pain

Static vs dynamic stretching. What’s the difference and what should I be doing?

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When it comes to preparing your body for a workout, the notion of static stretching as a warm-up is facing a considerable challenge. Recent research is uncovering potential drawbacks, revealing that this traditional approach might not be the performance booster we once believed it to be. In fact, static stretching could have the counterintuitive effect of decreasing muscle power for hours post-stretch, potentially hindering your athletic performance.

The promise of injury prevention often associated with static stretching seems to fall short in the scientific realm. Studies are urging fitness enthusiasts to pivot toward dynamic exercises for a more effective warm-up routine. Dynamic exercises, such as proprioceptive training, strength workouts, and dynamic warm-ups, are emerging as champions in preserving performance levels and reducing the risk of injuries.

The shift from static to dynamic warm-ups has a growing evidence base. Dynamic exercises engage your muscles in a way that static stretching simply doesn’t. They prepare your body for the dynamic movements that lie ahead in your workout, enhancing flexibility, blood flow, and overall performance. As we bid adieu to the old-school static stretches, consider embracing a new era of warm-up routines that incorporate dynamic, agility, strength, and balance exercises for superior results.

So, before you settle into that long-held stretch pre-workout, take a moment to reassess. Your body might just thank you for the switch, unlocking a new realm of athletic potential and injury prevention. After all, in the dynamic world of fitness, adaptability is key. ????????

Groin and adductor pain in sport

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Newcastle physiotherapy for groin and adductor pain in footballThe NU Moves Physio team has recently completed a masterclass debating the best approach to manage and treat adductor pain and tendon problems with footballers. Journal articles were found and discussed relative to the NU Moves approach to diagnosis and treatment.

The following is a summary of the NU Moves masterclass. The current best approach to assist a footballer with pain in the groin or adductor region:

  • Diagnosis is essential: There are many different possible sources of pain into the groin / hip area. Identifying the likelihood of each of these (e.g. osteitis pubis, stress fractures, avulsion fractures, bursitis, tendon strain, hernia, arthritis, lower back referral) via a thorough assessment is essential. Subsequently investigations (Xray, CT scan, MRI, Ultrasound) to confirm or negate are considered. The timing of investigations depends on the risks of the problems and whether treatment is altered because of the investigation findings.
  • Treatment of adductor tendon pathology:
    • Note that this requires consideration and exclusion of all the other potential causes of hip pain.
    • Don’t stretch the adductor muscle area – the right type of strength and functional return to sport exercises will assist recovery of flexibility and stretching is more likely to irritate the problem.
    • Stability is essential – becoming core stable in the pelvis by focussing on strengthening the gluteal and abdominal muscles in sport specific positions (i.e. one leg stand) is the starting point and can often be done very quickly after injury occurs.
    • Strengthening the adductor tendons – when commenced at the correct time after the injury, adductor strength exercise is useful in improving long term outcomes of full pain free return to sport. This could be a ball squeeze between the ankles / knees in lying or a band or cable resistance exercise in standing (as long as the pelvic stability stage has been achieved).
    • Graded return to running: graded return to jogging then running then change of direction exercises is essential. Once the tendon can cope with it and the pelvic / core stability is adequate then a terrific way to strengthen the area for running is to start jogging. The problem is when you go too hard too soon and create a flare-up of pain that lasts several days. Flare-ups are a set back to the eventual goal of return to playing again.
    • Sport specific exercise: kicking / striking / passing the ball in football can all be done lightly and gradually increased in a comparable way to jogging and running. Similarly, once pelvic / core stability and sufficient local strength of adductors is achieved, these are a great way to strength load the area for sport. Again, be wary of flare-ups by progressing too quickly.

The adductor tendon strain is a frequent problem in sport and particularly in football. The best advice is to get an accurate diagnosis first then an active exercise program including 3 parts: the pelvic / core stability, the adductor tendons themselves, and a sport specific program. Getting the right level of loads on the area during each phase of recovery is essential to the process. That is where we help the best.

If you want the best diagnosis and treatment then call us at NU Moves if you have groin pain or a known adductor problem. If you have a friend or family member needing advice to get back to sport then recommend us.

Low back pain … learning to take control yourself

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Low back pain

A recent journal article in the Medical Journal of Australia* prompted this blog to encourage our clients to learn more about how they can take control of back pain. Low back pain gets 80% of us over our lifetime. It often resolves without treatment in the first week or two but recurs in up to 70% of cases. It is also common in adolescence (up to 50%). The assessment of back pain must consider the mechanics or movement relative to the muscles and spine itself however red flags and biopsychosocial factors are equally if not more important.

Red flags are indicators of medical conditions (rather than musculoskeletal cause of back pain) that need to be considered via assessment and sometimes GP referral. The diagnosis process sometimes involves investigations via Xray or MR scans which is important but comes with risks of opening a pandoras box of what may be causing the pain (e.g. knowing there may be a problem with our spine often adds to the psychological side of how pain can persist, when in fact we shouldn’t be worrying about most of the findings on scans). It is generally understood that in a small % of cases (usually <20%) a problem identified on investigations can be related to the cause of a person’s pain. In the rest of people with back pain the findings do not correlate with what is causing their pain.

For the 80% which is the majority, the word biopsychosocial is now generally applied to understanding the reason for a person’s back pain. Yes we still need to rule out the red flag problems and the persistent mechanical back pain coming from the musculoskeletal system. But the 80% of people with low back pain need to consider the many contributors that are often psychological, social and environmental / lifestyle factors. These must be considered in taking control of back pain. Getting a good opinion early on that considers all of these factors is essential but sadly is not common enough.

Good things to remember with low back pain:

  • Getting active helps a lot of people take control of pain. The reason why can be complex but it works … you just have to find the exercise that suits you best.
  • Stress is a big factor with persistent pain. Just considering this is a start towards managing the problem.
  • Surgery is rarely the answer for low back pain.

* Atkinson & Zacest MJA 204 (8), p 299-300, 2 May 2016

Exercise can help osteoarthritis

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water exercise

Do you know anyone who suffers from osteoarthritis? It occurs when the cartilage that lines the bones in your joints breaks down through trauma or age. It is most common in weight bearing joints such as your hips, knees and ankles. The greater the compressive forces placed through these joints – the greater the inflammatory response, pain and stiffness. Being overweight increases the compressive forces on our joints, making weight bearing challenging and exercise painful. Once you get arthritis pain it then becomes harder to exercise.

What is the best management of being overweight and having osteoarthritis?
There is a common misconception that weight loss occurs through exercise and physical activity. Recent studies looked at the effect of diet and exercise on weight, inflammation (measuring markers in the blood), joint compressive forces, pain, function, mobility and quality of life in people with osteoarthritis. The study reports that in fact a combination of diet and exercise provided the greatest loss of weight (10%) compared to exercise alone (2%). The group with combined diet and exercise management also experienced a better reduction in joint inflammation and pain, as well as improved function, mobility and quality of life compared to the exercise alone group.

What type of exercise is best?
A separate study looked at types of exercise undertaken in individuals with osteoarthritis. The study found that the best type of exercise for pain relief alone is water based exercise. The type of exercise most beneficial to improve function was a combination of strengthening and flexibility exercises alongside a low impact form of physical activity e.g. aqua aerobics or walking.

The general advice that can be provided based on these articles is valuable but everyone is different in the type of arthritis through to what exercise program will give the best results. If you or someone you know are suffering from osteoarthritis the best approach it to start with personalised research based advice on how to reduce pain, increase strength or decrease weight. Our physio’s at NU Moves are experts in exercise for arthritis.

* Uthman OA, van der Windt, et al. Exercise for lower limb Osteoarthritis: Systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347: f5555

* Messier SP, Mihalko SL, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis. JAMA 2013; 310 (12):1263-1273.

Have you got persistent neck pain

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Neck discomfort

The scalene muscles could be the culprit. There are 3 scalene muscles (anterior, middle and posterior) on each side of the neck. They primarily control the side tilting motion of the head but given they also attach to the first and second ribs, can assist with upper chest inspiration or shallow breathing.

At NU Moves Physio we find these muscles become overactive and painful with excess computer / screen use. If you then add stress the posterior scalene muscle in particular tightens further which has a flow on effect in how we move the neck and further increases pain. Sometimes the reported cause is sleeping awkwardly but often this is the trigger and the cause relates back to the extra muscle tension that you take to bed.

How to control it:
1. Deep tissue massage and myofascial releases combined with thoracic spine manual therapy works immediately in reducing tension and associated pain.
2. Try to diaphragm breathe – tummy breathe. Shallow breathing into the top of the chest uses the scalenes even more. Get more oxygen deeper into your lungs and give the scalenes a break.
3. Minimise the chin poked posture at the computer (too much laptop time)
4. Lastly the most common management strategy, getting active and away from the desk. Be careful if you are really tight and start with a low intensity cardio session again with a lower deeper breathing focus (e.g. go for a brisk walk). Upper body gym sessions or high intensity runs can sometimes increase the tension and discomfort when you are really tight.

If you need help with neck pain during busy times call us on 49216879. We will reduce pain and tension and help you get active.

How is your bed mattress treating you?

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Sleeping postureHow do you know if your bed mattress is contributing to your back pain?

If you are like most people, you will spend 6-8 hours in bed each day. If your mattress is providing insufficient support for your back, it can aggravate or cause you back pain.

Sleeping postureA mattress with poor support allows your spine to rest in an abnormal position and alters stress on the discs, joints and soft tissue in and around the spine. This can cause pain and stiffness. Identifying if the mattress is a contributing factor for a back problem is an important step in overcoming the problem.

So how do you know if your mattress is causing or aggravating you back problem? Here are some simple points to consider:

  1. If you wake up feeling stiff and sore most mornings this can point toward the mattress as a contributor
  2. Sleep in a different bed as a trial, preferably one with more support, and see if you feel less pain and stiffness

A mattress doesn’t last forever. Flipping your mattress regularly can help maintain your mattress but care is required in doing this. Having said this, sooner or later you may need to purchase a new one. If your mattress is contributing to your back pain you should look for a high quality orthopaedic mattress. Most bedding stores or bedding departments can advise you about mattress quality.

If its not the mattress then you need to see your physio and be assessed.

Get moving and keep a balance in your physical life

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It’s busy again on campus and the need to get moving is greater now than ever. Musculoskeletal pain will often occur with trauma and is most common when we spend too long in one posture (sitting or standing). Similarly the amount of time spent looking at a screen (including a phone) increases the chances of neck shoulder and arm pain. The chances then increase considerably if we add stress of any type (even busy stress). You can avoid this type of muscular / soft tissue pain if you subscribe to regular activity … walk, jog, cycle, gym, yoga, Pilates, etc.

Exercise & BalanceBalance your disc with some form of daily activity. 10 mins of activity is a minimum dose, 30 mins is optimal, and 150 mins is a good target per week.

Prescribing running shoes – A guide through the fog of misinformation

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Running shoes are often prescribed based on arch height, degree of pronation they show when running and the latest trends like maximum cushioning and minimalist shoes. So how do you know what advice to follow and which shoes are right for you?

1. Arch Height
It is common practice to prescribe footwear based on the height of your foot arch, such as motion control shoes for people with flat feet and a cushioned shoe for people with high or stiff arches. This has previously been common practice but does not appear to affect the likelihood of sustaining an injury while running.

2. Pronation
Although over-pronation (too much rolling in) of the foot while running is often blamed for many running injuries, there is conflicting evidence to support this. It is unclear what a normal amount of pronation is and the difference between the movement of the shoe and the movement of the foot can be up to 20% while running, which makes measuring the amount of pronation difficult even with video analysis. If you cannot accurately measure pronation then fitting a shoe based on foot type becomes trial and error.

3. Trends
Over the years many trends regarding footwear have come and gone such as minimalist, anti-pronation and extreme cushioning shoes. It is important to consider that even people with the same foot type will respond differently to the same shoe. Therefore it is clear that one type of shoe will not suit everyone and buying shoes based on the latest trends can be erroneous.

So how should you choose what shoes to wear when you run?
1. Experienced Runners
Draw from experience, know what works for you and stick with it. Don’t be tempted by the latest trends and marketing, but if you are, incorporate the new shoe slowly and as an occasional change of pace.

2. New Runners
The most important thing to consider for a new runner is comfort. Try a few pairs on in the store and see how they feel. Initially staying away from extremes such as anti-pronation or extra cushioning shoes is a good place to start.

3. Runner with recurring injuries despite a change in shoes
Remember that shoes play a small role in sustaining most injuries and it is important to consider body mechanics, movement patterns and training habits when attempting to reduce injury risk.

If you are having recurring injuries while running, have a physio assessment to work out what is the best way to get you running pain free.

This blog is a summary of a great educational video from Kevin at Running reform http://www.runningreform.com/

Watch the original video at https://vimeo.com/126720173

Looking after your physical health as a uni staff member

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NU Moves massage

Did you know that there is a physiotherapy clinic on campus? NU Moves Physiotherapy offers discounts to all uni staff members. It is important to us to help keep UoN staff healthy and active. If you are in pain see a physio today.

Our physios at NU Moves have post-graduate qualifications in manual therapy; exercise prescription; expert clinical problem solving; and clinical research. We undertake a thorough assessment to determine the cause of your pain and an appropriate treatment plan to suit your goals. All of our treatments sessions are one-on-one. Whether you wish to be pain free while sitting at work, or staying active through exercise – NU Moves can help.

NU Moves are familiar with the workplace demands that at times are associated with prolonged sitting, increased stress and not enough time to exercise. All of these factors contribute to pain. A good start is to make time for your daily dose of physical activity every day. Another method of relieving pain associated with stress or muscle tension is massage. Manual therapy from a physio involves massage of varying types; joint mobilisation (gentle form of manipulation) and stretches. You may also be helped via advice around posture or your computer and work station ergonomic set-up.

NU Moves Physiotherapy also performs dry needling, orthotic prescription, bracing / splinting, exercise and gym programming, and work specific functional rehabilitation.
To book an appointment with NU Moves call 4921 6879.