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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.
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If you have ever had jaw pain, you will know how uncomfortable it is, A pain that stops you from eating anything that isnt blended isn't much fun. Having temporo-mandibular pain (jaw pain) stops you from doing anything that requires opening of the mouth and even small movements can cause clicking and locking in the jaw. The temporo-mandibular joint (or TMJ) is made up of 2 bones with round surfaces (the mandible and temporal) with a disc in between that allows the glide and movement so you can yawn, eat, chew and talk. This way this joint can get messed up in a number of ways including, bad teeth, grinding habits, poor bite patterns and neck issues that might relate to posture. With all that we now we have a very angry disc. So what are the signs of temporo-mandibular pain?There are a number of different signs and each person will be a little different but the main things you will notice if you have temporo-mandibular pain are:
So what are the different types of TMJ pain?The differnt types really boil down to 3.
What causes it?In most cases there are a few factors that often lead to jaw problems. An expert in jaw pain can explain which ones you have after doing an assessment. Some of the more common are:
What can I do about it?the first step in treating it is identifying and addressing the factors above. After that treatment can include a number techniques to assist the mucle and joint function:
 Colin Sau,
Senior physiotherapist and jaw pain expert at Eagle Vale and Liverpool 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!
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.  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.
Well that's because the real problem is somewhere else. Let me explain. A feeling of tightness in those muscles (called the upper trapezius and levator scapulae) happens mostly because they are hypertonic. That means that those muscle fibres are over-active or tense from over-working. The reason they are having to do so much can vary but they often boil down to 2 main reasons.
Mobile phones, TV, computers, laptops all make this posture more and more common in our daily lives.
The second reason is weakness in other areas. In particular the ones that stabilise the shoulder blade and keep the upper back straight. Why these get weak in the first place usually ties in closely with your posture but other reasons can also contribute like previous injury, abnormal spinal curvatures, repetitive activity or sport and even respiratory problems. the good news is that these are correctablte and by treating the right area you can get to the underlying cause and get long lasting improvement in that upper shoulder pain rather than having to constantly be bugging someone for a massage! One thing we always test when assessing any lower body problem is the ability to lift a straight leg up into the air when lying down on your back. We check the patients ability to do it on their own and we also check how far we can raise it. More often than not the response we get when the back of the leg starts to feel tight is "my hamstrings are really tight".
Although yes this is one reason, we find it is by far not the only one. In fact we find that the hamstrings are "tight" (we will get to what tight actually means later ) however there are other more relevant issues that limit this movement. The first one is pain. This could be in the lower back, the pelvis, the back of the knee or in other muscle groups apart from the hamstring (like the glute or the calf). Pain itself will limit movement but even if you are moving through the pain, you need to recognise that pain with this kind of activity that isnt a stretchy pain isnt normal. The second one is restriction in other areas. The straight leg raise requires movement through more structures than just the hamstring. If you have tightness in your gasstroncnemius (calf), back of the knee, gluteals or lower back muscles then it could limit you. Also if you restriction in your knee joint, hip joint, pelvis and lumbar spine then it could also reduce your range. So what can you do to see if you have an issue. 1. Do you have pain during this? (apart from the pain of a muscle stretching for the first time in years) 2. Is there a difference between the two sides? 3. Do you feel the tightness any where apart from the back of the thigh? 4. Is there a big difference between how high you can lift it yourself (without using your hands) vs how far you can stretch it with a towel or belt? If you find the answer to any of these is yes then theres a good chance that there is an underlying issue that could cause you problems down the track (or is already part of the issue with the problems you already have). And a last note on what "tightness" is. The term tight is a fairly general term and can mean several things. Each with its own way of managing it. A shortened muscle from disuse needs to be stretched with long holds, restrictions in the joint may need dynamic stretches or treatment for the joint, a muscle can be tight because it is overactive or hypertonic. This may be more about a weak muscle than a "tight" one. There are other reasons but thats just a quick note on what tightness may or may not actually be. So next time you try and stretch out your hamstring pay more attention to what you are feeling. It may tell you a lot about what's happening in your lower body. I've had a few patients that come in with back and leg pain and the most common self diagnosis (or often the medical/health professional diagnosis) is that it is sciatica. The thing is, not all forms of leg pain that seem to stem from the back is sciatica. In fact as far as what I have seen come through our clinic, the vast majority isn't. The danger is that when diagnosed with true sciatic pain, it can be debilitating and very difficult to treat. Very often it can require corticosteroid or neurosurgery. I find that it is important to ensure that you are dealing with true sciatic pain only before taking those steps. Sciatica refers to lower back pain associated with leg pain due to compression of a spinal nerve root which travels down the leg and becomes the sciatic nerve. This compression usually occurs as a result of degenerative disc changes.  So how can we tell if it is or isnt sciatica?
Well firstly you want to ensure that the assessment is complete. You could be dealing with back pain in conjunction with a lower limb condition such as anterior hip impingement, ilitibial band syndrome, peripheral nerve tension or hamstring strain. I find that in most cases though the leg pain IS directly related to the lower back however not as a sciatica issue. Rather the lumbar spine condition is occuring (or has led to) changes in pelvis orientation causing symptoms radiating from the posterior pelvis. The most common mechanism I come across is a form of piriformis syndrome where either spasming of the piriformis muscle can create pain or the muscle can irritate the nearby sciatic nerve, causing pain that travels down the leg. In all cases of sciatic symptoms short term physiotherapy or chiropractic can be valuable in identifying and differentiating between various lower back injuries. If it isn't scaitica then treatment can significantly reduce symptoms within days. |
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