Muscle stretch hamstring

How to Treat Hamstring Tendinopathy

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Hamstring tendinopathy is becoming an increasingly recognized cause of pain in both sitting and activity related posterior thigh pain. This pain is often present at the top of the hamstring underneath the gluteal fold. This is where the hamstring tendon attaches onto the ischial tuberosity. It is important to know how to treat hamstring tendinopathy as the hamstrings make up the bulk of the muscle in the back of the thigh. They are formed by three muscles and their tendons. The muscles are semimembranosus, semitendinosus, and biceps femoris.

As hamstrings are known as runner’s muscles, hamstring tendinopathy is often diagnosed in clients who are avid runners. Typically, runners who have suddenly increased their training volume, training intensity or have started hill running.  However, with the right management of active self-treatment and strengthening exercises you can get back to running pain-free.

At Barefoot Physiotherapy, our treatment includes a combination of hands-on techniques, movement modifications, strengthening exercises and advice and education. This helps clients cure their hamstring tendinopathy and get back to moving and feeling good.

What is Hamstring Tendinopathy?

Let’s break it down further – what is high tendinopathy and how do you heal high Hamstring Tendinopathy? High hamstring tendinopathies are more commonly referred to as a proximal hamstring tendinopathy. This is due to the usual location of symptoms high on the hamstring. People who have developed a proximal hamstring tendinopathy will often complain of a deep, annoying buttock pain. This pain will be present during activities such as running, prolonged sitting/ driving or hill walking/ running.  

The role of a muscle’s tendon is to attach the muscle to bone. A normal tendon consists of fibrous tissue which contains type one collagen, the structure is often imagined looking like a rope. There are specific cells in a tendon designed to look after the tendon structure. Tendons are vascularized however there is less blood supply at the part of the tendon which attaches to bone, which is consequently where tendinopathy will occur. Tendons do not like sudden changes to load, and this can cause a tendinopathy.

What are the Causes?

When determining how to treat hamstring tendinopathy, you need to understand the causes of a proximal hamstring tendinopathy. Unlike an acute hamstring tear, the pain typically comes on gradually and is usually aggravated by repetitive activities such as prolonged sitting and running.

As previously mentioned, a tendon doesn’t like sudden variances in load. When the hamstring tendon is put under a high load that exceeds its ability to effectively recover, the tendons structures can change. The changes that occur when a tendon is unhappy involves collagen structures becoming disorganised. Therefore unfavourable alterations occur to the neurovascular and cellular components of the tendon. These changes can therefore result in the pain symptoms at the site of tendon insertion. 

Who is most likely to get a high hamstring tendinopathy? The most significant risk factor for hamstring injuries is a history of previous injury to the muscle. Therefore, seeking out physiotherapy treatment for an acute injury can be paramount in preventing further injury. The following is a list of common causes of proximal hamstring tendinopathy: running, jumping, and kicking, history of lower limb injury, lack of flexibility (stiffness in muscles), weakness in muscles, inadequate warm-ups, muscle fatigue, increasing age and muscle imbalances.

How to Treat Hamstring Tendinopathy

At Barefoot Physiotherapy, we utilise the best evidence-based research to know how to treat high hamstring tendinopathy. Your Physiotherapist will ascertain the extent of your injury and formulate a plan for the best steps to start your healing. In most instances, your physiotherapist will suggest a conservative approach to rehab. This will include initial rest, icing of the area, stretching and strengthening of the affected muscles and surrounding muscle groups. In some instances when the pain doesn’t improve with conservative management, further treatment interventions may be required. Your physiotherapists will consult with you and your GP if they believe alternative treatments such as corticosteroid injections may be beneficial.

Treating Proximal Hamstring Tendinopathy

Your Barefoot Physiotherapist will be highly skilled in knowing how to treat a hamstring tendinopathy. They will prescribe a management plan which may include some of the following exercises.

Initial phase:

The initial phase of rehab will include relative rest or a reduction in training volume. Your physiotherapist will help you understand your individual aggravating factors for the tendon and work with you to build solutions. This might include regular breaks from sitting, avoiding hill walking, using a cushion to sit on and tendon relieving exercises. Some of these exercises include isometric hamstring contractions i.e., digging your heel into ground while you are sitting. 

Loading phase:

The next step in your rehab will be to gradually reload the tendon. In knowing how to treat a proximal tendinopathy, specific stretching and strengthening exercises are a must. Muscles which may be strengthened include the hamstring group, glute muscles and abdominal muscles.

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1. Squats:

Squat exercises are functional and a great way to start rebuilding appropriate strength throughout the whole lower body to ensure the surrounding muscles of the hamstrings are strong. When performing a squat, your physiotherapist will assess your form to ensure your back is not over-active, glutes are engaged, and you have the appropriate hip range to complete the movement. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue. Typically, you will want toes facing slightly out, feet about shoulder width apart and the ability to maintain a neutral back throughout the movement.

2. Romanian dead lift:

Your physiotherapist will instruct you to activate your deep abdominals, create a slight bend in the knees and hinge at the hip. You should feel a tension building in the hamstrings and glutes. Focus on pushing hips backwards like you are going to sit down and then standing back up straight without over-extending into the back. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue.

3. Hamstring Bridge:

A hamstring bridge is an excellent targeted exercise to the hamstring muscle group. Your physiotherapist will instruct you to lie on the ground with your heels on the bed and feet flexed back towards you. You will then tuck your pelvis and push heels into the bed and create a lift. Your hamstrings should be firing the most and some glutes. If there is any discomfort in your back let your physiotherapist know and stop the exercise. Reps and sets will be determined based on your ability to load your body and how many you can complete before fatigue.

The exercises listed above show how to treat a high hamstring tendinopathy. These are three key strengthening exercises that are commonly used by our physiotherapists. Your physiotherapist will work with you to tailor a specific program to your exercise ability and stage of rehab.

Treat Hamstring Tendinopathy with Barefoot Physiotherapy

The aim of this article was to help you understand how to heal high hamstring tendinopathy and how Barefoot Physiotherapy can assist you in this process. If you or anyone you know is suffering from deep buttock pain, pain with prolonged sitting, or running/hill walking, it could be a hamstring tendinopathy and one of our friendly Barefoot Physiotherapists can help. 

Your Barefoot Physiotherapist will work with you to construct a treatment plan which best suits you and your lifestyle so you can get back to enjoying the activities you love pain free. You can give us a call on 1300 842 850 or book into our Brisbane clinic online.

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How to Activate Glutes

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There’s a reason that glute activation is such a popular area of focus for health and fitness professionals. While there are many different approaches for how to activate glutes, the importance of doing so is clear.

The ‘glutes’ actually refers to a group of muscles located around the hips, that make up the buttocks. Together, the glutes play an important role in stabilising the hips and pelvis, supporting the lower back (especially during lifting) and contributing to knee and ankle stability. As a result of this, good glute activation is of high importance for injury prevention and also injury recovery. The best way to improve and maintain glute activation is through specific exercises. These are covered in more detail below:

Why Are My Glutes Switched Off?

Before we get to how to activate your glutes, it is relevant to understand why they may not be working well in the first place. There are a couple of reasons that your glutes may not be firing as expected.

First of all, the phenomenon of ‘pain inhibition’ can play a significant role. Studies have shown that in the presence of pain, glute muscle activity is often significantly decreased or inhibited. This can be from local pain (such as the hip) or further removed, such as the ankle. There are a number of theories as to why muscle activity is inhibited in these instances, what we do know is that just because the pain resolves does not mean the muscles automatically start activating normally again.

There is also some evidence that spending a lot of time in sitting, where the glutes are on stretch while the hip flexors (the opposing muscle group) are activated may also contribute to poor glute activation. What is definitely clear, is that because the glutes play such an important role in the stability and movement of the lower back, hip, knee and even ankle, glutes that don’t activate well can contribute to pain and injury in a wide variety of areas.

The importance of knowing how to activate glutes

At this point, the importance of knowing how to activate your glutes is clear so you are likely asking “How do I activate my glutes?”. To understand the how, it is relevant to know some basic anatomy. The glutes are a collection of muscles, which can be broken into 3 further subgroups.

  • Gluteus maximus is the primary hip extensor (takes the leg out behind you). It plays an important role in walking and running and when working correctly, generates lots of power
  • Gluteus minimus and glutes medius make up the hip abductor group. That is, they take the leg out to the side. This means they are also key for providing stability at the hip, knee, and ankle
  • Piriformis, obturator internus and externus, superior and inferior gemelliwork together as hip rotators. They will typically be referred to as “deep hip rotators” and are usually not what we are referring to when talking about glutes. It is also worth noting that often these hip rotators take over when the other glutes are not strong enough and this can also lead to pain and injury. Just another to make sure you are activating your glutes well!

How to activate your glutes?

As with all muscles, glutes are best strengthened with targeted exercises. When looking for how to activate your glutes, choosing the right exercises is important. Good technique and finding the muscle activation cue that works for you is also important.

Some examples of cues are “Push your legs away from one another” and “Create tension in between your feet”. When glutes are well activated, the hips and pelvis should be stable (even when on one leg) and the knees should not drop inwards.


Glute activation exercises

Slow marching

When people are first learning how to activate glutes, walking on the spot is a really great way to feel what is happening. In most cases, if you feel the upper glute muscles with your hands whilst walking on the spot, you can feel them switch on when you stand on that leg and switch off as you swap sides. You can use this both to learn how to activate my glutes as well as to strengthen them

  • March on the spot – the slower the better
  • Use a mirror to ensure the pelvis is staying square – not dropping down to one side or rotating
  • To progress, you can hold a weight in close to your chest

Squat

Squats are one of the most well-known glute exercises. Important points to remember are:

  • Start with activating the glutes before moving (try some of the cues above)
  • Send the hips backwards and down (like sitting down), also allowing the knees to bend. The upper body will have to come forwards slightly however avoid collapsing forwards
  • Return to the start position, being sure to initiate the movement at the hips – driving them forward and up
  • Squats can be done on both legs at the same time or progressed to single leg where suitable. You can also modify the depth of the squat depending on your strength/experience

Muscle release glute

Crab walk

Walking sideways is a great way to work the gluteus medius and minimus as it really targets hip abduction.

  • Start with a small bend in your hips and knees and think of switching on your glute muscles
  • Then take slow, purposeful steps to one side (10-20 steps) before returning in the opposite direction
  • You can add a resistance band around the knees for extra challenge – just ensure that you are still focusing on pushing the knees apart, rather than rotating them outwards

Hip hinge

To really activate the gluteus maximus, this exercise targets hip extension

  • Start with feet hip width apart, slight bend in knees and activating the glutes
  • Keeping the spinal in neutral, send the hips backwards whilst keeping the knees in the same position. Your body should resemble a shape similar to the number 7
  • Focusing on initiating movement from the hips and return to the start position
  • As with squats, you can make this more difficult by working into more range, adding weight or doing it on one leg

Step up

This exercise is very important for how to activate glutes as most people will go up/down stairs during their day and having good muscle activation is important. It is also a good exercise for those who do a lot of running or walking for exercise

  • Place one foot on a low box or step and activate the glute muscles
  • Ensuring the pelvis stays square and stable and the knee does not collapse inwards, step up onto the box
  • Keeping the same control and activation, lower back to the start position
  • Do all on one side, then swap legs and repeat on the other side
  • You can make this more difficult by adding weight or increasing the box height

Glute activation with Barefoot Physiotherapy

Having good glute activation is key for injury prevention and performance enhancement. If you are concerned about your glute muscles, book in to see on of the physiotherapists at Barefoot Physio so they can assess your glutes, work out if they are contributing to pain or injury, prescribe you personalised exercises and ensure you know how to activate your glutes.

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What Causes Knee Pain?

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Knee pain is a common reason that people present to physiotherapy. They may be suffering from knee pain in isolation or within a broader complaint of symptoms. Your knees are important in mobility and day to day activities, and are influenced directly from the feet, ankles and hips. This article will look into what causes knee pain and the most common presentations we see in our clinic. The vast majority of knee pain can be treated conservatively through a treatment program created by your Physiotherapist. Most of the knee pain presentations that we see at Barefoot Physiotherapy are a result of sustained increased load.

What Causes Knee Pain?

The knee joint is a modified hinge joint that moves primarily in one linear direction. A relatively small amount of rotation occurs as the knee moves through full extension and flexion. The joints that make up the overall knee joint complex include the tibiofemoral (between the thigh and shin), the patellofemoral (the kneecap) and the nearby tibiofibular (between the two shin bones). There are a series of ligaments and cartilage structures also involved in this joint. These include medial and lateral collateral ligaments (MCL and LCL respectively) external to the joint capsule, Anterior and Posterior Cruciate Ligaments (ACL and PCL respectively) and the fibrocartilage meniscus within the joint capsule. Around the patella or kneecap are the patella tendon and ligaments.

Knee pain can also come from tightness or overuse of muscles in the area. Or it can be from nerve irritation presenting with symptoms in this area.

Depending on the activities, age and history of the client, the physiotherapist will perform a variety of assessments. These will determine what causes knee pain in the individual person. A younger or more athletic person may have pain stemming from an acute injury to the above tissues, or from muscular overload. Whereas an older person may be more likely to have osteoarthritis or nerve irritation in the area. This is not a hard and fast distinction, and it is important not to rule causes in or out prior to a thorough assessment from a health professional.

The Most Common Reasons for Knee Pain

As previously mentioned, there are many knee pain reasons. Prior to a physical assessment, your physiotherapist will discuss a detailed history, including any other injuries or niggles that may be relevant.

  • Acute injuries: These are more commonly seen in a sporting context. This can be from a fall, physical contact/ tackle, or an awkward pivot. This may include ACL or MCL tears, meniscus tears or muscle strains. More rarely there may be a bony fracture involved.
  • Tendinopathies: This is an overload of the tendon (where the muscle attaches to bone). This is due to an increase of loading that occurred beyond the capacity of the tissue. Tendinopathies are commonly seen with a recent addition of plyometrics or running.
  • Nerve Irritation: this can present as a feeling of overall muscle tightness around the knee, pulling/shooting behind the knee. Particularly when the hip and knee is straight.
  • Osteoarthritis: as we age it is common to have arthritic changes within joints, and especially common within the knee joint. This can present as pain, decreased ranges or difficulty moving in certain ways. Although we can’t alter arthritic changes (outside of surgery), we can positively influence the body’s response to these changes. Moving better and getting stronger can decrease the overall pain experienced.
  • Paediatrics: Conditions such as Osgood-Schlatters Disease are relatively common in adolescents undergoing a growth spurt. This can lead to an overload of the tissues at the front of the knee. In this population it is important to rule out Perthes Disease. This is an idiopathic necrosis of the femoral epiphysis (top of the thigh bone) which can refer as knee pain.

What Are My Treatment Options for Sore Knees?

We now know there are multiple factors involved in what causes knee pain. Therefore there are multiple factors that can be addressed in your treatment. After ruling out the need for immediate imaging, our goal is to de-load the area and reduce the symptoms you are experiencing. Your physiotherapist will use a combination of hands-on treatment to reduce any relevant nerve irritation and muscle spasm. This may include joint mobilisations, soft tissue massage or dry needling.

You will be given advice on immediate load management and changes to activity. In the initial stages of rehabilitation we want to find a zone of activity to keep you moving without any aggravation of symptoms. Following this initial de-load period, your management will consist of muscle activation and retraining. This will likely focuse on glutes, hamstrings, quads, calves, and abdominals (this is different for every person).

At Barefoot Physiotherapy we assess the entire body to determine if there are any areas that also need to be addressed. This will help to reduce the overall load on the knees and the rest of the body. From here we build on increasing strength whilst maintaining improvements to ranges and symptoms. Our clients all receive a home exercise program that is relevant to them.

The Best Exercises for Sore Knees

The best exercises for improving knee pain and reducing the underlying factors in what causes knees to ache follow the principles of de-load, retrain, and reload.

De-load: This usually involves muscle releases to help improve pain free movement ranges. Most often they will focus on the knee itself, plus any other areas your physiotherapist has found relevant for you. Typical releases include glute, deep hip rotator or quad muscles with a trigger ball, calf releases using your thumb or a trigger ball, gentle active range movement stretching glutes, adductors, calves, or quads.


Retrain: After de-loading it is important to retrain movement and activation patterns. This helps to prevent accumulated strain from causing symptoms in the future. Your physiotherapist will help you find cues for glute activation, quad and hamstring co-contraction, intrinsic foot activation and improved balance, amongst others.

Reload: This section becomes a bit more exciting as we add a strength component. The muscle activation cues now get to be layered on larger movements like squats, deadlifts, dynamic balance, and lunges. If you have a particular activity to return to, this part of the rehab can be specialised to your specific movement demands.

Muscle stretch quads

How Can I Prevent Sore Knees?

To prevent sore knees in the future it is important to stay mindful of your overall load management. For example, if you are wanting to start running you need to consider more obvious elements such as speed and length of your run. However, you also need to consider your strength and balance capacity, the surface you run on or the shoes you run in. As you increase the load in one area, it is important to include an effective warm-up to help prepare the body. Also make sure the body is receiving enough support in the form of rest/ sleep, nutrition, and muscle de-loading. This is true of any activity, whether that is training for a marathon, going for a hike, or playing with the grandkids.

Have Knee Pain? Contact A Physiotherapist Today

The aim of this article was to help you gain a better understanding of what knee pain is, how it is caused and who can help. Whether you have been experiencing long term knee pain, or just starting to feel a bit of a niggle, Barefoot Physiotherapy can help get you back to your activities as quickly as possible with our knee pain Brisbane treatment. If you have any concerns regarding knee pain, see Barefoot Physio for a thorough assessment, treatment, and management plan.

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Common Running Injuries and How to Avoid Them

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Running is a great form of exercise that works the whole body from legs to lungs and everything in between. Given that running seems so simple, people often underestimate the load it places on the body, leading to running injuries. Runners at any level of fitness can experience pain or injuries and physios are well equipped to help manage and prevent injuries. Using hands-on treatment as well as exercise prescription and training adjustments, physios play an important role in treating running injuries. This article will explain common running injuries and how to avoid them so that you can keep enjoying your run.

Common Running Injuries and How to Avoid Them


Given the repetitive nature of running, it’s not surprising that a majority of common running injuries are often overuse related. ‘Overuse’ or rather, accumulative strain injuries, are more than simply too much running.

For runners of all fitness levels, load management plays a key role in common running injuries and how to avoid them. Load management can include days of total running in a week, the intensity or how fast the running is. It can also include the total number of kilometres in a week, the number of rest days as well as considering other activities in the week (like strength training or playing social sport).

Delayed onset muscle soreness is the achy feeling in your muscles when they are recovering from exercise. Anyone who has tried a new activity or even had a big day of gardening will know the experience of DOMS. For most runners, DOMS is a regular part of training. DOMS is a normal response from the body and most commonly occur after increasing the distance or intensity of a run. They are not a cause for concern and can usually be managed with gentle stretching and movement.

How injuries occur

How Do Running Injuries Occur?


As mentioned, many running injuries are related to poor load management. Therefore, when it comes to avoiding common running injuries, having a program that is individualised to your needs and fitness is key.

Common running pains often occur when there is too big of an increase in training, too quickly. This can be an increase in volume – either suddenly going from 5km run to 10km run or an increase in load across the week, such as going from 3 days of running to 5 days of running. An increase in intensity can also contribute to injuries – such as adding in sprints or high intensity running without preparing the body.

A good rule of thumb for any training program progression is to increase by no more than 20% and to only change one variable (eg. distance or intensity) at a time.

It is also important to consider other factors in injury prevention other than training. Load refers to all aspects of the body – so while training is a big contributor there are other influences to consider. These can include sleep, rest/recovery between sessions, strength, past injury history, not warming up appropriately and nutrition.

What are some common running leg injuries?

Due to the nature of running, most injuries occur in the leg. Common running leg injuries include:

  • Hip pain or hip bursitis
  • Hamstring muscle tear/hamstring tendinopathy/hamstring muscle tightness
  • Anterior knee pain/patellofemoral pain
  • Achilles pain/Achilles tendinopathy
  • Shin splints
  • Plantarfascia pain/plantarfasciopathy


While there are a wide range of running injuries, the underlying treatment approach is consistent. Treatment for running injuries will typically include:

  • Deloading the area: this may include hands on treatment from your physio. For example, joint treatment, dry needling, massage, nerve treatment or taping. As well as modifying your training to an appropriate level. This may be a reduction in volume, swapping out some running for cross-training such as bike or pool sessions or occasionally a short period of complete rest.

  • Improving function: once the injured site has been deloaded, the focus shifts to improving the range of motion and strength of the injured area. As well as ensuring good strength and flexibility of the entire leg and body for future injury prevention. This may include more hands on treatment from the physio as well as a home exercise program

  • Appropriate reloading: Once symptoms have decreased alongside improved mobility and strength, the goal shifts to getting you back into full training. Your physio will work collaboratively to create a gradual return to training schedule

How to know when to see a physio for your running injury?


As mentioned, some general muscle aches are to be expected from running. However, knowing the difference between normal training soreness and injury pain is important. Many common running injuries start out mildly and get worse over time. What most people think of as small niggles, are often the early signs of an injury and should be addressed sooner, rather than later.

Delayed onset muscle soreness is the main common running pain that is not a cause for concern. This is a dull generalised ache across the whole muscle (or a number of muscles). It usually occurs 1-2 days after a big training session. It should ease slightly with gentle movement (such as going for a walk or light run) and resolve entirely around the 48-hour mark. Most other common running pains are the start of injuries and should be addressed by a physio sooner rather than later. Key signs to look for include:

  • Pain is in a particular spot. For example right on the heel or under the knee cap (not generalised across the whole muscle)
  • Pain gets worse with more running
  • Pain is accompanied with stiffness or weakness/heaviness
  • Difference side to side (eg sore on the left, but not the right)
  • Pain does not resolve within 1-2 days

How to prevent running injuries

Muscle release quads

There are many strategies when it comes to common running injuries and how to avoid them. As previously discussed, load management is the most important approach. Either having a physio or experienced coach help determine the appropriate amount of training for your fitness level is the first line of defence for injury. However, determining the right amount of running is not foolproof and even with careful planning, injuries can still occur.

Another important step to consider is incorporating strength training alongside running to ensure that your leg muscles are properly conditioned. Again, this should be personalised to you by a physio or coach but may include exercises like squats, lunges and calf raises. Getting assessed by a physio early on is also very important for preventing common running leg injuries. Physios can help identify areas of restriction or weakness that may contribute to an injury and help put a plan in place so that niggles don’t become more serious injuries. You don’t even have to have a niggle to see a physio – in fact, the earlier you see a physio, the less likely you are to need time off training with a serious injury.

Expert treatment for your running injuries


Whether you are getting started on your running journey or are well into your career, Barefoot Physio can help with common running injuries and how to avoid them. Utilising sensitive nerve and range of motion tests to identify potential problems, they combine hands-on treatment and home exercise programs to develop a personalised treatment plan to help prevent and treat injuries so that you can continue running.

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What Is Women’s Health Physiotherapy?

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At Barefoot Physiotherapy, we offer various physiotherapy services; one of them being Women’s Health Physiotherapy. In fact, this is one of our primary service offerings in Brisbane. So, what is Women’s Health Physiotherapy? 

Women’s Health Physiotherapy typically refers to Physiotherapy focusing on Pelvic health. At Barefoot Physiotherapy, we use the term to cover Physiotherapy concerns across the female lifespan, including adolescence, antenatal, postnatal and menopause stages of one’s life. 

Most commonly, all these concerns will relate to the function and pain in the bladder, bowel, pelvis, lower back muscles and pelvic floor muscles. However, it can also incorporate a return to function and exercise concerns pre and post-pregnancy, gynaecological surgery and around menopausal age. At Barefoot Physiotherapy, we aim to empower women across the lifespan to maintain control of their bodies to live their best barefoot lifestyles. Working with a physiotherapist to address any of the above issues can help improve your overall quality of life and wellbeing. 

What Is Women’s Health Physiotherapy?

Women’s Health Physiotherapy is different to general physiotherapy as its practitioners have a special interest and extra training in a range of female-oriented concerns across the lifespan. A women’s health physiotherapist will work with you with the aim of helping you achieve your physical best. 

So what is Women’s Health Physiotherapy? As previously mentioned, it generally tends to focus on women’s pelvic health concerns across the lifespan. Contrary to common misconceptions, it isn’t just for pregnant women; but in fact, it addresses the changes to the female body throughout the various stages of life. Clients who work with a Women’s Health Physiotherapist have someone to guide them and organise a health team if needed to achieve their individual goals. 

A general musculoskeletal physiotherapist can assist with injuries to various body areas, including symptoms associated with pregnancy and gynaecological surgeries. However, they may not have a deeper understanding of how to effectively treat pain and injuries stemming from the pelvic region long term and prevent reoccurrence. Therefore, they will often refer to a Women’s Health Physiotherapist who can utilise their extra knowledge, hands-on skills and exercise prescription in this area to achieve the client’s goals and keep the area strong and healthy to prevent reinjury. 

Why Would I Be Referred to a Women’s Health Physical Therapist?

So why would you be referred to a Women’s Health Physical Therapist? At Barefoot Physiotherapy, we don’t do internal examinations: the only type of Women’s Health Physiotherapy we typically refer for is an Internal examination. If this is needed, we have great contacts to refer to and work with to help get you the best care. Therefore, there are plenty of reasons your GP/ general physio may recommend you to Barefoot Physiotherapy for Women’s Health concerns. 

These concerns can include;

  • Lower back, mid-back and neck pain pre and post-pregnancy
  • Pelvic girdle pain or coccyx pain 
  • Sacroiliac joint dysfunction or pain  
  • Postnatal pelvic floor assessments (excluding internal examinations)
  • Bladder concerns including; stress urinary incontinence, urge incontinence/ overactive bladder syndrome, bladder pain syndrome and urinary retention. 
  • Bowel function concerns including incontinence and constipation 
  • Painful sexual intercourse (dyspareunia)
  • Exercise programs for menopausal women 
  • Exercise programs to increase bone density 
  • Exercise programs for a return to exercise post-pregnancy 
  • Advice and education on safe exercise throughout pregnancy 
  • Endometriosis pain
  • Vaginal Pain 

If you are unsure about what health practitioner is needed to help resolve your women’s health concern, give us a call anytime to address your concern, and we can assist you in determining the best course of action. 

What Happens at a Women’s Health Physio Appointment?

Hopefully, by now, you will have a greater understanding of “what is Women’s Health Physiotherapy?”. Let’s now break down what happens at a Women’s Health Physio appointment. 

At Barefoot Physiotherapy, your typical initial assessment will start with a detailed subjective examination. This will include asking the client to detail previous medical history, previous injuries or physical concerns, current physical injuries or concerns, any current medications, who your current health care team is, and any other relevant information to your presentation. 

Then your Physiotherapist will go through a series of objective assessments, including testing for underlying neural irritation, any movement restrictions throughout the body, tightness in joints or muscles or any specific weakness in the pelvic floor or deep abdominal muscles. We don’t do any internal examinations; we have thorough assessment techniques that we use. And if we deem that an internal examination is necessary, we may refer you to a trusted colleague.

Once your Women’s Health Physiotherapist has a thorough understanding of your presentation, they will utilise the remainder of the appointment for treatment; this may include but isn’t limited to; manual therapy to relieve tight muscles/joints/ nerve irritation, advice and education about exercise, activity modification and postures and muscle activation or light strengthening. 

Depending on the reason for your visit, your Women’s Health Physiotherapist may also recommend an SIJ belt or taping to help relieve your symptoms. 

What Are The Benefits of a Female Health Physio?

When visiting Barefoot Physiotherapy for Women’s Health Physiotherapy, there are a variety of benefits of working with an educated, knowledgeable and experienced team. 

At Barefoot Physiotherapy, we pride ourselves on providing the best possible treatment by staying up to date with cutting edge research around pelvic health. We undertake extensive extra training and learn from various leaders in the women’s health industry to constantly upgrade our skills in hands-on treatment, advice and education, and exercise prescription. This extra training also allows us to find excellent options for clients in terms of practitioners who provide internal women’s health examinations to be confident they are working with a team of highly trained professionals. 

Whilst general physiotherapists can provide pain relief for some common musculoskeletal women’s health concerns; a general physio might not know how to effectively prevent reoccurrence with certain women’s health issues or who to refer to for specific women’s health concerns (for instance; internal examinations or pessary fittings for pelvic organ prolapse). Therefore, it is highly beneficial to seek out a Women’s Health Physiotherapist from the start of your physiotherapy journey. 

Hopefully, this article has helped to understand the question of “what is Women’s Health physiotherapy?”, and you now feel confident to request a Women’s Health Physiotherapist early on in your care. 

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How Can a Female Health Physio Help With Pregnancy?

A major area of Women’s Health Physiotherapy is the focus on antenatal and postnatal issues. A female’s body undergoes major changes throughout pregnancy. Therefore, as the body adapts, females can develop issues or concerns with pain and dysfunction, which can last throughout the entirety of their pregnancy and into post-pregnancy if not addressed by a Women’s Health Physiotherapist. 

Women’s Health Physiotherapy can help prevent pregnancy-related concerns such as; pelvic girdle and coccyx pain, pregnancy and postnatal lower or mid back pain, incontinence (bladder or bowel), pelvic organ prolapse and or exercise-related muscle fatigue/ pain. A Women’s Health Physiotherapist can address the above issues through advice and education around pelvic organ health, hands-on therapy to release tight muscles causing discomfort, exercises to increase pelvic floor strength and endurance and postural education. In addition, they can work with you to develop a safe plan for exercise during pregnancy and a graded return to activity post-pregnancy. 

Women’s Health Physiotherapists aim to empower you to feel confident in your body, prevent issues from occurring or reoccurring and achieve your individual goals. 

Find the Right Women’s Health Physio For You

This article has aimed to provide you with the answer to the question “What is Women’s Health Physiotherapy?” and how Barefoot Physiotherapy can help you resolve your women’s health concerns. 

At Barefoot Physiotherapy, we always utilise the most cutting edge research to shape our treatments, and you can be confident that your Physiotherapist will listen to your concerns and work with you to achieve your goals and resolve your issue. Therefore, if you need Women’s Health Physiotherapy in Brisbane, please don’t hesitate to reach out to us to chat about what you would like to come in for or book an appointment. You can book an appointment by calling us on 1300 842 850, or you can book online here. 

Exercises for Lower Back Pain

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Lower back pain can be one of the most debilitating conditions that clients present with at Barefoot Physiotherapy. Clients will often ask, “why do I have lower back pain?” especially when they can’t correlate it to a specific mechanism of injury or if it has a gradual onset. 

Physiotherapy can significantly increase the quality of life for people suffering from pain in their lower back region. Manual therapy techniques, exercise prescription, advice, and education play an important role in our client’s rehab and, when prescribed together, prove to provide the best outcomes overall for clients. 

It is ideal to start Physiotherapy as soon as you begin to feel any symptoms of lower back pain; this helps reduce the severity of the discomfort and get you back to being pain-free quicker. This article will help you understand what causes back pain in lower back areas and what Physiotherapy can do to help manage it. 

Why Do I Have Lower Back Pain? 

At Barefoot Physiotherapy, clients present with lower back pain from a variety of underlying causes. Your Physiotherapist aims to not only relieve your symptoms but utilise a thorough assessment to determine the underlying cause and to help prevent the back pain from reoccurring.

When clients ask us, “why do I have lower back pain?” we will start with taking a thorough past and current medical history, including any previous aches/ pains or injuries to the body. This helps your Physiotherapist understand what condition your body is in, walking in the door.

Sore lower back causes are often related to a history of tight/reduced hip range, sore or weaker glute muscles, reduced ability to activate core muscles, and accumulated strain on the body. However, these issues might not be the cause if the client has had a direct, forceful mechanism of injury to the lower back, for example, a fall or a rugby tackle. Individuals with pain in their lower back may feel any of the following symptoms: a general ache in the muscle or joint, tightness throughout the back region, sharp/ pulling pains with movement, and it can affect the client’s ability to move freely, i.e. walking, sitting and running. 

Common Backache & Pain Causes 

The following section lists some of the main musculoskeletal causes of back discomfort that clients present with at Barefoot Physiotherapy. 

  • Accumulative strain injury (reduced movement range or strength in hips, thoracic and lower back) 
  • A reduced range of motion throughout the hips, lower back, and thoracic region can build up tightness in these regions. 
  • If there is movement restriction, you are more likely to overstretch yourself in these positions and therefore cause yourself pain. Clients will often describe having a big day of driving or gardening and then waking up with a muscle spasm throughout their lower back. This is an example of how reduced muscle range can contribute to lower back pain. As both driving and gardening typically require 90 degrees or above hip flexion. However, if the hips are tight, they don’t have full ability to perform these tasks easily and will therefore recruit nearby muscle to assist, i.e. lower back. This overload on the muscle from a repetitive task can cause pain and discomfort.   
  • Acute injury to the lower back (a fall, rugby tackle, car accident etc.)
    • An acute injury can cause tissue or muscle damage to the lower back region, resulting in pain. 
    • There are many structures in your lumbar region, including lumbar joints, discs, ligaments and muscles; injury to any one of these areas can cause pain and require Physiotherapy to reduce discomfort and restrengthen the muscles. 
  • Regardless of the type of injury, your Physiotherapist will determine if there are any ‘red flags’ in your presentation and recommend whether imaging or medical referral is necessary. 

What Causes Back Pain in the Upper Back? 

The upper back region is another common area of complaint that clients will present with at Barefoot Physiotherapy. Sedentary lifestyles and sitting jobs are a large contributor to the prevalence of upper back and neck aches.

Some of the main causes of upper back pain we find are sitting posture, length of time spent sitting, weak upper back muscles and nerve irritation. Prolonged periods of sitting can cause upper back pain as the muscles don’t get to move and, therefore, become stiff and eventually weaker. For instance, if you held your wrist in one position for multiple hours, it would also become sore. In addition, nerve irritation can also affect the upper back muscles, as when our nerves aren’t gilding well, they can cause the joints and muscles around them to tighten, which has a flow-on effect for the rest of your body. Therefore, if you are experiencing any neck or upper back discomfort, it is a good idea to get it checked by a Physiotherapist to resolve your symptoms and learn some strategies to prevent it from reoccurring. 

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What Causes Back Pain in the Lower Back? 

When asked “what causes back pain in the lower back?” we will often start questioning what the client’s typical day of activity looks like. This helps us ascertain the reason for the build-up of pain and helps to understand the client’s individual causes of discomfort.

Similar to upper back pain, a very common reason for lower back pain is lack of movement, which leads to a build-up of tightness and irritation throughout the lower back muscles, joints and ligaments. In addition, awkward posture and positioning, which is overloading the back structures, i.e. in sitting, exercise, heavy lifting and manual labour, can cause irritation and discomfort in the area. Therefore, it is important to ensure that you consult a Physiotherapist when you first start to develop back ache symptoms to address the underlying issue. 

Long Term Back Issues 

Back issues can develop over a period of time due to a consistent overload on the structures of the body, or it can be from an acute specific injury to the lower back region. In both circumstances, it is imperative to receive Physiotherapy treatment as soon as possible to avoid any long term changes in muscle strength, muscle length, range of motion and nerve irritation. This article has so far discussed the most common backache pain causes that are musculoskeletal in nature; however, some causes of lower back pain can be more sinister in nature. If your symptoms don’t fit a clear musculoskeletal pattern, your Physiotherapist will likely order imaging of your back and recommend you consult your GP for other possible causes of your pain. 

Exercises for Lower Back Pain? 

With any back pain, it is ideal to consult your Physiotherapist to have a treatment plan individualised to your injury. As a guide, your Barefoot Physiotherapy lower back pain treatment will typically include; manual therapy, advice and education, strengthening exercises, stretching or trigger point releases and self-management strategies. When reducing pain, a part of the treatment plan is helping clients understand how they can prevent their lower back discomfort from reoccurring. It is very important to ensure clients have good work postures, exercise techniques, manual loading, and heavy lifting ergonomics in this instance. When you move well, you are less likely to overload your muscles and injure yourself. 

There are some typical exercises and stretches examples listed below that clients will often be prescribed for their lower back pain management; however, it is recommended your consult your health professional to decide what works best for your body.

  1. Glute trigger point releases with a lacrosse ball 
  2. Glute stretches 
  3. Hip flexor stretches 
  4. Child’s Pose Stretch 
  5. Deep 360-degree breathing exercises 
  6. Pelvic tilts 
  7. Glute activation squats 
  8. Cat / Cow stretch 
Muscle stretch lats

Treat Back Problems With a Physiotherapist 

I hope through reading this article you have gained a better understanding of the question “why do I have lower back pain?” and feel confident to seek out professional help from your Physiotherapist to help ease your symptoms, treat the cause and get you back to living your best Barefoot Lifestyle. If you are experiencing any of the lower back pain symptoms mentioned, please don’t hesitate to reach out to the friendly team of Physiotherapists at Barefoot Physiotherapy, who can help you relieve your pain and improve your quality of life. You can give us a call on 1300 842 850 or book online. 

Muscle release forearm

How to Fix Tennis Elbow with Physiotherapy

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How to Fix Tennis Elbow: Our Approach

Tennis elbow, or lateral epicondylalgia, is a diagnosis of overuse injury to the elbow. It can be a painful injury that usually occurs when the elbow is overloaded, typically due to repetitive motions of the wrist and arm.

Tennis elbow is defined as a tendinopathy of the extensor muscles in the forearm. These muscles attach to the outer part of the elbow at the lateral epicondyle of the distal humerus bone and run down to the wrist. Whilst the injury is called tennis elbow, only approximately 5% of people suffering from tennis elbow draw correlation to tennis.

This article will explain how to treat tennis elbow, the symptoms of tennis elbow and manual therapy and exercises which are used to treat it. At Barefoot Physiotherapy, we have experience treating a wide variety of clients who present with tennis elbow symptoms; the following information is backed by our team of experienced Physiotherapists.

What Are the Symptoms of Tennis Elbow?

Knowing how to fix tennis elbow means we must first understand how the symptoms are caused, so we can identify the problem and treat the source of the pain.

Tennis elbow is defined as a type of tendinopathy which is essentially the inflammation (swelling) of tendons, and this can cause pain in the elbow and forearm region. The tendons of the forearm extensors are bands formed of tissue whose role is to connect the muscles of your forearm to your elbow bone or lateral epicondyle.

As previously mentioned, you can get tennis elbow without playing tennis, as movements such as repetitive gripping activities can also cause the tendons to become inflamed. Typical symptoms of tennis elbow are pain and tenderness at the elbow’s lateral epicondyle, this pain can also radiate into the upper or lower portion of the arm. People with tennis elbow may also experience swelling in the elbow, weakness in the forearm or reduced range of movement. If you are suffering from tennis elbow you may have pain when gripping or lifting objects, driving the car, turning doorknobs, or opening jars, or potentially while typing.

Misconceptions About Tennis Elbow

As with any area of the body, the reason you are experiencing pain in your elbow can vary. Not all pain experienced in the elbow or forearm is tennis elbow. Pain and discomfort in the outer elbow region can often be misdiagnosed as tennis elbow or lateral epicondylalgia.

There are many structures which can influence the movement and feeling in the elbow and therefore a thorough investigation of a client’s symptoms is always essential to ensure there isn’t a misdiagnosis. At Barefoot Physiotherapy, we often see clients who have underlying nerve irritation which is diagnosed as tennis elbow, if there is nerve irritation in the brachial plexus (which is the nerves that supply the arm) they can cause pain at the lateral elbow. In addition, wrist or shoulder dysfunction or pain can load up the elbow and cause the elbow joint discomfort and symptoms similar to tennis elbow. Furthermore, general upper body muscular weakness can also cause discomfort after repetitive movements.

How to Fix Tennis Elbow Quickly

At Barefoot Physiotherapy, we aim to provide pain relief as soon as possible for clients with tennis elbow. Understanding how to fix tennis elbow quickly requires a focus on pain relief and symptom management. This enables the Physiotherapists to sooner start the required treatment for long term resolution of the injury.

On assessment at Barefoot Physiotherapy, we will first check to ensure there are no further underlying issues contributing to your pain including muscular tightness or nerve irritation. Treatment to upper body nerves and tight muscles can help relieve pressure and inflammation at the area, assisting in providing the client with pain relief. In addition, if it is safe to do so, your Physiotherapist will advise the use of over-the-counter anti-inflammatories to help reduce the internal source of inflammation.

In the session, your Physiotherapist may also assess that the use of supported strapping tape at the region is beneficial for you and your individual symptoms. Once sufficient pain relief is achieved, the source of symptoms needs to be identified so appropriate treatment can commence for long term tennis elbow relief.

How to Cure Tennis Elbow Long Term

At Barefoot Physiotherapy, we aim to help clients achieve long term success for all their goals. To understand how to cure tennis elbow, we undertake our Barefoot Treatment plan.

This plan, as previously mentioned, entails a thorough investigation of your previous physical history including any repetitive injuries, pain, or other health conditions. Then, an initial assessment which includes testing for any nerve irritation present throughout your body, reduced range of motion or tightness in muscles or joints. If present, we aim to clear nerve irritation first, so any gains made in muscle range or strength can hold between sessions. Your Physiotherapist will also likely discuss the need for you to rest the painful joint as much as possible, and work with you to initially modify any aggravating activities.

Once sufficient pain relief and reduction in inflammation is achieved, your Physiotherapist will work with you with a combination of manual therapy, advice and education and exercises to improve your elbow strength and resolve your tennis elbow injury.

Treating Tennis Elbow with Exercises

When working with your Physiotherapist on how to fix tennis elbow, you will likely be prescribed exercises focused on lengthening and strengthening the target muscle groups. This will not only help reduce your symptoms but will also assist in preventing future problems with the elbow.

The following are examples of exercises which may be used; however, it is recommended that you consult your own health professional for a personalised exercise program.

Lengthening exercises will often include wrist/ elbow extension and flexion stretches. Light strengthening exercises can be completed in elbow/ wrist flexion and extension before progressing to supination and pronation. You may use a light handheld weight or resistance bands to increase the difficulty of the exercise and build strength.

Grip strengthening is another important part of a tennis elbow home exercise program. Grip strength exercises can help build up forearm and wrist strength that can improve your ability to do activities of daily living pain free.

A combination of these exercises can include a towel twist which works grip strength and the wrist flexors and extensors. Whilst strengthening of the local elbow and wrist muscles is important, dependent on your underlying cause of symptoms, your physiotherapist will likely recommend the strengthening of other upper body muscles. This can include, but is not limited to; biceps, triceps, latissimus dorsi, rotator cuff muscles and intrinsic hand muscles.

Address Your Tennis Elbow with Barefoot Physiotherapy

As the article has summarised, if you are experiencing any pain or discomfort in your elbow or forearm it could be due to an overuse injury such as tennis elbow and it is recommended to book in to see a health professional for a thorough assessment and treatment plan.

Muscle release quads

What Causes Hip and Groin Pain?

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Hip and groin pain is prevalent across the population, from athletes to office workers. There are many factors to be considered in what causes hip and groin pain. As a person ages across the lifespan, the factors contributing to this pain change. In a younger population, muscle and cartilage tears are more prevalent in an athletic population. As you get older, muscle overload, such as tendinopathies, can occur as can osteoarthritic changes to the joint. All of these can be managed alongside a physiotherapist and the vast majority of hip and groin related conditions can be managed conservatively with a combination of manual therapy, exercise and guidance regarding activity.

What Causes Hip and Groin Pain?

The hip is a large ball and socket joint, connecting the femur (thigh bone) to the pelvis. This means the leg can be moved in all directions to a varying degree and provides force transfer between the lower limb and the torso. The hip joint is surrounded by strong ligaments and muscles that assist in stability and movement.

When considering what causes hip and groin pain it is important to look at a variety of factors, including range of movement, strength and lifestyle factors. Outside of acute injuries, what could cause hip and groin pain is often a combination of many factors that all need to be addressed in treatment and management. Hip and groin pain can be influenced by bony or cartilage changes such as osteoarthritis, labral tears or Femoro-acetebular impingement, muscle overload such as iliopsoas or adductor tendinopathies, movement restriction from muscular tightness and pregnancy related changes such as pubic symphysis inflammation.

It is important your Physiotherapists assesses the whole picture when diagnosing and treating hip and groin pain. This way any treatment will have lasting effects not just resolving your symptoms but solving the underlying issue long term.

What are the Symptoms of Hip and Groin Pain?

When determining what causes hip and groin pain, your Barefoot Physiotherapist will undertake an assessment around the joint, carrying out a number of movement and muscle tests, the exact tests will be dependent upon the individual’s presentation. Your Physiotherapist will ask you about what symptoms you are experiencing and if you are experiencing hip or groin pain you may notice:

  • clicking or catching in the hip joint
  • stiffness in movements
  • pain that is worst in the morning
  • pain that improves with activity
  • referred pain into the buttocks or thigh
  • pain that started after an increase in physical activity
  • localised pain that increases with single leg activity
  • sudden pain after a loaded movement, such as kicking
  • an ache around the outer hip, in a “C” shape

These are some of the more common symptoms reported by hip and groin pain and can help your physiotherapist determine priority for treatment.

How Will a Physio Diagnose Hip and Groin Injuries?

When diagnosing a hip injury causing groin pain, your physiotherapist will complete a number of objective assessment tests. At Barefoot Physiotherapy, our treatment framework helps to guide our process so it is thorough and we can get to the root cause of your pain. Some of these tests include palpation of various tissues involved in the hip complex; range of movements such as hip flexion and rotation and lumbar (low back) movement; intra-articular orthopaedic tests; resisted muscle activation; functional movements such as squats or single leg stance.

During these tests, we are looking for restriction in movements, asymmetries in range and strength and pain replication. While these tests are not fully accurate in diagnosing, they can be helpful in creating a picture to guide clinical decision making and management. Once your Physiotherapist has a good idea of what type of hip/ groin pain you are presenting with, they will move on to treatment of the area which will be discussed below.

How to Treat Hip and Groin Injuries:

Regardless of what could cause hip and groin pain, at Barefoot Physiotherapy, a client’s treatment plan typically consists of symptom management, a focus on increasing mobility of the affected area, and targeted functional strengthening of the affected muscle groups.

The initial stage of symptom management may include a reduction of the aggravating activities, utilising pain relief or anti-inflammatory medication, muscle releases and/or low level muscle activation exercises. You may be able to begin initial management independently, however where possible it is best to seek out a health professional’s advice to alleviate pain as quickly as possible.

For long term, sustainable results, it is recommended that you see a physiotherapist to create a management plan that gets you back to enjoying your activities pain free. As you progress on a strengthening program, your Barefoot Physiotherapist can help guide you to ensure you are maximising your exercises with appropriate muscle activation and loading into appropriate movement ranges for your body. At Barefoot Physiotherapy, we also treat any underlying neural irritation that may be contributing to your symptoms or adding to muscle tightness and movement restriction in the area.

The Best Exercises for Hip and Groin Injuries

When working on a rehab program for a hip injury causing groin pain it is important to go back to basics. Your Barefoot physiotherapist will introduce muscle activation and motor control exercises involving the back, hips and lower limb. Examples of this may include pelvic tilts working through comfortable ranges in anterior and posterior tilt positions to improve mobility in the low back, or glute activation exercises to increase muscle fibre recruitment of the glutes i.e. in a squat position, step up or sit to stand.

If appropriate, you may be prescribed stretches for the psoas, glute and thigh muscles to help maintain an increase in movement ranges. Strengthening exercises usually start with double leg dynamic and functional options, such as squats and lunges, and static single leg options to include balance work. An overall lack of abdominal strength and control can be a component of what causes hip and groin pain and therefore exercises targeting these areas will be included in your exercise management program.

As your treatment progresses these exercises can be tailored to more specific activities that you like to do for sports, hobbies, or other recreational activities. For instance, if you are getting back to running, there will be a focus on running drills to further strengthen the hip or if you are wanting to return to heavy lifting your exercises will focus in on technique and form at the gym.

The exercises utilised in your recovery can be continued after your symptoms have resolved, now with a different ratio or focus. You may do less frequent specific activation exercises and start to increase the load used in your strength work. It is important to continue strength and mobility work even after the resolution of initial pain symptoms so that your body is better able to tolerate the activities of your daily life.

Talk to Expert Physiotherapists

As mentioned in the article there are a variety of factors contributing to hip and groin pain. Working with a physiotherapist can help you manage your symptoms and get you back to pain free activities. At Barefoot Physiotherapy, we undergo a thorough assessment and provide an appropriate management plan to get you back on track. If you are suffering from hip or groin pain, you can contact us on 1300 842 850 or book with our Brisbane physiotherapists online.

Pelvic girdle pain physio

How to Relieve Pelvic Girdle Pain During Pregnancy

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Throughout pregnancy, many women will experience some form of Pelvic Girdle Pain (PGP). Knowing how to relieve pelvic girdle pain during pregnancy is vital to ensure women still have a good pregnancy experience and one that allows them to continue their normal daily activities for as long as possible.

PGP during pregnancy is a relatively common condition affecting approximately half of all pregnant women. For 25-30% of pregnant women, the condition can become quite severe. This blog will introduce the topic of pelvic girdle pain and allow you to develop a better understanding of what causes it, what the symptoms are and how you can work with a Barefoot Physiotherapist to relieve your pelvic girdle pain and comfortably adapt to your body’s changes.

What is Pelvic Girdle Pain?

Pelvic Girdle Pain (PGP) is classified as pain felt either at the front of the pelvis over the pubic joint, pain at the back of the pelvis near the sacroiliac joint or pain on one or both sides of the pelvis. PGP which relates to the pubic symphysis joint can also refer pain into the inner thigh (adductors), groin, vaginal or lower abdominal region. Approximately 90% of woman recover from PGP within 12 months of having a baby, however, up to 10% of women have continued PGP pain up to 2 years post birth.

What Causes Pelvic Girdle Pain During Pregnancy?

To determine how to relieve PGP in Pregnancy, your Physiotherapist will need to assess your pelvis and the related muscles in the region. PGP can have multiple causes stemming from both ligaments and muscles. During pregnancy your body undergoes multiple changes including:

  • The increasing weight of the baby on your pelvic floor muscles
  • Your centre of gravity pushing forward as your baby and stomach grows which challenged your balance and adds increased load to your back.
  • Hormonal changes: Relaxin is one of the hormones responsible for an increase in ligament laxity, as it alters the collagen structure of your connective tissues (which composes ligaments). Ligaments help to control your joint movement and support your pelvic floor muscles.
  • The pelvic joints usually have very small amounts of movement when you are not pregnant. However, as this increases during pregnancy your pelvis requires your muscles to help control and stabilise the pelvis. Therefore, if your muscles aren’t doing their job correctly this can increase the strain on the ligaments/ joint which can result in inflammation and pain. 
  • Finally, as your abdominal muscles stretch throughout pregnancy and the weight of the baby bears down on the pelvic floor, it is more difficult for muscles to tighten and support the pelvis. This can also contribute to poor control of the joints and therefore increased pain.

Practical Tips: How to Help Pelvic Girdle Pain

There are numerous effective Physiotherapy techniques utilised for relief for pelvic girdle pain in pregnancy.

Some things you may want to try at home are

1- Icepack. A soft icepack over the area of pain can be relieving. Icepack can be applied over the painful joints around the pelvis for approximately 20 minutes at a time. It is recommended you then rest for at least 40 minutes before reapplying ice as needed. Ice can help settle your pain and relieve the inflammation at the joint.

2- Heat. Some people find heat to be more calming and relieving than ice. A wheatbag warmed up (not burning hot!) applied over the back or hips may be relieving. This also applies to a warm shower or bath.

3- Focussing on bilateral stance activities. Ok that sounds technical but it is about having weight evenly distributed through the joints as opposed to time spent on one leg. So try not to ‘hang off one leg’ when you’re standing. Take shorter steps. Sit with both feet on the floor.

4- Pillow between your knees when you’re lying down. And having that pillow in between when you roll over.

5- SIJ belt. Now this will usually need to be fitted by a Physiotherapist but if you don’t have access to one this is definitely worth a try. The simple test you could do at home to determine if you think an SIJ support belt may work for you is to get someone to compress on either sides of your hips (at the widest point) while you are standing. If you get relief or it ‘feels easier’ this would subjectively indicate it is worth trying an SIJ belt. Now make sure to get the measurement correctly (for size) and wear it as instructed (always lower down than you think). We stock and recommend the Serola SIJ belt. Again we recommend you are fitted and taught to wear/use by a physio.

6 – Tubigrip. Again this is usually a thing a Physiotherapist would determine if worthwhile using. And again we know not everyone has access. Doubled over Size L or M Tubigrip can have enough compression do give some good feedback to brain for support around tummy and hips. It’s likely you would source this at a Physio but potentially a pharmacy may stock it. You’ll need 90cm at least. Pull up as single layer then fold back on itself so that it covers from the bra line down across the hips.

7- Taking it easy. You may need to reduce your activity if you are getting PGP. If you see a Physio they will be able to help determine how long to do this for (to calm the body down) before reintroducing activity and strengthening as appropriate.

If you are in Brisbane please book in so we can take care of you. If you are not feel free to reach out to us and we will happily talk you through care over the phone or help you choose a physio local to you. We really are passionate about helping people get the best care for them.

How To Relieve Pelvic Girdle Pain During Pregnancy with Pelvic Floor Exercises

Pelvic floor muscles act to support the weight of your growing baby. As your baby increases in weight, the load on these muscles increases and it can cause a slight stretch to the muscles. Correct pelvic floor and lower abdominal muscle activation, strength and length are vital to a happily functioning pelvic girdle. For example, if pelvic floor muscles become weak that can cause other muscles such as the adductors to pick up the slack and tighten, which in turn pulls on the pubic symphysis joint. In addition, dysfunction of lower abdominals, glutes and hamstrings can all negatively impact the pelvic girdle. Therefore, it is essential for your Physiotherapist to thoroughly assess your individual symptoms and determine what muscles need to be treated either through manual therapy or exercise.

Your Physiotherapy exercises may include, but is not limited to the following:

  1. Increase correct breathing patterns
  2. Lower abdominal strengthening
  3. Glute and Hamstring strengthening 
  4. Pelvic floor strengthening
  5. Gentle adductor strengthening
  6. Muscle releases
  7. In addition, the use of a support belt for your pelvic girdle pain might also help.

Relief For Pelvic Girdle Pain with Physiotherapy

It is recommended to work with a trusted health care professional, such as a Physiotherapist to help determine how to relieve pelvic girdle pain during pregnancy. Booking an appointment with a Barefoot Physiotherapist will allow us to thoroughly assess your situation, determine where your discomfort is coming from and then work together to determine your best treatment plan for both in the clinic and at home. Your Physiotherapist will show you how to help pelvic girdle pain by creating a multimodal treatment plan. You can expect your treatment to include: hands on techniques to relieve pain, advice around how to move without aggravating your symptoms and exercises to help keep you moving well.  

Whilst majority of women report a decrease in pelvic girdle pain symptoms after giving birth, it is still important for women to return to their full strength and mobility without pain as soon as it is safe to do so. Physiotherapy can help women adjust to motherhood and implement strategies and exercises to help their bodies adapt to the new load of raising a child.

Book In with Barefoot to for PGP Management Today

If this sounds like the type of Physiotherapy you are searching for, please don’t hesitate to reach out. If you or someone else you know needs relief for Pelvic Girdle Pain in pregnancy or is experiencing other pain or discomfort associated with pregnancy, we can help assess and determine your best course of treatment. Barefoot Physiotherapy provide leading pregnancy physiotherapy, pelvic floor physio and women’s physiotherapy services in Brisbane. Book in with Barefoot Physiotherapy today by calling us on 1300 842 850 or using the book online link on our website.

Physiotherapy car setup

Back Problems from Driving? Try These 3 Tips

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Back pain is one of the most common reasons that people see a physiotherapist. An important activity that back pain often interferes with is driving. People may have ongoing back pain that flares up when they drive, or sometimes the only time they have back pain is while they are driving or immediately after. Physiotherapy can help acute back pain, and long-term, chronic back pain and help you manage any back problems from driving.

Why Do People Have Back Problems From Driving?

There are many factors that are involved in back problems while driving. People commonly feel back discomfort in a variety of places. It may be more in the hips and low back, or in the upper and mid back, or even a combination. The best way to understand how to avoid lower back pain while driving requires taking a look at why it’s happening in the first place.

If you are consistently upright and tightly gripping the steering wheel you may feel it more in the upper and mid back or front of hips. If you are sitting in the one, maybe slumped, position for an extended period of time you may feel it more in the lower back. Driving in constant stop-start traffic can result in fatiguing hip and back muscles resulting in back discomfort.

People may experience ongoing or chronic back pain with driving, particularly if their job requires long hours behind the wheel. When sitting in a moving vehicle the body experiences forces and challenges that it wouldn’t in a stationary chair. You have to compensate for changes in speed and direction, the constant vibrations from the vehicle, and changes to your base of support as you use your feet on the pedals or shift to check your blind spot.

What Causes Back Pain?

Back problems from driving can occur from poor posture, sustained postures, restricted movement ranges, and decreased variety of movements. Your spine and back are comprised of your vertebrae, the discs and ligaments between and around vertebrae and muscles at the back, side and front of your spine. There can be structural changes to these tissues from age or from trauma that can change the capacity to tolerate load. Muscles can tighten up from habitual poor posture or repetitive small muscle strains. When the body continues to tighten up to protect itself from a perceived threat, we begin to lose options for our movements, often associated with an increase in symptoms.

How To Avoid Lower Back Pain While Driving

There are several ways to know how you can avoid lower back pain while driving. The correct driving position to prevent back pain is the one your body can tolerate without stress. Your body will send you signals it is unhappy via tight muscles in the shoulders, hips and low back. Especially when taking long drives you want to be as comfortable as possible. Take the time before you set off on your drive to get in the right position for your body.

3 key tips to avoid lower back pain while driving:

  • Adjusting Seat and headrest: we often find that people’s car seats aren’t set up ideally. Most cars will have multiple places that you change the seat position. Make sure that you are able to rest the back of your head on the headrest without it pushing your head forward. Try tipping the backrest to a different angle, even a slight change can make all the difference. The seat can slide forward and back to find a spot where the knees aren’t up against the dashboard but you don’t have to sit stretching the arms forward to reach the steering wheel. You may also be able to change the height of the steering column.
  • Using Lumbar Support: if the inbuilt options to change the seat set up are enough, or aren’t quite right you can use external additions. A lumbar support might be appropriate for you. You can also fold towels and use them under the hips, behind the low back or behind the shoulders.
  • Taking Regular Breaks: even after all of the changes you’ve made to your car seat, it’s still not going to feel completely great after hours and hours of driving. It’s recommended that you get out of your car and move the body every 2 hours to prevent mental fatigue. This also helps physical fatigue and is important in reducing back discomfort while driving. If you know your suffer from back discomfort with long drives take breaks more frequently.

How Do I Reduce Back Pain After Driving Long Distances?

To minimise back pain after driving long distance you can try a few stretches or movements in your breaks or once you get to your destination. Depending on how much space you can try some gentle standing movements. Lean forward with bent knees like you’re trying to touch your toes. You can gently rock from side to side here like a “ragdoll”.

You can also lean back with hands on your hips, or side to side. Lunges or squats can help move the hips and activate the glutes after being stationary. From a seated position you can take a twist to both sides, lean forward between the legs, or arch and curve the back with your hands on your knees. The point is to give your body the opportunity to move again after being relatively still and to reduce back problems from driving.

What Are the Best Exercises For Lower Back Pain?

Depending on the underlying cause of your lower back pain there are a variety of exercises that you can do to ease your back problems from driving. These can include mobility, strengthening, motor control and general exercise.

Mobility exercises can help to increase the overall range of movement that your body is comfortably able to access. These can include cat/cow where you arch the back in both directions from a kneeling or a seated position or bow and arrow which is a twisting movement of the thoracic spine from a side lying position. You can also use a trigger ball to release muscles or include a gentle stretching movement.

There are helpful releases on our Muscle stretches and releases page: GLUTE RELEASE, LAT STRETCH, QL RELEASE are a few you might like to try. There are plenty more on the page!

Strengthening can help increase the body’s tolerance and endurance to sustained postures. Key areas to strengthen for back pain is abdominal muscles, glutes and hip flexors, and back extensor muscles. Strengthening exercises can include pilates exercises such as single leg lifts, teasers, or planks through to weighted squats or deadlifts. It is important to work with a health professional to determine the appropriate level of loading or complexity for your body.

Motor control exercises are important in helping to change the patterns of the body. These can include pelvic tilts, where you tip the pelvic “bowl” forward and back, or hip shifts, where the hips move side to side. These help to highlight subtle position changes in the lower back joints and muscles and can provide more options when sitting for longer periods of time. Read more about Muscle Retraining here.

General exercise helps to reduce inflammatory levels in the body, improve overall strength and endurance and improve mood. All important elements in reducing back pain and discomfort.

Book In with Barefoot to Manage Lower Back Pain Today

It is common to experience back pain from driving. These are all general tips and suggestions to try to minimise your discomfort. If you are wanting more specific tips or want to know how to prepare your body for driving contact us at Barefoot Physiotherapy by calling 1300 842 850 or booking online.