Hip Stability For Runners

The more stable your hips and pelvis are when you run, the less chance you have of getting injured

Here a four essential hip stability exercises for every runner (best performed straight after you run x2 per week)

1. Crab walks. Knees extended fully, feet pointed straight and pelvis tucked gently activating core. Slow steps work best 💥
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2. Single leg bridge. Try and keep your hips level as you extend one leg straight. Remember to keep breathing!
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3. Single leg squat with theraloop. Sit back into your hip (like you’re going to sit down & then straighten up, tucking your pelvis under and squeezing the glutes
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4. Monster walks. Maintain pelvis tucked under with core activation and push back and diagonally
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Please tag any runners you think might benefit from this workout & please let me know if you have any questions at all.
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Happy running 😎

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Other Blogs To Help You Move and Feel Your Best:

5 Things Everyone With A Disc Issue Needs To Know

The story:

You’re at home and reach down to pick something up and feel a twinge.

Ouch!

But you don’t think much of it.

Until the next morning when you are unable to get out of bed because of severe pain and muscle spasms.

You’ve never felt anything quite like it - even sitting on the toilet is just about impossible.

You ring your doctor and they order an MRI - you somehow you manage to stumble into the radiology centre (lying down for the scan isn’t all that much fun).

The next day you get the results - and it shows a disc in your back has been injured.

You jump on Google and are suddenly confronted with all sorts of pictures showing discs pushing on nerves. Every website you read says that you may need surgery and you should be avoiding heavy lifting, bending and twisting.

Sound familiar?

When you have been diagnosed with a disc issue, you have two problems to deal with:

1. The physical side of the pain that can be overwhelming in the early stages and

2. The mental side, that can be equally as bad. It can very hard to think clearly when your life comes to a complete halt..(who knew back pain could stop you in your tracks so suddenly and cruelly?!)

All sorts of things can go through your head when you are lying in bed, unable to move due to pain.

That you might develop chronic pain. That you might need surgery. That you can’t go through daily life with the same care-free attitude about how you move your body as before. That life as you know it is over and you will be living in fear of recurrence.

But there are some problems with the above scenario.

Some assumptions and beliefs that need some clarifying.

A lot of clarifying.

Be careful who you take your advice from.

There are a lot of unhelpful beliefs out there and you need to avoid catching a 'thought-virus’ that can derail your recovery and unknowingly put you on a path of ongoing pain and dysfunction.

When you have injured your back, it’s amazing how all of a sudden you start receiving all sorts of (unsolicited) advice from every Tom, Dick and Harry on the street.

Everyone has their approach that works for them.

But because there is so much conflicting advice, the uncertainly can make you feel even more confused and scared…what do I do? and who do I see to help?

Recently on a facebook post, a local Adelaide media identify asked, “How do I fix my disc?”

There were around 1,300 comments and I counted at least 50 different types of treatment.

The main thing to ask yourself when hearing advice is,

• Are they using an evidence-based science approach?

If you stop and really think about this, unfortunately many well meaning people (including health care professionals) are simply giving out terribly outdated advice that creates a huge amount of unnecessary fear in people with disc issues.

This blog post is an attempt to clarify some unhelpful beliefs about disc related back pain.

There are 5 things everyone with a disc issue needs to know:

• Scans are often misleading (most people have some disc bulging but have no pain)

• Disc issues generally have a favourable outcome (and like a good wine improve with age)

• The bigger the bulge, the better

• Slumping might actually help you recover faster

• Running is very beneficial for the disc

Essentially discs are one of the most stable and resilient structures in our body.

As always the following information is general and please use in conjunction with your trusted health care professional.

If you have any questions or concerns, please reach out to dan@kinfolkwellness.com.au

Let’s explore each of these statements a little more closely…

1. Scans can be misleading…you can have a disc problem and not even know about it

It must be understood that in the normal pain-free population, there is a high prevalence of abnormal findings on MRI scans (see table below).

Brinjikji et al 2014

This systematic review by Brinjiki and colleagues in 2014 studied closely the MRI’s of asymptomatic people i.e. they had NO current back pain (or any history of back symptoms).

They found that all the people in the study showed some level of disc problems.

For example, 30% of all 20 year olds had a disc bulge and no pain.

This percentage increased with age, with over 60% of 50 year olds having a disc bulge, (and these are people who had no symptoms whatsoever).

This indicates that many of these features—particularly when found incidentally — should not be considered pathological and instead be regarded as normal age-related changes.

This makes it difficult sometimes to find what it truly driving the pain experience.

Many doctors and health care professionals (knowingly or unknowingly) contribute to a heightened pain state and increase risk of catastrophization by doing a poor job of communicating scan results.

Once a fear has been created, adrenaline can surge continually through the body, creating anxiety and fear of movement.

Having an experienced clinician explain your scan findings is an absolutely critical part of your recovery.

Evidence shows that rushing too quickly into an MRI imaging for a back strain results in a poorer prognosis, (with an increased chance of surgery).

After an injury or episode of pain, the body will heal (often over 2-3 month period).

But sometimes the pain can persist because the person feels frightened and intimidated by the diagnosis and there is subsequent ongoing protective muscle spasm (see below).

Some of the muscles that can tighten up after a disc injury and stay locked up, causing ongoing tightness and pain

2. Disc issues generally improve as you age 

Although they can be extremely painful in the initial phase, the natural history of disc issues is favourable and the majority of disc prolapses resolve with time.

Many people assume because they have had a few bad episodes of back pain that they will continue to deteriorate over time. Some people even fear they will end up in a wheelchair.

If you have had these thoughts, I would like to tell you…after 25 years of studying/working as a Physiotherapist, I have never once seen someone’s back pain progress to the point of requiring a wheelchair to get around.

Interestingly, studies (such as above) have shown that as you age, the degree of degeneration in the discs increases when scanned, but that does not correlate with pain, disability or clinical symptoms, which tend to reduce with age.

After the age of 40, your discs actually start to stiffen up and become more stable.

This stability leads to less chance of the disc causing ongoing pain.

So the take home message is once you have had a disc issue you may always have changes on scans. They can be thought of as ‘wrinkles on the inside’ - a normal part of ageing and nothing at all to be concerned about.

3. The bigger the bulge, the better

Some studies indicate that about 85% of lumbar and 90% cervical acute disc herniation will get better in an average of 6 weeks, (but sometimes take up to 3 months for symptoms to settle).

In 2014, Chiu and colleagues conducted a systematic review to determine the probability of a spontaneous disc regression.

The aim of the systematic review was to investigate the probability of disc herniation regression and complete resolution.

The different types of disc issues and severity can be seen in the picture below.

The study showed the probability of a spontaneous regression was:

• 96% for disc sequestrations

• 70% for disc extrusions

• 41% for focal protrusions

• 13% for disc bulges

Essentially, the study offers some very encouraging statistics to tell us that the larger or more severe disc herniations often have a higher chance of spontaneous recovery.

Lumbar disc herniation can regress or disappear spontaneously without surgical intervention.

4. Slumping might actually be good for you

A study done by Pape (2018) showed slouched sitting can rehydrate the lumbar discs and essentially ease the pressure off the discs.

This study showed slumped postures can provide a valuable alternative to upright sitting and “may be recommended for recovering spinal height in the working environment following periods of loading”.

A simple way to think about this is if you were to clench your fist as hard as you can for 60 seconds.

Pretty soon the muscles in your arm start to fatigue and eventually, if you held it for long enough, you’d start to feel some pain from the constant contraction.

Exactly the same thing can happen with the muscles in your spine.

After you’ve had an episode of back pain, you may start to worry about your back, and a well meaning health care professional has told you to “be really be careful with your posture and never slump!”.

Sometimes people can take this literally, always trying to sit up straight and never giving the muscles in the spine a chance to actually relax.

This can lead to the ongoing muscle tightness and tension that we mentioned earlier.

With back pain, there is no perfect position.

You don’t have to sit up straight forever - in fact doing this trying to protect your back may overload the muscles and give you more pain.

The people who don’t get pain and the ones who explore a wide variety of movement and change positions frequently. “You’re best posture is your next posture”.

5. Running significantly benefits the human intervertebral discs

A study recently that showed people who run have stronger and more resilient discs than those that don’t run.

The study showed that long distance runners and joggers had better hydration and glycosaminoglycan levels than non-athletic individuals.

“We expect that tissues will adapt to loads placed upon them,” says lead author Daniel Belavy (Burwood, Australia).

Just like your muscles and bones need stress to grow stronger, your discs also respond and adapt in the same way.

This is great news if you are a runner, as previously it was thought that the impact of running was potentially aggravating to the discs.

Now we know that runners have healthier discs, if you are considering getting back into running I would encourage you to work closely with a Physiotherapist who can help guide you back safely.

Interestingly this study showed a long distance runners using a walk / run pattern seemed to be the best for the disc, as opposed to just walking or always running fast.

This suggest that knowing your ‘easy’ running pace and sticking to it during your recovery phase may be an important part of keeping your spine healthy.

If you would like to find out your easy pace, based on your current fitness levels, please use our free online running calculator.

To be very clear…

Disc issues can be extremely painful and limiting in the first days/weeks and you need to take care of yourself by visiting a Physiotherapist who you know and trust.

Realistically, disc issues can take some time to fully settle down - sometimes up to 3 months.

Disc issues CAN be serious 1-2% of the time.

It will really only start to cause you grief if it starts to contact and compress the nerve root.

If it gets to this point, you may have pins and needles, numbness, weakness of the area supplied by the nerve that is affected.

Some of the signs you may need to consult with a doctor include:

• constant numbness / pain in the leg

• extreme constant pain and not able to get any sleep at all

• bladder or bowel incontinence

But that leaves 98% of disc issues that can be well managed with a personalised Physiotherapy program.

Some people are more susceptible to disc problems than others.

Risk factors include:

• obesity

• lack of fitness

• lack of regular exercise

• cigarette smoking

• history of anxiety or depression

How Physio can help

We are experts in treating people with disc pain and can help you in two main ways:

• designing an exercise program designed to improve strength, flexibility and fitness

• provide short-term relief with massage, spinal mobilisation or manual therapy to reduce pain and get you moving well again

If you would like to find out more information or start your healing journey right away, please use our easy online booking system to find a time that suits you.

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating lower back pain.  He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

Research Links

Ma D, Liang Y, Wang D, et al. Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly. Clin Interv Aging. 2013;8:1047-1050. doi:10.2147/CIA.S49698

Martínez-Quiñones JV, Aso-Escario J, Consolini F, Arregui-Calvo R. Regresión espontánea de hernias discales intervertebrales. A propósito de una serie de 37 casos [Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases]. Neurocirugia (Astur). 2010;21(2):108-117.

Kim ES, Oladunjoye AO, Li JA, Kim KD. Spontaneous regression of herniated lumbar discs. J Clin Neurosci. 2014;21(6):909-913. doi:10.1016/j.jocn.2013.10.008

Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-195. doi:10.1177/0269215514540919

Pape JL, Brismée JM, Sizer PS, et al. Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs. Appl Ergon. 2018;66:9-17. doi:10.1016/j.apergo.2017.07.016

Belavý DL, Quittner MJ, Ridgers N, Ling Y, Connell D, Rantalainen T. Running exercise strengthens the intervertebral disc. Sci Rep. 2017;7:45975. Published 2017 Apr 19. doi:10.1038/srep45975

Tennis Elbow: Fast Track Your Healing

Tennis Elbow: 6 Steps To Fast Track Your Healing

Tennis elbow is a common condition and, if left untreated can become annoying and persistent.

This quick guide will explain the cause of tennis elbow and walk you through a 6 step process to ensure your healing gets on the right track.

If you have any specific questions or want to get booked in right away for an assessment and treatment, please use our easy online booking system below:

What is tennis elbow?

Tennis elbow refers to pain coming from the tendons of the forearm that connect the muscle to the bone in the elbow (called the lateral epicondyle).

These tendons run from the fingers and wrist right up through the forearm and eventually insert into the elbow.

Tennis elbow can also be referred to as tendinitis and lateral epicondylagia but the current preferred name in the medical world is elbow tendinopathy.

Who does it affect?

It tends to affect people:

• who use their arms a lot for work

• most common between the ages of 35 and 50

• people who have other conditions such as diabetes, high blood pressure, menopause

• people who are very active, (especially with a big competition goal coming up) and tend to push themselves to get fitter

Interestingly, only about 5% of people suffering from tennis elbow actually play tennis!

Symptoms of tennis elbow

• Pain and muscle tightness comes on gradually

• Related to a recent increase in loading of the muscles in the arms

• Often sore during warm up but then feels better during activity 

• Often feels worst 24-48 hours after activity

6 Steps To Fast Track Your Healing

Step 1. Get the right diagnosis

You will need to have a thorough examination by a physiotherapist to determine if you have have tennis elbow.

Sometimes elbow pain can be referred pain from your neck and shoulder.

Once we can clarify the diagnosis, we get figure out the best treatment plan for you.

Once you have been diagnosed with tennis elbow, it’s important to have realistic expectations of recovery.

Patience is definitely required as the healing process of tendons is longer than any other tissue in the body and take anywhere from 2 months to 2 years to full recover from tennis elbow.

You may need to continue with an exercise regime in the long term - even after you stop seeing your physiotherapist.

This will ensure that your pain stays away for good.

Learning to listen to your body and know how much your arms can handle is a very important skill to learn as you recover.

Step 2. Calm things down phase (4-6 weeks)

Firstly, stay calm and know that it will get better - your body is a powerful self healing machine.

But unfortunately recovery is very rarely linear, and more often ‘2 steps forward and 1 step back’ pattern. Or a bit all over the place.

To help calm things down, we need to identify all of the aggravating activities that are contributing to the tendons becoming overloaded.

This is probably the most important step in the calming phase and people who have persistent tendon pain often have not been able to identify and reduce the aggravating activities.

To be clear, our bodies our incredibly resilient and adaptable to many loads and stresses.

But when there is chronic overuse and loading without adequate recovery (sleep, nutrition and muscle care), then an overuse situation develops.

Relative rest is an important part of allowing the tendon to heal.

Common activities that increase the load on the elbow tendons are:

• computer use - typing, using mouse e.t.c.

• texting on your phone

• gardening / weeding

• Lifting heavy weights - bicep curls, overhead, swings, pullups

• aggressive stretching of the tendons that can irritate them

• lifting groceries all in one go

• carrying a heavy bag around

• knitting

• lifting small / big children

• racquet sports or rowing

• driving lots in the car and gripping the wheel too firmly

• Push-ups / yoga / body weight exercise on arms

• Massaging / manual therapy

• playing musical instruments

• ironing

• doing dishes

• peeling vegetables

• gripping a bicycle handle or car steering wheel

There are of course many more potentially aggravating activities, and you will need to really have a hard thing about your personal circumstances.

Next is to write out a list of all the activities that aggravate it.

And then prioritise the activities with the most important at the top.

Ideally try and cut out or delegate the bottom 80% of the activities that aren’t important for you to keep going with.

This might be enough to settle your symptoms and allow you to keep doing the important activities in your life.

Achieving the right loading dose is a real combination of art and science and quite frankly a bit of trial and error. 

Learn to listen to your body during an activity and the 24 hours after when the tendon tendons tend to flare up and let you know if you’ve pushed too far.

As you progress through rehab, some level of pain will be normal and acceptable (see below).

Important to know: mini-flareups are completely normal during your recovery. In fact they are a sign you are on the right track as you are gradually building up your capacity.

So definitely don’t freak out when you get a flare-up!

Step 3. Ice/ Heat and TENS

Apply ice to the elbow regularly to reduce the pain and inflammation, particularly at the early onset of pain.

Some people find heat in the form of a wheat pack works better, as this can reduce the tension in the muscles and increase blood flow.

Another option is using a TENS machine that can stimulate blood flow to the muscles and tendons (this gives only short term relief and must be used in conjunction with other methods listed).

Step 4. Massage and dry needling

Techniques such as massage and dry needling can be used to release tension around the arms, shoulders and upper back.

Muscles that have been overused over a long period of time often form knots or trigger points that can be palpated easily.

When tight, they can become a source of referred pain, with each muscle having a different area of referral (see below).

Dry needling has the ability to get achieve a quicker and more effective deep release of the muscles. As tendons have quite poor blood supply, dry needling can also stimulate the deep blood flow and increase the healing process.

The effects of Dry Needling were studied in this new study that took 110 people with tennis elbow and evaluated two treatments. 

One group received dry needling and other group received anti-inflammatory medication (Ibuprofen 100mg x 2 day) and a brace. 

The patients were evaluated after three weeks and six months.

Results:

Although both treatment methods were effective at three weeks, dry needling was significantly more effective than the medication and brace group at six months.

Conclusion:

Because of the low complication rate, dry needling is a safe method, and it might be a more effective treatment option for tennis elbow.

At Kinfolk Physio & Wellness, in addition to specialising in dry needling, we also take a holistic view of your movement and set you up with a personliased home exercise program that maintains flexibility and builds strength and capacity, to give the best long term solution.

If you would like to get your elbow pain on the fast track to healing, please click below to book an Initial Assessment (or call us 1300 657 813).

Step 5. Graduated loading program (12 weeks - 2 years)

At the end of the day, we want to gradually build the capacity of your forearm muscles so they can withstand the demands from your daily life.

This involves a graduated, progressive program of specific strengthening under the supervision of a Physiotherapist.

We follow a 12 week program to rebuild strength in the muscles of the forearm, shoulder and even through the neck and core muscles.

You would be doing exercises 2-3 x per week for about 15 minutes.

Tendons require gradual load in order to heal properly, so it’s very important to continue to strengthen your muscles even if your pain has improved.

Our focus is on building your body's capacity so that you have a buffer or 'zone of relaxation' where you can handle with ease the stress and loads that are placed on your body in your life (see graph below).  

The effort you put into building your foundation will result in:

- less pain and frequency of flare-ups that keep you out of action

- dramatically reduced need for pain medication

Building capacity is a bit like trying to scale a mountain.

You require a map telling you where you want to go (goal capacity) and where you currently are (current capacity).

Then you need a plan and to help you achieve your goals.

Mindset, sleep, nutrition and general fitness are all important ingredients as you gradually scale the mountain.

Get started on your journey…

To find out more about our loading program for tennis elbow and start your journey, please use our easy online booking system by clicking below.

Step 6. Create the optimal healing environment

With tendon problems, it’s really important to know that your body is always trying to heal itself.

So it’s important to try and create the optimal environment for that healing to take place.

This would include:

• Get a good 7-8 hours of good quality sleep per night

• Eat a high energy diet with sufficient protein and carbohydrates

• Get enough rest during the week

• Decrease stress in your life as much as possible

• Ensuring your ergonomics at work are suitable

Do I need a cortisone injection?

If first-line treatments aren’t working a more invasive approach could be considered that includes a corticosteroid injection.

Corticosteroid injections, while giving effective short term relief, tend to wear off after 6-12 months, and the pain can return, (often worse than before). 

The problem also with cortisone injections is they tend to weaken the tendons in the elbow, greatly increasing the risk of future overload.

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating elbow pain.  He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

Returning to Sport: COVID19 Safe

Returning to Sport: COVID19 Safe

As our communities gradually return to sport, it’s important to know how to keep your body safe and prevent injuries.

Some of Australia’s top athletes are supporting a new social media campaign from the Australian Physiotherapy Association (APA) to highlight the increased risk of sports injuries after the long COVID-19 lay off.

There are a series of educational videos (please see below) with the athletes and their Physio’s giving some invaluable tips on:

• how to return to sport safely

• how to warm up properly

• some key strengthening exercises to prevent injuries

APA National President, Phil Calvert notes “restarting community sport across the country is key to our COVID-19 recovery. Now that we have the green light to get started we need to make sure widespread injuries don’t further sideline community sports people from doing what they love.

“We’ve already seen some significant pre-competition injuries among some of our AFL and soccer players so it’s clear that there is an increased risk of injury to athletes if they train too hard, too soon.”

Return to Basketball - Pre Game Warm Up

Return to Basketball - Strength and Conditioning

Return to Basketball - Knee Injury

Return to Netball - Injury Avoidance

Return to Netball - Ankle Sprain Prevention

If you are wanting some more information on how to prepare your body for the return to sport or have any concerns about any niggles or injuries, please don’t hesitate to contact us 1300 657 813 or make a booking using our online booking system below.

Are you low in Vitamin D?

Vitamin D deficiency is a common, serious medical condition that significantly affects the health and well-being of those affected.

It is estimated 30-40% of Australians are Vitamin D deficient.

Vitamin D deficiency is commonly misdiagnosed as fibromyalgia, chronic fatigue syndrome or depression.

Role of Vitamin D:

Vitamin D is extremely important for strong and healthy bones, as it help our bodies to absorb calcium.

Some research shows low levels of vitamin D may increase risk for sports injuries, including stress fractures because the nutrient is so vital for bone health.

Vitamin D also plays a key role in:

• Muscle contraction– vitamin D is required for the activation of certain enzymes involved in muscle stimulation

• Nerve stimulation– vitamin D is necessary for the nerves to carry messages between the brain and other parts of the body

• Immune system– vitamin D helps activate and mediate the body’s immune function

Causes of Vitamin D deficiency include:

• low UV exposure

• inadequate nutrition

• dark skin pigmentation

• malabsorption disorders

• people who spend a long time indoors

• elderly

• people who are obese with a body mass index greater than 30 

Symptoms of Vitamin D deficiency:

Vitamin D deficiency has been linked to various health problems, including cognitive decline, depression, osteoporosis, cardiovascular disease, hypertension, diabetes, and cancer.

The symptoms of vitamin D deficiency are often subtle, so many people don’t know they are deficient.

Some of the symptoms include:

• Fatigue or tiredness

• Bone pain

• Joint pain

• Muscle weakness, muscle aches, or muscle cramps

• Increased muscle sensitivity to pain

• More frequent illness

• Anxiety

• Irritability

• Weight gain

• Hair loss

Tips to for adequate Vitamin D intake:

Ultraviolet (UV) radiation from the sun is necessary for the production of vitamin D in the skin and is the best natural source of vitamin D.

Sunlight and Vitamin D:

Getting 10-15 minutes of full body of sun exposure to arms, legs, abdomen and back, two to three times a week is ideal for Vitamin D production.

You may need less direct exposure in summer and more in winter. Be sure to always wear sunscreen if you out in the sun for extended periods (more than 15 minutes).

UV radiation from the sun is also the main cause of skin cancer, so striking the optimal balance of sun exposure is critical (see graph below).

Finding the sweet spot for sun exposure

Vitamin D and exercise:

This study showed people who performed three or more hours a week of vigorous exercise—such as running, jogging, or playing basketball or soccer— have higher levels of vitamin D as well as higher levels of HDL (good) cholesterol.

Another reason to go out and exercise in nature.

Foods that contain vitamin D:

• Fatty fish like salmon, tuna, herring or sardines

• Cheese

• Milk

• Egg yolks

• Mushrooms

Other processed foods with added vitamin D usually say “fortified with vitamin D” on the package. These products include dairy products, orange juice and cereal.

Summary

Vitamin D deficiency is a commonly undiagnosed condition that can have serious impact on your wellbeing.

If you want to find out more and get yourself checked, please discuss with your GP.

References:

Ultraviolet radiation and health: friend and foe

Vigorous exercise linked to higher vitamin D levels, lower heart disease risk

The Role of Vitamin D in the Aging Adult