We use this powerful muscle to “flex” our hip. So this means any kicking action (footballers in particular) or forward bending movement of the trunk (eg. sit ups). We also use this muscle for virtually every movement including walking, running and even maintaining our balance and keeping our truck upright. But can this muscle be TOO powerful? Absolutely.

The iliopsoas can be the source of alot of backpain, and also sometimes lower abdominal/groin pain. The muscle itself can be too STRONG, and/or too TIGHT especially if it’s in the shortened position for too long (regular prolonged cycling and sitting will do it!).  If it is too strong or overactive, it’s easy to imagine it pulling on the spine from which is originates from, causing back pain.

If it is too tight, you can imagine it pulling the lumbar spine “forward” (see pic below).

This is often the cause of those with individuals with exaggerated curvatures in their lower back (usually women). This is called a Hyper-Lordosis. A common complaint for some women is that they get back pain when they wear heels. This might be because wearing heels does encourage women to arch their back more, causing additional strain on the spine.

So if you do a one sided sport that requires alot of hip flexion movements (soccer, dragon boating, cricket bowling, hurdling) or if you sit for most of your working day resulting in a shortened tight hip flexor, you are at risk of back pain.

What can we do about it? There are some simple hip flexor stretches that you can do such as this one below.

Although better than nothing, it is not as effective as using a TRIGGER BALL (above right)! The trigger ball exercise for the hip flexor is incredibly effective. In fact the results should be instant. All you have to do is place the spiky trigger ball on the ground, and lie on top of it (below left).

The position of the ball should be 3-5cm on either side of the belly button. You might have to move around until you find a painful trigger point. Once you find this painful spot (this should be the tight iliopsoas muscle), hold it for 30 seconds. Repeat this along the length of the iliopsoas muscle for 5 minutes. You will notice after the exercise the spikes will leave temporary marks on your abdomen. The position of the “marks” should be in the following area (marked blue). Note the diagonal alignment and length of the iliopsoas orientation.

Good luck! If you do have any problems, feel free to email admin@1physiotherapy.com or call us at +65 6883 1141.

All the best!

Same goes for Steve Nash, Grant Hill, Jason Kidd…. all over 36 years old and still gunnin’ it as NBA starters. Now i know the argument, “yeah but they all train everyday and do it for a living.” My counter to that is…. YES thats precisely the point. They are lean, fit and make the effort which allows them to do what they do. PLUS they are competing against 19 and 20 year olds who ALSO “train everyday and do it for a living” and still holding their own. So how do you prolong your bball “career?” Here are some tips

1. DO NOT GET FAT. Thats probably THE most important factor. BIG guys (when i say BIG i am referring to width, not height) over time will eventually wear their joints down. You are born with a certain amount of cartilage in your knees and ankles, so look after it as it wont be growing back! Chubby players will eventually decline ESPECIALLY when they hit 30. Derrick Coleman, Antoine Walker, Oliver Miller (see pic)….. gone. I have never seen a chubby player over 35 who is still starting in the NBA, Shaq included. He could be so much more if he watched his diet and waistline over the years. Kareem Abdul Jabbar was averaging almost 20 points and 10 rebounds at Shaq’s age (38 this year and averaging 12 points, 7 rebounds currently). So watch what you eat and how much you eat especially after 30 years of age. Basic rule…. sugar, rice, sweet stuff including juice, white bread, pasta are all high calorie-low nutrient foods (carbs)… oh, better include beer too.

2. STRETCH. Yes good old fashioned stretching… it’s SO important. If you don’t believe me, watch this video on Kobe right to the end. He sums it up beautifully.

So what’s the correct amount to stretch and when? In general before the game, warming up is far more important than stretching. The fastest way to increase flexibility before the game is to warm your muscles up (light jog, lay ups, 3on3, 1on1). Your muscles will naturally become more flexible when you are breaking a sweat. Feel free to stretch though before the game, but preferably after you are warmed up. And after the game STRETCH STRETCH STRETCH! I would say 20-30 mins of stretching after the game is a good amount. The main bball specific muscle groups would be calves, quads, hamstrings, gluts and adductors (groin).

3. HIT THE GYM. Now most people think this means you have the join the gym, and lift HEAVY weights until you drop. In fact, this is absolutely NOT TRUE. Below are a series of videos showing you the interesting and diverse drills you can do at home. All you really need is a gym ball (fit ball), dumbbells, and a bench of some sort. You will also notice the weights they are using are relatively light (remember most of them are 200cm tall and 230 pound giants). They do high reps-lower weights (about 10-15 reps), fast movements (but controlled). The exercises often involve the WHOLE body (what we call combined movements) rather than just standing still and doing bicep curls. They also engage their CORE (abdominals and back muscles) using fit balls, or simply standing on one leg. Personally, i do ALL my weights standing on 1 leg. Main muscle groups to work on for basketball are the QUADS/HAMSTRINGS, LOWER BACK/CORE, CHEST and ARMS.

Now for the videos! Do try to watch all of them. All the exercises are quite safe and easy to do. Enjoy!

Kevin Durant: Note he uses alot of his own body weight and resistance bands, rather than heavy weights per se. This is because they don’t want him to bulk up too much too fast, and lose his greatest asset which is his speed and dexterity. As he gets older though, they will eventually incorporate traditional weight training to his regime.

Dwight Howard: It’s really surprising how light the weights are considering his size (see pic above)! He does alot of HIGH-reps work and trains his core. At the 36 second mark, note he does dumbbells one hand at a time to add some instability to his drills. This is to engage the CORE and lower back.

Phoenix Suns Trainers: The Suns have a famous medical and rehab team. Grant Hill and Shaq have both said their team of Physiotherapists and Trainers are the best they have worked with. They focus ALOT on the core muscles using gym balls and balancing/wobble boards. They also do alot of functional drills, meaning the exercise closely resembles the movements they do on the court (eg. 3min 38 sec mark).

Luol Deng: I included this video because of the drills Luol is doing at the 5min 30sec mark. I like the tyre pushing. Great workout. I also like the platform jumping he does at the end. Great for building up those quads as he jumps UP to the platform, without over-doing it impact wise.

Dwayne Wade and Tim Grover: You might be asking Tim who?! Tim Grover is the man responsible for building Michael Jordan’s body. After the beating Jordan took against the Detroit Pistons, Tim worked out with Jordan EVERY morning to build his strength without compromising his speed and explosiveness. Notice he uses alot of combined movements involving the whole body. At no time is Dwayne just doing a standard, one dimensional, one muscle group drill. For those who are interested, Tim Grover now owns Attack Athletics. It’s a 65000 square foot basketball training and rehab facility with 4 basketball courts and a team of Physiotherapist, Trainers, Coaches etc. Now for the Dwayne Wade videos… both are similar to each other.

4. EAT VITAMINS AND DRINK WATER. There are 20 essential vitamins and minerals that are required for basic functioning. It’s a well known FACT that you don’t get all of these from your normal diet. It’s virtually impossible. Take Vitamins guys. Ask a 60 year old man with heart disease if he could turn back the clock, would he do it differently. Heck yeah! I recommend taking a GOOD multivitamin and an OMEGA-3 FISH OIL. Dont take Centrum. You might as well eat sand. Karl Malone was an avid vitamin guy. He took the brand i take called Pharmanex. You can google it yourself. Also drink tons of water. Not only is it good or you, but it helps suppress your hunger pangs. Jason Kidd prescribes to that theory.

5. CROSS TRAIN. Studies show those who do abit of cross training tend to get injured less. So it’s a good idea to do something OTHER than basketball during the week. Pilates, Yoga, Gym, Swimming are all great. If you already play bball 3-4 times per week, jogging is probably something you want to avoid. Do something low impact for a change.

6. TREAT INJURIES EARLY. Despite our best efforts, injuries do happen. You step on some clown’s foot, or you land awkwardly from a lay up, or take a hard foul. The basic rule is to treat it early so it doesn’t get serious. Also for you older ballers, those aches and pain you feel the next morning (especially if it’s always in the same spot eg. heel pain) is most likely to be TENDINITIS! It’s a mild inflammation of the muscle tendon causing it to tighten up. Probably feels better once you are warmed-up as it gets more flexible once warm, only to tighten up again the next morning… right?! This is the time to treat it. Dont let it become a full blown injury! A simple ACCIDENT POLICY will cover ALL your doctor and physio fees and it’s only $5 per month. Call Bandar for more info on this 90990926.

Anyway hope you all found this email is useful. See you on the court!

Leslie Ng (Sports Physiotherapist and avid basketball player!)
www.1physiotherapy.com

Leading up to the last major run of the year (Standard Chartered Marathon), we have seen an increase in injuries related to  increased intensity of training. An important point to remember is that as your “mileage” increases (the total number of kilometers you run in one week), any weak points like flat feet, leg length differences can start to magnify themselves. Hence a typical patient may have no problems when they were running 10-15 km per week, but as they increased to 20-25km per week and beyond, they started to experience more aches and pains. Does this sound like you? A lot of these aches and pains can be avoided and treated effectively with Physiotherapy, so that the runner CAN run pain free at these higher intensities.

Lets start with the feet. Asians generally have softer, wider feet and are more prone to       “over-pronation” (also referred to as collapsing arch, low arch, pes planus, flat feet). This picture shows the 3 types of feet, from left to right (normal, high arch and low arch). You can make your own comparison by checking out your footprints after you come out of the shower.

A common injury related to over-pronation is PLANTAR FACIITIS. The plantar fascia can be seen in this picture in pink, and it’s role is to support the arch. But feet that are flatter tend to over stretch the plantar fascia, and typically people will start to complain of pain near the heel. It will hurt more in morning, but as you warm up the fascia will get more flexible and the pain will go away, only to return after a period of rest! Stretching your calf muscles, massaging the plantar fascia (by rolling your foot on a golf ball) will help. Ultimately, it is proper foot wear with good arch supports that make the biggest difference. Some people might benefit from using an insole like the one pictured here. Often a generic insole, that sells for about $60 can do the trick.

Or a pair of custom-made insoles which cost only $120.

If all else fails, we recommend trying a sock-like device that you can see at www.1physiotherapy.com/strassburg-sock/

For our patients who are regular runners, we normally recommend them to Feder Sports at Peninsula Plaza. Ask to speak to Jeffrey as he fits many of the national athletes and high level runners and triathletes. His knowledge in footwear and choosing the best shoe for your feet is unparalleled. Simply put… he knows his stuff! Remember, different feet have different needs. E.g.. Low arched feet need shoes with good arch support, whilst high arched feet need shoes with good cushioning.

Now lets move on to  the knees. The most common knee injury in runners is called RUNNER’S KNEE (surprise surprise). It may also be known as Knee-cap Pain, Chondromalacia Patellae (CMP) or Patello-Femoral Pain Syndrome (PFPS).

Caused by friction behind the patella, it commonly hurts to walk up or down stairs, and to run (especially up or down hills). It may be associated with some swelling, and almost certainly is associated with quadriceps muscle weakness. As common as it is, this injury can be treated very effectively, and should not require a long period of rest.

Addressing tight musculature around the area will also be of benefit. The ilio-tibial band (ITB) has a natural tendency to tighten up in runners and cyclists. It can be seen in this picture as the substance in white. It helps stabilize the outside aspect of the leg, and connects to the outer edge of the kneecap. Hence if it is tight, it can pull on the kneecap, causing CMP. In fact professional cyclists and runners, might get this ITB massaged DAILY during peak training periods! If you have CMP, doing some self massage to the ITB will almost certainly help as well!

Lastly, you might want to think about whether your feet are implicated in causing your knee pain. Again over-pronating will not only stretch your plantar fascia in your foot, but also alter certain angles and alignment for your patella, causing CMP.

Good luck to all the avid runners out there!

√Deadlines, bills and family pressures…

√Traffic, relationships and job uncertainty…

√Muscle soreness, chronic pain and headaches…?

To varying degrees ALL of us are dealing with an assortment of modern-day pressures on a daily basis.

But alongside the complex but more obvious psychological effects of stress it may surprise you to know that stress also has an impact on our muscles. Scientists have come to realize that stress could be worsening or even causing your pain and headaches! “How?”

Posture and fatigue

When we are over-worked we may spend unnaturally long hours sitting at a desk or in front of a computer in a less-than-ideal slouched posture. Our postural muscles become fatigued (just like your biceps do after a long weights session) and struggle to hold us up straight for long enough. When we are stressed we also tend to become overtired as we have less down-time to revive, and sleep can be restless or elusive. The more tired and fatigued we become, or when our morale and energy are low… the worse our postures become. Lack of sleep also decreases our brain’s coping abilities and makes it harder for us to ‘cope with’ our pain.

Headaches

We know that poor posture is a cause of neck pain and low back pain. Did you know that it’s also a common cause of headaches? You may notice that when you slouch at the computer your ‘hunchback’ in your middle back is exaggerated, and the upper part of the natural S-curve of your spine –your neck – has to compensate into an exaggerated, sharper extension curve.

This puts the upper joints and muscles in the neck in an uncomfortable, ‘squashed up’ position and they can become stiff and painful. But as well as the neck pain – this area has a tendency to send ‘referred pain’ (pain that is sensed in a different location to where it’s actually coming from) up the nerve pathways and into your head, so that you experience the pain as a headache. A headache radiating around the back of the head may actually be originating from the joints between your 1st/2nd and 2nd/3rd uppermost vertebrae in your neck.

Myofascial pain and ‘trigger points’

Have you ever caught yourself in a stressful situation unconsciously clenching your jaw muscles? Or hitching your shoulders? And you haven’t even noticed how tight they were until you finally relax them and remember how different that sensation is? When we are tense our muscles also become tense. “We all hide our stress somewhere in our bodies” says David Butler (internationally renowned pain guru, and former lecturer of Julia’s). This stress affects our ‘Myofascia’ (muscles and fascia).

For those of you who haven’t heard of the word ‘fascia’ before (probably most of you) – it is a soft-tissue layering that encases every muscle in our body – a bit like the skin of a sausage. It is thinner than tissue paper in some places, but in other places (like the ITB on the side of our thigh or the Thoraco-lumbar fascia in our backs) it is quite thick. Anyone who ever cut up and prepared chicken will have seen real-life fascia – it’s that thin clear/white lining all around the outside.

Now, with persistent stress and muscle tension, emotional pain, bad posture or fatigue… the Myofascia changes. A single tiny muscle fibre in the muscle bundle may go into a micro-spasm, bunching and creating a contracted ‘knot’. The rest of the muscle is affected by the knot inside of it and becomes taut, ‘ropey’ and less flexible. The myofascia on top becomes thickened and glides less smoothly against nearby soft tissue further disrupting muscle function. That ‘knot’ is also known as a trigger point. Trigger points are a common and stubborn source of pain which are self-perpetuating and may last for months or years. Sometimes they’re painless, sometimes just a ‘niggle’ or other times they are more severe and bothersome.

If you don’t believe that stress can affect our myofascia think back to that chicken breast fillet we were thinking about before. The same kind of phenomenon can be seen. There is a reason why the best restaurants only serve the meat of ‘free-range’ hens who have lead a peaceful outdoor existence rather than meat from ‘battery hens’ who have lived stressful lives packed in tiny cages amidst hundreds of hens and pecking their own feathers out from boredom! The ‘chilled-out’ free range chicken’s meat will be more juicy and tender.

TRIGGER POINTS are also a common cause of referred pain – which can be sent down the arm, down the back or leg or once again up into the head, causing headaches. And they can occur in any muscle.

Julia herself admits that she tends to carry her tension in her Butt! BUT, while having a ‘tight butt’ sounds like an asset… muscle knots in your gluteals and piriformis (a small but often problematic buttock muscle) can refer pain to the low back or down the thigh.

Other common examples include:

♦Calf trigger points –can cause cramps, referred shin or ankle pain

♦Rhomboid trigger points–causes pain between the shoulder blades

♦Trapezius (on the top ridge of your shoulders) trigger points – may cause pain up into neck and temples

Stress hormones and the Mind-Body connection

What is a feeling? Over the past two decades Scientists have learnt a lot about how emotions and pain look through the microscope and how they manifest within our brains. One of their conclusions is: “At any instant our body is in our mind and our mind is in our body” –Candice Pert, author of Molecules of Emotion – Why you feel the way you feel. Sound like a strange thing for a scientist to say? Well when the brain is under ongoing stress certain areas within it are activated and the nerve pathways are imprinted. They react with biochemical secretions and a cascading upset in your body’s hormonal balance. These stress hormones float throughout our bodies and have a range of negative effects. One consequence is that they lower your body’s general pain threshold, therefore AMPLIFYING the pain signal as it is interpreted by your brain. Unfortunately this causes a nasty cycle: PAIN→DISTRESS→MORE PAIN ↔MORE DISTRESS

So what can you do?

EXERCISE

•Staying active increases your overall energy levels and strength so that your posture improves

•Endorphins improve your mood

•Relaxation (swimming is especially meant to be ‘meditative’ due to the rhythmical breathing and strokes)

SET UP YOUR WORK STATION

•Make sure your shoulders are relaxed, your low back supported, your chair the right height etc.

•Take regular breaks even if it’s just to walk to the water cooler to give your body a break from sitting

•Do some gentle stretches and remember to breathe deeply

MASSAGE

•Helps maintain the healthy condition of tight muscles

•‘Trigger point therapy’ from a physiotherapist to work out any myofascial trigger points

•Touch is very therapeutic and enhances wellbeing

OTHER FORMS OF STRESS RELIEF

•Stress management techniques or seek professional help if need be

DON’T LET YOUR PAIN BECOME ANOTHER SOURCE OF STRESS

•Seek advice and treatment from a doctor or physiotherapist

We all have heard that after an injury such as a joint strain, ligament tear, or muscle pull we should apply ice. They tell us it will help. They say it can even shorten the healing time! Can it be so simple? Does an ice pack REALLY make a difference. Well consider that in many professional sports, the athlete will actually ice their joints after the game, regardless of whether they have any pain, and regardless of whether they have an injury! It’s inevitable that certain joints like the shoulder and elbow in baseball pitchers, or the knees and ankles in basketball players, will have a certain degree of wear and tear. Ice can help keep inflammation in check, and can even help to prolong the career of the athlete. So can it help you?!………………..Absolutely.

It is important to understand the process of inflammation first when you injure yourself. Sprains, strains, pulls, bruises all involved one thing…. microscopic tears or micro-tears in the soft tissue (muscle, tendons, ligaments). Whether you were hit by blunt object, or you tripped on a step and over stretched your ankle ligaments, the result is the same. Micro-tears. Next comes the pain and then the swelling! It’s the swelling that will slow your recovery. This mystery swelling will get in between all the tendons and joint space making your joint stiff. Dead blood cells, white blood cells will accumulate and further restrict the joint movement for several days. The is turn will mean less movement, delayed recovery and weakening of your muscles. The swelling will also restrict blood flow into the area for many days or even weeks, as the body tries to repair itself and remove waste products. Depending on the area of the body and the structure you injured, there will be varying degrees of swelling. Ankle swelling is the most obvious as it is a bony area and it’s easy to spot. Also because of the ankle’s location, gravity works against us and the swelling accumulates.

When tissues tear microscopically, they leak out tissue fluid and blood, that begins to accumulate. Frequently the region will be warm and have a reddish color due to the increased circulation immediately after the injury. This process begins immediately after an injury, but it can take 24-72 hours for enough tissue fluid to accumulate in order to cause symptoms of pain and stiffness. This is why many people frequently do not see their physiotherapist or physicians immediately after an accident or injury – it simply doesn’t hurt enough (or it may not hurt at all) initially.

Ice should always be used immediately following an injury because it constricts blood vessels, which will lessen swelling, as well as numb pain and control bleeding. DO NOT APPLY HEAT OR RUB THE AREA. Applying heat may actually slow healing during the first 72 hours after an injury takes place. (By the way, alcohol will make it worse too. By alcohol I don’t mean alcohol rubs, I mean beer and alcohol of that sort!)

When to Use Ice: During Acute Stage (First 72 hours immediately after an injury)

• To decrease swelling and inflammation
• To numb pain
• To decrease muscle spasms
• To treat an acute burn

After the first 72 hours, the need for ice varies. In some cases usually depending on the location and nature of the injury, heat can be more effective. But as a general rule, if there is still swelling in the area, ice can STILL be effective even after many weeks or months AFTER the injury!

So the next time you injure yourself, think about reaching out for the good old fashioned ice pack, before you grab the heat rub!

By now we have all heard of the concept of The Core. Yes it was a blockbuster movie about a journey to the centre of the earth, but to us Physiotherapists, it’s more about certain muscles in our body that are VERY important. It’s talked about frequently during your Pilates sessions, or during your Yoga sessions. And although they may use different words and phrases like “generate your force from within” or “from the centre” the concept is the same.

So what is this elusive “core” and what’s all the big fuss about? Why is it more and more professional athletes from Olympic level swimmers to professional basketball players have jumped on the band wagon? Can it really help prevent back pain? Can it really improve your sporting performance or even improve your posture?! Absolutely….

Firstly it’s important to understand the role of your muscles. There are the PRIME MOVERS (or fast twitch muscles) and then there are your STABILZERS (slow twitch muscles).

These slow twitch stabilizers are what makes up “The Core.”



Let’s talk about the PRIME MOVERS first::

These are muscles that are responsible for MOVING your body and joints around. Whether you are walking, running, lifting something off the floor, these muscles contract to move your joints and body parts around. The muscles like your quadriceps, your pectoralis, your hamstrings, your biceps and triceps, are perfect examples of these prime movers. They tend to big large muscles, located superficially near the skin (see pic). They are designed for quick short bursts of activity and fatigue fast. Can you also notice how they all tend to anchor from the pelvis or from the centre of the body?

The other group of muscles are the STABILIZERS (core):

These are the unsung heroes. Because they are smaller and deeper within the body, they often go unnoticed and neglected. Their job is not so much to move your body around, their job is to tighten and hold your joints together. In essence, they hold everything together. In fact research shows that before you move (eg. run, jump, sit, stand)  these muscles are the ones that activate first (not the Prime Movers). They activate about 60 milliseconds before the Prime Movers, as your body “anticipates” the movement and recruits these muscle to help provide a stronger base for everything else to work off. These stabilizers are designed for long periods of sustained contractions, and are highly fatigue resistant.

So when you do resistance training and train your Prime Movers (your big muscles), don’t forget to train your Stabilizers. In fact an imbalance in strength between the Prime Movers and Stabilizers can lead to pain and injury! The benefits from training these muscles range from preventing and reducing back pain (if you already have it), to improving your speed, agility and strength on the sporting field!

Now that we know what the core does, we have to know how to train it! These core muscles are actually located everywhere in your body. From our ankles and our knees, to our neck and back. Today we will focus on 2 core muscles located DEEP in our lower back. The multifidus (MT) which lies at the back, and the transverse abdominus (TA) which sits in the front. Inserted are a series of pictures to illustrate both these muscle groups.

MULTIFIDUS (MT) and the TRANSVERSE ABDOMINUS (TA)

To activate them you simply have to visualize your MT and TA pulling your pelvis in together! It’s that easy! You should feel your LOWER abdominal region (near your belt line) tighten up both in the front and the back. You might even see your tummy get pulled in abit giving you a more slim figure (at least temporarily)!

There should be no change in your breathing pattern or depth, and you shouldn’t be tightening your backside muscles either. A helpful hint to facilitate the MT and TA tightening is to sit or stand on straight. Slouching actually make it hard for these muscles to contract. Also remember that these are slow twitch muscles, so there is no need to try to tighten these muscle too hard. About 20% of your maximal effort is all it takes. The trick is to hold the contraction while you breath, while you walk, even while you talk! It takes abit of practice and you might not feel the benefit for a few days or even weeks, but you are bound to feel a difference eventually. Please consult your Physiotherapist for further advice.

The elbow is made up of 3 bones – the humerus, ulna and the radius. As each bone loosely connects with one another, the elbow joint is able to produce 4 different movements and is surprisingly mobile and flexible.

Tennis Elbow

Also known as Lateral Epicondylitis, this is the most common injury to the elbow.  Despite it’s name this condition does not only affect tennis players, but also golfers and badminton players. In fact some people can get this condition even without playing sports!

The cause is inflammation to some tendons that move the wrist in one particular direction (EXTENSION). These tendons anchor from a very small area near the outside of the elbow. If they undergo enough physical stress, the tendons can become inflamed or in a worse case scenario… a tear to the muscle tendon itself.  The bad news is…. computer use has also been shown to be associated with the development of this condition!

Symptoms include pain at the outside aspect of the elbow. It should hurt with wrist movements, lifting weights or if severely inflamed…. even simply holding a weighted object like a cup will hurt!

You can help yourself by:

• Applying R.I.C.E (Rest, Ice, Compression and Elevation) • Stretching the wrist extensors  ( See picture ↓) • Massaging the affected muscles using a technique called Cross Frictions Using a Tennis Elbow Brace as featured in this link also helps a lot!

Left Elbow Stretching Exercise

Golfer’s Elbow

Also known as Medial Epicondylitis , this condition is the equivalent of ‘Tennis Elbow’ but on the inner aspect of the elbow instead.  Though not as common,  this condition can occur in many types of individuals (not just Golf Players)!

The cause is exactly the same as Tennis Elbow. Muscles that move the wrist in a particular direction (in this case FLEXION) all attach to a small region on the inner aspect of the elbow. Once overworked and under physical stress, inflammation or micro-tears can set in.

Pain is usually brought on by gripping actions,  lifting heavy objects, or even perhaps pulling on a heavy door. And treatment is much the same as Tennis Elbow. As seen below… stretching like this and using an elbow guard like the one featured here can help.

One of the main reasons both Tennis Elbow and Golfers Elbow  occur so commonly (especially in those over 50 years of age) is that the areas that these tendons join to the bone, has a notoriously low blood supply. As you age the blood supply to these regions reduce as well,  making you even more susceptible to this injury.

This does not mean you shouldn’t play sports, it just means that when you take up a new activity or increase the amount of sports you do, you  should give your body at least 8 weeks to adapt to the increase in work load. For example, don’t suddenly increase your badminton sessions from ONCE per week to THREE times per week. GRADUALLY ease into it…..

So if you think you are suffering from Tennis or Golfers Elbow, do seek Physiotherapy Treatment as soon as possible.  Don’t let it become CHRONIC….. !

A lot of people suffer from heel pain, but some people also get pain at the BALL of the foot. It’s called Metatarsalgia.

Most people know we have an arch in our foot the runs length-wise of the foot. But we also have a less well-known arch that runs in the front of our foot (across the width). From excessive pressure in this area (the ball of the foot), one can develop pain. The result is a burning pain that develops slowly, which can become chronic and extremely painful to walk.

This excessive PRESSURE to the forefoot may be caused by

- Improper fitting footwear – Excessive running and jumping sports – Over training and marathons – Age can be a factor as the fat pad in our feet tends to thin out, reducing the cushioning – Women who like to wear heels a lot (as this transfers the weight to the forefoot)

Wearing heels shifts the weight to the front (ball of the foot): 

The solution is simple. Forefoot domes or Metatarsal Domes as they are correctly called, can help to support and distribute weight more evenly across the ball of the foot.

It is easy to apply and comes with adhesive peel-off backing, allowing you to position it exactly where the support is most needed.

Neck pain is one of the most common injuries in this day and age. In fact a 2004 study by Singapore General Hospital, found that 33% of Singaporeans actually suffered from neck pain at least once in their lives. In some cases it can even cause headaches and disturb your sleep, ultimately affecting your job, your relationships and your well being.

Studies show that women are more prone to getting neck pain (up to double the incidence rates compared to men). Some studies go further to suggest that psychosocial factors plays a bigger part in women when it comes to causing neck pain (i.e. stress affects women more in causing neck pain).

Lets start with the anatomy of the neck, also known as the CERVICAL SPINE. As you can see in this picture, there really is not a lot of room for error. Your neck is only about 10cm long, and within this parameter there are dozens of spinal nerves, 7 discs, 14 (facet) joints, and countless ligaments and muscles.

In VERY general terms, the discs absorb the shock and takes the weight of your head, whilst the facet joints at every level allow for movement.

The discs in your neck are relatively thin, and thus prone to injury. In this picture it shows several forms of disc problems (not a pretty picture!). Damaged discs not only cause pain, but they can press on the nerves in your neck sending pain into your shoulder and arms.

The facet joints which are located at every level of the spine (see RED arrows) also contribute to taking some of the weight, and they allow for movement to occur (think of 2 dinner plates rotating over each other). They too will go through a certain amount of wear and tear over the years, a condition known as SPONDYLOSIS, which is another way to describe neck osteoarthritis. As one passes 50 years old, neck pain and stiffness from Spondylosis is more likely to occur.

So what can we do about it? As shown before since there are so many complex structures crammed into such a small area, anything that will cause MORE compression or increase the pressure will worsen the problem. Hence the key word here is to decompress the neck. Take the pressure OFF the discs and facet joints. Physiotherapy can help of course. A common treatment for disc related pain is traction, which literally stretches the neck and takes the pressure OFF the discs.

As for the facet joints, some manual therapy techniques such as MOBILSATIONS can help loosen the facet joints, “break” the stiffness, and promote better facet joint movement.

But at home and in the office you can help to decompress the neck too. A lot of people don’t realize the position of your head can either put MORE or LESS pressure on your discs and joints. And it’s this cumulated stress on your joints over many years that will do the damage. Your neck is designed to support the weight of your head, but it’s only “strong” in one position.

Without changing the position of your head, draw an imaginary line from your earlobe vertically downwards. Now if your earlobes are in front of your shoulders (which should be in 90% of the people reading this), then your head is in a non-ideal PROTRACTED POSITION (position A). In this forward protracted position your head actually drops lower causing more compression. Imagine a bowling ball about  to drop off the edge of a table, and that’s what happening to your head now.

As your head drops forward (and lower) it stresses the ligaments and your muscles must work harder as well. This explains why sometimes people get neck pain just by sitting down in a slouched position! What you ideally want is for your earlobes to line up nicely with your shoulders (see position B). You need to RETRACT your head backwards. As you do this, watch as your neck magically elongates (almost as if you are growing taller as can be seen this picture). Aim to get your earlobes in line with your shoulders. This position helps decompress your neck.

Now some of you will have difficulty getting your earlobes inline with your shoulders, and that’s simply due to structural changes and poor posture over the years. However with more practice and repetition, you can improve. This RETRACTION exercise also helps improve joint mobility and strengthens the muscles in your neck. So as much as possible during your daily life, try to maintain this posture. Start with holding this position for one minute, afew times per day. Incorporate it into your everyday life and make it a point to do it regularly (eg. waiting in the taxi stand, in the MRT, at the traffic lights…..

To further help decompress your neck, some patients would use “home-traction” devices like the ones shown here. They are cheap, comfortable and easy to use (available at www.1physiotherapy.com)

So before your NECK PAIN becomes a constant pain in the neck…. start your retraction exercises today!

A study conducted by SGH shows that 80% of Singaporeans will suffer from back pain at least once in their life. The scary fact is that once you suffer from back pain, you are more at risk of getting back pain again and again. If left unchecked, it could cost businesses more, in the form of absenteeism, increase health care costs and falling productivity and staff morale.

There are several causes of back pain, but our lifestyle is an important factor. We know for a FACT that obesity, lack of exercise and even PROLONGED SITTTING increases the rates and severity of back pain. This is good news, because it means YOU can do something about it!

Your back is a fantastic structure. Capable of withstanding large amounts of force, yet flexible enough for you to bend in several different directions. Part of the credit goes to your intervertebral DISCS. They act as shock absorbers for your back much like the suspension in a car. Strong, flexible but also capable of wear and tear. The interesting thing is that when you sit down, there is actually a 30% increase in the amount of force going through these discs! Additionally in the sitting position, the force no longer is centered in the middle of the disc (where it is designed to take the weight), it shifts to the front of the disc. This uneven weight distribution, coupled with the increase force tends to push the disc (nucleus) in the opposite direction?backwards (see picture)!

Over time there may be structural changes, from overstretched ligaments to weakened muscles. Eventually pain may set in and depending on the severity of the disc ?bulge?, the pain you feel can be across your back, or even down your thigh and leg. So consider how much we sit in our everyday lives and you will see why back pain is so common in our modern world. From the time you wake up to eat breakfast, to resting at home in your sofa, you are sitting the whole way! No wonder our backs hurt. So what can you do?

Try this simple exercise called the McKenzie Back Extension exercise once per day, and it not only improves your flexibility but helps restore normal disc shape and integrity. Push yourself up lifting only your shoulders off the floor. Hold for 1-2 seconds and slowly lower yourself. Do 10 repetitions slowly, but stop if there is any pain.

So do try to look after your spine. Start today and feel the difference exercise and Physiotherapy makes! And please seek advice if you do get back pain in the future, from a Physiotherapist or a Doctor. The earlier you do it, the better! Your back will thank you!