Back Pain: Part II (Strengthening Exercises)

Continuing from Back Pain: Part I (Stretching/Mobility Exercises), this article will look at some strengthening exercises for the back. 

Much of the latest research on back pain have focused on the importance of two muscles: transverse abdominus and multifidus, and their roles in back pain. This is because both of these muscles lie deep in the spine, forming the functional core of the body. The multifidus muscle stabilises the joints at each segmental level of the spine. Hence you may have heard physiotherapists emphasising the importance of retraining your 'core' stability. 

Research has shown that in people with back pain, these two muscles are weakened, their recruitment patterns are altered and their ability to stabilise the spine is impaired. If these problems are not addressed, evidence suggests that the chances for recurrence of back pain would be increased. 

Strengthening these deep core muscles and retraining their activation patterns during functional activities are two essential components of all back rehabilitation. 

Back Pain: Part I (Stretching/Mobility Exercises)

Back pain can be a frustrating condition to fight off as it seems to keep coming back without any warning. You may have been careful with posture, didn't do any heavy lifting or strenuous activity, however you wake up with a bit of a niggle that worsens on specific movements or particular activities.

What causes back pain?

There are many causes of back pain. The spine consists of nerves, discs, joints, muscles, tendons and ligaments which can all produce pain. Without going into too much detail on the topic and theories of pain, back pain can be thought to be a result of a chemical or mechanical cause. Chemical pain could be a result of inflammation which irritates nerve endings and causes pain. Mechanical pain could be due to joints that are stiff or hypermobile, muscles that are strained or overactive (spasm), bulging disc with possible nerve impingement (which can also cause radiating pain down extremities), overused tendons/ligaments, etc. 

Latest research findings on the reliability and accuracy of clinical tests to diagnose an ACL tear

Q: With regards to the tests for ACL tear, which is most reliable and/or accurate?

A: The 3 main clinical tests that are usually performed by therapists to diagnose an ACL tear include the Anterior Drawer test, Lachman test and Pivot Shift test. However the reliability and accuracy of these tests have been questioned. Here are the findings from three studies (Ostrowski 2006; Benjaminse et al 2006; Peeler et al 2010) regarding the reliability and accuracy of these tests.

Do musicians have different brains?

Does musical training reorganise the brain? What are the implications? 

An article published in Psychology Today, June 11, 2010

In the last twenty years, brain imaging studies have revealed that musical training has dramatic effects on the brain. Increases in gray matter (size and number of nerve cells) are seen, for example, in the auditory, motor, and visual spatial areas of the cerebral cortex of musicians.

Do you get wrist pain from typing or writing?

Q: "I get pain in my right hand near my wrist after long periods of typing and sometimes the area around my wrist (palm side) gets a bit swollen too.  What can I do to help the problem?"

A: This sounds like a case of "Occupational Overuse Syndrome" (OOS), or more commonly known as "Repetitive Strain Injury" (RSI). There is usually no discrete pathological cause for RSI - it is rather related to the overuse (and/or improper use) of particular areas of the body resulting in pain and/or other symptoms.

Shoulder Complex (Part III) - Anterior/Posterior/Multidirectional Dislocations & Exercise Rehabilitation

Traumatic Anterior Dislocation

Anterior Dislocation

Mechanism:

• Accounts for 75-95% of dislocations
• Forced abduction and external rotation of the shoulder (eg. basketball player attempting to block an overhead pass - watch video here)

Initial Presentation:

• Severe pain
• Lateral outline of shoulder flattened
• Possible bulge under acromion
• Possible nerve +/- vessel injury

Shoulder Complex (Part II) - The Unstable Shoulder

SHOULDER INSTABILITY

Glenohumeral instability is the inability to maintain the humeral head in the glenoid fossa.

Classification Scheme:

1. Degree

2. Frequency

3. Etiology

4. Direction

Introduction to the Shoulder Complex (Part I) - What structures are involved in providing shoulder stability?

Introduction

The shoulder is the most mobile joint in the human body. A normal shoulder precisely constrains the humeral head to the centre of the glenoid cavity throughout most of the arc of movement. 

Anatomy

Glenohumeral joint (GHJ):

• Multiaxial ball and socket synovial joint
• Large ROM (range of motion) up to 180 deg with 3 degrees of freedom (flexion/extension, abduction/adduction, internal rotation/external rotation)
• Glenoid fossa is relatively shallow and provides little bony support for stability of the humeral head (humeral head = 3 x glenoid fossa; at most, only ~25% of humeral head is in contact with glenoid fossa in any given position)

Shoulder Stability

Shoulder stability is the result of a complex interaction between static and dynamic restraints.

• Static stabilisers (capsule, ligaments, labrum) act as concave structures to deepen the glenoid fossa.
• Dynamic stabilisers include rotator cuff and surrounding larger muscles that provide scapular stability (serratus anterior, lat dorsi, rhomboids, trapezius, pectoralis)

Review on LARS - An alternative for ligament reconstruction

I was asked about the efficacy of LARS as an alternative surgical option for ACL reconstruction. 

In recent years, the use of LARS ligaments have been increasing with promising clinical results. In fact, these ligaments have been in clinical use for over 15 years. LARS stands for Ligament Augmentation & Reconstruction System, and these artificial ligaments are intended for the intra or extra-articular reconstruction of ruptured ligaments.

Knee injury: ACL (Part II)

In follow-up to my previous article on "Knee injury: ACL (Part I)", here is the 2nd half of my discussion to provide an overview of ACL surgery and post-op rehabilitation.

Who will benefit from surgery?

• Individuals with active lifestyles
• Individuals involved in high-level sporting activities (eg. soccer, basketball, netball, footy, skiing, etc)
• Those with recurrent knee instability due to ACL deficiency
• Those wishing to protect their knee joint and cartilage from future damage
• Individuals who have attempted and failed conservative management with recurrent knee pain and instability

Knee injury: ACL (Part I)

My sister-in-law recently ruptured her ACL playing touch footy and will be undergoing surgery in a month. Hence it prompted me to write about the ACL - what it is, what happens with an ACL injury, and provide an overview of surgery and rehabilitation from a physiotherapist's perspective.

What is the ACL?

The Anterior Cruciate Ligament (ACL) is one of the four major stabilising ligaments of the knee.

The other three are: Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL).

The term 'cruciate' is used as the ACL crosses the PCL in a crucifix position.

Baby milestones: 7 to 12 months

Understanding the developmental milestones of a baby is a good way for parents to monitor their child's growth. It is of course important to mention that all babies are different and some may achieve certain milestones later than others, and this is nothing to be worried about (unless you notice this delay happening consistently).

Following on from my previous article "Baby milestones: 1 to 6 months", here listed below are the major milestones to look out for in your child between 7 to 12 months.

Baby milestones: 1 to 6 months

Understanding the developmental milestones of a baby is a good way for parents to monitor their child's growth. It is of course important to mention that all babies are different and some may achieve certain milestones later than others, and this is nothing to be worried about (unless you notice this delay happening consistently).

Here listed below are some of the major milestones to look out for in your child.

1 month: 

• Lifts head when lying on tummy
• Responds to sound
• May stare at faces

2 months:

• Starts to vocalise (ooh, aah, coos, gurgles)
• Can start to follow objects
• Plays with hands
• Lifts head at 45-degree angle for short periods

3 months:

• Smiles
• Lifts head > 45 degrees (and shoulders) when lying on tummy (mini-push up)
• Visually tracks objects
• Recognises your voice

 

4 months: 

• Smiles and laughs more frequently
• More vocalising and responds by cooing when you talk to him/her
• Starts to roll over (most commonly from tummy to back)
• Starts to bring hands together and swipe at toys 

 

5 months: 

• Plays with hands and feet
• Grasp toys
• Rolls over in both directions
• Imitates sounds

  

6 months: 

• Sits without support
• Imitates sounds
• Turns to sounds and voices
• Mouths objects
• Start solid foods

Question received re: Exercises suitable for when sick with the cold/flu

QUESTION RECEIVED 31/8/10:

"What kind of stretches/exercise can you do when you are sick with the flu and a lot of your body hurts? How can you get your blood circulating well without exhausting yourself?"

Good on you for thinking about exercising even when you are sick. It is often so hard to motivate yourself to get up off the bed or couch, or sometimes you just physically are not able to stand up long enough before feeling dizzy or weak.

Here below are some gentle exercises that I would recommend for you to do to keep the blood circulating and prevent your body getting stiff (without causing too much exhaustion). Just select a few that you like and try to do them 3 x a day. I have also written down the sets/reps that I would recommend. Of course, the key is not to over-do, so do what your body can handle!

Ankle pumps

In lying (1-2 sets, 10-15 reps):

• Ankle pumps
• Static quads (tightening the thigh muscle with your knee straight)
• Straight leg raises

Squats

In sitting (1-2 sets, 10-15 reps):

• Seated calf raises
• Knee bends/extensions
• Seated leg marches
• Sit-to-stands

In standing (1-2 sets, 10-15 reps):

• Mini squats
• Mini lunges
• Calf raises (with arms down by side first; then progress to holding arms straight out to sides)

Light strenghtening exercises using hand weights (eg. 1-2kg; 1-2 sets, 10-15 reps):

Bicep curls

• Bicep curls 
• Tricep curls (palm facing inwards with arm held back, straightening/bending elbow) 
• Deltoid flies (with elbow straight, elevate your arm out to the side)
• Overhead press (push arm straight up into the air)

Gentle fitness exercise (15-30 mins):

• Walking is important - If possible, try to get some fresh air and go for an easy walk around your area, sticking to the flats rather than doing hills

Gentle stretching exercises (hold each for approx 15secs, repeat 2x):

• Neck: tilting head sideways, rotating both sides, looking up and down
• Shoulders: 
• Pull one arm across the front of your chest and feel the stretch at the back of your shoulders



Posterior Shoulder Stretch

• With hands together, stretch arm upwards and hold above the head

•  Reverse shoulder stretch

 

• Wrap around shoulder stretch

 

• Calf stretch

• Quads stretch

Hope this has been helpful for you. If you have any further questions, please don't hesitate to contact me.