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Hip and knee pains can occur due to injury or for any number of reasons and therefore it is important to always visit your practitioner for diagnosis and advice so that you can obtain the correct treatment for your condition.  However, here is a little self help advice that may just help you relieve some tight tissues that can result in hip and knee dysfunction and pain.

This video demonstrates two stretches that are common culprits for these complaints. (It may appear that the video has been cut short and in a way it has; I shortened it as I was speaking too much with information that may have confused you.) The first stretch is for the Psoas muscle and the second stretch is for the TFL/ITB. The only thing you may like to add to the second stretch, to make it more effective, is to raise the arm toward the ceiling, on the same side that you have the knee in contact with the floor.

1/ ILIO-PSOAS STRETCH

The ilio-psoas muscles are one of the major postural muscles; it is the main hip flexor whose origin is the anterior (front) surface of the 12th thoracic to the 5th lumbar vertebrae of the spine and attaching to the lesser trochanter of the femur (thigh bone).
Anterior_Hip_Flexes_ilio-psoas-muscles

When these muscles are tight/dysfunctional they prohibit you from taking a full stride, altering the movement of lumbar vertebra, this can lead to lower back pain, increased lumbar lordosis or an antalgic stance as well as possible hip/groin pain or, in guys (obviously), testes pain (read this if this is of interest to you).

2/TENSOR FASCIA LATAE

The tensor fascia latae (TFL) muscle originate from the iliac crest and insert into the iliotibial band (ITB); aiding in hip stabilisation, flexion and abduction. The ITB runs along the lateral or outside aspect of the thigh, to the lateral condyle of the tibia, or bony bit on the outside of the knee; crossing both the hip and knee joints. The TFL is an important stabiliser structure of the lateral part of the knee as the joint flexes and extends and therefore, they can cause a lot of hip and knee problems.

Iliotibial Band Syndrome

Iliotibial Band Syndrome

SELF-TREATMENT 

Soft tissue work – with your prickly ball or jack-knobber or foam roller (READ MORE HERE)- (we carry all of these at the clinic).

Increase flexibility – by doing daily stretches demonstrated in the video at the beginning of this blog.

Strengthening exercises – stretching is not going to do it all. The mentioned muscles may be having to work too hard because they are compensating for other muscles that are not firing properly. A plan of exercises to strengthen these involved muscles is needed. Your practitioner will be able to tell you which muscles are involved. The most commonly involved muscles are weak gluts as well as foot pronation causing incorrect alignment and function. However, please visit your practitioner as she/he will be able to advise you.

Hope you find this helpful.

Written by Anne French, BSc(Hons), MSc Chiropractic, D. C.

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With the kids back at school and sanity returning to many of my patients lives I figure this is an optimal time to attempt to get you interested in a good exercise routine to counter poor posture. This will be especially beneficial for all those office workers or anyone spending a lot of time in front of a computer but to be honest, I can’t think of anyone who wouldn’t benefit from this exercise. Also, the great thing about the Brugger exercise, IT ONLY TAKES 10 T0 15 SECONDS.

This seems to be the posture of our age:

How not to sit.

How not to sit.

I’ve talked about it before; the head is carried in front of the body, the shoulders are rounded forward (and possibly worn as earrings). This posture also known as Upper Crossed Syndrome. It usually accompanies upper back (thoracic) pain/stiffness, neck pain/stiffness, cervicogenic headaches and many times, low back (lumbar) pain. This posture also affects your breathing, encouraging excessive use of accessary breathing muscles (that should only be used under times of physical stress) of the neck and shoulders instead of using your diaphragm.  I have previously written a whole blog on this condition, complete with exercise videos on how to counter it to which I have recently added further videos. So please feel free to follow this link to read the updated version.

Now let’s get on with the ‘how to’ of this exercise:

You can do this exercise either seated or standing. I think it is easier at first to do it seated. Your posture before you start the Brugger is of upmost importance so check out the video in case my written instructions are not clear enough:

Seated

  • Sit perched towards the edge of your seat; this will naturally place your lower back into a curve (lumbar lordosis) with your butt sticking out a little. As you do this your breastbone (sternum) will naturally lift up.
  • Separate your legs to 45 degrees each side with your feet turned out slightly and in line with your knees
  • Your shoulders are relaxed and down with your chin tucked in, making the back of your neck longer – imagine a piece of string is attached to the top of your head and someone is lifting you up.
  • Fully straighten (extend) both elbows. Make sure you keep your shoulders down and imagine your shoulder blades [scapula] are pushing together and down into a V.
  • Turn your thumbs out (externally rotate), palms up.
  • Separate your fingers.
  • Hold for 10 – 15 seconds. Repeat 2-3 times per hour.

Standing

  • Stand with legs slightly apart; feet in line with hips.
  • Find a neutral pelvic position; you can do this by finding the centre between the extreme of tilting your butt out and then tucking your tail under. As you do this your breastbone (sternum) will naturally lift up.
  • Your shoulders are relaxed and down with your chin in making the back of your neck longer – imagine a piece of string is attached to the top of your head and someone is lifting up.
  • Fully straighten (extend) both elbows. Make sure you keep your shoulders down and imagine your shoulder blades [scapula] are pushing together and down into a V.
  • Turn your thumbs out (externally rotate), palms up.
  • Separate your fingers.
  • Hold for 10 – 15 seconds. Repeat 2-3 times per hour.

For those of you that like it – the science bit!

This clever exercise was developed by a Swiss Neurologist, Alois Brugger MD and the ‘science bit’ is throughout Janda’s work, who first named Upper and Lower Cross Syndromes.

This exercise is clever because it’s not your usual straight stretch or strengthening exercise; it works neurologically and does both in a way that is complementary to the way your body is wired to work.

Our bodies are neurologically much stronger in all of our flexor muscles. This is displayed perfectly if we look at a person with a neurological disorder, e.g. cerebral palsy; their body naturally has increased tension (hypertension) in the flexor muscles, also known as the spastic posture. This demonstrates our natural prosperity to an Upper Cross Posture.

Now muscles work in groups. When one group is working then the opposing group are unable to work (inhibited).  An easy example to visualise of this is when you place food in your mouth. To do this you flex your fingers, wrist muscles, bicep muscles and pecs., all flexors. However, to be able to do this you have to inhibit your finger extensors, wrist extensors, triceps, rhomboids etc. This is called reciprocal inhibition. If you were unable to do this you would be unable to feed yourself.

The Brugger exercise works on the principal of reciprocal inhibition. When doing this exercise you are activating all your extensor muscles and therefore inhibiting all of your (usually hyper activated) flexor muscles. Clever or what?

Take a Brugger Break

If you are a patient of mine, you have probably heard me say the following; regardless of what chair you have at work, one of the best things you can do to counter back/neck pain from sitting in front of a computer is to stand up, walk around your chair and sit down again and to do this every 20 to 30 minutes. Please add the Brugger exercise to this healthy habit. It only takes 10 – 15 seconds and will reduce tension, improve breathing and improve posture. The best way to remember to do this is to put a reminder/alarm on your computer.

Written by Anne French

The summer has come and gone and it’s time to get the kids back to school.

A study conducted by the BCA in 2008 found that 45% of children had already suffered with some kind of back pain by the age of 11. Why? Well the same study also found that 72% of Britain’s kids are carrying around heavy books and sports equipment for most of the day. Plus, the world has changed and therefore, so has the stresses and strains on our children’s bodies.

So the real question is – what can we do to improve our children’s posture and health?

Well – quite a lot actually.

1. Bag
– The best way to carry all those books is in a rucksack, where the straps are adjusted so that the bag is held close to the body and the weight is distributed evenly over both shoulders.
– Keep the weight of the bag as low as possible so only pack necessary items.

2. Exercise
– Encourage your child to get off the couch and exercising. Regular exercise will result in a fitter child which means your child will have less chance of injuries.
– Walk or bike to school if possible.

– Richard Husseiny wrote a great blog on this early in the year. Definitely worth a read

3. Computer/gaming

– Make sure your child is sitting comfortably and their spine is supported.
– Put an alarm on the computer so that they get up every 20 to 30 minutes and just walk around their chair before they sit at the computer again.
– Most importantly – limit the time on the computer.

4. TV

– Limit the time spent watching TV.
5. Diet
– Give them real food, not pre-cook/processed food. Buy it, cook it, and eat it.

If you would like us to check your child’s posture for the start of the school year, you are in luck as Richard Clements, Osteopath and myself, Anne French, Chiropractor, are offering Free Posture Checks for the month of September. Call the clinic to book your child’s now.

Written by Anne French

As a garden loving nation with the spring and summer months upon us, the longer daylight hours beckon us out into the garden. Always a great time for people like myself as we are usually very busy trying to deal with the sudden increase in patient numbers due to over exerted joints strained by being in awkward positions for too long.

A tulip from the clinic garden (thanks to the tender care of Neil)

Whilst gardening is a great way to keep physically active, it is worth noting that an estimated 3,900 people each week end up in hospital following accidents or injuries caused in the home or garden.  The main causes of injury are twisting awkwardly, stretching, and overuse of joints and ligaments in the spine causing pain, inflammation, and muscle spasm (rubbing my hands together).

Help is at hand! 

By following a few simple guidelines most injuries can be avoided and your passion can continue painlessly:

  • Try to make sure that any materials are delivered as near to the area where they are to be used to avoid unnecessary lifting.  If you need to move them at any point always ask for assistance.
  • When lifting heavy materials such as paving slabs, keep them close to your body with your knees bent, keeping the legs well parted and the back hollow with your buttocks sticking out.
  • Avoid digging hard soil, it is better to wait until after rain when the soil  is softer
  • Always kneel with one leg rather than two.  This avoids placing strain on the back.  If you have knee problems or find it difficult to stoop, use a gardening cushion or stool and try to keep the back hollow.
  • Vary the tasks.  Change your activity after 20 minutes as different activities will use different muscles.  You can always return to an activity several times until it is complete.
  • When mowing use a backwards and forwards motion and avoid swinging the mower side to side
  • Keep warm – warm muscles work better and injure less!
  • Avoid over reaching when pruning and weeding
  • Do not ignore pain – stop if you begin to ache and if it continues see your chiropractor/osteopath/sports therapist/acupuncturist (we could carry on).
  • Take regular breaks!

Warming Up

It is always important to do some warm up exercises before any exercise.  The best form of warming up is walking. The following gentle exercises to stretch and improve the flexibility in the muscles are a must and should be repeated before and after a period of gardening.

Knee to Chest Stretch

Lie on your back with your legs straight out in front of you.  Bring one knee up to the chest and grasp the back of your thigh.  Pull your knee towards your chest stretching your buttock muscle.  Repeat but this time; pull the knee to the opposite shoulder.  Repeat exercise with the other leg.

 

Stretching the Thigh

    

 

Stretching the Inside of the Thigh

Hold for 10 seconds and repeat 3 times.

 

Back Extension

Lie face down with your hands in the small of your back.  Slowly lift your head and shoulders off the floor just a couple of centimetres until you can feel your muscles working and hold for 5 seconds.  Repeat 5 times.  This exercise helps to strengthen the back muscles.

Cat Stretch

Kneeling on all fours, relax the back and let it go hollow.  Then arch the spine, effectively reversing the curve in the back.  Repeat 3-5 times.

Thigh Strengthening

Resting your back straight against a wall, move your feet out 12 inches.  Squat downwards slowly until your legs are at 45 degrees.  Hold for 10 seconds and repeat until your muscles feel worked.

For the Buttocks

With feet a few inches apart, tense the buttocks for 5 seconds and release and repeat 5 times.  This exercise can be done anywhere and should be practiced throughout the day.

Tensing your Stomach Muscles

Without taking a breath in, practice hollowing your stomach towards your spine by tensing your stomach muscles and hold for a least 5 seconds.  Repeat 5 times.  This exercise can be done anywhere and should be practiced throughout the day.  It is an excellent way of supporting your back during exertion.

Remember, prevention is better than cure – a regular exercise routine and stretching allows you to enjoy your activities even more!

Written by Anne French

A while ago I wrote a blog on Upper Cross Syndrome, complete with exercise videos on how to counter it. I said at the time that I would also write one for Lower Cross Syndrome – and finally – here it is!

I don’t want to repeat the same information so I suggest you look at the first blog here to get the full explanation as it’s good to understand why you are doing something(it means you are more likely to do it). The same rules apply – you need to stretch the hypertonic (tight) muscles first before you do the exercises to strengthen the hypotonic (weak) muscles. The stretches are really important, so don’t miss them out!

Here’s a picture to help you visualise the posture (or you could possibly look in the mirror).

As with Upper Cross Syndrome, certain muscles are tight (hypertonic) while others are weak causing a posture that is results in pain, looks unattractive and is very common if you start looking for it.

And here is the list of muscle involved with Lower Cross Syndrome.

Tonic Muscles

Prone to Tightness or Shortness

Phasic Muscles

Prone to Weakness or Inhibition

Gastroc-SoleusTibialis PosteriorHip Adductors

Hamstrings

Rectus Femoris

Iliopsoas

Tensor Fascia Lata

Piriformis

Thoraco-lumbar extensors

Quadratus Lumborum

 

Peroneus Longus, BrevisTibialis AnteriorVastus Medialis, Lateralis

Gluteus Maximus, Medius, Minimus

Rectus Abdominus

 

These are very important, large postural muscles that are possibly functioning incorrectly but with the correct stretching and strengthening exercises these muscles can improve in function which will result in improved musculoskeletal function and pain reduction (if not pain elimination).

So – let’s start!

We are going to start with the foam roller on the IT Band.

You can use these rollers for most muscles groups to work out the knots so experiment. (And yes – it really should be that painful to start with but the pain recedes quickly if you keep doing it regularly). You can also use them for core strengthening exercises. We sell these at the clinic and quite honestly, I don’t know how I survived before I had one of these. They are very versatile and extremely effective. My advice would be – get one!

Now we are going to S-T-R-E-T-C-H.

We are starting with the calf muscles. Here is a simple stretch of the Gastroc and Soleus Muscles that you can do anywhere (you will also get the Tibialis Posterior slightly).

This next video demonstrates how to stretch the hip Adductors which are the large muscle group of the inner thigh.

Now for the Hamstrings.

And then the opposing muscle from the Quadratus group of muscles, the Rectus Femoris. Make sure you tuck your tail under for this one – then you will really feel it.

This next video demonstrates how to stretch the Iliopsoas and also the Tensor Fascia Lata. This last muscle goes into the IT Band so don’t forget to foam roll first.

Here are a couple of stretches for the Piriformis. Always a favourite!

And this video shows stretches for the Quadratus Lumborum and Thoraco-lumbar Extensors.

Okay – stretching done, now we can start strengthening the opposing muscles. We will start with the Tibialis Anterior (don’t want to confuse you with an exercise for the Peroneus muscles so we will stick with this one at the moment). You need a resistance band (which we sell at the clinic) or something that will add resistance to the muscle as you work it. As with any strengthening exercise you need to do sets of repartitions and increase the number of reps and/or sets as you get stronger e.g. start with 3 sets of 10 repetitions? Here’s how…

Now for the Gluteal muscles and here’s Rich demonstrating how.

And another…

And lastly, here is a good way to start working your abdominal muscles.

If you follow these recommendations you have the opportunity to have great posture, wonderful musculoskeletal function resulting in less chance of injury and pain.

You have a wealth of knowledge available to you from all the practitioners at Coast so take advantage of us. We are here to help you reach your goals, whatever they are.

Written by Anne French, Chiropractor

Posture – it is part of the first impression that you make to the outside world and it says so much about how you feel about yourself. Poor posture is highly prevalent in our society and one of the most common incorrect postures you will see if you start checking people out (or look in the mirror), is this –

Anterior Head Carriage

Now this famous woman is a perfect example of someone who carries her head before her body, also known as anterior head carriage. Many people walk around like this; it’s as if they are already somewhere else or trying to be, never actually present.

Ideally, a person’s ear should be in line with their shoulder and their shoulder should be in line with their hip. For every inch the head is forward from its natural position, it is twice as heavy and heads are really heavy to start with. This results in muscle imbalances as they strain to keep the head in position. In this posture, because the head is anterior, it naturally tilts forward resulting in the small muscles at the base of the neck, called the sub-occipitals to tighten, to enable the head to tilt up so that the person can see around them.

Upper Cross Syndrome

This is a further photo of the same woman showing another posture that commonly goes with anterior head carriage; here, unfortunately, she looks rather glamorous but the reality is her shoulders are forward and her scapula (shoulder blades) are winging (sticking out). This is due to hypertonic (too strong) muscles of the chest and hypotonic (weak) muscles of the back. This posture was first named by Dr. Vladimir Janda, a Czech neurologist and physiatrist, as Upper Cross Syndrome.

Janda’s approach is based on the function of the body rather than just the structure. Through observation and electromyography tests he concluded it was not just the strength of the muscle that was important but the sequence of the firing of muscle contraction, therefore an interdependence of the musculoskeletal and central nervous system, termed the ‘sensorimotor’ system, or lack of it, that was of great relevance and could predict injury patterns of a patient. Changes within one part of the system are reflected by compensations elsewhere within the system as the body tries to reach equilibrium (you’ve probably heard me say this one way or another, many times as I work on you). Janda noted that these changes in muscular tone create muscle imbalance, which leads to movement dysfunction that can result in pain elsewhere in the body and possible degeneration (wear and tear) of joints. Therefore, it is important to determine the cause of pain rather than just treat where it hurts.

I don’t want to bore you by getting into too much detail so hang in there, this is worth knowing.

The human body can reasonably be divided into two muscle type groups, Tonic and Phasic. The Tonic muscle group is made up of flexor muscles and this group is phylogenetically older and more dominant than the Phasic muscles. The Phasic group are extensor muscles that emerge shortly after birth and activate to resist the forces of gravity. Due to the dominance of the flexor muscles, they tend to tighten becoming shorter, whereas the extensor muscles are flaccid and therefore are weaker and have less tone. This can be observed when there is neurological damage e.g. a person with cerebral palsy or a cerebrovascular accident (stoke), the more dominant flexor muscles go into spasm producing a spastic posture.

Here is a table of Tonic and Phasic muscles.

Tonic muscles Phasic muscles
Upper limb flexorsStenocleidomastoid

Scalenes

Levator Scapulae

Upper Trapezius

Pectoralis major

Upper limb extensorsDeep neck flexors

Rhomboids

Serratus Anterior

Lower Trapezius

Now what this all really means is – many people have incorrect muscle patterns resulting in a combination of tight and weak muscles and commonly, in the upper body, the pattern of imbalance looks like this (I think a picture always helps):

Now you know what I’m talking about, don’t you? So what can be done about it?

Well, Janda determined that a tight, shortened muscle can inhibit its opposing muscle e.g. tight pectoral muscles will result in a weak serratus anterior muscle. And the good news; Janda also determined that many times just stretching the tight muscle allows the opposing muscle to function better. Therefore, the first step to counter Upper Cross Syndrome is to stretch the pectoral muscles.

Pectoralis stretch – In this video, Rich is demonstrating just that! 

Now how to strengthen the weak extensor muscles-:

Deep neck flexors – by doing this exercise, you are also stretching the tight sub-occipital muscles.

Wall Angel – stand with your back against a wall and your feet a shoes length away from the skirting board. Keep your spine, including your neck, against the wall. To do this you need to keep the ribcage/diaphragm down by activating the abdominal muscles and not let the ribcage lift as you put your arms into position. Many people can’t get into position, let alone do the exercise. Don’t give up, just keep doing it and you will improve. Here is Elke demonstrating the exercise.

Holding a Platter 1  for those that find the Wall Angel too difficult at first, try this is exercise and then progress to the one below.

Holding a Platter 2 – once you can do this exercise well then progress to the Wall Angel.

Prone Angel – here Rich is demonstrating another way of doing the Wall Angel for those people that find it hard to get into Wall Angel position (but don’t give up on Wall Angel). 

The Y exercise – it is important with this exercise not to lift your shoulders to your ears as you stretch out your arms. Don’t activate the Upper Trapezius muscles; keep those shoulders down. Here is Elke showing us how to do it.

Serratus Anterior – this is a difficult exercise to do correctly but it’s really important as the weakness of this muscle is usually the foundation of most shoulder problems. The biggest mistake people make is they just move their shoulder blades together and apart but the exercise is about moving the blades down and to the side. (It’s also difficult to explain) Here it is demonstrated really well by Rich.

New Addition – this is the latest video addition for the Serratus Anterior – think you may find it easier to understand, feel and do.

Brugger Exercise this exercise can be done either sitting or standing (please follow this link for the whole story)

Now obviously along with these exercises, body treatments such as Chiropractic, Osteopathy, Sports Therapy, Acupuncture and Massage really benefit to activate the sensorimotor system. Treatment and exercise, including Pilates, Yoga or Qi Gong, are the perfect combination to facilitate correct sensorimotor function and to improve your posture.

So that’s the top half of the body done. How about the bottom half? (Here’s the link to Lower Cross Syndrome).

Written by Anne French

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