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newsletter - low back pain 
 
Low Back Pain 
 
This fact sheet helps you to know what’s ‘normal’ and what you can expect to happen if you suffer from back pain. It also tells you when you should become concerned and when it’s best to seek advice from a healthcare professional. 
Useful facts 
 
What is lower back pain? Low back pain describes tension, soreness and/or stiffness in the lower back, in most cases without a specific underlying cause. 
How common is back pain? You’re not alone – low back pain affects 8 out of 10 people in the UK at some time in their life. 
Are my symptoms likely to be serious? No, low back pain is rarely due to a serious underlying cause, even if you’re in quite a lot of pain. 
Do I need to rest? Backs are made for moving. Despite your pain, try and get back to normal activities as soon as you can – the sooner, the better. 
 
 
What can I expect to happen? 
 
How long are my symptoms likely to last? Your back is likely to get better by itself within 6 to 12 weeks, and often sooner. But you may experience occasional twinges and aches for weeks and months. 
Do I need any medical treatment or surgery? Back pain usually gets better without medical treatment or surgery, even when a ‘slipped disc’ is responsible. 
Will I need further tests? You’re unlikely to need X-rays or any other tests. 
What can I do myself to get better – now and in the future? 
 
Back exercises Simple back exercises, improving your posture, pilates, yoga and the Alexander Technique can be helpful. 
Keep moving Avoid lying in bed and remain active as far as possible, even if you’re uncomfortable. This won’t harm your back, and you can expect to get better more quickly. Stay positive and keep going out to do things you enjoy. 
Heat and cold A hot bath or hot water bottle can ease pain from tense muscles, while cold from an ice pack or a bag of frozen peas (wrap in a wet cloth and apply to the painful area) can help relieve discomfort from sudden back pain. 
Painkillers ‘Rub-on’ (topical) treatments and pain killers such as paracetamol and ibuprofen are effective in most cases. Stronger medicines, such as codeine, are an additional option when simpler ones are not working. Ask your pharmacist for advice. You can visit www.medicinechestonline.com for a list of general pain killers that are available without prescription at pharmacies and other stores. 
Sleeping position Take the strain off your back by trying different sleeping positions and putting a pillow between your legs or under your knees if you prefer lying on your back. 
Lifting Lift close to your body, bend your knees instead of your back, and try to avoid lifting heavy items. 
Work Try to stay at work or return to work as soon as you can and together with our employer consider options such as a phased return to work, altered hours, amended duties or workplace adaptations. Your GP can help with issuing a sick note (now called ‘fit note’) if you need to stay off work for more than a week. 
Other treatments Physiotherapy, acupuncture or seeing a chiropractor or osteopath can also be helpful (make sure they’re registered). 
When should I seek medical help? 
 
If your symptoms don’t start to improve within three days, or if your back pain recurs regularly for more than six weeks, contact your GP surgery. Seek immediate medical advice if you notice any of the following warning signs, which may suggest that your back pain could possibly be caused by a more serious underlying condition: 
 
Pain getting worse You have severe pain that gets worse rather than better. 
Feeling unwell You feel really unwell from your back pain. 
Fever You have a fever (a temperature of over 38°C, or 100.4°F) as well. 
Chest pain You have back pain that travels up into higher areas of your chest. 
Injury Your pain started after a major injury (such as a fall or an accident). 
Age You have new back pain and you’re younger than 20 or older than 50 years. 
Sleep problems You have night-time pain that affects your sleep. 
Walking You’ve become unsteady on your feet since your back pain started. 
Weight loss You’ve also been losing weight for no obvious reason. 
 
The following suggest an emergency: 
 
Unusual sensations You feel numb or notice ‘pins and needles’ in the area around your bottom (the ‘saddle area’), your genitals, or both of your legs. 
Urine problems You can’t keep your urine in. 
Bowel problems You lose your bowel control. 
Reproduced with permission from the Self Care Forum (www.selfcareforum.org) 
Newsletter - Stroke 
 
Stroke 
 
A stroke occurs once every 3 minutes and 27 seconds in the UK and is the largest cause of disability. This totals approximately 152,000 strokes occurring in the UK every year. At present there are 1.2 million stroke survivors in the UK. 
 
Types of stroke: 
There are 2 types of strokes, ischaemic (blood clot) or haemorrhagic (bleed). 
 
 
An ischaemic stroke occurs when a blood vessel within the brain becomes blocked by a blood clot causing a blocking and cutting off the blood supply to that area of the brain. Ischaemic strokes account for 85% of all strokes. Often these types of stroke are caused by narrowing in the arteries of the head or neck commonly due to atherosclerosis (a build-up of fatty deposits). This causes blood to collect and the chance of clots forming increases. Another cause is atrial fibrillation, blood clots can form in the heart and when they escape they can become lodged in the blood vessels of the brain. 
A haemorrhagic stroke is when a blood vessel bursts causing blood to leak into the surrounding tissues, these account for 15% of strokes. This type of stroke is most commonly caused by high blood pressure causing arteries to become weakened making them more likely to rupture. Or there may be aneurysms of badly formed vessels within the brain. 
Stroke classification (Bamford/OCSP): 
This classification is based on the extent of the symptoms and can predict the extent of the stroke and the area of the brain affected:- 
 
Total Anterior Circulation Stroke: all 3 of the following symptoms will be present: motor and sensory deficits, hemianopia and higher level deficits (swallowing difficulties, visuospatial disturbances, reduced consciousness). 
 
Partial Anterior Circulation Stroke: 2 of the three above symptoms will be present 
Posterior Circulation Stroke: sensory or motor deficit affecting either 1 side or both sides of the body, visual deficits and cerebellar dysfunction. 
 
Lacunar stroke: sensory or motor deficit involving 2 of the face/arm/leg only. 
A stroke can affect someone in many different ways depending on where it occurred in the brain, no one stroke is the same. 
 
Below is a list of ways someone may be affected: 
 
Arm weakness (77% of stroke survivors report arm weakness) 
Leg weakness (72% of stroke survivors report leg weakness) 
Visual problems 
Facial weakness 
Slurred speech 
Impaired bladder and bowel control 
Swallowing difficulties (dysphagia) 
Communication difficulties (aphasia) 
Depression or emotionalism 
Sensory impairment 
Tonal changes 
Balance difficulties 
Cognitive deficit 
Fatigue 
 
Stroke risk factors: 
High blood pressure 
Diabetes 
Atrial fibrillation (irregular heart beat) 
Patent foramen ovale (hole in the heart) 
High cholesterol 
Sickle cell disease 
Smoking 
Increased alcohol intake 
Drug use 
 
Recovery after a stroke: Neuroplasticity 
Initially after a stroke there will be a central area where there has been poor blood supply, this is the area where there will be some cell death. Directly surrounding this area is the ‘penumbra’, this is where cells may have had a reduced blood supply but were still getting some input from collateral vessels. Depending on the roles of the central cells depends on what symptoms you may have, for example arm weakness. 
Neuroplasticity is the term used to describe how a brain has the potential to rewire or reorganise neural pathways after an injury. Studies have shown the most effective way of enhancing this rewiring and reorganizing is through repetitive task-specific training. So this means that there may be potential to rewire/reorganise the neural pathways in the brain so that you can regain use of the weak arm. 
 
Physiotherapy and other rehabilitation services hope to enhance the neuroplasticity of the brain to improve a stroke survivors functional recovery and abilities. 
 
How can Physiotherapy help? 
Recovery from a stroke can occur in the initial weeks, or even months later. For those whose stroke may be chronic may go through periods of time when their physical abilities deteriorate through illness or general deconditioning. Physiotherapists can offer expert advice and specialist treatment strategies to enhance neuroplasticity and functional recovery following a stroke. Research studies have shown positive effects of physiotherapy on improving outcome and quality of life after stroke. Below are some of the treatment approaches which can be used: 
 
Graded strengthening programs 
Balance rehabilitation 
Gait re-education 
Postural advice 
Massage 
Taping 
Constraint induced movement therapy 
Stretches 
Core stability exercises 
Activity analysis and rehabilitation 
Newsletter - Male Chronic Pelvic Pain Syndrome 
 
Male Chronic Pelvic Pain Syndrome 
 
Chronic pelvic pain syndrome is only one of a number of male pelvic floor dysfunctions that physiotherapists can treat. Chronic pelvic pain syndrome is hard to diagnose and diagnosis is only the beginning of what can be a long—and painful—journey. This condition affects 90 million men worldwide. 
 
Male chronic pelvic pain syndrome is defined as chronic pain, pressure, or discomfort localized to the pelvis, perineum, or genitalia of males lasting more than 3 months that is not due to readily explainable causes (infection, tumour, or structural abnormality). Faced with a negative test result, family doctors and urologists are often stumped. After months and maybe even years of dead ends and dashed hopes, patients are told there’s not much their doctors can do. They’ll have to learn to live with it. 
This syndrome occurs only in men and common symptoms include pain or discomfort in the perineum, suprapubic area, penis, and testicles, as well as pain on peeing and ejaculatory pain. Patients may also have urinary symptoms, both obstructive (slow, intermittent stream) and irritative symptoms like urgency and increased frequency. Sexual dysfunction is also common. Other symptoms include muscle and joint aches and unexplained fatigue. 
 
For many years the prostate was (and often still is) wrongly assumed to be the source of the pain and dysfunction. The vast majority of cases are not caused by the prostate gland, and are therefore more accurately called Chronic Pelvic Pain Syndrome (CPPS) rather than Chronic Prostatitis (CP). 
 
The background cause is still incompletely known and is probably a complex process comprising many issues that eventually results in a chronic nerve and/or muscular pain syndrome. Triggers of this condition are believed to include infection (including sexually transmitted diseases and organisms and viruses), trauma (including perineal and urethral trauma), nerve overstimulation, non-infection-related inflammation (auto-immune or neurogenic), dysfunctional peeing, and pelvic floor dysfunction/muscle spasm. Common conditions associated with this include depression, stress, and anxiety disorders. 
 
Current research has shown that tension and dysfunction in the muscles of the pelvic floor play a significant and are often the primary role in the development of this condition and its subsequent symptoms, including pain. However, many Doctors neither appreciate nor understand the havoc that chronic tension plays in the pelvic floor. 
 
The impact of this condition on quality of life and activities of daily living can be significant. Coping with chronic pain is exhausting and it can negatively affect almost every area of life. If the pain impacts sexual function, it can cause self-image and relationship woes, problems sitting—sometimes for anything longer than a few minutes—and difficulty with bowel and bladder management can affect a wide range of activities, including employment, athletics, driving and socializing. Some men are prescribed antidepressants or anticonvulsants to help manage the pain, which have their own set of side effects. Simply feeling alone and without answers can be debilitating. 
 
How did this happen to me? 
A pain may start in a pelvic organ such as your bladder, bowel, or prostate, it may also start in muscles, or joints following an injury. It may start following prolonged stress with tension in muscles. Whatever the original cause of pain, if it doesn’t settle then the pain can become chronic. Generally it is considered ‘chronic’ if it is still present after 3-6 months. No-one understands why a similar condition in some men might lead to chronic pain, while in another man might go away completely. 
 
Once a pain has become chronic, the pain situation is usually more complicated. There may still be the original problem, but there is now pain from tight painful pelvic muscles and a change in the nerve pathways that send pain messages to the brain. Both of these types of pains are pains that cannot be seen from the outside and do not show on scans or during operations. Often the pain from pelvic muscle spasm can become the worst part of the pain, it can be a cramp on the inside of the pelvis. Many say the feeling is like sitting on a golf ball. 
 
Once muscles and nerves in the pelvis start behaving abnormally, other organs can develop problems too. There may be difficulty passing urine, with bowel function or with sexual function. 
Treatment: 
How can I manage my pain? - Learn more about your pain 
Everyone is different and it is important to learn more about your individual condition – why you have pain; where it is coming from; and what makes it better or worse. Remember that no matter how the pain started, if you have pain on most days, it is likely that tight, tender and painful pelvic floor muscles are part of the problem. 
 
Learn how to locate and then relax the pelvic floor muscles 
Locating and understanding the pelvic floor muscles allows the muscles to work normally again. The pelvic floor muscles are all internal muscles that cannot be seen externally, so you may not be familiar with their position, size and function. Reducing the tension in the muscles of your pelvic floor will help reduce your pain. 
 
Internal exams, which can be performed only by a pelvic floor therapist with special training, help to identify the key objective findings. Men with chronic pelvic pain syndrome usually have at least one—and usually more—of the following: increased pelvic floor muscle activity on EMG biofeedback and/or Real time Ultrasound scanning, increased pelvic floor tone on palpitation, presence of pelvic floor trigger points, increased external anal sphincter tone and poor or decreased pelvic floor proprioception and motor control. 
 
Treatment from a Specialist pelvic floor physiotherapist may include combinations of the following interventions: 
 
Pelvic floor proprioception and motor control exercises, both with Real time Ultrasound scanning with or without EMG biofeedback, to teach pelvic floor relaxation techniques 
Pelvic floor trigger point release. Stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points) including digital intrarectal massage, physical therapy to the area. 
Progressive relaxation therapy to reduce causative stress. 
TENS 
Acupuncture has reportedly benefitted some patients 
Visceral mobilization and myofascial release techniques 
External trigger point release 
Behavioural and dietary bladder and bowel interventions and education to help with constipation and bladder pain 
Peripheral and central pain pathophysiology education and interventions to increase the patient’s ability to minimize pain sensation 
Sexual health education and referral to sex therapists if warranted 
Referrals to other health professionals, including doctors, counsellors, dietitians,employment supports and ergonomists, who have an interest and experience in managing chronic pelvic pain 
Aerobic exercise can help those sufferers who are not also suffering from Chronic Fatigue Syndrome (CFS) or whose symptoms are not exacerbated by exercise. Acupuncture has reportedly benefited some patients 
Referral to GP for advice on medication (using tricyclic antidepressants and benzodiazepines). A number of medications can be used to treat this disorder. Alpha blockers and/or antibiotics appear to be the most effective with NSAIDs such as ibuprofen providing lesser benefit. 
If you, or anyone you know, is suffering with any degree of Pelvic Pain  
then please contact Katrina Wade in complete confidence. you can  
email her directly at katrina.wade@bodyworksphysio.net or phone  
her on 01206 844410. 
 
Anything that you wish to talk about will be in complete confidence. 
 
Do Not Suffer In Silence. 
 
“We Know How Your Body Works” 
NEWSLETTER - Sciatica 
 
The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. 
 
Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve. When something compresses or irritates the sciatic nerve, it can cause a pain, often the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. 
 
Sciatic pain can range from being mild to very painfulI. It consists of leg pain, which might feel like a bad leg cramp, or it can be excruciating, shooting pain that makes standing or sitting nearly impossible. Sciatica usually affects only one side of the lower body. For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse. 
 
Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control. 
 
The pain might be worse when you sit, sneeze, or cough. Sciatica can occur suddenly or it can develop gradually. You might also feel weakness, numbness, or a burning or tingling ("pins and needles") sensation down your leg, possibly even in your toes. 
 
Causes of sciatica 
 
A herniated or prolapsed disc that causes pressure on a nerve root — this is the most common cause of sciatica. 
Piriformis syndrome — this develops when the piriformis muscle, a small muscle that lies deep in the buttocks, becomes tight or spasms, which can put pressure on and irritate the sciatic nerve 
 
Spinal stenosis — this condition results from narrowing of the spinal canal with pressure on the nerves. 
Spondylolisthesis — this is a slippage of one vertebra so that it is out of line with the one above it, narrowing the opening through which the nerve exits 
A prolapsed disc is the most common identified cause of sciatica, but in some cases there is no obvious cause. 
 
Treating sciatica 
A combination of things you can do at home, such as taking over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms. 
 
Treatment for sciatica focuses on relieving pressure and inflammation. Typical sciatica treatments include: 
 
Medical treatments 
Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or oral steroids, to relieve inflammation. 
 
Physiotherapy 
Your physiotherapist will be able to help you achieve a pain-free state quickly. Your physiotherapist will use a variety of treatment modalities to reduce your pain and inflammation. These may include: ice, acupuncture, de-loading taping techniques, joint mobilisations and exercise. The initial aim is to try and centralise the pain, taking the pain out of the leg. 
 
This treatment helps to prevent further episodes of sciatica. In many cases of a herniated disc, the symptoms can be relieved if you get into a position of spinal extension, but if this position is painful it should be avoided. Spinal extension can be achieved by lying on the front and gently propping the shoulders up on the elbows. 
 
As the inflammation and pain reduces, your Physiotherapist will then focus on restoring your normal back joint range of motion and resting muscle tone, lower limb nerve flexibility and posture. Tight leg and back muscles may need to be released to allow full and normal movement of your legs and back. Normal muscle length and muscle strength prevents injuries. 
 
Another area that your Physiotherapist will work on is restoring good core muscle control. Research into back pain has highlighted the importance of good deep abdominal core stability to maintain a healthy back. 
 
The next stage of your rehabilitation is returning you to your normal level of fitness and daily activities. And finally preventing any further recurrence of the problem. 
 
Epidural steroid injections 
Steroids, with their strong anti-inflammatory effects, are delivered at the origin of the inflamed sciatic nerve roots. 
 
Surgery 
Surgery may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments. 
Preventing sciatica 
 
There are some steps you can take to minimise your risk of disc or back injury that could lead to sciatica. This includes: 
 
• Better posture and lifting techniques 
• Stretching before and after exercise 
• Simple, regular exercises to improve flexibility 
 
Lifting and handling 
 
One of the biggest causes of back injury, particularly at work, is people lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent sciatica. 
 
• Think before you lift – can you manage the lift? Are there any handling aids you can use? 
 
• Start in a good position – your feet should be apart with one leg slightly forward to maintain balance. When lifting, let your legs take the strain – bend your back, knees and hips slightly but do not stoop or squat. Tighten your stomach muscles. Do not straighten your legs before lifting as you may strain your back on the way up. 
 
• Keep the load close to your waist – keep the load as close to your body for as long as possible with the heaviest end nearest to you. 
 
• Avoid twisting your back or leaning sideways – especially when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time. 
 
• Keep your head up – once you have the load secure look ahead, not down at the load. 
 
• Know your limits – there is a big difference between what you can lift and what you can safely lift. If in doubt, get help. 
 
• Push, do not pull – if you have to move a heavy object across the floor, it is better to push it rather than pull it. 
 
• Distribute the weight evenly – if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body. 
 
 
Posture 
How you sit, stand and lie down can have an important effect on your back. The following tips should help you maintain a good posture. 
 
Standing 
Stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight. Imagine a large bunch of helium balloons attached to your head softly lengthening your spine. 
 
Sitting 
You should be able sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back. 
 
If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles. If you are concerned regarding your work station position then seek professional advice to have it assessed properly. 
 
Driving 
Make sure that your lower back is properly supported. Your knees should not be higher than your hips so make sure the base of the car seat is correctly positioned. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks so that you can stretch your legs. 
 
Sleeping 
Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight. Support your head with a pillow, but make sure that your neck is not forced up at a steep angle. 
 
Exercise 
Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. However, if you have chronic back pain (pain that has lasted more than three months), consult your physiotherapist before starting any exercise programme. 
 
Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt. 
 
Activities such as Pilates or Yoga can improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor. 
 
There are also a number of simple exercises you can do in your own home to help prevent or relieve back pain. Your Physiotherapist will be able to advise you on the correct exercises to carry out. 
 
If you would like any advice or further information on the above information then please do not hesitate to contact us on 01206 844410 
NEWSLETTER - Cycling Injuries 
 
Cycling injuries 
 
Cycling pain can be a problem and it is repetitive cycling injuries that cause unnecessary pain to cyclists. Some of the problems can be caused by overuse or issues with posture an answer to this is to rectify an improper riding position. 
 
Muscle tiredness 
Over long rides, lactic acid builds up in the muscle, causing pain. Most cyclists rely on their thigh muscles, the quads, to power the bike forwards and as a result this is where cyclists will feel a lot of fatigue. One way to keep the quads in shape is to use kinesiology tape which can promote muscle endurance and aid recovery. Another possible solution is to alternate between pedaling in and out of the saddle. This will spread the load among other muscles and avoid overloading the quads. 
 
Muscle tightness 
Tight calves and hamstrings can sometimes be a problem and can lead to muscular tearing. Warm up regimes before exercise and cool down afterwards will help. 
 
Point of contact injuries 
These injuries are often the most common complaints among cyclists. This is about the parts of a cyclist that touches their bike: the hands, the bottom, and the feet. 
Cleats fasten cyclists feet to the pedals, the problem with this can be that if the cleats are not correctly positioned at the right angle, it can result with shooting pains in the knees and issues with the achilles tendons. 
 
Achilles Tendonitis 
Achilles tendonitis is an overuse injury caused by inflammation or could be a result of a poor bike fit. If the saddle is too high this keeps the foot pointed down, causing constant tightening of the calf muscles. Lowering the seat and making sure that the cleats are correctly positioned will help to even out what muscles are being used. Allowing the foot to point up during the bottom portion of the pedal stroke can ease the tension on the achilles, allowing the tendon to have needed periods of rest. 
 
Patellar Tendonitis 
This tendon attaches the quads muscle to the shin bone. Inflammation of this tendon can be caused by having the seat too low or using big gears for too long a distance. As a result, the buttock muscles (gluts) are not being used as well as they should be and the quads become overworked and fatigued, leading to tendonitis in the tendon. Kinesiology taping can also assist. 
The bottom 
With regards to the bottom, saddle sore is the main thing to watch out for. This is caused by friction between skin, clothing and the saddle, and can result in sore buttocks and/or skin rashes. Decent padded shorts can make a difference as well as not wearing underwear under the cycling shorts. 
 
Back and neck pain 
Cycling can highlight any underlying problems that some cyclists may have, especially with some bikes that see them pitched forwards in the saddle. Riding with the back muscles in neutral would be the ideal posture, but this is often not possible when the bike is not set up to your exact size. The best answer is to get a professional bike fit done, once that perfect riding position has been found, those aches and pains in your back disappear pretty quickly. 
 
Kinesiology tape on the lower back area is another option to use. It will help stimulate the skin in the area, promoting muscle function and decreasing pain. 
The hands 
 
Handlebar Palsy 
Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in the ring and little finger and controls most of the muscular function of the hand. 
Holding the handlebar in the same position for a long period of time, gripping it too tightly, or leaning too far over the front wheel, can cause compression of the ulnar nerve. Often, the nerve may be stretched when a drop-down handlebar is held in the lower position. The pressure placed on the ulnar nerve can result in numbness and tingling or hand weakness, or a combination of both. Symptoms can take from several days to months to resolve. Rest, stretching exercises, and anti-inflammatory medications usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding bending the wrist back too far can help to prevent a recurrence. 
Carpal tunnel syndrome 
Although it is less common than handlebar palsy, carpal tunnel syndrome (compression of the median nerve at the wrist) is another overuse injury that cyclists often experience. Injury often occurs when a cyclist holds the handlebars on top and applies pressure directly on the nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Symptoms usually resolve quickly once you stop cycling for a short period of time. Although handlebar pressure contributes to these symptoms, there can be other causes for hand pain and numbness; therefore, an assessment for other possible causes of carpal tunnel syndrome should be performed by your GP or Physiotherapist. 
The simplest way to prevent problems with these nerves is to make sure that the hands are moved around the handlebar and not to get stuck in one position on long rides. Road bikes are specifically designed to allow riders to grip the handlebars in different places - on the sides, above, or down below on the drops - so that the riding position can be altered. 
 
And finally…. 
 
Whether it is from a crash, overtraining or from poor bike fit, injury is part of the cycling sport. Although some injuries are impossible to avoid, there are some things every cyclist can do to prevent injuries. With the proper training, equipment and a correct bike fit these risks can all be minimised or completely prevented. Adjusting the handlebars, the seat, and the pedals to the correct fit is the key to preventing most overuse injuries. 
 
Bodyworks offer a Bike Fit Service, call us now to book your bike fit for a safer and more comfortable ride. 
 
“We Know How Your Body Works” 
NEWSLETTER - Radial shockwave therapy (RSWT) 
Are you one of millions of people who suffer from pain. If you are one of them, you know how chronic pain can become unbearable. Now there is an outpatient therapy which fights the causes of chronic pain without the need for injections, medication or surgery. 
 
Shockwave therapy is a non-surgical treatment, and works by delivering impulses of energy, targeted to specific damaged tissues. This type of treatment was first discovered many years ago and was used in breaking up kidney stones (lithotripsy). More recently however it has been found that shockwave can be very effective in the treatment of various sports injuries and musculoskeletal conditions. Radial Shock Wave Therapy is effective for many musculo-skeletal problems even when other therapies have proved ineffective. 
 
 
NEWSLETTER - Ski injuries and their Prevention 
Ski injuries and their Prevention 
 
Injuries 
Skiing has become accessible to more people. Faster ski lifts and expansion of trails at ski areas, as well as improved snow making capabilities, have increased the numbers of skiers on the slopes. Over the years there have also been dramatic changes in the equipment as well. Ski boots have evolved from soft leather cut boots to mid-calf plastic boots that rigidly support from the lower leg and ankle. Advancements in sophisticated multi-directional release bindings continue to reduce the number of lower extremity injuries. Falls injuries, account for approximately 75-85% of skiing injuries. Collisions with objects including other skiers, account for between 11-20%, while incidents involving ski lifts contribute between 2-9%. 
 
Studies demonstrate that the majority of injuries are sprains, followed by fractures, lacerations and dislocations. While fractures were more common prior to these equipment changes, it is now more common to see injuries to the ligaments of the knee. This could possibly be partly attributed to the change in design of the equipment over the years. 
 
Ligament Injuries: 
The most common injury to the knee is damage to the medial collateral ligament (MCL). This injury occurs with slow twisting falls or when beginners maintain a snowplow position for lengthy periods and stress the ligament. Virtually all degrees of MCL sprains can be managed conservatively with bracing and limited range of motion, and physiotherapy. 
Another common knee injury is rupture of the anterior cruciate ligament (ACL). Many factors can attribute to this injury, such as a backward fall as the lower leg moves forward. 
A similar shearing force can occur when the lower leg is suddenly twisted away from the upper leg as in “catching an edge.” These injuries often require surgical repair and extensive rehabilitation. Fractures of both the femur and tibia occur more commonly with violent twisting falls or collisions. 
Injuries to upper extremities account for approximately 30-40% of all injuries. The most vulnerable joint of the upper body is the thumb. Injury to the ulnar collateral ligament of the thumb is second in frequency only to MCL injuries of the knee. These injuries occur when a skier falls on an outstretched arm that is still gripping the pole. The thumb is suddenly pulled outward, injuring this joint. It may be that using poles with straps rather than the fitted grip may result in fewer injuries. 
Like knee sprains, sprains of the thumb are graded first degree, second degree or third degree, depending upon the severity of damage to the ligament. Surprisingly, injuries to the thumb can be serious and, if not cared for properly, can result in long term disability. A protective cast is used in nearly all cases for lengths of time varying from three to six weeks. Physiotherapy is very useful to speed up recovery and return to full function. Infrequently surgery is required. 
While fractures of the upper extremity are infrequent, dislocations of the shoulder are quite common. Good quality rehabilitation of the joint is vital to prevent recurrence and be assured of a complete recovery. Surgical repair is sometimes necessary to restore the joint to a more functional state. Skiing should be discontinued if it causes further pain. 
 
Top tips for avoiding ski injuries 
 
1. Take lessons 
The better your technique, the less chance you will put undue strain on your joints. 
 
2. Set your bindings correctly 
Skiers using incorrectly adjusted skis and bindings are eight times more likely to suffer injury. Crank up the DIN setting (which controls how easily the bindings snap open) beyond what is appropriate for your weight and ability, and you are asking for trouble. When hiring skis, know your weight in kilograms, and be honest about your ability. 
 
3. Take a rest day 
The highest risk of accident is after 3pm on the third day of your holiday. This is because muscle fatigue reaches its peak 48 hours after you start your holiday. 
 
4. Take the lift at the end of the day 
You will be tired, the pistes may be icy and crowded, and there will probably be bare patches in the snow - a perfect recipe for a fall. 
 
5. Control your weight 
The heavier you are, the more strain you are putting on your knees. 
 
6. Take nutritional supplements if you suffer from osteoarthritis 
Both glucosamine and chondroitin, which are available from chemist shops, are known to have beneficial effects. 
 
7. Keep within your comfort zone 
Control is good, bravado is bad, and icy moguls - at least if you already have any damage to your knees - are very bad indeed. 
 
8. Don't drink alcohol at lunchtime 
It slows your reactions and makes you more reckless. 
 
9. Ski off-peak 
The quieter the slopes the less danger there will be of your being called on to take sudden evasive action. 
 
10. Don't wear a knee brace 
According to Bell, the only skiers who might benefit from a brace are those who are returning to the sport with an old or partially healed ligament injury (they might want to use a hinged brace), or those with mild arthritis (who might benefit from a neoprene sleeve). Otherwise, skiing without a brace improves the ability of the muscles around the knee to respond effectively to the different stresses and strains. 
 
11. Seek advice immediately after an injury 
Clinics in ski resorts are well versed in treating knee pain. Above all, do not ski with a swollen knee: put ice on it, and take anti-inflammatories until the swelling subsides. 
 
12. Consider snowboarding 
Snowboarders are less prone to the twisting effect that causes knee injury. (On the other hand, they are more at risk of head and wrist injury.) 
 
Remember that everyone heals at a different rate. 
 
If you have suffered with an injury and need some advice or treatment please do not hesitate to contact us. 
 
"We Know How Your Body Works" 
NEWSLETTER - Whiplash Associated Disorder WAD 
Whiplash Associated Disorder WAD 
 
What is a whiplash neck sprain? 
Whiplash is a non-medical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck. A whiplash neck sprain occurs when your head is suddenly jolted backwards and forwards in a whip-like movement, or is suddenly forcibly rotated. This can cause some neck muscles and ligaments to stretch more than normal (sprain). Whiplash is commonly associated with road traffic accidents, usually when the vehicle has been hit in the rear. Whiplash accounts for more than three quarters of all injury claims after road accidents. 
 
What causes whiplash? 
As well as traffic accidents, blows to the head, particularly during sports such as boxing or rugby, or a slip or fall that causes the head to suddenly jolt backwards can also cause whiplash. 
 
Some people are surprised at having symptoms after a minor road traffic accident. Even slow vehicle knocks may cause enough jerking movements of the neck to cause symptoms. 
What are the symptoms of whiplash? 
After an accident, the symptoms of whiplash may be delayed until around 6-12 hours later and may become worse over the following days. However, people who experience whiplash may develop one or more of the following symptoms, usually within the first few days after the injury: 
 
Neck pain and stiffness is the most common symptom. The pain and stiffness often become worse on the day after the accident. 
Headaches are the second most common symptom, usually occurring on one side of the head, beginning at the base of the skull (occiput) and often radiating to the top of the head and frontal regions. 
Movements of the neck may be difficult, being stiff and painful. 
There may be associated pain or stiffness in the shoulders, between the shoulder blades or down the arms. 
Pain or numbness in the arm and/or hand. Arm pain can be caused by nerve compression or referred pain from the facet joint or disc. 
There may be pain and stiffness in the upper and lower part of the back. 
Dizziness 
Blurred vision 
Pain in the jaw or pain on swallowing, unusual sensations in the skin on the face may occur for a short while, but soon go. Tell a doctor if any of these persist. 
Ringing in the ears 
Difficulty concentrating or remembering 
Irritability, sleep disturbances, tiredness 
How is whiplash diagnosed? 
In most cases, injuries are to soft tissues such as the discs, muscles and ligaments, and these cannot be seen on standard X-rays. The diagnosis is usually made from a detailed description of the accident and the symptoms and by examination. 
 
If a problem such as spinal injury is suspected then specialised tests, such as CT scans or magnetic resonance imaging (MRI) can be carried. 
 
What is the treatment for whiplash? 
 
To help with recovery: 
 
Ice your neck to reduce pain and swelling as soon as you can after the injury. Do it for 10-20 minutes every 3-4 hours for 2-3 days, or as recommended by your doctor or physiotherapist. 
Take painkillers or other medications, if recommended by your doctor. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen will help with pain and swelling. However, these medicines can have side effects. Always follow the dosing instructions. Prescription painkillers and muscle relaxants are sometimes necessary. 
Apply moist heat to your neck - but only after 2-3 days of icing it first. Use heat on your neck only after the initial swelling has gone down. 
 
Exercise your neck and keep active: 
 
At first the pain may be bad, and you may need to rest the neck for a day or so. You must not allow your neck to stiffen up. However, gently exercise the neck as soon as you can. Gradually try to increase the range of neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities. You will not cause damage to your neck by moving it. 
 
Physiotherapy: 
Although treatment is tailored to individual needs general aims of physiotherapy treatment should be to: 
Improve function 
Return the person to normal activity /work 
Relieve symptoms 
Advise on pain relief 
 
Once the acute symptoms have gone, you may benefit from exercises ideally under the supervision of a physiotherapist. This will make your neck muscles stronger and more flexible. It will help you recover and reduce the odds of straining your neck again in the future. Various treatments may be advised by a physiotherapist. These may include: 
 
Joint mobilisations to increase neck range of movement 
Soft tissue massage to alleviate pain 
Active exercises to alleviate pain and to restore normal movement 
Acupuncture 
A detailed home exercise plan 
Postural re-education. A good posture may help. Check that your sitting position at work or at the computer is not poor. (That is, not with your head flexed forward with a stooped back.) You may need to get your employer to assess your work station set up. 
 
Treatment may vary and you should go back to see a doctor: 
 
If the pain becomes worse. 
If the pain persists beyond 4-6 weeks. 
If other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in part of an arm or hand. These may indicate irritation to or pressure on a nerve emerging from the spinal cord. 
 
What is the outlook (prognosis) after a whiplash neck sprain? 
This will depend on the severity of the sprain, but the outlook is good in most cases. Symptoms often begin to improve after a few days. Most people make a full recovery within a few weeks. However, in a small number of people, some symptoms persist long-term. 
 
Whatever you do, do not rush things. People who play contact sports need to be especially careful that they are fully healed before playing again. Do not try to return to your previous level of physical activity until you can: 
 
Look over both shoulders without pain or stiffness. 
Move your head all the way forward and all the way back without pain or stiffness. 
Move your head from side to side without pain or stiffness. 
 
If you start pushing yourself before your neck strain is healed, you could end up with chronic neck pain. Other pain-relieving techniques may be tried if the pain becomes chronic (persistent). Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated. 
"We Know How Your Body Works" 
NEWSLETTER - BREAST CANCER 
Breast Cancer 
 
What is breast cancer? 
There are several types of breast cancer. It can be diagnosed at different stages and can grow at different rates. People can have different treatments depending on the type and position of the breast cancer. Around 55,000 people are diagnosed with breast cancer each year, about 400 are men. 
 
Types of surgery 
There are two types of surgery for breast cancer: 
Breast-conserving surgery 
Breast-conserving surgery ranges from a lumpectomy or wide local excision, in which just the tumour and a little surrounding breast tissue is removed, to a partial mastectomy, in which up to a quarter of the breast is removed. After breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells. 
 
Mastectomy 
A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, in which your breast is removed, along with a sentinel lymph node biopsy (SLNB). A simple mastectomy is often a suitable treatment for widespread DCIS (ductal carcinoma in situ). If the cancer has spread to your lymph nodes, you will probably need more extensive removal of lymph nodes from the axilla (under your arm). 
 
Reconstruction 
Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy or it can be carried out later. It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast. 
 
Lymph node removal 
For invasive breast cancer, it is recommended that some or all of the lymph nodes under the arm are removed to see whether or not they contain any cancer cells. 
 
Sentinel node biopsy 
Another way to find out if the breast cancer has spread to the lymph nodes under the arm is a sentinel node biopsy. This involves injecting a small amount of radioactive material and a dye into the body to identify the first, or sentinel, node(s) to receive lymph fluid from the cancer. This node is then removed and examined. If the sentinel node is clear of cancer cells it usually means that the other nodes are clear too so no more will need to be removed. If the results of the sentinel node biopsy show that the node removed is affected by cancer it may be recommended that you have a second operation to remove the remaining nodes 
After your operation 
 
Fluid collecting around the wound (seroma) 
Fluid can build up in the area around the wound. This is called a seroma. It usually goes away within a few weeks. Sometimes your nurse or doctor may need to drain it off with a needle and syringe. 
 
Stiff shoulder or arm 
After a mastectomy or having lymph nodes removed, your shoulder or arm may feel sore or stiff. It is important to do the arm exercises that your physiotherapist shows you. This will help improve the movement in your shoulder and arm and reduce the risk of long-term problems. You should start the exercises the day after your operation and gradually build up what you can do. Should you find that you are struggling to restore your normal shoulder and arm range of movement then it is advisable to seek advice and treatment from a specialist physiotherapist. 
 
Numbness and tingling in the upper arm 
You may have this if nerves in your breast and armpit are injured during the operation this should slowly improve over several months but is sometimes permanent. 
 
How your breast looks 
It is common to have swelling and bruising after your operation this should improve after a few weeks. Wearing a crop top or sports bra might feel more comfortable until the swelling settles. 
 
Scars 
After breast-conserving surgery the scar is usually small and in the area where the cancer was, depending on where the surgeon makes the cut. A mastectomy scar is across the skin of the chest and into the armpit. After surgery to the lymph nodes, the scar is in the armpit and should not be noticeable from the front. A Specialist Physiotherapist can help to work with you to restore as much flexibility to the scar as possible and to improve its look. They can teach you how to stretch the scar yourself using Myofascial Release (MFR) Techniques and they can work on the scar to restore movement. 
 
Axillary Web Syndrome (Cording) 
Axillary web syndrome (AWS), also known as cording, sometimes develops as a side effect of sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Both procedures involve removing just a few (SLNB) or many (ALND) of the axillary, or underarm, lymph nodes. Most people with breast cancer need to have at least one of these surgeries. Scar tissue from surgery to the chest area to remove the cancer itself also can contribute to cording. 
If you develop axillary web syndrome, you may be able to see and/or feel a web of thick, ropelike structures under the skin of your inner arm. In some cases, you may not see or feel the cords, but sensations of pain and tightness will tell you they are there. You may first notice them when you are doing something that involves raising your arm to shoulder level or above your head. If it happens, cording typically occurs anywhere from several days to several weeks after your surgery, although there have been individual cases where it appears many months later. 
With cording, it is possible to have one large cord or several distinct, smaller cords running down the arm. These cords usually start near the site of any scarring in the underarm region and extend down the inner arm to the inside of the elbow. Sometimes they can continue all the way down to the palm of your hand. The cords tend to be painful and tight, making it difficult for you to lift your arm any higher than your shoulder or straighten the elbow fully. This pain and limited range of motion can have a major impact on your day-to-day life. 
Researchers are still studying what exactly makes cording happen. Some experts believe that the surgery to the underarm and chest area traumatizes the connective tissue that encases nearby bundles of blood vessels, lymph vessels, and nerves. This trauma leads to inflammation, scarring and eventually hardening of the tissue. This hardening can spread down the fibers of the connective tissue which causes the cords to form. 
 
Managing axillary web syndrome 
If you have symptoms of AWS, ask your doctor to refer you to a Physiotherapist or other medical professional who specializes in breast cancer rehabilitation. Look for someone who has seen many patients with cording. It is not a good idea to wait and see if the condition will resolve on its own. Your natural reaction to the pain of cording will be to avoid moving the arm and shoulder, which can lead to more tightness in the shoulder and chest area. Moving and stretching under the guidance of an experienced Physiotherapist are the best ways to resolve the condition and stop the pain. 
 
Your treatment plan may include: 
 
Stretching and flexibility exercises: Your Physiotherapist can work with you to help you learn exercises that gently stretch the cords and improve your pain-free range of motion. He or she can teach you exercises to do at home and advise you on how often to do them. 
 
Manual therapy: Your Physiotherapist also may gently massage the cord tissue. Using manual therapy, your Physiotherapist would gently pull the tissue on your outstretched arm, starting in the upper arm and moving down into the forearm. This sometimes causes the cord to snap or break, and you may even hear a popping sound when that happens. It's usually not painful, and it often brings relief by extending your arm's pain-free range of motion. 
 
All of these treatments focus on releasing the tight scar tissue that makes up the cord(s). Fortunately, cording usually resolves for most people after a few therapy sessions, or at least within a few months. For some people, cording may get better and then come back later. But usually cording is a one-time event that does not become a persistent problem. Even after cording resolves, it is a good idea to continue with stretching and flexibility exercises. These can help keep the joint and soft tissue mobile during additional treatments, such as radiation therapy, and your ongoing recovery from surgery. 
 
Pain and changes in sensation 
Sometimes women continue to have numbness, tingling or pain in the upper arm because the nerves were injured during surgery. 
 
Changes to your arm/shoulder movement 
Arm and shoulder movement and strength usually improve after surgery. Doing your exercises helps reduce the risk of long-term problems. If you have problems, ask your doctor for a referral to a Specialist Physiotherapist. If moving your shoulder or arm is painful, your doctor can prescribe you some painkillers. 
 
Lymphoedema 
Surgery or radiotherapy to the lymph nodes in the armpit can sometimes lead to swelling of the arm (lymphoedema). If you notice any swelling, speak to your breast care nurse or doctor. 
The earlier treatment for lymphoedema begins, the more effective it can be. A Specialist Physiotherapist may also be able to advise you with regards to preventing and treating Lymphoedema. 
 
Katrina Wade: Clinical Specialist Physiotherapist in Women’s Health 
Katrina has been working with post-operative breast cancer care patients for over 10 years and has gained extensive knowledge and expertise in this treatment area. Her skills include: 
 
MFR to scar tissue 
Shoulder mobility exercises 
MFR to muscle around the shoulder and scapular (shoulder blade) region 
Soft tissue release and soft tissue massage for the treatment of cording 
Advice about preventing and treating lymphoedema including teaching simple lymphatic drainage techniques 
 
Sally Davis: Physiotherapist and Rehabilitative Exercise Specialist 
Sally is a Physiotherapist and Rehabilitative Breast Cancer Exercise Specialist. Sally runs the 'Pink Ribbon Pilates' course which is designed specifically for clients post breast surgery and/or reconstruction. Each participant will be individually assessed and exercises will be tailored to their specific needs. 
Classes are held twice a week for 6 weeks, helping the transition from post surgery through to rejoining regular Pilates classes. 
NEWSLETTER - Plantar fasciitis 
Plantar fasciitis 
 
Plantar fasciitis involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain. 
 
Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot warms up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. 
 
Plantar fasciitis is particularly common in runners. In addition, people who are overweight, women who are pregnant and those who wear shoes with inadequate support are at risk of plantar fasciitis. 
Symptoms 
In most cases, the pain associated with plantar fasciitis: 
• Develops gradually 
• Affects just one foot, although it can occur in both feet at the same time 
• Is triggered by — and is worst with — the first few steps after awakening, although it can also be 
triggered by long periods of standing or getting up from a seated position 
• Feels like a stab in the heel of your foot 
 
Causes 
Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. 
 
Risk factors 
Factors that may increase your risk of developing plantar fasciitis include: 
 
Age: Plantar fasciitis is most common between the ages of 40 and 60. 
 
Sex: Women are more likely than are men to develop plantar fasciitis. 
 
Certain types of exercise: Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis. 
 
Faulty foot mechanics: Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're standing and put added stress on the plantar fascia. 
 
Obesity: Excess pounds put extra stress on your plantar fascia. 
 
Occupations that keep you on your feet: Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia. 
 
Improper shoes: Avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock. If you regularly wear high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel. 
 
Complications 
Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking. 
 
Treatments and Medication 
About 90 percent of the people who have plantar fasciitis recover with conservative treatments in just a few months. 
 
Medications: 
Medications to ease symptoms of plantar fasciitis may include: 
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, may ease pain and inflammation, although they will not treat the underlying problem. 
Corticosteroids. This type of medication may be delivered by injection. Multiple injections are not recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Ultrasound guidance is sometimes used for more accurate placement of the corticosteroid injection. 
 
Therapy: 
Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include: 
 
Physiotherapy to instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. 
 
Application of ice: Try rolling your foot over a frozen drinks bottle. 
 
Taping: A Physiotherapist may also teach you to apply tape to support the bottom of your foot. 
 
Night splints: Your physiotherapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching. 
 
Orthotics: Your Physiotherapist may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly. 
 
Surgical or other procedures 
When more-conservative measures are not working, your doctor might recommend: 
Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It is usually used for chronic plantar fasciitis that has not responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling, and has not been shown to be consistently effective. 
Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot. 
 
If you feel that you have a problem affecting the plantar fascia or indeed any other area please do not hesitate to contact us. 
 
"We Know How Your Body Works" 
 
If you would like to speak to us about problems that you may have regarding any other issues then please contact us either via the website or phone the clinic on 01206 844410 
NEWSLETTER - Work Station Assessment 
Work Station Assessment 
 
Bodyworks are pleased to announce that we are working with Sarah Tapley, an occupational ergonomist, who has extensive experience of identifying, advising, inspecting and investigating occupational health safety and ergonomic issues across the whole spectrum of working environments in the UK. This experience was gained from over 20 years working for HSE as a Specialist Inspector. 
 
Ergonomics and workstations 
 
Workplace Ergonomics is all about making the workplace fit for business and allowing people to work without pain and discomfort. Staff who are comfortable are able to work more efficiently and effectively. 
 
Office ergonomics concentrates on computer users and making sure that computer workstations are set up to suit the individual users. Increasingly though, office space has shrunk and staff have to ‘hotdesk’, so the next stage is to make sure staff know how to set their workstation up to suit themselves wherever they are working, be it at a desk in an office, at home or traveling out and about. 
People often think about ergonomics as all about chairs…. it is so much more holistic than that. It involves looking at the individual and how they are using and interacting with the whole desk or workstation including monitors, keyboards, mice and most sort of postures and practices they are adopting at work and at home as well. 
 
We are increasingly and regularly seeing and advising patients who are using computers at work and at home. Time after time people are complaining of aches and pains and unexplained niggles in their necks, shoulders and wrists and not realising that it was their computer making them sore. 
 
We are passionate about people not being hurt by the things they use in everyday life for work and personal use. There are some very simple things that can stop a computer hurting the person using it, the first of which is an awareness of the ways how a computer will hurt given the chance. 
 
We believe in making things clear, easy to understand and practical to stop people being hurt or made uncomfortable when using their computer. 
 
If you have any concerns about your work station set up then please do not hesitate to contact us. Do not wait until you have neck and arm problems before you seek help. 
 
"We Know How Your Body Works" 
NEWSLETTER - Headache (Cervicogenic) 
Headache (Cervicogenic) 
 
What is a cervicogenic headache? 
A cervicogenic headache is simply another name for a headache which originates from the neck and is one of the most common types of headache. It is important to note, however, that there are many types of headache of which cervicogenic is just one. Another common type is vascular (this includes migraines). 
 
The spine comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. During certain neck movements or sustained postures, stretching or compression force is placed on the joints, muscles, ligaments and nerves of the neck. This may cause damage to these structures if the forces are beyond what the tissues can withstand and can occur traumatically due to a specific incident or gradually over time. When this occurs pain may be referred to the head causing a headache. This condition is known as cervicogenic headache. 
 
Cervicogenic headache typically occurs due to damage to one or more joints, muscles, ligaments or nerves of the top 3 vertebra of the neck. The pain associated with this condition is an example of referred pain (i.e. pain arising from a distant source – in this case the neck). This occurs because the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears.. 
 
Although cervicogenic headache can occur at any age, it is commonly seen in patients between the ages of 20 and 60. 
 
Causes: 
Cervicogenic headache typically occurs due to activities placing excessive stress on the upper joints of the neck. This may occur traumatically due to a specific incident (e.g. whiplash or heavy lifting) or more commonly, due to repetitive or prolonged activities such as prolonged slouching, poor posture, lifting or carrying (especially in poor posture), excessive bending or twisting of the neck, working at a computer or activities using the arms in front of the body (e.g. housework). 
 
Signs and symptoms: 
Patients with this condition usually experience a gradual onset of neck pain and headache during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly upon waking the next morning. 
 
Cervicogenic headache usually presents as a constant dull ache, normally situated at the back of the head, although sometimes behind the eyes or temple region, and less commonly, on top of the head, forehead or ear region. Pain is usually felt on one side, but occasionally, both sides of the head and face may be affected. 
 
Patients with this condition often experience neck pain, stiffness and difficulty turning their neck, in association with their head symptoms. Pain, pins and needles or numbness may also be felt in the upper back, shoulders, arms or hands, although this is less common. Occasionally patients may experience other symptoms, including: light-headedness, dizziness, nausea, tinnitus, decreased concentration, an inability to function normally, and depression. 
Patients with cervicogenic headache typically experience an increase in symptoms during certain movements of the neck or sustained positions (e.g. driving or sitting at a computer in poor posture). Patients may also experience tenderness on firm palpation of the upper part of the neck just below the base of the skull along with muscle tightness in this region. 
 
Diagnosis: 
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose cervicogenic headache. Occasionally, investigations such as an X-ray, MRI or CT scan may be required to assist diagnosis. 
 
Prognosis: 
Most patients with this condition heal quickly and have a full recovery with appropriate physiotherapy treatment. Recovery time varies from patient to patient depending on compliance with treatment and severity of injury. With ideal treatment, patients with minor cases of cervicogenic headache may be pain free in as little as a couple of days, although sometimes it may take 2 – 3 weeks. In severe or chronic cases a full recovery may take weeks to months. 
 
Contributing factors: 
There are several factors which can predispose patients to developing cervicogenic headache. These need to be assessed and corrected where possible with direction from a physiotherapist. Some of these factors include: 
 
• poor posture 
• neck and upper back stiffness 
• muscle imbalances 
• muscle weakness 
• muscle tightness 
• previous neck trauma (e.g. whiplash) 
• inappropriate desk setup 
• inappropriate pillow or sleeping postures 
• a sedentary lifestyle 
• a lifestyle comprising excessive slouching, bending forwards or shoulders forwards activities. 
• stress 
• dehydration 
 
Physiotherapy: 
Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence. Treatment may comprise: 
 
• joint mobilization 
• joint manipulation 
• soft tissue massage 
• acupuncture 
• electrotherapy (e.g. ultrasound) 
• postural taping 
• postural bracing 
• the use of a lumbar roll for sitting 
• education 
• activity modification advice 
• the use of an appropriate pillow for sleeping 
• ergonomic advice 
• exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture 
• Pilates 
 
Exercises: 
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 – 5 times daily and only provided they do not cause or increase symptoms. 
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. 
 
Initial Exercises: 
Chin Tucks 
 
This exercise can stretch and strengthen the upper neck muscles and reduce forward head posture. 
To perform: 
 
1. Sit with your head facing forward. 
2. Place your index finger and middle finger on your chin and guide your head into a “double chin” position. 
3. The motion should be directed straight back and you should continue to look straight ahead. 
4. Hold for 2 seconds and repeat 10 times provided there is no increase in symptoms. Repeat 3 – 5 times daily. (N.B In some cases it may be beneficial to perform this exercise every 1 or 2 hours provided the exercise does not cause or increase symptoms). 
 
Do not let your head tilt up or down during the exercise. 
NEWSLETTER - Frozen Shoulder 
Frozen Shoulder 
 
Frozen shoulder is a painful condition that affects movement of the shoulder. Frozen shoulder (sometimes called adhesive capsulitis of the shoulder) is a condition where a shoulder becomes painful and stiff, it is fairly common, affecting 2-5% of the population. The flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened. If you have frozen shoulder, the amount of movement in your shoulder joint will be reduced. In severe cases, you may not be able to move your shoulder at all. 
 
The hallmark sign of a “frozen shoulder” is being unable to move your shoulder - either on your own or with the help of someone else. 
 
It is thought to be due to scar-like tissue forming in the shoulder capsule. Without treatment, symptoms usually go but this may take up to 2-3 years. Various treatments may ease pain and improve the movement of the shoulder. 
Risk Factors for Frozen Shoulder 
 
Ageing - In Japan frozen shoulder syndrome is called "Fifties Shoulder". 
Posture - especially round-shouldered 
Shoulder - intensive sports 
Shoulder - intensive or repetitive manual occupation 
Diabetes - Types I and II 
Trauma 
Immobilization / splinting 
Fracture of the collar bone or humerus (arm bone) 
Surgery (especially after shoulder surgery, or mastectomy with breast reconstruction) 
 
Frozen Shoulder Fact File 
 
More common in women (60%) 
At least five times more common in diabetics 
Slightly more common in patients with Dupytren's contracture of the hand. 
May have a genetic component i.e. it can run in the family 
Seems to affect 40-70 year olds 
About 15% of people develop frozen shoulder on both sides (commonly within 6-12 months of the first occurrence) 
 
Symptoms of frozen shoulder 
 
The most common symptoms are pain and stiffness in the shoulder. These symptoms often follow a particular pattern:- 
 
Phase one - the 'freezing', painful phase. The first symptom is usually pain then stiffness may gradually build up. The pain is typically worse at night and when you lie on the affected side. This usually lasts 2-9 months. 
 
Phase two - the 'frozen', stiff or adhesive phase. The pain gradually eases but stiffness and remains and may get worse. All movements of the shoulder are affected, however outward rotation of the arm may be most affected. The muscles around the shoulder may waste a bit as they are not used. This usually lasts 4-12 months. 
 
Phase three - the 'thawing', recovery phase. The pain and stiffness gradually go and movement gradually returns to normal, or near normal. This usually lasts between one and three years. 
 
Treating frozen shoulder 
 
The aim of treatment is to ease pain and stiffness; also, to keep the range of shoulder movement as good as possible whilst waiting for the condition to clear. 
 
One or more of the following may be advised to help ease and prevent symptoms: 
 
Painkillers 
 
Anti-inflammatory painkillers 
 
Physiotherapy 
Many people are referred to a physiotherapist who can give expert advice on the best exercises to use. Also, they may try other pain-relieving techniques such as warm or cold packs and possibly the use of acupuncture. 
 
Shoulder exercises 
These are commonly advised. The aim is to keep the shoulder from 'stiffening up' and to keep movement as full as possible. It is important to do the exercises regularly, as instructed by a physiotherapist. 
 
A steroid injection 
An injection into, or near to, the shoulder joint brings good relief of symptoms for several weeks in some cases. Steroids reduce inflammation. It is not a cure, as symptoms tend to gradually return. However, many people welcome the relief that a steroid injection can bring. 
 
Surgery 
An operation is sometimes considered if other treatments do not help. Techniques that are use include: 
 
• Manipulation. This is a procedure where the shoulder is moved around by the surgeon while you are under anaesthetic. 
• Arthroscopic capsular release. This is a relatively small operation done as 'keyhole' surgery. It is often done as a day-case procedure. In this procedure, the tight capsule of the joint is released with a special probe. 
 
Although surgery has a good rate of success it does not help in all cases. 
 
If you are struggling with this condition then please do not hesitate to contact us to see how we can help TELPEHONE 01206 844410 or click here to email us... 
 
"We Know How Your Body Works" 
NEWSLETTER - Benefits of Sports Massage 
We would like to welcome Melissa Mills to our team. Melissa is a Sports Massage Therapist and treats people for a wide range of problems from various injuries, tension, stress and muscle tightness. 
 
WHAT IS SPORTS MASSAGE ? 
 
Sports Massage is a deeper, more intensive massage technique incorporating kneading and the manipulation of soft tissue in order to prevent sports injuries, improve performance, treat existing sports injuries and help alleviate the stress and tension which builds up in the body’s soft tissue during physical activity or in day to day life. 
 
WHAT ARE THE BENEFITS OF SPORTS MASSAGE ? 
 
Sports Massage has 5 main benefits: 
 
1. It helps to maintain the entire body in a better physical condition 
2. It reduces the possibility of injury and the loss of mobility 
3. It can aid in the cure of injured muscle tissue and therefore restore mobility 
4. It can boost athletic performance and enhance endurance 
5. It can extend both the good health and overall life of a sporting “career” 
 
How many of you are ‘born again’ sports men or women ? Having been motivated by the likes of Mo Farah and Jessica Ennis at last year’s Olympics or more recently by Andy Murray or Justin Rose, have either dug out and dusted off the old trainers from the bottom of the cupboard or the golf clubs from the garage or the old Slazenger from the top of the wardrobe ! 
 
How many of you think that you are relatively fit and so able to start up your old sport again just because we either walk the dog, push the pram or walk to the station to work every day ? Your mind may be willing and able BUT is your body ? 
 
This is where a Specialist Sports Massage Therapist can prove to be of real benefit to you : 
Prior to commencing your chosen sport, Sports Massage may be used in order to help you loosen warm and better prepare your muscles so that their performance and endurance can be enhanced thereby reducing the risk of injury. After all, you still may have to go to work tomorrow ! 
 
In addition, a lot of people today have taken up running Marathons. Sports massage is an ideal therapy to aid your performance and endurance prior to the event as well as an aid to relieve pain, prevent stiffness and return muscle back to their normal state after the event. 
 
For more information on how Melissa can help you, or to book a Sports massage therapy session, please contact BODYWORKS on 01206 844410 or email enquiries@bodyworksphysio.net 
 
"We Know How Your Body Works" 
NEWSLETTER - Tennis Elbow 
Tennis Elbow 
 
We are often asked to treat patients with lateral (outside) elbow pain and its prevalence is becoming a little more noticeable. It is termed Tennis Elbow although it is not just playing tennis that causes it. It is often caused by other activities that place repeated stress on the elbow joint, such as decorating or playing some musical instruments 
 
It is commonly caused by overusing the muscles attached to your elbow and that are used to straighten your wrist. If the muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) on the outside of your elbow. 
 
Most of these cases will eventually resolve by themselves within 6 months to 2 years, however in many cases these timescales can be shortened through Physiotherapy intervention. In non-resolving cases referral to an upper limb consultant is indicated for an MRI Scan and/or x-ray and when indicated cortisone injections administered or in very rare cases, surgery is performed. 
 
Signs and Symptoms 
 
• Difficulty holding onto, pinching or gripping objects 
• Pain, stiffness or insufficient elbow and hand movements 
• Forearm muscle tightness 
• Tenderness on palpation of the outside of the elbow 
 
There is very good evidence for the use of specific exercises to treat tennis elbow – they are called eccentric exercises and are simple and quick to do, and if done regularly will on average result in improvement or resolution of symptoms over 8 – 12 weeks. 
 
A dumbbell is perfect for these exercises, but any weight can be used, as can the rubber exercise/physiotherapy bands (available from Bodyworks) or online. The weight or the strength of the band should be such that after the exercises, the forearm feels tired, but not so heavy that the exercises cannot be completed or are excessively strenuous. 
 
An example of an eccentric exercise would be as follows: 
 
Seated in a chair, support the forearm over the edge of a table or over your knee and hold the weight in the hand with the palm facing down 
From a position with the wrist fully extended (cocked back at 90 degrees) slowly lower the weight until the wrist is fully bent (flexed). Repeat this movement 10-15 times. 
Use your other hand to take your wrist and the weight back into the fully extended position between each repetition. The important movement is the lowering of the weight. 
After 10-15 repetitions rest for two minutes then do a further 10-15 reps. Rest for 2 minutes and then do a final 10-15 reps. 
Do 3 x 10-15 repetitions twice daily. 
 
These eccentric exercises are effective when used in combination with stretches and strategies to reduce any inflammation that may be present. 
 
Physiotherapy Treatment 
 
The difference between quick resolution of these injuries and a more chronic long lasting problem is often physiotherapy intervention. Research suggests that physiotherapy is more effective than cortisone injections and rest in the first 12 weeks of development of the pain. 
 
Treatment might incorporate ultrasound, specific massage techniques called frictions and deep tendon manipulation, acupuncture, a look at the biomechanics of the cause of the injury, application of tendon offload braces and taping and certainly a tailored self-rehabilitation exercise programme. 
 
We also use Radial Shockwave Therapy for very effective treatment of chronic tennis elbow that has not responded to other therapies. Take a look at the Radial Shockwavr Therapy section on the website. 
Your physiotherapist will guide you through a phased rehabilitation process depending on the level of your injury, but in the first instances of pain remember that quick implementation of R.I.C.E (rest, ice, compression and elevation) is essential. 
 
Sport Specific 
If the underlying cause of the injury is in fact tennis or squash then it is even more essential that you seek help from a Physiotherapist skilled in sport specific rehabilitation. I have successfully treated tennis players, squash players and hockey players that have all developed lateral epicondylitis through modifying equipment and technique in order to effect a biomechanical change in stress on the injured structures. An example of this would be looking at the racquets used including racquet material, head size, string tension and grip size and the relative effects that these components have on the elbow. 
 
If you are suffering from this condition, which can be very painful and debilitating, we would be delighted to hear from you so that we can help you on your journey to full recovery. 
 
"We Know How Your Body Works" 
NEWSLETTER - What is Constipation? 
Well it seems to be that time of the Month again. We have been looking into the use of Social Media to increase the number of people we can reach and hopefully help in one way or another. We had an extremely useful training session from Chris Bullman of Think Social Business last week. Now what Chris does not know about Social Media can be written on a postage stamp! If any of you have access to Facebook then please visit our page, like and share it for us, thank you. 
 
We hope that you find this neswletter useful, if not for you, then maybe for someone you know? 
 
CONSTIPATION 
 
What is constipation? 
 
The word constipation means many different things to different people. To some it means hard, pellet like stool, or difficulty passing stool, or just not going every day. Constipation can be defined in a variety of ways including opening the bowels less than three times a week, needing to strain to open your bowels on more than a quarter of occasions or passing a hard or pellet-like stool on more than a quarter of occasions. 
 
Many people have been educated or brought up to believe that we MUST empty our bowels on a daily basis and that it is harmful not to do so. This is not the case, the normal range for opening your bowels can be between three times a day, and once every three days. Very few people actually go regularly every day, and in fact some people will take regular laxatives or spend long periods of time on the toilet trying to go due to this misconception of needing to go daily. 
 
Constipation can occur in babies, children and adults, and affects twice as many women as men, and affects between 3% and 15% of the population. It is thought that up to one in six people may suffer with constipation. Older people are five times more likely than younger adults to have constipation, usually because of diet, lack of exercise, use of medication and poor bowel habits. Approximately 40% of pregnant women experience constipation during their pregnancy. 
 
Causes of Constipation 
 
There are many possible underlying causes of constipation, some of these may be due to an anatomical problem such as a rectocele (prolapse of the back wall of the vagina), a megacolon (large, dilated bowel) and nerve injury. 
 
There are numerous functional problems that can lead to constipation and these include:- 
• Certain medications 
• Diet 
• Decreased fluid input 
• Pregnancy and following childbirth 
• Environmental factors – some people just have a preference for their own loo 
• Fear of pain – this is very common in children. A child who has a single episode of problems opening 
their bowels leading to pain when going can cause future problems. Or an adult who maybe has piles causing pain when passing stool can lead to problems 
• Post-surgery 
• Stress 
 
What can be done to help? 
 
Lifestyle: Bowels benefit from routine. Allow yourself time and privacy to empty your bowels. When you feel the need to empty your bowel - respond! If you keep ignoring the bowel you can make yourself constipated. Often people will find that they need to go about thirty minutes after a meal or a warm drink. 
 
Exercise: Regular exercise, within your limitations, can stimulate the bowel to work regularly. 
 
Diet and fluid: It is important to make sure that your diet has adequate fibre in it. The best advice is to eat 5 portions of fruit and vegetables a day. Avoid skipping meals, especially breakfast as this can lead to a sluggish bowel. It is also possible to have a diet that is actually too high in fibre and this can slow your gut transit time down too much, leading to bulkier and harder stool. 
 
Examples of foods which can act as natural laxatives for some people include prunes / prune juice, figs / fig juice, molasses, liquorice, chocolate, coffee, alcohol (within recommended limits!) and spicy food / curry. Porridge oats are a natural stool softener and the best fruits are kiwi, pears and oranges. Linseed seeds can be useful, one to two teaspoons on your cereal each day. 
 
Drinking the correct amount of fluid for your body weight can help constipation. The job of the last part of the gut is to absorb fluid back into the body. It will do this even if you are drinking very little. If you are not drinking enough, this makes the waste hard and makes it difficult for you to get rid of waste. Fluid helps the waste to remain slippery and therefore easier to pass. Ensure you drink at least 1 ½ litres (3pints) of caffeine/alcohol free fluid in a day. 
 
Probiotics: The bacteria within your intestines are key to a good digestive health. It may help some people to maintain a favourable balance by taking a probiotic product each day. This tops up the 'good' bacteria you should already have in your large intestine. Acidophilus capsules are a very good probiotic as they are a slow release capsule and can be purchased at any health food shop. 
 
Medication: Some medicines you take may upset your bowel habit. Do not stop medication, but ask your nurse, doctor or pharmacist if you suspect this, for advice. 
 
Laxatives: Long term laxative use can be quite harmful. The nature of long-term use is that the bowel becomes progressively less responsive to all these agents, meaning that increasing doses are required. 
 
‘Pooing Posture!’: When you do open your bowels, it is important to get into a good position to get as empty as possible. Unfortunately, modern toilets are not ideal for this, as the most natural position is squatting. You can get close to this by supporting your feet on a low stool or a couple of telephone directories. 
 
Lean forwards slightly with your forearms resting on your thighs, palms uppermost (as if you are reading a book). Take your time - try not to feel rushed. Try to relax your shoulders and allow your tummy to bulge as you gently blow (blow gently, as if trying to blow a candle flame to make it flicker). Only take as long as you need - don't sit for ages. 
 
Physiotherapy: There are many things that a Specialist Physiotherapist can do to help with the treatment of Constipation. Here at Bodyworks Physiotherapy Clinic I treat a lot of patients with bowel issues many of whom suffer with constipation. I have good results advising patients with everything already discussed in this article. I also teach pelvic floor muscle exercises and use biofeedback either with real time ultrasound or the biofeedback machine. 
 
WHEN TO SEEK HELP FROM YOUR GP? 
 
If you have a sudden or unexplained change in your usual bowel habit. 
If you experience unexplained abdominal pains. 
If you have bright or dark red in your bowel motions. 
If you cannot control your bowels, or leak from the back passage. 
 
I get very good results and very satisfied customers. Do not suffer in silence as there is help out there for you. If you would like to discuss your problems with me in complete confidence then please email me or phone the clinic directly. 
 
 
“We Know How Your Body Works” 
Newsletter - Posture Problems? 
In today’s hectic and busy world, we do not give enough thought as to how our posture can affect our health. Whether it is sitting at the computer, driving in our cars, the daily commute or general day to day activities, our posture can affect our well-being. 60% to 80% of us will get at least mild back pain at some time in our lives. Bad posture is a great contributor towards back pain which in turn leads to many man hours lost in employment. 
 
Poor posture can be the underlying basis of many back problems. As we age, bad habits such as poor posture and reduced activity cause muscle tiredness and tension that can lead to back pain. Poor posture can lead to rounded shoulders, a poking head position, joint aches, muscle fatigue and headaches. 
 
Postural muscles (slow twitch) should be working all of the time to support our spine and joints. These muscles burn their energy very slowly and can therefore work for long periods of time by being able to conserve their energy. The muscles responsible for movement and activity (fast twitch) put all their energy into shorter bursts of activity, and therefore run out of energy quickly. Poor posture will gradually have the effect of making our fast twitch muscles work more to try and maintain these postures. This will in turn cause the deeper supporting muscles to waste away from lack of use. Weak, unused muscles tend to tighten which can compress the spine and cause further posture issues and pain. 
 
When maintaining correct posture, the joints, ligaments and muscles of the neck and back are kept in an optimum position so they are under the least amount of stress possible. Prolonged poor posture can also lead to weak abdominal muscles which means less support for our spine and pelvis. Strengthening your deep lower abdominal muscles will assist your posture and possible back ache. This can be achieved by core stability / pilates exercises. 
 
Contributing factors to the development of postural problems: 
 
There are several factors that may contribute to the development of postural problems. These factors need to be assessed and corrected with direction from a physiotherapist and may include: 
 
Joint stiffness (particularly of the neck or upper back) 
A sedentary lifestyle 
Poor core stability 
Muscle weakness (particularly the deep neck muscles and shoulder blade muscles) 
Muscle tightness 
A lifestyle involving large amounts of sitting, bending, slouching, shoulders forwards activities or lifting 
Decreased fitness or fatigue 
 
What is correct posture? 
 
An optimal spinal posture allows your muscles to generate more efficient force which improves performance in daily activities. As a general rule, correct posture can be achieved by ensuring there is a straight line from your ears, to your shoulders, to your hips. Think about maintaining a tall, long spine as though a piece of string is pulling your head toward the ceiling, or that you are being held up by a huge bunch of helium balloons. 
 
Can you change your posture? 
 
The more time you spend maintaining correct posture, the easier it becomes. This occurs for two main reasons. First of all, your joints and muscles loosen up with maintaining this optimal spinal posture. Secondly, your muscle 'memory' improves over time, so that with enough practice, maintaining this position occurs more naturally. Your ability to maintain correct postural alignment won't develop over night. Every time you find yourself slouching, don't give up, just think of it as a time you can correct your position and do something productive, thereby gradually breaking bad habits. 
 
Sitting: 
 
In sitting, it is important to have a chair which gives firm support thereby allowing your body to maintain a correct posture. Your bottom should be situated at the back of the chair and the back of the chair should give good lumbar support to assist with maintaining optimal spinal alignment. Your shoulders should be held back slightly and your chin should be tucked in a little. The height of the chair should allow your hips and knees to be at right angles (it is important not to have your knees higher than the level of your hips as this may encourage a flexed lower back). This position is also of prime importance when driving. 
 
Improve your general posture: 
 
If you spend periods of time in a forward flexed position then you must try to bend backwards periodically to reverse this posture. 
Improve muscle flexibility by carrying out stretching exercises a few times a week. 
Regular exercise will improve muscle strength and tone. 
Regular deep abdominal muscle exercises. 
Avoid standing on one foot for long periods of time 
Avoid sitting in soft, squashy chairs. 
Use lumbar rolls to support your lower back when sitting or driving the car. 
Use a pillow that supports your neck sufficiently. 
Make sure your mattress is supportive enough to keep your spine straight when lying on your side. Remember you could be spending up to a third of your life in bed! 
Keep your back straight and use your thigh muscles when lifting. 
 
Utilising these tips on a regular basis, should ensure a better posture which in turn will result in fewer instances of back and joint problems. 
 
"We Know How Your Body Works" 
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