Gluteal, Hips, Improving Movement, Physiotherapy, Stability

Happy Hips

Whether you are a walker, a runner, footballer or even a belly-dancer, everyone needs good hip stability to be able to perform their sport (or their art) with optimum control.

Belly Dancers Hips

Poor stability around the hip joint can lead to problems such as trochanteric bursitis, lower back pain, sciatic pain and groin injuries. If you have one of these problems it is possible that you have weakness and poor control of the deep muscles of your hip joint.

Hip stability is achieved by having not only strength of the big gluteal muscles that make up the bulk of your buttocks but also good timing of activation and control of the deeper muscles of the hip joint. These deep muscles are responsible for stabilising the hip joint during movement to allow the larger gluteal muscles to move your hip with better joint alignment.

Hips Start

Knees bent, pelvis tilted

To test your deep hip stability simply follow these steps:

1) Stand in front of a mirror with your knees slightly bent (around 30 degrees) and your pelvis tilted forwards.

Now place your hands on your hips to feel the muscles just behind your hip with your thumbs and your abdomen with fingertips.

Hip exercise

Hips always level

2) Gently transfer your weight to one side, aiming to keep your knee, hip and shoulder aligned on the side that you are leaning toward e.g. your hips stay level with the ground.

Hold for a few seconds then transfer your weight to the other foot, again keeping your hips level.

If you have good stability you should be able to do this and maintain alignment of your hips, knees and shoulders, as shown in the animated image on the left, and you will feel the muscles activate strongly.

If you have poor stability you will find it hard to keep your balance and you may see your hips drop or your shoulders sway too far out to the side, as shown below.

Happy Hips Wrong

Left – hips crooked, Centre starting position. Right – hips crooked

Practicing this simple movement daily can help to improve the stability of your hip joint.

Keep it up! Remember; stable hips are happy hips!

Post by Angus Tadman B. App. Sc (Phty) Hons Class I

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Daily Exercises, Improving Movement, Physiotherapy, Stretching

Avoid the Hump – the stiff thoracic spine

Do you spend hours bent over a workstation? Does your job involve repetitive bending and heavy lifting? Do you, like so many of us in recent years, use a tablet, smart phone or laptop computer for hours every day?

Thoracic HumpIf you answered yes to any of the above then it is very likely that you will have developed stiffness in your upper back.  This ‘thoracic region’ is the largest part of our spine.  It starts at the base of your neck and ends just above the lower back.

As a result of daily habits, like those described above, and poor posture, the thoracic spine is more likely to become stiff.   This may not present as a major problem initially but it can have flow-on effects to the lower back, neck and shoulders.

The most immediate obvious effect of thoracic stiffness is in an increase in the natural curvature of your upper back and causes you to stand with “rounded shoulders”. This poor posture that we so often adopt as a result of laziness of our muscles eventually becomes permanent as the joints lose their ability to move back into a more upright position!

There are two wonderfully effective stretches that can help to increase thoracic spine mobility:

1)    The open book stretch: Lay on your side as shown. Breathe in as you move your top arm across your body and turn your head and shoulders with it, keeping your knee firmly placed on the floor. Breathe out as you hold the stretch for around ten to fifteen seconds, then return to the start and repeat 10 times.

Thoracic Open Book stretch

2)    Extension over ball: Place a small inflatable ball on the floor – an exercise ball is best as it is quite squishy but a soft soccer ball will also do. Lay over the ball positioned between your shoulder blades. Make sure your head is supported on a pillow or a rolled up towel and your legs are bent. Stretch for 2 minutes with your arms overhead, breathing fully and relaxing into the stretch.

Lay over ball

Post by Angus Tadman B. App. Sc (Phty) Hons Class I

abdominals, Gymn Dangers, Physiotherapy, Pilates, Shoulder, Stability

Strong is the new SEXY

Strong is the new sexy but you have to be stable to be strong

Fit Woman

The media image of gorgeous and sexy has changed in recent years. It seems the willowy overly thin or the voluptuous curvy image of attractive woman has been surpassed with healthy strong and muscular women like Michelle Bridges or Anglina Jolie as Lara Croft. Men with muscles and great posture have always been the most admired and now the girls are aiming for the same.

In endeavouring to achieve this end it is essential to increase core strength and stability as we build power. A failure to address the “stability” part of “strong” will leave the body at risk of injury. Building muscle bulk is quite possible without core strength but pain might build to and there is nothing sexy about being injured or in pain!

We see increasing episodes at the clinic of back pain, tendon injuries and knee injuries in the strong but unstable individual who has been focusing purely on developing power and a good looking pysique.

Cross TrainerSome gym machines provide so much control of movement there is no challenge to stability, resulting in increasing strength but without the protection offered by the co-activation of stabilising muscle systems throughout the body.

Holding onto the handles of the cross trainer has the machine providing control of movement direction, minimising how much stability you have to provide from within.   Using the cross trainer not holding the handles ensures YOU have to provide the stability and control to maintain smooth movement.

Try it and feel the difference…. carefully at first!!  It is a much harder workout – and thats the acid test.  If its easy its not doing you as much good.

BOSU

Incorporating free weights and weight bearing exercise on unstable platforms like a BOSU will have you protecting the joints while building strength.

We know that good control and correct activation of the deeper abdominals flatten the tummy. Without this the rectus abdominus  (the six pack muscle) can strengthen but the abdomen can remain distended.  We often see very strong men with big bellys… a result of poor training technique.

Strengthening the deeper muscles around the shoulder girdle gives improved contours through the back and will stop the winging of scapular (Chicken wings). Strong shoulders look great!!

So ..if you are aiming for Strong and Sexy remember to train for stability too. Power in useless without control!!

Post by Catherine Stephens B. App Sc (Physio) MAPA.

Physiotherapy, Shoulder

Frozen Shoulder – a predictable mystery

Although the reasons for onset of Frozen Shoulder remain unclear to the medical profession, the physiological process and symptoms experienced are quite predictable.

Most patients present with a general stiffness, restricted movement and some associated pain in the shoulder that radiates down the upper arm.  In some cases the pain is slight and in others extreme.

Ultrasounds and MRIs can detect many subtle abnormalities of joints and surrounding muscle and tissue but Frozen Shoulder is largely diagnosed by the physician based on movement dysfunction and associated pain, especially when elongated timeframes are involved e.g. 6 months plus.

Frozen shoulder age chart

It might sound a bit hit and miss but Frozen Shoulder is quite common – in fact 2% of the population suffer it with the vast majority of patients in their 50s.  If you have diabetic issues then the chances of it developing are even greater.

And ‘Developing’ is the only way to describe it.  Frozen Shoulder mainly occurs from no obvious associated injury to the shoulder.  In fact it can just develop for no apparent reason, though it will often accompany a recent traumatic incident – though again not necessarily to the shoulder.  A patient presented recently who had had a car accident, suffering whiplash and three weeks later developed a frozen shoulder.

The Process:

What happens is that the body ‘believes’ the main shoulder joint is damaged and therefore triggers an inflammatory response in order to heal it.  This involves streams of white blood cells, platelets and fibroplasts being sent to the joint lining and surrounding joint capsule and ligaments which causes inflammation and subsequent shrinkage which in turn restricts movement.

Frozen Shoulder Capsule

Left: Normal capsule allows generous movement Right: Frozen capsule shrinkage restricts movement

This process is like a ‘domino effect’, once started it naturally continues with no known way of stopping it – even though there is no original injury that triggered it.

Domino effect

It is as if the immune system makes an error of judgement.  In fact it is a natural hormonal change that instigates this ‘Inflammatory Cascade’ in the first place, which is why it affects women in their early 50s and men in their late 50s who are experiencing natural hormonal life changes at this time.

Eventually, after many months (usually around 5-7 months) the ‘dominoes’ run out and the inflammatory cascade stops, at which point Myofibroplasts are then sent in to smooth out the scar tissue.  This is exactly what happens with external injuries where the initial ugly scar tissue will soften and decrease until it eventually all but disappears.

Frozen shoulder timeframe

Pain starts to decrease and mobility return, but this is often a very slow process taking up to two years (and sometimes more) to complete and cannot be hurried along.

Treatment:

The most common treatment that can be effective during this ‘post freeze’ time is a cortisone injection into the glenohumeral (shoulder) joint which reduces the inflammation making it less painful and debilitating to everyday activities for around 3-4 weeks.  The injection can be repeated if needed.

Cortisone effect chart

It is a popular treatment that has much success but doesn’t always have optimum effect and in some cases can be relatively ineffective.

There are other methods for severe cases including arthroscopic capsular release, which is a key-hole, day-surgery procedure.

Physiotherapy:

Shoulder treatmentPhysiotherapy may exacerbate the pain in the first few months following the onset of symptoms in the ‘freezing’ phase or the inflammatory phase. But in the ‘thawing’ phase when the inflammation has settled, then physiotherapy and stretch exercises will help accelerate recovery in range of motion.

Due to the restrictions on movement inflicted by the Frozen Shoulder, all the other muscles surrounding the shoulder area will weaken and ligaments shrink, so a gradual stretching and re-building of muscle tone will be required over at least 6 months, sometimes longer.

Your physiotherapist is best to advise on exercise and stretching regimes, while taking care not to impinge the recovering joint.

Arms Spread

Author: This is a shortened version of an in-depth article by Mark Haber, specialist orthopaedic surgeon, M.B. B.S.  F.R.A.C.S. (Ortho). All illustrations copyright Mark Haber.   See full length article here.

Mark Haber conducts consultations at Warringah Medical Centre, Dale Street, Brookvale on referral from your GP.