Pregnancy, Gymnastics and Weightlifting....Why Pilates?

The simple answer…

‘Pilates helps you make the most of what your body can offer’

I am definitely biased, but teaching Pilates has changed the way I assess and treat as a Chiropractor!

Just yesterday in the studio I was helping a lady in her 2nd trimester with pelvic pain, a junior elite rhythmic gymnast work on her turns and competitive weight lifter strengthen his core.

Interesting combination right…

So,

What Exactly is Pilates and Who’s It For?

Developed in the early 20th Century by Joseph Pilates, or Uncle Joe I like to call him, Pilates is a movement system where the focus is to strengthen, stretch and stabilise key muscles.

Originally it was a means for the rehabilitation of soldiers. Years later, after being refined through work with New York Ballet it is used by people of all walks of life to

• Deal with pain like supporting a growing belly during pregnancy

• Improve movement control like the turns required by a rhythmic gymnast, or

• Strengthen the core to assist in transferring force from your legs move a heavy barbell overhead

For me..

It’s the missing link between treatment, traditional exercise rehab and return to sport (or life)…

Now I am sure most of you have heard the connection between Pilates and your core.

It’s the key!

Your ability to become aware of and control movement from the centre out is critical for:

• improved performance

• injury prevention

• rehabilitation

This ‘core control’ is the central philosophy for all Pilates based exercises. Your ability to move effectively and efficiently transfers directly to recover and performance.

So you might be asking yourself,

What Exactly Constitutes Your Core?

I think it is essential that we all understand what the core actually involves.

I won’t go into too much detail but let’s start with the basics.

The core is like a barrel:

• The top is the diaphragm (or breathing muscle) and is located under you lower ribs.

• The bottom is your pelvic floor and is like a hammock or trampoline at the bottom of your pelvis. Most people think the pelvic floor is only important in women who want to or have had kids. Noooope! It is super important for everyone (including you, boys!)

• The front is a muscle called your transverse abdominals or TVA for short.

• The back consists of muscles called your multifidus

• Side consists of internal abdominal obliques or IAO

Your core muscles work together to create a strong powerhouse in the centre of your body.

If our core works well, it helps to control the rest of our body.

There are so many stories I could tell you about patients who have directly benefited from Pilates…

• The Mum who told me she has no pain in her back for the first time in 5 years

• The CrossFit athlete who hit a PR after learning how to utilise their core

• The runner who runs without lower back pain

Awareness of and ability to control your core ‘barrel’ play a critical role in your ability to recover and perform.

Pilates just happens to be a form of exercise perfect for teaching these skills.

Whilst it can be frustrating at times learning new ways to move – no growth or improvement comes without some type of struggle.

If you remember the case of my patient in her 2nd trimester…

She had been seeing me throughout her pregnancy for lower back and pelvic pain. This was her first pregnancy and by this point she was struggling to bend over and sleep due to the pain in her back.

A lot of her pain was due to the fact her pelvis was stretching to allow the growth of her baby. A completely normal part of pregnancy!

But for her…

It was causing constant discomfort.
She was struggling to sit and stand, drive and sleep.

Along with manual treatment to manage her pain, we implemented a gentle Pilates program to help her strengthen her core to help support her constantly changing body. Despite getting frustrated at times, these simple exercises worked perfectly to stabilise her expanding pelvis.

The combination of treatment and Pilates worked perfectly to reduce her pain levels as well as move more freely (without fear of injuring her lower back).

Clinical Pilates at Balance

Using specially designed equipment in the reformer, trap table and wunda chair we keep classes to a max of 3 so the program is always individualised and specific to your goals.

If you know there are issues with your core strength and movement control Pilates is the missing link.

There’s a reason I see most of our practitioners at Balance and there families for Pilates!

See the difference it will make for yourself.

For all Pilates appointments please call the clinic. If you have a friend you know would also benefit, get them to come along with you…

Shoulder Pinches? What you Need to Do...

If I had a dollar for every time I heard, ‘Why does my shoulder pinch every time I lift my arm overhead?’

I’d live in a 4 story mansion in Vaucluse, with a Lamborghini, Ferrari and Porsche in the garage. Well not quite, but you catch my drift.

Most of us have either experienced or heard someone complain about this type of pain in the shoulder. It’s one of the most common questions I hear in clinic.

Often followed by a series of pressing queries…

• Am I lifting too much weight?

• Is my form wrong?

• Should I stop lifting all together?

• Is this what Armageddon feels like?

Alright, just calm down for a second or two.

Without keeping this blog too dry, let’s have a quick look at what the shoulder joints are made up of

The Shoulder Joint Simple, Systematic and Sweet

The shoulder is made of 3 main joints:

Scapulothoracic 

Shows how well and smooth the connection is between the shoulder blade and the back of the ribs

(yes your ribs are not just at the front but in fact start at the spine – hence the word ‘ribcage’.)

AC (acromioclavicular) Joint

Is the connection between the collarbone and the front of the shoulder blade

 Glenohumeral Joint

The connection between your arm and the shoulder blade

Have you noticed a common theme in the shoulder? If you read the table you’d pick it… Do you think the shoulder blade is important with any sort of shoulder problem? I bet you’re saying, alright baldy, I’ve heard enough on the anatomy lesson…

The Shoulder Blade Is Key
But How Do I Fix My Bloody Pinching?

This is where I get to have some fun playing detective. Need to figure out the ‘why’

Usually when people complain of pinching going overhead at the tip of the shoulder, they point straight to the AC joint.

Why?

Well, what is in the joint… bursa which reduces friction between the tendons of the long head of biceps tendon and the supraspinatus tendon.

Why is that important? If you look at the mechanics of the shoulder, in simple terms

Glide – Slide – Rotate – Compress

When we lift our arm from by our side over our head:

• our shoulder blade has to “glide” upward and outward freely over the rib cage.

• the humerus head simultaneously “slides” downward while “rotating” upward.

• the AC joint (at around 45 degrees +) needs to “compress” itself to allow for the continuation of this movement.

*If it any point the words highlighted are altered in anyway, you will have pinching in the shoulder,

Alright mate, stop with all this medical mumbo jumbo and get to the point.

WHY?

Just kidding, but really I’m not. The “pinching” sensation is the effect and site of pain. This can be treated and you would feel better. But as the spinal neurologist Dr. Karel Lewit said –

“He who treats the site of pain is lost”

The pain will always return unless you treat the WHY?

The pinching pain could be from inflamed structures within the joints or altered mechanics. Generalised rehabilitation of your shoulder doesn’t always work.

It needs to be targeted and specific to YOUR diagnosis and/or dysfunction.

If you don’t believe me, have a look at how many muscles influence the shoulder joint…go on I’ll wait

Even without reading all those crazy names of muscles above, you can appreciate that any one of them overworking or underworking will have an effect on the functioning of the shoulder.

Now that we have looked at the functioning and anatomy of the shoulder how can I tell what is the real cause? You need

A systematic approach to diagnose a disorder or dysfunction of the shoulder

I like to start at the joint closest to the body. The reason for this, is what I like to call

The “cascade” effect

If the joint closest to the trunk of the body is dysfunctional, it would make the rest of the chain also dysfunctional. Hence a wrist or finger issue could be cause by a shoulder blade issue. So….
I start with the shoulder blade, and then make my way to the AC and glenohumeral joints respectfully.

But…How do I fix my shoulder pinching?

Well…. 

I’m not going to tell you!

I could give you 50 releases and another 50 rehab exercises, but I have no idea if it’s going to help YOUR shoulder.

Everyone is different!

We are all unique in our makeup, character and function. That is why it is so imperative to have a diagnosis of your shoulder issue.

My best advice

Get your niggly shoulder that:

• has been pinching for the last 3 months

• you thought would get better with time

• and hasn’t…

Checked by a medical professional. Make sure they explain what is wrong with YOUR shoulder and how to solve the issue.

Lastly, don’t be afraid to ask them WHY?

Runner's Knee - Do You Have It?

For me, there’s no better feeling than completing a solid early morning 5k. The fresh breeze and crisp morning sun gets the endorphins going, sets you up for the day.

We all know there are many benefits to running:

• Reduced risk of lifestyle diseases

• Improved heart health

• Losing weight

• Stress relief

• And more…

Whilst not everybody shares my love of getting up at the crack of dawn to go for a run. It is one of the more popular activities when it comes to staying fit and healthy.

Problem is…

Not Everybody is Ready to Run

Did you know,

‘knees experience pressure equal to approximately
5 times the body’s weight when running’

It’s not surprising that I see so many knee problems from people who run for fun. Particularly patellofemoral pain syndrome. They just keep coming in!

One of the cases I saw last week is very typical.

If your knees hurt when you run this might just be you!

Like I try to… she runs 3-4 times per week for about an hour. Without fail, as soon as she hits 2k a dull ache creeps in under the right knee and doesn’t go away.

There’s nothing worse than finally getting into a rhythm and having to start walking because of your stupid knee.

Interestingly, she also complained of tightness in the front and inside of her hip which got worse after a run.

Like you would treat any kind of pain it’s a,

Simple 3 Step Process to Treat Knee Pain

1. Assessing her running technique

2. Use tests to confirm a diagnosis

3. Treat and manage the problem!

What to Look For…

It didn’t take long to work out her knee caved in every time she landed on the right leg. Remember the 5x body weight pressure on the knee when you run?

This amplifies that pressure!

No wonder the knee always hurts…

You might not notice it yourself when you run, but look at the picture below. It just looks wrong when the knee caves in!

So What The Heck Causes the Knee to Cave?

It could be a few different factors. In this case…

An extremely weak right gluteus medius
(side of your butt or hip)

If anatomy of your bottom interests you, the medius is one of 3 gluteal muscles:

1. Gluteus maximus

2. Gluteus medius

3. Gluteus minimus

The role of the gluteus medius is to:

• Abduct the leg

• Externally rotate the femur

• Stabilise the hip and pelvis during single leg stance.

In simple terms, it’s is essential to keep the leg straight! If it’s weak or doesn’t work…

The body compensates by recruiting the hip flexors, quadriceps and adductors. Hence you may recall the sore hip after my patient went for a run!

This is PFPS or patellofemoral pain syndrome.

It affects a wide range of ages, beginning in early adolescence and creates greater risk of knee osteoarthritis if it isn’t dealt with on its first occasion.

So how do we fix this problem?

Come and see me or one of the team… That’s the obvious answer, but here’s a brief snapshot of how I approached this case of ‘runner’s knee’

Process For Treating PFPS

• Release what is overactive through the use of soft tissue massage, dry needling or active release technique

• Provide external support initially through taping to ensure the kneecap sits correctly

• Activate/strengthen what is underactive through the means of strength exercises

• Provide a targeted, individualised home exercise program to ensure ongoing strength improvements

• Progress running distance as strength progresses!

I know first hand how frustrating this problem can be. Just like my patient I’ve had to overcome the debilitating nature of the pain and its effect on running.

Good news is… If you get it early, the rehab and progress is quicker than you might think. There’s a strong chance you will be back running pain free before you know it.

If you or someone close to you complains of the knees hurting, or they won’t run because it hurts we would love to help.

Just call the clinic and one of the team will be there to help you. It’s a condition we all treat regularly with good success.

Is Back Pain Interrupting Your Life?

Let me show you the exact 2 steps you need to all but eliminate the ongoing discomfort in most cases.

Considering 90% of people suffer from it at some point in life, “I have a sore back” is not an uncommon phrase. Just last week in Castle Hill I had a patient who’s been saying it for 18 months!

The hardest part for him…
it came from nowhere

No major fall, no sporting accident, nothing significant he could remember.
Being in pain and not knowing the cause, that’s frustrating!

Injuries like his, which occur innocuously are usually the result of everyday tasks. Turning to the shut door, picking the kids up or carrying the groceries in. Movements you need to live!

It’s not like you can just avoid getting in and out of the car..

Instead…

You subconsciously create a behaviour pattern called fear avoidance.

You still perform those daily activities, your body just compensates.
It get’s on with the job.

In fact, sometimes the pain even goes away…
Well for a few days anyway, before it usually creeps back.

This really resonated with my patient.

‘Matt, you’re right – I’m actually not feeling too bad today, I wasn’t sure I needed to see you’.

It’s almost as though he felt like a fraud walking in.
He wasn’t sure there was an issue because it doesn’t always hurt.

I can tell you now,
the pain will always return.

That niggle in your back does not just go away!

Want To Know How To Fix It?

The problem here lies in function, not the condition. Even though it ‘feels stiff’, the underlying cause is weakness not tightness.

As it was in this case, the chronic back pain was the result of the true core muscles not working

Step 1 – Make sure your core is working and strong

This is always the first step..

And I don’t mean start doing crunches and holding planks for time. I’m talking about your inner core. A group of muscles consisting of the transverse abdominus, pelvic floor, internal oblique, diaphragm and multifidus.

The most effective method I’ve seen for achieving this is clinical pilates. Not the choreographed classes on every gym timetable, but performing individually chosen exercises on reformers and trap tables in a studio.

In this case, we got the core working and within two weeks his back was feeling better than it had in a long time…

After 4 another four weeks of Pilates, his back had improved out of sight. I thought it was time to ask if he felt pain anymore?

“Nick, it’s so much better! I only get the odd niggle now and then..”

So it’s better, but not right!

Step 2 – Go Back and Fix Your Old Injuries

That old ankle sprain or shoulder problem may be why you core is putting in a sub par performance, forcing your back to pick up the slack.

Let me explain…

When you injure a joint, the natural reaction is for the muscles to spasm into flexion.

Think of what someone does when they hurt their shoulder. Immediately they lean forward, bend the injured arm and hold onto it for support.

They’ve flexed the torso, both shoulders and both arms!

This response is a primal instinct for survival. Safety of the injured area is your brains priority. In my experience, if you don’t do your rehab properly this ‘protective mechanism’ becomes an ingrained movement pattern..

Your ‘shoulder’ will function first instead of your inner core. This compromises your central stability causing what problem?

That’s right…back pain!

Whatever you do – don’t try and diagnose then fix this yourself.

You must get it properly assessed…
determine which old injury is the problem…
then formulate a plan to correct it!

Stop wasting time, putting up with the pain and get your body sorted…

Connect Your Brain to Your Body - And Your Body to Your Brain

It’s a bit of a tongue twister, but it is one of the easiest way to explain the concept of motor control. Why is this so important?

It’s the cascade effect. Poor motor control lead to an…

→ inability to coordinate muscles with movement

→more pressure through passive structures (joints, ligaments)

→injury

But what is it exactly?

Motor Control Technical Explanation

 According Roller et al (2012) in Contemporary Issues and Theories of Motor Control, Motor Learning, and Neuroplasticity, the production and control of human movement is a process that varies from a simple reflex loop to a complex network of neural patterns that communicate throughout the Central Nervous System (CNS) and Peripheral Nervous System (PNS).

In simple terms…

connecting brain and body to produce movement

In clinic, the first step with any new injury is to work out the diagnosis. You need to know what you’re trying to fix right!

In my experience, this diagnosis can be loosely grouped into two categories:

1. The result of direct trauma

2. Behaviour and motor control

And guess what?

Direct trauma creates a change in behaviour and altered motor control….

I’m sure you’re starting to get an appreciation for just how important motor control is in how your body functions. I’d love to share with you a couple of examples to highlight this…

Motor Control and the Shoulder

You may be aware the shoulder is a ball and socket joint. Its structure is designed to provide freedom of movement.

Imagine a tennis ball sitting on a golf tee…

This allows movement in all planes – forward, backward, up, down, and internal/external rotation.

Holding the joint in place through movement is your rotator cuff. The role of these muscles is to pull the humeral head in various directions ‘stabilise’ the ball and socket joint as it moves through range..

If the control isn’t there…

We start to encounter problems:

• Shoulder instability

• Rotator cuff or bicep injury

• Reduced shoulder rotation

• Reduced scapular muscle activation

All of the above contribute to poor biomechanics and thus reduce control, quality of movement, stabilisation and efficiency. A motor control problem.

These dysfunctions then lead to common injuries like shoulder impingement. Pushing through the pain feeds the issue and can lead to greater injury, such as tendon or muscle tears and labral injuries.

Motor Control and the Pelvis

For those runners, heavy lifters or even dancers! Lack of pelvic control, whether it be forward/back or side to side, places increased stress on lower limb muscles and tendons.
For example; poor core activation during activity

• leads to excessive anterior tilt of the pelvis,

• the hamstrings work overtime…

• overuse and tendinopathy or hamstring strains.

Another example at the hip…

Do you know someone who complains of knee pain walking up/down stairs or during a squat? I’ve had it myself!

Poor control and activation of the gluteus medius (muscle at the side of your butt) leads to

• a drop of the hip on the same side

• internal rotation of the upper leg (causing the knee to drop inwards)

• increase load and force through the outside of the knee joint

• pain and dysfunction.

Have you noticed the pattern?

Issues with motor control have a cascade type effect that almost inevitably ends up with some type of injury.

So the million dollar question…

Can You Fix a Motor Control Problem

Short answer is YES!

With a physio or chiro assessment, we determine what’s compromising your movement and provide treatment and rehabilitation to conquer the problem. The most important thing is that you do your homework!

This will allow you to move pain free, with more freedom of movement, control and efficiency!

The earlier you identify and work to correct a motor control problem the easier and quicker it is to fix…This begs the question:

How Do You Know If You Have a Motor Control Issue?

Be aware of how you move…

• Do you take most of your weight through one leg?

• Is it easier to rotate one way over the other?

• Do you find ways to cheat with exercises?

Alternatively – get your movement assessed by someone who knows what to look for…

Men's Health: Action-> Awareness-> Reduction

Awareness is not only for men – It’s important for partners, friends or family!

When people hear the term Men’s Health… inadvertently you think worst case scenario:

• prostate cancer and

• testicular cancer

Yep that’s right, we always have our family jewels on our mind!

But what about other issues like sexually transmitted infections, erectile dysfunction, male-pattern baldness, cardiovascular disease, and in my mind one of the biggest issues of them all: mental health, also known as The Black Dog.

I’d like to bring to your attention some alarming facts about men’s health that doesn’t involve cancer or depression.

Men…

• on average, live 4.4 years less than women.

• are more likely to die from heart disease at early ages.

• are at a significantly higher risk of dying from liver disease.

• have an increased risk of dying from diabetes

Plus:

• 80% of spinal cord injuries occur in young men.

• 70% of developmental and learning disabilities affect boys.

• Men make up 56% of the workforce, yet 94% of all workforce fatalities are men.

• Alcohol kills almost 6x more men than women.

Most of these facts above are lifestyle related. Which means THEY ARE REVERSIBLE!

That is 70% of a Man’s overall health is determined by unhealthy lifestyle choices, meaning 30% of men’s health is determined by his genetics. The image below sums this up perfectly.

Lets take a look at different decades in a man’s life and see the biggest issues that arise. If you are a guy reading this, or you’re a partner reading this, I like to look at this as “planning ahead”.

20’s – I call this “the fun decade”.

That’s why in young men their is a high incidence of contracting STDs. Some advice for you all: WEAR PROTECTION

It’s called a condom and don’t be afraid to ask if your partner is on some sort of protection too. Their is never a dumb question when it comes to this, and a recommendation, get an STD check, especially if you experience burning while urinating, itchiness (down there), pus discharge from your penis, and discomfort in testicles.

In fact, it is suggested to get a physical and blood/urine tests yearly, and after each sexual partner.

And now to the fun part… lads, get your hands in your trousers, because its testicular examination time from now until late into your life.

Movember describes this as “Knowing Thy Nuts”. Grab 1 of your mates downstairs and feel around for any irregular bumps, granules, tenderness or any change in size or shape. Then rinse and repeat on the other mate down there. I know we spend a lot of our time with our hands in our pants, but it is recommended that you also ask your GP for an exam too.

30s – This decade is the greatest rate for suicides among men.

Very close behind are teenage and 20s years and 40s. This is one of the most ‘in your face’ topics we need to address. Suicide and mental health issues among men have increased significantly over the years.

Great initiatives and organisations such as Movember, Man UP, Beyond Blue and R U OK? are the segway into dealing with suicide and mental health.

One of the hardest things for men to do is open up about such issues, whether they believe it to be embarrassing or an inferior trait. 1 in 2 Australian men experience some form of mental health problem at some stage in their life, and 3 out of every 4 suicides are men.

Guys, don’t be afraid to talk. Talking leads to asking, asking leads to listening, and listening leads to encouraging action!

40s – The decade where all our bingeing, drinking and inactivity really catches up with us.

Cardiovascular and coronary disease are the leading issues here, as well as the scary finger up the bum. Yep that’s right, screening for prostate cancer, well really starts in your 20s/30s, but you’re going to get 1 every year from now on until late in your life. Male pattern baldness, if it hasn’t already popped its head in (pun intended), is surely on its way if your family has a tendency for it. And as 1 bald man to another, fuck it…embrace the baldness and rock the living shit outta it!

50s and 60s –

The time where health checks become more regular as all the issues above are still present, and even more so colorectal screens for cancer and Alzheimer’

So, how do we combat all these issues that arise in men’s health? Lets keep it simple and sweet.

Eat healthy – spend 80% of your diet eating fairly healthy, 10% of your diet eating moderately healthy, and the last 10% eating whatever you want. In simple terms we need a balanced lifestyle when it comes to eating “right”. This will help reduced cardiovascular and coronary disease, diabetes, and improve mental health and physical health.

Be active – not going to say train 6/7 times a week, because lets face it, it probably won’t happen. Try and train 3x/week at moderate intensity. I would recommend 1 cardio session (run, swim, hike, bike), 1 strength session to include weights, and 1 workout session (HIIT is great!).

Get regular checks from the GP – getting regular checks from the GP regarding your health is recommended. Staying on top of your health, whether it be lifestyle related or genetics is an important part of the screening process into Men’s health and prevention.

Be heard – someone is always listening, and from 1 guys to another, we are here for you! Don’t be afraid to speak out, especially if something is bothering you physically or mentally. People often think action requires motivation. No. It is action that generates motivation to create more action to continue the cycle.

Don’t be afraid to take action today, so that we can live life tomorrow.