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!!

Read More From Our Blog

Have Kids Ruined Your Core?

If Your Back Constantly Aches, Your Hips Feel Rotated And You’re Embarrassed To Run

You Need To Check For Separation

If after having children you struggle to control your bladder when you run, worry about sneezing and refuse to skip because it’s just embarrassing then you need to have your separation assessed.

Even if your kids are nearly 10 years old!

This is what I found with one of my recent patients in Bondi. But it’s not why she came in…

She wanted help figuring out why her back pain just wouldn’t go away. There was nothing severe about it, just a constant tightness.

She brought the recent xrays her normal chiro made her get…the spine was in great condition. Way better than mine. There was

           no scoliosis

                  no obvious degeneration

                           no glaring bone deformity

It was fairly straight and uncomplicated. So why the constant back pain?

At 43 years old, she was just sick of waking up in the morning her feeling like an old woman.

Before coming to Balance she was seeing her every month, sometimes more. They believed the pain was a result of her ‘twisted pelvis’. Getting it adjusted helped but it always seems to come back.

To me…the twist seemed more like a compensation pattern than the root of the problem.

As we were discussing how her body moves and feels in general I discovered she still pees a little when running or sneezing unexpectedly. To me this is a massive hint she has a core issue. Immediately my focus went to assessing it.

She had what we call a diastasis rectus abdominus. Abdominal separation. It was around about 2cm and has probably been there since giving birth 9 years ago.

In her case the separation was actually 3/4 more on the right side compared to the left. This same side also tested weaker through the internal oblique (one of your inner core stabilisers). No surprise she also feels the back pain more on the right!

Her body has been forced to work around this issue for 9 years. Walking, running, in the gym and  with everyday activities her body has found a way to compensate for this core issue.

You know how she compensates – rotating the pelvis!

Until she addresses the core imbalance treating the hip will only ever be a temporary solution. You may be thinking…

Why did the Obstetrician and the midwife nurses not say anything about the separation in the abdomen?

She was definitely surprised they didn’t!

Whilst I could argue they should have mentioned it, honestly it is not life threatening and not that bad.

However… If these things aren’t addressed soon after giving birth, then they carry on. They become a problem years later. At the end of the first appointment we had our diagnosis, she understood what the actual problem was. Not a twisted pelvis but asymmetrical abdominal separation.

We also had a specific plan of attack…

1. Treat the back pain and hip rotation for some temporary relief

2. Specific corrective exercises to

   • address the separation and

   • strengthen the weak internal oblique

We followed this approach for two weeks. Each time reassessing and making sure we were following the right path. It was improving steadily which is always a good sign.

A month later she booked in for a review. She was so excited to tell me it hadn’t felt this good in such a long time. I reassessed everything, the back and pelvis, the separation, the core. The difference was significant.

The best news… There was no reason I needed to see her again.

This is just one of the cases I’ve seen recently where problems have developed in women who haven’t addressed common post natal issues. Whether it’s pelvic floor dysfunction, abdominal separation or asymmetries in the core…you really need to get it checked.

A few simple but targeted exercises with a little specific treatment can prevent niggles like ongoing back pain from ever becoming a problem.

If you have kids and know you don’t have full control your bladder let one of our physios assess your separation and core control. The longer you wait the harder it can be to reverse the compensation. Just call the clinic on 9899 5512 and ask for one of the physio’s who specialise in post natal care.

Ever Wondered What A Popped Rib Feels Like?

Have you ever sneezed and felt something ‘go out’ in your back? Can’t twist, can’t stand up straight, its hurts to breathe let alone laugh!

Almost feels like you’ve popped a rib out.

I don’t know about you, but if I had these symptoms I’d be freaking out! What have I done? Why can’t I breathe properly? Being in a position where you feel frozen and any movement hurts is always going to cause alarm. A completely normal reaction and that’s okay.

Fortunately… This type of injury doesn’t hang around for too long. And ribs definitely don’t literally ‘pop out’!

Still, it’s quite a scary injury to suffer. So, why does this happen and what should you do?

Simple Reason Why You May Be Susceptible to a ‘Popped Rib’

Usually it’s a good sign you’re not using your core symmetrically.

As a result:

• Your ribcage wants to rotate better on one side than it does to the other.

• This compresses your rib joints next to your spine on one side

• All you need to do is twist (or sneeze) and it feels like you’ve ‘popped’ something.

The 5 Steps To Manage a Rib Injury

1. Stay calm – you will be okay

2. Try and put yourself in a comfortable position lying down with you knees gently bent and feet flat on the floor

3. Gently lower your knees from one side to the other 3x each way.

4. With knees back in the centre – take 3 slow, controlled breaths as deep as you can without pushing through pain.

5. Repeat 3 times and then as often as necessary throughout the day

Obviously, you also want to seek treatment to help get out of pain as quickly as possible.  Breathing and moving your upper body is quite important after all. Just be careful you avoid some really common mistakes in the meantime. The last thing you want is to make it worse by: 

• Trying to ‘crack’ your own back to ‘put it back in’

• Take anti-inflams and continue on with normal activity

• Trying to get a ball into the sore spot to release it

• Asking a friend to ‘crack’ your back

Once we get you out of pain, the next step is to figure out why it happened in the first place. It’s not something you want to happen again.. Trust me.

Getting an appointment ASAP is the best course of action. The last thing you want is to try and sort this out on your own.

Exercises Are Only Problematic If They Are Poorly Prescribed… Why Most People Misinterpret The Jefferson Curl

Coaches, chiros and physios all seem to miss the fact this movement is not a strength exercise! It’s not designed to load spinal flexion.

It’s time to set the record straight…the for and against of using this exercise

3 Reason You Should Learn The Jefferson Curl Before You Blow a Disc In Your Spine

Is Your Spine Intolerant To Flexion?

Every day I see patients who have a ‘flat spot’ in their lower back as they bend forward. To me, this is an indicator of either…

• a previous either a history of back pain or,

• an increased risk of injuring their disc.

You need to be able to flex your spine. If you struggle to do this it’s not a matter of avoiding it. You can’t live without spinal flexion. 

Instead of continually hurting your discs, would it not make sense to learn to flex each vertebra one at a time… This focus on motor control teaches the brain to understand a movement that should automatically occur, be reflexive.

A Jefferson curl starting at the neck then slowly curling your entire spine one vertebra at a time is brilliant in helping the brain understand how the spine should move into flexion.

Do You Need To Learn How To…

Simultaneously Maintain Spinal Movement And Center Of Gravity?

This control is critical every time you want to pick something off the ground. 

When you flex your spin, your hamstrings need to engage to maintain centre of gravity. Basically they are the anchors stopping you from falling forward every time you lean forward. 

The goal is not to build strength in the hamstring but teach them how to eccentrically load in conjunction with the spine.

Note again it’s about the movement and coordination of muscles. Not strength!

Can You Eccentrically Control Your Spinal Erectors?

For your spine to stay stable, you must be able to lengthen the spinal erectors under tension. 

This will only occur if you allow your core structures to take over. As you breathe out to flex the spine your…

• Lower abdominals

• Lower obliques

• Pelvic floor

• TVA

…all have to engage to create enough spinal flexion! 

At the same time…your lumbar and thoracic erectors have to eccentrically load firstly and then secondly so do your multifidus. Multifidi are usually the ones that fail. 

It happens near when you bend and rotate to pick something off the floor because you haven’t taught them how to eccentrically load. This is where people end up hurting their L4, L5, S1 discs. 

The Jefferson curls is a great because it…

• teaches the multifidus and spinal erectors how to eccentrically load

• helps you understand how to breathe for movement control

• help the hamstrings understand their role as anchors

• facilitates engagement of TVA

If you don’t know how to control this common movement, how are you going to pick anything up off the floor?

In saying that…

You Just Can’t Give This Exercise To Everyone

If you don’t know how to use your hips properly…

• You’re never going to be able to engage your hamstrings correctly

• You will always incorporate too much of a knee bend

Before You Even Contemplate a Jefferson Curl You Must Be Able To Hip Hinge

If you don’t you’re always going to rely on their quads. The problem with this, it’s not going to allow your posterior chain to eccentrically load. This puts pressure on the front of your hips first then straight through your discs.

Lifting weights without knowing how to hip hinge means it’s only a matter of time before you’ll start seeing lower back and disc problems.  

The ability to hip hinge takes priority over using a Jefferson curl to learn motor control of flexion.

Even Then It’s Not Your Go To Exercise

I will never prescribe this exercise until I know you can perform a regressed non weight bearing variation. I use band assisted roll up (sit up). It’s orientation to gravity is different so the challenge isn’t exactly the same, but it does follow the same movement pattern.

If you can’t perform this exercise I’m not going to add more variables and increase the challenge by having you stand up and do a Jefferson.

The Biggest Reason To Avoid A Jefferson Curl…

 PAIN!

If it’s aggravating your symptoms this exercise is way to advanced for you. Do not push through because you need to learn the movement pattern. Stop immediately, regress and then build up to a Jefferson.

Remember You’re Not Doing This To Build Strength

Focus On Movement Control And Save Your Spine

Injuries and Fatigue: What You Need to Know to Train Safely

Have you ever felt a muscle spasm towards the end of big really intense workout in the gym?

Whether it’s from training with your PT, smashing through a Crossfit class or pushing yourself at an F45 gym, we often see patients who sustain minor injuries under fatigue..

That little pull in the lower back,

Twinge through the shoulder,

Catching in the knee!

It doesn’t happen right away. It’s usually the last set of Squat Cleans, final round of Kettle Bell swings or the nasty little finisher your trainer gives you at the end of the session.

If this sounds familiar to you…

Here’s Why It Happens

Throughout a workout your body actually undergoes multiple changes including:

• Physical movement and mechanics
  does your first rep look and feel exactly the same as your last one!?

• Adjustment to basic respiration
  (you start breathing harder right!?)

• Chemical changes
  (ever felt the burn from lactic acid build up!?)

You even experience..

• Psychological changes
  (I know I have to constantly focus on my mindset to keep pushing toward the end of a workout)

What this means…

If you can perform a repetition of a movement, let’s say a deadlift, extremely well in your first 10 reps this doesn’t equate to you being able to perform the same quality of deadlift under fatigue.

Okay, so we know fatigue changes things (you probably knew that to some degree already).

Question is, how do you manage these changes?

Three Steps to Reduce Risk of Injury Under Fatigue

1. Develop proficiency in the movement skill

2. Incrementally increase strength loading to build tolerance.

3. Work on your proficiency of movement under incrementally increasing fatigue

How quickly you move through these three steps really depends on the ‘skill level’ required for the movement.

For example,

Olympic lifting variations    VS    Burpees, air squats, rowing erg

Performing a large number of burpees or air squats or calories on the rower could be deemed as much safer due simply because they require less skill.

Olympic lifts are not only more technical but involve greater loads.

In other words, they require more movement proficiency, have greater strength demands and are harder to perform under fatigue!

Applying these 3 steps to any strength program, rehab program, general training will ensure you are doing everything you can to stay healthy and we know what that means → more gains.

Ever Heard of Snapping Hip?

Have you ever heard someone’s hip make this audible popping noise? Maybe you’ve felt it yourself…

That yucky feeling when your hip clicks as you straighten your leg from a flexed position at the hip. Sometimes it gets a little bit sore but it definitely doesn’t feel right.

Chances are this could be what we clinically call:

‘Snapping Hip Syndrome’

Sounds painful doesn’t it!?

In actual fact, the click itself is simply either your hip flexor tendon flicking over part of the pelvis, or your hip joint rubbing on joint surface.

Why does this happen?

Simple Answer:

Your core is underperforming causing changes in the position and muscle usage at the hip and pelvis

For those of you who love the detail…

The Cause of Snapping Hip Syndrome

One of your hip flexor tendons, the Psoas, connects your spine to your hip joint. It’s main job is to coordinate the position of the hip and spine – kind of like a marionette puppet. It can only really do its job properly when the core and the spinal muscles are working properly.

So when you feel the ‘click’ its a great indication that your core is under-performing, forcing your psoas muscle to work harder to keep the spine stable, at the same time as needing to produce hip movement. It then changes its position relative to the pelvis and starts snapping on the iliopectineal ridge of the pelvis and starts to change the position of the hip joint.

So, we know what it this Snapping Hip Syndrome is. I’m sure the next question is…

How Do You Fix a Snapping Hip?

Or maybe we should be asking… Do we even need to solve this problem?

A purist Chiro or Physio would say – absolutely you need to solve it. A disengaged core will overload your spine, pelvis and hip and expose you to potential injury.

Conversely, If it’s not always painful, and isn’t interrupting your ability to perform your everyday tasks do you need to fix the problem?

Or is it simply a matter of management?

That’s a question I can’t answer for you.. 

However,

If it is painful, affecting your everyday task, restricting you’re ability to perform as an athlete…

Or

You just want to get rid of it. We will help you!

It’s a simple problem to solve.. but that doesn’t mean it’s easy!

If you want your hip to go from snappy to happy

We need to assess the core, build it and teach it to work with your hips. There’s no hands on ‘release’ that will solve it!

Recovery: The Forgotten Child of Training

Coaches, trainers and the like put plenty of time and effort into developing the perfect training program.

But what happens after each session or game?

I know at our touch footy comps, grabbing a cold one after the game is not uncommon. Obviously there are better ways to recover than going to the esky.

Question is,

What’s the Right Option for Optimal Recovery?

Recently there has been an increased focus on the importance of recovery to enhance performance. However, with so many different methods advocated and very limited research available to guide our decisions the jury is out on the best way to recover.

Our bodies are remarkable systems which adapt to the physiological demands we place on them. There are so many protocols for training and athletic development. Yet when it comes to recovery – well it’s not so clear…

To start with, let’s have a look at,

Recovery for Performance
The ‘Big 2’

1. Sleep

I believe this is the most important recovery strategy. Mum always told me as a kid I needed to go to bed early, get a good nights sleep before a big game!

I’m sure many of you have similar memories.

Now I know why…

Sleep deprivation has been shown to have negative impact on your:

• Endocrine function

• Cognitive function

• Pain perception

• Performance

• Metabolism

• Immunity

• Mood

• Etc…

Essentially it affects your body’s ability to function. And isn’t recovery designed to improve how well your body works….

If sleep is number one, a close second when it comes to recovery is,

2. Nutrition

Replace Fluid, Fuel and Encourage Repair

Nutritional guidelines will vary based on your goals however in general should involve:

1. Replacing fluids

   1. As a guide for every 1kg of weight loss during exercise, 1 litre of water should be consumed.

2. Replacing fuel

   1. Carbohydrates will be the major fuel supply during activity, replacing these following activity is particularly important. Appropriate carbohydrate rich foods should be consumed within a 2-4 hour period after exercise.

3. Repair

   1. If you train hard, early intake of essential amino acids helps promote recovery of protein building which breaks down during prolonged and high-intensity exercise.

To understand how your body would best be rehydrated and refuelled speak to a nutritionist/dietician who is familiar with sports energy requirements.

So you have the ‘Big Two’ when it comes to recovery.

What are the other options?

Unlike sleep and nutrition, it’s hard to create an order of importance for the other recovery
modalities. But let’s take a quick look at:

• active + passive recovery

• hot and cold treatments

• stretching, and

• massage

Active Recovery

Involves low intensity work performed after exercise. It has been demonstrated to be most effective following longer duration activities. Why?

• It stimulates blood flow

• Fosters the removal of metabolites, particularly blood lactate. (the presence of blood lactate following exercise may hamper subsequent performance)

Active recovery can be performed through running, pool or cycle modalities. Will it prevent muscle soreness after training? Debatable…

Passive Recovery

Following a high intensity, short duration exercise, passive recovery involving low intensity aerobic activity like cycling on a stationary bike, has been shown to reduce fatigue levels.

It is thought that passive recovery promotes the resynthesis of a protein called phosphocreatine, which facilitates performance outcomes following high intensity work.

Cold Treatments (e.g. cryotherapy, ice baths etc…)

Intented to treat symptoms of exercise-induced muscle damage. Their application constricts blood vessels in muscles thereby lowering the oxygen requirements of tissues and blunting any inflammatory response.

Research has demonstrated improvements in sprint performance, endurance parameters, jump performance and strength following cooling techniques. There are also various other positive cardiovascular effects from cold water techniques.

Hot Treatments (e.g. spas and saunas)

There is not a lot of research out there to guide best practice when it comes to hot water treatments for recovery. One study showed deep water running for three consecutive days following intensive exercise to reduce muscle soreness and speed up the restoration of muscle strength.

Stretching

Often the go to for many people, stretching is potentially one of the most controversial topics.

While there are some isolated studies which show improvements on performance following stretching, from the majority of research there is very limited evidence.

This is not to say that stretching doesn’t

• improve tissue compliance

• reduce muscle tone

• increase joint range of motion.

So don’t completely drop your trigger balls, resistance bands and foam rollers yet.

Massage

Has been purported to have numerous effects on sports recovery…

• Increasing local blood flow to remove metabolites and mobilise inflammatory markers (active recovery is better for this)

• Reduce muscle spasm/tone. Anecdotally, there is evidence to support these claims however there is limited research on direct links

• DOMS. While there is some evidence from studies that massage helps reduce post-exercise soreness, its effectiveness in improving muscle function is less convincing.

As a general rule, for massage to be effective treatment needs to be administered within two hours following exercise.

The science of recovery and how to best enhance performance is still evolving.

It seems that sleep and nutrition are the best avenues for optimising recovery at this stage. However there is enough evidence out there to target your recovery based on your desired outcome.

If you have any questions when it comes to recovery, hit me or the team at Balance Health and Performance up for some recommendations.

Dizziness Explained...

I love getting in the boat and going fishing with my father. Spending time on the ocean, outdoors with a slight sea breeze… there’s no better way to spend a lazy Sunday afternoon.

The only problem, we’re not the best fisherman and our lines get tangled every time!

Sitting there trying to untangle the mess of fishing line. It’s not long before I start to feel a little queasy. Stomach churning, struggling to get a deep breath – you’ve got to love sea sickness.I know by jumping in the water or getting back to dry land it will feel better. I can’t imagine what it would be like to live with this constant dizziness all the time. Just ask someone with vertigo what it’s like. They’ll quickly tell you

‘Vertigo is one of the worst symptoms someone could ever have’

Question is…

Why does this happen?

Our brain does a lot of heavy lifting for us presenting a clear picture 100% of the time. Instinctively we rely on this clear picture of the world to allow us to scan our surroundings to keep us safe. These days it so we can drive properly as one example.

I want you to try this little trick…

• Grab your phone, press record

• Go for a 100 metre walk keeping your phone still

• Play back the recording.

What you should see is that despite your best efforts the video starts ‘shaking’ or ‘tilts’ or is ‘uncontrolled’..

But, I’ll bet you vision and what you saw was smooth and controlled!

Interesting right.

Have You Experienced One of the Following?

• After you’ve been looking at the computer screen all day and your vision is just a little bit ‘fuzzy’

• Spin around 5 times and your world keeps spinning just a little more

• Looking over a the edge of a cliff you get a disturbing gut feeling that you shouldn’t go any further

We can give all the wonderful credit to…

Our Vestibular System

It’s a nucleus in our brain which collates information from our eyes, our ears and our spine. Through reflexes and signals it allows them all to communicate and stay coordinated.

It really is fascinating…

As you tilt your head to the left, your spinal position tilts. Fluid gets pushed around in a certain way in the semicircular canals in your inner ear and thanks to your “righting reflex” we developed as infants, your eyes have no choice but to move so that they keep looking toward the horizon.

Pretty cool!

So when you go for a walk, you are shifting your body weight from left to right and back again forcing the spine to compensate. From there, yours eyes need to stay centred and the fluid levels in my ear need to correspond. That what gives you clear vision.

Back to my fishing…

To explain sea-sickness, you’re swaying on the boat. Your spine sways, your ear fluid sways, and your eyes must correct… BUT, what happens when we look down?

We see the stillness of the boat floor. The signals don’t marry up and your brain thinks there is something wrong. Your nervous system gets put under stress and you’re not as comfortable with your surroundings, so you go into fight/flight:

• Your heart rate goes up

• You need to breath more

• Your body tries to get rid of abdominal contents

You’re see sick and the only way to sort that out is by getting those signals to marry up again.

But what if you feel dizzy on dry land?

The principle is the same…‘the signals don’t marry up’

 Problem is figuring out why!

 There are many types of vertigo, and I don’t want to go into what they are.. They all happen for different reasons. Commonly an infection/problem with the inner ear, but, it could be a problem with any of the three stimuli which feed into the Vestibular nucleus – your eyes, ears or spine.

Either way, someone with a balance or dizziness problem needs to have all three checked so that those signals can marry up again.

Have I helped patients with dizziness or vertigo or balance problems?

Absolutely! But not every one of them..

All I can do is assess the spine for dysfunction, restore it and teach your spine and eyes to cooperate again (with some basic exercises) – and most of the time, this helps!!

Either way, you should be looked at by an Ear/Nose/Throat specialist first.

Please also keep in mind, there are many causes for dizziness, some of which may be cardiovascular, respiratory, psychological and other neurological. Don’t make your own mind up.. It’s not a normal symptom and must be checked out.

Struggle With Headaches? Learn How to Make Them a Thing of the Past

We all have that friend who keeps a couple of Panadol on them ‘just in case’. My better half always has a packet in her handbag. It’s the ‘go to’ for dealing with niggling headaches so you can get on with the million tasks to do each day.

You only have to look at the “Panadol” website to see how heavily they market their product to deal with headaches. It’s the first two symptoms listed..

1. Headaches

2. Migraines (which are just a type of headache).

For some,

Dealing with the pain from headaches is a constant battle…

• The ache sitting behind your eyes

• The band of pressure around your skull

• That feeling someone is driving a nail into your temple.

Okay, so the last one is on the more extreme side. But I’m sure you can imagine the feeling. It’s definitely not what you want to put up with.

Over the years, I’ve been able to help all types of people suffering headaches. Of all the patients, there’s one which really stands out…

As they say:

”you never forget your first”

Having suffered almost-daily headaches for over 10 years he’d all but given up. Everything he had tried seemed to help a little bit. But without fail it would come back. I don’t know exactly why, but he was sure I was the last option he had.

No pressure!

As much as I just wanted to help the guy, I knew the processes to follow. Before I could provide any effective treatment…

Step 1 – Figure Out The Type of Headache

Not as simple as you might think.

There are so many types of headaches. Each with their own category and multiple sub-categories. So extensive is the list, the International Headache Society, compiled it into an almost-200 page document.

For most people, this is slight over-the-top, but for clinicians the differences between headaches are subtle and important.

So which type is it?

Time for interrogation…

On top of the usual medical history questions, it’s also critical to look at lifestyle.

“Do you sleep well?”

‘better after a few beers’

“How long do you usually sleep”
“About 4 hours a night. Sometimes a little bit more, sometimes a little bit less.”

“How much water do you drink a day?”
‘maybe a bottle’

“What colour is your urine usually?”
‘slightly yellow’

“How do you cope with your stress?”
‘not well’

“What’s your diet lie?”
‘okay but could be better’

Sleep, Water Intake, Stress and Nutrition 
Essential to working out why headaches affect some of us and not others

Back to the story…

Based on probability, it was likely to be one of the common types of headaches:

The Three Common Types of Headaches

1. Migraines Tension-Type Cervicogenic

   1. Have their own specific set of criteria.

   2. Characteristically, they are one-sided pulsating headaches, associated with a sensitivity to light and noise

   3. Sometimes you can get a kind of visual disturbance, balance disruption, dizziness, or hearing changes.

   4. They often last from 4 – 72 hours, and you won’t like it if you try to exercise them away.

2. Tension-Type

   1. Pressing tightening feelings around your skull, like you’re wearing a cap three sizes too small.

   2. They usually linger around from 30 minutes to 7 days.

   3. Exercise can help ease these headaches, and there can sometimes be noise and light sensitivity.

3. Cervicogenic

   1. Cervicogenic is a medical term that be translated to ‘coming from the neck’.

   2. The Headache Society specifies that there has to be a time-relationship of trauma to the neck present.

   3. This can include whiplash disorders, poor handstand push up technique, or bops of the head.

 After learning my patient had been involved in a high speed car accident, along with some lifestyle issues, it was clearly a cervicogenic headache. I confirmed this through various tests for neck function and control.

Targeted treatment along with simple rehabilitation exercises to improve function and we had control of the headaches for the first time in 10 years!

I think I was almost as excited as he was….

Since this ‘first time’ I’ve treated a huge array of headaches. Whilst the type and range has varied greatly, it’s the same,

3 Step Process To Treat Any Headache

1. Detailed medical history including lifestyle

2. Assessment to provide or confirm a diagnosis

3. Treat and manage

If you deal with headaches on a regular basis don’t wait 10 years to get treatment. Panadol will help with some short term relief but it doesn’t compare to finding and then treating the cause.

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.

PS. If you have a friend or family member always complaining to you about their headaches we’d love to help make a difference to them (and inadvertently you as well).