Fearful or Frustrated?

What Emotion Motivates You To See Your Physio: Fear or Frustration?

There are many reasons you would reach out to a physio (or chiro) you trust. The question is what’s more important for them to provide you with:

• Reassurance that your problem isn’t major? or

• A plan of attack on how it will be solved?

You’re probably thinking that both are important! You’d be right - they are..

However...

Generally speaking the key emotion which is also the likely motivating factor behind reaching out for support with your current concern is either fear or frustration. And each injury can be different.

It’s an interesting concept you wouldn’t necessarily think about at the time. But remember back to the last few times you’ve needed physio. What was your motivating emotion?

Let’s look at each of them and how the approach should adjust accordingly.

Fear As The Motivating Emotion

What it sounds like and what to do

“This pain has been gradually getting worse and I don’t know what it is and I don’t know why it’s developed…”

This is something we hear a lot! It’s important that once we do find the cause, you know it’s more often than not, nothing to be majorly concerned by.

You might be surprised by how many patients are just happy to know that their headaches aren’t coming from a brain tumour - and if that’s you - be reassured, you’re not alone.

Check out a throwback to an episode where basic hip pain took a turn for the worst

So what do we do?

First and foremost, it’s important to understand exactly what the person is fearful of. A great physio will ensure the consultation works towards addressing those fears. Usually there needs to be reassurance up front that we will do everything we can to get to the bottom of what is going on. Then it’s about performing a thorough assessment, working towards a diagnosis and triaging the problem. Is it minor and can be dealt with in the clinic, or does it need to be escalated with a referral for further intervention.

MOST of the time, it’s comfortably dealt with in the clinic!

We explain what is going on and what we need to do to put you at ease.

Conversely, sometimes it just that:

Your Pain Is Frustrating You To Know End

Here’s how we manage it

“I’ve had this for ages and it stops me from training the way I want to, and most importantly, it stops me from sleeping through the night. I’m committed to doing whatever I can to get rid of it!”

People carrying frustration with their problem are often motivated, not necessarily by the pain level, but often with what the pain stops them from doing. In fact, many of these people might actually be happy to live with ongoing pain as long as it doesn’t stop them from doing the things they love doing.

So what do we do when a patient is frustrated with what is going on?

First step is to understand the frustration.

Usually it’s activities they can’t do. In some cases, it’s the constant nagging pain signal that just doesn’t go away.

Ensuring that addressing the frustration is the focal point of the examination. Once we have a solid starting point based on the assessment, it’s time to set some goals around how we will overcome the frustrations together. If it’s sleeping through the night without pain, then it’s crucial that the goals are set specifically towards overcoming the frustration more so than getting rid of the pain.

We’re always here to help!

If this has resonated with you, or you know someone this relates to, push it to them to… Sometimes they just need a little push to get them started on their journey!

Physio Myth Busters

There are some super common, and really unhealthy attributions to why you might have a problem. These comments medicalise things that are NORMAL and COMMON!!My core is really weak!?!

My glutes don’t work???

My pain comes from my scoliosis :O

My posture is really bad!?!

Let’s debunk these generalisations right now!!!

My core is really weak!?!

You’re not the only one with a core that needs to be worked on!

Yes, strengthening it does relate to improving back pain (and other) symptoms…

BUT

Having a weak core doesn’t cause back pain.

There are probably many different reasons why your back is sore, and commonly it’s because you’re overloading it. That’s not necessarily because your core is weak. We say this because there are many people that continue life with a weak core and go on without pain or discomfort.

If we find that your core can be worked on, it’s only because strengthening it has been shown to improve back pain, but it’s not necessarily why it’s sore in the first place. This might also explain why back pain occasionally returns even though your core is actually quite strong… It’s multifactorial!

My glutes don’t work???

I promise they do work, they might need to get stronger!

The next question is…

“So what if your glutes don’t work?”

Yes, if they don’t work well it might put extra load on other areas, and strengthening them might help, but I can assure you, your glutes do work, and if they didn’t you wouldn’t be able to stand up and walk!

Some people’s glutes just work better than others and occasionally they need to catch up in strength.

My pain comes from my scoliosis :O

The spine you have is the only spine your body knows… if you weren’t ‘told’ that you have a scoliosis, would you know? Would it matter?

People with scoliosis need to build strength everywhere just like everyone with a spine shaped like a pencil. It might just mean your structure might encourage you to move more one way versus another and all it means is that your movement and training needs to be multidirectional and well balanced.

Low and behold - so does everyone’s movement and training!!

My posture is really bad!?!

So?

Not everyone with bad posture has problems. There are theoretically perfect positions that allow people to have well balanced weight distributions through their spinal joints. If your posture is always bad and it’s the cause of your pain, then why don’t you have the pain all the time?

You’ve probably had bad posture your whole life…

It’s just your pattern of movement.

You don’t need to feel guilty for having bad posture. But if you want to improve it, we can work towards a theoretically good position, but it may not necessarily be related to your pain or problem.

The point here is…

You don’t have to be stuck with your problem just because of some excuse that someone convinced you is the cause of why your problem keeps coming back.

It’s a multi pronged approach that is required to help you long term and it’s important that we don’t blame an unchangeable part of us - there is nothing more disempowering..

As always, we’re here to help support you.

Do I need to improve my posture?

We get asked this a lot…

As a physiotherapy and chiropractic clinic, we are frequently asked whether it's necessary to improve posture. While good posture has its advantages, such as reducing muscle tension and preventing back pain, it's not essential for everyone. In this blog post, we'll explore the benefits of improving posture, as well as discuss why it's not always linked to pain and injury, and why it may not be necessary for everyone.

Benefits of Good Posture

Good posture can have numerous benefits, such as improving breathing and circulation, preventing muscle fatigue and tension, and enhancing balance and coordination. Good posture can also improve your confidence and self-esteem, as standing up straight can make you look and feel more confident.

However, it's worth noting that good posture does not guarantee that you won't experience pain or injury. Pain and injury can result from various factors, including poor biomechanics, overuse, and genetics. Although good posture can help reduce muscle tension and improve alignment, it's not a guarantee that you won't experience pain or injury.

Considerations for Posture Improvement

While good posture has benefits, not everyone needs to focus on improving their posture. Some people naturally have good posture, while others may have postural issues that don't necessarily cause pain or discomfort. In fact, some postural deviations, such as a slight forward head posture or a mild scoliosis, may not require treatment.

If you have postural issues that are causing pain or discomfort, it may be worthwhile to seek treatment from a physiotherapist or chiropractor. They can help you identify the underlying causes of your postural issues and develop a treatment plan to address them.

On the other hand, if you don't have any pain or discomfort related to your posture, then it may not be necessary to focus on improving it. However, it's essential to maintain regular exercise, stretching, and movement patterns, as these can help reduce muscle tension and maintain optimal alignment.

Conclusion

Good posture can have its advantages, but it's not necessarily something that everyone needs to focus on. While it can help reduce muscle tension and improve alignment, it's not a guarantee that you won't experience pain or injury. If you have postural issues that are causing pain or discomfort, it may be worth seeking treatment from a physiotherapist or chiropractor. However, if you don't have any pain or discomfort related to your posture, it may not be necessary to focus on improving it. Regardless, it's important to maintain regular exercise, stretching, and movement patterns to promote optimal physical health.

Learning About Your Health

"We repeat what we don't repair"

(Christine Langley-Obaugh)

It goes without saying, repair your injuries!! But that's not the point.

Every patient we meet comes into the clinic not just for pain alone but because the pain is stopping them from doing something important to them!

Over the last decade of practising as a chiro, one observation I’ve had is noticing how in time patients learn more and more about their problem, their body, their health…

It becomes less about us doing the "fixing" and much more about learning how to live in a much more healthy way!

Our speciality is in physical health, so often we help people see the importance of moving more, moving well, being consistent and making that a positive experience rather than "training because if I don't then (insert punishment here)"

We have literally witnessed thousands of people transform their lives, and it's a privilege to behold and be involved in the process!

The other side of the coin…

There are also lots of people that make the decision that their pain is our problem to solve.

They come in when they're in pain, and once that pain is a bit better and they can get back to whatever they were doing, then it's like the problem was never there!

Low and behold…

3 or 6 or 9 months later, they're back again with the same problem!

‘We repeat what we don’t repair’

It is these people (that probably won't read this) who need to learn the crucial lessons about what they need to do in order to live a healthier life.

Pain is an interpretation of a signal and there is research to show that stress amplifies it, and improving emotional regulation decreases it! This has everything to do with personal development and is in the complete control of each and every patient (not the practitioner)

But it comes back to education.

You have the primary role to play in improving your health!

and often…

people make better choices because they are better informed.

Our goal is to support and assist you to repair physically.

Learning about your health and how to live a healthier lifestyle is each of our responsibilities and we all individually need to take ownership of the one and only body we were born with so injuries don’t follow the 3, 6 or 9 month cycle of repeating themselves,

We're here to help, and we always will be!

So Can I Keep Training?

“So can I keep training?”

If I had a dollar for everytime I’ve had to answer this question…  

and the response may not be what you’d expect.

Many people come into the clinic because their training has brought an old problem back up, or because a new problem has gradually emerged.

All we can say here is:

That's completely normal.

You're moving more, probably moving better and if you've been consistent over a period of time, there are probably areas of your body that have undergone chronic loading (consistent loading for more than 12 weeks).

Literally stopping will stop the pain from occurring… Awesome right!? 

However, If you stop - you will also lose a chunk of your progress :(

Stop training for a week, the strength losses take you back about 3 weeks!!

(depending on which source you read it can vary) 

and with strength being such a large contributor to ongoing pain and injury, it's in our best interests to keep you training unless the problem is so bad that we can't find a way around it.

My answer to the question  "so can I keep training?" 

YES, of course you can!

It's great that you've made a great decision to train and exercise consistently, so the last thing we will recommend is that you stop. 

There are however, a few things we will need your cooperation on in order to make this work though…

1. Stick to the guidelines. If we ask you to substitute an exercise, don't ignore us… we don't care that you think it feels alright today and want to test it! It's important we work through the problem together which means we need you to work as a team.

2. Let us talk to your coach. Your coach is in the best position to help you substitute the right exercise so that it works for your goals and also works in the class. We can convey the issue to them to help you in the context of the gym… telling them "I've got tendonitis" doesn't help them one iota… put us in touch

3. See it through till you're 100%. The last 20% is always the slowest and the trickiest. There's probably a strength deficit we're trying to bridge at this point, and strength takes 6-12 weeks to develop. Not only that, returning you back to your chosen training type or sport, requires some specificity as well.

Returning before we're done is impatience on your end and incompleteness from a rehab perspective which will only put you at potential risk from it recurring. This is also highly individual, so if you want to return early, just tell us so we can try to modify things to make your goals and desires the priority. 

Training consistently and building strength is a long term game. The benefits outweigh the negatives by a landslide. We want to work with people that are motivated to look after their health and make movement a priority so we are here to support you every step of the way.

Headaches, Tennis Elbow and Plantarfasciitis

What do they have in common? 

Aside from being painful and in completely different and seemingly unrelated parts of the body…

From a mechanical standpoint, there is a long chain that would connect them all! 

Of course they’re all connected in some way, but if you move your foot it's not like it's going make your shoulder move or make your neck wobble. Our nerves, lymph, arteries and veins however are an intertwined system and all of these make the entire body a much more tightly knitted unit. 

As more research gets published, we are noticing more and more, that recurrent gradual onset of pain, that is not caused by trauma (i.e. you didn't fall and land on your elbow as a cause of pain) is more a sign of tissue "sensitivity" than it is actual tissue 'damage'. 

How do we know this?

Time and time again (and as it's been portrayed in the research), patients complaining of foot pain that mimics plantarfasciitis, elbow pain that mimics tennis elbow and patients that have headaches, undergo MRI studies… which come back with findings that display no tissue damage that might correlate to the patients pain.

When we see this in the clinic, our patients say one of three (or all) things:

1. That's so frustrating and what a waste of time and money that was

2. So, does that mean that the pain is in my head? (i.e. feeling that their experience has been invalidated)

3. What does this mean? If there's nothing on MRI, then why do I have pain? 

The MRI isn't lying, and neither are you. 

Getting scans are great to rule in/out pathology and they help us grade the severity of pathology allowing us to know what to do in the case there is serious pathology. So they're good to have. But when they come back completely clear of pathology and this pain is bad enough that it wakes you up at night, or it's so sharp that you can't walk on it, or your head is pounding to the point you can't concentrate… something has got to explain this.

Let's draw attention to the nervous system.

The Biomechanics of Running Podcast

Jess Larder is one of the fittest Physios you will ever meet and on this talk Jess uses her first hand experience to dive into the common issues involved with running. Jess talks about the biomechanics, common issues runners experience, and the other non biomechanical factors that influence runners. If you’re a runner or participate in running sports then you will love this chat.

Our nervous system detects sensation from our tissues and from the outside world, synthesises it in the brain, decides what to do about it in the brain, and then sends signals to the muscles ordering action associated with what decisions were made (simples right!?!) 

When someone has pain, it's because your brain is synthesising certain sensation and interpreting it as threatening and that threat is perceived as pain. 

The trick with our nervous system though…

It's sensitivity is impacted by stressors that are physical, chemical and psychological… yes, doing 1000 squats the day before will add to some sensitivity for the next little while, but so will stress, emotional awareness and management, foods that are irritants, a poor work/home environment!

Essentially, anything that is not in line with promoting health will detract from it and add to increasing sensitivity (huge generalisation but for simplicity let's go with it).

If you've collated a cocktail of stressors, it can sensitise your nervous system and start to amplify nerve signals that already exist and because of this amplification, the brain synthesises it as unusual and therefore threatening leading to the perception of pain… only in this circumstance, there's actually no tissue damage - in fact, your function is no different to yesterday and the day before.

This is why we hear…

"I think my elbow is sore from using my mouse too much"

And this same person, hates their job, is stressed at home, eats way too much chocolate (amidst their healthy diet) and has fluctuating exercise habits (sorry if you feel attacked - we hear it all the time).

Is it really the elbow, the foot or the headache? 

Or is it sensitivity coming from all your stressors? 

Now one thing for sure, pain doesn't accidentally choose the elbow, foot or head! There are probably some mechanical implications that are leading to an overload in the regions as well. So often though, we restore the function in the area, and pain persists… health is holistic and you need to start looking at stressors.

The take home message here is…

• Pain is a symptom and a sign of more things happening under the surface. 

• Being healthy is removing stressors and adding things that are good for you 

• See a psych or a dietitian, they'll probably help you with contributors to your persistent pain

• Pain in the absence of injury, we need to look at you health holistically and Physio/Chiro is likely to be ONE (albeit important) component 

What The Balance Team Is All About

I remember walking away from the clinic one night…

After a long day seeing patients. All day, I'd felt the love, people's appreciation, and in essence, the abundance of the feeling one would get when you're making a difference to people's lives.

After closing the clinic door walking to the car I just felt alone. Despite all those good feelings throughout the day.

I couldn't help but think… I've spent all day helping people, but at the end of the day - who is looking after me?

This is the moment I realised Balance needs to be a team effort.

Throughout the days, I would often consult patients that had travelled hours, interstate and in one instance, from Jakarta, to come and see me… but why???

It comes down to trust. They couldn't find people that were up to date, values driven and authentic enough close to them. I originally felt hugely complemented. This turned into compassionate and sympathetic. And then frustration with the industry and our society which has built a reliance on a certain "person" rather than a group of people that they can trust.

This is when I realised Balance needs to be in multiple locations.

Over time, I've learnt that a happy team:

• transfers that goodness to our patients, clients and people watching from the outside-in.

• has each other's back and supports each other to keep progressing and move forward.

• stays together and keeps things consistent for the patient, and if there are schedule changes,

• won't feel a hesitation to introduce their colleagues for future care.

Over time I have realised that happiness comes from a sense of having that perfect balance of challenge and comfort… from having fun and not so fun discussions about cases. It comes from accountability and flexibility.

Why am I sharing this?

Because this is the team you've chosen to take care of your health.

Written by our Practice Leader,
Nick Papastamatis

Latest Research For Lower Back Pain

So what is the latest research showing us? 

Lower back pain impacts 4 million Australians today. It can scale from being mild and tolerable all the way to severe, debilitating requiring surgical intervention. It can be due to an injury or it can be a slow gradual build up.

We pretty much see low back pain in the clinic at every point on this scale.

People that have had it for years and people that are freaking out because they've never had back pain before and they fear that they're about to be paralyzed (I’m not exaggerating here either - it can be frightening)

Here’s my key takeaways of a few things you need to know:

1. Your pain levels have NOTHING to do with the severity of injury. They are separate. You could have a very minor injury and it can be painful as all hell! Your experience and your feelings are important both to us and the management.

2. Movement!!! Things often hurt because they're not moving properly. And when things don't move properly, it's often perceived by our brains as potentially harmful = "pain". We need to help you restore your movement as quickly and as early as we can.

3. Gone are the days of "being out of whack". It would be reassuring to know that discs don't "slip".. and bones aren't "out of place". These are descriptions of what it might feel like, but rest assured that this is NOT what is happening. You are simply perceiving a difference between how it feels now versus how it normally feels… it's reasonable to perceive that something isn't working right. 

4. We need to help you, help yourself. Empowering you to be able to self-aid your pain. This comes from: knowing what is wrong; and knowing what movement is going to help you; and knowing when it's time to reach out and contact your practitioner for further advice or to bring forward your session.

Gone are the days of 

• long sessions lying face down the whole time (although sometimes that can help)

• "realigning" things

It's now about understanding your problem, getting you moving and knowing how you can help yourself.

Results Driven Healthcare

One very important component of our culture here at Balance is that we're "results driven"

What does that mean?

An important component of managing injuries is that the right intervention doesn't take 6 weeks to take effect… it often works well early on - usually within the first few sessions..

In order to:

Set you up for success, we need to regularly test and retest

What this means is we need to find a meaningful test that reproduces your pain or problem clearly, apply an intervention, and then retest again.

This allows us to narrow down which intervention your problem is going to respond to and allows us to dive further into why your problem is there in the first place. And that’s dependent on whether an intervention makes things better, worse or no different.

Of course, we want you to get better…

BUT… sometimes things get worse or do not change at all

Let's put it this way..

If you have tight muscles and you get a massage… you can expect to get better.

However,

If you get worse, does it necessarily mean that the massage was "bad"?

Or, was massage the wrong intervention for you? (Hint: more the latter)

What if you go for a massage and it makes NO difference to your tightness… does it mean it was a 'bad' massage, or was it ineffective against the cause of your tightness?

Communication is crucial

Things getting worse means something to us and we don't take it personally. It's important to us because it helps us get closer to the cause of your problem and how we're going to solve the problem.

Stay close, we're here to help you and we need your help to work as a team so we can make a difference to you and solve the problem.

“Will My Lower Back Pain Go Away?”

Lower back pain impacts 4 million Australians today.

Among people under the age of 45, LBP is the 2nd most common reason to visit a physician (after the common cold), the 3rd most common cause of surgical procedures and the 5th most common cause of hospital admissions

Lower back pain can be mild and tolerable and can be severe and debilitating. It can be due to a specific event causing an “injury”, It can be a slow gradual build up or it pops up whenever you’re really stressed and have a lot going on in your life..

There are people that have had it for years and there are people that are freaking out because they've never had back pain before and they fear that they're about to be paralyzed (I’m not exaggerating here either - it can be a frightening experience)

We pretty much see people with low back pain in the clinic at every point on this scale.

Here are our key takeaways after helping thousands of people with back pain:

1. Your pain levels have NOTHING to do with the severity of injury. They are separate. You could have a very minor injury and it can be painful as all hell! Your experience and your feelings are important both to us and the management.

1. Movement!!! Things often hurt because they're not moving enough (or too much). And when things don't move properly, it's often perceived by our brains as potentially harmful = "pain". We need to help you restore your movement as quickly and as early as we can.

1. Gone are the days of "being out of whack". It would be reassuring to know that discs don't "slip".. and bones aren't "out of place". These are descriptions of what it might feel like, but rest assured that this is NOT what is happening. You are simply perceiving a difference between how it feels now versus how it normally feels… it's reasonable to perceive that something isn't working right. 

1. We need to help you, help yourself. Empowering you to be able to self-aid your pain. This comes from: knowing what is wrong; and knowing what movement is going to help you; and knowing when it's time to reach out and contact your practitioner for further advice or to bring forward your session.

Gone are the days of long sessions lying face down the whole time thinking that’s going to "re-align things”.

It's now about understanding your problem, getting you moving, knowing how you can help yourself and setting achievable and meaningful life based goals.

Is it good to be sore after working out?

So many of my patients believe that if they’ve woken up the day after training and feel that post-exercise muscle soreness it means they’ve done a good job, trained hard and made progress.

But is muscle soreness actually the best sign of a good, productive
training session?

Short answer… NO!

Often it can happen when you change up your routine or haven’t trained in a while and this sort of experience is normal and a common reason to experience soreness. But you can also be experiencing
muscle soreness for reasons such as poor sleep or hydration.

If you continue to experience ongoing muscle soreness it can mean that your body’s not recovering well enough or that you’re putting yourself through too much strain.

We often think that “more is better” but it actually might not be the case and it could be worthwhile getting a professional to look at how you structure your workouts and training and see if they’re suitable for where you’re at in your health journey.

But if we’re not basing training effectiveness on soreness, what should we be looking for?

Here are 3 SIGNS of effective training to making overall progress:

1. Making overall progress:
   Are you working towards your goals? Whether it be lifting heavier, running further, putting on muscle or training consistently.

2. Training Consistently:
   You’re better off doing 3 good training sessions a week than the best session imaginable once a month. Good habits and consistency will mean less soreness and gradual
   progressive changes and feeling good after your sessions.

3. Feeling good after your sessions:
   Experiencing a post exercise ‘high’ is one of the best benefits from doing exercise. We should feel accomplished and happy with what we’ve done as well as some fatigue that isn’t too uncomfortable

The greatest results from your training will always be at a tipping point. The tipping point being, that if you do any more you enter the realm of diminishing returns. The challenge for all coaches is to find each persons tipping point.

There is some truth to the point that our bodies can do a lot more than we think we can handle. Breaking through these mental barriers are important as long as they aren’t to the detriment of what you can tolerate biochemically and physically as well.