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The Body Refinery
In Physiotherapy, Pilates

Pilates and Low Back Pain

Pilates low back pain

Chronic Low Back Pain (LBP) is a condition that affects more than 50% of the population, with  70% of the population believed to experience an episode of LBP within their lives. Research shows that 60-80% of these patients will experience another episode of back pain within 1 year of an episode. With such a high prevalence, LBP is the second most common reason for absenteeism and for seeking medical consultation.

Through research, we now understand that after an initial onset of LBP there is a dramatic weakness, accompanied by an incorrect firing pattern in the key spinal stabiliser muscles, including the core muscles & multifidus. Importantly, without specific retraining, these muscles do not spontaneously recover. Despite the lack of pain, this ongoing weakness means the spine is not receiving sufficient support to prevent ongoing shearing forces across the disc and joints, which can result in chronic or recurrent LBP.

A common misunderstanding is that the strengthening of the superficial abdominal muscles is directly related to the deep core stabilising system. Many patients have heard of the need to perform abdominal exercises post LBP, and so begin strengthening exercises for the rectus abdominis and for the internal/external obliques. However, these strengthening exercises are not very effective in preventing LBP, compared to specific stabilising exercises involving the transversus abdominis & multifidus muscles.

 

Work on your core system

Studies have found that strengthening superficial muscles, despite not being stabilising muscles, does help to decrease pain and improve function after an episode of low back pain. However, the results were not as significant as those achieved by performing specific stabilising exercises of the core system. Core strengthening resulted in a 90% improvement in both reported pain and functional disability when using the McGill Questionnaire. The significant improvements with specific core training are explained by the fact that the two primary muscles, which are inhibited by LBP are re-activated to function correctly. As the multifidus has been found to atrophy after LBP, without specific training this muscle does not revert back to its pre-injury state, and therefore does not provide the stability required.

Patients who focus solely on exercising the larger superficial muscles still show improvements in pain and function. With a moderate contraction of the rectus abdominis and obliques, there is still an increase in intra-abdominal pressure which helps to alleviate compression forces on the disc. However, despite significant improvements in the strength of the superficial muscles, studies show that there was no change in activation of the deep core stabilising muscles. The increase in intra-abdominal pressure is a secondary stabilisation system and does not provide the micro segmental stabilisation that is delivered by the core stabilisers.

low back pain

Strengthening the superficial abdominal muscles certainly has its role in recovery from chronic LBP, however, it is necessary to first target the primary muscles that provide spinal segmental stability prior to global strengthening. Even without the superficial muscles, activation of the transversus abdominis and multifidus alone results in better outcomes for LBP patients. With correct management and guidance, patients with LBP who reactivate their core system in combination with their global stabilising muscles have a far better chance of preventing future episodes.

 

Pilates for LBP

This research clearly demonstrates the significant benefits to LBP patients that the addition of a targeted exercise program, such as Pilates, can have in retraining the deep spinal stabilisers. Pilates is designed to seamlessly progress patients into functional strengthening so that the spine is supported during everyday activities.

Can’t make it to our studio? Physiotherapist, Aga, has developed a 4-week Low Back Pain Online program in order for you to exercise everyday at home, at your own rhythm. More info on https://www.thebodyrefineryonline.com/low-back-pain-program

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Book an appointment with a Physiotherapist today by calling 07 3358 3915 or visit info@thebodyrefinery.com.au.

Can’t make it to the studio? Take your physiotherapist and Pilates Instructor with you with our 4-week online Low Back Pain program.

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The Body Refinery
In Physiotherapy

Understanding Sciatica

Sciatica is the term used to describe pain felt along the course of the sciatic nerve. The sciatic nerve is the longest nerve in the body. It travels from your lower back through the buttock, and down into the hamstrings and lower leg.

The symptoms of sciatica can include one or more of the following:

  • Pain in the buttock and/or leg that may be worse when sitting or standing; it usually only affects one side
  • Pain may radiate down the back of the thigh, back and outside of the calf, foot and toes
  • Associated tightness and spasm in the surrounding muscles
  • Burning or tingling in the leg or foot
  • ‘Pins and needles’, numbness, weakness or difficulty moving the affected leg or foot
  • Sharp / shooting pain that may make it difficult to stand up or walk

 

Causes of sciatica:

  • Sciatic pain is usually caused by direct compression or irritation of the sciatic nerve, or the smaller nerve roots that form it. This can be due to:
    • Injury to the intervertebral disc, causing it to bulge or herniate, which can lead to direct pressure on the nerves as they exit the spine (usually the L5/S1 nerve root is involved).
    • Degeneration / arthritic changes in the spine, which can lead to decreased disc height, narrowing of spaces between the vertebrae, and decreased space inside the spinal canal.
    • Restricted or abnormal movement through the lumbar spine due to poor posture, trauma, a sedentary lifestyle and repetitive heavy lifting or loading can lead to irritation of the joints between the vertebrae, inflammation and associated muscle spasm and tightness. These changes can result in irritation of the sciatic nerve.
    • Piriformis syndrome – the piriformis muscle is located deep in the buttock. The sciatic nerve runs below or through the piriformis muscle, and tightness or spasm here can irritate the sciatic nerve. It is rare, however, for a tight piriformis to be the only cause of sciatica.
    • Sacroiliac joint (S.I.J.) dysfunction – this joint is located between the sacrum and the pelvis. The sciatic nerve runs close to the sacroiliac joint, and damage or inflammation of the joint can lead to irritation of the sciatic nerve.
  • Referred pain from muscles or joints in the lower back, pelvis or hips can mimic sciatica. Referred pain is usually dull and achy in nature, not sharp or shooting, and it does not usually cause neurological symptoms i.e. numbness, tingling or muscle weakness in the affected leg or foot.

sciatica
 

Physiotherapy management of sciatica:

  • Most cases of sciatica can be resolved within 6-12 weeks, though this will vary for each individual and is dependant on the underlying cause and severity of the symptoms.
  • Your physiotherapist will start by getting a history of your pain and symptoms, as well as identifying aggravating and relieving factors, to help diagnose the cause of your sciatica.
  • A thorough functional assessment will then be undertaken, which may include an assessment of your posture, spinal range of motion, muscle strength, balance, sensation and reflexes.
  • If further investigation is needed, your physiotherapist or doctor may refer you to imaging of the spine – a CT scan or an MRI.
  • The initial aim of treatment is to reduce the irritation of the nerve and to manage pain and inflammation. Your physiotherapist will also advise you to avoid aggravating activities, such as prolonged sitting, bending or lifting. You will start with some gentle exercises to help to reduce your symptoms.
  • Once the acute pain and inflammation have settled, your physiotherapist will focus on restoring normal range of motion, flexibility and posture. You will be given an individualised exercise program to address the underlying cause of your sciatica. The exercises will help to correct any muscle imbalances, increase your core control and improve the stability around your lower back and pelvis.
  • The aim of the next stage of rehabilitation will be to safely return you to full function in your daily activities and/or sport. Sciatica can recur, mainly due to insufficient rehabilitation. Your physiotherapist will teach you self-management techniques to prevent recurrence of symptoms.

 

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Book an appointment with a physiotherapist today on 07 3358 3915 or info@thebodyrefinery.com.au

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The Body Refinery
In General Fitness, Physiotherapy, Pilates

Hip pain – Pilates can help you

hip pain

Hip pain is very common and can result from numerous different causes. Hip pain tends to occur commonly in two distinct age groups: the young (from 0 to 15 years); and the older population (>45 years of age). ‘Hip’ pain is usually located in the groin, upper thigh or buttock, but may also be somatically referred from the lumbar spine.

 

The most common causes of hip pain in adults are:

  • Osteoarthritis of the hip (>50 years)
  • Lower back problems
  • Fracture of the femoral neck
  • Traumatic muscular strains and bursitis or tendinitis (sport-active adults)
  • Infection – septic arthritis, osteomyelitis
  • Malignancy

 

In children and adolescents, the common conditions leading to hip pain are:

  • Congenital dislocation of the hip
  • Perthes’ disease: (4-8 years) necrosis (tissue destruction) of the femoral head due to lack of blood supply.
  • Slipped capital femoral epiphysis (SCFE)

 

A recent study estimated that nearly 25% of the population will develop symptomatic hip arthritis before the age of 85. Risk factors for the development of arthritis are now well established and include femoral acetabular impingement, labral tearing, developmental dysplasia and slipped capital femoral epiphysis. As our understanding of hip pathology evolves, the focus is shifting to early identification and treatment to prevent or slow the progression of hip conditions.

The challenge for general practitioners and physiotherapists alike is to elucidate whether an individual’s hip symptoms originate from intra-articular disorders or from the surrounding extra-articular soft tissues and to target treatment accordingly. Optimal patient care is best achieved with a multidisciplinary approach involving education on lifestyle factors (diet, activity modification), medications, and physiotherapy.

hip pain

How can we help with your hip pain?

The Body Refinery’s physiotherapists are skilled in the assessment and treatment of hip conditions. We understand that the successful management of hip pathology requires thorough examination of the hip joint, as well as adjacent joints, including the sacroiliac joint and lumbar spine. Additionally, our physiotherapists undertake a thorough biomechanical analysis of the affected lower limb to determine any underlying issues that may be predisposing the individual to their hip problem.

Physiotherapy aimed initially at improving hip pain and flexibility can be expertly progressed to exercise therapy. This with a strong focus on optimising lower limb biomechanics, thereby reducing the risk of re-injury and encouraging a return to work, sport and activities of daily living.

Essentially exercise therapy should be individualized and patient-centred, taking into account factors such as patient age, mobility, co-morbidities and preferences. An assessment of specific impairments such as strength, the range of motion, aerobic fitness and balance are needed to determine the most appropriate exercise regime.

 

Pilates can help you

At The Body Refinery, once any manual therapy has been carried out to aid hip mobility and/or reduce painful impingements, our physiotherapists use a progressive, individualised treatment program to correct any aberrant movement patterns, instability or poor mechanics that overload the hip or adjacent areas. Clinical Pilates is an excellent form of exercise for hip rehabilitation.  Pilates is a progressive form of exercise that can be individualised and progressed to suit the individual’s rehabilitation needs. Pilates focuses on the alignment and function of the lower limb. As a collection of exercises, it also allows the body to be trained functionally.

 

The Body Refinery’s physiotherapists are also trained Clinical Pilates instructors, making The Body Refinery Pilates studio the ultimate environment to take clients from acute pain back, through to function, and into performance.

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Book an appointment with a physiotherapist today on 07 3358 3915 or info@thebodyrefinery.com.au

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The Body Refinery
In General Fitness, Physiotherapy

One sneeze too many?

incontinence The Body Refinery New Farm

Recently, actress Kate Winslet was being interviewed on the Graham Norton show. She was talking about how having babies had affected her and specifically her ability to remain continent when sneezing. “I can’t jump on trampolines anymore, I wet myself,” Winslet, 42, said on the show. “It’s awful, especially if you’re wearing a skirt.”

The mother of three attributes her incontinence to childbirth. “When you’ve had a few children you know, it’s just what happens,” she says. “It’s amazing, two sneezes, I’m fine. Three, it’s game over.”

 

So, is childbirth responsible?

While many people think that incontinence is a condition that only affects the elderly, it can affect men and women of all ages. Urinary incontinence, and in particular Stress Urinary Incontinence (SUI), is a significant health problem which can have a considerable impact on an individual’s quality of life.

SUI is defined as the involuntary loss of urine on effort or physical exertion, such as sneezing or coughing. Current evidence indicates that stress incontinence affects 4% to 14% of younger women and 12% to 35% of older women, with a peak incidence in midlife around the time of menopause.

Many women with urinary incontinence do not seek help for their condition. Some women have SUI of a mild nature and do not feel that treatment of the condition is warranted; others are embarrassed to speak with a healthcare provider about their condition or fear that treatment will require surgery.

 

incontinence The Body Refinery New Farm
 

What if we told you that simple Physiotherapy can help?

Whilst the cause of SUI is often multifactorial and may involve muscle, nerve or sphincter issues… research provides overwhelming support that pelvic floor physiotherapy is effective at reducing SUI. Furthermore, there is widespread recommendation that pelvic floor muscle training should be included in first-line management programmes for women with stress, urge or mixed urinary incontinence.

So if you, like Kate, experience symptoms from ‘’one sneeze too many”, there is help available! The Body Refinery offers women’s health physiotherapy, which involves assessment by specifically-trained, female Women’s Health Physiotherapists, who can then help with the management of stress urinary incontinence.

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Book an appointment with a Women’s Health Physiotherapist today on 07 3358 3915 or at info@thebodyrefinery.com.au

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The Body Refinery
In General Fitness, Physiotherapy

What is your posture like at your desk?

posture tips the body refinery

It is very common to find people with back and neck problems that are related to their work setting and posture. As physiotherapists, we seek to understand the underlying factors that are responsible for each patient’s ailment. For this reason, we always ask our clients: “What makes the pain worse?” The most common answer we hear is “When I sit at my desk at work”.

Obviously, avoiding sitting at a desk isn’t usually a viable option, however, we can teach you some strategies for working at a desk that will minimise the likeliness of further injury or pain. It may sound strange that just sitting can cause injury, but that’s exactly what can result from poor static posture when sitting at the desk!

There are many reasons for this: Firstly, the human body is not designed to be seated in a chair for 8 hours a day. Stress, poor workstation ergonomics, and bad posture are the main cause of this sort of injury or pain. To remedy these, it is important to position your arms, legs and spine in the appropriate alignment, to distribute the appropriate load on your joints and muscles. Doing so avoids excessive overactivity or overstrain.

 

Here are 5 tips for a good posture in order to prevent ergonomic injuries:

 

1. Find your natural posture

  • Move your chair away from your desk and sit down comfortably. For most people, it would look a lot like sitting in a car. Your feet are on the floor in front of you; your hands are in your lap, and your shoulders relax as you lean back just a bit.
  • This is called your “natural posture.” In it, your vertebrae are stacked, your entire back moves as you breathe, and your pelvis is positioned so that your spine is stacked properly.
  • Memorise this natural posture.

posture desk tips the body refinery

2. Keyboard and mouse placement

  • Building around the natural posture, the keyboard and mouse should be positioned in a way that keeps your elbows to your sides, and your arms at or below a 90-degree angle. This way, the muscle load is reduced and you’re not straining.
  • Position your keyboard 1 to 2 inches above your thighs. For most people, that probably means employing a pull-out keyboard tray. Alternatively, you can lower your desk, but the keyboard tray is a preferred method. Here’s why…
  • Tilt. The keyboard should ideally be positioned with a negative tilt — down and away from you so that your arms and hand follow the downward slope of your thighs. That being said, you should never use the kickstand that is incorporated underneath most keyboards.
  • Position. Ideally, your keyboard and mouse should be shoulder-distance apart and as level as possible.

 

3. Position your screen(s)

  • Distance. If your screen is too far away, you’ll start doing something called ‘turtling’, or craning your neck, and you’ll find yourself extending your neck to see it.
  • To find the right screen position, sit back and extend your arm. The tips of your middle finger should land on your screen. That’s the spot.
  • If you have two monitors, set them up side by side (no gap), and place the secondary monitor off-centre. Those who use both monitors equally should centre them both. Now, sit back and extend your arm and pan in an arch. As you pan your arm, your fingertip should almost always touch the monitors. Use the same logic when placing other items, like a document holder or a phone.
  • Height. To adjust the height: close your eyes. When you open them, your eyes should land on the address bar. If not, lower or raise the monitors using the built-in option, with risers, or with other items (as long as the monitor is safe and stable).

 

4. Adjust your chair

Your chair is your best ergonomic friend. It supports your back, bottom, and posture. Here are some things to look for in a good chair:

  • Shape. Think back to your natural posture. With your tailbone sticking out just a bit, and your vertebrae in their slight curve, the lumbar portion of your spine points in toward your belly. To help you sustain this posture, find a chair that offers good lumbar support.
  • Length. When you sit down, there should be a little space between the edge of the chair and the back of your knees, about the size of your fist. Depending on the chair, you might be able to adjust the seat depth accordingly.
  • Height. When you sit, your feet should be on the floor (not dangling) in front of you, and your thighs should be slightly below your hips. Shorter people may need to use a footrest, while extra-tall people may need to adjust the height of the desk.
  • If you ever find yourself tucking your feet behind you, sitting on one leg, or in another irregular position, your chair needs to be adjusted.

 

5. Move every hour (minimum)

  • Take a break at least once an hour to walk around the office or stretch. If it helps, set an hourly alarm as a reminder.
  • No matter how ergonomic your workstation is, stretching your body is the only thing that can combat the health issues that arise from prolonged sitting.

 

If you have any questions or concerns about any pain or discomfort you are experiencing, do not hesitate and consult one of our physiotherapists. With Pilates, we can improve the endurance and strength of the postural muscles, so that sitting in the appropriate posture is eventually something that comes naturally.

We have also developed an online 4-week Low Back Pain Pilates program. Take your Physiotherapist with you!

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Follow us on Facebook, Instagram and Twitter for a daily dose of Pilates and Wellbeing.

The Body Refinery
In Physiotherapy, Pilates

Physio and Pilates – the ultimate combination

Pilates Physiotherapy Combination

A combination of Physiotherapy and specific exercise protocols in a Pilates program are the key to a successful Pilates workout.

Why change something if it’s not broken?

Pilates has been around since the early 1920’s. Recently, physiotherapists have started returning to exercise-based therapy and in particular, the Pilates method, which can provide a number of benefits, according to evidence-based studies (3).

The first Pilates teaching courses for physiotherapists in Australia started in the early 1990s, with an aim that Pilates would be another tool for physiotherapists to use. Postgraduate training (by teachers such as Butler, McKenzie, Sahrmann and Janda) along with spinal stability training and muscle energy techniques all had a part to play in adapting Pilates to a clinical setting (4).

Physiotherapists in Australia have traditionally used a “hands-on” approach in the acute stages of injury, which provides excellent outcomes to a point, beyond which exercise is a logical progression. Unfortunately, most patients progress to a gym setting that is often not appropriate or specific enough to address the underlying biomechanical causes, and all too often this aggravates the original problem.

Combination Pilates Physiotherapy

Research over the last two decades has shown that the most effective way to manage spinal instability is with specific exercise programmes that are designed, and supervised, by a physiotherapist. Improving activity of the core group of muscles is now accepted as being more effective than other training regimes that focus on strengthening periphery muscles (4). Motor re-learning strategies that look more at muscle and movement efficiency are replacing strength and power regimes (3).

“The success of the Pilates system in managing pain, inhibiting pathology and training coordinated movements, is that it gives the physiotherapist a tool to be able to address the motor control specifics of dysfunction and more importantly problem solve the reason or pathology behind the situation” (4)

The value of Pilates to physiotherapists now extends beyond rehabilitation exercises, which act as an adjunct to treatment, to being a very effective treatment tool in itself.  It can be employed as an alternative to “hands-on” management, helping the clinician to confidently progress to a more pathology-specific exercise regime rather than a programme of generic exercises (2).

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Join our Clinical Pilates classes and focus on your health and mind-body connection. Call us on 07 3358 3915 or download our app.

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References

  1. Lim E et al (2011) Effects of Pilates Based Exercises on Pain and Disability in individuals with persistent Nonspecific Low Back Pain: A Systematic review with Meta-analysis. J Orthop Sports Phys ther Vol 21 (2)
  2. Tulloch E, Phillips C, Soles G, Carman A, Abbott H (2012) DMA Clinical Pilates Directional Bias Assessment: Reliability and Predictive Validity JOSPT: 42(8):676-687
  3. Wajswelner H, Metcalf B, Bennell K (2012) Clinical Pilates versus General Exercise for Chronic Low Back Pain: A Randomised Trial. Med. Sci. Sports Exerc, Vol.44 No 7, PP1197-1205
  4. Phillips C (2003) Pilates, the clinical changes are key. Musculoskeletal Physiotherapy Australia Newsletter IN TOUCH issue 2/3 2003
  5. Rydeard R, Leger A, Smith D (2006) Pilates-Based therapeutic Exercise: Effect on subject with nonspecific chronic Low Back Pain and Functional Disability: A Randomized Controlled Trial.  JOSPT 2006;36(7): 472-484

 

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