Are you sabotaging your recovery?

Coming back from an injury can be difficult, continuing to train through your injury though is even more difficult. At Active RX Physio we believe you should be able to train (in some capacity) whilst injured and we try to encourage active rehabilitation. With that said we certainly see some people that aren’t just pushing the envelope when it comes to training with an injury but are bursting through it.

We are hoping to provide a couple of pointers things you may be doing that are potentially sabotaging your rehab/recovery and keeping a little niggle around longer than it should be.

Training Through High Level Pain

When recovering, in most instances a little pain is something to be expected and not feared. However continuing to train when experiencing high levels of pain (not that good hard workout type of pain) is certainly not a good approach and its a sure way to keep an injury hanging around . We often will advise pain levels to stay around a 2-3/10 pain. Monitor how you  feel during, after and the next day, if you don’t feel any worse then you get the green light to keep training.. Most times too if you are truly honest with yourself you know when you’re pushing yourself too far.

Not Altering Your Workout

If you are finding that every time you back squat your hips hurts – don’t just keep doing them, there are literally over 10 + variations of the squat you could do to achieve a similar result. This can be extrapolated for nearly all training and it isn’t just limited in the gym – running, cycling etc. All have variations that could be used in the short term whilst you recover. Learn how to adapt, ask someone if you don’t know a alternative but altering a workout to keep you training should be something you can do. What’s that definition of insanity – doing the same thing every single day but expecting a different result?

Not Doing Rehabilitation Exercises

I know physio/rehab exercises sometimes aren’t the most exciting part of training, but if you’re injured they might be essential to your recovery. Remember you shouldn’t have to do these for the rest of your life they are a short term necessity for a quicker return to what you want to do. Not only do they help in recovery they also might be the missing link to make your future (uninjured) self run fast, lift heavier, move freer, jump higher, swim smoother, cycle further, breathe easier… I think you get the point. Physio’s don’t dream up boring exercises for no reason, most of the time they have a specific purpose related to your recovery goals.

Returning to What Injured You Too Soon

Yes we all want to get back to doing what we love to do as fast as possible BUT going back too soon to an activity that caused your injury in the first place may be a recipe for disaster.  You should be able to get back to whatever you like after most injuries (there are always exceptions to the rule) but slowly re-introducing yourself will be the key to making sure you don’t sabotage your recovery. Build the foundations for whatever you are training, whether that be running shorter distances before that marathon, lifting lighter weights before going for a PB – the key is to expose your body to the old movements hopefully with new found strength, mobility and resiliency.

The majority of injuries we see have the potential to recover 100% but I think 80% of injuries take a little longer than we may like thanks to one of the above mentioned factors. Yes it can be frustrating BUT short term self control and diligence will pay off in the long term.

Sciatica. How do we treat it?

As discussed in part 1 there are numerous causes of sciatica, so if you missed part 1 you can read it HERE.

Part 2 of this blog will be discussing some of the treatment options that are available to help relieve sciatica. Remember these are only a guide and we always recommend you see your Physio for a thorough examination to ensure the exercises are appropriate for you.

Trigger Balls

Trigger Balls or foam rolling are both great tools to help provide short term pain relief. Our suggested focus areas would be the lower back, glutes and hamstrings. We always recommend these should include an active component to get the muscles moving. The reasoning behind the effectiveness of a trigger ball is still a bit of a mystery but studies have suggested that it can have a short term analgesic response. Reduction in pain may enable you to complete further exercises that will be effective in creating longer change.

Stretching and Mobility

Light stretching and mobility can also be beneficial in providing short term relief. Stretching should be pain-free and gentle to begin with, again focusing on the lower back, glutes and hamstrings. In certain cases some stretching positions can actually further aggravate sciatica so if you are unsure make sure you check with your physio!  Mobility work should be about controlling movement of joints through pain-free range of motion. Avoiding positions that create pain should be paramount during these exercises.

Neural Gliding

Neural gliding is essentially a stretching exercise that focuses on ‘sliding the nerves’. We use the analogy of the nerve being a piece of string traveling from the base of the skull down the spine out into the leg and down too the foot (this is the route of the sciatic nerve). Along its path it crosses underneath, between and over certain muscles. In order to function efficiently this nerve slides freely along this path. Sometimes with Sciatica the neural pathway gets ‘stuck’ and this sliding mechanism is affected. A neural gliding exercises aims to restore the smooth sliding of the nerve along its path. These exercises are different to static stretches, should be pain free and form an important part of the rehabilitation for neural irritations that are causes by muscles and joints. Due to their ability to aggravate symptoms further we would recommend checking with your physio before you begin.

Strengthening

Re-estabilishing strength shoulder be the long term focus of treatment. It is vital to firstly figure out why the nerve is irritated. Not all lower back pain and sciatica comes from weak core and glutes so focusing only on these two common areas to strengthen may not be  the solution for everyone with Sciatica. Addressing other muscles like the hips flexors, hamstrings, obliques or lats may be what you require.

Movement Patterns

Another treatment that is critical towards long term recovery is correcting movement patterns. Potentially the way you run, squat, deadlift and move in general might be contributing to your sciatica. If you get pain every time after you run, your running style may needs to be checked – and the same goes for other forms of exercise. People with chronic lower back pain or siactica also often pick up poor patterns as a response to long term pain so sometimes movement retraining is required. Most commonly individuals become very stiff in their back and develop fear avoidance patterns where never bend their back which will only contribute to further stiffness. Slow exposure to bending and moving the spine may be a way to get rid of this chronic irritation.

Ultimately to treat sciatica there needs to be a diagnosis and from there a longer term management plan that addresses strengthening what is weak combines with mobilising what is stiff. This will be totally dependent on the individual and one should seek a health care provider’s advice.  There are cases where conservative intervention may fail and more invasive treatments may need to be explored.

If you have any questions about Sciatica, it’s management or any other physio related question feel free to email us activerxphysio@gmail.com or head to our instagram page and send us a message!

Sciatica. What is it?

The word SCIATICA seems to instil fear in patients when it first gets mentioned. Everyone knows a person that has suffered from sciatica at some point in their life, which means that most people have heard the term Sciatica, and whole most people know it has something to do with leg pain very few people actually understand what Sciatica really is.

It’s not uncommon for people to be given the diagnosis of Sciatica, however Sciatica is not a diagnosis but rather a set of symptoms that can include buttock, leg and foot pain that originates from the back.

The goal of this blog is to give you a better understanding what Sciatica is, explain why one might get it and to explore some strategies to prevent it from returning.

What is Sciatica?

As mentioned sciatica is a description of symptoms rather than an actual diagnosis. What that means is – any pain/symptoms that travels from the glute, down the back of the leg to the foot that originate from the back is termed ‘sciatica.’

There are other potential musculoskeletal injuries that can cause a similar pain pattern, clients with these conditions do not have sciatica, even though their symptoms may present like so.

The term sciatica is derived from the sciatica nerve which is the largest single nerve of the body.  It is this nerve that gets ‘irritated’ resulting in this specific set of symptoms. As a result of this irritation one might experience one of more of the following:

  • Sharp pain or a dull ache in the back, glute, back of leg, foot with or without back pain
  • Burning, tingling, pins and needles down the back of the leg
  • Weakness or difficulty moving the leg, foot or toes
  • Pain with sitting (pain may be reduced with the use of a pillow)
  • Pain aggravated by coughing or sneezing

Why do people suffer from Sciatica?

There are numerous reasons why people get sciatica and to cover them all would require countless blogs, but let’s touch on a few in a broad sense.

It’s probably important to mention that sciatica ranges in severity and so too do the conditions that can cause sciatica.  From complete compression of the sciatic nerve which may cause alterations in strength and sensation of the leg to a more localised inflammation which may cause dull radiating pain into the leg. Part of our job is to determine the underlying cause which will ultimately guide the course of treatment.

  • Nerve Root Issues: The nerve root is the exiting portion of nerve that leaves the spinal cord. There are nerve roots for each level of the spine with one exiting each side. Compression and / or irritation of the nerve roots by surrounding structures can result in sciatica.
  • Spinal Stenosis:  This refers to the narrowing of the spinal canal which can place pressure on the sciatic nerve. This is a degenerative condition usually related to osteoarthritic changes of the spine.

    Image highlights a few of the intervertebral disc injuries that can contribute to sciatica
  • Injury of the intervertebral disc: The discs are the shock absorbers in the spine. Injury to these structures can vary from disc degeneration, disc irritation, disc herniation (commonly known as a disc bulge), or a disc rupture all of which have the potential to place pressure on the sciatic nerve.
  • Spondylolisthesis: A condition where one vertebrae slips forward in relation to another. This can often be the result of a stress fracture left untreated in a younger athlete.
  • Neural Irritation: After the nerves exit the spine they have a somewhat complicated pathway as they travel down, under and between all our anatomical structures to supply all the areas of he leg. If the nerve gets irritated or impinged at any point on this pathway you may see sciatic symptoms occurring.

They are just a few very brief descriptions of some issues that can lead to sciatica.

The key to treating sciatica lies in determining the underlying cause. That’s our job. How do we do that? Keep an eye out for next weeks blog which will touch on this.

In the meantime…. any questions? Feel free to email us or contact us via social media.

Self management for long term pain relief

At Active RX one of our main aims is to give our clients the basic knowledge and understanding of how the body is put together in the hope that one will have the ability to SELF-MANAGE their problems and a visit to the physio becomes a complementary appointment.

At the end of taking a new clients history I will ask – What are the goals of your treatment? Often the first reply will be “to have no pain”  and the second most common answer being self-management strategies.

To achieve long term pain relief self-management strategies are vital and this blog post focuses on a few simple ways that you can start to help manage your own pain and dysfunction.

Strengthening

It’s our belief that strengthening is the key to long term pain relief. Of course there are many other factors that contribute but overall weakness is one that simply cannot and should not be overlooked. When we talk about strength it’s all relative, you don’t have to be the strongest person in the gym but what is required is the strength for you to complete your activities of daily living. For example a labourer who loves to lift weights, surf + run will require different strength to a grandmother who like to go on walks and read BUT both need to be strong in their own right. The key is be aware of where you might be lacking and implement exercises that target such weaknesses. It’s also important to remember that the need for strengthening doesn’t mean you need a gym membership, for many simple resistance exercises can be very effectively done at home.

Mobility

Being flexible and pliable is also extremely important, but the term mobility fits the bill a bit better as to be mobile you need to have strength in your flexibility. It’s all well and good to be flexible but if you can’t control that range of motion of your joints and muscles then you may well find yourself on the physio table. Self management requires awareness of flexibility and the ability to be strong through your entire range of movement.  Too often we see someone who has taken up a vigorous stretching program only to find themselves more injured than before. Why? Because they have not learnt to control their complete range of movement. Mobility requires a balance between strength and flexibility. Too little or too much of one just can easily be a contributing factor to longer term pain.

Recovery

Looking after yourself seems like a no-brainer but it’s actually a part of training many people neglect. Recovering from your workouts, games and even everyday life is another step towards long term pain relief. If you’ve put yourself through a grueling training week, slow down for just a moment– have a dip in the ocean, go get a massage, do some stretching. You can check out our blog on ‘there’s no such thing as over training just under recovering’ for some good ideas. Recovery also applies to every day life situations, if you’re a breastfeeding mother a 10 minute trigger ball session can go a long way to release the upper back and shoulder tension. If you’ve just put in a 60+ hour work week to hit a deadline, go for a long walk & swim on the weekend. Then there is recovery in forms you wouldn’t expect; like nutrition, hydration, adequate sleep, sunshine + Vitamin D.  A body that is physically + mentally worn out will be more sensitive to pain, and this is a conversation we often have with clients because their pain may not necessarily be solely musculoskeletal so for a  long term recovery these other holistic factors need to be addressed.

Proximal Hamstring Tendinopathy

This injury is a serious pain in the butt. Literally.

I actually suffered with for a few months myself and weirdly I have since seen about half a dozen women with the same issue.

Proximal hamstring tendinopathy (sometimes known as hamstring origin tendinopathy) is a painful condition that presents as pain in the lower buttocks which can refer down into the hamstring. Often it will warm up with activity only to return after exercise. It can linger around for several hours, or in more severe cases several days.

In almost all of my clients the onset of pain correlates with a change in volume or intensity of training combined with compression factors such as long periods of sitting and increased hamstring stretching. It’s not unusual for symptoms to appear quite suddenly, but unfortunately don’t tend to resolve quite so quickly.

The rehabilitative phase can take up to 12 weeks however rest assured our tendons are strong, adaptable and in most cases very responsive to a good strengthening program.

Management of hamstring origin tendinopathy can differ slightly between clients but the general principles of rehab are constant.

There may be an initial period of rest required, not from training altogether. I often encourage pain free cross training. Too much rest will actually be detrimental for the tendon when it comes to coping with load again.

I make a concerted effort to allow my runners to keep running, albeit with a modified load. For example reducing the speed, eliminating hills or a shortened stride length are all ways to facilitate overall load reduction on the tendon without stopping running altogether. In the gym one may reduce the weight of their squats & deadlifts or work through a smaller range. Using pain as a guide is important, a 2-3/10 is acceptable, anything more and you are in the no go zone (we call it the red zone)

Avoiding compression is really important. Sitting on softer surfaces instead of hard chairs and steer clear of stretching your hamstrings. Other gym related sources of compression include lunges and heavy deadlifts.

A strengthening program will often start with isometrics – an isometric is a contraction where there muscle is switched on but not moved through range at all. Such exercises have been shown to assist pain modification as well as preparing the tendon for both concentric and eccentric strengthening. The rehabilitative process can take several months so a little patience and perseverance is important.

There are also some hands on techniques that your physio can use which can be helpful. I use both active release and dry needling to target areas of tension both in the hamstring but also around the glutes and lateral hip.

If conservative management doesn’t seem to be working there may be some more invasive options such as PRP injections that your physio or sports doctor may discuss with you. You will most likely need an MRI scan to confirm the diagnosis as hamstring origin tendinopathy prior to this discussion.

Recovery from hamstring tendinopathy can be a slow process, and one that requires careful consideration of each individual case with regards to load management, training and strengthening. We strongly advise you seek guidance from your physio if you’re dealing with a pain in the butt, it may save you weeks worth of rest or self guided rehab that is targeting the wrong issue.

Tips to help you avoid injury

Not all injuries can be avoided, there’s just those freak accidents that no amount of training or foresight can prepare you for. However many injuries occur when the your workload exceeds your capacity.

When we refer to workload we are talking about the demands you have been placing on your body which includes not only your training load but work, gardening, moving house, lack of sleep etc.

To put it simply:

WORKLOAD >> CAPACITY == POTENTIAL INJURY

To avoid these injuries you have one of three choices: increase you capacity, decrease the workload or improve your recovery.

Increase Your Capacity

This means increasing the demands your body can tolerate.

Think of it as a number. If your current capacity is 100, your aim is to improve it to 125 or 150 (or higher if your wish)

How? Through training in all of its forms – strength, flexibility, mobility, aerobic training, sports specific skill work etc. The aim of training  is to push your body as close to your ‘threshold’ as you can. With each session you may try do just a little more, whether its an extra set or few extra reps. This is called progressive overload and it forces your body to start to adapt and change.

Lets consider another example. You are training for your first marathon, and you’re not really a runner. Your first run shouldn’t be 42km, instead you will start small and slowly build up your running tolerance over a matter of weeks; as a result you are increasing your running capacity. This concept can be applied to simple day to day situations. If you don’t normally garden and all of a sudden you spend a weekend shovelling soil there’s a pretty good chance you’ll have a sore back by the end of it because your body is not accustomed to that amount of activity. On the flip side if you garden regularly you have better capacity to tolerate that type of load and your back may not get sore.

Having a greater ‘capacity’ can help to avoid certain types of injuries because the body is better conditioned to deal with greater loads.

Decrease Workload Accumulation

Decreasing workload might seem like the exact opposite of what we just discussed above BUT WAIT… the key word here is ACCUMULATION. Consider 100 as our capacity again. Each different type of workload represents demand on the body and that accumulates over time with the total being our functional capacity.

For example,

    • Workout = 40 + House work and gardening = 20 + Work  = 20

Which leaves us at 70/100. Then your friend rings and asks you if you can help her move house. You politely oblige and that’s another 40 points. Now your capacity is 110/100 and you wake up the next day with a sore, stiff back. It may not  necessarily be the lifting boxes and furniture that caused your back pain but rather an accumulation of that weeks worth of load. What’s the solution? Say no to your friend? Of course not!! It’s more of an awareness thing, firstly to be able to acknowledge that you probably did too much but then also to be able to apply this concept to your training by understanding when you may need back off to protect your body.

Recovery

A very very very important consideration when trying to avoid injury. RECOVERY.

I feel really strongly about this topic (so much so that I have actually written an entire blog on it which you can find HERE).

Let’s stick with our capacity of 100. Remember workload accumulates, and the sum of the total work is the capacity. Strategies that assist with recovery such as sleep, stretching, massages, dry needling, nutrition, hydration, de load weeks etc can all decrease the workload accumulation. They are essentially like a minus in the workload equation because you are paying back to your body. If you find yourself up near your functional capacity threshold, maybe its time to treat yourself to a massage (we have an amazing massage therapist if you need one!!)

These numbers we have used are arbitrary but I think it just helps break it down into simpler terms. Use some of these strategies and you might just notice some of those niggling aches and pains disappear for good!