October 2019 – Should we re-evaluate how we look at Posture?

By Joel Wallace

We are surrounded by talk around posture.

This includes how we should stand, how we should sit, how posture is the cause of our pain and the amazing new devices we should get to instantly fix it. At work we often told about the correct ergonomic set up to prevent posture pain, we are told about how we should or shouldn’t move and lift to prevent injury.

It’s very easy to take this information as fact, with OH&S reinforcing this, and many health professionals feeding into it with treatment plans about correcting posture and switching on and off different muscles.

Interestingly, looking at the evidence available, very little of what we hear is well supported by research and is often contrary to evidence based advice.

A great journal article, ‘Sit up Straight’ – Time to Re-evaluate’, has recently been produced looking at the research and what it actually says when it comes to posture.

Below are 7 key points that that the authors concluded.

There is NO single ‘correct’ posture

Despite common posture beliefs, there is no strong evidence that one optimal posture exists or that avoiding ‘incorrect’ postures will prevent back pain.

Differences in postures are a fact of life

There are natural variations in spinal curvatures and there is no single spinal curvature strongly associated with pain. Pain should not be attributed to relatively ‘normal’ variations.

Posture reflects beliefs and mood

Posture can offer insights into a person’s emotions, thoughts and body image. Some postures are adopted as a protective strategy and may reflect concerns regarding body vulnerability. Understanding the reasons behind preferred postures can be useful.

It is safe to adopt more comfortable postures

Comfortable postures vary between individuals. Exploring different postures, including those frequently avoided, and changing habitual postures may provide symptomatic relief.

The spine is robust and can be trusted

The spine is a robust, adaptable structure, capable of safely moving and loading in a variety of postures. The common warning to protect the spine is not evidence-informed and can lead to fear.

Sitting is not dangerous

Sitting down for more than 30 minutes in one position is NOT dangerous. However, moving and changing positions can be helpful, and being physically active is important for your health.

One size does not fit all

Postural and movement screening does not prevent pain in the workplace. Preferred lifting styles are influenced by the naturally varying spinal curvatures and advice to adopt a specific posture or to brace the core is not evidence-based.

 

The full article can be found in full at: Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:49 Issue:Pages:562–564 DOI:10.2519/jospt.2019.0610.

 

 

 

 

 

 

March 2019 – Explaining Pain

Explaining Pain
by Catherine Macrae

‘All Pain experiences are a normal response to what your brain thinks is a threat’

The construction of the pain experience in the brain relies on many sensory cues. There are danger sensors throughout the body (Nociceptors), that when excited to a critical level, pass a message on to the spinal cord. Here excitory chemicals are released, which in turn can lead a message to be sent to the brain. The brain relies on credible evidence to process and decide if and what response is required.

Pain is not always produced. Sometimes the brain concludes that other behaviours such as movement are more appropriate to avoid threat or injury.

THE AMOUNT OF PAIN YOU EXPERIENCE DOES NOT ACCURATELY RELATE TO TISSUE HEALTH
Pain is only a protector. The unpleasant feelings produced by the brain are designed to change your behaviour, to allow for your tissues to heal or to avoid perceived threat.

SOMETIMES PAIN IS NOT HELPFUL especially when it persists. All tissues will heal, and the majority of pain will be gone within 3 months. However when Pain becomes persistent, the nociceptors are conditioned to become more sensitive to stimuli.

WE LEARN PAIN and become better at producing it. With Persistent pain thoughts and beliefs become more involved and can contribute to the problem.

RETRAINING THE PAIN SYSTEM:Accept that ‘Retraining the brain is complex’
We cannot easily ‘switch off’ the brain.Using Pain as your guide is also not always helpful. This can lead to drastic limitations of activity and meaning in life.

HOW CAN WE HELP?
Through education and helping you to understand your pain better, the research proves that it can help you cope, and shift unhelpful attitudes and beliefs about your pain.
We can also support you in moving more than you are or believe you are currently capable of through pacing and graded exposure techniques.

Read more about Pain from Lorimer Moseley, one of the world’s leading Pain Scientists at:
https://www.tamethebeast.org/

Our team at Motion Health is available for any further questions

October Newsletter – Exercise Considerations for the Pelvic floor

pelvic floor physiotherapy

The pelvic floor refers to the group of muscles that run from the pubic bone at the front of the pelvis to the coccyx (tailbone) at the back of the pelvis. This group of muscles play an important role within the body. The pelvic floor is responsible for voluntary control of urine, faeces and flatulence, sexual functions and maintaining support of the pelvic organs such as the uterus in women and the bladder and bowel in both men and women. It also very importantly forms part of our deep core system along with the diaphragm and the transverse abdominus (deep abdominals) and multifidus (deep spinal muscles). During exercise the pelvic floor, diaphragm and deep abdominal and spinal muscles work in a coordinated manner to control the pressure within the core system in response to load.

In the ideal situation, the coordination of pressure within the abdomen happens automatically. When lifting a weight, the muscles of the ‘core’ work together well- as you lift the load, you exhale (diaphragm ascends), the pelvic floor should contract and the deep abdominals and spinal muscles contract to provide support for the spine. In this scenario, the pelvic floor muscles respond appropriately to the increase in abdominal pressure. If the pelvic floor is not working optimally, a loss of function can result.

Common symptoms of pelvic floor dysfunction include:
– Accidentally leaking urine when you exercise, laugh, cough or sneeze
– Needing to get to the toilet in a hurry or not making it there in time
– Constantly needing to go to the toilet
– Finding it difficult to empty your bladder or bowel
– Accidentally losing control of your bladder or bowel
– Accidentally passing wind
– Pain in your pelvic area
– Painful sex.
– A prolapse:
– in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping
– in men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go

(Source: Pelvic floor first – http://www.pelvicfloorfirst.org.au/pages/how-can-i-tellif-i-have-a-pelvic-floor-problem.html)

The pelvic floor can change at different stages of life and can sometimes become weakened and not work optimally. Some of the groups of people that may commonly experience pelvic floor dysfunction include: pregnancy, post natal, menopause, people on hormone replacement therapy, people completing frequent high impact activities (heavy lifting, jumping), chronic coughing/sneezing.

If you have any of these symptoms, we recommend contacting a Pelvic floor Physiotherapist to assess your individual condition. Once you know what you need to work on then our qualified practitioners can assist you work towards your goals and maintain the health of your pelvic floor.

September Newsletter – Greater Trochanteric Pain Syndrome – A pain in the behind

What is GTPS
Greater Trochanteric Pain Syndrome GTPS is common cause of hip pain affecting the outer portions of the hip, thigh, or buttock regions of the body. People experiencing GTPS commonly report painful symptoms over the posterior aspect of their hip joint or buttocks when sitting or standing for Long periods of time, climbing stairs or lying on the affected side.

What is the source of the pain:
GTPS is an umbrella term that encompasses inflammatory or degenerative changes to the gluteal muscle tendons and/or inflammatory responses to the gluteal bursae . Previously people with the symptoms were often given the narrow diagnosis of hip bursitis and treated with cortisone injections into the bursea alone. The classification of GTPS takes a more expansive approach and includes the often involved tendons to the glute medius and glute minimus tendons where they attach onto the top of the thigh bone.

What are the symptoms of GTPS:

The main symptoms reported by people experiencing GTPS include pain to the outside of the gluteal muscles or side of the thigh that is typically described as a deep ache type pain. It may progress gradually over time or be brought on by a traumatic event such as a fall onto the affected side.
Aggravating activities Of GTPS pain include:
Pain when walking/running
Pain when sitting particularly in low chairs for long periods of time
Pain when standing for prolonged periods of time
Pain when walking up/down steps
Pain when lying on the affected side

What are the treatment options for GTPS:
Physiotherapy in the form of Deep Tissue Massage, stretching and strengthening provides the front line treatment of GTPS.

If you have any concerns, please give Motion Health a call on 03 9825 2697

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761624/

February Newsletter – Private Health Insurance Reforms

private health insurance reforms

Pilates Rebates

You may remember the government announcement late last year regarding a reform package for the Private Health Insurance sector.

Commencing April 2019, private health insurance will no longer cover natural therapies, including aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.

However the APA (the Australian Physiotherapy Association) have advised that members should not be unduly concerned about the removal of Pilates from the list of rebateable natural therapies. Any physiotherapist delivering a one-on-one or group consultation on any patient(s), whether it be classed as Pilates or something else, is unaffected by the PHI reform package. Their patients’ ability to claim for the service will be unaffected. The same will apply to accredited Exercise Physiologists.

The APA understands that physiotherapists who incorporate Pilates treatment into their overall management of patients do so with a full understanding and assessment of the patient’s condition, and with ongoing reassessments and modifications to the patient’s treatment as required.
Physiotherapist-instructed Pilates is one part of a wider range of treatment options utilised by our members in these instances, and is in line with the best practice, evidence based contemporary care that physiotherapists employ.

The reform package measures have been set with the understanding that there is a clear difference between physiotherapist-instructed Pilates programs and those used by other practitioners. As a result, physiotherapists utilising Pilates methods in their patient treatment plans will not be affected by these changes.

All of our staff here at Motion Health fall under the category of Accredited Physiotherapists and Exercise Physiologists.

December Newsletter – Benign Paroxysmal Positional Vertigo

vertigo

Benign paroxysmal positional vertigo (BPPV) is a condition characterised by episodes of sudden and severe vertigo when one’s head is moved around. Common triggers include rolling over in bed, getting out of bed, and lifting the head to look up. BPPV is caused by particles within the vestibular system of the inner ear. Usually, BPPV affects only one ear.

Vertigo may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.

The most common cause of dizziness is BPPV. Others include: Inflammation in the inner ear, Meniere’s disease, neck joint dysfunction, vestibular migraine and acoustic neuroma. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage. Under age 50, head injury is a common cause. Vestibular viruses can also play a role. BPPV can also be a result of surgery due to prolonged supine positioning and possible trauma to the inner ear.

The symptoms of BPPV can include:
Sudden episodes of violent vertigo which may last half a minute or more.
Dizziness and/or nausea.
Movements of the head trigger the vertigo.
The eyes may exhibit nystagmus.

BPPV is caused by otoconia (calcium carbonate crystals) moving from the maculae of the inner ear into the fluid-filled semicircular canals. The peripheral vestibular labyrinth contains sensory receptors in the form of ciliated hairs in the three semicircular canals and in the ear’s otolithic organs. They respond to movement and relay signals via the eighth cranial nerve. Visual perception such as gravity, position, and movements also receive signals from somatosensory receptors in the peripheral vestibules. With the displacement of the otoconia into the semicircular canals, these delicate feedback loops relay conflicting signals that can result in any symptom related to BPPV. It is thought that injury or degeneration of the utricle may allow the otoconia to dislodge and escape into the balance organ and interfere with the vestibular system, however most cases of BPPV are idiopathic.

There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be ‘hung up’ on the bundle of nerves that sense the fluid movement (cupulolithiasis). With canalithiasis, it takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin. Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo stop. With cupulolithiasis, the crystals stuck on the bundle of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. It is important to make this distinction, as the treatment is different for each variant.

Once the healthcare provider knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then the appropriate treatment maneuver can be carried out.

Our physiotherapists at Motion Health are well placed to diagnose and treat BPPV using otoconia replacement techniques. Ascertaining whether or not there is a cervico-genic component to the patient’s symptom pattern is also important.

A test we commonly use to determine the unilaterality of BPPV is the Dix-Hallpike test.
To check for right side involvement, rotate the patient’s head to the right 45 degrees while in the long sitting position (this aligns the right posterior semicircular canal with the sagittal plane of the body).
The examiner grasp the patient’s head and quickly moves the patient to the supine position with the neck slightly extended (ear down position).

The examiner checks for nystagmus. If present, note the latency, duration, and direction (should not last more than 1 minute).

Once we have determined that the loose crystals can move freely in the fluid of the canal (canalithiasis),a commonly used treatment technique is the Canalith Repositioning Procedure or Epley manoeuvre. We may need to complete this manoeuvre over 1 to 3 visits in order to obtain complete resolution of symptoms.

August Newsletter – Jaw Pain

jaw pain physiotherapy

Musculoskeletal disorders involving the jaw are commonly known as temporomandibular disorders (TMD). TMD affects 10-15% of adults and is often associated with jaw degenerative changes. People with TMD often report jaw pain, facial pain, clicking, decreased range of mouth opening and joint locking during activities such as yawning and chewing. In some cases, people with TMD may also notice their teeth clenching or feel their teeth grinding. Upon reporting these symptoms, TMD sufferers are typically directed to the nearest dentist for an occlusion splint by their doctors.

However, TMD is often associated with other musculoskeletal symptoms such as neck pain, neck tightness and headache resulting from prolonged poor sitting posture. Poor neck posture has been demonstrated to alter jaw muscle and joint mechanics which could abnormally increase jaw loading resulting in jaw pain. Additionally, increased stress level, anxiety and increased oral activity besides eating; such as chewing gum or nail biting, can increase jaw muscle activity resulting in TMD symptoms. Thus, splinting the jaw does not always target the source of TMD.

See Your Physio!

Physiotherapists are experts in diagnosing and managing TMD-related symptoms and sources. Currently, there is emerging evidence that many TMD presentations respond well to manual (hands-on) therapy such as joint mobilization, joint distraction and jaw and neck exercises. Exercise has been demonstrated to improve pain and jaw range of motion faster than occlusion splints in people with TMD. Additionally, physiotherapists may advise TMD patients on lifestyle changes regarding to jaw usage and educate TMD patients on self-management strategies.

Physiotherapists play an integral role in the management of TMD patients. Timely physiotherapy intervention of people with TMD can lead to superior clinical outcomes and greater satisfaction. Motion Health Physiotherapists strive to work closely with you to ensure optimum recovery of your TMD. Please contact us or call 9825 2697 should you or someone you know require help with this condition.