Spinal

How Good is Your Core Stability?

Research clearly shows that core stability retraining has short and long-term benefits for low back pain sufferers. The good news is that we also know that core stability training markedly reduces your chances of re-injury. Research on lower back pain sufferers has shown us that if you can re-activate your core stability muscles, your chance of recurring back pain reduces. Your chances of not experiencing another bout of low back pain (LBP) within twelve months are almost three times better if you have undertaken an ultrasound-guided exercise program84% vs 30%. After three years, you still have a two in three chance of not experiencing low back pain if you did the exercises. Adding even more research support, if you didn't do the exercises, you only have a one in four chance of being pain-free. You're still over twice as likely to not experience another episode of back pain. Hides et al. (2001). PhysioWorks physiotherapists have professional knowledge in the training of core stability muscles. The difficulty has always been how to quantify a patient's level of stability control. That is, until now. The solution has been to develop a useful and clinically practical method of assessing your core stability level. We can then determine, and at what level it fails to cope with your body's demands. That is, what is the individual client's functional Back Stability Score (BSS)?

How Do We Assess Your Core Stability?

Your PhysioWorks physiotherapist will assess you to determine your current symptoms, pathology and functional requirement. Then, they'll physically test you to decide on your back stability based your ability to activate your core control muscles (transversus abdominis, multifidus and gluteals). If you can isolate these muscles, we can test further when your core stability muscles lose control of your spine and become inhibited or fatigue. This testing assists us in determining what tasks make you vulnerable to back pain or injury.

What Happens After Your Core Stability Score is Determined?

Based on your functional needs, your treatment directs towards your specific areas of weakness. The result is a much stronger, stable and pain-free back. If you would like to know your Back Stability Score, please contact PhysioWorks.

What are the Benefits of the Functional Back Stability Score?

For Patients

  • You have a quantitative guide to your functional goals.
  • You have a current status score. Progress is measurable.
  • You can progress quickly through the BSS levels to maintain motivation and self-esteem.
  • Individualised treatment. Different retraining options depending upon desired outcomes.
  • You can self manage in the long-term.
  • Your goals are functional (task-related) rather than merely a strength score.
  • Quantitative Feedback for You, Your Health Practitioners and Insurers.
  • Achieve stepped goals and sensible, steady exercise and treatment progressions.
  • We'll educate you on how to prevent future injuries.
  • You'll be introduced to ergonomics and understand the best postures for you.
  • You will prevent future bouts or at least minimise their severity.
  • It's a research-backed solution.
  • It's perfect for all ages and physical ability.
  • There is a clear path for progression.
  • You perform your exercises in the comfort of your own home without expensive gym equipment or membership.
  • You'll have personalised professional guidance for assessment, reassessments and progressions.
  • You'll be pain-free ASAP.

For Clinicians & Insurers

  • It's a precise measure of your functional capacity.
  • It allows better judgments on patient directions, e.g. returns to work.
  • It offers better-individualised advice and treatment.
  • It reduces jargon through measurable standardisation.
  • It's a practical measure that can be related to other outcome measures such as Oswestry Disability Score.
  • There is a clinically relevant correlation between subjective and objective findings.
  • It reduces malingering.

What Conditions Does the Back Stability Program Improve?

  • Spinal Pain
  • Spinal Posture
  • Pelvic floor function
  • Sciatica
  • Spondylolisthesis
  • Spondylosis
  • Degenerative Disc Disease
  • Poor Balance or Fall History

Core Stability vs Pilates

The whole 'core stability' phenomenon started back in the 1920s with a chap named Joseph Pilates, who's exercise regimes have become quite trendy in the last ten years. Pilates talked about developing a 'girdle of strength' by learning to recruit the deep-trunk muscles. Even without complete knowledge of anatomy and the benefits of the latest muscle activity research, he was aware of these deep muscles' importance and their supportive effects. Core stability training targets explicitly the smaller and deeper back and stomach muscles. Once recruited, these muscles control the position of the spine during dynamic movements of your body.

Is Pilates for Everyone?

Sadly, No! Exercise programs that aim to develop your deep core strength can often do just the opposite. The most common reason for injury and back pain is the incorrect timing of core muscle recruitment.  Pilates, Yoga, gym strengthening, and other exercise forms place high demands on your core stability system. Abnormal core muscle recruitment order increases your injury chance proportion with the exercise difficulty. Remember, if you build a tower on a weak foundation, it will eventually topple. Look what happened to the Leaning Tower of Pisa. It's got lousy core stability! The same goes for your core stability muscles. However, recruiting the deeper core muscles before your superficial layers, just like adding floors to a sturdy skyscraper and your back, will forever be healthy and pain-free.

Why is it Important to Specially Retrain your Core Stability Muscles?

Once the core muscles become weak, and their timing is incorrect, you can experience prolonged back pain and are at much higher risk of re-occurrence. Research has identified that the order of core muscle recruitment is one of the most critical factors in the prevention or resolution of pain.  Real-Time Ultrasound Physiotherapy has proven particularly useful to correct the muscle recruitment order. To solve your back pain and to reduce your re-injury risk, you must retrain these muscles back to an appropriate level for your needs. If you are relatively sedentary, you may only need a low level of control, however, if you are a high-level sportsperson or a manual worker you will need to work up to a much higher core strength level.

What Should You Expect?

In the initial stage, you need to consciously activate these muscles and incorporate them into an exercise program. A lot of people find it difficult to isolate these muscles and need help to be able to activate them effectively. Research has discovered that real-time ultrasound-guided treatment is the most effective way to successfully retrain an isolated and well-timed core stability contraction.

More information

Pilates is available at some of our PhysioWorks clinics.
Real-Time Ultrasound Physiotherapy is available at some of our PhysioWorks clinics.

Article by John Miller

What Causes Lower Back Pain?

Researchers and spinal health care practitioners categorise lower back bain into the following categories:

1. Specific Spinal Pathologies  (<1%)

2. Radicular Syndromes (5-10%)

3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)

Specific Spinal Pathologies

Some conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:

These conditions do require early diagnosis and prompt referral to the appropriate medical specialist.  Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed.

Some referrals should be IMMEDIATE!

Radicular Syndromes

Lower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of back pain presentations to general practitioners.

Radicular pain (e.g. sciatica)

The most common pinched nerve in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you suffer radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve).

The following back injuries may cause radicular pain:

Pain is due to swelling or space-occupying material adjacent to the spinal nerve. The affected nerve may be irritated, resulting in radicular pain. Or, even worse, become pinched or compressed, resulting in radiculopathy.

Radiculopathy

Lumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your walking ability.

Spinal Stenosis

Spinal stenosis is a slightly different condition and relates to the narrowing of the spinal canal. Spinal stenosis is usually more prevalent as you age.

Non-Specific Lower Back Pain (NSLBP)

Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify lower back pain sufferers with no specific structure injured. It is a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms.

Fortunately, these conditions account for approximately 90-95% of lower back pain and can nearly always successfully rehabilitate without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.

NSLBP Causes

The causes of NSLBP are numerous but roughly fall into either sudden (traumatic) or sustained overstress injuries.

Most people can relate to traumatic injuries, such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (e.g. poor posture) are probably more common and straightforward to prevent. In these cases, positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain.

Most commonly, NSLBP causes include back muscle strain or back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly your acute disc health and predispose you to severe pain.

The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment are the easiest way to recover quickly from lower back pain and prevent a recurrence.

Back & Neck Pain Prevention Tips

Here's some beneficial advice to help you prevent back pain and enjoy life to the maximum.

Posture

I'm afraid that your mother was right. If you slouch, you'll end up with problems. Just one of those problems is back pain. You'll find other problems elsewhere on this website. Think "Grow Tall".  Imagine that you have a string screwed onto the back of your head, just above your hairline. Then think that someone is dragging you up off the chair you are sitting on. Hold this "grow tall" position for 10 seconds and repeat every half hour. As well as greatly reducing your chances of back pain you'll note that your chest has lifted, shoulders are relaxed, the chin is tucked in, the head is level and stomach muscles have contracted.  Not bad for such a simple exercise. This posture can be repeated in sitting, standing, sleeping, walking or running. Try it, and the physio will work for you too!

Lifting

The best method to avoid back pain from lifting is delegation. If this isn't an option for you, try the following:
  • Use back support to lift loads over 15 to 20kg.
  • Bend at the hips and knees with your feet shoulder-width apart.
  • Firmly grip the load and hold it close to your body.
  • Think "grow tall" to tighten your stomach muscles and look upwards to straighten your back.
  • Stand using your strong thigh and buttock muscles to lift.
  • Once upright, turn by using your feet. Avoid twisting your back.

Sitting

Use the "grow tall" principle each 15 to 30 minutes while sitting. A supportive chair or lower back cushion is essential if you must sit. If possible, don't stay seated for too long. Regularly stand up, stretch your back and walk short distances for a variety of posture. After all, we were designed for hunting and foraging - not sit in front of a computer!

Exercise

Fitness has many benefits. Stronger, more flexible muscles and less weight to stress the bones and discs. PhysioWorks specialises in the provision of exercise programs to keep your back flexible, strong and pain-free. Exercise can involve aspects of flexibility, strengthening and postural control. Consider Real-Time Ultrasound Retraining to ensure you are doing it right!

Sleeping

A quality pillow and mattress are necessary for a healthy spine. You do spend somewhere between one-quarter (1/4) and one-third (1/3) of your life sleeping. Do it in comfort!  You'll need to consider a new mattress if you wake up through the night or in the morning with back pain.  Please ask your PhysioWorks therapist for advice at your next visit.

Driving

Use the "grow tall" principle each 15 to 30 minutes while driving. The combination of sitting and bumpy roads is a recipe for back pain. A  lower back cushion is essential if you must drive any distance. If possible, don't stay seated for too long. Regularly break your travels to have a walk and perform simple stretching exercises for a variety of posture and a healthy spine. After all, we were designed for hunting and foraging - not sit in front of a computer!

Article by John Miller

Is an Exercise Ball Good for Lower Back Pain?

Exercise Ball for Lower Back Pain

Back pain is often the result of having weak stabilising muscles supporting your joints. Without strong support, your joints collapse. Your bony skeletons don't stand up by themselves. The bones are held upright by efficient, supportive muscles that work across every joint in your body.

Research has shown us that pain causes these supportive muscles (known as your "stabilisers" or "inner core stability" muscles) to stop working. Research on lower back pain sufferers has found that these muscles stop working every time you experience back pain.

Even worse, in most cases, these muscles don't automatically start working again when your pain goes. They need to be deliberately re-started by your brain.

Your exercise ball is an unstable surface. When you sit or exercise upon one of these balls, your body automatically recruits your natural balance reactions. One of the critical components of your balance reaction system is the activation of your core stabilising muscles. With repeated use over just a few days, your stabilising muscles will usually automatically start working again in most cases.

So, doe the use of an exercise ball help lower back pain? In most cases, YES. But, in some cases, it can aggravate your lower back pain.  Please consult your trusted back pain physiotherapist for an individualised assessment and back care program.

There are several ways to reactivate your core stability muscles. One of the most effective is to use a Physio Exercise Ball. Usually, some simple exercise all exercises can often automatically 'kick start' these stabilising muscles.

Your physiotherapist has special training in the reactivation techniques of these stabilising muscles. For more advice, please get in touch with your physiotherapist.

Smoking Effect on Lower Back Pain

It's more bad news for smokers. A new study strengthens the link between smoking and lower back pain. It also sheds light on the causes of degenerative lumbar spine problems. Numerous researchers have proposed a link between smoking and low back pain, but the exact nature of that link had remained largely untested in long-term studies. The new study on smoking and low back pain, which examined 1,337 doctors, followed some participants for more than 50 years.

Research Findings

Researchers discovered that smoking history, high blood pressure, and heart disease - all of which are risk factors for narrowing the arteries - significantly increased the likelihood of low back pain. These same risk factors and high cholesterol levels were also significantly associated with lumbar spondylosis development (degeneration).

Why?

These findings support the theory that the arteries' narrowing may cause lower back pain and degenerative disorders of the intervertebral discs.  Researchers have suggested that damage to the discs and joints' vascular structures (blood supply) is the injury mechanism in low back pain.

Conclusions from Smoking and Low Back Pain Study

The study concluded that the development of lower back pain was significantly associated with smoking history and high blood pressure. The development of lumbar spondylosis was significantly associated with smoking history, and high blood pressure and cholesterol.

What about Diabetes and Lower Back Pain?

The good news for people with diabetes was that diabetes did not increase the incidence of lower back pain or lumbar spondylosis (degeneration).

Lower Back Pain Research

Lower back pain (LBP) is one of the most common conditions in health care. It is suggested that 80% of the population will suffer low back pain at some point in their lives. Lower back pain costs our country billions of dollars every year through absenteeism and injury rehabilitation. It is critical to all those who suffer from low back pain that a safe and effective treatment protocol can beat lower back pain. Australian physiotherapists lead the world with groundbreaking research to improve the treatment and prevention of low back pain. At PhysioWorks, we are glad to offer both immediate pain-relieving techniques and longer-term preventative programs to stop recurring lower back pain.

How Can PhysioWorks Help Your Lower Back Pain?

Well-designed research and highly skilled clinical practice have physiotherapy evidence as a safe, effective and low-cost management approach for low back pain. PhysioWorks' physiotherapists are highly skilled. They are well respected to assess, diagnose, and successfully treat patients with low back pain from musculoskeletal dysfunction. Our injury management involves not only 'joint manipulation' like some other health practitioners, but also less forceful but equally effective passive examination and treatment techniques, effective therapeutic exercise (strengthening and stretching) and vital advice on posture, lifting and movement pattern abnormalities. In other words, your physiotherapist will fix the immediate problem and then help you to stop it coming back using a multitude of techniques and skill.

Evidence-Based Physiotherapy for Low Back Pain

There has been substantial research undertaken by physiotherapists investigating the techniques used. This research has been conducted according to stringent research guidelines. Unlike some alternative back pain remedies, physiotherapists base their treatment protocols on scientific research evidence. Based on a comprehensive review of the scientific literature the Australian Physiotherapy Association (APA), with assistance from the Musculoskeletal Physiotherapists Association (MPA), has developed a recommendation for the successful treatment of low back pain.

Low Back Pain - Acute (less than 3 months)

There is considerable evidence to support that spinal manipulative therapy (SMT) including passive mobilisation and manipulation, McKenzie therapy and the encouragement of early active movement, rather than bed rest, is effective in the short-term management of low back pain. SMT provides a better short-term improvement in both pain and the return to normal activity levels than the comparison regimens of traction, massage, short-wave diathermy and epidural injections. Compared to placebo or other conservative treatment, a recent meta-analysis reports twelve out of sixteen trials favourable for SMT.

Chronic Low Back Pain - Greater than 3 months

There is strong evidence to support that exercise programs result in a faster return to work rate, reduced absenteeism, and disability than control groups. Your PhysioWorks' physios possess the necessary skills and education to individually assess each low back pain candidate and then appropriately design, prescribe, supervise and progress your successful low back pain exercise program. Currently, physiotherapists are pioneering research investigations into the mechanisms contributing to chronic and recurrent low back pain. The evidence to support their efficacy is continually increasing. The spinal manipulative techniques (SMT) has been strongly shown to be more effective management of chronic low back pain than bed rest, pain killers and massage, with six out of eight trials supporting this evidence. More importantly, the combination of SMT and specific exercises has increasing support in managing low back pain. Your PhysioWorks physio has the necessary skill and knowledge to provide you with optimal low back pain care.

Real-Time Ultrasound-Guided Treatment

The best way to activate the correct core stability muscles is to see them working on an ultrasound scan. Yes, it's just like seeing an unborn baby. We now have this fantastic technology at several of our PhysioWorks clinics.

Electrical Stimulation

There is no harm in applying a home TENS unit to minimise pain while strengthening the muscles supporting your spine.

What are the Symptoms of a Heart Attack?

Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

chest pain

Shortness of breath. May occur with or without chest discomfort.

Chest discomfort. Most heart attacks involve discomfort or heaviness in the chest's centre that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one (commonly left) or both arms, the back, neck, jaw or stomach.

Other signs include breaking out in nausea or vomiting, cold sweat, or dizziness/lightheadedness.

If you think you or someone with you is having a heart attack, Call 000 Immediately!

Don't wait longer than a few minutes (no more than five) before calling for help. Call 000. Get to a hospital urgently.

What are the Symptoms of Chest Pain Originating from Your Spine?

Your spine is a prevalent cause of chest pain. Treating your thoracic spine and rib cage is usually the solution. However, chest pain originating from your spine won't kill you, but a heart attack can!

Spinal Discs can refer to pain through your chest wall like a knitting needle. Coughing or Sneezing hurts.

Thoracic Facet Joints refer to pain around your rib cage. Trunk movements will aggravate or ease your pain.

Rib Joints send pain down and around your rib cage. Pain can increase with coughing, deep breathing and trunk or shoulder movements.

Back Muscles will generally be more painful in sustained postures, e.g. sitting at a computer. These are commonly felt between your shoulder blades and can be relieved by massage.

What to Do Next?

As mentioned earlier, if you suspect a heart attack, Call 000 immediately and get to the hospital straight away. If your symptoms are not heart attack related, consult your physiotherapist to assess your spinal and chest joints and muscles. Most of your muscular or thoracic and rib joint pain will be relieved after your very first consultation.

For more information, please consult your doctor or physiotherapist.

More info:

Thoracic & Chest Pain

What are the Advantages of Good Posture?

good-posture-sitting

Good Posture Benefits:

  • It keeps your bones and joints in the correct alignment.
  • It helps to decrease the abnormal wearing of joint surfaces.
  • It decreases the stress on the ligaments holding the joints of the spine together.
  • It prevents the spine from becoming fixed in abnormal positions.
  • It prevents muscle fatigue.
  • It prevents any backache and muscular pain.
  • It contributes to a competent and confident appearance.

To Achieve Good Posture You Will Require the Following:

  • Good muscle flexibility
  • Normal motion in the joints
  • Strong postural muscles
  • A balance of muscle forces on both sides of the spine
  • Awareness of your posture, plus knowledge of proper postural position, leads to conscious correction.

Practise the correct posture for standing, sitting, and lying down (as described below) to gradually replace your old position.

Article by John Miller

What is Good Posture?

That's why proud and confident people stand tall with excellent posture. It's a habit! Standing with good posture looks and feels fantastic, plus it's very healthy for your joints, muscles, bones, blood circulation and most importantly, your self-esteem.

How you hold your body in space is your posture. Your posture is a direct result of the postural habits that you commonly exhibit. You can choose to hold good posture or poor posture. Gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture.

The good news for you is that you can quite easily change your postural habits and train your body to sit, stand, walk, and even rest in great postures. Good posture also places the least strain upon your supporting muscles and ligaments.

But, no one posture is good to maintain all day. As a human, you were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. This means that your best posture is your next posture!

Benefits of Good Posture

Good posture:

  • Prevents postural muscle fatigue.
  • Correctly aligns your joints and bones while encouraging efficient muscle activity.
  • Help minimalise joint stress.
  • Avoids passive ligament overload.
  • Prevents backache, neckache and muscular pain.
  • It contributes to your enhanced confidence and a good appearance!

Standing comfortably with good posture should feel natural and energy-efficient. Bad postural habits can cause a few muscular aches and pains for a few days during the early transition (posture habit change) phase. You may experience temporary joint or muscle discomfort or fatigue as your joints realign, ligaments stretch, and postural muscles start working. The good news is that your body will quickly adapt and feel more comfortable and strong in your new normal posture if you keep maintaining a good posture.

Plus... the upside is that not only will you be less likely to suffer pain, but you'll also look confident and feel fantastic too!

How to Improve Your Standing Posture:

The number one tip to achieve a great standing posture is to "stand tall"! All the muscles that you need to push you taller are the same ones that improve your posture.

  • Stand tall!
  • Extend your head directly up (think balloon lifting your head with a string in the top of your skull) - but keep your chin tucked in. Avoid tilting your head forward, backward or sideways.
  • Your earlobes will line up with the middle of your shoulders.
  • Keep your shoulders back, your knees straight, and your back straight.
  • Let arms hang naturally down the sides of the body
  • Lightly draw in your core stomach muscles. Avoid tilting your pelvis forward.
  • Avoid locking the knees.
  • Ensure your feet arches are in a neutral (not flat) position.
  • Stand with weight over the centre of your feet.
  • Stand with your feet slightly apart (shoulder-width).
  • When standing for sustained periods, shift your weight from one foot to the other, or stand in a walk stand and rock your weight from your front to back foot.

How to Quickly Check Your Standing Posture

Stand against a wall with shoulders and bottom touching wall. The rear of your head should lightly touch the wall.

How to Correct Your Posture?

If you experience discomfort in the above test and can't easily correct your posture, you may have some joint, ligament or muscular movement restriction. All of these problems can be quickly assessed and quickly improved by your physiotherapist. Please consult them for advice.

Having difficulty maintaining a normal upright posture? You are probably suffering from reduced muscle endurance or strength. But these can both be easily improved with some practice of the right exercises. Your physiotherapist is an expert in prescribing the best postural exercises for you in a stage-appropriate manner to help you improve your posture without causing unnecessary pain or injury.

Your physiotherapist may also advise a posture brace or prescribe some posture taping to quickly assist you in achieving and maintaining a good posture.

Contact your physiotherapist for posture advice specific to you and your needs.

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