Month: October 2015

Finding Balance in your Life

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balanceAs physiotherapists and exercise physiologists, we help people address the neuro-musculoskeletal system (nerves, muscles, bones and joints) of the body with physical exercise strategies. This is reliant on a person getting involved with our recommended strategies and advice. The biggest barrier to not getting involved is time available and prioritising. Even when it actually makes us feel better to go for a walk or do a stretch, the time available often gets in the road.

Physical balance is similar to nutrition advice. We know a balanced diet will make you feel better – so will finding a balance in exercise and movement. This balance changes throughout each week, month and year of our life but keeping a routine amount of the right type of activity for you will increase your feeling of well-being and reduce the risk of many health conditions such as diabetes and heart disease.

Most commonly it is too much sitting and not enough out of the chair activity that creates problems. Other times it is too much running and not enough recovery.

The message we commonly convey to our clients is:

Why do you exercise, why don’t you exercise, how much activity do you do, how does the activity levels weigh up against the amount you sit? The body will respond to the loads you put on it; similarly it will respond to what you eat and how much stress you are under.

Find the balance:

Consider what activity makes you feel good and write down a plan to achieve it. There is no better time to do it than today! Remember, it’s not always about doing more – some of you will be overdoing exercise for your own reasons – in this case finding the balance might be going for a swim or a walk instead of a run.

Do you know how to correct your posture?

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correct postureMaster the simple things and you will get the best outcomes!
We all have our own unique postures – some with increased curves, others with reduced curves, and sometimes with sideways curves (scoliosis). Posture should also be considered relative to whether you are sitting, standing or dynamically moving. Achieving a biomechanically correct spinal posture is important for several reasons.

Firstly, in helping our clients we often find that achieving the correct posture can reduce pain and discomfort associated with sustained standing and sitting postures. For those who have to stand for long periods in retail or hospitality, an increased curve in the lower back can lead to pain. A simple correction is to lean up against the wall slide down to bend the knees slightly and flatten the lower back to the wall. If this eases the discomfort we need to focus on what creates this posture type – tight hip flexors, poor tone or weakness in the lower abdominals and gluteal (buttock) muscles.

Alternatively those who get discomfort in the lower back, mid back or neck with sitting at the computer, it often is associated with the ‘lazy, slouched posture’ where the curve in your lower back (normally known as a lordosis) is reversed and there is one arched curve (instead of two) from base of the spine to base of the neck. The head then protrudes forwards and the shoulders become rounded. Again a simple correction is pelvic tilting – rolling the pelvis forwards over your hip bones. Getting that lordosis curve back in the lower back will often reduce pain and allows for the mid back (thoracic spine) and neck posture to be corrected. You have to get a stable base to work from and slouched is not a stable base.

Secondly correct posture increases the efficiency and safety of how we move, for example with lifting. The squat lift (knees fully bent) or semi-squat lift (knees bent to 90 degrees) are both acceptable methods of lifting. If you keep your lower back straight and bend at the hips and knees it will engage the gluteal muscles and provide stability to the pelvis and lower back.

The big message, it is OK to relax your posture at times so long as it isn’t occasions such as when you are lifting loads or sitting for prolonged periods.

 

Shoulder Impingement and the Rotator Cuff

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xray imageWhat is the rotator cuff?
The rotator cuff muscles consist of 4 small muscles that work together to keep the shoulder joint centred – supraspinatus (most commonly associated with a rotator cuff tear); infraspinatus and teres minor (the external rotators); and subscapularis (the internal rotator and least understood but arguably the most important).

Why is it important?
Imagine the shoulder joint as a golf ball sitting on a golf tee. It requires the small rotator cuff muscles closest to the joint to stabilise it so the larger muscles can move the arm efficiently.

What is shoulder impingement?
Impingement is the most common pathology seen in the shoulder, which involves the tendons and other soft tissues get squished under the acromion (a bony arch forming a roof above the shoulder joint).

How do we manage it?
The management largely depends on the cause. Often a muscle imbalance is created by repetitive use of the arm over shoulder height (throwers or swimming). The muscle imbalance can be associated with the scapula (resulting in scapula winging or lack of rotation control) which requires specific exercise to stabilise the shoulder blade region.

Additionally a muscle imbalance of the rotator cuff can be created by the pain associated with impingement symptoms. This can be identified via a physical assessment of active movement control versus passive range available and if clinically relevant to the symptoms will result in improvement within a 2 week period. Occasionally the acromion is shaped in a hook fashion which increases the chance of impingement and this can require surgery (acromioplasty) to shave away and make more space in the area.

The concept that muscle imbalance and fatigue can lead to shoulder impingement has been validated over the years, and supports the use of rotator cuff strengthening exercises as an effective treatment for shoulder impingement.

 

 

Eccentric exercise for the achilles tendon

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calf muscle and achilles tendonExercise for the achilles tendon is most commonly done via eccentric exercise which involves contracting a muscle as it lengthens. The opposite is termed a concentric contraction where the muscle shortens as it contracts. The force generated during an eccentric exercise is higher than a concentric contraction. The subsequent loading of a tendon occurring with an eccentric contraction is the basis for the Alfredson protocol of Achilles tendon rehabilitation.

An example of an eccentric contraction is for the calf muscle and achilles tendon complex. If you stand with both forefeet on a step and push up onto your toes, a concentric contraction results where the muscles shorten as they contract. If you then lift one foot off the ground and lower yourself down on the other foot, an eccentric contraction occurs with the muscle contracting but lengthening at the same time. Higher force is generated in the Achilles tendon during this movement which is the basis for the Alfredson protocol. Repeated loading of the tendon via this exercise results in the tendon being able to tolerate higher loads. Not all achilles tendon problems are suited to this approach. A good place to start is an individual assessment by a NU Moves physiotherapist. 

Don’t Be Limited By Your Tendons: Achilles Tendonitis

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achilles tendon physio newcastle

Achilles tendonitis … if you have suffered from it you know how much it can limit you with everyday life activity. The actual diagnosis is now termed ‘tendinopathy’ rather than tendonitis as recent evidence has found there is not an actual inflammatory process within the tendon. Regardless of the name, it refers to pain located usually up to 5cm up from the back of the heel. There are several different types of Achilles tendinopathy so if you suspect you have this problem it is a good idea to get a physiotherapist to confirm the diagnosis and type of presenting problem.

The good news is simple inexpensive treatment is available and quite effective in getting you active again. We commonly recommend 3 strategies that help:

  1. Despite the lack of bleeding or inflammatory cells present in a tendinopathy, applying ice safely to the local area still does provide benefit to many people. Simple things can be beneficial even if the understanding of why isn’t so simple. Put simply the benefit of ice is to reduce pain which assists beneficial exercise to be undertaken.
  2. Relative rest is also advised when managing tendon pain. This doesn’t mean complete rest from the aggravating activity but usually a reduction in the task that aggravates the pain.
  3. Active exercise based rehabilitation is the key to regaining strength and reducing pain with everyday life and exercise. This involves gentle and progressive loading exercises for your Achilles’ tendon known as the Alfredson protocol. The exercise is a type of eccentric exercise that is optimally performed with knees straight and knees bent and involves 3 sets of 15 repetitions of each. There may be soreness or pain that can last for a day, but the soreness should reduce as you progress the exercises over the course of weeks. Working with your physio will guide how much soreness is OK and when the protocol should be modified.
  4. To compliment these 3 treatments we also provide stability exercises for the core and legs muscles to compliment the Achilles exercises. For example, a lack of strength at the hip can increase the requirements and load on the calf and Achilles region. A more comprehensive and effective program will find any such imbalances and help if the goal is regular or more intensive exercise. To learn more, read our What is Eccentric Exercise? article.

If you have an achilles problem, start with a physio assessment and ask if the Alfredson protocol is appropriate for you.