Top 5 Holiday Mobility Tips

It’s crazy to think how close we are to the end of the year. I don’t know about you, but I always start getting a little excited right about now. After a big year nothing can beat a couple of weeks off around Christmas and New Years. Spend some quality time with the family and get out of Sydney for a few days.

Who doesn’t love holidays!

Jumping on a plane to spend New Years in Hawaii, heading up the M1 to the family beach house or simply a weekend trip up the mountains…

It all sounds exciting doesn’t it.

Unfortunately with this ‘change in routine’ we often forget to look after ourselves. I know my diet goes out the window, training is less of a priority and mobility work is all but forgotten.

Sometimes a break in routine is needed. It’s a holiday after all. However,

There’s nothing worse than ‘throwing out your back’ at the start of a trip….

You want to focus on doing what you can to enjoy your relaxation time. To help you stay safe, healthy and happy I’ve put together a few handy tips to keep you health on point as you travel to your destination of choice.

Don’t worry they won’t take much time…

Driving up or down the coast?
5 Simple Steps Stay Supple

1. Take advantage of those pit stops to get some mobility in! Your car’s bonnet makes a great bench to stretch those hamstrings!

2. Roll up a towel (or jumper) and pop it behind your back to make a comfy arch support. It’ll help encourage better posture, and distribute load more evenly through your spine.

3. Stretch that chest! Tuck your arm behind the adjacent headrest and ease in to the stretch. By gently pushing in to the stretch and then releasing, you’ll ‘trick’ your muscles into relaxing a little more.

4. Sit upright with your head against the headrest before you set your mirrors up. This will remind you not to slouch as you’re motoring up the highway.

5. Keep your fluids up! Sip water often.

If you’re lucky enough to be heading overseas…

5 Mobility Tips When Flying
(Number 2 is my favourite)

1. Make sure you lift your suitcase with your knees, and not your back! You don’t want to blow a disc before you even walk onto the plane

2. You’ll get some funny looks doing air squats in the aisle way… but It will help keep your body moving and make you more comfortable.

3. Take your own supportive pillow, if it fits in your luggage. There’s nothing worse than a sore neck after sleeping on a rock of a pillow.

4. Roll up a towel (or jumper) and pop it behind your back to make a comfy arch support. It’ll help encourage better posture, and distribute load more evenly through your spine.

5. Keep your fluids up! Sip water often.

Once You Arrive…

5 Things You Should Do Before Going To The Bar

1. Stretch first. You’ve just been sitting for hours on hours. Make sure you get moving and stretching first before you hit that hotel gym session.

2. Make sure you unpack your mobility ball and put it somewhere easy to see. The more you see it, the more you’ll use it.

3. Make sure the mattress is supportive. If you notice any large indentations in it, then compensate by placing a small soft towel in the ‘hole’.

4. Remember that most of us aren’t used to walking around for 8 hours a day. So if you’ve been busy exploring Venice all day, take 5 minutes to stretch before bed. Your muscles will love you for it….

5. Enjoy yourself!

Relax

Your mental health is as important as your physical!

And of course, we will be here when you get back!

That's Where I hold My Stress!

Workplaces have been intense this year. Whether business have suffered, or in some cases boomed, there have been so many external factors influencing the place we know to call 'work'. With the surge in work from home arrangements, staggered staffing and endless amounts of 'zoom' conferencing, it would be understandable if you had said that 2020 has left the mind a little stressed out...just a little.

What's been interesting across all our clinics, is the rise in the frequency of people presenting with neck pain. Of course, that may well be from being less (even less) mobile than before; and perhaps a less than advantageous work from home setup... but what has been consistent, is increased stress. 

A 2016 study by Oretgo et al. reviewed and categorised research performed to assess the association between stress and generalised neck/shoulder pain.. When collating their findings, there was a strong association found between stress and neck/shoulder pain, with the proposed causing mechanism being "cognitive-emotional sensitisation". (visit this study here - or ask us for the full copy)

"Cognitive-emotional sensitisation" refers to the "overstimulation of pain related areas in the forebrain and brainstem regions'' due to psychological stress...

Yes, your pain may have become more noticeable because of stress.. but that doesn't mean it's all in your head. 

Psychological factors create a hypersensitivity of nerves, and so your brain detects more signals being fired, in comparison to less stressful circumstances. 

Here are some questions about stress and how it relates to your pain: 

- If stress is related to my pain, will treatment help? Yes, not only will it help you achieve some targeted relief, but with the release of endorphins that come from receiving treatment, you'll also have a chance to change your state of mind. It has been documented that after receiving treatment you have an increase in serotonin, dopamine and oxytocin - which are all hormones which make you feel good.. Of course, this feeling is temporary, but it gives you a chance to improve your thoughts and actions in the short term. 

- Why do I 'feel my stress' in my neck? There are multiple causes for this.. It may be that you already have an existing issue in the neck and stress is sensitising it; it may be that you're also straining your jaw which has a strong relationship with the neck; it's common to take short shallow breaths when you're stressed, so it may be that you're not breathing through your nose, and neck pain is linked to breathing shallowly through your mouth; it may be that you're staying in a fixed position all day, looking at your computer creating a "compter vision syndrome" (check out our instagram post about it)... We could continue coming up with reasons why it's your neck that becomes irritated, and it's largely dependent on your unique situation. 

- So my pain won't go away until I stop stressing? I'm always stressed... Stress is a normal part of life. It's unreasonable to ask any person to "stop stressing", but what we need to look at is how you're managing that stress. Do you have enough strategies in place to help you deal with the psychological load placed on you. Firstly, it's ok to not be ok.. but you need to speak up.. especially to help you manage the people or events around you that can afford to ease up and let you ride out the wave of stress. Try not to manage to many high stress things at the same time - this is very dependent on your personal ability to tolerate stress - know you're limit. You're pain can go away if you learn how to manage your stress levels. 

- If I can't reduce my stress, how can I manage it better? 4 easy ways that you can do right away... 

1. Exercise - this immediately changes the way your brain is working. 

2. Food - Get to know which foods you should avoid for your gut health and have a good balance of protein, carbohydrates and fats to help nourish your brain with the fuel it needs to function - (comfort foods taste good, but lead to more discomfort). Also if you need a good nutritionist, let us know. 

3. Breathing exercises - breathing in for 6 seconds repeatedly will allow you to take control of you breath and your mind - as the breath is one of your body's indicators of whether you're in a relaxed or stressful state. We like to take 3 drops of RocketFuel to clear the upper airways and nose breath 6 seconds in (letting it out) for 90seconds every morning and every night. (Ask us about our get to sleep routine). 

4. Meditation - building awareness and leanring to manage your emotions is a skill that can be learnt. Meditation allows you to face them and wrestle with your mind so, long term, you can learn how to control your mind. If you manage to do all 4 stress management strategies we have put forward here, you have given yourself a fighting chance to manage and control the stress you have in your life... Especially if you can't lower the causes of your stress. 

Our Chiropractors and Physiotherapists are always here for you, ready to Make a Difference to your life, and to your family and friends. If you know someone that could do with our help in Castle Hill, Bondi Junction, Brookvale, or Penrith OR, if you know someone on the northside of Brisbane, in Virginia, feel free to Make a Difference to them by sending this to them and we hope to be able to help them the same way we have helped you - to the best of our abilities.

How Do You Know If You're Recovering Enough?

We've worked with hundreds of athletes... 

Different sports

Different levels

Different shapes

Different sizes 

Across the board, there are common themes they all share, and in particular, the simple fact that they all need adequate recharge and recovery.

So let's talk about recharge and recovery in 3 different aspects:

1. Manage fatigue

2. Managing fight/flight

3. Managing mental health

Managing fatigue:

There are 3 kinds of fatigue as a result of training - mechanical, metabolic and neurological.

Mechanical fatigue refers to the amount you’ve accumulated in terms of volume and load. Metabolic fatigue refers to the biochemical processes required to deal with constantly producing and recovering from the usage of energy. Neurological fatigue refers to how intense your workout is or how much concentration was required. 

Your workout tends to lean towards one over the other, but you can have all three. There are physiological processes involved in the recovery of each one. There are some ways you can naturally expedite your recovery, but the best way is to simply respect the process involved. 

The amount of recovery required is hugely contextual and dependent on what you did compared to what you’re conditioned to do. 

Keep in mind, recovering from fatigue induced by the strength and conditioning program, does not mean you can return to training when you are ‘mentally’ ready. 

The best way to manage this recovery is to program it, and the best way to program it, is to work with a strength & conditioning coach who understands what type of fatigue they’ve just induced. 

Managing fight/flight:

Training can be stressful... It’s either your competitive side OR it’s your perfectionistic side. 

The competitive side comes out whether you’re racing against the clock or if you’re up against your training partner. The perfectionistic side comes out when you’re trying to master a skill or you’re in preparation for an event. 

Either way, it’s stressful! 

This fight/flight state is moderated by calming your nervous system down. Whether your tool is to use breathing exercises, meditation or supplementation, part of recovering well is moving from “fight/flight” to “rest/digest”. 

Managing Mental Health:

Training is a great way to manage your mental health… It improves our thoughts, it changes our hormonal profile, changes brain activity, empowers us. 

But, here we broach a crucial topic, that we see all too often...

So for people that NEED to train for their sanity, without understanding their mind, we see them heavily overtraining, and if they take a break, it causes them psychological adversity… so they become a slave to training.

More recently, we have also seen professional athletes suffer from psychological distress after the end of their careers. 

Learning about yourself, and understanding how to manage your mind, is absolutely essential. It is absolutely healthy to seek psychological support from a professional. Understand yourself first, so you can stay in control of your exercise and your decisions about training. 

If you need recommendations, let us know. 

I Got Told My Glutes Don't Turn On... What Does That Mean?

If only it was that simple - then we could flick a switch and go from "off" to "on". 

Believe us, your glutes work! 

Really what is happening here is a description of how you prefer to move or perform a task - a movement pattern or mapping pattern. Think about it this way... 

How many ways are there for you to drive to the beach? 

You could probably find 2-3 ways quite easily right?... Well, the same could be asked of your brain - how many different ways can we use our body to kick or throw a ball? 

There are many ways to do this, but the way YOU throw a ball would reflect the most learnt way of doing it, or your most preferred way to do so. It’s not always efficient or technically sound, but you can use so many different parts of your arm to throw the ball, but really, who's to say which is the 'best' way? 

So if someone said that your pec doesn't "turn on" when you throw.. you could easily reply with "so what?". So here's the real issue... 

We as humans in the 21st century have adopted behaviours, such as sitting for extended periods of time, that choose NOT to incorporate our glutes in daily activities.... But saying your 'glutes don't turn on' is unhelpful to help move us towards how we can improve. 

For argument's sake, if you NEVER used your glutes in your life and you also NEVER had an injury or pain - who is to say that using your glutes would be better for you? 

Let's go back to the map analogy of getting to the beach. If you only used one road to get to the beach, what happens if the road you take is closed? Do you have alternative routes to take? 

To be robust and resilient humans, we need multiple strategies to get from Point A to Point B, so we can accomodate for unexpected changes along the way.

Not using your glutes frequently, is like not using a highway frequently.

But to start learning how to use them, you need to learn how to incorporate them into your behaviour patterns - so doing 10,000 glute bridges won't necessarily teach you to switch them on more frequently. So a better thing to be told is… 

"We need to build more strategies for your movement which incorporate your glutes.."

or “Let’s create more alternative routes to get to the beach”.

Your exercises need to target the pattern you're trying to build! We, as Chiros and Physios, don't flick any switches, but we can help fast track your remapping.

Why Do I Feel 'Out of Whack" and What Does That Even Mean?

Have you ever had the sense that you’ve felt 'out of whack'? 

A lot of people get told that "one leg is longer than the other'' or that their "pelvis is twisted"... These phrases (or anything similar) are just narratives we use to help us explain what this feeling is, or why we have this sense of not being 'in line'. Long term though, these narratives and explanations aren't helpful... Your behaviour will naturally create asymmetry and activities in life are not symmetrical. 

So why should we expect our bodies to be symmetrical?!

So, you can feel 'centred' but be mechanically asymmetrical... And that is perfectly normal... But, how do we explain the feeling of being 'out of whack'? Let's explain this with a practical example... 

We are supposed to strive towards taking 10,000 steps per day, but how many of those steps did we consciously think about? We're more likely to detect mis-steps or steps that were unexpected, rather than notice all the thousands of steps that went according to plan... Walking is a reflex, and so is standing, so is sitting and so is working at your desk... So if part of your body isn't functioning the way it used to, your brain detects that there has been an interruption to your normal reflexive patterns. But how does that even happen? 

Our lifestyles are generally sedentary, and with the rise of people working from home, people are less and less active. When we stop moving part of our body, your brain stops receiving signals from the areas that aren't being used. It's clever, your body takes on and uses what it needs... So it will only build and maintain what it needs based on what demands are placed on it... In this way if you don't move your spine all day, you'll feel 'stiff' even if you've got the flexibility of a gymnast. 

The way to combat that, is to constantly remind the brain, how to use the joint and muscles to their fullest potential... Move, move, move. 

It doesn't mean you need to be a fitness freak, or super strong - it just means you need to MOVE. So when your behaviour only puts demands on one side of your pelvis, or on one side of your neck, what can happen is your perception of how well one side functions compared to the other is skewed, in comparison to how you have felt previously... We as humans, describe this process, as a feeling of being 'out of whack'... 

If you feel 'out', a great solution is to get MOVING, but you can always see a chiro or physio to help those areas that aren't moving to get a little push along, so it's easier to move it... 

The easiest, fastest, simplest and best solution is to MOVE. 

So, next time you're told that your 'hips are out of whack' or 'one leg is longer than the other', please know, that's completely normal, and what you need to do more of, is shake what your mumma gave you more often! 

Whether it's Chiropractic or Physiotherapy, we at Balance Health & Performance, have your back... Literally! In 4 locations in Sydney - Norwest, Bondi Junction, Brookvale &n Penrith.. AND our BRAND NEW SPACE in Virginia in QLD, we're here for you

Why does Balance Not differentiate between Physio and Chiro?

Is my problem a "physio" thing? or a "chiro" thing?. We get asked that a lot. Historically, there has always been a perceivable difference - going to the Chiro if "you're out of whack" and heading to the physio to recover from a “pulled ligament” or “strain”. 

Thankfully, we've come a long way, and we thought that rather than just share what the differences are, why don't we look at the similarities of what Chiros and Physios do here at Balance; and what we hope will also shape the future of this wonderful industry that helps Make a Difference to People's Lives. 

Here is what a Chiro or Physio will do at Balance Health and Performance. 

1. Get to Know You - we want to spend the time it takes to understand you and how the problem is affecting you. Sometimes, the pain is more than just 'pain' - it can enter your conversations, can leave you feeling like you're whining all the time and can even leave you feeling unmotivated and frustrated. The better we get to know how the problem is affecting you, the better we will be able to guide you through the process towards being back at your best. 

2. Find the Cause - regardless of whether you're a Chiro or a Physio, an important component of identifying where to start, begins with answering the question..."Is the problem due to behaviour or trauma?"... If the problem is due to trauma, a clear diagnosis and a management plan would need to be in order (like an ankle sprain or repair from surgery - yep Chiros do that stuff too)... and if the problem is due to behaviour, then it's less about what is 'injured' and more about what habits are 'injuring' it, or as we prefer to refer to it these days - makes the area "sensitised". Once we unpack the cause and get clear on whether the problem is a diagnosis like a sprain or strain; or something to do with your lifestyle, the next step is to... 

3. Make A Plan - it comes down to your goals. Your goal might be to just get out of pain, and return when you're back in pain again; or your goal could be athletic performance; or you need to feel good to be able to work; or to be able to look after a newborn; or you just want to feel young again...the list goes on. Whatever the goal may be, we want to work with you to set a target and work towards it. 

4. Follow Up - we want to ensure that we are with you along the way. We really do care about helping our patients, but just generally, we love helping people. We are keen to keep the conversation going, whether you’re in clinic or at home or work - as long as that's ok with you. 

5. Helping Family and Friends - it's common that your pain creeps into your daily conversations, and if it's been going on for a while, your partner knows about it, maybe even your boss and probably your friends too. We really do understand the impact of pain and it's why we take our roles so seriously. It means the world to us that if we can ‘Make A Difference’ to your life, then we can help you be better for all those around you - and better yet, we can help them feel their best too.... 

Now, knowing all this... Do you still want to know the difference between a Chiro and a Physio? Most people are ok with it... but if we want to look at some finer details... 

a)  Physios are trained to rehabilitate post-surgically within hospitals, and Chiros aren’t.  

b) Chiros are trained to manipulate joints and only some Physios are trained to do that. 

c) Chiros are trained to look at how they can impact the nervous system and physios are trained to look at how they can impact the musculoskeletal system.

d) They have a different certificate.

e) That’s about it.

The result, is always that you are cared for and are progressing towards achieving better health and optimising performance.

Across our 4 locations in Sydney: Norwest, Bondi Junction, Brookvale and Penrith; we ensure that all our teams are trained and professionally ready to build a relationship with you.

We're also opening in Virginia, North of Brisbane, Queensland, where we will be building a team there too. 

So if you know anyone, we'd love to help them up there.  

Running - The Importance of Load and Capacity

“It is estimated that 60% of all running injuries are due to training errors” - Hreljac, A; 2005.

This statement illustrates that when it comes to running, a huge factor in injury prevention is seen in setting up their technique and managing a person's volume of training. That is the total amount of training, not just running, in a program and may include frequency, duration, and intensity. This is referred to as the load of training.

“Have you ever felt like you can’t recover, or constantly feel tired?”

“How much training load is going through your body?”

When looking at training load, you need to appreciate that all training is, is creating a demand or stress. Your body has the ability to adapt to these training loads, which include muscles getting stronger, an increase in bone density, and tendons becoming more resilient. Load has 2 components that you need to take into account also: internal and external. Internal components are very dependent on the yourself, for example, factors like mood states, bloods (sex hormones, thyroid function, athlete monitoring systems), and rate of perceived exertion/RPE. External factors are influenced by creating physical, psychological or physiological demands like the training distance, frequency, time, speed and elevation.

As you could imagine by now there are a lot of factors to take into account, especially as a practitioner, when dealing with running and related injuries.

Most commonly people present with a disengagement in the training load and create overload. This is seen as pain or injury!

The 3 most common types of overload injuries in runners include:

1. Medial tibial stress syndrome (shin splints).

2. Achilles tendinopathy.

3. Plantar fasciitis.

“But why do you feel like you are getting injured all the time even when your diet, sleep and other factors are managed, while others rarely see an injury?”

It all comes down to capacity and recovery.

Capacity is your ability to absorb load and adapt to it. Much like when going to the gym. You lift a certain weight for 4 weeks and the weight becomes easier. Your body has adapted to the load and increased its capacity to lift more. Much is the same with running.

When looking at someone's training load it's important I see areas of increased volume with areas of decreased volume. Your recovery should be illustrated in your training schedule as well as incorporated into periodization.

What is periodisation you ask?

It’s the systematic planning of training. It is made of building blocks with variable loads and recovery to overall increase your capacity and assist in your performance. It is known as a chronic training base, and is made up of layers of foundation building.

Now, if you’re the person who doesn’t have a coach and usually programs for yourself, listen up! This will be useful. The 10% rule. It allows you to add 10% to your weekly training load to steadily increase your capacity to load. Yes it is still dependent on yourself and any prior training base building you’ve established to have a starting point (chronic training load), but generally is a helpful guide to training volume.

Where do I as a practitioner come into effect? I am here to mitigate any loading errors you may develop, while still increasing your capacity to load. Essentially, you increase your training capacity while staying relatively pain and injury free.

Sounds pretty good doesn’t it?

Concussion

In sports these days concussion is taken extremely seriously. Have you ever seen a big hit in the footy and the person gets up groggy and stumbling? Chances are they have some form of concussion.

Now people sometimes recognise concussion as a result of someone being completely knocked out! Which is true to some degree. However, there is a large scale of what is considered to be concussion, so let’s discuss why that is and the return to sport process.

In the US alone there are 3.7 million concussions each year. Of these cases, 10-30% suffered impairment or symptoms for months to years.

Pretty staggering stats!

Firstly, let's identify what concussion is and the forces involved in concussion.

In recent years, concussion has been difficult to define due to the range of symptoms that can occur with traumatic brain injury (TBI). B. Ferry (2019) described this difficulty because they “have varying severity, ranging from mild, transient symptoms to extended periods of altered consciousness, and the fact that most symptoms are self-limited.” Loosely it is deemed a disturbance of brain function due to trauma. 

Like I said, very broad and of large scale.

There is also current debate into what actually occurs in concussion. We know that concussion occurs due to a rapid acceleration and deceleration force and not just impact to the head, but some of the ideas proposed of the physiology of what occurs during this event include shearing of axons (brain cells) on one another, coupled with the proposed chemical imbalance that occurs post trauma. We could go down a rabbit hole here, so let’s leave it as food for thought.

Let’s have a look at some common scenarios and compare them to a concussion.

The forces involved in a concussion range between 82G and 116G (~98Gs).

A seatbelt force in a car crash at 50km/h - 60Gs.

The average football impact - 30Gs.

A sneeze - 3G, hence why they say don’t open your eyes when you sneeze.

Reflecting on these figures, you can really appreciate how much force the human body can absorb and deal with. The most common causes of a concussion are motor vehicle accidents (whiplash), and high impact sports e.g. hockey, rugby, footy.

Now let's have a look at the symptoms that CAN occur in a concussion, and remember, people have a myriad of symptoms and each case is variable.

• Headache

• Dizziness/Balance Problems

• Weakness or numbness in arms/legs

• Cognitive Disturbance/Slurred Speech

• Seizures.

• Memory/Concentration Impairment

• Visual Disturbances

• Fatigue/Drowsiness

• Psychological Distress

• Nausea/vomiting

• Neck Pain (in some)

See how all these symptoms are subjective and each symptom can have a large range of severity. That is why the definition and austerity of concussion is so broad! Nowadays, practitioners on and off the field need to identify this, and a great tool to do so is the ‘SCAT5’ (Sport Concussion Assessment Tool 5th Edition). It is a standardized tool for evaluating concussions. Click here for more information on the SCAT5.

Hip Rehab

Hands up if you’ve ever had a hip issue?

It's pretty common right?

They’re more common than we’d like to admit, and are often a risk factor in the development of injuries lower down the chain in the leg, knee and ankle. It's our job to assess whether it's the source of pain or injury, a symptom or a perpetuating factor.

Some of the more common list of hip injuries include:

• Hip osteoarthritis.

• FAI or femoroacetabular impingement.

• Bursitis.

• Tendinopathies - most common being the gluteus medius tendon.

In the event that the hip is the source of dysfunction for pain lower down in the chain would include injuries like ankle sprains/strains, ankle osteoarthritis, patella tendinopathies, patello femoral pain syndrome, and knee osteoarthritis.

It is imperative when assessing the hip for injuries that we really understand the anatomy, specifically with the power generators and the stabilisers. The main power generator of the hip is the gluteus maximus and the top (proximal) hamstring. These guys help drive forces through the hip to generate forward and backward movements. The stabilisers of the hip, and arguably the biggest hip injury offenders, are the gluteus maximus and minimus. These guys sit on the outside of the hip and help stabilise side to side movements of the hip. Funnily enough, there are little research papers that don’t differentiate the 2, and more emphasis is placed on the gluteus medius.

So how bout we look at the function of each the gluteus medius and minimus muscles in the table below provided by Semciew et al 2013. This will help us with choosing the appropriate rehab and why it's important.

Gluteus Medius and Minimus Functions

Let’s have a look at the different types of gluteus medius and minimus rehab exercises and how much Maximum Voluntary Isometric Contraction (MVIC), or the percentage of contractile tissue.

Take note: Reiman et al 2012 stated that 40% MVIC is the level of activity believed to be required during exercise to improve muscle strength.

GMED Rehab

Commonly gluteus medius rehab exercises are: 

• Clams (38-40% MVIC)

• Sideways Lunge (39% MVIC)

• Pelvic Drops (57% MVIC)

• Unilateral Bridge (47% MVIC)

Research has found that the most effective are:

• Side-bridge to neutral spine position (74% MVIC)

• Single leg squat (64% MVIC)

Side-bridge to neutral spine position video

Single leg squat video

How often have you been given one of the exercises from what the research suggests? Pretty significant in difference of results aren’t they?

Now remember what we said above about what little research there is differentiating gluteus minimus and medius? Moore et al 2019 states “The most effective exercises are those in standing positions with banded resistance” and there was “extremely poor research on isolation of the gluteus minimus muscle, and EMG data to support specific exercises”.

GMIN Rehab

Minimal research has found that the most effective exercises are:

Anterior segment

• Resisted hip abduction extension exercise (51% MVIC)

Posterior segment

• SL bridge (49% MVIC)

• Side Lying Hip Abduction (43% MVIC)

• Resisted Hip Abduction Extension (43% MVIC) 

• Single Leg Squat (40% MVIC)

Resisted hip abduction extension video

SL bridge video: same as above.

From the point of view of the practitioner in assessing and rehabilitating the hip, it's important to understand the differences in the function of the gluteus medius and minimus. Being able to understand and recognise what the current research states in accordance with specific types of rehab exercises and how much contractile tissue is involved with each is important when treating hip pathology. In other words, which exercises isolate the muscle we are trying to target globally in movement patterns and specifically. It’s not a cut case of “out with the old and in with the new”. Factors like demographics, non/partial/full weight bearing progression, and even patient reference need to be taken into account.

This is where we as practitioners have a duty of care to our clients to stay up to date with current research so that we can use the best evidence based medicine to assist in treatment and rehabilitation.

Heel Pain In Most People, Is Probably Not Plantar Fasciitis

Is heel pain a problem for you?

Has it been diagnosed as plantarfasciitis but not responding to any treatment?

Across our clinics we see many patients who present with heel pain after getting stuck into a new running program.

Trying to run, or even walk, with what feels like a little pebble in your shoe is quite debilitating!

At best it is definitely not comfortable.

If this sounds familiar, you will probably relate to following story we here all the time…

• You’ve just set your goal. A half marathon for the first time!

• People keep telling you which shoes to buy.. how to run.. how fast to run..

• After downloading the most popular running app to help coach you through your distances you start training.

• As at the start of any new fitness program your fitness improves. You feel good after each run! Secretly you start to enjoy the lung burn.

• Something happens…

• At the start of your next run, you notice a little ‘tug’ under your heel. It almost as if there is a pebble or something in your shoe. There’s nothing there, so why does it hurt a little? Probably nothing major.

• Run it out right!?

• You get to the end of your 5km for the day. Bit sore, but not too bad.

Until….

Waking up the next morning. Your heel is sore! Hobble around and it starts to free up and you’re looking forward to your next run. It’s there at the beginning again, but like last time it goes away.

3kms in, ‘Bang’

There it is again, but it’s worse than before. You need to stop and stretch! Something is definitely not right! This does not mean you have plantarfasciitis! Interestingly,

The majority of heel pain patients I help, present with symptoms of muscular overloading due to accumulative strain in impact type exercise. This is usually coupled with inefficient movement patterns and does not always support a diagnosis of plantarfasciitis.

I’ve noticed almost every case of heel pain in runners, will present with:

1. Smaller calf size on the affected side

2. Less strength endurance capability on affected side (single leg calf raise comparison)

3. History of ankle sprains

4. A recent change in load (hills/flats/sprints), equipment (type of shoes/orthotics), or technique (standing taller/toe strike vs heel strike etc)

Where we have had plenty of success in clinic is simply

• Identifying the component letting you down

• Strengthen it

• Integrate it

• Plyometrically and Directionally load it

• Metabolically load it

Then you’re free!

If you still feel you have plantarfasciitis there is one other reason your not getting better….

The plantar fascia is tissue that helps you transfer force through the foot and up the achilles to be absorbed by your calf, hammie, quad and glutes. So if it starts to hurt, it’s because someone else up the chain is not pulling their weight.

In the end… whether it’s heel pain or plantarfasciitis, the solution does not lie with just hands on therapy. You need to:

1. Get your movement checked and

2. strengthen the area’s of weakness and assymettry.

The Importance of Finding The Cause

When you’re body continually breaks down you get frustrated...

Why can’t someone just fix the problem!

It gets to the point where people considering giving up the activities they love. Whether it’s a sport you’ve played for years, going on long hikes through the bush or even simple things like gardening… you’re worried deep down some injury is going to prevent you enjoying what you like to do.

This was the case with one patient I saw last week. A 24 year old female who plays just below the National Netball League came in after 6 months of knee pain!

Her story shows the only way to eliminate pain

is uncovering the real trigger

The knee was just the latest in a long list of injuries... 

• Rib fractures (netball is definitely not non-contact)

• Occasional lower back tightness

• Stress fractures in the foot

• Recurrent ankle sprains

• Posterior shoulder pain

• Neck pain 

• Her Knee 

She had seen over 20 physios in 10 years!

Frustrating?

Words won’t do it justice. Even coaches and other players doubted she’d last more than 1 or 2 games. Since the knee is the current source of pain we have to start the investigation there.

What I found really interesting was off the court it only hurt at certain points … walking on sand, up hills and unstable surfaces. 

The rest of the time was pain free! 

She had already seen 3 different physios for this, I needed to help her before she gave up.

But how?

It’s not like the others did anything wrong. 

They followed an appropriate formula...

Evidence Based Approach: Treat the Local Area, The Joint Above and Below

That’s great, but what happens when it doesn’t work?

All this patient’s orthopaedic tests were clear. I tested everything that might directly affect the knee. There was no observable difference between left and right. In this case,

How do you justify treatment without a measure to improve...

No objective findings, muscular tightness or joint restrictions

And then… If there objectively there is nothing wrong why is  she still suffering? Now pain is a subjective interpretation of a signal inside the brain… could it be made up?

I don’t think so!

Why only uphills and unstable surfaces?

If it’s bad enough to stop her playing netball…

Why can’t I reproduce her symptom?

It’s Not The Knee

That’s why treating it hadn’t worked!

She has some sort of instability affecting her body… I just had to find it. Personally, I always go back to the body’s priority system and work from there. What has to fire first in every movement?

The CORE!

She had broken ribs before. I wonder if they’ve affected its ability to work? Definitely worth exploring. When you breathe your diaphragm contracts allowing air into your lungs, expanding your rib cage. It should be even on both sides.

My patient couldn’t open her rib cage on the right. Same side as her neck problem. This explained a few things for me but most importantly…

We have a measure from which to base treatment. There’s a difference between left and right diaphragm. 

Further testing showed a weakness in her right internal oblique. A muscle required for rotational stability of your torso. It can also indirectly affect the function of the knee.

I can all but guarantee if there had been an element of core stability in the initial rehabilitation she wouldn’t have had knee pain for 6 months! She would be playing netball and confident of completing the season. 

What Happens If I Don’t Locate The Underlying Cause?

• She’ll probably end up tearing the hamstring... 

• Compensate with other muscles creating a hip impingement. 

• More and more niggles = more frustration.  

• She would end up giving the sport away for good.

You Could Treat The Injury Forever And Never Fix It...

It comes down to being alert to the possible problems. Diagnosing on the principle of how the body functions not what treatment should be.

If you’re in pain and it’s not getting better it’s likely you haven’t found the real trigger!

Where So Many Practitioners Go Wrong

I’ve always loved this quote by author and psychiatrist Dr Gordon Livingston. It’s a short but challenging sentence I’ve used to great effect mentoring new physios.  

“If the map doesn’t agree with the ground, 

the map is wrong” 

It encourages you to think outside the box. Really look and understand what you see in front of you.

Whether you realise it or not, you have been taught to follow maps you’re entire life. As a child your parents provide you with a mental map to follow. They show you right from wrong, provide you with values...gave you a direction to abide by.

University is no different!

It teaches you the theory. Provides you with a thought process to follow. A path to adhere by. But what happens when the problem does not stick to the rules?

Everyday we see patients with injuries that don’t fit the mould.

In fact…

Less than 30% of patients fit exactly ‘what the textbook says’

Many physios and chiros fall into the trap of pigeon holing problems based on what they learnt at uni. They stick to and ‘trust’ the process.

Question is,

• What if your injury or tightness does not follow the rules

• Have you suffered other injuries that might be involved

• What if your body is different?

At what point do you stop, realise you're lost and recalibrate? 

Create a new guide based on what you actually see

I can tell you this…

If the theory applied does not match your body exactly, you won’t get better! 

 80% of the Time There Will Be a Curveball 

You will have symptoms which don’t respond to traditional thinking and treatment. 

One of the patients I looked after the other week is a perfect example. He had been suffering Achilles tendonitis for close to 6 months. He had tried every textbook approach

• Physio and treatment

• Had an injection

• Stretched,

• Rested

There was no change!

As is often the case…

In taking a more detailed history it turned out he had broken his femur causing the hamstring to stop working properly. This affected the tibia, changed how the ankle worked and put stress on the achilles. 

Unless the hamstring starts working the achilles will take the load and the tendonitis won’t go away.

Bottom line is this…

If It’s Not Getting Better...You Are Looking At The Wrong Map

You need to find the right one!

You should have some change after about 3 visits. If you’re not starting to see positive changes or progressing as you should you need to be able to quickly change direction. No point continuing the wrong way right!

If the plan isn’t working, you don’t stick to it just because. You alter the approach based on what you see. 

I’ve seen Achilles problems stem from a spinal issue, a shoulder problem, a neck problem, an opposite side ankle problem. It’s simply because everyone will compensate in their own way. 

Remember the quote,

If the map doesn’t match the land then the map is wrong. The theory needs to fit the patient, not the other way around.

This approach works. 

It’s a big reason why we get the results you’re after. 

7 Steps of Pain

According to the International Association for the Study of Pain, pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” (http://emedicine.medscape.com/article/1948069-overview#a1)

Lets discuss this. Yes, there is an injury present. Depending on what type of tissue and where the tissue is located, we may be more or less sensitive to it. So you’re not making it up, but you’re brain is definitely not helping!!

In my experience this is the general process in your head

1. Injury

2. Ignorance phase

3. Denial phase

4. Frustration phase

5. Analysis phase

6. Catastrophe phase

7. Referral phase

Let’s run through an example of how this process might work in action…

INJURY: (DAY 1)

Case history – 30 year old active tradesman, feels a little sore in the lower back during a set of deadlifts.

IGNORANCE PHASE: (DAY 2-3)

“Hmmmmm, that didn’t feel right. Probably a one off, let me try again next set see how it is”

The pain is still there and gradually increasing.

“I should stop but its probably cause its heavy. I’ll finish the workout cause its not that bad. Should be gone tomorrow, never really had it so it’s probably a one off”

Next morning…

“Ouch, my back is really quite sore, but its getting better after that hot shower, its probably just DOMS from the workout”

Been sore all day, must of been a tougher workout yesterday, I’ll go to the gym tonight though, see how it is.

No need to scale the workout - “I’ll be fine!”

DENIAL PHASE: (4-7)

Now it feels like it’s been a little too long for DOMS... Usually everything’s better by now.

“I should probably not train as hard and tell my trainer. I’ll do some mobility that should help”

FRUSTRATION PHASE: (DAY 7)

“This thing isn’t going away!”

It’s now stopping you from training and annoying you all the time!! Probably need to do something about it..

ANALYSIS PHASE: (Day 7-14) – where you now ask yourself the questions

– When is it hurting me?

– What can’t I do at the gym and at work?

– Where exactly is the pain?

– Every time I think about it, the pain gets worse!

CATASTOPHE PHASE: (10-14) – you now think its the worst case scenario

No need to lie… we’ve all been in this place and asked ourselves many of the following questions:

– This isn’t going away, am I going to be stuck with it forever?

– What if I can’t go back to training, then I’ll put on weight and feel the way I used to feel..

– What if I can’t work? Then I can’t make money and support my family..

– Can;t even play with my kids, am I gonna be one of those guys! That’ll kill me

– Do I need a scan? What’s wrong with me???

REFERRAL PHASE: (DAY 14-28/or longer) depending on severity

– I need to see someone about this quickly, I don’t know who though... I know, I’ll ask my trainer.

Bottom Line: Analysing the problem before you present for a consultation will help the practitioner, but book in with someone BEFORE that 10 day mark – it’ll save you a whole lot of stress that your mind creates for you and the process makes your pain feel worse than what it is!!

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