Two Bears Physiotherapy & Health Services

Two Bears Physiotherapy & Health Services

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Get the latest news about the fields of physical therapy and health care through this blog. We, at Two Bears Physiotherapy & Health Services, will regularly post features and discussions that can help you understand more about your condition as well as what you can do to combat it. Our team is located in Elimbah, Queensland, and we serve clients in various areas.

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Diastisis Rectus Abdominis

Posted on 4 August, 2016 at 23:35

What is it?

Diastisis Recti Abdominis (DRA) is the widening of the connective tissue (linea alba) between the Left and Right muscle bellies of the “6-pack muscles” (rectus abdominis). This widening is commonly worst around the navel area but can occur further up towards the ribs or down towards the pelvis.


While a large number of pregnant woman encounter this issue, it is not specifically caused by pregnancy. Rather it is related to intra-abdominal pressure, and commonly affects men and children as well. In fact most newborns (especially premmie babies) have DRA.

Aside from aesthetic concerns, the widened central tissue no longer provides adequate tension and stability which affects the whole body functionally as well.


 

Important things to remember:

• It is estimated that nearly 100% of pregnant women have some level of DRA by the third trimester. For many women the gap remains widened at 8 weeks, and left untreated this gap will often continue unchanged.

• 66% of women with DRA also suffer from pelvic floor dysfunction. These problems often go hand in hand, and although a weak pelvic floor may not affect you as much aesthetically it can lead or incontinence or prolapse.

• You may see a “pooch” or “mummy tummy” with DRA but your tummy may also be flat unless you contract your abdominals (then you will see some coning). Significant abdominal wall protrusions may also occur without DRA and some women experience “mummy tummy” without a widened linea alba.

• It is never too late! Research has shown that DRA can be improved even many years post-partum.

• While doing specific exercises is fantastic, what you do for the other 23.5 hours a day is also very important and will often determine your long-term outcomes. Posture and movement habits significantly affect our intra-abdominal pressure which is why we believe in a full-body and lifestyle approach.

• Nourish your body (with good food and a good attitude) so it can heal. We all compare ourselves to others, but be kind to yourself and give yourself some breathing room. Try not to continually re-assess your DRA or obsess over fitting into pre-pregnancy clothes. This is your journey and you will recover at your own pace.


 

What to avoid?

• Crunches and sit-ups (ie. exercises that isolate the abdominal muscles). These are generally not recommended for early post-partum women anyway as they forcefully push the internal organs down towards your pelvic floor.

• Front planks or abdominal exercises in 4-point kneeling etc. In the early days of recovery at least, this is not recommended as the abdominal contents are pushing against the weakened linea alba in this position.

• Lifting heavy items or anything that causes you to feel strain through your tummy.

• Thrusting your ribs forward or up, or poking your hip out on one side to carry your baby.

• Sitting straight up to get in/out of bed. It is better to roll onto one side and lower legs at the same time as using your arms to push into sitting up from this position.


 

Why is a whole body approach important?

There are a large number of factors that contribute to the development DRA, some which can be helped and some which are entirely out of your control.

A problematic diastasis rectus is a result of excessive intra-abdominal pressure. This means that the pressure inside your abdominal cavity can’t be contained by the body’s musculoskeletal system and starts pushing outwards (affecting your core), downwards (into your pelvic floor) or upwards (affecting your ribs and breathing). This is the same pressure that can lead to a prolapse or a hernia.

So, in this sense DRA is a symptom of your whole body not functioning optimally to contain a natural pressure. Of the factors that you can control, it is usually a combination of a weak core and poor body alignment (particularly ribs and pelvis) that are to blame. Once these are fixed, the body can start to heal itself and the gap will diminish. There is no point focusing on just one muscle (or obsessing over the gap) as the issue, every person needs to be addressed as a WHOLE.


 

 

Should I use a splint or binder?

Compression is often helpful in the third trimester or early days post-partum for increasing awareness and general support. It is important to remember however that pulling the sides together won’t make them stay there when the support is not on, so any use must be in conjunction with core activation and movement changes.

Furthermore, any compression on the abdominal area can increase pressure on the pelvic floor. Imagine a tube of toothpaste: pressure in one area displaces the contents upwards and downwards. For this reason, compression wear in the form of full pants (such as recovery shorts) is often preferable over a straight waist binder style; but none should really be used long-term.


 

Exercises

1. Finding Transversus and activating the core correctly

Lie on your back with your knees bent and your feet flat on the floor. Place your index and middle fingers just above the top of your iliac crests, and then bring them in approximately an inch towards your navel. Slowly take a deep breath in, and then as you breathe out you are going to gently activate your core. You should feel tension under your fingers (like tightening the sheets) but your fingers should not be pushed upwards, as this means you are using the more superficial muscles (rectus abdominis and the obliques).


Some good cues for proper core activation are:

• Imagine you are wearing a tight pair of jeans that are on around your hips. As you breathe out imagine the zip slowly doing up.

• Float your navel gently to your spine

• Engage your pelvic floor and gently narrow your waist

 

 

2. Activating the Core with a bent knee fallout

Starting in the same position as before. Inhale to prepare, exhale and gently activate your core. Breathe in, and on the next breath out slowly lower one knee down towards the floor keeping the heel/outer foot on the floor. Only the hip/knee should move, try and keep your low back and pelvis still. As your breathe in, gently bring the knee back to the centre.


 

3. Side lying plank

Your elbow should be under your shoulders, and shoulders and hips should be stacked.

 

 

4. Glute Bridges

Lying on your back with knees bent and feet flat on the floor. As you exhale, roll the tailbone away from the floor, squeeze the glutes and lift your bottom. Inhale, and slowly lower.



5. Single leg deadlifts

Try to pivot at the hips rather than bending your back, and aim to keep your hips level. You should feel a stretch in your hamstrings.


 

6. Wall pushup

Place hands shoulder-width apart on the wall infront of you, feet slightly apart with heels slightly lifted and core gently activated. Inhale and lean in towards the wall, gently squeezing between your shoulder blades. Then exhale and push back to the starting position. Take care to keep your back and legs straight.


 

7. Hanging

Start slowly and gently keeping your feet on the ground and varying hand position. Concentrate on maintaining shoulder and pelvic stability.


 

8. Legs up the wall

Make sure your pelvis is untucked and your back is in neutral. You may need to start this pose using a bolster to help with alignment.


 

9. Childs Pose


 

10. Psoas stretch

Make sure to tuck your bottom under before you lean forward.



11. Squat

Inhale to prepare, exhale and engage your pelvic floor. Inhale again, this time as you exhale lower yourself into a squat (as if sitting into a chair).


 

A blog about Barefoot...

Posted on 18 July, 2016 at 4:50

“The Shoe paradox: We’ve come to believe that shoes, not barefoot, are natural and comfortable, when in fact wearing shoes simply creates the need for wearing shoes. Shoe designers are convinced our feet need to be protected against the ground, and the result is our feet are so sheltered they do become fragile” (Adam Sternbergh, The New Yorker 2008).


It is estimated that shoes (in some form) have been around for approximately 30 000 years. They can be seen in ancient cave paintings, and remnants of footwear have been found on mummies and other burial remains. Without doubt it is assumed that for humans to have survived in the cold glacial periods prehistoric populations must have had some form of insulating protection on their feet.

Today, the environment, as well as cultural norms and fashion trends, still have a large impact on our footwear choices. We no longer spend most of our lives in a natural environment. For many of us our days are spent on concrete, tiles and other hard flooring. We may also run the risk of foot damage from sharp metal, glass or needlestick injuries. Additionally, we have a far more sedentary lifestyle than our ancestors, and have therefore become weaker through our whole body, including our feet.


What’s in a foot?

Each of our feet consist of 33 joints, 26 bones, 20 muscles and many tendons, ligaments, blood vessels and nerve pathways. While most of us pay little attention to our feet as long as they carry us around through our everyday life without a problem, they are actually capable of some amazing things. In other cultures, feet are commonly used for tasks such as holding fishing lines and scaling trees. With practise, feet can be used instead of hands for skills requiring high levels of dexterity: painting, playing musical instruments or completing many activities of daily living (such as brushing teeth, changing nappies, making food)!


So what happens when we wear shoes?

Many of us put on our shoes every day without ever really thinking about an alternative. In the Western world, as babies start to learn to walk (sometimes even before) they are placed into shoes, and barefoot time isn’t routinely encouraged. In Australia due to our climate and our love of the outdoors, we do tend to spend more time in minimalist shoes, but even our favoured Aussie thongs can have some disadvantages compared to simply going barefoot.

Interestingly, research has shown that the walking in shoes actually increases the load through our joints, which over time leads to increased wear and tear (usually noticed in our knees and hips).

Why does something that is supposed to protect our joints from impact actually increase it? This increase in load is assumed to be largely attributed to the changes in gait (the way we walk) that occur when we put shoes on. People tend to take longer strides, have their foot in a more out-toed position and land more firmly on their heel with in-shoe walking. This is because we are less cautious of injury to the soles of our feet (from sharp objects) and often believe that the padding in our shoes will absorb the impact on foot landing. We are no longer carefully scanning the ground ahead for danger and landing lightly in case we need to withdraw our foot again quickly. In addition, when we walk barefoot, the nerve endings in our feet give us accurate feedback on exactly how hard we are landing on the ground. This feedback becomes disrupted when another surface (ie. a shoe) is placed between our feet and the ground.

There is no denying that shoes change the natural shape of our feet. Studies have shown that people who wear shoes the majority of the time from a young age tend to have narrower, less flexible feet and toes. Most shoes also have a raised heel of some degree (even our everyday school, athletic or work shoes) and a stiff sole, compared to the flexibility of our own foot. This changes the way our foot can react and adapt to ground forces and similarly, has been shown to increase loads further up the chain (into our knees, hips and back). On top of this we have a host of conditions that commonly develop because of poorly fitting footwear and the way shoes limit our natural foot movement: blisters, bunions, hammertoes, ingrown toenails and corns to name a few!

As an obvious follow on, strength in our feet decreases with the habitual use of shoes over a long period of time. While it has been shown that problems such as flat feet and plantar fasciitis (largely caused by weakness in the feet) occur worldwide, they are found to be much more prevalent in habitually shod populations.


What happens when we go barefoot?

When we allow ourselves to go barefoot and rediscover our natural stride we tend to have much healthier feet. With the increased sensation and movement the circulation to our feet increases and they become stronger and more flexible. As a result, issues such as plantar fasciitis, foot neuromas and bunions often start to heal. Even an arthritic foot can improve.

Having our feet directly in contact with the ground stimulates the proprioceptive and vestibular systems which improves our overall balance system. We also receive better internal feedback on our posture, which coupled with returning to a smaller stride and losing the anterior pelvic tilt (encouraged by the added heel height in our shoes), makes it easier to stay in natural alignment.

Several studies have also looked at a “grounding” effect that occurs when we are barefoot on a natural surface. When we are in direct contact with the Earth our bodies draw in negatively charged electrons and discharge positively charged ones (free radicals). This can change electrical activity in our bodies and brain. Research shows that it may affect us in a number of ways including: reducing pain and inflammation throughout our whole body; lowering stress; improving sleep and energy levels; shortening recovery time from injuries and relieving muscle tension; normalising biological rhythms and improving blood pressure and flow.

Last, but not least, by stimulating nerves on the bottom of our feet we may also receive many benefits from reflexology points. Similar to grounding, these comprise of a boosted immune system, faster healing processes and reduced stress and tension.


Transitioning to barefoot

The fantastic thing about going barefoot is that it doesn’t have to be an all or nothing decision. In fact, for most of us that have been in shoes for many years, it is recommended to start with only small amounts of barefoot time on relatively gentle surfaces (grass or sand).

It’s important to keep in mind that shoes do have a role in protecting us from direct injury to the soles of our feet, keeping us warmer, and reducing the risk of invading parasites or viruses (such as plantar warts). Furthermore, extra caution should be taken for those that are overweight, overly pronated, have intrinsic instability and are prone to stress fractures or suffer from fat pad atrophy.

So, how do we safely start reaping the benefits of barefoot time?

Just like starting out at the gym or in a new sport etc. I would recommend seeking some professional guidance to help get you started correctly and avoid potential problems down the track. There are specific exercises that can help you regain foot and leg mobility and strength to help with the transition (I will cover some of these in a blog post in a few weeks!).

General guidelines however, are:

• Start slow and gentle – soft surfaces and short time periods. Even simply standing outside barefoot will start to give you some benefits.

• Do your barefoot walking first before your legs become tired (especially as you start to build up onto trickier surfaces). Carry your shoes with you if you are completing a longer walk and put them on when you need to.

• Give your soles a chance to toughen up and your feet and legs the opportunity to strengthen. Slowly progress to longer walks, include uphill and downhill areas, and as many different natural surfaces as possible (smooth pebbles, rocks, leaves and sticks, muddy areas).

• Don’t walk barefoot if you have an open cut or an injury that makes it painful at the time!

 

Getting out into nature benefits us all emotionally, physically and mentally. Encourage your kids outside to play (and join them!), take walks, find a way to incorporate some movement into your day and reap the benefits of letting our body work as nature intended it!

 

NOTE: I will be doing a future blog on barefoot running as well. The training to start transitioning to barefoot running should be far more involved process for most people and there are other considerations to be factored in as well. If you would like further information on transitioning to barefoot walking or running please feel free to contact us at Two Bears Physiotherapy and Health Services.


 

A Pain in the Jaw

Posted on 21 June, 2016 at 23:50

Problems with the temporomandibular joints (TMJ), the jaw, are very common and are estimated to affect 33% of the population at some point within their lifetime. Unsurprisingly, the TMJs are the most used joints in the body as they are involved with breathing, eating and talking.


There are a wide range of symptoms with TMD (temporomandibular disorder) and pain or tenderness in the jaw itself is not always present. Some common symptoms include:


• Clicking, popping or grinding

• Limited opening of the jaw, or inability to clench jaw closed

• Pain in the teeth, jaw, ear or upper neck

• Headaches and dizziness


So why do problems occur?

Like any joint in the body, the TMJ can be susceptible to strain or damage to the muscles, ligaments or tendons; dislocation or fractures. It can also become affected by osteoarthritis (wear and tear as we age), or generalized inflammatory conditions (like rheumatoid arthritis or ankylosing spondylitis). Pain may come on for no apparent reason or there may be an inciting event (eg. Impact to the jaw, dental procedures, stress or biting into something unexpectedly hard).

There are 4 main muscles that control movement of the jaw, 3 extracapsular ligaments, and a disc separating the two bony surfaces that make up the joint. Muscles may become tight, weak or overactive; the disc may be displaced out of the joint; and/or the joints may be moving asymmetrically or out of alignment.

Poor posture often contributes to TMD as chin poke/forward head posture makes muscles (including those around the jaw) work harder to hold up the head.



What can be done about it?

Prognosis depends on the exact reasons for the problem, but is usually very good, with patients feeling significant relief within the first few weeks of treatment. Treatment also varies, as every case of TMD is different.


Common treatment programs involve:

• Muscle work: stretching, massage, trigger point release

• Joint mobilisation and movement correction

• Stabilisation and strengthening exercises for the muscles surrounding the jaw

• Posture correction

• Mobilisation for the neck muscles and joints

• Relaxation exercises

• Ultrasound, TENS, heat and ice to decrease swelling, improve circulation, and relieve pain


It is important if you think you may have a problem with your TMJ to have it properly assessed, so an appropriate treatment plan can be worked out. At Two Bears Physiotherapy, we are happy to investigate any issues you are having and determine their source and whether they are likely to respond to treatment.


Don’t put up with something that can be fixed!

 

What is Real Time Ultrasound and What can it do for me?

Posted on 16 June, 2016 at 22:15

Have you ever been told to contract your core or pelvic floor and had no idea if you were doing it correctly or not?


Real Time Ultrasound (RTUS) is a machine similar to those used in obstetrics that allows this to happen. High frequency sound-waves (inaudible to us) are sent into the body from the probe and create a two-dimensional image of the underlying tissues. It is a painless and non-invasive way for both the physiotherapist and yourself to see what is actually happening when a muscle contracts.


This can be used very effectively to aid in treatment and rehabilitation of:

• Low back pain and sciatica
• Pelvic pain and instability in pregnancy (SIJ etc.)
• Pelvic floor muscles and incontinence

The deep core stability muscles Transversus Abdominis and Multifidus co-contract to directly stabilise the spine and reduce low back pain. However, these muscles can be hard to feel (as they are deep beneath other muscles and tissue), so being able to visualise the actual muscle on RTUS allows you to learn to correctly contract them in isolation and recover faster.

RTUS has also been shown to be valid and reliable at assessing pelvic floor function which can be a useful adjunct or alternative to an internal exam. Both men and women of all ages can be affected by pelvic floor dysfunction, which can cause low back/pelvic pain, incontinence or loss of sexual enjoyment or function. Correct activation is crucial to recovery.

A study conducted in 2001 by Hides et al. showed that your chance of not experiencing another episode of low back pain within 12 months are 4.4 times better if you have undertaken an ultrasound guided exercise program. Furthermore, if you complete the exercise program, after 3 years, you still have a 2 in 3 chance of not experiencing low back pain.



At Two Bears Physiotherapy we use RTUS both during physiotherapy treatments for many of the above conditions, and also during the initial assessment for pilates classes. This ensures that you know how to correctly activate your core, as well as allowing us to reassess over time, and prescribe specific exercises to help you achieve optimum results.

 

Why you should do Clinical Pilates...

Posted on 11 June, 2016 at 8:05

Pilates is an exercise form that focuses on posture, balance, control, core stability, strength, flexibility and breathing. This style of exercise was developed by Joseph Pilates in Germany in the early 20th century and has many benefits for a wide range of people including athletes, the elderly, during pregnancy and post-partum, and those wanting a great total body workout.


The benefits:

• Regular exercise has been shown to significantly improve a sense of wellbeing and fight depression in participants.

• Clinical pilates trains your body to move correctly which minimises the stress and strain felt by your body and maximises the efficiency at which it works to give you greater strength, speed and flexibility. If you think of your muscles like tent poles holding up a tent; all muscles must be of equal strength and taking equal pressure for it to function correctly. If one area becomes shorter or weaker (one area of your body becomes destabilised or injured), then the whole tent is liable to collapse.

• Pilates leads to improved posture and core stability which is crucial for optimal physical health and pain-free living.

• It is a great form of exercise for anyone over 50 (especially women) as it encompasses the attributes that prevent falls and fractures: improved balance, coordination and bone strength.

• During pregnancy in particular, pilates can:

o Reduce the likelihood of low back and pelvic pain by countering the laxity in your joints (caused by the release of the hormone relaxin) with increased core and pelvic floor strength.

o Increase awareness of your posture as your body changes to accommodate the growing baby (decreases pain that often occurs in back, neck and pelvis)

o Strengthen your pelvic floor which will support your bladder and bowel and decrease the risk of incontinence during and after your pregnany.

o Encourage good breathing control which is great for you and your baby and can be helpful during labour.

o Assist in maintaining a healthy weight through regular gentle exercise which in turn will decrease your risk of gestational diabetes.

o Help you relax and slow down from the stresses of every day life.

o Decrease side effects such as fluid retention, leg cramps and varicose veins.

o Speed up post-partum recovery.


 

At Two Bears Physiotherapy we conduct private or group clinical pilates which is made specific to you. Our classes are kept very small to allow maximum individual guidance, monitor progress and ensure you achieve the results you desire. Before joining a class we arrange a time for you to attend an initial session where we can identify your strengths and weaknesses, teach you the fundamental principles and ensure your pelvic floor and core muscles are correctly activating. We have classes to suit you whether you are fit and active, moving a little more slowly, pregnant or have a baby in tow.


So really, why would you not want to participate in a fun exercise class that will make you feel fitter, leaner and stronger; challenge you and relax you at the same time; and help you stay injury and pain-free??


Book an assessment and come along and see what pilates can do for you.

 


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