The world’s leading experts have compiled their top list of common misbeliefs and addressed them with some real world facts….
We can all take something from these…the over arching theme is that back pain is normal, it will get better and in general movement is good for us – its what we are designed to do!!
Back pain can be disabling, frustrating, stressful and impacts many aspects of people’s lives. Unfortunately almost 80% of us will experience back pain at some stage or another and it is the leading cause of disability worldwide. This can be driven by unhelpful beliefs in modern society that further compound the effects of this condition and impact recovery on individuals.
To combat this, some of the world’s leading practitioners (O’Sullivan et al 2019) have compiled some of the most common beliefs and responded with 10 facts about back pain. The more health professionals such as ourselves can incorporate these facts when treating our patients and clients the more we can gradually start to change people’s attitudes and improve outcomes.
We can all take something from these 10 facts – the over arching theme is that back pain is normal, it will get better and in general movement is good for us – its what we are designed to do!!
If you are experiencing back pain and would like to have a chat about these facts and how we can help, don’t hesitate to get in touch: email@example.com 01276 916 346
O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611
Physica Health are delighted to announce a new initiative for this marathon training season. If a patient sees us as part of their preparation to run a marathon for charity we will to donate 10% of their total spend with us to their chosen organisation *.
We know first hand the work and training that goes into training for a marathon and understand there will be aches and pains along the way. Many runners need a little help from time to time… whether that be some physio, massage, advice or pilates and strengthening for running, we at Physica Health aim to be your one stop shop to help to get you to that marathon finish line.
Our experience in pro sport is second to none, helping us to advise you on your running preparation, planning and strength regime. Our Physio and director Vanesha has gone on the same journey by training for and completing her first London Marathon also. We feel this combination of expertise and experience together with an open door and availability to call in and chat about your preparation, excitement and any worries make us a great partner to have on your side for the journey.
If you need to spend money on physio or training to help you get through your journey then why not make sure some of it goes to your chosen charity.
Here is an overview of what we offer:
Physiotherapy – sporting and non sporting injuries
Pilates – We offer classes including Pilates for Runners. We also offer 1-1 sessions for Matwork and Reformer Pilates.
Rehabilitation – We have extensive experience of rehab in pro sport as well as rehab studio with equipment on site.
Women’s Health – Therapeutic treatment of all disorders affecting the pelvis and pelvic floor, including pregnancy related problems.
Occupational Health – We can work with companies to provide wellness workshops as well as pilates and flexibility classes.
Athletic Screening – We use our pro-sport experience to screen for flexibility and strength imbalances that can be targeted to reduce injury risk.
Performance – Our strength and conditioning experience means we can put bespoke programmes together to assist with running performance and injury reduction.
We pride ourselves in offering:
A local ‘go to’ service that can offer treatment and advice with the same community feel as your running club or friends.
Quick service: we can usually get your clients seen within 48 hours.
We are covered by all major health insurers (*5% donated to your charity if using these)
Should you require any more info don’t hesitate to give us a call on 01276 916 346 or email us at firstname.lastname@example.org
How to get the best out of your foam roller this marathon training season….
With the marathon season drawing ever closer, high volumes of training will be starting to lead to better times and improved performance. However, with this increased training load comes a build‐up of stress on the body, muscles and joints.
Very simply put, physios and soft tissue therapists use their hands to apply mechanical forces to the muscle tissues. The aim of this is to promote tissue health, improve flexibility, clear waste products, and breakdown and improve the alignment of scar tissue. This mechanical force can also be used to ease tight nodules in the muscles known as ‘trigger points’ or ‘knots’ that can often be a source of local or referred pain in the musculoskeletal system.
While many people may have the resources to get this treatment done by a professional, the rest of us weekend warriors do have another effective option at our disposal…… ‘Self Myofascial Release’ better known as, ‘Foam Rolling’.
Foam rolling has quickly become a staple in training programs worldwide, from elite sports teams who use it as part of their warm‐up before training sessions, to individuals who just want to use it to improve flexibility or relieve pain from high volumes of training or being desk bound at work. Unfortunately there is still a dearth of research in existence to back up its effects but its wide use in professional sport is testament to the benefits it can have in a real clinical setting.
What should I use?
Rollers of various densities and diameters are available today. Beginners will generally need to start with the softer, larger diameter foam roller as this will be more tolerable at first. Having used this for a while and as your tissue quality improves; denser, firmer options will be needed to continue to be as effective. These can be hollow rollers such as The Grid TM (below) with a tough plastic tubing covered by a softer foam. As some of these options can be expensive, the DIY crowd can make their own by getting some PVC piping from their local hardware store and wrapping it in a Pilates style matt!!
One final option for targeting very specific areas such as the underside of the foot or the glute is a tennis ball. When this becomes easy then it can be progressed to using a cricket ball as it is denser and will increase the force applied to the tissue.
How long do I spend rolling?
There is no hard and fast rule for this as it largely depends on the quality of your muscle tissue to begin with. If you are just starting out there is every chance that your tissue quality will be poor or so you will need to do it more, but as this improves and you become more familiar with the techniques and targeting problem areas, the amount of time you’ll have to spend on the roller will decrease. A general guide would be to spend one or two minutes on a given area such as one calf muscle for example and just increase that if some areas are particularly tight (go easy at first as this may cause some muscle soreness initially if too much pressure is applied). Obviously the key is to spend most time on the tightest tissues.
It is worth noting that as this is a method of making the muscle tissue more supple and less dense, this is a fantastic time to get some stretching in directly after rolling to optimise tissue length and flexibility. Spending 30 seconds on each stretch will give the best chance of increasing muscle length.
So how do I target specific muscle groups?
Targeting specific areas is all about positioning and using your own body weight to create the force needed to press on certain ‘trigger points’ and to roll out adhesions and tight areas effectively. In order to expose certain knots as in the glutes for example, putting the muscle on gentle stretch will greatly improve your ability to locate and treat problem areas.
When rolling one area such as the IT band for example, you may feel some referral in other areas such as down the outside of your leg. This is normal and just means that you are rolling on an ‘active’ trigger point. If the sensation is too unpleasant, just ease off on the pressure.
Glutes and piriformis
Sit on the roller and go into a stretch position for the glute. For the right side, put your right foot up on your left knee, using your right hand to support your weight behind. Let your weight onto the roller as you roll back and forth tilting your pelvis and finding different tight areas.
Lie with the side of your thigh resting on the foam roller with the roller perpendicular to your body. Use your hands and the non‐involved leg to support you, and adjust the amount of body weight that you can comfortably tolerate. Then roll your leg up and down the roller focusing on the upper third of the ITB, then the middle third and so on, all the while locating and targeting knots.
Perhaps one of the most simple to areas to target, simply lie on your front with your quads on the roller. Again your body weight will immediately flag up tight areas of the quad that you may not have known about before. Similar to the IT band focus on the area 1 third at a time and rotate slightly every now and then to expose the sides of the muscle also.
The hamstrings tend to be a deeper group of muscles so you may have to apply more weight to target areas of this. Lie with your hamstrings on the roller, support yourself with your hands and roll and rotate on small areas at a time to effectively improve tissue density. Just cross a leg to increase the pressure.
Groin (adductors muscles)
This is the trickiest area to treat as it is difficult to apply enough pressure. As shown, try to have the roller perpendicular to the thigh, and shift your weight onto the roller.
While this can be a sensitive area at first, it can improve well with enough attention. Both calves can rest on the roller at first. When more pressure is needed, simply rest one leg on the other to increase the weight going through the target area. For more specific points a tennis ball or lacross ball can also be used.
Peroneals and Tibialis Anterior (shin muscles) Identical to rolling the IT band but just lower down. Alternatively you can also roll on a tennis/cricket ball to target more specific areas.
Plantarfascia (sole of foot)
This is where the tennis ball or golf ball comes into its own. Simply apply pressure through the underside of the foot onto the ball and roll around to expose tight areas. Again take it one bit at a time and apply as much pressure for a strong but comfortable treatment sensation. The effects of a minute or two of treatment can be felt immediately when taking a few steps with bare feet as the foot will be left feeling much looser and supple. If you think you are suffering from plantar fascitis then rolling your foot on a frozen bottle of water can provide some soothing pain relief but again only apply as much pressure as is comfortable.
So that ends this particular blog on rolling. At the end of the day, while no roller can out do the hands of a physio or other hands-on therapist, a good rolling and stretching regime can be of enormous benefit to your training overall while decreasing your chances of injury further down the line. It may not be the most comfortable at first, but it will have you feeling and moving better within weeks.
For any further info or advice don’t hesitate to give us a call or pop in for a chat.
It’s been long anticipated so we are delighted to inform you that we will be reopening some of our in-clinic services on Monday8th June. Initially we will be able to offer Physiotherapy and Women’s Health appointments in line with both government policy as well as our governing body’s (Chartered Society of Physiotherapists) advice as set out below. Our face to face Pilates classes and rehab based client sessions will continue online until we receive further government guidance as to when we can restart these in clinic. If you would like to arrange an appointment then please let us know by giving us a call on 01276 916 346 or email us on email@example.com. We can then discuss whether virtual or face to face is most appropriate for your issue. We would like to reassure you that we are putting significant measures in place to help protect you and our team, and would really value your support with making some adjustments when you next visit the clinic. There are several things that we are putting in place for your protection and to prevent the risk of infection.
What will the changes look like?
The guidelines for treatment have eased but not entirely, therefore in line with our profession we will operate a ‘virtual first approach‘. However where this is not possible or where a person is deemed suitable following an initial triage phone call, there is scope to progress to face to face appointments with best practice policies in place.
We are obliged to run through the associated risks of COVID and get your consent for treatment before you come in. Our team will discuss this with you prior to booking you in for a face to face appointment.
All patient appointments will be staggered to minimise crossover with other patients. This is to ensure our team can adhere to the strict hygiene processes we have in place. These include cleaning down the treatment rooms and door handles/hard surfaces between each and every patient.
There will be no use of the waiting area in reception. We would ask that you wait in your car and we will come and get you once we have the surfaces (and our hands) sanitised.
Your clinician will open the clinic doors for you so that you can avoid touching any handles wherever possible. No need to press the buzzer or open the door – we will come and get you at the time of your appointment.
We will position the chair in the treatment room in line with social distancing measures to minimise contact time where possible.
Your clinician will wear an apron and face mask throughout the session and when doing ‘hands-on treatment’ will wear disposable gloves.
We will require our patients to also wear masks for their own protection and ours. Patients can bring their own or can purchase single use masks on arrival for cost price (£1)
We will use contactless means of payment – such as BACS transfer or payment link sent to your phone.
What do we need you to do?
On booking your first session we would ask you to complete a short covid-19 screening questionnaire and consent form before your appointment.
Please arrive as close to your appointment time as possible.
If possible please avoid using the toilets at the clinic. If you do, please wash your hands before and after.
Your clinician will ask you to use our hand sanitiser thoroughly when entering and leaving the clinic.
Please come alone unless it is essential for you to be chaperoned in which case this can be discussed with us ahead of the appointment.
We won’t give you an appointment card – we will utilise our computer based appointment system to email you with details.
All of these measures will be integral to looking after your safety and our team’s safety.
We hope you are as excited as we are to be reopening the clinic and we very much look forward to welcoming you soon. If you have any questions in the meantime, please don’t hesitate to get in touch.
This article was featured on HADO’s website when the consulted with Damien on advice for low back pain.
To get some expert advice into the subject, we questioned Damien Kelly, Director and Physiotherapist at Physica Health about how 10 different everyday tasks can exasperate existing back pain, giving tips for those suffering about how they might be able to minimise their discomfort during these activities.
Sleeping in an awkward position can result in a restless, and sometimes painful, night’s sleep. Depending on a person’s type and location of low back pain, the optimal sleeping positions can vary, however there a couple of good rules to follow…
Generally, if a person sleeps best on their back, then using a pillow or 2 underneath their knees can help them maintain their natural curve of their lower back and reduce pain and discomfort.
The same can be said for side sleepers – however this time it would be advisable to pop 2 pillows underneath their top knee or else sleep with both knees bent and have a pillow in between them. This reduces rotation in their lower back while sleeping and offloads the lower spine and surrounding muscles.
There are no absolute “no-no’s” for sleeping positions – just listen to your body – if a position is uncomfortable or you find yourself sore waking up the next day then that position may not be for you.
2. Going to the toilet
Going to the toilet can exacerbate back pain. Sometimes bowel movements can be uncomfortable due to the position you have to hold for good defecation. The perfect position to open your bowels is sitting with your feet on a stool and leaning forward onto your knees with your elbows.
As you can imagine, it can be very difficult to comfortably hold this position if you are experiencing back pain. Some may experience difficulty in opening their bowels due to an increase in analgesia, if this is the case it is important to increase the amount of fibre and water in your diet or ask a pharmacist for a suitable laxative.
Another reason it may be difficult to open your bowels is that when we have back pain some of the aligned muscles can become quite tight, making it very difficult to relax our pelvic floor and bottom muscles in order to easily pass a stool. In extreme cases, some people experience a loss of bowel and bladder control along with their back pain. In these instances, it is very important to seek medical help quickly.
3. Bathing and showering
Hot water in general can have a soothing and relaxing effect on any muscles that are in spasm. However, it may be worth waiting until 24-48 hours after the onset of back pain as heat may exacerbate the inflammatory response if used too early after injury. After this time frame, both showers and baths can be useful.
The best advice would be to say if a sitting position in a bath is comfortable then this will be most beneficial for local muscle spasm and pain as you are immersed in the warm water allowing your muscles time to warm up and relax.
However, many low back pain sufferers particularly those with disc-related issues find these sitting or flexed positions painful. In this case showering is best, and the flow of water can be directed over the painful area.
4. Getting dressed
The most common feedback from patients in relation to getting dressed is that activities where they need to bend forward (creating flexion in their lower spine) tend to aggravate their back pain. This tends to be activities such as putting on socks and shoes, or the movement or straightening up again after these activities.
If this is the case, the main advice would be to take your time and select items of footwear and clothing that are very comfortable and easy to put on.
Some find driving very painful due to the position you have to remain in for a prolonged amount of time. We would recommend on long journeys to take regular breaks to ensure that you can get out of the car and move around.
Cars with bucket seats can be worse for back pain sufferers so trying to raise your chair out of a bucket position can be helpful – for example, using a seat pad. A lot of cars these days have a built-in lumbar support so ensure you use this feature to support the lower back, which in turn will help you position yourself in a good position. Try and have hips at 90 degrees to the back and not less, with the back support upright into a supported sitting position.
6. Sitting at a desk
The best advice for sitting at a desk is to get up and move as often as possible! If you need to keep working then try and find a way to alternate between standing and sitting while continuing to work – this can be done by utilising a standing or height adjustable desk, or by moving to a countertop every now and then.
If you do have to sit down for an extended time then try to ensure you have a good chair, with adequate lumbar support that keeps you relatively upright and close to your desk.
Make sure your screen monitor is high enough that you can look straight ahead and that your keyboard and mouse are close to your body so you don’t have to reach forward to access them for long periods of time.
If you want to find a more “active way of sitting” then some people find sitting on a Swiss ball for short periods quite useful – this allows some movement while sitting but also encourages activation of the local spinal stabilisers of the back.
Light Housework – Cooking and very light housework should be manageable with low level back pain.
The priority is to avoid sustained flexion (bending forward) for long periods of this is a movement that aggravates your symptoms. Try to keep moving around and avoid being in any position for too long. If your symptoms are aggravated by standing for long periods which can be more associated with lumbar facet type back pain, then it may be more comfortable to do some of your chopping and food preparation in a seated position.
Heavy Housework – Heavy housework can be problematic for those suffering with back pain.
Depending on the source of the back pain repeated bending and heavy lifting can increase your symptoms. Our recommendation would be to try and minimise heavier tasks and chores as best as possible for the short term.
If this isn’t an option then to try and break down tasks to reduce the load – for example, instead of carrying the whole load of wet washing out to dry, break this down into stages. First of all, remove the washing by placing a chair at the washing machine and placing individually into a basket on the work surface above. From there then carry 2-3 pieces of clothing out to the washing line. This is a good example of reducing your bending and lifting.
Heavy vacuums can be very problematic so if your back pain is chronic it may be worth investing in a lighter hand-held vacuum to make the task easier.
8. Lounging on the sofa
Sitting or maintaining any one position for long periods can have you feeling stiff and sore – even lounging on the sofa.
The best advice for anyone sitting on a sofa or at a desk for any long period of time is to get up and move at regular intervals. Whether this be to do a gentle mobility exercise for your back or just get up and walk around, your back will thank you for it!
When you are sitting, it can be helpful to avoid being too slouched, sit relatively upright (but not too rigid) and support your back’s natural curve with a cushion or pillow. It can also be helpful to support your feet with a futon or similar if you have access to one. As with all advice about low back pain- see what set up works best for you but above all, get up and move a little and often.
Typically, the most common aggravators of back pain within exercise tend to be those involving loaded flexion.
These include weightlifting exercises, such as the squat and deadlift. While both are fantastic exercises for building strength in the general population, they would not be recommended for those experiencing back pain due to the loads placed on the lower vertebrae.
Over time, it is possible to return to some variations of this under guidance from a qualified health professional, but a good option is to select other effective leg exercises, such as the leg press or seated variations, where strength can be gained without placing too much load on the lower back.
General cardiovascular exercise can also be beneficial, but the type of exercise selected will depend on whether your back pain tends to occur more in a flexed position (often disc-related) or extended position (often facet-related).
For those who are comfortable to flex, then cycling and static bike can be good options, while walking, jogging and cross trainer machines can be useful for those comfortable into extension. Both groups can often find that getting into the water or swimming pool can provide some relief.
Try to include some gentle low back mobility exercises before and after exercise and most of all listen to your body during and after exercise. Did you feel comfortable during and after? Or did you wake up the next day with increased pain and stiffness. This will tell you if your back is happy to continue doing this type of exercise or if you need to back off or consider something else.
Studies have shown people with back pain have significantly less sex than those without. This is attributed to a number of reasons, such as loss of interest in sex, fear avoidance, low self-esteem, and pain. Sex positions can be adapted to be able to facilitate a better experience together. Depending on the type of back pain you are experiencing, you will want to adapt your sexual positions accordingly.
If your back pain is disc-related (or increases with bending) then positions that require you hold forward leaning postures may not be the best for you. If that is you then your back will feel best in a supported position, such as missionary. For further support it may be beneficial to put a pillow under your hips and under the knees will make you feel much more supported.
If your back pain is worse when arching backwards (or those with facet joint problems, arthritis, or stenosis of the spine), you may find it more beneficial to try the side-by-side spooning position.
If you experience any additional pain during intercourse then it is perhaps better to stop, try a different position, or try again at a later date. Pillows can help to adapt positions to make them more comfortable. Move with your hips and knees as opposed to overusing your back. Take pain relief where needed, seeking guidance from a health care professional. Most importantly communicate with your partner regarding any concerns or worries