To assess if this is a problem you might need to address, get someone to take a photo of you from the side on profile, just as Sarah stands side on in the video. If you’re at the gym you can get a bit of an idea standing side on in a mirror but you won’t be able to see your neck posture properly and it’s not a good idea to be checking your posture throughout a movement such as a deadlift or squat so def set up a camera or get someone to film you for movement based posture self analysis.
Common posture seen during workout
Ear is forward of your shoulder
Shoulders and ears are forward of the centre of your hips
Whole body is tilted forward
Whole body is tilted back
Sway back (bottom tucked with rounded shoulders)
Kyphotic / Lordotic back (exaggerated curve both in the upper and lower backs with forward tilt of hips)
Straight back (reduced curve in the upper and lower back)
It’s one thing to treat and manage poor posture but it’s good to know what things might be causing it so you can start to make some positive lifestyle changes too. The most common causes of poor posture we see in the clinic are:
Sitting at a desk for work without regular breaks
Studying at a desk without regular breaks
Imbalanced upper body or core exercise programs
Side sleeping without adequate support
Couch potato syndrome
Gaming without adequate support
Overuse of iphone/ipad
Lack of awareness of posture
Poor biomechanics during sport such as tennis or golf
At Myothrive we like to address the underlying cause of your posture problem by doing a thorough assessment to see what’s strong, weak, long and short. From this we can help workout what pre workout routine will help you get in better alignment beforehand and watch stretches or release work might be helpful for after your workout.
If you think your posture could be improved, reach out and we can have chat, simply fill in the form below or ask our bot to contact us for you. We find the sooner you address postural concerns the less likely you are to end up with pain or injury. This goes for sport as well. Adding load by repetition in a game of soccer or netball can be just as bad as lifting a heavy weight when it comes to poor posture. If you know you need our help, you can click here to find a time that suits you best.
There are several reasons why you might experience pregnancy pains related to muscle, joint and nerve. Depending on where the pain is, the intensity of the pain and the type of pain will determine the best course of action to resolve your pain. If the following exercises don’t help or if your pain is intense, […]
Have you ever experienced low back pain that is also a pain in your Bottom? When LBP strikes it is hard to know what to do or how to become pain free again. Clinical Myotherapist Dwan Rosairo explains Lower back and leg referral pain to you! What and why? LBP at any stage of life […]
What is TOS and how do us myo’s treat it? That’s what today’s blog is all about! If you have any hand or arm symptoms such as pain, numbness or tingling even if it only occurs at night it would be worthwhile having a read.
What is TOS?
Thoracic outlet syndrome is where the blood vessels and/or nerves become squashed between the first rib and the clavicle. This can result in numbness, tingling or pain in the neck, shoulder, arm or hand or a combination of symptoms in a combination of areas on down the same arm. If you’re experiencing any of these symptoms it can be diagnosed and treated. It usually takes a month or two to resolve. If your symptoms are severe we suggest going straight to a medical practitioner for scans and specialist opinion however if your symptoms are moderate or mild Myotherapy may be a quicker and cheaper alternative to alleviating your pain.
How does Myotherapy treat TOS?
We will first do some clinical assessment including a neural assessment to check what is causing your symptoms. Sometimes even though you have the symptoms of thoracic outlet syndrome, your pain and symptoms can be coming from elsewhere such as carpal tunnel, from the neck of referred pain and tingling from trigger points around the shoulder, neck, arm or forearm. Once we determine the true cause for your symptoms we can usually do some treatment straight away.
The treatment for TOS specifically involves treating the muscles and mobilising the joints involved in drawing the first rib and the clavicle closer together. These might include the scalenes or the pectoralis minor for example. Next we will work with you to develop a plan so it doesn’t become a recurring theme. This may involve simply identifying the cause and changing some habits however it may also include some home based exercises, self treatment with a self release tool or some specific exercises you will need to do under supervision. We take into account your busy lifestyle so don’t worry that you’re going to go home with a long list of exercises.
What is the best home treatment for TOS?
Want to try something at home to help? Find us on instagram or facebook @myothrive for tips such as spiky ball release for the pectoralis minor muscle. Because the pec minor attaches from the coracoid process which sits just under the collar bone, and then down onto the first couple of ribs, when it gets tight and short, it can lift the rib cage up causing a narrow space for the nerve, artery and vein to pass through. By gently releasing the muscle we can allow the rib cage to drop back to it’s usual resting place and give more space to the blood vessels and nerves. Overdoing this one will leave you feeling bruised so take it slow for best results.
If you want to organise a chat with one of the Myotherapists here at Myothrive, simply email us at [email protected] and we can organise a time. Want to book now? Here’s the link!
The elbow joint is made up of the humerus, radius and ulna bones with muscle and tendon support from forearm and upper arm muscles crossing the joint at the front, back and sides. Deeper down ligaments also offer support on both sides. We also have 3 nerves (radial, median & ulnar nerves) crossing the elbow […]
Yes, please help me improve my squat! Here’s a few mistakes we commonly see in the clinic with customers squats. Improving your technique can lead to reduced pain & better strength gains! Make sure you check out instagram or facebook @myothrive for more tips on squatting. Squat Tip 1: Tucky Bum This is a common […]
WHAT IS IT? Did you know Sciatica or Sciatic Nerve pain is a term used to describe a set of symptoms caused by an underlying medical condition; it is not a medical diagnosis. It may refer to a sharp or burning pain that radiates down the legs from the buttocks. For you to have true Sciatica, […]
Do you ever experience groin or hip pain during or after running, deadlifts or squats? Do you feel like you never get a good hip flexor stretch even though to you they feel tight? It might be a hip alignment issue. A hip alignment issue can lead to Femoral Acetabular Impingement (FAI) which means an impingement of the hip.
FAI can become a problem for active and sedentary people alike. It may be aggravated by activity, sitting for long periods of time, operating the pedals in a car and crossing your legs.
On the other hand, even if you don’t have any symptoms these exercises may improve the quality of your chosen exercise. Check out the video below where I demonstrate 3 simple exercises that are quick and easy to help get your hip alignment improving. Let us know your favourite by leaving a comment!
Think you might have FAI?
There are 3 main types of FAI but often aligning the joint can make a huge difference to pain and function. Often people we treat in the clinic avoid surgery and cortisone injections all together.
Cam – This type of FAI occurs from a bit of extra bone on the head of the femur which then jams on the hip socket (acetabulum) during activity. This type typically occurs in young athletic men.
Pincer – This occurs more often in middle aged women and is the least common type of the 3. This type is caused by extra bone around the lip of the hip socket at the front then as the femoral head rotates it catches or jams against the extra bone.
Mixed – This is a combination of the two previous types; cam and pincer. As described above it causes a catching or jamming in the front of the joint capsule.
These 3 types all describe bone issues however often the pain is from other tissues around the area including ligament, tendon and muscle. Better hip alignment helps reduce the bodies protective mechanism. If movement begins to feel easier and pain begins to reduce, we know we are on the right track!
If these exercises didn’t help your hip alignment or hip and groin pain we have a lot more tricks in our Myotherapy bag. Reach out and we can have a conversation or click here to book. We offer both online and face-to-face consultations.
What to learn more? Check out this other articles.
Femoroacetabular Impingement (FAI) also known as hip impingement is a problem among active and sedentary people alike. Symptoms may include pain in the groin or hip area and restricted hip range of motion (ROM). It may be aggravated by activity (both intense and endurance types), sitting for long periods of time, operating the pedals in […]
CR Stretching or Contract-Relax Stretching is a form of stretching where you hold the muscle in a state of contraction for a period of time (usually around 5-10 seconds) then on the relax phase (usually around 3-5 seconds) you move the joint to it’s new longer range and repeat. Repeat this contract-relax phase for 3 to 5 times until the muscle no longer increases in range. Follow this by holding the last position for 30 seconds. Sounds easy enough, right? But what is actually happening and why choose this form of stretching over dynamic stretching or passive stretching?
What happens when you stretch?
We used to think that stretching was causing a change in the structure and length of a muscle. We now know that stretching is more to do with the nervous system than the muscle. Our bodies are adaptable to our environment and within certain limits we can either shorten or lengthen a muscle over time depending on what feedback the nervous system is receiving.
So what is actually happening? When you hold a stretch, your nervous system gives feedback to your central nervous system that tells it is safe to “let go”. The central nervous system then sends a signal back to the muscles instructing them to lengthen a little bit. When we contract-relax stretch we fast track these messages. Holding the final position for 30 seconds also helps the nervous system to think of this as the new normal. If repeated often enough, i.e. daily for a period of 6 weeks, you should see significant gains in flexibility.
Factors that affect flexibility
Factors that can limit a person’s flexibility include:
previous injury to the muscle that has caused scar tissue (scar tissue lays in a cross fibre pattern unless stretched during the repair phase)
elasticity of the skin
temperature of the tissues on stretch (warmth increase flexibility)
time of day (most people are more flexible in the afternoon)
age (pre-adolescents are typically more flexible than adults)
gender (females are typically more flexible than males)
and the most important factor, ones commitment to achieving flexibility!
Who choose CR Stretching?
When considering what type of stretching is most suitable, always consider the sport or activity you want to master. If you are wanting to weight lift, you don’t just want length in the muscle but you also want strength, therefore dynamic stretching using your weight lifting in conjunction with lengthening the muscle may work best. If doing gymnastics you need strength at end range so passive stretching is not enough to keep injuries at bay, you again need a slower version of dynamic stretching to keep the strength in the end range of your stretch ability.
Contract Relax stretching is a great choice for people wanting to increase their flexibility. Try stretching at night after all your training and work for the day is done and focus on balancing your body out. For example, my hip flexors are short compared to my hamstrings when compared to standard range of movement charts. As much as I’d achieve the splits a lot quicker if I stretch my hamstrings each night, it would do no good for my gym and running technique so I choose the slower pathway to flexibility over injury!
You can also choose a CR stretch when preparing for strength training. Once you have completed the round of contract-relax stretching and held the last position for 30 seconds or so, you simply need to activate the muscle to be ready for strength training. You can do this by holding one last contract phase for a period of 10-30 seconds. This sends signals to the brain to get ready for contractions rather than stay relaxed. Passive stretching before working out before activating the muscle can leave you vulnerable to injury.
The most common desk related aches and pains we hear of in the Myotherapy clinic are neck, shoulders, back and wrists not to mention headaches! Here are some simple stretches you can try and see if they help alleviate your aches and pains. But first a couple of ground rules. If you have any medical […]
Short calf muscles, mainly the deeper soleus muscle can easily hold back your squatting ability. When this muscle is short you will have trouble letting the knee travel past your toes. In a normal squat (and particularly once you add load) in order to bio-mechanically keep everything aligned, the knee needs to travel past the toes […]
First of all, if you are having a new symptom around breathing difficulty, you should go get checked out by your doctor. If severe, call an ambulance or get to your emergency department as soon as possible. Breathing difficulties can be signs of heart and lung issues so always get the more serious causes ruled out first and foremost! Lesser medical causes of breathing difficulties may include asthma, inflammation from a common cold and even anxiety or panic attacks.
Tight muscles can absolutely cause breathing difficulty. There are certain muscles involved in both the exhalation and inhalation process. If any of these muscles become tight, overused or develop trigger point activity (commonly referred to as a knot in the muscle) then this muscle’s function may be inhibited.
The diaphragm is innervated by the phrenic nerve which comes from the neck (C3-C5). It is the primary breathing muscle and also acts as a barrier between your lungs and stomach. This muscle attaches to your ribs, your spine and the lower part of your breast bone. (picture from yoga anatomy)
Because of the diaphragms attachment points, it can easily be affected by postural changes. If you have any neck neck issues, this can also play a role in dysfunction of the diaphragm leading to breathing difficulty. To assess the function of your diaphragm, place your hands on your lower ribs and take a breath in. Did you feel your ribs opening outwards to the sides? If not, it may be a sign that at least in part, your diaphragm is contributing to your breathing difficulties.
Practice Diaphragm Breathing to Relieve Breathing Difficulty
Tie a stretch band around your lower ribs and look in a mirror. Try to breath to make the band expand out to the sides. If you don’t have a band, you can use your hands, but the mirror is helpful to see a visual cue for the movement. Practice this daily with 10 slow deep breaths in, and 10 slow breaths fully exhaling and feeling the ribs come back to their resting place. Once you get good at it, you can practice it more often throughout your day without the aid of the mirror and band.
The intercostal muscles that run between each rib are another main breathing muscle that can cause breathing difficulty. If you get a knock in the ribs, have a cough, sneeze or do strenuous exercise, these muscles can become overworked or develop trigger points and tight bands which affects their ability to expand properly during breathing. The diaphragm breathing exercise mentioned above may also assist these intercostal muscles.
Intercostal Muscle Exercise for Breathing Difficulty
If a different area of your rib cage is not expanding properly, try lying with the “stuck” rib area facing towards the ceiling and doing some slow deep breaths concentrating on breathing into the affected area. Again 10 breaths once per day to start is plenty. Treatment wise we can do some cupping and massage around the rib area to assist with this expansion.
Accessory Breathing Muscles
The muscles around the front of the neck, front of the chest, some abdominal muscles and outside of the rib cage also play a role in assisting either the breath in or the breath out. Some of these muscles assist forced exhalation such as during a sneeze or cough, some assist to lift the rib cage to get more air into the lungs during heavy breathing when working out for example. One of the most common issues we see in the clinic, is the front of neck muscles overworking and causing breathing difficulty. These ones should only kick in to get a really deep breath but often we see them working with a regular gentle breath.
Front of Neck Relaxation Exercise for Breathing Difficulty
To test this, place your hand gentle on the at the front of your neck, just to the side of your wind pipe with fingertips facing towards and onto your collar bone. Take a deep breath and feel which muscles come into play. Now, take a gentle breath. If these same muscles are still working then start practicing keeping them relaxed during a gentle breath. To aid this, use the breathing techniques mentioned above once or twice a day. If you are a shallow breather or have head forward or rounded back posture, you may find this particularly difficult. Make sure you come in for some professional advice to get you working on the underlying causes.
Our mission is simple – Help get busy people out of pain quickly so they can get back to doing what they love. We offer shorter appointments which we can do because we use techniques that are quick and highly effective such as dry needling and the McKenzie Method movement therapy. Once you are out of pain lets keep you there with easy to follow remedy routines and strengthening routines to keep you one step ahead of your fast paced lifestyle!
Shoulder posture is often overlooked until pain hits. We use our shoulders so much without realising. Every time we are at the computer mousing or typing away, every time we reach for our cup of coffee, every time we pick up the kids, the washing, the toys lying around and if you’ve made some time for yourself, every time you do your HIIT workout or yoga routine. We all know by now to relax the shoulders down away from the ears (hopefully without pinning them!) so I’ve focused this blog on a few different tips. Hope you get benefit and please if you have any questions, email me, I love questions!
Tip 1. Fix shoulder blade alignment
Did you know that your shoulder blades are not fixed to your rib cage? This is key, because it means it’s all up to the muscles to hold them in place so if you’re not aware of their positioning, they could be doing all sorts of things! Winging (the inner border of the shoulder blade lifts off the rib cage) is one of the most common postural concern of the shoulder blade.
Correct Winging with this routine…
To fix winging of the shoulder blades you first need to find awareness of them. To do this try these cues:
Widen your upper back by thinking of stretching your shirt sideways
Imagine you’re trying to blow up balloons that exist under your arm pits without using your chest muscles (this is hard but good!)
Before you start this next one, sit up tall and bring your ribs back over your hips (i.e. no flaring ribs). Next, hold onto the front edge of your seat, gently pull towards yourself and imagine the shoulder blades gluing firmly onto the ribcage.
No you know what you’re feeling for you can try incorporating your new skill into your workout routine. Try using a band to activate the muscles before you start your workout. Simply use the cues above for 1-3 set of 10 light pulls and 10 light pushes with a band (start with yellow, the lightest band and work your way up as you improve. Bands available at Myothrive). Then keep the cues in mind as you perform your workout. If you lose your awareness you can come back to the basics until you feel it again. Over time your shoulder blade posture will get better and better!
Tip 2. Fix Rounded Shoulders
Rounded shoulders can happen in two ways. It can come from the shoulder blades when weak lower trapezius muscles are combined with tight pectoralis minor muscles. We are going to focus on this problem today as the second problem takes a bit more assessment and specific exercises.
The other way you can get rounded shoulders is from the shoulder joint itself which is a ball and socket joint. The shoulder is the most moveable joint in the body in terms of its available range of motion. It doesn’t have much ligament support and is really reliant on the muscles and tendons to hold everything in position. This means if one of the muscles gets tight, or if ones gets weak then the shoulder can become slightly out of position. The most common movement we see is when the head of the arm (the ball) moves forward in the joint (the socket). This can lead to impingement, bursitis and tendinopathy or in short, pain and inflammation! As I mentioned, this second way of shoulder joint movement takes a little more assessment and personalised exercise prescription, so if you think this might be you, it might be worth booking in an Online Consultation with one of our musculoskeletal professionals here at Myothrive.
Try this routine…
To fix rounded shoulders we want to take a 2 pronged approach. One, we want to release the tight muscle at the front (pectoralis minor) and second, we want to strengthen the weak muscle at the back (lower trapezius).
Release pectoralis minor with a spiky ball, lacrosse ball or tennis ball either on the floor or against the wall. Below is a picture of the trigger points you are trying to find. Place the spiky ball against the trigger point then come to the wall or floor to add pressure. Next, move your arm up and down the wall to assist releasing the trigger point. You can simply hold the trigger point if you prefer. 60 seconds is plenty and a max of 3 spots. Pro tip: use a yoga block or book to add distance between yourself and the wall or floor.
2. Stretch pectoralis minor – see this post for three ways to stretch pectoralis minor.
3. Strengthen lower trapezius – see this post for ways to strengthen lower trapezius or find us on instagram or facebook for videos and pics (@myothrive)
Try these cues for during your workout to help shoulder posture:
Think of keeping your collar bones smiling 🙂
Keep the front of your shirt wrinkle free
Wear a tight shirt, if you feel your shirt starting to stretch around the shoulder or shoulder blade adjust until corrected.
Pro tip: Make sure not to over correct or pull your shoulders back unnaturally, this will work against your efforts. Just let it all happen naturally with time, with these tips you will get there!
Tip 3. Fix Head Forward Posture
If you have head forward posture it can place extra stress on the muscles around the shoulders which can lead to poor shoulder posture. This can happen in two ways. Firstly, it can cause the muscles that attach from the neck to the shoulders to work under stretch or work in positions that make their job more difficult. This in turn can create pain and trigger point activity in those muscles but like a cascade effect can also create tension and compensation in other muscles around the shoulders and shoulder blades.
Secondly, the nerves that come out from the neck down into your shoulders, upper back and arms can be put under stress. When these nerves get stressed they send signals that tell the muscles they are in control of to tighten. This is a protective mechanism because all the nerves feel is danger, they don’t necessarily know what is wrong or where. This over reaction can create a lot more pain than you bargained for.
Try this exercise…
This is one of my favourite exercises to help head forward alignment and thus, shoulder posture! Sit or stand in front of a mirror, imagine your chin is sitting on a shelf. Gently slide your chin back off the shelf until you feel the first point of resistance. Do 5-10 repetitions. I like to do this throughout my day by incorporating it with going to the bathroom. Doing small amounts more often will have a quicker effect.
Once you’ve been doing this for about a week or 2, you can try adding some over pressure to push slightly beyond that first point of resistance. If you have neck pain or suffer from headaches, just stick to the basic or come get some personalised advice from us by booking a Online Consultation. Here’s some more tips to help correct a head forward posture.
A few more tips…
Seeing is believing! Set up your video camera and watch yourself at your desk, watching TV, on your phone or doing a workout. Sometimes simply seeing what you’re doing incorrect can help you to adjust. Record yourself again doing it correctly so you can associate the new feeling with the correct head posture.
Lift your gaze. Get your screen higher whether it’s your desktop, laptop or iphone, try using books or pillows to prop up the screen to a better height. Same when you are working out, lift your gaze slightly until you feel your head is alignment with your spine. This one tip can help your shoulder posture a lot!
Strenghten your neck muscles. People have generally become a bit scared of working out the neck muscles in fear that it will create neck pain. It’s quite the opposite, weakness is associated with far more pain than strength! A great neck workout is to lie face down and perform your head retractions explained above. Just imagine sliding your chin off the shelf. Start with 1 set of 5 and work your way up to 3 sets of 10 over time. This can be done on hands and knees rather than on your belly if you prefer just try to resist dropping your head to far forward on the relax phase though!
The TemporoMandibular Joint (TMJ) or jaw works hard for us. It’s one of the most complex joints in the body as it moves up and down and can also slide front to back and side to side. Unless you’re suffering from TMJ pain right now, you’ve probably already done a number of jaw related things today; such as, talking, eating, yawning and breathing. Because it does so much for us, it makes sense to give the TMJ a bit more attention, at least we think so! Jaw dysfunction doesn’t just related to jaw pain, lock jaw and clicking of the jaw but can also create headaches, neck tension, ear aches and teeth or gum pain. Below you will find some causes of TMJ and our top tips to start giving your jaw a bit more TLC.
Do you have TMJ dysfunction?
How do you know if you have TMJ dysfunction? First, it’s quiet common with 50-75% of people dealing with TMJ issues at some point in their life; second, our jaw is utilised about 2000 times per day! So in short, it’s highly likely if you have some of the symptoms listed above, it’s TMJ. The most common functional symptom of TMJ dysfunction is the inability to open the mouth very wide. Four fingers is considered normal range of movement and 3 fingers is considered functional. Use your non-dominant hand when testing. Next have a look in the mirror and slowly open and close your mouth; did it go from side to side when you opened or closed? If so, combined with pain or tension, it’s time to try a few of our tips or come into see a Myothrive practitioner for some personalised advice and get some TMJ pain relief.
Causes of TMJ dysfunction
With jaw pain, sometimes there is just one cause, which when altered can make a huge difference to how you feel; sometimes, it’s a combination of things going on. Genetics can play a role, degenerative conditions such as arthritis can be a factor, you may have done an injury to your jaw; most commonly though it’s a musculoskeletal imbalance and/or the nervous system at play.
Some common nerve related and musculoskeletal causes include:
Clenching and grinding at night (more common) or during the day
Pressure on the trigeminal nerve can refer pain to the head and face as well as affect chewing function
Postural habits such as slouching and head forward posture
Faulty pain signals causing tension to protect, when there is no reason to protect
If you are new to the world of TMJ and experiencing it for the first time, please know that in most cases, the pain and discomfort associated with TMJ disorders is temporary and you can achieve TMJ pain relief with:
self-managed care such as movement therapy and strengthening away from poor posture
Myotherapy modalities such as dry needling help to naturally stop the pain cycle. Great in conjunction with movement therapy to help address the underlying causes
Mouth guards worn at night to help with clenching and grinding and to hold the jaw in a better “neutral” position
Botox injections (typically last around 3 months and better when used in conjunction with other therapies to address underlying causes)
Tip1. Get a good nights sleep
Did you know practicing good sleep hygiene helps reduce teeth grinding and clenching at night? Here are our top tips for getting into a better sleep routine and achieving some TMJ pain relief!
Get off your devices at least 30 minutes before bed and don’t take them into the bedroom. Grab a boring novel instead. This hack will help in calming your nervous system. I’m sure we’ve all accidentally read an email we shouldn’t or seen a facebook post that upsets us right before bed. Better to deal with these things in the morning, not right before you get your beauty sleep! Not only that, unless you’ve amped up the yellow tones of your screen, the blue light sends day time signals to your brain which reduces melatonin. Melatonin is absolutely vital for a good, deep sleep.
Make the room dark and quiet. If there is outside noise that disturbs you, consider a white noise track to play as you are going to sleep. I love white noise and have been using it for years. If I wake in the night I play the track again and I’m back to sleep in no time! Also make sure any lights from electronics are set to low and faced away from you. Better yet, get them out of your room all together if you can.
Limit caffeine and dark chocolate consumption. The average half life of caffeine is about 5 hours. This means if you’re having a 4pm pick me up coffee, you’re probably not going to sleep deeply. Dark chocolate also contains caffeine, in fact, 2 servings (around 50g) of 90% dark chocolate can contain as much caffeine as a standard cup of coffee! It also contains a stimulating amino acid called tyrosine, so enjoy your dark chocolate earlier in the day if you want a good nights sleep.
Tip 2 – Work on your posture
Happy, healthy necks make for happy, healthy jaws! This might involve head retractions or chin tucks for example.
A stronger core (not just abs!) makes for ease of movement through neck and shoulders. This might involve some Pilates style exercises for example.
Strong and balanced glutes. Balance should be achieved between left and right sides and between front and back planes. This helps offload neck and shoulders when doing certain day to day tasks such as opening doors and reaching into cupboards for example.
Tip 3 – How to deal with a flare up
Avoid using the jaw too much. Stick to soft foods or smoothies and soups for a few days until it calms down.
Perform your prescribed exercises. If you don’t have any, head to our instagram or facebook page for a demo of something you can try. As always with a new exercise during a flare, start with minimal reps and sets and if it feels okay after an hour you can try some more. Just try one at a time as well or you won’t know which is okay and which isn’t! Typical exercises used are head retractions, tongue on roof of mouth while you open your mouth, sliding the jaw forward and back, sliding the jaw side to side.
Perform some self massage on the jaw, neck, upper back and shoulders. Head to instagram or facebook for videos and pics of how to do this. Usually this will involve massaging from the top of your jaw near your temple down towards the angle of the jaw. It may also involve putting your thumb in your mouth to get the inside jaw muscle however we only recommend doing this one if you’ve been shown how with a practitioner. You can use a spiky ball or a body back buddy to help release your neck, shoulders and upper back.
Patellofemoral pain syndrome or PFPS is a common cause of knee pain, especially among women. Usually the pain is focused around the front of the knee and/or around the knee cap. There’s usually increased pain with descending stairs, walking downhill or sitting for long periods of time. Rest or straightening the knee will usually feel relieving. Want to know more? Read on for common causes and latest research on how to most effectively remedy PFPS.
What’s causing the pain?
The most widely accepted theory in regards to the cause of the pain in PFPS is an increased pressure of the kneecap on the underlying bones. This could be either at rest or when doing activity and is referred to as patellofemoral malalignment or maltracking. (4) Sometimes this is from the knee joint itself causing the malalignment, sometimes it’s from muscles around the knee pulling at the knee cap. In the later case it can even be a ankle, hip or back issue making the knee joint and muscles compensate. That’s why if you have unfamiliar pain, it’s always good to get a proper assessment to check the underlying cause. How frustrating to do a months worth of knee exercises, when all you need is a weeks worth of hip exercises!
What exercises are effective according to the research?
Knee and knee cap in alignment while performing functional exercises can be helpful. For example, here at the clinic we use the McKenzie method to assess which movement is going to align the knee the best to create pain free movement. We then teach you exercises to continue with or use tape to help hold it the correct alignment while you exercise. This is useful for the short term until your body gets stronger. (2)
Strengthen your quad, especially the VMO (vastus medialis obliquus) muscles. Depending on your fitness and current strength this could be a straight leg raise or squats just to name a few. Squats performed with feet slightly wider than hip width apart active the VMO better. This muscle is shown to be weak in people with PFPS. (1, 2)
Active stretching for the hamstrings, quads, calf and front of the hip. Check out helpful videos and pics on our youtube channel or social media account on instagram and facebook @myothrive. (2) This is something we can help with via video consultation very effectively if you’d like something tailored to you!
A more recent 2018 meta analysis where they reviewed a number of recent good quality studies found that strengthening multiple joints was more effective than strengthening the knee alone. (11) Therefore make sure you look to strengthen your glutes, back, ankles and knees. Sometimes the shoulders need strength to assist with the lower body, or the core, so again, it’s important to get a proper analysis done to save you time in your approach to recovery!
What exercises are not effective, according to the research?
As mentioned previously, it’s ideal to strengthen multiple areas of the body in helping your knee, however, strengthening those areas in isolation is no better than strengthening the knee only. The research showed that hip strengthening should not be your primary exercise focus.(2, 11) Some examples of hip strengthening exercises are clams or side lying leg work where the knee is not engaging.
Exercise under supervision is no more beneficial than doing the exercises on your own.(2) However there are a few note worthy points around this. Firstly, the assessment is still really important. Once you know what to do, if you’re self motivated, you can likely do the exercises on your own. Secondly, if you know you’re someone who is not self-motivated or needs regular check ins and progressions to keep it interesting then enlisting the help of a trainer is probably best.
Only focusing on the VMO strengthening is shown to be less effective as the evidence is pointing towards multiple factors being involved in PFPS. (3, 4, 11)
What do I need to be careful with?
Doing too many knee flexion and extension exercises as this may aggravate your pain. Keep the reps and weight low when doing things like a squat or lunge and slowly build up to higher amounts and more weight. All exercises should be pain free and other than workout muscle soreness you should not feel increased pain the following day or after your workout. Some low to moderate pain that lasts less than 10 minutes is acceptable.
Going too deep in knee flexion as this may aggravate your symptoms. Start with shallow squats and lunges and as your strength builds and pain is reducing you can slowly bring yourself into a deeper posture.
Sitting for too long as this may aggravate your PFPS. The amount of time tolerable can be different for everyone and you probably already know how long you can tolerate. If you happen to sit for too long, come up slowly and carefully. Also try not to tuck your legs under the chair or sit on your foot with the knee maximally bent.
Put yourself in an unstable position or on an unstable surface until you are well on your way to recovery. There is an increased chance that you may fall with PFPS because the muscles around the knee aren’t getting proper nerve signals. This will improve with the exercises but you need to be careful in the initial rehabilitation phase. (2)
Kneeling as this may aggravate your symptoms. Putting something soft down can help relieve this problem such as a Pilates mat, a cushion or some foam.
What non-exercise treatments are shown to be effective?
Unfortunately good quality PFPS research is lacking when it comes to non-exercise treatments. The below treatments may be advantageous for some people with PFPS.
Kinesio Tape can be beneficial in the initial stages to help with knee proprioception (the connection between the brain and the knee) when combined with low impact rehabilitation exercises. It is not appropriate to use with high impact exercises such as running. (5)
Myofascial release and self myofascial release to reduce general musculoskeletal pain.(6) This may involve trigger point therapy, dry needling or massage in a clinic setting or a foam roller or spiky ball at home. Again check out our YouTube, instagram or facebook accounts for videos and pics or join us for a video consultation and we can go through it with you.
Ice, ultrasound, biofeedback, neuromuscular electrical stimulation and laser may be beneficial in combination with exercises however alone they showed no improvement.(7)
Taping specific to your needs (i.e for lateral glide, rotation etc…) can be beneficial in early stages but loses effectiveness at 4 weeks and research showed no changes at 3-12 months.(8)
Orthotics can be beneficial over no treatment at all.(9) However this could be a simple arch support from the chemist, you don’t necessarily need an expensive moulded orthotic.
Surgery can be considered after failure of a comprehensive rehabilitation program.(10)
Hopefully you’ve got some good ideas on how to help your knee pain move forward to increasing function and decreasing pain. Have a question for us? Click on the help button (bottom left) to chat with us!
Eun-Mi Jang et al. Journal of Physical Therapy Science 2013. Activation of VMO and VL in squat exercises for women with different hip adduction loads.
Demetris Stasinopoulos et al. The Open Sports Medicine Journal 2015. A systematic Review of Reviews in Patellofemoral Pain Syndrome. Exploring the Risk Factors, Diagnostic Tests, Outcome Measurements and Exercise Treatment.
Els pattyn, PT et al. American Journal of Sports Medicine 2011. Vastus Medialis Obliquus Atrophy Does it Exist in Patellofemoral Pain Syndrome?
Frances T. Sheehan (PhD) et al. Clinical Biomechanics (Online) 2012. Alterations in vivo Knee Joint Kinematics Following a Femoral Nerve Branch Block of the Vastus Medialis: Implications for Patellofemoral Pain Syndrome.
Freedman (PT) et al. Sports Health 2014. Short-Term Effects of Patella Kinesio Taping on Pain and Hop Function in Patients With Patellofemoral Pain Syndrome.
Adelaida Maria Castro-Sanchez et al. Clinical Rehabilitation 2011. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial.
David A. Lake et al. Sports Health 2011. Effect of Therapeutic Modalities on Patients with Patellofemoral Pain Syndrome: A systematic Review.
Christian Barton et al. British Journal of Sports Medicine 2013. Patellar taping for patellofemoral pain: a systematic review and meta-analysis to evaluate clinical outcomes and biomechanical mechanisms.
April D. Jessee (MS) et al. Journal of Athletic Training 2012. Bracing and Taping Technques and Patellofemoral Pain Syndrome.
Sameer Dixit et al. American Family Physician 2007. Management of patellofemoral pain syndrome.
Kristen Scali et al. Is multi-joint or single joint strengthening more effective in reducing pain and improving function in women with patellofemoral pain syndrome? A systematic review and meta-anaylsis. International Journal of Sports Physical Therapy. June 2018.
Just like adults, children and adolescents can also experience musculoskeletal imbalances, conditions and pain. So how do you tell what your child is going through and what health professional to take them to?
If you child has been complaining of severe pain following a fall or injury it may be worth a visit to the doctor to rule out a fracture. If you’re not sure, come to us first to avoid exposing your child unnecessarily to radiation associated with scans. We will be able to assess whether it’s something that needs further investigation.
Other pain in children or adolescent that may be encountered include; growing pains, sprains and strains, muscle cramps, tight muscles from sport, joint alignment issues, scoliosis and other conditions such as childhood forms of arthritis. Some of these conditions we will be able to treat and some we will need to refer to your doctor or a specialist.
So how exactly can a Myotherapist help?
Step 1. Assessment
The first step in treating pain in children is to talking to your child about their pain complaint. Sometimes they need a bit of help from you (parent or guardian) but we try to develop a good relationship with your child by encouraging good communication with us directly. We might ask questions about your child’s pain; how long as the complaint been occurring? How long does the pain typically last when it comes on? Have you had this in the past? What type of pain (or can you think of another time you have had this kind of pain)? When do you notice it the most? Is there anything that relieves the pain?
Once we have an understanding of what has been going on, it gives us ideas of what things to check. This helps us rule out more serious conditions or confirm something that we can treat on the day. The assessment might be getting them to do a specific movement, it might include testing joint, nerve or muscle or getting them to do an exercise to see if it helps.
If we find something we are unsure of we will refer you to the appropriate health care professional such as a GP. If we find something we can help with we will move on to the treatment phase of the consultation.
Step 2. Treatment
With pain in children and adolescents, it’s really important to try to empower them to learn about their bodies and treat themselves. That’s why we try to stay as hands-off as possible. Treatment will usually start with specialised movement therapy or instructing them where to place a spiky ball to help. Upon reassessment if progression is slow then we will become more hands on. This hands on treatment may include joint mobilisation (not cracking), dry needling (if when discussed child and parent is not apprehensive), trigger point therapy and massage/myofascial release techniques.
Sometimes treatment will include a few different approaches but rest assured we will always explain what we’ve found and discuss the treatment plan with you as we go. We then like to retest and make adjustments throughout the treatment to make sure the pain is reducing and the range of movement is increasing. Again always discussing with your child and yourself as we go.
Step 3. Management
Next we will talk about things that are going to be helpful at home for your child’s pain complaint, we like to call this a “Remedy Routine”. This may include applying heat or ice to an affected area. It may include and exercise to stretch or strengthen, mobilise or align. It may include self treatment with a spiky ball or foam roller, it may include a care plan where we check in on their musculoskeletal complaint more regularly (this is ideal for more persistent problems). We will also answer any questions you have and make sure we have set an achievable plan that will fit into their schedule and into your life as a parent/guardian too.
We have built great professional relationships with some local sporting clubs including a gymnastics and acro club, a cricket club and some dance studios.
The clubs find their members are away less from injury when working with us and the parents find they are more confident in the clubs because they know we can offer advice and help out where needed.
We have been treating pain in children and adolescents since starting the Mount Waverley clinic in 2012. Over the years we’ve found the most common issues are posture at school and when doing study at home; not understanding how to control their bodies properly for particular sports or activities; and overuse from having breaks over school holidays, for example, then amping up training regimes when returning from the break. If this sounds like your child then get in contact and find out more about how we can help 🙂
We believe keeping your children active and happy is important to their overall health & development.
Just remember, persistent pain in children is not normal and should always be checked out. Email [email protected] if you have a specific question or click here to make a face to face or virtual booking. Virtual consultations are great for kids because we get to see their environment where they study or play and give them exercises that they can comfortably do at home. Best of all you don’t have to drive them to another appointment!
Why is my ankle stability important? Whether you enjoy running, gymnastics, lifting weights or walking the dogs, ankle stability is important. Even moving from standing to sitting and vice versa requires some ankle mobility and stability. We want your ankles to be strong and flexible. Keep reading to learn how to test your ankles and […]
I’ve labelled this blog Myotherapy & Osteopathy because they work so well together. I personally get a Osteopath treatment every 1-3 months and I get a Myotherapy session every 2-6 weeks depending on how much training I’m doing and if I have any niggles from old injuries. Many of our current patients use both Myotherapy […]