Neck pain? Try these 4 simple exercsies

Neck pain is really common. 

Thankfully, most neck pain is not related to anything structurally wrong, but more a warning sign from your body telling you, "it's time to move".

Your muscles don't like stagnant conditions, as the blood flow is restricted and creates acidic conditions in the tissues which contributes to the pain experience. 

If you can, pay close attention and become aware of the early stages of stiffness building up in your neck and shoulders. 

If you can get moving as soon as possible, there's a good chance you can avoid the downward spiral that often involves more intense neck pain, restricted movement and headaches.

These set of four exercises targets the upper back (thoracic spine), which is often very stiff in people who experience frequent bouts of neck pain. 

Cat-Cow

Start on your hands and knees with your back in a neutral position.
Arch your back, lifting your head up and pushing your tail bone out, making a dish with your spine.
Hold this position for one breath.

Next, arch your upper back by tucking your head and tail bone in and pulling your belly button in towards your spine, making a curve through your back.  Exhale completely as you activate your deep core stabilisers.
Repeat x 10 times

Thread The Needle

Bring yourself up onto your hands and knees.
Your hands should be under your shoulders and your hips over your knees.
Take one hand off the floor and reach in and through between your other hand and leg on that side.
Allow your shoulder and head to follow, moving down towards the floor as your hand reaches through.
Allow your upper back to twist and rest your head gently on the mat. 
You should feel a stretch in your upper back and shoulder blade.
Hold for 30 seconds and then repeat on the other side. 

Push-Up To Side Plank

Push yourself up into a plank position with your hands under your shoulders and
Perform a half push up.

As you're coming up, rotate your body, turning one arm up towards the ceiling.
Allow your head and body to follow the movement.
Your may rotate a little on the balls of your feet.
Return your hand to the floor and repeat on the other side. Repeat x 3 each side.

Thoracic Mobilisation On The Foam Roller

Lie with a foam roller in your mid-back, and hug your arms across your chest to open up the upper back.
Lift your hips off the mat, and roll back and forth for about 30 seconds, pushing with your legs.  You may feel a few cracks and pops which is a great sign your are releasing the joint stiffness.

Try spending 5 mins every morning and night and see how it helps your neck pain.

If you have any questions please contact us dan@kinfolkwellness.com.au

If you'd like to get a more personal assessment and treatment of your neck pain, please use our easy online booking system below to make an appointment:

Explain Pain Supercharged

Awesome evening attending the book launch of the new edition of 'Explain Pain: Supercharged' with Pain Educator, Author & Legendary Physiotherapist David Butler.

A few nuggets that I took away:

• Chronic Pain (lasting more than 3 months) is complex - and needs to be considered from a Bio Psycho Social (BPS) perspective 

• Pain is a protector. There is no need for a 'war on pain' & this defensive attitude can create more problems

• There is no such thing as a 'pain receptor'. Your brain only ever receives 'potential damage messages' from the tissues, not 'pain' as such. Depending on the context, the brain then creates the pain experience to get your attention and motivation to change behavior.

• Your thoughts about your pain and injury have real and direct correlations with the immune and nervous system.

• Catastrophization about your experience  can literally turn up the sensitivity dial to the sensations coming from your tissues.

• Innocuous twinges can become amplified, like an overly sensitive car alarm that goes off every time a strong wind blows.

• "RECOVERY is right on the cards "

• The pills aren't working for chronic pain sensitization (33,091 Americans died from opioid overdoses, according to the Centres for Disease Control—almost three times the number who perished in 2002), neither is the surgery. Might work better with pain education combined with gradual return to activity

• Education + reconceptualising out-dated and unhelpful beliefs is the most powerful tool we have !

Do you have an issue with chronic pain?

We'd love to help.

Please click here to see how we can help you...

Top 10 Muscles That Respond To Dry Needling

Top 10 Muscles That Respond To Dry Needling

One of the benefits of dry needling is it's a very precise way of releasing a muscle. 

Compared to massage, getting a twitch response out of a muscle gives a very predictable and effective release, deep from within the muscle belly.

In this post, I wanted to give you some insight into some of the best responding muscles that dry needling can help with.

If you want to learn more about exactly how dry needling works, please read more here.

Of course dry needling can be done to any muscle.   The following post is to give you some insight into some commonly treated muscles that give especially good 'bang for your buck'.

*Please also see some important notes at the end of the post.

1.  Deltoids

In terms of shoulder pain, the deltoid is a very under-rated muscle.

The deltoids include three sections (anterior, middle and posterior) that sit superficially around the shoulder.  The deltoid is involved in almost all shoulder movement.

The way the it wraps around the shoulder makes it a very difficult muscle to stretch and it is prone to building up tension.

Trigger points and knots often develop in the deltoid that can give rise to shoulder pain (see pic above). 

This pain can be quite severe and unrelenting and stubborn to usual treatment.

A common history is over-doing some push-ups and waking up the next day with pain in the front of the shoulder. 

Or someone who has done a lot of heavy over-head weights (Cross fitters...!) over the years and doesn't do much stretching. 

Sometimes it's the last small movement and final straw the breaks the camels back so to speak.

Dry needling the deltoid often gets some powerful twitch responses. 

Expect soreness and a dead arm feeling for a few days before things settle down.

2. Latissimus Dorsi

The latissimus dorsi is a fascinating muscle. 

It has attachments to the hip, shoulder, upper back, lower back and rib cage - and that makes it the largest muscle in the upper body.

Tightness in the latissimus dorsi has been shown to be an important cause of chronic shoulder pain and chronic back (especially upper back) pain.

Because of its extensive attachments, it can be another difficult muscle to stretch effectively. 

Dry needling gets in there and gets the job done.

If your lats are tight, you will need to add in some regular childs pose and over-head stretching, in addition to foam rolling your upper back.

3. TFL / ITB

The fastest way to release your ITB ? 

Release the under-rated small muscle that attaches to it, called the Tensor Fascia Latae (TFL).

The TFL is a small but powerful hip flexor and usually tight from excessively sitting, walking, running and cycling.

When overly tight, can contribute to knee pain by causing mis-tracking of the kneecap. 

Combine dry needling with some specific gluteal activation and you will be well and truly on the way to saying goodbye to your ITB pain and tightness. 

If you look after your TFL well, there's a good chance that excruiating ITB foam rolling will not be required.  Happy days :-)

4. Glutes

One of the cool things about dry needling is that we can access deep points in a muscle that you would otherwise be unable to access.  

The gluteus medius is an interesting muscle that can be dysfunctional in chronic lower back pain, hip pain and knee pain.  

Dry needling can immediately 're-set' the glutes and allow for a graduated re-loading program. 

Long-term, a well functioning gluteus medius will protect your hips, knees, ankles and lower back. 

5. Calf - Gastrocnemius & Soleus

Calf muscle tension and limited flexibility is especially common in the modern age. 

When tight, the calf muscles are prone to cramping and eventually tearing.

Deep tissue massage can be effective, but can be very painful, bordering on intolerable.

Dry needling to the calf muscles, whilst intense, is quicker and more effective in its release. 

Expect some treatment soreness for 1-2 days post-needling.

And don't forget to re-build your calf capacity with an appropriate strengthening program.

6. Upper Trapezius

Much like the calf above, the upper traps can be loaded with tightness. 

Causes can include poor posture, lack of physical activity and prolonged stress. 

Heavy handed massage can stir up more irritation in the muscle.

Dry needling is more like using a sniper approach - with a few direct releases, you can release the traps and get the blood flowing much more effectively and deeply. 

This study recommended dry needling for immediate pain reduction in upper body myofascial trigger point dysfunction.

Using heat on the traps via a wheat pack is really helpful, especially in the evening before bed.

Also make sure you are getting enough down time as chronic upper traps tension is a sign of sympathetic over-activity.

7. Infraspinatus

The infraspinatus is a sneaky little muscle that sits behind your shoulder blade. 

It is often weak and gets overloaded when using your arm and shoulder.  

When the infraspinatus gets tight, you'll often feel pain in the front and deep part of your shoulder.

Dry needling de-activates the trigger points quickly, but be prepared for a dead arm for a few hours.

Don't forget to re-build with some simple strengthening exercises with a thera-band.

8. Wrist Extensors

Tennis elbow is a very common condition that primarily affects the extensor tendons on the outside of the forearm. 

The pain often drags on for months and years due to a very poor blood supply in the elbow tendons.

The research shows that dry needling releases a very specific chemical, known as Platelet-Derived Growth Factor (PDGF), that produces a strong increase in blood flow into the muscle.

In effect, blood is a healing agent, bringing oxygen and critical healing chemicals to the damaged cells.

No other technique that I know of is capable of doing this.

9. Biceps

When was the last time you stretched your bicep muscle?  

Another muscle that gets used a lot, and builds up a great deal of tension. 

You'd be surprised how that niggling pain in the front of your shoulder improves after your biceps is released through dry needling.

10. Hamstrings

Tight hamstrings are pretty common. 

Stretching them normally does more harm than good (see here).  

Dry needling produces a quick and effective release.

Specific strengthening exercises that lengthen the muscle gives the best long term solution. 

Conclusion

Dry needling certainly isn't for everyone, but it can be a very effective and powerful treatment in the right context. 

Two quick notes:

1.  There are different types of dry needling and this blog refers to the type that activates a local twitch response. 

This is very different to acupuncture and dry needling where the needles are inserted superficially and left in for 20 minutes as the practitioner leaves the room. 

2.  Dry needling is always used as part of comprehensive treatment approach. 

This includes assessing your thoughts and beliefs about your injury, movement patterning and general health considerations. 

Specific exercises targeted towards your individual needs will help give you the best long-term outcome.

If you have any questions about dry needling - please feel free to give us a call 1300 657 813.

If you'd like to schedule a dry needling session and start feeling better straight away, please book online below:

The Best Defence Is A Good Offence

If you've had a few niggles or been in pain recently, you might find yourself feeling a little overwhelmed. Sometimes the pain forces us into a defensive or protective mode.

Defensive strategies could include:

• ignoring the pain & hoping it will go away
• regularly taking pain killers / anti-inflammatory to numb the pain
• reducing or eliminating any sort of exercise for fear of causing a flare up

You may also find yourself bracing your body rigidly, every time you move or you may hold your breath (subconsciously) the majority of the time.

Defence IS an important short-term strategy for a new injury, don't get me wrong.

But, after a few months, you're tissues have generally healed the best they can.

Then you've got to take a leap of faith and breakout out of defence and start to re-build proactively...step by step.

When planning your offensive play...success comes from having multiple strategies.

Just like in sport, if you're repeating the same offensive strategy all the time, your body will quickly see it coming and the positive adaptations become limited (and the risk of overuse injuries increases).

The best offence to build resilience in your body would include a good variety of types of movement.

Forming the foundation would be doing a form of Cardio aerobic exercise (whatever you enjoy), Pilates, Yoga, strengthening with a PT, and weight bearing exercise to stimulate bone growth.

Challenge for 2018:

Try x 5 NEW types of exercise or movement approaches that you haven't tried before.

TIP: try something that is the opposite of what you currently do. If you tend towards high intensity exercise than try something easier. If you tend to do easy stuff try something more intense.

Some movement options you could try:
- hiking, stand up paddle boarding, rock climbing, triathlon, cross fit, F45, orange theory fitness, Feldenkrais, karate, surfing, dancing, Parkour, BOUNCE, acroyoga, foam rolling, restorative Yoga, sprinting, 7 min workout, mountain biking, tennis, Aussie rules (especially for women!)

Keep challenging yourself.

Your body and mind will thank-you :-)

Tendinopathy Update

The past weekend I attended Peter Malliaras's course, 'Mastering Lower Limb Tendinopathies'.

Peter is an Associate Professor at Monash University and has spent many years researching and working with people with tendon problems. 

In recent years there has been a lot of significant new research in the world of tendon rehab.

If you've ever had an issue with an ongoing tendon problem, you can understand how frustrating the long term pain and dysfunction can be. 

There is much conflicting advice and out dated treatment approaches that can contribute to the poor outcomes many people face with tendon injuries. 

Thankfully, Peter has put all of the latest based evidence into a comprehensible format and in this blog post I'd like to share just a little summary.

This blog would be particularly helpful if you suffer from ongoing pain in the:

• Achilles tendon

• Hamstring

• Patella tendon

• Hip pain/bursitis

• Plantar fascia

What is a tendon?

Tendons connect the muscle to bone.  They are made up primarily of collagen fibres.

In the lower limb, role of tendon is to absorb and release energy

Tendons are like springs that absorb stretching forces and then release energy when we move.

What causes tendon problems?

Tendons are very sensitive to changes in load. 

Essentially, tendons become injured when we over-load them too soon, or when demand exceeds capacity.

This can be from:

• too much volume

• too much intensity

• change in footwear or surface

For example a runner may start to include sprinting or hill work too soon or increase mileage suddenly leading up to a big race.

High training load is not a risk for injuries, it's how you get there that is the important factor (i.e. avoiding acute spikes in training loads).

                   Tendons become damaged when demand exceeds their capacity

What is the difference between Tendinitis and Tendinopathy?

Tendinitis refers to the inflammation in the early stages of an injury. 

This is opposed to tendinopathy that refers to the process of degeneration that tendon goes through in response to chronic overload.

Recent research suggests a lot of what we previously thought of as tendon inflammation was actually related to tendinopathy.

Who is likely to suffer from a tendon problem?

Patella tendon (front of knee)

Usually occurs in younger people involved in jumping sports such as volleyball, basketball and football.  There is some evidence to suggest pathological tendon changes can begin in early adolescence if there excess load on the maturing collagen in the tendon.

Achilles tendon (back of heel)

Affects people across the lifespan, in particular long distance runners, sprinters, football and soccer players.  Often there is pain and stiffness that is worse on waking and when running. 

Gluteal tendon (side of hip)

Common in young females that are doing a lot of running or playing sport.  Also older women, especially around menopause or after post a hip injury / surgery.  Pain is often worse at night time, standing and walking.  There is some research showing a reduction in oestrogen can pre-dispose to tendinopathy. 

Hamstring tendon (back of hip)

Fast walkers, footballers, runners and people who do a lot of yoga are susceptible to hamstring tendinopathy.  They often experience pain on sitting, walking and bending forwards. 

What are the key risk factors for developing tendinopathy?

One of the biggest risk factors for a tendon injury is a past injury (2-19x greater risk of injury).

According to the research, people with tendon problems are not getting the rehabilitation and re-building of capacity they need.

Often patients self-discharge when their pain has gone away. 

It is imperative for the treating clinician to educate the patient that rehabilitation is a two step process:

1.  Reducing pain and then

2.  Re-building capacity in the tissues to match the demands placed on them

Other systemic conditions that can increase the risk of developing tendon pain include:

• Type 2 Diabetes ( 3 x risk)

• High cholesterol

• High blood pressure

• Menopause

• Obesity

• Inflammatory arthropathies

Some other factors that put you at a higher risk of ongoing tendon pain:

• unrealistic beliefs about likely healing time and optimal load management strategies

• inaccurate beliefs pain e.g. avoiding movement due to fear or rupturing a tendon

• too much passive treatment

• reduced variability of movement / exercise

How is a diagnosis made? 

Tendon issues are diagnosed with a combination of history and physical testing. 

If you have a localised pain that gets worse with movement and you can recall a sudden change in loading, there is a good chance you have a tendon problem.

Do I need a scan? 

Ultrasound scans can be useful to confirm the diagnosis and rule out certain other conditions. 

(See below for more info on scans)

Recovery and Management :

1.  Education ... (And Addressing Beliefs About Pain)

The long term goal is to create greater capacity in the tissues and this is your job, under the guidance of the physiotherapist looking after you.  

Manual therapy and dry needling does have a role to play in the short term to decrease pain and normalise muscle tone.

Credit: Jill Cook

Pain and Pathology

You may have a scary sounding ultrasound report, with words such as 'severely degenerative'.

The bad news first.  Your scans will most probably always look terrible. 

Structurally over time, there will be no change, despite what you do in terms of treatment.

The good news:

Many high quality research studies have shown that there is no correlation between pain and structural changes on scans. 

Your tendon will always be degenerated.

However, the thing we do have control over is the mechanical adaptation in the tissues around the tendon, as well as optimising biomechanics and sharing the load around the body.

The goal of treatment is to build the capacity in the tissues surrounding the tendon so that it meets the demand and creates a buffer zone of relaxation.

Some very important things to remember:

"Pathology is common in people without pain, so it cannot be the cause of pain.

Worse pathology does not mean it will be harder for you to get better.

Tendon pathology often does not change, even when the pain resolves" - Peter Malliaras
 

Recovery Time Line

It's important to understand the nature of recovery is often a case of 2 steps forward and 1 step back pattern. 

It's normal for your pain levels to fluctuate.

If you can accept this, while continuing with your rehab, you will have a much greater chance of success.

Credit: Adam Meakins

2.  Reduce the load temporarily while reducing pain and inflammation

Pain can be brought under control by managing load and using ice and NSAID's. 

You may need to take a short break from any aggravating activities.

If you can't take anti-inflammatories you may need to look at your diet for areas to address inflammation.

How can isometrics help decrease pain?

Isometric refers to a static contraction of a muscle without any movement. 

For example the diagram below shows an isometric contraction of the calf/achilles:

Benefits of isometric contractions in tendon healing (Malliaras et al 2013):

• Isometrics can decrease pain without adding excess load to the tendon.  

• time under tension can be maximized to allow greater tendon strain, which is a likely stimulus for tendon adaptation

• there is minimal soreness after doing isometrics, making them an ideal exercise 'during season'

• loading can be performed in a range that is not painful and tendon compression can be minimized

The positive research around isometrics is in it's early stages and mainly focuses around the patella tendon.

3. Assess current load capacity and tolerance then begin re-loading the tendon.

Your Physiotherapist will take you through a comprehensive load capacity assessment and then develop a re-loading strategy.

This most important factor is that we progress the load over time to bring out positive adaptation and improved load tolerance. 

You will most likely meet with your Physio once per week in the short term to closely monitor and progress the load at a suitable rate.

4.  Clean up biomechanical issues and kinetic chain deficits

Biomechanical issues that may need addressing:

• poor running technique

• over-pronation

• landing mechanics

• postural issues

Kinetic chain deficits that may need addressing:

• weak glutes

• weak calves

• weak quads

• weak hamstrings, adductors

• weak core

• excessively tight muscles and joint restrictions

We will address these factors in the clinic.  By optimising your movement efficiency, you will increase the likelihood of successfully returning to doing what you love and staying pain-free.

5.  Progress the load and build capacity to greater than demand and gradually ease back into sport / exercise

This is where you get to really to push the boundaries of building capacity and gradually resume training and getting back to what you love. 

It's important at this stage to think not only about training but also proper recovery to allow the tissues to optimally adapt. 

You will want to optimise things like sleep, food / protein intake and foam rolling to keep your muscles tuned up.

This stage may weeks / months to fine tune and this is where we will monitor you loads to ensure a successful return.

In Summary - 5 Take Home Messages:

1.  There Is Hope

Despite your ugly looking scan and long-term pain, there is good evidence to suggest you can make a good recovery and get back to doing what you enjoy.

2.  It Takes Time

Tendons are resilient and adapt.  But you need to give them time. 

The time-frame on average to achieve this is a minimum of 12 weeks (but continual small improvements can still occur up to 5 years later).

3.  Get Assessed By A Physiotherapist

There is a significant degree of complexity involved in a tendon problem and a Physiotherapist, after a comprehensive assessment will be able to guide you towards a positive outcome. 

4.  Only Exercise Can Increase Load Tolerance

"Your tissue capacity will only be as good as the load you put on it" - Professor Jill Cook

The end game is to build your resilience and capacity to create a 'buffer' zone of relaxation. 

5.  Think Quality Of Movement Before Quantity

Movement capacity develops step by step. 

Small mindful movement of the muscle-tendon complex can improve efficiency and help ensure that your tendon issue becomes a thing of the past.

This is where Pilates can be very useful. 

Pilates provides the perfect environment for sharpening the mind-muscle connection and also introduces elements of movement variability that help improve resilience.

Bonus Tips:

• PRP injections are a waste of time

• Steroid injections can have short term benefit but 12 months later can end up worse due to weakening of the tendon.

• Fast walking can cause hamstring issues

• For a tendon problem, generally it's best to avoid stretching

• Hip bursitis is treated with same strategies as gluteal tendinopathy

• Extracorporal Shockwave therapy is worth trying (more info about this click visit our friends at Adelaide Podiatry)

Thanks for reading this summary and if you have any questions or comments, please feel free to email dan@kinfolkwellness.com.au

If you have a tendon issue you would like to have assessed, I'd be honoured to help guide you.  

You can make a booking using our easy online system here.