One of the most difficult shoulder problems to improve is a frozen shoulder.  So what is it?  

Also called adhesive capsulitis it is characterised by a stiff shoulder, pain and a loss of range of movement.  It involves the capsule of the shoulder thickening and becoming inflammed, often associated with other shoulder injuries like rotator cuff tears and bursitis as well as surgery or when immobilised for long periods.

The true reason for this developing isnt fully known.

Frozen shoulder will proceed in 3 stages 
1.  Freezing (painful) stage.  This is at the beginning and is characterised by the shoulder getting more and more stiffer as well as high levels of pain in the shoulder joint.
2.  Frozen stage.  Where the shoulder is stiff and limited in movement but usually no longer painful unless stretched.
3.  Resolution (or thawing) stage.  In this stage the shoulder is able to gradually regain its movement.

The timeframe for frozen shoulder can be difficult to predict.  It can often last for 1-2 years and in many cases resolving on it's own.

Treatment for frozen shoulder in each phase is focusing on managing pain and inflammation as well as improving or maintaining range of movement.

Physiotherapy techniques, like capsule releases, dry needling and stretches may improve movement and pain and in some cases a cortisone injection may help.

In the early phase of a shoulder injury if there isn't improvement in movement then it may br progressing to a frozen shoulder in which case progression to movement maintenance is important as a fast recovery may not be realistic.

​Below some of our senior physiotherapists show us exercises to improve movement in the early phase of frozen shoulder.  The first is from our physio Paul at our Clemton Park clinic demonstrating the pulley range of movement exercise.

Paul's second exercise is the wall crawl.  Again a good exercise to use in the early phase when the shoulder is stiff and sore.

The third exercise from Paul is our laying down shoulder flexion exercise.

and our third is from Steve, our head physio at Sans Souci demonstrating the external rotation movement exercise for the shoulder.

These exercises are all useful to do in each phase of frozen shoulder even the early phases.  It is likely to be more painful and difficult early on so it is important to check with your therapist how many repetitions is appropriate and how far you should take the movements.

One you reach the resolution or thawing phase of frozen shoulder it is important to include strengthening and stability exercises to rebuild the shoulder strength and function as the movement returns.

In most cases there are minimal lasting effects once the recovery from frozen shoulder is complete but it can be a challenging condition to live and work with while you have it.

To reduce the risk of getting frozen shoulder make sure that you manage any shoulder injury promptly and correctly and ensure that recovery after surgery is done as the specialist recommends (even if it is a relatively mild one), 

If you feel like you are getting a sore shoulder and movement is very limited see a physiotherapist or a doctor and get it diagnosed in a lot of cases it may not be frozen shoulder and a quick recovery with treatment is very much possible.

Leave a comment if this has been helpful and thanks for reading!

By now everyone is probably aware that we all sit more than we should and it is having a huge impact on our health.  We sit at a desk for work, sit at home, look down at our phones more often and sit longer on our way to and from work.

Not only is this having an impact on our obesity levels, cardiovascular fitness and core strength but it is also a big reason behind persisting neck and shoulder pain.

This is tied in most cases to 2 things:
Sitting for too long at a time, and
Sitting with worse posture.

We will chat about what good posture is in another blog but today I wanted to focus on what is causing that pain and few easy exercises you can do to help reduce these pains.

What most of us feel is a sense of stiffness in the back and tight shoulders and neck.  This comes from that rounded upper back position we all haev when we are hunched at a laptop, looking at our phone or have been sitting at a computer for too long.  We all know we should sit up straight but lets face it, that isnt easy to keep up..

The muscles in your neck and shoulder that get tight are usually one of two.  The first being the upper trapezius muscle which runs from the top of your shoulder up to your neck.  When you get that big knot on top of your shoulder, that's the upper trap.  below our senior physio Michael shows how you stretch out the uppper trapezius muscle.

The other big muscle in the neck and shoulder is the levator scapulae.  This also runs from the top of the shoulder and up to the base of the skull.  Michael is back below to show us the best stretch for the levator scapulae (it is also a really good exercise for headaches that are caused by the neck).

Now all of that neck and shoulder tightness happens because of that stiff upper back and that hunched position we all spend too much time in.  It's a big complex area so we have got 3 different ways to relieve stiffness, improve movement and reduce pain in that area.

First one is Michael again showing us a mckenzie extension exercise you can do against the wall.

The next 2 exercises are with the foam roller.  Below we have our chiropractor Michael (I know it gets confusing and they both work at the same Moorebank clinic as well!) showing us a rotation exercise for the thoracic spine.

And chiro Michael is back to show us a thoracic extension exercise for the upper back with the foam roller.

These exercises are great to reduce the effects of sitting in the short term and also potentially reverse the effects of years of sitting.  So give them a try.

With that being said there is one thing is very important to note.  Exercises and treatment can help manage the effects of poor posture and reverse some effects but it will always be an uphill battle unless you look at your sitting posture first.  Sit for less time and sit in better positions.  These 2 simple things will make all the difference.

Foot drop can happen with a range of conditions, most typically when there is irrtation or damage to the common fibula nerve including the sciatic nerve.

In itself it is a symptom so it's important you see a physio to get to the cause of it.  While addressing the underlying cause it is important to address the footdrop itself.  Below are a few simple exercises that might help.

Foot drop can be a difficult condition to live with because it makes it hard to walk.  It is also an issue that can lead to trips as the toes can get caught on small cracks or edges on the walking surface.  The last thing you need is a fall!

One of the consequences of a foot drop is tightening of the muscle groups at the back of the calf. 

The first two exercises focus on stretching the gastrocnemius and soleus muscles.  Below Matt (head physio at Clemton Park) demonstrates these).

Once you have started work on flexibility of what is tight you then need to strengthen the muscles that raise the foot back up.

​The first exercise to try is a simple foot lift.  Below, our Senior physio at Activ Therapy Casula Lawrence shows how to do this exercise.

The next exercise is resisted peroneal strengthening.  Lawrence again shows how to perform this exercise.

The last in this series is the tibialise posterior exercise.  Along with the peroneals they function to lift up the foot.  Lawrence shows how to perform this in the video below.

Give the exercises a try.  If you have any issues get in touch with one of our physios with your questions.

Do you sit for work?  Even if you don't chances are you sit for a good part of your day.  Recent research has suggested that on average we sit for 9 hours each day!!!

All this sitting position does a lot of things to our bodies.  Weight gain, reduced leg strength, muscle density and neck and lower back issues.  One thing that we find increasingly that often is forgotten is gluteal weakness.  The sitting position puts the the hips into a bent position leading to tightness of the hip flexors (at the front) and weakness of the gluteal hip extensors (at the back).

Weakess of the glutes then can lead to a spiral of further tightness of the hips and gradually increasing load and reliance on the lower back.

There are a LOT of exercises that can improve gluteal strength but a staple is the glute bridge and its progressions.  The glute bridge is a favourite because it is relatively simple to perform, safe and it can be beneficial for everyone from elderlies that have trouble getting around through to athletes.

So let's start with the simple hip bridge, the most basic version.  Paul Truong,  Senior physio at our Casula clinic shows how its done.

If the hip bridge gets easy you can add holds or place a weight like a bar or dumbell on your hips to make the exercise more difficult.

You could also progress to a one leg version for a real challenge.

Another of our favourite progressions is the elevated bridge.  This helps to increase the range through which the hip works.  To add some stability challenge to this you can perform the exercise on an exercise ball.  check out Paul's video below.

If you can do this version then the final version in our sequence is the walking bridge.  We love this exercise because it also challenges your trunk stabilisers (core muscles) while also using your glute muscles.

Paul demonstrates it in the video below:

Give these a rtry and build your hip strength and save yourself from tight and weak hips!

​A lot of individuals will experience lower back pain at some point in their life, as it is fairly common. In the old days' bed rest was recommended if your back was “playing-up,” while in the present day it is suggested to continue working out. Of course, the workouts that you perform have to be fitting, we are not proposing to go for a run or lift heavy weights, as that would not be the smartest thing to do. Still, there are quite a few excellent workouts you can perform which should aid in relieving your lower back pain. These exercises are tremendously mild, but of course, pay attention to your body and discontinue if you start having any pain.
The workouts act by elongating out muscles that are generally taut when you have lower back pain and firming up muscles which have a tendency to be weak. Of course, there are a lot of causes for having lower back pain, so it is probably wise to get it checked out by a physical therapist or a doctor.
Make certain you warm-up your muscles in advance to stretching them (you could even perform a few breathing exercises to get you in the mood). You should under no circumstances spring up in the course of stretching, and all stretches should be gentle and measured. Do not overstretch, stretch your muscles until you feel a minor stretch only, and maintain every stretch for 20-30 seconds.

                                             Image source: https://www.self.com

It is also nice to stretch out your hip as your hip flexor muscles are every so often taut when you have lower back pain. When the hip flexors are taut it can change your stance resulting in what is designated as ‘Donald duck posture’ where your butt sticks out too far. This stiffens up your lower back and can result in lower back pain. To stretch the hip flexors, go down on your knees with one knee on the ground and the other foot in front with the knee bent. Thrust the hips onward and retain your back in an upright position. Hold the stretch for 20-30 seconds. Recap two times on each side.

The days are getting warmer, the beaches are getting busier and the holidays are just around the corner, summer is officially here!
 
Though most of us may be looking forward to spending our days sunbathing at the beach, for some this time of year means finally getting our bodies back on track starting with early morning workouts, after work bootcamps or perhaps getting back out onto the paddock for some early preseason training.
 
Whatever you’re doing, getting your body fit and ready for the summer and the coming months can be tough, especially with so many distractions present this time of year.
 
So, making sure that you’ve gotten yourself into a good stretching routine for your workouts can be a great place to start!
 
When looking to improve sports or training performance, stretching regularly, knowing when to stretch and which type of stretch to apply can be a simple but effective method for keeping yourself on the pitch and off the treatment tables.

​Now most of us have probably been told at some point in time by our coaches, parents or physiotherapists, to sit down reach forward and hold for an indeterminate amount of time, usually 30 to 60 seconds, to stretch out a muscle group and then transition to a different position then rinse and repeat.
 
Though not necessarily wrong, dependent upon the activities that you may be engaging in, the timing of your stretches and the type of stretching you perform may influence your overall performance and your risk of injury.
 
Multiple stretching techniques exist and a few of the common techniques that we come across are static (passive) stretching, dynamic (active) stretching, ballistic stretching and proprioceptive neuromuscular facilitation or PNF stretching for short.

​Probably the most familiar technique to us all, static stretching involves passively lengthening the muscles by taking the tissue as far as comfortable, to the end of its range and maintaining that position for a length of time. 
 
This form of stretching is often a great tool for relaxing tense musculature and for improving tissue flexibility and joint mobility.
 
However, when performed immediately prior to strenuous activity requiring maximal muscle effort, this form of stretching has been shown in some studies to impair performance with strength and coordination based tasks.
 
As such this form of stretching is best served as a cooldown stretch following physical activity or as a flexibility exercise outside of vigorous activity, as it may help reduce the muscle contracture associated with physical exertion.

​Also known as active stretching this technique involves actively stretching the muscles and joints through the performance of a series of controlled movements designed to take the tissues through their full range of motion.
 
These types stretches are great when used as part of a warm up routine as they have been shown to improve muscle flexibility and joint range of motion whilst maintaining muscle contraction velocity and strength.
 
It has also been shown to be particularly useful with the performance with agility, balance and coordination based tasks.
 
For a great example of a quick dynamic stretching warm up check out the link below.
https://www.youtube.com/watch?v=Dy3yB_I9FBA

​Another variation of a dynamic stretch, this technique utilises quick, active movements or ‘bouncing’ movements to forcibly move a joint and its surrounding tissue to end-range positions and oscillates between sub-maximal and end-range position.
 
This form of stretching has been shown to assist with improving tendon elasticity and flexibility.
 
However, it is not highly recommended due to risk of injury associated with improper application due to the high levels force that can be applied to local structures associated with the stretch.

​PNF stretching for short, refers to a series of stretching techniques that combine passive stretching with isometric (contraction of the muscle without movement) or isotonic (contraction of the muscle with movement) contractions of the stretched muscle.
 
Traditionally used as a rehabilitative exercise for patients with neuromuscular conditions such as those found in stroke, for the everyday person, PNF stretching has been shown to be one of the most effective forms of stretching for improving joint range of motion and muscle flexibility.
 
There are three different variations of PNF stretches which are the hold-relax, contract-relax and hold-relax-contract stretches.
 
Hold-relax stretches involve placing the muscle into a stretch position and holding for a few seconds, then isometrically contracting the muscle against stretch for 5-10 seconds and then relaxing the stretch and repeating at a deeper range.
 
Contract-relax stretches are similar to hold-relax stretches, except instead of isometrically contracting the muscle, the muscle is contracted whilst moving through range. For example, in a hamstring stretch, contracting the hamstring against light resistance as the leg returns to the floor.
 
Hold-relax-contract stretches again are similar to hold-relax stretches, except instead of relaxing into a passive stretch, the stretch is brought on by actively pushing further into the stretch. For example, in a hamstring stretch, activating the quads and hip flexors to pull the hip further into flexion to increase the stretch on the hamstring group.
 
Similar to static stretching, PNF stretches have also been shown to reduce strength and power when done prior to high intensity exercises such as sprinting, though conversely have been shown to improve function with sub-maximal exercise such as jogging.
 
For any other questions regarding stretching or formulating a proper stretching routine, pop by and chat to your local physio to see how we could help you with improving your exercise regime.

Most of us have had some experience with lower back pain, whether it be severely debilitating where sitting or standing is already causing you excruciating pain, to just a niggle in the lower back that’s constantly there throughout your day. We can all agree that, YES, the pain is annoying and very frustrating, but it’s worse when it prevents us from doing what we love – for some it’s running or lifting weights, for myself it’s Brazilian Jiu-Jitsu (BJJ).
​
BJJ is a grappling martial art and combative sport, which involves controlling and submitting your opponent with pressure, chokes and joint locks, often this is happening on the ground with you crunching up and on your back. This position can lead to the front of your hips, abs, chest and neck muscles to become very tight, while back becomes stretched out and weak. This combined with the fact that a lot of us spend most of our day sitting, can lead to muscular imbalances in our bodies, which not only has a direct impact on our performance but can lead to issues like low back pain. 

To get relief and correct those muscular imbalances you want to stretch out the tight muscles at the front of your body and strengthen the muscles at the back.
Here are my THREE GO-TO stretches and exercises that I do in all my warm-ups.

• Half Kneeling Hip Stretch
  • Chest up
  • Tail bone tucked under
  • Slightly push your hips forwards

It’s also important to off-set all that sitting we do at work, so every hour get up and spend 30-seconds on one of the follow stretches or exercises:

• Half Kneeling Hip Stretch
• Standing Ab Stretch

• Squats
  • Focus on keeping your trunk upright and chest up.
  • Keep your heels on the ground
  • Aim to get your hip crease below your knee level

​A good variation is to use a bar or weight on your chest which can help you maintain your centre of gravity forward and also give you feedback to keep your chest up.

All of these stretches and exercises should be pain free. In addition to the above, if you have access to weights, try to front squat 3x a week to strengthen all those back muscles. Personally I prefer using the barbell as it encourages you to extend through the mid back which can get extremely stiff after prolonged sitting, which in turn had a significant effect on my ability to invert as I transitioned into different positions.
​
Give these exercises a try and watch your body and game thrive. Oss!

Paul is a senior physiotherapist at Activ Therapy Casula
He trains at Absolute Fighting Arts and holds the rank of blue belt.
Paul's special interests are in recovery and perfomance for combat sports.

Happy Tuesday! Hopefully everyone’s enjoyed their October holiday break and none of us have come back feeling any worse for wear. Last weekend, I found myself at the 2017 Oceanic Championship Jiu Jitsu Tournament run by Events BJJ as both a physiotherapist assisting at the event and as a competitor.

On the mats, it was a great day of competition and an interesting experience being the first tournament that I’ve participated in myself. Having previously worked at or spectated previous events, I’ve had some idea of what to expect from the competition watching from the sidelines. However, nothing quite prepares you for the mixture of nerves, anticipation and rush of adrenaline that you feel once you step out onto those mats.

Unfortunately, at the end of the day, I didn’t quite get the result that I was after but it was a great learning experience which has helped to highlight some of the flaws in my technique and has identified areas in which I need to better prepare myself for in the future.

It was also an interesting day on the table as the theme appeared to be upper limb and shoulder discomfort, mostly borne from posting out onto an outstretched arm, landing on the point of an elbow or from getting dumped onto the point of the shoulder. Now these aren’t particularly uncommon positions to find yourself in with most contact sports (think getting tackled in rugby) or everyday life (falling and protecting yourself with your arm) but it seemed to be an issue that was prevalent amongst jiu jitsu competitors due to the nature of the stand-up game.

​One of the more common conditions I came across on the day was AC (acromio-clavicular) joint tenderness which is caused by shearing of the AC ligament as the head of the humerus gets jammed into the glenohumeral joint and causes movement of the acromion away from the clavicle. As a result, in most cases it becomes quite uncomfortable to actively flex or raise the arm overhead and positions involving rotation at the glenohumeral joint are often also quite uncomfortable. Thankfully for those involved on the day, the fix was relatively simple and a quick trigger point release of the upper trapezius, pectoralis minor and deltoid seemed to clear most things up.

If you have found yourself in similar positions in that past, here are some quick easy stretches that you might be able to try out to help alleviate some of the symptoms. Of course, as with any injury if the symptoms persist it may be a good idea to contact your local physiotherapist to provide you with a proper assessment and rehabilitative program.

• Pectoralis Minor Release using Mobility Ball – 30 second hold, 2 reps, 3 times daily

​Start by feeling across your collar bone and towards the tip of your shoulder.
Just before the end, drop your fingers down you should feel a notch, this is your coracoid process which forms an attachment point for the pec minor.
Position the ball just below this point on the muscle and lean into the wall applying pressure against the ball.
Hold this position for up to 30 seconds or until desired effect is achieved, as the tissue may be tense this may feel quite sensitive.

• Upper trap stretch a/a

​Start by leaning head away from side you’re attempting to stretch.
With your opposite hand pull your head further across to intensify stretch.
Hold this position for up to 30 seconds or until desired effect is achieved, as the tissue may be tense this may feel quite sensitive.

​Brazilian Jiu Jitsu is a form of martial art and combat sport system that focuses upon grappling and ground fighting. The central theme of the sport is to utilise leverage and proper technique to control an opponent in ways that force them to submit via joint locks or chokes.

Steve Ngo
Practice Principal at Activ Therapy Sans Souci
Physiotherapist for combat sports, martial artists and grappling athletes
Training at Kings Academy Moorebank

Adding extra weight to the big lifts is always a good feeling...
 
For me it's an indicator that my training program is effective, my sleep and nutrition are going well, and that my time spent in the gym is actually paying off
 
In other words, I am getting results.
 
What if I could teach you how you can add an extra 5-10kg on your best squat or deadlift after reading this article - would that be worth your time?
 
Of course these results will differ from person to person and there are a lot of variables in play here, but using this strategy I have managed to help others hit personal records in their lifts. Not by coaching or training them, but by teaching their body how to move more effectively.
 
I will divide article into 3 areas to work on:

• Core
• Hips
• Bracing

​The core refers to the deep stabilising muscles of your spine - their role is to control the spine under load and during movement
 
Under a heavy load like the deadlift or squat, the best and safest position of the spine will be in neutral. In other words, the spine should not bend or curve during these lifts.
 
Unfortunately a lot of people who get hurt in these lifts are unable to control their spine well enough under load and this stress is transferred into the back
 
The first step in our strategy is to teach the body how to find and maintain a neutral spine position
 
Find this in the quadraped position (on all-fours): first round the lower back as much as you can, then arch as much as you can, and then find the middle position
 
In this neutral spine position, we are going to control our arms and legs while maintaining full control of the spine. It's harder than it looks. What we're trying to do here is to differentiate between the spine, arms, and hips.

​The gluteus maximus is essentially the engine of the body... having this guy not working is extremely detrimental to athletic performance and injury prevention
 
The gluteus medius controls the hips in the frontal plane (side-to-side movement) as well as the transverse plane (rotational movement) and therefore has a massive stabilising role to play
 
An easy way to get these muscles working is with the single-leg bridge and the clamshells in sidelying
​

​Do a couple sets of these before you start with your lifts and feel the difference

Why do some people love lifting with belts and others don't?
 
It's all to do with creating intra-abdominal pressure, ie. creating stability in the spine through an effective bracing strategy.
 
I've seen many people over-extend (arch) through the lower back when they squat or deadlift, placing compressive forces on the facet joints, spinal erectors and posterior structures of the spine.
 
I've also seen people round and flex forwards at the lower back, putting themselves at risk of disc herniations and muscle strains.

The most ideal way to protect the spine during a heavy squat or deadlift is to learn how to actively recruit the core muscles and teach them how to stabilise the lumbopelvic region

The following cues may help achieve a good braced position:

• Butt tucked in
• Ribcage down
• Fill belly 360 degrees with air

How did you go with these drills? Did they help you with your lifts?
​
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About the Author:
Lawrence Khuu is a qualified Physiotherapist and Movement Specialist. His mission is to help motivated clients perform at their highest level through a combined hands-on treatment and exercise rehabilitation approach. He currently treats clients at Activ Therapy Casula.

Every single Personal Trainer and Physio has heard this story.
But the tightness never goes away, does it?  It's funny how so many people continue to stretch and massage their hip flexors repeatedly, even though they know the tightness will return a few short hours later.

It's how Einstein defined insanity - doing the same thing over and over again, and
expecting a different result. So how about we go about it a different way and ask
ourselves,

"Why are the hip flexors so tight in the first place?"

A massive factor is how sedentary we are in today's society - we are living in amazing
times where technology and science is so powerful that we can sit behind a desk and run
multi-billion dollar companies.

Let's have a look at the physical stress that prolonged sitting can place on the body.
​

​The most common sitting position is pictured above: slouched, rounded, unflattering. It's adopted all over the world by students, desk workers, IT experts, teachers, doctors and many other professionals.
 
What your body and mind practices, it gets very good at.
 
In this position, the hip flexors are working isometrically in order to keep your weight balanced and prevent you from falling backwards. After a few hours, they are going to get tight. They also get really strong after a while, which is a problem to surrounding muscles.
 
It can be tight enough that it inhibits the function of key muscles such as the deep abdominal muscles and the gluteals, contributing to lower back pain and instability.
 
So releasing the tight hip flexors is only one piece of the puzzle... we need to also strengthen the abdominals and gluteals, as well as change our sitting habits if we want to make a long-term change.
 
I'm going to show you how.
 
The first step is releasing the hip flexors. My favourite way to do this is by using a massage ball. Simply place this over the targeted muscles and put pressure on it against the ground. Spend 30 seconds and wait until the tension starts to disappear before moving onto the next spot. 

​Another option is of course the classic hip flexor stretch. For this stretch, make sure your pelvis is tucked under by squeezing your glutes, then gently move forwards into the stretch. I like to incorporate this with diaphragmatic breathing drills to get a better effect.

After this, what you want to do is start activating the deep core muscles to that they can support your back and pelvic positioning.
 
We use a drill called the "Dead Bug" to teach our clients how to maintain spinal positioning while their arms/legs move in opposite directions. Perform 2-3 sets of this exercise, making sure you concentrate on breathing and spine position.

Finally we need to get the gluteals functioning properly again. The easiest way for this is to perform the glute bridges. Make sure to keep the spine straight as you raise your pelvis into the air.

Your body learns a new skill through repetition, so follow this routine 2-3 times per day for at least 21 days - the minimum time to form a new habit.
 
See how you go with this routine and enjoy the freedom in your hips and lower back.
 
Liked this content? Follow us on Facebook @ActivTherapyCasula for the latest updates.

Lawrence Khuu is a qualified Physiotherapist and Movement Specialist. His mission is to help motivated clients perform at their highest level through a combined hands-on treatment and exercise rehabilitation approach. He currently treats clients at Activ Therapy Casula.