Study: When is bending too much?

This recent study looked at sustained bending and the time it takes before our postural muscles give in and we begin to rely on our passive structures for support.

Alessa 2017

How long is too long, to be in a forward, bent posture? Many of us spend hours doing house chores; weeding, DIY, working on the car etc. Not to mention the time spent leaning over a computer desk or looking down at your phone.

Back pain

Your muscles play an amazing role of suspending us in these positions, but just like with exercise our muscles will reach a point of fatigue. When the postural muscles aren’t able to provide the support we then rely on “passive” structures like ligaments and fascia, which is not their primary role, eventually leading stress and increased risk of injury.

This study looked at 2 angles of the spine leaning forwards and found that within 40 seconds the participants transitioned from the support of postural muscles to the passive structures. While this was found to be a natural transition the prolonged strain on the passive structures has been shown to increase the risk of lower back pain as suggested in another study.

As mentioned in a previous blog, these positions are not “wrong” but it’s better for the overall health of the spine to regularly change position and break from sustained load on an individual structure to provide balance.

Abstract

Static trunk bending is an occupational risk factor for lower back pain (LBP). When assessing relative short duration trunk bending tasks, existing studies mostly assumed unchanged spine biomechanical responses during task performance. The purpose of the current study was to assess the biomechanical changes of lumbar spine during the performance of relatively short duration, sustained trunk bending tasks. Fifteen participants performed 40-s static trunk bending tasks in two different trunk angles (30° or 60°) with two different hand load levels (0 or 6.8 kg). Results of the current study revealed significantly increased lumbar flexion and lumbar passive moment during the 40 s of trunk bending. Significantly reduced lumbar and abdominal muscle activities were also observed in most conditions. These findings suggest that, during the performance of short duration, static trunk bending tasks, a shift of loading from lumbar active tissues to passive tissues occurs naturally. This mechanism is beneficial in reducing the accumulation of lumbar muscle fatigue; however, lumbar passive tissue creep could be introduced due to prolonged or repetitive exposure.

 

Alessaa F. et al (2017) Changes of lumbar posture and tissue loading during static trunk bending. Human Movement Science

Continue reading “Study: When is bending too much?”

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Understanding your Nervous System

A healthy nervous system allows us to perform at a high level. Using particular methods we can tap into the subconscious side to improve the running of vital bodily functions.

You can’t control the wind, but you can adjust your sails

Our nervous system has a connection to all structures in the body. Without a healthy working nervous system most bodily functions suffer, our performance in life situations and sport are hindered and recovery from injury is impacted.

The Nervous system

Part of our central nervous system, within our subconscious is a mechanism for handling stressful situations. This is called the Autonomic Nervous system. It branches into two parts; the Sympathetic NS (SNS) and Parasympathetic NS (PNS). The SNS stimulates the bodily functions preparing us for the “fight, flight or freeze” in life threatening situations. The PNS is the other branch that prepares us for “rest, digest and heal”. It’s the PNS that should be the primary driver of our physiology.

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Using the mailman and dog as an example. Most canines are territorial and when unknown visitors arrive they become defensive, will bark and jump at the door. It’s ready to fight. When the postman leaves, the dog quickly forgets what happened and is able to fall asleep within minutes. It recognises the threat has gone and can immediately relax.

Consider yourself in the same situation, feeling threatened of an intruder. You might shout at them to leave or prepare to engage with them. When the person retreats could you relax straight away or will you be on edge for hours or even days?

The SNS is important but only has a purpose for the short term, to allow us to deal with threatening situations. Unfortunately with hectic lives, our brain interprets these physical and mental stresses as life threatening, which frequently triggers the SNS on a daily basis. Constantly stimulating SNS can lead to chronic issues…

  • Anxiety
  • Fatigue
  • Irritability
  • Sleep disorder
  • Non-working muscular tension
  • Hyperventilation
  • Adaptation failure
  • Cognitive dysfunction

The brain struggles to identify physical stress’ and imagined stress’. Anxiety of an electricity bill, job cuts at work or relationship issues will fire up the SNS.

Throughout exercise/sport our PNS and SNS working in balance. Depending on particular stressors like speed, distance, duration, the SNS may start to have a greater influence. It’s important to get into our PNS state for improved decision making, better oxygen delivery and for achieving optimal recovery.

Ways of Activating the Parasympathetic Nervous System

The PNS is the system we should be using most frequently . Therefore finding methods of staying in this state even when put under perceived levels of stress are important.

1. Breathing Mechanics

The way we breath has a deep connection to the autonomic nervous system. Shallow, apical breathing has a direct link to our SNS. But taking Deep diaphragmatic breaths stimulates the PNS. Using breathing exercises daily can help train you into a more relaxed state.  Methods such as….

Wim Hof Method

Apnea Breathing

Kapalbhati Breathing

2. Meditation Practices

Through channeling your thoughts and breathing, meditation can help induce a state of relaxation. Following this 5-10 minutes daily can help improve many different functions. Easy to use apps for this are…

Head Space

Wildflowers

                      SoundCloud – Mindfulness Works

3. Muscle relaxation

Using methods like meditation or yoga are ways of achieving muscle relaxation. Having massages and soaking in a hot bath also offers a way of relaxing muscles. The release of tight muscles indirectly sends signals to the brain to activate the PNS and switch off the SNS.

Continue reading “Understanding your Nervous System”

Iliotibial Band Syndrome

Whether your running, rowing cycling or lifting. Repeated knee flexion may irritate structures on the outer knee. It is important to get on top of this condition to stop it hindering your training.

Setbacks are the perfect opportunity to grow

Iliotibial band syndrome is most commonly experienced with runners. But also in all sports that require repetitive knee flexion under high load. Early signs and symptoms often go unnoticed (or ignored) until it’s blown up into a fully-fledged injury.

What is the Iliotibial Band?

Iliotibial band

The Iliotibial Band (ITB) is a thick fibrous band of strong connective tissue running down the lateral side of the thigh. Its attachment points at the hip are from the Glutes at the back and Tensor Fascia Latae at the front. The bottom connection feeds into the outer border of the knee and patella. It’s at this attachment point that pain and inflammation develops and would be classed as Iliotibial Band Syndrome (ITBS).

The role of the ITB is to provide the knee with stability and to abduct the hip outwards. When we walk, run or squat it’s working hard to keep the knee in the correct position and force is distributed evenly.

What are the symptoms of ITBS?

Problems arise when the lower limb moves in abnormal directions repeatedly, causing the band to flick over bony structures of the knee, leading to irritation. It may also get tighter than normal through shortening or over activity of the Glutes and Tensor Fascia Latae. This results in the ITB becoming a tighter band pulling more at its attachment and compressing other tissue around it.

ITBS usually is a sharp pain or burning sensation in the lateral knee. Generally, felt during exercise when the knee flexes repeatedly through mid-range. This range of 30-40 degrees is when pressure of the ITB against the bone is at its highest. If this movement is repeated enough, it causes friction and irritates the tissue.

What causes ITBS?

There are a number of factors that can cause a stir up of ITBS. Physically there could be a muscle imbalance, with tightness or weakness around the pelvis, hip or knee, reduced balance, and reduced ground reaction time. Mechanically, often due to the physical limitations that cause incorrect movement patterns, poor weight transferring and distribution of load.

On top of this are issues with training error. How quickly a programme is progressed, especially if it involves load or speed. From running to weight lifting, training loads need to be gradually increased to reduce the risk of injury.

Management of ITBS

Initially you may be restricted from doing the activity that caused your pain while your body recovers. An assessment will help you identify what factors are triggering your ITBS. Treatment will be multifaceted providing advice for tissue loading, gait retraining and specific muscle strengthening and stretches. Additionally, soft tissue manipulation, strapping and dry needling.

With the improved running form, increased strength and flexibility you will gradually be introduced back into the activity. This will make you overall better at your sport and reduce the risk of this problem returning.

Evidence shows that ITBS responds well to conservative management with a success rate as high as 92%.

If you’re struggling with recovering on your own contact me on 09 5290990

Lunge Hip Mobility

The 2nd part of hip mobility focuses on your lunge shape. Having full access to hip extension will improve your running, throwing and kicking abilities.

This is the second part of the hip series. These hip shapes are positions that we should all be striving for to have confidence and feel safe to function if exposed to complex positions. 

Following on from the blog hip opener for the hinge shape is our next hip position we should try to achieve. The lunge shape is full extension and internal rotation of the hip with the knee positioned behind the hip and foot pointing forwards. This shape is most seen in lifters doing split jerks, kicking a football, ball throwing. But most commonly seeing this lack of range with runners, not utilising the full hip extension in the push off at the end of stance phase.

Over the years adaptive changes happen either through injury or more with positions we adhere to. The most common being sitting, which results in anterior structures of the hip becoming limited. Lacking the end range of this movement could mean we’re selling our self short of momentum, power or endurance.

Running-lunge

Using the picture of long distance runner Mo Farah, he demonstrates a great lunge shape at the hip. While maintaining a neutral spine he manages to reach full hip extension and toes are pointed forwards, maintaining the internal rotation of the hip. Lacking hip extension can compromise running form of the upper limb and spine. But as you can see he reaches a good press shape of the opposite shoulder in the arm swing making his running style extremely efficient and balanced.

Below are a series of stretches and mobility exercises to help improve your lunge shape.

Couch stretch

If hip flexors are tight this is one of the best stretches for improving length back. A long sustained hold of this stretch with full diaphragmatic breathing over 2 minutes is extremely effective.

Illiopsoas Trigger Point Release

This muscle sits within the abdominal cavity and if tight it will feel sore with pressure through the abdominal wall towards the muscle. At first the pain can be quite high but relaxing into the pressure overtime the pain subsides and will feel looser once released. Aim for 1-2 minutes hold.

Hip flexor stretch (with band)

Another hip flexor stretch with a joint mobilisation using a band. Position the knee behind the hip. Allow the band to pull the hip forwards, contract the glutes to get the best anterior hip stretch.

Quads and inner thigh release with LaX ball

A lacrosse ball is a great tool for isolating sections of tight muscle. Rolling on the ball like you would a foam roller will be more effective, if tolerated. Then opening up inner thigh/hip adductors using the kettle bell handle. The knee flexion/extension stretches the muscle through range while being tacked down.

Suspended split stretch

This is for the more adventurous. It will help your lunge go deeper while increase stretch through the hamstrings. Throughout this movement, it is important to keep the glutes switched on to avoid hanging of the hip capsules. Spend around a minute each direction.

Continue reading “Lunge Hip Mobility”

Hip Opener for Hinge Shapes

The hip hinge is an important movement in daily activities as well as in sports. Many people are unaware this movement exists and struggle with reaching their potential.

Many lifting injuries result from a lack of movement awareness and weakness of the posterior muscles. The hip hinge is a foundational movement for so many actions like deadlifts, squats, sprinting, jumping. Lacking an effective hip hinge is like racing a formula 1 car on flat tyres.

Developing a good hip hinge will improve the strength of the posterior chain. This includes muscles like the glutes, hamstrings and back extensors. The hinge movement is primarily coming from the hip. The goal is to maintain a neutral spine throughout the movement, the hips start to bend with your butt moving backwards and minimal flexion in the knee. This will increase the tension on the hamstrings and glutes.

The majority of people find this pattern of movement unnatural, as it’s rarely practiced and in most cases, are quad dominant. This quad dominant pattern causes weight to be distributed anteriorly, which is fine with some activities, but most actions we need to be more engaged with our posterior chain.

hip hinge movements.jpg

 

Below are a series of stretches and strengthening exercises to help Improve your hip hinging abilities.

Weighted Hip Hinge

This exercises is a great way to warm up and encourage the hip back movement while fighting the resistance to maintain a neutral spine.

Banded Hip Distractions

These two movements are also great for warming up. Both encourage release of the hamstrings but also the band provides a traction force on the hip socket. This should allow the joint to move free’er and help you access more range in the joint.

Dynamic Hamstring stretch

This is a deeper stretch of the hamstrings. Having more flexibility here will help you hinge better at the hip which will off load the knees.

Jefferson Curl

This movement is a great way of developing movement segmentally and will help build strength when maintaining a stable spine. It’s important to note if you have a spinal injury to avoid this movement until you have gone through the appropriate phases of rehab.

Continue reading “Hip Opener for Hinge Shapes”

Do your hips get the green Light?

Functionally the hip has certain positions that create stability and power. We should be looking at accessing its full range to ensure the health of the joint.

Healthy joints make difficult movements easier

Just like the shoulder, the hip has an important role in allowing us to function in various positions. It’s also a ball and socket joint, with both joints acting as catalysts for power, stability and accuracy of its connecting limb.

Unlike the shoulder as you may already know, the hip is held within a deeper socket, but still has a multitude of muscles surrounding the joint, including its own rotator cuff. The hip also has a ligamentous capsule with fibres angling in different directions. Using the capsule the joint can wind up into some very strong and stable positions. Accessing these ranges of tension puts the joint into a safe place to absorb load.

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These high torque shapes held by the hip are our start and finish points of most movements of the lower limb. Most of the time we can function well within the realms of the inner movement. But if we struggle to start from these positions it becomes difficult to transition and finish in a safe end shape. The goal should be to have full physiological capacity.

In the hip, there are 3 shapes we should all be able to achieve.


  1. The first movement is the squat/hinge a combination of flexion and external rotation at the hip. This movement takes all the glory, it’s all of our squat movements, it’s dead lifting, it’s rowing and the list goes on.
  1. Next is the Lunge/run which is full extension of the hip with internal rotation. This could be the bottom of a split Jerk, in running it would be your trailing leg before leaving the ground.
  1. Pistol is the last movement which alludes a lot of people (including myself), requiring full hip flexion but also full ankle dorsiflexion.

While the squat/hinge position is the most common hip shape used. We should also feel competent at the other 2 positions. Over the next few weeks I’ll go through the 3 movements and provide some ideas to achieve full depths.

Redefining your “Normal”

Taking a look what could be limiting your physical potential to grow and redefine what you would class as “normal”.

You are braver than you believe,

stronger than you seem,

and smarter than you think.

~ Winnie the Pooh

YOUR PERCEPTION OF NORMAL COULD BE LIMITING YOUR GROWTH?

Our bodies are constantly adapting. I see people of all ages, from different backgrounds, each individual with their own experience of pain and weakness. Most have learned to live with this feeling and avoid certain movements through fear, apprehension or a lack of practice over time.

This restricted level of function has become their new norm.


My experience of this was quite recent. In preparation for a snowboarding trip to Mt Hutt I thought I’d get some practice in at the local indoor slope. After having not snowboarded for 2 years I was already feeling a level of anxiety knowing what was coming. Getting there I decided to have a few practice runs on the magic carpet (a beginners slope, relatively flat).

My first run went as expected, with a few falls, poor coordination of my feet, but this slowly improved. I was soon at the top of the slope back to my novice level of linking turns, still with a few falls.

At that point, I was then trying to push myself to go over small ramps, this lead to a return of anxiety. But once accepting that I can overcome this challenge and then achieve it my confidence only increased more.


For new Crossfitters the box jump can be quite a daunting obstacle. For some, it’s a movement that’s not been attempted for years. This isn’t their current norm and has been lost from their movement vocabulary. With appropriate scaling of this skill and positive reinforcement they are able to clear this milestone. Confidence quickly increases and it becomes a normal skill within their training.

Our bookends of normal function throughout life are expected to change with the onset of physical deficits. But when these restrictions are defined by lifestyle rather than capabilities our limitations are instead self-imposed.

Many people think that the body only adapts to the physical, without considering that psychological barriers could be the largest hurdle.

Thinking under the premise that “we can’t do something because we haven’t tried it” only sets us up for a limited version of ourselves. Try accepting that we are capable of doing more than we perceive, through patience of developing skills and strength. This will slowly help you define your new normal.

Lets stop calling it tennis elbow

This injury affects more than just tennis players. Unlike its name the treatment for lateral elbow pain has advanced.

Lateral elbow pain is a regular complaint from athletes to manual workers, even office workers are exposed to the risks of these injuries. Sometimes this injury can be difficult to shake off without the necessary changes being made.

Why tennis elbow and what should we call it?

The diagnosis of “tennis elbow’ dates back to 1882 described as “lawn tennis arm”. While it effects up to 50% of tennis players throughout their careers there are many other activities other than tennis that cause this problem.

Lateral Elbow Tendinopathy (LET) is a more appropriate and clinical description of the injury. It encapsulates both a tendinitis (inflammation of the tendon) and tendinosis (micro-tears of the tendon).

With repetitive use of the arm, whether you’re doing a swing, cleaning a 60KG barbell, hammering together a fence or typing up endless reports. As the muscles in the forearm are being used continuously without rest the immune and metabolic bi-products cause micro tears in the tendon, leading to scarring, swelling and lateral elbow pain over time.

What can cause LET?

Forearm anatomny.jpg

The most common cause for LET is mentioned above, the small tearing of tendon inserting into the lateral epicondyle (outer elbow). Most commonly the tear occurs with the small muscle Extensor Carpi Radialus Brevis due to its weak insertion into the extensor tendon. But there are several other wrist extensors that can also overload this tendon complex.

For a long time, it was thought the sole problem was with the tendon and its connecting muscle. But the most recent model of LET suggests that as well as inadequate muscle power and endurance, there are also external factors influencing the pain.

These external factors could be…

  • Neck and mid back dysfunctions – Particularly the lower Cervical spine, the nerves that supply the lateral elbow have nerve roots at this level (C5-6). If nerve roots are irritated at these levels it can enhance the feeling of pain in its pathway down the arm, into the elbow. Following the Law of Denervation (This is a whole other blog!).
  • Posterior shoulder trigger points – Following that same C5-6 nerve root into the shoulder, it supplies posterior shoulder muscles. The development of trigger points in these muscles can irritate the nerve branches travelling down the arm causing enhanced pain into the elbow.
  • Thoracic Outlet Syndrome – This is another condition that effects the nerves supplying the arm. The pressure places on these nerves can also cause pain in the elbow.

As you can see all these external factors add a nerve component to the elbow pain and should be cleared in assessment to ensure they’re not involved or treated appropriately.

How long it takes to recover?

Like all injuries, it will vary. Depending on the severity and how irritable you are this could be a few weeks to a few months. Following the guidance and management of the injury from physio you will have greater success than treating it on your own.

If symptoms persist, with no overall improvement over 12 weeks an ultrasound scan may be indicated, followed by an assessment from an orthopaedic specialist.

How do I prevent LET?

LET is a silent assassin, it’s one of these conditions that develops unknowingly (with scarring and tissue inflammation) until it’s too late (when you feel pain).

If you’re involved in sport or work that uses repetitive motion at the elbow, you’re already a candidate for this type of injury. Consider that your warning and take control.

Firstly, those forearm extensors need to be managed. Taking regular breaks to stretch and strengthen the wrists will help. Rolling the lacrosse ball into the forearm and back of the shoulder to reduce tightness. Consider your posture when sat at work or in the car, aim for your head to be over the shoulders.

For those in the gym, look at your wrist position. Most movements other than front rack and press positions, you want to maintain a neutral wrist. Look at your kettle bell swing or pull up, keeping the wrist close to neutral will reduce the force through the muscles of the forearm.

How can physio help?

Depending your presentation when assessed there are a range of treatments that could include…

  • Soft tissue manipulation of the wrist extensors, neck and shoulder
  • Joint mobilisations to the elbow, cervical and thoracic spine
  • Dry needling of forearm wrist flexors/extensors, deep neck extensors, posterior rotator cuff.
  • Mobilisations with movement for the elbow, neck and shoulder
  • Strapping of rigid or kinesio tape
  • Prescription of elbow brace/clasp
  • Specific exercises to strength and stretching exercises for the wrist, shoulder and cervical spine
  • Mobility exercises for thoracic and cervical spine

There are many treatment options available but to help with a quick recovery it’s important to provide a tailored treatment plan to meet your individual needs.

For an appointment, call on 095290990