Patellofemoral pain syndrome

Patellofemoral pain syndrome

Time to talk a little about one of the most common form of knee pain Patellofemoral pain Syndrome

What is Patellofemoral pain syndrome (PFPS)?

Patellofemoral pain syndrome (PFPS) is a condition of the knee caused by a compressive or sheering force of the patella (kneecap) on the femur. This excessive force may be due to several factors including excessive foot pronation (flat foot), glute and hip weakness, training overload and poor training techniques, particularly with squatting motion.

Patellofemoral pain

The knee is often thought of as an innocent victim between the hips and the feet. The theory behind this is that the knee is a hinge joint and only bends forwards and backwards. Therefore, when the knee tracks inwards or outwards, it is the feet or hips are often the cause. The effect of the hips and feet can also contribute to changes in the direction of pull of the quadriceps thus affecting how the patella moves along the femur.

Hip & foot affect on the knee

So how to I overcome PFPS?

The most effective management strategies are to modify aggravating activities, retrain the gluteals and quadriceps, monitor loading of patellofemoral joint and work on technique correction. Taping techniques can be used to change the position of the patella and improve foot pronation. If pronation taping techniques have a positive change on pain, then orthotics may be a useful way to settle down symptoms long-term.

Long Term effects

In most cases patellofemoral pain should resolve within 4-12 weeks. Unfortunately, the long-term prognosis of PFPS is bleak. 70% of individuals who acquire PFPS will have a reoccurring episode. It is important to provide patients with self-management strategies in case there are any future flare ups.

How can I avoid flare ups

At FIT Healthcare, we believe exercises and activity is one of the most important ways of getting healthy. We believe that exercise is a very important component of achieving patients’ goals. This is especially true when it comes to PFPS. Long term management of PFPS involves following a rehab care plan for the hips and lower limb. The aim is to ensure that force through the knee and patella is dispersed adequately. Our gym space allows for patients to perform their exercises in a safe and supervised environment.

Glute Bridges

For an in depth look into your knee pain and to get a rehab plan designed for you, get in contact with us or make an appointment to see get started on improving your issue.

Fascia – The Untold Story of Connective Tissue

Today lets talk about one of our favourite topics FASCIA. There’s currently a lot more research coming out these days and we’ve done a lot digging around this week to get the latest goss and scientific news. It’s important to note the people doing this pioneering research that T .Meyer’s, Carla Stecco and Robert Sheilp to name a few have done on the topic of fascia and connective tissue.

So with that in mind read on!

Today we are jumping right in to the deep end and taking an in depth anatomical look at the fascia of the body.

To keep things simple, we are going to refer to the fascia as the connective tissues of the body.

If your new to the topic of Fascia please head on over and have a read of our introductory blog post about Fascia : The Wonderful World of Fascia

Cool now you’re up to speed.

*As always this article is an educational tool not a self diagnosis sheet okay!, So if you experience any symptoms or have reoccurring pain it’s important to see your health professional to get it double checked*

Read Responsibly.

FASCIA AN IN DEPTH LOOK AT THIS MAGICAL ORGAN

Fascia is one of the most under researched organs in the body. Yes it is an organ.

Quick refresher…

Who doesn’t love food? Exactly, so lets use food analogies to explain fascia!

You’re a sausage (no pun intended) your bones, organs, brain, muscles are the meat of the sausage and your fascia is the lining of that sausage. It connects all your muscles, organs etc together like a chain of sausages, but rather than everything being in a line, there are links everywhere.

Fascia sausages

Another way you can look at it is like a piece of marbled steak. So everyone knows that you have a skeleton. It is common to believe that you then have your tendons which attach to the muscle. Technically that’s right but its a little bit more intricate. Your tendon is a tough tissue that fans throughout the muscle fibers much like a good piece of marbled steak. This then leads to the tendon on the other side of the muscle. So rather than tendon – muscle – tendon, they actually blend in together. This happens all the way throughout your entire body.

Fascia steak

You can see how it holds everything! And everything sits in fascial pockets. Your fascia then intertwines and winds around the body to form “fascial lines”.

So what’s the big deal?

Well since your connective tissue holds everything in your body, it’s kind of a big deal! It a part of everything you do!

The reason it isn’t addressed is because it was removed from the body before people got to dissect the cadavers. So it’s literally been ignored for 100s of years. But thanks to the group of pioneering individuals mentioned before, the research is getting done and new findings are being discovered.

What’s it made of?

Connective tissue is primarily made up of water, proteoglycans and tissue. It’s hydrated by water and hyaluronic acid. There is also a new cell that has been recently discovered in the fascia by Carla Stecco (A German researcher specialising in the cutting-edge discovery of fascia). Carla identified a new type of cell called fasciacytes. These fasciacytes are responsible for facilitating the gliding motion between the fascial layers and are “devoted to producing the hyaluronan‐rich extracellular matrix”- (Carla Stecco, Caterina Fede, Veronica Macchi, Andrea Porzionato, Lucia Petrelli , Carlo Biz, Robert Stern  Raffaele De Caro, 2018, Abstract exert).

Fascia is compiled in sheets that glide over one another. It therefore requires a significant amount of hydration (hyaluronan‐rich extracellular matrix) to be able to glide across itself and the muscle tissue.

Healthy fascia

Robert Schleip (another famous German scientist) has discovered among many other fascia- nating things,  that fascia consists of fibroblasts and collagen matrix.

Fibroblasts are a part of the connective tissues. They are essentially what makes your connective tissue tighter.  Fibroblasts do a lot of the grunt work when healing the connective tissues of the body. According to new research these fibroblasts become overactive during times of immobility or injury. This causes Fibroblasts to over produce collagen fibres within the connective tissue. The fascia then basically becomes overcrowded and matted.

Overcrowding of the Fibroblasts dehydrates the connective tissue, therefore hindering it’s ability to glide freely.

Hydrated VS Non Hydrated fascia

When the connective tissue is stretched or stimulated by physical activity or manual therapy the hyaluronic acid and water flows back in and the fibroblasts respond by relaxing.

How does connective tissue work?

Basically, your connective tissue is a giant morph suit like a spidy suit which it is made up of collagen fibres. It moves in a gliding motion over each layer.

connective tissue

If you have a fascial restriction in one area, it can pull on all the other fascia in the body.  Having tight connective tissue in one area effects the rest of the body in numerous ways because well it holds everything.

 

Let’s have a look at an example:

Take Joe Blogs here:

bad sitting posture

 

Look familiar?

He sit’s at his desk all day. What’s happening to Joe’s connective tissue? It’s tightening! Through the chest and front of the body. This doesn’t stop here either it travels all the way down the body. Soon Joe will have pain and stiffness in his upper back but also his lower back and gluteals hips and legs.

PLUS he’s sitting there like that for 6 plus hours what do you think the fibroblasts are doing? They’re multiplying and getting tighter with the prolonged period of immobility.

Why and How does connective tissue cause pain?

Like everything else in the body your connective tissue has receptors that it uses to communicate. One of the biggest reasons your connective tissue is so sensitive to pain is that:

  1. Fascia has 6 – 10 times more afferent free nerve endings than muscles present so it perceives things as a lot more intensively.
  2. Robert Schleip discovered that TGF-b1 is linked to our stress response in our body. Research is showing that there is now a neurochemical link between your emotions and how your fascia responds via your sympathetic nervous system. ( Does Fascia hold memories?2014 Elsevier,18,259-265)

 

What’s the best remedy for Myofascial pain?

It is important to note that whilst there are many ways to assist the connective tissue there are fundamental differences between techniques and their effectiveness. Fascia does not require a lot of pressure or force to loosen, rather it is more important that the pressure to be applied correctly.

There are a couple of specialised massage techniques which can give good relief of connective tissue tension.

Fascial Release Techniques

MFR (myofascial release) is a gentle stretching pressure that is applied to release the stuck connective tissue.

ROLFING– is a slow sustained deep pressure that helps to push the fluid out of the fascia like towel, just wringing it out. Once the pressure is released studies have showed that the water and hyaluronic acid count is higher in the fascia than it is prior to a ROLFING treatment.

Massage also helps to stimulates the fibroblast cells to produce new collagen within the connective tissue and this helps reduce pain and tension within 3 days.

myofascial release

Myofascial trigger point release VS Deep Tissue Massage

“Trigger point therapy is sustained pressure at a single point where as Myofascial Release is more of a sustained stretching of tissue between two spots.”- ROLFING institute.

Deep-tissue massage works on the deep layers of muscle. “If the fascia around these muscles is restricted it will not allow the muscle it encases to relax into proper function”- Amy delvanthal.

Other things that can help connective tissue

Other things you can do that have scientifically shown to improve your connective tissue is a good old-fashioned workout and staying well hydrated drinking 2 litres of water per day as our bodies are 68% water.

drink water

So now your all up to date with the latest science behind this fascia-nating organ.

Liked this article? Feel free to share and comment

Body feeling stiff and sore? Book in for a session today

 

Want to learn more? Check out these great links

*Carla Stecco  Caterina Fede  Veronica Macchi  Andrea Porzionato  Lucia Petrelli  Carlo Biz  Robert Stern  Raffaele De Caro, 25th March 2018, The fasciacytes: A new cell devoted to fascial gliding regulation, Wiley Online Library, 05/20219. https://onlinelibrary.wiley.com/doi/10.1002/ca.23072

*The Mysterious World Under the Skin Documentary- https://www.youtube.com/watch?v=bWU_DnC9t4I

*Book Review of Fascia: The Tensional Network of the Human Body- https://www.researchgate.net/profile/Thomas_Findley/publication/289814802_Fascia_The_Tensional_Network_of_the_Human_Body_The_science_and_clinical_applications_in_manual_and_movement_therapy/links/584bd49e08ae4bc8992be8ae/Fascia-The-Tensional-Network-of-the-Human-Body-The-science-and-clinical-applications-in-manual-and-movement-therapy.pdf

*Fascia Magnified 25x- https://www.youtube.com/watch?v=uzy8-wQzQMY

*Fascia Research Congress: The discovery of a new cell & new ways to improve well being- https://www.youtube.com/watch?v=V26LZgqDPgU

*https://www.bodyworkmovementtherapies.com/article/S1360-8592(13)00192-7/pdf

Headache – the plague of the 20th Century

HALT!!! Stop the googling, right now. I am here to explain one of the plagues of the 20th century, HEADACHE. Yeah, you know those thing’s that make you google “is it a tumor?”
 
Well for most people googling brain pain, here is a few reasons NOT to panic. First off, we live in the modern era, it’s fast paced and high stress and it’s super easy to get overwhelmed. It’s even easier to forget about the most important thing in your life, yourself, until it’s gone to far and your in crippling pain.
 
So today I want you to stop googling, humor me and ask yourself these 3 simple questions:
 
1. Are you in any pain right now? Do you have a headache?
2. What’s your job?- do you spend all day sitting? or standing in one area? Do you exercise?
3. Are you stressed about work, worried about your personal life or prone to anxiety and depression?
 
If you answered yes to any of these questions, there’s a good chance that this article can help you get some clarity as to why you are potentially experiencing headache. 

Modern problems

 

Speedy Gonzales

 
Take a second to stop what your doing and put your hand on your tummy and take 3 slow deep breaths in and out feel your tummy expand and deflate. Do it it’s easy, I’ll wait. 
Great! How do you feel better? Refreshed?
 
#1 Breathing- this is so important guy’s if your not breathing properly your really not helping your muscles out. (Deep breathing increases oxygen to the blood – blood travels to the brain and muscles- muscles and brain work better). Breathing is also linked to emotional health and when were stressed or in “fight or flight” mode your breathing becomes shallower and you use your secondary muscles of respiration instead of your diaphragm and abdominals. These muscles (on the left upper hand corner of the diagram below) the scalenes, sternacloidamastoid and pectoralis minor lift the rib cage upwards as you breath, causing them to shorten and become tight overtime. These muscles also refer pain to the surrounding head neck and shoulder region.
 
Breathing muscles 

Poor Posture

 
You’ve probably heard this a million times, it’s your “poor posture” that’s causing you pain. Well it’s true and I am going to tell you again in case it didn’t sink in from the last time you heard it. Poor posture specifically forward head posture causes lot’s of little muscular imbalances to happen. These head positional changes make your head heavier and this can cause “trigger points” (those knotted sore bits you push you when you get this headache pain) to activate and refer pain into your head region.
 
Basically as your chin slides forwards and your shoulders hunch over, your weight shifts and your head becomes heavier. The average head weighs 5.4kgs. For every inch that the head shifts forward from mid-line, the effective weight on the neck increases by 10 pounds.
 
So if your head sits 5 cm forward from mid-line (which is incredibly common!) your head effectively weighs 10kg more! That is a massive weight shift that your body now has to cope with. No wonder your in pain! Now I want you to be honest with yourself here… is this your current posture? Do you find yourself slumping over your desk, are your shoulders slowing creeping forwards when you stand?
 
Forward head posture
 
Then I have some good news for you! It’s reversible.
 
If this is you then you probably have poor posture with your head shifting forwards and are potentially experiencing what’s called a “tension headache”. 

Tension Headaches

 
Basically, the pain you feel is caused by your muscles, specifically the ones at the base of the skull (suboccipitals), your upper neck (trapezius and levator scapula, scalenes and sternacloidamastoid muscles). They have all become too tight due to the forward shifting of your head and now have active trigger points in them. 

So what can you do?
 
Today I have told you about your breath muscles and now I am going to tell you 3 more muscles that are affected by forward head posture and what you can do to help them out. 

Anatomy of muscles that can cause tension headaches.

 
There are many muscles in the body, currently there are 700 named musculoskeletal muscles in your body. All these muscles work very hard everyday 24/7 to keep you moving. Naturally if you don’t look after them they’re going to protest your choices and cause you pain to let you know they are unhappy and need some help. One of the main things they do is hold your head upright on top of your body. 

Suboccipitals– These muscles connect the base of the skull to the upper neck. When irritated they refer pain to the back of the eye and across the side of the head.

 
SuboccipitalsSuboccipital referral pattern causes headaches

 

Upper Trapezius– This diamond shaped bad boy spans across a large portion of your upper back and neck. It typically refers pain up and over the head even into the front of the face and eye area.

 
Upper Trapezius 
Upper Trapezius referral pattern causes headaches 

Levator Scapula is responsible for pulling your scapula up. It can become overactive if your upper trapezius muscle (dude above) becomes overactive, becomes weak or through an injury. It refers pain in his general area over the top of the neck and shoulder and down the middle of the scapula’s (shoulder blade region).

 
Levator Scapulae 
Levator Scapulae referral pattern
 
All these guy’s refer pain up and around the head region. This happens when they become weak and stretched due to the head shifting forwards and them having to hold up the extra  kilos! They get active trigger points within them and the result is a whopping bad headache.
 
Obviously, this is not the ONLY thing that can cause a headache. If you are experiencing extreme headaches or migraines it’s best to see your health professional just to be safe and rule sinister things out. This article is in no way intended to be a “diagnose yourself article” it’s purpose is to merely educate you in  what happens with a forward head posture and give you some clarity as to what’s involved with a common condition that we treat in the clinic all the time. However, tension headaches are becoming increasingly more common and so is forward head posture.
 
There are other things that can be the cause of headaches such as previous whiplash injuries, or degeneration of the spine such as arthritis or from surgery or injuries, stiff facet joints or nerve impingement. However it’s always best to see your GP to get checked.
Here is an exercise to help you check and correct your posture and start to build some body awareness. 

Practice good posture

 
Practice good posture 

 

Exercise to improve posture

 
Exercise for improving posture 

Hope this article helps you build some more body awareness and perhaps helps you breath a little better.
 
Know anyone with persistent headache issues? Share this article to let them know what’s going on? Have this problem and want some help? Pop into our clinic and get an assessment to find out how to best overcome your pain. https://www.fithealthcare.com.au/appointments/

What is Sciatica?

Sciatica

Sciatica
 
One of the more broadly used terms when it comes to low back, glute and leg pain is Sciatica. It is also one of the most commonly misdiagnosed and mismanaged injuries. But what exactly is Sciatica and what causes it?

 

The Sciatic nerve is the longest and largest nerve in the body. It originates from your lower back and travels down the back of your leg all the way to your knee. The term Sciatica simply refers to any pain that radiates along the Sciatic nerve. It is usually felt as a pain along the back or side of the buttock and runs down your leg. As the nerve is so long, there are multiple ways that a problem can occur along its path.

 

OK so we know what the pain is, but why is it happening?

 

There are 3 major ways that the Sciatic nerve can be irritated, Disc Bulge, Joint irritation or Muscle pinch

 

Disc Bulge

 

It is known by many names; slipped disc, herniated disc, protruding disc but we will call it a Disc Bulge. One of peoples most feared diagnosis is a disc bulge. Just reading the word might make you shiver. To make you feel better have a look at this stat: 54% of people aged 40 have 2 disk bulges and don’t even know they have it! So just because you have a disc bulge doesn’t mean you will get all these problem and pains.

 

 
Your spinal discs sit between each spinal bone and acts like a shock absorber for your spine. They allow for movement between the spinal joints as well as allowing space for the nerves to leave the spine.
 
Bulging disc
 
Spinal discs are made up of many tough fibrous rings along the outside and filled with a jelly-like substance in the middle. The easiest way to think of it is like a jelly doughnut. When the outer rings get damaged it allows the inner jelly-like substance (nucleus) to push out and cause a herniation/bulge. When this happens in the lower back, it can push out and put pressure on the Sciatic nerve as that is where the nerve originates from. Nerves don’t like pressure on them and will become irritated which causes you feel as pain.

 

Joint Irritation

 

Each spinal segment has multiple joints. Joints connecting it to the segment above and the segment below and on each side of the spine. We call these the facet joints. Your Sciatic nerve leaves the spine from the space created by the facet joints.
 
facet
 

Facet joints can get irritated in a number of ways, repetitive movements, trauma, arthritis etc. Where there is irritation there is often inflammation and we all know how inflammation works. The joint gets swollen and produces pain. Now just like with the disc bulge, this swelling can put pressure on the nerve as it leaves the spine. And as we know, the nerve does not like being put under excess pressure. That is when your symptoms kick in.

 

Muscle Pinch

 

 
The final one we are going to talk about is Muscle Pinching. As the Sciatic nerve runs through the buttock and leg, the surrounding muscles can pinch or put pressure on the nerve. The most common one the Piriformis muscle. This muscle is located within the buttock region and the Sciatic nerve runs right along side it. The nerve can even pierce through the muscle in some people! When the Piriformis gets tight or irritated, it then compresses the nerve. I don’t have to tell you how the nerve reacts as a result, you’ve heard me say it many times by now. The Hamstring muscles are also guilty of this. Have a read of our blog post here to learn all about the hamstrings.

 


Know the cause to know the solution

You can see how the Sciatic nerve can run into a problem in different ways. It is important to understand why your Sciatica is happening rather than just blanket diagnosing as Sciatica. Know why and how so that you know how to properly manage the issue.
Speak to one of our injury specialists to find out where your pain is coming from and to start a management plan specific to your issue.

Why your ankle sprain might not be as simple as you first thought


 
Ankle sprains are one of the most common injuries seen within clinics across Australia. Most of us have experienced an ankle sprain at some stage whether it occurred while playing sport or simply having a misstep getting out of the car.
 
The general perception about ankle sprains are that all you need to do it give it some rest and it will be good as new in a few days’ time. What most people don’t realize is that a seemingly “simple” ankle sprain can have long lasting or reoccurring consequences that can be experienced long after the injury.
 

It changes the way you use your leg muscles

The first problem that we see is the way that you use your leg and foot muscles changes. Your body’s reaction to the sprain is to make certain leg muscles tighten up or work more. This might help in the short term, to lock up the ankle so it can heal. More often than not they do not return to normal. The muscles keep on working overtime well after their clock off time.
 
This tightness or over-activity within certain muscles lead to stiffness particularly within the ankle and foot. If one area of the body doesn’t move as well as it should the body will still need to complete the movement so it will compensate for the stiffness in other areas.
 
A perfect example of this is in a squat movement. One of the most common reactions to an ankle sprain is a reduction in adequate dorsiflexion (toes up).  What will happen in order to allow you to do a squat is that the ankle will either roll in (invert) or you will end up bending more in the back/hip than is normally required, which ends up stressing out your back.
 

 
Excess stress being put through areas of the body that are used incorrectly can lead to other issues popping up. It is common for knee, hip or back issues to be felt much later after an ankle sprain.
 

It changes the sensory input from your leg to your brain

Another issue that we see is that coordination of the foot/leg goes all out of whack. Your ankle is vital for balance and coordination of the entire lower limb. Because of this there are a whole heap of nerves around the ankle to help coordinate its movements and spatial awareness(where your body is in space). When a sprain occurs, these nerve functions gets impaired. This means that the connection between the brain and foot will be compromised.
 
To put it simply, your brain will not know how your ankle/ leg is moving. This leaves it more prone to re-injury or other injuries occurring.
 

 
Commitment to a rehab program designed to improve your ankle strength, coordination and balance is vital. Everyone’s body reacts differently when an injury occurs. If you are unsure of what you need to do, have a chat with one of our injury specialists on (02) 9797 0009 or book an appointment here.

Muscle Strength vs Muscle Activation

muscle strength

Everyone wants their muscles to be nice and strong. It can help them pick up heavy objects, do lots of sit ups and even prevent back pain. What if I told you that as part of your rehab you should be focusing on more muscle activation rather than just strength? And what exactly is the difference?
 

Muscle Strength

 
I think most people would understand muscle strength so I wont go into it too deeply. Muscle strength is your muscles ability to produce force. The stronger your muscle the more force it can produce. This is important in terms of resisting and moving load.
 
muscle strength
 

Muscle Activation

 
Your muscles ability to switch on and work is what we describe as muscle activation. This often comes down to the mind-muscle connection. You require a greater connection between your mind and muscles to make it more active.
 
What does that actually mean? It means your brain has an easier time engaging a particular muscle. This makes sure that you are using the correct muscles at the correct time which is something that we see in our clinic daily that needs to improve.
 
This concept is important because in order to do an exercise or movement efficiently and safely you need the appropriate muscles to work. You’ve heard the saying before; there are many ways to skin a cat. This applies to movement. There are many ways that you can do a particular movement but there are some more efficient and safer ways than others.
 

Let me give you an example

 
Lets look at a shoulder abduction movement. You have many muscles within the shoulder complex that assist with this movement whether its for stability or movement of the arm.
 
Shoulder abduction
 
The muscles that should be doing majority of the work are the Deltoid and Supraspinatus muscles. They are the muscles that move the arm up away from the body. A common pattern that we see is when the Upper Trapezius and Levator Scapulae muscles are overactive. What you will notice is that your shoulders shrug as you lift your arm up and away from the body. This Upper Trapezius should only be used as a stabilizing muscle rather than contributing to the movement. This mismatch shows how muscles activate and dominate during certain movements. Muscle activation is good but over-activation is not necessarily a good thing.
 
Have a look at someones Shoulder Blades while they abduct the arms and see if you notice a difference between the right and left side. If you notice a difference, it is the muscle activation that is doing this.
 
In certain movements a muscles contribution may be required more or less. Not only can a muscle be too active but others become less active.  The reason certain muscles become overactive and others under-active often comes down to habits such as performing movements in alternate ways or as a reactive due to injury. You need to work on both overactive and under-active muscles to have the best outcome.
 

OK that’s great, but how to I build or reduce my muscle activation?

 
Great question, glad you asked. Lets look at deactivating muscles first. Stretching is a very common and simple way to switch a muscle off. Don’t fall into the trap of doing heavy stretching as this creates a contractile reflex in the muscle as a safe guard. Start light and work your way into the stretch.
 
stretch armstrong
 
Another great way is through a method we like to call recipricol inhibition. You might be thinking what the hell is that, well let me explain. When you use a muscle, its opposing muscle relax. The easiest way to think about this is with your biceps. When you show off your guns and flex your biceps, the biceps are activating and the triceps are deactivating to allow for the movement of the arm.
 
Another example is in the glutes and hamstrings. When you flex your hip, the hamstring and glute muscles which control hip extension relax to allow for the flexion movement.
 
Hamstring Stretch
 
We can use this to our advantage. Say you want to switch off your hamstrings, contract your quads whilst getting into a hamstring stretch. This switches off the hamstrings through the use of the quads and allows for a better stretch.
 

Now to turn on the correct muscles

 

Once the overactive muscles are switched off, now you need to switch on the correct muscles. Sending the right feedback to your brain is essential in cementing a new way of moving. You do this by engaging the correct muscles during a movement or exercise.
 
activate
 
One way you can activate the right muscles through practising a movement without excess load or with minimal load. You are not trying to build strength, just engaging the correct muscles and get that mind-muscle connection working more efficiently. Once you master the movement then you can add load to challenge it even further and create stronger connections.
 
Lets look back at the shoulder abduction movement. It is a common gym exercise to build and strengthen the deltoid. If you are using the Upper Trapezius muscle then you wont be benefiting from the exercise as much as possible. Go through the exercise with no or minimal weight. Concentrate on pinning the shoulder down and stopping the Upper Trapezius from activating. Run through this until you don’t have to concentrate so hard to achieve this. Sometimes dialling back the exercise like this is a simple way of activating the right muscles.
 
One great exercise that activates the core in a very beneficial and supportive way is the Deadbug exercise. This exercise is great for activating the core to provide support whilst you are moving the rest of your body. This can apply to almost any movement or action as poor core stability will have an influence on performance but also stress out other structures which can lead to injury and pain.
 
dead bug
 
The gist of activating the correct muscle comes down to knowing what you need to activate during particular movements and practise that movement or other appropriate movements, ensuring the desired muscle is working. Dial back on using load until you can comfortably use the correct muscles as excess weight can alter how you recruit your muscles.
 
You can see how doing an exercise to “strengthen” the muscle might not necessarily be what you need. Making sure your activating the right muscles must come first before you think about strengthening muscles through big exercises such as squats or deadlifts.
 
If you are unsure what muscles you need to work on, whether it is activating or deactivating, talk to one of our specialist who can guide you.

Why can’t I get rid of my tight hamstrings?

Tight Hamstrings

Tight Hamstrings
 
“I have always had tight hamstrings” “No matter how much I stretch my hamstrings stay tight”
 
If I had a dollar for every time I’ve heard a statement like this I would have a private island right next to Sir Richard Branson.
 
The age old tale of the tight hamstrings. The stubborn muscle that never seems to relax. If its so common is it meant to be like that? The short answer is no, here’s why.
 

Find the problem

 

If you have been stretching your hamstrings but they still feel tight then its time to look elsewhere. If they were actually tight hamstrings then they would have relaxed after regular stretching. What most people fail to think about is the Sciatic nerve.
 
Most people have heard of the Sciatic nerve and most likely associate it with Sciatica, nerve pain that you feel in your back and down the leg. This is not the only way that the nerve can hinder you.
 
Sciatic Nerve

 

The Sciatic nerve is a big nerve that originates from the lower back and travels down the leg. The nerve has a long way to travel, ducking and diving around lots of big active muscles. This creates lots of places that the nerve can be caught, trapped or pinched. Stretching your hamstrings when the Sciatic nerve is trapped will definitely stop you from reaching your full potential.
 
To put it simply, when you do a hamstring stretch with an immobile sciatic nerve you are asking for trouble. Like all over structures in the body nerves don’t like being put under excess stress.
 
Joint mobility issues, whether it be hip, pelvis or lower back, can affect the stretch of your hamstring. Lets take a quick anatomy lesson. The Hamstrings are a group of 3 muscles that start at your sitting bone (part of the pelvis) and end below the knee. Your low back, pelvis and hips all have a direct influence on your hamstrings. If either one are not moving well, your hamstrings will start their stretch earlier.
 

Try this exercise

 

Lie on your back, stiffen up your abs and core whilst you lift one leg up into a hamstrings stretch. Now relax your core and let your hips and low back round if they want to during the stretch. Notice how much further you can get.
 
Hamstring Stretch
 
This shows the amount these joints influence the hamstrings. What can often happen is that these joints lock up due to mobility issues and therefore your hamstrings begin to stretch earlier like how they did when you did the test with a solid core.
 

What do I do now?

 

Figure out whether the feeling of tight hamstrings are actually a muscular problem, joint mobility issue or nerve issue. It could be a combination of the three.
 
If its a muscular issue look at your hips, calves and feet. You’d be surprised the effect they have on the hamstrings. Have a read of our post on Fascia on how they link. If it is your hamstrings that are simply tight, rather than just doing your regular stretch, try putting it under a little load. Doing a Stiff Legged Deadlift is great for this! You’d be surprised how adding a little bit of load can help lengthening out those tight hamstrings.
 
Straight leg deadlift
 
For joint mobility issues, do some joint mobilisations. How to do these really depends on the affected joint and its limitations so best to consult your Therapist. Don’t disregard the muscles that can be causing your joint mobility dysfunction!
 
If you find its your Sciatic Nerve that is stopping you, try the Sciatic Nerve mobilisation. Redo the previous hamstring stretch test we did previously. This time at the top of the movement, pump your ankle up and down repeatedly. This gets the nerve moving along its path down the leg and can free it up from anything that may be stopping its mobility.
 
Sciatic nerve mobilisation

 

As you can see it might not actually be your tight hamstrings that are getting in the way. Give those a try to combat those “tight hamstrings” and as always if you need some extra help speak to one of our Therapists who can help get you out of pain and performing at your best.

Knees collapsing in? it might be causing your knee pain!

Knee collapse comparison

One of the most infamous movement patterns that you don’t have to look very hard to find is the inwards collapse of the knees.

Those of you who are in tune with your body during exercise may notice the knee fall inward during your activity. It is common in weight bearing activity, like a squat, running, jumping, or during sport specific movements like cutting. Knee collapse can often be seen as a precursor to developing knee pain.

Knee collapse comparison

 

Why Does it Happen?

I like to describe the knee as a dumb joint. The reason is that your knees follow what happens at the feet and at the hips. One easy way to demonstrate this is by giving yourself flat feet. Let the arches of your feet collapse down flat against the floor. You will notice that your knees will shift with it. This is a huge component of knee collapse. A change in the foot, whether it be structural or functional (such as your flat feet) have a kick on affect up into the knee. Work on stabilising those arches and get that foot functioning to help correct the knee.

flat foot

Another major source of knee collapse comes from the hips. Typically a lack of stability within the hips allows for the knee to drift medially (inwards). The main contributors to that is the much loved glute muscles.

The good ol’  Glute Max is responsible for extension, abduction (movement away from body) and external (outward) rotation of the hip. Strengthening/activating the Glute Max will be a good start to correcting the knee collapse. So get working on those kick backs and hip thrusts!

kick backs

 

Naturally, women are more susceptible to knee collapse due to their wider hip angle compared to men. This leads to an increased chance of knee pain and injuries. The reasons mentioned above are only 2 ways in which these areas allow for the knee to collapse. In reality it is more complicated than this, however it is a good place to start.

An often missed cause of knee pain

Knee pain is so common these days. Runners, gym goers, Footy players or even your weekend warriors commonly complain of some sort of knee pain. It is so important to look to the source of the problem, which when it comes to knee pain, isn’t necessarily the knee. Assessing your hip and foot biomechanics and your movement patterns can be a huge help in overcoming knee pain, particularly those pesky ones that never seem to go away.

Come and chat with one of our injury specialists about getting an assessment to see what is irritating your knee and putting together a plan on how to overcome it.

Call us on (02) 9797 0009 or make an appointment here.

Tennis Elbow, could I have it?

It may be called Tennis Elbow but that doesn’t mean you have to play tennis to suffer from this condition. People from all forms of profession and sports can develop Tennis Elbow, here is how.

 

Lets start off with a little anatomy lesson. Lateral Epicondylopathy or Tennis Elbow as its more commonly known is a condition affecting the outside of your elbow. The muscles that control extension of your wrist and fingers merge together to form the Common Extensor Tendon. This tendon then attaches to a bony prominence at the end of your Humerus bone called the Lateral Epicondyle.

wrist extensors anatomy

 

Now what happens in Tennis Elbow is that micro tears occur in the Common Extensor Tendon, most often due to overuse. Most people believe that the next step would naturally be inflammation due to the damage. This however, often does not happen in this condition. Inflammation is not apart of this condition which  leads to why it can be such a long lasting condition. It is actually considered a degenerative condition

Many people believe inflammation to be bad but that couldn’t be further from the truth. Don’t get me wrong, prolonged and unnecessary inflammation is not a good thing. Inflammation is the way the body eliminates dead cells and organizes the appropriate cells for healing start repairing tissue. If this isn’t happening then the healing process takes a whole lot longer!

 

How does the damage occur?

Just like with anything use it over and over again and problems can occur. Overuse of the wrist and finger extensor muscles is the most common cause of Tennis Elbow. Repeated movements over and over again can stir up the muscle and tendon and eventually the tendon gives way. The force placed on the tendon becomes more than the healthy tissue can handle. It is possible that trauma such as a hit at the elbow can also cause this, however, inflammation is more likely to occur in that scenario making much easier to overcome.

But I don’t play Tennis

tennis elbow 2

So now that you know the anatomy, cause and effect of Tennis Elbow, how do you get it even though you don’t play? It got the name Tennis Elbow because it was so common among players. Tennis involves repetitive use of the extensor muscles when they are moving the racket to hit the ball during play. The whole game revolves around this movement. Therefore they are doing this day in day out, thousands of times in a row. You can see why the tendon gets fed up.

Tennis isn’t the only place where this occurs. Office workers who spend all day typing on the computer or Tradies who are spending their days hammering away or using a screw driver commonly feel its wrath. Realistically  any repetitive action that involves your wrist and finger extensors can lead to this condition.

There is also a condition called Golfer’s Elbow which is the same condition but affecting the wrist and finger flexors on the inside of the elbow.

How do I get over Tennis Elbow?

 

Modifying behaviours, removing the load, progressive strengthening program, releasing of muscle tension and biomechanics modification are all ways in which you can overcome Tennis Elbow. As with every injury or issue, every case is different and understanding your personal circumstance is essential.

Call us on (02) 9797 0009 to discuss how you can overcome your case of Tennis Elbow or make an appointment to see one of our injury specialists here.

Shoulder Clicking? Here is what it means

shoulder pinching

shoulder pinching

One of the most common questions we get with our patients is “Why does my shoulder click when I lift my arm over my head?”

Most people have either heard someone say this or experienced it themselves. But what exactly does it mean?

First off lets look at what makes up the shoulder

Made up of 3 bones, many ligaments, multiple bursa to reduce friction and a whole heap of muscles, you can see why the shoulder is one of the more complex joints in our body.

Shoulder Anatomy

Muscles coming from the back, shoulder blade, neck, chest and arm all play a role in how your shoulder functions. That’s a whole lot to consider when trying to figure out what could be causing your problem.

Lets look closely at a group of muscles you might have heard about before called the Rotator Cuff Muscles. These 4 muscles play a huge role in how your Humerus (arm bone) sits in the glenoid cavity, aka your good ol’ ball and socket joint. It also helps maintain this position throughout your shoulder’s many planes of motions. Maintaining a good position within the joint is important to allow for free moving, unrestricted movement.

What causes the clicking and pinching?

Keeping the Humerus in its right position requires a whole heap of coordination between the Rotator Cuff muscles. If a muscle isn’t quite pulling its weight, it can cause the joint to move in an altered way. Altered movement patterns often result in pinching or clicking of the shoulder.

Another cause of the clicking can also come from the control of the Shoulder Blade (Scapula) itself. Poor stability or control of the Shoulder Blade can cause an improper placement of the shoulder joint and also poor movement.

scapular winging

 

Why does this cause me pain?

 

When improper control or movement occurs, often it comes at an expense of other structures. These structures include muscles, tendons, bursa or ligaments. I’m sure you don’t like dealing with extra stress. Well guess what, neither do your body structures. Extra stress placed on unintended structures over time lead to inflammation. It is inflammation that ends up causing you the pain you complain to us about.

How do we get rid of it?

 

As you can imagine, there is no real simple answer. Treating the site of pain can help you but unless you look at the cause of the dysfunction and correct that, eventually it will come back to haunt you again.

I could give you countless muscle releases and rehab exercises but that doesn’t mean its going to help you with your shoulder.

It is incredibly important to target your specific dysfunction when we look at shoulder problems. Generalised rehabilitation plans often don’t have a successful outcome.

How do you find out your dysfunction?

 

If you’ve had a persistent shoulder issue and it is not getting better it is best to have it looked at by a professional. They will look at the way your shoulder is functioning and how that is leading to your issue. This way you can have a personalised approach to solving your issue as everyone’s case is unique.

Feel free to contact us on (02) 9797 009 or at info@fithealthcare.com.au to discuss formulating your personalised treatment plan and start getting you back to 100%

Visit our blog page here for more informative post to help with your aches and pains.