Category Archives: Conditions, Injuries & Advice

Sciatica – What is it?

Sciatica is a term often used to describe any pain down the leg. However, there are numerous causes of leg pain and Sciatica is a specific diagnosis. The sciatic nerve exits the spine at the lower back level, runs through the buttock muscles and travels down the back of the leg, passes the back of the knee and ends at the back of the foot. Irritation of this nerve at any point along its path may cause leg pain, however true sciatica is caused by nerve root irritation as it exits the spine (termed radiculopathy). The most common cause of sciatic nerve root irritation, seen in those with true Sciatica, is a disc herniation. A disc herniation (also known as disc bulge) occurs when the inner ‘jelly substance’ of the disc is ‘pushed out’ of its normal boundaries and out through the outer fibrous ring. Nerve roots are closely situated to the discs and vertebrae so can easily become irritated during a disc herniation. Nerve roots can become irritated due to the inflammation and increased blood flow from the disc injury. However, nerve roots can also become irritated if the ‘jelly substance’ during the disc herniation compresses a nerve root.  A herniated disc may result from an acute incident, or more commonly, it occurs gradually over time with repetitive strain to the spine. Symptoms of sciatica include pain down the leg, weakness of the muscles of the affected leg, altered sensation (such as pins and needles, numbness). The pain is often described as a ‘shooting’ pain and may disturb sleep. Movements that aggravate sciatica are movements that increase the pressure on the disc herniation such as bending forward, sitting for long periods, driving, lifting. If you are experiencing any leg pain, please visit your physiotherapist. Your physiotherapist will first conduct an assessment to identify whether your leg pain is in fact sciatica or whether you are experiencing another cause of leg pain. Other causes of leg pain include facet joint pathology and piriformis syndrome. Facet joint pathology such as stiff and irritated facet joints as well as osteophytes (bone spurs seen in those with low back arthritis) can cause nerve irritation and leg pain. Piriformis syndrome is used to describe the compression of the sciatic nerve as it passes through the piriformis muscle (a muscle deep in the buttock). In a small percentage of people, the sciatic nerve passes in the middle of the piriformis muscle (instead of just below it) so if this muscle gets tight or spasms up, the sciatic nerve can get compressed resulting in leg pain. Physiotherapy can be very beneficial for the treatment of sciatica, as well as the other causes listed above. Treatment of sciatica may include soft tissue massage to any muscle spasm, joint mobilisation to restore full movement, posture advice and a home exercise program consisting of specific stretches and strengthening exercises to restore full strength and prevent further recurrences. By Jessica Norton

More To Muscles Than Meets The Eye

Back pain is one of the most common and debilitating conditions that strikes the population today.  In this day and age we put more stress on our backs by sitting at desks for hours on end, standing in jobs, lifting, bending and various sports where we push our bodies to the limit.   It costs the community as a whole, hundreds and thousands of dollars per year in lost income, treatment and insurance payouts to name a few. It can haunt us forever if not properly managed by both the therapist and the individual involved.  It is the therapist’s job to not only mobilise and massage but to give the patient the tools to treat themselves by a series of home exercises. While sit-ups will make us look good on the beach in our swimmers and maybe attract a few from the opposite sex, it does nothing to protect our backs from pain and dysfunction.  It is the deep stabilising or “core” muscles that are important in treating low back pain.  It is almost guaranteed that these muscles are not working properly in someone with back pain.  Pain causes the inhibition of these muscles until eventually they “switch off”. The exercises need to be progressed in stages.  Firstly, the exercises need to be given in a “basic” position such as lying down.  It is important to activate the muscles and learn the pattern of movement. Then the exercises need to be progressed to activate the muscles in a standing or sitting position. Finally, the exercises need to be progressed to a “functional” level.  As your muscles being working better they need to be challenged to work in ‘normal’ conditions such as walking or running. They also need to be ‘specific’ for example during gardening or lifting; which are two activities that may cause back pain. These muscles need to be trained for the specific environment or sports undertaken. There is no point being able to activate your ‘core’ while sitting on a Swiss ball unless you are involved in a seated sport such as motor racing or paddling. For example, golf, tennis and football are three activities which require different demands on our muscular system.  Therefore, we need to train our ‘core’ specifically in these environments.  By lying on a Swiss ball or Pilates reformer it will only partially improve the control and may not fully treat the problem. By Melanie Roberts

A Pain in the Neck

Neck pain is a common problem in the current population. Occurrence of neck pain is thought to be on the rise, with occupation playing a major role. As we spend increased amounts of time in a seated position and perhaps, with our attention focused on a computer screen, the postural alignment of the middle segments of your spine and neck can be compromised and can eventually contribute to painful symptoms in this region. Pain in this region, the cervical spine, can also arise as a result of a motor vehicle accident, sporting injury, unplanned movements, or simply by sleeping in a poor position. There are many different potential sources of neck pain due to the complex anatomical nature of the cervical spine and its’ surrounding structures. For example, articulation with the base of the skull, presence of high amounts neural tissue, and close muscular connection with the shoulder girdle all contribute to the complexity of this region. An injury in the cervical spine can result in shoulder and upper limb symptoms and can also be the source of headaches. If not treated in its early phases, neck pain can often become a chronic issue, lasting for over 6 months, or even years. Physiotherapists utilize subjective information and objective measures to assess and determine appropriate, effective treatment for neck pain.  Quite often when an individual is experiencing neck pain, the patterns of their movement change in response to the pain, which only contributes to further symptoms of joint stiffness and muscle imbalance. Deep muscles that stabilize the spine may become weak, predisposing the individual to further injury and ongoing symptoms of pain. There is also the possibility of nerve root irritation, which, as mentioned previously, can manifest as a headache or pain, numbness or tingling sensation in the upper limb. Prescribed retraining of movement patterns, postural control, and strengthening, combined with hands-on therapy from your physiotherapist is an effective way to relieve symptoms of the neck pain and prevent recurrence of injury in the future. By Jake Bagley      

Headaches and Physiotherapy Treatment

The first three nerves of the neck supply the three upper joints of the neck and their supporting ligaments as well as the muscles.  They supply the sensation of pain to the head and face during a headache if there is some dysfunction in any of these top three joints.  This is called referred pain.  The joints may have been damaged during trauma such as a “whiplash” injury or just stiffness due to degeneration with arthritis or poor posture. Long term stress or bad posture can cause a tightening of the muscles around the neck which can go into spasm and the overactivity in these muscles can cause a headache.  The tight muscles can also cause a pulling on the vertebra which can cause changes in movement patterns or even rotation of the vertebra.  This may affect the nerve and cause an irritation and referral into the head or face. The headache may be felt at the base of the neck, in the temples or above or behind the eyes.  It may be only on one side.  The distribution of the pain will help to determine which of the upper three vertebral levels is most affected.  The headache may be made worse by sustained bad posture or holding the neck bent forwards for extended periods such as with reading, writing or sitting on a computer. Sleeping may also make headaches worse if you do not have the correct pillow or you sleep on your stomach. Physiotherapy treatment for headaches will consist of mobilising or manipulating the affected joints, massage and soft tissue releases, correcting posture at the computer and during sleep as well as a strengthening program to assist with the overall neck posture and strengthen the deep stabilising muscles of the neck called the deep neck flexors. By Melanie Roberts

Shoulder Pain – What is the Cause?

Chronic shoulder injury is a common problem and not just for athletes.  Among the population day to day activities can produce pain.  Some activities may include hanging out the washing, gardening or working out in the gym.  Many people pile on the weight at the gym without paying attention to technique or balanced strengthening. The incidence of rotator cuff tears increases with age, with adults beyond the age of 50 most vulnerable.  Sports people in specific sports are at risk of chronic shoulder injuries.  These sports include swimming, tennis, cricket, javelin and baseball, all of which involve variation on the throwing action when the arm moves above the head. This action requires a large number of muscles and combines a large range of motion with high forces and speeds at the shoulder joint; especially in a repetitive motion. For the shoulder and arm to move efficiently there needs to be co-ordination of movement between the shoulder blade and upper arm.  If this pattern is disrupted due to poor posture or muscle imbalances injury and pain may result. An accurate assessment of your shoulder by your physiotherapist can address any tightness, weakness or poor co-ordination of muscles contributing to this debilitating condition. By Melanie Roberts

Bursitis – What, Where and When?

Many bursae are situated throughout the body. Bursae are small sacs of fluid located in areas of increased friction: usually between a bone and a tendon. Bursitis is inflammation of the bursa and usually arises from repetitive stresses to the area. These stresses may be repeated movements of a joint whereby the bursa becomes irritated from overuse.  A direct blow to a bursa can also cause it to become inflamed due to bleeding.  The sub-acromial bursa (shoulder), the greater trochanteric bursa (hip), the ITB bursa at the knee and the retrocalcaneal bursa (Achilles) are the most common problematic bursae.  Local tenderness and swelling and pain with specific movements can be associated with bursitis. Physiotherapists can help to diagnose bursitis through special tests and may refer to have an investigation performed to confirm or rule out involvement of a bursa. Physiotherapy can help cure bursitis by releasing stress and tension on surrounding structures, strengthen weak muscles/tendons which may not be coping with the demands placed on them, stretching tight surrounding structures, and giving advice on the use of anti-inflammatory options. Occasionally, a persistent case of bursitis may need to be drained of its fluid via an injection. By Todd Purser

Cracking Joints

Have you ever thought about what it means to have joints that creak or crack.  Often this is a sign of an unstable joint, moving in a manner that will eventually lead to accelerated wear and tear.  The knees are a good example.  If you can imagine a train running off its rails, you can imagine what’s happening to your knee cap as it glides and creaks as you bend your knee.  If you hear your knees grinding away when you squat or climb stairs, don’t ignore them.  It may not necessarily be painful every time, but it is an early warning sign of things to come. With a proper strength and flexibility routine, it’s possible to stabilise the knee so as to slow down or stop the progression of cartilage and bone degeneration.  This applies to all joints.  Listen to your body, and if something doesn’t feel right, have it looked at soon, before it’s too late.

How to Avoid Gym Injuries

Injuries sustained while working out at the gym are common. The most common areas injured at the gym are the shoulder and low back. Most injuries arise from a poorly designed gym program or poor technique while completing the exercises. A poorly designed or unbalanced shoulder workout, for example, often includes too many ‘push’ based exercises such as bench press and shoulder press, and not enough ‘pull’ based exercises such as a row. A program that includes too many ‘push’ based exercises and not enough ‘pull’ based exercises will often lead to shoulder and neck problems. ‘Push’ based exercises strengthen the muscles at the front of your shoulder and chest, such as your pecs, while ‘pull’ based exercises emphasize muscles at the back of your shoulder and upper back such as your rhomboids. A balance is required between the strength of the muscles at front and the muscles at the back of your shoulder and upper back. This allows correct movement of your shoulder without overloading any structures such as tendons and joints throughout your neck. A gym workout for your lower back involving squats and dead lifts should be avoided first thing in the morning. Overnight, the discs in our spine rehydrate or absorb water, so when we wake up our discs are ‘full’ and the pressure within the discs are high due to the extra fluid. Exercises such as squats and dead lifts performed first thing in the morning, have the risk of further increasing the pressure within these discs and may cause damage. To avoid this, leave any heavy lifting gym workouts until you have been ‘up and about’ for a couple of hours. Poor technique while completing exercises is the other common reason injuries are sustained at the gym. Two exercises that are often done poorly are the deep squat and bicep curl. To complete a deep squat with good technique, good flexibility is required of the muscles around the hip, such as your hamstrings. If you do not have the appropriate flexibility, you will be unable to maintain the correct posture in your lower back as you deepen the squat. As you squat lower, the tight muscles will cause your pelvis to tilt slightly backwards which increases the pressure throughout the discs in your lower back. If you do not have enough flexibility, only squat down to a point before you lose the normal posture in your lower back. Repetitive squats with poor technique may result in injury to the lower back or knees. Bicep curls are also often performed incorrectly. When performing a bicep curl, you should always have your shoulders back while squeezing between your shoulder blades. If you do not squeeze back, your shoulders will be in a forward or hunched position during the curl. Repetitive curls in this incorrect position will increase the load put through the rotator cuff tendons around the shoulder and may lead to injury. If you are unsure of your gym program, technique or which exercises would be best for you; your physiotherapist can advise you on these issues. By Jessica Norton

Clinical Pilates From a Physio Point of View

Pilates is more than just a workout.  In recent times with all of the media attention and community interest in this form of exercise the other basis of Pilates has been ignored.  We are concerned with which celebrities are participating in the growing craze and how their body shape has changed while never hearing about the health benefits it serves. Physiotherapists all around the world are integrating the exercise into their management of patients with pain and dysfunction.  This exercise based program is known as “Clinical Pilates”. There has been a general decrease over the years of physical fitness amongst children and adults alike.  This decline in fitness level brings about many medical conditions and physical ailments. It is known that participating in regular exercise is of great benefit in promoting internal health by improving functioning of organs and external health by maintaining flexibility plus condition of muscles and joints.  Having good strength in your deep stabilising muscles of your spine is very important and makes movement more efficient while it helps to protect the body against injury.  For daily activities such as lifting, gardening or vacuuming good trunk strength (or core stability) reduces injury risk. Physiotherapy research highlights the important of developing good condition of the stabilising muscles of the body, particularly in musculoskeletal areas such as your neck and back, for example “whiplash” or chronic low back pain. An individual tailored exercise program can be devised to concentrate on those areas of dysfunction. Having a strong and stable “core” system of your body gives greater support and efficiency for most athletic endeavours. Therefore, athletes and the general public alike can benefit from this type of exercise.  It assists with people’s posture especially those people who are involved in static working postures, which can be a large cause of neck and back pain.  Research suggests people with chronic low back pain do not have a correctly functioning “core” and improved muscle stability of the spine is crucial for treatment of this condition. The Pilates exercises can be helpful in treatment of chronic low back pain, especially when under the supervision of a physiotherapist who understand through years of training the body and pathology involved. Clinical Pilates involves the reintegration of exercise back into the lives of people suffering from chronic low back pain.  It is an effective way to rehabilitate, especially when carefully prescribed and monitored individually or in small groups. By Melanie Roberts

Neglecting Injuries

These days we worry about our family and their health, yet seem to neglect ourselves.  We often put things off in order to please others, especially our friends and family, and forget about doing things for ourselves.  We get busy in our work and home lives and forget about the simple things like going for a walk on the beach or having a massage for relaxation. If we have aches and pains, they are often neglected with the excuse that they will “go away”.  This is often not the case and in fact the opposite may occur, where adaptations and compensations develop to cope with the injury or dysfunction.  An example of this is with shoulder pain, which may be from a simple fall or lifting injury.  If left, compensations occur, as muscles or ligaments may be injured and prevent the muscle from contracting properly, due to pain inhibition.  This in turn means that other muscles must take over and work too hard, and therefore become tight.  The whole shoulder becomes dysfunctional and can then put extra strain on other parts of the body, for example, the neck.  This neck pain may in turn lead to headaches, and so on.  By leaving problems because you do not look after yourself as well as you would look after your loved ones may lead to a lot of long term unnecessary pain.  Think about it…if your child came home from school or footy and said that they hurt themselves, you would have them off to the doctor or physio the next day.  Take more time to love yourself, as you only have one body, so look after it! By Melanie Roberts