Comprehensive and specialised physiotherapy services

Hip Bursitis

Hip Bursitis: A pain in Our Butt

 

If you have had pain in the side of your hip, often aggravated by lying on your side, crossing your leg, or when walking up or down stairs, you may have been told that you have hip bursitis. This diagnosis is used quite often, but we prefer to call it by another name, greater trochanteric pain syndrome, or even just simply lateral hip pain!

Bursae typically get a bad reputation for being the cause of a lot of issues, through shoulders, knees and hips alike, but did you know that you have over 150 bursae in your body! They are small, fluid filled sacs that act as a pillow for certain locations in your joints where tendons wrap around a bone, and their primary function is to reduce friction. So sometimes when there has been in increase in load to a muscle or tendon, the bursa can get irritated and painful, hence the term bursitis.

The reason we don’t like using this term is because it doesn’t describe the actual cause of the issue too well. The reason your hip is sore is not because of the bursa, it is because the muscle and tendon surrounding it has been working harder than it can handle.

So what can you do about it?

In the short term, so settle down the irritation, it can be useful to avoid certain positions that increase pain, such as crossing your legs when sitting, or laying on your side in bed. These positions add a little bit of compression to the painful area, but will not cause you any further damage! Once you get back normal, these positions will be fine to return to.

To fix the cause of the issue, you need to get the muscle and tendon stronger to handle more load. To do this, we would prescribe some strengthening exercises for those muscles such as clamshells or resisted hip abduction movements (pulling leg out to the side). Start with something manageable, that doesn’t flare up pain, and slowly build up to doing harder and heavier exercises, until you can handle all the activities you need to, without running into pain!

If you want some guidance for how to progress your strength slowly, use the link below to book an appointment with any one of our knowledgeable physios!


Core Strength

Like to know where your core body strength is?

 

Well, let’s explore that question a little from the point of learning something that may add to our self-care habits.Have a look at this 2min 21sec YouTube clip that gives us a good picture of the mechanics of abdominal muscles as a group where our core body strength is derived:

 

So, that’s how they work. There are many core strength exercises which you can find online these days, but just be wary about the source and the expertise so that you can be informed about your own safety as you try out these exercises. My advice is:

 

  • To always follow an exercise only after viewing it to the end, so you know what is expected of you physically before you even begin
  • To go at a level and pace which suits where you are at – and practice this with conscious awareness of your body’s internal sensations – if in doubt, go slow and easy
  • The most critical tip I can give you about choosing and doing exercises to develop your core body strength is to make sure it is enjoyable for you to do it. Yes, there can be a small factor of extending your current capability – like holding a pose that few seconds longer – but it should always feel right for you to do it.
  • And afterwards, you have this feeling that you have accomplished something this day that you feel proud of within yourself – I call that experiencing an internal smile!

 

The Psoas and deep tissue treatments in remedial massage

 

In remedial massage, I have a special fondness for the psoas when it comes to treating issues like low back pain. It is not a comfortable treatment (for both the client and the therapist) but I have seen amazing results and relief in my clients after one or two or sometimes, three deep tissue treatments of the psoas.

 

The psoas is part of the Iliopsoas – the inner hip muscle whose function is to flex the thigh at the hip joint. It is a large muscle composed of the union of two individual muscles; iliacus and psoas major. It takes its name from the combination of the names of these two muscles. Iliopsoas is the chief flexor of the hip joint.

 

If you sit all day, the psoas becomes rounded like a crescent moon; then, when you stand up, the psoas pulls on your back, making you more prone to pain and lower-back injury.

 

How do you strengthen the psoas muscle?

 

This is a difficult question as I am not totally convinced with many exercises offered to achieve this. One way to strengthen a weak psoas is by bringing your knee above 90 degrees. Sit with your knees bent on a low box or bench (6 to 10 inches high). Maintaining good posture and keeping your abdominal muscles tight, use your hips to raise one bent knee slightly higher than your hips. Do this several times each day. The key to building core strength is to do exercises daily and make it into a habit that you enjoy.

 

Published by Alan Quek – Remedial Massage Therapist

 

If you need help with strengthening your muscles or would like to book a remedial Massage, click the link below


“No pain, no gain”

 

Most of us have heard this phrase before when it comes to exercising and working towards our goals. Some people live by this phrase where as others scoff at it.

 

So how much pain is acceptable to have while exercising?

Unfortunately there is no concrete answer to that question, as it depends on the context. An acceptable level of pain is different for each individual and their circumstances.

For example, we tend to encourage people with chronic pain to work through their pain as it may empower them and reduce their fear of exercise. On the other end of the spectrum, we may advise someone who doesn’t listen to their body to reduce their exercise load, which will allow their body to rest and prevent an injury.

 

Does pain mean that I’m going to have an injury?

Not necessarily.

Although pain is an output from our brains that is normally designed to warn us of an injury, this output can be reduced or heightened depending on the person. It has been shown that people with chronic pain have changes in this process that causes the experience of pain even without the risk of injury.

 

Is there a rough guideline of how much pain is acceptable?

As a rough guide, we normally advise that a pain level of 4-5/10 is acceptable while exercising as long as it settles within 24 hours.

Pain levels are different for everyone however, so it is important to listen to your own body and understand how you respond to pain.

 

How can physiotherapy help with my pain during exercise?

Acceptable pain levels during exercise depends on the context of each individual person and this can include but is not limited to; whether you have any previous or current injuries, what type of exercise that you perform, your exercise goals etc.

A physiotherapist can help you identify your exercise goals, and help you understand what level and type of pain is acceptable to keep you on track to achieving your goals.

If you or anyone you know could use some advice around pain and exercise, book online or give us a call on 83523582 to see one of our physiotherapists.

Are you suffering from pain throughout your pregnancy?

Understand your body and find out what physiotherapy can do to help!

   

Pregnancy should be a memorable and joyous time; however the reality is that 71% of women experience lumbopelvic pain (LPP) that may have very little impact or be completely debilitating. The disheartening thing is that most women (70%) believe that LPP is to be expected with pregnancy, with only 25% seeking treatment. Whilst low back pain and pelvic girdle pain is common amongst pregnant women, physiotherapy treatment can help manage your pain and support you so that you can enjoy the remainder of your pregnancy.

 

But, why is LPP so prevalent during pregnancy?

Pregnancy stimulates a number of changes within the body including biomechanical, hormonal, vascular and psychological changes.

  • The increased weight positioned at the front of the body when carrying a child shifts the body’s centre of gravity (COG) forwards. Postural changes are adopted to compensate for this altered COG, causing your back to extend (lumbar lordosis) in order to maintain an upright position. This postural adaptation places a larger stress on the lumbar spine which may contribute to low back pain.
  • The abdominal muscles stretch to accommodate an enlarging uterus. As a result, their function in maintaining body posture is reduced, placing more stress and reliance on the lower back for support.
  • A hormone called ‘relaxin’ is believed to increase production ten-fold during pregnancy, causing ligaments to become lax and pliable, reducing the stability of the pelvis and lower back.
  • Vascular supply is altered throughout pregnancy. The growing uterus, in conjunction with increased fluid retention that occurs during pregnancy, may compromise the blood supply and lead to hypoxia (absence of sufficient oxygen) in the pelvis and low back.

All these changes within the body can cause a variety of symptoms including pain, stiffness, instability, poor bladder control, tight muscles, sciatica and more.

 

Suffering from LPP during pregnancy is NOT inevitable and it does NOT have to stop you from enjoying your pregnancy.

 

So, how can physiotherapy treatment help you?

There are a range of different treatment options that can help reduce your pain, increase your support and provide you with some comfort throughout your pregnancy. Treatment varies on the individual and their presentation but can include:

  • Joint mobilisations
  • Dry needling
  • Massage
  • Physical Activity/Exercise e.g. walking, strengthening, stationary cycling
  • Pelvic floor exercises – to increase the support of the womb and speed up post-birth recovery
  • Hydrotherapy/swimming
  • Activity modification/postural advice
  • Belts and compression shorts

 

A combination of the above is most effective in providing support for both you and your child throughout the duration of your pregnancy.

 

Want to know more about some of these treatment options? Read below:

 

Joint mobilisations – Due to the postural changes mentioned above, increased load is directed through the joints in the lower back, which may cause them to become compacted and stiff. Providing gentle mobilisations to your low back joints whilst either side lying or lying face down on our comfortable pregnancy belly pillow, may help relieve compression, improve movement and provide some pain relief.

 

Dry needling – Although needling may sound daunting at first, it is completely safe to perform in the back, buttocks and legs. Dry needling works at reducing muscle tightness by increasing the blood flow to the area, flushing away all the ‘nasties’ and restoring muscle length. It can be a great tool to help provide pain relief and reduce muscle tightness.

 

Massage – Similarly to needling, massage helps to reduce muscle tightness. It can also help to reduce swelling of the feet, legs and arms which commonly occurs as a result of increased fluid retention during pregnancy. Massage can help reduce stress and relieve muscle and joint pain. Here at PhysioWest we are fortunate enough to have our very own in-house massage therapists who we work in collaboration with to ensure the best results for both you and your baby.

 

Exercise – Whilst massage can help provide temporary relief, it is important to compliment it with exercise and/or strengthening. As the ligaments soften causing the pelvis and low back to become less stable, there lies an increased need to strengthen surrounding core, hip and back structures to compensate for this reduction in pelvic stability. Strengthening the abdominal, glute and back muscles reduces the risk of further pregnancy-related back pain and also makes for a speedy post-natal recovery. Through assessment, we can identify any areas that require strengthening and create an individualised and safe program for you to perform throughout your pregnancy. Low impact physical activity such as walking, swimming or pregnancy specific exercise classes can help prevent excessive weight gain, reduce risk of gestational diabetes and enhance fitness/strength to cope with labour.

Pelvic floor exercises are also important to consider here. Strong pelvic floor muscles help support the growing weight of the baby, reduce stress incontinence (urine leakage during a cough/sneeze) and speed up post-natal recovery.

 

Hydrotherapy/swimming – Can help relieve pain as the buoyancy of the water reduces the pressure on the joints and muscles of the lower back and pelvic floor. Higher impact land-based exercises that are advised against during pregnancy such as jogging and jumping, can be performed safely in the water. Strengthening exercises can be performed in the water to increase the support of surrounding structures whilst relieving pressure on the joints. Another benefit of exercising in the water is a reduction in fluid retention and swelling associated with pregnancy.

 

Advice – We can provide our professional opinion and recommend advice regarding pain relief, activity modification and postures to help relieve your pain, symptoms and provide you the most support throughout your pregnancy. Using heat packs on the low back and buttock muscles can help reduce muscle tightness and provide pain relief for those during pregnancy. Avoiding prolonged sitting and getting up and moving regularly can reduce pain, discomfort and excessive weight gain which may lead to pregnancy complications.

 

Belly bands, belt and compression garments – These pieces of clothing can be effective in providing support and relief during pregnancy.

SRC are the leading brand in Australia for pregnancy compression garments and are highly recommended by obstetricians and specialists around the nation. They provide a range of different garments including mini shorts, over the bump shorts and leggings.

They may provide comfort, support, improve sleep, reduce vulval varicose veins and swelling, improve walking, improve sciatic nerve pain and reduce low back and pelvic girdle pain. The compression activates your muscles which promotes better core and pelvic stability.

Research shows that 82% of women who wore SRC pregnancy shorts or leggings reported a reduction in their discomfort and increase in support.

You may even be eligible to claim for health fund rebates as SRC products are classified as medical compression garments, designed to aid with the recovery and health of expectant and new mothers.

 

Book in with one of our female physiotherapists, Zoe, Lauren or Sophie to help create a management plan for you.

 

This is an amazing time that should be celebrated and cherished, so let us help you have an enjoyable pregnancy!

 

Sophie Alderslade

Physiotherapist – PhysioWest

References
George, J.W, Skaggs, C.D, Thompson, P.A, Nelson, D.M, Garvard, J.A & Gross, G.A 2013, ‘A randomized controlled trial comparing a multimodal intervention and standard obstetric care for low back and pelvic pain in pregnancy’, American Journal of Obstetrics and Gynecology, vol. 208, no. 4, p. 295, doi: 10.1016/j.ajog.2012.10.869.
Health Direct 2019, Pregnancy massage, Health Direct Australia, <https://www.healthdirect.gov.au/pregnancy-massage>
Jean Hailes 2017, Pregnancy and Weight, Jean Hailes for Women’s Health, <https://jeanhailes.org.au/health-a-z/fertility-pregnancy/pregnancy-weight>
Jessica Pratley 2020, Hydrotherapy and pregnancy, LifeCare, <https://www.lifecare.com.au/clinic/lifecare-southcare/news/hydrotherapy-and-pregnancy/>
Pierce, H, Homer, C.S.E, Dahlen, H.G & King, J 2012, ‘Pregnancy-Related Lumbopelvic Pain: Listening to Australian Women’, Nursing Research and Practice, vol. 2012, no. 387428, <https://www.hindawi.com/journals/nrp/2012/387428/>
Pregnancy Birth and Baby 2018, Pelvic Floor Exercises, Health direct, <https://www.pregnancybirthbaby.org.au/pelvic-floor-exercises>
Queensland Health 2019, What you should know about your pelvic floor: pre-pregnancy, during pregnancy and after giving birth, Queensland Government, <https://www.health.qld.gov.au/news-events/news/pelvic-floor-pre-during-pregnancy-birth-exercises-physiotherapist>

Your Questions Answered – Low Back Pain

Most of us are familiar with low back pain, whether it be from our own personal experiences or from others we may know. Back pain can have a huge impact on our everyday life and tasks of daily living may become a struggle or even seem impossible.

Suffering from low back pain is not uncommon and you are not alone!

Typically, low back pain affects 60-80% of us throughout our lifetime.

 

How long can it last?

Low back pain can be somewhat confusing. For some it can go away so fast they forget it was even there, or for others it can feel like a lifetime of pain.

Luckily enough for most, low back pain can be short lived. Acute low back pain can resolve independently within days or last for up to only 6 weeks.

However, this pain can also progress to a chronic state and last longer than 12 weeks.

What is the source of my pain?

The sources of low back pain varies for all individuals and the causes can often not even be found via imaging. The ligaments, muscles, bones and/or discs that make up our backs can all be sources of pain.

In fact, for majority of low back cases, no one definite anatomical structure can be identified as the source of pain. This is what we call ‘non-specific’ low back pain, a term you may already be familiar with.

More serious and specific pathologies like infections, inflammatory disorders, cancer and fractures only ever make up a small amount of cases and are rarely the source of our pain.

How did this pain start?

Different factors can contribute to the initial cause of our low back pain and this varies and is specific to each individual. Some may experience pain after sudden trauma or movements (twisting, bending and lifting etc.), others may arise from repetitive movements, overload, prolonged positions/postures and many other things. Pain can also develop without any recollection of an apparent cause.

What can I do and how can Physiotherapy help?

Management differs depending on the individual and how they present.  One important thing to consider when experiencing low back pain is trying to remain as active as possible (specific to your own presentation). We don’t want our back pain to stop us from doing the things we love, so it is great to try and continue doing our normal things or even modifying them accordingly.

Seeing a physiotherapy is a great place to start, as they can help you understand your back pain and can work with you to develop an individualised management plan to help you treat/manage your pain. Some ways a physiotherapist can help is by providing manual therapy techniques (massage, mobilisation, and manipulation), guided exercises, education and advice around self-management.

If you or anyone you know could do with some help or would like further information, our group of physiotherapists are happy to help. Check out our website for more information of the techniques we can provide or contact our clinic to book your next appointment.

 


Balague, F, Mannion, AF, Pellise, F & Cedraschi, C 2012, ‘Non-specific low back pain (Author abstract)(Report)’, The Lancet, vol. 379, no. 9814, pp. 482–91.

Brukner, P, Clarsen, B, Cook, J, Cools, A, Crossley, K, Hutchinson, MR, McCrory, P, Bahr, R & Khan, K 2017, Brukner & Khan’s clinical sports medicine. Volume 1, Injuries, 5th edn., McGraw-Hill Education (Australia) Pty Ltd, North Ryde, NSW.