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The most common misunderstandings about SCIATICA that can make it worse!

13/11/2020

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Do you or someone you know suffer from radiating back or leg pain?
Sciatica is a frequently occurring condition that has been estimated to effect 5 in 1000 people (1). Sciatica is most commonly caused by a herniated lumbar disc where the nerve root is compressed by the disc. The nerve can also be compressed by bony changes occurring around the spine. Regardless of the cause, the nerve is still undergoing compression, and combined with inflammatory and immunological processes seems to be the important cause of sciatica pain.

Sciatica can be a pain in the buttock, literally! Left unmonitored and untreated it can be debilitating and things like walking and sleeping can become difficult. This can affect quality of life and lead to low mood, which often leads to a vicious cycle rather than the road to recovery. On top of this, sciatica pain is known to make things like
 bending, twisting, coughing and even sitting painful, making even the simplest of tasks to be unbearable. ​​
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​A recent study found that patients with low back pain who saw a physiotherapist early, had significantly lower out of pocket healthcare costs and decreased use of opioids than those who saw physiotherapist later or not at all (1). When you consult with us, we will work with you to provide an adequate explanation of the nature and prognosis of sciatica. In the early stages, international guidelines suggest that bed rest is not recommended unless pain is significantly disabling. In fact, we will work with you to keep you physically active and doing activities that are important to you. We will combine activity with nerve relief manual therapy and nerve easing position and movements for you to do at home.

Once relief has been achieved, treatment will be more recovery focused, and involve muscle memory tasks and goal specific rehabilitation.

Physiotherapy uses a combination of evidence-based research, clinical experience and clinical training to diagnose and treat your presentation of sciatica. ​For examples of exercises that can be used, remembering that every sciatic presentation is an individual one, check out this exercise video for sciatica below: 
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References:
  • J Physiother (2020), 66(2), 83-88
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THE THORACIC SPINE ENIGMA

7/2/2020

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THE THORACIC SPINE ENIGMA

A well-functioning thoracic spine can accelerate your running and promote pain-free living.
The thoracic spine is the mid-back between the neck and the waist (lumbar-region). The ribcage attaches to it. This special part of our spine gets less attention in science journals than other spine areas. It an important source of local or referred pain for spine, hip and shoulder problems. This is due to its unique nerve supply and mechanics as a junction between the upper and lower body.
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“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

As an important mechanical lever of the body, taking 47% of body weight (1), the curve of the thoracic spine impacts on shoulder girdle movements (2-3) and the lower limbs. For example, walking and running rely on thoracic rotation to store and generate momentum. In turn, the thoracic spine is very stable alongside its partner, the ribcage, affording protection to vital organs. Consequently, it is less mobile than the neck or low back.

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

Motion of the shoulders relies on rotation and side bending in the thoracic spine (2-3). If this part of the spine loses the little flexibility it has, more load is placed on the shoulder joint, girdle and rotator cuff. The compressive forces from a lack of spine flexibility can set up problems elsewhere in these other tissues.
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“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”
​

Walking and running uses to-and-fro arm swing and shoulder motion, whilst simultaneously the thoracic spine winds up and down via twisting motions. This enables balance and, like a spring, enables energy transmission to the arm swing to propel the body forwards. In fact, to increase speed when running, you need to increase your thoracic twisting motion (4). You can compensate for this via the hips or overarching the lumbar back, but for how long?
The nerve supply of one thoracic vertebral segment is also known to include several levels, meaning a mixed nerve supply. A problem in one area can refer to many seemingly unrelated regions of the arms, buttocks and legs. Occasionally, when counterfeit symptoms resembling organ pain are from thoracic joints, physiotherapists will judiciously examine for key features of musculoskeletal involvement, being pain on movement, tenderness and tightness of musculoskeletal structures (5). If these musculoskeletal features are absent, then the case requires further consultation from a medical practitioner.

References
1. White, A. A. 1969. Acta Orthopaedica Scandinavica Suppl: 127, 8-92.
2. Tsang, S. M. H., Szeto, G. P. Y. & Lee, R. Y. W. 2013. Manual Ther: 18, 431-437.
3. Crosbie, J., Kilbreath, S. L., Hollman, L. & York, S. 2008. Clin Biomech: 23, 184-192.
4. Tojima, M., Osada, A. & Torii, S. 2019. J. Phys. Ther. Sci.: 31, 661-665.
5. Harding, G. & Yelland, M. 2007. Aust Fam Physician: 36(6), 422-3, 425, 427-429.
 
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Munich – Beerhalls and Muscles

8/5/2017

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Munich

Understanding muscle injuries

​Muscle injuries are common for people who exercise regularly and aim to improve their health status. Not all muscle injuries are bad, such as the soreness after a gym session, run or returning to activity you haven’t done for a while. There are times though when muscle pain is not pleasant, and it results in a pain that last for longer than normal and limits your ability to exercise and move. It is these types of injuries that need expert management. 

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    Luca Scomazzon-Rossi APAM

    Luca graduated from a Bachelor of Physiotherapy with honours and has a background in personal training.

    Jayce Gilbert FACP, APAM

    Clinic director & Specialist Musculoskeletal Physiotherapist* in treatment for back, neck, headache and TMD (Jaw/Face) problems.

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