Spinal Health week is coming up again!!

We always look forward to this time of the year when we open up our doors to friends and family of our clients who may need our help.

Often life gets in the way and we end up too busy to look after ourselves like we should. But these events remind people to go and get that niggling pain in their shoulder looked at. You know, a lot of the time its not a big deal. A little advice on what to do at home and that’s it. But 1 out of 10 people that come in find out their issue is a bit more of problem. Luckily though they came in, had it assessed, find out whats wrong and what they need to do to get it better…before it becomes a big problem.

So if you are in the Sydney CBD or Bondi Junction next week, email or call in and make an appointment for a Free Assessment for Spina health week.

Or just click HERE 😊

We are now open in Bondi Junction!!

And the cool thing is we now provide Shockwave Therapy. What is shock wave therapy I hear you ask....well simply put is the latest form of electrophysical therapy such as ultrasound and intereferential. But its effectiveness is amazing.

Shockwave is an acoustic wave which carries high energy to painful spots and musculoskeletal tissues with subacute, subchronic and chronic conditions. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissues. Shockwaves are c

Some of the benefit of this type of treatment are:

Reversal of Chronic Inflammation

Release of trigger points

Stimulation of Collagen production

New blood vessel formation

Dissolution of calcified fibroblasts

Dispersion of Substance P

So if you suffer from any of the below the send us a message to discuss how Shockwave could help you.

Achilles Tendonitis

Rotator cuff Tendonitis

Tennis Elbow

Muscle strains or tears

Knee pain

Chronically Tight traps

For a little Demo of how it works check out the video below

https://youtu.be/2GeyR9ndkFI

For: upper shoulder pain, trapezius pain, scapular pain, upper back pain, bicep tendonitis

Not for: frozen shoulder, rotator cuff tendonitis, labrum tear or any type of sharp pain form the neck, upper back or shoulder.

This protocol is not for acute injuries or those listed above. It is for chronic, low to medium grade pain in the upper shoulder to mid back including the scapular (shoulder blade). If you are not sure, just PM me and we can have a quick chat about it.

I call it shoulder pain as most of my patients refer to it as that. To me upper back, shoulder blade or trap pain would be more accurate but hey it’s not up to me! So this 6 week shoulder (really upper back/shoulder blade/trap) protocol is about correcting the muscular imbalances that lead to overuse in certain muscles and hypermobility and pain in certain joints. Remember it’s not a fix all. If you’re not sure, please ask.

Most of my clients have sedentary jobs. And with sitting a lot of the time, comes poor upper back posture.

A rounded upper back, forwardly rotated shoulders and a forward head carriage, which leads to inevitable changes in use, length and strength of certain muscles.

Upper traps, scalenes, SCM and levator scap become hypertonic (short and tight). So do the pecs and anterior delts.Middle and lower traps become weakWith these muscular changes, the scapular round out laterally exposing the joints between the ribs and spine. As this happens they slowly become hypermobile and sore.Rotator cuff muscles (the little muscles that sit on top and behind the scapular) shorten and limit shoulder ROM.

With all of these changes, pain can be generated from a variety of structures, the most common being the upper traps and the upper costovertebral joints (creating pain along the inside edge of the shoulder blade). And in most cases, consistent pain comes along after these imbalances have been in place for a while, so getting rid of pain now isn’t going to occur after one massage or one gym session (If anything this will lead to an aggravation of symptoms).

So what do you do?

Simple! Follow the protocol below for the next 6 weeks and you’re sorted. Or if you don’t, risk suffering a more acute injury to your shoulder joint (ie: develop rotator cuff tendonitis or strain a joint in your neck or upper back). It took time to make a mess of your upper back/neck biomechanics by slouching at your desk and not enough regular exercise, so accept it will take time to turn it around.

Week 1

Gently reintroducing extension into the upper back and neck.

1. lying flat on the floor with a rolled up towel under your neck for 15 minutes, twice a day.

2. Pec stretch.

Best to do in the shower so the muscles are warm and can take the stretch easy. Hold each one for 45 seconds 2/3 times per side, once daily.

Week 2

Keep the exercises from above going and add,

3. Scalene and trap stretch– again best to do in the shower. Same reps and time for the pec stretch above.

4. Posture maintenance.

Start being aware of your posture at work, on the bus, during exercise etc. Start to practice correct posture as a form of exercise daily. The best way to do this is to and from work. If you catch public transport, drive or walk, make it your goal to maintain correct upper back posture during this time. Lift your chest and roll your shoulder blades down your back, keep your head tall. Keep it this way during the journey. It will be uncomfortable to begin with (because you never do it) but slowly your muscles will adapt and it will feel more natural.

Week 3

Once we have completed 2 weeks of rebalancing, you should be feeling a little less pain and probably feel it more intermittently rather than constantly. Now we have a better foundation to get some work done.

5. Modified push up.

The purpose here is to retrain correct upper back muscle firing as well as developing the scapular stabilizers. The push up is going to start off against the kitchen bench or dining room table so its not too hard and we can focus on the movement being correct. IT IS NOT A FULL PUSH UP. It is a short movement from the bottom position, up 15cms and then back down. Almost like a little pulse movement. We focus on the chest being lifted up, head tall and the shoulders away from the ears. In that position we pulse in the bottom third of the push up. We are going to try and complete 3 sets of 10 reps and look to complete this every second day.

6. Get a massage ball or a tennis ball and massage out the rotator cuff muscles.

Basically we lie on our back and pop the ball under the shoulder blade. You should notice as you create pressure against the ball and roll around you’ll find a couple of spots that are quite tender. Any tender spots just maintain pressure on these for 10-15 seconds and then move to the next tender spot. Over the next two weeks as it loosens up, the tender spots will become harder and harder to find (as the muscles are loosening up). Aim to massage each side for 4-5mins each day.

Week 4

Keep going as above. Nothing new to start this week.

Week 5:

Yoga shoulder movement

Great exercise to maintain the scapular stable whilst stimulating increased ROM of the shoulder joint. Again focus on your posture; chest lifted, neck tall, tummy tight. Take a wide enough grip that you can get the towel over without compensating. 2 x 20 reps. Best to do after the shower (as you have the towel handy)

Week 6

Continue with all the exercises.

Somewhere from week 4 – 6 you should see your symptoms dissipate quite a lot. Depending on the particular structure that is causing the pain and the duration that you had your symptoms for, you may still have a low grade level of discomfort remain. If this is the case it is best to have it professionally assessed. After completing the 6 week protocol, you should find your response to treatment from a chiropractor or physiotherapist to be a lot faster.

Let me know how you go guys!!

Dr Riaz Behi

TheBackGuys

riaz@thebackguys.com.au

One of the more common injuries I see are hamstring strains and tears. Most people tend to view a hamstring injury as a localised muscle tear (which is it) but often then seek treatment that is only applied locally to the site of injury. Although this needs to occur, if the non-local factors are not assessed and treated, then what was a single injury becomes an ongoing chronic condition where any excessive exertion leads to re-injury.

What are some of these non-local factors that I tend to look for when a patient presents with a hamstring strain? As most of you know, my job is to look at the underlying structure, the skeleton, and to see if its orientation is leading to overuse and overstrain in certain areas of the body. The more common ones I see that contribute to hamstring overload are:

1. Rotated pelvis 2. Pronated feet 3. Hyperlordotic lower back 4. Anterior pelvic tilt

Some easy little at home checks you can do to see if any of these are contributing in your case are:-

1. Side view in the mirror A quick an easy check is to look at your profile from the side in the mirror. It takes 5 seconds but can tell you so much. Are your legs perpendicular to the floor or leaning forward a bit? Does your butt stick out? Do you have an overly large curve in your lower back? Any of these will contribute to a tightening and overloading of the hamstring.

2. Do you recurrently strain the hamstring on one particular side?

If so it usually will indicate that you have a rotated pelvis or a pronated foot.

3. Pronated feet check If your feet are super flat, it’s pretty obvious and will contribute to all of the above non-local factors. But if your feet are mildly pronated, asymmetrically or functionally pronated, these will be harder to see but will still have a massive effect. Roll your feet out so you are balancing on the edge of your feet and then let your feet drop. Do you sway forward a lot? If so it might be that your feet are letting you down.

Although hamstring strains are common and most cases will resolve on their own, with persistent or recurrent strains, try the few little checks out above and see if any are present in your case. If so, make an appointment and have it corrected.

https://chiromt.biomedcentral.com/articles/10.1186/1746-1340-13-4

Most people tend to think that once a problem stops hurting then that’s the end of the problem. Its healed. All done. Let’s move on. Likewise, prior to having pain, there was no problem. Everything was perfect.

The reality is that in most cases (barring a direct trauma like a fall or tackle gone wrong) the problem existed long before pain came along. And once the pain resolves, there are consequences that can be long term if not corrected.

So let explain with an example;

Peter aged 36 is your normal kind a guy. Exercises a bit here and there, has a 45 hour a week deskbound job. Eats reasonably ok.

One day, Peter wakes up in the morning and notices his lower back feels a little sore and tight. He tries to loosen it up with a hot shower before work but it doesn’t do the trick. Slowly over the day his pain starts to increase until about 2pm when it becomes sharp and spasmy.

Sounds like a common story. I hear it a lot.

The problem is most people want a reason why their back hurts so they will attribute to the closest causal factor they can think of; “the gym yesterday, that must have done it!” or “I did all that work around the house on the weekend!”. In some cases they can be right, but a lot of the time it isn’t the only reason why.

So in Peter’s case, once we do a bit of digging we find out that Peter had a nasty fall about 5 years ago when he fell off a ladder on his bum. Back was a bit sore but felt fine after a day or two. What Peter didn’t realise is that even though the pain went, the damage done to his back and the alteration to how his lower back worked (joints and discs) has stuck around and adapted and adapted over that 5 year period. That combined with his right foot that has become pronated after recovering from a twisted ankle 7 years ago which has caused a rotation in his pelvis, has all combined to make Peter’s back not as adaptable to stress and load as it should be. Now fast forward to today when Peter’s back is in spasm and we take an xray, we can see that there are long term physiological changes to the joints and discs of the lower back that didn’t happen overnight. We can see a distorted pelvis that took years to get that way. It now functions in a way totally different than it did 7 years ago. He is now has visible osteoarthritic changes to the spine and its joints as a consequence of the fall.

Over time, the body decays; that’s life. But particular to the spine, if it is aligned well, it will distribute weight and work evenly so that the natural degeneration that occurs over time is even. You shouldn’t develop visible arthritic changes in the spine till you are 70+. I am seeing it in 30 year olds. Falls, accidents, long term postures (like sitting or staring at your iphone) lead to changes in the way the spine works which in turn speed up the processes by which it wears away. And wear and tear is a one way street.

So falls, accidents, sporting injuries are important to get checked. Even if the pain goes in a day, it can still have long term consequences, which can sometimes be irreparable.

You have heard the stats that 8 out of 10 people will suffer from back pain and I’m sure you all know someone that has back pain right now. Why is that? Obviously it is multi factorial and each person is different however over my 15 year career I would have to say the most common factor is LIFESTYLE.

We sit too much and don’t move enough.

So the solution is obvious right. Don’t sit and start moving. Ok problem solved. Blog done.

But its not that simple is it. There are factors that are outside of your control. Genetic factors, falling down the steps factors etc. So with this blog, I’m going to run over the 5 most common factors that predispose you to developing back pain. The solution still remains the same (sit less, move more) but we will expand on the that in a later blog.

1. Congenital factors (How your particular body was put together)

This is a big one. Most people don’t think about this stuff but in my job it’s a daily occurrence. Everybody’s body is put together a little differently. Some of the more common congenital factors I see are

Anatomical leg length differences Narrow central canal (the hole where your spinal cord sits) Additional vertebrae

When you are built a little differently it doesn’t mean you will have a life of back issues. Most people will develop in their own way and be totally fine. But with certain congenital issues it will change the mechanics of the way the spine moves and distributes load, causing asymmetrical loading and degeneration over time. In some cases there are things you can do, in others there aren’t. One thing you can do is find out.

See a chiropractor, get some xrays done and see if there is an anatomically reason why your back is consistently hurting.

I cannot tell you how many times someone has come in with back pain, having seen every practitioner under the sun without ever having an xray taken of their back and when we do, BANG! There it is, an anatomically short leg which once accounted for, the patient sees long term lasting relief.

2. Accident and falls

We all have had a fall, sporting injury or car accident. But most people think, if it doesn’t hurt any more, then its fine. WRONG! Even though the initial tissue damage from the fall or accident heals, the lasting mechanical changes to joint and muscle function lasts and will rear its head 5-10 years down the track. Had a whiplash injury from a car accident? Felt better after a week or two right? Suffering from chronic headaches 5 years later right?

Just think about it logically; if your head is whipped forward and backwards at high velocity, doesn’t it stand to reason that changes may have occurred to how those joints may work? It’s not like the only two choices are “perfectly fine” or “dislocation”! If the joints in your neck don’t work properly you will inevitable end up with headaches. The same goes for the lower back. If a scrum collapses on you, it’s highly probable that the joints and muscles of the lower back, hips and pelvis will have been altered and now things to don’t work so awesomely. Go get it checked!!

3. Nutrition

The lower back, like every other part of your body, requires you to eat and drink well so it has the building blocks for tissue repair.. If your diet is not great you will lack those building blocks making tissue repair less effective and making those tissues prone to damage. The discs of the of the spine are primarily water. No water means no disc height and decreased elasticity etc. Add a bit of sitting to that and you will have problems.

4. Stress

Stress has a general effect within the body, sapping nutrients and sucking up energy. But particular to the lower back it causes localised, static contracture of muscles in the glutes and lower back. This by itself can cause pain but more commonly it will predisposed the lower back to overloading as the muscles are not doing their job of dispersing load.

5. Repetitive Stress

Sports, gym work and repetitive movements at work all do the same thing. If you use your body in the same way a lot of the time you will consistently use the same structures in exactly the same way. A lack of variety will lead to injury. Examples are running, swimming, bench presses and typing, slouching, sleep postures etc. All of these use the body over and over again the exactly the same fashion. This will cause the same ligaments, muscles, joints and discs to get hit with exactly the same force over and over and over again. Those tissue will slowly become damaged then one day doing something benign like picking up a pencil off the floor your back will spaz out and here comes the pain! The pencil didn’t do it, overdoing your deadlift with poor form, no antagonist training and no stretching is what really did it.

So, as you can see from the above, there are plenty of additional factors that will contribute to back pain. What does this mean? It means there are plenty of things you can do to help your situation rather than blaming the poor pencil. Go see a chiro, get it properly assessed and get on the road to recovery!

If you have been a patient of mine for a while, I’m pretty sure you would have heard my opinion on interval training. From years back, before it came into fashion, I’ve always harped on about pushing yourself to your end limits from time to time. If you don’t. how will you grow? (Goes for all facets of life)

So here is a great piece by our very own ABC on the science behind interval training and why it needs to be a part of everyone’s training program.

http://www.abc.net.au/catalyst/stories/4319131.htm

As a chiropractor who has been practicing in the Sydney CBD for over 15 years, it has to be the most common question I hear.

“I don’t know who I am meant to see for this type of problem! Should I see you??”

So let’s break it down.

Each profession has their area of expertise, what they do best but unfortunately we are all taught “what the other guy does” for some reason. Back when I was in Uni, we were taught heaps and heaps of rehab –which is really the domain of physiotherapy. I still to this day refer patients on to a physio if they are post-surgery and need to rehab a joint. I still continue with their adjustments and could technically do the rehab myself but I acknowledge and understand that a physio will do it better.

Likewise when people have injured their back or neck, I’m amazed that anyone would choose to see anyone else other than a chiropractor! I mean all we studied for 5 painful years at university was the spine. We dream about spines; every chiropractor’s clinic logo is some version of a spine! It should kinda give it away I would have thought. But to this day, I have patients that show up after having spent time having physio or massage and it not getting better and then finally TRYING chiropractic. And what happens, one simple adjustment and they get relief; they feel things change, they get better!

I wonder why this happens; why do people not know what to do or who to see? It is just a lack of information out there about what to do? Is it misinformation?

So below is my simple way how to decide. It’s in bullet points so it’s nice and simple. I’ll deal with the misinformation in a moment.

Physio –

Physiotherapy or physical therapy is basically muscular rehabilitationSo if you have had surgery, or badly injured a knee (meniscus tear), shoulder (eg. Rotator cuff tendonitis) or ankle (torn ligaments) then see a physio.If your back hurts or your neck hurts don’t waste your time. As much as you may think it’s muscular, it’s not. The underlying cause is an incorrect functioning joint.

Osteo –

Is kinda like a combo of massage and chiro but the manipulations are a lot bigger and non-specific. Why can I say this? When I went to Uni we were basically taught a combined degree (Before Chiropractic was taught at Macquarie Uni it was the Sydney College of Chiropractic and Osteopathy and a lot of it carried over). I chose not to practice them as I cannot guarantee how the body will respond or react.

Massage –

Great to relieve muscular tension and remove adhesions within muscles, aids healing etcDoes it correct anything? No. How often have you had a massage for tight shoulders only to notice your traps are sore and tight two days later?Works great when combined with chiro in certain cases. I work together with many of my patient’s massage therapists to get a better result.

Now Chiropractic

I’m hoping here we can clear up a few things about what it is a chiropractor actually does. Even in 2015 with Google people still tell me some interesting things about what they think I do.

Chiropractors look after the most fundamental structures in your body; Your skeleton and your nervous system. Or put differently – the thing that everything hangs off and the thing that tells everything else what to do. If those two systems are working correctly, you feel awesome and you function as nature intended. If they aren’t, you will injure yourself, develop imbalances that cause certain muscles to work too hard and feel sore and joints become prone to degenerative changes over time.

Therefore if we work with your body’s most fundamental structures, then chiropractic is the most fundamental therapy in getting musculoskeletal injuries better. It just stands to reason.

How do we do this? I’m always amazed at what people think I do. New patients that have never seen a chiro think I’m going to crunch them and end up equally amazed at how small the changes I make are. Simply put, my job is to restore normal correct function to a joint that isn’t moving correctly. There is a number of ways a chiro can do this but the most fundamental is what is called a chiropractic adjustment. We introduce a small movement to the joint to get it going again. And what happens next? You feel awesome! Literally AWESOME!!! That small, simple change a chiropractic adjustment makes to a joint has such profound effects on how the joint moves, how the muscles that guide that joint work, how the nervous system in the area functions all the way up to the brain and its function. It’s truly amazing.

So my advice to anyone stuck about who to go see for their injured back or neck (or shoulder/knee/hamstring/wrist/anything for that matter) is go see your local chiropractor, or at the very least ring them and ask them if they can help you and how.

As always, if any of you have a question, please feel free to ask by emailing me directly at riaz@thebackguys.com.au.

I have always said that Non-Steriodal Anti-Inflammatories (or NSAIDs for short) are just bad for you. Somehow it just doesn’t seem to get through. As though the relentless affects of marketing somehow made the facts not real. I tell patients that there is a reasonable risk of dying from NSAIDs and it does happen often enough to be concerned, yet if there is an ad on TV saying its ok then the stats don’t matter.

Well here is yet another bunch of stats proving how bad these things are. To be able to affect the hormal system so strongly and in such a short period of time is just scary. So please, please be scared. Use your ice pack instead. Better still, keep your chiro appointments so you don’t need either!!

http://www.sciencedaily.com/releases/2015/06/150611082124.htm

Spinal Health Week was a great success. It’s always a great reminder of how much chiropractic can help and how important it is to get checked. Not all back pain is the same; here are three examples that were picked up this year.

Case 1 – a patient brought her mum in to get checked. She had a fall a couple of years back and had back pain since. The hospital at the time had checked her and given her the ok. Her physio was treating her regularly with no success. What did we find? Well after that fall, she had actually fractured her spine which was completely over looked and drastically affects her treatment. Two treatments with decompression therapy so far and she is 80% better.

Case 2 – A client referred from one of my patients came in with lower back pain. But looking at his neck something was wrong. After a quick question I found out that he had suffered paralysis of the muscles on the right side of his neck after a forceps delivery. Over 50 yrs with no muscles on one side of his neck. And after his first adjustment the relief he felt was amazing. not to mention the increased mobility.

Case 3 – a patient brought her 14 yr old daughter in who suffers from knee pain. She competes in Latin dance. A quick assessment showed a lack of Achilles mobility and calf tightness that changed the way her knee moved. One little exercise was prescribed. The mum has told me just this week that her knee doesn’t click and doesn’t hurt any more. So simple.

So thank you to all my patients for getting their mates and family in to get checked.

You know I have been practicing now for over 15 years and still to this day a lot of people come in not knowing very much about what it is a chiropractor actually does. Which amazes me that they still come in! But if you are in that much pain and have exhausted every other option, you’ll do and try anything I guess.

I must also say that some of responsibility rests with the profession itself which has always had trouble expressing clearly what it is that we do. Or more correctly have tried to mould chiropractic concepts to a public they fear might not be so welcoming.

So let me have a go at it…

I’m going to give you MY five basic principles of what chiropractic is and what chiropractors do. Remember this is my opinion; formed after many years of clinical practice. Hopefully it will help my patients by giving them a succinct (I’m not known for being succinct) written tool to express to their mates and family what it is I do for them and the general public that have not seen a chiropractor before.

1. Chiropractors are spine specialists; although that isn’t all we do.

In Australia we study for 5 years, completing two degrees. There isn’t another profession that knows the spine like we do. It’s make up, how it works and what happens when it stops working properly. If your back or neck is giving you pain or discomfort, why would you see anyone else.

But more broadly chiropractors are trained “joint” specialists. We know and treat Joint dysfunction anywhere in the body. I myself am a sports chiropractor and commonly look after shoulders and knees. And no one can do that better than we do!!

And more broadly still – we are musculoskeletal specialist. We know joints, ligaments and muscles.

2. Chiropractic – as proven by countless research papers – is the most effective form of therapy for back & neck pain.

One of my colleagues website has a great page with a host of research articles for those who like a read

https://www.backtobasicschiropractic.com.au/chiropractor/chiropractic-research/

But to sum it up; chiropractic adjustments aid in restoring correct motion to joints. By doing so, this affects the joint, local pain receptors, surrounding musculature and ligaments which quickly restores lost function and reduces pain.

3. Chiropractic restores correct nervous system function. What does that mean??

A simple example to explain; when you cross your leg for too long, your lower leg can get pins and needles and even can go numb. Why? because you have mechanically compressed the nerve at the back of your knee so it cannot transmit correctly anymore. This is exactly what happens in the spine when the spine isn’t functioning correctly. If you have a disc injury in your lower back, you will more than likely suffer from pain in the leg and or loss of function in the leg for this very same reason. Cerviogenic headaches are another example. headaches that arise from the neck are caused in part by nerve compression at C1 and C2.

But this can happen on a more insidious level and one that most people won’t attribute to their spine…..that is until they get adjusted! Often patients will come in and as a secondary complaint they will suffer from reflux/hearburn for example. Now even though I am not treating them for this at all, they inevitably will tell me after a period of treatment that their reflux/heartburn has improved. By restoring correct function to the spine the brain-body connection is enhanced and the brain can do its job in better regulating bodily functions.

4. Chiropractic is great are altering the structural alignment of the skeleton – the underlying cause of most musculoskeletal injuries.

If you have a rotated pelvis due to a pervious fall, which inevitably results in asymmetrical muscles length, joint usage and weight distribution, why are you surprised when you strain your hamstring at soccer training? The same hamstring you always strain. Or if you have a mild scoliosis resulting in a small twist in the ribcage, why are you surprised when you can’t do pressing movements at the gym evenly and always strain the same shoulder over and over again?

Having the spine and skeleton properly assessed and treated helps people not only overcome chronic nagging injures, but its awesome at AVOIDING injuries.

5. Chiropractic is simple and effective.

It just is.

A simple quick adjustment to the function of a joint creates profound change to the musculoskeletal system and the nervous system. It gets rid of pain so quickly, and restores lost function so simply that there is literally nothing like it.

Biased much!!

I hope this helps guys.