Home care during stage 4: Move and Soothe your back and hips

This post is for anyone missing their normal routine and would like some tips on getting rid of the tension and restriction you may be starting to feel in your back and hips.

As most of you are aware, during the stage 4 restrictions in Melbourne, allied health are only allowed to practice on an urgent care basis, meaning that a lot of our regular clients are missing out on getting their regular adjustments as well as maintaining themselves while living in lock down!

Never fear however as Martin and Kieran have got your back and are still in practice!

If you have a specific issue please do not hesitate to contact the practice so we can see how we can keep you going.

Due to popular demand, here are some more stretches and mobilisation exercises to use at home!

Below is a video Martin made at home about how to keep yourself moving at home, helping your back and hips feel human again after the change in routine from the last few weeks of stage 4 lock downs.

As usual with our videos, the transcript is available below, but I strongly recommend you have a watch as Martin runs through some excellent tips, stretches, exercises and muscle releases that will have you feeling a lot more yourself during this period.

Enjoy!

Welcome: 

Hi, it’s Martin here from Align Chiropractic. This is a follow-along video, so you can follow along as I run you through a series of exercises. Today’s video is really about moving and soothing the lower back, hips and sacroiliac joints.

When we are taking care of people in the practice in this area, there’s kind of a hierarchy that we work through to help people’s bodies work at their best. We want to restore movements to the joints first, because if the joints aren’t moving then it tends to create increased stress and strain on everything else. Lack of movement also affects the alignment, and if the movement and alignment of the joints is not the way it should be, then it causes changes to the firing patterns of the nerves. This affects the muscles, which affects the ability of your spine to balance overall, and affects the stability of how that whole system and the body works.

Begin: 1:01

We’re going to work through a sequence. Whilst it’s not as good as getting an adjustment- which is often the only way to get each of the segments working, we can use movements of our body to maximise the amount of movement we’ve got with our spine. We want to make sure that we’ve got everything moving nicely first, and then we’re going to move into increasing and improving the alignment so that we can translate that into having things working as stably as possible. 

Often your body will hold onto muscle tension when things not working properly. We’re going to run through a few releases that you can do to help things feel as comfortable as possible.

Lateral Flexion: 1:40

We’re going to start off with some lateral flexion movements. Lateral flexion is a really important movement in the way that our spine works because the coupled motion of the spine means that if you’ve got lateral flexion, every other movement will perform better.

We are going to slide our right hand all the way down your right leg. We don’t want to force this movement- just get to a point where we feel a point of tension. We are going to go through a count of 3 here, then come all of the way up to go to the other side. We are going to go through this sequence 5 times each way. This should be nice and gentle. We really want to get each of the vertebrae moving as much as they can. 

Flexion and Extension Introduction: 3:45

So, next we’re going to move into flexion and extension. It’s a bit of bias towards really wanting extension as much as possible because so many of our activities, whether we are sitting or bending forward, encourage flexion. For this reason, there is a bit of bias towards encouraging extension.

Flexion/Extension Exercise: 4:03

We are going to start off with extension. Hands on the lower parts of your hips here, and then we’re bending back this way. You just want to be careful that you’re not jamming things, so we’re not going super far into this one. Just get to a point where you feel a degree of tension, then holding for 3. 

From here, we’re going into flexion. I’m going to be nice and gentle here. If your back is feeling a little bit tight then just stop at the first point of tension. It’s fine to have your hands on your legs there, or if you’re feeling free then we’re just going to go as far forward as we can. In this case, the fingers are touching the ground for 3, and then we are going to come all the way up. 

Nice and slowly, coming back into extension. Hand is on the lower back for 3. Same thing coming forward. Nice and easy, just dropping from the hips. That’s our second time through. I’m going to come back here. All the way forward for our third sequence of five. Onto four. Nice and easy coming forward, then last one. All the way back for 3, and then last one forward. 

Rotation: 6:22

For the next part, what we want to do is increase the amount of rotation that we have with our lower back. There are a couple of different ways that we can do this, but I’m going to pick an easy way.

So, what I’m going to have you do if you’re able to, is get your foot over so that it’s at the level of the other knee- that’s ideal. If that’s not comfortable, you can end up just with the leg down like that- but ideally, we want it up like this, so we’re then using leg as a bit of a lever. 

So, with this one, we’re going to incorporate a little bit more breathing. So, this time I’m going to get you to breathe in through your nose, and then out through your mouth. Rather than rotating back and forth, we are just going to hold in a rotated position for three breaths.

So, we’re going to come all the way around, I’m just hooking my elbow onto my knee. The other hand goes around like this way so I’m getting a nice rotational stretch, then just increase it a little bit if I’m able to. That’s two, so we can get a little bit more.  

So just little point of performance there, we’re not wanting this sort of position, we’re wanting a more upright stretch, so stretch comes through our back. So nice 3 breaths there, and then we’re going to swap legs there and stretch to the opposite way. 

So, leg over and then this way. Get that rotational twist in there- in through the nose and out. 

Sacroiliac Joint Movement: 8:33

Okay. So from there, we have some rotational movement. Now we want to get some movement through the sacroiliac joints. They’re the pelvic joints, the joints right at the very bottom. Their plane of movement is rather than this sort of plane, they twist forward and backward a little bit this way. The best way of working them is we want to pop one foot right out in front, and with the other we’re basically going into a long lunge here, and so the back leg is there. It’s really important that this front knee is behind our front foot, and we’re wanting to get this knee back nice and long.  Then what I’m going to have here is I’m going to reach my hands in on the inside of my hips there. So, it’s a bit of a hip flexor stretch as well as mobilising the sacroiliac joints. So, from this position I’m going to hold here. I breathe in through my nose, and out through my mouth, just dropping a bit further in with each breath.

Okay so that’s 3 for that side, just going to swap positions here. I pop that leg forward and this leg back and keep my hands on the inside. If that’s too much then you can do more or less the same thing from this position, but ideally we want to really encourage a lot of movement into those sacroiliac joints because when we’re sitting, they’re not getting much movement at all. Some breathe in through the nose, and out. Just gently come out of that. 

Exercise for Postural Alignment Introduction- 11:03

Okay, so we’ve now got some movement through both the spinal joints- the lumbar spinal joints, and the sacroiliac joints. So, what I want to move onto now is an exercise to just help in terms of our postural alignment. We’ve got everything moving, so let’s do an exercise that will kind of offset that tendency toward flexion and slumping forward that many of us have just from hours spent sitting. What I’m about to show you now is an exercise called a superman exercise

Superman Exercise: 11:30

It’s a really great exercise both in terms of encouraging better posture in your spine, and also it can translate to some improvements in stability.

So really simple exercise. You can lie face down, arms extended in that classic sort of superman position, and what we’re wanting to do here is just quite simply start of quite low. Lift up and hold for 3- that’s one repetition. Making sure you just sort of pinch your shoulders back as well, and having better posture through the middle back as well. That’s 10. Okay, so movement and alignment taken care of. Now we want to see if we can get rid of and release some of the tension that builds up. 

Glute Tension: 13.22

The biggest driver of tension tends to be that tension in the gluteal muscles, so we want to focus on that for this sequence. You can use a lacrosse ball, a tennis ball, a cricket ball, a spikey ball, or a foam roller- this is a little short one, but the same thing works with the bigger roller. For today I’m going to use the spikey ball, but any of these will work.

So, to start with we’re going to go on our side. We’re going to work this big fleshy part on the side here called your gluteus medius. What you’re aiming for here is if you reach down you’ve got the side you’ve hit that top of your hip bone, which is called your iliac crest. There’s a fleshy bit between that and the next part of your hip called your greater trochanter. So, what we’re going to do here is we’re going to lie on our side with that there. Just find a tender spot, and then we’re going to hold that tender spot while we breathe. You’ll notice I’m slightly backward of exactly on my side- your tender spot could be slightly forward or back of there. 

Breathing Introduction: 14:35

From there, I’m just going to breathe in through my nose, then one more deep breath until we’re at that full point, and then out. We’re going to repeat 3 times. 

Okay, so that’s the gluteus medius released. That type of breathing also helps to get us relaxed, or what’s technically called a parasympathetic, or rest and repair state. 

Piriformis Release: 15:24

Now we’re aiming for is a muscle called the piriformis muscle, which is kind of in this fleshy part right where the pocket of a pair of pants might be. We can either just put the thing on the floor and go straight on there. If you want to increase it a little bit more, you can pop that ankle of the right leg onto the knee of the left. Find that tender spot, and then we’re just holding pressure there. We’re going to do double breathes again. Let’s just relax into it. Last one. 

Gluteus Medius: 16:30

That’s it, so now I’m going to flip over to the other side there. Again, we’re going to start with the gluteus medius, so come onto that side and find that tender spot- that’s the one right there. Breathe in through the nose (double breath). Alright, so let’s just released that gluteus medius.

Piriformis: 17:20

So now we are going for the piriformis. Now I don’t have a pocket on this side, but imagine where a pocket would be. I’ll pop my ball there and just have that leg straight like this, with the other one like that, or if that’s too much, just like that works fine as well. We’re going to find that tender spot- yeah that’s the one, it’s a bit more on this side than on the other side. So, I’m going to breathe in, and again. 

Conclusion:

Perfect! So, there we have it. Sequence to move and improve the alignment, and then soothe and release the muscle tension there. Thanks for watching

How to train when you have a low back injury for the Crossfit, F45 and HIIT athlete.

For all you CrossFitters, F45 junkies and HIIT people, we hear you: injuries are boring and no matter what, you need to be back training like…yesterday.

Taking time out of training is boring normally, but when you have become used to (read as “addicted to”) getting the most out of your body, training with intensity and seeing the huge improvements in your health and performance that style of training brings, injuries take on an altogether more frustrating element.

The reality is, the better you allow your body to heal, the quicker you can be back to 100% and the less likely you are to have recurring injury, and the rehab is going to take some effort on your part…but surely as a HIIT training person, you aren’t afraid of a little hard work are you?

The first thing to work on is recognising that just like gains in training, THERE ARE NO SHORT CUTS.

Sadly we cannot immediately heal injuries without letting your tissues repair themselves, but you CAN work smarter to reinforce healing, strengthen what you can strengthen, and make sure that you’re healing things properly to minimise risk of recurrence.

In the video below, Martin outlines some of our possible recommendations for managing back pain while still keeping up your training.

For those of you who miss the old school romance of reading, the video is transcribed below!

As always, if you have any concerns, low back issues (old or new) or just want to get the most out of your training, we are here for you so don’t hesitate to get in touch!

Hi, Martin here from Align Chiropractic and in today's video what I wanted to talk about is a question that we really commonly get asked in our practice from people who are involved in high intensity training. 

So commonly people who do CrossFit, people who do f45, people who are at the gym they're doing resistance training but they're ramping up the number of repetitions, a lot of research shows that it's a great way of getting fit, and it's something that people really love and enjoy doing. 

So what we're really about in terms of taking care of people who into those types of training, is giving them what they really value, which is that they want to keep training, even if they happen to get an injury. 

A really common situation that we have with these people is they’ve come to see us because they’ve got a lower back injury, they're getting some low back pain and they want to know;

“what can I keep doing because I don't want to stop everything, and in particular, what can I do that is lower body oriented?"

“Obviously there's lots of things that I can do in my upper body but I still don't want to lose everything that I gained in terms of strength and conditioning through my legs hips etc” 

The clinical process that we work on with people is we use the acronym ‘M.A.B.S’ in terms of what we prioritise. 

That is, we want to make sure we get proper Movement back into joints before we are concerned about Alignment, as you can’t really change alignment until you have proper movement. 

Again before we deal with Balance, we need to have proper

movement and alignment and before we can even really think about Stability, we need to address those other issues. 

So while a lot of people want to talk about stability as something that they want to have, the key to effectively building stability is actually to prioritise movement first. 

Same thing in terms of exercising your lower body. 

When you've got a lower back that's painful that's not working well and the joints aren't moving the way they should, we want to reduce particular movements.

The number one moment that we get people to reduce when they having issues and they do any form of training is lower back flexion. 

Flexion is when you are tipping forward, like would happen if you are doing a deadlift, you were doing a kettlebell swing, you were doing any sort of squat variation, they involve some form of low back flexion, so we want to reduce that or take that out altogether. 

So, when you’re talking to your trainer, the type of exercises that we suggest that you DO do, that you CAN include for most people who are having low back issues are lunge variations. 

Your trainer will have a bunch of different ones; front lunges, rear lunges, weighted lunges, front rack lunges, there's endless variations there.

Also, step ups, where you're stepping up onto a plyometric box, so they're the

two that allow you to have a really good workout, both get your heart rate up as well as improve your strength, but in a way that keeps your lower back nice and neutral and not introduce that low back flexion. 

So, then when people get further down the process of recovery from an injury, that's where we start to reintroduce some flexion movements, but again we're going to prioritise movement before we start adding load. 

We’re going to start people back doing something like an air squat, before they’re going to start doing a heavy back squat.

And certainly, probably the last exercise that we tend to add back in for people who have lower back issues are deadlifts, when you're picking things up off the ground, because that's the movement we have the most low back flexion.  

I hope this tip has been useful, if you're having troubles with your back but you want to keep training, make sure to give us a call and we'll be able to help you hit your goals both in training as well as get back on track doing the things that you love to do.

9 tips for more comfortable travel

If you’re traveling and have back pain or you're concerned about making sure you're still comfortable once you actually REACH your destination, this post is aimed at you. 

For Kieran and Martin’s 9 tips to prevent back pain, neck pain and headaches when flying, skip to the bottom this post. 

For more back ground and some extra info about looking after yourself when you travel, please read on. 

With the school holidays upon us, a number of our clients are planning to get away with the family for what we hope will be a fun and relaxing time for them all. With that in mind, we wanted to share a few tips on traveling in comfort to maximise how great you get to feel no matter where the destination. 

Like I said...gloating. This was on my first day in Tokyo at Shibuya crossing, the busiest intersection in the world.

Anyone who follows me on Instagram was made very aware in the last few weeks that I went away for a few days… and lets be honest, isn't gloating really all insta is about? 

My point is, if you looked at someone’s travel photos, you see beautiful views, drinking in glamorous locations and sometimes food (I don't really show food as I am too busy eating it) but there is a side to travel that you’ll never see on people’s insta profiles. 

You never see the multiple times that you have to lift and shift luggage, the waiting in lines, the lack of opportunity to exercise and of course, the dreaded aeroplane seats and accompanying lack of leg room with its *ALMOST* enough to be comfortable but not quite level of recline. 

I was contemplating this when I realised that even though it was only a quick trip and a relatively short flight, my girlfriend who has no injury and no major history of back pain and is quite fit and active, had me bring my activator along so that I could adjust her if need be while we were traveling. 

Originally I was jealous because I would have LOVED to have travelled with my own private chiropractor. 

Then I remembered that most of Align’s clients feel the same. 

I cant tell you how many times people in the practice who are about to fly have joked “can I just take you with me to have you on call for the whole trip?”

Yet no matter how many times I have said “yes, pay for my flights and Ill see you at the airport.” no one ever takes me up on it. 

What I mean by all this is, it doesn't matter if you're headed away for a holiday or work, long or short haul flying, everyone knows what it feels like on the other side of travel and wishes they could somehow avoid it. 

The fact is, even though we are keen, even though we might have a person willing to be your travel chiropractor, for most of us (my girlfriend excluded) it is just not practical to bring one, nor does it seem possible to avoid the physical pitfalls of travel. 

This even appears to be true for people I see who don't have to travel in the same class that I do, those fortunate enough to have seats that recline MUCH further and have access to vastly superior champagne. 

It appears that our bodies just aren't built to be inactive for extended periods then immediately lift weights from above head height and repeatedly walk, stand in line, sit again, lift and twist until FINALLY we are at our destination. Who’d have thought? 

Who are you to tell me how to fly?

For both Martin and myself, our interest in comfortable plane travel goes beyond seeing clients every week who are flying all over the world.

Me at Harajuku...not looking like a tourist at all. As you can see, NOT suffering a post flight migraine, the reason in flight health is so important. 

As a lot of you are probably already aware, Martin regularly runs seminars and workshops on chiropractic education here in Australia, but what you might NOT know, is that he is actually a highly sought after speaker internationally as well. In just the last few years Martin has spoken in the USA, Argentina, New Zealand, the UK, Ireland, Holland and Spain and what always amazes me is how short his turn around times will usually be. 

For instance, for his most recent speaking engagement in Scotland, Martin left the practice slightly early on a Thursday evening, flew to Edinburgh for a seminar and was back in Melbourne again Tuesday evening to start practice at 7am Wednesday morning. As someone 18 years his junior (I had to fit that in somewhere) it always astounds me how much energy he still has on the other side of those trips! 

For my part, I began taking more than just a professional interest in healthier travel when as I got into my later 20’s, international flights started to trigger migraines. 

Think of how fun you find airports and customs, and now imagine doing it with burred vision, an inability to deal with noise and a headache seemingly splitting your head in two from the back of your neck to just behind your eye. 

Obviously, I was keen to avoid repeating this fate and so, in recent years have adjusted (pardon the pun) my travel habits to accommodate. 

Well get on with it Kieran, what am I meant to do?? 

Kieran and Martin present:

9 tips to prevent back pain, neck pain and headaches when flying

1. Seating position

For tips about ideal degrees of seat back position, read my post on sitting here.

Don’t forget, that tiny pillow we are given on a plane that seems useless is a great substitute for short term lumbar support or to go under your legs if the seat cushion is pressing in behind your knees.

Another rule of seating position is to mix it up! Your back hates being still for too long and your circulation NEEDS us to change position. You wouldn’t fly to London without moving your ankles toes and feet to avoid DVT and you should think of your low back the same way. 

There are at least 4 seating positions available to you no matter what class you travel in, upright, reclined, upright with lumbar support, reclined with lumbar support. Keep changing between these 4 options to allow your low back the chance for at least SOME movement. 

2. Neck Pillows

No one can actively hold their head up while properly being asleep, as is characterised by the nodding and catching movement we do continually when sitting on planes. 

I have a number of clients who return from flights (many people literally call us to come in on their way home from the airport!) with symptoms that are like mild whiplash. Tight neck muscles, headaches, pins and needles in their arms and restricted neck range of motion are just a few of the symptoms we regularly see after flying and a lot of these could have been avoided if they had been able to properly relax their necks while attempting to sit upright. 

Believe me, I know how lame neck pillows look but there better/less daggy options out there and for me, a neck pillow has changed my life for when I arrive and the quality of my sleep. 

If you are limited for space or forget one, a towel from your carry on or the blanket the airline gives you can be used in a pinch. 

3. Hydration

Staying hydrated tends to be hard everyday in real life, and can seem especially hard when you have to ask someone else for water all the time, but for avoiding headaches, migraines, quality of sleep and relaxing your muscles it is essential. 

The air in the plane tends to dry us out so you should always try to keep your water intake up. Some people travel with a small amount of high quality salt to put a sprinkle in their water to try retain fluid so that drinking doesn't mean too many trips to the bathroom but be careful not to go too far with that. 

The most boring suggestion I have is to limit/don’t drink alcohol while flying. Alcohol inhibits the realise of Anti Diuretic Hormone (or ADH) from our brain, making us need to use the toilet more frequently leading to further dehydration, its one of the main reasons we get hangovers! For further proof of this phenomenon see: “You on a Sunday morning prior to having children”.

4. Sleep

Get as much as you can at the right time. Obviously we need to acclimatise our body to wherever we are traveling to, so if this is in a vastly different time zone, try to sleep like you are already. there.

Neck pillows (as discussed above), eye masks and good quality ear plugs are essential.

The rise in affordable noise cancelling ear plugs has been a God send, but Martin and myself recommend ‘in ear’ earplugs/headphones as larger over the ear ones can make it harder to get your head in a good position for sleeping. 

5. Don't just sit there

Get up and move an annoying amount. Do not care what other people in the cabin think about you getting up and moving about the cabin. 

Obviously this is recommended for avoiding DVT but has the added benefit of stretching and moving the soft tissues of your body. 

My personal tip is to try do some discrete glut activation while you are up. Your gluten are you main pelvic stabilisers and your Glut Max is your largest muscle as its meant to be used for all your lifting, you need it to get your bag down from the overhead lockers and taking luggage off the carousel. 

Remember, you aren't trying to be good at flying, you're actually wanting to enjoy yourself at the other end! 

6. Travel light

The lighter your bags and the less bulky and awkward they are to move around, the easier it will be on your body, no matter how strong you think you are.

7. Prepare early so that you're rested

I cannot tell you how many times I have had to adjust people who have injured themselves PRIOR to leaving for a holiday because getting ready to leave has meant a lot of extra stress in and of itself!

Wry necks, disk issues and headaches are just a few of the issues we see that can be exacerbated or even caused by stress, so do everything you can to be ready early for wheels up - including at work. How often do you stress out about having to get things ready at work so that you can get away? Start looking after yourself in the weeks leading up to your departure and from day one you'll actually feel like you're on holiday. 

8. Meditation

Let’s face it, travel can be stressful. Delays, anxiety about making a connecting flight and of course, your fellow passengers can be an ordeal. 

It can pay to have a good meditation app or relaxing music (as I have said in a previous post I am an Enya man, but there are a few types of music more relaxing than others. For more tips on distressing that post can be found here) can make you more chilled while you fly, leading to a better rested version of you once you get out of the plane on the other end. 

9. Have a brilliant time

You deserve to enjoy your holiday. If you have been putting these tips into practice, you'll be maximising your chances of having the trip you have planned, not one marred by injury. 

Don’t worry! If you find yourself in a spot of bother while you are away, shoot us an email, you'd be surprised just how many places we will be able to fond someone great to get you back on track while you are away. 

If you have any questions about these tips or any suggestions of things I have missed, please feel free to contact us at Align. 

Have a safe and healthy school holiday!

 

Ice Ice Maybe?

Before I get into this, I need to clear up two things.

1. When I use the term 'Ice' or say, 'use ice' I am of course ONLY referring to frozen water. Whatever you do, DO NOT take those terms out of context.

2. let's just get it out of the way:

An obvious yet somehow necessary gag to put at the top of a discussion on anti-inflammatory protocol

There, now that this blog has a soundtrack, we can get started. 

Should I use ice or heat?

As Chiropractors, we get asked this a lot. There appears to be a lot of confusion out there about what you should use, when and why, and that confusion is not just limited to the general public! 

There is a lot of debate and conflicting info about ice vs. heat amongst different health care professions and even between practitioners within the SAME profession, so it is little wonder that when people are injured, they aren't sure what to try. 

In this post I will attempt to explain a bit of the ins and outs of the issue, as well as some of the  the common sticking points in the discussion and ultimately, try to give a summary of the basic approach you could try, based on the best and most current research I am able to get my hands on. 

So, if you are the type of person who just wants to get a few tips WITHOUT having to go through the rest of it (and to be honest, I don't blame you if you do), then please feel free to skip down to the bottom of this post where I will summarise the main info in bullet point form. 

However, if you're like me and you're kind of into the back ground of things, then please read on. 

So why would I use ice or heat anyway?

Full disclosure...this will not be an exhaustive explanation of how inflammation works because that would be WAY too much info to put in this blog and to be honest I really couldn't do the topic justice with my explanation anyway (however, if you would really like to geek out and marvel at just how incredible the human body is, and get a much more complete picture of what is happening at a cellular level in detail, I suggest you check out a video called "Basic Inflammatory Response". Be warned though, videos like this are only the start of a fascinating rabbit warren so be sure to have a clear afternoon for all the other info you'll want to follow it up with).

To EXTREMELY oversimplify the situation: 

1. You injure yourself
2. Your body detects the injury
3. Chemical signals are released to signal to your body to begin healing and cleaning the injury up.
4. The chemicals also cause more healing factors in your blood to come to the area/slow down in the blood stream at the site of injury and help to clean up/heal
5. The resulting 'inflammatory Soup' causes redness, swelling and alterations of movement at the affected site as well as activation of nerves that carry information about the damage to your brain where it is registered as being painful.

As stated above, this is a very simplified version of events that skips many steps in the process but I feel gives you an idea of the situation. 

The most important take home message though? The body is very smart and so it does all this to HELP you, so we want to allow healing to occur as much as possible without hindering the healing process too much.

The reason then that we employ heat or ice is to limit the levels of swelling and discomfort you have to experience, while allowing all these steps to occur and let you live your life while your body gets on with the task at hand. The cooling or heating of tissues is used to constrict or dilate blood vessels in order to modulate the inflammation to inhibit or help the healing factors to arrive at and move on from the site of injury.

Heat and ice have the added bonus of having relatively few side effects compared to their pharmaceutical counterparts, something I find clients are generally very keen to avoid having to take where possible.

Kieran, you haven't answered the question yet, do I use heat or ice? 

That depends on the injury. 

Generally speaking, we use ice for acute injuries (i.e. injury that has only occurred in roughly the last 48 hours) and heat for more chronic injuries (i.e injuries arising more than 2 weeks ago). 

In yet another simplification, we use different modalities because in the early stages of injury, the inflammatory soup is different to one that has been around for a longer period of time. In the gap between 2 days and 2 weeks, you can use ice or heat, or ice AND heat. 

You can however have a chronic injury that you exacerbate, in which case you might need to act like its a new injury and switch back from heat to using ice on it again. 

By now I am sure you can see why so many people can become confused as to what they should do. Don't worry, Ill still give that summary below. 

Does it matter where the injury is? 

No, that shouldn't be a factor.

In the past, some health professions have prescribed ice for acute inflammation for everywhere on the body EXCEPT the spine. For some reason they appeared to have forgotten that the spine is made up of joints, ligaments, tensions, muscles, blood vessels that have the same characteristics as other areas of the body. 

So, in cases of acute injury and pain in the neck and/or back, you should still use ice like you would on a knee. 

Some important points to remember...

As I have said, this is not an exhaustive discussion of this topic, and there is still a lot of argument among researches and practitioners as to the best practice for ice or heat (just type ice vs heat into Google and you'll get a sense of what I am talking about) I am just attempting to summarise what I have discovered from the best sources of research information I can find, as well as my experience with clients with acute and chronic injury in practice. 

Other important points to remember are:

• It appears that crushed ice in a bag is more effective than traditional cooling packs
• Do not return to activity immediately after using ice
• Don't use ice for more than 20 minutes of constant contact/ 
• If you have any questions or concerns about your injury, contact your health practitioner immediately.
• If either of the approaches make you feel worse, stop using them immediately and contact us to discuss your options. 

In Summary:

• Ice for acute injury (roughly under 48 hours old).
• Use ice for 10 minutes on, 10 minutes off, repeat as often as you like.
• Heat for more chronic issues (especially for injuries over 2 weeks old)
• You can alternate heat and ice for 10 minutes of one, 10 minutes of the other 
• There is no hard and fast rule, these are tools designed to make you more comfortable so let your body be your guide. 
• I would still recommend avoiding heat for acute inflammation.
• Do not just put up with pain or even just hope for the best with an injury, the earlier you act the better your prognosis. 
• Call us at Align to have a chat about your injury and discuss how to get back on track. 

If you're the type of person who would like to know where the information I have talked about here came from, please feel free to contact me at the practice at any stage and I will send you through the details of the research articles I have used, 

I will be keeping my eye out for newer, more definitive research and promise to update this post if anything new comes to light.

If you have any other questions or concerns, please do not hesitate to get in contact. 

Kieran

What is the best way to sit?

"How should I be sitting?"

We often get asked this by our clients and on the surface it sounds like a pretty simple and straight forward question but when you think about it, its a much broader subject than it first appears. 

If you subscribe to the theory that the researchers at QI are correct about pretty much everything (and let's face it, who doesn't?) then this video will explain to you a little about the *ideal* way to sit, but what do they mean by the BEST way to sit?

For instance, it could be argued that what you are sitting FOR might actually dictate how you could best attempt to sit. Then again, there are some people who argue that we shouldn't be sitting for more than just short periods at all! 

In this post I wanted to discuss a few different types of sitting and when you might want to use them.

But Kieran, what do you mean by different types of sitting?

I'm glad you asked! there are a few different ways in which we position our bodies when we sit and each has its own set of pros and cons. 

In the video above, they make reference to sitting with an angle between your low back and your hips of roughly 30 degrees. They don't specify this in the video but sitting with an angle like that refers to research for the best sitting position to ease pressure on your lower lumbar vertebrae and disks, hopefully reducing the risk of low back pain or injury including disk bulges. 

When I was studying biomechanics as part of my Bachelor of Applied Science (Chiropractic) at RMIT, (back then, the course was an undergraduate degree and a Masters by course work instead of the 5 year Bachelor degree Chiropractors currently undertake...also Youtube was only 1 year old...thats not relevant to that last point other than it gives you an indication of how old I must be) we learned that the ideal angle to sit was indeed NOT sitting up straight but between 100-110 degrees. Definitely within the ball park of what this episode of QI suggests.

So why are we always trying to sit up straight?

It seems strange doesn't it that despite scientific evidence to the contrary, that we should still be obsessed with sitting up straight. 

I can't find any rational reasoning for this but I posit that it's due to our societal awareness of posture in reference to our shoulders and head forward positions, rather than any awareness of our spinal health at large. 

Well then...which is it? Posture or low back health?

To be completely honest, I do not believe that there is one answer to this question. 

Firstly, if you know you have, or at risk of a low back injury, then it is reasonable for you to, as much as possible while sitting, attempt to have an appropriate angle of between 10 and 30 degrees beyond sitting up straight. I would also add, if you have or believe you are at risk of a low back injury, please contact us at Align Chiropractic to see what ELSE you can do to get on track beyond remembering how to sit. 

Secondly, if you don't have a specific reason or concern in reference to your low back, then as stated earlier, perhaps it is best to remember the context in which you find yourself sitting. 

If you are going to be at a computer for most of the day, then a focus on correct sitting posture. 

A couple of quick reminders are:

• Key board - Positioned more directly in front of you, so you aren't reaching for it or turning your     wrists to get the correct angle.
• Screen - Directly in front of you,at a height where your eyes are aimed directly in the middle just about the centre of the screen.
• Chair - Adjusted to a height where your feet can easily touch the floor with your hips at or just past 90 degrees to your torso.
• Mouse - Just to the side of the keyboard, easy to reach in a way that keeps your arm bent, not reaching for it.
• Alignment - Sitting up straight, don't slouch and don't let your head and shoulders slump forward. 

Always remember to keep what you need to use IN FRONT OF YOU in an easy position to use.

Computers and equipment was designed to fit US, not the other way around!

Your other best line of defence is to try utilise a standing desk for at least some part of the day!

However, the above video raises an interesting point, If sitting more casually, i.e. watching a movie etc, then sitting up straight as if you are using a computer doesn't really feel like it makes much sense. Lets face it, it doesn't matter who you are, no one can sit up straight for extended periods of time. 

It makes sense to do it while working, where we can get up from the desk to stretch, get water or to stop our body from fatiguing, but if you're planning to sit and enjoy Casino Royal, re watch the Back to the future trilogy or binge The Sinner, then you can hardly annoy everyone you're watching with and interrupt the show with incessant stretching. 

This is where finding that 10 to 30 degree angle for your low back really comes to the fore.

Similarly while driving, I do not expect you to stop every 20-40 minutes on your daily commute for a walk, so keep that position in mind when you set up your car seat (I will post about correct driving position in the near future, but as a general rule, give yourself that slight angle, position the steering wheel so you aren't leaning forward to reach for it and make sure your head isn't being pushed forward by the headrest).

Another question we get asked frequently is should you sit on a gym ball instead? 

My answer is always the same...if your living room or office aesthetics suit the presence of a gym ball as a permanent piece of furniture, then perhaps posture and sitting is NOT the biggest issue you are currently experiencing. 

More seriously though, in my experience, sitting on a gym ball doesn't provide you with a better sitting technique for an extended period. Like anything, our body will fatigue if we ask it to hold a more rigid position for a long time and eventually we all end up slumping. Personally, I believe that a gym ball can actually help you to slump your shoulders forward as it offers you no form of support to relax into a better position. 

If you DO insist on sitting long term on gym ball, always be mindful of when your head slumps forward and your low back has started to curve in the opposite direction. 

Yep, just like any product sold on late night infomercials, the sad reality is, sitting on a gym ball will NOT automatically give you abs. 

The same can be said of ergonomic chairs or those kneeling 'chairs', not only are they usually more of an eyesore than you would hope them to be, they are really about trying to make the most of a crummy situation. They will try place you in a better posture but without adjusting your position, mindfulness of your body and remembering to get up and move frequently, your body will always try to reduce energy expenditure and slack off as soon as you aren't looking. 

So what SHOULD I be sitting on?

For a hint at the type of chairs we at Align DO actually like people to sit in, look at the furniture in our practice. 

The Eames chairs we have in the practice weren't just chosen for how beautiful they are, or how well they stand up to being sat on by hundreds of people, they also allow you to be comfortable in a relatively good position for a reasonable period of time. 

At the end of the day, there really is no substitute for body awareness. 

Listen to your body. Stand up when you need to stand up, move when you have to move, and re-position yourself when your body tells you it needs re-positioning. 

To discuss the best ways to combat bad posture, exercises to improve your ability to sit better, or discuss your concerns about your posture, contact us at Align on (03) 9696 1057, or bring it up during your next visit so that we can discuss your issues specifically and tailor an approach to your and your needs. 

School is Back so Back Pack chat is Back

Back to school time...

Yep, I'm sorry to ruin your child's holidays but we knew this day was coming eventually. 

Although to be honest, this blog shouldn't really just about going BACK to school. For some reason we only talk about back packs when we are about to commence a new school year, but really we need to focus on them the whole year through. 

No matter how old the school bag or how old your children are, back packs represent one of the most common physical stressors that children will face in our society. Research suggests that back packs should not be heavier than 10-15% of the body weight of the child carrying it, yet how many times have you picked up your child's bag and thought it would be uncomfortable for YOU to wear?

As a matter of fact, an international study printed in Spine found that 79.1% of children find their backpacks are heavy, and 46.1% complained that their bags caused back pain.

This is made worse by the fact that in the same study, it was discovered that even though nearly half of the students had back pain, 33% of all of the students were still wearing their back packs too low!

If you want an idea of what happens to posture and spines when you wear a back pack incorrectly, see the photos of our amazing practice model Nicholas below. Nicholas has great posture and is more active than an average boy of his age. (On top of that, he is hilarious and an absolute gun for being a part of this post!) As you can see, none of that matters when he wears his bag incorrectly.

Nicholas shows us what happens when your back pack is too low, note that his head is forward, his shoulders are rolled and his low back has increased curve. 

The reality is, this overloading and incorrect loading of your child's spine may be putting them at risk of longer term spinal damage.

Add that to the time spent sitting or looking at the screen of a phone or iPad and....well I don't need to tell you what this means for posture. 

I have already discussed the issues with poor posture earlier in this blog, (for a look at a more in depth discussion about posture, read the post here) but in summary, poor posture is bad, and the longer it's left unmanaged the worse things get.

So what should you do?

At Align we are concerned about the future of younger generation's health and posture, which is why Martin and I will be providing free back pack assessments to ensure that your child starts the year off with their best foot forward. 

It is always fascinating to see how a small adjustment to a child's backpack can have far reaching effects. 

If you would like to book a Back Pack assessment for your children, please do not hesitate to contact us on 9696 1057.

In a slump...Is it time to stand tall and stop your mum from nagging you?

Good Posture...I know, I can feel how bored you are already. I don't blame you. Can you even count how many times you have been nit picked about slouching? 

And why the hell should you care right? I mean, who cares that you slump a little? Plus, its so hard to stop doing! You try so hard to be upright when you first get to your computer but sure enough, 2 hours later you find yourself leaning into the screen of your computer with your shoulders hanging from your ears and a back hunch that would make Mr. Burns envious. 

A man displaying woeful posture...in need of nagging

As a Chiropractor, 2 things happen often in my life. 

The first is that at almost every time I am introduced to a person or group, most people instinctively straighten their backs and sit or stand taller, as if they all instinctively know that 'Good Posture' is important (even if we don't know why) and that its something we only think about when prompted to (even though we know deep down that our posture isn't great in the first place)

The second is that poor posture is one of the leading causes the issues that we see in our practice every day!  

Low back, neck pain, jaw pain, shoulder injury, predisposition to spinal degeneration, carpal tunnel type symptoms, migraines and tension headaches are some of the most common symptoms we see day in and day out and it doesn't take much Googling to find that a lot of these problems are either caused by, or at the least made worse by, poor posture. 

So, how does having bad posture lead to these issues? 

The answer is actually really simple and its actually a major part of understanding what we do as chiropractors:

Nervous system feedback and the body’s position in space

"The deeper layers of muscle are concerned with ‘sensing’ our position in space and relaying this information to the brain. If this function is taken over by muscles... (As a result) the brain gets an incomplete picture. The brain assumes that the body needs to be propped up to counteract the effects of gravity, so it triggers further muscle contraction. This adds to the general fatigue and pain felt by the person with poor posture." - The Victorian Government's better health website 

The issues with poor posture appear to go beyond just the physical mechanics as well! 

If I told you to imitate a person who is stressed out, anxious or depressed, I bet you would tighten and slightly raise your shoulders, pushing your head forward and making you shorter. Sound familiar? 

Some authors discuss that consistently being in this position might actually lead to deepened depression, increases in perceived stress, circulation issues, as well as negatively affecting digestion, breathing mechanics and the we way we are perceived by ourselves and others!

So what can we do about it? Well I'm here to tell you that dealing with posture is both simple AND challenging. 

Simple in that there are very basic ways that we can start to work on and improve how our body holds itself, yet challenging in that as Australian's, we are sitting or lying down for an average of 23 hours and 47 minutes, so we have a lot practice at bad posture to try and work against!

Over the space of a few more blog posts, I am hoping to talk you through some strategies to start tackling this problem, but until then, if you have any questions, or if yourself or someone close to you needs help getting out of their slump, please do not hesitate to contact us at Align on (03) 9696 1057.

Kieran