Pain in the lower back has become a common complaint. We hear everyone from 11-year old children to 80-year old grandparents complain of lower back pain. A survey conducted by the Back Society of Singapore shows that 1 out of every 5 Singaporeans suffer from either a back or neck pain. The same study indicates that 1 out of 10 Singaporeans experienced such pain at least once a month. That is a very high incidence rate.

What are the effects of this pain?

1. Restriction of movement
2. Restriction of functionality and participation in recreational sporting activities
3. Reduced participation in social, community and family events
4. An awareness of the fragility of the back
5. Feelings of being old

While the pain can be physically debilitating, it can have an even more profound effect on the mental and emotional well-being of the individual. An inability to physically keep up with one’s peers may result in feelings of inadequacy. Depression is often seen as a “complication” of a chronic pain (pain that lasts for more than 3 months). Thus the saying

“You are only as young as your spine is flexible.”
-Joseph Pilates

What prolongs an acute lower back pain and makes it chronic?

We all have our tool kits to manage back pain – Yoko Yoko, stretches, “tui na”. Most of these remedies address lower back spasms. Reduction in pain is considered good; and a reason to return to functional and recreational activities with full vigour. Until the next attack of lower back pain.

So here’s the interesting thing about lower back pain – every time the body experiences such pain, the core muscles “switch off” a little and they just don’t switch back on. Even when the pain disappears. We lift, carry and run and the pain reappears. A vicious cycle of pain and no pain is started off. This is when an acute pain becomes a chronic pain.

What do the core muscles have to do with breaking this cycle?

The core muscles are situated between the diaphragm (breathing muscle that separates the ribs from the abdomen) and the pelvic floor. These muscles

• Stabilise the lower back and pelvis
• Even transmission of weight from the upper body to the lower body, thus preventing this weight from getting “stuck” in the lower back

Training these core muscles to activate at the right time and in the correct ratio will thus form a strong foundation for efficient movements; thus breaking the pain cycle.

What is effective core training?

Core muscles (Diaphragm, Pelvic Floor, Transversus Abdominus, Multifidus) are always working. If they didn’t work, we would just be a pile of bones. Thus they don’t need to be “switched on.” These muscles need to be trained to vary their levels of activation based on the load that is being placed on the trunk.

Thus core training would involve the following in different functional activities:

• Teaching the Pelvic Floor to switch on JUST before the Transversus Abdominus and Multifidus
• Teaching the Pelvic Floor how to respond to the Diaphragm

What is effective core strengthening?

Loading a core that has been taught to activate in a timely manner and in the right ratios for all functional activities.

How do we stop lower back pain from recurring?

By doing specific core training exercises before rushing into core strengthening exercises.

Interested to find out more about our Singapore Physiotherapist or our Pilates services? Call us today!

 

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What is shoulder impingement?

Impingement syndrome is an increasingly common cause of shoulder pain. The rotator cuff is a sling of muscles which support the glenohumeral joint. Over time, with movement, the tendons and bursae within this complex become trapped and compressed, developing tears or inflammation causing an acute flare up in pain.

What can cause it?

• Trauma
• Repetitive overhead movements

Within the shoulder girdle, the muscles of the rotator cuff should glide smoothly beneath acromion. With overhead arm movement, this subacromial space narrows and when this happens repetitively, the friction between the structures can become inflamed causing pain.

Types of shoulder impingement

• Primary impingement – this is caused by structural changes within the joints such as bony spurs which can narrow the subacromial space.
• Secondary impingement – this is affected by a person’s posture and movement patterns such as increased joint mobility or muscle imbalance within the girdle.

People with who participate in physical activity or have occupations which involve repetitive overhead movement are most at risk.

Symptoms include:

• Pain when bringing your arm into an arc above head, cross body or hand behind back movements.
• Soreness when lying on the affected side.
• Weakness and loss of function of the affected shoulder.

If you have any of these symptoms, it can have huge impacts on your quality of life and occupational ability.

Diagnosis

• Physical examination using specific shoulder tests.
• Ultrasound is often used to assess the extent of the impingement along with associated tendinopathies, bursitis or muscle tear.
• X-rays are sometimes used to rule out and bony deformities such as arthritis or spurs.

Types of treatment:

• Corticosteroid Injection – Not a long term solution. The relief provided is transient, it is helped in cases where the pain is very severe.
• Subacromial Decompression Surgery – There is high quality research which reveals that there is no differences in outcomes.
• Physiotherapy – a 12- week program of graded exercises has proven to reduce pain and to improve strength and function.

When treating shoulder impingement, it’s important to determine which type of impingement you are having and to consider the cause of the impingement as opposed to the specific structures involved. Our posture, muscle strength and muscle length in our upper trunk play an important role. Through strengthening, stretching and postural re-education with the guidance of your physiotherapist, we aim to regain your full range of motion, restore the shoulder strength and scapular stability and return you to a healthy and pain free movement pattern.

Written By: Mary Wrixon, Physiotherapist

 

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Congratulations! You’re pregnant! It’s nine months of excitement; but also involves some planning and lot of research. The last three months can also involve physical restrictions. Symphysis Pubis Dysfunction (SPD) is a real complication of pregnancy that arises from increasing size and weight.

The pelvis is made up of three bones – the two iliac bones and the sacrum. The sacrum is connected to the iliac bones through the sacro-iliac joints (found along the posterior aspect of the pelvis). The two iliac bones are connected to each other in the front through the symphysis pubis. Minimal movement occurs at these joints. Their function is to provide a stable platform for the movements of the arms and the legs.

A hormone called relaxin is released in the pregnant body during the second trimester. This hormone loosens up the ligaments of the pelvis, allowing the baby to pass through without any difficulties or complications.

As the ligament of the symphysis pubis loosens, the body increasingly relies on the muscles of the pelvic floor, hips, and the overlying fascia, to maintain the alignment of the pelvis. The inability to do so may result in pain and instability in the pelvis; and is termed symphysis pubis dysfunction (SPD). Although not very common, experts believe that more than 2% of all pregnant women will experience the symptoms of this dysfunction. SPD often goes undiagnosed and unmanaged, possibly because the symptoms are considered “normal” during pregnancy.

Signs and symptoms:

• Back and/or hip pain
• Pain in the pubic area, accompanied with a grinding or clicking sensation
• Pain and/or tenderness along the inside of the thighs
• Pain that increases during weight transfer (walking/running/going up or down stairs), when stepping side-ways, turning in bed
• Pain that is worse at night and possibly stops you from sleeping. Getting up to go to the toilet in the middle of the night can be especially painful
• Weakness in the legs; inability to support oneself in a seated or standing position

These symptoms can be quite distressing in the prenatal period. Symptoms persisting into the postnatal period could affect the new mother’s ability to look after a newborn, as well as her self-confidence. Early diagnosis is key.

A women’s health physiotherapist will be able to provide ergonomic advice (movements to avoid), supports (trochanteric or SIJ belts) and exercises critical for the effective management of SPD. Make an appointment with the Physio department if you experience any of the symptoms listed above; or if you want exercises to keep your pelvis supported through your pregnancy.

Article written by Aparna Shah, Physiotherapist

 

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Non-specific lower back pain can be troublesome and is more prevalent than you think. It effects over 80% of the adult Singaporean population at some time in their lives (Sing Health) and up to 60% of people in their adult life worldwide (WHO). It is one of the leading problems resulting in unemployment and disability when chronic. However there are a few changes that can be made to our lifestyle to relieve some of the causes of back pain.

1. Knowing when to Seek Help

Knowing the severity of your symptoms can help to identity the kind of health professional to engage as a first point of contact. In the acute stage (24-72 hours) pain can be intense, especially if the cause was due to trauma or a disc related injury. Seeking the advice of a medical professional is essential if you experience all or some of the following symptoms:

• Pain that can keep you up at night
• Severe pain which limits your daily functions
• A loss of bladder and or bowel control
• A significant reduction of strength/ power in the legs or back
• Severe numbness

Please consult a doctor as these are often suggestive of a more serious underlying problem.

For back pain of a less serious nature, there is light at the end of the tunnel! Here at the Moving Body our experienced Pilates instructors and or Pilates trained Physiotherapists are at hand to help relieve that pain! But here are a few other changes that you could make for a healthy and happy back.

2. Posture

How many times have you found yourself slumped at your desk or sofa, or standing more on one leg than the other? Adverse postures can have a significant effect on your joints. Incorrect sitting or standing postures can contribute towards compression of the lower back. Over a period of time a poor posture can result in secondary muscle changes such as lengthening of the gluteal muscles and shortening/lengthening of the lower back muscles. Simple changes such as a chair that allows for support of the natural curve of your spine can help to reduce additional stress in the lower back. Alternatively using a lumbar role or towel can make a world of a difference to giving your back the support that it needs.

3. Core Control

Although the jury is not conclusive on the literature surrounding the science behind lower back pain and core stability, it is still a very important component of back strength. The core is made up for 4 key muscles, which align the spine and form a corset and hammock like structure that supports the spine and torso. These stabilizing muscles lie deep to the bigger muscles or the prime movers, to keep the spine stable and reduce excessive or potentially damaging movement. Not sure where your core muscles lie or how to activate them? Pilates is a great way to gain awareness and build up your core strength, and for those with a longer history of back pain a physiotherapist can help to work with you to regain function.

4. Muscle Balance

Short and tight muscles can be a source of pain. We all know what it feels like to have developed areas of tension, which may be rather uncomfortable to release via massage. The muscles in the lower back can be prone to tightness, especially the muscles on either side of the lower back called the quadratus lumborum and the parapinals , which are common sites for trigger points and referred pain patterns. Stretching or manual release can help to relieve this tension.

5. Keep it Moving!

Pain can be the start of a downward spiral for inactivity, which in turn can be a source of pain, so it is important to break this cycle. If you are having any of the more serious symptoms above then gentle exercises should be prescribed and monitored by a healthcare professional, as it is still important to strengthen the surrounding areas. If you imagine the muscles in the back of your body as a chain, and one part of the chain has a problem it is likely to affect the other muscles in the chain; this is why conditioning is important to maintain overall health. Exercises such as swimming or walking through water can be extremely beneficial as the water will give resistance to movement, strengthen several large muscle groups whilst weight bearing is reduced by up to 60%. Keeping active is also a great way to keep your weight controlled another factor that will increase the stress on the joints!

Article written by Rebecca Taylor, Physiotherapist

 

Diastasis Recti is a fairly common condition during pregnancy and post-partum. Also known as abs separation, there is a widening of the gap between the left and right rectus abdominis muscle, at the mid line fascia.

Diastasis Recti reduces the functional strength of the abdominal wall and can aggravate lower back pain and cause pelvic instability.

Risk factors:

• Separation in a previous pregnancy can significantly increase the probability and severity of the condition in subsequent pregnancies.
• Women with multiple pregnancies and multiple birth pregnancy.
• Petite women.

A simple self-test for Diastasis Recti:

• Lie on your back with your knees bent, and the soles of your feet on the floor.
• Roll your upper body off the floor into a “crunch”.
• Check for a gap/separation at your mid line.

Things to avoid when you have this condition:

• Avoid any movement or exercise that places strain on the mid line, like full sit-ups,crunches, oblique curls, reverse
• curls, and full roll-ups and planks.
• Avoid heavy lifting.
• Abstain from backbends and other spinal flexion movements.

If you think you suffer from diastasis recti, please contact us at info@themovingbody.com.sg so we can work with you on a treatment plan.

 

Image credit: Unsplash, Szabolcs Toth

Ways to Improve Your Posture

 

By understanding proper posture, you can learn about your own postural deviations and determine which corrective exercises will work best to improve your alignment. The easiest and most effective way to correct imbalances is to stretch the overactive, short muscles and to strengthen the underactive, weak muscles. With correct alignment and good posture, your muscles will work more efficiently. You can prevent pain and injury, look and feel better.

Pilates is a good form of exercise that can help with postural correction. You can get a postural assessment and work with your instructor to correct your muscle imbalances.

Posture can signal both the enduring characteristics of a person (character, temperament, etc.), and his or her current emotions and attitudes. So, if your health is not enough reason to improve your posture, then the way you look might be?!

The Physiotherapist from The Moving Body can assess your posture and check for imbalances. Contact us at The Moving Body if you feel that you need help with improving your posture or if your misaligned posture has already led to an injury.

All our Physiotherapists at The Moving Body are Pilates trained. Pilates is a good form of exercise that can help with postural correction. Our Pilates instructors can also do a postural assessment and work with you to correct your muscle imbalances. The physio’s and instructors work closely together and can refer you to each other in case they feel you are better off with the other discipline, to ensure the most optimal outcome for you!

Understanding your posture

 

Ideal Posture

Good posture, or ”neutral spine” is the proper alignment of the body. Deviations from neutral alignment are identified as excessive curvature or reduction in curvature. Ideal posture indicates proper alignment of the body’s segments such that the least amount of energy is required to maintain a desired position and a minimum amount of strain is placed upon the tissues of the body. It is ideal to maintain a neutral spine whether its sitting or standing!

A Common Postural Imbalance

Most postural deviations occur because the muscles that work to hold a joint in place are imbalanced – one muscle group will be too tight and the opposing muscle group is too weak. Muscles that are in a prolonged, or stretched position can’t function properly and lose strength. A muscle in a shortened position will decrease in length, since it is not being used causing muscle tightness.

For example, people with shoulders that hunch forward often have tight pectoral muscles that pull the shoulders forward and rotate them in towards the midline of the body. Pair tight pecs with weak back muscles and you have an imbalance that pulls the shoulder girdle away from its ideal position. When imbalances like these occur, for a prolonged period of time, overactive muscles compensate for underactive muscles, which causes tension, fatigue, discomfort and injuries.

The above described posture – the forward head posture is one of the most common postures these days. This posture leads to a typical imbalance of the upper postural muscles, described by Czech Physician Vladimir Janda as the upper cross syndrome.

This posture starts a domino effect; the head shifts forward, the centre of gravity shifts forward, the upper body shifts backward, and to compensate that, the pelvis tilts forward. The entire spine responds to the change of the head position. The load on the cervical spine increases from 5.4 kg to 19 kg!

 

Joseph Pilates said: “The health of our spine is directly proportionate to the age of our body. If your spine is inflexibly stiff at 30, you are old. If it is completely flexible at 60, you are young.”

What happens when we get old?

As we age, there are many changes to our bodies such as:

• Degenerative conditions of the spine and joints
• Spinal stiffness, Osteoarthritis, Osteoporosis
• Knee pain and weakness
• Weakening muscles
• Loss of balance and proprioception
• Slower metabolism

Regular exercise and physical activity could delay or reduce the risk of some diseases and disabilities that develop as people grow older.

In Pilates, we focus on strengthening the core- it’s designed to build core strength of the body through balancing, stretching and correct breathing techniques, which will help to protect the spine and reduce the risk of osteoporosis and back problems.

It’s also a safe exercise- it can be customised and modified for all types of body, fitness level, and any age groups.

There are many benefits to doing Pilates to help avoid the adverse effects of aging:

• Improved posture
• Increased balance and stability
• Reduce chronic pain
• Build bone density and strength.

It’s never too early to start strengthening your core.
Let’s stay active. Keep your body and spirit young.

 

Image credit: Unsplash, Joyce McCown