The effects of over developing one muscle group i.e. your chest muscles (pectorals) in the gym, whilst neglecting your back muscles, often affect your posture resulting in neck, back, and shoulder pain

To understand why this occurs, you must be familiar with the notion that most joints in our body have two or more separate and opposing sets of muscles acting on the joint. Take the elbow as an example.

When the biceps contracts and shortens, it bends the elbow joint. As the elbow bends, the opposing triceps, must relax and lengthen to allow this movement to occur. And vice-versa, for the elbow to straighten; the triceps contracts and shortens and the biceps must relax and lengthen.

To gain a well rounded physique you must consider strengthening more than just one, if not all the muscle groups. An over developed muscle (group) will create more tension on one side of the joint. Over developed muscles are also often tighter (shorter) than normal.  The balance between muscles at the joint is lost, pulling the joint away from its mid-line and changes the angle of rotation at the joint.

Muscle balance at a joint
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Muscle imbalance at a joint
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The Shoulder

The shoulder is a more complicated joint, however the same principles apply.

From personal experience as a physiotherapist, one of the most common mistakes in the gym is over-training the chest muscles.  This causes an imbalance between the muscles at the front of the body and those at the back. The shoulders with time are pulled forwards as the chest muscles get stronger, bigger and shorter, making the posture more rounded, creating pain and potential pathology.
Lateral postural Picture

Rounded posture with over-developed Pecs
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Why is a rounded posture problematic?

Rounded postures place the shoulder joint in a unbalanced position away from the ideal centred position. This unbalanced position leads to increased compression at the shoulder, resulting in pain and reduced function:

• Compression of muscles and other structures at the front of the shoulder joint, may cause pain in the neck, and or down the front of the shoulder and side of the arm. Pain is usually worse with overhead activities. If the compression of the tendons continues for long enough, tears of the tendons (rotator cuff) may occur.
• Rounded postures often lead to neck pain. A large number of muscle that attach to the shoulder also attach to the neck at the other end. If these muscles are affected (lengthened and weakened by the pull of the shoulders) the neck often tends to rest into a head forward ‘chin-poke’ position. This increases the pressure on the neck joints and also other pain sensitive structures around the neck that can cause symptoms (Szeto, 2005).
• The shoulder’s range of movement is significantly reduced as a result of having less space for the joint to move. (Bullock et al, 2005)

Additional contributing factors leading to rounded shoulders

Modern Lifestyles
Think about all your daily activities; washing your face and hair, driving, sitting at the computer.  People are becoming chair-shaped, and this keeps the shoulder in a rounded position.

Pain Response
Your body’s response to pain is another factor.  When you have neck and shoulder pain we often adapt a rounded posture.  This initially is good protective mechanism to prevent further damage for the first few days post-injury, however in the long term this posture keeps the shoulder in a poor/compressed position and will hinder healing.

How to correct your rounded posture?

As a guide, when looking from a side view your shoulders should be fairly central compared to the trunk, and the head should be central on the shoulders.  A ‘plumb line’ from the centre of the ear should fall through the centre of the shoulder.

Correct posture in sitting
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To get into this position roll your shoulders all the way forwards, then all the way back (your shoulder blades should touch), then find the mid-point between these two position.  When you have this, gently tuck your chin in, so that your head is positioned on top of your shoulders.

Workout program to prevent the over-training

Weight-training:
If you work the chest 2 x weekly, doing 6-9 sets of 12 repetitions, then do the same amount of work, at the same load and intensity for the opposing muscle groups – the upper back muscles.  Most chest exercises involve pushing – therefore to balance this and work the upper back you must include pulling type activity.  Some ideas are provided below.

• Lat pull down
• 45 degree angle lat-pull down
• Seated row
• Bent over row
• Pull ups
• Shoulder external rotation

Stretching
As well as strengthening (which contracts and thereby shortens muscles), you should ALWAYS stretch all the muscles you have trained (lengthen the shortened muscles ) at the beginning and end of your workout to reduce tightness of these muscles. In this scenario it is therefore strongly recommended to stretch both the pecs and back muscles.

Pec stretch
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• Hold 30 seconds
• rest 30 seconds
• repeat x 3 (4 x daily)

References:

1. Brukner and Khan. Sports Medicine
2. Bullock, M., Foster, N., Wright, C., (2005). Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Manual Therapy 10, 28–37
3. Kwok Tung Lau, Ka Yuen Cheung, kwok Bun Chan, Man Him Chan, King Yuen Lo, Thomas Tai Wing Chiu (2010). Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Manual Therapy 15 . p457-462
4. Szeto, G., Straker, L., O’Sullivan, P., (2005). A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—2: Neck and shoulder kinematics. Manual Therapy. Vol 10. p 281–291

Gym Users – Are you OVER-working the PECS? is a post from: Musculoskeletal Consumer Review

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As of the 1st August, muslims worldwide are observing a complete fast from food and drink during the daylight hours, for 30 days.

Ramadan has a tendency to affect a person in several ways not only as they are not eating but it affects their sleeping pattern and exercise regime.

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So… some useful tips to help you get through this month

1. Eat nutritious food and avoid over indulging and eating complex carbohydrates and fats when breaking the fast

2. Eat evening meals slowly to facilitate digestion. This will also prevent a person from over indulging

3. If you are person who regularly exercises, it is probably not a good idea to stop exercising all together during Ramadan but consider modifying your normal routine so exercise should be less intense and in shorter bouts. However if your someone who never normally exercises, I would strongly suggest you seek professional advice before partaking in exercise

4. Good times to exercise during Ramadan would be at least 2 hour after a light evening meal or before breakfast in the morning

5. Ensure you drink plenty of water after sunset to replenish your water levels and remain hydrated

6. Avoid caffeine drinks such as coke, coffee or tea as these are diuretics and will encourage water loss. In addition a sudden reduction of caffeine can lead to headaches and irritability and therefore should be minimized gradually

7. Avoid excessively spicy and sweet meals to reduce potential for later discomfort

8. Prioritize your day so that activities requiring more brain power or energy are done earlier (closer to breakfast in the am) as this will enable you to utilize the glucose stores better

9. Aim to go to bed early and get a good night sleep. Lack of sleep will make a person feel low in energy

  On behalf of core concepts, we hope and wish you all a safe, healthy and blessed month

Tips for a healthy Ramadan is a post from: Musculoskeletal Consumer Review

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Pilates is a unique body conditioning exercise designed to rebalance the body, bringing it, into its correct neutral alignment whilst targeting the deep postural muscles (Transverse abdominals and muscles of the pelvic diaphragm). In essence pilates challenges the core muscles and builds strength from the inside out, helping a person to reshape their body, adding to a leaner and more toned figure. It boasts of a perfect balance between strength and flexibility, whilst relieving unwanted stress and tension. The phenomena of pilates is a popular and growing trend in western countries amongst athletes and celebrities, as well as in the treatment of peripheral and spinal musculoskeletal dysfunction. Today pilates is evolving and is taught worldwide in gyms and hospital, benefiting millions of people. The aim of this article is a brief introduction to pilates and its clinical benefits in physiotherapy.

Background

Pilates was first discovered in Germany in the early 20th century by a keen diver, gymnast and boxer by the name of Joseph Pilates. Joseph Pilates had spent the majority of his childhood fighting rickets, asthma and rheumatic fever and this fuelled his desire to become physically immune to these ailments. Through studying a variety of different disciplines (yoga, Zen) he brought about this new notion of exercise. During the war he practised his theory of exercise, and became involved in the rehabilitation of war victims. Once the war ended, Joseph Pilates relocated to New York and soon went on to open the first pilates studio attracting elite actors, dancers and athletes.

Image from Pilates Suffolk click for larger view

Clinical Pilates vs Pilates

Clinical pilates is used to treat people with musculoskeletal injuries and is conducted by a physiotherapist certified with Clinical pilates certification. If a person experiences an injury or repetitive injuries, they may have joint stiffness, muscle spasms, poor posture or abnormal movement patterns as a cause or a result of the injury. It is therefore important to first treat the above complaints before commencing pilates.

In addition certain pilates exercises may aggravate the symptoms. An example is someone who may experience a back strain, due to too much extension in the lower back. Such individuals may have an exaggerated lordotic postures and therefore extension pilates exercises may not be advisable. This is something that would not be picked up if a person was to attend a routine pilates class, which does a combination of both flexion and extension exercises.

Not only is it important to select the right type of pilates exercise, it is also necessary to ensure that the correct and appropriate level is prescribed. Routine pilates may be too challenging for a person with back pain. This will cause the individual to compensate and utilise stronger global muscles as opposed to the core muscles, therefore negating the benefits of the pilates exercise. As a secondary result, a person may start to experience muscle spasm in the global muscles due to the increased exertion. The physiotherapist having tested your muscle strength and range of movement, will be able to ensure that the exercises are appropriate and although challenging not detrimental to recovery. 

The added benefit of clinical pilates to routine pilates is not only is it more individualised to the person and their problem, it can also be more functional. If the person for example is keen to return to an activity or a sport (swimmer, footballer, dancer) the standard exercises can be modified by the physiotherapist to strengthen the core muscles whilst carrying out the aggravating movement. This could mean that the core muscles of a footballer is challenged as he kicks, dribbles a football and not just in static postures.

Peripheral injuries

When dealing with peripheral joint/ muscular injuries e.g. ankle instabilities the ankle is the main focus of the treatment. This makes sense and is always a good place to start to strengthen and rehabilitate local structures. However the research is beginning to move towards looking at the whole picture. Improving an individual dynamic control of their movements, will mean that person is less likely to sustain injuries. There is a growing trend to rehabilitate athletes whilst incorporating Pilates based exercises to teach a person to move more efficiently. Pilates can be used to treat hip, shoulder, knee and ankle injuries. 

Spinal Injuries

Pilates in conjunction with manual joint mobilisations and soft tissue release is an effective way to treat back pain.
Time and time again the research has shown that any form of back pain leads to a loss of function of the deep muscles (multifidus) of the spine at that level. Unfortunately these muscles do not have the capacity to turn back on again, once the initial episode of back pain has resolved, and therefore these muscles require specific training to reactivate and stabilise the spine. In the long term these muscles without exercise will continue to waste further and subsequent muscle spasm in the global and more superficial muscles is experienced. This predominately occurs as a mean to stabilise the back in the absence of the deep muscle activity. Such individuals will report recurrent flare ups of back pain in the year due to the ongoing weakness of the spine.

In addition to weakness, back injuries usually occur after an extended period of time, in a bad posture, excessively loading the joint.

Clinical pilates is a form of exercise that both facilitates the strengthening of these deep muscles whilst educating a person where a neutral spine lies. In time a person will feel that there back is stronger, as they become more aware of what sitting or standing in a good posture entails.

In the long term they will also have the endurance to sustain these better postures for longer periods, through conducting the exercises.

If a person is new to pilates one- to one sessions with a physiotherapist or very small classes is initially strongly recommended, this is to ensure a person can be taught the correct techniques and the 5 concepts of pilates accurately (breathing, neck, rib pelvis position and stabilizing). Pilates can be a little tricky and can easily be done incorrectly and therefore close supervision is required to prevent faulty patterns learnt. 

The benefits of Pilates
 
•    General fitness and body awareness greater strength and muscle tone
•    Improved flexibility
•    A flatter stomach
•    Improved efficiency of the respiratory, lymphatic and circulatory systems
•    Better posture and awareness
•    Less incidence of back pain
•    Increased joint mobility
•    Lower stress level

Which clients would benefit from Pilates?

•    Males and females
•    Pregnant: Pre and post natal
•    Athletes and dancers
•    Amputee and stroke rehabilitation clients
•    Elderly
•    Children 12 years-old +

Clinical pilates therefore  targets the musculoskeletal injury more specifically. The physiotherapist is able to identify your posture type, establish the mechanism of injury, understand what the peron is aiming to return to and work out which exercises would be of more benefit to the individual. Clinical pilates therefore looks at treating the cause as well as selecting the appropriate repertoire of exercises to strengthen the injured areas and even be done for injury prevention.

If your suffering from recurrent episodes of back pain or peripheral injuries – Clinical Pilates may be just what you need!

Pilates and Physiotherapy is a post from: Musculoskeletal Consumer Review

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Source: Physical Therapy at FLAGSTAFF ATHLETIC CLUB
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PFPS which used to be known as Chondro-Malacia Patella (CMP) , Anterior Knee Pain and Runners’ Knee are all very similar conditions. These conditions and symptoms can occur due to a varying degree of wear and tear (degeneration) of the cartilage behind the knee cap, also known as the patella femoral joint.

What are the main contributing factors?

Three main factors attributed to cause increased degeneration of this cartilage are:

1. Muscle tightness:

The quadricep muscles and the Ilio Tibial Band (ITB) tend to be tight in people with PFPS. If the quadricep muscles are tight, it has a tendency to pull the knee cap much closer to the thigh bone. This increase in pressure leads to grinding of the knee cap against the thigh bone causing the degeneration of cartilage.

The ITB has attachments to the outer side of the knee cap via a connective tissue known as the lateral retinaculum. The knee cap tends to sit comfortably in a congruent position within the thigh bone. However when the ITB is tight it pulls the knee cap in an outward direction shifting the knee cap away from, and out of its natural groove.

This slight shift or tilt increases the pressure or loading behind the knee cap leading to degeneration of cartilage and pain.

2. Muscle Strength:

Imagine jumping and landing on a straight knee compared to a bent knee. There is definitely more impact that goes through the knee in the first instance because your muscles are not helping to absorb the impact whereas a bent knee allows the muscles to contract and dampen the impact on the joint.

Similarly if the quadriceps, are not strong enough, your knee joints takes the slack with every step that you walk, run, or stairs that you climb.

The knee joint in this situation will be grinding excessively as muscles are not effectively stabilising the joint and supporting a person’s body weight.

3. Biomechanical faults:

Flat feet (poor arches), knocked knees, knee cap position (rotation/ tilt) and increased Q angle are all factors that result in an imbalance of muscles around the knee joint and mal-alignment of the knee cap, that may accelerate the degeneration of the cartilage in the patellafemoral joint.

So what can you do to solve your knee pain?

Treatment for PFPS would entail stretching exercises for the quadricep muscles and ITB and strengthening exercises for the muscles around the knee joint in particular the quadriceps. In addition getting appropriate footwear to support the arches of your feet or considering customised orthotics to correct your biomechanical faults would also be strongly recommended. If your keen athlete, or struggling with pain, you may even want to consider a knee support for symptoms reduction and control.

PFPS- Knee pain: Cause and solution! is a post from: Musculoskeletal Consumer Review

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How much weight can I lift in the gym to prevent injuries?

LIVINLAVIDALOWCARB
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A safe intensity for resistance training can be determined using your 1RM aka the maximum weight that can be lifted with only one repetition.

70% of 1RM will give you the appropriate weight. Eg, if 1RM is 50kg, the safe weight to use is 35kg, derived from 70% of 50kg.\

How do you find out what is your 1RM?

To find out what's the maximum weight you can lift is to use a relatively lighter weight and lift it repetitively until exhaustion. If you are able to do it for more than 12 repetitions, the weight is too light and you should try to increase the weight. If you can complete 12 repetitions or less, apply the following equation to determine your 1RM.

RM = Weight × ( 1 + ( 0.033 × Number of repetitions ) )

Increasing your weight is only 1 way of increasing your training intensity. Try varying it with number of repetitions. Bear in mind that the training intensity will also depend on your training goals to achieve better endurance or strength. Generally endurance training involves higher repetitions using lesser weights and strength training involves lower repetitions with heavier weights.

Simple sets with 70% 1 RM -e.g 3 sets x 8 repetitions with 70% of 1 RM, is a good way to start off your resistance training regime. Know your training goals and pick the appropriate weight and intensity to meet those goals safely.

Safe and effective weight in the gym is a post from: Musculoskeletal Consumer Review

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Stretching for Tennis Elbow video is a post from: Musculoskeletal Consumer Review

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tennis elbow
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• 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).

Why Badminton Players Get Tennis Elbow? is a post from: Musculoskeletal Consumer Review

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Disclaimer: Note that stretching is not warming-up. It is a common misconception that warming-up equates to stretching. ‘Warming-up’ literally means raising your core body temperature. It is advised that before you begin on your stretches and run, a general warm-up such as brisk walking between five to ten minutes be performed to prevent injury to your ‘cold’ muscles. (see To stretch or not to stretch before an event?

Top 5 stretches:

Hamstrings Stretch

click for larger view	Start off with your body close to your thigh and your knee about 90 degree
click for larger view	Straighten the knee gently while keeping your body close to your thigh Hold for 15 seconds and repeat 3-5 repetitions

Calf Stretch

click for larger view	Upper Calf stretch Place hands on front thigh, with one leg to rear Keep the rear leg straight and foot flat with toes pointing forwards Bend the front leg and feel the stretch through the rear leg Hold the stretch for 15 seconds and repeat 3-5 repetitions.
click for larger view	Lower Calf Stretch Place hands on front thigh, putting your weight on your rear leg Keep the rear foot flat with toes pointing forwards Bend rear knee forward over rear foot and feel for the stretch over the lower calf Hold the stretch for 15seconds and repeat 3-5 repetitions

Quadriceps Stretch

click for larger view	In standing, bend your knee and take your heel towards your bottom, keeping your back straight until you feel a stretch in the front of your thigh
click for larger view	To further stretch the front of your thigh, extend your thigh and bring your heel closer towards your bottom Feel for the stretch at the front of your thigh Hold the stretch for 15seconds and repeat 3-5 repetitions

Iliotibial Band (ITB) Stretch

click for larger view	To stretch the IT band of your right leg, stand with your right leg crossed behind your left.
click for larger view	Put your weight on the right leg and lean your body towards the left. You should be able to feel the stretch in your hip and down the IT band along the right side of your right thigh Hold for 15 seconds and repeat 3-5 repetitions

Glueteus (Buttock) Stretch

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Sitting on the floor with one leg straight out, bend the other knee and place the foot over the straight leg Using your hands, gently bring the bent knee up towards the opposite shoulder. Feel for the stretch in the buttock Hold the stretch for 15 seconds and repeat 3-5 repetitions.

Stretches For New Runners is a post from: Musculoskeletal Consumer Review

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Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. 

Don't throw your shoes out too soon

Chalk up 800km to 1000km before discarding your shoes. Switching to new shoes too soon makes your body re-adapt unnecessarily, which may increase your risk of injuries.

Review your running style

It is better for long-distance runners to land on their mid-foot instead of the heel as it prevents excessive stress to the legs. running short distances under 5km? You are better off landing on your forefoot.

Stretch for relief

Do a lunge with the front knee bent. Straighten your other knee and make sure both heels are placed flat on the ground. You should feel a comfortable stretch on the calf of your back leg. Hold for 15 seconds and repeat 10 times.

Lower Calf Stretch

Tips to Run Pain Free is a post from: Musculoskeletal Consumer Review

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1. Upper Trapezius	stretches 001
2. Triceps and Latissimus Dorsi	stretches 002
3. Deltoids	stretches 003
4. Hip and quadriceps.	stretches 004
5. Hamstring	stretches 005
6. Pectorals	stretches 006
7. Piriformis	stretches 007

Stretches for Swimmers is a post from: Musculoskeletal Consumer Review

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