Category Archives: Reducing Pain

BACK PAIN AND SPORTS – Biking

Picture1111Bicycling
Bicycling mainly strengthens the muscles of your legs which is important as it takes the strain off your back when getting in and out of chairs and when lifting. It does not do much for the muscles around your spine but if you try to keep your tummy muscles tense and your back in the correct alignment then you will be teaching the muscles to stabilise your spine as you bike. Mountain biking on uneven surfaces can cause jarring and sudden compressions (squeezing) on the spine.
Tips to help make bicycling easier on your back include:.
• Select the best bicycle for your purpose. For casual bike riders, a mountain bike with higher, straight handle bars (allow more upright posture), and bigger tires (more shock absorption) may be a better option than a racing style bicycle
• Adjust the bicycle properly to fit one’s body. If possible, this is best achieved with the assistance of an experienced professional at a bicycle shop
• Use proper form when biking; distribute some weight to the arms and keep the chest up; shift positions periodically
• Periodically gently lifting and lowering the head to loosen the neck and avoid neck strain
• Discuss and review your pedaling technique with your physiotherapist or other knowledgeable professional in order to get the most out of the exercise
• Use shock absorbing bike accessories including seats and seat covers, handlebar covers, gloves, and shock absorbers on the front forks (front shocks or full suspension shocks depending on the type of riding you plan to do and the terrain)
• The muscles that bring your leg up toward your abdomen are called flexors. They are used a lot when you ride a bicycle. Keeping these muscles stretched out is important because it will help keep the proper balance in the muscles around your spine and hips.

PILLOWS – WHATS RIGHT FOR YOU

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In the past pillows were made of feathers, foam rubber, foam chips or dacron. Nowadays there are many different types of pillows such as memory foam, contour pillows, buckwheat and orthopaedic style pillows.

Unfortunately no one pillow suits everyone. The pillow that you find the most comfortable and that allows you to wake up in the morning with no neck pain, stiffness or headaches is the right one for you. If you have a number of different pillows in the house, it is a good idea to try them out before purchasing another pillow.

A good pillow should support your head and neck so that it is maintained in a neutral position while you sleep. The pillow or pillows need to accommodate the position in which you sleep as well as your body shape so that your neck is supported as well as your head.
Foam rubber, foam chips and sometimes dacron pillows have a recoil factor which causes the muscles in the neck to maintain some activity through the night and this may lead to an uncomfortable nights sleep.
Children don’t require a pillow until their shoulder width increases beyond the width of their head when a thin pillow would suit.

SLEEPING ON YOUR BACK
In most cases you will only need one pillow when lying on your back. It should support your neck as well as your head and keep you head in neutral with your face horizontal. For example the shape of a contour pillow is such that the head is in the “gutter” of the pillow and the neck is supported on the higher contour as in the photo. If you have a “mouldable” pillow such as a feather pillow you can bunch the pillow up under your neck and pull the corners of the pillow around the sides of your neck for further support.Picture16

 

 

 

 

 

 

 

As you get older, you may become more rounded in your spine and therefore require two pillows under your head to keep you spine in neutral.

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As you can see from this diagramme the “C” curve in the upper back is bigger in the person on the right, the head is further forward and so two pillows are needed to support the head and neck in the neutral position.

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If you feel pain or a strain in your lower back when sleeping on your back you should put a pillow under your knees as in the diagramme above.

SLEEPING ON YOUR SIDE
Most people like to sleep on their side. In this case the pillow should fill in the space between the mattress and your head and neck. If you have wide shoulders you will need at least two pillows depending on your shoulders and the size of the pillow. Once again it is important that your head and neck are in correct alignment when sleeping on your side.Picture19

 

 

 

 

 

 

 

If the pillow is too high or too low as in diagrammes 2 and 3 above, the neck soft tissues and joints will be placed in a position of stress for the whole night and you could well wake with a sore neck
These pictures show the correct alignment of the head and neck but don’t show the neck being supported as in the picture below where the person is using a contour pillow. Contour pillows don’t suit everyone; it is a matter of what feels comfortable. Other types of pillows can be bunched up to support the head and neck. Remember that if you have wide shoulders you will probably need two pillows.Picture17

 

 

 

 

If you have low back pain when sleeping on your side you can try to put a pillow between your knees as in the diagramme below.Picture12

 

 

 

 

SLEEPING ON YOUR TUMMY

This is not recommended as your neck is placed in a position of rotation at the end of the range of movement for the whole night. This compresses one side of the neck and stretches the other side which over time could give you a painful neck and/or headaches.

 

 

HOW TO CHOOSE A MATTRESS AND SLEEPING POSITIONS

MATTRESSES

Unfortunately there is no “ one size fits all” when it comes to choosing a mattress which will help you sleep better at night and to wake in the morning feeling refreshed and limber. When choosing a mattress, personal preference is an important factor and you should spend some time lying on the mattress in the shop to see if it still feels comfortable after, say, fifteen minutes.
There are some guidelines for what constitutes a good mattress
· Most people prefer a firmer mattress but if it is too firm for your body weight it will cause pressure points over your hips and shoulders if you sleep on your side. This can be a problem especially if you have trochanteric bursitis, gluteal tendonopathy or a shoulder problem . A good mattress should support your body so that when you are lying on your side your spine is horizontal and the normal postural curves of your back are maintained. See photo below. Your waist should not sag into the mattress, the mattress should support your waist. If you have a small waist and big hips you may need extra support under your waist such as a rolled towel or small cushion

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If the mattress is too hard the hips and shoulders will not sink into the mattress and the waist will sag down as in the photo below which shows a person lying on a hard floor ( simulating a hard mattress) with no pillow which is the extreme hard mattress situation.

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If you sleep on your back a good mattress should allow your bottom and shoulders sink into it so that your back is supported.

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Once again look what happens when the mattress is too hard ( the floor for purposes of this explanation). See photos below. The lower back is not supported in either of these scenarios

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Although a firmer mattress will give you more support it is not absolutely necessary as there are no major external forces at work while you are sleeping. If you wake up in the morning with a stiff and painful back ( having gone to bed with no significant back pain) then you do need to think about changing your mattress. Otherwise comfort is the main factor.
GENERAL SLEEPING GUIDELINES

There are no hard and fast rules when it comes to which position to sleep in except that it has to be comfortable for you. However here are a few pointers for those people with back, hip or shoulder problems
Osteoarthritis/spondylosis/degeneration of the low back/spinal stenosis. In general these types of low back problems are present in the older generation and these backs like to be held in a slightly flexed position. Try, either, on your side with the knees bent up in the foetal position or on your back with a couple of pillows ( or more) under the knees. A pillow under the waist and a couple of pillows between the knees may also help.
Lumbar disc problem
If you have a lumbar disc problem it is usually better to sleep on your stomach. However this is not always the case and comfort should be the guideline. It depends on the direction of the disc problem. Even if lying on your stomach makes your back more painful but relieves your leg pain then it is a good position. This is something you need to discuss with your physiotherapist.
Shoulder problems
Lying on your back: You may find it more comfortable to have a pillow under your arm
Lying on your side.
· If you are lying on your “good” shoulder you may find that having 1-2 pillows under your upper arm will relieve the pain in your sore shoulder
· If you are lying on your sore shoulder you can take the pressure off the shoulder by having two pillows under your neck and one pillow under your ribs with your shoulder in the hollow in between the pillows. Try to keep the sore shoulder directly underneath the top shoulder.
Hip problems
If you have a painful hip due to a strain or arthritis you will probably find it easier to sleep on your side with one to two pillow between your knees or on your back with one to two pillows under your knees
If you have an inflamed bursa on the side of your hip (trochanteric bursitis/gluteal tendonopathy) then a firm mattress will be uncomfortable and you may need an “eggshell” topper pad as well as a couple of pillows between your knees for when you are sleeping on your side

 

 

 

 

ICE OR HEAT

HEAT OR COLD/ICE THERAPY
WHICH TO USE
In general use heat for old injuries and ice for acute or new injuries.
HEAT THERAPY
Old or recurring injuries usually do better with heat. The heat causes the blood vessels to dilate and bring more blood the area. The blood in turn brings more nutrients and oxygen to the area helping to relax muscles and reduce pain in the joints. The heat will also make the joints and muscles more flexible and so you will be able to move more easily.
Tips for using heat therapy
• The heat should be warm not hot
• The heating pad/ wheatbag/hottie or whatever the source of heat is, should not be applied directly to the skin. Put a towel in between the skin and the source of the heat
• Use the heat for up to 20 minutes unless otherwise suggested by your therapist or doctor
• Don’t use heat where there is swelling. Use ice first.
• Don’t use heat if you have poor circulation or diabetes
• Don’t use heat over an area where you have reduced sensation
• Don’t lie down on a heat source. You could fall asleep and burn yourself
• Dont use heat on an open wound or stitches
COLD THERAPY/ICE
Cold therapy causes the blood vessels to constrict thereby slowing down the blood to the area , reducing or restriction the inflammation and helping to reduce the pain. It should be used with a new injury where there is increased swelling, bruising and pain.
Cold therapy is applied as an ice or gel pack. An ice pack can be bought from the chemist and kept in the freezer so that it is instantly useable when you need it. You can also make an ice pack up by folding some ice cubes in a wet tea towel and then crushing the cubes with a heavy object. A bag of frozen peas can also be used as a ice pack.
Tips for using an ice pack
• Put a moist towel in between the ice pack and the skin
• Leave the ice pack on for 15-20 minutes, ideally every 3-4 hours over the first 3 days. When you take the ice pack off the skin should be pink. It should not have gone white – if this is the case you may have given yourself an ice burn. It is a good idea to check the skin while you have the ice pack on.
• Try to make sure that the ice pack has molded to the shape of the area being treated
• Don’t use an ice pack if you have areas of loss of skin sensation
• Remember RICE for management of acute injuries

Rest (minimize movement of the injured body part)

Ice (apply a cold pack)

Compression (light pressure wrap to the affected body part can help minimize leakage of blood and swelling)

Elevation (raise the body part up so that the pressure from the blood and tissue swelling the affected area is reduced as the fluids drain from the area by gravity)
ARTHRITIS – HEAT OR COLD?
When you have joint inflammation from arthritis you should use ice. However remember that ice does cause stiffness so if you suffer from morning stiffness of your arthritic joints you may want to try heat in the morning and ice later on if your joints become inflamed and painful from over use.

 

 

HEADACHES AND NECK PAIN

NECK FACTS

Neck pain
Picture71This is largely due to overstressing  (see example of mechanical stress in picture below) of the various structures in the neck i.e. the discs, joints and nerves. This pain may be a deep aching pain or a burning pain and may be felt in the neck, head, arms or thoracic area. Other symptoms you may experience along with neck pain are numbness, pins and needles and weakness. Less common symptoms are nausea, dizzyness ringing in the ears and visual disturbances.
Headaches
One of the most common causes of headaches is the overstressing of the upper joints of the neck, just below the skull. This is often the result of whiplash injury or prolonged poor posture.

If the pain is felt in the arms or you are experiencing symptoms of dizzyness, nausea, visual symptoms or ringing in the ears, it is a sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.

EXAMPLE OF MECHANICAL STRESSPicture1

Hold your index finger back until you feel the strain and then hold it there for a few minutes. It will soon start feeling sore not only around the joint but the pain will spread further afield. Imagine if you did that to your neck when sitting in a slouched position for a long period of time.

 

 

GETTING TO KNOW YOUR SPINE

Your spine is composed of 24 bones called vertebra, which are separated in front by a shock absorber called an intervertebral disc and at the back by the facet joints. Through a hole in each vertebra runs the spinal cord, sprouting nerves which lead to other parts of the body. The spine has five sections; the cervical spine or neck, the thoracic spine, the lumbar spine, the sacrum, and the tailbone or coccyx. (see fig 3).

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THE VERTEBRAE (see Fig 2.)

The vertebra are building blocks, they house and protect your spinal cord. You can feel them if you run your fingers up the middle of your back. Your vertebrae may be responsible for neck pain when:one is fractured due to the application of strong enough forces.e.g. diving into a shallow pool and hitting the head.

Physical stress over a long period of time causes the shape of your vertebrae to change (poor posture).Also certain diseases weaken them e.g.Osteoporosis.

THE INTERVERTEBRAL DISC(see Fig 4&5).

The disc sits between two vertebrae. It has a jelly like centre which acts as a shock absorber as well as allowing movements of the spine.

Injury to a disc can occur with:Picture3

  • Abnormal forces being applied to the disc causing it to tear or rupture e.g. bending forward and twisting.
  • Wear and tear or injury to your disc, causing the supporting ligaments to weaken leaving the jelly like centre to create a bulge in the disc.

HERNIATED OR RUPTURED DISC.

If the bulge in the disc is big enough it can put pressure on adjacent sensitive structures causing pain and other symptoms e.g. numbness and pins and needles. Disc pain is commonly felt in the neck alone, down into the shoulder blades, down the arm or as a headache.
THE NERVES
The nerves leave the spinal cord though holes between the vertebrae. These nerves can be pinched by a herniated disc, inflamed facet joints or bone spurs.
Injury to a nerve may give rise to a burning pain, pins and needles, numbness or weakness in the head, neck, arms and chest. Coldness or heaviness may also be experienced.

 THE MUSCLES

neck 1

The neck is surrounded by muscles which either serve to move the neck, or to support and stabilise the neck. As a result or poor posture, injury or bad habits an imbalance between these muscle groups may occur. One muscle group becomes strong while the other becomes weak.The body then loses its natural balance and the various structures of the spinal column become overstressed.

Pain is often felt across the top of the shoulders and is put down to stress. Usually what happens is that stress, poor posture or poor movement habits of the shoulders or neck cause the muscles across the top of the shoulder to become overused, tight, tender and painful.

THE LIGAMENTS

The ligaments are strong fibrous bands which hold the vertebrae together, limit their motion as well as protect the disc. These ligaments are most commonly injured :in quick unprotected movements as in whiplash.or slowly due to poor posture (head poked forward).

POSTURE

It is important to have a good understanding of the effect that posture and movement have on your neck. As there are may different types of neck problems it is essential that you understand what will benefit your particular neck problem.
The postures and movements which reduce or bring the pain from the periphery into the middle of your neck are the correct ones for you. If the pain moves down into your shoulder or arm then it it the wrong movement or posture for your neck.

REMEMBER if you have pain  in the arm, numbness, pins and needles, dizzyness, nausea, visual symptoms or ringing in the ears, it is sign of more serious trouble and you should seek immediate help from your physiotherapist or doctor.

CAUSES AND PREVENTION OF NECK PAIN

Neck pain can be caused

  • accidents such as a whiplash injury
  • holding sustained postures where the neck is stressed by being held at the end of the available range of movement. This happens with poor posture ( especally when sitting and driving), working overhead for long periods of time as in painting the ceiling.
  • lifting heavy objects where the muscles that stabilise the neck are not strong enough to do so

 SITTING

Most people if they have to sit for a long time will eventually slouch. They will lose the natural inward curve of their lower back and their head and neck will assume the “poked forward” position. (see Fig. 7) This results in stressing the structures of the neck, which over a long period of time will lead to pain. Initially the pain will only be there when assuming this position for hours on end. But as this position becomes a habit, the pain will become constant and there will pain with neck movements as well

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HOW TO HELP YOUR NECK

It is important to sit in the correct posture whether as a preventative measure or to relieve stress on an already painful neck. In order to maintain correct neck posture it is essential that the posture of the lower back is correct as well. When sitting you must keep the natural inward curve (or lordosis) of your lower back.This will make it easier to hold your head in the correct position neck 3(Fig 8). Your shoulders should be relaxed.
Maintaining good posture in a chair with a back rest is made easier with a lumbar roll. A lumbar roll is an especially designed cushion which provides support for the back when sitting and is available from most physiotherapists. Be careful of chairs with headrests as they tend to push your head forward unless they are exactly right for you.
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When sitting leaning forwards over a computer or a desk it is important to lean forward at the hips, keeping the lordosis in your lower back and your head in the correct position.

Fig 7

LYING AND RESTING

When lying and resting it is important that you sleep in a good position with your neck fully supported. If you experience neck pain which is worse in the morning then your sleeping position may need correcting.
PILLOWS
Pillows supply the support needed for your neck when sleeping. It is important that you can mould them by adjusting the contents of the pillows. Memory foam  pillows. moulded pillows and feather pillows(as long as you aren’t prone to asthma sinutus etc.) are examples of pillows which will give your neck good support while you are sleeping. Dacron pillows can be made more easy to mould to the shape of your neck by opening the pillow up and teasing the dacron into “cotton wool balls”.
Sleeping on your back. One pillow is usually all that is needed. It should be moulded to support the hollow at the back of your neck and the corenrs of the pillow pulled around to support the sides of your neck..
Sleeping on your side. The height of your pillow should fill the gap between your ear and the bed, supporting your neck and keeping your spine in a straight line.Therefore two pillows are usually required. The top pillow should be able to be moulded to support the hollow of your neck between the neck and shoulders so that the head and neck are correctly aligned. It is not neccessary for the bottom pillow to be able to be moulded as it supplies the bulk.
Sleeping on your stomach. This is not ideal
In this position your neck is usually turned fully to one side and kept in this position all night.This can give rise to pain due to mechanical stress. (Remember the example of mechanical stress on the first page!) This places a lot of strain on the structures of the neck and often results in neck pain which is worse in the morning and eases during the day. In this case sleeping on your stomach should be avoided.
N.B. Should you not be able to mould your pillow to support your neck, make a soft roll of foam about 8cm across and the length of your pillow. Place this inside the pillow case (at the lower edge) on top of the pillow. This will support the hollow of your neck when lying on your side or your back.
If you have trouble finding a comfortable position please ask your physiotherapist. Sometimes they might have a pillow for you to take home and try out.

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PHYSIOTHERAPY TREATMENT FOR HEADACHES AND NECK PAIN

Physiotherapy treatment depends on an accurate assessment to determine the cause of the pain. The cause may be one or all of those mentioned above.
• postural education. Retraining of good posture so that it becomes second nature. This may also require improving the movement and strength of the muscles and joints of the neck and back
• Joint mobilisations and manipulation. These are ‘hands on” techniques used to increase the movement of the joints in the neck and back
• Nerve mobilisations- these are ‘hands on” techniques used to improve the movement of the nerves through the structures and tissues of the neck
• Techniques and exercises to reduce intervertebral disc bulges
• An individualised stretching, strengthening and functional exercise plan
• Advice re returning to work or sport
• Education on how to prevent future back pain
• Onward referral for X- Ray if needed
• Onward referral to GP or specialist if needed

 

 

COMMON CHRONIC OR RECURRING RUNNING INJURIES

COMMON CHRONIC OR RECURRING RUNNING INJURIES

The severity of running injuries can vary from those which prevent you from running to those nagging injuries which cause you mild discomfort and reduce enjoyment of your chosen sport. Obviously if you have an injury which prevents you running you need to seek physiotherapy treatment in order to get back on the road but if you have a nagging injury which does not actually stop you running – then you have a choice. You can either carry on and hope that it doesent get worse or seek treatment. Treatment may involve reducing your running initially, orthotics, and starting on a long term proactive injury prevention strategy such as stretches, strength training and retraining your gait. Runners homework!!
COMMON PHYSICAL FACTORS WHICH MAY LEAD TO RUNNING PROBLEMS.
Weak lower back or core muscles
Strong back/stomach muscles are essential to stabilize your lower back when running so that there is not excessive movement of your vertebrae and pelvis as your legs pound out those miles. As your legs swing forward and land your pelvis and back should be stable. Your pelvis should not go up and down with each foot strike, it should not rotate excessively and your lower back should not arch as you push off.
Weak hip abductors, extensors and lateral rotators
Hip abductors are the muscles which move leg out sideways and as such stabilize the pelvis when you are weight bearing. The hip extensors also help to stabilise your hip when weight bearing.The hip lateral rotators rotate the hip/knee outwards and stop the hip/knee turning in when weight bearing.

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A – The hip abductors don’t exhibit any weakness
B – The whole upper body shifts to the right – very weak hip abductors
C – The hip/pelvis is raised on the weight bearing side – weak hip abductors
D – The hip and knee turn in on the weight bearing side – weak abductors and lateral rotators

Hip-Weakness-Pronation

Weak hip abductors and lateral rotators allow the lower leg to rotate inwards and lead to increased torsional stress from the hip down to the foot as in diagramme.

Conditions such as patella femoral syndrome( pain over the front of the knee), hip pain, plantar fasciitis, shin splints and Ilio Tibial Band Syndrome may result.

 

 

 

Weak, tight and/or unbalanced quadriceps.

The quadriceps muscle is the large muscle on the front of the thigh and is made up of four muscles which end at a common tendon below the kneecap. Problems occur when the medial and lateral parts of the quadriceps become unbalanced and there is an uneven pull on the patella giving rise to patella femoral syndrome(PFS) where the patella is pulled out of alignment ( as in 2b )

 

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Tightness of Rectus Femorus, which is the most superficial of the quadriceps muscles, will cause the patella to ride higher than normal which can also be a factor in PFS. Research has shown that weakness of the whole quadriceps mechanism is a major factor in long term anterior knee pain (PFS)

Hamstring problems

The hamstrings are the large muscles on the back of our thighs which bend our knees, extend our hips and drive us up hills when running. The hamstrings can be a problem if they are weak. They can be short and weak or long and weak. Either way it is important to strengthen the hamstrings and in the case of the short hamstring – to stretch it.

Pronated or supinated feet
When running the foot naturally pronates as the foot hits the ground and supinates at push off. There is a problem however when there is excessive pronation or supination. A person with a pronated foot has a reduced arch/flat foot and one with a supinated foot has a high arch.

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Factors which will influence gait and lead to excessive pronation or supination are incorrect hip rotation at foot strike, poor lumbar stability, pain and injury leading disturbed muscle function in the leg or foot and anatomical discrepancies .

 

 COMMON RUNNING INJURIES 

PATELLOFEMORAL SYNDROME (PFS) (anterior knee pain)

Picture61Commonly known as “runners knee” this is an irritation of the cartilage on the underside of the patella or kneecap because the patella has migrated laterally and is not sitting in its specially designed groove at the bottom end of the patella. See diagramme under Weak, tight and/or unbalanced quadriceps. It is usually noticed during long runs, going up or down hills and stairs and after sitting for a long time especially with the knees bent.

The risk factors are weak quads, gluts, lumbar and hip stabilizing muscles, excessive pronation and tight hip flexors.
Rehabilitation involves strengthening the quads, gluts, lumbar stabilizers, stretching the hip flexors if tight, corrective taping of the patella, orthotics and gait retraining – see below

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There are special knee braces which can be used instead of corrective taping of the patella.

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The above Mojo brace can be used for anterior knee pain.

ACHILLIES TENDONITUS
Picture41The Achilles tendon attaches the two major calf muscles to the back of the heel. When under too much stress the tendon becomes irritated and inflammed. A tender lump is usually able to be palpated on the tendon.
Risk factors are suddenly increasing training, especially hill and speed work, tight or weak calf muscles, poor hip and lumbar stabilizers, faulty foot mechanics such as pronation or supination.
Rehabilitation involves ice if acute, massage, stretching (gentle) and eccentric strengthening of the calf muscles, taping, addressing any hip and lumbar instability and orthotics if necessary.

 

HAMSTRING PROBLEMS

Picture11The hamstrings can become a problem when they are weak and either too short or too long.
If the pain in your hamstrings comes on quickly and the area bruises it is likely that you have strained the muscle in which case you will need to stop running and seek physiotherapy treatment. If it is a less severe chronic nagging injury you can usually run but you need to take it easy. A good alternative while healing takes place is bicycling, pool running or swimming.
Rehabilitation consists of stretching and strengthening exercises for your hamstrings, buttock strengthening exercises, taping and deep tissue massage. Wearing compression tights during and after a run can be helpful.

 

PLANTAR FASCIITUS

Picture31The plantar fascia is a thick band of fibrous connective tissue which supports the arch of your foot and runs from the arch to the toes.
At risk factors are excessive supination or pronation, increasing your running mileage too quickly, standing on a hard floor for too long without corrective footwear, weak or tight calf muscles, tight hip flexors, weak lumbar stabilizing muscles and a history of low back pain.
Rehabilitation consists of ice ( rolling your foot over a frozen bottle five times a day), stretching and massaging the plantar fascia, strengthening or stretching the calf muscles and strengthening the lumbar stabilising muscles, taping and orthotics.
Running through it can delay healing which is notoriously slow and can take up to a year or more. It is advisable to do alternative exercise such as pool running or swimming to keep the weight off your feet.

SHIN SPLINTS

Picture21Shin splints are small tears in the muscle which lies over the shin bone, or where the muscle meets the bone. They cause an ache down the front of your lower leg.At risk are those new to running or who have returned to running after a long period of no running and have done too much too quickly. They can affect those people with excessive pronation or supination, those who are wearing old shoes or the wrong shoes.

Rehabilitation initially involves stopping running and dealing with the inflammation by using ice, anti-inflammatory medication and rest. Kinesio tape can help by inhibiting the muscle action, correct running shoes and orthotics can help. When returning to running it is important to increase the mileage gradually.

ILIOTIBIAL BAND SYNDROME (ITB)
Picture51The ITB runs down the side of the thigh from the hip to the knee and while running with the knee bending and straightening, friction can occur between the band and the side of the knee causing pain.
At risk are those runners who increase their mileage too quickly, do a lot of down hill running, have weak hip and lumbar stabilizers, over pronate or have a leg length discrepancy.
Rehabilitation initially involves rest, strengthening the hip and lumbar stabilizers and knee extensors, shoes or orthotics to correct excessive pronation, stretching or using a foam roller on your ITB to make it more flexible. Returning to running should involve a gradual increase in mileage.

How To Set Up Your Office Chair

Top Six Guidelines for Office Chair Setup

An ergonomic office chair is a tool that, when used properly, can help one maximise back support and maintain good posture while sitting. However, simply owning an ergonomic office chair is not enough – it is also necessary to adjust the office chair to the proportions of the your body to improve comfort and reduce aggravation to the spine.
The first step in setting up an office chair is to establish the desired height of the your desk or workstation. This decision is determined primarily by the type of work to be done and by your height. The height of the desk or workstation itself can vary greatly and will require different positioning of the office chair, or a different type of ergonomic chair altogether.
Once the workstation has been situated, then you can adjust the office chair according to your physical proportions. Here are the most important guidelines – distilled into a quick checklist – to help make sure that the office chair and work area are as comfortable as possible and will cause the least amount of stress to the spine.

office chair

1. Elbow measure
First, begin by sitting comfortably as close as possible to your desk so that your upper arms are parallel to your spine. Rest your hands on your work surface (e.g. desktop, computer keyboard). If your elbows are not at a 90-degree angle, adjust your office chair height either up or down.

2. Thigh measure
Check that you can easily slide your fingers under your thigh at the leading edge of the office chair. If it is too tight, you need to prop your feet up with an adjustable footrest. If you are unusually tall and there is more than a finger width between your thigh and the chair, you need to raise the desk or work surface so that you can raise the height of your office chair. Your hips should be slightly higher than your knees.

3. Calf measure
With your bottom pushed against the chair back, try to pass your clenched fist between the back of your calf and the front of your office chair. If you can’t do that easily, then the office chair is too deep. You will need to adjust the backrest forward, insert a low back support (such as a lumbar support cushion, a pillow or rolled up towel), or get a new office chair.

4. Low back support
Your bottom should be pressed against the back of your chair, and there should be a cushion that causes your lower back to arch slightly so that you don’t slump forward or slouch down in the chair as you tire over time. This low back support in the office chair is essential to minimize the load (strain) on your back. Never slump or slouch forward in the office chair, as that places extra stress on the structures in the low back, and in particular, on the lumbar discs. If the arch in your lower back is quite pronounced you may need to consult your physiotherapist regarding adjusting the back support as too much support in this area can also cause low back pain.

5. Resting eye level
Close your eyes while sitting comfortably with your head facing forward. Slowly open your eyes. Your gaze should be aimed at the center of your computer screen. Your eyes should be level with the upper to middle part of the screen. If your computer screen is higher or lower than your gaze, you need to either raise or lower it to reduce strain on the upper spine.

6. Armrest
Adjust the armrest of the office chair so that it just slightly lifts your arms at the shoulders. Use of an armrest on your office chair is important to take some of the strain off your upper spine and shoulders, and it should make you less likely to slouch forward in your chair.

No matter how comfortable one is in an office chair, prolonged static posture is not good for the back and is a common contributor to back problems and muscle strain. To avoid keeping the back in one position for a long period, remember to stand, stretch and walk for at least a minute or two every half hour.

Lifting Techniques

Designed to minimise strain on your back.

Basic Lift (Diagonal Lift) – This lift is the most common  method of good lifting technique.   Use the basic lift for objects  small enough  to straddle  where you have enough room to use a wide stance

liting

  1. Get close to the object.
  2. Stand with a wide stance: put one foot forward and to the side of the object.
  3. Keep your back straight, push your buttocks out, and use your legs and hips to lower yourself down to the object.
  4. Move the load as close to you as possible.
  5. If the box has handles, grasp the handles firmly and go to step 9.
  6. Put the hand (that is on the same side of your body as the forward foot) on the side of the object furthest from you.
  7. Put the other hand on the side of the object closest to you. Your hands should be on opposite corners of the object.
  8. Grasp the object firmly with both hands.
  9. Prepare for the lift: look forward.
  10. Lift upwards following your head and shoulders. Hold the load close to your body. Lift by extending your legs with your back straight, your buttocks out, and breathe out as yo u lift.

If you are doing this lift correctly, your head will lift up first, followed by your straight back. If your hips come up first and you must bend your back as you straighten up, you are doing this lift incorrectly.

 

Power Lift – Use the power lift for objects too large for you to straddle. This lift is very similiar to the basic lift. In the power lift, the object shifts your center of gravity forward, and you must push your buttocks out to compensate. (Professional weight lifters lift using this position.)

 LIFTING 3

  1. Put one foot next to the object. Keep your back straight, push your buttocks out and slowly lower yourself down onto one knee. (For support as you lower yourself down, put one hand on a stool or on your thigh for support.)
  2. Position the object close to the knee on the ground.
  3. Grasp the object firmly with both hands.
  4. Slide the object from the knee on the ground to mid-thigh. Keep your head forward,
  5. your back straight, and your buttocks out, and lift the object onto the opposite thigh
  6. Grasp the object firmly with both hands.
  7. Prepare for the lift: look forward.
  8. Lift upwards following your head and shoulders. Hold the load close to your body. Lift by extending your legs with your back straight, your buttocks out (exaggerate this position), and breathe out as you lift

 

Tripod Lift – Use the tripod lift for objects with uneven weight distribution (example: sacks of food).
Recommended for people with decreased arm strength. Not recommended for people with bad knees

lifting 9

  1. Put one foot next to the object. Keep your back straight, push your buttocks out and slowly lower yourself down onto one knee. (For support as you lower yourself down, put one hand on a stool or on your thigh for support.)
  2. Position the object close to the knee on the ground.
  3. Grasp the object firmly with both hands.
  4. Slide the object from the knee on the ground to mid-thigh. Keep your head forward, your back straight, and your buttocks out, and lift the object onto the opposite thigh.
  5. Put both of your forearms under the object (with your palms facing upward) and hug the object to your stomach and chest.
  6. Prepare for the lift: look forward.
  7. Lift upwards following your head and shoulders. Hold the load close to your body. Lift by extending your legs with your back straight, your buttocks out, and breathe out as you lift.

Partial Squat  Lift – Use the partial squat lift for small light objects with handles close to knee height.

LIFTING 4

  1. Stand with the object close to your side.
  2. Place your feet shoulder width apart, with one foot slightly ahead of the other.
  3. Place one hand on a fixed surface (such as a table or stool) or on your thigh.
  4. Keep your back straight, push your buttocks out and slowly lower yourself down to reach the object’s handles.
  5. Prepare for the lift: grasp the object and look forward.
  6. For support as you lift, push down on the fixed surface (or on your thigh).
  7. Lift upwards following your head and shoulders. Lift by extending your legs with your back straight, your buttocks out, and breathe out as you lift. 

The Golfers’ Lift – Use the golfers’ lift for small light objects in deep bins and to pick small objects off the floor.  Recommended for people with knee problems or decreased leg strength.

LIFTING 5

  1. Place hand near the edge of a fixed surface (such as the edge of a table or bin). This hand will support your upper body during the lift.
  2. Keep your back straight and raise one leg straight out behind you as you lean down to pick up the object. The weight of your leg will counterbalance the weight of your upper body
  3. Grasp the object firmly.
  4. Prepare for the lift: look forward. Keep your leg raised as you initiate the lift.
  5. To lift, push down on the fixed surface as you lower your leg. Keep your back straight and breathe out as you lift.

 

Straight Leg Lift – Use the straight leg lift when obstacles prevent you from bending your knees.
Be careful! Lifts over obstacles that prevent you from bending your knees put you at increased risk for muscle strain. If possible, avoid this lift. Only use this lift when absolutely necessary (i.e. lifting out of a grocery cart, car trunk).

LIFTING 6

  1. Stand as close to the object as possible with knees slightly bent.
  2. Do not bend your waist! Push your but- tocks out.
  3. If the obstacle (preventing you from bend- ing your knees) is stable, lean your legs against the obstacle for support.
  4. Use your legs and hips to lower yourself down to the object.
  5. Grasp the object firmly with both hands.
  6. Prepare for the lift: look forward.
  7. Lift upwards following your head and shoulders. Hold the load close to your body. Lift by extending your legs with your back straight, your buttocks out (exaggerate this position), and breathe out as you lift.

 

Overhead Lift – Use the overhead  lift to place objects on an overhead  shelf.  This lift begins with the object in your hands.  Be careful! Overhead lifts put you at increased risk for muscle strain. It can be difficult to maintain balance during the lift. If possible, avoid this lift. Only use this lift when absolutely necessary.

lifting 8

  1. Hold the object very close to your body.
  2. Keep feet shoulder width apart, one foot slightly ahead of the other.
  3. Prepare for the lift: look forward.
  4. Raise the object to shelf height using the arm and shoulder muscles. Keep the object close to your body and breathe out as you lift.
  5. As you reach the shelf, slowly shift your weight from your back foot to your forward foot. Keep your back straight.
  6. When the load reaches the edge of the shelf, push the object onto the shelf.

 

Pivot  Technique – When you must lift an object  and then turn to carry it away, it is common  to twist the body.  Twisting  while lifting can cause serious  damage  to the tissues  of the back.   Use the pivot technique to avoid twisting  while lifting

lifting 11

  1. Lift the load using any of the previous techniques.
  2. Hold the load very close to your body at waist level
  3. Turn the leading foot 90 degrees toward the direction you want to turn.
  4. Bring the lagging foot next to the leading foot. Do not twist your body!

 

 

 

 

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