Blair Chapman

Hip Pain and the Dorsa Vi

DorsaVi

One of the common issues we see in the clinic, especially amongst the running population, is poor hip control and strength.    This type of hip dysfunction often leads to a variety of injuries such as anterior knee pain, hip pain and low back pain.  As clinicians we are able to subjectively view someone’s running gait and determine where their deficiencies are.   This however is purely subjective and doesn’t give us concrete data on how bad the control actually is and is hard to measure positive change effectively.

This has now become an issue of the past with recent technological developments.     Using Vi Move, which is a system using sensors, we are now able to quantify hip stability and strength issues.   One of the ways in which we do this is by hooking a patient up to 2 sensors on the shin bone and measuring knee collapse in anything from single leg squat to box jumps.   It’s a great objective measure that we can then rehab and re-measure after following a strength program.

Further to these sensor placements we can also put them on the low back and pelvis and test single leg hurdle step and a lunge to see how the hip is affecting low back and pelvis alignment.   The benefit of these sensor placements is you can then look at it with real time training.   This will allow you to watch the sensors on the screen and give you real time feedback on how to move properly and engage better hip control.

8 Tips For Running at Night

 

Many people find they ease off their running on these darker days, but there is little reason to! A few simple steps can ensure you enjoy running year round.

Running during the day is always a safer choice, but if you have to run at night or in the early morning, make sure to follow these guidelines.

Eight Simple Tips For Running At Night:

  1. Dress appropriately with some warmer yet breathable clothing, which can keep you warm but doesn’t make you feel like you’re over-heating on your run. Choose light colours, or reflective material. Ask at your running or sports shop to recommend the best clothing for winter running- it can really make a difference.
  2. Do a proper warm up. Some light jogging and dynamic stretching can help prepare the body for more explosive running. See the other great post by Sydney Physiotherapy Solutions about warm-ups.
  3. Run in an area with street lighting to allow you to see the cracks and pot holes in the pavement to prevent any unwanted ankle injuries.
  4. Carry ID with you. Whether it’s a driver’s licence in your pocket or an ID bracelet, it will prove useful in case of an accident.
  5. Run a familiar route. Tonight is not the time to explore that part of the neighbourhood where you have never been.
  6. If you run in dark or wooded areas, which are more isolated, it might be a good idea to leave the headphones at home, so you are more aware of your surroundings. You may also consider running with a group or partner – this can be more fun as well.
  7. It’s always good to let someone know you’re out for a run, so get in the habit of letting a friend or partner know you’re heading out, and the time you expect to be back.
  8. Always run against traffic.It is easier to avoid cars if you can see them coming.

Pull Your Head in

In today’s working professionals, the time spent sitting adds up to a huge portion of their day. Unfortunately what seems to be coinciding with this long period of sitting is neck pain.

Everyone hears about posture and how to have good posture but here’s the reality of what happens when your chin and head stick forward

chin protruded

The head is very heavy—anywhere from 3-5kg. If it sits in the correct position atop the cervical spine you are holding up the actual weight of the head when standing. The common wisdom holds that for every inch that your head moves forward of the spine it adds an extra 3-4kg of weight for your neck to hold up.

This is sustainable for a time but your muscles will eventually fatigue. They are overworked and therefore start to feel constantly tight, specifically in your upper trapezius and Levator scapulae.

Massage and stretching can reduced symptoms temporarily but why not do what we were designed to do and pull your chin in.

If you suffer from neck or back pain why not contact the team at Sydney Physiotherapy Solutions to make an appointment at either of our Sydney CBD physiotherapy clinics or at our recently opened Chatswood Physiotherapy clinic.

5 Fun Facts about the Knee

knee-diagram

1. There are four major bones in the knee, the femur, the tibia, the fibula and the patella. That means that there are three joints as part of the knee complex, the knee joint between tibia and femur, the patella-femoral joint, kneecap and femur and the superior tibia-fibular joint

2. The knee has 14 ligaments. 7 intracapsular ligaments including the anterior cruciate (ACL) and posterior cruciate (PCL). 7 extracapsular ligaments including the medial collateral (MCL) and the lateral collateral (LCL)

3. The function of the knee is particularly important for weight bearing activities, such as walking, running and going up/down stairs. The load distributed over the kneecap can be up to 5 times the body weight, particularly on going down stairs.

4. Babies are born without kneecaps. They don’t appear until the child reaches 2 to 6 years of age. Technically newborns do have kneecaps, however, they don’t show up on x-ray very well because they’re not ossified, or bony

5. The knobbles on our knees are all different. It has been suggested that they may be as unique as irises and fingerprints – and research has started into the possibility of implementing an MRI scanner that works at knee-level for airport security systems.

If you are having problems with your knees please feel free to contact one of the Sydney Physiotherapy Solutions team at our Sydney CBD or Chatswood Physiotherapy clinic

Training to be a Desk Worker

desk-worker1

Office workers are the new endurance athlete.

Sounds strange but I think we need to start treating these workers like athletes. Just like we get a myriad of overuse injuries with endurance sports such as marathon running, Ironman, Cycling etc,  sitting at a desk for 8-10 hours a day comes with a whole laundry list of overused muscles and joints and make us much more prone to injuries. Now you may feel like you sustain some of these injuries outside of work for example bending over and tying your shoelaces sending your back into spasm or doing overhead weights leading to shoulder problems.

In reality, the range of motion deficits which are primary contributors to your injury have built up over time with poor posture and lack of daily movement, and then slowly crept into the way you move when exercising or doing any kind of physical tasks around the house.

Here are some things you should be “training” to prevent injuries.

Upper body – specifically shoulders, neck

1.  Pec muscle tightness – These don’t feel tight until you actually have someone palpate or massage them, but this leads to shoulder mechanics issues, and that dreaded tightness in upper back and traps.  I measure shoulder position all the time and the symptomatic side is always way tighter in the chest muscles.  It leads to poor shoulder mechanics and shows up in clinic with  a patient who has hurt their shoulder doing a military press or a sore neck and upper traps area after doing burpees or pushups.

2.  Deep neck flexor weakness – Poking your chin forward all day and not using your deep neck flexors, which are like your core but for the neck, leads to weakness.  This leads to increased load on the discs and facet joints of the neck.  These two structures are a common complaint in clinic.   A lot of evidence in the literature has focused on deep neck flexor strength and shows that it plays a large role in reducing neck pain.

Lower Body – Specifically hip and back

1. Tight hip flexors – if you sit all day with your hips flexed at 90 degrees then your hip flexors are shortened.  Over time they become a real restriction to hip extension. If you are a runner you need good hip extension or you will begin to extend through your lower back. With repetitive back extension plus the load of running you can expect to load the joints poorly and eventually have pain.

2.  Lumbar discs – The pressure on the discs in slumped sitting is enormous and can lead to bulging sometimes even neurological symptoms like pins and needles and numbness or loss of strength.

So as athletes would do, you need to be training your deficiencies. Stretching/massaging/foam rolling the muscles you know are going to be prone to tightness.  Strengthening the muscles prone to weakness.  Here’s a general list of areas to start with ….

Stretch

  • Pectorals
  • Upper Trapezius
  • Levator Scapulae
  • Hip Flexors
  • Quadratus lumborum

Strengthen

  • Deep neck flexors
  • Lower/ mid fibers of trapezius
  • Serratus anterior
  • Core
  • Glute medius

For tailored programs it would be best to consult a professional

Running Injury Free

running Tberg

Every year when the running season starts to pick and more and more recreational runners start to enter into events like the Blackmores Half or Full Marathon and even some of the international events like the New York or Boston Marathon we see an increase in the same running injuries.

Common injuries that are usually a result of a certain factors that can be changed.   One factor is the periodization of the training program.   This means the progression of volume and load that you’re subjecting your body to.  Another factor is muscle strength and stability, for example, poor hip strength leading to poor knee mechanics.   And lastly running technique has a huge impact on injuries, whether it is high ground reaction forces as you land hard and pound the pavement or things like over striding.

All of these factors can be altered whether it’s through strength training at the gym, running drills and/or sitting down and planning a run program that will see proper running progressions.

First of all its important to find someone who can help you identify what the issues may be but then you must know how to implement it.

Here are a few key points to consider

  1. Training program- Instead of just going out and running distances you feel like you’re comfortable with, sit down and actually plan your distances.  The program should included different intensity runs to train all your energy systems.   Sprint training for short durations to increase your anaerobic system.   Tempo runs to target your lactate threshold and really learn how to push your race pace.   Long slow distances to increase your aerobic capacity and get some more KMs under your belt.  I generally look to increase your weekly volume by a steady 10% each week for safe progressions and would suggest that every 4 weeks is a recovery week in which you reduce volume from the previous week to allow your body to recover and prep for the next 3 weeks of increasing workload.
  2. Leg Strength- Make sure that you’re training your hip stabilizer muscles such as gluteus medius to ensure running efficiency.  You will most likely need someone to visually look at your running and single leg control to figure out if you’re lacking stability but you could start with doing some single leg squats in front of a mirror.   Compare sides to see if you can find a noticeable asymmetry between them.  Watch your knees and see if they collapse inward.
  3. Have someone film your running from behind and side on.  Look for the foot  to land under your hips and torso not out in front.

The Functional Movement Screen – Simplifying Movement

Developed by Gray Cook in the United States, the functional movement screen (FMS) was created to help standardise movement assessment.  With the FMS we can derive objective measures to assess injury risk in performance activities.  The FMS looks at 7 fundamental movements such as squatting, inline lunge, straight leg raise as well as rotary stability and trunk push up.  With the screen the patient is ranked from a score out of 3.   3 is a score showing you are able to perform the task well, where 1 is a poor score and indicates either a range of motion issue or a strength/stability issue.  Total score is out of 21. FMS-Pictures

The main objectives of the FMS from a clinical stand point is to try and identify any flaws with movements and more importantly any asymmetries between right and left.   Asymmetries can lead to overload on certain joints and over time lead to injury. A score lower than 13/21 is generally considered poor and indicates the person is a high risk of injury in a dynamic sport.  If there are significant differences between sides ie. a score of 1 on the right leg forward lunge compared to a 3 on the left leg, this can signify a problem. It helps our physios communicate properly with you, your coach or your trainer to discuss the safest and most effective ways for you to exercise.

After the test, you’ll get a report with some recommendations about how best design your exercise programs to minimise your chances of injury.

If big issues come up during the test, like pain or gross limitations in the way you move, we may suggest you return for a follow-up physiotherapy consultation to appropriately address those problems.

 

Shoulder Pain – Poor Scapula Control

In 2013, the second international consensus conference on the scapula was held in Kentucky to discuss and accumulate knowledge of scapular involvement in various shoulder injuries ( Kibler et al, 2013).

The major conclusions were

1) scapular dyskinesis is present in a high percentage of shoulder injuries

2) shoulder impingement symptoms are particularly affected by scapular dyskinesis

3) treatment strategies can be more effective if they include evaluation of the dyskinesis

4) rehabilitation programs to restore scapular position and motion can be effective within a more comprehensive shoulder rehab program.

Multiple studies have identified appropriate and effective strategies, positions and exercises to activate scapular control muscles as well as identifying optimal scapular positions for movement.  A 2008 Study by Kibler et al, demonstrated the effectiveness of scapular muscle motor control exercise using EMG biofeedback and was able to determine appropriate exercises for the difference muscles contributing to scapular dyskinesis

Clinical Significance

With  knowledge of the anatomy of the shoulder and scapula we are able to assess scapular dysfunction and determine whether it is purely a motor control issue or if there is a mobility issue that is preventing proper scapular movement.  When a proper assessment has been performed we can then attain great results based on the individuals deficiencies.   If a motor control program is indicated we are able to use our dual channel EMG biofeedback machine which allows patients to view on a TV monitor their activation and gives them visual feedback when trying to achieve better control.  If range of motion is indicated a combination of hands on treatment and stretching will be included in the patients treatment plan

Do you see a difference?

scap dysk

If you are suffering from shoulder pain why not contact the team at Sydney Physio Solutions to have it checked out.