Why Does My Squat Hurt And What To Do About It

Squats aren’t bad for your knees or your low back. In fact being able to squat well is essential for life. If you can squat well you can sit well. Squatting well protects your low back from injury, creates happier healthier hips and is a compound movement requiring lots of muscles to work. It also triggers the release of testosterone and human growth hormone in your body. 

So here are a few common patterns we see with the squat 

Poor knee alignment: This is when you squat and your knees start tracking inwards excessively. It’s really common on one side of your body. Take your shoes off and squat in front of a mirror. Look at each knee and line it up with the middle of your toes. Does one look more inwards than the other? This can cause all sorts of problems which lead to pain.

Solution: Try using some thera band around your knees. Squatting and lightly pushing out into a band can wake up your hip muscles and help them turn your knee out. Remember it is subtle and using a mirror for feedback will really help. You can take it too far and push too far out. This can lead to knee pain as well so use your good side as a reference and if you get stuck come into the clinic and we can help you. 

Squatting with a twist: Some people squat and as they squat their body twists and their body squats to one side. So essentially their base of support is to one side. This can put excessive pressure through the structures on the side you are squatting to and excessively stretch the opposite side. 

This can be from an old ankle sprain whereby you never gained sufficient range of motion, increased hip and low back restriction on one side also again due to injury or muscle imbalance from sport or work habits (leg crossing).

Solution: I recommend using a block or rolled up towel under your heels. This will give you more space to create a good squat technique. Also consider reducing the depth of your squat until you solve the problem of why your ankle, hip or back is restricted. Yes you can still rehab an old injury you should of rehabbed 10 years ago. It is never too late so don’t give up on those ones! 

Butt tuck squatting: This is when you tuck your back side under, over squeeze your back side muscles and compress your hips as you squat. You’re essentially tucking your butt under. It isn’t great because it inhibits your actual glutes from working and creates really tight deep hip muscles which actually leads to hip and back pain. It’s a really important pattern to break.

Solution: Work on your hip hinge. Hinging from your hip helps create space for your hips to open right up. Some times you just shouldn’t be squatting until you solve this problem. There are two exercises we use here at the clinic to help teach people to hip hinge and not over use their deep hip muscles. The first is the four point rock and the second is childs pose. Both exercises help you relax your deep hip muscles and allow you to fold from your hips creating space in your hips and low back.

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We spend a lot of times as a Physio working on the squat because so many people have pain sitting. Squatting well into sitting is an important tool for reducing pain and leading to happier and healthier joints for the long term. 

If you are worried about your squat or sense something is wrong book an appointment. Once you have one of the team breaking down the different parts of your body to see where the problem is you will have an individualised plan to improve it. Just click HERE and you can book a time that suits you.

The Evolving Science Behind Sporting Injury Rehabilitation

A good motto we have at Balance In Motion is “understand the movements required for the patient to succeed and create resilience and strength in the body. Plus continually review changes in the science”

The way Physiotherapists manage injuries is constantly evolving. Personally i’ve come a long way from pushing the sore bit and putting machines on a patient 23 years ago. We now know that doesn’t work. Another example is when you just injure yourself we now recommend the POLICE protocol not the RICE protocol (more on this later). 

It is generally agreed that you break an injury program down into phases but with a very active exercise focused program. We now know that prolonged periods of pure rest can negatively affect the majority of injuries. 

It is also generally recommended that rehab is progressed via goals not time.  There is a very big time difference between a 23 year old full time athlete with nothing else to do and a working mum with 3 kids under 7 hitting the same functional goal.

The first acute phase such as rolling your ankle or pulling your calf is all about promoting tissue healing and down training old unhelpful movement patterns. 

This can be a frustrating time. Coming to terms with your weekly training routine falling apart, your mental health suffering from the lack of endorphins and your goals you wanted to achieve looking further away,

Traditionally, we were taught to employ rest, ice, compression, and elevation (R.I.C.E) with the aim of avoiding further tissue damage, reducing associated pain, swelling, and attempt to promote the healing process. 

Although recently immobilization and rest have been shown to have a potentially detrimental effect on muscle tone and strength. It was recently proposed that we as Physios follow a protocol inclusive of protection, optimal loading, ice, compression, and elevation (P.O.L.I.C.E) for initial acute injury management.

Early mobilization and tissue loading (generally after 48 hours) has shown to have a positive effect to promote tissue reorganization and tissue healing. Ideally as soon as pain permits. 

Reconditioning phase

Rehabilitation involving strength and conditioning looks very different between two patients. Strength for someone that has never used certain muscle groups could look like lifting there arms up on their back with 1kg weights. It could also look like squatting 100kg 3 days after tearing your hamstring.

 It is really important to monitor the persons rehabilitation to ensure optimum loading of injured and recovering tissues through an individualized approach. Just because something isn’t still hurting it doesn’t mean the tissue has fully recovered.

Gradually loading healing tissue plays a successful role in a rehab program. It actually has a name - mechanotherapy. Tissue needs more weight to heal. 

Return To Sport And Training 

Once you are ticking all the functional goals and feeling pain free it’s time to plan your return to training and sport. The assessment of risk is an art as well as a science. With more and more protocols being studied for different injuries and sports. 

Once the athlete is training, a partial return to sport is recommended, which may include not playing an entire game or coming on as a substitute.

Prevention Of Reinjury

A previous injury is the highest risk factor of reinjury and therefore, it is extremely important to monitor you even when you have returned  to full participation. 

Modern rehabilitation methods have significantly increased the time to return to the playing field compared with old school protocols We attempt to get someone on the field asap. If you have just had a sporting injury and want to get back on the field asap without reinjury, give us a call on 02 93650004 or click HERE to book online

What role does sleep play in injury recovery?

What role does sleep play in injury recovery?

Everyone knows sleep is a vitally important part of life. We need to do it at the end of each day in order to recharge our batteries for the next day and function like a human, not a zombie.

But why is sleep so important and what role does it play in injury recovery?

The human body has a lot of internal clocks that control how we function. Everything from when you feel sleepy or wide awake, when you’re hungry and when you digest food most efficiently, when you are alert with a lot of energy or drowsy, to when your heart beats fastest is all controlled by internal clocks.

These internal clocks, at least the ones related to sleep, are highly tuned to the sun. As we are exposed to light as the sun rises, our hunger levels, alertness, and even heart rate rise as well. When the sun goes down, our hunger and digestion rate slow, we become drowsier, and our heart slows. This shift happens because melatonin rises as it becomes darker and our body shifts into sleep, or repair mode.

During sleep, our body is able to rest from the effort it takes to be awake for the day. Our brain cleans itself of the toxins that naturally build up when we’re awake and the cells in the rest of our body take a break from being active. When we don’t sleep, our sympathetic nervous system (the fight or flight response) doesn’t get a chance to rest, which results in the increased risk of a number of diseases like diabetes, high blood pressure, digestion troubles, and dementia.

Where does all of this fit into injury recovery and rehab? Well, there are two ways a lack of sleep impacts your recovery from injury:

High sympathetic nervous system activity from a lack of sleep leads to increased inflammation in the body. While the body’s inflammatory response has a role to play in injury recovery, chronic inflammation does not allow the body to repair itself as needed. This lengthens how long you need to recover from an injury.

Sleep is where your body rests but your brain goes to work in strengthening its connections. Amongst connections like emotional regulation, sleep is where the brain remembers new information and skills learnt throughout the day. When we talk about the need to change the way you move or reprogram your body to recover from or prevent injury, sleep is when your brain does this best!

What can you do to help yourself sleep at night?

Our Western lifestyle doesn’t revolve around the sun like our internal body clock does so having a night time routine to promote sleep can be really useful in winding yourself down after a busy day and preparing yourself for sleep.

This might not come as a surprise but avoiding blue light (TV, computers, phones), avoiding eating late, and avoiding caffeine and alcohol are just some things you can do to encourage your body to wind down and prepare itself for sleep.

Your body needs to cool down in order to sleep so having a hot shower before bed can be useful. This increase in body temperature causes your body to ‘dump’ heat in order to cool itself, which can help make you sleepier.

Seeing bright light soon after waking reminds the body that it is actually awake. Get up and turn the lights on, or better still, get outside for your morning coffee or walk. Remember, the internal body clock revolves around the sun and light wakes you up.

In summary, you might hear us talk about sleep so much because it plays a vital role in your recovery from injury by firstly repairing any damage while you are asleep, and secondly by helping your brain and body form new connections to use the right muscles to help your body move well and stay injury free in the future!

Cheers

Nick Carr

Our Top Tips For Reducing Back Pain As We Get Older

I swear on significant birthdays your body just starts to hurt more. One common site for 85% of the human population is back pain. It can feel pretty awful when you get out of bed in the morning. Rolling over in bed can be a problem and putting on your socks makes you feel older than you are!

The two Nicks and Mitch have given some of their best advice to help reduce your pain today. 

Tip 1: Stop Sitting Well

Nick C: I have been changing the way people sit with lower back pain. A lot of people sit with 'really good posture' that places them in way too much spinal extension which compresses their back. I've been getting people to relax their tail bone and soften their chest to create a more neutral spine and people are enjoying it a lot. Effectively getting them to sit up less with far better results in terms of pain relief.

Tip 2: Posture in General

Nick C: Taking the above “excessive ” sitting posture, I recommend everyone try that same posture when they squat at the gym or stand in general and you instantly recognise how it places too much pressure on your back. Try relaxing your tail bone muscles and softening your chest in other positions to reduce compression on your back.

Tip 3: Add Some Variety: 

Mitch: Too often as we age we tend to pigeon hole our bodies into one type of movement, whether that be walking or swimming etc. Our body loves variety and still as we age it will adapt and change as we expose it to different types of movement stimulus. To help with preventing back pain as you age try starting something new for movement. Always start slow and listen to your body but with time you will feel your body change and adapt! 

Tip 4: Add Some Resistance: 

As we age resistance and load becomes even more important. Our bones, muscles and tendons need load to stay strong, and as we age we need to maintain these things. We need it in all our joints, not just our legs, so if your exercise is solely walking then look for some loaded exercises you can do for your arms too! Just remember that if you haven't been doing resistance training before, you will need help from a Physio, personal trainer, pilates instructor etc to make sure you are loading safely. 

Tip 5 Eat Less Inflammatory Food

Nick T: Processed food like burgers, fries and a few beers can increase the inflammatory load in your body. If you suffer from low back pain this will cause more back pain. Ever noticed how your back hurts after a weekend like that? Start to reduce your weekly alcohol intake. For example do you  really need a couple of wines from Monday to Thursday or Friday? Could you use a meal plan service or prepare your meals on a Sunday night to stop adding extra processed food to your week? Reducing inflammation in your body and adding fish oil and tumeric can really reduce your day to day pain.

Tip 6 Meditate Daily For 10 Mins

When you have had pain in the same place for more than 3 months it starts to become a “brain thing” as well as a “back thing”. The area of your back pain represented in your brain starts to enlarge relative to other parts of your body on the brain map. What does that mean? It’s creating more pain signals than is actually the case. Normal movement can suddenly be perceived as a threat.

Stress can make this pain worse as your nervous system is over stimulated. The simple act of returning to a focus on your breath can down regulate your nervous system and reduce your pain. Try breathing 10 cycles of 4 seconds in through the nose, 4 second hold, 6 seconds out through the nose. Twice per day. Otherwise try the app headspace for 10 mins per day. 

If you need some help with where to start. Come in and see Nick or Mitch to get a solid plan in place moving forward. They are normally booked a couple of weeks ahead so book online HERE

Knee Pain Over 40? Then Try This!

Over 40 with knee pain? Try this!

Not many people like clicking on these posts and admitting we are old but … doing these things really works.

Knee pain over 40 can present in a few ways 

• Pain the first few steps in the morning

• Pain at night that aches after more exercise than normal

• A giving way sensation or pain up and down stairs 

• Pain when you’ve been sitting or squatting for a while and go to stand

The most common thing people say to me when they come in is “it’s probably arthritis and i’ll have to live with it”

The most recent example I can think of was a lovely lady in her 60’s who loved hiking. She walked every day around 6-7kms and 3 x per year would go on a 3-5 day walk.

6 weeks prior she had done a hike that was around 5 hours and had more steps than she had ever done. She also hadn’t been on a big walk for a year due to covid.

She came in and immediately went with the “it’s probably arthritis isn’t it?”

“I think i’ll just walk with poles from now on and just walk once per week”

Yes 7 weeks ago she had no knee pain. My reply was “that’s a pretty rapid aging process of your knee in 6 weeks don’t you think?’

I reassured her that she will not be retiring anytime soon from walking. We constructed an 8 week program with Physio, Pilates and strength work and she did a 3 day hike 10 weeks later. I also saw her walking last week and joked “where are your walking poles I thought you had arthritis?”

All jokes aside there is no relationship between arthritis and pain. You can have a pretty arthritic knee joint and no pain. You can also have a pretty healthy knee joint and have tremendous pain.

The key things you need to do are

• Settle the pain quickly

• Fix any mechanical issues

• Change your walking or running stride length (if excessive)

• Restore pre-injury function to your knee

• Grow your muscles (8-12 weeks)

If you tick those 5 boxes then you generally have done your absolute best at getting your knee pain under control. The above is also backed by a load of evidence in the form of the GLAD knee program. A 3 month knee rehab protocol which we use.

So i’m going to show you one thing from each of the above categories to help head you in the right direction.

Settle the pain quickly

This taping is really really good at settling knee pain. You can get this tape from any pharmacy and we have it in the clinic. It comes under loads of brands but is stretchier than normal rigid tape. 

Click HERE to watch a video of Matty taping a knee. I would recommend this taping.


Fix any mechanical issues

The most common one I see is over striding when you walk. What we typically do in the clinic is get people to walk outside and film it. We look at you walking from behind and the side. When we film from the side we look for over striding. 

Over striding simply puts a lot more pressure on your knee than walking with a smaller stride. 

Reducing your stride reduces the force through your knee. Imagine walking with less pressure through your knee for 8000 to 10000 steps per day! 

Restore pre injury function to the knee

We tend to restore function via exercises. Initially starting with isometric exercises where by we contract with good form for anywhere from 10-45 seconds depending on current strength levels or pain levels.

Try these two exercises which I like to start with. There should be no pain. If there is try reducing the depth of the movement or duration. 

Isometric Bridge 

Isometric Wall squat

Grow your muscles

Muscles get used to the same stimulus really quickly so if you do the same thing every week don’t expect to get better. You will initially but you will plateua. 

You can grow the muscles by a couple of ways. Double to single leg exercise progressions. More reps. Less rest. More weight. It’s a science and an art to nail this.

But with the examples above of the bride and squat you could try these.

Squat with weight

Split bridge. 

So try the above. It really works. It will never replace a well designed Physio and rehab program. If you can dedicate 8 weeks to getting your knee under control email me at nick@balanceinmotion.com.au with a brief description of your issues. I can recommend the right Physio for you to get back to what you love doing. If it sounds like I need to refer you on i’ll refer you to the right person who can help.

Cheers

Nick T 

Why Do Growing Children Playing Sport Get Pain And What To Do About It

Kids injuries are different to adult injuries. We regularly see kids from 10-17. It’s really important to understand why our kids get sore and what can be done about it. I hope by  reading this you understand the differences. When your child points at their Achillies tendon it probably isn’t their achilles…..

Kids grow very differently compared to their friends. Did you know that in an under 13 sporting team there could be a variation of 3-5 biological years between them despite all being born within the same year! 

Kids tend to grow feet first then legs then spine. So we generally see kids under 13 getting heel pain first which is called“severs disease” followed by front knee pain “osgoulds slatters disease” (13-14 years) then teenagers will then get spinal issues such as “pars defects” or “sheurmans disease”. 

So what are all these “diseases”? They sound horrific but aren’t really. 

The most common child to adolescent injuries revolve around the growth centres of their bones. Kids bones don’t fully fuse until well into their teenage years. Where the area isn’t fused is called a growth centre. As bone grows during the child to adolescence phase fusion isn’t uniform. Parts of the bone can harden and others take a bit longer and remain soft. So the system around the growth plates isn’t balanced or stable. So as kids go through growth spurts their bones may grow but it doesn’t necessarily mean they are now harder and can handle the stress of jumping sports. Bones get long before they get strong so even though a kid has gone through a growth spurt their bones aren’t strong. 

Interestingly girls bones don’t fully mature til around 18 and boys bones later at 21. Children and adolescents' long bone ends are 2-5 x weaker than adults. 

As we grow we get this imbalance of soft areas of bone and hard areas of bone that aren’t happening equally. We get muscles and tendons that aren’t lengthening at the same rate as the bones are growing. These attach on the growth centres. When you play a lot of explosive sports such as soccer, gymnastics, tennis or rugby you can over load these growth centres. A combination of imbalance in the bone modelling system, tightness in the muscles and tendons with loads of sport and a lack of recovery leads to apophysitis. 

It can vary from mild pain during a game on certain days to being barely able to walk. Symptoms can last up to 2 years and can really put kids off sport so it’s important to manage it well. 

So what can be done?

I’ve found taking a holistic approach to the injury really helps 

Some questions to ask yourself as a parent

• Is your child getting enough sleep? Remember a lot of our recovery happens when we sleep. Bone remodeling etc. So if there is a lack of sleep this can influence things. Think about teenagers. They tend to be night owls, gaming with their mates and looking at screens until bed which can be really late. Yet they are expected to be at school by 8.30.

• Are you kids getting a good nutritional balance? 

• How much sport are they playing per week? One of the key aspects to treatment is working out their current weekly sporting diary. What days is the worst? What else are they doing that day?. 

Also remember kids have PE at school and often play sport all lunch time.

It is really important to bring your kids in early when they have pain. Not only because we can manage them quickly but also to exclude other conditions that can masquerade as the above.. 

Particularly if there have been fevers, chills and a lot of night pain. 

You also need guidance on how to strengthen the area. You also need to “wake up” the communication between the brain and the affected area.How many times have you seen your kids go through that phase of constantly hurting themselves. Walking into walls and tripping over. Rest alone in the presence of a lack of strength won’t help get them better. 

So if you think your child is suffering from the above, bring them in. Just click the link HERE, fill in your details and bring them in. I’d also recommend bringing in a pair of shorts and their training shoes. 

How To Reduce Tennis Elbow Pain Today

Tennis elbow can be one of the the most frustrating injuries you can get with a common pattern of recovery anywhere between 4 and 18 months. 85% of them get better by 1 year. Pain is located on the outside of the elbow.

Ironically it’s actually very rare to see tennis elbow in a tennis player.

It’s more common in gardeners and parents constantly picking up kids. As we come into spring and the garden triples in size people spend hours in the garden when they haven’t for a while and this leads to the injury.  

Tennis Elbow Symptoms

It can be so annoying that if you have your arm bent for a while then try and straighten it can be really painful. People describe being asleep and getting woken up when trying to straighten their elbow. 

If you have tennis elbow and someone attempts to shake your hand, you aren’t in a hurry to shake hands.  Opening doors and jars, picking up a bag or any other activity that requires gripping and straightening your arm. 

Tennis Elbow Cause

So what causes it? You can nearly always trace it to a sudden overload of something involving excessive gripping of the wrist. For example, if you decided to get on the power tools for a weekend on a background of minimal power tool use, that could do it. 

Sometimes it becomes mildly uncomfortable but over a series of weeks it continues to get worse.

It normally involves the tendon of the muscles that extends your wrist. It particularly affects a little muscle called extensor carpi radialis which is designed to lock your wrist into place while you do things with your wrist. 

If the load is too much for the tendon then the tendons structure starts to change, abnormal blood vessels grow into it and the collagen makeup begins to change.

So what can help tennis elbow?

The important thing to note is that a 4 month recovery is considered a good result in terms of recovery from tennis elbow. There is a great study that looked at tennis elbow treatment that compared the following 

Physio techniques with a progressive strength program

Progressive strength program alone

Cortisone injection into the elbow with a strength program

The winner was physio techniques with a strength program by a lot. The group that took the longest to recover was the cortisone jab group. Despite getting initial pain relief they took the longest to fully resolve. 

I will often start peoples rehab with this exercise. It helps reduce pain and is the first place I start for rebuilding grip strength. Click the link HERE to watch how to do it.

Avoid the following to help settle the pain

Pain-provoking activities (avoid  lifting with a straight arm and palm down. Change to palm up with a more bent elbow and grip less aggressively when holding something that causes pain 

Come in for Physiotherapy 

You need to be assessed on what caused the tennis elbow. What is weak in your upper body that needs strengthening to offload the injury. We will tape the area to let it settle and do some techniques to reduce the pain. 

You will need your program increased over time to improve the symptoms.

You can click HERE to book an appointment through our online booking system. 

We often see tennis elbows that haven’t got better. My question to you is 

Is the load you are lifting heavy enough to continue to improve?

Have you done the program for long enough?

Is your grip strength being assessed and getting better slowly?

What other muscles are weak in your upper or lower body on the same side. Has this been assessed? 

Click HERE to book an appointment online. 

How To Reduce Winter Aches and Reduce The Risk Of Winter Injuries

Waking up early in the morning when it is pouring outside, it’s dark, you can hear the trees smashing against the side of the house, you know it’s freezing out there ….. It just doesn’t inspire you to leap out of bed and punch out 10000 steps. 

People often complain of feeling sore and stiff during the winter months. Usually people come in and say  “I can tell when the weather is about to change because my old injury/ osteoarthritis starts to hurt more”. 

We also see a huge increase in ligament injuries during winter months from changing direction during sport, opposition player force or just slipping over in your driveway. Arguably these are less in summer. 

So why do we tend to hurt more in winter? Why do old joint injuries suddenly turn into meteorologists? Why do we see more ligament injuries during winter? What can we do to minimise feeling like the tin man during the colder months?

Some of the common reasons we see an increase in the above are obvious but how many people action them regularly?

Reason 1: Our incidental exercise is greatly reduced

As a result of the wind, cold and slippery tracks our daily step count is reduced considerably. If it rains constantly it could be a week before you do any real incidental exercise. 

This lack of mobility means stiffness, tight tissue and more compression on joints. If those joints are or have been injured in the past they can hurt more. 

Reason 2: Change in atmospheric pressure 

Change in weather conditions tends to make your joints and old injuries/ fractures hurt more. The change in air pressure causes joints to swell and the change in this pressure causes pain. Yes it’s actually a thing.

Reason 3: Sickness

It’s fair to say this year has been a bit of a stitch up with regards to everyone being sick. Especially those of us with kids:  Being reintroduced to other humans again combined with covid version 6.0  has meant lots of nasty bugs around. The same inflammatory cells that are released when you are injured are released when you are sick. How many people felt every old injury they’ve ever had when they had covid? 

Reason 4: Mood 

Winter sucks unless you're mountain skiing. It can make you feel a little down. Constant rain, darkness, mud and dampness doesn't make you feel amazing. There is a direct correlation between your mood and pain. If you are stressed or down, your pain is magnified. 

Changing the above can make a real difference to how your body feels during winter. Try some of the below and let me know how you go! 

Increase that step count with adding a couple of light layers

Get out and increase your step count with a couple of light layers you can remove as it gets warmer. It’s unpleasant for 4 mins and then you’re good to go. 

Start your day with movement

Do some yoga on an app or try a warm room yoga class, do your Physiotherapy program first thing in the morning (this should also mean less pain and discomfort throughout the day), try one of our morning BIMFIT strength and pilates classes. How much better do you feel afterwards? 

Your body is warm while everyone else is freezing. Nothing hurts and you feel good! This has to be the biggest secret weapon against feeling pain in winter. 

Take a joint health supplement and fish oil.

Drink loads of water

We still sweat in winter! However we tend to swap water for more coffee and tea. Both tea and coffee are diuretics and make you pee more dehydrating you. Lack of hydration to your muscles and fascia in winter leads to muscle tightening which can lead to pain and  injury. Keep up your water intake! 

Do a nightly stretch routine

If you are felling stiff finish the day with a nightly stretch routine. Do it watching netflix. It’s a great way to unwind especially combined with breath work. If your not sure where to start with breath work simply try box breathing: push into the stretch, breathe through your nose for 4 seconds, hold for 4 seconds, out for 4 seconds. Next round or next stretch. 

Do your Physio program to wind down. Make sure your body is in better alignment and settled before you sleep. Particularly if you are susceptible to a little night pain . 

Meditate or book a holiday!

So commit to a couple of the above. My fave is movement before starting anything else. Let me know how you go! 

P.S if you want a Physio Rehab Program to keep your body feeling aligned and strong over winter click HERE

How To Prevent Golf Injuries With Jimmy

Golf has a wide variety of health benefits, such as
increasing your cardiovascular capacity, improving your strength and
endurance, and challenging your motor control and coordination.

While golf is generally considered a low-risk sport, the explosiveness of a golf
swing and the repetitions required to progress in skill can lead to a wide
variety of injuries occurring, most commonly around the back and upper
limb. Because of this, it is important to ensure you are spending time
improving your strength and mobility, so that your body is ready for the
demands of golf.

Mobility
Golf is hard! To effectively produce a golf swing that is powerful and
accurate, you need to have access to your bodies full range of motion.
This involves rotation through your upper back, cross-body reaching
through your shoulders, combined flexion and rotation in your hips, and
compression and lateral flexion in your lumbar spine. Forcing yourself into
these end-of-range positions can lead to injuries occurring over time.
Because of this it is important to give attention to improving your joints
range of motion, so you have access to more movement and less chance
on injury.

Strengthening
Golf is tiring! Anyone who has tried to hit a driver off the first tee will tell you it is
an explosive activity! Hitting a golf ball effectively requires combined strength
from your hip and knee extensors, your shoulder’s rotator cuff, your wrist
extensors and grip strength, as well as the muscles that rotate your trunk and
stabilise your low back. All of this places a large strain on your musculoskeletal
system, which is why it is important to dedicate time to improving your whole-
body strength through your full range of motion, to help reduce any chance of
injury.

Want to improve your golf game or sick of persistent golf niggles?

Our resident Golf expert Jimmy has developed a unique assessment to address muscle imbalances, strength deficits and mechnical advice to reduce injuries and improve your game.

For a limited time we are offering this 60 minute assessment at $79 (Usually $170 saving $91).

If you want to take advantage of this limited time offer then click below to book your BIM Golf Assessment.

The Physio Rehab Journey: The Tests You Must Pass In Order To Achieve Your Goal

The journey of coming to a Physio, understanding why you were injured, committing to a plan and finding a goal big enough to do the rehab is a tough journey. 

You will be tested along the way and if you pass those tests you come out better and stronger than ever (ideally).

Having done some work recently with a mindset coach called Ben Elliot in South Australia I couldn’t help but think of the injury journey and the similarities. I’ve taken his teachings and applied them to the injury journey. To hopefully set you up for success. It’s also important to know you’re not alone and that you’re human. However the hard work to achieve your goal will be worth it so read on. 

The Inspiration Phase

This is generally the first two weeks of seeing your Physio. You’ve committed to a rehab plan, you have a goal that excites you and you are very motivated by pain and a fear of not being able to do what you want ever again.

Generally in this phase you are super disciplined. Your Physio has given you some exercises and you’ve done them every day. You may notice a couple of quick wins in terms of feeling a little better and less pain (It may be too soon and that’s ok as well!)

In this phase you will be the most motivated in the whole rehab process. You’re happy to do the homework.

It is really important during this phase that you create systems that work for you. 

For example is there a time when no one can bother you and you can do the exercises? 

Is there any area in the house that has enough room for you to move? 

Do you need to set google calendar reminders with the instructions or reminders to get up and do the exercises at set times every day? 

Would it be better to just go to the classes because you literally don’t have time. If so get an assessment quick so you can integrate the classes into your schedule while your motivation is high.

An example of a solid system would be 

I am going to wake up 15 mins early. Head to the garage. Put down my yoga mat. Put in my headphones and watch the videos the Physio gave me.

I will set a google calendar reminder to beep at 7pm and i’ll head back into the garage for 10 minutes and repeat the exercises.

Or I will continue to go to the gym every day despite being injured and i’ll start by doing the exercises then jump on the bike for 30 minutes.

Finally I have booked in for a BIMFIT Pilates assessment tomorrow. I’ve booked into two bimfit pilates classes for the next 4 weeks and will do the exercises at home 2 days per week.

Make  these systems sustainable, work with your Physio to make sure they work for your schedule. Work hard at making them work. This will set you up for success.

Perseverance Phase

The next phase is tougher and in order to get success you will go through some tests that you need to pass to get to your goal. If you pass the tests you generally win and are back doing what you love. 

Unfortunately the initial motivation is going to drop at some point. So you need to be ready for the next tougher perseverance phase.

The wins are not as obvious, the exercises that were new and novel are getting a little boring. Things aren’t progressing as quickly as the first phase.

What’s the biggest thing people generally do at this stage? 

They look for the next shiny object.

This could be in the form of a new therapy, a new device off amazon, some you tube exercises from an instagram influencer you saw. You jump onto their exercise regime instead.

Aside from shiny object syndrome you will probably encounter the time test.

You thought you would be miraculously cured in 2 weeks and it’s taking a little longer than you thought. It’s a tough time but at this point in time i’d recommend you do the following

• Keep taking massive action towards your goal. Work hard at the exercises. Don’t give up. You have to keep pushing and remembering you’re why goal. Why are you doing these exercises? What are you trying to avoid again? What will you be doing soon you want to be doing?

Show the exercises to your Physio. Do they need refining? Is your technique ok? Are you doing the sets and reps required eg are you just doing 10 reps instead of 4 sets of 10 as prescribed?

Sometimes you’re just not working hard enough to see the results. 

The second test you may encounter is the circumstances test.

This one is a tough one. You were on a roll. 5 days per week doing the exercises in the spare room. No one was bothering you then …..

• The kids bring home covid, work sends you interstate urgently, sxxx hits the fan, the cat dies.

Everything went from smooth and crushing it to chaos.

It’s at this point you enter the flight fright or fight stress response. Your brain is all over the shop and you start panicking. Your pain should go backwards during this time as you stopped your routine and the stress response ramps up your pain levels. 

You can play the victim role in this phase and blame external influences but it won’t help you reach your why goal. Why are you doing these exercises? Was it to be more active, to run when you thought you couldn’t, to feel young again when you spring out of bed. 

The solution to this test is to control what you can control. Get back to your routines. Set that alarm again and do the exercise routine. Get an early win each day to take your mind off the stress. Meditate before you do your exercises. Keep your appointment. Don’t cancel it. Make sure you record the exercises on your phone so you don’t forget them when you leave the clinic. 

 The next test is when you get into a rut.

We all get into a rut where we just can’t be assed. You get the sxxx and just need a “break”.

 Sometimes it helps to talk to your Physio about how you’re feeling. Your Physio can break it down into smaller manageable tasks. Maybe just focus on one week to the next week to the next week eg this week we are going to squat properly. Then next week we go to the single version. The following week we add weight and endurance. Then we are running! Your goal maybe literally two weeks away.

I also find visualising yourself doing that goal in great detail helps. For me it works to do this first thing as i’m waking up and as I turn the lights off at night. I visualise myself doing the task well. The more detail the better. It is a key tool in most sports psychologist tool boxes.

Other ideas are to post in our facebook group about your struggles. What happened. Sometimes some support from someone who has been through that journey is the best way forward. 

What happens if you pass all the tests?

You’re hitting the snow ball phase. You are crushing it. You’re moving better, you’re stronger, you’re back doing what you want and feeling good.

The snowball phase is boring so the tendency is to look for the next shiny object but you are now getting good results so stick with what is working.

So to summarize you have probably been here before in life. I did it after my shoulder surgery. I did the first 5 weeks of rehab and then filled my diary with lots of patients and prioritised everything but my rehab.

My shoulder got to the point whereby lifting it hurt every time. It took me 5 months to do something about it. I couldn’t be bothered doing the exercises so booked myself in to the bimfit classes twice weekly for 8 weeks. They then became addictive because i always felt better afterwards. So if you’re going through the journey at the moment ….. maybe read this when you’re feeling down. Join our facebook group for motivation. We are all humans but we as Physio’s get the ultimate buzz when you pass these tests, graduate from Physio and get back to doing what you didn’t think you could do again. 

Top Tips To Reduce Your Pain Naturally

The majority of people come and see us because they are in pain and want a diagnosis and a plan to get better. Pain is frustrating and it can be scary, particularly because you don’t know what is going on. It can also make you grumpy. Are you going to be ok? Do you have arthritis? Will you be able to make the start line? 
 
We now know that two people's experiences of the same pain, even if that pain is at the same level, can be perceived completely differently. How do we know this? Functional MRI studies of the brain have given us a lot of those answers.
 
When people experience pain, a multitude of areas in the brain light up at the same time. Areas responsible for past experiences, beliefs etc. An example would be someone that has never had back pain before. They overdo it at work and have no previous frame of reference for why they are in pain. They are optimistic in their recovery and just want to get back to work. But if you compare this to someone who had a similar back pain injury, but this person had back surgery and took two years’ off work to recover, there would be huge differences in their pain perception. The level of threat, past experience and anxiety would be vastly different between the two. There would be differences not only in the perceived outcome, or path to healing, but the pain levels would arguably be enhanced in the second version because of past experiences. 
 
Combine this with the fact that most tissue injuries should resolve within 3 months, but if they don’t - the brain has an even bigger effect on someone's pain perception levels.
 
So, given pain is the most common problem people come to see us. What are some things all of us could do today to reduce pain?
 
Here are a few tips
 
Sleep More: People who sleep less than 6 hours are far more likely to experience higher levels of pain. Sleeping 6 hours or less tends to overload the sympathetic fright or flight part of the nervous system. This leads to a real increase in pain. 
 
A question I commonly ask people is “How much sleep do you get?” For patients that have high levels of pain for prolonged periods the quickest way to reduce pain is to get a good night sleep.

If you want to know more about good sleep hygiene check out a blog I wrote about in the past HERE. 

See what a consistent evening routine does to your pain levels.

Meditate or spend time in nature: Again anything you can do to get you into the parasympathetic nervous system response is crucial . There are so many amazing meditation apps now that it really is impossible to come up with a decent excuse not to. If you can’t find 5 minutes in your day to put some headphones in and press play you are doing something wrong 

Calm, headspace and aura all have amazing pain relief meditations. I’m currently using Aura as it has hypnotherapy, life coaching and breath work for the same price as calm or headspace. 

Reduce inflammatory load on your system: This is a great tip from our Waiheke Island physio Nadia. Removing sugar from your diet and reducing your caffeine can really reduce your inflammatory load. A reduction of inflammatory markers in your body means a reduction in pain. Another great tip to reduce inflammation is to do a minimum of 40 minutes of non fasted cardio in the morning. This could be as simple as going for a 45 minute walk every morning on an empty stomach with the dog. 

Mobilize your body 

Moving our body through a full range of motion (or as close to possible) is very important. Essentially “move it or lose it”. Our Physio Matt Barker believes in a rounded approach to improving mobility. This includes static stretching, dynamic stretching and rolling with a ball or roller. Mobility is for everyone, you don’t need to be an elite athlete to gain benefits from it. A simple routine is important for desk jockeys or weekend warriors alike as in our day to day lives we perform the same movements over and over again and this can cause tightness in areas that can affect how we move. This can also cause an overload of a system and lead to injury. 

It can enhance our lives so we are in less pain, stiffness and can be more flexible to do what we want in our lives. 

See a Physio earlier to sort a little niggle. A small pain can turn into a big pain but it's always easier for a physio to turn around a small little niggle as opposed to a big debilitating problem. If you want to book an appointment to get your pain levels under control click HERE to see us today to get pain relief fast.

How I Discovered Connect Therapy - Matt Barker

As some of you know we do things a little different here at Balance in Motion and whilst all of us
have different stories of how we walked through the doors I thought I’d share mine, especially
considering I started on the other side of the treatment plinth!

I have a long history of playing competitive sport and what usually comes with that is an injury or
two. One of the worst of these was an injury to my right hip which was diagnosed as a mixed
lesion along with a Labral tear and was at a time when I was studying to become a Physio. In
common tongue this meant that I had an extra bit of bone growing on my pelvis and on my thigh
bone where they met to create the hip joint and a tear in the lining of the hip joint as well.

It is a relatively common injury for kicking sports to have some form of bony growth in the area
all though I did manage to get one on both parts of the hip and then the tear on top of it. I was
uncomfortable most of the day with the injury and it was something that caused catching pain
with sitting to stand motions, a dull ache with sitting for longer than 10 minutes and playing
sports was horrible especially afterwards.

I sought help from a family friend who is a physio and a damn good one at that (shout out to
Loretta). We did everything we could for my hip and I checked in with her once a week for 6
months trying every strengthening exercise possible and under her incredible unrelenting care I
managed to get my hip into a place where I could at least decrease the symptoms in sitting and
in some everyday life movements. However the pain was still very up and down and I wanted to
return to sport, especially soccer.

Loretta attended a course and our next session she tried a different approach. I was a little
confused to say the least but happy to go along with it. She had a few findings and decided it
was best to see if someone with more experience in this new approach could help out, so I was
sent off to Balance In Motion to see a Nick Torrance.

I arrived at the clinic with little hope that I would get any relief or that this Nick person would find
anything else that could help me but with the long standing pain I was ready to try anything.

Nick was a nice enough guy and had good enough banter for a lanky Kiwi but I clearly
remember him looking around my rib cage with me thinking “mate you’re looking in the wrong
spot” but I was polite and kept my mouth shut. He treated my Thoracic rings and explained how
the thorax was a super important part of our body that isn’t assessed very well and how it has a
large area that has many muscular connections that can affect the body in heaps of different
ways.

I was still skeptical about it all but the results spoke for themselves. Over the next week my
symptoms had dropped dramatically and my hip was feeling freer than ever. Over the next
couple of weeks it continued to improve but the damage was done and the structural damage
was too much.

I ended up in the consultation room of Dr Michael O’Sullivan after an MRI and it was decided my
best route was surgery where he would shave the bone back and repair the tear whilst he was
in there. Although I was relieved to see the light at the end of the tunnel, I knew it would be a
long 6-9 month process that would take a lot of effort on my part but I managed it well with
support from everyone I had met along the way.

Over the next 2-3 years I completed my Masters of Physiotherapy, started a job but had a
massive desire to know the magic that Nick seemed to be able to work. I kept popping my head
into the clinic at every chance I had to learn more and watch Nick and Melita like a hawk in the
sessions. I looked at LJ Lee’s site every day to see when she would be returning to our shores
to teach and I enrolled in the sporting Thorax and pelvis as soon as they became available.
Eventually Nick gave in to my constant nagging (and Melita’s) and offered me a job at Connect
Therapy and I have never looked back.

I know my life would be very different without ConnectTherapy both personally and
professionally and I am stoked that I have been able to learn from some amazing people and
physios along the way.

If you’re looking for a more holistic approach, have a stubborn injury, feel that you could just
perform better or even just want to learn more about how we treat please get in touch, you won’t
regret it.

How to set your exercise year up to achieve your goals and stay injury free

It’s the start of the year. We’ve all had the time and space to reflect on how much mental and emotional energy lockdown took out of us. It also made us reflect on how good exercise is and  how we miss connecting with our team mates or exercise buddies.

The new year is a good reset time to start thinking of some fitness goals. The new year is also a time where dreams can be  dashed because of overzealous training. Our bodies don’t forget we sat and relaxed on holiday (on a background of  a very long lockdown). So this year let’s do things differently.

Below is a Q and Q session with three of our BIM Physio team on how to achieve your exercise goals this year without getting injured because three minds are better than one!

So here are some questions to help you reflect on planning your goal successfully for this year

Give me your top three mistakes people make that could have been avoided in planning an event?

NICK T Not allowing enough time for the body to adapt to such an increase in exercise load is probably the most common I see. In terms of an event i'll use running as an example: if you've never run before a good goal is to do a 5km or 10km race. If you've done a couple of them and want to push your self consider a half marathon. You've done at least three or four halves consider going to a marathon

A good tip I can recommend is to reverse engineer your goal event over a minimum 3 months or 6 months for a longer endurance event. Try and work out an increase of 10-20% in load per week to get there. The human body tends to adapt well to this increase in load. Remember exercise load can be duration as well as speed and increasing both at the same time can get you in trouble. 

Failing at the final hurdle: Tapering for a race/ event can be a real mental test. You have trained so hard then all of a sudden you don’t have those endorphins. Your brain is telling you you need to train but your coach is telling you no. I’ll give you two examples from this week. A patient competing in her first half marathon decided to do a strength class followed by a 90 minute yoga class on a background of not doing yoga for a year 4 days out from her race. She hurt her back because she wasn’t used to doing two exercise sessions in a row. 

Second example:  I had a patient purchase a new pair of shows at the pre race event the day before the race. Completely different to their current shoes. They finished the race but didn’t run for 10 weeks afterwards.

You get the idea. Chill when you are told to taper so you have a full tank of gas for the race. You have done all the hard work. Don’t let the voices in your head tell you you need to do more. 

Finally going to work is also an exercise  load. If you just worked 70 hours and then have your biggest training weekend don't expect it to be pretty. You are training tired and stiff from work. Consider adjusting your training schedule or chuck in a yoga session, recovery session or BIM FIT Pilates class. 

MATTY B

People lack consistency in training. In my experience people start strong with the goal in mind but then don’t put in the work through the middle and back end. I find people won’t be in the gym doing the work enough and will be up and down with how much and how hard they train. Some weeks good and some weeks nothing 

Increasing the exercise load too quickly - Like most activities I see a lot of people skip steps in their training and try something they've seen on instagram or feel they can up the load much too quickly. As a very basic rule weekly increases by 10% are what you are looking for and are enough load to get more adaptation without the risk of injury

GET HELP!! - A lot of people find the gym and strength training very confusing and there is just so much content out there they struggle with how or where to start. The best thing you can do is see a Physio then an exercise physiologist/ Personal Trainer who will look closely at your biomechanics and help you plan a program around you and your goals! It is highly worth the investment and most people will get more out of the time they spend training.

NICK C

Not gradually returning to activity. COVID has meant a lot of people haven’t participated in sport for a longer than normal period so you will need to slowly get your body used to playing again via training before jumping into an intense game.

Not warming up and cooling down. Going from 0 to 100 rarely works in terms of physical activity so you need to make sure you allow your body to adapt to the load you’re about to put it through. Cooling down also gives your body the best chance to recover from the activity you’ve just completed.

Not treating a little niggle. Aside from traumatic events, all injuries tend to start as little niggles that don’t seem like a big problem. These little niggles are always easier to treat and settle from a physiotherapy point of view compared with a bigger, more severe injury. Make sure you pay attention to how your body feels and get some assistance with feeling good!

How do you stay injury free in pursuit of your goal? 

NICK T Getting stronger is one of the only evidence based ways of reducing injury risk in exercise pursuit. Add some strength training to your program Or you could do our BIMFIT strength and Pilates classes to take the guess work out of it

MATTY B  

Stay injury free by ensuring form stays consistent which can be very helpful to have a health professional such as a trainer or physio look at how well you perform the actions. Using equipment such as bands can help build strength in areas that need extra work. It is also important not to ramp up the weight too quickly with strength training, that is where we find injuries as Physios. Adaptation hasn’t occurred yet and the tissue is unable to take the load placed upon it. 

Warm ups are another super important aspect of strength work. I find a lot of people will race from work to jump in the gym and kill themselves for 45 minutes without performing any basic movements beforehand to help get their body prepared for the work ahead. As a very basic rule you can do the exercise before adding any weight whatsoever and go through the full range of motion to at least help your body to prepare for the exercise. More advanced warmups will include increased range of motions and adding resistance with bands or lighter weights. 

NICK C 
Gradually return to participation after a break such as lock down. Coming from a team sport background my examples are from cricket and soccer. Start to take part in training sessions before jumping into intense, competitive games. Whether they’re formally organised by your team or whether they’re sessions you do individually, training sessions allow your body to adapt to movements, postures, and positions you may not have experienced in a long time.

Make sure you complete a warm up before your training session and game as well as completing a cool down session afterwards. In the warm up, gradually build the intensity and complexity of your movements to mimic what you’ll need to do in your session. In the cool down, make sure you complete a wide variety of movements in a number of directions to gradually ease out of the intensity of the main session. If you are naturally a stiff person than finish with some stretching at night in front of the TV or use a spiky ball/ foam roller.

Not All Heel Pain is Plantar Fasciitis

It is summer aka “Plantar fasciitis” season. We go from spending a few months in shoes to days on end in a pair of thongs. I know some people that can hit 20,000 steps during this summer period in a day in only thongs (guilty).

But one of the issues with this is your plantar fascia doesn’t like the sudden change from shoes to no shoes. The plantar fascia is the ligament on the bottom of your foot!

It is designed to lock up the middle part of your foot during walking push off so you have a nice stable foot to walk on. It does this via the windlass mechanism which sounds more like an infomercial product. The windlass mechanism despite being cool to say is the tensioning on the plantar fascia band from your  toes extending which locks the mid foot.

BUT: It can be overloaded because of changing support under your foot suddenly. Running shoes to thongs. Supportive shoes to minimalist shoes.

It can also be injured by too much weight bearing exercise too quickly eg walking for two hours when it is used to walking for one hour.

This can be further aggravated when you have “wheel alignment” issues or bio mechanical problems from bad habits or old injuries. 

How do I know I have it?

It normally really hurts in the morning. The worst being those first few steps. If you have been sitting for a while and stand up it also hurts. If you had a big day standing or walking it will always be worse the following morning.

But that isn’t me! What else could it be?

Believe it or not there are actually over 7 different structures that can cause heel pain! Below are some questions we ask to tease out whether other structures are involved.

Does it hurt when you are driving?

For example if your heel really hurts when you are sitting or driving it can’t be your plantar fascia. You need to be weight bearing for it to hurt. 

When this is the case a network of different nerves around your heel can get stuck in tight muscles or old surgical scars.

Treating these areas of entrapment helps considerably.

Have` you had a long history of back pain or recent episodes that have finally recovered?

Yes one of the nerve roots that exits your back refers to your heel. Treating the back in this case will resolve your symptoms

Does it burn or tingle especially at night?

Again this is more likely to  be a nerve entrapment then plantar fascia

Does it hurt when you walk?

You also have a big fat pad under your heel that doesn’t like hard heel striking when you walk. It needs some TLC and a change in walking. The best thing in this situation is to come in for a digital gait assessment to work out whether this is an issue.

It could also be a muscle under your foot and or one in your calf which also can be strained but refer to your heel. 

Could I have more than one structure causing my pain at once?

Unfortunately yes. I have seen people with all 7 at once. They require different strategies for each structure. I think of it like layers of an onion . With a structured organised plan they can do really well. 

So not all heel pain is plantar fasciitis despite your next door neighbour Karen telling you that’s what it is and some reiki/ light therapy will fix it.

If you suspect this maybe you or a friend make an appointment and figure out a plan with us. You can click here to book online.

MATT IS BACK - Q&A

Matt Barker is back from his two year working holiday in London and we are stoked to have him back. I’m sure there are plenty of people super happy to know Matty is back. We’ve asked him some questions on his fave parts of Europe. We also asked for the latest food spots from BIM’s resident foodie. Matt was working in one of the worlds most fancy Physio clinics so we wanted to know how that was also.

Matt Q&A

1.How was being a Physio in London? What were some of the skills you picked up whilst there

I was working in an amazing clinic called Vanbrugh Physiotherapy (go check it out if you’re ever in London) which had a big multi disciplinary team and housed an amazing gym just for the physios use with patients. It had all kinds of rehabilitation gear, including an Alter-G Treadmill, running track and squat rack. It also had a separate pilates/wellness studio that housed any kind of pilates equipment you could think of so I was very lucky to spend my time there with an amazing team that is super skilled and also at the top of the game in the Connect Therapy world just like BIM.

I’ve always considered myself an extremely hands on physio and my time there really hammered home for me how important a thorough and targeted rehab program is for achieving those goals. I was able to be in a space to increase my knowledge around strength and conditioning and how that can benefit all populations and especially athletes of any level. 

2. Where was your favourite place to visit and why?

This is obviously a super tough decision but I would go with absolutely anywhere in Italy. I was super fortunate to be able to spend a lot of time there (shout out to the Di Stefano family) on multiple occasions and everywhere is more beautiful than the last place and the food my god the food!

A mentionable and very close second would have to be Copenhagen though. Amazing city with super friendly people and life just seems very easy there.

3. Coolest dining experience?

London is a massive hub in terms of food and drink and you could spend countless hours and added kilos trying new places but the number one would have to be a place called Maos which was super immersive and highly recommended. 

That said, my absolute favourite to go was always a restaurant called Sager + Wilde. I’m a bit biased as my mate was the manager and it had an amazing wine list but more importantly met some of the best humans on the planet there. 

If anyone needs a list of places to go and I have plenty!!

4. Why London and what is it like living without sunshine?

Honestly a big reason I moved was that I thought it sounded like a great idea after a few drinks with one of my mates and from there it just seemed to grow and eventuate. I grew up in Sydney and was looking for a change of some form so I figured the best way was to do the complete opposite so I moved over to the land of grey and no surf and didn’t look back. My mates thought I wouldn’t last 6 months but 4 years and a global pandemic later I decided it was time to enjoy the sun and surf again along with the sandwiches from The Shop and Wine Bar.  

As for no sunshine I really struggled in my first winter. I was tired a lot for no reason at all (except after the nights at the pub) and had troubles finding motivation to get out of bed due to the lovely grey that was projected through the window. I spoke to some fellow expats and found some Vitamin D helped restore the balance and make sure you have a holiday planned in February/March so you had something to make the winter seem a bit shorter. Having said that, I do think they do Christmas way better.

5. What’s one thing people don’t know about you?

I’m a massive Star Wars nerd and am proud of it (I’m looking to get the millennium falcon tattooed on me at some point). I’ve managed to read a heap of the books, watched every side series known to man and even have a signed figurine from Kenny Baker so if you want to come in and chat about the upcoming Kenobi series I’m all ears. 

Ab Exercises

With summer fast approaching you see all kinds of weird and wonderful ab exercises popping up around the place, with everyone attempting to do something crazier than the next. I decided to find out which exercises are more beneficial to us, and point out those causing more harm than good.

We need to understand why doing certain exercises are so bad for us. Firstly, it usually involves over-working the upper abdominals and hip flexors whilst under working the lower abdominals and more importantly your DEEPER abdominals like your transverse abdominus and pelvic floor muscles. 

Weaker deep stomach muscles means you have much less dynamic support in your abdominals and lower back and can even lead to a prolapse. On the flip side, if you do the right exercises you will get much more recruitment from your lower abdominals (below your belly button) and those deeper tummy muscles.

The other big problem with massive strengthening in the area, which we see a lot of in the clinic, is that these overactive muscles end up pulling your rib cage forward and down, in front of the line of gravity. This causes a more stooped and rounded posture, increasing the amount of load in the muscles and joints of your lower back.

The diaphragm is also affected by over-activity of the upper abdominals. As we know the diaphragm is responsible for drawing air into our lungs by contracting and flattening as it descends into your abdomen. Over-activity, shortening and general bracing of these muscles, like trying to hold your belly in, inhibits the diaphragm from performing its descent and means you take a shorter breath.

BAD EXERCISES

Now that we have a basic understanding on why some abdominal exercises can be harmful to us, here are some of the worst ab exercises I have seen..

1.Sit-ups

By sit-ups I mean those full range motions people do, whether they are on a piece of equipment or just lying on your back. Not only is this exercise doing all the poor things we talked about above but people will throw themselves at those last few creating really scary shearing forces in their lumbar spine, especially the higher segments. It ends up being no surprise that it is really common to hear people ‘putting their back out’ from sit ups.

2. Double leg lifts

These exercises have the ability to create a bad back from a healthy back or make a bad back even worse. This exercise over trains your powerful hip flexor muscles (psoas).  These muscles attach to your lumbar vertebrae and pull on them as you try and lift those heavy legs off the ground. It causes compression and shearing forces and you will usually feel uncomfortable doing these exercises.

3. The abs cradle

This is one of those devices that is being sold as a quick and easy way to achieve ‘the stomach of your dreams’. Unfortunately, like most exercise shortcuts, it has been proven to be 80% less effective than the traditional abdominal crunch and that’s not even the worst part. Due to the rocking motion the device is more likely to over stretch your neck and cause damage of some form to either the muscles or discs in your cervical spine.

GOOD EXERCISES

Replace those poor exercises we talked about before with these.

1.Reverse Curl Up

This exercise is great in controlling the lower abdominal muscles and also supporting your lumbar spine. Transverse abdominus and your internal obliques are really targeted in this exercise and will help to switch those protective muscles back on and strengthen them up. It also has the added benefit of aiding good breathing technique by not using those upper abdominals so much.

To do this exercise all you need to do is start by lying on your back with knees and hip bent at 90 degree angles and slowly round your lower back as you bring your knees to your chin whilst keeping your head on the floor. Repeat this 15x

2. Legs Passing

Legs passing is very similar to the reverse curl up. It again is very good at recruiting TrA if you do it properly.

Start this exercise by lying on your back with knees bent and both feet flat on the floor. Raise your right knee to your chest, bringing it nice and close to your right armpit and then slowly return it. Whilst the right is returning to the starting position move your left knee towards your left armpit so the legs pass each other mid-air. On the way down your foot should just very lightly touch the floor before moving back up towards your chest. Ensure that at all times you never straighten your legs and put that strain on your lower back but rather always keep them bent and keep your back flat on the floor. Perform x15 on each leg.

3. Bird Dog

This exercise is excellent at targeting your multifidi muscles, these muscles wrap around your spine and hook into the back of your pelvis to provide stability to these areas no matter what movement you are performing. 

To perform this exercise start on your hands and knees, sink your tummy all the way to the floor then lift it back up as high as you can towards the ceiling and meet in the middle. Make sure you don’t collapse through your chest and shoulder blades. 

Hold this position and now lift and extend one of your arms straight out in front of you and hold this position for 3-5 seconds ensuring that you keep a nice and position and then slowly return to four point kneeling. Now switch to the other arm and perform the same movement. Repeat this 8-10x on each arm. 

Mastered this and looking for more of a challenge? Try lifting the opposite leg whilst you lift your arm (i.e. right arm and left leg) keeping a nice and stable base through the movement. 

Remember to always seek out a health care professional before undertaking any exercise regime!!

Happy exercising.

How To Manage An Achilles Injury

An Achilles injury is  frustrating but very common. The Achilles tendon is a really important spring that propels you forward during walking, running or jumping. It is generally injured when you over load the Achilles spring with too much spring.

Common over Achilles springing can include some of the following common examples

• Adding some sprint training or faster tempo sets when you haven’t done these for some time

• Coming out of lockdown and trying to do your fave explosive gym class at the same intensity as pre lockdown

• Going for a PB in a half marathon by sprinting the last kilometre

For those of us that are a bit older it can be going for a longer walk than normal. Initially the Achilles tendon can be pretty sore for 14-21 days. It is especially sore in the mornings on those first few steps. The pain is generally localised to the middle part of the Achilles tendon. Please note if your pain is at the bottom of the of the heel then that is a very different injury and requires different management. 

Sometimes without the right management an Achilles tendon injury can drag on for weeks, months and years. Following the below advice will go along way to avoiding the above issue. 

So what happens if you over load your Achilles spring with any variation of the above?

• The first thing is to stop all spring like activity until you have seen us or a local Physio. That can include running, jumping and skipping. I can’t emphasise this enough. You can drastically reduce your time out of exercise if you stop all of the above. 

• Consider taking Neurofen. You definitely need to check with your pharmacist before taking neurofen or ibuprofen however it can really settle your tendon down. Ibuprofen reduces the activity of your tendon cells or tenocytes thus reducing the pain in your tendon.

• Do the below exercises 2 to 5 times per day initially. Recent research has found that doing isometric calf raises can really help settle your achilles tendon pain down. Isometric  calf raises are basically calf raises without moving up or down. You have to do them at around the mid point of the calf raise. If you raise up too high in the calf raise it can actually make you worse. Watch the videos below for two good options to start with along with single leg variations as progressions.

If you injured your achillies walking i’d start with 5 x 10 second holds (two legs) with a minutes rest between each set. If you are fairly fit and strong go for 30 to 45 second holds x 5 with a minute between each set. Jump on a bike and maintain your fitness with the bike. You should be able to push yourself pretty hard on the bike as it is a non spring form of exercise. Swimming or the cross trainer are other good options.

Please note if your achillies is sore with the above you need to come in as the chances are you actually have something else going on. We have plenty of options for fixing those as well!

What else can help?

Take any stretch off your Achillies by living in a pair of running shoes for the first week or any other shoe with a higher heel pitch. I don’t normally say this but even a half high heel is useful at offloading your Achilles pain early!

Walking around in thongs or bare feet is putting your Achilles on a bit of stretch and potentially increasing your pain.

If stretching is bothering your Achilles also consider stopping this until your pain is under control.

So to summarise if you have injured your Achilles Tendon the key take aways are

• Stop any spring like exercise until you have seen us

• Do these exercises 2-5 x per day as long as they make your Achilles Tendon better

• Consider ibuprofen

• Take the stretch off your Achilles Tendon by wearing a higher pitched shoe and limiting barefoot walking for at least a week

So come in early with this injury so you can get an accurate diagnosis. There are seven other causes of Achillies pain so if the above isn’t helping don’t freak out. We have plenty of tricks up our sleeve for the other causes also!

You can give us a buzz on 0293650004 or Book HERE to get your Achilles Injury under control ASAP

Thanks for reading!

Nick T

Hamstring Strains - The Key Things You Must Do And Not Do

If you have ever had a hamstring strain you definitely don’t forget about it anytime soon . Whether you were sprinting along at full pace for the ball or doing sprints at the park. It stops you immediately in your tracks. It’s like someone just kicked you in the back of the leg, you stop immediately and do that stiff legged urgent bathroom walk. Alternatively you just lie on your back holding your thigh because the pain and cramping are so bad. It can look pretty black and bruised sometimes and you just do not want to move your leg.

The hamstring has to do a lot when you sprint. It has to move your hip and knee at the same time because it crosses both joints. The most common point you get a hamstring strain is when you are swinging your leg through at full pace just before your foot strikes the ground (terminal swing). It’s at this point that the hamstring has to really decelerate the leg before it hits the ground while the hamstring is in a very stretched position.

Here is  great example of a hamstring tearing in an AFL player to help understand the above position

I want to reassure you that the majority of hamstring strains return to sport within 3 to 4 weeks max. That is with the right rehab program and early quality management. It has a really high reinjury rate in the first 15 weeks of between 20 and 33% so it’s really important you complete the rehab program to a high level to condition the hamstring to sprinting. 

People are surprised at how early we get you running (7-8 days). Sprinting drills 4 days. Riding a bike (3-4 days). Sprinting at 2 - 2.5 weeks in some form.  What is really important is those first few days. Minimising the damage done. Reducing extra swelling. Trying to set up an environment where you can rehab quality healing hamstring tissue.

So what should you do if you have just strained your hamstring?

The first thing you should do is go home and rest. I’d put some compression bandage, k tape or compression tights on during the day and take them off when you sleep. This reduces the swelling and bleeding. The less swelling, the quicker you can start rehabbing. 

DON’T take voltaren. It delays scar tissue when we really want to lay some scar tissue. This is arguably the most common mistake people make. If you are in a lot of pain I would recommend panadol or ice packs. 

DON’T drink alcohol. Sometimes you want to feel like drowning your sorrows after this type of injury which usually happens when you’re in great form. But don’t …. it simply increases the bleeding and swelling.

Work from home if you can for the first two days and ideally just chill on the couch.  There isn’t really any new tissue laid down until day 3 so trying to be a hero by limping to work a day after injuring yourself doesn’t do you or your hamstring any favours.

Try and elevate your leg above your heart on a couple of pillows for the first two days is also useful.

Early rehab phase 

On your first visit to the clinic our goal is to really settle your pain, begin gently reloading the hamstring, gently strengthening your hamstring and give you some explosive vertical propulsion movements to maintain your power and figure out what we can do to maintain your cardio fitness.

It’s really important to book an appointment to see us or your local physio on day 3. If you can’t and have to wait a couple of days try the below exercises (don’t try on day 1 or 2). 

Do the below exercises twice per day BUT they need to be pain free.

Exercise 1: Isometric bridge 6-8 x 10 seconds. Progress out until the point just before pain. 

Isometric Hamstring Progression

Exercise 3: Bridge with core sliders and sliding lunge

Exercise 3: Single Deadlift and Reach

People get worried when they start doing this at day 3 or 4. However when they can see it’s safe and pain free it can be a real confidence booster. The hamstring needs to be stretched out further with speed to bother it so these are safe exercises as long as done pain free.

If you have access to an exercise bike I would also start cycling. It should be pain free and you should be able to add a bit of resistance to get a proper work out to keep your fitness up.

So that’s a pretty good start to your hamstring strain rehab program. I consider it a “good” injury to get because your hamstring has a great blood supply and you can work around a 14-28 day return to sport most of the time. There are times where it can be slower. This generally indicates that you may have injured the central hamstring tendon. We would get an MRI to diagnose this if you weren’t back on the field post doing our sprint testing protocol.

So there you have it. Create the nice environment needed for both of us to get you on the field or training ASAP. Give us a call on 0293650004 or book online HERE to get your program started asap. 

Thanks for reading :)

Nick T

Oxygen: The New Anti Aging Drug

Oxygen has become the new wonder drug. The simple art of breathing has taken the crown of sleeping. Just like the coconut did to kale and goji berries. 

Something we do subconsciously and automatically has now been broken down into a bunch of different systems and made to be complex. It can be overwhelming on which one to pick. To be honest they are all great. I’d probably just start with something simple which we will go over later. Like running 5kms instead of a marathon the first time you try. 

I’m currently spending many hours studying to become a Buteyko breathing practitioner because I truly believe faulty breathing mechanics are a big part of why people are in pain.

A patient of mine came in just before the lockdown. She felt the key issue to her back pain was her weak core. So we got the ultrasound out to see if her core was “weak”. Her pelvic floor wasn’t moving and the right side of her deep tummy muscles was flat-lining.

What was more obvious was she was using her neck muscles to breathe, mouth breathing, breathing rapidly and shallowly. I asked if she was asthmatic. She said she was a kid and had developed anxiety of not being able to breathe ever since. 

We did a couple of mindful breathing exercises to change her breathing mechanics and then all of a sudden her “weak core” was now functioning perfectly. It wasn’t her weak core that was the issue, it was her breathing pattern. Just like getting strong or fit this stuff takes both patience and time but being aware of it is a huge step in the right direction. 

So what’s the big deal with the breath anyway?

The breath is kind of like the on-off stress button. Stress is actually good for you in small doses. It’s how we evolve, become more robust, and more resilient. It’s also a bit anti-aging as well. Think of the Infrared sauna, cold baths, High-intensity exercise, and intermittent fasting as a couple of options of “good stress”.

Bad stress is different. It’s when the stress button is left on for a while. Like an IV drip of constant stress. Not helpful. Think pandemics, home schooling in lockdowns, work stress that lasts for weeks not hours. The nights you grind your teeth in your sleep. 

Changing your breath from those shallow rapid breaths to slower, deeper nasal breaths to your diaphragm or tummy is the quickest way out of that state and into the parasympathetic calm zone. The zone where we repair and do the good stuff our body needs. 

Interesting facts about mouth shallow breathing: it can increase oral cavities by 60% and increase your susceptibility to viruses by being a mouth breather when you sleep. It correlates with a bunch of chronic illness and auto immune disorders.

Taping your mouth when you sleep is now a thing people do to change to nasal breathing.

So what do I do Wim Hoff, Butyeko? I’m confused?

You can try Wim Hoff if you want. He has an app HERE

However, if you have been an asthmatic, suffer from breathing anxiety, or want to optimize your breathing pattern try the below

Step 1: Lye on your back with one hand on your chest and one hand on your tummy. Close your eyes and focus more breath to your tummy hand than your chest chest hand. Breathe in and out through your nose. The nasal breathing is really important.

Step 2: Make the breathing patterns 3 seconds in and 3 seconds out x 10 breaths.

Step 3: Now make them 5 seconds in and 5 seconds out x 10 breaths

Step 4: Add a 5-second breath-hold between 5 in and 5 out x 20 breaths

Step 5: Pat yourself on the back. That will do. Still feel as stressed? Probably not.

Step 6: Don’t beat yourself up if you don’t do it perfectly the first week. Also don’t overthink it or panic.  You’ve survived this long breathing the way you have. Be patient. It takes weeks not days to get it better and you’re going to get events like a pandemic where you still get overwhelmed.

It’s a great tool to get that stress button off. You can do this exercise driving, you can do it walking and at your desk. You can even do it on a ski chair lift if you have a massive fear of heights like myself.

You know what….it could even strengthen your “weak core”. 

Here are a few breathing exercises:

Breathing The New Anti Aging Drug

Breathing Drill 2

Immediate Stress Relief Breathing Exercise

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Myth: Physio Is Just For Muscle Strains

Physio’s don’t just treat muscle strains! We assess and treat the entire musculoskeletal system; bones, joints, muscles, ligaments, fascia, tendons, and more. If you have an issue (pain, stiffness, weakness, instability) that is associated with movement, then it is likely that a Physio is the right person for you!

Muscles and bones (and everything else) work as a team, you can’t treat one and not the other. If a muscle is tight, it can make the joint it crosses feel more stiff e.g. your back could feel stiff if your back muscle is tight. This could be treated by spinal joint techniques (mobilisation or manipulation), muscle loosening techniques (massage or dry needling), or exercises/stretching. These are just different ways of approaching one problem.

Often what we find is a different approach will work for different problems and different people. Maybe your back loves Pilates, while your neck and shoulders crave some hands on attention, but you need to keep your knees strong. This is very common, and why we always recommend you have a variety of physical activities in your week. It also means it’s ok to see a few different health practitioners, but it’s best to let each of them know they are part of the team so we can communicate if needed and work together.