You have bad knees right?? No matter what you do you end up with knee pain. You’ve foam rolled your ITB till you're black and blue, you’ve strengthened your VMO (inside quad muscle - can’t really be independently strengthened, but that’s another story), you’ve had x-rays, M.R.I’s and consulted very expensive specialists who surely should know best as to what’s going on with your knees. But alas, you still have knee pain. Have you ever considered that it may not be you knees that are the problem?

Whilst a lot of knee issues can be the knee joint itself, especially traumatic injuries to the knee, more often than not it is the knee that is screaming out in pain because you have an issue upstream or downstream of the knee, ie: the hip or the ankle. There is also the case where it is a knee pathology that is being aggravated by an instability in the hip or ankle so it is alway important with the knee to check the hips and ankles.

Regional interdependance.

In regard to the body regional interdependence basically means that each part is mutually or equally dependent on each other ie: the hips rely on the knees as much as the knees rely on the hips for proper biomechanics.

Joints take turns from the foot all the way up to the head, alternating between stable and mobile joints. A mobile joint is considered a joint that can move in many directions. A stable joint doesn’t like to move in many directions and usually only moves fin a couple of directions and prefers stability.

Here is a list:

Foot - Stable

Ankle - Mobile

Knee - Stable

Hip - Mobile

Lower back (lumbar spine) - stable

Middle back (thoracic spine) - mobile

Lower neck (cervical spine) - stable

Upper neck (cervical spine) - mobile

Scapula - stable

Shoulder - mobile

Elbow - stable

Wrist - mobile

Hand - stable

The ankle is a mobile joint. This means that it can move in many planes of motion. Ankles can flex up or down (dorsi flexion= pulling foot up towards body and plantar flexion: pointing foot down)., they can go in and out (invert and evert), pronation and supination as well as a bit of rotation.

The hip is even more mobile than the ankle. It can rotate, move forwards and back (flex and extend) as well as go out the side and back across the body (abduct and adduct).

The knee however really only likes to move forwards and back (Extend and flex) as it is a hinge joint. Think of the movement a hinge in a door will do. The knee can rotate slightly but many issues can arise when we ask our knee to rotate too much or in repetitive tasks for the knee such as running. Anyone who has torn their ACL in the knee will agree with this as the ACL is most commonly injured when the knee is asked to rotate more than it can.

So you can imagine that if the hip is unstable then the knee can move all over the place. The most common issue is that the hip stabilisers aka the Gluteus Medius and Minimis are weak or not doing their job properly so instead of holding the knee in proper alignment the knee can drift inwards over the big toe side of the foot. The knee will likely also rotate inwards too.

Also if the foot is pronating, which usually means the ankle is dropping inwards, then the knee will also follow it and drop inwards.

So there you have it. If the ankle and hip are unstable or weak then the knee will be asked to move in ways that it isn’t capable of doing and over time can damage the knee joints the ligaments or the meniscus inside the knee joint. One of the most common knee injuries is called patellofemoral pain syndrome. One of the most common causes of this injury is that the patella (knee cap) isn’t sitting well in its joint on the femur, often called a patella tracking issue. This can often be caused by the femur and or the tibia rotating inwards caused by the hip or the ankle weakness or tightness.

So what can you do?

What??, I hear you ask, you mean I have to do something?? Yes, unfortunately, if you want to fix these kinds of issues you need to put some good time into exercises to help strengthen muscles and establish motor patterns that can allow for stability in these important joints.

Obviously having an assessment to see where your issues lie is the first step. But a general rule of thumb is to check if your feet are dropping inwards or you have flat feet. You can also stand in front of a mirror with your knees exposed and see if your knee caps rotate inwards. This is a sign that the femur (upper leg bone) and/or tibia (lower leg bone) are rotating internally.

To fix the hip

The first thing to do if your hip is dropping inwards we need to find out if it is a weakness in the abductors/external rotators of the hip or if it is a tightness in the adductors or internal rotators that are keeping the femur locked into an internal, dropped position.

To help the femur rotate externally or outwards and to also stop the femur from dropping inwards you need to strengthen the gluteus medius. The Glute medius, most commonly called Glute Med (pronounced mead) is an overachieving muscle as it wants to do pretty much all of the hip ranges of motion. This includes hip abduction (lifting leg out to the side), external rotation of the femur, extension of the femur (taking the leg back), the front fibres of the muscle also perform internal rotation and flexion of the hip as well. So the only hip action the glute med doesn't do is adduction. Often left out of anatomy books as to what glute med’s action is, is hip stability, which is basically the hip flicking out to the side. If you think of an olympic walker flicking their hips all over the place, or a catwalk model, then this is what Glutei med is trying to prevent. A strong glute med is seen when you stand on one leg and the pelvis stays level and the hip doesn’t push out to the straight leg side.

To self assess your hips you can stand of a mirror and place your fingers on the bones that stick out at the front of your pelvis (A.S.I.S). Stand on one leg and then lift the other leg bending it at the knee. You should lift the knee up to hip height. The pelvis should stay level, so you shouldn’t see one of your fingers drop down as the pelvis drops. If the pelvis drops on the side where your leg is straight then it is showing that the glute medius can't hold the hip in position.

Glute Medius/minimus strengthening / stabilisation exercises.

Easy isolated exercises: banded clams, Jane Fondas,

More functional exercises: banded crab walks and all the variations - side walking, forward/diagonal walking, backwards diagonal walking, 90/90.

Stability exercises: single leg exercises are the key to hip stability and therefore knee stability. Single leg deadlifts, lunges, single leg hip thrusts,

You can also incorporate glute med strengthening and stability into your everyday life. When walking try to make sure that your knee doesn't drift inwards. The rule of thumb is that your knee- cap should track over the 2nd and 3rd toes.

Stretches:

adductor stretches. The adductors can pull your femur inwards when they are tight. Internal rotation stretches like the 90/90 can be great to loosen up the tight internal rotators of the hip.

To fix the ankle

If the foot is dropping in or flat the this will also let the knee drop in which then means the knee joint isn’t aligned properly and also the knee cap can be rubbing at the patello-femoral joint.

Try this!! If your feet are flat or you think/have been told you have flat feet then you can do this quick assessment to see what is causing the flatness. Flat feet or over pronated feet can be caused by a variety of issues. The 2 main ones are weakness in the muscle that holds the arch or the way your bones are aligned. If you can lift the arch in you foot then it is likely that it is just weakness in the Tibialis Posterior muscle which lies deep to your calf muscles and attaches to the Navicular bone in your foot. If this muscle is weak then it will just drop the navicular bone and it will appear you have flat feet. Most commonly flat feet is just weak feet. Most people have flat feet because most of us have weak feet. When was the last time you did isolated foot exercises at the gym?? But you’ll do biceps or glutes right?? Same thing, we need strong feet and ankles.

Exercises:

Isolated: banded foot inversions (strengthens tibialis posterior), toe curls, arch raising, toe spreading, toe raising. More functional: calf raises, single leg calf raises (can easily do calf raises at the traffic lights or waiting for the bus), toe walking (walking around on the toes. Being more mindful of keeping the arch up when walking and not letting your foot drop inwards, this also helps to reprogram the motor control of foot mechanics or the way you walk. You can also apply this to any gym training. If you are doing squats, deadlifts or lunges make sure to keep your arch raised and not let your ankle drop in.

Stretches:

If the ankle or foot is tight then the ankle won't be able dorsi flex enough, this then means that the foot will roll in when you walk. The foot will compensate by using the pronation of the foot which will also make the knee drop in. To increase your dorsi flexion you need to stretch your calf muscles. If you have tight calves then you may find you pronate and then get knee pain.

Stretching the peroneals (outside of lower leg). If the peroneals are tight then they can be pulling the ankle and foot into pronation.

A good combination of Mobility (flexibility and strength), Stability and Strength is important to fix injuries and also prevent them from happening in the first place.

So there you have it. Hopefully now you realise that those pesky knees aren’t so pesky after all and it may have been the ankle or hip all along. Whilst knee pain can be caused by the hips and knees it is always important to still check the knees themselves as there may be an injury there that is being aggravated by the instability or tightness in the hip or ankle. At Muscle Therapy Australia we endeavor to perform a thorough assessment so we are not just making assumptions and guessing about what the issue is. A good assessment will look at the whole body and not just isolate to one joint, this way we are less likely to miss things.

As always we are here to help if you would like to have a professional assessment and find out if your knee pain is actually coming from the hip and/or ankle. Also if you need more direction on any of the exercises then feel free to get in touch.

Part 3 - Jane Mathews - Author of The Art of Living Alone and Loving it; Costa Georgiadis - Get in touch with nature; Jocelyn Brewer - Digital Nutrition – how much is enough? Or too much digital use?; Jill Stark - Anxiety & managing your inner child’s needs; Ross Menzies - Anger: we need to let go of anger and Toni Noble - The rise of Perfectionism

Jane Mathews

Speaker Jane Mathews, author of ‘The Art of living alone and loving it’ resonated with me most, probably because of my life stage right now – like her, and 1 out of 4 households (fastest growing demographic in Australia and global trending), I live alone. She questioned why marketers rarely feature single people in advertising, focusing on couples and families despite the growth – perhaps a strong stigma still persists for single people and or people who live alone.

Health implications of living alone are that it could be worse than smoking or obesity on immunity, so it is more important to focus on developing networks and friendships in these households.

Its important to realize that feeling lonely is normal, that it will pass, be kind to yourself, build self worth by learning/achieving something and in turn resilience. Reframe living alone to ‘solitude’, a time for reflection and discover/rediscover who you really are.

Tips for those living alone and staving off the feeling of loneliness:

Have hobbies – learn something newMarie Kondo your friends – keep the radiators, ditch the drainsMake new friendsHelp othersGet out of the house – go exploring, socialiseLonely proof your house – have pics of your friends, artwork, things to doHave things to look forward to – eg. plans, magazine subscriptionsHave things you wear that give you strength

And most of all, love yourself. Fiercely.

She wrote this in the book I bought and I almost instantly burst into tears with gratitude.

“we want predictability to have a sense of control…we need to make peace with unpredictability and uncertainty, its ok not knowing…”

– Dr John Maddocks, author of Against the Odds

Costa Georgiadis - Get in touch with nature

Costa Georgiadis, Gardening Australia presenter says “there’s nothing wrong with being analog in a digital world”, coming on stage with some notes copied and glued onto his pages. Who knew people still used gluesticks?! As humans we cannot live without plants, we often take them for granted – reconnect with nature, get out and go observe nature.

“Give more, take less. Produce more, consume less. Collaborate more, compete less…”

Jocelyn Brewer - Digital Nutrition – how much is enough? Or too much digital use?

Jocelyn Brewer, psychologist,www.digitalnutrition.com.auspoke of the need to monitor and manage our digital consumption.

As more and more of us are glued to our phones, filling waiting time or empty space with devices – it’s important we stay human in a digital world. And being human, we are ‘awake’ and try to remain kind, authentically connected to others, empathetic and conscious of our actions.

The addiction to devices, and social media in particular, reflects our desire tobelong and survive socially.

Her 3 M’s for digital health:

Mindful – be present here right nowModerate– are you getting enough sleep? How do we react online?Meaningful– choose meaningful news to consume

Jill Stark - Anxiety & managing your inner child’s needs

Refreshingly honest, authentic and outwardly vulnerable Jill Stark, award winning journalist and best selling author of Happily Never After and High Society, spoke of her childhood anxieties and how they carried through to her adult life.

“I felt I wasn’t enough” and despite all the achievements, looking at the end point the New York Times spoke of ‘the arrival fallacy’, that happiness will spring from the arrival of success or milestone met. There is “too much focus on the wedding, not the marriage, or the birth and not the pregnancy…”, when we should be enjoying the process of getting there.

She spoke of the ‘fairytale filter’social media often overlays on people’s lives, and that we are getting jealous over filtered photos or altered photos that aren’t real!

When she was a child her parents were preoccupied looking after her very sick brother and felt neglected or abandoned, and thought perhaps when she reaches success she would get all the attention she finally wanted, and when it didn’t...

“I had a best seller…thought it would bring happiness…felt a void in my life”

Jill spoke of self compassion, giving love to yourself and reconnecting with your inner child (what do they want and need). Take yourself on dates to do this – ‘play just because, like you did when you were little’ and ‘go back to that little girl and give her love and compassion’

Other great quotes she mentioned:

“I’ve had panic attacks on stage a number of times…my heart’s racing right now but you’d never know would you?” – appearances aren’t all what they seem

“everyone is struggling … no one has a perfect life”

“try to be kinder – everyone is holding an invisible battle”

Embrace the full range of emotions, not just happiness

‘telling our kids that happiness is the ultimate goal is going to get them into trouble, we need to teach them we need to embrace a full spectrum of emotions and feel comfortable with them” – Jill Stark

Ross Menzies - Anger: we need to let go of anger

Ross Menzies from UTS and co-author of The Anger Fallacy explains why we get angry and that it comes at a cost. “You get angry of the view of the events rather than the event itself – when you think it shouldn’t be this way”

A startling statistic about domestic violence he reported:

6% of males die by the hand of their partner66% of females die by the hand of their partner

The NHS reports a 36% increase in domestic violence when the World cup is on and it increases when England loses. Anger is costing us lives.

It doesn’t have to keep making you angry if you change your belief system, that things aren’t expected to run perfectly every time with predictability and certainty. Anger tends to beget MORE anger, and expressing it creates more anger. He suggests we need to learn to express it more calmly.

Toni Noble - The rise of Perfectionism

The is a perfectionism epidemic growing since the 1980s, especially with social media growth. Meritocracy is on the rise and it is making us more competitive. Professor Toni Noble, leading psychologist in student wellbeing says mistakes are ok, in fact lots of great discoveries were made via mistakes eg. The post it, white out, slinky, and we learn from them.

Unhelpful thinking makes us more upset! We must rethink of how we are thinking. With 70,000 thoughts a day, observe which are helpful and those which are not.

We should aim high, but not for perfection as we are setting children and adults up for failure.

A lot of our clients work incredibly hard, train intensely – we want to make sure you are taking action for recovery. At least we know you’re getting treated by us, but what else?

In Kristen Neff’sSelf Compassion book sold at the conference, she lists a bunch of things aim to recharge your battery:

take time offhave a napdo a yoga/stretch classtake a bath (add 1-2 cups magnesium chloride/Epsom salts!)see a comedy showgo for a walk in natureget a massagego to a sauna/steam roomdo an exercise class that you like

For my birthday this year I think I did all of these in one week! My sister says I’m perhaps too good at this self-care business…

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So there you have it, my takeaways from the Happiness and its Causes conference 2019. I would highly recommend going next year - you can use this code to get a discount for next year:

Visit www.happinessanditscauses.com.au/register/ - use VIP code ONSITE for 50% off (its about $600 for 2 days after discount- trust me, worth taking time off work for)

If you have any questions about my experience or more about the speakers, feel free to email me

Part 2 - Thea O'Connor on Body Intelligence (BQ), Drew Harrisberg (Exercise Physiologist ) on his 6 S's to happiness and Dr Elissa Epel on chronic stress and Telomeres.

Thea O'Connor

Thea O’Connor is a work wellbeing advisor and spoke of ‘BQ' ( body intelligence) and the ability to be present in our bodies and listen to it.

Body intelligence (BQ)

Ability to notice sensations in the bodyAbility to listen to our body (signals given)Ability to respond without over riding the signals

We have this ‘more is better’ or ‘no pain no gain’ mentality, pushing ourselves to the limit. We need to learn to trust our bodies more, listen.

When hungry, eat. When tired, rest.

When you’re not sure of a decision, pause, and ask your body how it feels and wait for the visceral response.

Drew Harrisberg

Drew Harrisberg, exercise physiologist/sports scientist/model and spokesperson for type 1 diabetes gave his 6 S’s for happiness:

Sleep - 7-9 hours recommended (how many of you are getting this?)Stress fit – not stress free, but managing healthy v unhealthy stressSun! Steps – just moveSmile – do the things that make you smile!Socialise – friendships are important

And his personal one, adopt a dog– his insta-famous staffy with 342k of followers @a.daily.dose.of.dennis – is guaranteed to make you smile!

When he was diagnosed with Type 1 Diabetes, he was absolutely devastated but realized through exercise he managed to lower and maintain his glucose levels.

“Exercise is a medicine we can administer for us for free” – I suppose that also depends whether you join a premium gym or studio!

Dr Elissa Epel

Dr Elissa Epel, professor and international expert in chronic stress, co author of the Telomere effect, spoke of telomeres (ends of DNA in chromosomes) and its affect of chronic diseases. The rate at which telomeres shorten as we age, is affected by:

Stress/traumaRelationshipsHabits

Self compassion, and loving kindness meditationmaintains our telomeres. The more social support we have and intimacy we share, the more our telomeres can grow (and slow down aging) – so get working on those relationships! Being happy lengthens telomeres – so ask yourself, what makes you happy? Then I say, go and do that thing. And do it some more.

It wouldn’t’ be a wellbeing conference without #mindfulness or #meditation mentioned. Mindfulnessis a $1.1 billion industry, and with popularity trends, there will be capitalizing! Sharon Harvey, award winning journalist, author of the Whole Health Life spoke of how meditationhelps catch your mind ruminating over worries, turn inwards to painful thoughts and feelings, hopefully discerning some wisdom in the process. Wisdom and learnings will arise where there is space and time made for observing and reflection.

Meditation can be equivalent to = medication + psychotherapy

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Next week we will hear from Jane Mathews, author of ‘The Art of living alone and loving it’; Getting in touch with nature by Costa Georgiadis (Gardening Australia); Jocelyn Brewer on digital nutrition - managing our digital consumption; Jill Stark on managing Anxiety & managing your inner Childs needs; Ross Menzies on managing anger; Toni Noble on the rise of perfectionism and Kristen Neff on Self Compassion.

Visit www.happinessanditscauses.com.au/register/ - use VIP code ONSITE for 50% off (its about $600 for 2 days after discount- trust me, worth taking time off work for)

If you have any questions about my experience or more about the speakers, feel free to email me

Part 1 - Michael Mosley

This week I attended the Happiness & Its Causes conference at the International Convention Centre Sydney (apparently the worlds’ largest conference in happiness and wellbeing!) and I couldn’t resist sharing some key take-outs with you. Ok perhaps quite a few take-outs! If you’re tight for time just skim the dot points by some speakers. If I were to call out some buzzwords from the day, I’d say nurture relationships, have self compassion, recover well, eat the rainbow (natural as possible), exercise, mindfulness, meditation, kindness and manage good v bad stress.

The opening speaker was UK’s Dr Michael Mosley, famous for writing the best selling 5:2 diet book which helped cure his type 2 diabetes – captivating in his stories and entertaining delivery. What was sweet was his obvious deep affection for his wife who he gushed over a few times in his presentation “she really did fill an emotional void in my life” and while he was on a panel at the end of the day.

Can you guess the happiest ranked countries?[1]

If you guessed Denmark, you’re right. But it’s not number 1.

Finland – twice in a rowDenmarkNorwayIceland

Australia came in at #10 (our NZ friends #8) and UK #19.

All the top countries tend to have high values for all 6 of the key variables that have been found to support well being: income, healthy life expectancy, social support, freedom, trust and generosity.

3 Major factors for Happiness:

Money – having ‘enough’Relationships – the most important predictorHealth – a healthy life expectancy

Money: How much money to be happy I hear you ask? Or how much is ‘enough’?

I suppose it depends on your values and what your priorities and goals are in life. However Dr Michael Mosley reports a surprising $30k for singles and $60k for couples (perhaps this is USD?!), with the diminishing returns on happiness levels at:

For males: $100k ($130k – feeling they’ve ‘made it’)For females: $80k ($150k – feeling they’ve ‘made it’)

Being in Martin place and the bulk of our clients being corporate rockstars, I’m sure some of you are giving yourselves a pat on the back for above :)

Ok, so money is taken care of, what next?

Relationships: So what are the secrets of a happy relationship?

We need to avoid expressing criticisms and contempt towards our partner/s.

Nurture mutual fondness and admiration (celebrate them!)Turn towards each other – give genuine attention and response when communicatingBuild love maps – take interest in their world, know the names of their friendsBe kind to each otherMake jokes

Health: What are the keys to a healthy life expectancy?

Healthy life expectancy is affected by weight, nutrition/diet, stress levels, fitness, strength, and balance. However, people are only happier doing strength and fitness training if they want to do it.

Weight and depression have been shown to have a direct relationship, with obesity increasing the rate of depression by 57%. With diabetes and obesity, 3x the likelihood of depression.

Mention of the Mediterranean diet featured across a few speakers as the most recommended diet for health. This typically consists of lean sources of protein like fish and poultry, vegetables, fruit, whole grains, legumes, and olive oil.

The microbiome (the 2-3 kg of gut bacteria) was touched on a few times as well – having a significant impact on emotional, psychological health and immunity levels. Michelle Hedge, author of ‘Eat, Drink, Still shrink” reported 95% of serotonin (chemicals associated with wellbeing – it is a neurotransmitter) are created in the gut, hence the gut having such an impact on emotions, chronic disease and levels of anxiety, depression and other mental health disorders.

Interestingly, Australia has the highest rates of antibiotic prescriptions and caesarian births globally and this messes with the microbiome.

Summary

So there you have it. If you can get your money sorted, relationships in order and look after your health, Dr Michael Mosley reckons you're on your way to a happy life.

So if you’re keen to attend this conference next year (which I highly recommend at least once in your lifetime) – there’s an early bird offer expiring 2nd July.

Visit www.happinessanditscauses.com.au/register/ - use VIP code ONSITE for 50% off (its about $600 for 2 days after discount- trust me, worth taking time off work for)

If you have any questions about my experience or more about the speakers, feel free to email me Jo@muscletherapyaustralia.com.au

In the next part we will hear from Thea O'Connor on Body Intelligence (BQ), Drew Harrisberg (Exercise Physiologist ) on his 6 S's to happiness and Dr Elissa Epel on chronic stress and Telomeres.

References:

[1] World Happiness Report, 2019

[1] World Happiness Report, 2019

Buying a mattress is one of those life events that can be confusing, stressful and annoying if you get it wrong. The lure of marketing and the overwhelming variety of brands and types of mattresses as well as “expert” salespeople, can make the decision more complicated than it needs to be.

Here are 3 common mistakes people make when they are purchasing a new mattress:

Going for the most expensive mattress. Let’s face it, if you have a spare $10K lying around then by all means drop that on a new mattress. Why not buy a few and then you can really test em out. You will get some serious bragging rights when telling people that you have the best mattress money can buy. Whether or not it is the best is another story. You really need to find a mattress that suits YOU, not someone else. So if the $1000 mattress in a box feels amazing, then go for it. You can spend the other $9K on a nice holiday. Not selecting a mattress for the position you sleep in. The rule of thumb for sleeping is that if you are a front sleeper you should have a firmer mattress to support your whole body and keep your spine aligned, otherwise it will sink into a soft mattress. For a back sleeper you will need a firm to medium mattress to keep your spine aligned. If you are a side sleeper then you need a softer mattress to allow you spine to stay aligned so the curves can sink into the mattress a little. Also your shoulder and hip will create pressure points and may cause or exacerbate pain if you have existing pain in these areas if the mattress is too firm. Generally mattresses that are extremely hard or soft are no no’s, unless your personal preference is for these. Blaming your old mattress. Unless your old mattress is 30years old and sinking in the middle it is a good idea to first look at how you are sleeping before you blame the bed. Sleeping in a bad position on a good mattress can cause pain and a disturbed sleep. If you sleep on your stomach with your neck cranked to one side all night, no mattress you buy is going to help. The best positions for sleeping are either on you back or on your side with both knees bent to keep the spine in a neutral position. On your back you can place a pillow under the knees to take the pressure off your back. If you are on your side you can place a pillow between your knees to prevent your knees from hurting and to take pressure off your hips.

Considerations when buying a mattress:

If you are sharing a bed then how does your partner sleep? If you sleep in the same position then this will be easy but if one is a back sleeper and the other sleeps on their side predominately then you will have different needs. Likely if you get a firm mattress the side sleeper will find it uncomfortable. The good news is bed companies have thought of this and some have options for either changing the foam inside on either sides or having 2 separate mattresses together, called a Split Mattress. Sleeping Duck (https://www.sleepingduck.com/au) offer a foam mattress like this. There are many others that have separate beds together from Sealy and others. Your sleeping position and pillow position are more important than the mattress or pillow. As I said before you can sleep in a terrible position on a really expensive mattress and still be in pain. It’s the same with office chairs. If you sit with poor posture in a really expensive office chair you will still get pain. Returns policy. Lots of the Mattress in a box companies like Koala and Ecosa offer 100-120 day trial periods where you can try it and if you don't like it they will come and pick it up, take it to a charity and give you a full refund. No issues. They may try to convince you to keep it by offering you a pillow top, depending on why you don’t like it. Some in store mattresses are also offer these periods too, which makes it a great time to get a new mattress. Never pay full price! Never ever! This mostly goes for retail shops like Snooze and Forty Winks. They usually have 40% off sales so even if there is no sale you should be asking what their best price is and shop around. Expect to get 40% off the retail. For the online mattresses they will usually be discounted anyway. You know the drill - “ Was $15,000,000, reduced to $1000”. There is no way to bargain with these but they are already affordable enough that you shouldn’t need too. Often they have promo codes especially from previous purchases, so if you have a friend who has recently bought an online mattress then they may have a discount code for you to save more. Are you sharing the bed with kids? You need a king size mattress. Even with this you will probably still find yourself clinging to the edges of the bed for dear life. These days King Size mattresses aren’t as expensive as they used to be so it will be a very wise investment.

Types of mattresses:

Coil Mattress:

There are two types of coil mattresses:

Continuous coil mattresses - are made from a single piece of wire looped into springs.

Open-coil mattresses - are made of single springs fixed together by one wire.

Price

$400 to $10,000 (based on queen size)

Pros

They're usually lighter than other options.

Typically cheaper.

Cons

Can wear out quickly.

Because the springs move as one unit the mattress is less responsive to your body.

Any tossing and turning is likely to disturb a partner.

Springs can rust.

Memory Foam:

Topped with a layer of temperature-sensitive viscoelastic material, aka memory foam. This contours to your body when you are in the bed. When you get out it goes back to its normal shape - this is where the “memory” comes in. Don’t worry, it won't remember what you get up to in the bed.

Price

$1500 to $6500 (based on queen size)

Pros

Absorbs your weight as you sink in, taking pressure off your joints and increasing circulation.

Can mould to the shape of your body.

No risk of rust (if foam only).

Cons

Can make you feel "encased".

Can feel too solid and dense (not springy). Not likely to please someone wanting a softer, more cushioned night's sleep.

Can get warm easily due to limited air circulation so you can end up a sweaty mess in summer. Not great if you run hot.

Very heavy compared with spring mattresses so this can make it hard to move.

Latex Foam:

A blend of natural and synthetic latex that moulds to body shape.

Price

$1800 to $4900 (based on queen size)

Pros

Durable and breathable.

Better for people with allergies as they don't gather dust mites.

No risk of rust

Cons

Has a solid feel, so they're not likely to please someone wanting a softer, more cushioned night's sleep.

Very heavy compared with spring mattresses so this can make it hard to move.

Cheaper versions can get saggy over time.

Pocket spring:

Has up to 3000 springs sewn into individual fabric pockets.

Price

$1200 to $6400 (based on queen size)

Pros

Good air circulation.

Firmness can be set by tweaking spring tension (by manufacturer).

Good support by distributing your body weight evenly.

Can support two people of two different body weights well because the springs are separate.

Cons

Can be heavy to turn, as they're filled with natural materials, such as lambswool.

Natural materials can exacerbate allergies.

Springs can rust.

So there you have it, buying a mattress is a minefield at the best of times. But if you take this advice with you then you should at least be able to make a more informed decision that works best for you.

Please note that this is purely based on experience and opinion. We haven't received kick backs from any of these companies so this independent advice.

If you have any further questions on pain you are experiencing from sleeping then feel free to get in touch and we can help you out before you drop $10K on a new mattress.

Mattresses are only part of the picture when it comes to sleeping. If you would like to find out about pillows you can read our blog post on them here.

References:

I often cite the benefits of magnesium for muscles and joints to clients, especially those competing in events and or training intensely who need all the recovery they can muster, in addition to foam rolling, massage ball trigger pointing, seeing us for sports massage and regular stretching (plus de stressing mentally!!). So, I thought I’d write a blog breaking down the benefits and regular questions I get asked on the best way to take it.

Overall, magnesium is a mineral that serves many crucial functions in the human body such as:

regulating blood pressuremaintaining heart healthenergy productionnerve functionprotein synthesis – important for muscle repair!healthy bone formationblood sugar controlregulating sleep cycles

So you can see, it’s really important for overall health.

Why is magnesium often mentioned for Muscle recovery?

If you are training for a sport or activity or exercising a lot you will be depleting your body of essential minerals and nutrients, such as Magnesium. Therefore, you will need to supplement these vitamins and minerals to give your body back these crucial nutrients allowing your muscles, nervous system and other systems to recover.

Here are some way Magnesium can help with recovery:

Assistance with muscle cramping

Although research studies effects on muscle cramping have been mixed, a study has shown participants who received 300mg of daily magnesium for 6 weeks had less muscle cramps than placebo group. Similarly, a study on pregnant women showed the same effect on leg cramping.

So, whether the results are psychosomatic, placebo, or supported (further scientific research is needed), taking magnesium daily has been shown to decrease symptoms of muscle cramps. It acts as a calcium blocker, helping muscles relax after contracting.[1]

Aids with sleeping (which helps with overall recovery)

As magnesium can aid with muscle relaxation and have positive effects on the nervous system, it can help people relax and thus improve sleep quality. Animal studies have shown it can help regulate production of melatonin, which guides the sleep-wake cycle.[2]

Can boost exercise performance

With less cramping, regulation of muscle contractions, better recovery and sleep – magnesium has shown in some studies to boost overall exercise performance. There have been a few studies including one of triathlon athletes who supplemented with magnesium for 4 weeks and experienced faster running cycling and swimming times, complemented with lower insulin and stress levels.[3]

What can happen if I lack magnesium in my body?

Weakness in musclesCrampingAnxietyPoor circulationMuscle pain in neck/ shoulders

How can I take magnesium?

Magnesium can be taking orally through foods or supplements as well as through the skins through oils or baths.

Orally

While there is a plethora of supplements on the market adorning the shelves of pharmacies and supermarkets – magnesium can be found naturally in below food:

pumpkin seedsnuts such as almonds and cashewspeanuts – great for fans of peanut butter!wheat cereal / breadBrown riceSoymilkSpinach, kale and green leafy vegetablesVegetables eg. Broccoli Black beansbananasCoconut water – a natural electrolyte drink, without the sugar that sports drinks and things like endura have in them. Dark chocolate – good news for chocolate fiends!Chia seeds

Overall, food that is high in fibre such as nuts, leafy greens, legumes, and whole grains are your best bet magnesium sources.

Extra-dermally – via the skin

While there are no reliable scientific case studies touting the recommendation of topically applied magnesium sprays, oils or baths – some clients especially athletes have reported better recovery from these including floatation tanks with dead sea salts (magnesium chloride).

Magnesium / Epsom salts baths

A lot of people don’t realise that Epsom salts are made of Magnesium. They are actually made of Magnesium sulphate. The benefits of Epsom salts baths come from the chemical structure breaking down into magnesium and sulphate, which is argued to be absorbed through the skin to help muscle and joint pain. You could also argue that the warm bath alone can help by relaxing the muscles and the mind.

How much do I add to the bath?

Usually 2 cups is enough for an average bath, but you can add more for your preference provided the water can dissolve it.

What temperature?

A heat to dissolve the Epsom salts but also be comfortable for your preference, just check it as you fill it up and before you get in so you don’t burn yourself.

Does it matter where I get the Epsom salts?

Not really. Depends how much you want to spend. Some fancy ones have essential oils in them such as lavender which can also help with relaxation. But standard Epsom salts are fine. You can usually get them from any good chemist, grocery or wholefoods store, online or some clinics.

Which magnesium is best for bathing in?

You can also get Magnesium chloride (or flakes – like those of the dead sea) which is best for absorption compared to Epsom salts which break down into magnesium and sulfate. However they may not be as readily available as Epsom salts.

How long should I bathe for?

15-30 minutes is recommended, at very least 12 minutes for the time poor amongst us! However 20 minutes is probably best for your muscles and brain to relax!

When is best to take magnesium?

Magnesium baths are best before bed so you can relax (or at least not working after it!), for supplements it depends on your objectives, if it is to aid sleep, then 1-2 hours prior to sleep, if its to help with headaches/migraines, then at the first signs of those. Otherwise, the Mayo clinic advises consumption alongside meals. [4]

Float tanks

Float tanks may be another way to get Magnesium into your body. Float tanks are sensory deprivation tanks that you get into and are enclosed. There is little to no sound, it is completely dark and you are literally floating, so you feel completely relaxed.

The core benefit of float tanks for musculoskeletal recovery is the incredible concentration of Epsom salts in there (350 kg usually) which allows you to float. That’s enough to rival the buoyancy of the dead sea and give you a sting if you have a cut you didn’t cover up!

The vast volume of Epsom salts means its like an Epsom salt bath multiplied by a million (ok I haven’t done my maths, but you get what I mean) which aims to aid muscle and joint stiffness, fatigue, pain and tension. In addition to that it’s very relaxing and meditative, so if you are feeling stressed, have neck and jaw pain or tension headaches or just let go mentally and physically float tanks could be of benefit.

What are the types of Magnesium supplements and which is the best one for your needs?

Magnesium Citrate

Magnesium citrate is a magnesium citric-acid complex that is widely available and versatile. It has better bioavailability (absorbs better) than magnesium oxide, and this popular magnesium supplement is widely recommended by doctors and health professionals.

Magnesium Oxide and Hydroxide

Magnesium oxide and magnesium hydroxide are similar in structure and function and are both common ingredients in over the counter digestive tonics. Both magnesium hydroxide and magnesium oxide can have a mild laxative effect.

These forms of magnesium generally cost less than other types of magnesium but have lower bioavailability. As a result, magnesium oxide and magnesium hydroxide supplements may contain as much as 60% more magnesium than other types of magnesium supplements to help make up for the lower bioavailability.

As a general rule, loose stools from magnesium supplementation are a sign that your body isn’t fully absorbing the magnesium or that you’re taking too much magnesium at once. If you want to avoid potential laxative effects of magnesium, it may help to divide your intake into 2 or more smaller doses taken at different times of the day.

Magnesium Chloride

Magnesium chloride is also a popular type of magnesium, but it usually isn’t taken internally. Magnesium chloride is commonly found in seawater and is believed to have high bioavailability. Magnesium chloride is available in flakes that can be added to bathwater or a foot soak, as well as in magnesium oil. This is a great option for people who have trouble taking magnesium orally, or for those who simply prefer to get their magnesium in topical form.

Magnesium Oil

Magnesium oils are gaining popularity as a convenient way to supplement magnesium intake. Quality magnesium oils are made with magnesium chloride and water, creating a super-saturated brine. This non-greasy mineral brine soaks easily into skin without leaving an unpleasant residue. Magnesium oil is typically available in a spray bottle, so you can simply spritz it on after a bath or shower. As a bonus, it helps moisturize your skin!

Magnesium Sulphate

You’ve probably heard of this type of magnesium before, but by a different name. If you’ve heard of Epsom salts —that’s magnesium sulphate! It’s very similar in appearance and usage to magnesium chloride. Simply dissolve a cup or two of Epsom salt in a warm bath and soak.

Bioavailability is lower with magnesium sulphate than with magnesium chloride. But that just means more bath time, right? Magnesium sulphate also provides sulphur, which may help soothe tired muscles. That makes Epsom salt popular among athletes looking to pamper sore or tired muscles from exercising.

Magnesium Carbonate

Magnesium carbonate is a naturally-occurring form of magnesium. In nature, it occurs as dolomite or magnesite and is ground into a fine powder for use in supplements. Because of its fine texture when ground, along with its superior mixability and solubility in water, magnesium carbonate is often used in calming magnesium powder drinks that are perfect for helping you unwind at the end of a long day. Most foods will also contain Magnesium carbonate.

Magnesium Chelates

Chelated mineral supplements, including magnesium chelates, are minerals that are bound to amino acid proteins to help make them easier for your body to absorb. There are many different types of magnesium chelates featuring various amino acids that provide additional benefits.

Magnesium amino acid chelates include:

Magnesium Glycinate – Magnesium bound with glycine, provides optimum bioavailabilityMagnesium Lysinate – Magnesium bound with lysine, helps pamper skin with amino acidsMagnesium Orotate – Magnesium bound with orotic acid, supports heart healthMagnesium Taurate – Magnesium bound with taurine, supports heart health while promoting calmnessMagnesium Aspartate – Magnesium bound with aspartic acid, helps fight fatigue and promotes cellular energyMagnesium L-Threonate – Magnesium bound with threonic acid, promotes mental sharpness and cognitive healthMagnesium Malate – Magnesium bound with malic acid, supports energy production

Chelated magnesium supplements may cost a little more because of the complex processes required to make them. However, since the body is very good at absorbing amino acids, magnesium chelates have higher bioavailability, making magnesium chelates a great option for boosting your body’s magnesium levels.

As you can see there are many types and brands of magnesium supplements on the market and it can be confusing as to which one to buy. However, it is important to consider the absorption rate in the blood stream for your needs. Make sure to check the label to see what type of magnesium it contains.

The table below summarises the core differences[5]:

Like most things, you get what you pay for. The cheaper Magnesium supplements are going to have less absorption and may cause laxative effects. The more expensive supplements like the chelates will have more bioavailability but will be more expensive.

It can be better to buy practitioner grade supplements from a pharmacy or naturopath as these will generally have more bioavailable Magnesium in them. These will be more expensive though.

How much should I take?

The ideal level of magnesium depends on age, gender and for women, whether pregnant or not.

Table Source: Berkeiser, K. (2018) Healthline, Magnesium dosage: How much should you take per day?, 6 July

According to the National Institutes of Health’s Office of Dietary Supplements, healthy adult men should generally consume 400 - 420 milligrams (mg) of magnesium daily[6].

Healthy adult women should consume 310 - 320 mg daily. Pregnant women require a higher dose than women who aren’t pregnant, which are increased to 350–360 mg per day.[7] Magnesium is a recommended supplement to take during pregnancy, however the MOST you should ingest is 350 mg daily. Pregnancy multivitamin supplements will usually contain this, so make sure if you are taking extra magnesium to not take too much.

Is there such thing as too much magnesium?

The short answer - yes! I had an overly gung-ho training friend who overdosed on his magnesium supplements and was shaking uncontrollably. Technically speaking an overdose on magnesium is called hypermagnesemia, which symptoms can include[8]:

CrampingNauseaDiarrhoea – excessive does may have a laxative effect.ConfusionTirednessBladder paralysisHypertension in heartCardiac arrest

In worse case scenarios of overdose – a cumulative affect of too much magnesium in the body can result in serious side effects including an irregular heartbeat, low blood pressure, confusion, slowed breathing, coma, and even death ( but you’d have to take a lot)[9]!

If in doubt ask your friendly pharmacist, naturopath, dietician or doctor for advice.

Summary

So there you have it, if you are training like the beast you are, are getting cramps, are pregnant or are stressed out and want to improve your sleep, taking Magnesium or eating more foods that contain Magnesium may be just what you need.

It can be a good idea to speak to your health professional about your needs and how much to take. Having a blood test to determine whether you are low in any vitamins and minerals is also important.

Jo Goh - Sports and Remedial Massge therapist at Muscle Therapy Australia.

Sources:

Breus, M. (2017) Magnesium how it affects your sleep, Sleep Doctor, 20 Nov

https://www.thesleepdoctor.com/2017/11/20/magnesium-effects-sleep/

Bunch, E. (2018) The types of magnesium you will be taking to reap the most benefits, Well and Good, 14 July

https://www.wellandgood.com/good-advice/types-of-magnesium-supplements/

Dersarkissian, C. (2017) Why take an Epsom salt bath, WebMD medical reference, 20 July

https://www.webmd.com/a-to-z-guides/epsom-salt-bath#1

Rayman, R. (2018) What Does Magnesium do for your body, Healthline, 9 July

https://www.healthline.com/nutrition/what-does-magnesium-do#brain-benefits

Shaefer, A. (2017) Can you overdose on magnesium?, Healthline, 3 May

https://www.healthline.com/health/food-nutrition/magnesium-overdose-whats-the-likelihood

Sheldon, L. (2017) Muscle pain and fatigue when taking magnesium, LiveStrong, 14 Aug

https://www.livestrong.com/article/520881-muscle-pain-fatigue-when-taking-magnesium/

Spritzler, F. (2018) 10 evidence based health benefits of magnesium, 3 Sep

https://www.healthline.com/nutrition/10-proven-magnesium-benefits

Swaminathan, R. (2003) Magnesium Metabolism and its Disorders, Clinical Biochemistry Review, 24(2), 47-66, May

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626/

WebMD Vitamins and supplements, Magnesium

https://www.webmd.com/vitamins/ai/ingredientmono-998/magnesium

Types of magnesium

https://www.swansonvitamins.com/blog/lindsey/magnesium-types-compared

[1]https://www.healthline.com/nutrition/magnesium-dosage#section1

[2]https://www.healthline.com/nutrition/what-does-magnesium-do

[3]https://www.ncbi.nlm.nih.gov/pubmed/9794094

[4]https://www.mayoclinic.org/drugs-supplements/magnesium-supplement-oral-route-parenteral-route/proper-use/drg-20070730

[5]https://www.wellandgood.com/good-advice/types-of-magnesium-supplements/

[6]https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

[7]https://www.healthline.com/nutrition/magnesium-dosage#section1

[8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626/

[9]WebMD, https://www.webmd.com/vitamins/ai/ingredientmono-998/magnesium

Carpal tunnel syndrome (CTS) is a commonly diagnosed condition but can be poorly understood. Around 2.7% of people will get carpal tunnel syndrome in their lives. You’ve probably heard of carpal tunnel syndrome, but how much do you actually know about it?

In this blog we will explore the anatomy of the wrist, forearm and hand, the symptoms of carpal tunnel syndrome, the causes and what you can do to resolve this, generally without surgery.

The anatomy

The carpal tunnel is a narrow passageway on the palm side of the wrist that allows the median nerve and 9 tendons to pass through it, from the forearm and into the hand and fingers. The transverse carpal ligament creates the roof of the carpal tunnel and the wrist bones (carpals) create the walls and floor (see image).

The 9 flexor tendons include the flexor pollicis longus (flexes the thumb), 4 flexor digitorum profundis and 4 flexors pollicis superficialis (flex the 4 fingers). These tendons originate from the muscles that all originate from the inside of the elbow.

The median nerve runs from the brachial plexus in the neck and travels under the collarbone, through the armpit, to the elbow and then down the middle of the forearm to the fingers, via the carpal tunnel.

Symptoms

The symptoms are the most important part of the diagnosis of carpal tunnel syndrome. These symptoms include:

Tingling or numbness in the thumb, index finger, middle finger and half of the ring finger (the half closet to the middle finger) on the palm side of the hand (see the picture) and the palm. On the back side of the hand it is more the tips of the thumb, index, middle and half of the ring finger that is affected. The rest of the back of the hand and those fingers is innervated by the radial nerve. The ulnar nerve controls the rest of the ring and pinky fingers as well as the pinky side of the hand. Weakness in the fingers that are innervated by the median nerve. This can manifest by dropping objects.Aching or pain in these fingers, the palm and/or the wrist.

Causes

This is where is gets tricky as there are many opinions and outdated information as to how carpal tunnel is caused.

Hereditary. 50% of people have CTS where it has been passed on from the parents and determined in the genes.Overuse. People who do repetitive tasks for work using their fingers and hands, such as process factory workers, cleaners, people doing data entry and just computer work in general are found to suffer the most.Pressure on the wrist. If you use a computer and rest your wrists on the table or laptop then you will be compressing the carpal tunnel. Over time this may form adhesions between the transverse carpal ligament and the median nerve. This can then cause the carpal tunnel syndrome symptoms. You can try getting a gel wrist rest, taking breaks, stretching and adjusting your desk setup to avoid pressure on the wrists.Diabetes. Diabetes, especially type 1 (genetic and not lifestyle based like type 2) can lead to nerve damage amongst other things. If you have diabetes then you are at a much higher risk of CTS.Other neurological conditions that affect nerves such as multiple sclerosis, motor neurone disease, Parkinson’s disease and some infections.Pregnancy. When you are pregnant a whole cocktail of hormones are released that can affect the connective tissues in the body. Especially Relaxin. When this happens the carpal tunnel can collapse and put pressure on the median nerve. Arthritis. With arthritis the joints of the wrist can swell and create less space in the carpal tunnel. This can then put pressure on the median nerve. Tendonitis of the wrist tendons can cause swelling that also creates less space in the carpal tunnel and you guessed it compression of the median nerve. Shape of the wrist. Unfortunately there is not much you can do about this as it is hereditary. It has been found that if you have a square shaped wrist that you are more likely to suffer from carpal tunnel syndrome. A square shaped wrist means that it is a wide as it is long. This would usually present as a narrow wrist and it is thought that this may tighten the ligament and put more strain on the median nerve. Oedema. Swelling can put pressure on the carpal tunnel. Surgery to remove lymph nodes in the arm pit can lead to swelling in the arms and hands. Trauma. If you have an injury to the wrist or hand, this may damage the carpal tunnel or increase inflammation and swelling.

How is Carpal Tunnel Syndrome Diagnosed?

Symptoms. This is the simplest diagnosis. If you are having tingling only in the median nerve pattern for the palm and fingers then it is highly likely that you have carpal tunnel syndrome.

The most definitive test is a nerve conduction test. This test pulses a signal through the nerve to see if the signal is getting through the carpal tunnel. If it isn’t then it is likely that the carpal tunnel is putting pressure on the median nerve.

Who this affects?

Unfortunately for all of you women carpal tunnel syndrome affects 3 times more women than men. Some thinking is that women tend to have a smaller carpal tunnel which means there is less space for the median nerve to travel. There is also some research to suggest that these statistics may be skewed by more woman having taken up manual tasks.

It is also more likely to affect you if you are between 40 - 50 years old.

Ok, so what can be done about it?

This really depends on how long you have had the issue, how severe it is (weakness or numbness), what you do for work or play and how risk averse you are.

Conservative management. This is always the first step for most injuries. Releasing the forearm muscles and the ligaments in wrist have been shown to take the pressure off the median nerve. Techniques such as Active Release Techniques have been designed to help to release nerve impingements. They do this by pinning the impingement and then using specific movements to move the nerve and getting it gliding again, taking the pressure off it. Splinting of the wrist. Wearing a wrist splint can help you to avoid positions that may put pressure on the carpal tunnel. This is common when we sleep. You may place your wrist in an extreme flexed or extended position that may irritate the nerve. Wearing a splint when at work can also help to stop the nerve becoming aggravating. Nerve flossing or gliding for the median nerve. These exercises can help to free up the nerve. These exercises are very useful to prevent carpal tunnel syndrome as well, so if you do a manual job that makes you at risk of CTS then performing these multiple times a day may help keep CTS at bay. Length of time. If you have had the symptoms of carpal tunnel for a long time then there may have been damage to the nerve. This means that your outcome may not be as good as if you had have treated it earlier.

What Muscle Therapy Australia can do to help

At Muscle Therapy Australia we have a unique methodology to help you get out of pain fast and keep you that way. Our approach involves:

A thorough case history to discover anything you may be doing or have done that has brought the symptoms on. This may be your job, lifestyle, any illnesses such as diabetes, accidents that may have injured your wrist. Other issues that may not seem linked. Remember that the body is a whole that works together and not all these separate systems. Postural, range of movement and strength assessment. This assessment is often overlooked by practitioners. We can often find the exact tissue that is injured through this assessment. Orthopaedic assessment. This involves those special tests mentioned earlier. Phalen’s test and tine’s sign as well as assessments to rule out neck or other nerve impingement involvements.Treatment. This is where we really shine and come into our own. Lots of practitioners and doctors may be able to tell you you have carpal tunnel syndrome, but can they help you beyond telling you not to do anything (which is kinda hard with the hand and wrist), put you in a splint and put you on anti-inflammatories. Our treatment focusses on releasing the muscles and fascia of the forearm, wrist, hand and fingers/thumb. We may also use dry needling to also release these tissues. Specific active release techniques (A.R.T) to get the median nerve to glide through the carpal tunnel or transverse carpal ligament. This is very specialised treatment and only those trained in A.R.T will know how to do this. There are very specific nerve releases that involve manoeuvring the clients hand, arm, shoulder and neck to get the nerve to move. Exercises. Stretching the forearm and the palm are key to getting the wrist to loosen up. Nerve gliding/flossing of the median nerve is also important to keep the nerve moving once it is freed up. Self care. As with any injury you need to take the reigns and put in the work to fix your injury. If you don’t and just rely on a practitioner to do this for you then you will never truly be in control of your injury. If you go back to the same old lifestyle then chance are the CTS will come back. This is even the case after surgery. We see many people years down the track after surgery who are complaining of the same symptoms.Nerve flossing. See images. Start with elbow and wrist bent. Shoulder down. Head tilting away. Then slowly and with control tilt head to the same side as the arm to stretch, shoulder down, straighten elbow and extend wrist by pulling it back (follow arrows). Do this 10 times at least 3 times per day. You can build up to 3 sets of 10 3 times per day.

Nerve stretching. You can also just stretch the nerve. Start at 30 seconds and build up to 1 minute. You may feel the symptoms come on as you stretch the nerve and this is very normal, so don't worry.

Wrist flexors stretch.

So there you have it. There is hope for CTS and it doesn't always need to have surgery. If you think you may have these symptoms or know someone that might then don't hesitate to get in touch as without being addressed CTS may get worse and lead to longer term nerve issues.

Remember prevention is better than cure so by doing these stretches and nerve flossing you may also prevent Carpal Tunnel Syndrome from coming on in the first place.

References

Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks? https://www.ncbi.nlm.nih.gov/pubmed/10845778Youtube carpal tunnel syndrome surgery https://www.youtube.com/watch?v=FhALIWs6oP8Median nerve glide - http://contrologypt.com/purpose-of-nerve-glides/http://sydneynorthneurology.com.au/carpal-tunnel-syndrome/

First things first. TMJ stands for Temporo-Mandibular Joint. When referring to TMJ pain, this usually means pain at the temporo-mandibular joint. TMJ pain can also be labelled TMD or TMJD meaning temporo-mandibular dysfunction/disorder or temporo-mandibular joint dysfunction/disorder respectively. Ok, so for the rest of this article I will use TMJ to mean the joint and TMJD to mean the dysfunction or pain. People will often just say they have TMJ (meaning pain), but technically if someone says “I have TMJ” you could easily say, “yes, and so does every other human and most mammals (i think)”, as this just means they have a temporo-mandibular joint. But that is being really pedantic and annoying… moving right along.

TMJD is a very common condition that we treat all the time. It would be one of the most common reasons people come to our clinic. Jaw clenching and grinding tend to be the most common causes of this pain and as most people clench or grind in their sleep at night, they usually don't have a sense of why they are getting pain in the first place.

TMJD can be debilitating and at its worst can mean you can't chew solid food without pain. There are many different causes and some underlying issues that can be at the root cause, making this a tricky injury to treat and manage.

Anatomy

Let’s start with the basics. What is the TMJ? This is where the temporal bone (side of the skull) meets the mandible (jaw bone). Where the mandible and temporal bones come together is a synovial joint. This joint actually has a disc just like our spine. This disc absorbs pressure as without this disc the pressure of chewing food would damage this joint.

The skull or cranium is actually made up of 8 bones. These bones are held together with sutures or connective tissue when we are born, to help the skull be more malleable so the head can fit through the birth canal. The sutures then fuse at around the age of 2 to become one solid bone. The 8 cranial bones are the ethmoid bone, frontal bone, occipital bone, parietal bone, sphenoid bone and 2 temporal bones (see picture).

The muscles of the jaw:

Temporalis: This is the biggest of the jaw muscles and takes up a good portion of the side of your head. This muscle controls closing the mouth (elevation of mandible) and pulling it in (retraction of mandible).

Masseter: this is the muscle right on the side of your jaw bone or mandible (also involved in closing your mouth and retracting it). This is one of the most painful of the jaw muscles to be massaged.

glove. There are 2 pterygoids, the medial and lateral. They control lateral deviation (side to side movement) and protraction (pushing the bottom teeth forward.

Digastrics: these are located under your chin and connect the jaw to the base of the skull (mastoid process). They open the jaw (depress) as well as retract and deviate the jaw.

Platysma: a big sheet of muscle that covers your throat and connects to your chest. They help to open your mouth.

Mylohyoid: under the chin. They help to open the mouth (depression).

There are some other muscles that also help with jaw movement.

What is TMJD?

TMJD (temporo-mandibular joint disorder/dysfunction) can be a complicated condition as there are many different presentations of TMJD.

The symptoms of TMJD can include:

Pain in the TMJPain in the muscles of the masseter (side of jaw), temporalis (side of head) or pain inside the mouth (pterygoids). Pain in the teeth - especially after dental work as the mouth can often be held open for extended periods of time and can aggravate the jaw. Clicking or clunking of the joint when chewing or opening the mouth. Difficulty chewingDislocation or locking of the jaw.Headaches/migrainesNeck painRinging or clicking in the ears

Some people may just have one of these symptoms, a few or all of them. When all the symptoms are present it is more serious and tricky to work on.

Causes of TMJD?

There are many causes of TMJD and the assessment and treatment of this will be different depending on the cause.

The most common causes are:

Grinding teeth or clenching teeth (bruxism) - usually at night while asleep. Misaligned teeth or jaw (malocclusion)Always chewing on one side of the mouth - this can often happen after having tooth pain. You chew on the good side to avoid pain and then become accustomed to it. Osteoarthritis in the TMJ.Disc damage to the TMJ. The TMJ has a disc just like in the spine, which has many. The Trigeminal neuralgia - a very painful issue with one of the cranial nerves that causes severe pain in the cheek and jaw. Fracture of the jaw leading to jaw dysfunction. Poor posture

What can be done?

The first step is figuring out what is going on with the jaw and what is causing the issue.

Grinding or clenching: if your issue stems from grinding then remedial massage, active release techniques and dry needling can be beneficially to reduce the tension and pain. Long term though you will need to address the stress. Self massage and stretching can help to keep the tension and pain from building up.

Misaligned jaw: rebalancing the jaw is key here. Releasing the tight muscles and strengthening the weaker ones can help to realign the jaw. If your jaw clicks on the left side, often the jaw is slightly coming out of the joint on the left. This could be because the muscles on the right side are pulling the jaw that way when you open it. Releasing the right side and then strengthening up the left side to prevent the jaw from deviating will be crucial to preventing the clicking. This can be a long road as it takes time to rebalance muscles. You can’t just do an exercise once and think it will magically fix it.

Severe clicking or locking: if your jaw if locking up regularly or clicking and catching then there may be an issue with the joint. The TMJ, like any joint, can become degenerated. This is generally age related wear and tear, meaning this will happen to everyone. If you have had a trauma to the jaw or have a long history of clenching then you may have prematurely damaged this joint. Having X-rays and seeing a specialist dentist such as an orthodontist or neuromuscular dentist will be essential to rule this out.

Osteoarthritis: Unfortunately at this point in history there isn’t a miracle cure for osteoarthritis, which is basically just wear and tear of the joints as we age. It can also be caused by a misaligned jaw, as it will keep running on the joint and degenerate it. There are lots of claims that injections such as Platelet Rich Plasma (PRP) or stem cells are the next generation of treating osteoarthritis, but at this stage it is very hit and miss.

Managing the symptoms is key here. Massage and dry needling can help to loosen up the muscles and take pressure off the joint. Exercises for the jaw are also important as this can help to realign the jaw and also take pressure off the TMJ. We always asked about supplements like glucosamine and chondroitin, which have failed to win over scientists and researches and have negligible effects at best, especially on severe osteoarthritis.

Therapeutic Botox is becoming more popular for chronic jaw pain. Botox is injected into the main jaw muscles which basically paralyses the muscles temporarily. This can work wonders, but will only last for a few months before you will need a top up. Getting to the root cause and fixing it is always better than covering it up with bandaids. Botox is a toxin, it hasn’t been tested over long periods, it’s expensive (can be $1000’s if you get it through a specialist and not the local beautician) and if you do go to someone who isn’t medically trained in it then there is a risk of more serious side effects.

In the worst case, surgery can be indicated, but like most surgeries there is a risk that it may not work and may actually make things worse. Once the jaw is modified it is hard to go back to the way it was and it can take years to get under control again.

What we do at Muscle Therapy Australia for TMJD

TMJD is one of the conditions we are passionate and skilled at treating at Muscle Therapy Australia. Jaw pain and headaches can be some of the most debilitating conditions out there, so to be able to help people overcome this is very rewarding.

Our approach:

Differential Diagnosis (what else could it be?)

Whilst we never want to think the worst, rarely jaw pain, migraines and headaches can the underlying symptoms of more serious issues such as:

Sinus issuesTrigeminal Neuralgia - as mentioned previously, TMJ pain can be a symptom of this nerve issue. Jaw fractureTooth decay MigrainesTinitusRheumatoid arthritis - this is where the body's immune system attacks our joints. As the TMJ is a synovial joint, it can also be affected.

These would be considerations to have investigated if you weren’t getting any better with conservative treatment. As always with our health, we have to be our own advocate and you aren’t happy with a doctor or health professionals advice or treatment plan then seeking a second, third or more opinion can be the difference in giving up on you health problem and accepting it or finding out what is actually going on and fixing it. The body/mind is extremely complex and most healthcare practitioners are only trained in a certain area. Different angles may need to be considered for chronic and/or severe cases. This could mean imaging or blood tests.

So there you have it. Most people are surprised to hear that TMJ related pain is one of the main things we treat at Muscle Therapy Australia, but you can see that will an increase in stress and sedentary jobs these problems are only going to increase. If you are suffering from jaw pain, headaches, migraines or chronic neck pain then it’s time to have your jaw assessed.

References:

https://www.nras.org.uk/jaw-problems

We are all perfect right? At least, I’m pretty sure I am. We do everything right and couldn’t possibly be doing anything wrong, especially when it comes to our bodies. We eat all the right foods, drink plenty of water, get enough sleep, meditate, exercise and have a positive outlook on the world. Right? We are all doing nothing to cause our pain and injuries. Well, that is correct, we may think we are doing nothing but as we will see in this article there is more to nothing than first meets the eye.

A common thing we hear in clinic is that clients have done “nothing” and now they are in pain. So we decided to take a look at this nothing, to see just how dangerous it is. You see it must be significant if it is causing so many injuries and pain. Whilst we are being a bit cheeky here with this article the point really is that there is no such thing as nothing. Even if you feel you are doing nothing to cause your pain or tightness, there will be something (including nothing) that has caused it. Whether it is a lack of movement, sleeping position, posture, repetitive tasks, lifestyle , etc.

N - nothing

O - overuse

T - training

H - habits

I - inclination

N - nourishment

G - goals

Nothing - if you are literally doing nothing all the time, then this could be part of the problem. To state the obvious. Without movement muscles and joints can tighten up and can become less lubricated and healthy. When we move, blood is pumped through our muscles which helps to bring new nutrients to them and also flush out any by products. Movement also lubricates the joints in the body. Synovial joints (most joints in the body) stay lubricated through movement. So if you don't move then the joints have less lubrication and this can lead to joint degeneration and pain. As they say “motion is the lotion”. Lymphatic fluid also needs movement to function, so without movement our lymph system, which is basically part of our immune system and our filtration system, becomes sluggish and we can end up with swelling and poor circulation. Movement is the key way our body stays warm. Muscles generate heat in our body. So instead of reaching for another puffy jacket in winter, why not do some squats or push ups to get the blood flowing and the temperature rising in the body.

Overuse - What do you do a lot? Maybe even too much? Sitting at the computer? Using a keyboard. These things may seem innocuous but over time these repetitive tasks and postures can lead to chronically tightened muscles and fascia as well as restricted joints. Once you are at this point it can be really hard to change the soft tissues and make a difference. This is why you will have a treatment and then a few weeks later feel the tension coming back. Regular treatment is the key here to prevent this tension building back up.

Training - what are you doing in your training or exercise? Do you do the same gym routine you’ve always done? Doing the same thing over and over can overuse muscles, soft tissues and joints. A classic thing we see is shoulder pain in guys who are bench pressing heavy weights. At some point, regardless of proper form, something will give in the shoulder, whether the biceps or supraspinatus (rotator cuff) tendons or the joint capsule.

Or are you pushing your body to the limit for your HIIT class or ultra marathon? Pushing yourself is great to reach goals such as losing weight or achieving goals, but will put massive strains on your body. It is how you maintain your body through this that is key. Good nutrition, hydration, sleep, good technique and regular maintenance through soft tissue work and massage. Putting your body through this kind of intensity is certainly not nothing.

Habits - We all have them. Some are good and some are not so good. Whether it is simple things like poor posture (sitting or standing), sleeping position, grinding your teeth, carrying a heavy bag on one shoulder or more serious things like excessive drinking or smoking, these things will also impact your musculoskeletal health. Breaking a habit can be hard work and involve a lot of mental toughness and staying power to achieve it, but it just may be the trick to ending your chronic pain.

Inclination - I really wanted to put “mindset” here somewhere, but there is no M in NOTHING, so inclination it is. Your inclination to do positive things for your health will have a big impact on your pain levels and activity. Pain is something that is felt in our body, but the way we perceive the pain is very much in our mind. If we have a negative outlook on life then this will have an impact on our pain levels and likelihood to make an effort with your health. A lot of research and focus these days is around pain and how our mindset and patterns affect it. Pain is being seen as a protective mechanism that is helpful at first, but over time can become detrimental. Once the danger has passed and we don't need to be protective any longer our body and mind can still experience pain. We can be holding on to it like an old friend.

Nourishment - Are you nourishing your body/mind? Eating good food, drinking plenty of water, getting lots of sleep, thinking kind thoughts, meditating? Not to say you have to be a Buddha but these things will definitely have an impact on your musculoskeletal pain. If you are not nourishing your body then this could be another (nothing) reason that is contributing to your pain and/or injury. How is your general health, aside from your musculoskeletal health? If you have/suffer from things like high blood pressure, stress, diabetes, irritable bowel syndrome to name a few then this will have an effect on every system in your body, Including the muscles, soft tissues and the joints as well as your ability to cope with pain and injury.

Goals - If you have goals you are more likely to succeed. If you write things down and have a plan then it is much more likely that you will succeed in whatever you do. Without goals we are set up to fail. As they say “fail to plan, plan to fail”. So this is a good time to set some goals on how you could improve something (or nothing) that you may be doing that could be contributing or causing your pain or injury.

So there you have it. You may think you’re doing nothing or nothing new to cause your pain, but as you can see there is a lot in nothing that you may not realise could be the key to your pain and/or injury. Doing nothing for our health will always lead to dysfunction and issues.

As always if you have any questions or comments we’d love to hear from you so please feel free to contact us via email info@muscletherapyaustralia.com.au or via facebook: muscletherapyaustralia or instagram: muscletherapyaustralia

What do you know about cupping, besides that it tends to leave red purple circle marks on peoples back?

There are basically 2 types of cupping. The traditional Chinese medicine (T.C.M) version and the more modern Myofascial Cupping technique.

Traditional cupping is an ancient traditional Chinese medicine practice that involves applying cups to the skin, whereby pressure is reduced using heat or suctioning out air to create a vacuum of skin and superficial muscle/fascia is held in the cup.

It’s not a new practice and has been around for centuries, apparently dating back to 281 A.D! However cupping has been popularised recently when Olympian swimmer Michael Phelps sported this around the pool, making it suddenly a bit cool for athletes to have these purple red rings on their back. I sometimes get requested for cupping for the purpose of getting these marks purposely to show off to their athlete mates they had it done. Please note that getting cupping will not make you an Olympic athlete.

One thing that is unique to cupping is that it pulls the muscle and fascia away from the body, releasing pressure. As compared with massage techniques that involve compression of the tissues. Both of these are effective and when used together can mean that we are able to approach the soft tissues in different ways meaning you can get more benefit than just massage or cupping.

Differences between traditional Chinese Cupping and Myofascial cupping technique™

Myofascial cupping involves gliding over the body with massage balm/cream and can incorporate joint movements, which is what we use at Muscle Therapy Australia.

Traditional Chinese Medicine Cupping:

- Cups are left on for a while

- Applied to acupuncture points (can overlap with trigger points used in western treatment techniques)

- Tends to leave red marks and bruising

- Can be painful where cups are left on for a long time

- Using flame with cups to produce vacuum on skin with heat

- Focuses on acupuncture points and flow of energy (chi) in the channels

Myofascial Cupping Technique™

- Cups generally glide over the body using balm and are left on for no longer than a minute or so

- Applied to trigger points as well as areas affected by pain

- Not intended to leave marks or bruising, but can incidentally but it is not the aim

- Performed at a pressure level that is almost painless due to massage balm glide

- Use of hand pump to create vacuum without use of heat

- Incorporates trigger point therapy, myofascial release techniques, manual lymphatic drainage and digestive techniques

There are variations of cupping within traditional Chinese medicine that include ‘wet’ and ‘dry’ and even the inclusion of acupuncture needles underneath the cups called ‘needle cupping’[1]. ‘Wet’ cupping involves small incisions into skin and cupping to draw blood up, where traditional practitioners believe this removes harmful substances and toxins from the body to promote healing, however it is unproven[2].

At Muscle Therapy Australia we don’t use this technique, so no cutting you open.

How are cups applied?

Traditionally cups were and still are applied using a flame to heat up the cups and as the cup cools, the pressure in cup drops creating a vacuum. At Muscle Therapy we use a modern hand pump to create a vacuum to apply the cups.

Those red marks

The red marks and bruising can result from fixed position cupping where cups are left on for a while (longer than a few minutes) as well as movement of cups. It is likely to leave more marks the longer it is held over the area, the more intensely it is applied (read below about intensity) and the less lubricant is used for gliding. The marks will last a few hours or as long as a few days.

Whilst these marks can look painful, they usually aren’t painful or harmful at all. You usually won’t even notice they are there until someone sees you with your shirt off.

How does it work?

Myofascial Cupping works through creation of negative pressure, lifting and breaking up soft tissue, promoting blood supply to the area to help with healing, while giving passive stretch to soft tissue underneath.

Cup intensity

Cup size, volume of skin/tissue suctioned up, technique used if moving the cup and the length of time the cup is left on skin affects the intensity of the treatment. Smaller cups, more tissue in the cup and the longer a cup is left on an area all drive up the intensity of the treatment. Myofascial cupping technique™ doesn’t aim to leave bruising or marks on the skin but rather aims to lift and separate tissue via negative pressure.[3]

Benefits of Myofascial cupping technique™

Improving range of motion in jointsReducing fascial adhesions (and hardened tissue) and trigger pointsCan assist with breaking up scar tissueReduce likelihood of injuries and aids recovery by increasing blood supply to injuryHelp maintain functional soft tissue by increasing blood flow and fluid exchange.Assist in reducing inflammationCan calm down sympathetic nervous system (calm you down) and make you feel nice and relaxed.

Injuries it is particularly helpful for:

Overused tight postural upper body muscles like trapezius, spinal muscles, lats, pecs including QLs and lumbar areaOverused tight leg muscles from sports activities or otherwise in calf, quads, hamstrings, adductorsPlantar fasciitis – great for breaking up fascial adhesions in the feetRunners knee and any ITB related issuesAnterior compartment syndrome in lower legsTennis ElbowCarpal tunnel or RSI issues in the wristHand fatigue from grip overuseAbdominals to help relax digestion issues, specifically irritable bowel syndrome (IBS)

Here at Muscle Therapy, we practice Myofascial Cupping, not Traditional Chinese Medicine cupping where the cups are parked on you for a long time and where the practitioner could leave the room and make a cup of ginseng tea to return later to remove the cups*.

If you have questions about Myofascial cupping or want to try it, ask your friendly Muscle Therapy Australia practitioner the next time you’re in. As always we love feedback, so feel free to shoot us an email or post on social media about your positive experience with Cupping.

*anecdotal joke

[1] https://www.webmd.com/balance/guide/cupping-therapy#1

[2] Ibid.

[3] Sheehan, D. (2002) Myofascial cupping technique™, http://www.wollongongremedialmassage.com.au/A4_MyofascialCupping.pdf

With the running season upon us and many running events popping up it is a good time to think about what you do after the event. You’ve trained hard for the last few gruelling months, some longer, for your big event. You completed it with a personal best time. And then it’s over. What now? Do you just keep on running? Well for some that is exactly what they do, but it can be a smart idea to get a post event treatment a few days after the event to help with recovery and get you back on track for the next event.

Here are 5 reasons you should definitely get a post event treatment.

It will make you feel better. Your legs will be feeling heavy and sore. You may be limping along like the wounded soldier you are. Having a massage will help to bring nutrients to the muscles by stimulating blood flow as well as flushing through all of the by products that have been built up through your run, through your lymphatic system. The lymphatic system doesn't have a pump like the heart so movement and massage help to move this fluid back into the bloodstream to be filtered by the kidneys. We can address any little niggles (pain) that you may have picked up from your training and also the event. You may think nothing of a sore knee, hip or ankle after the event but this will be your body telling you that something is going on. When you come in for treatment we will be able to address this and prevent it from turning into an injury. Massage has been shown to reduce inflammation. After a long run (especially a marathon or ultra marathon) you will get micro-tears in the muscle tissue (this will then become DOMS or delayed onset muscle soreness) which is all very normal and happens with any form of exercise. This is the way the body adapts and changes. Having a sports massage after a long run can help this inflammation from getting out of control and speed up your recovery time. This means you will have less pain and will be able to get back to running asap. This will also extend your running life meaning you can run, without injury til your ripe old age. It can prevent runner anxiety. Getting treatment can make you feel more relaxed and also that you are doing something positive to help your running. That way you can be more relaxed about your running. Sports massage after an event can help to improve your flexibility. You may be feeling very stiff and immobile. Stretching out the soft tissues will help you feel more flexible and open afterwards. I know we said 5 reasons, but we couldn't resist a bonus 6th reason. You will become super human and start winning every race you enter a la Usain Bolt. Well, we can't guarantee this, but if it happens then we'd sure love to take credit for it :)

When should I have a Sports Massage after my event?

Generally it is a good idea to leave it a couple of days before having a sports massage as you may just be too sore to be touched any earlier. Some people like having them straight after the run whilst you are still warm. It can also be beneficial in speeding up recovery. Remember that the healing process will take a little bit of time to kick in, so getting the massage 2 days later will be when the pain is really kicking in, so it can be of more benefit to you then.

So there you go. If you still need convincing that having a sports massage after your running event then you will have to try it for yourself. We think you will be pleasantly surprised as we treat many runners with great results.

Don't just stop there. We highly recommend that if you are a serious runner, you make sports massage a regular part of your training regime. This could be once a month or once a fortnight, depending on your needs. But making a positive move like this will help extend your running life and thats what we all want!

We are ready to help you reach your goals and be the best runner you can. So book in now for your post event session. Feel free to book online at a time that is convenient with you or call 02 9233 5769 during reception hours (9am- 5.30pm).

As always we love to hear feedback on our blog, so please feel free to get in touch with your positive running experience on how sports massage has helped.

Do you focus on your technique at the gym? I assume that the answer is yes. Most people spend ages scrutinising every aspect of their form when it comes to exercises like deadlifts and squats. This is with good reason as when lifting weights with poor form you can seriously injure yourself.

Does this carry on into your everyday life at home and at work? Do you drop a pen on the ground and then squat down with perfect form to pick it up or do you just bend over and pick it up without thinking about it? Do you use perfect form to put on your shoes or wash the dishes, keeping the back and neck straight? Do you squat down into and out of your chair or do you just flop down into it with careless abandon. When gardening do you take a break from bending over between sets or do you just stay stooped over for hours?

Here’s the challenge, should you choose to accept it. Every movement you do, think about your form, regardless of how light the thing you are picking up off the floor or how simple the movement seems. At Muscle Therapy Australia we see a lot of people injuring themselves mostly without exercising at the gym. We see people aggravating their lower back discs by bending over to tie up their shoes. We see shoulder impingements from getting a jar out of the cupboard or putting a shirt on in the morning. The difference here is that when you are in the gym you are more likely to be aware of your posture and form than you are when you are doing a menial task at home or in the office. These tasks can be just as dangerous and cause injuries.

Heres some tips to try at home or in the office:

when bending over to pick something up off the floor, even if it is only light like a pen, use a perfect form squat or deadlift to pick it up. The key here is keeping the spine straight or neutral. When you mindlessly and dynamically bend over to pick something up the risk of damaging a disc is really high, especially if you are twisting and bending forward. Ideally, if you have a back injury, you should never do this movement, unless you want a whole world of pain. When lifting something heavy off the floor approach it like a barbell and either deadlift it or squat to pick it up. Keep the spine neutral, inhale and brace the core, keep the head looking straight ahead to avoid stressing the neck, keep the weight close to your body, like you would a barbell. Then lift it like it counts. You may feel silly at first but just think, that was another rep for your training today. Make everything a workout. When reaching for a jar high in the cupboard assess just how heavy the item it. Reaching above the head, especially out the side, is one of the most vulnerable things you can do with your shoulder and it is then easy to overstrain or damage the rotator cuff, leading to impingements, bursitis or at worse tears to the joint (labrum). If the weight is heavy, reduce the lever by getting a stool or step ladder to raise yourself up so it is not such a strain on the shoulder. Keep the weight close to your body. Use torque to brace the shoulder muscles (externally rotating the humerus and keeping it locked on) to keep the shoulder stable and strong. Then keep the shoulder muscles (especially the rotator cuff at the back of the shoulder blade) engaged. When washing the dishes, if you are tall, widen your stance to lower yourself down so that you don’t need to strain your lower back or neck by bending forward. This goes for anything you are doing when you are standing a table or desk that is too low for you. When putting on your shoes or pants keep your back straight so as not to strain your lower back. Use a deep breath in (and hold) to brace your core. When walking up and down stairs try to engage your glutes (like you were doing a lunge) and press down with your heel to move the load from your quads (and knees) to the glutes. This will also help prevent knee pain when walking on stairs as you will be more stable and less likely to stress out the knee joints. This is especially important if you have bad knees or have had surgery on them. When standing waiting for a bus or the traffic lights notice where the weight is in your feet. Is it in the balls of the feet (leaning forward which over uses the quads and calves) or is is in the heels (using the glutes). Ideally you should have the weight evenly distributed in the balls of the feet, the outside of the foot and the heel. When sitting, keep your spine neutral. When using a smartphone, cross one arm and then rest the arm that is holding the phone on the other arm so that you are then holding the phone in front of your face. This will stop you slumping to look down at your phone and saving the horrible neck pain and ugly posture. When you sneeze, try to stay upright and brace your core. Don't throw yourself forward or bend forward as this can hurt your discs. You can also put one hand into the small of your back to help keep the curve there. When walking around, notice how your feet are landing. Are you walking on your heels or your toes? Are you slamming your feet down like you are stomping out a grass fire? Do your feet roll in or do you feel like you are walking on the sides of the feet. Use walking to perfect your walking technique and strengthen those feet. Ideally the heel should touch first, then the wight shoulder roll up the outside of your foot to the toes and then the weight should roll inwards to the big toe where you finally toe off and propel yourself forward as the other foot lands and repeats. More on this in an upcoming blog on walking. This can also help to fix plantar fasciitis and other foot, knee, hip and back pain. When gardening, try to squat down and not bend over. You can get knee pad or use a cushion to protect your knees. As you will still have to be bent over it is important to take breaks. Think of this like sets of exercise at the gym and take a break between sets of gardening.

Every opportunity is there to reduce stress on the body and prevent injury. So if you use perfect form in the gym, take this out into the real world and use that training for your real life, where it counts. This can also be a form of mindfulness. If you are aware of everything you are doing then you will become more mindful and also more present to your life, which has the side effects of making you happier, more calm and more peaceful with your life.

If you would like any advice on correct form when doing a task at home or at work then feel free to get in touch.

This is a question that comes up all the time in the clinic. Whilst dry needling and acupuncture seem to be the same thing, they are very different.

In fact the only thing they really have in common is that they use the same type of needles. You see in acupuncture and dry needling we use acupuncture needles.

These needles are really thin - 0.25mm (1/4 of a millimetre), so they are nothing like hypodermic needles and that is why you can’t really feel them when they go in. A human hair is anywhere from 0.08 - 0.12mm thick, so these needles are around the thickness of 2-3 hairs.

What separates Dry Needling and Acupuncture is the approach and philosophy.

Acupuncture is based in traditional Chinese medicine (T.C.M). This is a major form of medicine in China and is very different to Western style medicine. TCM uses a system of meridians in the body, which are like energy lines that run throughout the whole body. The idea is that if there is a blockage along one of those lines then it could be causing a dysfunction in the body. Acupuncture can be used to treat a wide variety of conditions and not just musculoskeletal injuries. The needles generally aren’t inserted all that far into the body, generally just into the skin. Usually you won’t feel very much. Sometimes you can feel a sensation elsewhere in your body. Acupuncture can also be considered quite relaxing.

Dry needling on the other hand is a western approach, involving the needles being inserted into the trigger point in the muscle. The trigger point is a point in the muscle that is defined as a small tender nodule within a taut band of tissue. Usually this is what most people would call a knot. The needle is inserted into this point and we aim to get a twitch or contraction from the muscle. This can help the muscle tissue to let go and reduce the tension. It also helps to bring blood flow to the area to help your own body heal the injury. Dry needling is definitely more painful than acupuncture as it is actually going into your muscle tissue. Most people explain the sensation as “weird” more so that painful. I find that it can be a bit of a surprise as you usually don’t feel very much and then suddenly, when the trigger point is stimulated, you will feel the muscle twitch. I always say that it won’t be as painful as my elbows digging into you.

So there you have it. These are the major differences between Dry Needling and Acupuncture. So if you are looking for dry needling you need to make sure that the practitioner is trained in dry needling and not just acupuncture. And vice versa, if you are looking for Acupuncture then this needs to be performed by someone qualified in it.

At Muscle Therapy Australia we are all trained in Dry Needling and find it helps us to get great results.

If you would like to try dry needling or find out more, don’t hesitate to get in touch or book in a session now.

If your first question is “what on earth is the ITB” then this post is definitely for you. Even if you feel you are all over it then you may be surprised there are a couple of quirky things about the ITB that people often overlook.

Firstly the ITB or Iliotibial band is a band of connective tissue that runs down the side of your leg. It is notorious for being very painful to the touch, especially when getting it massaged or foam rolling it. It can also cause pain in the outside of the knee and hip and can be one of the most obvious causes of pain in this region. It often gets really tight from things like running, cycling and jumping as it works to stabilise the hip and knee. It can also tighten up from lots of sitting and inactivity as it is a hip flexor and if you sit all day you basically shorten up the front/side of your hips.The ITB is also known as the ITT or Iliotibial Tract (mostly Americans because they like to be different). More technically it is known as the Fascia Lata (not Latte). Fascia Lata basically means the lateral fascia. So the ITB is technically a thick band of fascia ( white connective tissue) on the outside of the leg. We have heard it incorrectly called the ITV or IBT. These are incorrect, but we know what they meant. The ITB is important for stabilising the hip and knee.What does the ITB do? As it attaches to the TFL and Glute Max it does these actions. Most notably internal rotation of the hip, hip flexion, abduction of the hip (lifting your leg out to the side). It also provides lateral hip and knee stability, especially when the leg is straight or the knee is bent up to 30 degrees. Meaning your hips and knees don't move out to the side when you are walking, running, jumping or doing anything where you knee is under load such as squatting, getting out of a chair, walking up and down stairs and pretty much everything you do. What can we do for a tight ITB? Well, the reality is that the ITB is supposed to be tight. Imagine the ITB is like a leather belt running down the side of your leg or a really strong, super elastic band that may stretch slightly but will snap straight back into position when you stop stretching it. Remember that the TFL muscle tenses the fascia lata (the ITB) so this muscle tenses or tightens the ITB so it can stabilise the knee and stops it moving laterally or outwards. That is what it does. So if we want the ITB to be loose then we wont be able to walk, it wont provide this function and will cause knee stability issues. Remember that there is a difference between tightness and pain. If you are feeling pain around the outside of the knee it may be from friction of the ITB running on the lateral condyle of the Tibia. The ITB can become over tight so releasing of the TFL and Glute max are the biggest muscle releases for impacting the ITB. You can also foam roll the ITB (this can be a very controversial topic amongst practitioners and experts) but if you have lateral knee pain and roll the ITB you will be surprised at how effective it can be. The ITB is supposed to be a very strong and tight structure. It is said that the forces the ITB can take before it even stretches a few millimetres would be the equivalent of town a truck with the ITB. That is more than you would ever be able to roll or stretch. When it comes to stretching the ITB is a tricky area. You can stretch the TFL and Glute max once again in the stretches shown. Do you think this could stretch very much? Not really. And I reckon you could probably tow a car with a leather belt and it wouldn't stretch very much either. Another factor if you are having issue with your ITB is to look at glute strengthening. As if the glutes are weak or inhibited (not working very well) then the TFL can become overloaded and the ITB will tighten. Therefore strengthening the glute max, med and minimus will help offload the TFL and also provide more lateral stability in the hips and knee. Strengthening the Quads is also a factor here. Obviously this is on a case by case basis as different injuries will respond differently so please take this as general advice and get it checked properly if you are in pain. I have seen people who have had such severe tightness in the ITB that they have had it surgically lengthened. This is a very aggressive and risky way of treating lateral knee pain and should be the very last resort after lots of conservative treatment and self management has been undertaken. The surgery is not always effective, so you can still end up with pain that may even get worse. There are many injuries involving the ITB. The most common is ITB friction syndrome. This is thought to occur from the ITB rubbing on the lateral condyle of the tibia. Whilst this makes sense the jury is still out as to whether this is the actual cause of the lateral knee pain. The common treatment is stretching and foam rolling of the ITB, but as we have established these can be tricky things to do and remember the ITB doesn't really stretch. Patella tracking issues have been linked to a tightness in the ITB and lateral quads pulling the knee cap out of alignment in the joint. Also lateral hip pain known as Greater Trochanter Pain Syndrome has been linked to ITB tightness. Common exercises that injure the ITB or lateral knee are running, cycling, weightlifting especially squats, jumping, skipping and most exercises that involve bending of the knee.

So there you have it. Just when you thought you knew something about the ITB there is always more to know. The big takeaways here are that the ITB isn’t a muscle, it is a band of fascia. It is supposed to be a rigid tight structure. The TFL and GLute max are the muscles that control the ITB so working on those muscles will give you more bang for your buck than purely hammering the ITB, which is most likely the vastus lateralis muscle anyways. There are some effective rolling techniques and stretches but we feel that the best way to have the ITB released is to have a professional work on it as well as perform a thorough assessment to get to the source of why this issue is happening in the first place. Treatment techniques such as Dry Needling, Active Release Techniques and myofascial release can be very effective at treating issues and injuries of the ITB. As always we love your comments so please feel free to get in touch. If you require help with your injury then we are here to help.

Refernces

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294943/

- http://www.kneeclinic.com.au/knee_exam/examination_knee/page09.htm

- https://b-reddy.org/the-best-damn-it-band-stretch-ever/

- https://keyassets.timeincuk.net/inspirewp/live/wp-content/uploads/sites/2/2014/03/Foam-roller-IT-band.jpg

Did you know that in 2019 the government will be removing the health fund rebate from many natural therapies? Our modalities such as Remedial Massage, Myotherapy, Dry Needling and Active Release Techniques aren't on this list to be removed but they are considered natural therapies by the government. To us this sets a precedent that they will remove any modalities they see fit in removing to save money and generate massive profits. There are many other things that have been removed as well outside of natural therapies such as some hospital coverage, prosthetics and some exercise therapies. It appears that the health funds and government aren't listening to the public, as millions of clients each year seek these natural therapies to maintain a healthy lifestyle. The Australian Traditional Medicine Society (ATMS) is urging clients to send in their positive stories to the government. This way we can show them that many people are getting a lot our of natural therapies and sway them to keep natural therapies safe and claimable. Click here to go to ATMS website for further info and to send your story.

Our passion at Muscle Therapy Australia is in helping people get out of pain, especially the chronic conditions where the client has seen many people and had no success. We are also passionate about raising the standard in the industry and letting the government and Health Funds know what we do and how successful it is.

A common story we hear around the clinic is that people have seen many medical practitioners including Physios and no one has been able to help. Then they come to us and we help them, often very quickly. And we also seem to know more about the condition the client has than their GP or specialist. It has always baffled me that our modalities such as Remedial Massage, Dry needling, Active Release Techniques and Myotherapy are considered Natural Therapies and you don't get as much coverage from your health fund. Even though this is the very treatment that has helped the client out of pain and away from the specialists, who generally only have surgery and injections as their options. Some of these surgeries, particularly spinal and knee surgeries, have a very poor evidence base, yet are continued to be carried out every day without question. The health funds are still covering this "evidence based" practise. These procedures cost Medicare and the tax payer billions of dollars every year. The government is talking about cutting money from Medicare and Health Insurance. They should be looking here at the high expense procedures rather than the preventative natural therapies.

With preventative treatment this keeps people out of hospital and away from GPs therefore saving millions/billions of dollars. When we asked a health fund as to why the health funds give so little for our therapies we were told they knew that people would use them. This contempt for their customers shows the amount they actually care about your health. Remember that these health funds are insurance companies and have a vested interest in you not using your health fund as this means they need to pay you out of their precious billion dollar profits. Insurance companies have huge overheads and need millions of dollars to run. So they don't want their customers wasting all of the insurance money on things they will actually use.

The unfortunate thing is that natural health care practitioners have dedicated their lives to helping people with health problems whereas the insurance companies are there to make huge profits for their shareholders. The practitioners are the ones who are punished at the cost of insurance company profits and government savings.

Remember that extras coverage can be a big expense when it comes to your health insurance. If you don't use much of it then the Health Fund will just be taking your money. It's like the health fund saying to you: "give me $1200 and I'll give you $500 back. Sounds like a good deal, right?" Wrong! If you really want a health fund where you can spend your extras money on anything you want to an agreed dollar amount then AHM is your only option. Note that we don't get kick backs or aren't sponsored by AHM. It is really the only true value extras coverage where if you want to spend $1000 on Remedial Massage then you can. Get it fast as they will soon realise that people will use it and take it down.

So in closing we urge you to have your voice heard and go to the ATMS website and contact your member to let them know that you support Natural Therapies and that you want to be able to claim these on your health fund.

References:

- 'Dangerous path': Medicare 'seriously threatened' by private health insurance

http://www.smh.com.au/federal-politics/political-news/dangerous-path-medicare-seriously-threatened-by-private-health-insurance-20170419-gvnpyj.html

- 'People are getting angry': Health funds accused of 'obscene' profits

http://www.smh.com.au/federal-politics/political-news/people-are-getting-angry-health-funds-accused-of-obscene-profits-20170517-gw766p.html

- When surgery is just a stitch up https://www.theguardian.com/science/2017/aug/20/when-surgery-is-just-a-stitch-up-placebo-effect

Most people would be thinking a beetroot supplement that gives you that extra edge. Whilst beetroot is very good for you and contains many vitamins and minerals what we are talking about here has nothing to do with the tasty purple vegetable. Beetroot is an acronym that contains 8 common reasons for why we can become injured. This can be a great way to go through the possible things that may be causing or contributing to your issue. This is also a great tool for practitioners and personal trainers to use to gain insight into why their patient or client may be injured and what could have changed that may have brought it on.

B - biomechanics. This is a fancy way of saying movement. So how you move is another way of putting it. If you are really tight, weak or unstable when you exercise you will be putting undue stresses on muscles/fascia, ligaments, tendons and joints. This can in turn cause pain and injury. An example is if when you lunge your knee drifts inwards, you may have a weakness or instability in the glute medius muscle. This may then lead to knee pain.

E - environment. This could be the running route you use or the type of gym or Yoga class you go to. If you change the environment you are exercising in then there is a good chance that this will contribute to an injury.

E - equipment. Shoes are the biggest example of equipment. If you suddenly change the shoes you run or train in then this can affect the mechanics of the foot and the support you are getting. You should think carefully about what shoes you run in especially if you have an event coming up that you are training for. Changing shoe brands at the last minute is a classic way to cause an injury.

If you are a cyclist and change your bike or bike setup then this can dramatically change the way you ride, for better and worse.

In the gym equipment could include weights, kettlebells, machines, treadmills, cross trainers etc.

Even the humble chair or desk at work can play a massive role in your posture and the strain that may be placed on your body.

T - training. What type of training do you do? Has it increased, decreased. Plateauing should also be mentioned here. If you are always doing the same training then this could lead to overuse injuries. If you have just taken up a new form of exercise and are getting pain then this is the most likely reason you are in pain. Taking a close look at what you may be doing in this new routine should give you an insight into what may be going on.

R - recovery. Is this something you think about? Do you train everyday? Do you do too much recovery, as in never train :) For athletes and amateurs who are taking their training very seriously it is still important to work in some recovery. Even if this is active recovery such as Yoga or massage. Allowing the body to rest and recover is just as important as your training. If you overtrain you are basically asking for your soft tissues to break down at some point.

O - older. I am always reluctant to bring up age as it can be offensive, so I will apologise in advance. But lets be honest, humans are living longer and longer and are more active than ever. The human body has a great working life up to around 40 years. If we were a product you’d have a warranty up to 40 years, over that you are getting a bonus. Unfortunately you can’t get an extended warranty :) Most people can relate to not really having any injuries up until they were in their 30’s. Before that you would get injured and the next day you would feel fine. It is the same with kids. I remember my daughter when she was 4 years old jumping on a Swiss ball and twisting her ankle really badly. It swelled up and looked terrible. She couldn’t walk on it. She had to have the day off daycare. The next day she was running around and jumping as though nothing had ever happened. The super healing powers of young kids should be bottled. If this was an adult it could have taken up to 6 months to recover.

The older we get the more we have to think about training smarter and not harder. As we age tissues such as ligaments and discs dry out and can become less flexible. This means there is more potential for injury. Taking up new exercise should be a gradual process when we are older. Also be wary of trying to keep up with all of the young people at the gym. As exciting as it is to beat a 20 year old at an exercise, the toll on your body will not be worth it.

The heart is also the most overlooked muscle when it comes to training. Have you had your heart checked to see if it is capable of taking the loads you are putting through it? A hamstring can recover but the heart is less forgiving.

O - overreaching. This can also be looked at as over training or over doing it. Many injuries are repetitive by nature so if you are over doing the same exercises like bench press (guys you know who I’m talking to) or sitting slumped at the desk for too long then this will also exacerbate your injury or pain.

T - threats. This can be any medical threats or history that may also be taken into account. An example of this could be a previous back injury you had that could once again flare up if you do the wrong thing such as poor form with exercise, over doing certain exercises or sit for too long at the desk without breaks.

So there you have it. Remember to eat your beetroot and also remember to think of B.E.E.T.R.O.O.T when you are feeling some pain or stiffness coming on.

We love to hear your feedback so if you have any questions, comments or corrections to make here we’d love to hear them.

Oh and for all of those people wondering what nutrients beetroot actually contains here is a list from nutritiondata.com

1/2 cup of boiled beetroot or 85grams

Protein: 1.4g (3% D.I)

Kilojoules: 157kJ (2% D.I)

Carbs: 8.5g (3% D.I)

Fats: 0.2g (0% D.I)

Vit A: 29.8 IU (1% D.I)

Vit C: 3.1mg (5% D.I)

Folate: 68mcg (17% D.I)

Potassium: 259mg (7% D.I)

Magnesium: 19.6 mg (5% D.I)

Manganese: 0.3mg (14% D.I)

So Beetroot is great for electrolytes and folate. So not a bad idea to add some of this powerful purple vege to your menu.

For full nutrition details of beetroot click here

The Muscle Therapy Australia Team.

Have you ever noticed someone with really bad posture? What does it make you think? Or have you ever thought or been told you have bad posture? Your partner, colleagues or friends may say stand up straight or sit up straight! Understanding what type of posture you have is the first stage in correcting your posture and bringing yourself closer to better posture.

So what is posture?

First up lets get into some technical terms that can help you understand posture. Here are the names of the common curves in the spine.

Kyphosis or Kyphotic

A kyphotic curve is a curve that moves anteriorly or forwards. It can also be called a convex curve. This type of curve is the typical hunch back where the upper spine is curving forwards. There is supposed to be a natural kyphotic curve in the upper spine or thoracic spine. When your posture comes more forward say from sitting hunched at a desk then this posture will be exaggerated and can then cause dysfunction in the spine, ribs, shoulders or neck. This can then lead to pain such as burning pain between the scapula, shoulder impingements, neck pain, headaches, rib pain, chest pain and more. A kyphotic posture is also one of the most noticeable poor postures as people can see that you are hunching forward. As you get older this posture will become more engrained, like the wrinkles on your face and will tell the story that you have had this posture due to your lifestyle.

Lordosis or Lordotic

There is also a natural lordotic curve in the lower back and in the neck. In the lower back this can be seen as the hollow in the small of the back. When excessive it can be seen as though a person is sticking their bum out or the technical term “ducks bum”. There is also a lordotic curve in the neck as well.

Scoliosis or scoliotic

Scoliosis is a lateral or side bend of the spine. So if you were looking at someone from behind with their shirt off it would look like and S bend in the spine. Scoliosis usually has a component of spinal rotation with it as well meaning that the ribs on one side will look like they stick out further that the other. If you were tilting to the right side ( also called convex left as the cover part of the curve is on the left side) the rotation is to the opposite side. This is due to the way the facet joints glide on each other (a bit more technical for this blog).

Scoliosis is a word that will probably strike fear into your heart, especially if you have it or have been told you have it. We wrote a whole blog about scoliosis which you can read here. The truth is most of us will have some degree of scoliosis and it is perfectly normal. Most general asymptomatic scoliosis is functional, meaning that you may be right handed and work at a desktop computer all day using a mouse. This would mean you will tilt slightly to the right side and therefore over years your spine will being to curve over to that side. This can be reversed.

Structural scoliosis on the other hand is a whole different beast. Structural scoliosis means that this is the way the bones and joints have developed. It is usually more pronounced and causes pain and dysfunction in the body including the spine, hips, shoulders, neck, ribs and more. Unless discovered early when the spine is still growing there isn't a huge amount you can do to fix it, only manage it and stop it getting worse.

Scoliosis can also be coming from a pelvic imbalance. If the pelvis is higher on one side then because the spine sits in the pelvis it will curve over the lower side. This will then make the spine appear to be curving. This posture can arise from standing with one hip pushed out to the side. Or sitting by leaning to one side. Men wearing wallets in their back pockets whilst sitting can also put the hips out.

Sway Back

This posture is often misunderstood and confused with the lumbar lordotic posture. If you look at the picture for a sway back you will see that the pelvis is actually pushing forward (anteriorly) of the imaginary plumb line running through the body, whilst the upper trunk or thoracic is shifting backward (posteriorly). The lower lumbar is actually flattened and not lordotic. There will also be a hyper extension of the hip and knee. This means that the glutes and hamstrings will usually be on all the time when standing. This could lead to hip, glute , hamstring and lower back pain. Symptoms such as sciatica can also appear as in this posture the glutes and piriformis muscles will tighten up and therefore compress the sciatic nerve.

This could also lead to hip, knee and ankle problems in the lower limb. With the chest collapsed you could see problems in the thoracic, neck and shoulders as well. Chronic headaches may also occur.

Sway back can also include:

weak hip flexorsweak external obliquesWeak upper back musclesWeak deep neck flexors.Shortened hamstrings & glutesShortened upper internal obliquesShortened chest and anterior fascia of the chestShortened neck extensors (headaches)

So what is correct posture?

Ok so the “correct” posture is to have a nice lumbar lordotic curve, followed by a gentle kyphotic curve in the thoracic spine and then again another gentle lordotic curve in the cervical spine or neck. These curves allow the spine to be strong and flexible as well as absorbing forces when lifting things and sitting. Once the posture moves away from this correct posture problems can occur leading to soft tissue injuries, joint problems and potentially intervertebral disc problems.

In the case of posture there are some really nasty postural issues which can be structural in nature meaning that there isn’t all that much you can do to fix them, only manage them and try not to let the structural issue get worse. For instance if you are kyphotic (hunch back) then sitting slumped forward will only make this issue worse. You may not be able to fix your posture and have the perfect spine, but at least it wont get worse and may even get somewhat better.

Over the years I have assessed thousands of peoples posture and one thing I have noticed is that no one has the perfect spine you see in all of the skeletal charts. I always wonder if maybe the “perfect” posture is actually the abnormal posture and who is this actually based on. If you look at multiple drawings or images of the skeleton it always appears to have the perfect curves but realistically if you are alive and have used your body for your whole life then your life will have had an impact on you posture.

But I don’t stand very much

These postures are all assuming that you are standing up a lot. In this sedentary, seated world we live in we need to consider the seated posture we all have. This is a really good point. So what if you don’t stand very much? How can these postures affect me then. Well the way you sit will be affecting the way you stand or you could also say the way you stand is because of the way you sit. For example if you sit slumped at the computer all day then when you stand you may find that your shoulders are still hunching forwards or your kyphotic.

How do you sit?

Are you sitting on your tail bone or sacrum (with your bum tucked under)? If so you could be compressing the sciatic nerve and lumbar discs. This is the typical slumped back in the chair posture.Are you sitting perfectly with you feet flat on the ground, your knees bent at 90 degrees, you backside right back in the chair, a hand width between the back of the knees and the seat so that your legs can take some of the load of you torso. Are you sitting on your sit bones (ischial tuberosity) giving the natural lumbar lordotic curve which then makes it easier to have a gentle kyphotic curve in the thoracic and then a natural lordotic curve in the neck so that the head can be supported comfortably. Is your head forward or looking down? This will stress out the joints and discs of the neck and over time cause premature degeneration leading to pain.Are your shoulders slumped forwards. If so try to lift your chest from the sternum. Often the collapsed chest will naturally lead to the shoulders slumping forwards. Try to relax the shoulders and don't force them back as this will also fatigue the back of the shoulders

Sleeping?

The way you sleep can also have an affect on your posture. The sleeping position that is the most neutral on the spine is sleeping on your back. If you sleep on your side with one leg over then this will twist your spine. Also if you sleep on your front you could be encouraging a sway back posture by flattening the lower back.

Other variations

There are many other postural variations that we haven't gone into here. You can have a combination of posture's as well. Such as Kyphoscoliosis where this is a combination of kyphosis and scoliosis. You could also be kyphotic and lordotic.

So what can I do to improve my posture?

Kyphotic posture

Remember that this is the hunch back posture. To prevent or to correct this you need to work to open up the chest and mobilise the soft tissues of the front of the body. A simple way to do this is to stretch your chest in the doorway. Another great way to open the chest is to lie on a foam roller with it perpendicular to the spine. Begin just above the ribs and then extend your back over it. Lay there for around 30 seconds and then move the roller up a couple of inches and repeat. You should be able to use at least 3 different positions.

Strengthening exercises to strengthening the upper back and lower back muscles will help you to keep your body upright.

Yoga can be great at opening up the front of the body by using back bends.

Lordotic posture

A hyper-lordotic lumbar curve can be prevented or corrected by releaseng the soft tissues ast the front of the hips and the lower back. The way to do this yourself to stretch the hip flexors including Psoas, Iliacus, Rectus Femoris, Tensor Fascia Lata and Sartoirus.

Strengthening the glutes and lower abdominals (core) are really important to counter this posture. If imagine muscles like a tug of war on joints, if one side is really strong and dominant then it will pull towards its side. Balancing out muscles is the key to stabilising the pelvis and bringing it into alignment.

Scoliosis

To help correct and prevent functional scoliosis (the one created by poor posture or repetitive actions) you can work on side flexing the spine such as stretching over to the side and rotational stretches.

Having a strong and stable core is also important to help align the spine as best we can. Doing rotational core work such as cable wood chops can help to correct or prevent tilts and rotations in the spine.

If there is a kyphotic element to the scoliosis then extension stretching like the cobra or foam rolling as outlined in the kyphosis section will also be beneficial.

Yoga can also help here as it is composed of stretches in all different directions.

Sway back

A sway back can be caused by lazy muscles of the pelvis and core. This can just be you pushing your hips forward and just hanging out on the ligaments rather than using muscles to hold you up. This could be a sign of a weak core and weak upper back muscles. Often the glutes are tight from being constantly squeezed.

Stretching and release of the glutes, hamstrings, chest and thoracic will help to take the tension off the soft tissues. Strengthening of the hip flexors, core and upper back muscles will help to rebalance the muscles leading to improved posture.

Final thoughts

With all of these postural issues it is important to stress that without a correct understanding of your posture it is really hard to correct it. You will need to be assessed for this by a professional as you can’t possibly see all of these things yourself.

Postural awareness is then the most critical of all elements. If you do all of the stretching and exercises but still choose to stand with the hip pushed out to one side then all of that work will have been in vain as you won’t make very significant changes.

If you would like to have your posture assessed and work towards correcting then book in now.

As always if you have any comments, questions or even to let us know you have enjoyed this article then feel free to get in touch or share on social media.

Thanks for reading.

Ok so you’ve been told you have weak glutes. What does this mean, why is it important and most importantly what can you do to fix it?

In this day and age, unless you exercise, your experience of the glutes is as a cushion for your backside and the closest thing to a glute exercise you’ll get is getting in and out of a chair or walking up the stairs. If you sit all day then you are crushing your glutes and locking them into a position that will be hard for them to get out of. This will be experienced as tight glutes. Sitting all day can also crush the sciatic nerve under the glutes and piriformis muscles that can also give rise to deep glute pain and nerve tension. This can be caused by adhesions that form between the nerve and the soft tissues. Weakness in the glutes is also one of the major causes of lower back pain and with the increasing prevalence of lower back injuries with our sedentary lifestyles there has never been a better time to get educated about the glutes and start focussing on strengthening them.

So what are the glutes?

Lets start at the start. The Glutes are actually a group of 3 muscles. The Gluteus Maximus, Gluteus Medius and Gluteus Minimis. They are not one single muscle meaning they have different attachments and actions. So when someone tells you that you have weak glutes you could be really annoying and ask which glutes are weak. Is it the gluteus maximus or the medius or all of them. It is an important distinction as the exercises to strengthen them and stabilise the hips can be different. Together these muscles are responsible for most actions of the hip including extension (taking your leg backwards), hip abduction (lifting your leg out to the side), tilting your pelvis, hip internal and external rotation (turning your hip in or out). In general though you will find that strengthening all of the glute muscles will be most beneficial at balancing the pelvis.

Gluteus Maximus -This is the largest of the glute muscles and attaches from the sacrum or lower spine and middle part of the pelvis to the femur (upper leg bone) and the Iliotibial band (ITB). Interestingly the Gluteus maximus links the lower spine to the upper leg and knee via the iliotibial band. It also has fascial connections to the latissimus dorsi muscle linking in the arms and shoulder. You can see how the Gluteus maximus can have a significant influence on all aspects of the body. If it is weak and tight then this tightness may influence the shoulder and knee, not to mention the lack of stability in the hips could lead to other more serious injuries of the lumbar spine, hips and pelvis such as disc injury, facet joint injury, Sacroiliac joint injury, hip labral tears to name a few.

What does it do? Gluteus maximus is responsible for extension of the hip/femur (taking the leg behind you), abduction of the hip (leg out to the side) and external rotation of the hip (rotating the hip outwards). You use this muscle when walking up stairs, especially as the leg comes backwards, standing up getting out of a chair, running, squatting, cycling, swimming.

Together with the latissimus dorsi it helps to rotate the body. It helps to keep the pelvis stable and prevents it from tipping forward too much (when your bum sticks out)

Exercises that strengthen the glute maximus include squats, lunges, deadlifts, donkey kicks, glute bridges, glute/ham raises, hip thrusters to name a few.

The gluteus medius and minimus can be seen as the side glutes or lateral glutes as they sit more to the side of the pelvis than the gluteus maximus. Their combined action is to stop the hip from "flicking" out to side when you walk or run. If you press your fingers into the side of the pelvis and then stand on one leg you will feel them contract (harden) on the side of the leg you are standing on.

Gluteus Medius (glute med) - attaches from the pelvis to the greater trochanter or side of the hip bone. I always think of glute med as one of those over achievers, raising their hand saying “pick me, pick me, I’ll do it” as it pretty much has a hand in most actions of the hip including extension, abduction as well as lateral and medial rotation. The only action it doesn't do is adduction or bringing the leg across the body.

Gluteus Minimis (glute min) - is like glute medius’ little sibling. Once again it is a hip stabiliser and depending on which anatomy book or app you look at it can also be seen as an external and internal rotator of the femur. It has “small muscle syndrome” which is a term I’ve coined meaning, like small man syndrome, it is always trying to prove itself to it’s bigger counterparts, namely Glute max and med. A condition of small muscle syndrome is that to stand out it will cause more problems. Gluteus minimus often has a trigger point that will refer down the side of your leg causing similar symptoms to a disc injury or sciatica. It can be more problematic than its larger counterparts.

Some common exercises for Glute med and min include crab walking, clam shells, single leg deadlifts, single leg toe touch, pistol squats, Bulgarian split squats, anything single leg (as they are stabilisers) side plank, side leg raises (Jane Fonda’s :) )

Here are 7 reasons that you need to strengthen your glutes

1 - let’s get this one out of the way. Everyone loves a tight booty, both males and females, so by strengthening your glutes you are doing humanity a service, from an aesthetic perspective. The side effects of having a shapely derrière is that you may just avoid back pain or serious hip/pelvis issues.

Ok, now lets get serious…

2 - Without strong glutes, especially maximus, your hamstrings may become overactive and tighten up leading to chronic hamstrings issues like tendinopathies or tears. When a muscle isn’t working effectively your body relegates the task to the next muscle in line. In this case it is the hamstrings and adductor magnus as they also extend the femur and stabilise the pelvis. Tight hammys and adductors, sound familiar anyone? This is one of the top 5 reasons people come into our clinic for treatment. (S. McGill 2009) http://www.backfitpro.com/pdf/selecting_back_exercises.pdf

3 - like in number 2 without strong glutes your lower back muscles such as the erector spinae and quadratus lumborum (QL’s) will become overactive. This can lead to lower back pain.

4 - the glutes can be considered part of the core and a stabiliser of the pelvis and hips. If the pelvis is unstable then it will place a lot of stress on the hip joints, sacroiliac joints, lumbar facet joints and the discs. This could lead to serious lower back injuries such as a disc bulge or early onset hip osteoarthritis, tendinopathies of the glutes or damage to the cartilage of the hip known as the labrum.

5 - Stability in the hips, especially the gluteus medius muscles, will also affect the knee. If you have ever squatted in front of a mirror you may have noticed that your knees drift inwards. Strength in the glute medius will help to stop the knees drifting inwards as it will keep the femur stable.

6 - The opposing muscles to the glutes are the hip flexors and adductors. When a the glutes are weak, this can create an imbalance in the pelvis known as lower crossed syndrome. This is where the glutes and abdominals are weak and the hip flexors and lower back muscles are tight. The opposing muscles will end up winning the tug of war pulling the hips into anterior tilt. An anteriorly tilted pelvis looks like you are sticking your bum out at the back. This can be called a hyper lordosis in the lumbar spine and can lead to back pain by jamming up the facet joints of the lumbar spine. Over time this posture can lead to more serious back problems such as osteoarthritis of the lumbar spine and hips, disc degeneration and spondylolysthesis.

7 - As a rule of thumb weak glutes = tight glutes. When a muscle is weak the nervous system will try to find stability by tightening up or slamming the brakes on so to speak. If you have tight glutes then a simple rule of thumb is that they are possibly also weak.

So what can you do to strengthen your glutes?

So there you have it. Everyone will now be hitting the gym strengthening up their glutes. So what exercises can you do to get some strength in the derrière? Well, it really depends on what access to equipment you have. If you are at home then you wont have the same equipment as you would if you are at the gym.

Simple at home exercises:

Glute bridges

These exercises are a simple and effective glute activation and stabilisation exercise. Lying on your back, feet hip width apart and arms by your sides. Press down with the heels and lift your butt off the floor. Squeeze the glutes at the top and hold for 2 seconds. Then with control slowly lower down. Repeat 10 times total for 3 sets. An option to make this stronger on the glute med muscles is to tie an exercise band around your knees and keep the legs squeezing out at around hip width.

When you can easily do the 2 leg version progress onto the single leg version. Keep one leg off the ground the whole time. Engage the core by sucking the belly button in slightly, feeling the deep abdominals engage. Hold this on while pressing down with the heel and lifting off with the single leg. Hold for 2 seconds at the top whiles squeezing the glute. Repeat 10 times for 3 sets.

Lunges and variations

The good old lunge is one of those easy to access exercises that is great for hip stability and also all over glute strength, as well as targeting the hamstrings and quads.

Standing up tall, back straight, step the right leg forward so that when you drop the hips and lunge the knee comes into alignment with the ankle. Try not to let the knee travel too far over the foot as you may damage the knee ligaments. Drop the hips down and bend the back knee so that the back upper leg is almost in alignment with the spine. Repeat 10 times for 3 sets. Repeat on other leg. A variation is walking lunges where you walk forward alternating between legs.

The next 2 lunges are often overlooked as people tend to only work their body in the sagittal plane, meaning forwards and backwards. The side lunge works on the lateral line of the body or the glute medius and minimus mostly.

With these lunges you need to be careful of your knees as this lateral movement performed with improper form could damage the meniscus or ligaments of the knee.

In the side lunge begin by standing up tall. step one leg out as far as comfortable, drop the pelvis down and bend the knee of the leg that didn't move. Try to keep the back as upright as you can. Step the leg back in and repeat 10 times for 3 sets.

Curtsy lunges - This time the foot comes across the body to the opposite side and you lunge down, like you were doing a curtsy for the queen. Try to keep the hips as level as you can, this is what the glutes do to stabilise the pelvis so that is why this exercise is so good. Keep the hips facing forwards. The back foot will pivot. Try to make sure that the knees stay in alignment so as not to damage the knee. This exercise is great for targeting all of the glutes especially the glute med and min.

Bodyweight Squats

This is one of the key glute exercises. The real secret with squats is to press down with your heels to engage your glutes as you press up to come out of the squat. Then when coming to standing slightly tuck the pelvis under and squeeze the glutes together, getting a further contraction of them. This works all 3 glutes.

Donkey kicks

On all fours, lift one leg back engaging the glute at the end. Bring the leg back to the ground each time. Repeat 10 times for 3 sets. You can increase the load here by holding for as long as you can with the leg back. You can also introduce a resistance band between your leg and your hand to increase the tension.

Fire Hydrants

These are also a great exercise to really target all of the glutes as they also incorporate some external rotation of the hip. They are similar to the Donkey kicks except now you rotate the hip outwards as though you were a dog and you were going to relieve yourself on a fire hydrant (I didn’t make this up and apologise if it’s a bit crude), ensure that you don't actually relieve yourself, so tuck in that pelvic floor :) Repeat each side 10 times for 3 sets.

Clams

This can be performed with or without an exercise band. Heels together and knees together. Make sure your hips are stacked on top of each other so that one isn't more forward. Raise one knee up, feeling the squeeze in the gluteus medius, also pressing the heels together. slowly release down. Make sure this exercise is controlled and slow. Repeat 10 times for 3 sets.

Crab walks

This is also a great gluteus medius/minimus exercise. The band is just above the knees (some like it around the ankles), bend slightly forward from the hips, sticking the butt out. Step one leg out to the side about 20-30cm slowly. Bring the foot to the floor and then slowly bring the other foot towards the stationary leg, also slowly. You then continue up to 10 times, gradually walking across the floor. Then repeat in the other direction. Repeat for 3 sets total. It is important in this exercise to always keep the band under tension, it shouldn't go slack as this exercise is a stability exercise.

More involved exercises you can do at the gym:

Barbell back squats

The key here is proper form. If you have never performed barbell squats of any kind then it is highly advisable you have an experienced, trusted personal trainer take you through this so as to prevent you from hurting yourself. Along with deadlifts, barbell squats are among the most common exercises people come into our clinic for with injuries.

Begin light to get your form. Practice the squats without any weight first and then with just a bar, so you feel comfortable before adding weights.

Place the bar across the top of your trapezius muscle, the fleshy part, so that it doesn't irritate C7/T1 part of your spine that sticks out more that other vertebrae. Keeping the spine neutral and head looking forward, suck in the breath and core, hinge slightly from the hips and bend the knees. Come down as far as is comfortable, then press down with the heels and drive yourself into standing tucking the pelvis under at the end to squeeze the glutes. Repeat 10 times for 3 sets.

A big tip here is to gradually increase the weight over time as you get stronger and more competent. If you suddenly try to lift a weight you haven't trained for or haven't warmed up for you WILL hurt yourself.

Romanian deadlifts or straight leg dead lifts.

Same thing applies here. Deadlifts are great glute and posterior chain exercises, but they are also one of the most common exercises that will cause you an injury. If you were going to invent an exercise to damage the discs in your back then this would be it. If you don't keep your spine neutral and flex your lumbar spine then you will compress the discs with more weight than usual, possibly causing permanent damage. On the other hand when performed with correct form, ie a neutral spine, it is one of the essential exercises that most people with healthy back should be incorporating into their workouts.

Begin with a light weight. Start with the bar at straight arms. Breathe in to engage the core and internal pressure. Hinge forward from the hips and slowly lower down as far as you can go until your legs begin to bend. Press down with your heels and imagine you are pulling the bar back into your body like you are trying trying to snap the bar over your body. Press down with your heels to engage the glutes. Tuck pelvis under at the end of the movement to really engage the glutes.

Mobility is also a key here. If you are really tight in your hamstrings then your range of motion will be seriously limited.

Single leg dead lifts

Single leg deadlift are a great hip stability exercise. Try to get the form before you add a dumbbell or kettle bell. Standing straight with feet together. Imagine hinging from the hips as though stretching hamstrings but in this case one leg will stay planted to the ground and one will stay in alignment with the spine and extend back. If holding a weight hold it in the hand of the side the leg is coming off the ground. Take a deep breath in and engage the core by tucking in the belly button deeply Keep the back leg and spine in alignment, it can be useful to have a mirror to check your form. Come down as far as you can keeping good form, you can bend the straight leg slightly. Then press down with the heel and hinge yourself back up keeping the core strong and the back straight. Repeat 10 times fro 3 sets.

Hip thrusters

If you have never performed this exercise before then start off with just the bar so you get comfortable. Also a tip for guys, be careful where you place the bar as you don't want 60kg squashing your manhood.

Lying on the ground in the same position as the glute bridge. Straighten your legs and roll the bar up your legs so it sits just above your pelvic bones, you can use a rolled up mat to soften the pressure on the pelvis. Use your arms to keep the bar in place. Press down with the heels and thrust the pelvis upwards, squeezing the glutes at the top. Slowly with control lower this down. Repeat 10 times for 3 sets.

Bulgarian split squats

This exercise can strike fear into the heart of the glutes. It hurts while you're doing it, but the amount of glute activation you will feel will be worth it. Plus you will barely be able to walk the next day. This exercise is one that should definitely be in your glute strengthening regime.

Place the back foot up on a bench, ideally around knee height. Bring the front leg forward far enough that when you squat down your knee will be over the toes. Begin with light dumbbells at first to get the form right. Squat down keeping the back straight and the spine neutral. Make sure the knee doesn't come too far over the toes so as not to put unnecessary strain on the knee ligaments. Press down with the heel to engage the glutes and then press up slightly tucking the pelvis under at the end of the rep, squeezing the glutes. Repeat another 10 times for 3 sets.

Note that if you are going to attempt more complicated weighted exercises then it is important to have a professional assess your technique. We advise that you seek out an experienced personal trainer to guide you on proper form to ensure you are lifting correctly. If you already have a personal trainer then ask for a more targeted glute program if you feel you have imbalanced or weak glutes. That is if you are not already of course. We have access to an extensive personal trainer network, so if you need a great trainer then please get in touch and we can put you in touch with the right person.

This is also not an exhaustive list of glute exercises. There are many more including jump squats, box jumps, step ups, stair running, the list goes on.

The other factor here to counter tightness in the glutes is having soft tissue work to release the tight structures. Increasing mobility will help to allow you to stabilise and strengthen safely and more effectively without creating injuries for yourself. Active release techniques, myofascial release, dry needling, fascial manipulation, trigger point therapy and deep tissue release can be very effective at releasing those pesky tight glutes.

As always if you have any questions or comments then please feel free to get in touch.

References:

Brukner and Khan - clinical sports medicine

Stuart McGill - Low Back Disorders, Evidence base prevention and rehabilitation

We get asked this question all the time. So what is the best health fund out there?

The short answer is there is no best health fund. There is so much competition out there with over 30 health funds available. Finding the best health fund is really a personal choice as there are many factors.

When it comes to being able to claim remedial massage you are really looking at extras cover. When getting health insurance you have the option of Hospital only cover, extras only cover or Hospital and extras. Most people choose hospital and extras as this gives you access to cover if you need a procedure that requires choosing your own surgeon and also the ability to claim a portion back of the cost of extras such as dental, physio, remedial massage and more.

The amount of money you get back when claiming extras depends on how much you spend each month. Basically the more you spend, the more you get back. The health fund will give you back a certain chunk of money per modality and once it is used up you have to wait until the next calendar year for it to reset, so you can claim again. With the exception of AHM, who reset on the financial year. Some health funds will give you a percentage of the total amount whereas others will just give you a fixed amount back.

If you use your health fund regularly then you will use it up reasonably quickly. People are usually surprised as to how quickly it will run out. This can be a false economy as when the extras you use have been exhausted you still have to pay. You can always toss up whether having extras cover is really worth it, or you just have hospital cover and put some money aside each week to spend on the extras you use.

AHM is a unique health fund as they don't give you an amount per modality like most health funds, they give you a total amount to use which you can choose to spend on whatever you like. The only downside is they have been gradually lowering the amount they give back each year. It is now at $700 per year and can increase the longer you stay with them. This can still be a good choice if the only thing you use is remedial massage as you will get $700 to claim back per year. If you use optical, dental etc then you will run it out pretty quickly.

Just remember that health funds are health insurance companies. Insurance companies are a business that needs to make money so they will always come out on top. Unfortunately there is no way to win when it comes to health insurance.

Another thing to think about is your hospital cover. If you require a procedure often your health fund won't cover all that much, so you will have to still pay most of it which can run into thousands. If you need something like pregnancy cover you will also have to plan ahead before increasing your cover as health funds will usually have a 12month waiting list on these expensive items.

The easiest way to find the health fund that works is to use an online health insurance comparison tool such as iselect, where you can put in what you want and it will show you the best options. There are many health funds that you have never heard of outside of BUPA, medibank and HCF so shop around.

If you have any questions then as usual get in touch.

This is a question that comes up all the time in clinic. People have often been told their hips, pelvis or back is out. For most people this means that there is some pain in the back or pelvic area. You may feel some tightness or pulling in back or hips that may feel like you are being pulled out of alignment. But what is really happening?

You may sleep in a funny position, bend, twist or lift something heavy in an awkward position and you feel a sharp pain in your lower back.

Many people have been to a Chiro or Physio that will just put your back back in. This is an oversimplification of what is happening. In reality there is nothing in your back that is going “out”. For this to happen you would be dislocating a joint, which would be extremely painful and would need some serious work to get the joint back in.

What is really happening?

There are many ways you can injure your back that may make it feel like it is “out”. Here are the most common reasons:

protective muscle spasm. The body is great at protecting itself. Say you go to lift that heavy box while you are moving house. It’s in an awkward position and you have to twist your back to get to it. By putting your spine in a compromised position there is a risk you may damage a spinal disc or sensitive facet joint so the body tightens up the lower back muscles to stop you from hurting yourself. The only problem is that the tightness can then lead to pain. The body can be a bit over protective when it comes to injuries.Disc bulge. If you have injured a disc in your spine, whether it is a herniation to the disc (fancy talk for disc bulge) or a tear to the outer layer of the disc (annular tear) you will lean away from the side that is painful. This will give you the feeling that your back is out as you will be tilting your spine. When the inflammation in the disc settles or heals you will find that your spine will naturally go back into alignment.Joint injury. This encompasses irritation or degeneration (a nicer way to say osteoarthritis) to the spinal facet joints as well as the sacroiliac joint (SIJ). Again if you have pain in a joint your body will try to avoid leaning on the joint so you will lean away, also giving you a sense that you are out of alignment.

With most of these injuries there will be an element of releasing the tightened, injured tissue as well as allowing the injury to heal and not re-aggravate it. This is where avoiding heavy lifting, twisting, running or sitting or standing for too long is important.

I can be a little pedantic when it comes to a diagnosis. People are often told they have injuries that don't really exist such as your back being out or your hips being uneven. Basically there is no such thing as your back being out. If you are told this then dig a little deeper and challenge your practitioner to be more specific. If they can't then you may not be getting a clear idea of why you are in pain.

Uneven hips, leg lengths, rotated pelvis and the ubiquitous "bit of scoliosis".

We hear these diagnosis’ all the time. The truth is there is little solid evidence to link these issues with pain. Most people have uneven hips, different, leg lengths, a rotated pelvis and yes, even some scoliosis. Scoliosis is the most common diagnosis that gets thrown around. Don't get me wrong a severe scoliosis can cause pain but a little bit of scoliosis is as likely to cause your pain as having a crooked nose may be affecting your sinuses. I always comment that we need to change what a normal spine looks like in the text books as no one has a perfect spine. If you compare everyone to a straight spine or aligned hips then of course we are all dysfunctional.

There have been many studies over the years and few of them have found a direct link to pain from things like leg length, rotated pelvis or uneven hips. Some studies have shown positive results from giving patients heel lifts to correct the leg length, but again these are big test groups and it certainly doesn't work all the time.

Leg Length

Practitioners such as Chiro's, Osteo's, Physio's, sports doctors, podiatrists, orthopaedic surgeons and massage therapists spend a lot of time scrutinising all of these things. Again if one of your legs is 5cm longer then you will notice some major issues up the chain. I have read, studied and have been told from many practitioners that there can be up to as much as 5mm-1.5cm difference between legs without issue. Most people can't actually decide on what the average is so if one practitioner says that 5mm difference is a problem then everyone suddenly has a problem.

If the bones of your legs are different lengths then this is called a structural leg length discrepancy. If the legs appear to be different lengths and the bones are the same length then it is said to be a functional leg length discrepancy. This can occur from muscle imbalances, foot pronation,

The big issue here is that it may not really be the legs that are uneven at all that make it appear that one leg is short or long. If the muscles of the lower back and hips are tight they could be pulling the pelvis up to one side making it appear that that leg is shorter. Also the way the head of the femur sits in the hip joint can influence the appearance of the length of your legs. The only true way to have your leg length checked is by scanning them and measuring the bones. Having someone put your ankles together and say that one leg is short is very unscientific and how do you know if you have a short leg or a long leg, which one is the problem. There are some easy special tests to check where this leg length is coming from. But at the end of the day everyone has a slight difference in leg lengths, just like we have slight differences in foot size.

Another thing to think about with leg length is that most people don't stand up all day and even if they do they don't stand in a square, even position where leg length may influence the pelvis. Most people sit all day, basically from school age, so the length of the legs will have a very small influence on the spine and pelvis anyway. Your leg length will only influence your pelvis in a standing, walking or running position. I think this is often overlooked.

Rotated pelvis

This is the king of the truly ambiguous diagnosis. Get ready to have your mind blown…. wait for it…. there is actually no such thing as a rotated pelvis. If someone tells you that you have a rotated pelvis make sure to ask exactly what they mean by this to make sure they aren't just being vague. What most practitioners and doctors mean by a rotated pelvis is actually called an anteriorly or posteriorly tilted pelvis. Each side of the pelvis can move independently and one may be slightly more tilted. Again this is all very normal and most people have some difference between sides. They are both very different issues. An anteriorly rotated pelvis will require a different treatment to a posteriorly rotated pelvis. There are other pelvic differences that may also get lumped into the rotated pelvis black hole. They are the illusive pelvic inflare or outflare and the high ilium. Pronation and foot biomechanics can also influence the hips and that is a whole other blog piece.

Just think about it for a second. If you are expected to have the perfectly aligned spine, hips and pelvis as well as your legs, feet and arms have to be the same length then we can all be diagnosed as being dysfunctional and we should all be walking around in agony from these misalignments. Whilst it is important to check these postural issues they may not always be the cause or reason you are in pain. Ligament sprains or tears, muscle strain, muscle spasm, disc injuries, joint injuries are much more likely.

The interesting thing with all of these postural considerations there is no consistency. One person with scoliosis or a longer leg may have pain but someone else with exactly the same issue may have no pain. If you broke your leg then you would expect everyone with a broken leg to be in pain. If a “rotated” pelvis was this much of an issue you would expect everyone with a rotated pelvis would be in pain.

What should I do?

Firstly if you throw your back out you should get it looked at and treated as soon as possible. The longer you leave an injury the more likely it won't just get better by itself, you may also injure it further and it may then become chronic.

Here are some tips:

rest and avoid heavy lifting while you are in the acute healing phase of injury. This is a great time to get everyone else around you to lift the heavy couch or groceries.keep moving. I know the last tip was rest but this doesn't mean just laying in bed watching netflix for weeks. Some gentle stretching and mobility will help your body not stiffen up which will exacerbate the injury.maintaining a strong core and pelvic region including glutes. This will mean your pelvis and lower spine will be more stable when you are moving about and lifting. Meaning you will be less likely to injure your SIJ or lower back.Squat to lift. This is very simple advice but most people still bend over to pick things up off the floor. If your bend forward and twist at the same time this is the easiest way to damage your spine.Correcting your standing or sitting posture can make a big difference to your pelvic position. Don't lean all of your weight to one leg when standing or one hip when sitting. Try to sit up straight on your sit bones so not to create pelvic tilts.get regular massage to prevent muscle tightness and spasm from building up.Don't sit or stand in the same position for too long. The body needs to move so if you keep it stationary for too long you are asking for trouble.If you really think your legs are different lengths then getting a scan or a thorough assessment to assess where the issue is coming from. If the root cause is found then it can be corrected.

So there you have it. To say that your back or pelvis is “out” doesn't really explain what is going on. practitioners often need a simplified way to explain to clients what is going on in their body. But being more specific leads to a more targeted treatment and plan for recovery and also to find out why it may have happened in the first place and to prevent it from happening in the future.

As always we love feedback so if you have any questions, comments or have found some grammatical or spelling errors (whoops)

Interesting further reading and links to research articles

https://www.painscience.com/articles/structuralism.phphttps://nccih.nih.gov/research/results/spotlight/070411.htmhttp://www.physio-pedia.com/Leg_Length_Discrepancyhttp://annals.org/article.aspx?articleid=705425http://journals.lww.com/spinejournal/Abstract/1991/04000/Leg_Length_Inequality_in_People_of_Working_Age_.7.aspx

Do you crack your joints? If so you’ve probably wondered if it is good for you. It usually gives you a satisfying pop or crack so it can't be that bad right. If you don't crack your joints then you probably find it horrifying that people do it. There is that one guy in the office that incessantly cracks his neck as though his trying to remove his own head.

What is cracking?

Cracking or popping of a joint is basically moving the two ends of a joint away from each other (cavitation) which will then release the nitrogen gas within it. The release of this gas creates the popping sound. It can be hard to believe that this sometimes loud sound can come from a simple gas release but you could liken it to pulling a suction cup off a piece of glass.

Is cracking good for me?

Well, the short answer is we don't really no. There is no definitive proof either way. There have been few studies into this to prove cracking is good for you. The classic story that is always brought out is story of Dr Unger who famously only cracked the knuckles on one hand for 60 years. He would then compare the hands to see if there was any difference, which he found that there wasn’t. Neither hand had arthritis.

The understanding that science has as to what happens when we crack a joint appears to be very safe. Releasing of gas from a joint appears to be a natural and normal part of everyday life. The old idea that it was the bones of the joint rubbing against each other that caused the sound is not correct. If you have osteoarthritis in a joint then it would be advisable not to crack the joints as it may cause pain, it may also release tension so this would be on a case by case basis. The reason osteoarthritis may be aggravated by cracking will be that the joint won't have cartilage to protect the bone ends so they may actually rub against each other.

What about Chiropractors?

From a Chiropractors perspective they usually advise you not to crack your own joints, especially the neck, as this can over stretch the ligaments in the joint which will make them looser and crack even more. You can then get hyper mobile joints that move too much, which means that the locked up joints won't move.

While we are talking Chiros we could add that the idea of putting a joint back in or that a joint can be “out” is a bit of an outdated idea. The reality of what is happening when they “adjust” a joint is just releasing gas or tension from a joint. If you watch the Ted Ed videoon what happens when you pop a joint it says that you will be able to “pop” a joint again in 20mins. So my Chiro challenge would be to have your back “adjusted” and then go back 20 minutes to have it cracked again, I'm sure that you would still get a pop as the gas has had time to build up in the joint. It’s like cracking your knuckles. If you crack them right now, you won't be able to crack them again straight away. My knuckles don't crack because they are out of alignment they crack because there is a gas build up in the joint which is a natural process and by product of a synovial joint.

So there you have it if you're a joint cracker and love it then there is no real proof that it is dangerous, just be careful in the neck not to over stretch it.

References:

http://www.scientificamerican.com/article/crack-research/http://www.dailymail.co.uk/health/article-3011085/Can-cracking-knuckles-cause-arthritis-One-man-cracked-joints-one-hand-60-YEARS-out.html http://ed.ted.com/lessons/why-do-your-knuckles-pop-eleanor-nelsen

Do you do tummy time?

Firstly you may ask what is tummy time? If you have kids or have had kids then one of the important things to do as a baby is to be given time on your tummy. Tummy time gives the baby some time to develop their back, neck and core muscles as well as encouraging them to crawl.

If you look into the primal movement patterns having a strong back, neck and core will allow the baby to then roll over which is actually a very complicated movement when you haven't got the strength in your legs or arms to just push you over, like an adult would. The next phase of movement is then getting up into crawling, which then leads to getting up into standing and finally walking. People often say that human babies take ages to develop compared to other animals, but when you look at how complicated these movements are it really does take at least a year to master all of these movement to finally allow you to walk. As a side note there are many other reasons that human babies take ages to develop which has a lot to do with us being a social animal and developing a strong bond with our parents. This helplessness means that human babies will have a very strong bond as compared to say a horse that comes out running.

3 reasons you should do tummy time

So why would an adult need to do tummy time, I hear you ask??? Think about your day. You probably spend a large chunk of time hunched over something. Whether it is a computer, a phone, a desk, a car, a machine of some description, a baby, another person, whatever. We spend most of our time in a forward posture. A lot of people will also struggle to even get down on the floor. This just highlights how important it is to keep mobile enough to be able to get down on the floor and get back up, especially as we age.1) Lying on your tummy reverses the forward curve and pressure on the spine and internal organs such as the lungs and intestines.

2) Tummy time also helps to strengthen your back and neck muscles that hold you up (erector spinae) and the deep spinal stabilisers (multifidus). This also helps release some tension in the spinal joints. So if you lie on your belly and then press up into a backward bend you may get a few cracks. This is the spinal joints releasing tension.

3) Lying face down or prone also gives a gentle stretch to the hip flexors which can tighten up from years of sitting. This can also help correct a lordotic posture (ducks bum) where you bottom is poked out.

So what can you do?

Well, the easiest thing to do is to become acquainted with the ground. Lying face down on the ground when watching TV or using a computer or phone. This can be done when at home in the evening or in the morning when waking up. You can also make this more involved by adding some Yoga postures to this such as the following:

Crocodile Pose (Makarasana) - best for watching TV

Cobra (Bhujangasana)

Sphinx (Salamba Bhujangasana)

This may seem like a crazy idea but it can be surprisingly effective at strengthening the back muscles and releasing the spine. If done regularly it may even help you rounded posture.

As always if you have any questions or comments hit us up on Facebook or email us at info@muscletherapyaustralia.com.au

Have you ever been told you have scoliosis? Sounds scary right? Whilst some scoliosis is very serious and can be debilitating most scoliosis is perfectly normal and may not really have much to do with your pain. Chiropractors and Osteopaths are notorious for telling people they have scoliosis as though it is a major problem and also that they can fix it. Whilst minor scoliosis can in theory be helped with manual therapy there is no way that cracking your spine will magically straighten it up and it certainly wont help with a genetic structural scoliosis. There is this idea in musculoskeletal health that the spine needs to be straight (within the realms of its natural curves) but in reality does anyone have a straight spine? As a practitioner with over 10 years experience and also a remedial massage teacher of 5 years I have never seen a “straight” spine, including Yoga teachers, pilates instructors and the ones that have seen the Chiro for years who has been trying to fix it.

Scoliosis can often be a symptom and not a cause. If you have bad posture by tilting to one side when you sit or stand all the time, then of course your spine is going to appear to be tilting or curving.

So what is scoliosis?

Scoliosis is a lateral curve of the spine, or when you have an S in the spine when looking at it from behind. Usually a scoliotic spine will contain an element of rotation as well due to the way the facet joints in the spine are formed.

There are 2 types of scoliosis, structural and functional. Structural scoliosis is basically a curve in the spine that is formed genetically by the bones and the way the joints have grown. Functional scoliosis occurs more from your posture or repetitive actions you do such as carrying a heavy bag on one shoulder for years or standing with one hip pushed out to the side. Generally structural scoliosis can't be fixed as it is the bones and joints structure that is causing the curve. Functional scoliosis can be resolved but it can be a lot of work, including soft tissue release to tight areas, strengthening to weakened areas as well as postural awareness.

For those of us who have a mild case of scoliosis (most of us) just changing your posture can make a massive difference. It is really your poor posture that is causing your spine to appear curved. As soon as you straighten up and stand or sit correctly your spine should right itself.

The reality is that just like every other part of our body nothing is perfect. Most faces aren't symmetrical, most legs aren't the same length, most feet aren't the same side, most peoples feet over pronate and yes most people have scoliosis. Are we trying to compare our bodies to an unrealistic perfect normal that will never exist. Over pathologising and also making healthy people worry, known as the worried well.

When scoliosis is severe.

When scoliosis is really bad this is usually discovered in infancy. A child's posture will be noticeably distorted and they may have pain in their back, neck or down the arms and legs from pain on the joints and nerves. The best assessment for scoliosis is an X-ray to effectively check the amount of curvature of the spine. A brace can be worn to attempt to straighten the spine, just like braces on the teeth. The worst case scenario is to have rods surgically inserted into the spine to straighten it as you grow. When you are fully grown it is highly unlikely that a brace will have any effect as the spine is fully developed. The joints will have formed in a manner that is unchangeable. If there is functional scoliosis, from the way you hold yourself, then soft tissue work, specific exercise and postural awareness will be the only things that will help.

Severe scoliosis can lead to problems in the shoulder as the shoulder blades wont sit properly on the ribcage. The thoracic spine connects to ribs so this is why the ribs will often look uneven with someone with scoliosis. The hips can also be affected as the sacrum (lower part of the spine) sits into the pelvis. This could also affect the appearance of the length of the legs.

The point of this blog was to give you some peace of mind that the slight curve in your spine probably isn't the cause of your pain and that most people live perfectly healthy lives with some scoliosis. I am also not saying that scoliosis can't be the cause of your pain, just not always.

If you feel that you have scoliosis and want to have an assessment an treatment then please make an appointment so we can assess and treat you.

As always if you have any questions or comments please feel free to post on facebook or email us at info@muscletherapyaustralia.com.au

Your first question is most likely what on earth is calving it? This is basically just strengthening your calf muscles. So do you? If you do, then well done for helping out your ankle stability and foot strength. If you don't then you definitely should start incorporating some calf work into your workouts.

Firstly what are the calves? A bit of anatomy...

The calves are technically 3 muscles and for those real anatomy nerds out there you could actually call them the second triceps muscle in the body. The Triceps Surae as opposed to the Triceps Brachii in the upper arm/shoulder.

Whilst I just said they are 3 muscles, they are in reality only 2 muscles. The gastrocnemius (which has 2 heads) and the soleus muscle. So 2 heads of gastrocnemius and soleus make 3 muscles.

The gastrocnemius is the bigger of the 2 muscles and is the more superficial muscle, so this is more the muscle you see and will think of when you think of the calves. It begins at the femur just above the knee crease and runs down the back of the lower leg to become the Achilles tendon. The gastrocnemius is responsible for flexing the knee (like the hamstrings) and also plantar flexion or pressing your foot into the ground or standing on tippy toes.

The soleus muscle is different to the gastrocnemius as it doesn't cross the knee. It attaches to the fibula head and the tibia and then also becomes the achilles tendon and attaches to the heel or calcaneus bone. Its only action is to plantar flex (tippy toes).

The differences between these muscles means that when we stretch or strengthen the muscles we have to do one with the knee straight (gastrocnemius) and one with the knee bent (soleus)

Why are the calves so important?

The calves are important as they are the bridge between the upper leg and the ankle. They provide stability for the ankle and also spring like energy for walking, running and jumping. With weak tight calves you are asking for injuries.

Big Arnie knew how to calf it.

When Arnold Schwarzenegger was first training to be a body builder he realised that is calves were his smallest asset. He had huge pecs, biceps and quads but his calves were tiny. He knew that to be Mr Olympia he would have to work on the calves. So he began to calf it. He embarked on a gruelling calf regime not just tacking a cheeky calf raise to the end of his workout. He would actually dedicate whole workouts to the calves just like he would any other body part. He would do standing calf raises, seated calf raises and donkey calf raises. With perseverance he went on to have 20inch monster calves and became Mr Olympia many times over.

I’m not suggesting that you enter a bodybuilding competition, but what we can learn from this is that through perseverance we can change this often overlooked body part and actually incorporate it into our workouts.

What injuries can calving it help with and prevent?

Ok, ok. I want to calf it but I don't know how. What are some calf exercises?

The great thing about the calves is that there are only a few targeted exercises so they are easy to remember. There are lots of other exercises that will incorporate the calves such as running and jumping as well as exercises where you go onto your toes.

Calf raises off a step - are probably the most accessible and easiest of all the calf exercises. Find a step, place the balls of your feet on the edge of the step. Raise your heels (calve it) to contract your calves, go right up on to your toes to activate the windlass mechanism of the foot that engages the plantar fascia. Then slowly lower down until your heel goes below the step. you should get a nice calf stretch here as well. By slowly lowering you are accentuating the eccentric phase of the contraction which basically means you're getting more bang for your buck with the exercise. Repeat 3x10. For more of a challenge you can try on a single leg. Warning though make sure the bannister rail is close by as you may fall over, especially in the beginning when you are just getting your balance. The single leg version is great for people with plantar fasciitis and also ankle instability. To add even more of a challenge you can use dumbbells or a barbell to increase the weight.

Standing Calf raise machine: You will need to have a gym that has this machine. There are a few variations of these machines. Usually you stand on a platform and 2 levers sit on your shoulders that have weights on them. You then stand with the balls of your feet on the edge of the platform, lifting your heels up, pressing up with your shoulders and then lowering your heels off the platform as in the basic calf raises.

Donkey calf raises: This is basically a calf raise while you are bent over at the hips. They target the upper portion of the calf muscles. There are machines to do this exercise or you could ask a friend to help out.

Seated calf raise: This uses a machine where you are sitting with your knees bent and the weight is on your knees. You press down with the balls of the feet (calving it). This works the Soleus more as remember the soleus doesn't cross the knee joint so will activate more when the knees are bent.

Seated calf machine:This is probably the easiest calf exercise. You sit on the machine, load up the weight and then basically press down with your foot into plantar flexion, then slowly release.

Some other calf exercises

Jump squats

Box Jumps

Sumo calf raises

So there you have it. If you're not calving it, it is about time you started. If you are not convinced about calving it then take it from Arnie.

For more information, advice or comments or for any other calf exercises you think are great please don't hesitate to get in touch with us on 02 9233 5769, info@muscletherapyaustralia or on Facebook.

Please note that this information is general and not specific to you. if you have an injury then you should definitely have this checked out before you begin any new exercise.

References and more reading:

http://www.running-physio.com/pf-new-research/http://www.simplyshredded.com/oak-roots-how-arnold-turned-his-biggest-weakness%C2%97-his-calves-into-a-showcase-muscle.htmldonkey calf raises - http://www.muscleandfitness.com/workouts/leg-exercises/videos/donkey-calf-raise

Let’s face it, we spend around a third of our lives asleep. Some people may spend their whole lives asleep but that is a different post. It is therefore logical to think that the things you are doing while you are sleeping will be contributing to your pain. If you are always sleeping in the same position then over a long period of time you will be always jamming up the same joints in your spine, shoulders and hips as well as compressing or stretching the soft tissues such as muscles, fascia, ligaments, joint capsules and tendons.

The million dollar question - Which pillow should I use?

If you ask a practitioner or bed sales person you will probably get many different answers, especially If they are trying to offload onto you a pillow they just want to sell you. Beware of buying a pillow because it was recommended, especially if someone is trying to sell it to you.

The most important thing with a pillow isn't the cost or whether astronauts have used them (tempur pillows), remember marketing is there purely to take your hard earned cash. The most important thing is that the pillow is the right size for your body. There is no one size fits all pillow and this is where it gets tricky. Just because one person found that a $250 Tempur memory foam pillow was right for them doesn't mean that it will be right for you.

The biggest factor in choosing a pillow is the position you spend most of your time in when sleeping, whether that is side sleeping, back sleeping, front sleeping or upside down. Most of us will go through a variation of these positions throughout the night and that is also a consideration. Sometimes when people talk about pillows there is this assumption that you just go to sleep on your back like Dracula and wake up in the same position. I always feel like saying to them "have you ever actually been to sleep?".

A comfortable sleeping position is usually one that we have been doing for a long period of time. This could have been since you were a child. As a child you are more flexible and your joints are healthier so you can get away with sleeping in a dodgy position. As we get older though we need to consider the impact sleeping positions are having on our pain.

Side sleeper

If you sleep on your side then your will need a bigger pillow than if you predominately sleep on your back. You really need to try out the pillow before buying it. When you lie on your side the your neck should remain in alignment with the rest of your spine. It shouldn't be tilting one way or the other. Have someone photograph you while you are in the shop so you can see how your neck tilts.

A common side sleeping pillow is the contour type pillow. This has a scooped out section for your head and then a larger section that supports your neck. If you exclusively sleep on your side then this could be the pillow for you. But remember if your neck is not aligned properly you will end up in pain.

Back sleeper

If you sleep on your back then you really don't need much of a pillow at all. Try not to use a really big pillow here or it will press your head forward into flexion. This can put pressure on the discs in the vertebrae which could lead to headaches or pain/tingling/numbness down the arms.

Front sleeper

You are basically doomed to pain. If you have to sleep in this position then using a very thin pillow will also be important so as not to strain the neck too much.

What's the best way to sleep?

Back sleeping is the most neutral and comfortable for the body. It may seem unnatural at first but practicing really makes perfect. The more you can do this the more used to it your body will become and eventually you will find this easy.

The other considerations with all sleeping positions are the effects on the rest of the spine and also the hips and shoulders. If you sleep on your side then you will be jamming up the shoulder joint on the side you are sleeping on. This can lead to shoulder pain and also the potential for nerve compression leading to numbness or tingling down the arm. Side sleeping can also affect the hips and lower back if your top leg is rotating forward. You should really sleep with your knees together and a pillow between them.

What's on the market

Generally all of the big brands such as Denton, Dunlopillow, Tontine, Tempur, Ikea, Target, K-Mart all have variations of the same thing these days. There is a lot of competition so each brand has a similar catalogue. The biggest difference between them will be the price. Budget is a consideration. Often when buying a pillow there will be some trial and error i.e: you may not get the right pillow first time around. So if you drop $250 on a pillow and it doesn't work for you then you will have completely wasted that money as there are usually no refunds or exchanges on pillows. Some shops have trial pillows but this isn't very common.

Contour pillows or Ergonomic pillows

These are best for people who predominately sleep on their sides. They usually come in various sizes such as low, medium and high profile. To get an idea of which size you need your will need to measure the distance from your shoulders to your neck. If you have narrow shoulders you will need a low profile, if you have braod shoulders you will need a high profile. These pillows usually have a difference height on each side so there is some fine tuning with height.

Memory Foam

These pillows claim that they are more supportive and "mold" to your unique head and neck shape so that they will be more tailored for you.

The biggest brand on the market (and most expensive) is the Tempur. They claim their memory foam is different to the generic memory foam that other brands use. They also have grades of density so if you like a firm pillow or a soft one you can choose.

Memory foam pillows are often made from latex and can be quite hot and sweaty, so this is also a consideration, especially in summer.

Down Pillows

These pillows are usually made of goose down and can be very comfortable pillows. They are usually on the softer side, but as mentioned before can be "fluffed" up to make them more supportive.

Stock Standard

These pillows are your standard soft pillows you get from Target or K-mart. In my opinion as long as you get the alignment right with the pillow you will have a good nights sleep. If the pillow if too firm and too high this is where you will get the most trouble. With a soft pillow you can bunch it up so it becomes bigger.

If you can find a shop where they have knowledge, maybe a physio or chiro on board who can assess and look at you sleeping with a pillow and then let you try it out this will give you the best result. More shops are doing this these days, but this also comes at a premium.

So there you have it. I hope this has given you some insight into the tricky world of pillows. The big takeaway here isn't that you need a fancy pillow, you just need to sleep in a position that best aligns your spine, shoulders and hips. If you get that right a $10 pillow from Target could do the job. I have been through many pillows over the years and the most comfortable one I use now is a goose down pillow. The last memory foam pillow I had was not that great and I find them too firm and give me headaches. But that may not be the same for you....

For any comments or questions feel free to get in touch by phone 02 9233 5769, email: info@muscletherapyaustralia.com.au or on Facebook.

We've all been to the gym and seen those big guys pumping up their guns in front of the mirror as though their life depended on it. This is all well and good if you want rippling muscles to show off at the beach, but if you want a healthy and balanced body you need to start with stability. Generally when people begin lifting weights at the gym they bypass stability and jump straight to strength. If you want to be strong and muscly then this makes sense. But this lack of stability is what leads to many injuries. Without stability the body tightens up to protect joints, ligaments, tendons and muscles. You can stretch and strengthen til the cows come home but without activating and strengthening the stabilising muscles you will always be prone to injury.

A good example of this is the core. Without core strength the muscles of the pelvis have to tighten up to provide pelvic stability. These muscles can then tighten up limiting pelvic movement. You will then feel tightness in your hamstrings and lower back, maybe even your hip flexors. Instinct says to stretch the muscles out which can provide some relief to the tightness but it just keeps coming back. The reason for this is that the core is still weak and therefore the pelvis is unstable. So stop doing your sit-ups and start doing some core activation exercises. The benefits of this will reduce the likelihood of lower back pain, hip problems, knee injuries and much more.

Core activation - Let's start at the start. If you can't activate your core without moving or without weights then you really shouldn't be adding extra load or weight until you can first activate it.

First the anatomy - You really need to understand the core muscles if you are going to activate them. So scrub up on your latin and lets go....

Transversus Abdominis (TVA) - This muscle is basically like a corset that wraps around from one side of the spine, all the way around the front and then attaches to the other side of the spine. It lives underneath the Rectus Abdominis (six pack) and oblique muscles.

How to find and activate them?Lie on your back with your knees bent. Tuck your fingers around your hip bones and press in gently but deep. Try to pull in your belly button but only with around a quarter of your strength. You should feel the contraction deep and not on the top surface which will be your abdominals.

Multifidus - These muscles basically stabilise the spine and are involved in rotational movement of the spine. They stop the vertebrae from slipping forward and keep them aligned. They traverse the whole spine from the lumbar spine right up into the neck (cervical). There is a lot of controversy as to how to activate and strengthen multifidus. The hardest part with these muscles is actually activating them. Here are a few different ways you can try:

Lie down on your back with your spine in neutral and your knees bent. Try to imagine you are pulling the back of your pelvis together. This will help to activate the lower multifidus.

Exercises:

Slow spinal roll downs and then coming up vertebrae by vertebrae bringing your head up last. Repeat 5-10 times. Any lower back pain then stop immediately.

Pelvic Floor muscles - if you have ever been pregnant, done Yoga or Pilates then you will be familiar with the pelvic floor. Even so, I generally find most people are baffled by these muscles and only have a very limited understanding of what they actually do. There are differing views as to what muscles make up the pelvic floor. For the case of simplicity we will say that they are made up of the Levator Ani group of muscles (Pubococcygeus, Ileococcygeus and Puborectalis) and the Coccygeus muscle.

Pubococcygeus (PC) muscle: a hammock like muscle that stretches from the pubic bone to the coccyx (tailbone) which supports the internal organs. This muscle helps control urine flow and sexual function as well as stabilising the spine and pelvic positions.Ileococcygeus muscle: This muscle connects from the ilium (pelvic bone) to the coccyx.Puborectalis muscle: this muscle forms a sling from the pubic bone to the rectum and is part of Levator Ani.Coccygeus muscle: This muscle connects from the sacrospinous ligament and inserts to the ischial spine.

How to strengthen them? 1) Lying comfortably on your back or seated comfortably. Imagine you are stopping the flow of urine. Contract this muscle and then relax. Repeat this 10 times and build up to 30 times. Once you can comfortably do this 30 times build up to holding the muscle contracted for 1 minute. 2) Now do the same but now contract the anal sphincter. Contract and relax up to 30 times. Once you build up to this then try to hold for up to a minute. When you can do these individually try and do them together by contracting both areas at the same time. When you have mastered these exercises you should always incorporate them into any exercise regime, especially core work.. For instance if you are doing a plank pull on the pelvic floor muscles but squeezing the anal sphincter and also stopping the flow of urine by doing exercise 1 and 2.

It is generally said that if you can switch on the transversus abdomens and the pelvic floor then the multifidus will fire as well. The multifidus are by far the hardest muscles to visualise contracting or feel as though they are doing anything.

Common general core exercises

Bridging: Lie on your back with your knees bent arms by your side. Switch on the core muscles and then press down with your heels and lift your buttocks off the floor. Your knees and shoulders should form a straight line. Hold for 5 seconds and then lower back down. Repeat 10 times. Have a 30 second rest and then repeat 2 more sets. Try to keep your pelvis stable and your spine neutral, that is don't over arch or over tuck your pelvis. If you can't do this then it is a sign that you are very weak in your core. Back it off and only raise up as high as you can whilst keeping stable.

Knee fallouts, raises and slides: laying on back, knees bent, spine in a neutral position. Pull up pelvic floor, pull front hip bones together (TA, transversus abdominus), pull back hip bones together (multifidus). Once holding the above contractions, repetitions of the following three exercises should be done without losing control of the pelvis and low back

A: drop one knee out to the side, then alternate (Knee fallouts) B: lift one knee and foot a few inches, then alternate (knee raises) C: slide one heel out until your leg is straight, then alternate (knee slides)

The Plank: lying face down on the floor. Elbows tucked in and hands together at the front forming a triangle. Tuck your toes under and then press down with your elbows coming up onto elbows and toes. Pull on core using the techniques described above. The Transversus Abdominis, Multifidus and Pelvic floor. Hold until you can't hold any longer. You should build up to holding for at least 2 mins. Any signs of back pain you should cease immediately.

As with any exercises if you feel pain or discomfort or feel that you are doing them wrong then get in touch. If you have any comments or questions please feel free to to get in touch: email info@muscletherapyaustralia.com.au, phone 02 9233 5769 or post on muscle therapy australia facebook page

Do you sit or stand all day? Would you say you sit up straight or do you feel you slump most of the day? This slumping could be the cause of your bodies aches and pains, especially headaches and neck pain.

The classic office posture involves hunching the shoulders up and slumping forward. When this happens the head naturally tilts backwards as the chin comes forward.

This posture then places a lot of load on the muscles that support your head and shoulders. The main muscles that become overused and then painful are the Upper Trapezius, Sternocleidomastoid, Sub-Occipitals, Levator Scapulae and the neck extensor muscles. Most of these muscles have trigger points that will then refer pain into the head. So the pain in your head is only being perceived in the head but the actual irritation to the soft tissues is in the neck and shoulders.

This irritation and overuse to the soft tissues is a gradual process. The pain may appear to be acute but it has actually been building up over time. It is always happening, sitting on the bus, slumping on the lounge, sleeping at night in a bad position. These small repetitions over a long period of time will gradually turn into a much larger problem. Like the straw that breaks the camels back or the snowball building up as it rolls down the mountain, your potential for pain is growing overtime you choose to sit or stand with poor posture.

So what can you do?

Well the first thing to do is to sit up straight, right now. There is no magic exercise you can do or expensive chair you can buy to fix your posture. If someone tells you there is or you can fix this really quickly then politely run the other way. Posture involves awareness and breaking patterns that have been held for years. It sounds simple but noticing your posture and then changing it will be reprogramming your body/mind to actually change.

Exercises that can be beneficial include:

- Chin Tucks to strengthen the opposing muscles in the front of the neck and also to stretch out the back of the head/neck.

- Stretching the chest and the upper trapezius will help to release the tightened muscle tissue.

- Thoracic foam rolling to open the chest can reverse the curved, slumped posture.

For more information or to have an assessment and treatment contact us on 02 9233 5769 or at info@muscletherapyaustralia.com.au.

When do you you usually get soft tissue treatment/massage? Is it when those pesky headaches come one or when that pain in the knee rears its ugly head? Or do you like to prevent pain coming on in the first place by having regular maintenance treatment?

It is in our nature to leave things until they are bad before we will seek help. Just like with our cars most people will take their cars to the mechanic only when the car is playing up rather that booking it in for regular scheduled maintenance. Our bodies are much more valuable that our cars (some people may disagree) so it is just as important to get our body in for a regular maintenance treatment.

You don't wait until you are smelly before you have a shower. If you did then you probably wouldn't be too popular. No offence meant to you if this is how you gauge your cleanliness. Showering daily prevents bacteria building up and getting infections, just like regular soft tissue work prevents injuries popping up.

Most injuries are caused by repetitive traumas to soft tissues. Whether it be the myofascia (muscle/fascia), ligaments, tendons or nerves. This means that even when you have no pain you are accumulating a soft tissue injury through exercise, your posture and general day to day activities. Even if you have a previous traumatic injury to your soft tissues there will still be a component of repetitive strain that will aggravate this as well. Simply put if you had a previous injury from years ago it may still be getting irritated and go under the radar without you even noticing.

We often get signs that an injury is on its way. You may feel a tightening or the occasional stabbing pain or tingling. This will then go away only to flare up later on down the track.

Trauma = Force/Load x Repetitions

This simple formula can give you an idea of how trauma comes about. If the force or load is high then it will only take a few repetitions to cause some trauma to the soft tissues. If the force or load is low, say sitting a desk with poor posture or typing on the computer, the repetitions will be high. So over time this injury could be just as bad. It’s like your brake pads in your car. Repetitive braking will cause them to wear down over time. You don't notice this happening until you hear a loud squeak or your brakes fail and it’s time to get them replaced.

Studies and clinic experience have shown that the person most likely to get injured is the person who was injured within the last 6 months. If you have been in pain in the last 6 months and now feel like you are “cured” then it is time to revisit the treatment and have a follow up as you may find that pain is just around the corner. If you are out of pain and you have gone back to doing exactly what you used to do that got you into pain in the first place, it is unrealistic to think that the pain will never come back.

When you have regular treatment your therapist can find and treat issues before they turn into pain. They can also address postural issues that can be contributing and give you advice on exercise and how to limit the stress on your body from daily repetitive tasks like sitting all day.

So there you have it. If you are not in pain then that is great, but it doesn’t mean there isn’t something lurking under the surface waiting to bite you. If you haven't had a treatment in a while it’s time you make a booking and have a check up.

For more info or if you have any comments feel free to email us at info@muscletherapyaustralia.com.au, phone 02 9233 5769 or post comments on our Facebook page at www.facebook/muscletherapyaustralia. You can also book online.

Can you stand up straight? If you've ever been at a bus stop watching people standing and waiting for a bus you would be forgiven for thinking that we've all reverted into apes. Slumped shoudlers, forward heads, one hip pushed out to the side, sound familiar? Well here are some tips on how you can change all of that whilst you wait for that bus to comeor at your stand up desk. With the increase of stand up desks it has never been more important to have good standing posture.

Firstly take stock of how you are currently standing. The ideal posture has your ears, shoulders, hips, knees and ankle bones all in alignment if looking at your posture from the side. Most people wont have this posture ever, even with lots of practice, but it is good to aim high.

How to do this? Stand a little way away from a wall and then back up to the wall so your back touches it. What hits the wall first? Do you feel you back, head and buttocks against the wall? This is the correct alignement. Your head, upper back and buttocks should be against the wall with your feet a few centimetres away. Now try to keep this postrue as you move away from the wall. This is your correct posture. See how long you can hold this until you end up slumped again.

Here's 5 ways you can improve your standing posture right now:

Stand evenly on your feet. The next time you are standing up notice where you are placing the weight in your feet. Is it more on the toes, more on the heels, more on the inside or outside of the foot? After you have noticed this try to place the weight evenly between the balls of your feet, the heels and the outside of the feet. Stand here for a minute or so and then notice again how you are standing. You will probably notice you have reverted back to the old way you were standing. Most postural changes take quite a bit of time to happen. You can't just stand up straight once and expect you will have amazing posture. Use this as an awareness technique whenever you have to stand for a bit of time, like waiting for a bus or standing at the pedestrian crossing.Make sure you are standing on both feet and not shifting more weight onto either leg. Like most postural habits you may find that you always stand with your weight on one leg. This is the best way to cause a pelvic imbalance, one leg appearing shorter (chiros love this) or painful overused hip muscles and fascia. When you put all of your weight on one leg it pushes one hip out to the side putting most of the load onto the ligaments, tendons and fascia as the muscles won't have to work as hard to support the pelvis and spine. You may end up ligament or tendon sprains in the hip. It will be much harder than you think to try to stand with your weight evenly over both legs. Try it the next time you are standing up.Tuck your tail under. When standing up for a period of time generally the core muscles will fatigue (that is if you are using your core muscles in the first place) leading to your lower back extending (duck bum or sticking your bum out) which will overuse the QL muscles and the erector spinae as well as jamming up the lower facet joints of the spine. To correct this you only need to tuck your tailbone under slightly. Don't overdo it, just a couple of centimetres. This will help to engage the “core” muscles and take some load off the lower back. To do this stand with your feet shoulder hip width apart with your weight evenly distributed onto your feet (see step 1). Now notice how your pelvic position is. Do you feel like it is tipping forward, like you are poking your bum out? If so slightly tuck your tail bone under. You should feel the lower back stretch slightly and the lower abdominal muscles kick in. Try to hold this position for a minute. If you drift off or can't hold it then take a break for 30 seconds and try again. You will be surprised at how hard this can be to do something so simple. A tip here is to practice this side on in front of a mirror, that way you can see if your pelvis is tipping forward or not. If your pelvis is tucked under too much then you will need to do the opposite and practice sticking your bum out a little more so that your lower spine isn't too flattened which can lead to spinal disc degeneration.“Shoulders back and down and for goodness sake don't carry the backpack/handbag on one shoulder all the time”. Is that a familiar order you heard growing up. Well it is true. To stand up straight you need to imagine the body like plates being stacked one on top of the other. If a plate is crooked then the next plate on top will continue to move in that way. The shoulders in good alignment will mean the neck and head are aligned. If the shoulders are slumped forward then so will the neck and head.Tuck that chin in. Unless you are listening to funk music your chin should stay reasonably tucked in. This means not poking your head forward as though you are about to peek around a corner. Look around you, most people have this unnatural posture and guess what? Most people have some form of neck or back pain. The thoracic spine plays a big part in this. If your chest is slumped then your neck will be too. Breathing in and arching your thoracic spine back slightly will help a lot. Once you feel like you are able to stand with the weight evenly on your feet and legs, your pelvis tucked under slightly, your knees soft, shoulders back and down, try to tuck the chin in slightly. Don't overdo this. Don't go for the double chin. The amount you need to tuck in varies between people. An easy way to find the right place is to tuck it in until you feel a stretch in the back of the head/neck and then relax slightly from there. Don't relax so much that you return to the old position.

As I mentioned if you stack the plates well from the ground up then the body will naturally find a better posture higher up. If you stand tall in your chest then the neck will naturally find its best posture.

The best way to do all of this is to have a professional assess your posture and also check where your normal is. This will make it much easier to correct on yourself when you are standing waiting for the bus.

As usual if you have any questions or comments hit us up on Facebook, email us or call 02 9233 5769.

Thanks for reading,

Garry

As we enter the new year it’s a great time to think about our health goals for 2016. Setting an intention before setting off on an endeavour is a powerful way of keeping on track. Our health is the most important thing we have so making this top priority is essential to a healthy life. One of the things that has resonated for me is having 3 words to keep in mind. Having 3 simple words gives a focus for your goals and can act as an anchor to bring you back to your goals when you might come unstuck (Easter is only a few months away people :) ).

My 3 words are:

Commit: this means setting goals and sticking to them. Having a training plan and showing up every day.

Endure: trying to push through those extra reps and not slacking off.

Focus: Staying focussed on the goals and outcomes for the year.

Why don't you take a few minutes to have a think of what your goals are for 2016 when it comes to your health? Write these down and put them somewhere you can see them regularly. At work it may be on your monitor. You may want to put them up on the fridge. I have mine in my phone under notes so I can easily go back to them for inspiration.

Some ideas for goals could include:

- Rehab: getting injuries sorted by having regular soft tissue work and sticking at the rehab exercises

- Accept: accepting where you are at any point without judging yourself or criticising which can be detrimental to reaching goals.

- Prioritise: making your health a priority in your life. Work will always be there.

Having goals really sets the intention for 2016 and means there is a higher likelihood that you will achieve everything you set your mind to.

To keep accountable and really stick at reaching your goals why not share with a friend? This way you can both encourage each other to keep on track.

We’d love to hear what your 3 words are for this year. Feel free to email us at info@muscletherapyaustralia.com.au or post them on our Facebook www.facebook.com/muscletherapyaustralia.

Also if you liked this article we’d love it if you’d share it on Facebook, twitter or email to a friend.

Chest stretching

This is an easy one. Find a doorway and you’re off. Bend the elbow to 90 degrees, elbow into the doorway. Turn your body to the opposite side, turning the neck to the same side. Hold for 30 seconds each side.

Hip flexor stretching

The hip flexors are often overlooked when it comes to stretching. If you sit all day then your hip flexors will become shortened and tight, especially if you sit so your knees are higher than your hips. This will use the hip flexors muscles even more and also shorten them more.

Try this one:

Stand up and hold onto your chair. Bend one leg and take hold of the ankle so the knee is bent. Pull the heel towards the buttock. Now pull back more on the ankle so that the knee comes back further than the hips. You should feel this stretch at the front of the hips. Try to tuck the pelvis under to increase the stretch. Stretch both sides and hold for at least 30 seconds increasing to over a minute.

Spinal extension

The best way to do this stretch is over a foam roller. You can also just do this in your chair as a stretch.

Foam roller: Place foam roller across your spine just at the base of the ribs. Place hands behind the head and extend over the foam roller. Stay over the roller for at least 30 seconds, breathing deeply.

Move foam roller a few inches higher. Repeat.

Move foam roller a few inches higher and you guessed it, repeat.

So basically you repeat this 3 times in total.

The point of this stretch is to counter the effects of slumping at the desk.

Chair: Place both hands behind the head and extend backwards with a big deep breath in. Exhale, breathing out squeezing elbows together, bending the head forward and slumping the chest.

This helps to get the spine moving and loosening it up.

The more you counter the effects of sitting at the desk the less likely you will get regular pain.

There are many more stretches you can do to counter these effects. For more info please call on 02 9233 5769 or email at info@muscletherapyaustralia.com.au

High intensity interval training or HIIT is all the rage at the moment. HIIT involves short training sessions that involve short burst of intense exercise followed by a brief period of rest. An example would be 20 seconds of push ups and 10 seconds of rest times eight reps. Then you move on to the next exercise, generally 4 exercises in total.

The question of how good HIIT training hasn't really been tested over a long period of time. More and more people are taking to exercise as a way to keep fit and active so in this case we are having more people who have never really exercised moving straight to a level of exercise that their body may not be ready for.

What is High Intensity Interval Training?

HIIT is a form of training that utilises short bursts of intense exercise followed by very brief rest periods. One of the most common HIIT workout methods is the Tabata training method which uses 8 sets of 20seconds each with a 10 second rest between each rep. You choose 4 exercises and do 1 set of each of these exercises.

The benefits of HIIT

High intensity exercise is great for cardiovascular heart as long as there are no preexisting heart condition which may be contraindicated for HIIT.Increased endurance noticed when applied to other sportsFast weight lossRapid increases in strength and fitness.Makes you feel good afterwards

The dangers of HIIT

When practiced under the guidance of an experience trainer HIIT can give you great results without any injuries.

It is when you are doing high intensity exercise with poor form where you open yourself up to injury. If you can't perform an exercise slowly with good form then you definitely shouldn't be doing them at high speed with intensity.

The choice of exercise here is important. If you have a shoulder injury then you shouldn't be including lots of shoulder exercises to perform with high intensity as the shoulder may become further injured as it wont be able to cope with the many repetitions at speed.

Another issue is that you only exercise in this fashion. It is important to challenge the body in may different ways. This should include a balanced program of mobility, stability, strength and cardio. If you are only ever doing the same thing then this can build up repetitive injuries in the body that can then lead to more serious injuries down the track.

Tips

Build up slowly - introduce just once a week of HIIT for the first month to get your body used to it. Then you can increase to 2 HIIT sessions per week and build up from there.Don't just be sedentary all day and then hit the gym and smash out a hardcore HIIT session and then go straight back to the desk and sit for hours. Warm up!! Do some mobility and stability warmups. Stretch afterwards and warm down if time allows.If you feel any pain then listen to your body and get those niggles looked at before they become more serious.Regular soft tissue work to keep your body performing at its best. High intensity exercise can take a toll on the body so soft tissue work can help iron out all of those knots.Stay hydrated over the day and after. Don't just drink water when at the gymEnsure you are getting enough magnesium and other vitamins and minerals that you can lose through high intensity training. These essential nutrients are required for muscle contraction and soft tissue health.Make sure your diet can sustain this extra load. You may need more carbs when working at a higher intensity so for those on low carb diets you may find HIIT exhausting. Talk to a nutritionist to tailor an eating plan that will suit your needs.

Final thoughts

If you are interested in starting to increase the intensity of your exercise regime then you should definitely enlist the help of a skilled and qualified personal trainer. High intensity exercise exposes you to an increased potential of injury so you want to make sure you get it right.

For more info or to be put in touch with a personal trainer please call us on 02 9233 5679 or email at info@muscletherapyaustralia.com.au. We do a lot of work with personal trainers and can match you to the right one for your needs.

References

http://www.nature.com/nrendo/journal/v11/n11/full/nrendo.2015.171.html

http://www.nrcresearchpress.com/doi/abs/10.1139/apnm-2015-0356#.VkZg5rzBBmE

If you go to the gym and train by yourself only then it may be time to consider bringing on board a personal trainer. Especially if you aren't making any headway with your goals or you feel bored in the gym. A trainer can be the spark that gets you inspired to look after your health.

If you do have a personal trainer then you will know these benefits but it’s worth reading anyway as you will need to be reminded of these after a big workout because you may hate your personal trainer from the pain inflicted.

So there you have it. If you already see a personal trainer then you will know the many benefits of it. If not then it is a serious consideration and investment in your health. Especially if you are overweight or feeling stiff and sore all over from sitting down and being sedentary.

At Muscle Therapy Australia we have a large network of personal trainers over Sydney as they trust us with looking after their body. We would be happy to put you in touch with the right Personal Trainer based on your needs. So please mention it to your practitioner when next in clinic or feel free to shoot us an email at info@muscletherapyaustralia.com.au or call on 02 9233 5769. Make the change today.

There is a lot of focus these days on getting enough exercise and eating well but what about relaxation? We have guidelines as to how much exercise we need, what to eat, how much water to drink etc but there are no guidelines as to how much time we need to spend per day relaxing.

After just coming back from holidays I can really see just how busy our lives are. Taking a break can give you that perspective as when you are in it you get so used to how busy you are that it is easy to think that this is normal.

What happens when we relax?

When you relax your body goes into a parasympathetic nervous system state which is the opposite to the fight or flight response or stress response. The benefits of being in a parasympathetic state include reduced blood pressure, better digestion and decreased stress which can have benefits throughout all of the bodily systems.

If you are in a stress system most of your day then your body will be in fight or flight mode. Even though you may just have to get an important email done or finish some work by a deadline your body will be responding as though you are being chased by a lion. These days we don't usually have to deal with things as stressful as being chased by an animal but unfortunately our body doesn't realise this and responds the same. If we never give our minds and bodies a chance to relax then your system will constantly be taxed.

Is watching TV relaxation?

Unfortunately not, especially if you're watching shows like “the walking dead”. Watching TV or using a laptop are just as stimulating to your brain as working. True relaxation is about giving your senses a rest. The most effective method of relaxation is meditation. Meditation doesn't have to be sitting in a cave wearing robes or burning incense and listening to Enya.

Is drinking relaxation?

As relaxing as having a drink after work can be it can be very taxing on your system. Some people have difficulty sleeping after a few drinks and may wake up through the night, not getting a good nights rest. The processing of alcohol can have many ill health effects such as increasing blood pressure, liver damage and the way you deal with stress.

What is meditation?

Meditation is basically conscious relaxation. What that means is that you are purposefully relaxing your body by concentrating on it. Just like when you exercise you focus on what you are doing trying to maintain a good form. When you are meditating you are focussing on good mental form focussing on your breath or letting go of tension in muscles.

Meditation is too hard!!

If you find meditation hard then you should try a different method. There are many apps these days you can get for your phone that take you through a guided meditation, such as headspace, that will help you to relax without any effort.

You can just pop in the headphones before going to bed and spend a few minutes deeply relaxing which will also help with sleep.

How much relaxation should you get?

Taking some time out in your day even for just a few minutes can change your whole outlook. If you are feeling stressed, even a few minutes of relaxation can help to calm down your mind and nervous system.

There are many different systems of relaxation and meditation. Some can be very intensive and take up hours per day, which is great if you have the time, but for most of us we don't have hours per day to be meditating. This can also put people off meditation.

I recommend people trying just 10-15 minutes per day and if that is too hard then as much time as you can spend. If you have 5 minutes then do that. The thing with meditation, like with exercise, is the regularity no the amount. You could exercise once a week for 2 hours but exercising everyday for 20 minutes would actually be better for your health. So frequency not quantity is important here.

So there you have it. Relaxation is just as important as exercise and diet and should be incorporated into your health regime. If you have any questions then feel free to get in touch at info@muscletherapyaustralia.com.au

As a gift for reading this you can click here or go to this address to download a free guided breath awareness relaxation.

The year is rapidly coming to an end and with it your chance to use up you health fund rebates. A lot of people don't realise that they may have hundred of dollars sitting for them in there health fund waiting to be used. These are your rebates to use freely so you may as well use them as come January 1 2016 they reset and you will lose any outstanding rebates you had available.

The good news for all of those people whose health fund rebates ran out long ago is that they will begin again January 1 and you can claim a portion of your treatment back once again. Yay!

A lot of clients ask what is the best health fund to go with as far as rebates for Remedial Massage. The best at this stage is AHM as they give you a chunk of money to use that you are free to use on anything you want rather than giving you a certain amount back per extras modality like most health funds.

Most health funds reset at the beginning of the calendar year whereas a handful reset with the financial year (just to make it confusing). If your helth fund resets with the financial year then you will have to wait until July 1 2016 for it to reset.

If you have any questions regarding your health fund then best to contact them directly to find out when your's resets and also what benefits you are entitled to.

How often should I get a treatment?

This is a question we get asked all the time and is a logical question when thinking about the nature of your injury or pain. This really depends on the reason you are coming into clinic in the first place.

people who are injured and need more regular treatmentpeople who are seeking maintenance of their injury/painPeople who want a regular session for prevention of injury/pain

Here is what we recommend:

Acute injury

An acute injury is an injury that has just happened such as a strain in the neck when you wake up in the morning from a bad nights sleep. When this injury occurs it recommended to have a few quick sessions back to back that will speed up the recovery process. This is continued until the pain/injury has reduced significantly. Different injuries respond differently to treatment so there is only ever a guide and never set in stone.

Chronic injury

A chronic injury is when a pain or injury has been there for over 3 months. After this time the injury is showing that it needs attention. By treating regularly, once per week, this will help to release the injured tissues and bring about healing. As the pain levels reduce and function returns you can move into a maintenance program.

Maintenance

After an injury the possibility of re-injury are high. Most people who visit our clinic in pain have been injured within the last 6 months so this goes to show how regularly your pain may “flare up”. The reasons for this are varied. You may not have rehabbed the injury properly, it may have not been fixed in the first place or you are re-aggravating it by repetitive actions, poor posture, gym, exercise or lack of exercise.

A monthly session can help to break up the scar tissue that will have reformed after your injury, address any new injuries and work on improving your posture.

Preventative

In an ideal world this is really where everyone should be who comes in for treatment. If we were to have regular treatment sessions then our likelihood of ru-injury will be reduced. We can address any injuries that may be brewing. Just like going to the dentist for a check up or a mechanic for a car service, a regular muscle therapy check up can improve your health and well being immensely.

I Just want a massage

Long hours at the desk, too much exercise, I just want a massage! And why not. You are allowed to just have a treatment. We do recommend a regular session but this may not always work out for each individual. As long as you are having some treatment then you are investing in your health and wellness.

So there you have it depending on you needs there is a treatment plan to suit everyone. The old saying “fail to plan, plan to fail” comes to mind here as having a solid treatment plan, even if that is a regular monthly session, means you have taken control of your regular pain.

Lower back pain is one of the most common reasons people seek treatment. One common cause of lower back pain is strain on the sacroiliac joint or lumbar facet joints. This can be caused by anterior (forward) tilt of the pelvis which can be coming from tightness in the hip flexors. There are many other factors that can cause lower back pain and also anterior tilt of the pelvis but here we will focus on the hip flexors.

These days most people sit all day and this shortens the hip flexors making them chronically tight.

There are quite a few hip flexors muscles the most notable being Iliacus & Psoas (Iliopsoas), Rectus Femoris, Tensor Fascia Latae (TFL), Sartorius and Pectineus.

Here are some easy and not so easy hip flexor stretches that may help you if you have lower back pain. Always consult your therapist first to see that these will be suitable for you. Some back conditions such as Sponylolysthesis may be aggravated by extreme spinal extension which can occur in some of these hip flexor stretches. As always if it hurts don't do it and seek advice.

Hold stretches for up to 1 minute and perfrom on both sides

This stretch can also be performed standing if placing your knee on the ground is painful. Place a cushion or mat under the back knee to protect it.

Make sure to stay upright and keep your pelvis square on. Tuck the pelvis under as per fig 2 (the drawn image). Lunging forward you should feel the stretch in the front of the back leg and also into the front of the hip. If you dont tuck the pelvis under you may strain your lower back and you also wont stretch the hip flexors.

A variation of this stretch involves placing the back leg up onto a bench or chair or against the wall. Always protect the knee on the ground by using a towel or mat.

An easier version involves lying on your side. Make sure to also tuck the bottom leg up to your chest to stabilise the pelvis.

And now for the more adventurous, flexible and pain free here is a more advanced stretch this will really target those hip flexors.

Sit on the heels and then gradually lower yourself onto each elbow. You can hold here if the stretch is strong enough. The next step is to lower your upper back onto the floor and then relax. You can then stretch the arms above the head for a stronger stretch. When beginning hold for around 30 seconds and then move your weight back to the elbows and then gradually push yourself back out of it. As you get better at it you can hold for up to 2 minutes.

To make any impact with stretching you need to do it often. Try to do at least one of these stretches once per day. The reduced tension on you pelvis will mean less back pain.

If you have any questions or comments feel free to email us at info@muscletherapyaustralia.com.au.

We get asked this question all the time. "What is the difference between Remedial massage and other types of massage?" In general it is the level of training that goes into it. Current Remedial massage therapists have to undergo years of training to achieve a Diploma of Remedial Massage. This is a nationwide, government recognised, association accredited qualification. Without the Diploma you can't call yourself a Remedial Massage Therapist. To be a Remedial Massage therapist you also have to be a part of a recognised association that allows you to be able to claim through health funds and have a minimum of $2 million indemnity insurance. The biggest issue these days is the influx of Chinese and Thai massage places that are popping up. We've all seen them and most of us have tried them when we have been desperate. Generally they offer a convenient, cheap general massage that is at best average. The problem is when you have an injury. More often than not these practitioners aren't trained to deal with your issue and also don't have the English skills to understand what is wrong with you, but they will treat it nevertheless. For example if you have a potential disc injury in your lower back and you think that a bit of massage might help loosen it up, then the massage therapist puts a lot of pressure onto your spine and may stretch you in lots of extreme positions, such as in Thai massage, then you may not be walking out of there. Other issues can be the cost. People usually assume that it is cheaper massage. In most cases they charge anywhere from $50- $80 per hour. This isn't a lot cheaper than most remedial massage, especially when you take into account the level of training and quality of the treatment. Also with Remedial you can claim some of your treatment back on your Health fund making the cost almost the same as the untrained massage. One other thing while on the topic of health funds is there are a lot of disreputable places that have one practitioner who is qualified and has health fund status and they use this persons heath fund provider number to run all of the practitioners in the clinic through, even though the others are unqualified. This has recently been investigated by Medibank Private and they have currently put a hold on giving out any new provider numbers. This is penalising all of the new Qualified Remedial massage therapists because there are some unsavoury characters out there who are bringing the industry into disrepute and also providing dangerous treatments with no regard for their clients. You can rest assured that they also wont have indemnity insurance if something were to go wrong. I have often walked past Chineses massage clinics and the person doing a seated massage is texting on their phone, this says a lot for how interested and intune they are with you. The Thai massages I have had from Thai people often include having them talk very loudly on their phone while I am being treated. Unless they are ringing their mentor to ask advice on my massage, which I highly doubt, there should be no fiddling with phones or talking to someone else during a treatment. It shows contempt and disregard for the client who has come to you for help. Another unsavoury issue can be the expectation of "happy endings". When you go in for a massage at some Chinese and Thai places you can sometimes get more than you bargained for. Some of these places are fronts for brothels or sexual massage services. So before visiting a Thai or Chinese massage clinic ask around and get some advice on where might be reputable. The short answer is if you want to take the risk then it is up to you. But if you want a great massage, from a qualified practitioner who can understand your needs and treat your injuries with knowledge and care then you need to go for Remedial Massage.

Shoulder pain is one of the main reasons people come into clinic and can be very debilitating and affect your gym workouts. We treat a lot of clients who go to the gym so we have a solid insight into gym injuries. At worse you may have to stop doing weights completely and let the injury rest. Finding out exactly what is wrong with your shoulder is important in understanding how to best treat it. When this is known you can then know exactly what you can do in the gym without aggravating your pain also improving your form.

These are the most common injuries we see in clinic in order of frequency:

1) Shoulder impingement.

A shoulder impingement is a broad term for shoulder pain that gets worse when you raise your arm generally beyond 90 degrees. Most commonly pain can occur through a painful arc of 90-120 degrees where either the supraspinatus tendon (rotator cuff), joint capsule, bursa, ligament or biceps tendon can get pinched under the acromion (side of the shoulder blade). Generally if you are told you have a shoulder impingement it will be the Supraspinatus tendon.

Causes can include repetitive pushing motions like push ups, bench press, over head press. Often the reason these actions cause pain is due to instability in the shoulder girdle, muscle imbalances (tightness in the pectoralis major and minor pulling the scapula forward, weakness in the stabilises and the rhomboids mid trapezius), winging scapula or poor posture.

Having good form, setting the shoulders and making sure the shoulder doesn't come forward when lifting is important as this forward movement of the shoulder means that the humerus comes into a position where the tendon can get pushed up against the acromion of the shoulder.

Posture sitting at the desk will also contribute to your shoulder impingement as if your shoulders are forward and rounded it means when you lift your arm above your head your humerus will pinch against the acromion. Try this yourself. Slump your shoulders forward and then try to lift your arm above your head, out to the side or out in front. You should notice that you feel a pinching in the shoulder. This is an example of if your shoulders are forward and you are lifting weights above your head you will be constantly pinching the tendons and other soft tissues against the acromion.

Stretching out the chest, focussing on having the shoulders set (back and down) as well as working on shoulder stability exercises will be your best bet in recovering from shoulder impingement and also preventing yourself from getting there in the first place.

As we age the acromion can become hooked which means that the bone will close

2)Rotator cuff tear

A tear in the rotator cuff tendon can cause pain in the shoulder. Generally this pain can be felt in the side/back of the shoulder joint. A tear in the rotator cuff muscles can be caused by trauma such as falls onto the outstretched arm or shoulder. Over use or heavy weights with poor form can also cause a tear. Usually you will feel the shoulder “go” when lifting something heavy. Generally this will be felt as a dull ache in the back/side of the shoulder with pain in movements above the head or any rotation of the shoulder. If a shoulder impingement goes untreated then it can lead to a tear in the supraspinatus tendon.

Improvement of posture, form, stability of the shoulder and releasing tension in the soft tissues can help this injury recover.

3) Long head biceps tendonitis

Pain in the front of the shoulder is often coming from the long head tendon of the biceps brachii muscle. The tendon of the biceps muscle runs up into the bicipital groove of the humerus and into the shoulder joint attaching to the labrum. Repetitive flexion of the elbow in actions such as heavy biceps curls can irritate the biceps tendon. Any pain in the front of the shoulder should be assessed asap as continual training on an inflamed tendon can lead to more lasting permanent damage.

Avoiding heavy bench press, especially going deep, will be key in not aggravating a biceps tendonitis. Deep bench press will but a lot of stress on the biceps tendon. Again having good shoulder stability and not rounding your shoulders is important in not aggravating the biceps tendon.

Other more chronic shoulder injuries

Subacromial Bursitis

Bursae are fluid filled lubricating sacks that live between tendons and bones to protect the tendon from friction. Overuse can lead the bursa to become inflamed. “itis” means inflammation so Bursitis is inflammation of the bursa. There are multiple bursae in the shoulder such as the subacromial bursa, sub deltoid bursa, subcoracoid bursa and subscapularis bursa.

Pain from bursitis can be felt as a dull ache in the shoulder that won't go away. Pain can be felt with overhead movements of the shoulder or internal/external rotation of the shoulder. If you have had pain in the shoulder for a long period of time then this may be bursitis. The most common bursitis in the shoulder is the subacromial bursitis. This lives between the supraspinatus (rotator cuff) tendon and the acromion. When this bursa is inflamed it can also increase the chances of the supraspinatus tendon becoming more inflamed as it will create less space in the shoulder for the tendon the glide.

Usually a scan on the shoulder will show bursitis. Bursitis is also more common in people over the age of 40.

Labral Tear

The Labrum is a cup of cartilage that sits inside the socket of the shoulder (glenoid fossa). It allows a deeper joint for the ball of the humerus to join. The labrum also provides some cushioning to the joint. If you have a fall on your shoulder or on an outstretched arm then you may damage or tear the labrum. Overuse and particularly overhead weights can also damage the labrum.

A labral tear will be experienced as clicking or catching in the shoulder especially lifting the arm up and rotating it.

Note that there is also a labrum in the hip joint that can also be damaged.

As you can see most of these shoulder injuries can present with the same pain symptoms. Injuries such as shoulder impingement are much easier to treat and have better treatment outcomes than something like a shoulder bursitis. Getting the correct diagnosis and treatment is the most important thing in getting better.

Have you ever noticed how people sit on public transport or should I say slump? Some commuters appear as though they don't even have muscles to hold them up as they pour into their seat like liquid.

Whether on the bus, train or ferry you see people every day slouched over their smart phones and tablets. This adds even more stress to the over worked and over stretched muscles and joints of the neck, upper back, lower back and hips.

I have often wondered why we take the approach of holding these devices so far away from the area of the body that we need to view them, the eyes.

There was an episode of the animated TV show Futurama that had Bender the robot character turn into a human. In his robot form he had a zoom feature in his eyes. When converted to being a human he wonders how you zoom. The answer was bring it closer to the eyes. This is our zoom or at least the less painful and problematic zoom. Most people choose to use their neck and upper back to collapse and crane over these devices to get a closer look and to use their phone or tablet. This then places all of those extra stresses on the areas mentioned previously.

So what really happens when you sit slumped over a phone or tablet?

Well, firstly it looks terrible. To a muscle therapist or anyone who works in this industry poor posture is a red flag and it stands out like, well you know.…

It suggests that you have absolutely no awareness or care for the way you hold your body. It is the equivalent of not showering or personal grooming. These also are telling about how you care for your personal self.

From a muscular perspective the front of the neck will tighten up, mainly the sternocleidomastoid muscles (SCM). These are the big tendon like muscles at the side/front of the neck that most people don't realise are muscles. These muscles are notorious for causing headaches via the trigger points around the side of the skull where the muscles attach (Mastoid Process).

The pectoralis muscles will also tighten up as the shoulders and chest are slumped forward.

And the poor old thumbs. Never in history have the thumbs copped such a beating. First it was the space bar, then the good old mobile phone and now the smart phone.

What can you do about it?

There are lots of things you can do to reverse this posture and make it a thing of the past.

The first step is awareness. If you are unaware that you have poor posture then you will never be able to make a change. When travelling on public transport or any time you are using a smart phone or tablet for that matter, check in on how you are sitting and also how you are holding the device. Bring the phone closer to your face so you song have to slouch over it.

Stretching the front of the neck - look down to the floor, place your fingers just under the collar bones

pressing gently into the muscles, hold a downward pressure as you slowly look up to the ceiling stretching out the front of the neck. When you are at full stretch push your chin forward while keeping your mouth closed.

Chin Tucks - I know no one wants to make a double chin but this is one time that a double chin is good for your health.

Standing with your back against a wall so your head is touching the wall at all times. Keep your head looking straight ahead. Place one finger on your chin and then imagine pushing this finger straight backwards.

Try not to let your head leave the wall as the tendancy is to look down and not tuck the chin back as in the picture.

Chest Stretching- This is one stretch everyone should do. In our forward shoulders world we need to spend a little bit of every day stretching backward. Find a doorway, place arms out to the side at shoulder height with the elbows bent and touching the door frame. Now turn your body to the opposite side. You should feel a stretch at the front of the chest and into the arm (pectoralis muscle). Doing one side at a time gives a better stretch but if you are strapped for time then you can do both sides at the same time. Place both arm up and walk through doorway. You should feel both sides stretching at the same time.

How to hold your phone or tablet

If you cross the arm you are not using and then rest the arm you are holding the phone with on the crossed arm you can then relax your phone arm. See the picture below. You can then relax your posture which will mean less strain to the neck and shoulders

So there you have it. No more excuses to slouch on public transport whilst using your phone or tablet. See if you can spot any people like this when you next commute and feel free to pass this blog onto them :)

If you have any questions or comments feel free to post on facebook or info@muscletherapyaustralia.com.au

Your posture tells a lot about you. It reveals part of the story of your life that can't be hidden, it is on display for all to see. Your posture is how you present yourself to the world. Some postural issues are genetic and there isn't very much we can do about it but most of our posture comes from what we do and have done on a daily basis throughout our lives. If you spend the day slumped in front of a computer and then the night slumped in front of the TV it is no stretch to imagine your posture will be well… slumped. Likewise if you stretch regularly, go the gym and live an active life then it is highly likely you will have upright, balanced posture.

If you want to improve your posture (and who doesn’t) then here are 7 ways you can help to improve your posture right now:

1) It sounds basic but sitting up or standing up straight right now is one of the main things you can do to improve your posture. One of the main influencers of your posture is self awareness. If you are aware of how you are standing or sitting then you can understand if it is not perfect and then change it. Try to check in with yourself regularly throughout the day to see what your posture is like and then correct it. Notice your regular tendencies and see how you can change them, treat it like a game and a challenge.

2) Use a foam roller to stretch out your chest and extend your thoracic spine. This will help to counter the effects of a slumped forward posture.

3) Breath deeply and slowly. You can't take full deep breaths if you are sitting slumped in a chair so if you breath in deeply right now you will naturally sit up straighter. You will also be able to notice if this breath is restricted by your collapsed posture.

4) Taking up a strengthening regime to improve your posture is one of the best things you can do. Whether it is Yoga, Pilates or getting a personal trainer working to stretch out the shortened overused areas at the front of the body such as the Pectoralis, Abdominals, Hip flexors and neck flexors as well as strengthening the weak and underused muscles of the back such as the Erector Spinae, Rhomboids, Mid and Lower Trapezius and Latissimus Dorsi.

5) Move regularly. The body wants to move. We evolved by moving and we have a pretty amazing body that can do all kinds of awesome things. Having a sedentary life means that you are going against your nature and invariably end up with a sloppy and weak posture.

6) Did I mention awareness??? You can even as your partner, kids or workmates to let you know when you are slumping. This can be annoying at first but if you turn it into a game and everyone is involved then we call all help everyone have great posture.

7) Regular soft tissue work to release the tightened, adhered and overused tissue can be just the ticket to unravel your slumped posture and release you into your amazing upright posture.

One of our biggest traits being human is our erect, upright posture. To remain human we need to end the slump and stand up straight. Having good posture has many documented health benefits leaving you feeling great and also looking more confident and healthy. Also if we keep slumping we may all end up devolving back into monkeys.

There are really 2 parts to this question. What is Myofascial release as a technique and what is Myofascial release as a theory.

As a theory it is reasonably easy to explain. Myofascial release is basically soft tissue massage that incorporates the muscles and the fascia. Myo is Latin for Muscle and fascia is the tissue that surrounds, entwines and supports the muscles, organs, nerves, bones and also blends to become ligaments and tendons. So by using the term myofascia we are taking into consideration that we are working on more than just the muscle tissueas well as being seen as a more holistic approach to the whole body.

Muscle is made up of collagen and elastin fibres and these fibres run in a particular pattern from origin to insertion (the attachments). Fascia is made up of collagen, elastin fibres and ground substance and generally wraps around the muscle tissue to spread the load and force as well as penetrating the muscle tissue and connecting it to the tendons ligaments, bones and organs. Ground substance has been shown to change its viscosity due to movement and temperature which can make it more flexible meaning it will slide and glide more easily amongst the muscle and fascia tissue. The acid known as Hyaluronic acid has also been shown to lubricate the fascial tissue and help it slide and glide around the muscle tissue. When there is a restriction in the fascia, say pain or “tightness”, myofascial release can help to get this moving again which will in turn release the pain.

As a technique myofascial release is varied from very gentle work do very vigorous and intense work. So when you see that a practitioner does "myofascial release" you may not always be getting what you are expecting. Having a chat with the practitioner beforehand can ensure that if you want a particular type of treatment then you will get it.

There are many approaches to Myofascial release or fascia work. Some of this work may include very gentle manipulations to the tissue such as in Bowen technique or the work of John Barnes where the work is more about the intention than deep releasing pressure. Other more “intense” versions of myofascial release can include Rolfing or fascial manipulation.

Rolfing was one of the original forms of fascia work. Created by Ida Rolf as far back as the 1930’s she had the idea that the body’s posture could be reorganised by releasing the fascia that was then restricting the muscle tissue, casuing pain and dysfunction. The idea with rolfing is that the Ground substance in the fascia can be changed from a hard substance into a more fluid and malleable substance through manipulation of the tissues. Rolfing techniues usually involve deep pressure and movement to release the fascia.

Thomas Myers has been a pioneer in bringing fascia work to the mainstream. His work progressed the Rolfing or Structural Integration idea using research and cadaver studies. In his book and course titled Anatomy Trains he brings together years of Cadaver studies into how the fascia connects throughout the body and especially how the muscles connect to each other. This gives a great model as to how tension or restrictions in one area of the body can be influencing an area further away that may seem irrelevant. By releasing these dysfunctions in the myofascia pain can be eliminated as well as improvements in posture which can then prevent the injuries from recurring.

The Stecco family are also known for their research and study into the fascial network and have developed their own brand of treatment technique called Fascial Manipulation which works to release restrictions in fascia to eliminate pain that may have been held for years by changing the ground substance and promoting the flow of hyaluronic acid in the tissues.

Robert Schleip is also one of the big wigs in fascial research. He is a well know Rolfer and researcher into fascia. His techniques and methodology are more gentle than many and he is also the creator of Fascial fitness which involves exercises to prevent fascial injuries and help "release" the fascia.

The interest in research into fascia has increased over the last 10 years or so with thousands of studies being published every year currently. Also every year the World fascia congress is being held where experts can share their research and knowledge and grow the understanding of this mysterious tissue.

After reading this you may be more confused than when you began as there are many approaches to "fascia work". Basically I wanted to give you the understanding that just because someone says they do Myofascial release it may not be what you are expecting.

In my opinion all massage, soft tissue work and stretching is myofascial release. The reason for this is that you can't isolate tissue when you are treating it or stretching it yourself. You can't say “I am just gong to work on muscles now and not the fascia” or vice versa “ I am just going to work on fascia without the muscles”. In our reductionist world we have tried to isolate our tissues - muscles, fascia, nerves, skin, etc. But the reality is that these are all connected together and have an influence on each other.

With all of the fascia research being undertaken these days muscles and nerves are often being left out of the equation. I feel that we need to keep an open mind to the fact that the body is an extremely complicated organism and our understanding of it is changing all the time. Things we hold dear and believe today can easily change tomorrow. When we cling to beliefs then we are becoming more religious and less scientific in our approach to the body and pain. There is definately a neuromuscular aspect to soft tissue work which can tell the nervous system to release tissues or turn off pain. In the years to come we will hopefully have a better understanding of this connection.

At Muscle Therapy Australia we are well versed in Myofascial release and the fascial system. Garry Luke has been practices the Thomas Myers Anatomy Trains method as well as structural integration methods. Richard Goncalves practices the Stecco Fascial Manipulation model.

By integrating the fascia model we can more effectively treat your pain and dysfunction that may have been affecting your life for many years.

Book now to see how myofascial work can help you.

We love your feedback so please get in touch if you have any questions or comments, thanks for reading.

For more info check out these websites:

- https://www.anatomytrains.com

- http://www.fascialmanipulation.com

- http://www.fasciaresearch.com

This probably seems like a pretty weird blog topic but hey this is something that comes up a lot in clinic and in conversation with people about what we do.

Have you ever called a massage therapist a Masseuse? This may seem perfectly normal and you may also think this is what we are supposed to be called. Well…. think again.

If you haven’t noticed we are not female at Muscle Therapy Australia. Few people seem to realise that the word Masseuse is actually French for Female massage therapist. So the short of it is that Richie and I aren’t female. It is the equivalent of calling us waitresses if we were working in a restaurant. The correct term is Masseur but even that word just sounds creepy and no remedial practitioner wants to be called a masseur either (images of a sandal come to mind). You can call us Muscle therapists or Remedial practitioners and we are happy with that.The term masseuse, even when applied to a female, doesn't really touch on what we do. We call ourselves Muscle Therapists to differentiate from the other “Massage therapists” out there. Those others include Thai massage, Chinese massage, aromatherapy massage, Swedish massage and many other alternative therapists. You have probably noticed that what we do is different and if you haven’t then you should go and have a treatment at one of those aforementioned styles of massage and then you will see just how different we are. Even when compared to remedial massage what we do is vastly different. We are looking to fix your pain and dysfunction and not just give you a nice relaxing rub down. We are highly trained in anatomy, physiology, injury identification, rehab advice as well as treatment techniques that most people have never even heard of such as Active release techniques, dry needling and fascia work - let alone practice. Very few practitioners are as qualified as we are.Credibility. The term masseuse or even massage can have connotations. If you told someone at work you were going for a massage with us they would probably respond with something like “la di da, lucky you, going for a massage, what a luxury”. If you told someone you were going to the dentist or the physio they would never have that response, unless they were a masochist. Next time tell someone you are going to see your muscle therapist to work on your injury and see what they say.

So there you have it. Next time you go to call us a masseuse think again, otherwise we will have to start wearing wigs and dresses and nobody wants that……

What is dry needling and why do I need it?

Dry needling is becoming a more accepted and common treatment modality these days. It can be great at fixing problems that just won't shift. Whether you’ve had this form of treatment before or not getting an idea of how it works makes all the difference in understanding your treatment. Lets take a look at what it’s all about.

What is Dry Needling?

Dry needling uses acupuncture needles inserted into individual muscles and precise soft tissue locations, as opposed to acupuncture points. The aim of dry needling is to target trigger points, fibrotic muscles, and densified fascia thereby getting you out of pain an often moving stubborn painful dysfunctions that have been there for years.

Here at muscle therapy Australia, we use super thin needles and target the precise location to insert the needle. Once the target tissue is contacted, we use a pulsing motion effectively "kneading" out trigger points or tight spots in the muscle tissue. This technique can often cause the muscle to twitch, and the relax. It is a great way reduce muscle pain!

Other effective ways we use to get a fantastic release is to spin or twist the needle, in where as we spin the needle, it wraps the fascia around the needle body effectively giving it the muscle and fascia a stretch. This kind of technique can also give you a very deep referring sensation, but ultimately giving you a great feeling of relieving your symptoms of pain.

What does dry needling do?

There are a few ideas as to what dry needling actually does. One idea is that trigger points don’t get the nutrients required to let go and release. Muscles need nutrients such as calcium and magnesium to contract and relax. It is thought that inserting the needle into this point will create micro traumas to the area and then bring nutrients to the area setting off the body natural healing process.

When a needle is inserted into the trigger point it can make it spasm as this can be the nerve trigger which makes the muscle contract and relax.

The twisting of the needles is thought to stretch or release the muscle and fascia as it wraps around the needle.

Why is it called dry needling?

It is called dry needling as there is no injection so the needle is dry. Sports doctors and some acupuncturists use injections into trigger points, acupuncture points and inflamed tissue and this could technically be called “wet needling”. No one actually uses the term wet needling though, you would generally just say and injection. The term dry needling was used to differentiate the technique from injections.

How is dry needling different to acupuncture?

Dry needling is not acupuncture. Acupuncture is a technique that comes out of Traditional Chinese Medicine and is based on the Chinese Meridian system. Needles are placed into acupuncture points all over the body to undo energy blockages. Dry needling works more on painful and specific spots in the body and the big difference being that the needles are inserted into muscles and fascia and has eveolved more out of a western medical framework. It is mainly the philosophy that is different between dry needling and acupuncture.

What is the history of Dry Needling?

Dry needling has its origin in Acupuncture, were needles have been used to move the flow of energy (or chi) in the body for thousands of years mainly in China. In the west it was not until 1938 that Professor John Kellgren of Manchester university first adapted modern neurophysiology concepts to the ancient technique, observing that by applying sustained pressure on muscles he could identify exquisite tender points and reproduce the patients pain, and ease them by injecting an analgesic (using “wet needles”). As other drugs were trialled over the years it became clear that pain relief was in fact dependent on the stimulation of the needle itself, and not on the substance administered.

One of the first Doctors to employ Dry Needling for pain relief was Dr Karel Lewit of Czechoslovakia in 1979. He reported favourable results on the use of Dry Needles i.e. stimulating trigger points with acupuncture needles in patients with musculoskeletal pain. The use of acupuncture needles is a refinement of the earlier methods which used hypodermic needles. This significantly reduces the risk of haematoma and bruising associated with hollow needles.

Janet Travell (1901 –1997) an American Physician contributed greatly to todays understanding of the type of muscle pain Kellgren and others had investigated. As it is the neural hyperactivity associated with the tender points in both muscle and fascia that triggers off referred pain. Janet Travell called the exquisite tender points “Trigger points”. She also introduced the term Myofascial trigger point (MTrP) (Travell and Simon’s 1999).

Does it hurt?

Generally dry needling doesn't hurt, often you will just feel pressure deep in the tissue. When the needle hits the trigger point in a muscle you can feel a twitch or spasm which can be more of a surprise than being painful. Other sensations you can feel include referral pain. It affects people in different ways. Some people may be sore for a couple of days afterwards and others will feel not pain at all. Some body parts are also more likely to be painful such as the calves. Stretching afterwards can greatly reduce any pain felt. It can be thought of like exercise soreness or DOMS.

Is it safe?

Dry needling is a very safe form of treatment. In qualified and experienced hands, with a solid understanding of anatomy you have no need to worry. If your practitioner is compassionate they will ensure that if you are feeling really uncomfortable that the needles will be removed immediately. In a rare number of cases people with a needle phobia may feel nauseated or feel light headed so in this case it’s best not to use dry needling.

What can Dry Needling help?

Dry needling can help with most soft tissue injuries. Whether is is chronic trigger points or fascial restrictions, muscle tears, tendonitis and also stiffness in joints and soft tissues.

What to expect after Dry Needling?

As with most effective techniques, dry needling may have you feeling a sense of stiffness or soreness in the needled region for a couple of days as the tissue repairs itself.

At Muscle Therapy Australia we use Dry Needling in combination with other therapies such as Active Release Techniques, Fascial Manipulation, Myofascial Release, Trigger Point Therapy and Deep Tissue massage as we find this makes it an even more effective treatment than just dry needling alone, getting you out of pain fast. Soft tissue work and stretching after dry needling can also reduce the amount of time you may feel sore after the needling.

If you have any questions, feedbank or want to book in a session go to www.muscletherapyaustralia.com.au or call 9233 5769

Whats all the buzz about A.R.T? You may have never heard of it or maybe someone you know has mentioned it or has had great results from it. And no it has nothing to do with painting or sculpting. For the lowdown read on.

Active release techniques are very specific soft tissue techniques that use precise pressure and tension created by the practitioner at specific places on the body whilst the client moves to release adhesions and dysfunctions in the soft tissues such as muscle, fascia and ligaments. Sometimes the practitioner may also move your body when the movement is complicated or you find it difficult. You can think of it as a pin and stretch technique but taken to a very specific level.

The beauty of ART is that it can work really quickly at restoring proper function to soft tissues that standard deep tissue massage can’t release.

Active Release Techniques has been developed by a U.S Chiropractor over the last 20 years who realised that repetitive strains within the soft tissues were causing injuries to the tissue and not allowing them to glide past each other smoothly, causing pain and dysfunction.

Within the body the muscles, fascia, nerves and blood vessels need to glide past each other smoothly. When we do repetitive actions or have a trauma such as a tear or a fall we can get injuries to the tissue that can then glue or adhere the tissues together. Adhesions can also occur between the soft tissues and the nerves causing painful nerve entrapments.

ART has some very targeted techniques for releasing these nerve impingements and adhesions in the soft tissues.

ART has quite a presence in the Ironman world especially in the US. Here in Australia it is gaining momentum as the gold standard in soft tissue treatment for its quick, lasting results so the more we spread the word the more people can benefit from it.

Some practitioners say they do it but may have never taken a course so it’s important to know whether the practitioner you are seeing has completed all of the main courses. There are 3 main courses which are Upper Extremity (arms, shoulders, wrist and hand), lower extremity (legs, feet, ankle, hips) and Spine (neck, jaw, head, spine, abdomen).

In the hands of a skilled practitioner that has great palpation skills and sound anatomy knowledge ART can be the difference between getting average results and getting you out of pain for good.

For more info feel free to get in touch and spread the word.

Do you suffer from headaches? Most of us do from time to time whether it’s stress related, not enough water or too much indulgence (alcohol or coffee).

But did you know that headaches can be coming from the soft tissues in your neck, back, head and jaw? These can be in the form of trigger points in the muscles, restrictions or adhesions in the myofascia (muscle and fascia), tightness that irritates the nerves in the scalp and jaw as well as joint irritation in the cervical spine or the jaw.

So before you reach for the panadol or nurofen you should consider having some professional soft tissue treatment that can address these potential causes.

Trigger points in a muscle can be a major cause of your headaches. A trigger point occurs when muscle tissue becomes tight and contracted. It then can become so sensitive that it actually refers pain to another area of the body. If you look at the pictures below you can see the red pattern that is the referral. The x is where the trigger point is and where we will be working as a practitioner.

Common Trigger Points:

Upper Trapezius Muscle - Trigger points casued by hunching at the desk, wearing heavy bags on one side, heavy weights overhead. As well as stress.

Sternocleidomastoid - looking down while working at the desk. As well as stress.

Sub Occipital muscles - Forward head position from sitting at the desk. These muscles are supporing the head.

Occipitalis and Frontalis - Caused by tension in the scalp, long hours concentration at the computer screen. Raising the eyebrows and stress.

Jaw muscles (temporomandibular joint) including: , Masseter, Digastrics, Pterygoid muscles - clenching the teeth, chewing gum, grinding, stress.

Temporalis Lateral Pterygoid

Masseter Digastric

Medial Pterygoids

Do these patterns look familiar? If so it's highly likely you have trigger points. The easiest way to check is to press on the area on these pictures marked with an X. If it is really tender and especially if it refers then you definately need to get it released.

How did I get into this pain?

The most common cause of these trigger points is posture. If you are seated at a desk all day then it is likely your posture will slump at some point. This will make your head poke forward and tilt the head backwards. This overuses the trapezius muscles (extending the head), sub occipitals (extending the head), Sternocleidomastoid (flexes the head and laterally flexes).

Grinding the teeth.

Teeth grinding or jaw clenching can also be a major cause of headaches. The more you clench your jaw the more overused the jaw muscles become and this over use of the muscles can be the cause of trigger points in the masseter, pterygoid and temporalis muscles.

Posture

If you are slouched at the computer all day then you probably don't need to be told it can give you a sore neck or a headache. There are many factors here but posture is one of the major ones. When you slump forward the head tends to poke forward. To do this you need to use the sub occipital muscles, the upper trapezius, the SCM, the Splenius and semispinalis capitis to name a few. By having these muscles working day in day our to support the head you can see how they will become painful. Imagine holding a weight out in front of the body. It wouldn't take long before your arm became sore. This is the same principle in the head also. These muscles are overworked and through this the trigger points develop which then refer pain to other areas in the head.

What can I do?

Having the trigger points released by a professional who knows what they are doing is the first step. They will also be able to give you advice in how to self treat and also how to prevent these trigger points from recurring. This will enable you to take control of your pain and not be a victim of it.

If there are other, more serious factors involved or you are just not responding to the treatment then we have a referral network that means you can get the appropriate treatment. For instance if your headache is jaw related then sending you off to a neuromuscular dentist to assess your jaw will be important.

If you are suffering from migraines and our treatment hasn't been successful then referring you on to get an MRI to look deeper into your brain will be important.

If you are suffering from headaches, jaw pain, migraines, neck pain or ringing ears then getting treatment sooner rather than later is important. You don't have to live in pain.

Feel free to contact us now.

Soft tissue work or massage is an important part of any injury prevention or rehab program. But what you do in between treatment sessions is just as important. This is where you come in. Self massage, just like strengthening and stretching is an important part of your rehab or exercise routine. Whether you are a desk jockey, a runner, a gym junkie or have an injury.

We often get asked what are the best tools for self massage. So here are the tools we use and recommend. If you have any questions about these tools or where to get them then please feel free to contact us. We do stock most of these items in clinic so the next time you are in feel free to try one out or pick one up.

1. Foam rollers

Foam rolling is an important part of your exercise or rehab program. It can be used to stretch out and release hard to get to areas like the ITB, rotator cuff, lats and quads as well as stretching out the chest.

Foam rollers are best used as a pre and post work out tool to prevent injuries and improve your performance, this goes for running too. They can also be used to reverse the hunched over posture we get into from sitting at a desk all day.

We recommend doing your foam rolling at night in front of the TV if you are finding it hard to fit rolling in to your daily routine. For some foam rolling tips click here to download a PDF.

There are lots of foam rollers on the market ranging from El Cheapo soft ones that wouldn't hurt a fly and therefore won't have any impact on your steel rod for an ITB, to deluxe foam rollers that will just stop short of breaking a limb. They come in different lengths so depending on your size and your need will depend on which one to get. If you are looking to just roll out the ITB and Stretch out your back then a short or medium one would be fine. If you want to do chest opening or pilates then the longer ones are what you need. The main key here is that it is really firm so as to get into the muscles and fascia. The shorter ones are also cheaper, easier to store and take places than the longer ones. We stock a small 30cm roller for $23, a medium roller for $30 and the long roller for $40. Another version of the foam roller is the Rumble Roller. It is the 1st picture below. They come in 2 lengths and also 2 firmness levels, pain or more pain. These rollers take the foam roller to the next level by adding ridges that stick out of the roller and can give you more point pressure than a standard roller. They are more expensive than a standard foam roller and are best to order online as we can't get them any cheaper. They cost from around $69 for the short ones and $99 for the long ones. If you are looking to up the ante from the standard roller then this is what you need.

2. Massage Balls

These can be likened to torture devices and in some ways they are. They will torture the pain out of your muscles. Use these guys for self release of Glutes, TFL, posterior rotator cuff, erectors and pretty much any superficial muscle. Ease into using the hard spikey balls as they can cause brusing and pain if you overdo it. Remeber some pain is to be expected. Pain for days afterwards means you've gone too far.

Also you can use any ball that suits from a tennis ball, cricket ball or even a lacross ball. Whatever causes "good" pain is key here. You need to be able to get into the muscles to release them. Bakballs are another massage ball that is just like the good old 2 tennis balls in a sock that you can use to massage up and down the muscles either side of the spine. It can also be used on other areas as a normal massage ball.

We stock both of these items. The massage balls are $10 and the Bak Balls are $40.

3. Theracane

This bizarre looking device is one of the best self massage tools you can get. It is very unique in shape and size so it can get to nearly all the hard to reach places. The major advantage of this tool is that you use your hands so the fine control is there. You can really pin point the problem area. This tool really shines when it comes to the upper trapezius (neck and shoulder) muscles and upper back as no other tool can get downward pressure like the theracane. If you are an office worker who gets aching shoulders then you need ot have one of these, no arguments.

A word of warning with the theracane. It is addictive and with great power comes great responsibility. I recommend not overdoing it when you get one as you can easily hurt your self with this one. If you ease into it you will have years of happy use and less neck, back and general body pain.

We stock genuine Theracanes and sell them for $55, we also ship them Australia wide.

Be careful of cheap imitations with the theracane as there are lots of fakes on ebay. These are usually around $20. So if seems to good to be true then it is. They will break when you apply pressure. We have had people come in to buy the genuine ones after buying the cheap ones.

4. The Stick Roller

There are a few different types of these tools but basically the principle is the same. It is basically a long plastic stick with a handle at each end. The middle then rolls as you move it up and down a muscle. Kind of like a thin rolling pin. These are great for Quads, ITB, Calves, Tibialis Anterior and if you have a friend you trust they can use it on your shoulders and pretty much anywhere. The image to the left is the Tiger roller which is a bit more comfortable on the muscles. The stick roller is the one on the right. They retail from $30. A great tool for keeping those niggles away.

Like the rumble rollers we don't stock these as they actually cost us more to buy than to sell to you for the price on their website. You would be better off buying it online.

Whilst these tools are great they dont replace the treatment of a qualified, experienced professional. You should always use them with caution and ease into how much pressure you use. Pain is not always a good thing so if something is really hurting make sure you contact us to find out if that is normal or not.

Generally we suggest having at least a massage ball, a foam roller and a theracane. If you have each of these then you can definately keep on top of all all your soft tissue issues and also maintain your body if you are exercising regularly.

Please note: We only stock things we use ourselves so you can rest assured that we aren't just trying to sell you things you don't need or that wont work. We also try to keep the prices as low as possible as it is more important to us that you actually have these tools than for us to make lots of money out of you. Often you can get these things cheaper online but once you factor in shipping they will be much more expensive. Also you cannot guarantee the quality. There are a lot of really cheap foam rollers online and they are really bad quality so you are better off buying one from us that is mid range in price but is top quality. We only get our products from top Australian Physio suppliers.

We spend so much time at the office these days that if the environment is stressful on the body, mind and emotions then it will impact on life outside of work and most importantly our health and wellbeing.

A few weeks ago we took a look at sitting and standing all day. This week I wanted to delve into some other facets that make up a healthy work environment.

The cost to the workplace

If a workplace has no wellness programs in place then the likelihood of things like muscle aches and pains, stress, poor diet and nutrition as well as team communication becoming a problem will be much greater.

Effective workplace health and wellbeing programs can:

Increase productivity at work by 29%.Improve overall worker health by 24%.Reduce absence due to sickness.Result in healthier and safer workers.Create a positive work environment and workplace culture.

Sitting or standing?

At the moment there is a real buzz around how bad sitting all day is for us. While this is true it is also true of standing all day.

Sitting has been linked to all kinds of illness and injury including:

muscle aches and pains affecting areas such as the neck, back, shoulder, arm and wrist.reduced metabolismlethargytirednessstressmuscle weakness.

The benefits of sitting include:

less pressure through the hips, knee and ankles.the ability to work for longer without breaksless likelihood of developing varicose veins compared to standing

So standing all day is the solution then?? I hear you ask. Well not necessarily. Standing all day can cause these issues:

Increased foot, ankle, knee and hip pain. Increase risk of varicose veins in the lower leg. Some links to increased heart disease (though this is also linked to sitting and inactivity).Lower back painHeel pain, bone spurs and plantar fasciitis.Bunions or corns. Though bunions aren't caused by standing, standing all day on a bunion will certainly make it worse.Achilles Tendonitis

The benfits of standing all day include:

increased metabolismimproved cardiovascular healthmore alertness and less tirednessreduced neck and shoulder pain

Basically if you do anything all day whether it be sitting, standing, lying down, standing on one leg, balancing on your head or anything else you can think of, it will cause you pain. The research and more importantly common sense says to move often. Get away from the desk. Go for a walk around the office. Get outside at lunch. Go to the gym or go for a walk.

Inactivity

I feel that this is the real heart of the issue. If we are inactive for long periods at a time then our body becomes slow and lazy. This also impact our mental state which in turn affects our emotional state. If we can exercise regularly and move often then the likelihood of serious health issues is reduced.

What can you do?

Posture

The biggest thing you can do to stop the aches and pains is looking after your posture. Sitting up straight at your desk. Having your monitor/s set up so your eye level is at the top of the monitor. Have the keyboard set up so you elbows can be at 90 degrees and your wrists are in a neutral position, neither extended or flexed too much as this can strain your wrists and elbows.

Repetitive strain

Take breaks!! If you do a physical activity over and over again without rest at some point the body will break down. At this breaking point you will then begin to feel pain. Once the pain has set in the body is telling you there is a problem. If you keep working on top of this pain then the problem will continue to get worse until you can't actually work.

Generally we see this in clinic with people who work in offices at the computer. If you are typing all day or using a mouse then it is no stretch to think that you could get wrist, elbow or shoulder pain.

This also goes with posture. If you are sitting slumped at the desk or slumped to one side standing up all day then this is a repetitive load on the body as well. If your head is forward then this increases the weight relative to your neck so your neck needs to work much harder to hold this already large weight up (not saying you have a big head, but all humans do have a large head relative to our neck).

You can also counter this by alternating using the mouse with the other hand. Using a trackpad or trackball instead of a mouse or just generally mixing things up.

These changes are ridiculously simple to make yet we find them so hard to implement.

Diet

In our busy lives it is not always easy to eat nutritious food. If you are busy and especially if you have children it can be hard to have time to prepare food. It is easy to eat toast and sugary cereal for breakfast as well as drinking too much coffee. Then grab takeaway for lunch or dinner. With so much choice around these days it is even harder to take the time to cook food at home or take lunch to work.

A poor diet can make you more likely to be sick which will then impact your health and your work.

Stress

Ok so unless you have been living under a rock for the past few years you would know that stress is one of the major factors in a lot of illnesses. You are probably stressed about the fact that you are stressed. Never fear there are simple things you can do to break the stress circuit and not only extend your life but decrease the risk of serious health issues down the track.

You can think of stress as repetitive strain for the heart, brain and cells.

Meditation/Mindfulness or deep relaxation can be a simple addition to your daily life. You don't have to don robes and go and live in a cave in India to meditate. I like to think of mediation as cleaning your brain or exercise for the mind.

Basically meditation is a focus exercise. It takes the busy, stressed mind and attempts to focus it on one thing. If you can slow down your busy mind for a few minutes a day then this will also induce a state of relaxation. It can decrease your sympathetic nervous system (stress) and increase your parasympathetic nervous system (relaxation).

There are many apps you can get on your phone or cds and downloads available so there has never been a better time to access meditation or relaxation.

Emotions

Emotional stress is really at the heart of issues in the workplace. If you are stressed then it will be hard to manage your emotions.

Emotional stress can manifest in many ways:

moodinessbeing rude to fellow workerspoor communication unwillingness to work in a team

Individually working with a professionial who can help you with your personal issues or team problems will be key here. There are many amazing coaches who can get the work and team environment working like a finely tuned machine, rather than plodding along with the same old problems.

In the work environment we have to work closely with other people. Our actions can play a big part in the wellbeing of our fellow workmates as well as ourselves. If we can make an effort to look after our physical, mental and emotional health within the workplace and outside of it then having a workplace you want to go to everyday will be a reality.

Workplace Programs

At Muscle Therapy Australia we are committed to helping workplaces improve their health and wellbeing. We are excited to be offering offices and companies the opportunity to have us come into the workplace and run a hands on fun presentation that will get you and your work mates thinking about your health and encouraging each other to be accountable.

Issues such as posture, repetitive strain injuries and stress management will be covered. As well as giving every employee the opportunity to come into clinic and have a complimentary discovery session to see what the individuals needs are.

We are also running in office massage services and meditation/deep relaxation. The massage/active release techniques help to improve posture and prevent injuries.

Please contact us for more information on these services.

References:

Anne Rongen, et al., Workplace Health Promotion: A Meta- Analysis of Effectiveness. American Journal of Preventive Medicine, 2013. 44(4): p. 406-415.Conn, V.S., et al., Meta-analysis of workplace physical activity interventions. American Journal of Preventive Medicine, 2009. 37(4): p. 330-339.http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/660/Cost%20of%20Work-related%20injury%20and%20disease.pdf

This week I thought I would share a podcast series that I think is really inspiring. It is titled "Conversations That Shape Us" and is basically a conversation with an inspiring leader, generally in the non-profit or social change sector. These talks are aimed at sharing insights into what it is to be a leader. They are relevant for anyone who has a role that involves working in a team or having the responsibility of leading.

I feel this is relevant as part of our general health and well being, as we spend so much time at work that if our relationships are stressful with our team members then this will play on into our health creating effects such as stress and tension.

The podcast series is created by my wife's company www.leadershipspace.com.au - so it has to be great!

To listen to the podcast on your computer or device click here.

If you use Itunes to listen to podcasts then click here or go to your podcast app or section and search for "conversations that shape us" by leadership space.

If you have ever trained in the gym or exercise a lot, including things like pilates and yoga, then you would be familiar with pain and/or injuries. By acknowledging pain and getting regular treatment you can limit the frequency or likelihood of getting injured in the first place.

We take a look at 10 common reasons you may be getting injured in the gym. This is by no means a definitive list as there are many reasons people become injured.

1. this is a really common issue especially in people who are new to the gym or who are stop/start in their approach. Taking your body from no training to training 7 days a week is a recipe for disaster. The best approach is to ease into it. Train at least 3 times per week with lower intensity training and then build gradually. A personal trainer is a wise investment at these times as this is when you are most likely to injure yourself.

Over enthusiasm + poor form = injury

2. the person who is most likely to injure themselves is the person who has been injured within the last 6 months. If you have had a previous injury then you need to be extra careful at the gym. Tell any personal trainers or gym instructors of your injuries and feel confident to modify your exercise or say no to things that you feel will reinjure you. This is especially important for trainers and instructors to remember.

3. This is one of the biggest reasons people get injured in the gym. They think they are doing the exercise correctly as they have seen it on youtube or in a picture but have no idea of the risks involved in having bad form. This is where having a personal trainer who is qualified can be a major asset in checking that your form is correct so that you're less likely to injure yourself.

Exercises like deadlifts and squats can look easy but there are many nuances that require practice and mastery before you can just lift heavy. We are always shocked at people who say they have great form and then show a video of them lifting and it is anything but good form. Again these are usually the self trained types.

4. When lifting heavy weights, especially over head, deadlifts or in chest press, it can be easy to strain the neck. Another common exercise we see this from is pull ups. Especially if you aren't strong enough to lift your bodyweight or are doing lots of reps. A simple way to combat this is to slightly tuck the chin (keeping the spine neutral) in while you train can mean you avoid putting unnecessary strain on the muscles at the base of your skull and also the front of your neck. Often you can wake up after a heavy gym session with neck pain and headaches that seems unrelated to your training session. This overstraining can be the culprit.

5. if you sit at a desk all day for work then it is highly likely that you have forward shoulders and tight pectoralis major and minor muscles as well as internal shoulder rotators. If you then go into the gym and start doing lots of heavy chest press or over head pressing then you are cooking the recipe for disaster, or a nasty shoulder injury. Stretching you chest, extending or laying over a foam roller as well as strengthening your upper and middle back will help reduce the likelihood of this. And again form is key. If you set your shoulders correctly before you lift and maintain it during the lift then your shoudlers will be less likely to drift forward.

6. When your body is in pain you need to listen to it. Imagine your car starts sputtering as you are driving along. Would you say “I’ll just drive it off” or “if I drive faster it’ll go away”. When it comes to a car we’d take it to the mechanic without hesitation. When it comes to the gym the hardest thing to do is acknowledge pain and rest an area when required.

7. if you always train the same muscle groups or over train them then you are heading towards an over use injury or RSI (repetitive strain injury). The more you use the muscles and connective tissues the more tension and scar tissue can build up in them. The amount of load or repetitions will be the factors that can speed up this process and bring on an injury faster. If you are doing heavy weights for your arms only and lots of them then it is no stretch to think that you may end up giving yourself a shoulder injury. The body's nervous system responds really well to new challenges so mixing up your training is the best way to give your body an overall workout. Sometimes we do the same exercises as this is all we have ever done. Getting a training program can give you more ideas on some variations on exercises or exercising different areas that you may never have worked on. There are tons of different training styles and approaches so if you always stick to one then you may stagnate with your training or become injured.

8. Not acknowledging injuries or pain- injuries can be debilitating and put us out of training for weeks or months at a time. If you train regularly then you have probably had an injury or two. If you know you have wrist pain for instance and you keep doing push ups or front squats and keep putting strain on those ligaments and joints then you can’t expect that these injuries will get any better. In fact most likely you will be making them worse. This little niggling pain can rapidly become an more serious injury. Getting professional advice on your injury and also your training form is crucial.

9. a lot of times we don’t take into account that our body is trying to tell us something in the form of pain. The fact that your knee starts to hurt when doing lunges is a good indicator that there may be an underlying issue going on. By getting some assessment and treatment you are reducing the risk of your pain turning into something more serious.

10. a guy comes into clinic and says “I get these really bad headaches”. I say “ What do you do that brings them on”, he says ‘banging my head against the wall”. I say “ have you thought of not banging your head against the wall?”. “But I love to bang my head against the wall” he replies.

Whilst this example is clearly ridiculous it not far off the reason a lot of gym related injuries don't get better. The injury is not given the rest it requires to heal and the client is continuing to aggravate the injury by continuing a damaging exercise.

So in summary the big takeaways are don't over train the same area and if you start feeling pain then rest that area and stop or modify the exercise that keeps aggravating it until you are recovered. Also getting guidance on how to train properly as our egos can get in the way here.

Getting regular treatment can be a great way of preventing injuries coming on in the first place and also finding and fixing them as they arise.

As always feel free to comment on this article or let us know any other things you think could be contributing to injury in the gym.