Neck Pain

In New Zealand neck pain is a growing problem due to a more sedentary lifestyle. They can be tricky injuries to recover from. Take a look at how physio can help.

Neck pain is a growing musculoskeletal problem with more of us sitting over longer periods of time. But also from doing heavy manual jobs or exercise.

This condition can cause various symptoms, including the following:

  • PainNeck pain Symptoms 1
  • Stiffness
  • Muscle spasm
  • Referred pain (face, arm, mid back)
  • Headaches
  • Altered sensation (ie numbness/tingling)
  • Nausea
  • Dizziness

These symptoms may be caused by strain to any of the structures around your spine. Structures such as the ligaments, muscles, joints, discs or nerves. Acute injuries are often brought on through excessive loading, this could be from an accident playing sport or in your vehicle.

Other more chronic forms of neck pain could have developed from an acute injury that was poorly managed. Or with an increasingly sedentary lifestyle, the sustained postures can overload tissue of the neck.

Preventing Neck Pain

Your next posture is your best posture

Our body is designed to handle multiple positions. Set regular intervals every 20-30 minutes to change your sitting position. Try alternating between sitting and standing. See my other blog Sitting Posture how important is it really”

Lifting correctly

We’re not all Olympic lifters, but understanding the basic principles of lifting are important to preventing neck pain. Also understanding your limits to lifting. If it’s too heavy be honest with yourself and ask for help.

Keeping calm and dealing with stress

Stress can have a significant impact with pain and ignoring stressful situations can lead to the development of neck pain. Dealing with these gremlins will be great for you in so many ways. See my other blog on “Coping with stress”.

How can Physio help my neck pain?

Identifying the source of your injury is our primary goal with a detailed assessment. Once the root cause of your neck pain has been identified you will receive an effective evidence based treatment. Treatment may consist of the following.

The aim of the your rehab is to fully recover with the confidence to use your neck normally, without fear. Also to leave with a greater understanding of your neck to prevent any injuries in the future.

For an appointment, call on 095290990

Best Drinks for Hydration

Keeping hydrated is important to maintain a healthy functioning body. This study examines different fluids to find the most effective hydrator.

Maughan 2016

Staying hydrated is important to us all. Following an intense workout or long run a high volume of water will have been lost through sweat. Keeping well hydrated has been shown in studies to help with brain function, recovering from injury, muscle growth, improving sleep and mental health.

What’s your go to drink to keep hydrated?

There was a study published in 2016 by Ron Maughan, investigated the beverage hydration index. Fluids that are consumed need to be retained. If you’re drinking a big glass of water but the peeing the same volume out, this is not effective hydration.

Maughan was looking at several different fluids, using water as the base to compare the other drinks from. Following the consumption of fluid, urine was measured over 2 hours and then compared with the volume consumed. There were some obvious results like coffee having a poor hydration index. Some surprising results with milk being one of the better fluids retained, results close to expensive electrolyte drinks. It is thought that the milk content slows down the absorption of water, which results in less fluid extracted by the kidneys.

Important to consider when trying to rehydrate. Other than just drinking water consider putting in some lemon or a small amount of sea salt (the potassium and sodium help slow down the water absorption). This was the first study of its kind. Hopefully there’ll be future studies about post exercise related hydration drinks.

FIGURE-2.png

Original Abstract

BACKGROUND: The identification of beverages that promote longer-term fluid retention and maintenance of fluid balance is of real clinical and practical benefit in situations in which free access to fluids is limited or when frequent breaks for urination are not desirable. The postingestion diuretic response is likely to be influenced by several beverage characteristics, including the volume ingested, energy density, electrolyte content, and the presence of diuretic agents.

OBJECTIVE:This study investigated the effects of 13 different commonly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage.

DESIGN: Each subject (n = 72, euhydrated and fasted male subjects) ingested 1 L still water or 1 of 3 other commercially available beverages over a period of 30 min. Urine output was then collected for the subsequent 4 h. The BHI was corrected for the water content of drinks and was calculated as the amount of water retained at 2 h after ingestion relative to that observed after the ingestion of still water.

RESULTS: Total urine masses (mean ± SD) over 4 h were smaller than the still-water control (1337 ± 330 g) after an oral rehydration solution (ORS) (1038 ± 333 g, P < 0.001), full-fat milk (1052 ± 267 g, P < 0.001), and skimmed milk (1049 ± 334 g, P < 0.001). Cumulative urine output at 4 h after ingestion of cola, diet cola, hot tea, iced tea, coffee, lager, orange juice, sparkling water, and a sports drink were not different from the response to water ingestion. The mean BHI at 2 h was 1.54 ± 0.74 for the ORS, 1.50 ± 0.58 for full-fat milk, and 1.58 ± 0.60 for skimmed milk.

CONCLUSIONS: BHI may be a useful measure to identify the short-term hydration potential of different beverages when ingested in a euhydrated state.

Maughan et al, (2016) A randomized trial to assess the potential of different beverages to
affect hydration status: development of a beverage hydration index. Am J Clin Nutr

Recovering from DOMS

Delayed muscle soreness after intense exercise is expected. There are proven ways of reducing these pains quickly to get back into your normal level of training

Your future is created by what you do today, not tomorrow

So we’ve discussed the specific differences of muscle soreness after a workout and soreness from an injury. When you get Delayed Onset Muscle Soreness (DOMS) it is quite annoying trying to continue with training. Knowing that with DOMS we get the following problems.

  • Strength can be reduced by up to 50%
  • Range of movement will be limited
  • Pain will last between 48-72 hours

Understanding these limitations, its important to scale the weight, the depths and distances to accommodate for these temporary draw backs. But there are ways of accelerating the recovery or at least making it more tolerable.

Protein BCAA glutamine1Proteins 

Amino acids are the building blocks of proteins. As muscle damage is the precursor to DOMS, supplying it with a good source of Amino acids has been show to assist in recovery. While having a well balanced diet, additional supplements of glutamine and BCAA’s can reduce the inevitable weakness post workout. It may even help with soreness. (1,2,3,4)

Vitamin D

vitamin-d-en-fb.jpgGetting a little bit of sunshine might not be enough. The latest NZ Ministry of Health stats showed 32% of the population had lower than normal Vit-D levels. There is a link between people low in vitamin D and increased pain sensitivities (5). Taking supplements of Vitamin D3 may help additional soreness.

1023029.jpgHeat

Jumping in the spa pool or a using the hot water bottle. Heat is always soothing but it has longer lasting benefits to use heat with DOMS for the overall recovery (6,7).

Tart Cherry Juice

Tart cherry Juice muscle.jpgThis one is an unusual remedy but the benefits have been shown in this study (8). Following Exercise there was a 22% less weakness from the cherry drinking group, but no effect on pain. There are many natural anti inflammatory agents in cherries that is thought to help.

CoffeeCoffee Muscle soreness

I for one am pleased this is on the list, it gives me more reason to drink it! Studies have shown that caffeine helps lower pain levels and improve weakness during DOMS (9,10). Also helping increase number of reps compared to control groups.

Compression sleeveCompression Garments

Not necessarily for training, but post workout studies show that wearing compression tights or tops can reduce weakness and pain levels (11,12).

backsquat technqueTraining with DOMS

Even following the above strategies you will still have soreness and weakness. Consider this when training. You want to ensure your training for quality not quantity. Studies show training with soreness is acceptable and will temporarily reduce pain levels (13,14).

Myofascial Rolling (Foam Roller/Lacrosse ball)

Using foam rollers and lacrosse balls into tight tissues is a good way of preparing tissue for working through full ranges of movement. Through changes to mechanorecptors and nociceptors. There are studies showing benefit post workout and regular intervals during 48-72hours of DOMS (15,16).

References

  1. Song-Gyu, (2013), Combined effect of branched-chain amino acids and taurine supplementation on delayed onset muscle soreness and muscle damage in high-intensity eccentric exercise. J Int Soc Sports Nutri
  2. Volek et al, (2013), BCAAs reduce muscle soreness (DOMS) J Int Soc Sports Nutr.
  3. Tajari et al, (2010), Assessment of the effect of L-glutamine supplementation on DOMS Brit J Sports Med
  4. Glyn et al, (2012), Exercise-induced muscle damage is reduced in resistance-trained males by branched chain amino acids: a randomized, double-blind, placebo controlled study. J Int Soc of Sports Nutri
  5. Plotnikoff et al, (2003), Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc
  6. Mayer et al. (2006), Continuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehab
  7. Petrofsky et al, (2017), The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Cl J of Sport Med
  8. Connolly et al, (2006), Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damageBr J Sports Med.
  9. Maridakis et al, (2007), Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. J Pain
  10. Hurley et al, (2013),  The Effect of Caffeine Ingestion on Delayed Onset Muscle Soreness. J Strength Cond Res
  11. Hill et al, (2014), Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Brit J of Sports Med
  12. Armstrong et al (2015), Compression socks and functional recovery following marathon running: a randomized controlled trial. J Strength and Con Res
  13. Zainuddin et al, (2006), Light concentric exercise has a temporarily analgesic effect on delayed-onset muscle soreness, but no effect on recovery from eccentric exercise. Appl Physiol Nutr Metab
  14. Trevor et al, (2008), Effects of a 30-min running performed daily after downhill running on recovery of muscle function and running economy. J Sci and Med Sport,
  15. Pearcey et al, (2015), Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. J Ath Training
  16. MacDonald et al, (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports & Exs

Sleep Deprivation and Exercise

Trying to balance a busy life, the easiest thing to neglect can be sleep. Trying to exercise in this state can produce poor results.

Souiss 2013 & Rae 2017

How many of us burn the candle at both ends? Balancing a busy workload, maintaining a healthy and social lifestyle. What often leads to sleep deprivation.

These two studies demonstrate the impact of sleep deprivation on performance.

Souiss tested his judo athletes with a number of measures including grip strength, anaerobic capacity and isometric test of elbow flexion. Tests were performed at 9am and 4pm after a judo match. There were 3 scenarios, full sleep (7.5hrs), partial sleep early (10pm-2am) and late (3am-6am).

The results showed with a full sleep performance was better in the afternoon. But with both groups with only partial sleep performance dropped in both the morning and afternoon. The partial sleep group woken early performed worse later in the afternoon.

Rae’s study of cyclists, measuring their strength the day after high intensity interval training, one group with full sleep (7.5hrs) and partial sleep (4hrs). They tested 24 hours later, testing peak power output and surveying fatigue and motivation.

These results showed that with sleep deprivation peak performance output reduced compared with normal sleep. Also sleep deprived felt more tired and less motivated to train. This is just from one night of disrupted sleep.

Sitting back and thinking about the relationship of sleep and performance these results seem pretty obvious. Giving your self normal levels of sleep can improve performance and brain function. Try and make sleep more of a priority in the life balance. The choices we make, dictate the lives we live.

 

Souissi et al, (2013) Effects of time-of-day and partial sleep deprivation on short-term maximal performances of judo competitors. J Strength Cond Res.

Rae et al, (2017), One night of partial sleep deprivation impairs recovery from a single exercise training session. Eur J Appl Physiol.

Continue reading “Sleep Deprivation and Exercise”

Understanding shin splints

There is no satisfaction without a struggle first

Those that have experienced shin splints know how frustrating it can be to train. Whether it’s running, skipping or box jumping. Pain can be so intense that we stop doing these movements for a short period or permanently out of fear. With shin pain, there are many different factors that cause it. This is why having it assessed and treated appropriately can help you ease back into these activities with more control over symptoms.

  • Shin splints is a vague term used to describe overuse or repetitive strain of structures in the lower leg.
  • In athletics and military, “shin splints” can affect up to 35% and is more prominent with females. (1)

Take a look at the several muscles in the shaft of the lower leg, and the layers we have in our bone.

It’s very easy to label the condition as “shin splints”. But looking at the different structures involved with shin pain a more accurate diagnosis would help direct treatment and management of the problem. Shin pain can also be produced by other conditions.  Another reason to get assessed.

Shin splints (other conditions)

Bony shin splints

The outer layer of bone called the periosteum has a great blood and nerve supply. This makes it a common area for feeling shin pain. When training under normal stresses with adequate rest the density of bone increases which allows us to tolerate running for longer. If stress forces increase with little rest time in between, inflammation and pain develops. Pain ignored for long enough could result in a stress fracture.

Rest period of stress fracture: Depending on the severity and nature of the fracture it may take 4-12 weeks. Having it assessed and possibly X-rayed will help guide the timeframe.

Rest period for inflammation of the bone: This requires a shorter rest time but should be closely monitored to ensure we identify the cause of extra stress to the bone. Usual rest periods will be 4-6 weeks.

Muscular shin splints

Compartments of lower leg.gif

Muscles of the lower leg are held within compartments wrapped up by fascia. During running for example these compartments build up in pressure. As the pressure rises, oxygen levels lower, toxicity builds and then results in pain. A condition known as Exertional Compartment Syndrome (ECS). If ignored this could lead to chronic exertional compartment syndrome which often requires surgery . 

Rest period for ECS: Similar to the inflammation of bone, it may require between 2-6 weeks of rest. In this time, it is about identifying the issues causing the problem and building up a tolerance to the activity.

Tendon shin splints

Tendons are the pulleys of muscles, they connect to specific bony points to cause a movement. Inflammation of the tendon can be cause by excessively loading the tendon . Three tendons that lead to shin related pain are the Achilles, tibialis posterior and the peronei. Most common being tibialis posterior.

Shin splints tendinopathy

The Tibialis posterior muscle supports the arch and if it fails can result in many changes to the foot and ankle. Catching this fault early will allow you to correct the problem easier.

Rest period for a tendinopathy: This really depends on the length of time you’ve suffered, the severity and foot mechanics. Recovery time can take up to 12 weeks. Giving time to offload the tendon and building up stress’ again.

Managing shin splints

As mentioned above, it’s important to make a clear diagnosis to provide adequate rest and adjust back into your activity. Along with normal hands-on therapy and exercise prescription, physio can help shin pain specifically through adjustments made to the following:

  • Training error – over training, excessive distances, change in running surface.
  • Poor foot mechanics – A foot with a high arch or that rolls in poses a higher risk for stress fractures and tendon pathologies when running.
  • Footwear – Shoes lacking adequate arch support for an unstable foot causes muscles/tendons to work harder.
  • Running form – Analysing running form will help identify weak structures and correct poor patterns.
  • Movement and balance control – Good balance at the ankle, knee, hip and a strong “core” of your trunk muscles play vital roles in evenly distributing the force.
  • Muscle flexibility – Tightness of muscles can put excessive load on the tibia while running.
  • Ankle mobility – Increased ankle range of movement with joint mobilisations and stretches can reduce stresses on the lower leg.
  • Muscle strength and endurance – The strength of a muscle helps maintain a good position while running or jumping. But it also requires stamina to repeatedly hold position.

Returning to running

Returning to normal running with shin splints is always an uphill battle and is never a smooth transition. It’s a learning experience, understanding what your body can withstand and tailoring your rehab appropriately. It can be frustrating, but having patience with the process will get you back into your activity.

Knee OA – The importance on strength training

Knee osteoarthritis can cause major disability. This piece of current literature supports that resistance training plays a major role in pain relief.

Bartholdy 2017

Knee osteoarthritis is a condition that gets treated overly careful due to its painful nature and limiting factors functionally.

Osteoarthritis is the gradual wearing down of the joint surfaces (cartilage) over time. Deterioration over time based on may factors, from the type of work and sport, injury history, genetics (collagen type) etc.

Knee Extensors OA

An exacerbation of osteoarthritis, especially in the knee can be debilitating. Reducing strength, restricting movement and limiting mobility. This recent study analysed almost 5000 participants from 45 trials. It found that the best results for reducing pain and disability was through increasing quads strength by over 30%.

This puts resistance training top of the agenda when trying to alleviate pain in an arthritic knee. Grading the exercises appropriately with the guidance of an expert. This study shows good results of strengthening the quads, we should approach it balanced by also working the other connecting muscles.

Original Abstract

OBJECTIVES: To analyse if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyse associations between changes in muscle strength, pain, and disability.

METHODS: A systematic search in 5 electronic databases was performed to identify randomised controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardised mean differences (SMD) with 95% confidence intervals (95% CI). Interventions were categorised as ACSM interventions or not-ACSM interventions and compared using stratified random effects meta-analysis models. Associations between knee extensor strength gain and changes in pain/disability were assessed using meta-regression analyses.

RESULTS: The 45 eligible trials with 4699 participants and 56 comparisons (22 ACSM interventions) were included in this analysis. A statistically significant difference favoring the ACSM interventions with respect to knee extensor strength was found [SMD difference: 0.448 (95% CI: 0.091-0.805)]. No differences were observed regarding effects on pain and disability. The meta-regressions indicated that increases in knee extensor strength of 30-40% would be necessary for a likely concomitant beneficial effect on pain and disability, respectively.

CONCLUSION: Exercise interventions following the ACSM criteria for strength training provide superior outcomes in knee extensor strength but not in pain or disability. An increase of less than 30% in knee extensor strength is not likely to be clinically beneficial in terms of changes in pain and disability

https://www.ncbi.nlm.nih.gov/m/pubmed/28438380/

The Office WOD

Do your best when no one is looking. If you do that, then you can be successful at anything that you put your mind to.

Following up from last weeks piece about SITTING POSTURE. It’s not about holding the perfect posture. Whats more important is changing position regularly, adding variation. Holding postures long enough results in changes to the strength of a muscle and how quickly it activates.

Neuroplasticity

This refers to the brain constantly changing to its environment, trying to find more efficient neural connections.

Consider your memory at school, studying a particular subject and you ace the exams. Now think 10 years on and you’ve done nothing relating to the subject, you’ll likely struggle with the same exam paper. The neural connections changed, these memories were not regularly reinforced and were forgotten.

Look at the typical sitting posture above that we find most of us in. Multiple changes are happening from head to toe. This also happens on a neural level. The longer we hold this posture the more the change will be ingrained. When doing complex activities that require fast reactions or more strength the adapted structures will make the task more challenging.

The Office WOD

The office workout is focusing on the neglected muscles we forget to stretch or use throughout the working day. Following this routine, 10-15 minutes at Lunch or on a coffee break will help maintain healthy muscle activity and length.

**This does not substitute exercise that gets your heart rate elevated.

The Workout won’t draw too much attention to you in the office. I won’t have you doing planks off the office chair or dead lifting the photocopier.

1. Chin Tucks (1 minute)

2. Neck Extensor stretch (1 minute)

3. Thoracic Spine Stretch (2 minute)

4. Posterior Shoulder Strengthening (1 minute)

5. Forearm  Stretch (1 minute Each)

6. Glute Strengthening (1 minute)

7. Hip Flexor Stretch (1 minute each)

8. Hamstring Stretch (1 minute each)

9. Calf Stretch (1 minute each)

Try these exercises in your workplace to get muscles fired up again and working. Feel free to leave a comment about any of the exercises or any suggestions for changes.

Disc Prolapses that Reabsorb

A recent study shown that re-absorption of disc prolapses is higher than previously thought.

Zhong 2017

The Concern and fear that the words “slipped disc” “disc bulge” or “degenerative disc disease” can be worse than the actual symptoms of pain. The image of being broken and not being able to recover. But as previously noted in another blog about MRI scans, a large number of the general public suffer with a disc prolapse without symptoms. They manage to carry out a normal fulfilled life.

This new study of pooled data from the UK and Japan showed a significantly high number of lumbar disc re-absorption. To be precise it was 66.6% (82.94% in the UK I might add!!). All patients received conservative treatment, there was no invasive treatments like surgery or steroid injections.

This goes to show that with patience in your recovery and the right guidance, spinal problems will resolve without being too hasty for surgery.

 

Original Abstract

BACKGROUND: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown.

OBJECTIVE: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging.

STUDY DESIGN: Meta-analysis and systematic review of cohort studies.

SETTING: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine.

METHODS: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement.

RESULTS: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%).

LIMITATIONS: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria.

CONCLUSIONS: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH.

Chiro.jpg

Reference

Zhong et al, (2017) Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician

Sitting Posture – How important is it really?

Sitting posture is something that get’s heavily criticised and over analysed. There could be more to it than simple ergonomics.

Your best posture is your next posture

In the last several years sitting posture has been classed as the “new smoking” or a dangerous position that will ruin your life. There are various arguments for and against sitting from different health experts and research. My opinion on this topic comes from my own clinical experience and taking value from all of the other respective parties.

First of all, sitting is not dangerous. But the longer we sit over a prolonged time is not healthy

Our body is dynamic and multi-functional, one of these functions is sitting. What’s up for debate is length of time and position. Recent studies have documented the following long term health risks from prolonged sitting.

diabetes-infographic

**These studies are predictors for potential health risks, but are also contributed by poor nutrition, sleep deprivation and lack of exercise.

What’s the physical problem with sitting?

In unsupported sitting (i.e. on the floor, perched sitting) we have some activity from core muscles that stabilise the spine. With no activity we would collapse into a heap.

Our central nervous system cleverly adapts to positions we hold most in the day. In supported sitting our body adjusts, slowly loosing flexibility in the thoracic spine, hips and hamstrings. The trunk muscles, “the core” reduce activity in sitting and loose their primary function of support when doing physical activities. Other muscles like the glutes, scapular stabilisers and posterior rotator cuff become short or weakened.

With the lack of support our body naturally falls into the path of least resistance and this is when changes in posture begin to happen. Essentially causing us to hang off the tension of ligaments and other soft tissue, instead of support from the tone and strength of stabilising muscles.

Chemical changes are brewing while sitting

The longer we sit without movement puts more stress and pressure specific tissues. Causing reduced blood flow to that area, meaning it gets less oxygen and less removal of metabolic bi-products. The muscle becomes increasingly toxic and acidic.

Luckily our tissues hold acidic sensing Ion channels that detect changes to PH levels. When in an acidic environment it sends our brain a signal and we get the feeling of discomfort.

Choosing to ignore the discomfort and stay in the same position causes an increase in toxicity and will result in the development of the trigger point phenomenon. Another phenomenon called central sensitisation may also happen. When pain signals constantly bombard the brain with pain signals it lowers your pain thresh-hold, making you more susceptible to pain in stressful environments.

Whats the answer to sitting?

Looking at the physical and chemical changes that happen in a sustained position you can see that any position for a prolonged time is not beneficial to us.

A posture that doesn’t move isn’t a postural problem, it’s a problem of movement.

“Neutral” spinal and postural alignment is all well and said. But even sitting in an ergonomically aligned position will feel uncomfortable if sat this way for 8 hours.

To counteract the negative effects of sustained sitting positions, here are some recommendations:

1. Position variation

Look at the postures below. Some of them were traditionally classed as “bad” postures. But these postures vary the tensions and stress’s applied to different tissue. By regularly changing these forces it will allow you to tolerate sitting for longer. Making a conscious effort to change position every 15-20 minutes (remember you can still work, just change position).

Sitting variation

2. Get up and move

Offload the stress and compression of your toxic butt! Giving a chance for tissue to oxygenate and flush unwanted toxins away. Also reducing eye strain, stress levels and fatigue. Not to mention all the other long term health benefits displayed above.

Studies have shown improvements in performance with intermittent breaks every 30 minutes (4). Consider standing when taking a phone call. Think about how many calls you get a day!

3. Sit-standing desks

Standing desks have taken off and are all the rage in open plan offices. Standing gives those stablising muscles a chance to work their magic. But even with standing you should consider regularly changing standing positions to offload pressures. Using a perching stool or foot stool to alternate step-standing.

4. Exercise

If this component is not included all of the above strategies will be wasted. Standing desks are not an exercise, it encourages a little more activity and is more sustainable. But your body needs to be challenged in other positions other than the one you hold most of the day. The long term health benefits are well documented for exercise.

Remember if you are just starting to exercise and coming from prolonged sitting over a number of years, ease into exercise gradually. Start off with regular power walks or exercycle. But as your fitness improves try to challenge it more, through other sources like pilates, yoga, resistance training or team sports.

Sitting isn’t the problem, it’s not moving enough. 

  1. Bell et al, (2014) Combined effect of physical activity and leisure time sitting on long-term risk of incident obesity and metabolic risk factor clustering. Diabetologia
  2. Schmid et al, (2014) Sedentary behavior increases the risk of certain cancers. J Natl Cancer Inst

  3. Katzmarzyk et al, (2012) Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis. 
  4. Thorp et al (2014), Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med.

Ligament Sprains & Timeframes

Ligament sprains are one of the most common injuries, as their main role is to support the
joint. If poorly managed there is a risk of further injury.

Patience is not about doing nothing. Patience is about doing everything you can. But being patient about Results

What are ligaments?

Ligaments are fibrous tissues that attach from one bone to another across a joint. The tissue is very strong, varies in thickness and is dense with nerve receptors. Its role is to provide stability, guide movement, maintain joint shape and act as position sensors for the joint.

Previously ligaments were thought of as inactive structures, they are in fact complex structures that influence the localised joint and the entire body once injured (1).

How are ligaments injured?

Ligament sprains are the result of loads exceeding the maximum strength of the ligament with little/no time to recover. This force causes acute tears of the ligament fibres.

These structures can be damaged through several mechanisms, like contact or direct trauma, dynamic loading, repetitive overuse, structural vulnerability and muscle imbalance (2). A sprain of ligaments usually affect the following joints:

How does it affect us?

As with most soft tissue damage there will be the typical acute pain and swelling. Injury to a ligament will compromise joint stability and ability to control movement. It can also reduce our balance, proprioception and muscle reflex time (3). With poor joint position comes restriction in movement and weakness of the surrounding muscles.

What types of ligament sprains are there?

The severity of ligament injury is graded using various clinical classifications. The most common is a three-level system that determines structural involvement.

Grade 1 Grade 1 sprain1

  • Slight stretching and microscopic tearing of the ligament fibres
  • Mild tenderness and swelling around the ankle
  • Heals within 1-2 weeks 

Grade 2

  • Partial tearing of 10-90% of the ligament fibresGrade 2 sprain1.jpg
  • Moderate tenderness and swelling around the ankle
  • Partial structural instability when tested by Physio or doctor
  • Healing takes up to 6 weeks

Grade 3

  • Complete tear of the ligamentGrade 3 sprain1
  • Significant tenderness and swelling around the ankle
  • Complete instability when put under stress
  • Poor weight bearing
  • Conservative treatment can take 12-16 weeks
  • Potential reconstructive surgery is required

*Timeframes are based upon the guidance of a professional. Treating injuries on your own poses a risk of not fully recovering and a greater chance of re-injury.

For an appointment, call on 095290990 

  1. Frank, (2004) Ligament structure, physiology and function. J Musculoskelet Neuronal Interact
  2. Gabriel (2002) Ligament injury and Repair: Current concepts. Hong Kong Physiotherapy J
  3. Hauser (2013) Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics. The Open Rehabilitation Journal