Shoulder Injuries: Why They’re So Common and What You Can Do

Why do I keep injuring my shoulder?

Did you know the shoulder is (arguably) the most injured peripheral joint we see in the clinic?

With injuries, there are many questions that come along with it. Have you ever asked yourself “Why the #*!? does this keep happening!?!”

As a chiropractor working in sports, I see a lot of shoulder injuries!

Like any injury these are super frustrating.
They impact your day to day life

...something as simple as grabbing a box of biscuits from the top shelf in the pantry can cause pain.

Wouldn’t be hard for me to guarantee you don’t want that pain!

Before we look at what you need to do next, it will be helpful for you to understand:

Why the Shoulder is So Much More Susceptible to Injury?

You see, shoulders are a shallow ball and socket joint because we need more range in our arms to be able to do our day to day activities. The downside…

there is less structural support at your shoulder!

This means we need to get the support from your ligaments, muscles and the labrum (which acts as a suction cup to keep the ball within the socket).

All injuries are generally caused by either:

1. Trauma - like falling and dislocating your shoulder or,

2. Behavior - a movement based issue resulting from a repeated behaviour such as throwing a ball with the same side
   
   

Either way…

We need to remember that there are 3 main components (ligaments, muscles, or labrum) that help to stabilise, control, and move your shoulder, and any (or all) could be involved!

Each muscle in your shoulder helps the others to provide movement & control. If one muscle doesn’t work as well as it should (say you injured it), the others need to pick up the slack (thanks guys!), but… now we’ve built a compensation.

Compensation short term is great. It helps you continue living life and doing what you need to do. But long term it can lead to a behavioural based problem. This means your shoulder now moves differently and you’re now putting more load through the other muscles. This means they may be predisposed to injuring THEM.

 And so the cycle begins!

Injury (Trauma) → others pick up slack (behavioural change) → overloaded muscles & abnormal movement patterns → injury → others pick up slack → injury etc

You see where I’m going with this?
(annoying right!?)

So what can we do about this pain you’re getting?!

If you already can’t tell, 
your shoulder is complex!

It’s not as easy as saying “oh yeah… your traps are TIGHT!” 
That’s great, they probably are, but they’re likely not going to be the cause of your pain.

And if I’m being honest:
if we’re not treating the cause then wtf are we doing?!

I know I can’t be the only one who has seen someone who rubs the sore spot and sends you on your way. Yes, giving you symptomatic relief is important, you don’t want to be sore!

But, 

if we’re not fixing this shoulder properly with the right rehab and progressions then I guarantee you’ll do that push up, kipping movement, or even a push press and that pinching pain you’ve been feeling will come back.

You know what, I’d be as over that pain as I am with COVID (I just want to lay on a beach in Bali with a cocktail in hand, Scomo, can you please just let me go!)

Can you do me a favour? 

If you experience pain, particularly in your shoulder, don’t stop doing the things you love! You don’t have to push through the pain either! 

Get it checked out!

Let’s put a plan in place, and get you back to doing the things you love without worrying about the aftermath!

Complex doesn’t mean impossible, it just means we need to understand and figure out WHY it’s happening, and then be intentional with the treatment & rehab to get you back to #living.

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Is It Okay to Exercise With Injury?

Nick Papastamatis

How Do I Strap My Knee?

By Crystal Noor

How to Stop Stress Urinary Incontinence

A must read for all women who leak a little (especially those who have given birth)

Are you someone who leaks a little when you sneeze, cough, laugh too hard or during a training session that involves jumping?

How many times have you been told that it’s ‘normal’ because you’ve given birth or it’s inevitable with age?

Let’s give you all a bit more information and clear up the main misconception that leakage is normal.

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Firstly, what is stress urinary incontinence (SUI)?

Simply put, it’s the leaking of urine during activities that increase the pressure within the abdominal space i.e. coughing, sneezing, laughing, jumping, physical activity and training that involves lifting heavy loads. SUI can happen to women who have or haven’t given birth, and they can occur to young and older populations.

But why is this happening?

In truth, there could be one of many reasons this is happening none of which are simple explanations.

Two Common Causes of SUI

1.      an increase in pressure downward onto the bladder

In this situation, we aim to decrease this pressure to reduce leakage. In clinic, it could be to alter the way you’re using your abdominal muscles or providing soft tissue treatment through your rib cage to decrease any tightness you may have.

2.      the deep pelvic floor or connective tissue’s inability to help support the bladder upwards.

If the bladder has minimal support holding it upwards when abdominal pressure is increase (i.e. during a cough or when laughing), the bladder will slightly drop causing leakage. It could also be due to weakness of the pelvic floor muscles at the entrance that help to provide a closing mechanism at the urethra (where urine travels down and out).

Whilst these are two common causes, the reasons for leakage will differ from person to person. It could be from…

-          pregnancy,

-          old age, or

-          a combination of reasons.

HOWEVER, the main thing to remember is; just because it might be common amongst certain populations i.e. those who have given birth, those who are older; it

DOES NOT mean it has to be normal.

Common and normal are NOT the same thing.

The questions is… 

What’s My Cause and How Do I Stop It?

That’s where a Women’s Health Physiotherapist comes in!

A Women’s Health Physiotherapist can do an assessment with the option of:

·      An internal examination that provides us with details of how your deep and superficial pelvic floor muscles are activating, whether or not you’re activating them correctly (i.e. some women may think they’re squeezing but they’re actually pushing instead), what their strength is and how your bladder is moving as well.

·       An external examination, specifically to assess how your ribs are moving and what your abdominal muscles are doing.

From there, we’ll know what treatment to provide and what exercises to prescribe you to help prevent leakage.

 

Treatment For Stress Urinary Incontinence

As mentioned, reasons for leaking urine will differ between individuals, therefore treatment will also differ. Just to give you an idea though, treatment can include:

• Soft tissue releases through your pelvic floor muscles, followed by pelvic floor muscle exercises that help to retrain them to activate and optimally function when they need to

• Improving your breathing

• Release through your ribcage and how your ribcage expands during breathing

• Retraining your abdominal muscles – being specific with which abdominal muscles we want to use for certain activities

• Releasing and optimising function of other parts of the body that could be contributing to SUI

• Advice about what you can and can’t do when exercising

• Advice on how to promote optimal bladder function (such as to empty completely and effectively)

• Referring on to specialists (if required)

It’s important to know that it’s not just about being told to do kegels and squeeze your pelvic floor. It’s making sure you’re receiving the most appropriate treatment to rectify the cause of SUI and then being prescribed effective exercises to self-manage it.

If you’re someone who is experiencing SUI, and you want some advice and guidance on what you can do to prevent leaking urine when training, laughing or any other activity you participate in that causes you to leak, book your assessment today and let us help you!

Are Chiropractic Adjustments Actually Good For You?

If you don’t already know, an adjustment is simply a technique we use as part of our arsenal as chiropractors. Yes it may create a cavitation that sounds like a ‘crack’. Really  it’s the same as when as a kid you used to crack your knuckles all the time! 

It’s less important to know what an adjustment is but rather

What Happens When You Get A Chiropractic Adjustment?

I’m possibly a little biased… but it feels bloody good :)

In all seriousness, let me start off by saying what is NOT happening when you get adjusted. 

You are NOT getting your:

• Bones cracked. 

• Spine re-aligned or

• Joints put back into place. 

There is enough research out there to suggest that none of these are happening. Think back to when you crack your knuckles, imagine that every time you cracked your knuckles you were re-aligning your joints. Can you imagine how disfigured your fingers would be after doing this for years?

Luckily it’s not true and the old wives tale...

‘ you will get arthritis if you crack your knuckles’

...isn’t true either otherwise we’d all be doomed. 

What the research actually suggests is happening with an adjustment you’re reducing pain around that area by helping add more movement. You can also create a better connection between the brain and that area of your spine. 

On top of this…

It also releases dopamine (you know that awesome feeling you get when eating chocolate) which can also explain why it feels so good to get your back cracked!

Might even be why we still continue to crack our knuckles… it just feels so delightful for our brains.

To summarise:

• Proper adjustment are great for,

• Pain relief and better brain/body connection. Pretty good right!?

So,

Should everyone get adjusted then?

The short answer:

NO

The long answer:

It’s person dependent (still a short answer :P)

In essence…

Using hands on modalities (such as. adjustments) will provide you with the all important pain relief. It will also open up a window for you to be able to perform rehab/exercises with CONFIDENCE.

This will play a major part in your recovery.  As along with education, exercises are said to be the greatest tools at our disposal as therapists. It allows you to be more independent in your own recovery and leads to higher rates of recovery and lower rates of re-injury. 

So adjustments are part of solution when it comes to recovery. Just not the only answer. In fact,  you can become too dependent on the adjustment,  getting treated constantly and possibly cause the area to be more sensitive and slow down recovery.

So yes, adjustments are good for you…

...when used appropriately!

Just make sure you understand what is happening, why it’s happening, and what the plan of attack is i.e. get educated and make sure you’re doing your exercises!

If you suffer from neck or back pain, feel like your spinal movement is restricted, know adjustments have worked for you in the past or simply want to understand more click here and reach out!

3 Top Tips For Your Post HIIT Workout Recovery

written By Tammy Ong (Physiotherapist)

Are you giving your body what it needs after a HIIT workout?

High-intensity interval training, more commonly known as ‘HIIT’, can be quite an acquired taste. Personally, I have a love-hate relationship with HIIT workouts! Similar to the relationship most of you must have with us 😂. It’s painful in the moment, and maybe even after, but wait a day or two, and you feel great and energised!

What is HIIT and why is it good for you?

Simply put, HIIT incorporates alternating periods of high intensity aerobic exercises with short rest intervals. These exercises can either be body-weighted or include the use of weights and other equipment such as rowers, assault bike and ski ergs (all the favourites, clearly), just to name a few.

HIIT is a favourite for those who want to burn more calories in a short amount of time. HIIT workouts can last anywhere from 10 minutes to 45 minutes. Research has also found HIIT burned approximately 30% more calories than other types of training.

It also helps to maintain a higher metabolic rate for a longer period of time after exercising. This means that you continue to burn calories even after you’ve stopped training. Studies have also found it encourages your body to use and burn fat to produce energy, rather than carbs. Therefore, also promotes fat loss in the process.

Additionally, HIIT has the ability to encourage and increase the efficiency at which your muscles use oxygen when exercising. It has cardiovascular benefits in the way it helps to decrease heart rate and blood pressure, especially hypertension for populations that are overweight or obese.

But how can I minimise that feeling of “oh my… my body does not like me, it just does not want to work right now”?

Alongside the feeling of losing half your respiratory system to a decent HIIT workout, you might feel that over the next few days, it’s sore to move and use muscles that were worked the most during that workout (aka Delayed Onset Muscle Soreness – DOMS), or you might feel a little more tired after a HIIT workout than other types of training.

Metabolic changes can in occur in the body during and after a high intensity workout. Some of these may include:

• Increased blood lactate levels

• Acidosis – blood acidity increases thus reducing the oxygen and nutrient stores that

• are required during aerobic exercise

• Gluconeogenesis – where protein gets used for energy, thus reducing the proteinstores we have left over to help muscle repair and growth

• Increase production of human growth hormone – helps with muscle growth and recovery

• Increased glycogen storage in muscles – glycogen used for energy but also helps to store water, good for aerobic exercise

It is important to remember that every person is different so recovery time might not always be the same for everyone, and that is okay! On average, it can take anywhere between 24 hours to 96 hours to recover fully after a metabolically demanding HIIT workout.

BUT… do not fear, I have my

3 Top Tips For Your Post HIIT Workout Recovery

1. WARM UP and MOBILISE!!

Warm-ups are crucial to ensuring that muscles are active and ready to go for what a HIIT workout is about to put them through. Warm-ups help to reduce the risk of injury, and can help to reduce the amount of muscle soreness you get afterwards.

Simply completing a few repetitions of whole-body movements, mobility and dynamic (not static) stretches over a 5 – 10-minute time frame can make a world of difference!

Here’s a simple warm-up sequence I love doing when I prep myself for a HIIT workout:

• High knees

• Speed squats

• Push ups with a twist

• Mountain climbers

• Supine knee rotations

• Glute bridge

• Butt kicks

• Sumo squats

• Burpee (or half burpees)

• Plyo lunges

• Mobility targeting all joints

2. COOL IT

Alright, time to fess up.

Who else doesn’t consistently cool down after a workout? I know we’ve all done it at some point. I’ll throw myself under the bus here and say I have occasionally walked out of the gym straight after finishing my program, and not staying back to do a decent cool down for my body.

It’s simply keeping your body moving, but just at a lower intensity.

Spending that extra time has so many benefits, some of which include:

• Helps to prevent blood from pooling in veins, and contributes to good blood circulation

• Helps to gradually return your heart rate, blood pressure and body temperature to your normal resting levels

• Reduction in lactic acid levels in the muscles that were most used, thus reducing muscle tightness and cramping. This doesn’t necessarily mean it reduces the effects of DOMs but does help to maintain good muscle length and flexibility

• Improving muscle length and flexibility

A cool down could be as simple as a 10-15-minute walk on the treadmill, followed by a combination of both dynamic and static stretches.

Here’s what stretches I usually do for my cool downs:

• Jefferson curls

• Cossack squat stretches

• Deep squat holds into trunk rotations

• Downward dog

• Deep lunge hip flexor stretch

• Thread the needle

• Child’s pose

• Cobra pose

• Pigeon pose

• Figure 4 stretch

• Happy baby pose

3. SLEEP and HYDRATE

We lose water during exercise through our sweat, and simply through breathing. Our muscles and body need water to repair and rebuild themselves.

Maintaining hydration levels between workouts is also very important to help with the next workout you plan on completing. Keeping constantly hydrated helps to:

• Maintain good and regular body temperature so it doesn’t rise too quickly

• Allow for your body to have enough energy for a productive session

• Have adequate electrolyte stores to help with optimal muscle function, and also reduce the chance of muscle cramps

Now, who doesn’t love sleep?!

We go through many stages of sleep, all of which play a big role in our body’s recovery. Deep sleep (stages 3 and 4 of non-REM sleep) is where our most important muscle recovery occurs.

When we sleep, blood pressure decreases, we breathe slower and deeper, blood that isn’t utilised to supply a resting brain gets sent to muscles when then help provide extra oxygen and nutrients to help muscle healing and growth, pituitary glands release growth hormone which helps with tissue growth and muscle repair, and lastly new cells are regenerated, and muscle tissue is restored.

It is recommended for us to sleep for at least 8 – 10 hours to allow adequate recovery. Any longer and our sleep cycle is changed for the following night. Any shorter, and our muscles and body systems won’t be able to optimally recover.

Hit us up with your favourite warm up and cool down exercises, and if you have any questions regarding recovery after a HIIT workout, don’t hesitate to reach out to us!

Staying Healthy in Lockdown

If you’re in Sydney in July 2021, then in some way shape or form, you or a loved one is impacted by the lockdowns.

There has to be a way to help us get through this together, whether that’s within our individual households, or as a collective.

By no means is the purpose of this piece trying to spin the circumstances we find ourselves in like they’re positive! We just hear so many different stories from patients every day, we hear such a variety of experiences and some of the stuff people are doing is pretty cool.

When I think back to last year, when we found ourselves in a similar predicament, there were many people talking about how they would “pivot”. That had to be the word of the year…

The survival of many businesses depended on how well they pivoted through unprecedented (that was another one) times. It seems like this year, people are simply fatigued and a bit deflated… and in many ways, angry.

So how do we manage these fleeting and undulating thoughts?

How do we stay healthy and fit?

How do we not gain 10-15kgs?

Even further, how do you manage to not go stir crazy just looking out the window… Can you go for another walk?

Ideas on what you can do to stay healthy

Exercise:

Steps - During a period like this, hitting around 6000 steps a day. This is about 4.5-5kms per day. It is SO EASY to literally do less than 500 steps a day if you don’t leave the house.. So get out and go for a walk - if the weather is bad, do it anyway. Daily steps targets are a great way to accumulate activity over time, so consistency is key.

Online workouts - Stay connected to your gym community. In particular, a lot of the smaller community based gyms are doing online workouts and programming or even 1on1 personal training sessions at the park. We know many GREAT quality gyms and PTs that are offering these types of services, so let us know if you’d like us to get you in touch with some great active communities

Nutrition:

Grazing - it’s the easiest way to lose track of what you’re eating. Fill and refill that bowl of chips, cause let’s face it, you’re not moving off the couch anytime soon…

It's something to be mindful of, and think of snacks and/or junk food as a reward for something productive you’ve accomplished.

You can’t eat it if you don’t buy it - some simple well known tips here…

But the main one is, don't go to the grocery shop when you’re hungry. Everything looks tasty and not only will you spend an extra $50-100 you didn’t need to but you’ll also stock your pantry and fridge with things that you’ll just have to eat… One step further would be to do a pantry and fridge audit and see how many items have just been sitting there that you could either start using as an ingredient or have spent enough time there and it’s time for them to go.

Mindset:

Perspective - A great person to follow on instagram is Peter Crone. Check this post out. https://www.instagram.com/reel/CQQpNJxneYq/?utm_source=ig_web_copy_link
If you have 15mins or so… Peter Crone has an extended piece. 14 Minutes To Change Your Life Forever - Peter Crone - YouTube

Meditation - two great apps to help you observe your thoughts and to learn the skill of being able to control your thoughts and your feelings. Waking up - with Sam Harris - Discover your mind or Headspace App Guided Meditation and Mindfulness - The Headspace App
Meditation can be deep and spiritual, and it can be light and relaxing. It does require some skill and technique, so I’d recommend it be guided. No, meditation is not “clearing your mind” or “thinking about nothing” - if that’s what you think, then it’s time you try one of these apps.

Part of being healthy is also utilising the time and getting focused on something that is productive! Keeping the news on repeat, and diving deep into research might be important to you, but drawing the line and getting productive is much better than scrolling on socials.

Here are some other things you can do… You’re welcome

Get Educated:

Masterclass - A great online platform where you can learn from the world experts in so many different categories. My favourites are Malcolm Gladwell, Daniel Pink and Chris Voss. I think I’ve got a few free passes.. Try this link..

Otherwise, sign up: https://www.masterclass.com/guest-pass/60670M3w2NzA2MzgzfDF8fHx8MTE1OA==?utm_source=Organic-Social-PR&utm_medium=web&utm_content=Share_Copy

Coursera - This is how I was introduced to the world of psychology. I did a 6 week introduction and it gave me enough of a taste to make me go back to uni through 2020 to complete my Psychology of Business and Management.

Who knows what a taste will do for you!

At the very least, this might help you in your career, or just touch on that topic you’ve always been interested in. Coursera | Build Skills with Online Courses from Top Institutions

Entertainment:

Board Games - get everyone involved and off the couch. There are heaps of laughs especially if everyone has a red hot go at it. If you want to make it interesting, maybe the winner gets some sort of locked down at home ‘privilege’ - just a thought…

Either way, here’s a link to a few great ones. I’m a big fan of Settlers of Catan. Eight best board games to play in lockdown 2.0 | RACV@Home | RACV

Netflix/Stan/Disney - These are some that I’ve personally enjoyed.. But of course, these might not tickle your fancy. You never know, if you haven’t seen some of these, you might thank me!

High Fidelity (Disney - Star) Star Wars marathon (Release order on Disney)

Harry Potter Marathon (Stan) Shark Beach (Chris Hemsworth - Disney)

Bo Burnham: what. (Netflix: Comedy: It’s a bit dark, but pretty funny)

Fatherhood. (Netflix: Kevin Hart’s movie) Killing Eve (Stan)

Podcasts - by all means tune in to our very own Podcast - The Balance Experience and leave us a 5 star review if you are a fan!! https://balancehp.com.au/podcast

Home Projects: How’s the backyard going?

There are always things you can do for some upkeep, and it’s outdoors!

The bits and pieces no one has time for… I promise, once you get stuck into it, it’ll get easier. You might just enjoy it!

I hope you enjoyed this piece, and we are here to help support your health and wellbeing in any way we can.

What Is The Best Exercise For Planta Fasciitis

Here Jen does an amazing job of explaining two exercises that can help with the pain and discomfort of Planta Fasciitis.

Planta Fasciitis is an inflammation of a thick band of tissue that connects the heel bone to the toes.

Symptoms include stabbing pain near the heel. Pain might be worst in the morning.

ACL Warm Up Exercises

Nelson takes as through a version of the the FIFA11+ warm up to help prevent ACL injury. If the thought of an ACL injury scares you, then this warmup is a good one to incorporate into your exercise schedule!

3 Ways To Prevent Knee Injuries!

Written by Crystal Noor - Chiropractor

If you’re like me, then you spend way too much time critiquing how the footy season is going this year.

What the hell the Broncos and Bulldogs are even doing in the comp?

#stopwastingmytime #atleastimwinningthetippingcomp (*see proof below),

Also...

What’s with all the injuries this year?!

(must be the chiro in me)

Whether you follow NRL or are interested in any of a multitude of winter sports, just think skiing, snowboarding, AFL (IMO the worst of all footy codes), rugby union, soccer, even polocrosse.

It’s always the the same 3 injuries at the top of the list

- concussion

- knee (typically ACL), and

- ankle (of some form like lateral ankle sprain, syndesmosis etc).

As the title suggests, I want to talk about knees today!

But first a quick rant on concussion...

As chiropractors we are acutely aware of all the media surrounding concussions. There’s a lot of hype around it and it’s rightly so.

Concussion has long term side effects that we’ve seen come to light in the NFL in more recent

years.

- Personality changes,

- increased aggression,

- early onset dementia,

- balance changes

Not to mention the short term potential for vision change, headaches, bleeding on the brain, memory loss, nausea, vomiting, light and noise sensitivity just to name a few.

Concussion injuries need to be managed by the appropriate doctor.

So back to what I want to discuss.. knees.

Is It Possible Prevent Knees From Injury?

As we move through toward the middle of the winter sports season our physios and chiros are seeing an influx of knee injuries in the clinic. And it’s not just us…

Just look at the 2021 NRL season. In the first 11 rounds we saw 22 knee injuries. TWENTY TWO.

That’s not including hamstring, groin, or calf, which have a pretty high correlation to knee problems either. If that were the case, we’d be talking about at least 34 (that’s not even including the 5 achilles, or various other ankle injuries either).

So is there anything that can be done for prevention of said injuries?

Well, for them, maybe yes, maybe no. We need to take into account their strength and conditioning program, the fact it’s a contact sport with unpredictable movements, and of course previous injuries.

Random fact:

Did you know if you strain your hamstring one season, you have a 50% chance of straining it again the following season?

Of course, this information is all well and good for professional athletes, but what about you?

(not to say you can’t be pro, I believe in you, the sky is your limit).

Well, I’m here to give you some tips for;

How to Avoid Knee Injuries for Your Winter Sports

1. Train your knees to be strong in all planes of movement

Yes, the knee is a hinge joint, which means it predominantly moves into flexion (bent knee)

and extension (straight knee), but the tibia (shin bone) allows for internal (toe pointed in)

and external (toe pointed out) rotation, which means the actual knee joint needs be be able

to tolerate rotational forces as well.

Try this: Imagine you’re standing in the middle of an 8-point star. Stand on one leg, with your knee slightly bent, and try to tap all 8 points of the star with the other foot. Work around that star 5 times on each leg. You’ll be able to see how your knee needs to manoeuvre through all planes to allow you to touch the points.

2. Prime the muscles around your knees for acceleration and deceleration

It’s not enough to only be strong. Hamstrings, adductors (groin muscles), calves & quadriceps take the forces for your knee, particularly with increasing & decreasing speed, as well as change of direction. Why not help your knees by training that?

Try this: Sprint training with varied lengths before and after the “main sprint” in which you have time to get to full speed, and to rest. Jumping and change of direction drills, e.g. T shaped drills where someone yells which way to run when you get to the intersection - bonus points for this one as it helps to prime you for unpredictable movements, as well as change of direction.

3. Build your tolerance

I know as physios and chiros we like to bang on about building tolerance, but that’s because it’s important - you’re not going to run a marathon when the most training you’ve done is walking around the block…

Not unless you’re happy to not be able to walk for at least a week after. The same goes for your knees, hips & ankles. They cop a lot on the daily, so if you want to be able to play whichever winter sport it is of your choosing, make sure they’re ready for it.

We saw it with the 4.5 month NFL lockout in 2011, with 12 reported achilles tendon injuries in preseason alone, compared to the average of 8 in a full season, and we saw it again when injury rates spiked 3-fold with COVID-19 lockdowns due to shorter pre-seasons.

I promise, we love having you in the clinic, but we also love knowing you’re not coming in as regularly because you’re doing well & injuries aren’t stopping you from doing what you love!

Try this: Don’t do too much too soon. Build to your goal by increasing your activity by 10%

weekly, provided it’s pain-free. As always, if you need us, you know where to find us! We’re here to help, and I can say it pretty confidently for the whole team at Balance HP when I say we genuinely love what we do, we love working with you to get you back to life.

If you think I can help you get to your best, you can connect with me via my instagram:

@crystalchiro, or call the clinic (02) 9899 5512 & book an appointment!

Lower Back Pain

Written by Anika Young - Chiropractor

Are you one of the 1 in 6 Australians who will answer yes to the following,

You:

• Currently have back pain

• Have experienced it in the past

If so…

This is for you!

Recent statistics say that just over 16% of Australians will experience low back pain over their life course. My point being that you are not alone!

This article will provide you with clarity about some:

• Sources of low back pain

• Reasons for flare-ups, and

• What you can do to manage them 

We know that there are several structures in our back that can produce pain. The back consists of bones, discs, facet joints, ligaments and muscles.

What is the source of your low back pain?

There are 3 main ‘buckets’ when it comes to what may be causing your pain:

• 90% of the time your muscles, joints, discs and/or ligaments are responsible.

• 10% Nerve roots can be the cause of pain in approximately 10% of cases and

• Less than 1% of the time there is an underlying serious condition responsible for back pain. 

If you think about the structures in your low back like a thread on a shirt, you can rarely entirely isolate every thread. Therefore in some circumstances multiple structures in your back can cause pain. This is why not every episode of back pain has the same pain characteristics. 

Research has been done into mapping individuals back pain over time. The majority of peoples experience of back pain is episodic. Meaning that you may have flare-ups!

Rarely lasting longer than 6-8 weeks, these are periods of time with higher pain intensity and before pain levels return to baseline (which may be mild pain or ideally no pain).

Not too long in the scheme of things, but you already know the implications of back pain or pain in general and flow on effects that this can have on your ability to cope.  It effects on your sleep, increase your worry, increase fatigue and much more.

Considering the impact on your life is high and the chances of multiple episodes is likely it pretty important you…

Understand The Reasons Your Low Back Will Flare Up

Time to talk about the nitty gritty of pain science and why your back is doing you dirty like this!

Pain is a necessary response as it can identify when there is a threat or the potential for injury. On a fundamental level your body has these things called ‘nociceptors’ that pick up signals and send them to your brain. 

Your brain interprets these signals, and this is where pain is first experienced.. once it hits the brain. The brain uses other information that can turn down and up how much pain you experience. 

• Feelings

• Thoughts

• Expectations

• Past experiences

In the acute phase, less than 6-week mark pain is useful to remind you that you are healing from an injury. However, when pain persists and enters the chronic phase, medically speaking lasting greater than 6 weeks the brain can become more sensitive to these pain signals and therefore can manifest in more pain. 

At a nuts-and-bolts level, lets link this with a tangible real-life experience.

We have our patient Bob. A 32-year-old male, he moved to a new house about 6-months ago. As he bent forward to pick up a heavy box of the ground he felt significant pain in his back. He has limited forward bending movements to not flare-up the pain. 6-months down the track, the initial injury has healed, however he is not back to his previous activities. 

This is because when he begins to bend forward the nociceptors in the back are sending messages to the brain and his past experience of back pain has associated this movement with pain. 

Don’t be like Bob!

Strategies to reduce the effects of injury 6 months later

To begin, when it first happens ensure, you have allowed the source of the pain to heal. This is where staying active, chiro, physio or osteo, heat, education, massage and acupuncture can be useful. 

In the chronic phase, the above management strategies are also useful. But let’s talk specifically about some of those factors we discussed earlier that you can influence to help reduce your pain intensity. 

Factors that can potentially increase our ability to cope with back pain ensuring that we are looking after our mental health, physical health and we feel supported by our family, partner and friends. 

Things that decrease our ability to cope with back pain at negative pain beliefs (e.g. in Bobs case, bending forward will give me pain), worry, stress, physical stressors – repeated strenuous loads, a co-morbid injury and social demands. 

I implore you to have a brainstorm and try to identify factors that allow you cope better with pain and those that do not. I will go first.

Please let me know how you go with weighing up factors that may be influencing your pain. If you have any questions please send an email to anika@balancehp.com.au or a direct message on Instagram to @chiro.anika.

If you are struggling with persistent back pain and feel as though you aren’t covering as many bases as you could be please book in and I would love to help you.

How Do You Do A Proper Step Up?

This tutorial teaches you how to control the whole movement from the start till the end. I'd say that every one rep of these step ups is worth ten rushed step ups. Step ups, when performed well, load the glutes, hip flexors, quads and hamstrings.

Learning to step up and down well, also challenges your ability to stay upright and maintain the load through the lower limb, without tipping forward or deviating to the side and losing balance.

It can easily be done at home and is a great addition to a squat, and might even carry over to greater symmetry of loading into the squat pattern as well.

What You Need For Core Stability In A Squat

Written by Vanessa Toh - Physiotherapist - Brisbane

Are you able to:

- perform proper diaphragmatic breathing?

- contract and lengthen/relax your pelvic floor?

- maintain effective intra-abdominal pressure throughout your abdomen?

- Sustain core control from the start of the squat, throughout descent and ascent?

If you can’t answer yes to every one of these questions then you really need to better understand how

your core works when you lift!

Because...

When it comes to lifting anything of substance (like in a squat)

Having the ability to control our position and movement is essential! Especially if you’re keen to spend

more time in the gym and less on a treatment table.

This control is determined by our level of ‘core stability’. Or to be more specific, our ability to maintain

intra-abdominal pressure (IAP), tension and positioning throughout the entire movement.

The 2 Misunderstood Concepts of Core Stability

Before you load up any bar there are 2 separate but intricately linked concepts you really need to understand about “core stability”:

1. Core control basics

Where your intrinsic and extrinsic core muscles (diagram below) synchronise concentrically and eccentrically to transfer pressure from one part to another.

This is what enables you to maintain your rib cage and pelvic stacked positioning throughout the squat. It’s what some people will call the ‘canister position’.

This stacked position provides us an optimal position to sustain and maximise intra-abdominal pressure, which is the necessary foundation for the 2nd concept.

2. Bracing Essentials

Where core control is to position…

Bracing is to build and sustain pressure!

It’s  your ability to maximize and sustain intra-abdominal pressure throughout the squat (or any movement really). It happens via coordination of all our intrinsic and extrinsic core muscles to maintain a better “canister” position. 

If you look at the skeleton you’ll see the difference between a strong ‘canister’ and a ‘scissor’ position.

So why is this actually important?

It allows: 

• minimal energy leakage 

• the glutes, hip flexors fire more efficiently and

• the lumbar erectors and thoracolumbar fascia to transfer force to move the bar 

Reflecting this clinically, 

I often see lifters present with hip or low back tightness who have difficulty with coordinating and building sufficient intra-abdominal pressure. If this is you, we know what to do!!

Hopefully you’re following along nicely:

Use core control to get into your canister position and brace to increase intra-abdominal pressure and maintain stability and force transfer.

Relatively straightforward,

But…

How does intra-abdominal pressure produce pelvic and spinal stability?

Let’s start with a very simple overview:

• Diaphragm creates downward pressure

• Pelvic floor create upward pressure

• Abdominal wall holds tight

It often helps to think of the core creating intra-Abdominal pressure like a piston as per the below diagram. 

Now this is where it starts to get a little more technical!

If you’re interested in the detail read on, however if you’d rather someone just tell you where you’re at and what you need to do the quickest way is to simply book in and see your trusted practitioner.

The Role of the Diaphragm

As depicted in the diagram above, the diaphragm has origin attachments to the lumbar spine. Therefore, the diagram has both respiratory and stabilization functions. Proper diagram breathing leads to optimal intra-abdominal pressure. This imposes a stabilization effect on the spine during compound lifts like the squat.

 The Role of the Pelvic Floor

Your pelvic floor muscles function to prevent your abdominal and pelvic organs from bottoming out, as well as helping you to breathe, cough, copulate, urinate, defecate and giving birth. It has an incredibly important job of being able to manage the pressure being placed upon it. In the context of the squat, we are going to look at the pelvic floor’s relationship with the other core musculature to generate and sustain intra-abdominal pressure. 

When we inhale, our ribs expand and diaphragm contracts to flatten, lower and move our organs down. The abdominal wall and pelvic floor stretch to a certain point in an eccentric contraction and then hold with an isometric contraction. During this, our pelvic floor muscles then lengthen and expand to make room for your organs (indicated by blue arrows above). Whereas when we exhale, our diaphragm lifts and our pelvic floor and abdominal wall contract and shorten, returning to their resting position.

In order to maximise intra-abdominal pressure during the squat, the entire (front and back) pelvic floor needs to contract and raise up, which allows a stronger pressurised cylinder. To do this we need to be able to contract our pelvic floor in conjunction with our breathing and bracing.

Linking it all together through your Thoraco Lumbar Fasica

One of the keys to connecting intra-abdominal pressure to core stability is the Thoraco-lumbar fascia. A dense layer of connective tissue serving as a junction point for the attachment of numerous extrinsic core muscles: 

• gluteus maximus

• latissimus dorsi

• quadratus lumborum

• spinal erectors and

external oblique and intrinsic core muscles

• transversus abdominis 

• internal oblique

When proper building of intra-abdominal pressure and bracing occurs, this exerts an outwards force against the spine and abdominal wall leading to an eccentric contraction of the entire abdominal wall including front and back (blue arrows). 

This in turn loads the thoraco-lumbar fascia!

Now there’s a huge difference between understanding what needs to happen and actually doing it. And to be perfectly honest, it’s nearly impossible to self assess where your core control and bracing is at without a separate pair of eyes. If it’s purely technical, a good coach should be able to pick it up and cue you into position.

A proper assessment will however look at breathing control, manual muscle testing and fascial restrictions. All things a trusted healthcare practitioner who’s got some experience in lifting can help you with.

If you’re not 100%  sure if you’ve got it right and want someone to look over your ability to control your core, brace and perform both a safe and efficient movement then book an appointment online.