Category: Physiotherapy

Exercise Extra – Piriformis Stretch

Posted on by Scott Ward

The piriformis muscle is found at the back of the hip joint. It is a triangular muscle attaching to the pelvis, sacrum (bone joining your pelvis to your spine) and the femur (thigh bone, also the strongest long bone in the body). The muscle is deep and hence has the gluteus maximus overlying it and below the skin.

The piriformis is an external rotator of the thigh in standing, however when sitting the muscle abducts the thigh (takes the knee away from the adjacent knee). Just like the rotator cuff of the shoulder, the deep hip rotators, of which the piriformis muscle is a member, is an important muscle in holding the ball of the hip inside the socket.

Interestingly, this muscle has been shown to have anatomical variation, rarely existing as two separate strands in the belly but commonly found as a typical single muscle belly. What we do know is that the sciatic nerve runs adjacent to this muscle and so a change to the tone of the muscle and the mechanics of the area can directly effect the sciatic nerve.

Functionally this means the piriformis muscle helps to:

  1. abduct the thigh in sitting eg. like moving the legs to the outside of the car to prepare for standing up
  2. moving from one chair to another without standing up
  3. stabilising the pelvis when the trunk is rotated (eg. golf swing)
  4. controlling the balance of the pelvis when standing on a moving bus

This muscle can therefore often be involved in hip, knee, sacroiliac and lower back pain. Often people have referred to a more non-specific diagnosis of piriformis syndrome.

The muscle therefore has many uses associated with pelvic control, hip movement and general lower limb and trunk alignment. The muscle therefore can like many others, be irritated by a single excessive load, prolonged excessive loading or through inactivity. Commonly we see people with symptoms associated with excessive sitting, overloaded exercise (lifting, stairs, running), twisting of the hip in sport, stepping in a hole or falling on the hip.

Common Symptoms

This muscle as stated earlier, has an important function with a number of joints around the back and lower limb and therefore can be involved in producing a variety of symptoms from knee pain to sciatic pain. Most commonly symptoms directly associated with piriformis activity present similarly to sciatica, a condition often associated with nerve irritation in the lower back. The earlier mentioned piriformis syndrome results from the sciatic nerve getting compressed in the back of the hip locally by the contracted piriformis muscle. Therefore symptoms often associated with its local compression on the sciatic nerve include:

  • tingling in the back of the buttock and possibly beyond and to varying degrees down the back of the leg
  • pain with sitting or direct tenderness on the buttock to pressure
  • pain that increases in the buttock with sitting or with some activity

Treatment

Often the best treatment is prevention. The team here at Nelson Bay Physiotherapy & Sports Injury Centre are experienced in treating this condition. Often the condition is prevented by sensible and frequent exercise patterns progressing in a graded manner. When someone has piriformis syndrome, there treatment includes advice regarding causative movements, corrective exercise (like found below) and manual therapy to restore resting muscle tone and joint mobility. Most of all, your physiotherapist, is very skilled in determining biomechanically whether this muscle is the messenger or the cause of some other deficiency of movement or strength. We will then advise you on what to do to correct this.

How to Stretch the Piriformis

This specifically stretches the piriformis. This can be useful for knee, hip and back pain when used appropriately.

  • Lie on your back with your feet flat on the floor.
  • Bring the knee of the leg you wish to stretch towards your opposite shoulder (up and across) using the hand of the same side
  • Maintain your back on the floor
  • Block the movement/keep the knee in that position with the same hand
  • Loop a strap/towel around the ankle of the same leg using your opposite arm
  • Maintain the knee bend at 90 degrees
  • Pull the foot around to create a stretch in the back of the hip
  • Maintain a hollow in the small of your back.
  • When you feel a comfortable stretch, hold there.
  • Hold for 30 seconds to 2 minutes.
  • Switch sides and repeat.

Feel free to try this stretch. Please be aware this exercise is not for everyone and is best considered for individual prescription following the advice of your physiotherapist. STOP IMMEDIATELY and do not continue if you experience ANY pain.

Article by Scott Ward

Dr Scott Ward

Scott Ward – MMSP, BAppSc (Physiotherapy), APAM BAppSc (Exercise & Sports Science), SMA-

Musculoskeletal Physiotherapist – Sports & Exercise Physiotherapist – Nelson Bay Physiotherapy
Scott Ward has extensive experience in private practice, including Sydney Whiplash Centre, specialising in the treatment of spinal pain and sports injury. He is a qualified Exercise and Sports Scientist, a preferred physiotherapy provider for Cricket NSW and has years of experience coaching with the NSW High Performance Coaching Panel.

References:

Norkin C.C. & Levangie P.K. (1992). Joint Structure and Function: A Comprehensive Analysis (2nd Ed).

Palastanga N., Field D., & Soames R. (2000). Anatomy and Human Movement: Structure and Function (3rd Ed.).

Back Pain In Nelson Bay? What You Need To Know

Posted on by Scott Ward

Back pain is very common among the population. Research has found that 4/5 people will experience significant back pain in their lifetime. Back pain is often very concerning to patients because of the intense pain, strange symptoms and disabling nature of the injury. An explanation and education about the injury can eliminate a lot of this concern.

This article will give a brief overview of different types and aspects of lower back pain.

Back pain can be caused by the classic bending over and lifting a heavy object, chronic overload, poor positioning over long periods, biomechanical abnormalities, and trauma including previous surgeries.

The severity and symptoms of lower back pain vary greatly depending on each individual patient. Different causes and different types of back pain affect what symptoms the person experiences. Common descriptions of pain include sharp, dull, shooting, burning, stabbing and aching. Symptoms can be felt in the buttock, hip and down the leg all the way to the foot.

In some cases, numbness, pins and needles, a decrease in strength and decreased sensation can occur. Aggravating factors depend on the patient but can include sitting, bending, sustained positions, walking, standing, twisting or sometimes any movement of the back. These can be quite disabling and scary for patients and that is completely normal.

There are many different types of back pain that will be briefly described here.

Types of Back Pain

Discogenic pain is when the disc has been irritated or injured. Pain is often aggravated by bending and sitting. This pain can refer down the buttock and leg.

Joint stiffness is when the joints in your back aren’t moving like they should. Often feels stiff and painful and often occurs with other types of back pain. This may be called facet joint pain or facet arthropathy and is often found in arthritic back pain.

Radiculopathy refers to the nerve being irritated or compressed where it exits the spine. This pain will often be described as burning or shooting and can include weakness, decreased sensation, pins and needles and numbness.

Referred pain (radicular or somatic) is pain felt in one location that originates from somewhere else. Sometimes the pain isn’t felt in the back but somewhere in the leg that the area typically refers pain to. This will be reproduced with certain back movements and can be the cause of a leg pain that doesn’t have a mechanism of injury.

Back pain doesn’t always originate from the back and other areas can refer pain to the leg and buttock. The hip and Sacro-Illiac Joint (where the pelvis connects to the spine) can cause similar symptoms and be misdiagnosed. Back pain can also originate from serious pathologies including fractures, cancer, infections, joint diseases, referred pain from organs and blood vessels.

Prevention is based around flexibility improvements in surrounding areas, strengthening relevant weaknesses, correcting biomechanical faults (lifting, sitting, walking, running, etc and lifting smart ie. using help when its there, holding weight close to the body and being aware of your capacity).

The best treatment for back pain which is supported by guidelines from around the world is physiotherapy. Physiotherapy treatment involves education, reassurance and activity modification, retraining movements, manual therapy including mobilisation and manipulation, positioning education, taping or bracing and addressing the cause of the original injury.

Common misconceptions

  • Slipped disc – Disc’s do not slip, they are strongly attached to the vertebra above and below. They can bulge/herniate but certainly do not slip out of place. The disc can be thought of as a shock absorber between the bony vertebral bodies. They have a fibrous outer wall and a gelatinous nucleus. Even loading on the disc within it’s physiological limits is great, but when we load a specific part of the disc repeatedly in a non-uniform manner, we can create deformation and movement of the fluid within the disc in the opposite direction.

This is a little like placing water into the skin of a water bomb, it stretches and deforms. Discs can bulge but this is a fairly normal thing and the extent of bulging will largely depend on the loading at any given time.

  • Sciatica – Sciatica is a term that is commonly used inappropriately. Firstly, Sciatica is not a diagnosis, it is a symptom. It is caused by compression of the nerve either in the back or in the buttocks. Pain running down your leg is not necessarily sciatic pain. As mentioned earlier in this article, pain can be referred from your back without any nerve involvement.
  • Disc bulges are for life – Disc bulges and herniations CAN heal on their own and without surgical intervention. Many studies have scanned acute lower back disc bulges and then again months and years later.

A recent analysis and review of the research found that approximately 2/3 of all disc herniations heal on their own. This means that if you have a disc bulge in your back it has a great chance of healing without the need of surgery.

For more physiotherapy information, read our previous blog on the benefits of physiotherapy!

Written by: Scott Ward

References

Ming Zhong, M. D., & Liu, J. T. (2017). Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain physician, 20, E45-E52.

What are the Benefits of Physiotherapy?

Posted on by Scott Ward

Physiotherapy, also known as physical therapy, is used to restore function to many parts of the body. It can be used for people of all ages and is often part of recovery after an injury or accident but can also be used to treat certain illnesses and diseases, and more importantly, identify causative factors to injury and prevent their reoccurrence.

Prevention is always better than cure, and physiotherapists are trained to prevent injuries not just treat, therefore saving your dollar and your health in the longer-term. The goal of Nelson Bay Physiotherapy is to improve your body’s function and ensure a high quality of life, fulfilling our vision to help you “live your whole life better”.

There are many benefits that go along with physiotherapy, including those that follow.

Control Pain

Many times, after an injury or accident, you’ll be in a certain amount of pain. Physiotherapy can help reduce this pain dramatically, and in some cases, can even eliminate it altogether.

Methods such as manual therapy (massage, mobilisation), dry needling, electrotherapy (ultrasound, electrical stimulation), education and exercise prescription are all forms of physiotherapy used to manage pain.

Improve Mobility and Stiffness

Another primary goal of physiotherapy is to improve your mobility, including standing, walking and moving in general. By strengthening and stretching your muscles, you improve your ability to move.

This is usually customized based on your needs and may include the use of exercise, manual therapy, dry needling, involvement in balance classes, or the prescription of braces/splints/mobility aids (moon boots, walking stick, walkers, crutches or other assistive devices to help you get around).

Improve Strength and Muscle Control

Often weakness is an underlying cause to many of the injuries that physiotherapists treat. Addressing weakness before an injury may prevent injury occurrence or some of the associated symptoms such as pain and stiffness that people associate with an injury.

When you are injured, pain can inhibit your brain from activating your muscles to support the area resulting in loss of strength and often more pain (this is very often the case post-surgery). Addressing weakness associated with injury is therefore not only an important part of rehabilitation from that injury but also important in preventing a secondary injury related to a biomechanical fault resulting from the weakness.

This weakness can be due to your brain signals not getting through to the muscle and/or the muscle losing function because of its non-use. Your physiotherapist is best trained to identify the cause of the weakness and address it appropriately to prevent injury, rehabilitate you effectively to a stronger body allowing you to live your whole life better.

Prevent Falls

If you have certain health conditions or you are recovering from an injury, stroke or accident, it may alter your balance, putting you at a higher risk of falling down and getting hurt. If you’re considered a high fall risk, your physiotherapy plan can help by using exercises to improve your balance.

Manage Chronic Health Conditions

Certain physiotherapy exercises can be used to manage a variety of health conditions, such as diabetes, heart disease, lung disease and other vascular conditions.

For example, some exercises improve blood flow for patients with diabetes, while others condition the lungs and make breathing easier. Physiotherapy can also help you recover your body function after having a stroke.

Prevent Surgery

If you can control your pain and health symptoms by using physiotherapy, you may be able to avoid surgery for your condition. Even if you must have surgery, physiotherapy can help you stay stronger and recover more quickly afterwards. Avoiding surgery can save you quite a bit of money so trying physiotherapy first is a good idea.

We offer Nelson Bay Physiotherapy from an award-winning practice. Call us or pop in to our clinic on Salamander Way to discuss appropriate treatment.

We are first contact practitioners meaning you don’t need a doctor’s referral to see a physiotherapist (only all third party claims require a referral), and in many cases, your physiotherapist will work as part of a team with your doctor and other health professionals to plan and manage treatment for your specific condition.

So don’t delay, get it fixed before it’s a problem.