Lumbar Stress Fractures (Cricket Fast Bowlers)
What is Lumbar Stress Fracture?
Cricket fast bowling is a unique asymmetrical action which loads the trunk through rotation, extension and side flexion at the delivery stride. This action repeated time after time can lead to the development of stress fractures in adult and adolescent populations.
Repeated microtrauma to the pars interarticularis is usually to blame for your pain. The pars interarticularis, or ‘pars’ for short, refers to the portion of the bone between the superior and inferior articular facets of your facet joints. The facet joints are synovial joints between each vertebra in your spine. Each spinal vertebra has two facet joints (left and right). When the ‘pars’ sustains a fracture it is termed a spondylolysis.
The terms spondylolysis, lumbar stress fracture, pars fracture and pars defect are often used interchangeably. Spondylolysis is classified as dysplasia (usually congenital), degenerative (age-related), isthmic (sport-related stress fractures) or traumatic. A cricket spondylolysis can be classified as isthmic due to a fast bowler’s repetitive flexion and extension moments shearing the pars. Pars defects most commonly occur at the L5 level with L4 being the next most common (Crewe et al. 2012). Bowling techniques which incorporate large moments of hyperextension and rotation pose the greatest risk.
What Causes Lumbar Stress Fracture?
Athlete age, bowling technique and overall load (i.e. the total number of deliveries bowled) have the largest impact on your likelihood of developing a spondylolysis. One study of 180 patients showed the mean age of pars stress fractures to be 20 years old (Brukner et al. 1996). Your bowling techniques can be classified as front on (left image), side-on (middle image) or mixed (right image) techniques. Studies have shown that if you bowl with a mixed bowling technique you have a greater risk of lower back injury than if you bowl with a side or front on technique.
Back Stress Fracture Symptoms?
Some pars interarticularis fractures are asymptomatic. Symptoms you may complain of include:
- Unilateral lower back pain on the opposite side to bowling hand dominance
- Pain aggravated by lumbar extension
- Improved symptoms with rest
- Excessively arched lower back and tight hamstrings
If your physiotherapist suspects you may have a spondylolysis they will likely refer you for an X-ray or other scan. Consult your physiotherapist if you suspect you may have a lumbar stress fracture and they will guide you as to your best scanning option.
Treatment: How do I get back to bowling?
Treatment for spondylolysis revolves primarily around restricting your pain provoking activity (usually bowling) and preventing the spondylolysis from progressing to a bilateral defect or spondylolisthesis. Spondylolisthesis is where part or all of the vertebrae can slip forward on one another. It is important that you consult your physiotherapist if you are experiencing lower back pain from bowling as a quick and accurate diagnosis is key to best management and spondylolisthesis prevention.
Your physiotherapist should work in close association with the fast bowling coach to determine adequate load and bowling technique correction applies.
PHASE I – Pain Relief & Protection
The first phase of physiotherapy aims to protect your fracture site and provide pain relief. This most commonly means a rest from bowling for 6 weeks. Other aggravating activities including running may be prohibited in this phase. Consult your physiotherapist for guidance as to what exercise you are permitted to perform.
PHASE II – Restoring Normal ROM, Strength and Deep Muscle Control (Hip & Core)
During this phase, you will typically remain restricted from bowling. Your physiotherapist will look at regaining your pain-free range of motion and commence you on PhysioWorks’ Back Stability Program in preparation for return to bowling. Adjacent joints around the stress fracture site will be mobilised and strengthened by your physiotherapist and any pre-existing muscle imbalances will be corrected in this phase. Towards the end of phase II, you may begin other activities including net batting, fielding and short throwing.
PHASE III – Restoring Full Function
Running and technique modified bowling will begin to be introduced once you reach phase III of your rehab. It is at this phase that the underlying technical faults which have placed you in compromising positions need to be addressed. It is now time for you to commence a graded return to running program in preparation for your pending return to bowling.
PHASE IV – Return to Sport
Once cleared safe to do so by your physiotherapist you will recommence bowling. Ask your physiotherapist and coach as to how many overs you will be permitted to bowl on your first game back as your workload is likely to be reduced. It is important to note that exercises and treatment plan adherence remain of vital importance in this stage.
What next? Am I at Risk of a Getting a Stress Fracture Each time I Bowl?
The more you bowl the more you are at risk of developing a stress fracture. The good news is that your physiotherapist is an expert at identifying and reducing your risk factors. One of the most important things to consider is the age of the bowler. PhysioWorks follows and recommends adherence to Cricket Australia’s Bowling Workload Guidelines for playing and training:
Cricket Australia Guidelines
Recently Cricket Australia published a number of guidelines surrounding fast bowling loads for adolescents. These have been designed to minimize the risk of injury.
AGE GROUP SPECIFIC GUIDELINES
|U11||2 over limit each spell & 4 over limit per match|
|U13||4 over limit each spell & 8 over limit per match Target* of 100-120 balls per week|
|U15||4-6 weeks bowling preparation before the season 5 over limit each spell & 12 over limit per match Target 100-120 balls per week|
|U17||6-8 weeks bowling preparation before the season 6 over maximum each spell & 16 over limit per match Target 120-150 balls per week|
|U19||8-10 weeks bowling preparation before the season 7 over limit each spell & 20 over limit per match Target 150-180 balls per week|
*weekly targets are a combination of training and match bowling.
[source: Cricket Australia]
In adult populations, load management remains an integral part of your rehabilitation plan. Your physiotherapist will assist you in ensuring you can minimise your risk of getting a stress fracture because of your bowling.
Common Cricket Injuries
- Back Muscle Pain
- Back Stress Fracture (Fast Bowlers)
- Facet Joint Pain
- Side Strain (Abdominal)
- Shoulder Impingement
- Rotator Cuff Syndrome
- Rotator Cuff Tear
- Bursitis Shoulder
- AC Joint Injury
- Dislocated Shoulder
Cricket Injury Prevention
Stress Fracture Spine FAQs Related Conditions
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Nerve PainNerve pain is pain that is caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the common type of pain that is due to an injury. This is known as nociceptive pain.
What Causes Nerve Pain?Neuropathic pain is caused by a problem with your nerves themselves, which sends pain messages to the brain.
What is Nerve Pain Symptoms?Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.
What Causes Nerve Pain?Various conditions can affect your nerves and cause nerve pain. Common sources of nerve pain include:
- Shingles (post-herpetic neuralgia).
- Trigeminal neuralgia.
- Diabetic neuropathy.
- Phantom limb pain following an amputation.
- Multiple sclerosis.
- HIV infection.
- Other nerve disorders.
Nerve Pain & Nociceptive PainYou can suffer both nerve pain and nociceptive pain simultaneously. Both pain types can be caused by the same condition.
Nerve Pain TreatmentNerve pain is less likely than nociceptive pain to be helped by traditional painkillers such as paracetamol, anti-inflammatories and codeine. However, other types of medicines often work well to ease the pain. Nerve pain is often eased by anti-depressant or anti-epileptic medicines. Please ask your doctor for more advice.
Pain LinksPain & Injury
Tens MachineWhat is a TENS Machine?
Pins and Needles - Paraesthesia
What Causes Pins & Needles?
A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.
Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can be a sign of permanent nerve compression. Please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically.
The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.
Common Causes of Pinched Nerves
The most common forms of nerve compression are in the spinal joints where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.
How Can You Fix "Pins and Needles"?
If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness" or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.
Youth Spinal Pain
Teenager Neck & Back PainTeenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control. The competitive athlete and most individuals who exercise regularly or maintain a level of fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Your physiotherapist can assist the resolution of any deficits in this area. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions. Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist with a particular interest in these type of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
PelvisCommon Youth & Teenager Sports Injuries Common Youth Leg Injuries Common Youth Arm Injuries
Back Muscle StrainsBack muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury. More info: Back Muscle Pain
Ligament SprainsLigaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible. More info: Back Ligament Sprains
Bulging DiscsA bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs. The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs. More info: Bulging Discs
Bone InjuriesYou can also fracture your spine if the force involved is highly traumatic or you have a low bone density (e.g. osteoporosis). More info: Osteoporosis
Poor PosturePoor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure. More info: Poor Posture
What Can Cause Severe Low Back Pain?A sudden injury most often causes acute low back pain. The most common injury sources are the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.
Warning Signs of a More Serious Back Injury?In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
Non-Musculoskeletal Causes of Low Back PainAlthough most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
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%)
Specific Spinal PathologiesSome conditions that cause back pain do require an urgent and specific referral and treatment. These conditions include:
- spinal infections
- cancer (malignancy)
- spinal arthropathies (e.g. rheumatoid arthritis or ankylosing spondylitis)
- cauda equina syndrome
- spinal fractures.
Radicular SyndromesLower 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 are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury, you can modify any spinal nerve function (e.g. femoral nerve). The following back injuries may cause radicular pain:
- Herniated disc (slipped disc)
- Facet joint sprain
- Degenerative disc disease
- Back ligament sprain.
RadiculopathyLumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or eversion muscle weakness that can affect your ability to walk.
Spinal StenosisSpinal 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 CausesThe causes of NSLBP are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries. Most people can relate to traumatic injury 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 more 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 the 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.
What is Back Muscle Pain?Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes. The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle StrainsMuscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems. Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor PosturePoor posture, when sitting, standing and lifting at work, can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, and this puts spinal joint muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligament SprainsLigaments are the durable, fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain. Awkward lifting, sports injuries and motor vehicle accidents are prevalent causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
What are the Symptoms of Back Muscle Pain?Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain. Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasm.
- Protective back stiffness.
- Sudden back pain onset.
How is Back Muscle Pain Diagnosed?Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain". X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain. Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence. Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Strain CausesWe do know that some people are vulnerable to repeated lower back sprains and strains. While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but are right next to the joint to control excessive slides and glides. When they don't work correctly, the joint can slide too far and strain its supporting ligaments. Ouch! That hurts. The good news is poor core stability can be easily corrected to prevent back pain. Please contact your physio for more information or to have your core activation accurately assessed. High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
What is Therapeutic Ultrasound?Therapeutic ultrasound is an electrotherapy modality which has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied. Therapeutic ultrasound may increase:
- healing rates
- tissue heating
- local blood flow
- tissue relaxation
- scar tissue breakdown.
How Could Ultrasound Help?Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.
Specific Ultrasound UsesMastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours. The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies. Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.
What is an Ultrasound Dose?A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all. Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.
How Does an Ultrasound Work?A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.
When Should Ultrasound be Avoided?Contraindications of ultrasound include:
- local malignancy,
- over metal implants,
- local acute infection,
- vascular abnormalities,
- active epiphyseal regions (growth plates) in children,
- over the spinal cord in the area of a laminectomy,
- over the eyes, skull, or testes
- and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
Ultrasound Physiotherapy Could Help You Beat Back PainResearchers have found that ultrasound physiotherapy has a 70% success rate of preventing a return of lower back pain within 12 months. The same study showed that those patients who didn't undergo the ultrasound physiotherapy had only a 16% chance of remaining pain-free. This finding means your chance of avoiding repeat back pain is 4.4 times better with ultrasound physiotherapy! Plus, there's even more good news. Researchers have discovered that 65% of sufferers didn't have another bout of pain within three years after undertaking ultrasound physiotherapy. This low recurrence rate means the ultrasound physiotherapy intervention also endures the test of time.
Brisbane Real-Time Ultrasound Physiotherapy ClinicsAt PhysioWorks, we believe that cutting edge technology and treatment techniques deliver the best results for you. We welcome clients who are currently attending other spinal health practitioners without ultrasound-guided rehabilitation. We are happy to work with you and your spinal health practitioner to solve your back pain as quickly and effectively as possible. PhysioWorks has several real-time ultrasound physiotherapy clinics in Brisbane. The diagnostic ultrasound equipment is expensive, so only a handful of physiotherapy clinics offer this premium service. Allow up to 45-60 minutes for your initial scan, including assessment, corrective exercises and treatment. Please contact one of the following PhysioWorks clinics that provide Real-Time Ultrasound Physiotherapy programs to make your booking.
Book Online 24/7:
Lower Back Pain Treatment Guidelines?While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
PHASE I - Back Pain Relief & ProtectionManaging your back pain is the main reason that you seek treatment for lower back pain. In truth, it was the final symptom that you developed and should be the first symptom to improve. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage. A course of non-steroidal anti-inflammatory drugs such as ibuprofen may also help in this phase.
PHASE II - Restoring Normal ROM and Strength. Early Back Exercises.As your lower back pain and inflammation settles, your lower back pain may feel better. Still, you are more vulnerable to re-injury during this honeymoon period when you don't have pain, but your muscles and ligaments are weak. During this phase, your physiotherapist will turn their attention to restoring your normal lumbar spine motion. Plus they'll assess your muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern). Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best back exercises for your specific needs.
PHASE III - Restoring Full FunctionDepending on your chosen work, sport or activities, your physiotherapist will aim to restore your back's function to allow you to return to your desired activities safely. Everyone has different demands for their lower back that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon or be a fast bowler. Your physiotherapist will tailor your back pain rehabilitation to help you achieve your own functional goals.
PHASE IV - Back Exercises - Preventing a RecurrenceRecurrence of lower back pain can occur. The main reason for a recurrence is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal core muscle exercises. You should continue a version of these back exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best activities for you to continue indefinitely.
Suffering Back Pain. What Should You Do?While lower back pain is commonplace, the diagnosis of the cause of your back pain is specific to you, and therefore, the treatment or investigation pathway varies for each case. A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to you. You should feel confident that your practitioner has screened you particular pathologies that require urgent medical attention. They should assess you for neurological deficits such as:
- loss of bowel or bladder function,
- leg muscle weakness,
- loss of sensation,
- diminished reflexes,
- and, day-to-day function.
What Should You Do When You Suffer Back Pain?
Rest?The latest research recommends that you only spend a day or two resting in bed. More extended periods cause muscle weakness which ultimately makes repeat back pain more likely.
Ice or Heat?We recommend ice treatment for 20 minutes every 2 or 3 hours for the first 48 hours. The ice should help reduce your pain, swelling and back spasms. After a few days, you are safe to use heat packs. We usually recommend avoiding heat (and heat rubs) in the first 48 hours. Heat packs encourage bleeding, which could be detrimental if used too early.
Should You Use a Back Brace?A back brace can help you to get back on your feet or allow you to return to work sooner. We don't encourage long-term use because research has shown that your stomach and back muscles will weaken as you become reliant on the brace.
What Medication Should You Use?Your Doctor or Pharmacist may recommend pain relief in the form of paracetamol or an anti-inflammatory. You are best seeking their advice as certain drugs can interfere with other health conditions.
When Should You Commence Physio?In severe cases, when the slightest movement causes unbelievable pain or spasm, it may be best to wait a day or two to start treatment. This delay will allow the majority of swelling to settle. Slight niggles or "my back feels out" sufferers can usually commence treatment (and maybe fixed) on the day of injury. If you are not sure what to do, please call us for advice. We'll happily guide you in your time of need.
What About Core Stability Training?The current trend in physiotherapy and fitness training is 'core stability training' (back and abdominal muscle control).
What If You Do Nothing?Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome and the quicker you'll get back to living your life. "Back pain is something you could be suffering needlessly".
What Results Should You Expect from Physiotherapy?Not only will your physio diagnose the cause of your pain and give you the "peace of mind" associated, but they'll also help you to:
- Relieve your pain quicker
- Cope better with your pain using proven strategies and tips
- Get you back to work and play quicker through faster healing rates.
- Loosen and strengthen your back with individually prescribed exercises
- Prevent future bouts of back pain via our holistic back pain management approach
Core ExercisesWhile all back exercises that strengthen the muscles that traverse your back are essential, back pain researchers have emphasised retraining your deep core muscles as a priority. "Core Stability" is your body's ability to control and support your spine via specific muscles dynamically. Your spine is an inherently unstable area of your body. Your lower back has five vertebrae that allow twisting, bending and arching with no other bones to assist. They sit on top of a triangular bone called the sacrum, which wedges itself into the pelvis. Unfortunately, without strong support, all of these bones would fall in a heap on the ground. Your deep core muscles are the main structures that support, control and move your lower spine and pelvis. They are also the most energy-efficient and best-positioned muscles to do the job for 24 hours a day. However, when they turn off, your spine is not fully supported by its usual muscular corset. This lack of support makes it quite vulnerable to injury and chronic pain. Research has shown that our back pain causes your "deep core stability" muscles to STOP working in EVERY case. The first time you experience low back pain, your brain automatically inhibits the Transversus Abdominis (TA) muscle's regular activity. This inhibition occurs in 100% of sufferers. Unfortunately, even once the back pain has eased the TA muscle does not automatically switch on again. Inhibition of the TA muscle exposes your spine to further trauma and hence "recurrent back pain". Each incident becomes a little more severe, and consequently, further wasting of the TA occurs. Other causes of muscle inhibition include previous abdominal surgery, pelvic pain and post-pregnancy.
What are the Benefits of Core Stability Training?Researchers have shown that the correct use of your core stability muscles not only prevents pain but also alleviates pain if you're already suffering. Also, your body's strength, power, endurance and performance will improve. You'll be able to run faster, jump higher and even throw further when these muscles work correctly. For more information, please contact your PhysioWorks physiotherapist.
Core Stability MusclesThe deep core stability muscles of the lower spine include:
- Transversus Abdominis (TA)
- Multifidus (MF)
- Pelvic Floor (PF)
Transversus AbdominisThe Transversus Abdominis (TA) is the deepest abdominal muscle. It is the "corset muscle" of the spine and pelvis. In the typical situation, TA contracts in anticipation of body motion to guard the spinal joints, ligaments, discs and nerves.
MultifidusMultifidus (MF) muscles are very short muscles running from the transverse processes (on the sides) of one vertebra up to the spinous process (the middle of the back) of the next vertebra upwards. Their primary function is back stability. They do not produce an extensive range of movement, but work to provide small, "fine-tuning" postural changes, all day long.
Pelvic Floor & DiaphragmThe TA and the MF work in conjunction with your pelvic floor and diaphragm to make a flexible but stable region around your lumbar spine. This ability to stabilise your lumbar spine in its many positions enables you to overcome back problems and reduce your chances of a reoccurrence.
What Are The Ideal Core Exercises?Your deep core stability muscles retraining uses specific low-level activation exercises. While a very skilled physiotherapist who has training in deep core activation can observe and palpate for the correct muscle contraction, the best way is to see them working on a real-time ultrasound scan. Real-Time Ultrasound Physiotherapy guidance allows you to see how your muscles are contracting in real-time. This visual feedback will enable you to correct your specific deep core muscles inside your stomach, lower back, and pelvic floor as you attempt to contract those muscles.
Beware of “Core Stability” Exercises!The fitness industry is full of fitness instructors who profess to know how to activate your core stability muscles. Unfortunately, the wrong core exercises will do you harm. Most progress your core exercises far too quickly and bypass these critical muscles to further strengthen your outer abdominal muscles and leave your deep core muscles weak. Research evidence has found that this renders you vulnerable to lower back pain and injury.
Ultrasound Physiotherapy May Help:
- Lower Back Pain - Transversus Abdominus & Multifidus
- SIJ Pain / Pelvic Instability
- Pregnancy Back Pain
- Hip Pain - Gluteal tendinopathy
- Shoulder Pain - Rotator Cuff
- Knee Pain - VMO activation
- Foot Exercises - Flat Feet
- Core Exercises
- Pelvic Floor
- Dry Needling
Lower Back PainUltrasound retraining of your Core Stability Muscles has fantastic benefits for low back pain sufferers. Researchers have investigated the benefits of ultrasound retraining since the 1990s. They have discovered that your chances of not experiencing another bout of low back pain (LBP) within 12 months are 4.4 times better if you have undertaken an ultrasound-guided exercise program: 70% vs 16%. It's effectiveness also lasts. After three years you still have a 2 in 3 chance of not experiencing LBP if you did the exercises. Hides et al. (2001). More info: Lower Back Pain
SciaticaUltrasound retraining of your Core Stability Muscles has fantastic benefits for sciatica sufferers. Since the vast majority of sciatica is caused by sciatic nerve pinching in the low lumbar spine, a treatment that helps your back will almost always alleviate sciatica. More info: Sciatica
SIJ DysfunctionThe Sacroiliac Joint (SIJ) should be a reasonably stiff or rigid link between the pelvic bones. In some people, due to trauma or just extra mobility, the SIJ has too much-uncontrolled motion. This new motion allows the joint to adopt an unusual position which may result in pain. The transversus abdominis (TA) and oblique abdominals through their attachments to the iliac bones help the pelvis's closure and improve the position, control and stability of the sacroiliac joints. Researchers have discovered that the contraction of the TA muscle significantly stiffens and supports the sacroiliac joint. This improvement is more significant than that caused by an abdominal bracing action using all the lateral abdominal muscles. (Richardson et al. 2002) More info: SIJ Pain
Pelvic Floor RetrainingStrong pelvic floor muscles are essential for men and women. Women have been encouraged to exercise their pelvic floor muscle for decades, but now we understand that it is just as vital for men. Research has found that a durable pelvic floor improves:
- incontinence (urine dribbling)
- post-childbirth (women)
- post-prostatectomy (men)
- erectile dysfunction (Uni of Bristol study, 2004)
- sexual sensations and enjoyment (Impotence Association, UK)
Pelvis InstabilitySome people are born a little more flexible than the rest of us. Usually, these people have poor muscle tone in their deep, stabilising muscles. The transversus abdominis is the most important muscle that holds the two halves of the pelvis together. Core stability retraining will improve your deep core muscle control, which dynamically stabilises your pelvis, SIJ and lumbar spine. More info: Pelvic Instability
Pregnancy or Post-Childbirth Back PainCarrying a child is a physically demanding task. The baby's weight places continual pressure on the pelvic floor muscles and stretches the lower abdominal muscles. The trauma of birth involves further stretching of the pelvic floor muscles and sometimes tearing. Hence, the pelvic floor muscles and the transversus abdominis become weak, stretched and inhibited. Along with this, a hormone called "relaxin" is released through your body during the months before and post-delivery. Relaxin makes the pelvic ligaments soften to enable the pelvis joints to stretch for the delivery. This elasticity means that the transversus muscle has to work even harder to stabilise the pelvis and lumbar spine. The good news is that Ultrasound Retraining is very safe for the unborn child. The ultrasound equipment is the same as that used by your Obstetrician for routine pregnancy scans. Caesarian births have additional complications due to the cutting of muscle layers and in some cases, nerves. We highly recommend US retraining following a Caesarian delivery. More info: Pregnancy Back Pain
Post Abdominal SurgeryAbdominal and pelvic surgery involves cutting through the muscle layers. Along with post-operative pain, the muscle trauma changes the core stability muscles' ability to work efficiently. As with other muscle cuts, your Transversus Abdominis, in particular, needs to be strengthened post-operatively. Otherwise, it will almost certainly remain permanently weak. The lower part of the transversus muscle's muscle fibres is separated (such as in appendix removal or caesarean births). Because of this, you need to retrain the muscle to learn how to use it again correctly.
Pre-Pilates, Yoga, Gym & Exercise ProgramsExercise programs that aim to develop your core strength can often do just the opposite. The most common reason for injury and back pain is the incorrect timing of muscle recruitment. Pilates, Yoga, gym strengthening, and other exercise forms place high demands on your core stability system. Suppose the core muscle recruitment order is abnormal, your chance of injury increases in proportion with the exercise difficulty. Research has identified that the order of core muscle recruitment is the most critical factor in the prevention or resolution of pain. Remember, if you build a skyscraper on a weak foundation, it will eventually topple. The same goes for your core stability muscles. Recruit the deeper muscles before your superficial layers just like adding floors to a sturdy skyscraper and your back will be healthy and pain-free forever. More info: Pilates
"Pot Belly" Syndrome"Pot Belly" - or whatever you wish to call it, is a cosmetic problem related to your lower stomach muscles. Some people have lax lower stomach muscles. No matter how hard you pull in your tummy, the lower part doesn't seem to pull in. Ultrasound retraining is a valid alternative to cosmetic surgery. The problem is that the transversus abdominis muscle has stopped working effectively, and the upper abdominal muscles dominate. Hence as you attempt to pull in your stomach muscles, the upper stomach muscles suck in, but the lower part doesn't. The result is a "Pot Belly"."Pot Belly" is a common problem post-pregnancy. With Ultrasound Retraining, you can learn to draw in your lower tummy muscles and solve your "Pot Belly" forever!
Core Stability vs PilatesThe 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.
Chronic Back PainIf you suffer back pain, you’ll know that it has a nasty habit of returning. Not only is it painful, but it can interfere with your work, sport or just everyday life. Acute back pain usually settles with conventional spinal treatment. However, the recurrence rate is extremely high. In fact, there’s an 84% chance of recurrence within one year! (Hides et al 2001)
Why Do You Keep Getting Back Pain?Researchers discovered that a couple of deep muscles in your abdomen and lower back need to contract to support your spine. When they work correctly, you’re much less likely to suffer back pain. The bad news is that these muscles turn off every time you suffer back pain and don’t automatically turn on again. This leaves your back at risk of injury. However, the good news is these deep muscles in your abdomen and lower back can easily be retrained. The most effective retraining method is via real-time ultrasound. The chance of lower back pain (LBP) recurrence within one year is reduced significantly.
Back & Neck Pain Prevention TipsHere's some beneficial advice to help you prevent back pain and enjoy life to the maximum.
PostureI'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!
LiftingThe 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.
SittingUse 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!
ExerciseFitness 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!
SleepingA 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.
DrivingUse 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!
Smoking Effect on Lower Back PainIt'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 FindingsResearchers 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 StudyThe 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 ResearchLower 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 PainThere 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 monthsThere 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 TreatmentThe 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 StimulationThere is no harm in applying a home TENS unit to minimise pain while strengthening the muscles supporting your spine.
What are the Benefits of Good Posture?
- Keeps your bones and joints in the correct alignment.
- Helps to decrease the abnormal wearing of joint surfaces.
- Decreases the stress on the ligaments holding the joints of the spine together.
- Prevents the spine from becoming fixed in abnormal positions.
- Prevents muscle fatigue.
- Prevents any backache and muscular pain.
- 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 muscles on both sides of the spine
- Awareness of your posture, plus knowledge of proper postural position, which leads to conscious correction.
What is Good Posture?Standing with the good posture looks and feels fantastic, plus it's very healthy for your joints, muscles, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a habit! 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 PostureGood posture:
- Prevents postural muscle fatigue.
- Correctly aligns your joints and bones to encourage efficient muscle activity.
- Helps minimalise joint stress.
- Avoids passive ligament overload.
- Prevents backache, neckache and muscular pain.
- Contributes to your enhanced confidence and a good appearance!
How to Improve Your Standing Posture:The number one tip to achieve a great standing posture is to simply"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 scull) - 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 the centre of your feet.
- Stand with your feet slightly apart (shoulder-width).
- When standing for a sustained periods, shift your weight from one foot to the other, or stand in walk stand and rock your weight from your front to back foot.
How to Quickly Check Your Standing PostureStand 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 you can't easily correct your posture, you may have some restriction of joint, ligament or muscular movement. 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 your improve your posture without causing unnecessary pain or injury. You physiotherapist may also advise a posture brace or prescribe some posture taping to assist you to quickly achieve and maintain a good posture. Contact your physiotherapist for posture advice specific to you and your needs.
What is the Best Standing Posture?Standing with your best posture not only looks and feels fantastic, but it's also very healthy for you. Great posture is the best thing for your muscles, joints, bones, blood circulation and most importantly, your self-esteem. That's why proud and confident people stand tall with excellent posture. It's a successful habit! Good posture also places the least strain upon your supporting muscles and ligaments. How you hold your body in space is your posture. Your everyday posture is a direct result of the everyday postural habits. You can choose to hold good posture or poor posture. The constant compressive weight of gravity is your worst enemy while standing or sitting. You could also refer to this as your spinal posture, back or neck posture. It's actually quite easy to improve your postural habits. But it is a habit and researchers suggest that it takes 10000 attempts to create a habit. That's a good or a bad habit! Why not start the new you with a proud and posture perfect body today?
What is Your Best Posture?Humans were always designed to move and be versatile. You were designed to move from posture to posture to avoid muscle fatigue and abnormal sustained tissue loading. When we were hunters and gatherers it was easy. But, with specialised jobs and postures, we tend to become static for too long these days and that causes postural fatigue, which leads to posture failure. This means that your best posture is your next posture!
Benefits of Good PostureGood posture:
- Prevents postural muscle fatigue.
- Correctly aligns your joints and bones to encourage efficient muscle activity.
- Help minimalise joint stress.
- Avoids passive ligament overload.
- Prevents a backache, neckache and muscular pain.
- Contributes to your enhanced self-esteem!
How to Improve Your Standing Posture:If I had to tell you one "switch" tip, it is simply to "stand tall" whenever you think about it. The muscles that you use to stand taller are exactly the same muscles that improve your posture.
- Stand tall!
- Think tall neck (ballerina or model style)- 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).
- Shift your weight from one foot to the other when standing for a sustained periods. Alternatively, stand in a walk-stand and rock your weight from your front to back foot.
How to Quickly Check Your Standing PostureStand against a wall with shoulders and bottom touching the wall. The back of your head should lightly touch the wall. If you can't do this without pain or strain, you may have some restriction of some spinal joints, ligament or some muscle tightness. All of these problems can be quickly assessed and quickly improved by your physiotherapist with some joint mobilisations, stretches, massage and/or strengthening exercises. Please consult your physiotherapist for specific advice regarding your posture.
Posture Fatigue?Having difficulty maintaining your normal upright posture? You are probably suffering from reduced muscle endurance or strength. Postural muscle fatigue can be improved quite easily with repetitive contraction and periodic posture breaks. This will help to strengthen and improve your postural muscle endurance. Your physiotherapist is a professional in prescribing the best postural exercises for you in a stage-appropriate manner. They may consider temporarily prescribing you with a posture brace or prescribe some posture taping to assist you to transition, achieve and maintain the best posture for you.
What is the Best Way to Sleep?
Your Best Sleeping Position?
Everybody has their favourite sleeping position. However, some are better for you than others. Try to sleep in a posture that helps you maintain the curve in your lower back. We recommend lying on your back with a pillow under your knees (if more comfortable) or on your side with your knees slightly bent.
It is preferable to not sleep on your side with your knees drawn up to your chest (the foetal position). However, having said that some back conditions will find this preferable. You should seek the advice of your physiotherapist if you are in doubt.
If you are suffering back pain, you could try lying over a lumbar roll or peanut cushion at night to make you more comfortable. A rolled sheet or towel tied around your waist may also be helpful. You may wish to avoid sleeping on your stomach, especially on a saggy mattress. This sag can cause back strain and can be uncomfortable for your neck.
What is Your Best Mattress?
Select a firm mattress or an ensemble that does not sag. If necessary, place a board under your bed's mattress. You can also set the mattress on the floor temporarily if needed. If you've always slept on a soft surface, it may be initially painful to change to a harder surface. Try to do what's most comfortable for you.
How to Rise from Bed
When standing up from the lying position, turn on your side, draw up both knees and swing your legs over the side of the bed. Sit up by pushing yourself up with your hands. Bend forward at your waist with your core muscles activated.
What is Your Best Pillow?
The human neck curves slightly forward (to sustain the weight of the head when upright), and it is crucial to maintain this curve when in a resting position. If the height of the pillow is too high or low when sleeping, your neck is bent abnormally out of alignment, causing muscle and joint strain. You can even wake with headaches.
Poor pillow support can also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep.
The best lying or sleeping position may vary, depending on your symptoms. No matter what posture you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.
To give your body the proper rest it needs, and to ensure the health of your spine, physiotherapists recommend only two sleeping positions: Side sleeping and supine sleeping.
Sleeping on your side, with the spine straight. Sleeping on your back, maintaining the primary curvature of the cervical spine. Both of these positions prevent poor alignment of the neck and upper back. Proper alignment can help to reduce the number of neck aches, backaches, pinched nerves, shoulder and arm referred pain, insomnia, and mental fatigue from a lack of effective sleep.
Common Sources of Spinal Pain & Injury
- Neck Pain - Cervical Spine
- Upper Back Pain - Thoracic Spine
- Lower Back Pain - Lumbar Spine
- Sacroiliac Pain - SIJ
- Scheuermann’s Disease
- Spinal Stenosis
- Rib Stress Fracture