Massage gun or ball for glute release

Should I get a massage gun?

With the increasing popularity and availability of the massage gun, one of the most common questions we get asked in the clinic is “Do those massage guns really work?”. So we thought we would break it down for you all.

What does a massage gun do

Massage guns aim to provide percussive or vibration therapy. The idea being that as the massage gun head oscillates in and out, small vibrations occur in the muscle, replicating the percussive techniques that massage therapists are trained in. If you’ve been to the clinic, you’ll know that this is not a technique that we commonly use. It is predominantly used for post-exercise recovery and occasionally in a pre-exercise/warm up capacity. In our experience, we don’t see it playing a significant role in injury recovery. This is also why, when we prescribe self-releases, we always encourage maintaining constant pressure on the tight spots for 60-90 seconds for most muscles, as this is what is usually required to make a noticeable change in the muscle tightness.

The evidence

There is some evidence that indicates percussive therapy administered by a massage therapist can help prevent delayed-onset muscle soreness (DOMS) and provide some relief for muscle tightness. As with most soft tissue treatment, the mechanism for this is largely neural – that is, the massage causes a response from the nervous system which responds, providing a short-term change in the tissue. This can be from increased blood flow or short-term inhibition of certain nerve endings which contribute to muscle tightness. Due to massage guns being relatively new on the market, there is minimal evidence at this stage investigating if they have a similar effect as percussive therapy performed by massage therapist.

How a massage gun works

Similar to rubbing your shin if you hit it on the coffee table, massage guns can also decrease pain in the short term by using the “pain-gating” theory. That is, if the brain is busy processing the input of touch (either your hand or a massage gun), it can’t produce pain too. This may actually be one of the bigger selling points of massage guns. Often the discomfort of doing self-releases is a preventative factor for people. So with therapy guns often being far more comfortable, this barrier can be removed. While the preference would be sustained pressure on a single spot for 60-90 seconds, if the realistic options are massage gun or no release… we would definitely choose massage gun! If you are looking at getting a massage gun or using one for the first time – think less is more. That is – pick the smaller vibrations and the flattest head (most come with a variety of attachments) and start with just 1-2 minutes per muscle group.

Physio in the water

Water running with Caitlin

As the weather warms up, many of us are looking for cooler exercise options. Water running is a great choice as it can be scaled up and down for fitness and experience level. With the added summer benefit of being in the water.

There are a few different ways you can engage in water running – each with varying technique, intensity and muscles used. Since water provides resistance to movement, all forms of water running will load the hip flexors more than normal walking and running. So this is worth keeping in mind if you have injuries or known strength issues in this area.

Shallow water running

The buoyancy of water means that running in the pool is a great low impact way to introduce the body to running. Running along the bottom of the pool means you can start to learn the mechanics of running without the same impact. Most public pools have either a shallow end or even a couple of shallow lanes that mean you can run along. Gently contacting the bottom of the pool while keeping your upper body out of the water. I would recommend this for people who are more hesitant in the water or are looking for a way to increase their tolerance to impact in preparation for return to running (eg following a stress fracture or pregnancy). Whilst you can scale the intensity of this up and down, generally this kind of water running won’t elevate your heart rate as much. So its a better choice for people with a lower level of cardiovascular fitness.

Deep water running

The other alternative is to run in the deeper water. Staying afloat will usually require a higher intensity and therefore result in a higher heart rate. This makes it a good option for people wanting to cross-train to maintain fitness during an injury. Given that these forms are higher intensity in nature, they are better suited to interval efforts. For example: 30 seconds work, 30 seconds rest x 20. Rather than a steady state effort for 20 minutes. There are two different technical approaches to deep water running outlined below. Both can be done with or without a floatation belt. Not using the belt is a way to increase the intensity/difficulty, as you have to generate all the energy to stay afloat.

“Run” 

Trying to mimic as close as possible to usual running technique. Getting knees up, toes up and cycling through along with arm swing. This form of water running in particular will load the hip flexors heavily so might need to be paired with hip flexor muscle releases

Arm focused run

Thinking of the leg action more as a freestyle kick/flutter (whilst still staying upright in a run position). Focusing more on a strong and fast arm drive. This comparatively is less load on the hip flexors, but more load on the abs and shoulder muscles.

If you’re looking for different forms of exercise to incorporate into your routine, have a chat with your physio about whether water running could be suitable for you. You can book with us online here.

Knee injuries

Let’s talk knee injuries.

The knee joint is relatively simple and moves as a hinge joint (i.e bending and straightening). The joint itself is an articulation between our femur (thigh bone) and our tibia (shin bone) for the hinge movement and patella (kneecap) sitting over the front to increase our quad strength. There are a series of ligaments, articular cartilage and muscles that are involved in this joint.

Ligaments and Meniscus

Collateral Ligaments: attach between the femur and the tibia outside the joint capsule and control side to side movement. The medial collateral ligament (MCL) is on the inside of the knee and the lateral collateral ligament (LCL) is on the outside.

Cruciate Ligaments: inside the joint capsule making an ‘X’ attaching from the femur to the tibia and prevents movement forward and backward. The anterior cruciate ligament (ACL) attaches from the front of the joint surface on the tibia to the back of the joint surface on the femur and the posterior cruciate ligament (PCL) attaches from the back of the joint surface on the tibia to the front of the joint surface on the femur.

Patella Tendon and Ligament: attaching the patella to the quadriceps muscle and tibia respectively.
Articular Cartilage: a smooth and slippery covering at the ends of the bones to allow for smoother movement.

Meniscus: a ‘C’ shaped piece of fibrocartilage within the knee joint for shock absorption.

Common Injuries:

Because of the relatively simplistic nature of the knee joint it is often exposed to increased load if there is restriction in the hip or ankle (check out our blog on accumulative strain). In addition to this, it is often injured in a single traumatic event. And these injuries may include a ligament sprain, meniscal tear or even bone fracture.

The most common ligament sprains are the MCL (from a direct hit to the outside of the knee or an awkward change of direction) or the ACL (from a pivot on a planted foot and straight leg or from hyperextension with high load). The meniscus can also be damaged from awkward pivoting or repeated knee bending (eg squats).  These three injuries frequently present together – “the unhappy triad” due to their similar mechanisms of injury.   

So if you present to physio following a sudden injury we’ll ask what happened at the moment of injury (including any sounds); whether you are experiencing instability, catching, locking, giving way; if certain positions are more uncomfortable; the amount of bruising and swelling at the time of injury. And we’ll then use a variety of orthopaedic tests to assess the integrity of these structures.  Depending on the results of these tests we can decide if it’s necessary to scan the knee.  Most lower level injuries can be successfully managed with conservative treatment (i.e physio and exercise) and do not require surgical intervention.

Physiotherapy Brisbane, Barefoot Physiotherapy

Shoulder and the Rotator Cuff

Shoulder Joint Anatomy

The shoulder is known as a ball and socket joint and is made up of three bones: the humerus, scapular and clavicle. The humerus is stabilised in your shoulder socket through your rotator cuff. The rotator cuff is a group of four muscles that merge together as tendons to wrap around the head of the humerus . As the tendons assist in the rotation of your shoulder they are therefore named the rotator cuff.  The four muscles of the rotator cuff are supraspinatus, infraspinatus, teres minor and subscapularis.

What is the Bursa and Bursitis?

In the shoulder joint there is a sac called the bursa which is located between the rotator cuff muscles and the bony top of the shoulder (acromion). The anatomy of the bursa helps the rotator cuff tendons to move freely with shoulder movements with decreased friction.  In some instances when the rotator cuff tendons become irritated they can cause the bursa to become inflamed and painful. On imaging this irritation can present as bursitis of the shoulder joint.

What is a Rotator Cuff Tear?

Whilst the rotator cuff is a group of four strong muscles, they can be exposed to injury due to their constant use. A rotator cuff injury could be due to and external force (i.e. sporting injury) or the natural aging of the muscles.

It is important to note that as we age the risk of rotator cuff tears increase due to the constant repetitive strain that is placed on our shoulders. Research shows that 40% of the population over 60 years will have some form of rotator cuff tear but still be asymptomatic (pain free).

If you have pain

If however, you do develop symptoms from the tear which can include but isn’t limited to; loss of range of motion, loss of strength or pain, your physiotherapist can determine a suitable treatment plan to help you can regain your shoulder function .

To maintain the strength and range of motion in your shoulder it is important that tears be identified before they progress and cause more irritation. A physiotherapy treatment plan may include a combination of manual techniques, pain relief and exercises to strengthen the muscles.

If you or someone you know is experiencing any muscle joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. We are open 5 days a week and a couple Saturdays a month. We have early and late appointments available. Please call us at 1300 842 850 or Click here to book an appointment.

Hip muscles Brisbane physio

Your hip muscles

Hip muscles

When people think of the hip muscles or buttocks, they often think of “the glutes”. What is often underestimated, is just what exactly “the glutes” incorporates.

There are 3 main muscle groups (and functions) in the gluteal region.

1 – Hip abductors

Made up of gluteus minimus and gluteus medius, they do hip abduction (ie taking the leg away from the body). One of their most important roles, is in hip and knee stability. They prevent the hip from dropping from side to side as you run or walk and they keep the knees from tipping inwards during activities too.

2 – Hip extensors

Primarily made up of gluteus maximus, this is the powerhouse of the glute muscles and is responsible for push off when walking or running, getting you up from the bottom of a squat and also plays a role in preventing the lower back from getting overloaded

3 – Hip rotators

“The deep 6”, are the muscle group responsible for hip rotation. This makes them very important for stability in pivoting or change of direction (such as any field sports). Sometimes they are referred to as the “rotator cuff of the hip”. They are made up of the:

  • Piriformis – most people are familiar with this muscle in the context of “piriformis syndrome”. As the sciatic nerve (major nerve from lower back down the back of the leg) travels through this area, a tight piriformis muscle can contribute to irritation of the sciatic nerve.
  • Superior and inferior gemelli
  • Internal obturator – this muscle shares fascial attachment with some pelvic floor muscles. So it is often implicated in overactive or weak pelvic floor function.
  • External obturator
  • Quadratus femoris – this muscle is particularly important in stabilising the femoral head in the socket of the hip joint (acetabulum)

Exercises

As always, when doing exercises around the hip – specificity if key. Given that the various muscles in the hip region have distinctly different functions,it is important to match the exercise to the muscle group that needs strengthening. Keeping in mind, if the hip abductors are tight you will likely need to strength them. Comparatively, if the hip rotators are tight it may be because they are weak or because they are over-worked from trying to do their job as well as the job of other muscles (eg hip abductors). In this situation, exercises that strengthen the hip abductors would be the best choice.  Check with your physio what exercises are right for you! You can book with us www.barefootphysiotherapy.com.au/book/start

yoga

Accumulative Strain Flare ups

Years of full-time dance, hip surgery as a teenager and a semi-recent auto-immune diagnosis means that every so often my body goes a little bit haywire and throws out a variety of physical symptoms (a flare up) that impact my day to day activities. Yes, your physio can be sore too! The nature of our work means that we are physically and mentally active for the majority of the day. Which all adds to that accumulative strain we talk about in sessions.  As a physio and ex-dancer I have the benefit of knowing my body reasonably well. And the nature of accumulative strain means that we can tip over the threshold to symptoms with a seemingly minor event.

What do we do?

So how do physio’s manage accumulative stain flare ups? Firstly – have a good team in place!  Have all your strategies ready to go (or know who you can turn to to ask for help). That may be a partner or friend, physio, GP, PT, dietician, massage therapist – the list goes on! For me my auto-immune flare up presents as moderate to severe neural irritation in one arm. This is not super helpful with my job. Firstly we make sure my physio appointments are booked closer together to treat all of the things we already know make my body happier. I also get super strict with my food. I do this by avoiding things that cause more inflammation in my body and eating more of the things that make me feel good. As well as making sure I get more sleep. And making sure I have the opportunity to lie down/do my releases throughout my work day.   This is why we are always asking questions about other things in your life – it all makes a difference!

Physiotherapy Brisbane

How to think about it

Context is key.  Especially in accumulation strain flare ups or brain overload situations. We are always looking at the big picture.  There may be an activity that isn’t amazing for a particular body part but the overall mental/social/physical benefits mean we still want to include it but with modifications or extra releases.  For example, when my hip is really cranky it doesn’t like walking for more than 15 minutes but it will tolerate cycling a bit better.  The benefit for my whole system of being outside with gentle movement is worth having to do an extra long release session pre and post cycling.  As your physio (and general cheer squad) we’ll always be asking you questions and teasing out info to help you make similar choices if needed.

Physio brisbane

You can find out more about accumulative strain here (Read more).  If you have questions or need some help about creating a team or modifying activity ask your physio. Book in by calling 1300 842 850  or online at  http://www.barefootphysiotherapy.com.au/book/start/

Barefoot Physiotherapy Brisbane example of a shoulder self release clients can do at home.

Muscle releases at home

At Barefoot Physiotherapy we love meeting new clients and helping kick start them of their health journey. For most clients it is important to be completing their own exercises and muscle releases between appointments to maintain improvements. In a session with a Barefoot Physio we will do a head-to-toe assessment to work out what muscles need to be released to help improve your movement quality and reduce muscle tension. Completing these muscle releases daily is ideal as this will help to ensure you are consistently reaping the benefits of happy relaxed muscles.

Benefits of keeping your muscles happy are:

  • A reduction in muscular spasm and pain
  • Increase or maintain movement range of the muscle
  • Helps with post exercise recovery
  • Reduces tension pain such as headaches
  • Preventing injuries!
  • Happy muscle and joints = happy nerves 🙂

How often do you need to do your homework?

It is important to work out a way of fitting your muscle releases into your daily routine, so that they can be easily completed with the least amount of fuss. As a guide we recommend setting 10 mins aside to work through your release list. However, the ideal amount of time for you could be more or less depending upon where you are at on your health journey. Your physio will help you work out the ideal amount of homework for you!

Tips to fit releases into your routine:

  • Dedicate the ten minutes at a certain time of day as ‘me time,’ a good way of setting your body up to happily complete all your daily tasks.
  • Think about the various positions you complete your releases, this way you can conveniently fit them into parts of your day. For example: Sitting – you can do them during the ad breaks while watching your favourite TV show. Standing – during a study/work from home break against the wall. 
  • Keep any tools you need in an easily accessible spot, so there are no barriers for you to quickly fit a session of releases in. Make sure your foam roller, lacrosse ball or spiky ball are not hidden in a faraway cupboard.
  • Use visual cues to help you remember to do your releases: i.e. a post it note on your fridge or computer screen or a daily alarm/alert.
  • Importantly keep a list of your muscle releases handy this way you can easily access what ones you need to do. If you ever need help on how to complete them you can also follow this link, to read more about them on our website.

We can help with teaching Muscle Releases if you need

If you or someone you know is experiencing any muscle joint or possible nerve irritation please contact us. We can determine if it is a musculoskeletal issue before having to see a GP. We are open 5 days a week and a couple Saturdays a month. We have early and late appointments available. Please call us at 1300 842 850 or Click here to book an appointment.

Injury management

What its like to have an injury

By Caitlin Sargent:

As a physio I, along with many of my clients, expect I would rarely suffer injuries. As an elite athlete though it is kind of considered part of the deal. While it would be nice to always prevent all injuries, the nature of everyone’s lives is that at some point we are often going to accumulate too much strain and experience some degree of stiffness, pain or injury. It may be a slow gradual onset of tightness and discomfort when sitting in front of the computer or, as in my case, it may be a hamstring tear whilst competing at State Championships in front of a crowd.  And yes there is photo evidence.

Race injury
Photo credit: Casey Sims. Mid race Hamstring tear

Acute injury management

Most people are familiar with basic injury management – relative rest (ie don’t do the things that hurt), ice to reduce the inflammation and reduce the pain, compression to minimise swelling and aid in blood flow, elevation again to minimise swelling in the area. What does not often get discussed as part of this process, is the psychological management. “Where did this come from?” “How long will it take to get better?” “Will I ever be the same again?” “Is this going to impact my ability to work?”… The thoughts and questions can be an unhelpful spiral.

Sometimes, being a physio in these instances is helpful – for example, my lower back had been tight that week so I was not entirely surprised when I felt my hamstring tear. However as a physio I also felt irresponsible and embarrassed that I had ignored what I thought was a minor tightness and let it become a far more significant injury. It is important to know, that all kinds of thoughts and emotions are normal when experiencing an injury. However getting caught up in them, is usually not helpful (and can actually make our pain worse). Almost all injuries will make a full recovery and if you follow medical/physio advice, a majority of common injuries will be noticeably better in 2-6 weeks.

Injury management
Cross training

Physiotherapy management

Given my profession, I am somewhat biased – however I truly believe that good physiotherapy management and care can significantly speed up the recovery time for injuries. In my own case, after my hamstring tear, I had physio multiple times a week for a number of weeks. Given that the sciatic nerve runs through the hamstring, there was significant nerve irritation and early stage (first 10 days) treatment focused on this. Once the nerve irritation was settled down, we were able to do a fully body assessment and testing which found that T11 (a mid-back joint) made the most improvements to my hamstring length, hamstring strength and lower back range of motion. While it was frustrating to have my running training hampered, it was very comforting to see objective improvements happening in each session – giving me confidence that I would be able to return to training soon. I was able to modify my training to maintain as much fitness as possible, whilst also not impeding my recovery.

I have experienced a variety of injuries during my time as an athlete and I can confidently say it never gets “easy”. There are always frustrations, worries and negative thoughts. However I have found that by putting my energy into what I can do to get better (getting enough sleep, doing my self-releases, avoiding aggravating activities) and focusing on what training I can do (rather than what I can’t do) – I am able to minimise the impact of those negative thoughts. It allows me to see the injury as just another challenge in the life of an athlete – an opportunity for growth that will make me a better athlete, human and physio.

Injury recovery
Back on the hills

Individualised treatment at Barefoot Physio

Treatment Direction Tests and Individualised Treatment

Every body is different in its experience of movement and load. People have different postures, different exercise/activities, different injury history with different compensation strategies and different daily load from life, based on occupational demands, sleeping positions and much more. As a result, no two bodies are identical or present in the same way. In fact, two people can present with the same symptoms but with very different tight muscles and joints. Consequently, they improve with quite different treatments. So, how do we know what works for you?

Here at Barefoot, we do a whole body assessment of each individual to get a really clear picture of where their issues are, looking for which muscles and joints are tight, which muscles aren’t working as well as they could be and what movements are limited. See here to learn more about our whole body approach. We then take this information and use it to perform treatment direction tests.

Treatment Direction Tests

What are treatment direction tests (TDTs)? It is a simple testing process that allows us to narrow in on what the most effective treatments are for each individual. We take the information gathered in the full body assessment and systematically trial treatment to these areas whilst doing a movement, to see which muscles or joints make the most improvements.

Our goal is to not push into pain, but rather be guided by what range of motion can be comfortably achieved. For example we might be trying to improve shoulder mobility – so while you lift your arm up in front of you, we trial releases to the areas we found were tight during our body assessment. This might be a shoulder muscle, a back joint or even a leg muscle or ankle joint glide. The body will show us, which of these areas is the most effective to treat by increasing the pain-free shoulder range of motion.

Treatment and Self-treatment

Once we have done this testing and know which areas make the most improvement, we focus our treatment on that area. We will also give you homework (if that’s what you want) to help keep your body happy. By narrowing the treatment area down through testing we can ensure that the homework or self-releases we are giving you are time efficient and effective!

Full body assessment

Why we use a Full Body Assessment at Barefoot Physiotherapy

At Barefoot Physio we treat the whole person, not just the specific injury that brought you in.  In physio we are often told to “look at the joint one above and one below”.  This means if you come in with knee symptoms, your hip and ankle will also be assessed and potentially treated.  The Barefoot Treatment Plan goes one further and assesses your whole body in our ‘full body assessment’ in order to find where the restriction and cause of compensation is coming from.  This includes assessing your nerves, muscles, joints and movements to gain a ‘snapshot’ of your individual body.

What is it?

A full body assessment gives us a list of significant findings in your body (or what we call 3’s).  Significant findings may include movements such as hip flexion (bringing knee to chest) or cervical rotation (turning head); muscles such as your bicep or gastrocnemius (calf); or joints such as your talocrural (ankle). We are feeling for points of higher muscle tone (like a “trigger point”), or joints that don’t glide as smoothly as they can.  Similar to our neurodynamic tests, we measure movements ranges to “R1” or the first point of resistance where your body starts to show signs of being unhappy in this movement via muscle guarding.

What do we tend to find?

As we complete our scan (full body assessment), it regularly reminds our clients of previous injuries or issues that may have been symptomatically resolved but are still presenting with lingering restriction or altered loading patterns. For example, a client may present with hip symptoms in their squats at the gym but a full body scan brings up an old shoulder injury that still niggles occasionally that they haven’t thought relevant. All of this adds to the picture of the accumulation of strain on your body. We collaborate with our clients in both isolating areas of interest in the body but also to then prioritise our findings for treatment. We then use our treatment direction tests (TDTs) to narrow to what is relevant and important for your body.  Once we’ve narrowed it down we can effectively treat, retrain and strengthen a handful of areas and keep your whole body happy.

More reading next week!

For more about TDT’s (treatment direction tests that help us work out what is most important to treat) watch out for our blog next week! If you’re interested in booking a session you can here