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4 Scoliosis tips from your Musculoskeletal Physiotherapist

In my time as a physio on the Northern Beaches one of the most common concerns people bring up during their physical assessments is their ‘Scoliosis’. Scoliosis is one of those conditions that just sounds horrible isn’t it? I want to start by saying the likelihood of you ending up with a Quasimodo-like hump on your back due to the condition is AT LEAST a million to one. Scoliosis is simply derived from the Greek word for bent or curved and is used today to describe the lateral curve in the spine caused by the condition. Scoliosis commonly presents as one curve, called a C-curve, or two curves, called an S-curve and is classified as either structural or non-structural depending on whether or not there is an added rotation on the spine present with the curvature.

X-ray-injured-back

What are the signs of Scoliosis?

Unless you can turn your head 180 degrees to the back (in that case we have bigger problems than mere scoliosis) it might be hard to self-diagnose the possibility of scoliosis, but physiotherapists look for the following as indicators of scoliosis:

  • Your head is not centred directly over your body
  • One shoulder sits higher than the other
  • One shoulder-blade sits higher or is more prominently sticking out
  • You have unequal gaps on one side of your body between your arms and your trunk
  • One hip bone is more prominent than the other
  • You suffer pain around those areas that are imbalanced

What to do if you have been diagnosed with a scoliosis

Did you know that Usain Bolt was diagnosed with scoliosis early in his career? It’s certainly not a career ending condition by any stretch of the imagination. Depending on the position of the scoliosis in your spine, your physiotherapist will give you a number of exercises or stretches to regularly perform. There are also a number of things to avoid if you have been diagnosed.

  1. Getting sucked into buying lots of things to fix it

“When I first bought a tempurpedic pillow it made me realise I was basically sleeping on a pile of rocks up until that point.” Human being have been in our current form for at least 200,000 years. For how many of those years have we have nice soft mattresses and perfectly contoured pillows? There is no evidence to support the hype around sleeping paraphernalia. That being said, if you are having pain at night, it’s time to talk to your local musculoskeletal physio about it! Sleeping accoutrements aside, other nonsense things to avoid are posture braces, long term orthotics and consistently taping!

  1. Get strong

It is important to find yourself a local physiotherapist who is knowledgeable in a number of complementary treatment options. Recent studies have shown that clinical Pilates and Yoga can be an effective reliever of chronic discomfort along with other non-surgical options such as meditation, massage therapy and a well designed functional training program.

  1. Don’t sit for hours on end

You would be surprised at how much spine and neck pain is exacerbated simply by sitting and doing nothing. Unfortunately, whether you’re sitting at your work desk all day or on the couch watching cricket for hours on end, it’s likely that your neck and spine aren’t in their optimal positions. Get up at least every hour and stretch your body from side to side and have a walk around to avoid placing too much pressure on these areas constantly. If the pain is getting worse, walk on down to your Dee Why physio and pick my brain.

If you think you may have scoliosis, or you have been diagnosed with scoliosis but have been neglecting your exercises or you have never been given a full body assessment for your condition, it is important to visit a local physiotherapist with the skills and equipment to create an in depth program for you. Scoliosis is a relatively benign condition when treated correctly, but can lead to further complications in the future if it is neglected.

3 proactive tips for preventing common workplace injuries

Person under stress due to workplace injury

Each year thousands of Australians suffer a work related injury that either causes them to miss time at work or diminishes their ability to carry out their role effectively. Safe Work Australia estimates that these injuries cost roughly $60 billion to the Australian economy.[1] Now that’s a lot of sick days (not to mention the sickies you chuck when the surf is up…) Not only that, but the way you carry out your job could be causing ongoing damage to your body that will eventually become painful, without you even knowing it. When most people think of workplace injuries, they think of one off accidents or injuries caused by repetition at physically demanding jobs. This couldn’t be further from the truth. With more people than ever working physically inactive jobs, many workplace injuries and illnesses are a result of poor posture, repetitive awkward movements and failing to identify aches and pains correctly to begin with.

With these tips you will be able to identify common workplace injuries and overuse problems, put in place proactive structures to avoid them and know when to see your local physio for further treatment.

Redesign your desk space

You’ve probably heard the term ‘ergonomic’ thrown around a lot in the last few years. There’s ergonomic keyboards, mouse pads, chairs, desks, pens, pencils, cups, water bottles, scissors and I bet somewhere somebody is trying to market ergonomic toilet paper to someone. Australians spend millions of dollars a year on ergonomically designed products that have no scientific facts behind them. Yep, you read that right. Most products are baloney. At its core, ergonomics is the study of how humans fit into their work environment. No fancy ergonomic pencils required. In fact, the most effective and proven ergonomic changes to your workspace don’t involve any new products at all. While people tend to focus on the type of chair they have, they tend to overlook how they hold their bodies while performing their work. For example, correcting your trunk position (or the position you end up in within that fancy chair), sitting with your body closer to your desk, having relaxed and symmetrical shoulders and feet flat on the ground can make a positive difference to your workspace. Try a few different positions for your most used items focusing on those principles and you’ll find that sore neck may just disappear.

Lift with your head (not literally)

About 30% of all workplace injuries are caused by manual handling tasks. Manual handling includes anything that involves lifting, pushing, pulling, holding, restraining, throwing and carrying. Manual handling related injuries can be minimised by a thorough and effective assessment of the risks. I know it’s easy to ‘just do it’ when it comes to the work, but that is often a sure-fire way to end up injured. Ensure you fully evaluate the layout of the workspace, the location of the item, the weight of the item, the duration and frequency of the tasks and try to streamline as much of the process as you can. Ask yourself ‘does it have to be done this way?’ Just because heavy boxes have always been delivered onto a high counter top for distribution does not mean that’s the best way to do it. Using mechanical aides such as forklifts, conveyor belts and wheelbarrows may be a better alternative. The importance of training how to do the task properly can’t be overstated. Inexperienced workers are much more likely to suffer a manual handling injury than well trained workers.

Recreate the work tasks for your physio to observe

It can be difficult for your local physio to get an accurate idea of exactly how a movement is being performed and under what conditions. As a musculoskeletal physiotherapist I regularly observe, evaluate and recommend alterations to the techniques of sportspeople who carry out a range of repetitive and awkward movements. Why should work tasks be any different? If you can’t start ‘a bring your physio to work day’, take some photos of your work area, or have someone take photos or video of you performing your regular duties in a work environment. This will allow your physiotherapist to evaluate your body movements, work area and advise of any possible changes that could be made. Plus, you’ll be able to feel like a professional sportsperson having your movements evaluated and corrected for optimal health and wellbeing. But seriously, if you work in a pub and want to bring your physio to work… I’m down!

Work doesn’t have to be one of the biggest causes of injury to Australians. Many injuries can be reduced or removed through simple alterations to your environment and being more aware of how you hold your body. A musculoskeletal therapist is perfectly trained to make these observations and give you the personalised tips to be able to go home every day happy and healthy. Without any of the gimmicks.

[1] https://www.safeworkaustralia.gov.au/statistics-and-research/cost-injury-and-illness-occupation

Part 1 – What is Posture?

Posture has been a buzzword in the past and it seems that it’s coming around again. Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Poor posture was something that my Mum harped on about (love you Mum). She would constantly tell me to “stand up straight” or “pull your shoulders back”. I tried to do these things, admittedly I didn’t apply myself to them ritualistically, yet I tried. This nagging was put into the category of things that mums just loved nagging about like washing your hands before dinner or not picking your nose. It didn’t bother me that I had “bad posture”. Until a fateful day of tennis.

Yes, this is me at age 16. Year 11 of school was a tough year and I’m sure I studied plenty, but surely this was just an overexaggerated posture? But as more and more photographs from over the years surfaced the sinking realisation came to me; my posture wasn’t just My posture imagebad. It was terrible. I was in a constant hunch.

For my final year of school I started taking an interest in how I could change my own posture. I took the same approach as most, beginning with doing my own research to see what would help before finally seeing the local physiotherapist. Religiously I would lie face down on my bed and pull my shoulderblades hard together to try and strengthen the area (Dr. Google told me this was a great idea, which is nonsense). I even had a friend help me tape my back as a regular occurrence so that I could learn to stand taller and with less of hunchback. Yet as the HSC drew ever nearer and as my priorities changed my posture was placed into the “come back to it later” basket and life moved forward. But it certainly influenced my career choices…

***

Posture is simply the human bodies position of strength in any given scenario. Hence, we have a favoured sitting posture, a favoured standing posture, riding posture, writing posture, handstand posture…the list goes on. Let’s run a mini experiment here. Please go and locate a mirror. Don’t worry, I’ll wait. Whip out that fancy smart phone of yours (that you are likely reading this article on) and take a pic of yourself standing side on in the mirror. Ideally this is done with minimal clothing on so you can see the contours of your body.

Done? What do you see?

If your body hunches forward into a position of comfort for you, then that is where your body has the most strength. If you notice that your hips shift forward and your ribcage shifts backwards this is your position of strength. If you have military posture you have either practiced this, or this is simply your position of strength. Maybe you see that you actually lean to one side, or that you have a really proud chest and your butt sticks out? The point is that it doesn’t matter what you look like. The reason you do whatever you do is because this is the most economical position FOR YOU IN THE GIVEN SCENARIO. What do I mean by the most economical position? I mean that in this position you must use the least amount of energy as possible. Humans as a species tend to find shortcuts to efficiency and posture is no exception.

What do we need muscular strength and energy for when we talk about posture? You guessed it, gravity. As Isaac Newton discovered, gravity is the enemy. The eternal force of gravity compresses us longitudinally as we are standing, causing our postural muscles to fire in order to attempt to (a) hold us upright and (b) decompress us.

The issues arise with poor posture or bad posture when:

a) the muscles, bones, joints, ligaments, tendons and nerve tissue that end up bearing the brunt of the load are unable to do that anymore. Our bodies have a set strength/endurance/tolerance for any given task. Holding ourselves upright is no different. If your body begins to ache after half a day of standing, it is likely that you have excellent tolerance of up to 4 hours of standing, yet at the 5th hour the muscles begin to fatigue and the body begins compensating as best as it can.

b) when the posture has been sustained for so long that the body has begun to adapt to always being in that posture. Over time, our body begins adapting to positions in which it is placed by forming small fascial adhesions (or Fuzz as coined by Gil Hedley – look up his Fuzz speech on YouTube). Ask anyone who has had their arm in a sling how stiff their elbow was at the end of 6 weeks… even if they were in the sling because of their shoulder! Every morning when you wake up you have a mini stretch which breaks down these mini adhesions and allows muscles and joints to function optimally. If we are constantly holding a hunched forward posture while standing for example, our body builds tiny fascial adhesions (aka Fuzz) that hold us into this posture.

Click to read my next article on whether we can change our posture!

Part 2 – Can we change our posture?

Practice doesn’t make perfect. Practice makes permanent. If you consistently practice your tennis shots poorly then you will always be a poor tennis player (note to all readers: letting your extremely talented better half try and teach you something that they are fantastic at will result in lasting  memories).

Hence poor postural practice makes poor posture permanent. Try saying that 5 times fast.

Some aspects of posture are definitely permanent because they are unmalleable. Bone morphology fits firmly into this basket. If my lower leg is genuinely twisted (for example those poor kids born with talipes equinovarus or kids with external tibial torsion) then no amount of brain power, muscular control or PRACTICE will be able to change how that bone looks. Yet the way bones interact with one another can certainly be changed. Hence poor postural practice makes poor posture only SEMI-permanent.

So bones can’t be changed yet the way they move with each other can. How about muscles? We spoke in the previous article about small fascial adhesions forming between muscles in times of immobility. We know that if enough of these adhesions form then they can hold us into a certain position. However the key piece of information that we need to take away from this is that by and large these can be reversed. They can be altered with manual work such as massage or myofascial release by physiotherapists and through stretching and applying movement to stiff areas.

Does this mean that posture can be changed?

The shortest answer I can give you is three letters. Yes. Yes of course we can change posture. Much like we can change the way that someone swings a golf club, or learns to play piano or learns to speak another language. This all relies on the neuroplasticity of the brain i.e the ability of the brain to adapt and change throughout a person’s life. This neuroplasticity means that the body can certainly learn an entirely new posture for any given scenario as long as the body can first physically move into that posture.

I guess that means its experiment time! As you’re sitting there please shrug your shoulders up as high as they can go. All the way up. Now attempt to hold them there for the next minute while you read the rest of this article.

You have moved yourself into a new and foreign posture. Firstly it will feel strange to have your shoulders up near your ears… which is fair enough because you probably look ridiculous. But then you will feel the big muscles on the top of your shoulders starting to come alive as their endurance capacity starts to get tested. This muscle normally doesn’t work in this fashion, in this scenario. This muscle (the upper trapezius) usually works to a much smaller degree when you are sitting or standing. It probably only works this hard when you are carrying something heavy in one hand.

But the point is that your body could adapt to this new posture. And with the right training it can become adept at maintaining this new posture.

However learning is all about consistency.

Your body just needs the right exercises, done with enough frequency, led by the right health care practitioner, in order to change for the long term.

Yes I hear you asking what happened to the slouched over little boy. Well there are two answers to that question. Firstly, he became a Titled Musculoskeletal Physiotherapist who loves nothing more than to help others change their posture. But most importantly, he proved to himself that it could be done by changing his own.

If you are having trouble with your posture then please don’t hesitate to call your local postural expert in Dee Why at The Beaches Sports Physio.

 

Physios are really just doctors to manage and prevent pain

Like doctors, physiotherapists are first contact practitioners. That means you don’t need a referral from anyone for a physio to examine, diagnose and treat your injuries. Physiotherapists can refer you to get scans but we don’t prescribe medicine. Physios are experts in back pain, shoulder pain, knee pain, ankle pain, hip pain, neck pain, headaches, muscle pain, pains in the butt… you get the drift. But we don’t just treat pain; we also aim to prevent it.

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New mums with wrist pain

Hi Northern Beaches Mums Community!

This short video compliments the content created exclusively for The Northern Beaches Mums regarding de Quervain’s tenosynovitis i.e. wrist pain in new parents. It describes how to test whether de Quervain’s tenosynovitis may be part of your wrist pain in the form of a 3 tiered test. The first 2 described are part of Finkelstein’s test while the third stage is Eickhoff’s Test. Please do them in order on the non-affected wrist first! Good luck!

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