Physical Therapy
Back Pain
Lower back pain is the most common problem we are faced with in the clinic each week. And no two cases are the same. There is a lot of misinformation out there about how to manage lower back pain. This can lead to an ongoing fear and avoidance of activities.
Do you find yourself holding your breath when you are pulling on your shoes in the morning or when getting up or down from a chair? Are you shifting you weight as you stand just so that you can stand without grimacing? If you are like this on a daily basis you most likely have found yourself to be altering your lifestyle and not doing the things you enjoy doing with family and friends because of the pain you feel, or will be feeling later.
Most people think of their back as being weak or vulnerable and very stiff or possibly you were told you need to sit up straight and hold your core tight every time you move. This is the kind of advice which is keeping people in pain for prolonged periods and the reality is your back is actually very strong and mobile and holding it rigid and tight can actually exacerbate your symptoms.
Imagine that the below graphic is the ideal situation below where the body is working equally across the entire body:
Generally when someone comes into the clinic, they have a weakness and it is usually either above the back or below the back that is not performing.
So even though the misconception tends to be that you have a weak back, reframing it this way shows you that if anything your back is too strong and over working and our main objective it to get it to turn off or relax.
What happens is the back ends up doing too much work or moves too much to compensate for other stiff areas. And this in turn can lead to back pain. So, people’s misconceptions of having a weak back is our first hurdle. Confidence in your back is the first step to recovery and believing that your back is able to move, lift, twist and load.
The body moves best when it moves in unison, I love this statement because it’s so simple, but for most it seems impossible. If we spread out the load on the body over the legs, lower back, upper back and arms then we have a 4 way split with all things being equal. That equates to the legs doing 25%, lower back 25%, upper back 25%, arms 25% as per the picture above.
Usually these overloads happen from some previous injuries at the hip, ankle or even from a breathing problem. The body is great at adapting and creating new movement patterns to protect you and a lot of the time these old injuries come back to haunt you down the line.
This is why it is very important that we must first understand your story and goals so that we can develop a bespoke plan that clearly defines a path to taking control of your life back.
At Alleviate we have a 5 step process that involves:
Some people believe that a massage every now and then or an adjustment three times a year is the solution to beating their low back issues. This system above is different for everyone who comes through the door but it offers more that just short term relief; our system is more about making you robust and confident about your back and how you move.
Hip & Groin Pain
Hip and groin pain are usually an overload issue where some muscles are doing too much and other muscles aren’t working enough. Sometimes, rather than strengthen an already overworked groin, it’s more important to train the muscles that aren’t working.
A lot of the compensations in the hip come from lower down the chain, mainly the foot and ankle. So with this in mind generally we look at the foot, ankle and knee in rehabbing common hip problems. Tiny movements at the foot have a ripple effect up the body, so this is why we really delve into your previous injury history, that ankle sprain, or broken toe most likely is the reason your hip is giving you problems.
Knee Pain
In a nutshell healthy knees go hand in hand with ankle and hips that can move well along with thigh mobility. So as simplistic as that may seem it tends to be 90% of all nonspecific knee injuries are down to issues with the foot and ankle. As long lasting or as sharp as the pain may be with knees the automatic belief is that there is damage, PAIN is not a good indicator of damage. Take your paper cut for example, there is nothing sorer, but the damage is limited or stubbing a toe is about as painful as it gets but again the damage is limited. So sharp pains in the knees do not always mean that I need a knee operation and more than not it’s the quadriceps (thigh) muscles overworking to compensate for some other part of the leg that is not doing enough.
Our first port of call with the knee is trying to regain full range of motion of the knee joint so that the quadriceps can tolerate the load they need to. Lay flat on your face and see if you can touch you heel to your bum.
If this isn’t achievable then we look at the many other possibilities for lack of mobility in the quads.
Never has the saying ‘movement is medicine’ been more prevalent than when it comes to talking about knees. And because a sore knee interprets all movement as pain then it is figuring out those specific movements to expose the knee to loads again is where we come in. Even with arthritic wear and tear the studies suggest that the knee function is increased with exercises. O’Hanlon et al in 2016 would recommend that 6000 steps per day offer reduced pain and increased function. Again beliefs are the most limiting factor in peoples’ knee pain: ‘If I exercise I will wear the joint out more’……’But I can’t exercise with my knee…’ I’ve heard all the excuses and these personals beliefs and mantras are the first obstacle we must overcome. From a Study in 2010, Zhang et al, Exercise is as effective as Drugs for pain.
Very often, when someone has suffered from a type of lower body injury their body goes into a state of protection, which usually means moving slightly different. This is initially a good thing to protect the injured area. The issue comes when this altered movement behaviour is carried on after the healing is done and that area no longer needs protecting. These new movement patterns can overload tissues in a way that the subconscious mind may perceive as a potential ‘threat’ to the system and in turn produce pain.
At Alleviate we look at the ability to tolerate load through the peripheral limbs with good foot pressures and hips loading while being able to relax the back, the ribcage and the neck. This is paramount for healthy knees.
Foot & Ankle Pain
The foot and ankle are very much overlooked in their function in the athletic population. Popular warmup routines tend to focus on warming up the calves, quads, hamstring, groin and glutes but never so much as an after thought for the feet, even though when you run some four times the weight of your body is pressed through your foot with each stride.
The foot is the foundation of all movements of the body, and you don’t build a house with dodgy foundations. So this neglect of the feet is an epidemic and as advanced as modern strength and conditioning may be this neglect of the positioning and mobility of the feet is where the leaks appear. The leaks may be old ankle sprains, broken toes or simply just casting your foot in a brace since the age of two.
Leonardo DeVinci once described the foot, ‘The human foot is a masterpiece of engineering and a work of art’. To say its complex is an understatement with some 26 bones, 33 joint, 19 large muscles and more that 100 ligaments.
Complex in make-up and complex in function, too much rigidity and the impact of forces will not be absorbed through the gait and forcing a shock up through the kinetic chain and too much mobility and additional forces are placed through the foot and ankle joints and again transfers additional forces through the knee, hip, sacrum, back, shoulder and neck. Yeah hard to believe, that your neck could in fact be sore because of your ankle.
Being one of the most commonly injured areas its often over-looked for maintenance and strength and conditioning.
And no matter what exercises and protocol you administer to the upper body or the spine itself, if we don’t treat or move the feet, the spine will continue to respond to the foot’s inefficiencies
‘A little water seeping through a small hole may swamp a canoe’ an old Maori proverb about how working together is way more efficient that not. We are more efficient united than pulling against one another. Our feet are magically designed to send brain signals about the ground below us and we need to complement this with the way we move. These long term ‘leaks’ lead to these dreaded plantar faciitis, achillies, bunions and mortons neuromas…….. where the foot finally has had enough and decides to cause pain for those years of torture.
They feet not only help us balance, they control the placement of our ankle, knee, hip, pelvis and spine. So not to be a pain in the NECK, its recommended to put the best FOOT forward!……(excuse the puns but I couldn’t resist).
Shoulder Pain
We have a lot of experience in successfully treating shoulder injuries in both the sporting and non-sporting populations with every age group from teenagers to the elderly.
We are very experienced in the diagnosis treatment and rehabilitation of conditions like:
Rotator cuff items
SLAP tears
Clavicle fractures
Frozen shoulders
Shoulder dislocations
AC Joint separation or sprains
Overload
Several factors can contribute to shoulder injuries including previous injuries, neck pain, elbow pain, wrist pain and movement deficiencies elsewhere in your body.
Neck Pain
We see neck pain everyday in the clinic and it comes in all makes and shapes; no two people are the same. The vast majority of neck pain is from poor breathing patterns from lifestyle or the stresses of everyday life. In many cases the shoulders are not loading correctly and in turn over work the neck muscles.
At Alleviate we look at the whole body when rehabbing the neck, it’s not uncommon to find from the patient’s history that their old knee injury or ankle injury ends up being the true stressors on the neck.
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