Sciatica

Sciatica

Sciatica describes the symptoms of pain (mostly) and sometimes tingling and numbness that runs from the Lumbar Spine into the buttock and down the back of the leg and sometimes foot.

What is the Cause?

The majority of sciatic symptoms come from back disorders between L4-S1 that put pressure on or cause irritation to a lumbar nerve root.

The symptoms can arise from an underlying Herniated Disc or Spinal Stenosis (which can compress the nerve root), or a degenerative disc or facet joint, which will release inflammatory proteins and irritate the nerve.

Signs & Symptoms

There can be any combination of the following:

  • Buttock, leg and/or foot symptoms
  • Burning, sharp, searing pain as opposed to achy or throbbing
  • Tingling / pins and needles
  • Weakness of leg or foot
  • Symptoms are usually only in one leg
  • Symptoms that are intermittent (can get better or worse, rather than staying constant)
  • Can be aggravated by sitting, walking, standing, twisting or bending

What Can We Do About It?

Physiotherapy will aim to identify the cause of your sciatic pain and treat with a combination of hand on therapy and specific sciatica relieving exercises

The Standing Desk

The Standing Desk

The standing desk seems to the latest new craze to avoid work related back problems. But do you know how to get the most out of your standing desk?

Yes the standing desk is a great way to avoid the sustained flexion we experience when sitting, but standing in one position for long periods can also have negative effects on our posture and musculoskeletal system. The best option is to alternate between sitting and standing positions throughout the day. One study found that a ratio of 2:1 sitting versus standing is optimal for body posture and for best productivity results.

It is key to remember the correct set up for both a standing and a sitting desk. Whether it is sitting or standing the correct desk height and computer screen position is crucial.

As a guide, the desk should be positioned so the elbows are at approximately a 90 degree angle. It has been found that the screens optimal position is 20-10 inches from the face, with the top of the screen at eye level. So as you don’t tilt your head forwards or backwards, the screen itself should have a 10-20 degree tilt back

When either sitting or standing, regular breaks are required. The spine loves movement! Staying in any one position for long periods will cause the spine to become stiff and the surrounding muscles to either shorten or lengthen away from their optimal position. Some people will naturally change positions regularly. For those who don’t, an app on your smart phone or installing reminder software on your computer may be a better option.

So remember

  • Vary sitting and standing throughout the day
  • Correct desk set up is crucial
  • Regular breaks are necessary to decrease occurrence of poor posture and musculoskeletal abnormalities

Thoracic/Upper Back Pain

Thoracic/Upper Back Pain

Thoracic and upper back pain refers to any pain and/or dysfunction of the thoracic section of the spine. It can be anything from stiffness in the upper back to pain when taking a deep breath.

What is the Cause?

The thoracic part of the spine is structurally very different to the lumbar and cervical parts of the spine. It is designed to be very stable and strong providing protection for the vital organs. . The fact that the ribs also connect into the thoracic spine provides more rigidity. This predisposes the thoracic spine to stiffness. Therefore the most common cause of upper back pain is joint dysfunction.

Signs & Symptoms

  • Upper back pain while breathing
  • Muscle spasm
  • Stabbing pain
  • Pain radiating out to the ribs
  • Pain in the shoulders

What Can We Do About It?

Posture plays a huge part in decreasing pain in the upper back. The Physiotherapist’s at Elite Spinal will assess your posture and advise you in how to make the appropriate changes.

The therapist will also use manual therapy techniques to decrease the stiffness through out the thoracic spine and ensure it is appropriately aligned.

Spinal Stenosis

Spinal Stenosis

Narrowing of the spinal canal and/or foramen where nerve roots exit the spinal canal which results in choking of the spinal cord and/or nerve roots

Stenosis of the spine can involve:

  • Narrowing of the central spinal canal (space where the spinal cord lies). This is also called a Myelopathy.
  • Narrowing of foramen through which the nerve roots exit the spinal canal

Most commonly happens in the Cervical Spine (neck) and Lumbar Spine (lower back)

What is the Cause?

The most common cause of Spinal Stenosis is due to the wear and tear, which comes with the aging process. Specific causes include:

  • Lumbar disc herniation
  • Facet joint arthritis (also known as Spondylosis)as we age and our discs lose fluid and height. There is an increased pressure placed through our facet joints, which connect one vertebra to another. Facets can become thickened and extra bone can grow into the spinal canal
  • Spondylolisthesis
  • Ligamentum flavum thickening:With age and stress the ligament can thicken which narrows the spinal canal

Signs & Symptoms

Some people can present with no symptoms however you may experience pain, numbness, pins and needles muscle weakness or loss of control of bladder and bowel. If you have loss of bladder or bowel control you may have Cauda Equina Syndrome (If you experience this you should consult a medical professional immediately).

What Can We Do About It?

The therapist’s at Elite Spinal Physiotherapy will identify the cause of your spinal stenosis and help in reducing symptoms (pain, pins and needles, numbness, weakness). They will also be able to refer you to the appropriate specialist if required.

A spinal decompression and core strengthening exercise program will be developed to help prevent any re-occurrence of symptoms and appropriate manual therapy will be used.

In most cases the spinal stenosis cannot be reversed however the progression of the stenosis can be greatly reduced, so you can enjoy a pain free, active life for as long as possible.

Myelopathy

Myelopathy

Myelopathy refers to compression of the spinal cord causing neurological deficit. Inflammation of the spinal cord is called Myelitis.

What is the Cause?

A Myelopathy is compression of the spinal cord caused by Spinal Stenosis. Specific causes of Spinal Stenosis include:

  • Lumbar disc herniation
  • Facet Joint Arthritis (also known as Spondylosis)
  • As we age and our discs lose fluid and height. There is an increased pressure placed through our facet joints which connect one vertebra to another – facets can become thickened and extra bone can grow into the spinal canal
  • Spondylolisthesis
  • Ligamentum Flavum thickening: With age and stress the ligament can thicken which narrows the spinal canal
  • Tumors

Signs & Symptoms

Signs and symptoms vary depending on which part of the spinal cord is affected and the extent of the compression.  Some general signs and symptoms are:

  • Pain in upper or lower limbs
  • Weakness
  • Numbness
  • Pins and needles
  • Jerky movements
  • Lack of coordination
  • Bowel or bladder abnormalities
  • Sexual dysfunction

What Can We Do About It?

The therapist’s at Elite Spinal Physiotherapy will identify the cause of your Myelopathy and help in reducing symptoms (pain, pins and needles, numbness, weakness). They will also be able to refer you to the appropriate specialist if required.

A spinal decompression and core strengthening exercise program will be developed to help prevent any re-occurrence of symptoms and appropriate manual therapy will be used.

In most cases the Myelopathy cannot be reversed however the progression of the compression or irritation of the spinal cord can be greatly reduced.

Ankylosing Spondylitis

Ankylosing Spondylitis

Ankylosing Spondylitis is a disease that causes inflammation of the spinal vertebrae and other joints. It affects up to 2% of Australians. It is a member of the rheumatic diseases and is associated with the presence of a genetic marker HLA-B27.

Chronic inflammation of the spinal joints causes the joints to produce extra bone formation, which leads to disruption of spinal alignment and may eventually lead to a bony fusion between the vertebrae.

What is the Cause?

There is no known cause to Ankylosing Spondylitis however the presence of a genetic marker HLA-B27 appears to significantly increase the risk of developing this condition.

Signs & Symptoms

  • Back pain
  • Spinal stiffness, especially in the morning
  • Stiffness in hips

What Can We Do About It?

The therapist’s at Elite Spinal Physiotherapy will identify whether your back pain is inflammatory or not and refer you to the appropriate specialist if required.

A spinal decompression and core strengthening exercise program will be developed to help prevent any re-occurrence of symptoms and appropriate manual therapy will be used.

Degenerative Disc Disease

Degenerative Disc Disease

Degenerative disc disease refers to the process of degeneration of an intervertebral disc. Your intervertebral discs are the fluid filled sacks, which lie in between each vertebrae and act as the shock absorbers for your spine. They are made up of two parts: Inner nucleus pulposes and outer annulus fibrosis.The annulus fibrosis is made up of dense fibrocartilage rings and encases the nucleus. The outer ring of the annulus is innervated, meaning there is a nerve supply and can be painful when damaged. The nucleus is the inner part of the disc, which is jelly like in consistence. It changes shape as it adapts to the different loads placed on the disc. A healthy disc is fluid filled. Breakdown of a disc begins when it becomes dehydrated or loses part of its fluid content. This can initiate a cascade of events, which leads to eventual breakdown, and degeneration of the spinal complex.

Disc degeneration can lead to: 

Disc degeneration is a normal part of the ageing process. It is important to note that you can have disc breakdown with the absence of pain. The good news is there is lots you can do yourself to rehydrate your discs and slow the degenerative process down. 

What is the Cause?

Disc degeneration is a normal part of the ageing process however there are certain things that can accelerate the degenerative process.

Risk factors include:

  • Sedentary lifestyle
  • Overweight
  • Poor core stability
  • Repetitive heavy manual labor 

Signs and Symptoms

  • Persistent pain at the bottom of the spine
  • Pain when sitting
  • Pain going from sitting to standing 

What Can We Do About It?

Your physiotherapist will first identify the abnormalities in movement of your spine and will then determine the cause of this.

Core stability training will form a large part of your rehabilitation and prevention of further episodes of back pain.

Movement is the key to rehydrating discs and encouraging repair. Your physiotherapist will provide you with an individualised exercise program to help enable the healing process.

Natural Anti-inflammatories

Natural Anti-inflammatories

In an acute episode of back or neck pain drug based anti-inflammatories may be necessary however they have a few side effects so  avoiding them where possible is a good idea. This is where natural anti-inflammatories can be very useful.

Curcumin

Curcumin has a long history in Ayuvedic medicine as a treatment for inflammatory conditions. Curcumin is the orange pigment in turmeric and is a potent antioxidant that offers numerous health benefits including cardiovascular function, joint health and painting the bodies normal inflammatory response.

Curcumin is generally poorly absorbed into the blood stream so taking a type of curcumin called Meriva curcumin helps increase the bioavailability of the product. Bioavailability refers to the degree at which the product is absorbed.  Some studies have suggested that meriva curcumin demonstrated 29 times greater bioavailability than normal curcumin.

When looking for the product that will help you the most you need to consider the bioavailability and the dosage. By looking for a product that contains meriva curcumin you are ensuring you have the best chance of absorbing it. With regards to dosage we recommend taking 1000mg when in s flare up and 125-250mg when not in a flare up, therefore keeping this in mind make sure you find a product that has a high dosage per capsule so you don’t have to take too many. The product we use here at Elite Spinal is Thorne Meriva-SR which contains 125mg per capsule.

Fish Oil

Fish oil has been shown to possess many health benefits. One of these is its ability to decrease inflammation through out the body. It acts in a way that resolves inflammation after it has done its job. Research shows that as we age we produce less inflammation resolving agents so taking fish oil you are increasing the amount of inflammation resolving agents in your system.

The active ingredients that are in fish oil are EPA and DHA. When looking for the right product for you you need to read the label and look at the level of EPA and DHA in the product. Many products will say the total amount of fish oil in each capsule for example 1000mg on the front of the container however it is important to read the back of the label to find the EPA and DHA level. You would want a product that contains at least 250mg of EPA and 230mg of DHA.

Another thing to consider when choosing your fish oil is the cleanliness of the product. Many companies obtain their fishoil from larger fish, therefore there is a risk that it may contain mercury. It is important to look at the purification method that is used to ensure there are not high levels of mercury in the product. The product we use here at Elite Spinal is Usana’s Biomega, it contains 290mg of EPA and 235mg of DHA. It is purified using a double distillation process leaving it essentially free of harmful contaminants.

With regards to dosage we recommend taking 1000mg  EPA and 920mg DHA when in s flare up and 250mg  EPA and 230mg DHA when not in a flare up, therefore keeping this in mind make sure you find a product that has a high dosage per capsule so you don’t have to take too many.

5 top tips to relieve headaches

1. Increase your water uptake

Dehydration is one of the main causes of headaches. Drink at least 2 litres of water over 2-3 hours.

2. Increase your thoracic mobility 

When your thoracic (upper back) is stiff your head sits further forward. This makes the muscles that run up to the base of the skull work harder than they should and become tight and sore. Doing thoracic mobility exercises is very helpful. See exercises below.

3. Meditate for 5 minutes 

This will help your muscles relax and increase the oxygen levels in the blood as long as you take some nice deep breaths while you are meditating.

4. Take a 20 min break from electronic devices

Over use of electronic devices such as computers, iPhones, etc for extended periods of time can aggravate your neck and strain your eyes. If you already have a headache take a 20 min break where possible. If you start to feel your eyes strain look away and focus on something in the distance for 20 seconds every 20 minutes. This will stop your eyes fatiguing.

5. Get your neck assessed by a physiotherapist 

Dysfunction in the first three cervical vertebrae can cause headaches, dizziness and nausea. These are called cervicogenic headaches. Having these vertebrae gently realigned and your thoracic spine mobilised by your physio will help immensely.

Thoracic Mobility Exercises

Bow and Arrow:

  • Lie on your side with your knees bent up
  • Place your head on a pillow or a rolled up towel
  • Bring your top arm back like you are about to shoot a bow and arrow
  • Keep your hips still
  • Repeat 10 each side

Thoracic Extension

  • Lie over either a foam roller or a rolled up towel
  • Allow your thoracic (upper back) to extend gently until you feel gentle stretch
  • Hold there for 1-3 minutes

Clinical Pilates: The best exercise for back pain

Here at Elite Spinal Physiotherapy and Pilates we combine both Clinical Pilates and Exercise Rehabilitation methods into the same session depending on your needs. All of our practitioners have degrees in both Exercise Physiology as well as Physiotherapy.

How we are different?

  • Physiotherapist led sessions
  • Small groups of maximum 4 per session
  • Health fund rebates available
  • Fully equipped, state of the art studio

Benefits of Clinical Pilates:

  • Reduced neck and lower back pain
  • Increased postural awareness and correction
  • Improved core strength and spinal stability
  • Reduced risk of injury from work and sport
  • Increased bone density
  • Whole body toning
  • Enhance performance in other physical activities