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.

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.

Back pain in new mums

Mother’s Day is just around the corner, so we wanted to dedicate this blog to all the mum’s out there. Being a mum is a tough job for anyone. Juggling work, keeping a home, family and friends, and of course caring for your little ones, can be draining both emotionally and physically. This is especially the case if you are a new mum, when life with your new addition is in its settling in period. Your body has been through a major change over the last 10 months, and it’s still changing now. Having a baby is a big deal, and you now have a recovery period ahead of you. But of course, you have a child to care for constantly, so there’s no time to worry about yourself, right? Wrong… it’s a difficult balance for sure, but looking after yourself means you’ll be able to look after your new recruit to the very best of your abilities.

My back STILL hurts 🙁

Mum holding baby on bedPain is a common symptom experienced by new mums, with approximately 10% of women still experiencing pain two months post-delivery. Imagine being in pain all that time AND having a baby to look after – it doesn’t sound fun does it? Now, whether you’ve been through a natural birth or c-section, your body is vulnerable and weaker than pre-pregnant you, so it’s important to look after yourself to ensure you recover quickly and nip that pain in the bud!

The back is one of the most common areas of the body affected during and after pregnancy. Other areas include the pelvis and the wrists. The main reasons your back will complain in those early days boils down to the fact your posture won’t have a clue what has just hit it. Firstly, during pregnancy, ligaments become lax, muscles stretch or separate, which can produce imbalances or weakness. Even your breathing might change, depending on where bub is sitting in your uterus. Then of course your body is frantically trying to realign your centre of gravity to deal with your growing bump. Your body is working like crazy simply to keep you upright!

Then baby comes along. Of course, there’s the trauma you may experience with a vaginal or cesarean birth. Then, straight away, you will be feeding, changing, bathing and dressing/un-dressing your bubba multiple times a day. All these activities require you to have your baby lying down in front of you, with you bent over them, keeping them fed, warm, and happy. This continuous motion, combined with broken sleep, tiredness, and a recovering body, can lead you to over-work those back muscles. It’s also important to remember that your core muscles will have taken a big hit during pregnancy, so you won’t be as stable in the trunk as you were pre-pregnancy. Eventually your body will let you know things are not right by sending a few signals to the brain – hello pain!

What can I do to help?

Now you know why you may experience back pain, we want to let you know some of the things you can do from the very first day you bring your newborn home, to care for your back (and the rest of you of course), and reduce the risk of injury and pain. That way, you can dedicate 95% of your time to looking after your son or daughter. “Only 95%” we hear you ask – don’t worry, we’ll get to that!

Feeding tips

To reduce the impact of feeding on your back, consider the following tips:

  1. Get a comfortable and supportive feeding chair: Avoid chairs that allow you to sink into them, such as a low arm chair or sofa. You will struggle to get yourself up from a slouched position, whilst holding your baby, without risking strain on your back and shoulders.
  2. Move regularly: Enjoy the one on one time, it’s magical! But, when you sit for long periods, your back and neck muscles will eventually feel it. Try some light neck stretches, and gentle spinal movements like rotating side to side and extending to open out the chest.
  3. Try a feeding pillow: As your baby grows, they will get heavier and heavier. A feeding pillow will take the weight of your baby so your arms, shoulders and back don’t have to bear the brunt of it all.
  4. Get your partner involved: If you’re a bottle feeder, then spread the load and ask your partner (or another family member) to feed when possible to give you a break. If you are breast feeding, they can still help by taking the baby from you when you have finished so you can get yourself up off your chair, minus the weight of your baby.

Changing tips

Oh so many nappies! “I didn’t sign up for this!” Ahem, sorry, yes you did! Just embrace the poo… It gets easier ;). The following tips also apply for dressing your baby:

  1. Get a change table: Whether it’s a nappy change or outfit change, do it at a height where you can stand comfortably and not be bent over for long periods.
  2. Following on from the above point… Avoid changing your baby on the floor. It’s not only your back that might complain, but your neck, shoulders and knees also!

Bathing tips

There is no easy solution to this one. Most baths are low to the ground and require you to kneel and lean right over to get to where you need to be. However, we have found that baby baths can be useful as they are small, mobile, and can be placed at a height that suits your back better. Some change tables even double up as baby baths. Obviously be careful about carrying a heavy bath of water though – as long as it’s safe, try to bath your baby near a sink where you don’t have to carry the bath to fill and empty it.

So, you mentioned 95%?

You’re right, we did! And this is very important. Your baby is going to need lots of attention. But you also need attention. So, the remaining 5% is just for you. The following tips are aimed to address other areas of your life that often get neglected when being a new mum:

  1. Sleep when the opportunity arises: Whether this is when your baby is sleeping, or when your partner or family member are looking after your baby, getting sleep is very important. You need time to restore energy levels and allow the body to repair and recover. Who cares if the housework gets left for an extra day or two – it will still be there when you are ready to do it. Better still, get a family member to help. Team work!
  2. Eat well, stay hydrated: Don’t forget about the importance of a good diet. Eat lots of fresh, nutrient rich food, such as fruits and vegetables. And keep a bottle of water on the go constantly. It’s easy to forget and become dehydrated. If you are breast-feeding, remember where the water in the breast milk comes from… YOU!
  3. Have a bath: Of course, this doesn’t have to end at bathing. Read a book, do a crossword, go and sit in the garden with a cuppa… Our point is, make time for yourself regularly. These little breaks will keep you sane during a chaotic time of life. If help is at hand, use it. It is OK to have a break from it all. We cannot stress this point enough.

These last points can also help in the fight against back pain. Sleeping, eating and relaxation will help to reduce the risk of fatigue. Fatigue will compromise your ability to hold your posture in standing, sitting, and other positions such as bending. So, you can see why the 5% is so important.

At some point, you will need to address the physical changes that have occurred as a result of pregnancy and giving birth. These may include abdominal and pelvic floor muscle dysfunction, as well as spinal and other joint restrictions and dysfunctions. Every woman that has given birth needs to rehabilitate and strengthen their core again. Unfortunately, many don’t get around to it or it isn’t high on their priority list. However, (see points above) it needs to be! And of course, if you’re reading this and are pregnant, or thinking about having a child, there is so much you can do pre-birth to aid your recovery after having your baby, so come and see us!

If you’re a new mum or have had a child in the last few years, we can’t recommend enough to come and see one of our women’s health focused physios. We’ll assess you, and advise you on the best course of treatment and exercise to get you ‘back’ (excuse the pun) fighting fit and who knows… Another baby anyone?!