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.

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.

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:

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

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. 

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. 

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. 

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. 

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.

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

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. 

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. 

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.

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.

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 

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). 

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. 

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”