Posts Tagged back pain

Physiotherapy For Low Back Pain Part 2: Treatment For Back Pain

In Part 1 of this blog series on back pain we reviewed the three types of low back pain, plus busted some myths about scans and radiology findings. In this post we will review the way physiotherapists can treat back pain, plus the lay out the best advice on what you should do at home or work to make your recovery as quick as possible. In Part 3 of this series we’ll review things that you can do to reduce your risk of future pain episodes.

As we have discussed in Part 1 there are three main types of back pain. Getting a correct diagnosis for your back pain is an important because it guides your initial treatment.

Physio for Non-Specific Low Back Pain

Physiotherapy treatment for this type of back pain focuses initially on relieving your pain and restoring your range of motion. We need to get you back to doing your normal daily activities as fast as possible, allow you to sleep normally, and be able to do your usual work duties. We use a combination of hands-on (manual) treatment together with structured exercise to increase your joint mobility, plus release muscles that are tight or in spasm.

As well as prescribing the right exercises for you, your physio will also clearly explain do’s and don’ts for you at home and work so that you help your back pain to settle as fast as possible. It has been extensively proven through research that staying active within your comfort levels, avoiding bedrest, and returning to your normal work and daily activities as quickly as possible is by far the best way for you to help your back pain resolve. Using basic medications like Panadol, Neurofen or Voltaren can also be very helpful at this stage.

Once your pain is resolving well your physiotherapist can guide you through a progressive exercise program to fully restore your strength, ensure you are moving correctly, and get you confident in returning to the gym or your usual sporting activities. Completing a supervised strength program with an accredited exercise physiologist is the gold-standard later-stage management program for low back pain, especially if you have already had several episodes of pain or are lacking confidence in returning to your full normal gym or exercise activities. If you prefer, Pilates is also an excellent way to exercise following low back pain.

Physio for Radicular Pain – Commonly Called Sciatica, Nerve Root Pain or a Pinched Nerve

The initial focus for physiotherapy treatment for back pain where a nerve is compressed (or pinched) is to relieve the pressure on the nerve. The degree to which the nerve is pinched or irritated can be gauged by the amount of referred pain that travels down your leg, plus the presence of other neurological symptoms including numbness, pains-and-needles or weakness. Hands-on treatment plus specific exercises are used to relieve these neurological symptoms as quickly as possible, plus medication such as Voltaren can be helpful. You will also be given exercises to do at home by your physio to help you relieve your pain and get moving again.

Once the pressure on your nerve is relieved, the physiotherapy management for radicular or nerve-related low back pain is largely the same as for non-specific low back pain. A combination of hands-on therapy plus structured exercise progression will relieve any remaining pain, restore your movement, and then reactivate your muscles. Staying active within your comfort, returning to work and daily activities as soon as you are able, and avoiding bedrest is strongly shown to be beneficial for this type of back pain.

Once your pain has settled then completing a supervised strength program with one of our physio’s or accredited exercise physiologists will get you fully back to your normal sport, exercise, work and daily activities. Pilates can also be very helpful, if you prefer this style of exercise. Any contributing movement problems that may have contributed to your pain can also be corrected to reduce your chance of future problems.

Physio for Possible Serious Pathology

Serious lumbar (low back) pathology is very rare – present in less than 1% of back pain cases. It includes things like spinal fractures (broken bones), tumors, and some types of infections and inflammatory conditions. During your initial assessment your physio uses specific and effective tools to screen for serious pathology, and they are concerned they will explain their concerns to you and provide you with a referral back to your GP for further investigation.

If You Have Back Pain: See A Physio And Stay Active!

So, now you know the guidelines for how physiotherapists treat the different types of low back pain. A key take-home message for you is that staying active within comfort, avoiding bedrest, and returning to your normal activity as soon as you are able has clearly been shown to be the best way for you to help yourself recover from back pain. Your physio will give you more guidance on this, plus use hands-on techniques and prescribe the most effective exercises for your specific situation to help you recover as fast as possible.

In the next post in this series on how physiotherapists treat low back pain we’ll review things you can do to reduce your risk of future pain episodes. As always, if you have any questions in the mean time please feel free to contact one of our friendly physio’s to see how they can help!

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Physiotherapy For Low Back Pain Part 1: The Three Types Of Back Pain

Low back pain is a very common problem that our physiotherapists treat every day here at Central Performance. There are lots of myths and conflicting advice out there, and this is very confusing and overwhelming for someone looking for treatment during a back pain episode. Although everyone’s presentation is unique and an individual assessment is the foundation of gold-standard treatment, there are some solid research-based guidelines that can really help you understand the process.

In this post we summarise some of the main things you need to know about the 3 different types of low back pain. The next post talks more about how physio’s can treat the pain, and the final one is about reducing the risk of having more problems in the future.

Low Back Pain Is Very Common

The first thing to know is that low back pain is REALLY common, with approximately 80% of Australians experiencing at least one episode of back pain in their lives. Whilst back pain can be very severe and debilitating, the good news is that the majority of cases of back pain DO NOT involve serious damage and will improve within 6-8 weeks.

Unfortunately there is a very high recurrence rate for back pain, meaning that if you have one episode you are very likely to have another one. Reducing this risk of future pain episodes is one of the major goals of physiotherapy treatment for low back pain. As well as physio you will often get great benefits from seeing an exercise physiologist who can prescribe an effective exercise program for you to reduce your risk of future problems.

Why Should I See A Physio For My Low Back Pain?

Even though most cases of back pain improve within 6-8 weeks, seeing a physiotherapist early can help you in three major ways;

1. An early diagnosis can rule out any serious pathology or the need for investigations like x-rays or an MRI (see below!)
2. Getting the right treatment and advice early can speed up your recovery, get rid of your pain faster and get you moving again
3. The right treatment and advice can help you minimise your risk of future pain episode

Two Important Facts About Low Back Pain And Imaging (X-ray, MRI and CT)

There are two very important findings to keep in mind from extensive back pain research looking at the use of radiology investigations like x-rays, MRI’s and CT’s;

1. The vast majority of back pains DO NOT need radiology investigations. Except in specific circumstances (see below), early imaging is not needed from a diagnostic or treatment planning point of view, and therefore it is generally unhelpful. Importantly, there is a solid body of evidence to show that merely having the scan in the first place can make your pain worse or persist for longer! This is because unrelated findings that often show up on scans can make people worry more about their pain (see the next point).

2. When people have scans for low back pain the report will almost always show “stuff”. A bit of degeneration here, some wear and tear there, a loss of disc height at this level or a bit of a bulge in a disc or two. But research clearly shows that most of this “stuff” is not actually really related to pain! Extensive research repeatedly shows that people who don’t have low back pain also often have disc bulges, disc degeneration, loss of disc height, facet joint degeneration etc… As a clinician I regularly see situations where a client is being treated for one-sided low back pain yet they bring in scans that they have already had done that show more degenerative findings on the other side. These things are usually just normal parts of the aging process, like getting grey hairs or wrinkles!

So, whilst there ARE times when imaging is indicated and the results ARE helpful when taken in the bigger clinical picture, it is important to remember that most back pains DON’T need imaging. Also,  if you do have a scan then get your physio or doctor to thoroughly explain the results to you because many of the scary-sounding words are actually not relevant.

What Are The Three Types Of Low Back Pain?

Whilst there are several systems around to classify low back pain, the most useful to the general population uses three categories.

1.Non-Specific Low Back Pain: this is by far the most common type of back pain, accounting for approximately 90% of cases. It describes pain that is felt in and around the low back area, and can sometimes extend down in to the legs. The pain can be anything from mild to severe, however there is no numbness, pins-and-needles or muscle weakness. It can be due to structures including joints, discs, muscles and ligaments. There may have been a specific incident to start the pain, eg a heavy lift, or it may just come on for no identifiable reason.

2. Radicular Pain – Commonly Called Sciatica, Nerve Root Pain or a Pinched Nerve: this type accounts for 5-10% of low back pain cases. It occurs when a nerve is compressed as it exits the spine, causing pain running from the back down into the leg. The pain may also be associated with neurological symptoms including numbness, tingling/pins-&-needles, or weakness. Clinical testing of nerve function may show reduced reflexes, power or sensation, and also positive neural tension tests including the straight leg raise (SLR), prone knee bend (PKB) or slump tests. If this nerve compression is present then it is important to begin treatment to relieve the pressure from the nerve as fast as possible. As with non-specific low back pain, radicular back pain can also be either from a specific incident or for no memorable cause.

3. Serious Pathology: this is very rare – less than 1% of low back pain cases are due to serious pathology. It includes things like spinal fractures (broken bones), tumors, and some types of infections and inflammatory conditions. There are specific and effective screening questions and tests that physiotherapists use to identify possible serious pathology and if they are concerned your physio will refer you for further investigation.

Well, that wraps up part one of our series on physiotherapy treatment for low back pain. Next time we look at how physiotherapists treat back pain, and then finally how to reduce your risk of future pain episodes. As always, if you’d like any further information please feel free to contact one of our friendly physio’s at Central Performance!

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How does Pilates help with my low back pain?

Low back pain is one of the world’s most common conditions and is a leading causes of disability and work absence worldwide. It affects over 80% of the world population and can result in a significant personal, social and financial burden.1 Low back pain usually settles down within 4-6 weeks but has an 80% chance of reoccurring within 12 months of the initial injury. Exercise therapy is the most common form of treatment for low back pain. It is low cost, easy to access, has a positive biological affect on the body and is recommended in most clinical practice guidelines.2

The Pilates method aims to improve posture and body awareness while building strength. The six basic principle of Pilates includes tightening the ‘powerhouse’ (trunk and gluteal muscles), concentration (cognitive attention), control (postural management), precision (accuracy), flow (smooth transition) and breathing while performing a range of exercises.2
It is a great way to get people moving in a smooth and controlled way. At Central Performance we use the reformer, wunda chair and mat-based exercises in a circuit style approach so that the exercises are varied and fun. These exercises use springs and body weight as resistance and can be adjusted to your ability. Our initial assessment involves a history of your injury and a physical examination to determine your exercise program. Than we get started! Starting on four 1-on-1 sessions to get used to the various exercises on your program. From there the choice is yours. Continue with 1-on-1 sessions or move to our group classes (max 4 people).

But how does this help with low back pain?

Just move! Our backs love movement. The worst thing to do when you have low back pain is to stop moving and stop exercising. Pilates allows you to move and exercise in a nice controlled and monitored way without using heavy weights. It can be a way of progressing your exercise tolerance or to transitions back into gym-based exercise.

I need a stronger core to get rid of my back pain!

This is often a very common perception in today’s society. We are often told to strengthen our core to prevent low back pain. However, if you have had ongoing or episodic low back pain than you may already bracing and overusing your core subconsciously to help ‘protect’ your back. Before strengthening your core it is important to regain normal relaxed movement of the spine. This relaxed spinal movement can fundamentally change the way your back behaves day to day. Pilates is a good way of starting off this process, using controlled movement of the spine before progressing to more progressive strengthening exercises, whether it be at the gym or harder Pilates exercises.

  1. 1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163-2196
  2. 2. Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC,Costa LOP Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7

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3 Things You Must Have Before You Begin A Training Program

Spring usually marks the beginning of an increase in gym traffic as many people begin to shake off the winter dust and head into the gym ready to shape up for the summer.
Unfortunately, much of this enthusiasm will wain early and the majority of well-intentioned and under-prepared trainees will fall off the path and never achieve the things that they could have.
Here are three things that we suggest you explore with yourself honestly and objectively, and address, before you begin your fitness journey, in order dramatically increase the chances of success and having your efforts come to fruition.
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1. A Reason WHY: 
Having a specific and meaningful purpose behind your training can serve as a strong foundation, and a fallback reminder for when times get tough, of what you truly value and why it’s important to do all the little things that are necessary, inconvenient and oftentimes uncomfortable in order to reach your goals. This is particularly important during the initial (and most challenging) period of trying to establish new habits and lifestyle change.
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The things that we say to ourselves, matter.
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So make sure that you anchor all of your actions off of a clear and powerful purpose and you will dramatically increase your chances of staying the difficult course towards success. As Roy Disney once said: ”When your values are clear to you, making decisions becomes easier.”
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2. A Plan
This one would seem like common sense but surprisingly the majority of gym-goers are entering the gym with no clear goal or plan of action and often end up performing whatever exercises come to mind at the time. The problem with this approach, however, is that:
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Random training yields random results. Period. 
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The old ‘something is better than nothing’ response is no excuse either. Particular training goals will have a very specific set of requirements that are guided by proven scientific principles and practical application.
Simply doing what you feel like is a road that leads to nowhere in particular, very quickly.
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A plan will give you a direction to send your best efforts, guard-rails to keep you on track against the many options and distractions as well as feedback on results. Your program should also have both short and long-term considerations in mind, starting from where you want to be, working back to where you are now and broken up into smaller, more manageable chunks of training time.
This provides the flexibility to change course throughout the process based on results and offers many smaller, specific and more attainable goals along the way that inject a bolstered focus and motivation to your training that you wouldn’t have otherwise.
Remember, random training yields random results. If this is not an area of specialty for you, getting a plan built by an expert in the area of program design can save you significant time, effort and frustration.
The same way that we rely on a mechanic to oversee the safe and efficient running of our vehicles, a doctor to oversee and provide guidance on our health and well being, it’s also valuable to seek help from an exercise professional who can guide you in the right direction with a clear plan of action.
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Having the right plan will work far better than having no plan at all and leaving all of your progress to wishes and guesses. Ultimately, the benefit of having a plan is that it provides clarity and focus. Discovering your why will provide you with a vision of what you want to attain, a plan will provide you with the clarity of what needs to be done, and the focus to address the small daily actions that will add up over time.
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Wishes and guesses: the preferred strategy of every unsuccessful person you know.

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3. A Support Crew: 
A support network of people who care about you, respect your goals, and who genuinely want to see you succeed is a hugely underrated component to success in any endeavour. There are going to be challenges and you will likely stumble from time to time along the way and having good people around you who’ll lift you in those difficult times might just be the very thing you need at the time to keep going.
Having somebody to be accountable to also helps, and this can be a training buddy, a coach or a friend to whom you can announce your intentions to, and check in with on a regular basis to hold you to your word.
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Remember, nobody has to understand or agree with your goals, but it is important that you gather around you people who respect and support your choices. Your environment matters and mediocracy loves company. Choose your support crew of coaches, training partners, and friends wisely. Find people who will push you and pull you up on your excuses. People you can lean on without relying on, and who you genuinely enjoy being around.
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If you’re looking to get started and would like to do it right, reach out to us here.

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness located in Surry Hills, Sydney. danny@centralperformance.com.au

Danny James is the Head of Personal Training and Strength and Conditioning services at Central Physio and Performance Fitness, located in Surry Hills in the Sydney CBD area. danny@centralperformance.com.au

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Low Back Pain – Keeping A Neutral Spine Posture

A Neutral Spine Is Important For Your Recovery

Lower back or “lumbar” disc injuries are a common type of back injury we see here at Central Performance. Our dedicated team of physiotherapists do a fantastic job of reducing pain & restoring the range of motion that can be lost as a result of a disc injury. Extensive research consistently shows that exercise plays a vital role in recovering from an episode of low back pain, but we find that many clients are unsure about how to begin or restart an exercise program. Many are not confident about getting back to even light or moderate exercise, fearing that they may re-injure their back. So today our Exercise Physiologists share a tip on how to avoid re-injury whilst exercising following a low back disc injury:

Keep a neutral Spine

Many people who exercise with lower back pain do so whilst holding their spine in positions that can increase their pain. Increased muscle tension due to recent pain can change both your resting posture & your movement patterns. For example focusing too much on not bending your spine (remember the old saying of “keep your back straight and bend your knees”?) can mean that your spine stays locked into extension (a deeper hollow in your low back than normal). This increases compression through some spinal joints, and if this is maintained as you go back to the gym this can cause ongoing pain. Alternatively, having hamstrings that are too tight can cause too much flexion (bending forwards) in your low back as you bend down, potentially increasing pressure on your spinal discs and causing more pain. 

A golden rule of exercising as you recover from a lower back injury, particularly disc injuries, is to maintain a neutral spine! A neutral spine is the term used for the position of the spine when all three curves of the spine (cervical, thoracic and lumbar) are in proper alignment with each other. It’s the most comfortable, stable position for the spine to be in whilst performing any activity, and you should aim to keep you spine neutral as you get back to exercise. Neutral Spinal Posture

Keeping a neutral spine is very important whilst exercising, as it distributes your weight evenly throughout the discs and joints in your back, as well as cushioning impact and other forces present throughout exercise. This allows clients with low back disc injuries to progress to performing more complex exercises and movements, which enables them to recover from their injury quicker and get back to doing the things they love!

Initial supervision and instruction on how to achieve and maintain a neutral spinal posture is an important first step to getting back to exercise safely and early following an episode of back pain. Contact us for more information on how our exercise physiologists and physiotherapists can help you with this, and stay tuned for upcoming posts about how to progress your exercises to give you the fastest an most complete recovery possible. 

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Build A Strong Healthy Spine With Clinical Pilates

Clinical Pilates To Relieve Back & Neck Pain 

Up to 80% of people will have back pain at some stage in their lives, & 10% will experience significant disability as a result. It’s one of the most common things we see here at Central Performance, & our Clinical Pilates program is one of the main tools we use to strengthen your spine to keep you active & moving in to the future.
 

How is Clinical Pilates different to regular Pilates?

Clinical Pilates is an exercise system based around core/central stability, balance, posture, movement control & breathing. Each person with back or neck pain will have a different injury history, lifestyle factors (eg desk workers compared to retail assistants) & a wide variety of things that aggravate or ease the pain. It is for this reason that specific individualised programs are vital to target each person’s pattern of instability, weakness or tightness.

New research has found that “exercises that are distinctly targeted to a patient & their individual needs have a strong correlation with improved symptoms, both immediately after exercise & over a three month period.” This individualised program feature is one area where Clinical Pilates differs significantly from more generic group-based Pilates classes.

Another way Clinical Pilates is different from regular Pilates is that your program is based on a specific initial assessment that clarifies patterns of movement (flexion or extension) that aggravate & ease your pain plus boost or inhibit your muscle function. Left & right asymmetry is also assessed to clarify target areas for your program. You are also regularly re-assessed throughout your sessions to ensure that you are improving & building strength as expected. Click for more information on Clinical Pilates. 
 

Who Should Try Clinical Pilates? 

Clinical Pilates is ideal for you if you have, or have had, pain in your back, neck or pelvis. It can be especially effective if you have had several episodes of pain in the past.

Many people will recognise the feelings of weakness or instability that often follow an episode of pain in the back, neck or pelvis. This happens because of our pain inhibition reflex – which is when our brain switches off our stabiliser muscles in response to pain signals. These muscles do not then automatically switch back to on to normal strength after the episode of pain passes, so we are left with a weak spot. This increases the risk of recurrent or continuing pain.
 
Research shows that there is an 80% risk of recurrence within one year after an episode of lower back pain. This risk can be reduced by 65% with a directionally-specific core re-training program such as Clinical Pilates, & the situation is similar for neck pain. Your Clinical Pilates program kick-starts your core stabiliser & other spinal muscles & builds their strength so you can confidently get back to doing the things that you love. 

 

Clinical Pilates at Central Performance

Your Clinical Pilates program starts off with four 1-on-1 sessions. This is known as our Quickstart Program & in these sessions you will be fully assessed, be guided through your personalised program, & get confident in correct form & technique when using Pilates equipment including the Reformer bed, Wunda chair & barrel.

Following your Quickstart program you may choose to join our small group classes (max of 4 people per class), or if you prefer you can continue with 1-on-1 sessions. Even in a group environment you will still be doing your own individualised program & be under the close supervision of our great instructors. 

Our Clinical Pilates program is achieving excellent results for our clients. The most common benefits reported include;

•  reduced pain in their back, neck & pelvis

•  increased confidence with exercise & daily activities like lifting, carrying & pushing

•  better & taller posture

All of our instructors are fully qualified & experienced physiotherapists with further certification in Clinical Pilates training. This gives you the confidence of knowing that your program is designed & supervised by highly skilled clinicians every step of the way.  

 

For More Information On Clinical Pilates Click Here.
 Or Click Here To Book Online 

 

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Do I Need a Physio, an Exercise Physiologist (EP) or a Personal Trainer (PT)?

So what actually is the difference between Physiotherapy, Exercise Physiology and Personal Training?

At Central Performance our physiotherapists, exercise physiologists & personal trainers all work side-by-side to care for our clients. Our  aim is to perfectly match our clients with the right program whatever their level of physical health, injury & performance. The flowchart below shows how it all fits together.


Central Performance Client Pathway


3 questions we often get asked by clients are; 

1. What does an exercise physiologist do?
2. How is exercise physiology different from physiotherapy?
3. How is exercise physiology different from personal training?

Firstly, exercise physiologists use exercise to treat chronic health conditions. The most common types of problems that our exercise physiologists treat are;

• Musculoskeletal Injuries, eg back & neck pain, osteoarthritis, sports injuries/sprains & strains, post-operative recovery like ACL knee reconstruction, shoulder & knee problems

• Cardiovascular & metabolic problems, eg high blood pressure (hypertension), heart problems, to reduce bad cholesterol (LDL & total) & increase good (HDL) cholesterol, &  diabetes management

• Mental health, eg depression & anxiety

Similar to how a doctor prescribes medicine, exercise physiologists prescribe exercise programs. When deciding on the correct program to prescribe they consider a range of factors about the client’s condition, any other unrelated conditions, previous injuries or health problems, & the client’s previous exercise experience. For example, a young male who presents with 6 months of back pain but no other injuries or medical conditions will receive a different ‘dose’ of exercise to a post-menopausal woman with a 10 year history of back pain who also has hypertension (high blood pressure). The goal is to match the client with the right type & amount of exercise, as well as to make the exercise interesting so that the client is much more likely to be consistent in their sessions.

Shoulder physiotherapyFor question 2 above, there are a few distinct differences between an exercise physiologist & a physiotherapist. Firstly, exercise physiologists specialise in treating chronic conditions while physiotherapists are more likely to see people with acute & sub-acute injuries. A chronic health condition is one that has lasted for longer than 6 months & can be musculoskeletal, metabolic or cardiovascular. By contrast acute & sub-acute injuries are within the first 3-6 months of when they began, although they also may be recurrent – where each episode is only short, but episodes may occur repeatedly over months or years.

The second difference is that physiotherapists are able to diagnose injuries & order some types of medical imaging, whilst exercise physiologists are not. If someone presents to a physio with a ‘tweaked’ hamstring after football on the weekend a physio is able to diagnose if they have a hamstring strain & what grade the hamstring strain is. By contrast an exercise physiologist isn’t allowed to give a client a diagnosis in that fashion & this is linked to exercise physiologists specialising in chronic health conditions rather than acute injuries. Similarly, physiotherapists can refer clients for some investigations such as x-rays while an exercise physiologist can’t.

Thirdly, exercise physiologists receive extensive training & education in the physiology of metabolic & cardiovascular health conditions. This gives them the skills & expertise necessary to prescribe exercise for people suffering from metabolic & cardiovascular health conditions. Physiotherapists don’t receive training to the same level in these conditions unless they have a special interest  in them & pursue further study.

Ball rollout for core stabilityRegarding the last question, there is a lot of overlap between exercise physiologists & personal trainers when it comes to musculoskeletal health. Exercise physiologists can be thought of as focusing more on corrective exercise for injury recovery, whereas personal trainers focus more on performance exercise where there are not significant restrictions imposed by injury or disease.

Personal trainers do not receive such extensive education or training in physiology, biochemistry or pathology to treat chronic health conditions. As a result they are not eligible for private health fund rebates or referrals from GPs under the Chronic Disease Management plan. Exercise physiologists however are eligible for private health fund rebates & most health insurers cover exercise physiology. Similarly, MediCare will also provide rebates for exercise physiology when referred by a GP under the Chronic Disease Management plan.

Exercise physiology rather than personal training may also be suitable for people who have no experience with exercise or gyms. Because exercise physiologists primarily treat people with chronic health conditions they receive training in cognitive behavioural approaches to help clients feel comfortable & confident while exercising. A similar cognitive behavioural approach can benefit those who have little to no experience with exercise & are therefore nervous to start exercise.

As you can see physiotherapy, exercise physiology & personal training all have different areas of specialisation. At Central Performance we believe in integrating all three in our multidisciplinary approach to provide you with a perfect pathway from pain to full performance, whatever your goals may be. For example a back pain client may initially see our physio’s for diagnosis & hands-on treatment to settle their pain & return to gentle movement. Then they may progress to exercise physiology for initial correction of movement biomechanics plus a return of baseline stability & strength. Once this is achieved they can progress to personal training to really build their strength & endurance, or train to achieve any other sporting or health goals they have.


Contact Us for More Info: For more information or help deciding which service would be the best for you to start, please contact us on 9280 2322 or via email. There is also lots more information on the webpage for each of the services – see physiotherapy, exercise physiology or personal training


 

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Lower Back Pain in Golfers

Lower back pain is by far the most common complaint for golfers of all ages and ability levels. Data collected from the Titleist Performance Institute (TPI) show that 28.1% of all players have lower back pain after every round. The most common trend is for trail-sided back pain, ie. pain on the right side of the lower back for a right-handed golfer or left sided back pain for a left-handed golfer.

In actual fact the lower back is generally not the cause of the injury but is the area of the body that is overloaded the most and eventually suffers from the pain. Most of the time it is the fault of the body segments above or below the lower back that are dysfunctional. If the hips, upper back, shoulders or ankles do not move correctly it puts more pressure through the lower back than it is supposed to cope with and it subsequently breaks down. For example, if you are tight through your upper back or hips, the rotation required to bring you to the correct position at the top of your backswing is unable to occur in the upper back and hips. This forces your lower back to compensate and attempt to rotate further. Your back is then repeatedly loaded with more force than it can take, ultimately resulting in the facet joint injuries we see so commonly in golf. It may be an injury that comes on all of a sudden during a swing, or it can be a gradually stiffening/tightening of the back or soreness that is present after a round.

There are 3 aspects within a golf swing that have a strong relationship with lower back pain. The first is an S-posture at initial setup position. As you can see in the picture below on the left, the S-posture creates increased compression forces through the lower back due to the excessive lumbar lordosis (curve). This compression puts heavier load through our facet joints and with repetition this can result in an acute irritation of the facet joints or gradual degenerative changes through these joints.

Instead of the S-posture set-up, we ideally need a straighter line through the lumbar spine. This requires core stability to draw the spine out of the large curve and maintain a stable lower back position throughout the swing. If you have an S-posture, you can begin to correct this by practising basic motor pattern and core exercises, sometimes beginning in lying or kneeling positions, then progressing into more relevant standing golf positions.

The second major feature of the golf swing that correlates with lower back pain is the “Reverse Spine Angle”. At the top of the backswing the line between our head and centre of the pelvis should point away from the target. A “Reverse Spine Angle” is where this line of the spine is tilted towards the target. In this position the facet joints of our lower back are in an open position so as we move into the downswing and ball contact there is a rapid compression onto the facet joints as we close down onto them. People may develop a “Reverse Spine Angle” because of an inability to separate the movement of the upper body from the movement of the lower body, such as restricted rotation at the upper back or tightness through the latissimus dorsi muscle (the lats). It can also be caused by restriction in trail hip range of motion or weak gluteals and core muscles.

“Early Extension” is the third characteristic of the golf swing which can result in lower back pain. This is the movement of the hips and/or spine straightening up too early in the downswing. It can be seen on the second image below where the buttocks moves forwards away from the back line, when it should actually remain in contact as the hips rotate rather than straighten. “Early extension” again jams down and compresses onto the facet joints of the lower back. The physical causes for this can be reduced hip rotation of the lead hip, poor rotational mobility in the upper back, tightness/shortness in the lats, poor gluteal or core strength and overall a poor overhead deep squat movement.

As well as assessing the golf swing to determine if these swing characteristics are present, a golf assessment must also include a physical screen. TPI teach a Physical Screen consisting of 16 tests, ranging from hip range of motion, upper back rotational range, overhead squat patterns and even to wrist range of motion. All of these body segments need to be working together as a unit to achieve a successful, safe and reproducible golf swing.

TPI’s philosophy of the golf swing is this:
“We do not believe in one way to swing a club, rather in an infinite number of swing styles. But, we do believe there is one EFFICIENT way for every player to swing and it is based on what the player can physically do.”

At Central Performance we have two practitioners who are TPI Certified to assess the golf swing and perform your golfing physical screen.
Helen Hathaway – Physiotherapist
Danny James – Strength and Conditioning Coach
We are by no means golf coaches who are the experts at swing analysis, but would love to work with you and your golf coach (if you have one) to ensure that the mechanics of your body allow for the most efficient and safe swing for you.

Our physiotherapist, Helen, and strength and conditioning coach, Danny, run Golf Biomechanical Assessments consisting of a Physical Screen and a Golf Swing Analysis. They piece together the information gathered from these tests and establish a plan to help you get the most out of your body to improve your golf game. For some, the goal may be to get through a round of golf without feeling stiff in the back for two days following. This may mean manual treatment with Helen to improve joint range of motion and muscle length, as well as a program of corrective exercises to restore normal function. For others, it may be that they want to improve the power in their swing and could benefit from strength and power development with Danny. If you are having pain or discomfort with your golf, or feel that your game could be improved by improving your body’s mechanics, feel free to call and chat, or email helen@centralperformance.com.au

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From Pain To Performance

client-performance-pathway-rooms-26-10-16At Central Performance we believe that clients in the 21st century are looking for a new model of health & fitness. In our view the line between “rehab” & “fitness” is blurred if not fully broken down. Our goal is to allow our clients to progress seamlessly from acute injury management right through to exercise for life-long fitness & sports performance, all guided by an expert team within one great location.

We find that our clients expect much more than just short-term symptom relief. Of course fast pain relief is still a crucial first step, but these days people want (& deserve) much more. They also want to know what implications their current problem has for their future health, & what they can do to prevent future injuries. Many people also want to know about options to improve their overall health & wellbeing, & for some they are looking for programs to improve their sports performance. Meeting these expectations requires a multi-disciplinary approach that focuses on each individual’s goals, lifestyle, history, exercise preferences & sporting aspirations.

These expanded needs & expectations demand a much broader view of “healthcare”. The line between injury rehabilitation & physical fitness is now very blurred, meaning that treating an injury is only the first stage in the “rehab” process. Once the pain is settled, what then? Should clients just be discharged back to their pre-injury lifestyle, bearing in mind that for most injuries the client’s pre-injury lifestyle was a big contributing factor to their injury! Think back pain in sedentary desk workers, hamstring tears for weekend-warriors who don’t get a chance to exercise during the week, OA knee pain in overweight individuals.

If a client’s “rehab” stops when their current pain episode settles down, we believe they’re just setting themselves up for more problems. These days most people realise this & are looking for a different approach, however they often don’t quite know how to go about fixing the situation. Central Performance now provides you with an effective & convenient solution, with a team of experts all working together in a single location.

OLD MUSCULOSKELETAL MODEL – Triage Care

In this model musculoskeletal services had a short-term focus on the diagnosis & relief from a specific episode of pain or injury, eg an episode of back pain or an ankle sprain. Once this episode was relieved patients were discharged, usually with some exercises to keep going with (which we all know almost no-one actually did!) & advised to make some lifestyle changes.
Working with this model there was almost an assumption of “I’ll see you next time something goes wrong” – whether it was the same problem recurring or something new.

Essentially, this paradigm focused on treating pain & then returning people back to their pre-injury lifestyle & level of function. But they became symptomatic in their pre-injury level of function, so if they just return to this level the chances of them becoming symptomatic again are very high.

The solution? People often find it hard to improve their overall health & fitness by implementing lasting lifestyle changes, but our new model of care at Central Performance is having great success in removing the physical, social & psychological barriers to make it much easier.


Old Model                                         →               New Model

Triage & symptom relief               →              Effective short term & long-term management

Isolated injury focus                      →              Whole-body health & fitness management

One or two main providers         →              Team approach; an expert in each area


THE NEW MUSCULOSKELETAL MODEL OF CARE: Patient-Centred Pain to Performance Model

When seen graphically in the pathway chart below it is easy to see that the “rehab” phase, i.e. the symptom relief phase, is just the start of our client’s patient’s path to sustained better health. In fact injury management & performance improvement are really just opposite ends of the same spectrum. There is no true dividing line between when exercise for rehab finishes & exercise for performance improvement begins.

Central Performance Client Pathway

It is crucial to note that our definition of “Performance” is completely individual. For one person performance may mean being able to play with the kids in the back yard, for another it may be elite sport. For some it may be staying mobile enough to keep living independently, for others it may be using exercise to combat depression. A desk worker may define performance as being able to do long hours without neck pain, another may define it as recovering from ACL reconstruction to return to the rugby field. Whatever each client’s definition of performance is, our services focus squarely on helping them achieve it.

It is also important to see that given the much broader scope of healthcare this model encompasses, it is impossible for one provider to be an expert in all areas. This is critical to the Central Performance care philosophy which states that:

At Central Performance we bring together a team of experts in each area of your program, all combining & working together in one convenient location.

The ability to provide all these services at one location is important because it removes many barriers that often hold people back. Convenience & time-efficiency are two aspects, but trust & familiarity are really the most important. For example if a client has been receiving physio & is now ready to progress on to more exercise-based management they are always much more comfortable knowing that they can still come to the same familiar place, they know the reception team, & whenever possible we have already introduced them to the person who they will be seeing for the next part of their program. Often there is a period of co-treatment, where clients may still have some physio sessions mixed in with their exercise sessions.

Most importantly we find that our clients will have built trust in their physio, & they know that their physio will have communicated closely with their exercise provider, so they know & trust that this next phase of their program will be at the same high standard as their physio program. This is vital as it greatly increases the number of clients who successfully make the transition from low-level injury-related exercise to exercise for sustained health, fitness & performance.

The same seamless integrated care happens at every stage of each client’s program. We help & support you right from initial recovery through to reaching your goals & making real & lasting improvements in your all-round health, fitness & lifestyle. Our clients have the real confidence of knowing that they will always see the right person at the right time, every step of the way.

For more information on how this new model of health & performance can help you reach your goals please contact us or call the clinic on 9280 2322.

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