Wondering about low back pain?

Why does it hurt?

Why do so many people in Melbourne have low back pain?

Human beings are designed to move! It may sound simple, but think back to your high school science classes. Apart from making all sorts of misuses of the Bunsen burner, do you remember learning about all those muscles attached to the bones of the human body? They’re everywhere! Unfortunately in the smartphone age, the most commonly used muscle is our adductor pollicis (ie. scrolling up with your thumb). But do you know what the main intended uses of your muscles is for? That’s right, you guessed it: walking! Plain and simple walking.

Now, many of us use our bodies in ways that it is not made to be used (think: sitting at computer nine hours a day then spending the evening scrolling through overwhelming Netflix options). What this does is put abnormal stresses on our body, in particular your lower back, which can result in low back pain. So actually, in most cases of low back pain, there’s not a lot of mystery involved in why it hurts. Backs just simply are not made for the sustained stresses that we put them through.

So if walking is the most basic movement that our bodies are designed for, then it’s no surprise that walking is an excellent remedy for low back pain. Research shows that a simple walking program can be the most effective way of reducing low back pain.

Of course there are limits to abide by, and low back pain is different for everyone, so guidance from your physio in starting a walking program is essential. If you are having trouble, our Physiotherapists  can guide your exercises and address work with you on your low back pain issues.

When it comes to low back pain, most people are looking for a quick fix. Well, this is it! Strap on those Nikes, and take to one of the many lovely tracks Melbourne has to offer.

You won’t regret it!

Daniel Zeunert

Physiotherapist

Daniel is passionate about achieving the best outcomes for his patients by keeping up with the latest evidence-based research in physiotherapy. He uses a combination of exercise and manual therapy, operating under a biopsychosocial approach to patient care.

A PAIN IN THE BUTT

The most common cause of persisting deep buttock pain or lateral (on the outside) hip pain is not sciatica, but caused by tendinopathy of the gluteal tendons: usually Gluteus Medius and Gluteus Minimus tendons. It’s also often misdiagnosed as bursitis, and treated (ineffectively) with cortisone or other injections.

This very common condition, also called greater trochanteric pain syndrome, is irritated by lying on either side at night. This puts pressure on those tendons between the greater trochanter ( ateral hip bone) and the bed surface when lying on the painful side, or pressure from the position of the top thigh as it crosses the midline when lying on the good side. It’s also made worse by sitting too low and getting up from sitting, crossing the legs, walking up hills and when climbing stairs. Lunges and Clam exercises can aggravate it. It can get so bad as to disturb sleep, create a painful limp and prevent walking & exercise altogether!

Affecting women much more than men, one study from Scandinavia (1) showed one in four women have got underlying Gluteal Tendinopathy, often becoming symptomatic with a spike in load. An event like overseas travel, extra walking or new impact exercise can trigger it, especially if the gluteal muscles (the buttocks) have weakened. This is so common, can last for years and its a pain in the butt !! However unlike sciatica, the pain will usually not refer below the knee or cause any nerve symptoms like tingling or numbness.

The good news is that clinical research (2) proves the right exercise program and advice on sitting and sleeping posture can resolve the pain and prevent it becoming chronic. Clifton Hill Physiotherapy / CHPR Physios Dr Henry Wajswelner and Dr Sallie Cowan were involved as treating physiotherapists in a landmark study called the LEAP trial, published in the British Medical Journal in 2018, that proved a physiotherapy program was the most effective form of management both in the short and long term. Education on the right ways to sit, stand, lie at night and move to minimise tendon compression is a key early component of the physiotherapy treatment program. Then a very gradual build-up of the right type of exercises to restore the gluteal, thigh and trunk muscles is the main form of longer-term management.

If you have persisting buttock/ lateral hip pain that is not responding: you probably have gluteal tendinopathy !!! Make an appointment with one of our physios to be assessed and get the right advice and exercises so you can get rid of this annoying pain in the butt!!

Dr Henry Wajswelner FACP* APA Specialist Physiotherapist (As awarded by the Australian College of Physiotherapy 2007)

Henry is one of the first Specialist Sports Physiotherapists in Australia, passing his College exam and gaining his Fellowship in 2007. He has over 35 years clinical experience at the highest levels including the Australian Olympic Rowing Team and the Australian Institute of Sport in Canberra.

Henry specializes in using Physiotherapy and Clinical Pilates for persistent spinal and joint problems. His experience comes from using Pilates in managing athletes’ injuries & through his doctoral research studies into Pilates for Chronic Low Back Pain. Henry also works closely with Orthopaedic Surgeons and Rheumatologists for all types of clients to develop specific Pilates programs to optimize recovery from surgery, pain and injury. Henry often works with other physiotherapists to co-manage difficult problems to achieve outstanding results.

Henry is also a researcher involved in studies investigating the best way to manage hip pain caused by Gluteal Tendinopathy. He is a Senior Lecturer and Course Co-ordinator at Latrobe University, where he leads the Master of Sports Physiotherapy Course for Graduate Physiotherapists from all over Australia.

Clinical Research Studies mentioned in this blog :

1. Segal NA, et al (2007) Greater trochanteric pain syndrome: Epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation 88:988-992.
2. Mellor R, Bennell K Grimaldi A, Hodges P, Kaszka J, Nicolson P, Wajswelner H, Vicenzino B (2018) Effects of education plus exercise versus corticosteroid injection versus no treatment on patient rated global outcome and pain among patients with gluteal tendinopathy: a randomized clinical trial ( LEAP trial ). British Medical Journal; 361:k1662

Are you getting enough sleep?

More and more research is coming out about the importance of sleep, yet almost a third of us get less than 7 hours quality sleep each night. Sleep takes place in three stages and deep sleep actually allows your brain to clean itself. Put scientifically, during deep sleep, the spaces between our brain cells expand by up to 60% allowing cerebral-spinal fluid to remove toxins such as beta-amyloid (a protein that can negatively affect memory). Also, research shows links between poor sleep and increased pain, as well as a correlation between lack of sleep and diseases like stroke, diabetes and depression.

The following tips may help improve your sleeping:

• Set a nightly routine.
• Dark, cool room.
• Warm bed.
• Relax and prepare for sleep before getting into bed; read a book, listen to calming music, do a puzzle.
• No smoking and alcohol close to bed time (both can cause waking during the night).
• No screen time 1-2 hours before bed; this will help your natural body clock.
• If your partner snores, try different ear plugs.
• Avoid a heavy dinner/dessert, but a light snack may help if you are hungry.
• Avoid stimulants in the afternoon and evening.
• Keep the bedroom for the two S’s.
• Try practising mindfulness; it can decrease the effort of sleep.
• If you are having trouble, don’t stay in bed worrying about it, get up but stay in a low-lit room.

If you’d like more help finding ways to improve your sleep quality, I recommend the 21 Day Sleep Programby Smiling Mind. Go to the App store, download the free App, create a login, go to ‘All Programs’ and it will be at the top of the page. Good luck and sleep tight.

Abdominal Separation: What is it? Can we prevent it? And what to do about it!

Ali recently headed to Sydney to update her skills and knowledge on DRAM management and the function  of the abdominal wall.

Abdominal separation or DRAM (Diastasis Rectus Abdominal Muscle separation), happens commonly during pregnancy, and, to a degree is a normal change in a woman’s body.  As your baby grows, the increase in abdominal pressure has to be transferred somewhere.  The fascia or Linea Alba (strong tissue holding our six pack abs together) softens and widens and the abdominal muscles elongate and stretch, resulting in these muscles pulling away from the midline and the characteristic ‘separation’.  Research states that up to 66% of women will have a diastasis in the third trimester of pregnancy, and other literature found 100% of women included in their study had a diastasis at 35 weeks!  So – it is certainly common, and to some degree we would expect it.

Why do we care?

Our abdominal muscles are important in maintaining the function and support of our abdominal wall and are involved in all movement of the trunk.  They help to maintain and contribute to intra-abdominal pressure which can affect the pelvic floor and lower back.  This is particularly important during the post-natal recovery phase as our bodies are recovering.

Furthermore, women are often concerned about the appearance of their belly post-natally and we know that treating and undergoing rehab for an seperation can help improve this.  DRAM has been linked to low self body image due to this fact.

Recovery:

We do know that there is a period of natural self recovery in abdominal separation, usually until 12 weeks post-partum.  If your separation remains wide following this time it is a good sign that you should seek an opinion from your women’s health physiotherapist, in order to ensure full functional recovery.

How do we assess it?

Your treating physiotherapist will use the real time ultrasound to visualise and measure the separation, assess superficial and deep abdominal muscle function, strength and endurance, and provide appropriate exercises based on this information.

How do we treat it?

Commonly used and researched treatment methods include, abdominal binding (Such as compression garments or tubigrip, load management, postural education and retraining, and appropriate exercise rehab.  The key to successful management of these conditions is to retrain and improve the function of the abdominal muscles and strengthen the fascia.  This is achieved by exercising the abdominal muscles in the right way and allowing your body time to retrain this function in a safe and load appropriate manner for your recovery.

And finally, can we prevent it?

Maybe, in some cases.  As we mentioned earlier it is most often a normal change that occurs during pregnancy!  However, if we can identify it early, teach postural awareness, load modification and the appropriate type of abdominal exercises, we can often reduce the degree to which a separation will occur!

Ali and all of our female physios are able to help provide assessment and management of these conditions in post-natal women.  If you have any further questions, don’t hesitate to give us a call to discuss further!  

You may be aware that the Department of Health’s private health insurance reforms for natural therapies will take effect from 1 April 2019. This means private health insurance rebates will no longer be available for a number of natural therapies. Physiotherapists will be the only practitioners who will be eligible to deliver exercises drawn from Pilates within their scope of practice and be eligible for Private Health Insurance rebates.

You are still covered for classes at CHPR when they are conducted by a qualified physiotherapist and you can still claim on your Private Health Insurance as usual.

If you previously claimed private health insurance extras for Pilates classes, you will still be eligible to make a claim for services provided by Physiotherapists at CHPR and nothing will change in that regard.

What will change?
The new rules mean that some wording has to change on receipts and how our classes are described online in MBO and our website, these will now be referred to as  Clinical Exercise Classes. The new rules also make it mandatory for you to have your program reviewed regularly by your physiotherapist. It is essential that you make an individual appointment to have your personal program and goals reviewed at least once every 12 months or sooner as guided by your physio. It is also essential that initial individual assessments are done and programs are designed and taught thoroughly before joining a class or rejoining after a long break or for a new problem.

Not all Private Health Insurers are adopting all the new rules. The reforms can be confusing, and we hope this helps explain the changes and how they may affect you. If you have any further questions, please don’t hesitate to ask us at CHPR.

Kind regards,

The team at CHPR