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PrintHard Core Muscles for Mummies (Part 1)
Recently our physiotherapist Cheryl Ng was interviewed by Young Parents Magazine and published in the July version on why having a "hard" core can save your neck and back from daily activities.
Do you have neck and back aches during pregnancy or after delivery? Do you really think it is part and parcel of parenthood? Think again.
What are the core muscles and why are they important?
Core muscles stabilize your body and the pelvis during dynamic movements, such as walking and running. The core muscles include the transverses abdominis (TA), multifidus, pelvic floor muscles and the obliques. These muscles are attached to the inner portion of your thorax, (the trunk region below your ribs to your pelvis), allowing them better control of your spine and pelvis while you move. Imagine a tree trunk that has been cut into half. The rings of the tree represent the layers of your core strength. The transverses abdominis (TA) is the innermost ring, acting as a thick corset around your spine. It gives stability to the trunk and support your spine to help maintain a correct upright position.
All movements of the trunk activates the core muscles, so even when you are lifting your hand, the core muscles in your back and abdominals are recruited to assist the movement. Hence, it is crucial that your core muscles are activated before movement occurs, in offer to offer support and strength to your spine, as failure to do so will result in excessive or faulty loading to your spine, leading to low back strains and pelvic dysfunctions. Fortunately, our core muscles are normally already activated when we are in good posture, the problem comes when we deviate from good posture or sustain back injuries, thus deactivating the normal auto-recruitment of the core muscles.
How are they related to persistent back and neck pains?
Weak or inefficient core muscles are one of the contributing factors to persistent back and neck pains. We are constantly loading our spine with our activities of daily living, such as, working at the desk or computers prolonged, and carrying laptop bags or groceries. These activities stress the spine and the muscles that worked to support it may strain and get injured. This results in faulty postures which either avoid or aggravates the pain, hence, changing the normal activation of the core muscles, thereby reducing the protective function of these muscles. This may eventually set in motion a vicious cycle, in which faulty posture lead to incorrect muscle activation and less protection of spine, which lead to pain, and eventual muscular weakness , which lead to more faulty postures and pain and eventual degeneration of the spine, with persistent and recurring back and neck pains.
What are the negative effects weak core muscles can have on pregnant women and parents (who spend a lot of time bending over to take care of the baby, carrying children etc.)?
During pregnancy, your core requires greater stabilization due to changes in your weight, posture and centre of gravity. As your pregnancy progresses, the muscles that make up your core, plus the muscles that support you and your growing baby become stressed and extremely challenged. In addition, relaxin, a hormone emitted during pregnancy, ‘loosens’ your joints and ligaments in preparation for birth; as a result your supporting muscles have to work harder to achieve adequate stability. This in turn may lead to overstraining of your core and supportive muscles. A weak core will then result in higher probability of back and pelvic strains, which can be debilitating. Hence, strong core muscles play an important role in supporting your spine during pregnancy and also in assisting recovery from child birth.
The same goes to parents who spend a large portion of their time nursing and doing other back-breaking tasks, such as carrying children, lifting heavy cradles or large bags. Since such tasks are repetitive, the stress in the back accumulates over time and may eventually lead to fatigue of the supporting back muscles, resulting in back sprains. Again, having strong core muscles will help in better supporting the spine and back, thus reducing the likelihood of injury.
Pin-Up Calendar of the Medical Kind
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Total Knee Replacement Surgery video
What is exactly happening when you go through a total knee replacement surgery? Click on the following video to have a better understanding about the procedure.
5 questions to ask about your pain
Treatment for musculoskeletal pains involving your joints, bones and muscles are a little different from treatment for a cold or flu. Often resolving the symptoms such as fever is pretty much the same as solving the problem itself e.g. the bugs are getting terminated! We all know that the better we understand our situation, the better we help ourselves. So here are 5 questions you should ask your doctor or therapist treating you using a sprained ankle as an example.
1) Ask for an explanation for your symptoms. This is a relative straight forward question to find out what exactly is hurting. This is not the same as what's causing the pain, which is the next question. Ask, "Why does it hurt at the outside of the ankle and not the inner side of your foot?" Symptoms: Your ankle ligaments have been stretched and are now inflamed. The initial swelling is a result of your body protecting itself and it part of the healing process.
2) Ask for the diagnosis behind the symptoms. Symptoms and diagnosis are two very different things. Symptoms are 'signs' of injury, while diagnosis is about determining the underlying cause of injuries. Unfortunately, the terms symptoms and diagnosis are often used interchangeably. A collection of symptoms are what points to a diagnosis of a condition. Some conditions like ankle sprains are relatively easy to identify as either they have a few simple symptoms and not many conditions share the same overlapping symptoms. But some conditions, like back pain, can be difficult to determine without undergoing a more vigorous process of elimination and hypothesis or critical analysis. The diagnosis here is an lateral ankle sprain, meaning that the ankle was inverted inwards from the outer edge of the foot beyond its limits, stretching one of the ankle ligaments.
3) Ask if the treatment resolves the symptoms or underlying cause. In the case of ankle sprain, the treatments such as cold compress and therapeutic ultra-sound that reduce the swelling and lessen the pain are simply resolving the symptoms – the inflamed ligaments.
After the swelling has gone down and it is no longer painful to move, your ligaments are still stretched and are longer than what they were before. This leads to reduced ankle stability and proprioception, making another ankle sprain happening again that much more likely
If your doctor or therapist packs you off after getting the swelling down, you have not addressed how to prevent an ankle sprain happening again in the near future. You have only treated the symptoms.
What is needed here is to prescribe a solution to compensate for the lax ligaments such as exercises, taping, supports to treat and manage the underlying cause.
4) How long should the treatments last? This is seems like an obvious enough question and is usually asked. But often the patients ask in order to find out when they will be done with the treatment.
You should also ask this question to collaborate what you observe with what the therapist says should be the improvement schedule, validating the diagnosis.
If the therapist says that the swelling should go down by two treatment sessions and it has not after four, the earlier diagnosis might have to be revaluated or you simply could be slow in responding to the treatment. It's just good to know.
5) Understand what you need to do to manage or resolve the underlying causes. Make sure your therapist know what constraints you face. If you have sprained your ankle playing football, you are not likely to follow your therapist's advice to stop playing football. Make sure that your therapist knows about your love of the game and that you intend to continue playing.
Your therapist can then teach you how to tape or brace your ankle before a game and train you with rigorous ankle proprioception and strengthening exercises.
Tian Li Feng
Tian Li Feng
Education
- Bachelor of Health Science in Physiotherapy from University of Sydney, 2001
- Graduate Certificate in Musculoskeletal Physiotherapy from University of South Australia, 2007
Career Highlights
- Senior Physiotherapist at Core Concepts Group
- Physiotherapist at KK Hospital, Singapore
Quick Facts
Management for ITB friction syndrome
Why Badminton Players Get Tennis Elbow?
- Diffuse pain over lateral elbow just below the lateral epicondyle;
- Reduced grip strength;
- Reduced ability to lift a heavy object; or
- In racquet game players, reduced ability to perform a backhand.
- Some people with tennis elbow also experience tingling sensation or numbness spreading over the forearm and hand.
- Therapeutic ultrasound, heat-retaining braces;
- Soft tissue therapies like deep tissue massage, trigger point treatment, myofacial release;
- Stretching of the tight wrist muscles;
- Specific mobilization techniques combined with gripping exercises;
- Taping, corticosteroids injection, and acupuncture are sometimes helpful;
- Neck and nerve mobilization can also be considered if necessary.
- Focus should be put to achieve good control of the wrist to prevent wrist from functioning at extreme ranges, either into extension or flexion;
- Racquet technique needs to be carefully assessed to correct any technical faults, especially wrist arm control in back hand strokes;
- Encouraging gripping that focuses on hand muscles (the Duck grip), rather than gripping that only focuses on forearms muscles (the Finger grip).
Skier’s thumb? Gamekeeper’s thumb?
Injuries usually occur as a result of a sporting mishap. It is commonly seen in skier’s, footballers and rugby players. The ligament may also be directly damaged as a direct result of a fall or other trauma.
- Pain and tenderness over the base of the thumb
- Swelling and or bruising over base of the thumb
- Pain with movement of the affected thumb and difficulty gripping objects
- Instability or catching of the thumb on movement
Treatment is highly varied and dependent on a number of factors.
- Severity/grade of the injury
- How long ago injury occurred
- Patient age
- Physical demands of the patient
- Likely adherence of patient to protocols
If only a partial rupture has occurred patients are either placed in a mild cast or wrist splint (known as thumb spica) for 4 to 6 weeks.
Following surgery, patients will be placed in a cast for four to six weeks to protect the repaired ligament. During this time gentle range of movement exercises will be commenced progressing to stretching and strengthening exercises. Return to sports and full activity usually occurs 3 to 4 months after surgery.
Running, Not Doctors…
One great fear of runners is visiting a doctor for their injuries and being told to stop running. This news article in the New York Times (Sports Injuries: When to Tough It Out) covers some of the issues surrounding the question, "should I or shouldn't I see a doctor for my pain?".
But the article left a few gaps for those aches and pains that don't seem serious enough to warrant a visit to the doctors.
Closing the Gap
One of the first thing to do is to ease off and reduce your training intensity. You can ease off in one of these four areas
- Duration – shorter runs
- Speed – slower or constant
- Frequency – fewer sessions per week with more rest in between
- Terrain – less challenging terrain – flat ground rather than uphill
Another thing is to stretch more regularly. If pain is new, do apply MICER. MICER is explained here in a post reply to a reader's question.
When to see the doctor?
Ease off your training intensity for a few weeks and monitor closely. If the pain persist, you may have to see a doctor or therapist to determine the underlying problem. Assuming that is not something serious like a torn ligament, there may a underlying bio-mechanical fault that needs to be identified and corrected.
Wrist Sprain – a common wrist injury
Wrist injuries are extremely common injuries. Typically they occur as the result of falling and landing on the wrist as you attempt to break your fall. This causes a traumatic injury to the ligaments and other soft tissues surrounding the wrist.
What is a wrist sprain?
Sprains occur when the wrist ligaments are forcefully stretched into positions beyond their normal limits. A ligament is strong, fibrous tissue or band that limits and controls the motion at a joint. Ligaments around the wrist joint stabilize the position of the hand and allow movement and weight bearing through the upper limb.
Sprains can be considered
Ø Grade I: Mild injury – wrist ligaments are stretched, no rupture.
Ø Grade II: Moderate injury – wrist ligaments partially ruptured.
Ø Grade III: Severe wrist sprain – wrist ligaments are completely ruptured and the wrist may be unstable.
Who is at risk?
Wrist sprains tend to occur after falls. Wet weather may cause slippery surfaces leading to increased numbers of falls. Sprains are also very common in sports such as football, rugby, basketball, skiing, snowboarding, rollerblading etc. The elderly population who are more prone to falls are at greatest risk or serious wrist injuries.
Signs & Symptoms of a wrist sprain?
Pain with movement of the wrist
Swelling at or around the wrist joint or into the hand
Bruising of the skin at wrist or into the hand
Tenderness over the wrist
Burning/tingling/pins and needles at the wrist or into the hand
Reduced function particularly with weight bearing and gripping activities
Diagnosis can be made by piecing together the mechanism of injury to the objective physical findings. There are several other conditions including wrist fractures and or tendonitis which can present similarly to wrist sprains.
An X-ray is important to exclude any possible fracture at the joints. In severe cases an MRI will be useful in determining the extent of ligament soft tissue damage. MRI can also be effective at determining a precise diagnosis if the wrist is failing to heal after the initial diagnosis is made.
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