Back Pain

Standing Firm - Why it sometimes hurts to stand from sitting?

The sit-to-stand (STS) is a test used to measure lower-limb strength in older people or those with significant weakness (1). 

It is considered an easy, quick and fairly valid measure, which involves measuring the time taken to stand from a seated position a certain number of times, or recording the number of repetitions you can do in a given period (2).

The findings of recent studies suggest performance in this test is influenced not just by factors associated with strength, but also balance and mobility, and a vast array of psychological factors (1).

But what about when sit-to-stand hurts?

Low back pain can reduce spine, hip and pelvic floor motion due to conscious or unconscious guarding associated with pain (3). 

Multiple studies have shown there are changes in how energy is transferred between bone and soft tissue in the spine, pelvis, and legs associated with pain (4).  And that inefficient energy flow or transfer then places more demand from everything.  A cycle of back pain-altered biomechanics can start, creating more back pain. With all the changes in energy transfer and muscle power, everyday activities such as standing up from a sitting position can become difficult.  

Muscle coordination, balance and mobility are affected, and psychological factors start to play in and effect our beliefs and so the cycle continues (1).

Stopping the cycle can be easy. 

You just bypass your traditional route to standing and try something different altogether. 

Try these simple tips.  You may not need all of them:

RELAX before you start

WIDER STANCE - think SUMO wrestler

SLOW DOWN (TIMING) - move more slowly

HANDS ON KNEES

BREATHE OUT - this is a big one.  The less compression in the container of the torso the better. 


Many people are surprised they can suddenly sit-to-stand with no pain after weeks or months experiencing twinges and outright muscle spasms when trying to stand after sitting.  


After a few days of pain free sit-to-stand, you can try heading back to your old ways as there is rarely a “right” way to do something.  You can get up and down any way you choose, each one of them equally valid. 


As a lot of research shows, the way you do something does start to matter. If you always get up and down via your arm on the desk, leaning forward to create momentum, it means the strengths necessary to do it another way are waning. 

Can this help if I have pain elsewhere?


This can also break the cycle if you experience pain in hips, knees and feet.


references


1. J Gerontol A Biol Sci Med Sci. 2002 Aug;57(8):M539-43. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. Lord SR1, Murray SM, Chapman K, Munro B, Tiedemann A.


2. Exp Gerontol. 2018 Oct 2;112:38-43. doi: 10.1016/j.exger.2018.08.006. Epub 2018 Sep 1. The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people. Alcazar J1, Losa-Reyna J2, Rodriguez-Lopez C1, Alfaro-Acha A3, Rodriguez-Mañas L4, Ara I1, García-García FJ5, Alegre LM6. 

3. Explain Pain Supercharged G. Lorimer Moseley and David S.
Butler. Adelaide City West: NOI Group Publishers, 2017. ISBN: 978-0-6480227-0-1

4. Gary L. Shum, PhD, et al. Energy Transfer Across the Lumbosacral and Lower-Extremity Joints in Patients with Low Back Pain During Sit-to-Stand. In Archives of Physical Medicine and Rehabilitation. January 2009. Vol. 90. No. 1. Pp. 127-135.

Is that a knot in my muscle?

Knots.jpg

54 year old Barbara has pain extending across the top of the shoulders, frequently extending into the neck. Is it a muscle? Is it a trapped nerve? Or is there something more complex going on?  Why didn’t it hurt six months ago?

Surely, the muscles are tight?

They may actually be a bit wound up actually, especially with a little bit of stress in your life.  Most of us have experienced a rush of adrenaline in the work place, at home or even crossing the road.  Adrenaline is great; it prepares your body to get moving by increasing your heart rate and your breathing so you can send more oxygen to your muscles.  The free-floating adrenaline also binds to your muscle spindles, increasing the resting tension so your muscles can burst into action. 

Most of the time though, we’re left not bursting into action but taking a deep breath and getting on with not moving.

But is all that tension going to make a knot?

One study specifically found there is no clear evidence of a strong relationship between increased electrical activity of muscles and the development of musculoskeletal disorders (2).  Keep in mind this was one study, and the definition of a musculoskeletal disorder might not include Barbara and her sore muscles across the top of her shoulders.

I can definitely feel a knot in there.

There is zero consensus about what that hard lump in the muscle actually is and ‘knot’ seems like a fairly innocuous word to all those other than knitters and sailors.  And just like knots in the real world, most are amenable to unwinding given the right intervention.

Bio (Body) Psycho (Brain) Social (Environment/Interaction) 

Like many things in the body and pain, the pathophysiological mechanisms remain unclear. We are always more than the sum of our parts and if we look at the risk factors above, you need to find out whether Barbara has stress in the workplace, disappointment in her job, her relationship, whether she has a cold, whether her dog just died and she’s stopped walking, whether her children left her with five grandchildren on the weekend? And then what is her ability to control any or all of these aspects of her professional and personal life?  

See the problem?  This is why a medical history is important, why Osteopaths ask a lot of questions, why we need to spend more than seven minutes with you to grasp how to help you out of pain.  We need to find out what’s tipped you from not even noticing that you’re a bit tight, to not being able to tolerate your shoulder discomfort a moment longer.  

Hopefully, it’s as simple as softening off the muscles, turning a computer to a better angle, taking some micro breaks in the workplace and heading out for a daily walk.

Let’s get back to Barbara...

Step One:

take a slow deep breath

drop your shoulders

release the tension

Step Two: 

get up from your desk occasionally

wave your arms around or run them quickly on the spot for ten seconds

smile at your colleagues and let them know you’re not crazy

Step Three:

Find some daily exercise that you love

Step Four:

Advise your children you can no longer care for all five grandchildren at once for an entire weekend.

References:

Ratey, John J.,Hagerman, Eric. (2008) Spark :the revolutionary new science of exercise and the brain. New York : Little, Brown,

 

Westad C, Westgaard RH, De Luca CJ.   J Physiol. 2003 Oct 15;552(Pt 2):645-56. Motor unit recruitment and derecruitment induced by brief increase in contraction amplitude of the human trapezius muscle.

Morning, I'm Broken!

We all know we feel better physically, emotionally and psychologically if we’ve taken the time to exercise in the morning but how do we reduce the general ache and stiffness that many of us feel before we even get out of bed?

The main thing people consult an osteopath for is pain.  Pain in their low back, between their shoulder blades and in their neck.

But a frequent complaint in practice is people reporting a general feeling of stiffness or ache in all sorts of places when they try to leave their beds of a morning. So while the good news is you aren’t woken with pain in the night, the moans and groans start when you haul yourself out of bed. And it can be enough to wake your partner, or the dog.

Is there any research on this?

There was nothing focused in the literature about whether stiffness improves with exercise, and certainly nothing as specific as morning stiffness. Although this may be because no one asked the question in an original study (i.e. it wasn’t set as a specific outcome for the population being studied).      

An educated guess…

Waking with stiffness would be due mostly to your body trying to adapt to new behaviours or resting postures you’d get out of given the chance if you were awake.

Examples of the types of things that might cause stiffness in your neck:

Stomach sleeping

Bingeing on Netflix in bed with a laptop

Long long hours at a computer

Long drives on straight roads

 

Examples of the types of things that might cause stiffness in your low back:

See above

 

Examples of the types of things that might cause stiffness in your feet and achilles:

Standing for long periods (cooking, ironing, gallery walking)

New exercises or an increase to new exercises (skipping, golfing, new shoes)

Or just good old DOMS the day or two after a workout at the gym

What exactly will you be mobilising? 

There is no exactly about it….you’ll be mobilising nerves, muscles, tubes, connective tissue, all manner of fluids including sparking up your brain juices.

A word of caution in the mornings.

Your nervous system is a bit protective of itself when we first wake up, as anyone who has ever done yoga before 6am will attest. That burning tightness behind your knees is not your hamstrings it’s actually your sciatic nerve letting you know it does not appreciate being pulled quite so aggressively before the sun has even risen.

Give it a fortnight.

It might take a while to tell if your body is going to love a new regime but in the meantime you can reward your mornings with these mobilisations:

 

ACHILLES and FEET stiff when you stand on them in the mornings? 

Prancing with straight legs

Heel to toe

Holding onto the door frame squat

 

If your low back stiff in the mornings?

Try this series of movements: 

LB twist 

 

Knees to chest

 

Cat/Camel

Child Pose with Lateral Flexion 

 

 

UPPER BACK and NECK stiffness in the mornings?

Sidelying bow and arrow

Neck slider/shoulder shrugs

 

 

 

All our mobilisations will be available on our BLOG this month. 

So make yourself a morning routine that suits you.

Share these tips and tricks to put some spring in someone else’s step this August.  

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Get Your Body Moving - 30 mobilisations for everybody

 

Let’s be honest people. We can’t always be as active as we want.

We find it inconvenient and at times impossible to answer the call for natural movement*. It’s hard to run across the grassy plains when we’ve only got a concrete path or it takes a two-hour train ride to get to a wilderness trek up the side of a mountain. And we have to be dedicated in searching out opportunities to squat, throw something, wrestle, dance, run, leap, climb or hang upside down off a branch.  

We need to do these things, but when we can’t, you can offer something else to your beautiful body. Something to nourish, so it can flourish! And so comes the concept of 30 ideas to mobilise your body.

WHAT THE HECK ARE MOBILISATIONS?

Mobilisations are like dynamic stretching.  They sit somewhere in between rehab and lifting weights. It’s difficult to get any specific research to support this kind of movement but we can draw some conclusions based on evidence supporting early movement after surgery for hip and knee replacement (1) daily movement for acute low back pain rather than bed rest (2) safe movement following a car accident instead of a neck brace (3) and a long history of committed movement in multiple cultures (tai chi, qi gong, ceremonial dancing, prayer and worship).

We might even want to throw it out there that mobilisations might be useful for:

  • pain relief
  • early healing
  • micro breaks
  • preventing pain
  • preventing injury (I said maybe!!)

 

the dip in the couch

We can get attached to not moving. You know the feeling when you’ve succumbed to the dip in the couch or you’ve shaped your body to the back of your ‘ergonomic’ chair. Our bodies sometimes try to get us to move out of desperation before the thinking part of our brain even gets a say.  We crack our neck, stretch our back over the back of the chair or twist forcefully to one side. Take charge of your runaway body and acknowledge that alarm bell for what it is. 

Convert that animal instinct into something to nourish your cells in all your tissues, including your brain. Pump and stretch those clumping cells and provide them with the nutrition they need via blood supply using the mechanics of your own body.  Help juice up your joints, tendons, skin, brain cells, muscles, nerves, ligaments, organs and move those tubes that string them all together.

 

we've put together 30 great ideas to inspire the modern human to combat physical stagnation.

The rules to follow:

  • easy and painless
  • lots of repetitions (i can do it i can do it i can do a little bit more) 25-75 repetitions (1-3) sets/day
  • joyful, fun, no protocol, no commitment beyond maybe a few days
  • if you’ve tried to make it easier and it still feels bad (or pointless) then STOP

INSTA VIDEO SERIES

SEATED ROTATIONS

hip and back tightness/pain, neck stiffness, excessive sitting

STIR THE POT

neck stiffness/pain, upper back pain, shoulder pain

FOREARM MOBILISATIONS

arm and shoulder tightness and pain, desk worker

SIDE RAINBOW

side stiffness, hip and back tightness, shoulder pain

HIP RELEASE - KATY BOWMAN STYLE

hip and buttock tightness/pain

STANDING ROTATIONS

stiffness everywhere, excessive sitting

SEATED GLUTE STRETCH

hip pain , low back pain , improve hip mobility 

CHEST OPENING AND CLOSING

upper back, chest and shoulder tension

ALPHABET EXERCISE  - ARM SWINGS 

thoracic and shoulder tension, low back too

BEAR HUGS

more dynamic than chest openings, more arm wrap around, good for shoulder and upper back tension

ASSISTED SQUATS

low back, hips, knees and ankles

ANKLE TWIRLS

stiff ankles, fluid congestion, motion is lotion

CAT AND CAMEL

good for spinal mobility, ask practitioner if this is right for you

THREAD THE NEEDLE

thoracic and shoulder mobility, low back stiffness

THREAD THE NEEDLE (V.2)

thoracic and shoulder tightness, standing at the desk version 

CATH A BUTTERFLY

shoulder, hand, forearm and elbow

HIP DROPS

low back hips and pelvis

LOWER LIMB AND GLUTES

glutes, hips, hamstrings and calf

WAG THE DOG

lower back, hips and pelvis

LEG SWINGS

hip stiffness, low back, balance, positional awareness

DO THE SWIM

shoulders, upper back and neck

LEG SWING V.2

hips and low back 

THE LAWNMOWER

Upper back, lower back and shoulders

NECK MOBILISATION

write out no. 1-10 with your nose, for general neck stiffness

SHOULDER SWINGS

good for stiff shoulders - who would have thought!?

BOW AND ARROW STANDING 

shoulders, upper back and chest

FOOT AND ANKLE MOBILISATION

foot and ankle mobility

CHEST OPENINGS

chest, shoulders and upper back 

THE SHOVEL

general back and shoulder  - better without a real shovel!

DISCO TIME 

looking good ladies - dance your way to better movement!

THAT'S 30! PHEW!

References

(1) Guerra, Mark L., Parminder J. Singh, and Nicholas F. Taylor. "Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review." Clinical rehabilitation 29.9 (2015): 844-854.

(2) Hagen, Kåre B., et al. "The Cochrane review of bed rest for acute low back pain and sciatica." Spine 25.22 (2000): 2932-2939.

(3) Teasell, Robert W., et al. "A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): Part 2–interventions for acute WAD." Pain Research and Management 15.5 (2010): 295-304.

(4) Chan, Roxane Raffin, and Janet L. Larson. "Meditation interventions for chronic disease populations: a systematic review." Journal of Holistic Nursing 33.4 (2015): 351-365.

 

thank you for your inspiration:

How to do Joint mobility drills - Todd Hargrove

Mobilize! Dynamic joint mobility drills are an alternative to stretching - Paul Ingraham

Therapeutic Stretching - Eyal Lederman

Nutritious Movement - Katy Bowman

Daniel Wolpert - TED talk

 

 

There are devoted proponents for natural movement who have wonderful websites. Check them out: 

Mark Sisson, Katy Bowman, Phillip Beach

Sitting at the desk can be a real pain in the %$*&

It's one of the most common questions we get in the clinic - what is the best sitting posture?

To be honest, it would be ideal if we didn't sit as much of the day as we do, but given the society we live in it's going to be a while before we all get to go primal.  

We have all had a think about it and the overwhelming advice we give revolves around optimal sitting postures and reducing the amount of time you sit altogether.

So what can you do?

We all need to become big softies. Softening your neck, shoulders and upper back will go a long way to reducing pain and dysfunction around that area. 

Start by dropping those shoulders. 

Whether you sit, stand or kneel you're still going to get a sore neck and shoulders if those upper back, neck and shoulder muscles are working hard for hours on end. They have to work hard any time you have your arms out in front of you for long periods of time. For instance, when you are tapping at the keyboard, driving the car, crocheting, and then throw in the added tension that stress creates. A neat trick that seems to help is to tuck your elbows to your sides, this lets the shoulders relax a little more and keeps you mindful. Always try and rest the weight of your forearms on the desk or chair if you are sitting. 

Some other good ideas to help you soften through your upper back neck and shoulders include:

1) Breathe and Release - most people find it easier to drop the shoulders, soften and release on an exhale.

2) Driving - hold the wheel on the two lower quarters and let your shoulders rest when you are in a more relaxed stage of a drive. 

3) A Trigger - find a trigger during the work day to consciously soften through the trapezius and drop the shoulders, e.g. hanging up a phone call, sending an email, etc. 

I'm sure you've noticed the recurring theme is 'letting the shoulders drop'. 

If you are quite conscious of this over a period of three weeks, there is a sense of 'retraining' your brain to release your shoulders and neck tension automatically.

There are definitely more optimal sitting posture than others.

We have included some photos of the good, the bad and the plain ugly. Some sitting positions are extremely sloth-like but extremely comfortable, and that's ok. But always remember the more comfortable you are in the position the longer you can hold it - and that can be the problem. 

The thing about maintaining good "posture" or sitting more upright is that the "better" your posture the more energy intensive and the harder it is to hold so then you move away from that position - therefore it’s better for you. Moving more is better for you - it is that simple.

Other simple tricks for the desk jockey:

1. Stand to talk on the phone wherever possible

2. Look out the window at something small and distant (like a bird in the tree) - this is good for your eyes.

3. Have walking meetings outside wherever possible. Who said a meeting had to be sitting down?

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The Massage (Lacrosse) Ball - Best $8 You Ever Spent

massageball.jpg

I love these little balls.  They’re cheap and they travel well.  Recently, I had a client who took one on a bus tour to the Czech Republic.  She took it to combat her mid back tightness and by the end of the trip all her travelling companions were impressed with it’s effectiveness.

Most people use it for ongoing tightness or a deep aching discomfort.  They rarely like using it for acutely tender, sharp pain and I would not recommend using it for that kind of pain. 

People often describe tightness building up over time, weeks or months that has rather suddenly turned into pain, like it has reached some kind of tipping point of tolerance and there is no turning back - not without a beach holiday, some meditation or some hands on therapy. Bring on the ball. 

But how does it work?  It has a local tissue effect due to the compress and decompress movement and also a nervous effect due to the DNIC approach that Todd Hargrove, a Feldenkrais practitioner from the US, writes about eloquently in this BLOG post from a couple of years ago.  Using a massage ball is essentially the same approach:

http://www.bettermovement.org/2013/how-does-foam-rolling-work/

My disclaimers about it’s use are simple: 

Use it for a maximum of 90 seconds in one location - nothing much changes after that and you’ll more likely cause injury.

Compress and decompress - that way you’re having a local tissue effect (squeezing and releasing the muscles) and you’re less likely to cause an injury.

Use it only every second day.  That way you won’t build up a tolerance to the hard little sucker and start bruising yourself.  

I recommend it for the big muscles down either side of the spine, the gluteal (buttock) region and the trapezius muscles.  

Here is a little demonstration video we put together to help you get started.


Michael Clarke's Back

Anyone who was watching the cricket yesterday would have seen the incident that led to Michael Clarke leaving the field with severe back pain. For the uninitiated Michael Clarke is the captain of the Australian Cricket team. The last week or so may have been, quite probably, the most traumatic and stressful period of his life so far. Recently there was the tragic injury, while batting, and subsequent death of Australian cricketer Philip Hughes. Phil Hughes happened to be a very close friend of Michael Clarke. A sad event all round and our condolences go to family, friends and the cricketing community at large.

I won't presume through this Blog to know exactly what is happening with Michael Clarke's lower back. I've heard it all from the commentators and journalists - disc degeneration, disc prolapses, sprained sacroiliac joints, pars interarticularis fracture - and the list goes on. No doubt he has a team of specialists giving their two cents on what is wrong and what he can do about it. What interests me is how such an innocuous incident could lead to a flare up of a pre-existing complaint.

The previous week Phil Hughes was felled by a bouncer while batting for NSW. Without going into detail it was a tragic and unfortunate accident that ultimately ended his life. Yesterday, while facing up to the Indian pace attack in the first Test Match of the summer Michael Clarke was travelling along quite well. He has recently altered his batting technique to take pressure off his "niggly" low back and hamstrings and it seemed to be working well. The Indian bowler at the time bowled a bouncer at Michael Clarke (which was a pretty ordinary ball putting the batsman under little pressure at all) to which he flinched to instinctively get out of the way. Wham-Oh! His back went into spasm and he was unable to continue.

Michael Clarke was under pressure - emotionally and physically. He was carrying a "niggly" lower back and hamstring problem. Suddenly a bouncer comes at him at 140km/hr and his brain says "ALERT, ALERT!" There is a reflex tensioning of the body and the messages from the brain to the lower back were greatly exaggerated. Here is a perfect storm for aggravating a pre-existing problem. Stress, anxiety and physical duress can all impact on the DANGER signals to the brain and the way the brain interprets that danger. It is quite likely Michael Clarke has not done any further "damage" to his lower back, and honestly I hope he is not being told how "damaged" his lower back is as it does not directly equate to a persons pain experience one iota.

Michael Clarke is an impressive captain to bravely go out and face that red ball under such stress and I'm sure will bounce back and hopefully be better for it. In fact, I think he just got a century.