Core topic: The thorax

Hello ladies and welcome to another installment of our health blog. This month we are focusing on the trunk, specifically the mid-back region of the trunk known as the ‘thorax’. This is one of the most commonly treated areas of the body in our clinic. It is central to many disorders we see on a daily basis, including neck, shoulder and low back complaints.

Anatomy

The trunk or ‘torso’ is the central core of the human body, out of which comes our arms, legs and neck. The torso can be broken down into three parts: the thorax, the abdomen and the pelvic bowl. The thorax, being the top part of the torso, is separated from the abdomen (the lower part) by a big muscle known as the diaphragm. Above the diaphragm sits the lungs and heart which are surrounded by our protective rib cage. The rib cage is made up of 12 pairs of ribs that (for the most part) attach at the back to the ‘thoracic’  vertebrae in the spine, and at the front to our chest bone (aka the ‘sternum’). It is an intricate part of the body which is made up of lots of joints, ligaments and muscles that all function together to allow us to move and breathe efficiently.

An analogy

woman being massaged helping her thorax and mid-back pain

The thorax, being a large part of our core, plays a pivotal role in the transfer of loads or forces that act on the body when we move. Our body is a unit, so it makes sense that a problem in one area can affect another area distant from that part. The mid-back has close connections to the neck, shoulder, low back and pelvis. If we have pain or are not moving well in the mid-back, then this can lead to problems in all the other areas (and vice versa). We liken the thorax to a train station. The trains coming into the thorax are the various loads or forces that are transferring from other parts of the body. Choo-choo!

A good example here would be if the muscles that span and stabilise the thorax are too tight, too weak, or simply activate at the wrong time in an attempt to handle one of the trains (forces) transferring through the region, the station becomes loud (ouch!) and over-excited. What results is pain and poor movement patterns.

A stiff rib or spinal joint may be able to cope with the loads temporarily, but eventually derailment occurs, and chaos ensues. The same can be said for joints at the other end of the spectrum. An overly flexible joint will struggle to deal with load just as much as an overly stiff joint does. Again, poor movement and pain occur.

The emotion of it all

Treating a person in pain is a complex thing. Yes we have to take into account how someone is moving and what they do daily to increase load on their body, but there is commonly an underlying emotional aspect to a person’s pain that we also need to break into with our treatment. Many women we treat do not realise the effect that stress has on their bodies. Pent up energy from everyday life stresses and difficult work and social aspects, gets stored and held in the thorax region of the body. Common areas we treat here include the tops of the shoulders, ribs and diaphragm. Muscles become tight, joints become stiff, and unless we can help to restore balance to this busy area of the body, the cycle continues with poor movement and painful episodes. When the trains aren’t running on time, it can get a bit much!

Problems in this region can also lead to poor breathing mechanics which can lead to a variety of issues including lack of energy, fatigue, and poor muscle function. A release of the diaphragm muscle under the rib cage can be helpful in releasing the tension and emotion held within us.

Treatment

Every woman we see in clinic requires a specific treatment plan, based on their presentation and needs. Pregnant, young, old, active or sedentary… We listen carefully to every woman who comes through our door before carrying out a thorough examination. Our findings will then help formulate a unique treatment plan which we discuss with each patient in depth before commencing treatment.

For complaints in the thorax, whether it be an angry over-worked muscle, a stiff spinal joint, or a sprained rib joint, we use a combination of:

  • Hands-on techniques to relieve tight muscles and stiff joints
  • Exercise prescription to increase strength and flexibility, and improve movement patterns
  • Postural advice / exercises
  • Stress management techniques to increase a patient’s awareness of their emotional state

Next steps

If you are struggling with mid-back, rib or pain elsewhere in the thorax, please call us today on 08 8443 3355. We’ll focus the spotlight on your busy train station and get things running smoothly and on time in no time at all.

Injury blog: Gluteal tendinopathy

Do you have pain on the outside of your hip area? If so, this blog will be worth a read. This month we are looking at a common issue we see in clinic involving a group of muscles known as the gluteal muscles. These muscles are prone to developing sore tender spots in them, but we are going to focus more on the tendons of these muscles… Specifically on an injury known as ‘tendinopathy’.

Your glute anatomy

The gluteal muscles are found in the hip and buttock region of the body and consist of three muscles altogether. These are:

  • Gluteus Maximus: A large buttock muscle which helps to move the hip backwards and rotate it outwards.
  • Gluteus Medius: A fan-shaped muscle found on the side of the hip between the pelvis and the hard bony ball you can feel a short way down your upper leg on the outside. This muscle helps to move the hip out sideways, as well as rotate the hip and stabilise the pelvis when we walk or run.
  • Gluteus Minimus: Another fan shaped muscle which sits deep to the gluteus medius muscle and performs a similar role.

The tendons of the gluteus medius and minimus muscles, where they attach into the thighbone, are commonly exposed to high amounts of compression and loading, which over time leave them open to injury. We will be talking about the medius and minimus muscles here.

What is tendinopathy?

Tendinopathy is the name we give to an injured tendon, whereby the tendon has undergone physical change, due to excessive loads acting on them when we move incorrectly over a long period of time. An example involving the gluteal muscles is where imbalances in the relationship between the pelvis and thighbone (i.e. from weakness of the gluteal muscles) result in the hip moving in an abnormal and inefficient way. Over time this places excessive strain on the gluteal tendons as the hip moves when we walk or run.

Initially the tendons and other tissues around them respond by becoming thicker, due to chemical changes that are occurring inside the tendon. A thicker tendon is able to cope more with the compression it is under, but there is a downside. During the thickening process, the tendon fibres also become disorganised or deranged, leaving the tendon less able to cope with the force a muscle exerts on it when it contracts or ‘pulls’ on it. As the process continues the tendon becomes more and more degenerated and eventually the tendon is no longer able to adapt to the excessive forces acting on it and a tear can occur. A tear can be the result of an untreated tendinopathy.

Who does it affect?

In the active population, gluteal tendinopathy is commonly seen in athletes, like runners. It is also commonly seen in people who are inactive where the effect of de-conditioning leads to weakness and changes in the way we move. So, you are not safe from this injury even if you don’t regularly exert yourself!

Signs and symptoms

The main symptom is pain on the outside of the hip that comes on without any real obvious ‘injury’ or event. This pain then worsens over time and is usually brought on by weight bearing activities like walking, running and climbing stairs. As with many tendon injuries, you may feel pain at the beginning of an activity, with a lessening of pain as the activity progresses, and then a worsening of pain again after you finish. A common symptom of gluteal tendinopathy is pain experienced at nighttime when lying on the injured side. You may also feel pain that radiates down the thigh to the knee.

Treatment

The good news is if you seek treatment early in the injury process, you can avoid long term complications like tears, which are notoriously much harder to treat. Our advice to you is come and see us as soon as possible after you start to feel pain.

We are extremely well versed in treating gluteal tendon injuries and can get to work immediately. There is a good chance weakness in your gluteal muscles will have been a factor in the development of the injury, as well as a disengagement of the way the trunk, pelvis and legs act together as a unit. Strengthening exercises which focus on building muscle mass, as well as specific exercises to gradually re-load and strengthen the tendon to its full capacity will be key to your recovery. We will also have to re-train your movement patterns to ensure any abnormal movements are corrected. That way we can be sure when you return to your full training schedule, or whatever activity you want, we won’t be seeing you back for the same problem two months down the line.

We may use any number of treatment techniques to help you back to full fitness. These may include massage, joint mobilisation, dry needling and shockwave therapy. So, if you have hip pain, come and see us today – we can help.

Lower back pain and lumbar disc bulge

Hello readers! This month we are going to talk to you about a common low back complaint. Let us paint you a picture. You’re a busy mum that tackles the same daily challenges of getting the kids through their morning routine, school drop off, housework and a day job. It’s hard work, not to mention having this niggly, nagging low back pain to deal with at the same time. Sound familiar?

It’s a scenario we are all too familiar with here at Physiotherapy for Women. We see so many busy mums who are struggling with low back pain, but are just so caught up in the daily grind that they don’t find the time to come get checked out. Usually the pain carries on for some time, then one day they’ll bend down to tie up a shoelace and bang… Crippling pain! It’s often at this stage that people come to the clinic barely able to move and in a very distressed state.

So what has happened?

The scenario of long-standing low back pain followed by a single episode of acute pain (often following a seemingly trivial movement) is common with a lumbar disc bulge. Let us explain what it is, how it happens, and what we can do to help get you back to being super mum again.

The spine is broadly made up of bones called vertebrae and discs that sit between them. The discs are responsible for allowing movement, whilst being strong enough to hold the vertebrae together. They also act as shock absorbers for the varying forces that our body must withstand on a daily basis when we move. Each disc has an outer and inner section. The outer section is a tough and fibrous material (aka the ‘Anulous Fibrosus’ or AF), whilst the inner section is more gel-like (aka the ‘Nucleus Pulposus’ or NP).

A lumbar disc bulge occurs when the NP pushes through the AF and the disc material moves into a space in the spine that it would not normally reside in. This causes inflammation and depending on the severity of the bulge, can press on nerves that run down to the legs. It’s important to point out that discs don’t just spontaneously bulge for no reason. The NP will slowly push through the AF over a long period of time (hence the long standing niggly pain), usually because we have spent this time doing lots of bending and lifting (who doesn’t with kids, right?!), which places high amounts of stress on the discs. Then there is the ‘straw that broke the camel’s back’ moment when things turn worse suddenly (in the example above, it was the tying of shoelaces).

Signs and symptoms

The signs and symptoms of a disc bulge will depend greatly on the level of the spine that is affected. Most commonly, it affects the lowest two discs in the spine. The nerves that exit the spine at each level have a specific role and will run down to serve different parts of the legs. Broadly speaking, you may experience any or all of the following:

  • Low back pain (especially when bending and sitting)
  • Pain that travels down one or both legs
  • Pins and needles, tingling or numbness down the legs
  • Weakness with certain leg movements

A severe disc bulge can lead to more serious signs and symptoms which include problems with your bowel, bladder and sexual function. These are rare but can occur.

Treatment

Recovery from a disc bulge usually takes 3-6 months, depending on the severity. That doesn’t mean you’ll be in pain for that long. Generally speaking, the acute pain from a disc bulge will start to settle within a few days to a week. Inflammation is a process the body goes through when injury occurs and it is vital for our recovery. So the early stages will definitely be the worst, but the good news is things will start to feel better quite quickly with some treatment and by following some simple rules. Coming to see us early on is important because we can educate you from the word go. It is normal in the early stages of an injury like this for people to want to stop everything, including moving, through fear of injuring themselves further. However, it is very important to keep moving! The worst thing you can do is to lie down on a lounge and do nothing all day. They say motion is lotion, and that’s true when it comes to disc bulges. Doing things like heavy lifting and bending is off the cards to begin with, but walking and mobilising the spine regularly is allowed and encouraged.

The injury will have left you with restricted joints and muscle tightness. We will use massage and joint mobilisation techniques to free you up and get you moving again. We will also give you some exercises to start following which we will progress slowly. These will aim to restore full movement to your spine and limbs, muscle tension to normal levels, and strength to the trunk and limb muscles that have been affected.

Many mums we see with this issue have poor core stability, most likely stemming from pregnancy and poor movement and breathing over the years. Being unable to stabilise through the trunk and pelvis during movement will have been the main reason the disc has bulged in the first place. So, it is natural for there to be some core strengthening needed for full recovery and to reduce risk of re-injury in the future. Over time we will start to re-introduce full movement, including bending and lifting. But this time round you’ll be moving well and safely.

If you have low back pain, we recommend you come to see us at the earliest possible convenience. Don’t wait for the big bang as recovery will be longer. Give us a call today on 08 8443 3355.

Wrist and thumb pain after pregnancy?

young mother holding newborn babyIt has been a long journey and you’ve been through a lot over the last 10 months. You’re already exhausted and you’ve only just started your life with a new addition to the family. Life doesn’t get much busier than this, right?! How frustrating then that you’re having to battle through this new period with a sore wrist and thumb. If it’s any consolation, you’re not alone. One study from 2017 reported over 50% of women experienced wrist pain following delivery of their baby, and over 80% of those still had pain two months on. Read on to find out why.

The most common cause of wrist and thumb pain after pregnancy is a condition called De Quervain’s Tenosynovitis. That’s a bit of a mouthful so let us explain simply. There are a few different tendons which run from muscles in the forearm along the thumb side of the wrist, which act to move the thumb away from the hand when the palm is held out flat. The tendons are covered in a thin ‘sheath’ of tissue which provides important lubrication to allow for smooth movement. On their journey from the forearm, the tendons and their sheaths have to pass through a little tunnel, made up of bone and soft tissue. In De Quervain’s, the tendons and/or sheaths become thickened and this leads to problems with movement through the tunnel.

It is thought that new mums are at higher risk of developing this condition due to the repetitive nature of lifting and holding their baby. These movements put the hand, thumb and wrist into a compromised position and increases strain through those tissues. It has also been suggested that increased fluid retention and hormonal changes following pregnancy could also be involved in the development of this condition.

Another common cause of wrist and hand pain following pregnancy is Carpal Tunnel Syndrome. This condition involves the pinching of a nerve as it passes through the wrist. This is different from De Quervain’s in that a patient will experience pins and needles and/or numbness in the hand as well as wrist pain—a blog topic for another month!

Signs and symptoms

If you develop this condition you can expect the following:

  • Pain and/or swelling around the base of the thumb, and thumb side of the wrist
  • Pain increased by thumb and wrist movements
  • Pain associated with gripping, lifting and twisting objects
  • Popping/clicking with wrist movements (in severe cases)

If you are reading this and alarm bells are already ringing, then you may want to consider giving us a call to book an appointment. We can help you with this problem so read on to see what treatment we offer.

Treatment

As this is a busy time of your life, our aim will be to get you out of pain and functioning as soon as possible. After all, you have a little one to prioritise now and it’s not like you can just stop parenting to allow your body to heal. Fortunately, you don’t have to. Our treatment for De Quervain’s may include any or all of the below options:

  • Rest and splinting: In the initial stages, you may need to alter how much you do with your wrist and thumb. Getting some extra help around the house from friends and family may help to take the load off. Using feeding pillows to support the baby during meal times is another way to reduce your ‘holding’ time. Wearing a splint or brace can help to reduce aggravating movements in key areas of the wrist whilst still allowing you to move and perform your everyday We may fit you with one of these if we think it is necessary.
  • Massage and joint mobilisation: To release tight muscles and restore range of motion to the hand, wrist and forearm joints.
  • Taping: To support the wrist or aid with drainage of the wrist area back up the limb towards the heart.
  • Stretching: To combat any tightness of the hand and forearm muscles. You’ll also need to do some of these at home.
  • Graded strengthening exercises: Evidence is pointing more towards gradual loading exercises to rehabilitate the tendon and restore full movement and strength to the tissues.

Other treatment options include therapeutic ultrasound and corticosteroid injections for pain relief. For severe or persistent cases that don’t respond to a more conservative approach, a surgical opinion may be required. We will always work hard to ensure you don’t reach that point because the recovery is always longer and it means a time period where your function will be much reduced, which is always difficult when you have a little one.

Our advice to you is to not let it get to that in the first place. No matter how trivial you think it is, if you start to feel pain in your wrist in the early days of motherhood, please get in touch with us here at Physiotherapy for Women. We can put all of the above in place straight away to avoid your pain getting out of control. That means more time for you and your baby. What could be more important at this time?

See you next month!

Knee pain: The ins and outs of patellofemoral pain

Do you get knee pain? Well this month we are looking at the knee joint and specifically talking about patellofemoral pain. So what does the word patellofemoral actually mean? You can break it down into ‘patello’, which refers to the knee cap, and ‘femoral’ which refers to the long bone (the femur) that runs down your thigh from your hip to your knee (remember, the thigh bone connects to the leg bone, the leg bone connects to the ankle bone, and so on!). The connection between your kneecap and thigh bone is called the patellofemoral joint and we’re going to look at some of the problems associated with this part of the body.

The phrase ‘patellofemoral pain’ is an umbrella term for many causes of pain at the front of the knee. The knee is a complex joint made up of lots of different parts, ranging from the bones that form it, the ligaments that hold the bones together and the various soft tissue parts that form and cross the joint, such as joint capsules, muscles, tendons and fat tissue. All of these (and more) can be involved in pain at the front of the knee.

Knee anatomy

women holding sore knee

The knee can bend and straighten, as well as twist and shear forwards and backwards a little. When our knee is straight, the kneecap, which is held over the knee within the tendon of the quad (thigh) muscles, sits over the end of the thigh bone. As we bend our knee, the surface of the knee cap and end of the thigh bone come closer together and slide over each other in a lovely smooth way, allowing us to perform movements like squatting, jumping, walking and running (basically anything that bends the knee) more efficiently.

What are the causes?

The main causes of patellofemoral pain include overuse of the various parts that make up the knee, or problems that affect the smooth gliding or ‘tracking’ of the kneecap over the end of the thigh bone while moving.

With an overuse issue, think of a person who spends their days walking up and down stairs, or having to squat down constantly. The constant bending and straightening of the knee can lead to overloading of the joint and surrounding tissues, leading to irritation and pain. Another example is that of a runner who may start to get knee pain having recently increased the distance or the amount of days in the week they run.

As we mentioned earlier, the kneecap is held within the quad tendon as it crosses the knee. The quads attach higher up at the pelvis and hips, and down below on the shin bone. So it makes sense that any issue that affects the back, pelvis, hips, ankle and feet can all lead to poor or incorrect tracking of the kneecap over the joint. Common issues here include muscle weakness of the glutes (buttock), quads and lower leg muscles, a twisted thigh or leg bone, and weakness in the ankles and feet, such as having a collapsed arch of the foot. Some people also have a misshapen kneecap, or one that doesn’t sit perfectly over the joint as it should, which can affect the line of tracking over the joint. Throw in having to consider a person’s size and weight, how they walk and run, and the types of footwear they use, and you can see there is a lot to consider.

Unfortunately ladies, this is one of those conditions that affects us more than our male counterparts. Researchers believe this may be because we tend to have wider hips than a man (yep, thanks for that). A woman’s wider pelvis increases the angle where the bones in the knee joint meet. Therefore, leaving more room for imbalance, misalignment or issues moving. Interestingly, research exists that looks into the link between the menstrual cycle and knee pain in women. Whilst the evidence is not 100% conclusive, it is believed that during the different phases of the menstrual cycle, sex hormones can affect the activation of the thigh muscles (quads) and how the body’s nervous system functions during lower limb movement, leaving a woman at potentially higher risk of injury in the knee region. Watch this space… When research catches up, we’ll fill you in on the finer details! What doesn’t break us, makes us stronger eh!

Treatment

So, what can we do to help? Well prevention is key at first:

  • Make sure you’re strong
  • Think about correct knee alignment when walking, running, stair climbing and so on.
  • People within a healthy weight limit also tend to experience less pain.
  • When starting an activity, increase intensity gradually.
  • Always warm up properly.
  • Keep up those stretches!

But if you do have knee pain, it’s best to source help to find out what is going on. Because there can be a variety of reasons for knee pain, there is, of course, a variety of treatments. Here at Physio for Women, we assess all knee pain in a consultation. We figure out what is causing the issue, and help you fix the underlying cause. This could be treatment via massage or other manual therapy techniques, strengthening or stretching exercises, postural alignment work and more.

So, there’s no knee-d to be experiencing knee pain! Come and see us and we’ll get you hopping, skipping and jumping back to normal in no time.

Ab separation in pregnancy: Diastasis what now?

Are you pregnant, or have recently been pregnant? Are you now internet trawling trying to find out what this abdominal separation thing is everyone keeps telling you about? You’re overwhelmed and busy enough either preparing for, or experiencing, newborn life to worry about ‘how many centimetres is yours?’ And rightly so. But it is important to look after yourself, so you can get your strength back, and avoid issues down the track like bulging belly and back pain. So, here’s a quick run down of what ab separation is and how you can treat it.

diastasis recti imageWhat is an abdominal separation?

An abdominal separation, or in medical terms, a ‘Diastasis Recti’ (yes, we prefer the non-medical term too), is a separation of the abdominal muscles. This regularly occurs in women during trimester three of pregnancy and can also affect them post-pregnancy.

Picture your ‘six-pack’ or ‘Rectus Abdominus’ muscles. There they are in all their glory (maybe just in your head, and that’s OK) – pairs of muscles nicely lined up, down the front of your belly region. These strips of muscles are separated by a piece of tough connective tissue called the ‘Linea Alba’. So your body can expand during pregnancy, the Linea Alba widens. This creates a gap between the two strips of rectus muscles. This gap can be felt by lying your own hand flat on the abdomen. If a person can fit two or more finger widths in this gap, that person is said to have an abdominal separation. Please note this is a very rough guide. We always advise to get an experienced health professional’s opinion when testing this.

It’s also not just pregnant women who get this problem… Post-menopausal women, newborn babies and men can also develop abdominal separation.

What causes it?

Contrary to popular views, being pregnant is not the cause of this issue (remember, men & babies can get it too), although it is a contributor. It is caused by excessive increases in intra-abdominal pressure. Yes, having a growing uterus inside you can lead to increases in abdominal pressure, but so can pushing during delivery, straining on the toilet, and obesity. A newborn may develop this issue due to under-developed abdominal muscles, but this will usually resolve itself with time.

What does it mean if I have ab separation?

There is debate over what the side effects of having an ab separation are. Most commonly you may notice a bulge appear in your belly when you try to sit forward, stand up or lie down. Often described as a ‘pouch’. After pregnancy, you may be left with a bulge in the belly region that may give the impression you are still pregnant. Evidence for anything else is limited, but you may experience abdominal pain, postural issues, bloating or constipation. Not so fun! Many people believe having an abdominal separation increases the risk of pelvic or low back pain, but while we see this in our clinic, there isn’t any hard evidence supporting this claim. Having a separation could also impact your core stability, which could lead to other problems like breathing issues or low back pain.

Can it be treated?

The short answer is yes, but it may not have to be. Some minor abdominal separations require very little intervention. A more severe separation may well require the help of a trained physio (ahem, why hello there!) and giving of rehab exercises. It’s not just a simple case of doing a load of sit-ups or crunches to get those abs back. Sorry! Did you know sit-ups and crunches will increase your intra-abdominal pressure? So, these exercises are not a good idea at this stage as they could make things worse… But that’s not to say you won’t get back to them!

Rehab requires working on your pelvic floor and deeper abdominal muscles. We will also address any breathing problems you may have with breathing exercises, as getting your diaphragm muscle and ribs to function correctly is also very important.

It is not always straight forward and not every exercise will be suitable for every person with an ab separation, so we recommend you book an appointment to see us first. We will be able to assess you accurately and get you on the ideal program for you, as well as advise you on all the do’s and do not’s about movement, lifting and general exercise.