Archive for category: Physiotherapy Column

At Barefoot Physiotherapy we enjoy helping people across the lifespan to maintain and regain control of their pelvic floor muscles. Cuing a ‘Kegel’ or a correct pelvic floor activation and relaxation is an essential part of pre and post-natal physiotherapy. Pelvic floor muscles work hard to support the pelvic organs, especially throughout pregnancy when the weight on them significantly increases. Therefore, it is important to work with clients on activating their pelvic floor correctly to ensure no unneeded compensations occur. When there is poor pelvic floor strength or control, clients can experience worsening abdominal separation, lower back pain or pelvic/SIJ pain.  A great way to start strengthening your pelvic floor is by learning how to correctly engage it. Below we’ve listed our top 5 pelvic floor activation cues. Once a client can activate the pelvic floor it is important to teach a correct relaxation as well.

Pelvic Floor Activation Cues

1. Squeeze and lift: this is the cue most people will start with to try and initiate a pelvic floor contraction. The idea is you are relaxed and breathing normally while you try and engage the muscles in the pelvic region to squeeze and lift around the vaginal opening.
2. Elevator Cue: in this cue we ask clients to imagine their pelvic floor is a lift. And that it’s resting tension is the ground floor, then you are taking it to the first and second floor and then you’re going to lower it gently back down against gravity. If they have trouble fully relaxing, you can cue for them to lower it to the basement as well.
3. Posterior cue: hold in the passing of wind – this is a good cue to try and initiate a pelvic floor contraction from the posterior side. Some clients find this visualisation easier making for a more effective activation.
4. Stop the flow of urine mid-stream: Similar to a squeeze and lift this cue again focuses on the anterior pelvic floor muscles.
5. Zipper cue: this cue focuses on asking the client to imagine there is a zipper from their vagina to pubic bone. Then asking the client to imagine doing the zipper up.

There are many more visualisation cues to use for pelvic floor activation. If you want to learn more about how to strengthen your pelvic floor or to address any pain or symptoms of pelvic floor weakness book in to see one of the team at Barefoot Physio. In addition, if you want to learn more about what a women’s health physiotherapy session looks like at Barefoot click here .

Running is a great form of cardiovascular exercise that incorporates the whole body and also has great mental health benefits. By utilising pace, distance and rest it can be adapted for beginner’s through to experienced athletes. However, runners at all levels can experience injuries which can lead to frustration, pain and time off from running. So understanding how to prevent injuries when running allows you to continue enjoying your exercise. We have many years of experience treating running injuries and helping people become more resilient to future injuries. In this article we’ve put together our top tips for running injury prevention.

Progressive overload

One of the most important aspects of preventing injuries when running is managing the overall load. Most injuries occur when the load is increased too much, too quickly. It is important to note that when talking about load management this refers to both volume and intensity. A generally accepted principal of progressive overload is to not increase the training load by more than 20% at a time. For example, if your longest run so far has been 5km and you want to increase your distance, 6km would be the maximum length of your new long run (because 20% of 5km is 1km). By this same principle, to prevent running injuries your total distance run across the week should also not increase by more than 20%. Intensity (ie pace or other factors such as hills), should also be gradually increased.

Whenever an increase in load occurs, there needs to be an adaptation period to let the body adjust to the new load before increasing again. So if you increase your training you would then stay at the new workload for 4-6 weeks before making another increase.

How to prevent injuries with rest and recovery

The importance of rest and recovery for preventing running injuries can not be overstated. Incorporating rest days into the training week can be helpful, especially for less experienced runners. For those who have not run much before, you should start with 2-3 days of running a week and slowly build up the frequency. Even for experienced runners, they will often have one day a week of no running (it may not be a total rest, but rather cross-training such as swimming or biking). These days off running give your muscles, joints and nervous system time to recover so you are less likely to get injured.

There are also more active forms of recovery such as:

• Cool down – at the end of your run, spend a few minutes walking to allow your body time to clear out waste products from your muscles (such as lactic acid). This will help you feel less stiff and sore the next day
  
• Muscle releases/foam rolling/massage – focusing on releasing tension in the main running muscles can help your body manage the training load and recover better between sessions. Some of our favourite releases for runners click on the links below:
  • Calf
  • Glutes
    
• Warm Epsom salt or ice baths – there is some evidence for the use of different baths to help with muscle recovery. Warm Epsom baths work by relaxing the muscles with heat while also absorbing the magnesium which is important for muscle function (low magnesium can cause cramping). Ice baths work by reducing inflammation in the body as well as influencing blood flow to help clear waste products. There is individual variation in response to these, so try them out and see what works for you
  

Prevent running injuries with Strength training

Strength training is vital to help the body prepare for and manage the stress of running. Running is essentially a series of single leg squat jumps, so working on good core strength and single leg control is very important for preventing running injuries. Strength training should be done 2-3 times a week – less frequently than that and there is not enough load for a proper training effect and conversely too often does not allow adequate rest and recovery for you muscles.

For a new runner, a week of 2 strength days, 3 run days and 2 walk/rest/yoga days is a nice balance. Strength training for runners should focus on strengthening calf muscles, abdominals and glutes. It is particularly important that at least some of the glute strength work is done one side at a time to ensure good single leg control. Some examples of glute strength exercises for running are squats, single leg squats, step-ups, lunges, Romanian (or straight-leg) deadlift. Click here for a blog on good squat technique.

There are several factors to take into consideration when trying to prevent running injuries. I would encourage you to look at your current routine and see what one change you can make to help prevent yourself from getting an injury. Whether it is giving yourself a rest day or adding in some strength training, taking steps now to avoid injuries is much more enjoyable than having to deal with time out later on. If you are keen to avoid injuries and want specific advice, book in to see on of the team at Barefoot Physio for personalised hands on care. You can book an appointment by following the link Book Online.

Why do we experience pain without any obvious cause of injury? This is a common question we get asked at Barefoot and the answer is most commonly, due to accumulative strain.

Let’s firstly summarise the main reasons we may feel pain:

1. Due to traumatic injury – we have a broken bone, torn ligament, or other tissue damage
2. Due to a disease process – such as an illness/infection, genetic condition
3. Due to build-up of accumulative strain – minor forces repetitively acting on the body over time

Now the first two reasons make a lot of sense, but sometimes the concept of accumulative strain can be a little harder to understand. Let’s walk through this together.

So, what is accumulative strain?

As we just mentioned, accumulative strain is the build-up of minor forces on the body (muscles, ligaments, joints, nerves) over time. This may result from a lack of good control, or from sustained strain over time. What do we mean by this?

Imagine sustained strain as walking the exact same path every day. After one day, or even quite a few there seems to be nothing different. But what you may notice over time is that your footsteps have begun to wear a path into the grass. This is like the same muscles and joints doing the work all the time without any variation. This strain starts to show over time.

When accumulative strain builds up, sometimes an innocent activity that you have done countless times without any issues (like bending over to pat the dog) can be the “straw that breaks the camel’s back” so to speak. Your body is sending you the message that you need to change something the only way it knows how….with symptoms.

How do we treat accumulative strain?

Accumulative strain can manifest in many ways. It might be felt as any number of symptoms, including pain, tightness, headaches, frequent bouts of illness.

Repetitive strain may be related to:

• Postures
• Exercise or sports techniques
• Previous injuries/illnesses
• Lack of sleep
• Emotional load – e.g. stress, anxiety

How do we treat accumulative strain at Barefoot Physiotherapy?

Firstly, we like to map it out. An accumulative graph is very useful as it allows us to both understand your current level of strain, and the journey your body took to get here. In the graph below you can see this depicted. Ideally everyone should be functioning in the optimal zone. This is when muscles and joints feel relaxed and mobile, movement ranges are 85% + and other factors such as nutrition, sleep and stress are being addressed.

We also have a discussion around the various influences contributing to the strain on your body and brainstorm strategies we can implement in order to help reduce them (for more on this – see Brain Overload).

Strategies that can contribute to reducing strain may include:

• Exercise modifications:  just like you don’t want to be the only one doing all the work when you are part of a team, neither do the muscles and structures in your body. We need to ensure their isn’t compensation and that all parts of your system are working to their best ability. We can assess and prescribe your exercises in your physiotherapy appointment, or visit you at the gym for a gym review.
• Workstation set-up: we tend to spend the majority of our time at work. Are there modifications we can make to help your body be more comfortable during this period?

What can you do to limit strain on your body?

Let’s talk about some other tips that you can use to reduce the repetitive strain on your body:

• Wear footwear appropriate for you and your activities
• Get enough sleep, it is important to let your body rest and recover from your day, and prepare itself for tomorrow
• Make sure you have a good work/life balance – engaging in some downtime or enjoyable activities helps to reduce stress levels
• Ensure you are strong enough for the activities you perform in your day – make sure that the right muscle systems are strong enough for your activities – for example: having good glute and core strength is important for running so that their isn’t over recruitment of the  back and hip muscles.
• Appropriate postural set-up for life activities – including at work, at home, in the car, at your desk or for the gym

If you want to learn more about accumulative strain, or want a personalized assessment to help reduce strain in your body come in and see one of our friendly Barefoot physiotherapists – book here.

Chronic, or persisting pain can have a large impact on all facets of our lives.  Chronic pain has typically been defined as pain persisting for more than 3 months.  Experiencing chronic pain takes up a portion of your daily energy and brain space, leaving people unable to fully participate in social or work situations, struggling to maintain strength and mobility, and/ or finding it difficult to perform activities of daily living.  A major component of improving chronic pain is self-management.  Working alongside health practitioners can help you determine your best chronic pain self-management strategies and implement ways to improve your function while minimising flare-ups.

What Is Chronic Pain Self Management?

Chronic pain is what is experienced after any tissue damage is resolved.  It may also be a result of systemic inflammation, postural loading, heightened and sustained stress or a variety of underlying systemic conditions. This pain can be experienced throughout the entire body, or at localised body parts.  Because of this persisting pain, people’s opportunities for pain-free movement can become significantly reduced and daily life will become aggravating with frequent flare ups.

It is important to regain control of your chronic pain experience and determine contributing factors that are individual to you. The more information you have about aggravating and easing factors, your functional baseline, and any protective factors (i.e. social supports, highly valued activities) the easier it is to build a graduated self-management plan.

Are Self Management Strategies Effective in Chronic Pain?

Higher levels of self-efficacy have been found to assist people experiencing chronic pain. Self-efficacy refers to an individual’s confidence in their own ability to function despite experiencing pain. Self-management strategies for chronic pain are aimed at empowering an individual about their condition, implementing cognitive and behavioural strategies to deal with and manage their pain and supporting an individual in navigating their social, work and health interactions.

Chronic Pain Self Management Strategies:

Education

Understanding the nature of chronic pain, and its lack of association to tissue damage is key in managing your pain. Realising that “hurt does not always equal harm” can be an empowering element in helping to regain independence and function. We know that pain can be increased by not enough sleep, by increased systemic inflammation, by stressful situations, by lack of social or medical support etc.  Figuring out what is relevant to you is a fantastic starting point. The NOI group utilise the concept of DIMS and SIMS (dangers in me and safeties in me) to help support the body and decrease the frequency of tipping over your personal threshold point and provoking symptoms.  You can work with your health provider to come up with these, or work independently using the Protectometer workbook from NOI Group.

Activity Pacing

It is important to consider everything you do in a day when determining your baseline for activity.  This is not just ‘exercise’ (e.g., gentle walk or a low impact exercise class), but all activity – things like chores (including grocery shopping, cooking, cleaning) or work and social interactions.  All of these add up to the total amount of load on the body in any given day.  It is important to consider activity pacing for each day as well as across an entire week/month to avoid overdoing it or increasing too much too quickly. ‘Borrowing from tomorrow’ in activity pacing refers to doing too much on one day, resulting in having less capacity than usual the next day to compensate. Your goals and priorities are also an important factor in creating a pacing plan.

Once you have determined your baseline for a day without flare ups, activity pacing is based around consistent exposure to activity that is 5-10% below that baseline to help build consistent tolerance and endurance without flare ups.  This is to avoid a boom/bust cycle where you have a good day and increase your overall activity (the boom), then have subsequent days with increased pain or decreased energy (the bust).  The all or nothing cycle leads to overall decreased level of activities, a diminished overall threshold and encourages fear avoidance behaviours.

Low Impact Exercise

The aim of including exercise in your management plan is to improve your physical capacity and endurance. Ideally you are including both cardio and strength training.  Options for cardio may include cycling (either stationary or recumbent bike), gentle walks, modified swimming, or water walking.  Options for strength may include modified gym exercises, pilates, or aqua aerobics.  It is important to work with a health professional to determine what is most appropriate for you at each stage. It is also beneficial to be incorporating mindfulness activities such as meditation or breath work, yoga or journaling. The best option will always depend on your body, personality and priorities.

The Benefits of Self-Management of Chronic Pain

One of the most important elements in improving chronic pain is feeling like you’re in charge. Due to the complex nature of chronic pain, people are often left feeling like they do anything to get better. This lack of control only contributes further to the issues associated with chronic pain. Seeking out a health professional who can help educate you to understand chronic pain and how it impacts your body is key to taking charge of your chronic pain self-management program. Actively changing your behaviour (such as your activity pacing) and cognition (eg believing you can improve) around your chronic pain can help improve self-efficacy, improve quality of life, increase participation, and help to better navigate your experience. Developing a chronic pain self-management program allows you to better cope with day-to-day activities, increase your capacity and resilience to reduce flare-ups while helping you to best manage any pain symptoms with reduced reliance on pain medications and less distress.

Talk to Your Physiotherapist About Chronic Pain Management

Navigating chronic pain can be a confusing journey.  If you are suffering from chronic pain and are feeling lost, we are here to help. The team are Barefoot Physiotherapy are here to address any concerns, help you move and feel better and support you in establishing a self-management plan.  Book online now or call 1300 842 850 to speak to one of the Barefoot Physiotherapists.

What Is Chronic Pain?

Chronic pain has typically been defined as pain persisting for more than 3 months.  This pain can be experienced throughout the entire body, or at localised body parts.  Pain is a wonderful tool for our body to protect us from perceived threat of tissue damage.  However, so often our ability to accurately determine this threat is altered. 

When we experience chronic, or persisting, pain it can have a large impact on all facets of our lives.  It may mean that we are unable to participate in social situations, or struggle to maintain strength and mobility. Experiencing chronic pain takes up a portion of your daily energy and brain space, so you may also find yourself being distracted, forgetful or irritable. It’s a multifactorial experience, and requires a multiple factorial approach to treatment.

Considering what is chronic pain and what contributes to chronic pain is a complex process.  We know that pain can be increased by not enough sleep, by increased systemic inflammation, by stressful situations and by lack of social/ medical support etc. While initially this may seem overwhelming, it actually means that there are multiple avenues that we can explore to help improve your chronic pain.

The Difference Between Acute and Chronic Pain

This section will compare what is acute pain and chronic pain. The obvious difference between acute and chronic pain is the length of time that pain is experienced.  Acute pain usually occurs with a relatively sudden onset and often interferes with mobility and function. It can often be associated with a specific incident, or mechanism of injury, where a particular fall, movement, landing etc. occurs just before the pain begins.  This can indicate the presence of tissue damage, or a suddenly provoked protective response from the body. Acute pain has a rapid spike in symptoms for the first few days to weeks, then can decrease steadily over the next few weeks, lasting no longer than 3 months.

Continuing to compare what is acute pain and chronic pain, chronic pain continues to persist long after the initial tissue damage or threat has gone. When considering what is chronic pain, there is often a mismatch in the symptoms felt, and the activities or movements that provoke these symptoms.  As mentioned above, nociceptors may be trained to activate at a lower threshold. Hyperalgesia is when something that may usually cause only a minor pain response can be exaggerated (eg a light scratch causing immense pain).  Allodynia is when a non-threatening stimulus causes pain (eg a feather lightly touching the skin may feel like a cut).  These are just two ways in which the information received from the body can be mis-identified, causing a painful response.

The Causes of Chronic Pain

As mentioned above, pain is a sensation created from contextual information following activation of nociceptors from a perceived threat to body tissues. Chronic pain is the continuation of these painful sensations beyond normal tissue healing timeframes, or in the absence of any tissue damage.

When trying to define chronic pain and what causes it, It is important to appreciate that we don’t have specific “pain receptors” in our body that become activated causing “pain signals”.  Instead, we have nociceptors or free nerve endings that respond to changes in mechanical, thermal or chemical stimuli.  I.e changes to movement/pressure, temperature or chemicals such as histamine. These nociceptors are activated and send electrical signals up to the brain.  It’s in the brain that these signals are interpreted and contextual information is added. If enough nociceptors are activated, and enough “danger” context is added, then the outgoing information that we feel in the body is pain. When we experience what is chronic pain, these nociceptors are being more frequently activated, and/or the danger context is being added much more quickly and frequently regardless of the threat of actual tissue damage.

The NOI Group (where so much of the latest research in pain science research and education comes from), describes a dynamic protective buffer between the onset of protection by pain, and the tissue’s actual tolerance before damage begins to occur. This is a warning system the gives us physical signals that we are about to push into our tissue’s threshold.

TWIN PEAKS IMAGE

You may push into this buffer slowly, eg running a marathon that you haven’t properly trained for, or quickly, eg a sudden burst of increased physical activity and experience pain and potentially tissue damage.  After this tissue damage has occurred, your protective buffer adjusts.  Your protect by pain threshold is lowered and you’ll experience the same or similar response as you did before but now at a decreased amount of effort/ load/ activity. This protective buffer can also be influenced by the overall inflammation in the body, stress, expectation of pain, lack of physical conditioning, poor sleep and nutrition or a history of physical injuries.

The Symptoms of Chronic Pain

It can be difficult to define chronic pain beyond the persistence of pain over 3 months.  The symptoms that people experience are complex and varied.  Chronic pain may be caused by underlying conditions such as endometriosis, arthritis, ankylosing spondylitis or fibromyalgia and chronic fatigue.  When we initially think of chronic pain symptoms we immediately think of the physical: dull, achy pain, sharp shooting pain; pins and needles or burning etc.  Other chronic pain symptoms include decreased sleep, decreased participation in social interactions or physical activities, increased irritability, decreased concentration, decreased productivity.  Unfortunately, the list is long, which is why it’s so important for us to address the whole person in treatment of chronic pain. Similarly, when asked how long is chronic pain, the answer can’t be easily given as it depends on the person, scenario, and interventions.  

Understanding the Mental Health Impact of Chronic Pain

The mental health impact of chronic pain is significant. As mentioned above there are so many situations where chronic pain can have a negative impact. Mental health issues and chronic pain go hand in hand.  Those experiencing persisting pain are more predisposed to symptoms of depression, anxiety or psychological distress.  This relationship works in both directions, people with diagnosed depression or anxiety are more likely to experience chronic pain.  The pain itself can be further be  influenced by low mood, rumination, inability to sleep and social isolation, often creating an important cycle to break.

How to Manage and Treat Chronic Pain

As chronic pain is a multifactorial experience it means there are so many strategies to help manage your pain. Ultimately we want to change the chronic pain meaning in your body and increase the amount of activity you can do before the protect by pain response is triggered (remembering the protective buffer from before). We do this by finding our ‘Goldilocks’ Zone’; not too little, not too much, but just right! There are many things that help to support this zone. It’s difficult to say how long is chronic pain, as it differs for the individual. Here are some tips that consider the physical, mental and social aspects of chronic pain.

• Increase the amount of incidental activity you do by gradual amounts.
• Pick an activity you can accomplish without causing a flare up (eg a 7 minute walk), repeat that more frequently. General exercise has an overall anti-inflammatory effect on the body.
• Pick a meaningful activity to do more of. You might find that picking up your grandchild is much more comfortable than picking up dirty laundry.
• Change the context! Repeat the activity but in an environment you enjoy. Eg a walk by the river, or to a café with a friend.
• Try to sleep more.  Go to bed when you are tired, sleep in a dark and quiet room, avoid caffeine later in the day and avoid screens before bedtime.
• Add in a mindfulness/meditation.  Even a brief mindfulness activity can help to balance the nervous system and assist in decreasing inflammation.
• Eat food that makes you feel good!  Try to add in one more fruit or vegetable to your meals and vary the colours of your food.
• Aim to focus on your function versus your pain.  The more attention we give our pain the more overwhelming it feels.
• Ask for help!  Have an engaged team of health professionals to assist you in creating a plan and to support you in this journey. This can include a Physiotherapist, a Psychologist and a GP.

How Barefoot Can Help with Chronic Pain

If you are suffering with chronic pain and don’t know where to start, get in touch.  The physiotherapists at Barefoot Physiotherapy can help you create a plan to get you moving and back in control.

Book online now