to increase pressure on the ball then move side to side to release the tight points. It’s ok if you aren’t sure whether you are getting the piriformis, all the tight spots in this area are worth releasing and can help with back pain.  Lower back extensionThis exercise has actually been shown to help those with lower back disc problems and is great in helping people with chronic lower back injuries. Start with lying on your stomach and then lifting yourself up onto your elbows while keeping the legs on the floor and hips and lower back relaxed. Hold this for 3 seconds then lay flat again. Repeat 10 times and perform for 3 sets. If this gets easier then try slowly raising yourself up onto your hands.  The bird dog exerciseIt has a funny name but we find that makes it easier to remember. Start on your hands and knees and set a steady base with your back in a neutral position. Then raise one arm ahead and the opposite leg behind you, pause then return to the start position. Repeat this on the opposite side then try to complete 10 times and for 3 sets. While doing this try not to hold your breath and focus on maintaining a steady back position (and not falling over!)  Do these exercises every-day, especially if you have had long term back pain, have bad posture or sit in a chair all day. If you find that it is helping your back and leg pains then there are probably a lot of other things you can do to completely settle your pain. They are easy to do but if you have any problems then get in touch any time.
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Knee pain is one of the most common problem areas we see at our clinics. We come across a lot of cases where the pain gradually creeps in with exercise or physical work so we have put together 3 simple things anyone can do to can improve knee pain and injury-proof you from future knee issues.  Strengthen the quadriceps muscle. More specifically the VmO, which is the inside part of the thigh (quadriceps) muscle and plays an important part in stabilising the knee and ensuring the knee-cap (patella) stays tracking correctly. One simple exercise you can do to improve the VmO is the straight leg raise. The straight leg raiseLay down on your back with your legs out straight. Tighten up your thigh muscle to lock one knee out straight and then raise that straight leg into the air as far as you can without letting the knee bend. Slowly lower the leg back down to the bed and repeat 10 times and repeat on the opposite side. Do this for 3 sets each day, before or after your workouts.  Stretch the popliteus muscle.We consider this little known muscle to be the key in how the body controls the twisting and locking-out actions of the knee. It sits just behind the knee and can be a common source of pain at the back of the knee. Stretching out the popliteus can be a good way to relieve pain and improve the way the knee handles twisting and actions that involve straightening out the leg. To perform the stretch you will need a small step (a thick hardcover book will do). Place the step against a wall so it won’t move and place one foot on the block so the heel is on the ground and the feet on the step. Straighten out the knee as far as you can and then slowly move your hip forward until you feel a stretch at the back of the knee. Hold this for 20 seconds and repeat 5 times on each leg.  Glute StrengtheningAt the end of the day the knee is really just a hinge and goes where the hip tells it to. So making sure your glute muscles around the hip work properly to keep the knee in the right alignment is probably the number one thing we find has been missed in many knee rehab program. One simple and effective exercise is the side lying clams. You can do this with a resistance band wrapped around your thighs just above your knee. Lay down on the opposite side to the one you want to work on with your knees and hips slightly bent. Open your hips out by lifting the knee up while keep your feet together. Pause at the top then repeat 10 times and do the same on the opposite side. Do this for 3 sets.  These exercises can make a difference sooner than you expect however like with most things, to keep your knees in the best shape you need to include it as part of an overall fitness program. If you do need more help, just let us know!
We see a lot of people come in with shoulder pain and movement issues, in particular when trying to do things overhead. A quick test we use is the behind the head reach. Try reaching behind your head and neck and touch the top of the opposite shoulder blade. If you have trouble doing this evenly on both sides then you may have a shoulder movement issue that is either causing you pain or may cause you problems in down the track. To help improve this we have put together 4 easy things everyone can do at home. Upper back self releaseThe muscles in the upper back play a big part in allowing fluid shoulder movement as well as controlling the shoulder blade. These muscles include the rhomboids, middle trapezius and lower trapezius  To improve the movement through here, use a firm ball (a tennis ball or lacrosse ball work) and place it against the wall and lean your back onto it. Try and position the ball between your shoulder blade and the spine. Walk your feet away from the wall to increase pressure on the ball and move side to side to release tight points. Spend about 30 seconds to a minute on each point and focus on the sore spots.  Shoulder blade setting exerciseUse any simple resistance band (you can get these from any physio) and hold one end in each hand. Keeping your arms by your side and elbows bent at 90 degrees, create some tension on the band by pulling your hands away from each other. Set your shoulder blades inwards and downwards and maintain that hold while pulling the hands away from each other without discomfort and without your elbows coming away from your sides.  Pectoralis major stretchPlace one forearm against the edge of a wall so that the hand is about level with the top of your head. Place the same side leg a step forward and lean forward slowly while keeping the forearm against the wall until you feel comfortable stretch. Hold the stretch for 20 seconds and repeat on the other side. Do this 3 times each day.  Posterior rotator cuff releasePosterior cuff release. Using the same ball, this time place it behind your shoulder and hold the arm against your chest. Position the ball on the tight points and walk your feet a step away from the wall so your body weight is against the ball. Move side to side to release the sore points for around a minute.  These simple exercises can make a big difference to the health of your shoulder and after just a few days of doing this you might find that moving overhead is easier! If you are having trouble with any of the exercises feel free to drop me a line!
"Open your hips!" "Fast hips!" "Squeeze your butt!" Ever heard your coach tell you to do these things during your workout, especially with barbell work? Ever wonder what they are trying to get you to do? Hip extension. This is where most of the power comes from (or should come from) during explosive movements such as the box jump, kipping pull-up and Olympic lifts. Ascending from the bottom of a squat, locking out the deadlift, and generating a good 2nd pull in the Olympic lifts all require powerful hip extension. Primarily, the gluteus maximus is responsible for producing hip extension. This is the large muscle of your buttock region. Have a look at any sport which requires explosive efforts (think Rugby, Olympic Lifting, MMA, sprinting) - I will bet that the top athletes have extremely well-developed glutes in order for them to excel at their sport. So where does it go wrong? Thanks to technology and our sedentary lifestyles which involve a lot of sitting, the front of our hips tend to get tight and overactive. Over time, what this does is creates an imbalance where the front of our hips dominate over the back of our hips (glutes!). The result of this is an anterior pelvic tilt/shift, as seen below.  This change in pelvis position makes it extremely difficult for the glutes to engageproperly. Some would argue that it's impossible. What does this mean for CrossFitters and the general population? Remember how the glutes are essential for movements such as the deadlift and to rise out from a chair? Well, since they cannot fire properly, the body has to find a way to compensate to take up the slack. One of the most common ways it does this is by producing lumbar (lower back) extension. The muscles in the lower back have a main role to stabilise the spine and keep it relatively rigid. When they are forced to produce power (as well as simultaneously stabilise the spine), these muscles often get overloaded. I bet you can think of someone who has lower back pain, who complains of lower back and hamstring tightness, and has under-developed glutes. The prone hip extension test is a simple way to assess how well you move. Lay on your stomach with your head on your forearms, and lift your hips up towards the ceiling while keeping your knee straight. Can you keep a flat back, or does your pelvis tilt (as above)? You should have 10-20 degrees of hip extension with no compensations elsewhere in the body, as shown in the picture below.  If you cannot do this comfortably, tightness in the front of the hips may be the main culprit. Releasing these muscles can be a great way to alleviate symptoms and restore crucial hip extension. The best way to do this is the with the "True Hip Flexor Stretch" (named by Mike Reinold, DPT, CSCS). In this excellent technique, line yourself up in a lunge position. Make sure the lower back is straight (no hyperextension!) and gently tuck the butt under on the back leg, as seen in the picture below. From here, lean forwards 1-2cm and you should feel a stretching sensation at the front of your hip. Take some deep breaths through your nose into your lower ribcage and allow the front of your hips to relax.  So if you're having trouble with producing power or constantly suffering from lower back tightness after deadlifts, have a look at your hips and how they are functioning. Having soreness in the same area after every single workout is not normal!
Coaches, if your athlete is struggling with explosive movements, have a look at their hips and refer them onwards if necessary. Hip extension - you need it. Working with many different CrossFit boxes, the number one complaint is anterior shoulder pain, particularly with pressing and overhead movements. In my experience, a vast majority of cases are due to impingement resulting from a lack of mobility and/or control. Considering how much overhead pressing is involved in CrossFit (clean and jerks, snatches, push press/jerk, thrusters, pull ups, muscle ups, handstand push ups), it is extremely important for shoulder health to be able to raise your arms overhead and be strong in that position. The shoulder girdle is a complex joint consisting of multiple moving parts. It involves the thoracic spine, the scapula, and also the glenohumeral ("true shoulder" joint). In CrossFit and gymnastics in particular, athletes require full overhead motion during movements such as overhead presses and handstands. If this is not achieved, there will be a compensation somewhere else in the body, typically with lumbar hyperextension and/or an anterior pelvic tilt. Restoring full mobility and strength in these end ranges is crucial for safe and successful performance of these movements. Not only will it limit the risk of injury, it will also make the athlete more efficient and improve performance.  Broadly speaking, the reason that an athlete is unable to achieve full overhead flexion is due to:
A quick screen to assess overhead mobility is to place your back flat against a wall and raise your hands over your head. With palms facing forwards, the back of your hands should be able to touch the wall behind you without any arching of your lower back or flaring of your ribcage. If you are unable to do this comfortably without cheating, how can you support a heavy barbell overhead or do handstand pushups safely? You can't. Now add speed and dynamic movement (such as in the snatch) and fatigue (in metcons) and you have more opportunities for dysfunction and pain to occur. Addressing the thoracic spine A dysfunctional thoracic spine will limit overhead motion as well as lead to compensatory patterns such as lumbar hyperextension. Therefore it is important not to overlook this area as it can contribute to lower back/pelvic pain as well as shoulder pain. We must ensure adequate thoracic extension as well as sufficient anterior core control.
Addressing the scapula In full overhead motion, the scapula must exhibit adequate upward rotation and posterior tilt to allow the shoulder joint to face upwards and accommodate for the arm.
Addressing the shoulder joint The final piece of the puzzle involves the actual shoulder joint. For an overhead press, fullshoulder flexion and external rotation is a requirement to ensure safe and efficient movement.
This is by no means an extensive list of the causes and fixes of restricted overhead mobility but it does provide a good starting place to address some of the limitations you may have. A strong suggestion is to incorporate some of these into your warm-up routine prior to performing more complex movements such as pullups, overhead squats and handstands. This will lead to better movement patterns, increased efficiency and greater safety and longevity in your sport. Anterior hip pain is a common complaint we see in the athletic population, particularly in dancers, gymnasts and CrossFitters. It is also prevalent in the general population who may experience symptoms described as sharp, achy or uncomfortable. In my experience, it affects females more commonly than males, particularly females aged between 12-25.
In athletes, pain is usually felt in movements such as toe-to-bars, knee raises, squatting and lunging. These can cause hip impingement (also known as femoroacetabular impingement or FAI) which occurs when the femoral head is compressed into the hip socket, causing irritation and pain and leading to conditions including:
However, it is due to how we move that determines if the hip will become irritated or not. Successful rehabilitation relies on the patient being able to fully control their hip by keeping it in the centre of the socket (similar to catching a baseball in the centre of the mitt). Restoring proper hip control is also essential not only for recovery, but to ensure other body regions are not compensating for poor movement patterns. A common example of this is when an athlete overarches the lower back instead of using the hip – this may eventually lead to lower back pain and conditions such as stress fractures of the lumbar spine. Treatment is targeted at restoring full range of motion at the hip/pelvis/lumbar spine, releasing any tight structures that will affect hip movement, and teaching the athlete how to move well in the hip. Medical intervention such as cortisone injections may be effective in the short term to relieve inflammation, however the true cause of the condition must be treated in order for long term improvements. Ankle mobility (or lack of) is one of the big issues that we see in the clinic. Many patients report having “tight calves” which restricts their movement and causes uncomfortable symptoms such as excessive fatigue and cramping. For the athletic population, it affects movements including running, skipping and squatting. Often one side is affected more and this is indicative of an asymmetry between sides.
Other giveaways of restricted ankle motion include:
So what can we do about it? Treatment for an ankle restriction is targeted at both the muscles around the calf/shin region as well as the ankle joint itself. Two of our favourite drills to help with this include:
Although the recent olympics have brought up a lot of recent interest (Ive had 4 patients in the last week alone asking about cupping because of Michael Phelps!) it's a treatment that's been around for centuries.
Recently it is used in several cultures to heal a variety of ailments, here in Australia it is probably most closely associated with chinese medicine where it is proposed to remove the bad blood and toxins from your system. The modern explanation for how cupping works is through three mechanisms. 1. By lifting and stretching fascia it created better movement of the soft tissue structures 2. By lifting and separating the various layers it can cause micro-trauma which triggers the bodies inflammatory response. This response is the beginning of the bodys healing process. 3. Through the vacuum effect, new blood is pulled into the area and old stagnant blood is removed. So what is a cupping treatment like? Well in a typical session a series of cups are placed on the skin and is sealed off to create a vacuum inside. This can be done through a few different methods, the traditional way used a small flame under a cup while recently a plastic pump can be used to create the same effect. Does it work? Well for certain muscular skeletal conditions there is evidence that it can help. However the evidence for some of the other proposed conditions remains unclear.  We recently celebrated our daughters first birthday and with a few mums there and mothers to be we had a chat about back pain (as often it seems to happen as a physio). It turns out that each of the women in the group had back pain and half had some since their children were born. Their question was is this normal?
My first response is "what is normal?" and then my second reply was "maybe not normal but very common" (which is what I think they were getting at. Studies tell us that back painof some sort during pregnancy happens in about 50% of women so if you are expecting a child and have back pain you are certainly not alone. So what causes it? To answer this we usually break it down into three main types.Pelvis pain in the first trimesterIn the first 3 months there hasnt been much weight gain and no large changes that would place additional mechanical stress on the lower back. However there are hormonal changes (the hormone relaxin is usually blamed) which has been associated with changes in the tension of ligaments around the pelvis and lower back. Particularly if it is pain around the pelvis, pain in the first trimester could be due to these changes.Lower back painPain a bit higher upin the back in the second or third trimesters is usually associated with either ongoing changes from the pelvis (that may may have started due to hormonal changes) or mechanical changes such as weight gain, postural changes, shifting in the centre of gravity and weakening and fatigue of the abdominal muscles due to being stretched. All these can place a larger load on parts of the spine and lead to pain.So what can you do about your pregnancy related low back pain?Well the first step is trying to understand the cause and where the pain is to devise an effective strategy. Based on this there are a number of things that work.
All in all back pain is common but treatment can work to reduce and manage lower back pain in most women during pregnancy and beyond.  Knee pain is one of the 4 most common body areas that we treat as physiotherapists andchiropractors (the other 3 being lower back, neck and shoulders). There are a number of problems that we see in the knee but by far the most common reason for pain that we see across most age groups is a result of poor tracking of the knee. Now to be clear in the vast majority, this happens alongside a range of other issues like joint pain or arthritis of the knee joint, hamstring pain, popliteal pain, meniscus, MCL or ACL ruptures. However pain at the front of the knee is easily the most frequently seen pain problem that limits peoples ability to function and play sport. So what is this problem exactly? Well the knee joint is made up by the point where the long thigh bone (femur) meets the shin bones (tibia and fibula) thus creating the main part of the knee joint. This is the area where the ACL and mensicus and cartilage exists which is what you probably usually hear about when talking about knee injuries. On top of this all is the knee cap which sits inside the muscle that makes up the quadricep (thigh) muscle and anchors on just below the kneecap as the patella tendon. When the knee works normally the knee cap moves up and down with minimal side to side movement however for various reasons (such as mechanical issues at the foot or hips) the force through the knee changes the way the knee-cap wants to move and creates some form of maltracking. ie it doesnt quite move as it should up and down the knee in its groove.
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