The Sink
The bathroom can be very stressful to a back that is cold, stiff, and not yet ready to bend. Once out of bed, many people start the day with a trip to the toilet. You probably have not spent much time thinking about how this can be stressful to your back, but hazards abound.

Sinks can be the next challenge for your back. Sinks are built too low for many people. Brushing your teeth or washing your hands can place a lot of stress on your back. Next time you brush your teeth, stop and check what position your low back is in. Odds are that you will catch yourself standing bent over the sink with all of your upper body weight hanging on your low back. Improve this position to reduce the stress on your back. Consider raising the countertop and sink or, more realistically, try placing a hand on the countertop to support yourself while you brush.

The Toilet
Here are a couple of ways to help your back when you use the toilet.
First, as you sit down and stand up, place at least one hand on your thigh or on a countertop to support your back and body weight. The best option would be one hand on your thigh and the other on the counter if that doesn’t involve any twisting or reaching. The more you can get your arms to do, the less your back will have to strain. Keep your back straight to avoid hanging all of your weight on your low back.

If it seems like a long way down to or up from your toilet, maybe your toilet is too low. The lower you have to bend to sit down, the greater the stress that is placed on the low back. Consider an elevated seat cushion, which can be purchased from a medical supply store, or consider having your toilet raised. Also, pay attention to where your toilet-paper holder is situated. Some toilet-paper holders are placed behind the toilet, forcing you to twist your back around to reach the paper. This movement is not good for a healthy back that is warmed up and stretched out, let alone for a cold, stiff back that just woke up. If the toilet paper is behind you, move it. Finally, some people choose the toilet as a place to read the newspaper or their favorite magazine. Although this is good for the brain, choose a friendlier location for your back.

Lift Your Feet
Forced bending and twisting of the spine is one of the worst activities for your back. Does sitting on the edge of the bed, with your feet on the floor and then bending over and twisting to put your socks on sound familiar? A way of making this task easier on your back is to bring your feet up toward your back. Try placing your heels on the edge of the bed or a chair and then putting on your socks or shoes. Also, the type of socks you wear does make a difference. Tight or very tall socks require more time and effort than do short or looser-fitting ones. If you have trouble getting your shoes on, try using a shoehorn.

Wear the Right Shoes
Shoes play an important role in the comfort of your feet and your back. Flat, thin-soled shoes often increase your back discomfort. When buying shoes, look for shoes with good arch supports and a fair amount of rubber or other soft material under the heel and sole to absorb the shock created when you walk. If you cannot find a shoe that meets these requirements, look into silicone or rubber shoe inserts. Your back will feel the difference.

Women may experience low-back pain when wearing high-heeled shoes — and not without reason. As you remember, the low back should have a slight inward curve to it. High-heeled shoes greatly exaggerate this curve and can compress the facet joints of the spine. Wearing a lower heel is usually a better choice for your back. If you work in an environment that requires you to wear high-heeled shoes, you can help your back by wearing a pair of athletic shoes to work and then changing into your dress shoes at work. This certainly makes a long walk or a long wait at the bus stop much easier on your back. Men need to watch out for a similar problem if they wear boots with tall heels.

So we’ve finally got you out of the house without having to wear a back-brace. You’re in the clear, right? Not even close. In fact, your car could be a major contributor to your back discomfort. In the next section, we will help your back survive that daily commute.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Hip pain is a very common complaint in a lot of people and can be caused by a wide variety of problems. The actual location of your hip pain can offer valuable clues to the cause.

Usually issues within the hip joint tend to respond with pain through the groin or the inside of the hip. However, pain associated with the tendons, muscles, ligaments or soft tissue structures surrounding the hip tend to give pain on the outside of the hip, upper thigh or outside of your buttock.

There can also be referred hip pain from structures relating to the hip such as the lower back, sacroiliac joint of your pelvis and your knees.

It is important to get an accurate diagnosis of your pain from a specialist, preferably  one specialising in hips, or physiotherapist experienced in treating these types of injuries.  In a lot of cases with a specified home program that a physiotherapist can detail for you, most hip pain can be self managed.

A very common source of hip pain that we regularly see in our clinic is gluteal tendonopathy, usually medius and minimus. These are muscles that attach to the hip to help with rotation and stability of the hip. Often due to muscular imbalances, overloading and stiffness this muscle comes under too much strain, causing the tendon to develop over use tears resulting in pain.

Symptoms may include an aching pain on the outside of the hip, which may radiate down the outside of the thigh and into the groin. These may be exacerbated when walking, prolonged standing, lying on the tender side, sitting and stairs. Often you will have an altered gait pattern we term a trendelenberg sign on the painful/weak side.

The exact cause of this condition can often be difficult to determine. Sometimes it can be after injury to the hip from trauma but usually it is from a mechanical dysfunction causing the tendon to breakdown.

 Some factors which may contribute to developing gluteal tendinopathy include:

• Gluteal weakness
• Poor back,pelvis,hip biomechanics
• Leg length discrepancy of more than 2cm
• A change or increase in exercise program
• Poor foot mechanics
• Pathologies with the hip joint itself

What you may be able to do to treat the problem:

• Sleep with pillows between the knees and try not to sleep on the painful side
• When sitting try to make sure the knees stay in line with the hips and don’t roll in towards each other
• Gentle stretches of the gluteal (buttock) muscles. Such as bringing your knee to the same shoulder, opposite shoulder and putting the ankle on the opposite knee gently push your knee away.
• Ice may help soothe the pain after activity but often it has gone past the point of actually help decrease any inflammation

Where to from here?

Once a gluteal tendonopathy has been diagnosed you will need to strengthen the muscle to help the healing process. A progressive rehabilitation program will assist in getting you pain free. Your physiotherapist can guide you through this program getting you back on track and participating in your normal activities once again.

Ride Right

Bring your seat close enough to the steering wheel to minimize the reach for your hands to grasp the wheel. Your legs should be bent at the knees and hips rather than kept straight. If you have an adjustable lumbar support, adjust it to where you have a slight inward curve in your low back. If your car does not have this feature, roll up a towel to about the size of your forearm, and place this in the small of your back. If your seat has a tilt adjustment, start with your body sitting up perfectly straight, and tilt it slightly backward but not too much. Keep your buttocks against the back of the seat so that they do not creep forward, causing you to slump.

If you travel long distances, or sit in the car for long periods, make slight but frequent adjustments in your seat’s position. Even if your seat is adjusted perfectly and your back is aligned just right, locking your spine in one position for the length of the ride can cause you a lot of problems. Remember, your back likes movement. Those slight shifts keep it happy and healthy.

If your job requires you to be on the road constantly, you might want to make seat adjustability a priority in your next car purchase. In your present vehicle, though, there are various seat cushions and inserts that you can buy to improve your back position and to make your driving more comfortable. Let your back guide you in your purchase — one size does not fit all.

With your seat all the way back, get a firm grip on the wheel and either the roof or the edge of your seat

Ease In and Out

Besides the ride itself, your car presents other hazardous situations for your back. You may not pay too much attention to how you get in and out of your car. Some people almost fall into their cars, twisting their backs in potentially dangerous ways. Getting out can be equally strenuous and hazardous if you are not paying attention. Here are a couple of helpful hints to lessen the strain on your back as you get in and out of your car.

Before you get out of your car next time, move your seat back away from the steering wheel as far as it will go. Open the door all the way, and place your right hand on the steering wheel and your left hand on the edge of your seat, next to your left thigh, or on the edge of the roof. Lift both legs off of the floor boards, keeping them together, and move your legs and upper body as a single unit toward the open door. You should feel like you are spinning on your bottom, without twisting your spine. Next, put your feet on the ground and use your legs, hands, and arms to help raise yourself up and out of the car. Push off with your hands from the seat or the door frame, whichever affords you better leverage. Remember to keep your back straight and your head up.

To get back into the car, turn your back to the open door and sit down in the seat, using the strength of your arms and legs again to lower your body into the seat slowly. You should still be facing off to the side of the car, not toward the front. Next, put your right hand back on the steering wheel or other stable part of the car, and move your body as a single unit back toward the steering wheel. Just like getting out, your whole body pivots on your bottom and your legs swing into position without twisting your back. Readjust your seat and you are ready to roll. It may take a few extra seconds to get in and out of the car this way, but in the long run, it will help keep your back free from aches and pains.

Feed Your Spine

Even with a perfectly adjusted seat, the lack of movement that goes along with a car ride starves your spine. On long trips, get out of your car as frequently as possible. When you make a stop, stand up, place your hands on your hips, and gently arch your back. This will relax and stretch tight, tired muscles and help to keep the joints lubricated. Like all stretches, remember to hold the position for at least ten seconds.

In addition to stretching your back, you should stretch your legs. Stretching your legs directly affects your back and can easily be accomplished with a short walk or by putting one leg on the bumper of your car and slowly straightening your knee until you feel a mild stretch in the muscles in the back of your thighs.

Once you’re at work there are a host of other potential hazards that can throw your back out of alignment. In the next section, we will show how to set up your cubicle to be back-friendly.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Lifting is not the only kind of stress that can hurt your back. Mental or emotional stress can be just as damaging, and many people encounter stressful situations daily. In the short term, the tension created by emotional stress can give you a backache; in the long term, it can set you up for a serious back injury, among other, more life-threatening health problems.

Recognize Your Stress

Many people hold emotional stress in their muscles, especially the muscles of the neck and shoulders. You might know this stress as a tension headache that starts in the back of your neck and moves up and down from there. A bad day at work or an upcoming job interview can bring on that creeping tightness.

What actually causes the pain? Well, normally, blood flows through the muscles of your neck and back with very little resistance. However, when you are emotionally stressed, certain muscles may tense up and squeeze these blood vessels. Like a garden hose with a kink in it, the flow of blood can get constricted or even cut off by these tense muscles. When your neck and back are not getting their proper blood supply, they let you know it with pain.

In addition to the temporary discomfort, more serious consequences can result from this stress-related tension. Because the blood carries the nutrients and oxygen that muscles need to function, a reduction in the blood flow can cause the muscles to weaken. They are, in effect, losing their fuel supply, and as mentioned previously, weak muscles are very susceptible to strain and injury. Learn to recognize when your mood and stress level are affecting your physical condition. When you feel that tension, be prudent — don’t decide to rearrange your furniture that day.

After you recognize the emotional stress in your life, how can you deal with it? There are many ways. Try to identify the people and situations that tend to bother you. Maybe you can avoid some of them altogether — that would be the best medicine. In reality, though, some situations and people cannot be avoided, such as rush-hour traffic, deadlines at work, or an unyielding boss. Some anxiety is just part of everyday life.

The next best thing to total avoidance is learning to anticipate these situations ahead of time and making the conscious decision not to let them get to you. You might want to plan a way to make the situation easier on yourself. For example, if you must go to the grocery store at peak hours, accept the fact that there will be long checkout lines, and plan a diversion for yourself; bring a book to read. If you just can’t stand battling rush-hour traffic, plan to work out at the gym for an hour after work. You avoid the traffic, relax your mind, and feed your back all at the same time.

Visualisation is one way to melt away stress

Learn to Relieve Stress

You might want to try cutting down on some of the habits that can aggravate your already stressed out condition. Caffeine and nicotine can have the effect of creating a sense of anxiety even when you aren’t anxious about anything. Cutting down your intake of stimulants may help reduce your stress level.

Of course, there is always the old stand-by method for melting away stress. Find a quiet place to get away; close your eyes; listen to some relaxing music; breathe slowly and deeply; and imagine yourself at the beach, with warm sand, lapping waves, and a gentle breeze. Sounds nice, doesn’t it?

As you can see, there are almost as many ways to prevent back pain as there are bad behaviors that cause it. If you make these suggestions part of your everyday routine, your back should be strong and healthy.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Myth number 4: Everyone’s back pain must be the same.

I cannot think how many time I have had clients into my rooms stating “ I have pain on the left and it was from gardening, jo from next door has the same thing and he said it was the disc”. Whilst this could be true after we assess the area, everyone is different and very individual. A pain that one might describe as the same in type and on the same side/area/distribution could be from a few different sources. Within our brilliantly designed spine we have ligaments/joints/discs/muscles/nerve roots and they could all be injured or inflamed or a combination but due to their close proximity to one another reproduce similar if not the same type of pain. It is always better to get the back assessed by a professional as they can determine which of these things may be causing the primary pain and treat accordingly.

I have found myself writing these down to try and give people an insight as to how their backs operate and hopefully in the process dispel some common ‘myths’, as I call them, about back pain.

Myth number 3: We must strengthen our back muscles to have a strong spine.

Whilst this is very true it is equally if not more so, important to strengthen our tummy muscles. Strong abdominals create a corset effect as they originate from around the front of the tummy to attatch onto the spine at the back. Therefore when activated properly they stabilize the spine at the back preventing any unwanted movements.

If you can imagine the abdominal cavity as a balloon with the spinal muscles at the back and the tummy muscles at the front. If we keep both of these muscles strong then the ballon sits nicely in the middle with no pressure or pull and as we bend over the tummy muscles push our spine up so that all the links remain in line. If our tummy was weak one or more of the links would be able to slide forward out of alignment which could have a painful effect.

I have found myself writing these down to try and give people an insight as to how their backs operate and hopefully in the process dispel some common ‘myths’, as I call them, about back pain.

Myth Number 2: Bending is bad for your back.

Contrary to popular belief bending is a very normal functional movement of the spine. Without this movement how would we bend down and tie our shoelaces, wash our feet,  or get something from the bottom shelf of the fridge…up the back?

The main reason people report they have hurt their back in a bending movement is because that is the type of movement we do most of during the day. There are few jobs or daily activities that require us to lean back at all.  People become fearful of repeating these normal daily movements.

We should realize how important bending is. Bending, all the way to our toes, creates pressure changes through our discs stimulating their metabolism. This slows the discs flattening, keeps the disc walls elastic, prevents the facet joints (joints of the spine) stiffening and allows the spinal cord and its nerve roots freedom within the spinal canal. However, it must be said that you need strong tummy muscles to bend safely.

By Danielle Keogh.

I have found myself writing these down to try and give people an insight as to how their backs operate and hopefully in the process dispel some common ‘myths’, as I call them, about back pain.

Myth Number 1: You must keep your back straight if you don’t want to have an injury.

Throughout my career as a physiotherapist I have had countless clients come in and inform me that they know they have to keep their back straight all the time when bending down or sitting in a chair otherwise they will hurt their back somehow. I must say trying to keep your back straight ALL the time is exhausting and almost physically impossible. Added to this it would more or less start to seize all those beautifully moving parts of the spine like rust invading a hinge creating more havoc than just allowing freedom of movement.

The spine is specifically and brilliantly designed to bend forward and backward, side to side and twist left and right. What it doesn’t really like is a static position. So this can mean in a straight OR bent position. It is just easier for us to slump in a chair or round our shoulders in walking as we are hanging off our bony structure and ligaments rather than using our muscles to hold us up. Like water running down a hill our bodies will naturally take the easier option to get us around, even if it not quite right long term.

Over time we have embraced the term “keep your back straight” as this is the opposite to what we want to do naturally and looks better than slumped over. However we may have taken this term too far and made our spines often rigid in the process.

Of course we all want to have great posture and to maintain great posture we need to be strengthening our tummy muscles. This will help to chock up our spine and allow for free movement.

Low back pain is an increasingly common complaint in modern day society.  It will affect 80% of us at some stage in our lives and, as many of you know, can be quite debilitating.

If you suffer a low back injury there are a few basic steps you can follow that have been shown to speed up your recovery. Try to remain as active as possible, however, you can limit activities that really aggravate your symptoms (often sitting and bending). When sitting avoid sofas, use a cushion or rolled towel to support the lower back. Painkillers and anti-inflammatories as prescribed by your doctor can help you to keep mobile. If your pain is not improving or is worsens after a few days then seek professional help such as physiotherapy.

Physiotherapy can help reduce your pain and get you back to work and normal activities as soon as possible. Physiotherapists use a wide variety of techniques including manual therapy, hydrotherapy, appropriate exercise and advice on back care and how to keep active to help you overcome your back problem as quickly as possible.

In addition to these ‘traditional’ techniques, recent groundbreaking research performed at the University of Queensland has found that retraining of the deep tummy and back muscles by a qualified physiotherapist can significantly reduce pain and disability.  More importantly, they found that retraining these muscles significantly reduced the likelihood of your back pain returning!

Sean Campbell runs the Sunshine Coast Back Clinic where he uses real-time ultrasound imaging to assist in retraining these important muscles.  Once able to isolate the correct muscles the exercises are progressed into a simple home program.  The results of the studies so far have been astounding.

For more information, on back pain or this new research contact Sean Campbell on (07) 5476 9068

One of the favourite TV shows in our house is Mythbusters. There is always great excitement when a myth is “busted ” and the more spectacularly the better. Personally I could watch it just for the moustached guys – they are so cool !

Let’s look at some myths in the pelvic floor, incontinence, bladder and bowel world. I may not have a moustache but hopefully together we can bust some myths and help you get back in control.We will start with incontinence and in future blogs we will look at bladder, bowel, erectile dysfunction,prolapse ,pelvic floor, pelvic exercises and more …if you have a topic you’d like the plain facts on – let me know

INCONTINENCE MYTHS

You have to live with it
BUSTED : 70-80% of cases can be cured, treated or better managed with professional help. This may be as simple as retraining your bladder, strengthening your pelvic floor or learning to use your pelvic floor more effectively. It may require treatment for a bladder infection or prolapse , sometimes surgery may be the solution but there will be a solution or management plan .

It is part of ageing
BUSTED : Skeletal muscle strength and bulk decreases with age but it has been shown in many studies that regular exercise can slow the process so get working on those pelvic floor or Kegel exercises. Take you pelvic floor to the gym , just like your other skeletal muscles : 1-2 kg weights for appropriate arm exercises help to build muscle bulk in your arm muscles , you can help your pelvic floor muscles and pelvic exercises with weights , cones, or biofeedback.
Urinary incontinence has been considered one of the most common contributing factors in the decision for admission to nursing homes – sad statistic for a largely preventable or manageable condition. Early prevention and management strategies could see this reduced.

Only older people suffer incontinence  – what I have isn’t a problem
BUSTED : Incontinence is defined as the involuntary loss of urine that is a social or hygienic problem ( Abrams Cardozo et al 2002). So if you have to wear a liner , change your knickers , stain your underwear or change your lifestyle ( stop yoga,golf etc) you do have a problem. These signs affect people of all ages, both sexes, all cultures – it does not discriminate.
Bo et al 2011 even showed that 26% of pilates and yoga instructors suffered from incontinence – that is 1 in 4 of a population you would normally consider to be younger, active and stronger  

Incontinence is a disease
BUSTED : Incontinence, whether it be urinary or faecal is a SYMPTOM of something going on -not a disease. It may be a urinary tract infection, a prolapse, a weak pelvic floor, damage to the tissues that support the urethra, damage to the urethral or internal anal sphincters …there are many other causes but the incontinence will be a symptom and you need to see a health professional to determine if there is an underlying cause. In many cases it will be a simple solution of retraining the continence mechanisms such as pelvic floor strengthening and bladder and bowel retraining.

So bust those myths and see that you may well be able to cure or treat your  ‘little’ problem so that it is no longer an embarrassment – free yourself up to enjoy life again, no matter how old or young you are !

This information is provided as general interest. It does not replace the advice of your health practitioner and should not be taken as specific advice. Please see your health practitioner for any conditions or queries you may have about your own specific health needs.