Thanks to Christian Barton, an expert knee Physiotherapist in Melbourne, for putting this useful leaflet together.
This freely downloadable PDF explains:
what exactly is patellofemoral pain and how it develops
contributing factors
key treatment options
how physiotherapy can help
If you’re feeling ongoing pain and have ruled out serious red flags with your doctor (such as infection, inflammatory arthritis, fracture, cancer e.t.c) then it’s important that your pain makes sense to you.
Research has shown the when you understand more about your pain, then you become less threatened by the experience and get back to focusing on enjoying a happy and productive life.
This 71 page PDF, (available for free download) is a comprehensive and easy to understand pain education resource, written by Canadian Physiotherapist, Chiropractor and pain science researcher Greg Lehman.
You can download the BOOK HERE
Greg Lehman is a physiotherapist, chiropractor, middling researcher and continuing education educator (Reconciling biomechanics with pain science). Greg’s career in health care started with a MSc in Spine Biomechanics where he researched the mechanisms of manual therapy and exercise biomechanics.
Fortunately, Greg was introduced to the biopsychosocial model of pain and injury at this time as well as some excellent clinician researchers who challenged and researched many of the dogmas of our professions.
In clinical practice Greg recognises that the biopsychosocial model is of importance in all conditions and believes in treating with as wide a net as possible to address a multitude of factors. Here is his website
Sleep is crucial to everyone who wants to be the best that they can be.
It is all the more important for athletes who need to be at their physical peak in order to perform at their very best. It can be tempting when you are training hard for an all-important competition to forgo your sleep in favour of extra training, but you really are not doing yourself any favours.
Read on to find out exactly why sleep is your best friend and why you should make it a priority, even if you are training hard.
When it comes to training, one of the most important factors is diet.
It is no good training hard to get your body into peak condition and then filling it with the wrong types of foods. When we don’t get enough sleep we can create an imbalance in the hormones that tell us when to eat and when to stop.
Ultimately, a lack of sleep can lead to surplus ghrelin, the hormone that tells you it’s time to eat and a reduction in leptin, the hormone that tells you that you are full. It’s easy to see therefore, how lack of sleep can lead to overeating.
Add to this the fact that not getting enough sleep makes you feel rubbish anyway, making it more difficult to make good dietary choices, and you can see how you might not be in a position to fuel your body in the best way.
Studies show that sleep releases a growth hormone that is responsible for helping to repair muscle damage. It also plays a part in building new muscle, burning fat and strengthening bones. These are all essential if you are to make sure that your body is in peak condition ready to compete in a big event. It is recommended that athletes aim to get around two hours of extra sleep per night, for this very reason.
To ensure you get this extra rest, you might need to consider setting up a sleep routine for yourself, to help you maximise the amount of sleep that you get. It’s all about creating the right atmosphere, to tell your body it is time for sleep.
Look at your routine, how comfortable your bed is and also the temperature in your room. The ideal temperature is around 16-23C (60-75F), so take a look at your thermostat and see if turning it down might help you.
Sleep deprivation affects glycogen and glucose production.
The body relies on these two substances to fuel itself and if you are not producing enough, it might be missing out on that extra fuel that it needs to get you through those difficult training sessions.
Not having enough glycogen and glucose in the system can also impair cognitive functioning, which could be detrimental when it comes to making sure you are on top of your game ready for the big event too.
Much success in sport comes from brain power and being able to logically work out your way to the top.
Don’t harm your chances by cutting back on your sleep.
Stiffness in the upper back and shoulders can develop over time, especially if you have an office based job. This can lead to compensations and eventually pain in the muscles around the neck and lower back.
Below you'll find a short (less than 3 minutes) set of exercises - that you can do once or twice per day to keep your upper back and shoulders healthy and mobile 👇
This would be really helpful for anyone who spends time sitting in front of computer or driving around a lot.
Movement is Medicine!
We each have our own strengths and weaknesses, so getting a personal assessment / set of exercises from your Physio would be best, but this would be a pretty good start.
Let me know how you go in the comments and please tag anyone you know who might benefit 🙌
The exercises include:
push-ups
cat-cow with hands on foam roller
childs pose lats stretch using foam roller
thread the needle using a foam roller
pecs stretch on the foam roller
foam roller upper back
Get To Know Your Muscles: Upper Trapezius
Upper trapezius trigger points are the primary muscles responsible for neck pain and headaches. The upper traps are also the most reactive muscles in your body to emotional stress.
This blog post discusses:
how the traps gets overloaded
symptoms of an overloaded upper traps
self-care tips
how Physio can help
The traps is the most superficial muscle of the upper back and runs from the base of your skull, along to the tip of your shoulder, all the way down to the middle of your back, (see image below).
The trapezius muscle consists of three parts that all have different functions:
upper part helps raise the shoulder
middle fibers retracts the scapula
lower fibers lower the scapula
This blog post will focus on the upper traps.
The traps can become overloaded from the following situations:
excessive sitting / computer use
whiplash (car accident, falling on your head, or any sudden jerk of the head)
tensing your shoulders
constantly pulling the shoulders down attempting to have a ‘good posture’
carrying small children around a lot
sitting with a chair without armrests, or the armrests are too high
extended car trips
looking down constantly at your phone
any profession or activity that requires you to look down for extended periods (i.e.. dentists/hygienists, architects/draftsmen, and secretaries/computer users)
bra straps that are too tight (either the shoulder straps or the torso strap)
a hand-bag or backpack that is too heavy
anxiety
recent surgery
unresolved emotional trauma e.g. PTSD
The upper traps has an interesting referral pattern, as shown in red in the diagram below.
The upper traps is often the ‘key’ muscle that can trigger other areas such as jaw pain and headaches.
Symptoms of upper traps over-load include:
severe neck pain
a stiff neck
facial, temple, or jaw pain
pain behind the eye
headaches on the temples / "tension" headaches
dizziness or vertigo (in conjunction with the sternocleidomastoid muscle)
intolerance to weight on your shoulders
sinus pain
Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your traps issue.
Some common manual therapy treatment approaches can include:
joint mobilisation to the neck and upper back
dry needling and massage to the traps to stimulate deep blood flow and release the tightness
addressing any biomechanical issues with stretching, strengthening and foam rolling
avoid extended periods of sitting
Think about ‘time in the posture’ vs trying to find a perfect posture e.g. have a short break every 20 minutes
consider a standing desk
avoid constantly looking down at your phone
apply heat to the traps 10 minutes each day to encourage blood flow
ensure you are getting enough cardio-vascular exercise each day (30 mins minimum)
take regular breaks on long car trips and consider using a pillow or support under your arm to take the strain off the traps
learn to breathe through your diaphragm and manage your stress
Wear bras that fit properly
If you suffer with anxiety, seek help through your GP or a take a free online course
Pecs stretch - feel the stretch at the front of the shoulder and hold 30 secs
Thoracic foam roller - release your upper back with a few rolls up and down
Upper traps stretch - hold gently 10-15 secs
Diaphragm breathing with legs at 90/90 - helps calm your nervous system
Constantly focusing on relaxing and releasing the upper traps can be counter-productive because it isn’t always getting to the root cause.
Focusing on the pain and tightness can keep your body stuck in the ‘zone of stress’ (see picture below).
The only way to get better in the long term, is to gradually start building your physical capacity with a personalised program, so you can create a ‘zone of relaxation’ where you have the capacity to handle all of your daily life without the muscles becoming overloaded.
The trick is to build up gradually - step by step. As soon as you push too far you risk re-activating the tightness by over-loading the muscle.
In the beginning it is best to be conservative.
As your work with your body more, you will get to know and respect your bodies limits.
Some of the exercises you could include would be:
push-ups
bicep curls
triceps
bent over row
lat pull downs
core work
increasing cardio fitness
When your neck symptoms are chronic, one of the most concerning things is the ongoing pain, which can sometimes go on for months or years, despite seeing multiple health care practitioners and trying different medications.
Understandably, this can create a lot of fear and anxiety about the underlying cause of the symptoms which can keep you in a state of fight or flight (see picture below).
For some people, when they experience pain or injury it may be associated with anxiety and catastrophizing about the pain, like for example whether or not it will ever go away and if it will get worse if they move too much.
Some people become fearful of exercising and being active (known as ‘fear avoidance behaviour' and 'kinesiophobia') and might rely solely on passive treatment and resting, which can have some adverse effects and may lead to decreased function and a lower load threshold which could result in more pain.
As you can imagine, a downward spiral of fear, lack of movement, weakness and de-conditioning can result (see picture below) and become very difficult to break.
Often there have been some scans showing some damage to a structure such as a disc or nerve issue.
Injuries and structural issues certainly do cause pain initially.
Unfortunately, sometimes the patient is not given a broader context in which to interpret the significance of the results.
The body has a tremendous capacity to heal, and generally tissue damage takes no more than six to twelve months to occur.
If you are still getting pain after this time (and you have been thoroughly investigated by your health care team), your pain is more likely to be coming from a sensitized nervous system (see picture below) than an damaged structural fault.
One thing is very clear with the recent research is that you can have structural abnormality and have no pain whatsoever (see picture below).
Degeneration, disc issues and arthritis are very common in asymptomatic individuals (i.e. who have no pain - see picture below).
The ongoing nature of the pain is more often to do with tight muscles with restricted and oxygen blood flow.
Just understanding this process can go along way to resolving your ongoing pain issues, but you will need an experienced GP and Physio to work with to help you diagnose and get you back on the fast track.
We have a special interest in helping people overcome their neck pain / headaches and get back to what they love.
If you think we are the right fit for you and you wish to get relief right away, use our simple online booking system to make an appointment. If you would prefer to speak to us directly, call us 1300 657 813
