1. Thoracic Spine Foam Rolling: Lie on your back with a foam roller positioned horizontally beneath your shoulder blades. Support your head with your hands, keep your knees bent, and feet flat on the ground. Roll back and forth along the foam roller, focusing on the mid-upper back region.
2. Cat-Camel Stretch: Begin on all fours with your hands directly beneath your shoulders and knees under your hips. Slowly round your upper back, tucking your chin toward your chest (cat pose). Then, arch your back, lifting your chest and tailbone while looking up (camel pose). Alternate between the two positions in a slow and controlled manner.
3. Open Book Stretch: Lie on your side with your knees bent and arms outstretched in front of you. Keep your bottom leg straight and lift the top leg up, resting it on a foam roller or a rolled-up towel. Reach the top arm across your body and rotate your torso, opening up your chest. Hold for a few seconds and repeat on the other side.
4. Thread the Needle Stretch: Begin on all fours, with your hands directly beneath your shoulders and knees under your hips. Reach one arm under your body, threading it through the space between your other arm and knee. Rotate your torso and gaze toward the hand that is reaching under you. Hold for a few seconds, return to the starting position, and repeat on the other side.
5. Standing Rotation with Club: Stand with your feet shoulder-width apart and hold a golf club or a long dowel across your shoulders, behind your neck. Rotate your upper body to one side while keeping your lower body stable. Then, rotate to the other side. Repeat this movement, focusing on a smooth and controlled rotation.

Remember to start with gentle movements and gradually increase the range of motion as you become more comfortable. It’s always a good idea to consult with a golf fitness professional or a physical therapist to ensure proper form and technique.

When learning to be become proficient with any task on the non-dominant side there is usually a frustrating learning curve. Ironically the mouse usually sits closer to the body midline on the left side as most keyboards have the numberpad on the right side. When considering using the mouse on the left side it is important to change the click buttons in the “control panel” so the index finger uses the inside click button.

Most people wait till they develop an overuse injury to consider using the mouse intermittently with both upper limbs. It is considered good ergonomic practise for anyone that uses the mouse significantly to consider sharing repetitive loads with both upper limbs by becoming proficient with mouse use intermittently with both upper limbs. This will help reduce the risk of an upper limb occupational overuse injury.

Exercise is reported to improve our physical and mental fitness, improving our mood, reducing anxiety and improving our sleep. It has been shown that moderate-intensity anaerobic (eg, touch footy, tennis) exercise is associated with greater mood improvements and a 10-30 minute exercise session is all you need (Chan et al, 2019).  Very interestingly, recent research suggests that the beneficial effects of exercise on the brain are related to several underlying mechanisms related to muscle–brain, liver–brain and gut–brain crosstalk.  Therefore, exercising regularly has potential underlying mechanisms involved in exercise–brain communication and great benefits for physiology and brain function (Nay et al, 2021).

Getting started…….

1. Move more throughout the day. Take the stairs, not the lift or escalator.  Use a standing desk at work. Get off the bus or train the stop before and walk home.
2. Set aside set times to make exercise and physical activity part of your daily or weekly routine.
3. Try activities with others in your household or workplace for joint motivation.
4. Use free apps and websites (Active and healthy events | Brisbane City Council) to find new, different and fun ways to be physically active.
5. See a health professional (physiotherapist) to determine what physical activities are right for your age, fitness level, skill level, and health.

Most importantly, make exercise part of your life routine and you won’t look back!

References:

John S. Y. Chan, Guanmin Liu, Danxia Liang, Kanfeng Deng, Jiamin Wu & Jin H. Yan (2019) Special Issue – Therapeutic Benefits of Physical Activity for Mood: A Systematic Review on the Effects of Exercise Intensity, Duration, and Modality, The Journal of Psychology, 153:1, 102-125, DOI: 10.1080/00223980.2018.1470487

Nay, K.; Smiles, W.J.; Kaiser, J.; McAloon, L.M.; Loh, K.; Galic, S.; Oakhill, J.S.; Gundlach, A.L.; Scott, J.W. Molecular Mechanisms Underlying the Beneficial Effects of Exercise on Brain Function and Neurological Disorders. Int. J. Mol. Sci. 2021, 22, 4052. https://doi.org/ 10.3390/ijms22084052

1. Get your light right – When your eyes tell your brain “we’re up and we’re clocking on for the day” this sets your circadian rhythm. If your eyes don’t see the sunlight until later in the day your brain won’t be ready to “clock off” until later in the night. Difficulty falling asleep anyone? Solution (and this is number one for a reason) – view sunlight for a minimum of 3-5mins within 30-60mins of waking. If your schedule doesn’t allow for outdoor early morning exercise then just taking your morning cuppa out onto the balcony will do fine at a pinch. If you can do the same thing at the end of the day as the sun is setting because the red light waves of the sun set actually triggers the production of melatonin which is our sleepy hormone.
2. If possible wake up and go to bed at roughly the same time every day : our body thrives on routine. At night, go to bed when you first feel sleepy, don’t fall asleep on the lounge and then push through with a second wind until late in the night. That nap takes the wind out of your sleep routine. This can result in waking up too early in the morning and not being able to fall back to sleep. Sticking to the same routine often means waking naturally as opposed to needing an alarm.
3. Beware of caffeine : caffeine has a half life of approximately 9 hours. This means it takes up to 9 hours for 100mg caffeine (2 shots in a standard barista made coffee) to be broken down to 50mg. This means if you have a coffee at 2pm and go to bed at 11pm, it will have the same effect as if you’d just had 1/3 of a shot of coffee just before you lay down! General rule of thumb – avoid caffeine after 10 -11am.
4. Don’t eat for a minimum of 2 hours, but ideally 3-4 hours before you want to sleep: Your body performs many functions but it does not like digesting and running repairs at the same time. It’s like trying to fix the plumbing while the tap is still running. This has recently been highlighted with dementia and other neurological conditions like Parkinsons. The brain needs to go through a “dishwasher” cycle for optimum health and function and cannot do so if you are still digesting.
5. Ambience: this is the sleep hygiene piece. Make sure that your bedroom is dark and cool.
6. Digital tools can can be helpful : modern technology can help provide feedback on sleep quality. Consider apps such as headspace, calm or reveri

https://bprimal.com.au/collections/correct-toes?gclid=EAIaIQobChMIgOaTqZLZ9wIVI4NLBR2UFQ-eEAAYASAAEgKfuvD_BwE

and by actively using the muscles that splay the toes.

The other group of people that are “so tight” is the situation whereby the person has protective muscle spasm in relation to an injury. This is a protective response from the brain and can be a very powerful response to protect the region. In this scenario, when the spasm settles the inherent muscle flexibilty returns. It is an important principle with protective muscle spasm to not be overly aggressive with any treatment (including trigger balls, roller, massage etc) or risk aggravating the protective response.

When people have too much flexibility it is termed hyperflexibilty. Hyperflexibility is largely genetically determined (and some environmental factors) and can contribute to increased joint loading and increased muscular demand. The key with hyperflexibility is to have muscular strength around the hyperflexibile region. The irony with people with inherent hyperflexibility is that they often get attracted to sports and activities in which they need lots of mobility eg. dancing, gymnastics, yoga. This is fine as long as there is a strength component to training regimes. The picture below demonstrates a hyperflexible shoulder into external rotation:

So what can you do to reduce your risk of a running injury?

The majority of injuries that occur when we run are due to overuse (repetitive microtrauma that overloads musculoskeletal structures) and there are three major factors associated:

1.      Biomechanics

2.      Training error

3.      Environment/equipment (eg. Shoes, ground cover)

A previous running injury is also a big factor in whether you will have another injury.  Proper rehabilitation is necessary to prevent reoccurrence of injury.  Sometimes, runners can change their biomechanical patterns when injured, probably in an attempt to protect the injured structure during running. This change of biomechanics may lead to overloading of other musculoskeletal structures causing a new injury.

Biomechanics

Common injuries such as achilles tendinopathy, knee pain, shin splints and plantar fasciopathy have all been associated with running biomechanics. Running injury risk may be increased with poor calf muscle length, poor hip muscle stability, narrow step width, tight, stiff ankles and some foot strike patterns.

Training Error

Irrespective of whether one is running for general fitness, competition, and/or vocational requirements, consistency of training is the key.  Try not to increase your running load too quickly, as this can lead to an overuse injury if you don’t allow for recovery time.  Overtraining is common and occurs when the body is unable to adapt to the load applied during repeated training sessions.

Equipment and Environmental Factors

Barefoot shoes have received a lot of attention in recent years as a more “natural” style of running. Barefoot or minimalist shoes have been proposed to better distribute impact forces by shifting to a forefoot strike. A prospective study published in 2016 aimed to address the question of whether barefoot runners experienced fewer injuries than their shod counterparts. The study found that the barefoot runners did experience statistically fewer overall musculoskeletal injuries than the shod runners, however, the barefoot runners ran on average just 24km/week compared to 41km/week in the shod group. Authors concluded that barefoot running is associated with fewer overall injuries per runner, but similar injury rates occurred in both groups. The injury rate was not statistically different between the barefoot runners and the shod runners due to a significant difference in kilometres run between the two groups.

Evidence backed ways to decrease running injury risk

• Following a training schedule allows you to plan your exercise intensity allowing time for recovery, avoiding excessive load and monitoring changes in volume over time.
• Monitor exertion, pace, heart rate helps to avoid over-training.
• Practising running specific drills improves biomechanics and running economy. Supervised gait retraining and running specific drills reduce injury risk by as much as 60%.
• Targeted strength and proprioceptive training can reduce overuse injuries by up to 50%.

See your physiotherapist to help with all of the above.

References

Harrast, M. A. (2020). Clinical care of the runner: assessment, biomechanical principles, and injury management. Elsevier.

Hollander, K., Rahlf, A.L., Wilke, J. et al. Sex-Specific Differences in Running Injuries: A Systematic Review with Meta-Analysis and Meta-Regression. Sports Med 51, 1011–1039 (2021). https://doi-org.ezproxy.library.uq.edu.au/10.1007/s40279-020-01412-7

Altman and Davis. Prospective comparison of running injuries between shod and barefoot runners. British Journal of Sports Medicine. 2016

Chan Z et al. Gait retraining lowers injury risk in novice distance runners: a randomised controlled trial. The American Journal of Sports Medicine. 2017

Lauersen JB et al. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine 2014; 48:871-877.

Oestergaard Nielsen et al. Training Errors and Running Related Injuries: A Systematic Review. The International Journal of Sports Physical Therapy; 7(1)

The plantar fascia is a band of connective tissue that runs from the heel to the ball of the foot. Its main role is to support the arch and joints in position, act as a shock absorber and allow us to push off with our big toe. Plantar fasciitis or fasciopathy is now considered to be a degenerative condition of the plantar fascia due to repetitive microtears. Initially there can be an inflammatory reaction, but it is now understood that it is not an ongoing inflammatory process. There is usually not one specific cause of plantar fasciitis but is usually due to multiple factors. Some of these factors include spikes in load, age, suboptimal biomechanics, delayed healing and obesity (Luffy, 2018).

Pain is usually felt on the underside of the heel, and is often most intense with the first steps of the day or after rest. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing, load or activity.

Prevention
• Start activity slowly and increase load slowly with a new exercise or program.
• Choosing the right shoe, both supportive and minimalist shoes can be helpful. Large heels should be avoided. Replace shoes when they are worn out.
• Allow adequate recovery time between workouts or training sessions. Stretch your calves regularly and strengthen your foot and toe muscles.
• Maintaining a healthy weight to minimise the stress on the plantar fascia.

Management
• Physiotherapy treatment includes soft tissue treatment of the plantar fascia, stretching and strengthening program for the calf muscles and small muscles of the foot, footwear advice.

References:
Hasegawa, M., Urits, I., Orhurhu, V. et al. Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Curr Pain Headache Rep 24, 55 (2020). https://doi.org/10.1007/s11916-020-00883-7
https://sma.org.au/resources-advice/injury-fact-sheets/plantar-fasciitis/

Luffy, Lindsey MSPAS, PA-C; Grosel, John MD; Thomas, Randall DPM; So, Eric DPM Plantar fasciitis, Journal of the American Academy of Physician Assistants: January 2018 – Volume 31 – Issue 1 – p 20-24 doi: 10.1097/01.JAA.0000527695.76041.99

Neck pain – what to do?

Most of us experience neck pain at some time in our lives.  It is in fact, one of the top 5 chronic pain conditions worldwide (Cohen et al, 2017).  It can be the result of trauma, for example, a whiplash injury following a car accident or due to our everyday function such as work or exercise.  Usually our neck pain will settle with some exercise, over-the-counter medications, the odd hotpack and we get on with our lives.  But, occasionally our neck pain does not settle, niggles on and becomes a literal pain in the neck to our function.  What do do?  Who to see?

As musculoskeletal physiotherapists, we have the education and experience to assess and treat your neck pain and to help you treat and manage it into the future.  It is important that the mechanism of injury and contributing factors to your pain are established early and addressed so your neck pain resolves and doesn’t flare up episodically.

Treatments such as massage, dry needling, mobilization can help to settle your pain and exercise therapy (Cox et al, 2019) and ergonomic assessment and management can give you long-term relief.  Ongoing exercise is important and has the strongest evidence in the literature for managing neck pain (Cohen et al, 2017).

References:

Cohen, SP, Hooten, WM, 2017. Advances in the diagnosis and management of neck pain. BMJ

Cox, LG, Kidgell, DJ, Iles, RA, 2019. Neck-specific strengthening exercises and cognitive therapy for chronic neck pain: a systematic review. Physical Therapy Reviews 24 (6), 335-345.