5 Things Your Physio Does That May Surprise You

1.  Chronic disease management through Medicare

Physiotherapists are trained to assess and treat people suffering from chronic health conditions such as diabetes, arthritis and chronic pain.  Physios focus on optimising movement to ensure independence.  Medicare will refund $50.95 for up to 5 services per calendar year under the Enhanced Primary Care Initiative.  To be eligible for this benefit, you will require a referral from your GP. 

2. Stress relief

Check out this great TED talk that discusses the links between posture and mood.

Many people suffering increased stress would benefit from an assessment by a Physiotherapist.   We know that a lot of us carry stress and tension in the neck and shoulders.  This can be aggravated by poor posture and sitting behind a computer all day.

Physios can show you specific breathing exercises, provide massage and dry needling to tight muscles and prescribe specific exercises to improve posture.  When your posture is good and you feel pain-free and confident, your resilience to stress is increased dramatically.  Make a booking with us here.

3.  Weight loss

We see many people with great intentions to lose weight.  Early on, the motivation is high, and often there is a tendency to push the body past its physical limitations.  Unfortunately, this normally ends in pain and injury. 

If you are hoping to lose weight, we would love you to come in for a screening assessment.  We can help you keep your body safe and healthy while you embark on your weight loss journey.  Prevention is better (& cheaper) than cure!

4.  Running assessment

Are you trying to get back into running and things aren't quite feeling right?  Or maybe you are trying to reach a new PB?  A Running Assessment could be just the thing needed to help identity inefficiencies in your running.  We can help you minimise the risk of injury and achieve your potential as a runner.  Book online here.

5.  Save up to $150 yer year on exercise classes with a Physio referral

If you have health insurance, did you know you can claim approximately $150 per year for 'health improvement benefits'?

This includes activities such as Yoga, Pilates, gym, personal training, swimming classes e.t.c.

A Health Improvement Form needs to be filled out by your Physio or GP to show that a specific health condition will be improved.

For more details, please ask us at your next session :)

A newly discovered muscle: The Tensor of the Vastus Intermedius (TVI)

A group of researchers in Switzerland and Australia have identified a new muscle in the thigh.  Part of the quadriceps, this muscle attaches to the upper outside of your thigh, near the Tensor Fascia Latae, and runs down to your patella.  It's called the Tensor Vastus Intermedius (TVI). 

Looking at the left anterior thigh, (from the front) 1- Tensor Vastus Intermedius (TVI)  2- Vastus Lateralis (VL)  3- Vastus Intermedius (VI) 4- Tensor Fasia Latae (TFL)  5- Rectus Femoris (RF)  6- Vastus Medialis (VM) _Picture from research article Grob et al

The researchers made the discovery after examining 26 cadavers.  They found the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella.  Essentially, they found an additional muscle belly between the vastus lateralis and intermedius.

Reference: Netter, Atlas of Human Anatomy

Implications

Like the TFL the TVI likely carries a lot of tension from repeated hip flexion and knee extension. 

This could have implications in particular for:

•  runners, cyclists and athletes in involved in kicking sports such as soccer and football

Dr. Ed Wittich from BAT Logic says:

"The new discovery of the TVI will not have a large impact on clinical approaches but may indeed make us think differently about the forces on the patella and the way that the quadriceps group works together. This is not just a slip but in fact an actual muscle belly, with independent nerve and vascular supplies. The mechanical model for force production and function of the quads may indeed be adjusted based on this addition to the known attachments and line of pull on the patella and even if it doesn’t, in effect it should create a change for the name for the Quads - Quins maybe?!"

If you've ever foam rolled the upper part of the quads towards the outside, you've probably experienced a lot of tightness/pain here (along with the other superficial muscles in the region). If you've had knee pain/patella tracking issues, the TVI could be playing a role in the dysfunction.

Whilst it's exciting to find a 'new muscle', much of the rehabilitation these days is focused on functional movement patterns and thinking more broadly.  Osteopath Bill Adamson from Errol Street Osteo in Melbourne states:

"Movement patterns are still the main issue facing knee joints the world over.  When addressing the knee we will still look at the hip and the ankle as well as the low back to make sure movement/load is evenly distributed across them.  The great thing with running and cycling coaches is they look at all overall movement efficiency. Which is the even spread of load across the body.  When there is a gross error in the way that an athlete moves then a manual therapist or movement specialist may regress the athlete to incorporate a specific muscle activation.

Summary

• The discovery of this new muscle confirms the complexity of the human body and our knowledge base is still a 'work in progress'
• I think rolling the lateral upper quads is way underutilized and can help a lot with ongoing knee pain especially in runners and cyclists
• Deep trigger point dry needling may have more of a role to play to release this newly discovered muscle

Stay tuned to find out more!

1. Reference: Grob K, Ackland T, Kuster MS, Manestar M, Filgueira L. A newly discovered muscle: The tensor of the vastus intermedius. Clin Anat. 2016;Pre-Press, available on-line

Reference Book: Frank Netter, Atlas of Human Anatomy

How To Start A Running Program: 7 Tips To Staying Injury Free

This is a 6 week "start running" program.  It will get you from the couch to 10km.  I'll give you some tips on how to start, how to stay injury free and also include a detailed 6 week running plan. 

WE ARE MEANT TO RUN

As a species, we are designed to run, move and be active every single day.  As the Homo Sapien evolved around 2 million years ago, our ability to cover long distances (around 20km on a regular basis) gave us a huge evolutionary advantage.  We were able to hunt animals efficiently and cooking the meat helped us develop strength and stamina as well as our brains. 

If we are meant to run, then why do so many runners suffer from injuries?

WHY 90% OF RUNNER'S GET INJURED

The truth is, running is the most challenging, high level activity you can ask of your body.

Running efficiently and pain free comes on top of a foundation of adequate flexibility, core strength and movement efficiency.

After 20 years of studying human movement, I can say very few of us have the natural foundation to run efficiently.

In the modern age, due to pain, injury, stress and too much time sitting and driving, we are losing touch with our bodies and what it means to have a good physical foundation.  Movement compensations and imbalances have become the norm. 

Physical therapist Gray Cook states you don't want to put fitness on top of dysfunction.  In other words, Move Well, then Move Often.

The thing is, in the short term you can still get by with a less than ideal foundation. 

You will be able to run because your amazing body works out a way to get the job done.  The problem is, the compensations have a limited time span before they burn out and pack it in.  Then you are really stuffed - you're in pain and you can't keep running anymore. 

Now you have 2 choices:

(1) Accept that "running is not good for you" and avoid it the rest of your life; or

(2) Learn about how your body works and set a plan to achieve your goals.

The good news is that you can learn to fine tune your body to prepare it for running.  You need to be smart and listen to your body - and have patience and dedication.  You can overcome your weaknesses and actually turn them into strengths. 

7 STEPS TO STARTING A RUNNING PROGRAM AND STAYING INJURY FREE

(1) Take one step at a time. 

Rome wasn't built in a day and either is a good foundation.  Be disciplined, stick with the program, but above all else, listen to your body.  Don't skip steps.  Load management is crucial.  Many running injuries can be traced back to pushing beyond capabilities too soon in a program.  A general rule of them is to not increase your mileage more than 10% per week. 

(2) Get yourself a heart rate monitor/GPS watch. 

You can get a basic model for under $200.  This will help you to get to know your body and also avoid over-training.  I recommend the Garmin.  Read more about using heart rate monitor here.  Seeing your progress over six weeks is great motivation. 

(3)  Eat well. 

When I was training for the New York marathon last year, I was given the advice "nutrition is key".  Food is fuel and you will feel much better when you cook fresh food at home.  Focus on slow release carbs such as sweet potato, along with enough good quality protein and vegetables. 

(4) Get yourself a team of health care professionals.

Chances are at some stage, you're body is going to develop some niggles.  Getting them addressed early will likely keep you functioning more efficiently with less pain.  Physio, massage therapist, nutritionist and chiropractor will all help keep you balanced and functioning optimally. 

See our links page for people we recommend. 

(5) Invest in a good pair of running shoes. 

Go to a running store and get them to check your running style.  According to Rob Robinson, a running coach at the South Australian Road Runners Club, you're better off buying two pairs and you can rotate between the two. 

(6) - Do the 7-minute workout regularly.

The perfect cross training and very time efficient.  Doing a few rounds twice per week will help develop strength in your core and gluteals; important for running. 

(7) Run softly. 

Research shows landing on the mid-foot helps improve shock absorption, decreasing the risk of injury.  Think about making as least noise as possible as your feet land. Check out the book Chi Running, which goes into more depth about how to run more efficiently.  Learn to use gravity and your body's natural elasticity to improve efficiency by 30%.  

You could also try a metronome (free download to your phone).  Match your step to the beat (170-180 steps per minute is the most efficient cadence). 

COUCH TO 10KM PROGRAM

This program is designed to run 3 days per week, allowing days in between for recovery.  Alter the days to suit your schedule.  Don't worry about running the whole distance.  Walk and jog as needed.  Always listen to your body!

Tuesday - Tempo Run (T)

This is a moderate-high intensity run.  Keep your heart rate between 70-80%.  These runs will improve the ability of your muscles to convert oxygen to fuel your body.  Warm up before by walk/light jogging for 1-2km.

Thursday - Sprints (S)

Warm-up by walking/gentle jogging for 2km.  These sprints are high intensity, you're heart rate should be between 80-90%.  Use your arms to power your core. Take 2 minutes rest break between each sprint.   These sprints will build power in your legs, as well as improving running efficiency.  If you've never run before or are getting back after an injury - take extra care with easing back into these sprints.

Sunday - Long Run/Walk (LR)

The long run/walk is going to help you build aerobic endurance.  You are going to build stamina and resilience in the muscles, joints are bones.  This is a low-intensity run i.e. keep your heart rate under 70%.  Take walking breaks as often as needed.  As you progress through the weeks, you should be able to do more running and less walking.

AFTER YOUR RUN
Cool down with a few simple stretches.  When you get home, spend 5-10 minutes on the foam roller working over the calves, hamstrings, ITB, quads, adductors and upper back.  If you live near the beach, walking in the water can be a great way to finish a run.  Ice any hot spots for 10 minutes after your run.  Hydrate properly and have a good meal with protein and carbohydrates.

Quads stretch

Calf stretch

DAYS OFF

- Cross training - yoga, pilates, swimming, cycling, 7 minute workout

- Hydration and eating well is important.

- Body work - physio/massage/chiropractic for maintenance.

- Take time to relax. 

So that's our 6 weeks plan to get you running 10km. 

Please give it a go, have fun and remember to listen to your body. 

In the words of Rachel Hunter, "It may not happen overnight, but it will happen".

Thanks to Rob Robinson for contributing his expertise and for more info about joining a start running group in Adelaide, please see the South Australian Road Runners Club Website.

Let me know how you go in the comments box.

Are you interested in an online consultation?



References:

The Story of The Human Body, Daniel Lieberman

Trigger Point Manual, Travell and Simons

Chi Running, Danny Dreyer

Get To Know Your Muscles - TFL (Tensor Fasciae Latae)

Author: Daniel O'Grady is a Physiotherapist in Adelaide, Australia.

Most people know about their ITB (Ilio Tibial Band)  that runs on the outside of the thigh; but not as many are familiar with the strip of muscle that joins the upper part of the ITB to the pelvis. 

This small muscle is known as the TFL (Tensor Fasica Latae). 

“If you’ve ever had problems with your knee, hip, lower back, calf or achilles, chances are you have some unresolved tightness in your TFL.”

QUICK ANATOMY REVIEW:

As you can see in the picture, the ITB has upper attachments to both the gluteals and the TFL.  Any dysfucntion/weakness in the glutes means that the TFL needs to work proportionally harder.  Gluteal inhibition is common - especially if you spend a lot of time sitting.

PALPATE THE TFL ON YOURSELF:

To feel the TFL, place your finger on your front of your pelvic bone.  Slowly move down and to the outside of the thigh until you feel a ropey muscle that is the the width a finger.  It may be tender to touch.

FUNCTION:

The TFL is a hip flexor, abductor and internal rotator.  It works in conjunction with the gluteus medius and gluteus maximus to stabilise the leg during the stance phase of walking and running.  The TFL anteriorly rotates your pelvis.  Functionally, the TFL is part of the Lateral Line and the Spiral line, according to Thomas Myers in his book Anatomy Trains.

The Lateral Line

The Spiral Line

SYMPTOMS:

Overload of the TFL can lead to pain and tightness in the front of the hip.  Very common is also pain and tightness in the outer part of the knee and into the ITB.  This is most noticeable when walking or up and down stairs/hills. 

Other symptoms:

• knee and hip pain (especially outside)

• the lower back and SIJ

• upper back

• calf and achilles

As the TFL pulls the head of the femur bone forwards, chronic increased tone is one of the prime causes of hip osteoarthritis and degeneration. 

HOW THE TFL BECOMES OVERLOADED:

The TFL becomes overloaded with repeated use in the following situations:

• excessive sitting, driving, kicking

• walking and running (especially uphill and downhill)

• cycling, swimming, kayak/canoe

• meditating crossed legged in lotus position

• sleeping in the fetal position

• standing with a swayed back and wearing high heels too often

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your TFL issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building gluteal and core strength is critical to prevent a relapse. ”

TRIGGER POINT DRY NEEDLING:

Tightness and shortening of the TFL responds well to dry needling, which can de-activate the trigger points (knots in the muscle) that can form in chronic cases.  The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms.  Dry needling is certainly an unusual feeling, but definitely beats 15 minutes of deep painful massage in that area.

SELF-CARE TIPS:

• apply heat to the front of your hip 10 minutes each day

• avoid sitting cross legged

• avoid walking and jogging uphills and on sloped surfaces in the short-term

• ensure your shoes are not overly worn

• sleep on stomach or side with pillow between knees

• when running - avoid over-striding and endure proper warm up and cool down

• use cruise control on long car trips to stretch the legs

GRADED EXERCISE PROGRAM TO ADDRESS TFL OVERLOAD:

PART 1 STRETCHES:

FOAM ROLLER ITB

Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER QUADS

Go harder along the quads. Keep breathing!

HIP FLEXOR STRETCH

Feel the stretch in the front of your hip as you tuck the pelvis under gently

FOAM ROLLER TFL

Angle your body across the TFL and roll it with medium to light pressure

PRONE EXTENSION COBRA DECOMPRESSION

Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PART 2 STRENGTHENING:

The goal is to strengthen and support the muscles around the TFL

BRIDGE

Feel a stretch in the front of your hips while your glutes activate in the back of the hips

CLAM SHELL

Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

SINGLE-LEG BRIDGE

Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

PUSH-UP TO SIDE-PLANK

Activate the obliques as you twist into side plank. Try x3 on each side.

PLANK

Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

PART 3: POSTURE / NEW MOVEMENT PATTERNS

“For many people, the TFL becomes the muscle that is always switched on and over-active.

Try these movements, focusing on keeping your core and gluteals engaged. ”

STANDING PELVIC-TILTS

Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING HAMSTRING CURLS

Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

REVERSE LUNGE

Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

SIT TO STAND SQUATS

Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

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25 Things I Learnt in 2015

1.  "There is no learning without pain" - Aristotle

2014 was a challenging year for my health.  It was a major wake-up call.  With the help of many people, books and courses, I learned more about health and wellness this year than any other.      I'm very grateful to all of the teachers, mentors, colleagues, friends and family who shared their knowledge and passion.  The good thing about pain is that it is a great guide and provides an opportunity to build resilience.  "The purpose of life is to be defeated by greater and greater things." - Rainer Maria Rilke

2. The 7 minute workout app

Downloading this app for free and performing it regularly has helped build my foundation.  I admit, when I first started, I sucked. 

Thank-fully over time, I did improve and now I can now perform multiple rounds and get a great workout.  The 7 minute workout eliminates lack of time as an excuse.  You also don't need any equipment so you can keep your fitness up while on the road.  Doing one round as soon as you wake up gets the blood flowing and gets your day off to a great start.

3.  Schedule what you love to do every day

For many people, switching 'off' can be difficult.  Work and other commitments can dominate our time and energy, leaving us burnt out.  This is a powerful technique I learnt during the year.  At the start of each week, schedule in a pleasant activity each day - it might be an exercise class, going to the beach, watching a movie, cooking, going on a hike or catching up with a friend.  This gives you something to look forward to and you feel more productive and happier the rest of the day.

4.  Wellness course

We all suffer from anxiety and depression at some stage or another.  The good news is that there is free professional and effective help, just a click away.  Click here to take the Mindspot Wellbeing Course.

5.  Surround yourself with an allied health care team

I was very fortunate to find a great team in Adelaide to help me run the New York marathon.   Thanks to them, I was able to finish in one piece! Highly recommend checking them out.

Physios - Active Bodies, Adelaide Applied Physio

Dry Needling Adelaide Physio Care

Chiropractor - Amy Hereen at ChiroAdelaide

Movement coach - Mary Whaling MoovPT

Massage Rani Active Bodies, Aspects of Healing, Nicolas Mouat at Zephyr Life

Nutritionist - Steph Gaskell Nutrition Strategies

6.  Drink Bone broth

Bone broth has become very 'hipster'.  But the benefits are incredible.  I found adding bone broth to my diet was especially good for my gut health as well as keeping my knee cartilage as healthy as possible.  Read about the benefits here.

Great for drinking 1-2 cups before dinner or throw into recipes to add flavour. 

7.  Exercise in Nature

Surfing, hiking, swimming, running out in nature has benefits to our body and mind.  You are in the moment, free from technology and better able to find the 'flow'. 

Read this National Geographic article , Your Brain on Nature

Join Our Meetup

8.  Keep your microbiome healthy

The truth is our microbiomes and bacteria outnumber human cells 10:1.  Keep your bacteria healthy and they will keep you healthy!

Check out this Catalyst episode

Make this easy sauerkraut recipe

Try Kale Brock's Fermented Foods E-Course

9.  Cook with a Weber Q

Benefits

- FAST - have dinner ready in 20 minutes

- TASTES GOOD - The Weber Q holds in the flavours like nothing else

- HEALTHY - simplicity and freshness beats fancy

- PORTABLE - Cook all year round - and take it with you to the park or on camping trips

- EASY TO CLEAN - takes less than a minute, after you've done cooking and while the plate is hot - using an official Weber Wire Brush

Thanks to my Dad for recommending this one! 

10.  Learn The Art of Running

Efficient, pain-free running is at the end of a long chain of preparation and skill development.  It takes a lot of time and patience to fine tune your body to be able to adapt to the loads.  90% of runners get injured at some point.  But don't blame 'running'.  Take a look at your foundation and see what you can do to build it up, and then you will be at less risk of injury.   Key principle - build up slowly and allow your tissues plenty of time to recover between sessions.   Also, grab a decent pair of running shoes fitted at Joggers Word.  Read Chi Running

11.  Power of foam rolling - building a foundation

Introduced by Moshe Feldenkrais, the use of foam rollers have gained popularity with many athletes.  There is no better way to improve body awareness, flexibility, core strength and enhance relaxation.  Grab your free e-book here. 

12.  Public speaking

7 Steps To Fearless Public Speaking

This audiobook helped me.  2 main points I took away 1) Have something to talk about that you feel passionate about and 2) - start your talk like a conversation - ask a question and engage the audience, rather than "lecture" to them.

13.  Don't put off surgery that will help you now

Many people fear surgery and believe it is a 'last-resort'.  I did too - putting up with a meniscus tear in the knee since playing footy at Uni.  I was nervous before the surgery that I wouldn't be able to run and I'd always be a cripple.  But thanks to Dr Mario Penta, I got back to running and exercise without a problem.  The knee will never be 100% so I am careful to look after it.  Regular foam rolling, Pilates and swimming have helped my knee the most.

14.  Foundation must be built 1 step at a time

If you skip steps, you fall back into old habits and patterning that got you into trouble in the first place.  Take your time building a good foundation.  For most, this means getting onto the floor and practicing a Pilates or Yoga.  Learn to breathe, learn to relax and connect with the earth.  Get a bit more flexible with a foam roller.  Build your core.  Anything is possible once your foundation is in place. 

15.  Look after your teeth!

I learnt a lot from Adelaide's best dentist: Mark Earl at The Dental Practice.

From speaking to Mark,

- Only brush twice per day

- floss at night time

- use an electric toothbrush to avoid brushing away your enamel

- avoid excess lemon/honey drinks

16.  To Build Positive Habits, Create the right environment

- Read The Art Of Tidying Up

- surround yourself with like minded people who share your values

- if you want to exercise in the morning, set out everything you need the night before

17.  Pain is complex
Perception of threat correlates to the pain you experience better than actual tissue damage.  Threat can come from many different angles.  This cool book by Adelaide based researchers David Butler and Lorimer Mosely encourages self-reflection and learning.  Get your copy of The Protectometer

18.  Mantras calm the mind

Repeating mantras brings focus and and calm to the mind.  I was skeptical, but this is powerful stuff.  Just hearing the voices of Deva and Miten instills calmness.  Thanks to my Mum and Sister for getting me onto this. 

19.  Power of Plasticity

Norman Doidge's follow up to The Brain That Changes Itself.  Learning about neuroplasticity is empowering and gives hope.  There is a great chapter on the body-mind practice developed by Moshe Feldenkrais.  Movement with mindfulness and awareness gets to the source of many chronic pain states.  Kinesthetic sense is enhanced by using a foam roller, first used by Feldenkrais on people with neurological issues.

20.  Hydrate properly

Plain water doesn't cut it. 

Try sports hydralyte, coconut water, magnesium and nuun tablets.

21.  Get enough Sunlight

30-40% of Australians are Vitamin D deficient. Getting 20 minutes of full body sunlight per day is ideal.   Another reason to go out and exercise in nature.   Note: never use a solarium because they increase the risk of skin cancer. 

22.  HRV

Learning about the yin and yang of the autonomic nervous system was a game changer for me.  You quickly figure out how important the simple act of breathing is on your wellbeing.  I love being able to objectively rate my stress and adjust my day accordingly.  You can either buy a heart rate strap or download an app and check your HRV on your phone

23.  Primal Movement Chains

In November, I attended Perry Nickelstons first 2 day teaching course in Melbourne.  He promotes good quality movement as a basis for good health.  His exercises are fun,  challenging and 'primal'.  Things like rolling, crawling and cross body patterning - good for the body and the brain.  A solid foundation is built without reflexively, without having to over-think things.  We incorporate these exercises into our Pilates Classes.

24.  Align with your DNA

Our DNA has evolved over 2 million years and is suited to a particular lifestyle.  In this book, Daniel Lieberman contrasts our current lifestyles to those we are designed for.  His theory is that the mismatch between the two is the basis for the chronic disease epidemic going on right now.  Thanks to Luke Bongiorno for getting me onto this one.

25.  Restorative Yoga

An amazing way to get into deep, healing, para-sympathetic states of relaxation.  If you suffer chronic muscular tension, this practice can help you get to the source.

Check out this great Restorative Yoga Class at Yogita Yoga

Read Yoga For Pain Relief