Boost Your Bone Health: What to Eat (and Avoid) to Keep Your Bones Strong and Out of the Hospital

When I worked in the hospital system I was amazed at how much people’s health deteriorated after a fall and subsequent decent fracture. It really motivated me to stay strong, keep my balance and more importantly - keep my bones as healthy as possible.

After attending a recent nutrition seminar for Physiotherapists, I thought I'd share my top tips for bone health. 

This is a big deal, particularly as we age and specifically for post menopausal women. 

Bones are constantly remodelled throughout our life. We create new bone and get rid of the old! 

Bone remodelling is a bit like your bank balance. If you take too much money out it isn’t great. So you need to hurry up and put some more money back in.

That’s a nice way to look at both nutrition and exercise for bone health.

The other thing to remember is that when we are young we can really get some good bone density. The more active we are as kids and teenages, the better. That’s why I'm always making my kids get outside, take their shoes off, kick a ball and encourage climbing some trees. It will pay dividends when they are older. 

Teenagers also see a massive spike in bone density, so we want teenagers out there - getting strong and loading their bones for maximum bone density when they are older.

So to make sure our “bone” balance isn’t in the red, we need to focus on 3 things


  1. Sleep (more than 7 hours ideally)

  2. Exercise (varied)

  3. Nutrition

As we age, our bone density slowly declines from our late 20’s - onwards. Initially it’s slow and then it happens rapidly. 

We need to eat enough to provide enough energy. If  you eat too little you are more at risk of bone injury. Why? Because you are going into the red with your bone remodelling. 

What should we eat ?

Bone tissue volume is 50% protein. Hitting your ideal protein target of approx 1-1.2 grams of protein per kg, spread over three meals per day. 

If you have a low protein diet and suffer from bone stress injuries, consider seeing a dietician to work out how to get more protein in your diet. 

For post menopausal women, make sure you are exercising between 3-5 times per week. Ideally varied with a mix of strength training, spring exercises e.g. skipping, banded exercises like pilates, and balance work - such as yoga. 

This reduces your risk of osteoporosis and osteopenia. 

CALCIUM (if you are low) 

99% of calcium is stored in your bones. We can’t make it ourselves so it all comes from our diet.

The human body likes keep calcium in a specific range - increasing calcium from dietary sources or supplements increases bone mineral density by 1-2 %

Please note, if you think you are calcium deficient - please get tested. It isn’t recommended you take it unless you are deficient. 

VITAMIN D

Stimulates bone creation and optimises calcium bioavailability. Interestingly vitamin D helps your body absorb more calcium

They did a large study on army recruits and found those with mid to low levels of vitamin D were significantly more likely to get stress fractures than those with high levels of vitamin D. 

Common sources of Vitamin D are oily fish and egg yolk. Also gaining sun exposure for 10-20 mins per day.

VITAMIN K

Vitamin K is found in green leafy vegetables and is thought to also be Important for skeletal health.

So to summarise if you are suffering from bone stress injuries, like stress fractures, or you have had more than one fracture. Get tested for deficiencies in the above. Make sure you are exercising regularly to maintain bone remodelling, eating enough and getting more than 7 hours of sleep. 











Should I Exercise Through Pain?

The main currency we deal with in Physio is pain. What level is it out of 10? Does it hurt at night? 

But let's be honest. As we get older is it realistic to aim for pain free? I’m going to say no unless you're on a concoction of Mexican supplements.

10 years ago I would have made every Physio exercise 100% pain free, and would not progress until everything was pain free. The reality is I was wrong and could have rehabbed things faster. 

The balance lies between living your best life - doing whatever flips your switch, training hard or just daily exercise AND preventing long term damage stopping you from doing the above.

So… what does the research tell us

That yes, it is generally ok to exercise whether that be your training, or your rehab program if the pain is up to a 4/10. Yep, it hurts a bit but you can still do it. It doesn’t flare up and you aren’t reaching for the voltaren. 

The benefit of a little bit of pain is it can also increase your strength a little faster. The stronger you get, generally the less pain you get. 

Other benefits of allowing a little bit of pain are: 

  • It builds resilience in your body. You’re able to push out of the box of movement restriction and therefor live a better life in your body

  • Weight Bearing (within reason) through a torn hamstring, or calf, by day four leads to a faster return to exercise/ sport

  • Allowing a little bit of pain through what you do during the day is also good. Research says those with a better relationship with mild pain recover faster.

What can happen if you are too worried to move?

  • The big thing with kinesiophobia, or fear of movement, is it can actually magnify pain in your brain. Every time you become fearful of movement it becomes more magnified. 

  • You do less movement so you become weaker and your recovery is longer

  • An example is a sprained ankle without a fracture. Those that don’t weight bear for a week or more are more prone to nerve pain, which can be very painful


When is the above advice really bad?

  • If your pain is getting worse the more you do, then please stop and see us asap. You could most likely be doing more damage and we need to figure out what is wrong

  • If you’re getting more night pain - not less, with what you are doing

  • If the pain hangs around for a few hours following exercise, it’s too much 

  • You have just injured yourself. Most injuries like a muscle tear, or acute tendon injury, require 48 hours of rest to really calm down. Back pain is the exception. 

So to summarize! 


A healthy relationship with a little bit of pain has a psychological benefit in getting trust in your body again. 

But also a physiological benefit. It strengthens your tissue, reduces the threat to your brain and makes your body more resilient to life's challenges. 

New Yew New Habit: Journaling 

New Yew New Habit: Journaling 

It’s a new year and a great time to introduce a new habit for your mental health. Something that I highly recommend and takes less than 5 mins per day, is journaling.

I recently listened to a podcast by an amazing GP Dr Rangan Chattergee who is a very holistic doctor. He is also a massive fan of journaling and calls it a “keystone” habit where if you do this one thing routinely, it has a massive flow on effect to the rest of your life. 

My current journal is a $1 kids school book from the local “two dollar shop”. I write where I left off and never go back and read it again once I've written in it. It’s that easy. If you want to get fancy, you can buy one of Rangan’s HERE, or ex All Black Ma'a Nonu has a great journal i’ve given to the BIM team over the years HERE. Personally, the old school kids school book does the trick for me. I leave it on the table with a pen, so when I have a coffee in the morning I can journal at the same time. This is the concept of habit stacking (coffee + journaling combo) from the book Atomic Habits. 

So question 1. is “What is the most important thing you have to do today?”

I know some of you just froze. One thing! Lol. I love it for this reason. Our ‘To Do’ lists and sense of urgency is greater than ever.

Simplifying one thing reduces the clutter and makes life simpler. One thing could be connecting with your partner, screen-free time with the kids, or simply going for a lunch time run. 

Keep it simple and write whatever comes to mind. One sentence or three will do. 

Question 2. is “ What is one thing you are truly thankful for in your life right now?”

Humans are wired to be negative. It has historically kept us alive from predators. Research shows for every nine negative inputs our brain processes there is one positive. So if you’re feeling a little negative from time-to-time it’s not surprising! So writing down somethings you’re grateful for is a little like meditating. It’s training your brain to look more for the positive things in life. 

The health benefits are research based, such as reducing anxiety and improving your relationships with people. 

Focusing on something you have, rather than something you don’t, is pretty powerful. Examples are - having an awesome gym class you love, catching up with a friend, your kids/ dog, whatever!

Finally the last question is “How do you want to show up in the world today?”

I love this one. Having worked with a lot of athletes, journaling is a key tool for success. Athletes will write what they need to do during the game. The key tasks they need to achieve to be successful in the game. What they did right and what they need to do more of. Richie McCaw uses the same school book and wrote in it before every test match. 


This is a variation of the athletes' tool for all of us. How do I want to show up today? Do I want to be more patient, more caring? I try this with driving, but everyone has their weaknesses. 


So give it a whirl. Go get an exercise book from the stationary shop. Add it to a habit you already have, like drinking coffee in the am, so it becomes a routine. It’s a new year so kick it off by adding this “keystone habit”



Creating Atomic Habits to Nail Your Physio Exercises 

Physio exercises work for the majority of injuries. In fact research shows they are probably the most important part.

But …. There are two problems 

1.They can be a little boring 

2.Once you aren’t in pain it’s easy to go back to not doing them.

However, to fix an injury you generally need to grow muscles, give them some strength, endurance, some power and get them moving in different planes of movement. It generally takes eight weeks to three months. So how do you stay on target, to genuinely change the way you feel in your body - for the better, once you’re out of pain? The best selling book Atomic habits by James Clear has some great insights into helping you get them done.

Tip 1: The author talks about using a cue to make you do the habit. 

One option before you go to bed is to stick a gym mat, spiky ball and some theraband directly by your bed so that when you wake-up you step on the mat and it reminds you to do it. If your partner isn’t into the grunting sounds you make on the spiky ball, put it somewhere else but place it somewhere obvious so you are reminded to do them.

Tip 2: Use an implementation intention. 

Be specific about your plan to do your exercises. For example, I'm committing to Tuesday - Friday. Four per week, first thing - without fail - at 6am. That easily gets me to the four sessions needed per week, so I can grow the muscle, without much fuss. Create a clear plan of action that is realistic and achievable.

Tip 3: Give yourself a dopamine hit

There is nothing better than crossing it off your to do list, or ticking it off on your calendar. It makes you feel good knowing you are progressing.

So add your implementation intention plan to your diary, or calendar and give it a good tick every time you do it.

You could do your exercises somewhere you love like the beach. Doing it somewhere you love gives you another dopamine hit.


Tip 4: Create a contract with your partner (or whoever else listens to your whining when you’re sore), your physio, or me.

Something like ‘If I don’t do the exercise program for the week I will give my physio $100.00 Happy to help you with this LOL

So to summarise: 

Have your gear by your bed. Have your plan for the week and add it to your calendar. 

Make sure you give yourself a big tick on your list after you’ve done it; and give me a hundred bucks if you don’t do it.

But know this … these little habits compound over time and you go from being pain free, to moving better, then performing better, then asking whether you could play sport, or play with the kids. Something you didn’t think was possible becomes possible all of a sudden.

How My Battle with Acute Low Back Pain Transformed My Approach to Solving Your Back Pain! 

My biggest fear was getting acute low back pain. I thought I'd dodged it. I’d never ever felt more than a twinge in four plus decades. 

I felt like I could get away with never having it, given my track record to date. Until two weeks ago on the tennis court, when I picked up a tennis ball and had to be helped up the stairs. 85% of the population will experience back pain at some point. It is the most prevalent condition seen in a Physio Clinic.I’ve treated it, seen patterns and given loads of advice.

There is one bonus to going through the experience, actually being able to not just have empathy, but totally understand what someone is going through. Speaking from the horse's mouth on what works to relieve the discomfort and pain, and what doesn’t.

These are my top tips for exactly that, which I've refined a little since that fateful game of tennis. Feel free to share this with someone who is also experiencing back pain at the moment.

When you injure your back there are a lot of things that go through your head. Is it a disc?
What if it involves the spinal cord? What if I need six weeks off work? How am I going to feed my family?


The reality is that back pain resolves well with the right management, and the healing process is sped up considerably with the right plan of attack. You don’t need scans for the majority of back pain, especially in the acute setting.  In fact, it’s been shown that getting x rays, or other scans, leads to worse outcomes with back pain. So if you don’t have the history of a massive fall, you don’t have bladder or bowel changes, and you don’t have significant muscle weakness, we will not get imaging - and we would be doing you a disservice if we did. For the record it isn’t really helpful to know whether it is a disc, facet joint, or something else. The management doesn’t change. The research either calls it “non specific back pain”, or “mechanical low back pain”

See a Physio. I’m a Physio and I had no idea what was wrong with me. What I thought was the issue wasn’t the case. One of my team was able to explain what caused it, how long it would take and what I could do to manage it. I couldn’t believe how much better I felt with some treatment, the correct exercises and reassurance I wasn’t going to end up in a wheelchair. 

Movement is medicine. Staying in one spot is not helpful. Moving throughout the day is good for you. Listen to your back. It will tell you what is good and what is bad movement. It will also let you know when you’ve done enough movement and need to rest again.

Some backs like sitting and some like standing. Most of them don’t like rolling over in bed and they are generally worse in the morning (after the initial couple of sleepless nights).

It’s ok to take a little time off work to get out of the acute phase. 


Get the exercises prescribed by a physio. Doing the exercises should immediately reduce your pain a little. It also gives you some control over your injury. I was doing it every 3 hours. I did the ones that were either pain free or stopped hurting after two reps. I didn’t do the ones that hurt. I used the spiky ball to give me some relief. 

Don’t listen to your neighbour, friend, or whoever else is a self-nominal expert in back pain. Every case is different and the advice is often whacky. Also take what you read on google with a grain of salt. A lot of it is old school and you can freak out thinking you have cancer when you have mechanical back pain. 


Sitting on the couch, or slumping, is generally a bad idea when it’s sore: sitting in a harder chair, that has back support, will generally be better for you. Adjusting your car seat so you're more up right and consciously avoiding slouching at all times are small things that help a lot.


Exercises are really the key to getting better and perhaps I could have progressed faster in hindsight. The reason you go back to the physio is really to know what exercises you need next, and whether you're doing them correctly. You need to keep progressing to more advanced ones.


There’s generally a change in load on your body and there can also be a mechanical component. My example was that I had been playing doubles in tennis with no problems, then decided to go back to singles. The extra volume led to an overload.

I also had a mechanical issue. I had a sore hip, which I chose to manage myself, which led to a weak glute, a weak core and poor mechanics of my pelvis. The picking up of the tennis ball was the ‘tip of the iceberg’ symptom of a much bigger problem. The  solution: a structured program rehabbing my body through the stages 1) initially waking-up of the core muscles. 2) strength and endurance. 3) Power and retraining different planes of movement 

So having back pain was shitty, but it really helped me get a clear understanding of what works and what doesn’t. If you know someone that’s hurt their back. Feel free to share this. 

Fitness Fads And Injuries Over The Years

I was walking in the bush the other day wearing a pair of thongs when I reflected on the barefoot running movement. Vibrams and other minimalist shoes, the law suits, the injuries and everything in between. I reflected on some of the other fads and inventions I've seen come and go. Us humans can have a tendency to just take things a little too far. So I've indulged myself and revisited a few trends/ inventions that have come and gone, taking a look at some of the injuries they’ve caused.




Let's start with the Born To Run book. Yes I read it. Yes, I told people to throw away their orthotics. 


For the record, I encourage my kids to run in bare feet and play sports in bare feet. I run around in bare feet. I know this is an investment in the future of their foot and ankle strength which will pay dividends when they are older. I also purposely spend a lot of my day in bare feet. 


But … if i’m running a marathon, half marathon, or anything in between, i’m pretty ok with a bit of cushioning under my feet. If it’s ok for Kipchoge it’s ok for me.


I saw some gnarly Born To Run injuries. Chronic calf tears from people that just transitioned too quickly and refused to stagger back from a less supportive shoe, rather than straight from super supportive to minimalist. Stress fractures from people doing long runs with minimalist shoes and no slow transition. I saw one patient whose feet had transformed into a pair of vibrams. The muscles of their feet were vibram shaped. Yes, vibram shaped.  


A lot of those people that did a large volume of running in those minimalist shoes now have to wear these to keep running


Now I know some of you still run David Goggins mileage in minimalist shoes and are triggered by this. Consider yourself biomechanically blessed! 


Another trend that springs to mind is sitting on swiss balls at work all day. If you sit on one and it helps you, please ignore me and keep it up! But for a lot of people they were using swiss balls to prevent hip, groin or back pain. A swiss ball is an unstable surface, so if you’re not strong enough to stabilize on the unstable surface, you have to grip through your big muscles. They aren’t used to doing this role so get tired and tight quickly, compressing joints and over tightening your core, which can also be a key driver leading to pain! There is even a study that showed replacing your desk chair for a swiss ball leads to spinal shrinkage (not sure how you measure this) and concluded there were more disadvantages to sitting on the ball than the chair. 


Now the next inventions are the Physiotherapy machines from the 80’s,90’s and early 2000’s. Therapeutic Ultrasound (not muscle imaging) and the Tens/ Interferential machines. Special shout out to the hot pack. I apologise if you ever heard me say “let's put a heat pack on your back for 10 mins before I get into the rough stuff”. 

Placebo at its greatest! I’m yet to find evidence to show it works and if someone you’re seeing still uses them then perhaps it’s time to change. 


My all time fave are infomercial ab machines. Trying to get you a six pack. So good. Isolating your abs and making them super tight is a great way to injure your back. Yes - your core can get too tight, and this was a pretty common response to these things. Training your abs doing hundreds of reps lead to loads of back pain; and those really slumpy postures, purely because the weak back muscles have no chance with such a “ripped” six pack.


When I reflect back on fads and inventions that seemed great, they maybe weren’t that great. Or … we just took it a little bit far.


I apologise for the above over the years. At least now we have more evidence based treatments than placebo based treatments! 

The Questions We Ask

With the evolution of science we now understand that both injury and pain are more complex than originally considered, and so treatment to heal requires a more holistic approach. Particularly if the discomfort from injury has hung around for more than a few weeks. 

When someone has had pain for more than 3 months it is deemed chronic and we often ask questions such as:

How many hours do you sleep?

What’s your step count per day?

What do you think is going on?

What may be perceived as random questions to be asked are all highly relevant for solving pain problems, and to identify the unhelpful beliefs that may be getting in the way of your recovery.

We know if you sleep less than six hours per night pain is ramped up in your nervous system, so the sensation is actually worse. 

We know if your step count has reduced considerably and suddenly, you are more likely to experience back pain (think working from home and lockdowns). 

We know that your subconscious beliefs, such as “my mum had a knee replacement at 50, so I probably need one”, or “it’s definitely arthritis because I'm 60”, need to be addressed and removed in order for you to begin your road to recovery. 


We also know that starting your day with movement - such as your physio program, some stretches/ yoga, will lead to a better day in terms of movement quality and overall reduced pain. 


We know from research and functional MRI studies of the brain that in the presence of pain, all sorts of areas you wouldn’t expect to light-up, such as past experiences, beliefs etc. 

So addressing pain and injury is not about setting some exercises and on completion expecting you to be sweet.


It’s a combination of the right exercise program, sleeping well, managing your stress, removing unhelpful beliefs, having better sleep hygiene, increasing your step count and a bunch of other factors.


If you’re in pain ask yourself - are there some beliefs that you hold which may not be helping? I’m happy for you to reply to this with ones you need help with. 

Think - Is your sleep good and you’re doing the right things in the lead up to bed time? Are you moving enough, or could you start your day by doing your physio program? Let me know your thoughts - I'm genuinely interested in hearing them.


What I've Learnt From My First Marathon

Being a physio for 10 years I’ve treated my fair share of people taking on a marathon and have

always been ready to give as much advice as I could but have neve had the experience to fully

understand the full demands of a training cycle and then the battle of the event it self.

That all changed this year when I decided to take on the challenge myself and see if I could

practice what I preach. So these are my top take aways from the experience

1. Get a program

I can’t express the importance of having a structured program enough. Whether you download a

free one, steal a mate’s or sign up with a coach it is an absolute must. The reason this is so

important is that a program will allow you to increase your runs at the correct rate and also help

you with pacing and speed work which are super important in running. One of the biggest

problems I see in the clinic is people increasing the kms too quickly or increasing the intensity

too quickly which both lead to an overload or injury and then require time off.

2. Get strong

Runners are notorious for skipping doing any exercises to keep strong and one area I see

where anyone can improve. It can be the difference between finishing a marathon and can also

make the fast even faster.

3. It is better to be 10% under prepared then 1% over

Life happens, we get niggles, we get sick, work gets busy. All these things happen and it’s

important to not stress about missing a run or two you can still get on track and pushing through

these things are more likely to get you injured and needing more time off.

4. Nutrition is king

The other major issue I see in the clinic is people not practicing race day nutrition early enough

or just enough in general. This can be make or break on race day and hitting the wall is a real

thing in endurance events like the marathon.

It is also important to be fueling yourself well throughout your training blocks to help with

recovery and getting enough calories in to help with the miles.

5. Shoes make a world of difference

Finding the right pair of shoes for you not only decreases your chances of injury but will make

running so much more enjoyable. Always try on multiple shoes to see what feels best for you

but also get someone that knows what they are talking about so they can recommend the right

shoes for your foot type and guide you on your way. For this I cannot recommend The Running

Company enough, the team is super knowledgeable for all your running needs.

6. Invest in yourself

This can be done in multiple ways whether it’s physio, yoga or massage it is super important to

check in with your body and see how things are tracking. You’ll catch niggles before they

become problems or areas that need more attention as the miles ramp up and keeping you

training smart.

It is never an easy task to run 42.2km but its a super worthwhile challenge that will push you to

your limits.

If you have any further questions or want to talk more about anything above get in contact matt@balanceinmotion.com.au

The "New" Pain Relief: Mindfulness

I remember when I first graduated from Physio school and someone actually gave me a job and I could practice on real life patients. My mind was in constant panic mode, thinking about what i’m doing next, what did I just do? Can I even feel what’s wrong? Are they going to be worse?  It was a constant state of fight or flight, or in my case FREEZE. 

Ironically the biggest thing I've learnt in 23 years as a Physio is that the more present, or mindful I am, the better I am at my job. The more present I am the more I can feel what is wrong, what needs to happen and what we need to solve. In some ways it is a very therapeutic job where the less you think, the more you feel. 

This led me down the path of mindfulness, breathwork and everything in between. Interestingly, along the way, I discovered that people in pain also respond incredibly well to mindfulness. Becoming more present and observing, rather than judging, calms your nervous system and reduces the noise coming out of the pain centers in your brain! 


Our brains are constantly thinking. It could be a negative replay of something someone said to you the past week. It could be a previous negative work experience that you keep reliving over and over. It could be something you're worrying about in the future. It could be all of these things all at once! It’s like having your computer on and you have 36 tabs open all at once (guilty). Being mindful or present is simply shutting all the tabs and just looking at one. Your breath, your surroundings, what you’re feeling, or what you’re hearing. Focusing on one of these to help you be present in the moment. For such a simple concept it took me far too long to understand it.

My current understanding is that being present in the moment is focusing on what’s around you currently without judgment. Looking at the sky and not attaching to it whether it’s a lovely sunny day, or it’s raining and miserable. 


“The present moment is all you ever have. There is never a time in your life when your life isn’t this moment”. Eckart Tolle 

So how does this relate to pain, injury or improving sporting performance?


There are a few ways and a lot of research to show that mindfulness meditation, breathwork, or mindset work are incredibly powerful. Here are 3 quick reasons based on systematic reviews and randomized controlled trials 


  • A study of 75 people with chronic pain, who did 4 sessions of 20 minutes of mindfulness meditation in a week, reduced their pain intensity by 27% and had reductions of pain unpleasantness by 44% when compared to just resting alone! On functional MRI’s of their brain, there was reduced activity in the pain centers of their brain. 

  • Also in chronic lower back pain, mindfulness was found to be twice as effective as painkillers in pain reduction!

  • Another cool study was that after 8 weeks of meditation, there was reduced activity in the amygdala of your brain. The area responsible for stress and anxiety (known to increase pain).

 If you think about being injured or in pain, there can be unhelpful subconscious beliefs that can be adding to your pain. Common things can be “I thought I'd be better by now, but here I am still in pain”. “All i’m trying to do is get better, but the work cover case manager doesn’t believe me”. Finally my fave  “i’m going to need a knee replacement, it’s definitely bone on bone”. These unhelpful thoughts are on a reflex loop. Going on - and on - and on, all day. 


Mindfulness meditation, or breathwork, is like a factory reset of your phone. Getting you back into the calm relaxed state your body requires to heal and repair, and muting those lovely negative thoughts. 


For athletes, being in the present moment or “flow state” is the name of the game. The less you're thinking, the better your performance. Mindfulness is like exercise. The stronger you can make your ‘mindfulness muscle’, the longer your attention span will be able to focus, the more you can get into the flow state where you play on instinct.


So how can I start being mindful? What’s out there? I googled it and gave up.


Personally I've found apps are the quickest and easiest way to get started. I have an annual subscription to Headspace, and it is worth every cent. There are multiple series on anxiety, stress, sleep, performance and everything in between. I regularly do the anxiety series. Each day it begins with a brief explanation of anxiety and then begins with a meditation, focusing on your breath or scanning your body. You get a free 30 day trial and that’s enough to see whether it’s for you. 


Calm is another option, similar to Headspace. Great app and even has sleep stories by famous celebrities and athletes.  I personally liked the LeBron James series. 


If you want to go somewhere and learn. I’d recommend these people, based in Sydney, who do an 8 week course on reducing stress, anxiety and pain. Click HERE to check them out


You could also try two mindfulness exercises right now! 

  1. Breathing: through your nose and out through your nose x 3. Now breathe in for 4, hold for 6 seconds and out for 7 seconds x 10

2. Name 5 things you can see. Don’t label them as good or bad just name them. Name 5 things you can hear (close your eyes if you want). Name 5 things you can feel. Again no labels. 


How does that make you feel? Calmer?

The cool thing is you can do these anywhere. At work if you’re wound up, with the kids when they are kicking off or on the drive home from work. 


Give it a try. Commit to it for around 4 days per week, for at least for 3 weeks. It’s ok to be constantly thinking. I like to think of them as exercise reps between thoughts. Good luck and email me for any advice. I’m doing my trainers certification at the moment because it’s made such an impact on my life. 

Help I've Just Strained A Muscle What Should I Do?

You're running at full pace then all of a sudden it feels like you've been shot in the leg. You look around and no one is there. Suddenly you can barely walk. Straining a muscle can be extremely debilitating when it first happens. It's a pretty scary thing, particularly the first couple of days, because you literally can't walk.

Your management in the first week makes a huge difference to how quickly you're back on the field or training. Most people are back running within 4-9 days post muscle tear with the right management. 

So I just wanted to go through that initial phase of management so that you can get back to what you love doing asap.

OK so you've just pulled a muscle, but you need to go to work that day. In that scenario, I would work from home or have a sick day and literally sit on the couch for the first day or two. The muscle has been strained, there is no healing taking place for the first 48 hours and walking around excessively increases the damge.

So don’t rush around, use this time to minimize the damage. They've done research where the less you do for that first couple of days the better your outcome is.

I like the acronym POLICE for management over the first 48 hours.

Step one, PROTECT. For that first 48 hours you're not going to do much walking at all. Put some Tubigrip or COMPRESSION bandage over the top of it. Wear this during the day and take it off at night. ELEVATE your leg on a couple of pillows on the couch to help drain any swelling out of your leg.

Next up is OPTIMAL LOADING. After the first 48 hours you actually need load in order for that muscle to heal. Optimal load doesn't mean go for a 20K walk but it does mean start gently walking on it. This is when you need to come in for Physiotherapy. By day 3 new scar tissue is beginning to be laid down and that actually needs the exercises to do a great job. We will also give you exercises to stop any muscle wasting in other areas. You may also be on an exercsie bike at this stage to maintain your fitness.

We actually see more problems from people that just do nothing for a couple of weeks than we do with those that started to get moving after that first two days. You will also get back on the sports field signifcantly faster that if you do nothing for 2-3 weeks.

Should I take voltaren or neurofen?

Most people are taught that racing for the Neurophin or Voltaren helps reduce pain and inflammation. But that actually is a bad idea, because what it's doing is it's delaying your scar tissue. And in this scenario we actually want scar tissue, because that's what our body lays down to repair muscle. So don't use Voltaren or Neurofen if you have strained a ligament or muscle. If it is really bad, use ice or Panadol to help kill the pain.

So to summarise

Step one: take some time at home to chill for a day or two to reduce more bleeding.

Step two: use compression bandage to reduce the swelling

Step three: elevate your leg on a couple of pillows on the couch

Step four: optimally load your injury after the first 48 hours to start to help strengthen the new scar tissue

Step five: Book in to see your Physiotherapist to begin rehab of the muscle strain

Once we have set up the muscle strain to recover well most muscle strains return to sport 6 days either side of 31 days with the right Physio rehab program. We will normally get you jogging within 5 days for hamstring injuries, 7 days for calf strains and quadricep strains at day 7.

So if you have injured yourself. Come in at day 3 and let’s get you back to training asap!

You can book an appointment at either our CBD clinic or Bondi clinic HERE

A Worrying Trend With Teenagers and Young Adults

I remember being a teenager and wanting to have a six pack. At that age, you’re learning about life, you’re learning about your body, you’re comparing yourself to everyone else. That was without social media, its ‘Influencers’ and myriad of filters. I honestly can’t imagine what it’s like these days to be a teenager, or young adult. 


What I am seeing in teens and young adults, however, are the results of failed attempts to achieve unrealistic physiques, presumably following social media trends, across all of our clinics - in both NZ and Australia. 


To an extent I'm sure there will always be an obsession to get “jacked” as a young person starting to take agency over themselves and how they present to the world. But … the process, or way I'm seeing kids go about getting “a six pack” is completely wrong.


#nodaysoff and #200pushupsperday is not how you get jacked. It’s the opposite - a great way to get huge muscle imbalances and shitty posture. As a result, I'm seeing kids in a lot of pain from these muscle imbalances and poor posture, who frankly are too young to be getting these injuries! All of which are mostly sustained from focusing on a single exercise, such as a sit-up or a push-up.


I recently treated a 20 year old who needs surgery after giving themselves a hernia from doing 600 sit-ups per day, 7 days a week -  #nodaysoff.


To be honest, I actually love push-ups as an exercise. It involves a lot of muscle groups and studies have shown doing them can reduce the risk of cardiovascular insult, such as a heart attack.  But having watched a bunch of you doing your set of 80 push-ups, your form starts to fall apart anywhere from 15-25 reps. So as a physiotherapist, observing you do anymore beyond that, let alone another 60, is like watching a car crash. And many of you are doing it multiple times per day.   


When I ask why patients are doing this, the most common reason I hear is ‘to grow muscle’.

But muscles need recovery to grow, so #nodaysoff actually leads to the opposite for most people. Muscles grow when you do more sets and less repetitions, with the last few reps of the set being the most challenging. Always ensuring great technique throughout! 


Then, train a different muscle group the next day, to give those ‘just worked on’ muscles a chance to recover, rebuild and grow. 


Otherwise, only working one muscle group every day, focusing on just one or two exercises, also leads to one set of muscles getting really short and the others getting really long. Which can effectively make teens and young adults look like a turtle, complete with a rounded spine and head poking out at the top. If done enough, this is what leads to a lot of pain at an age where you just shouldn’t really be in any. 


The muscles also get really short because as you grow your bones grow faster and your muscles are playing catch up. Which leads to more compression on your joints. 


So, what should you do?


By all means if you're doing a challenge - go for it. But reduce your reps and increase your sets, so you can keep your form. When I film people’s form from 25 reps and up, they get a shock at how bad it looks. So remember - more sets, less reps!


It’s also good to try different push-ups e.g. wide grip, narrow grip and decline push-up positions. 

What else?


Do the opposite muscle group the next day. For example, one day do your push- ups then get a pull-up bar and do different forms of pull-ups. 


Do abs one day, then do some back extension work the next.


Finally, the number one rule - give your body a chance to recover. Go for a walk, or swim. Chill and rest. Believe it or not, this is when your muscles are doing the most growing. 

Outside Hip Pain: Here Is What To Do

If you’re having a lot of hip pain at night particularly towards the outside of your hip and you are perimenopuasal or menopausal you potentially have outside hip pain syndrome. We used to call it trochanteric bursitis and occasionally it is called Gluteal Tendinopathy. The great news is there has been some amazing research out in the past 5 years which shows exercise therapy is the most effective intervention. Far more effective at 12 months than surgery or a cortisone injection. 


Why does menopause affect it? Because of the lower levels of oestrogen, this can lower the collagen in tendon repair. So tendons can become stiffer and thinner, making them more prone to injury.

What else makes the outside of your hip worse aside from sleeping?

Sometimes night pain is the only symptom and can be really painful.

Walking up hills, going up stairs, sitting to standing can all hurt. Also this first few steps in the morning can be a problem. 

What can I do to manage this pain?

The first thing we try and identify is how many steps you take each day. If walking is making you worse we will initially reduce your step count by 50% until the pain is under a 3/10. It literally is a completely unique step count reduction per person so this can vary greatly depending on severity of symptoms. 

Reduce stretch on the gluteal muscles against the outside hip pain. This is really counter intuitive because it feels stiff so you want to stretch it BUT stretching makes it more sore. Modify positions like leg crossing, standing leaning to one side or doing loads of pigeon pose.

Change your sleep position. The best position is lying on your back with a pillow under your knees. The next best is sleeping on your non sore side with one or two pillows between your knees.

Start strengthening your glutes isometrically. Isometric just means contracting your muscle without moving. Again this varies between people and no two people will probably have the same exercise. You can start with a bridge on your back. Make sure your knees are over your feet and hold for 30 seconds x 5. At least once per day. The best thing to do is come in and get your exercise program prescribed.

Get your walking or running assessed. Sometimes this is the most important part. It can be as simple as your knee crossing the midline when you walk or reducing your stride length slightly. It is hard to assess yourself so better to get one of use to do it for you.

We also generally will assess how you go up or do stairs and modify this as well.

So outside hip pain is very manageable. It does take around 3 months to really go well because tendons are slower to recover. However it is worth it to escape the night pain! If you think you need some help to get on top of it you can click HERE to book online






Common Running Mistakes We See Before A Running Event

We are absolutely pumped about the City To Surf this year. The bands playing, people supporting and those guys painted blue in Rose Bay. Less excited about Heart Break Hill, but it will be awesome. Whether you're running, or walking, who cares. It will be fun. Even our kiwi team is coming across the ditch for it. 


With 7 weeks to go until the City To Surf, it’s a good reminder of what mistakes we see and how not to make them.


1: Going for a larger distance too quickly

With new runners, the running injuries we have seen lately have been due to the amount of mileage increasing per run too quickly. For example a patient we saw two weeks ago, had just run for the first time in 2 years. Now that’s a long time between runs and by day 5 unfortunately an injury had developed. The progression was day 1: 3km, day 2: 5km, day 3: 7km, day 4: 9km day 5: 3km and limp home 

Another example is someone with no running experience in life and who didn’t really play a lot of sport as a kid entering a half marathon. My advice would be to train for a 5 or 10km run first. See how your body tolerated the load. If you were feeling great go for a half. If it felt like hard work then enter another 10km then consider a half. 

A good range is probably a maximum of 10- 20% load change per week. And that is per week not per run! 

This gives your body a chance to recover and adapt slowly to the new load. Every single person is different so you may be slower than this to progress if you haven’t done much previously or you have medical problems getting in the way. Or previous injuries. Never compare yourself to your friends.

Speed is the other issue aside from duration. Going too early to sprinting on a background of not much running is a risk for tearing a muscle or overloading your lowerlimb tendons. 

The reality is that research suggests that 80% of our running should be cruisy recovery running. Simply turning over the legs. 20% should be tempo running of a higher intensity. 

If you are stuck with figuring out a program after everything I’ve just said keep it simple!

Change one of the above per week only and don’t increase the above by more than 20%.

If you’ve been injured in the past 12 months re read the first part of this a few times until it sinks in!

If you want to check your program is right for you, then to shoot me an email HERE.

What else can cause running injuries?

Mistake 2: Not Adding Strength Work. 


Strength work is one of the only evidence based things that has been shown to reduce injuries. The trick is to know when to put it in your program and how much. If your not sure where to start i’d suggest trying this nice little workout we created. You can click HERE to check it out. 

Mistake 3: Not getting assessed if you are getting niggles

There are a lot of muscle imbalances or technique issues that can be changed quickly. We highly recommend getting onto things quickly. We very really woulkd stop you running as most injuries need loading to help heal. The only exception is bone stress. So don’t be afraid of being told you can’t run. Get filmed. Understand what is wrong, how you can fix it and carry on training. 

Mistake 4: Not Having The Discipline To Rest!


Trying to play catch up on a session you missed earlier in the week is not a good idea. Your brain is telling you that you need to do more but doing too much is just as bad as staying in bed. It’s better to be underdone by 15% than over done. Trust me after 23 years this holds true. Making the start line is the biggest battle for professional athletes, so should be the same for you. 


Mistake 5: Running In The Wrong Shoes


Probably not that much of a big deal for the City To Surf but if you're training for the next half marathon or more it is. Going to a shoe shop that knows their shxx is worth it. Todd at the Running Company is my guy. I can’t recommend him enough. Worth the trip down to the shire. Click HERE for his details. I’ve seen it all, changing shoes the week of the race (yes even pros do it), going from super supportive shoes to minimalist shoes. Changing shoes then doing a 5km time trial. Don’t be that person. Invest in your shoes. It’s actually a pretty cheap sport. 


Mistake 6: Not tapering


Again the battle is to get to the start line. I hate tapering. It's the worst. You're addicted to running and you’re fit. Now you have to do very little. It’s absolute torture. Take it out on the race with a full tank of gas. Don’t go into a race with tired legs unless your coach is doing it for a reason. 

That’s it. Enjoy running. It’s addictive and great for your mental health. 

Can’t wait to see you all at the finish line.

Nick 



Do You Have Sit Bone Pain?


If you’re suffering from lower buttock or sit bone pain it could be your hamstring tendon. It  literally becomes a pain in the ass as it can hang around for months/ years


Your hamstring tendon is normally injured with a sudden change in walking, running or over stretching your hamstring.


Common examples when walking can include a walk where you were walking faster than normal to keep up with someone taller, more walking up hills or just more speed walking


Running follows the above with more running with speed, hills or just way more running thant your used to


Over stretching your hamstring tendon can look like doing a bunch of yoga such as a retreat, loads of weeding in the garden or slipping over and over stretching your hamstring


When your hamstring is sore it usually hurts to sit on. Particularly hard chairs or driving in the car. Sometimes this is the only symptom.



Getting out of bed in the morning is sore and it feels like you want to stretch it but quite often this makes it worse!


Pain is generally localised to your sit bone or very close to it. 


Why am I getting pain?


Essentially the hamstring tendon has become enlarged, filled with water and is now compressing against the bone which causes the pain. Any time your tendon pushes against the hamstring bone or it is stretced this causes the pain.


For example things like It doesn’t like cleaning your teeth, gardening and stretching can flare it up so….


How do I get rid of this hamstring tendon pain?


Unfortuntely it can take up to 21 days to get the pain under control followed by an exercise program that lasts up to 12 months. Unfortunately tendons are the slowest healing structure we have. Muscles normally are good to go with the right rehab in 28-36 days. Bones 4- 8 weeks depending on where they are and tendons are generally 12 weeks due to their poor blood supply. 


It’s generally a combo of things that help such as reducing stretch on the hamstrng throughout your day combined with specific exercises that need to be progressed and a mechanics assessment. What isn’t working that is causin your hamstring to work so hard. 


So try some the below 

1.Do not stretch it if it is sore! I know you want to but stretching actually makes it worse. Sit on a pillow or ideally stand when you can until the pain is under control

hamstring tendon do not stretch

2. Consider neurofen if it’s really painful as this has been showing to calm tendon cells (please check with your doc or pharmacist first)

3. Sit on something soft or stand to take the pressure of the sensitive tendon

4. Do isometric exercises. I’m going to show you a couple of these below.


It’s also important to know rest doesn’t help tendons heal. Exercise helps settle them down, reduces pain and normalizes tendon function. These exercises need to be challenging and progressed regulalry with your Physio. 


We always start with isometric exercises away from where the tendon can be compressed.


Here are 2 options 

  1. Hamstring curls (see video below for instructions)

  2. Wall BridgeBridge 


So a combination of the above will defintely help reduce your symptoms initially but you should really involve a Physio to properly structure your program. It is also important that you understand what went worng and what areas need rehabbing to stop it coming back. 


People can become disillusioned with this injury because it literally can be there for years but… If you get through the initial 3-4 weeks of work it takes to get on top of it you will generally come out on top and get back to what you love. 


f you think this might be you but want to make sure click the link HERE for a free 10 minute phone consult or click here to book yourself online 













Is All Inflammation Bad?

There are plenty of social media gurus telling anyone who will listen that all the problems in your life are down to toxic inflammation and your lifestyle is the cause of all the inflammation in your body. The question is, are they right? And is this inflammation bad?

They’re partly right and partly wrong.

Inflammation is our body’s response to stress it encounters. The gurus on social media have this part right. But not all inflammation is harmful. In fact, the body’s inflammatory response is not only helpful in some situations, it’s actually vital to our survival. This is the part the poorly qualified influencers on Instagram have gotten wrong.

We’re experts in the injury and exercise world so we are going to stick to talking about inflammation in these situations for the most part, but when thinking about whether inflammation is harmful or helpful, consider how the body recovers from a cold or the flu, or when you cut your finger when making dinner.

The body’s response to a cold or the flu is to increase the production of various cells in body, like white blood cells, to fight off the infection. This inflammatory response kills the infection and prevents us from dying. When you cut your finger, the body sends an army of cells to repair the cut and restore your finger back to normal. This occurs because of an inflammatory response, which is needed for repair.

In the exercise and injury world, the previous best practice and immediate management of acute injuries was RICE – rest, ice, compression, and elevation.

It was believed that ice stops the inflammatory response and prevents further damage occurring after the acute injury. While we know that prolonged icing does reduce the inflammatory response, we now know this is a vital response to allowing the injury to heal.

Inflammation in response to an injury like rolling your ankle is a key part of recovery. The increased blood flow that causes the swelling occurs because your body is sending an army of healing properties and extra nutrients to the injured area to kickstart the healing process. Prolonged icing reduces the number of good soldiers coming to help you.

Ice is no longer recommended as a key part of the initial response to injuries but it can play its part. Ice is incredibly good at numbing the area it’s applied to, which can help reduce the pain associated with acute injury. After this pain is under control though, there is little role for ice to play.

When you exercise, your muscles, tendons, ligaments, bones, and other tissues in your body undergo stress. This stress results in an inflammatory response that increases blood flow to the area, along with increased nutrients and oxygen that help repair the small amount of damage that occurs. The inflammation and associated repair help build muscle, strengthen tendons and bones, and reduce the baseline level of inflammation in our body.

In longer term injuries, inflammation can help kickstart and aid in your recovery. The small amount of inflammation in response to exercise assists in repairing damage and improving the ability of your injury to become stronger. Over time, this results in successful recovery and rehabilitation from your injury.

This is why, as physiotherapists, we are not necessarily concerned if you experience a small amount of pain while exercising, but this shouldn’t be a large amount of pain that persists for an extended period of time after you finish exercising.

In short, the inflammatory response to small amounts of stress helps to reduce our overall level of inflammation and build our body’s tolerance to stress.

If the body is exposed to longer periods of inflammation, or chronic inflammation, there is the risk of conditions like heart disease, stroke, diabetes, and cancer developing. But this is a topic for another time and other experts.

You shouldn’t be concerned at a small amount of pain or inflammation, particularly when recovering from an injury. Inflammation exists as the body’s defence mechanism and recovery process.

Have I Got Kinesiophobia?

Kinesiophobia! 

Sounds like a pretty severe phobia doesn’t it. 

Basically it’s a fear of movement. 

They’ve done studies on people who have dislocated or subluxed their shoulders. Then had them surgically repaired with a solid physio based rehab program. They are objectively in great  shape, yet anytime they lift their arm out to the side, using some rotation, they hit the panic button. 

They’ve also done similar studies in people who hurt their backs bending forward. For months, to years afterwards, alarm bells start ringing when they have to bend forward. 

Another example is when someone's been told by a surgeon “i’ll see you in 3 years for a knee replacement” so the patient purposely uses their knee as little as possible to make it “last”.

Our job as Physiotherapists is to restore confidence and stop kinesiophobia. We purposely challenge people in areas that provoke a lack of confidence, so as to prove and strengthen the body's resilience.

I recently treated a patient who slipped and tore her hamstring almost completely off the bone. She was barely able to walk for months'. I worked with her over a quarter year period. She was running again, super confident with every step. I then purposely added an exercise where she had replicate the movement she injured herself with. There was no muscle resistance needed for this exercise, it just required sliding her leg out. To put it into context she was able to single leg hamstring curl 30kg and dead lift 60kg. But the movement out to the side triggered old emotions around the accident and fear. We had to work through that to break the “ghost” of the injury and award her more movement options to live a better life. 

We always wait until you're strong enough to challenge areas being rehabilitated, however it does trigger emotions around the initial injury. BUT it’s important to work through them.

It’s vital so that you can go and live your life again, doing what you love without that ghost injury constantly haunting you 

What To Do With Neck Pain That Won't Go Away!

1/3 of neck pain after an injury can hang around for over a year. That’s quite a large stat.

Whether that is in the form of your neck catching every time you move, an ongoing ache that comes at the end of the day, or purely your neck feeling stiff and noisy when you wake up.

Research is beginning to come out on solutions for persistent neck pain. 

The two key and MOST effective interventions are a combination of exercise and “hands on” Physio. 


EXERCISE
 


This can be specific neck muscle retraining. Subtle exercises targeted at the smaller endurance muscles are option 1. We try and incorporate these early. Firstly because they can be done pain free even when your neck is very sore. It also builds from the inside out, meaning once the key stabilizing muscles are going their job well we can then focus on building neck strength in the bigger muscles. Doing this early means that within 6-8 weeks you are seriously reducing your chances of your neck pain persisting.


Another exercise option that has been studied is global postural muscle strength exercises. This focuses on posture globally, working larger postural muscles with bigger exercises affecting multiple muscle groups.


They did a study comparing the above interventions against each other relating to persistent neck pain. They both signifcantly improved neck pain however they couldn’t determine which was more effective. They concluded they were both effective.


Here at Balance In Motion Physio we like to throw the whole kitchen sink at neck pain and combine both interventions.


Making sure the deep little muscles are working through the ranges you need, then introducing the bigger gross postural and strength exercises to build resilience in your neck.


We combine this with imagery cues to make sure we get the most specific contractions possible to enhance results.


The final exercise intervention that has been shown to reduce persistent neck pain is cardio. Most people that suffer from this find going for a 40 minute walk or run makes them feel considerably better.


If you do get neck pain with walking make sure you come in and get your gait assessed. It sounds like you are using your neck muscles to walk. When we film you walking, you will see for yourself why you are getting neck pain.


I wanted to go through a couple of basic exercises from each of the above exercise groups for you to try. I’ve added videos to make it easier for you to understand.

Exercise 1: Deep Neck Flexor Isometric Holds

This exercise wakes up the deep neck flexors of your neck. Their primary job is to hold the neck joints in a snug stable position and prepare your neck for movement. In pain they can be inhibited and the shallow overactive smuscles take over. These bigger muscles weren’t designed to stabilize your neck so get tight which leads to sore compressed painful joints and muscles.

The exercise is essentially doing a gentle nod or yes motion with your head, making sure you aren’t overusing the front neck muscles. It is subtle and you won’t feel much. Hold for 10 seconds and repeat 10 times.

Exercise 2: Deep neck flexor hold in neck flexion

This is a far more advanced version of the first exercise. It requires a lot more neck strength. Don’t try this without at least 1-2 weeks of the initial exercise. Watch the video for instructions

Exercise 3: This is a great postural exercise for necks. If you notice your head sticks forward relative to your shoulders, this one is for you. You should never feel pain. It should feel challenging but manageable. Ideally hold for a few seconds and build your endurance from there. Once you are doing 6-8 x 30 seconds you are doing well.

Every single neck that walks through the door is different and generally requires a very specific tailored approach. Alot of neck injuries aren’t caused by the neck but the neck joints are a victim of some other part of the body not working optimally such as the shoulder, trunk or pelvis. Yes sometimes treating someones pelvis once immediately removes their neck pain. We think it is pretty cool too.


HANDS ON PHYSIO

In order to help restore balance to the neck we use “hands on” physio techniques. We then progress to adding hands on techniques through all the movements we do during the day. Why? because we don’t live lying face down on a treatment table. 

Once the neck muscles begin to wake up we can start heading towards the exercises above. But quite often we will use “hands on” physio while you do the exercise initially. This helps you get the feeling of what your neck should be doing through out the exercise.


Why hold your neck in an optimal position? To see whether the exercise is going to make you better or worse. One exercise can be effective for someone but not for another person. Prescribing exercises that have the same positive effect on your neck as “hands on” physio is the name of the game. An art as well as a science. You could get 5 people next to each other and those same exercises could have 5 different effects. Put together 4 good exercises that target neck control with upper body, lower body, abdominal control and you start to really solve the problem of persistent neck pain. 

So try the above exercises. See whether they work. It’s ok if they don’t. Your neck pain may not be caused by your neck! Just come in and let us help figure out your unique neck pain puzzle. If you do want some help now you can click HERE to book an appointment. Otherwise if you want a free 10 minute phone consult with our Physio team to see whether we can help click HERE









Try These Sleep Positions If Pain Is Keeping You Awake!

Some injuries can hurt at night. In particular, tendons (the bit at the end of a muscle that attaches to bone). When you injure a tendon they become enlarged and are very sensitive to stretch, or  pressure against bone. For example, if you have a sore outside hip tendon and you lie on your pain-free side, it can wake you up because you are bringing that leg across your body, stretching the tendon against the bone below. This is really, really painful.

If you have overloaded your shoulder rotator cuff tendons, lying on your sore side will generally wake you up. This occurs due to the enlarged tendons pushing against the boy structures above them.

The problem with this is the lack of sleep. We really need good quality sleep in order to repair. The more optimal sleep, the better the recovery. 

So i’ve gone through the body from neck to foot with some sleeping positions to try to help you get a better night sleep depending on your injury.


Remember a better night sleep is the key to healing and recovering from an injury as quickly as possible.  A minimum of 6 hours and ideally 8 plus hours of sleep.

So before you try some of these tricks remember you need good sleep hygiene. This is a quick summary from a blog I wrote on sleep hygiene but you can also read it HERE


Sleep tips

  • Put your phone on flight mode an hour before bed.

  • Have a shower before bed.

  • Dim all the lights in the house an hour before bed.

  • Don’t ingest coffee 8 hours or less before bed

  • Meditate for 10 to 20 minutes then read a book before going to bed.

So once you’ve ticked all those boxes try the following positions 


Neck Pain:

Sleep with a rolled up towel under your neck and wrap it around like a scarf. It stops your neck twisting when you sleep. Play around with one versus two pillows but ultimately the neck needs to be neutral and not side flexed to one side.


Shoulder pain:

The idea here is to sleep on the non sore side or your back. Sleep with a pillow in the arm pit to create space for your shoulder tendons to not be compressed by the boney architecture.


Back pain : Similar to the neck you are just trying to get the spine in a more neutral position. Try a pillow between your knees or lye on your back with pillows under your knees.


Hip pain: if the outside of your hip is sore then I would scoop your hips so there is minimal pressure on your outside hip. Otherwise ideally sleep on your back with a pillow or two under your knees. Another option is to sleep on your non sore side. Just remember the pillows between your knees to stop your sore side crossing the midline.


Knees: Don’t generally like being overly extended or flexed. So pillows under your knees is a good place to start or between your knees and ankles. Also a good idea to raise the injured side to the limb is above your heart.

Try these positions if you’re getting pain at night. Try getting some good sleep hygiene to maximize your ability to be able to sleep so you can get out of pain and back to what you love as quickly as possible.


Remember that if this isn’t helping your night pain and you don’t recall a possible reason why you are in pain, then you must see a doctor as soon as possible. Other things can masquerade as night pain and it is important to not forget about those. 









Not All Shoulder Pain Is Caused By The Rotator Cuff

A lot of shoulders get better with a standard approach. Get the rotator cuff working well, sort the shoulder blade mechanics and reduce the load through the tendon for a little while and they slowly but surely get better over 8-16 weeks.


But what if that doesn’t work. What if the exercises make it worse?


The simple answer is that there is probably another area in your body that is not working well. This causes your shoulder to over work or puts your shoulder into a compressed unhappy position. Working an already compressed overworked joint with rotator cuff exercises will simply make it hurt more.


So what other areas could be causing the shoulder to be more compressed?


It could be anywhere from an old ankle sprain to altered painful hip mechanics. The more likely scenario is it is something close to the shoulder. The rib cage which the shoulder sits on or the neck which the shoulder sits next to. The link are the muscles and fascia which connect the two areas.

It is normally two levels of your rib cage or neck that can cause the problem but there may be the following in your history which makes it become more apparent that it isn’t just your shoulder


1. The pain moves to the opposite shoulder from time to time

2. You recently changed from being more active to a more desk based job

3. Desk work bothers it

4. You play sport that is asymmetrical or have habits that are asymmetrical eg racket sports, holding kids, kick boxing

5. Pain will move through to between the shoulder blades or neck and no amount of foam rolling or spiky ball work helps

6. You’ll also get headaches or difficulty twisting your neck or trunk

7. Your shoulder pain comes back 2 days later after treatment

8. Your breathing feels off or you just can’t take a deep breath no matter how much wim hoffing your doing


If you suspect this is the case a Connect Therapy Hour assessment is a good way to delve into what is actually going wrong. 


A big focus is on your unique story. How potential past injuries may influence your body now, what habits and work may also influence your body. It looks at all these old injuries or areas affected by bad habits and assesses how they link with your painful shoulder. 


Does correcting them into a better position offload the shoulder and help you immediately move better? 


Do the two areas make each other worse? 


It helps answer these questions and finds a way into your system to create immediate rapid change. How? By “disconnecting these fascially stuck” areas and creating space via our hands,  acupuncture needles and mindful movement to help solve the problem long term. Not just a temporary bandaid solution. The goal is to strengthen those weakened areas whilst also rehabbing the painful area for great long term results. 


The rib cage and neck make up to 20% of whole body length and up to 35% of your body’s mass. If you have imbalances in muscle control of your thorax, it can result in a lean of your thorax to one side – left or right – and you will then habitually and repetitively end up loading one shoulder more than the other – this often explains why repetitive loading your shoulder makes it worse!

The rib cage is the centre for trunk twisting. Think of how many movements require your trunk to twist well from running to twisting in your chair to look at a second screen. If this isn’t working well your shoulder compensates and has to twist more. 

It is generally from a postural habit you have or an old injury. The good news is that old injuries can be rehabbed. They are normally muscle imbalances that require a guided program to get better so don’t just think it can’t be fixed. It’s simply a matter of understanding your unique story and how it may influence your shoulder. Then it’s a better of decompressing that area and then balancing out the system which is a combination of down training tight muscles and up training weak core muscles followed by a good strength program that progresses slowly. 

Check out this video which shows a shoulder moving in a less than optimal way causing persistent pain over months of repetitive strength training. The cause of the problem was actually a muscle imbalance around the trunk (secondary to limping from a hip injury). As you can see when this imbalance is corrected via a thoracic ring correction the shoulder immediately moves in a better way. Retraining this new pattern will fix the shoulder pain for the long term as opposed to a bandaid temporary fix!


If you feel this could be you send me an email with your story to nick@balanceinmotion.com.au. I can tell you whether we can help, which Physio you should see and if I don’t think we can help I can recommend somewhere that can. 

OR you can click HERE to read more about Connect Therapy.