Back Facts

Low back pain is definitely one of the things I treat the most.  The statistics surrounding how many of us will suffer from low back pain at some stage in our lives is staggering.  What is more concerning is the number of people who are hugely affected and left unnecessarily incapacitated by low back pain.

Over the years I have attended many courses, lectures, workshops and read many articles, research papers and the like all to do with the assessment, treatment and rehabilitation of low back pain.  My approach varies between hands on manual therapy, exercise based rehabilitation, and self management techniques.   I strongly believe that movement, exercise and strength work as well as a change in attitude to pain is key.  Fear of pain can be a major cause of delayed progress with regard to rehabilitation.

A recent article by Peter O'Sullivan and his colleagues published in the British Journal of Sports Medicine sums it up nicely!  I have taken the liberty to reproduce their list of ten unhelpful Low Back Pain beliefs and Ten Helpful Facts with regard to low back pain.

Ten unhelpful LBP beliefs

Unhelpful LBP beliefs are common, culturally endorsed and not supported by evidence.

  • Myth 1: LBP is usually a serious medical condition.

  • Myth 2: LBP will become persistent and deteriorate in later life.

  • Myth 3: Persistent LBP is always related to tissue damage.

  • Myth 4: Scans are always needed to detect the cause of LBP.

  • Myth 5: Pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.

  • Myth 6: LBP is caused by poor posture when sitting, standing and lifting.

  • Myth 7: LBP is caused by weak 'core' muscles and and having a strong core protects against future LBP.

  • Myth 8: Repeated spinal loading results in ‘wear and tear’ and tissue damage.

  • Myth 9: Pain flare-ups are a sign of tissue damage and require rest.

  • Myth 10: Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP.

Ten helpful facts about LBP

A positive mindset regarding LBP is associated with lower levels of pain, disability and healthcare seeking. Once red flags and serious pathology are excluded, evidence supports that:

  • Fact 1: LBP is not a serious life-threatening medical condition.

  • Fact 2: Most episodes of LBP improve and LBP does not get worse as we age.

  • Fact 3: A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.

  • Fact 4: Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.

  • Fact 5: Graduated exercise and movement in all directions is safe and healthy for the spine.

  • Fact 6: Spine posture during sitting, standing and lifting does not predict LBP or its persistence.

  • Fact 7: A weak core does not cause LBP, and some people with LBP tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.

  • Fact 8: Spine movement and loading is safe and builds structural resilience when it is graded.

  • Fact 9: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.

  • Fact 10: Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).

It may seem a little controversial in places especially around posture not causing low back pain and core weakness not being a contributing factor!  However my thoughts on these two points are as follows:

  • The best posture is a varied one.  No one posture is bad for your back.  Inactivity and sustained amounts of time in any posture can overload tissues
  • Core strength and Core control are two different things.  Core control is about having a good network of core muscles which are able to control spinal movement and contribute to efficiency of movement and distribution of load as we move.  Individual muscle strength of core muscles is less important, rather how we move as a unit

Source: O'Sullivan PBCaneiro JO'Sullivan K, et a lBack to basics: 10 facts every person should know about back pain

Here is a lovely graphic for you:


Pain in the Calf Muscle!!

Calf muscle injuries are a relatively common occurrence in active people.

The calf is actually made up of three individual muscles: soleus, plantaris, and gastrocnemius. The plantaris muscle is a small, thin muscle that runs from the medial aspect of the distal femur (inside area of your lower thigh) down the middle area of your lower leg until it meets the other muscles and they form the Achilles tendon. The gastrocnemius muscle has two heads which start from the medial and lateral aspects of the distal femur (the area just above your knee). They merge a few cm below your knee and continue down before joining the Achilles. The soleus muscle is the deepest of these. It originates on the posterior surface of the proximal tibia (the back of the main bone of your lower leg).

The plantaris muscle is rarely injured. The gastrocnemius is more commonly injured than the soleus, due to it crossing both the knee and ankle joints. Approximately 20% of people who sustain a calf injury reported feeling tightness in the week or so prior to injury.

calf Gastrocnemius injury commonly occurs when accelerating rapidly (e.g. starting a sprint), or changing direction particularly from a stationary position (e.g. while playing tennis), when the knee is straight and the foot dorsiflexed (toes pulled up).

Commonly people report feeling a stabbing pain or tearing sensation in the medial head of the gastrocnemius or in the musculotendinous junction (the area where the muscle fibres merge with the tendon fibres).

Calf injuries are separated into three grades – grade I is a tear in a small proportion (<10%), grade II is a larger tear (10-50%) and grade III is a larger to complete tear. Soleus injury is reported as being less common, but it may be frequently misdiagnosed.

Accurate diagnosis and appropriate treatment are essential to minimise disability and time off work/sport.

Initial treatment should consist of POLICE (Protection Optimal Load Ice Compression Elevation) for 48-72 hours. Heel raises should be used if weight bearing is painful. At about 36-48 hours gentle stretching should begin, as tolerated. Massage to release tight areas of muscle. A graduated strengthening program should begin with bilateral calf raises on a flat surface, progressing to single leg on a flat surface and two legged off the edge of a step to single leg off a step to heel drops and finally functional activities e.g jumping.

Recovery ranges from around two weeks for a mild grade I strain to about four months for a severe grade III, if you do get the right diagnosis and treatment.

So, if you have a calf injury, are experiencing any pain in the calf muscle OR are just feeling tight in your calf muscles get in to see a physio to assess it properly and help prevent future injuries.

How to Run Smarter and Avoid Injury

How to Avoid Running Injuries this Winter

By incorporating these simple strategies in to your training, you can reduce the risk of running related injuries!

1. Choose your footwear wisely! Not all shoes are made equal so choose a shoe that is right for you! Seek advice here from a Podiatrist if in doubt

2. Stretch!! (Boring I hear you say!!) Maybe join a group class such as yoga if you find doing your own stretches a chore

3. Shorten your stride!! Latest research contradicts previous ideas that lengthening your stride was best!! Over striding is a common mistake that can lead to decreased efficiency and increased injury risk. If you shorten your stride, you’ll land “softer” with each footfall, incurring lower impact forces. Longer strides increase the force at heel strike, however shorter strides encourage landing on the middle of your foot where we naturally have better shock absorption. A shorter stride will usually lower the impact force, which should reduce injuries,”

4. Strength train. You don’t want to “bulk up” and have bulging muscles. You need just enough core, hip, and lower-leg strength training to keep your pelvis and lower-extremity joints properly positioned. You also don’t want to overload individual muscles and joints. “Healthy running should be as symmetrical and fluid as possible,” says Michael Fredericson, M.D., associate professor of sports medicine at Stanford University School of Medicine. “If you don’t have muscle balance, then you lose the symmetry, and that’s when you start having problems.” If you don’t like strength training on your own then try a group class such as Pilates, which targets whole body, functional strength.

5. Listen to your body and know your limits!

Run Smart

Run Smart