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!!

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.