How To Stay Injury Free This Winter: The Runner’s Guide

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Does the temperature have any bearing on whether/how to prepare for workouts or runs?

In the winter months, I recommend spending that little longer warming up and easing into your run. Injury risk increases when you go straight into a workout without preparation.

A 10 minute warm up is sufficient enough and will get the blood pumping to those muscles, as your body starts to generate heat the connective tissue around your joints will be able to tolerate the workout a lot better. Once your body is warm, I recommend stretching out any specific tight spots you may have before you begin your run. The best way to discover these discrepancies in the body is from warming up. Staying on top of those tight areas will help you be in tune with how your body responds to the strength and conditioning you are applying to it

Even though it is cold, don’t be fooled into thinking you don’t need to drink as much water as you would need to on a summer’s day.

Make sure you monitor your water intake the same way you would in those warmer seasons.

Appropriate clothing is a must. We are lucky that our climate in winter is fairly mild. However, a lot of heat can escape from our hands, feet and head. So you might need to have a look at your running wardrobe and update a few items.

Are there other seasonal hazards related to typical workout types in winter?

Your winter workout surface can most certainly be a potential contributor to injury. Unstable, slippery or hard surfaces can increase the risk of developing injuries such as, plantar fasciitis, shin splints and Achilles tendinopathies.

To avoid such injuries you may want to slightly adjust your expectations for speed and time, aim to run on days where the surfaces aren’t slippery from rain or dew, mix up your surface between the path and grass. And importantly ensure your cooldown is specific to your activity, for example in running a plantar fascia release with a firm tennis ball or lacrosse ball can help you stay on top reactive tightness development

Another surface that tends to get forgotten is the good ol’ treadmill. This is a popular choice for gym goers who still would like to do their running training when the weather isn’t cooperating.

When you think about it, the treadmill belt helps you run. It makes the running gait a little easier by assisting your hip extension (pulling your leg back). In turn, your glutes don’t get their regular workout they would on your favourite running track.

It is important to keep in the back of your mind if you have had to do a little more treadmill running training that usual, spend more time focusing on some isolated glute strengthening exercises like lunges, clams and sidelying hip abduction exercises. This will help prevent the stain on the knee when it is a sunny day and you hit the running track again after prolonged treadmill training.

Or maybe it’s a good time to spend time indoors fixing technique that may over time lead to injury.

I highly recommend including an indoor strengthening and stability regime to your running schedule that involves focusing on your gluteals, quadriceps, hamstrings and your core.

In practice, I see that there can be a common reason why athletes get injured. They neglect the rule of the Terrible Toos.

TOO MUCH – TOO FAST – TOO SOON

If you push yourself in these three, you will get injured. Simple

This can be especially relevant in the winter months as your body is working extra hard anyway to deal with the weather and any changes in the terrain.

Follow the 48 hour rule. Don’t ignore a niggle if it is lingering on for longer than 2 days

Delayed onset muscle soreness (DOMS) is a normal part of increasing our exercise regime and I think it is a nice friendly reminder that we are doing good for our body. However if you have pain or discomfort that doesn’t fall under the category of “good sore” then it is time to get help. If gentle stretching, adequate warm up/cool down, use of a foam roller (Figure 1) and rest don’t help it is vital to see a physiotherapist that has experience working with athletes and getting them back in their runners.

 

About the Author

Jennifer Dodge received her Bachelor of Physiotherapy from The University of Newcastle. Her combined interest in sports medicine and occupational health has enhanced her practice in the clinical setting, with elite athletes and contributed to the success of her business The Office Athlete. Jennifer is registered with AHPRA and HAAD, practicing in both Australia and The United Arab Emirates.

The featured image from this article was supplied by Runners World

Chronic Pain – What Exactly Is It?

Massage Back Pain Well Being Relaxation

What is pain? It might not be something you’ve really thought about but it seems like a pretty easy answer – you stub your toe, it hurts. You touch a hot burner, or you roll your ankle and they hurt immediately. Pretty straight forward right? Pain is your body’s response to physical danger. Your brain receives a signal, whether it’s the crushing impact on your toe, or the heat from the burner on your skin and interprets those stimuli as a danger and creates a pain experience to alert you that something is wrong. In this way, pain is crucially important to our survival. People with decreased sensation can suffer serious consequences due to their inability to feel pain. Makes sense right, trauma = pain. Thank you Captain Obvious!

 Not so fast….

Pain is easily explained in acute situations like the ones above, but how do we explain pain that lasts for weeks, months or even years? Low back pain is a common example. Maybe you hurt your back picking something up, or you sleep in a weird position and wake up hardly able to move. For some lucky people this pain will last a matter of weeks and disappear, but unfortunately they’re the minority. For many others, the pain will continue to persist. We know how long various tissues take to heal, so how can this pain still remain long after those expected healing times have past? (Note: this cycle is often incorrectly attributed to continuously re-injuring the affected area but this isn’t always the case).

The answer lies in our brain, or more precisely, our entire central nervous system. We once believed that we had specific pain receptors all over our bodies but this isn’t entirely correct. What we actually have are called nocioceptors and can be thought of as your “danger sensors”. These receptors are simply sensors that monitor for a variety of potentially harmful stimuli and are responsible for alerting the brain. When we touch a hot stove our nocioceptors sense the increase in temperature but that’s all the information they know. They can send a “we’re touching something warm” signal to the brain but it becomes the brain’s job to interpret this signal. If your brain decides that it’s just warm, but not hot enough to damage your skin, it responds by inhibiting the original signal and you don’t feel any pain. However, if the brain decides that the temperature is enough to cause damage, your brain creates a pain signal and you will instinctively pull your hand away to protect the area.

So, if it’s the brain’s interpretation of these constant danger signals that can result in an experience of pain, why does your back still hurt 6 or 12 months after the initial injury? Longstanding pain is due to a process known as “sensitization”. This can happen in two places: First, at the original site of injury, the sensors around the injured area become more sensitive as they become accustomed to sending increased signals. Their increased input continues after the physical damage has resolved but the brain isn’t aware that the healing process is complete and continues to produce a protective pain response. This can occur to a stimulus as simple and harmless as light touch or movement. Secondly, changes can occur within the brain itself. The brain has designated areas for each and every body part and these areas are able to adapt and change over time. If the area for the low back is being constantly stimulated by danger messages, this area can grow and even start to overlap with surrounding areas. This can cause movement in other areas of your body to trigger danger messages that the brain interprets as originating from the back, and again you feel pain. This feeling of very real pain in the absence of true physical damage is what we know as chronic pain.

The good news….Both of these processes are completely reversible! The first step is understanding the complexity of the pain process are realizing that there may no longer be a physical injury. Then you can begin the process of re-training the brain and desensitizing the nervous system to restore a pain-free state!

It’s important to understand that this article only covers the physical mechanism behind pain. Pain can also be affected by non-physical elements such as emotional and social factors but that’s a subject for another blog! If you have longstanding aches and pains you may be suffering from chronic pain. Drop by and have a chat with your local physio to determine the appropriate treatment method to get you back on your feet!

This article originally appeared on Stoke Physio.

What is Femoroacetabular Impingement (FAI)?

What is Femoroacetabular Impingement - FAI

Hip impingement, also known as femoroacetabular impingement (FAI), is a condition where there is abnormal contact between the femur bone (femoral head) and the socket of the hip joint (acetabulum) during certain movements of the hip.

The resulting impact can lead to damage of the cartilage inside the hip joint. This may in turn lead to premature arthritis.

FAI is traditionally described as due to either an abnormality of the shape of the ball of the femur (CAM deformity) or of the acetabular socket (PINCER deformity). Movement of the hip joint is complex, and more recent research has demonstrated that the overall 3-dimensional shape and orientation of the hip should be considered to properly evaluate and treat clinical impingement.

Symptoms:

Patients with FAI often experience pain in the groin with deep flexion (bending) or rotation of the hip during certain activities. There may also be inflammation of the tissues surrounding the hip such as on the outer side of the hip (trochanteric bursitis), the groin muscles (adductor tendonitis) or inflammation of tendons in front of the hip, especially if the condition has been around for some time. Eventually, as the damage continues, the patient may begin to develop more arthritic symptoms such as a stiffness and a dull ache in the groin. Hip-related pain is not always felt directly over the groin. It may also be felt on the outer aspect of the thigh, the buttock or traveling down the leg.

Investigations:

Patients who have symptoms suggestive of hip impingement are usually investigated with x-rays of the hip first. Further investigations could include a CT scan and special MRI scan. The CT scan is performed to study the bony detail of the hip and the MRI is used to assess the cartilage, labrum and other soft tissue structures in and around the hip.

Treatment:

Non-surgical Treatment for FAI:

Treatment of femoroacetabular impingement symptoms often begins with conservative, non-surgical methods. Physiotherapy treatment may involve soft tissue work to relieve tight muscles around the hip, however the majority of treatment is rehabilitative based, to try strengthen the deep hip stabilizing muscles. The aim is to improve the stability and function of the hip. At Port Melbourne Physiotherapy & Pilates we commonly treat patients with hip/groin pain with a structured Pilates program aimed at strengthening the hip and pelvic muscles.
Rest, activity modifications and selective use of non-steroidal anti-inflammatory medication are often helpful in alleviating early symptoms. An injection of the hip joint with anaesthetic can provide some relief as well as diagnostic information in patients with symptoms which are unresponsive to treatment.

Surgical Treatment for FAI:

For patients not responding to conservative management, Femoroacetabular Impingement (FAI) can be addressed with surgery to improve the shape of the hip.
The aim is to correct the bony deformity before there is irreversible joint damage. In many cases this can be done by hip arthroscopy (keyhole surgery).

If you’d like further information on FAI or if you feel your symptoms match the description above, speak to your physio about what treatment options are available for you and whether further investigations are required.

This post was written by Sheree Freedman – Physiotherapist/ Director at Port Melbourne Physiotherapy & Pilates

Common Knee Injuries and How To Treat Them

Common Knee Injuries And How To Treat Them

In this post we will focus on knee injuries, and what treatment may be required to get back to living your barefoot lifestyle!

Common knee injuries can occur through daily movements and activities, whether it be a car ride, sport or landing differently on your knee. Three common knee injuries we will look at are ACL, PCL and Meniscus tear which cause discomfort and potential long term effects if not treated properly.

Common Injuries

Meniscus tear: Damage to the meniscus, can be caused by awkward pivoting on the knee, direct blow to the knee or in some cases repeated squatting with poor technique. Symptoms include pain in certain ranges of movement, a feeling of something ‘catching’ or ‘locking’ in the knee

Medial collateral or lateral collateral ligament tear: Damage to these ligaments typically occur from changing direction. This can be when the foot stays planted or a direct blow to the inside (LCL) or outside (MCL) of the knee. Symptoms include localised pain, swelling and feeling of instability.

ACL tear: Depending on the severity of the injury, the ACL could be strained, partially torn or completely ruptured. Damage to the ACL is often caused by pivoting/change of direction when the foot remains planted (most common). Damage can also be caused by hyperextension (eg knee being pushed past straight) which can occur when the foot remains planted, and the body pushed sideways (eg in a contact sport).

Symptoms include an audible popping noise at time of injury, significant pain and swelling immediately or a feeling of instability. Due to the mechanisms of injury, it is not uncommon for an ACL tear to occur with meniscus damage and medical collateral ligament damage (known as the “unhappy triad”).

PCL tear: PCL tears are much less common than ACL ruptures, as they are stronger and larger ligaments. A PCL tear can occur from direct force to the shin, while the knee is flexed (such as knee hitting the dashboard in a car accident). This is the most common cause of PCL injury. Another common PCL tear can occur from falling onto a bent a knee, with hyper extension causing damage to the PCL.

Symptoms are often similar but far  less severe than an ACL tear.

Treatment
If you have suffered an acute knee injury, or are feeling pain and discomfort in your knee/s then the following can help to reduce pain and inflamation,

Settle inflammation down:
Relative rest (don’t do anything painful, but don’t do nothing- aim to gently keep your knee moving); ice for 20 minutes every few hours; no alcohol; discuss anti-inflammatory medication options with your doctor or pharmacist

  • Consult your doctor or physio to determine if imaging is necessary. There are clinical tests that can help determine if any of these structures are damaged. Your physio or doctor should talk you through each test and your results. If there is any concern, an MRI (magnetic resonance image) will often be recommended for more certainty
  • If damage is detected on imaging, then your doctor will likely refer you to an orthopaedic surgeon (specialist doctor) to determine the best management for your injury (ie surgery or physio)
    Whether your injury requires surgery or not, we suggest popping in to see one of our physio’s to get you back to doing what you love, sooner!

This article was originally posted on barefootphysiotherapy.com.au. It has been re-published with the permission of the author.

Sore back playing golf?

Sore back playing golf?

Over one million people play golf in Australia, making it one of the highest participation sports nationally.
Golf related injuries are common for both amateur and professional golfers, with lower back pain contributing to approximately 25% of all golfing injuries, in those that play at least three times per week.

Research also reveals that on average a lower back pain episode will keep you off the golf course for up to six weeks. It therefore makes sense to practice not only your playing techniques but also your preparation habits – to reduce your risk of injury.

In amateur golfers lower back pain is caused by:

  • poor swing technique
  • overuse
  • failure to warm up
  • reduced flexibility – especially spine and hips
  • reduced trunk muscle strength
  • reduced general fitness
  • ill-fitting equipment

We know that the main force going through your lower back during the golf swing is compression and this has been measured at up to eight times your body weight. The majority of this force occurs at impact (when you hit the ball).

Low back pain is often caused by stresses to the discs, ligaments and muscles in these areas. Excessive flexion or ‘slouching’ of your spine in various positions such as when bending forward or sitting is a common cause of pain.

Preparing for your day on the green

Golfers are often giving their back a work out prior to hitting the first shot off the tee – where habits can cause stress to the back overtime.

What habits you have formed that may be contributing to lower back pain? Use the checklist below to consider the type of load on your back associated with playing golf:

  • lifting your clubs and buggy in and out of the car
  • driving your car to the golf course
  • assembling your buggy and searching through your golf bag
  • hitting and then picking up practice balls, including putting practice
  • teeing up the ball
  • pushing/pulling your buggy – especially up hill
  • repairing pitch marks and getting the ball out of the hole

So how does this help you to manage back pain with golf?

Gaining a better understanding of the contributing factors to back pain with golf is the first step. Now whether you’re looking to manage golf related back pain or prevent it, we’ve listed our most important tips – no matter your playing level.

  1. Warm up! This should incorporate specific stretching exercises; driving range and putting practice; and practice swings on the first tee. These warm up exercises should take no longer than 10 minutes each.
    See your physiotherapist for a massage, stretching routines, or to strengthen the trunk, low back and neck muscles using Pilates based techniques and methods.
  2. Have a 3D golf swing analysis and/or golf assessment to correct your swing technique. This is otherwise referred to as ‘the MRI of your golf swing.’ A 3D analysis can assess in detail exactly the way your body moves during the golf swing in real time. This will make the cause of your back pain during golf easy to identify and manage.
  3. See a golf professional for a lesson to ensure your technique is correct.
  4. Adopt correct lifting and bending techniques to maintain spinal curves and bent knees
  5. Pay attention to correct equipment and usage – lighten your bag and push rather than pull your buggy.

So next time you’re preparing to head out for a game of golf or even a practice session, take note of the above, prepare like a professional and continue to enjoy your time on the green.

Ben Corso – Director of The Physio Clinic recently presented a workshop on Golf Injury Management and Rehabilitation to the Italian Sports Physiotherapy Group in Milan, in May 2017 through Manualmente.
This article is a patient centred summary of the information presented and how this can assist your golfing patients. www.thephysioclinic.com.au

Not All Hamstring Strains Are Equal

Not All Hamstring Strains Are Equal

Hamstring Strains Are Most Frequently A Sprinting Injury

The winter sports season is upon us, meaning physiotherapists all around Melbourne will be dealing with athletes having suffered hamstring strains. AFL and soccer are sports with notoriously high numbers of hamstring strains the majority of which occur during high speed running.

70% of hamstring injuries in elite football players occur during high-speed running (sprinting) and the rest with stretching, sliding, twisting, turning, passing, jumping and overuse.

Predictors Of Poor Recovery With Hamstring Strains

Poor prognostic predictors regarding hamstring strains and athletes returning to play following hamstring injury (referring to hamstring injuries that are likely to take longer than average to recover) include:

  • Suffering a stretching type injury such as reaching for a ball with an outstretched leg or bending to pick up a ball whilst on the move are injuries that have on average 84% longer return to play times than contraction injuries (contraction injuries referring to hamstring strains occurring during regular sprinting motions).
  • The area where the peak point of pain is to touch on the back of the thigh. The closer to your sit bones (the ischial tuberosity) the peak pain point is felt the longer the recover times.
  • Location of swelling. Similar to the location of peak pain, the closer any swelling present is to the ischial tuberosity the poorer the prognosis.
  • Most weekend warriors will not require an MRI for an acute hamstring strain but another predictor of poor prognosis found was the length of swelling upon MRI. The longer the area of swelling visualized on imaging likely indicates a longer return to play time frame.
  • These findings although relating to the professional footballer (soccer player) can arguably be applied to the weekend warrior. Notably the professional athlete may have both more resources and motivation to aid their return to play but these can be considered useful guidelines for the armature sportsman to help with estimating a safe return to play.

Return To Play In 23 Days

45% of athletes return to play in 23 days following sustaining a hamstring strain. Individuals variations will always exist and many variables come in to play such as pre injury status, adherence to any physiotherapy guided protocols… But it is nice to have a bench mark to aim for and the realization that with the majority of hamstring strains the sportsperson is likely to miss 2-3 matches based on having weekly games.

It is easy to see improving recovery times by just a few days could be the difference between missing only two matches verses three or more. In a short season every game missed through injury is significant so adherence to physiotherapy advice and protocols can help you play more matches during the season which is what being a weekend warrior is all about, getting out there and having a run.

Loading Over Stretching With Hamstring Strains

With hamstring strains rehabilitation programs based on exercises primarily involving high loads at long muscle-tendon lengths were found by Askling CM, et al to be the most effective at reducing the time to return to play.

The idea is that rehabilitation in a controlled graduated fashion should attempt to mirror the particular situation that lead to the injury. Where rehabilitation of acute hamstring injuries should build on attaining eccentric loading at long muscle lengths (the phase of contraction that occurs as the muscle lengthens is considered an eccentric contraction).

Eccentric loading and loading muscles towards their end of range can put strain on healthy tissue let alone muscle tissue recovering from injury so guidance with such rehabilitation techniques is crucial for successful outcomes.

Professionally Guided Management Makes The Difference

If you have sustained a hamstring strain having a physiotherapist assess your injury to help gauge a working return to play time frame and set up a rehabilitation protocol. Can help you return to play quicker and reduce the likelihood of any recurrence.

Reference: 2013 Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Askling CM, et al Br J Sports Med 2013.

Written by Hayden Latimer. Hayden’s practice is based in Sydney, he is the owner of Sydney Physio Clinic. Prior to opening https://www.sydneyphysioclinic.com.au/ Hayden has worked as a physiotherapist around the world for over 15 years.

How Do I Avoid Injury? Prevention Is Always Better Than A Cure

How Do I Avoid Injury

The new year has turned over and everyone is having a fresh start.

It’s the time of year most team sports are into pre-season training, new year resolution fitness regimes are taking off and excitement is high for new opportunity.

Players may be returning from long injury lay-offs, runners hitting the track following their Christmas holidays and of course cricket and tennis are in full swing.

This is also means it’s the time of year that a lot injuries occur!

Whether it’s an athlete returning to their sport or someone in the middle of a long season, I regularly get asked as a physio, ‘how do I best avoid injury’?

The answer to this involves a lot of factors but a great place to start is to identify your injury risks and preparing well for your sport.

Although accidents happen and we can never guarantee an injury won’t occur, what we do know is that different sports are more susceptible to different injuries due to their differing physical demands. For example, we tend to see overload injuries such as Achilles and Patella tendinopathies in runners and teenagers, shoulder impingements in swimmers, ankle sprains in jumping sports like basketball and netball, hamstring and groin strains in AFL footballers and of course the dreaded ACL injury with our Basketballers, Netballers and Footballers.

The good news is we know that the risk of a lot of these injuries occurring can be reduced by implementing preventative strengthening and improved neuromuscular control programs.
As mentioned above, a lot of sports are prone to the devastating ACL injury and given it’s long rehab and unfortunately low rate of return to previous level of sport amongst athletes who have undergone an ACL reconstruction, it’s become the ‘poster injury’ in sports medicine.

As research shows that 50%-70% of non-contact ACL injuries are preventable, this makes it a great example of how identifying your injury risks and implementing an injury prevention program can help you stay on the park longer.

If you’ve been listening to the news over the past few months or are just a keen sports fan you’d be well aware of the media attention and hype around the upcoming AFL Women’s, and also recently the Women’s Big Bash cricket taking off. You may have also heard or read about the conversation regarding the concern of a potential increased injury rate as these sports grow, and in particular, again, ACL injuries!

The reason for this concern is due to several reasons, as research has shown us who is most at risk and why.
We know through research that most at risk are girls aged between 14-18 and men aged 19-25, teenagers with recent growth spurts, previous ACL injury, athletes who are increasing their training load and the athlete who has increased their level of competition.

You can quickly see why these young girls, who are going from semi-professional footballers to elite AFL stars, are regarded as high risk for injuries!

Now although this attention has centred around our soon to be AFL idols, the caution for increased injury rates filters right down to our grassroots where participation numbers are on a rapid rise, particularly with our adolescent female footballers.

Continuing with our example of ACL risks, our research shows young females are at more risk of ACL injury compared to young males and this is thought to be due to a smaller attachment site of the ACL, increased hip angle which biomechanically increases loading through the knees and a decreased ratio of quads to hamstring strength. What this often results in is a decrease in control through the knee when jumping, landing, twisting and turning. The mechanism for ACL injury!

Now the point I’m making here isn’t that it’s all doom and gloom for adolescent female athletes, it’s how important efficient biomechanics and strong neuromuscular control are to avoid injury. Not just for ACL injury, but all injuries.

So what can we take away from this?

Whether you’re an elite athlete, weekend warrior or returning to the running track, we’re all susceptible to injuries but they can be prevented!

By identifying what injuries you’re likely to be exposed to and understanding your biomechanics, implementing an injury preventative program to improve biomechanics and neuromuscular control, you can reduce your chance of becoming another injury stat and improve performance.

Remember, Prevention is always better than a cure!

This post was written by Tristan Dower and originally appeared on vivaphysio.com

RISE: Our New Balance Rehabilitation Program

RISE 3

At Fresh Start Physiotherapy, we see all too often clients that present with injuries from falls, trips, stumbles and overbalancing.

As humans, if we experience something that shakes us up a bit, we have a tendency to lose confidence in our abilities and avoid tackling the problem head on.

Herein lies a problem.  If we become less mobile and less adventurous with our walking and daily activities, our body decreases its ability to respond the same way in those particular circumstances. We become less conditioned to moving, bending, twisting, balancing and our body’s response to overbalancing or a trip is significantly impaired.

The real question is “how do we fix this?”

Fresh Start Physiotherapy has a solution.

By becoming a participant in our program RISE, you will be taken through a series of tests to determine which of your body’s mechanisms are not responding at the optimum capacity in a 1:1 consultation. We can discuss your goals in relation to where you would like your body’s capacity to be.

Our program runs over a six week period, one hour per week for six consecutive weeks. The session involves two parts. Part 1 is a series of warm ups, balance exercises and stretches that are tailored to your individual needs over a 30 minute period.

Part 2 involves 30 minutes of education from a health care professional in relation to managing your balance issues with medications, footwear, set up of your home and others.

After your six week participation, we will take you through your initial tests and measure your improvement. You will then have the option to continue a further six weeks of progressed balance exercises to further improve your confidence and function.

Our goal is to restore your confidence in your body’s capabilities, reduce the fear of falling and get you back on your feet with a smile.

For more information, please make an appointment online by visiting freshstartphysio.com.au/book-now or call the clinic on (03) 4201 5074.

Sciatica: What You Need to Know

Pilates

Sciatica is commonly described as pain experienced mostly on one side of the body and runs down the buttock, hamstring and sometimes extends to the lower leg. Sciatica pain is normally caused by compression of the nerve that originates from your lower back. It can be triggered by joint inflammation, tight buttock, arthritic growth or locked facet joints.

Symptoms that are generally experienced are:

  • Pain in the lower back, buttock and back of leg
  • Pins and needles down the leg
  • Weakness and numbness of the leg or foot
  • Sharp pain when standing up

However, just because you tick most of the boxes above, you still may not have sciatica. Leg pain can be from various causes and sciatica is often misdiagnosed. Therefore, you should always get yourself diagnosed by a therapist who will take into consideration the findings from the physical examination and the history of symptoms.

Treatment

Sciatica is firstly managed conservatively with a combination of pain relief medications and physical therapy. The majority of people who experience sciatica get better within a few weeks or months with the right Physiotherapy treatment. If the symptoms do not improve your therapist might suggest surgery (only as a last resort). However, research has shown that long term benefits from surgery appear to be equivalent to the conservative care.
Research conducted in 2011 showed that the best results are seen by restoring normal flexibility, posture and strength through a directional bias exercise plan. Here, at Fresh Start Physio we treat our patients using the concept of Clinical Pilates which is a rehabilitation modality developed by Craig Phillips, Director of DMA (Dance Medicine Australia). Clinical Pilates is used to restore dynamic postural stability deficits following the directional bias concept.

This article was originally published on Wisdom Physiotherapy. It has been modified and re-published with permission.

References

Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). “Sciatica.”. Best practice & research. Clinical rheumatology. 24 (2): 241–52. 

Markova, Tsvetio (2007). “Treatment of Acute Sciatica”. Am Fam Physician. 75 (1): 99–100.

Angela Dunsford, Saravana Kumar and Sarah Clarke. (2011). “Integrating evidence into practice: use of McKenzie-based treatment for mechanical low back pain”. J Multidiscip Healthc. 4: 393–402.

The Benefits Of Clinical Pilates

Girl Doing Clinical Pilates

As Physiotherapists, we often get asked what the difference is between Clinical Pilates classes and gym run classes. Although both versions use machines called reformers, that is where the similarities end.

Firstly…what actually is Pilates?

Pilates is a form of exercise targeted at improving your core strength, balance and stability. It focuses on building strength in your deeper layer of abdominal muscles, your deep supportive spinal muscles and your hip/pelvic musculature. The idea being that building a strong core foundation will allow your body to function at a higher capacity, improve your posture and reduce the incidence of lower back pain.

Clinical vs Gym/studio Pilates

The first major difference is that Clinical Pilates reformer classes are run by fully qualified Physiotherapists, not Pilates Instructors. This means that not only does your Instructor have 4 years of university training in anatomy, physiology and injury management, they are also trained in what is known as “clinical reasoning”. This means that they are fully qualified and highly trained to assess you and establish which particular type of exercise is suitable for your injury or condition, whether that be lower back pain, shoulder pain, a medical illness or pregnancy. Your Physiotherapist will also be able to modify your exercise program to account for flare ups or changes in your injury on a particular day or week. Hence, your Clinical Pilates program is specifically tailored to meet your needs.

The second major difference is the class size. Clinical Pilates classes are usually kept to a maximum of 3 or 4 people per group, ensuring that you receive adequate supervision and attention, in order to monitor technique and prevent injury. Gym classes often have 10-12 people in a class, sometimes up to 20! It is impossible for the instructor to monitor technique and also modify exercises for the individual. When using any piece of exercise machinery whether it be a reformer or gym machine, correct technique is essential otherwise injuries can occur. It can be very difficult to monitor each person closely in bigger class sizes, which is why classes are kept small.

Why should I do Clinical Pilates if I don’t have an injury?

You don’t need to have an injury to attend Clinical Pilates classes, many people attend classes to keep fit and healthy, enjoying the personalised attention that a small class size allows. It gives them the peace of mind to know that they are performing the exercises correctly under qualified supervision. Clinical Pilates improves core strength, changes your body shape, assists with posture and alignment, and provides a safe way to tone the whole body.

There can be the misconception that Clinical Pilates won’t be as challenging as a gym based reformer class. However, this is not the case at all. Programs can be as challenging as the individual requires and are always modified and progressed over time as your body adapts. It all comes back to the small class sizes, and therefore having the ability to individualise programs.

Written by Sally Maple. (Modified by Sophie H-M)

Physiotherapist and Director of Port Melbourne Physiotherapy & Pilates