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What exercises can help lower back pain?

12/13/2018

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​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.

Lower tummy strengthening

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                                        Image source: https://myhealth.alberta.ca

It is vital to make your lower tummy muscles stronger for the reason that these muscles work together with the lower back. This denotes that if the lower tummy muscles are weak the lower back can stiffen up, which can result in lower back pain.

A perfect workout for the lower tummy muscles is illustrated in the picture down below. It is very mild and is also very much effective. Lie down on your back with knees bent and feet straight on the ground. Breathe in and as you breathe out move one knee in the direction of your chest and as you breathe in, put back the foot on to the floor. Do this exercise again, at least six to eight times on each leg.
If your back aches at all, then this workout is not a good fit for you OR at least you are not ready for it as yet.

Bridge

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                                          Image source: https://backpainok.com

Yet another excellent workout for mobilizing the lower back is the bridge, as illustrated in the image right below. To move out this workout lie down on your back with knees bent and your feet positioned hip distance spaced out on the floor. Take a deep breath in and as you breathe out to lift your hips off the floor up until shoulders hips and knees are in a straight line. As you breathe in lower your hips to the ground. Do it again around eight to twelve times.

Once more, you should not feel augmented hurt in your back with this workout.

Lower back stabilisation

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                                              Image source: https://www.active.com
 
​Stretching your lower back is going to be truly beneficial in relieving your lower back pain. Go down on your knees on all fours, with your knees in a straight line under your hips and hands straight under your shoulders. Make sure that your spine is in an impartial position. Place your head in line with your spine, your shoulders back and circumvent padlocking your elbows. Take a big deep breath in and as you breathe out bit by bit take your bottom backward in the direction of your heels. Keep the stretch for 20-30 seconds. As you breathe in bring your body up onto all fours for a second time. Do it again at least six to eight times.

This stretch could make your back complaint a lot worse if you have a herniated disc.  Discs do not like that extent of flexion. If you do not recognize what is bringing about your low back pain it would be sensible get it checked by a doctor.

Piriformis stretch

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                                                Image source: http://insideryoga.com

​One more muscle which can be taught when you have lower back pain is the piriformis, a muscle in your butt. The stretch under is certainly effective in elongating this muscle, and extremely simple to perform. To carry out the workout, lie down on your back and cross the right ankle over the left knee. Hold the thigh of your left leg and take a deep breath in. As you breathe out jerk the knee in the direction of yourself. Keep the stretch for 20-30 seconds. Do it again at least two times for each side.

Once more this stretch may be too forceful for acute low back pain.  We can help alter it so you do not make it poorer.

Hip stretch

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                                             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.
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Why Your Warm Up Routine is a Waste of Time

8/30/2017

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Most people's warm up routine consists of a few random stretches of the calves, hamstrings, lower back and a few other key problem areas that they might have
 
They might do a slow jog or some star jumps to get the body warm and the blood flowing
 
But is this an effective warm up? Is this actually allowing you to perform better during your workouts?
 
Have a read of this short article and decide how effective your warm up routine is.

STATIC VS DYNAMIC STRETCHING

One big mistake with warm up routines that I see are that people focus too much on static stretching - an example of this is lazily holding a hamstring stretch for 1-2 minutes. Although this type of stretching before workouts can temporarily increase flexibility, it also decreases strength and power output which is not ideal for any activities that require your muscles to contract.
 
If you are looking to improve performance, you should instead be focusing on dynamic stretching. The difference here is that you are actually engaging your brain and muscles through repeated and quick movements.
 
Below is an example of dynamic stretching for the hamstrings and posterior leg muscles
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PREPARING MUSCLES TO FIRE

A runner should feel great when he or she is running on the spot and doing a few stairs, just like someone who squats heavy loads should be easily able to do some light squats.
 
So after getting some more range of motion, we need to prepare the muscles to contract!
 
Missing this important step can lead to feelings of "sluggishness" and might even lead to increased risk of injury... most people can't go from 0 to 100 safely and consistently without a good warm up
 
One of our favourites for lower body activation is the slow reverse-lunge. Try a few each side for 3-5 sets. Your goal is to keep your weight on your front leg and maintain full control on the way down.
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PREPARING THE WHOLE BODY TO FUNCTION

​The final point I will touch on in terms of warm ups is to consider what you actually have to do during your workout. Are you trying to prepare your muscles to lift heavy weights (strength/power training), to produce lots of force quickly (such as sprinting), and in what range of motion?
 
Also consider the requirements of a runner versus a powerlifter during their sport - completely different, right? These two groups of people surely cannot have the same warm up routine if they want to perform at their best
 
These factors will determine what movement drills are most appropriate for you as you prepare for your workout
 
For runners, you should include some plyometric work such as box jumps or skipping in order to prepare your body to rapidly accept and produce force through your lower body.
 
If you're a powerlifter, your warm up should include some light squats which are focused on moving the bar as quickly as possible. This can include banded squats/deadlifts or box squats at <50% of your max.
 
I hope this challenged your thinking a little bit as you tweak your warm-up routine and perform better.

​If you liked this content and would like to find out more, follow us on Facebook @ActivTherapyCasula for the latest updates.
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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.

https://www.facebook.com/activtherapycasula/
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3 Simple Ways to Improve Your Knee Pain and Start Exercising Again

6/16/2017

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​So you have some knee issues after exercising or maybe a lot of walking during work
 
It can feel like general tightness around the kneecap or aching and burning underneath it
 
It's usually there for most of the day, gradually getting worse as the day progresses.
 
You've seen your GP... rest and Voltaren tablets is what he offers you. You try and persist in doing your exercise sessions but the pain is just too great!
 
What you need to do is rehabilitate the knee and improve your walking and running biomechanics

Massage the lower quads

Using a foam roller or massage stick, gently massage the lower portion of your quad muscles (just above the kneecap)
 
These strong muscles can pull hard on your shin if they are overworking and cause increased forces on your anterior knee structures, making them hot, puffy and inflamed.
 
Spending even 1-2 minutes massaging these muscles can make a big difference to how your knee feels
 
They can be VERY tender so be careful with how much pressure you use!
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Strengthen the hips

​If you've read my previous blog posts, you'll know that the knee is primarily a hinge joint (it goes forward and back only) and the hips/feet largely influence how it moves
 
So it makes sense to ensure that these surrounding joints are strong and capable enough to control the knee, right?
 
There's a lot more to it but one of the most common deficits we see with our clients suffering from knee pain is a lack of lateral hip stability... this forces the poor knee into a compromised position
 
One of the easiest ways to restore lateral hip stability is with the super-popular Clamshell exercise
 
It's a really effective way to activate the outside part of your glutes so that they can offer more support and stability to the knee. Start with a towel between the thighs with no resistance, and gradually progress if you are able to perform over 15 repetitions easily.
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Strengthen the feet

​Your contact with the ground is through your feet (obviously)... so why don't many people pay attention to them when addressing running-related knee pain?
 
Through the gait cycle, your feet has to be able to land in supination, control pronation, and re-supinate in order to effectively absorb shock and create propulsion
 
Using orthotics or shoes that BLOCK pronation is not the answer
 
You need to be strong enough to CONTROL pronation if you want to be an effective runner
 
A simple drill to restore pronation control can be performed by standing on one leg while holding onto the wall for balance
 
Make sure this movement is coming from your ankle/foot, not your knees or hips.
 
Slowly allow the inner arch to drop while remaining in control at all times, then proceed to lift it back up. Play within the “safe range” – can you control this easily throughout the wrong range on one foot?
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Try these before your next run... I'm sure your knees will thank you for it
 
If you liked this content and would like to find out more, follow us on Facebook @ActivTherapyCasula for the latest updates.
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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.
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Improve your shoulder press in 10 minutes or less

5/13/2017

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If you're serious about training, you'll know what the shoulder press is. Also called the military press, there are many variations including the seated press, dumbbell press and push press.

Because of the challenging nature of the movement, there are many people who will either avoid this exercise or injure themselves doing it.  

Believe it or not, there is A LOT more going on when you lift a weight over your head than you might initially think. We won't go through that today because I know you're not that interested... you just want to lift heavy weights safely, right?

So lets jump into a routine that will take you 10 minutes or less to improve your shoulder press strength.

Minutes 0-2 - Shoulder

Circles Start with a general warm up to get the blood flowing through your shoulders. This will make it easier to change the tissue around the shoulder in preparation for the next 8 minutes of this routine.

Begin with small circles which will get bigger and bigger. Make sure you are always in control of the movement rather than flailing your arms wildly. Change directions and repeat for 2 minutes.

Minutes 2-4 - Pec Minor + Collarbone Release

You will need to invest in a massage ball if you don't have one already. These muscles act to pull downwards on the shoulderblade which limits the ability for you to move your arm over your head (in a shoulder press motion)

Releasing these muscles can produce dramatic improvements in shoulder function. Follow the under-surface of the collarbone from the shoulder all the way to the chest.

Simply place a massage ball (or similar) on these muscles and slowly and gently roll over them, thinking about releasing all the tension from them. They can be VERY sore so be careful not to add too much pressure - more pressure is NOT better.

​Spend 1 minute each side and move on to the next sequence
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Minutes 4-6 - Rhomboids Release

Using the massage ball, release these muscles while lying on your back or against a wall

Once again this can be very sore so be mindful with how much pressure you are applying.

​Work on the inside border of your shoulderblade and slowly work your way up towards your neck, spending 1 minute each side for a total of 2 minutes.
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Minutes 6-8 - Thoracic Extension

Place the foam roller in the middle to upper part of your back Interlock your fingers and support your head as you slowly see-saw over the foam roller.

You may hear a few clicks which is okay as long as they are not painful. Gently make your way up and down the upper back/thorax in the same manner.

It may help to breathe in and out deeply, imagining all that tension leaving your body on the exhale.

​An important tip is to always keep the ribcage down rather than letting it lift upwards in order to protect your lower back Spend 2 minutes on the roller before moving on
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Minutes 8-10 - Single Arm Press

Now that you've released the tight muscles holding you back, you need to train the correct muscles to help move your shoulder blades and give you a really solid overhead press.

Using a LIGHT weight (3-5kg for most people), carry the weight with the upper arm parallel to the ground and the forearm vertical (90/90 position).

​From here, use your shoulder to press the arm over your head. I find this drill very useful for teaching the shoulderblade how to contribute to the motion correctly Perform 2 sets of 10-15 each side
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So there you have it!

Give this routine a try before any of your upper body or shoulder pressing days and see the difference it can make. If you liked this content and would like to find out more,

Follow us on Facebook @ActivTherapyCasula for the latest updates.
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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 patients at Activ Therapy Casula

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Top 5 reasons why pilates is fantastic for women over 40

4/10/2017

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Everyone knows about pilates and most know that it’s a great form of exercise for people across a wide age group.  Here are 5 reasons why it is a great form of exercise for women above 40.
 
Improved flexibility
We all see how flexible young children are and most of us have probably started to see that we aren’t as flexible as we once were.  There are a number of reasons for this, some we can’t do much about like the tissue and muscle changes that happen with age but there are some we can like our posture, our habits and exercise.
 
Pilates has a huge focus on flexibility with control which is more than just sitting and stretching your legs a few times a day.  It’s about developing flexibility that you can actually use and maintain.
 
Improved muscle tone and strength without high impact
Strength is something that tends to increase as we grow up, plateau around our 30s and then start a rapid decline after 40 or so.  Although there are physical changes in our body that cause this, we can do a lot to slow down the decline and reverse it.  Pilates is one way of strengthening and our opinion one of the big benefits is that it can be developed without doing high impact exercises that can accelerate degeneration in your joints.
 
Improved stabilisation of the spine
Back pain is the number one issue we see at our clinics and the older the age the more preventable the back issue.  This because a lot of lower back problems develop in our later use as a result of years of poor posture, lack of exercise, bad habits, injuries and poor management of those pain episodes.  A big factor in spine health is maintaining the activity and strength of the muscles that control your lower back and abdominals.
 
Modern pilates and in particular clinical pilates is specifically developed to target and work the muscles that stabilise and control the spine.
 
Improved breathing
Anyone that has done a pilates class has no doubt hear the instructor talk about how important the breathing is while they exercise.  Pilates helps our breathing in a number of ways. 
1.Improved lung capacity so we can get more air in and out of our lungs
2.Improved circulation that comes with deep breathing
3.Improved function of the diaphragm which is our main breathing muscle
4.Improved control of our breathing patterns, in particular when we are performing physical activity.  This makes us more efficient and promotes better function of our rib cage and all the muscles around it.
 
Improved coordination and balance
 
Coordination and balance tends to reduce gradually with age and the risk of falling is a major issue for all of us in our later years.  How well we are able to maintain balance and coordination can go a long way to reducing the risk of falls.
 
Pilates exercises emphasises the use and control of the small muscles in our body around our joints that help us maintain balance and control fine movement.  Pilates also helps improve the function of our nervous system through control of our breathing and developing good movement patterns.
 
So if you have considered whether pilates is useful then consider some of the above factors that make pilates a great form of exercise.
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3 Simple exercises to fix your posture

2/19/2017

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Are you sitting at a desk or in front of a computer for more than 3 hours a day? If so, chances are that you may suffer from the “Upper Cross Syndrome”. This posture is linked most commonly with upper back and neck pain, headaches, and pain at the front of the shoulder.
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Your body is an excellent adaptation machine – if you are spending a lot of time in a certain position, your body will become really efficient at it! So if you are sitting and slouching a lot, you will eventually end up with rounded shoulders, a slouched back and a head-forward position.
​We see this so often at our clinics and are able to get instant relief for almost all of our clients through thorough assessment and specific treatment.
Fortunately, there are a few really effective ways to improve your posture and alleviate some of the symptoms you may be experiencing. Before starting, make sure you are safe and confident to perform all of these exercises by consulting with your doctor and health therapist.
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Release the chest muscles

​The pectoralis minor and the anterior deltoid are both muscles that contribute to that rounded shoulder position. This can lead to discomfort in the shoulder, as well as add tension to your neck. Releasing these muscles can provide immediate relief. To start, place a massage ball on the tender area on your chest just inside the armpit. Gently lean onto a wall/doorframe and allow the muscle to soften and release. A few relaxed and deep breaths can help a lot with this.
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Upper back extension

​Regaining the uprightness of your upper back is important in correctly positioning your neck and shoulder position. One of the best ways to achieve this is placing a foam roller/peanut ball on the floor under your upper back. Apply pressure by arching over the foam roller – make sure your lower back remains straight and support your neck with your hands if you need to. You may hear a few clicks – this is completely normal.
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Shoulder W's

​This is an excellent exercise to strengthen the upper back and shoulder blade muscles to maintain your posture. Start by grasping a light resistance band approximately shoulder-width apart. Remain tall in the chest as you rotate your shoulders outwards as far as you can without arching your lower back. Hold this position for 10 seconds and slowly return back to the start. Repeat 10 times.
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Try these exercises out and perform them daily. If you are experiencing any pain or increasing symptoms, STOP and consult a qualified professional before continuing.
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Hope this helps,

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​Lawrence Khuu,

Physiotherapist and business director at Activ Therapy Casula and Hoxton Park Road
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How to get better more flexible ankles

1/9/2017

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​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.
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How do you know if your ankles are restricted?
One of the tests we use is called the Knee-to-Wall test, which measures how far the ankle can bend into dorsiflexion.
  • To perform this test, keep the heel flat at all times.
  • Reach your knee towards the wall, making sure to keep the knee tracking over the 2nd toe.
  • There Self be a point where your heel starts to lift off
  • At this point, measure the distance from the 2nd toe to the wall.
  • Unrestricted ankle range is a measurement of >10cm.
Other giveaways of restricted ankle motion include:
  • Feelings of tightness or cramping in the shin or calf region
  • With squatting, falling backwards or if the athlete comes off their heels.
  • Feet turned out (“duck position”) in standing
  • Collapsed foot arches (“flat feet”)
  • Big toe valgus (when the big toe starts to face outwards) and development of bunyons
The causes of restricted ankle dorsiflexion are usually a combination of joint and muscular issues. The way that we move plays a large role in this, such as our technique with squatting and running. Previous history of ankle and/or foot injuries will also predispose the athlete to ankle restrictions.
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:
  1. Self-myofascial release for the calf region and sole of the foot:
    • Using a foam roller or similar tool, massage around tight areas in the calf regions. Focus on areas which are particularly tender and apply gentle pressure. Be careful not to push too hard – more is not better! Other areas to target include the front and outside of the shin.
    • https://www.youtube.com/watch?v=xgta3Ai-9eQ
  2. Banded ankle distractions:
    • Attach a band to a rack upright or sturdy object, then around the front of your ankle. Get some tension in the band and perform knee bends to mobilise the ankle. Pay attention to keeping the knee to track over the 2nd toe as you bend.
    • https://www.youtube.com/watch?v=XM0TT04ZKVM
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Prevention is better than cure.  How do we predict risk of future injury?

12/30/2016

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The big movement in health in recent times has been about prevention of injuries.  This is particularly a big issue in sports where an injury to a star player can cost the club a lot of money.  So how can we prevent injuries from happening?

Well some injuries you probably can't (unless you lock yourself away in a room, although you will likely be at risk of developing other issues) however a large number of conditions that we see on a regular basis are the result of a combination of things that can be seen in a person's history, lifestyle and physical examination.

So what are some of the things to look for?

The number one biggest factor that increases the likelihood of an injury is a previous injury.  Why is that?  Well even if a structure, say a ligament in the ankle, has fully healed, the body can still have changes that carry on.  These changes in the body likely wont be painful.  They are adaptations and changes that allow an individual to continue to function.  Unfortunately these changes can lead to future injury.

There are a number of tools which we use in combination with a history One of the tools we use in the clinic to identify underlying musculoskeletal issues.  One of the most helpful ones being the SFMA.  These tests help us to find out if there are any issues with how the body is or isnt able to move and if there are changes to how the body activates its muscles.

Lack of normal movement or a change in the normal movement or muscle firing pattern give us a good indication of problems that research has shown to have a strong link to future injuries.

So if you have had a previous injury and you feel a sense that something isnt quite right then it may be worth getting that checked from a qualified professional to make sure you wont be dealing with future problems.
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Whats the best sleeping position, mattress and pillow?

12/28/2016

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Sleep is something that has changed a lot for me in the last 7 months.  That's when our beautiful young daughter arrived and as all parents know, a decent night's sleep can be hard to come by.

We spend a couple of nights a week staying over at the in law's in a different bed, a different pillow and in a different sleeping position (due to our little 7 month year old sleeping on our bed).

It brought me thinking about the importance of sleeping position and its a question our physiotherapists and chiropractors get asked often.  In particular in relation to neck, shoulder and back pain at night and in the morning.  So what is the best position to sleep in? What mattress and what type of pillow should I use?
Well a lot depends on what you are used to, as it isn't easy changing your position after several decades.  There are a few things that you can do.

If you are a back sleeper then a firmer mattress is preferred as it will better support your spine posture.  You also would want a slimmer pillow to support the curvature at your neck.

If you sleep on your side then a softer mattress may suit you better as it won't compress your shoulder when lying on it.  Your pillow needs to be a bit higher to support the space around your shoulder and the side of your neck. 

Now many people move a lot from side to side and their back.  If you are in that boat then a curved foam pillow with a low and high side of the pillow can do both.

If you sleep on your front then it often means that you have your head to one side and arm up over your head which places your spine in a rotated posture and your shoulder in an awkward position.  Its not an easy thing to change but one thing you can do is to try sleeping with a pillow underneath one chest when on your front.  That way you are a little closer to be a side sleeper! 

So the answer to sleeping position, pillows and mattress isn't a one size fits all matter.  It depends on what you have gotten used to and what pain or discomfort you experience during the night and in the morning.  Its about putting in place a strategy to improve your current sleep situation.  Who would have thought there was so much to it?
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5 great self releases to reduce pain and improve flexibility.

12/25/2016

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Every day stresses to the body (both physical, emotional and chemical) can cause changes to the way the soft tissues in our body (muscles and fascia) act.  In particular all of us would have noticed "tight" muscles or "knots in different areas of the body.  Now it would be great to have your favourite physio, chiro or massage therapist in your pocket to pull out and release these each day but for most that isnt possible.

One thing we highly encourage (that you can do every day) is use a trigger point ball to self release.  Read more about the trigger point balls here.  Below are 5 different self release you can do using this simple but easy treatment tool.

1. Tight shoulders (posterior cuff and rear deltoids)

A great release to help with shoulder function.  If you are having issues with lifting overhead or lack that overhead range then this is a must have.  

We recommend performing these just before you do your overhead exercises.

Target the area just behind your shoulder and outside of your shoulder blade.
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2. Calf muscles (gastrocnemius and soleus)

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The calf muscles is one area that gets tight for a lot us without us realising it.  Flat feet, poor footwear, poorly recovered ankle sprains, leg length differences, changes in body weight distribution due to hip, knee or back pain can all lead to increase muscle pain and restriction.

Use a step to elevate the calf muscles on top of the ball ad use your hands to lift more body weight onto the ball. Use small controlled movements, targeting the knotted segments.

3. Painful heel (Plantar fascia)

Tightness of the muscle underneath your foot goes hand in hand with calf tightness, we usually see one if the other is there.

Place the ball on the floor and put your body weight onto it.  Focus on the area from your heel to the base of the big toe.

tip:  try doing these first thing in the morning when the area is often tightest.  ​
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4.  Upper back (thoracic spine)

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The upper back region is tight to somedegree in the majority of patients.  The biggest culprit being posture.

Use a wall to lean against the ball and target the area just alongside the spine on either side.

Try placing your feet further from the wall to create additional pressure.

5.  Tight hips (Gluteus medius and piriformis)

This is the exercise that I personally do the most.  With more time spent in sitting positions a lot of us don't have the best function when it comes to use of our glutes in relation to our lower back (one of the big reasons contributing to a lot of back issues these days by the way).  
To release these target the centre and the outsides of the glute area on each side.  You can also perform this against the wall if you want to control the amount of pressure a bit better.
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Let us know how you go with these exercises.  If you didnt get the body region that gives you issues, shoot us an email or speak to your physiotherapist or chiropractor.
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    Welcome the the Activ Therapy Blog.
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    Author: Richard Kim

    rRichard has been a physiotherapist since 2003 working in public hospitals, workplace injury and gyms before establishing Activ Therapy.  He currently works with powerlifters, martial arts and crossfit athletes,

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