Advice
Core Stability
The spine, like other parts of the body is controlled by two types of muscles –
- Keep the spine upright –
maintain a good posture - Segmental stability –
keep each vertebrae in line with surrounding vertebrae
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Imagine the spine like cotton reels balancing on each other. Some muscles only attach to every two or three vertebrae and so during movement the vertebrae are not held in strict alignment. This can cause stretching of spinal capsules and ligaments, which are very pain sensitive and produce ‘back pain’.
Segmental muscles – we are particularly interested in Transversus Abdominis on the front and Multifidus on the back, attach from segment to segment, thus allowing full stability and control when movement occurs.
Recent research has shown that recruitment or ‘use’ of these segmental muscles is switched off during an episode of acute lower back pain and they are not necessarily switched on again once the pain has settled –
Physiotherapists teaching specific core stability exercises educate these muscles to work so stabilising the spine and preventing strain and sprain of small ligaments/capsules and subsequent lower back pain.
The Transversus Abdominis is interesting, as it works as a ‘corset’ to protect the vertebrae and can be activated at will, when lifting or bending to provide a natural corset.
Research on chronic lower back pain sufferers who undertake exercise programmes is promising.
Muscle Imbalance
Many biomechanical problems that we treat are the result of muscle imbalance. This is especially true of the shoulder and the kneecap, which are predominantly stabilised by muscles rather than ligaments.
Joints move when activated by muscles, which pull them in a specific direction. Most joints have a combination of muscles applying forces in different directions at the same time. This gives the joint a new direction of movement. A problem occurs when one of the muscles in the group becomes weak compared to the others (ie: as a result of injury, overuse, under use, or postural mal-
In this situation, the physiotherapist treats the joint locally to decrease pain, swelling and spasm and then assesses the muscle balance (length/tension relationship) to ensure that the cause of the problem is addressed.
An example is the kneecap, which runs up and down ‘tram-
The symptoms of this are:
- Pain under the kneecap (especially when bending down or descending stairs).
- ‘Creaking’ knee; the need to straighten the knee from a bent position and ‘crack it’
- A build up of pain when the knee is bent for any length of time (eg when driving or sitting in a cinema).
The problem is resolved by taping the knee and specific exercises helping to redress the muscle imbalance.
Osteo Arthritis – Hips & Knees
General advice for Osteoarthritis of the Hips and Knees
- Pain at night: sleep on side with a large-
ish pillow between knees. - Buy cushioned insoles to place in shoes. This decreases the impact through the lower limbs when taking a step. If walking or standing a lot wear trainers or cushioned sole shoes.
- Non-weight bearing exercise within your pain-free limits. E.g. swimming or cycling (easy pedalling with a higher than average seat height.) If swimming is difficult, try floating in the water and gentle hip and knee stretches. (bend/straighten).
- If descending stairs is painful on the knees, turn around and descend ”backwards”.
- If you are carrying extra weight, consult a dietician to aid weight-
loss. It can be difficult to achieve if life is sedentary due to pain, but a dietician can help. Registered dieticians can be contacted through your GP. - Talk to physiotherapist in a one-
off appointment to learn a series of knee and hip stretching and strengthening exercises. This decreases the load through the joint and removes strain from the soft tissues surrounding the joint. It is often these that account for pain in osteoarthritis rather than true bone pain. - In a morning, lie on your back and bend and straighten legs a few times before standing up. Begin with a small range of movement and increase the range as pain allows.
- Always have a stick measured to the correct height by a physiotherapist –
the wrong height will place strain on other structures. The sick is held on the OPPOSITE side to the painful side.
Injury Management
Immediate injury management has moved from RICE (rest, ice, compression, elevation) to PEACE, do no HARM!….and then LOVE. This does not mean RICE is wrong, just that current evidence adds more to it.
Protect the area by off-loading and restricting movement for up to 3 days. This might mean crutches or a sling. This will minimise further injury to the area. Pain signals will help guide you.
Elevate the injury above your heart to help reduce swelling.
Avoid anti-inflammatories as these can inhibit tissue repair in the early stages of healing. Use other medication such as Paracetamol for pain relief, for the first week or so after injury.
Compress the area in an attempt to reduce further swelling or bleeding, using bandages or tape, and rest the area. This must be professionally applied to prevent further damage.
Educate yourself by speaking with your physiotherapist on advice for RELATIVE rest (resting by avoiding activities that could aggravate the injury) and which exercises will speed up your recovery. Ask about exercises to help maintain the rest of your body whilst recovering, and progressive exercises and stretches for the injured area. Find out about set goals for recovery time and progressive loading of injured tissues.
IN THE IMMEDIATE POST INJURY PERIOD (2-3 DAYS) DO NO HARM! YOU SHOULD AVOID DOING THE THINGS BELOW FOR 72 HOURS AFTER INJURY.
HEAT: Applying heat to the injury could increase bleeding and swelling
AVOID ALCOHOL: This can increase bleeding and swelling. This will delay your healing
RUNNING OR RE-INJURY: You can cause further injury that isn’t strong enough to take the impact of running or exercise.
MASSAGE: Massaging increases blood flow and massaging the injured area directly could increase bleeding and swelling.
AFTER THE FIRST FEW DAYS HAVE PASSED, YOUR INJURED TISSUES NEED LOVE!
Loading the injury within the limits of pain, early on in recovery has been shown to promote healing and tissue repair. Ask your physiotherapist for guidance on what this looks like for your specific injury.
Optimism aids your recovery – depression and fear about an injury have been shown to predict a poorer recovery and outcome of an injury, than being realistic, informed and positive, working actively towards a full recovery.
Vascularisation is key to recovery. Improved blood flow through the tissues helps carry nutrients and oxygen to promote your healing. Gently moving the joint and working the muscles around the joint will improve blood flow and encourage healing. A physiotherapist will show you what exercises are appropriate for your injury at each stage.
Exercises in a healthy combination of controlled and progressive, within your pain limits, are key to recovery. Restoring mobility, strength and proprioception will help speed your recovery and prevent further injury.
Important note about advice given on these pages
The advice and information presented here is not provided as a medical cure or for prescription of your condition. We strongly recommend you visit a qualified and accredited Physiotherapist for advice and help for your condition. All details are provided for informational purpose only and user accepts full responsibility for any actions taken as a result of such. The above, details suitability for purpose is the responsibility of the reader, use of this site is subject to our usual terms of business which are available on request in writing.
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