of your baby. But what about after? Once you’re a new mum, your role and occupation shifts from

perhaps being deskbound and computer based, to suddenly becoming a night shift manual labourer

with stretched abs that offer little support!

How do we best recover from pregnancy and labour to get on with the job of learning to become a

mum? How do we regain our bodies to be able to enjoy this phase of life and return to exercise?

Of course, everyone is different and will recover at different rates. In many cases it can take up to

one year and this is normal.

So how does a Women’s Health Physio help?

The early post partum period should involve gentle pelvic floor exercise and gentle walking.

Sometimes the physios and nurses at the hospital may recommend an early post-natal private

physiotherapy follow up to address abdominal muscle separation and organise muscle retraining

and support for the healing structures.

Sometimes there are pressing issues with the pelvic floor and continence that need attention in the

early days and weeks. And sometimes simply holding the baby for long periods of time while you

both learn to breastfeed and settle creates strain in the back and neck that requires treatment and

a little TLC.

Many women wait until after the six week GP post-natal check-up and then present to

Physiotherapy saying “My abs don’t feel the same. I want to check that I am using them correctly”.

And, “How do I return to exercise safely? When can I lift weights and run?”

What should I expect during my post-natal physio consultation?

The initial post natal physiotherapy assessment involves discussing the labour you experienced and

any impact on the pelvic floor and abdomen (if you had a c-section), current activity and exercise, as

well as your past exercise habits and goals for return to exercise. We discuss and investigate how

your lower abs and pelvic floor are working together to operate as the “core” in order to support

your back while bending and lifting to care for your baby, as well as when you are walking and

exercising.

Our Realtime Ultrasound machine is a great tool for this because we can look through the

abdomen to see if you are correctly engaging the pelvic floor in terms of support for the pelvis and

back, and whether you are lifting in the correct direction (towards the head). It is important to avoid

breath holding and “bearing down” through the pelvic floor. “Bearing down” can cause undue strain

to the muscles and connective tissue in the pelvis and prevent a return to full strength and function.

The Real Time Ultrasound machine also allows us to image the lower abs and help you to understand

how to correctly engage them. Many patients are surprised at the subtly of the action of the core

muscles (the lower abs and pelvic floor working together). Sometimes women who have been

involved in high intensity exercise pre pregnancy need to learn how to relax the upper and outer abs

in order to let the core engage and come back on deck to support the pelvis and back.

The core is a postural muscle, it is meant to engage prior to movement and support through

movement. The amount of effort required to activate the muscle is very low (say 20 % of maximum

effort), but it needs endurance to be able to work all day to support. Just today a new mum was

surprised when we used the ultrasound and she re-learnt how to engage her core. “It’s almost

invisible!” she exclaimed. It is definitely easy to over do it and re-training with guidance makes the

process much easier.

During this session we can also check for rectus abdominus muscle separation. It is important to re

train the core first before launching into sit ups and other exercises designed to exercise the outer

abs. We can help set the abdominal rehabilitation program and progress it specific to your needs

and situation.

You will be asked how your pelvic floor is recovering and whether you are experiencing any issues

with continence in terms of frequency of urination, urgency (rushing to the bathroom) or leakage

with cough or sneezing. If need be this area can be assessed further in order to provide advice and

guidance for specific pelvic floor muscle retraining. Pelvic floor retraining can seem like a bit of a

mystery and women sometimes say that it is hard to “feel” if they are doing the right thing. There is

the opportunity to check whether you are doing your pelvic floor exercises correctly if you are

concerned about technique and would benefit from feedback. Most women are relieved to learn

what is going on and what they can do about it.

Looking after a newborn involves a lot of bending, squatting, baby holding and settling. The initial

physio session will look at how you are managing these tasks and how best to use your core to

support your back.

In terms of exercise progression, the initial step is to learn how to activate the pelvic floor and lower

abs (the “core”) and engage these muscles in daily life. The second step involves basic pilates style

exercises performed lying down, exercises for the abs on all four’s and postural exercises to help

with standing, baby holding and the bending and squatting associated with baby care, as well as

developing endurance in core activation for walking.

The third stage usually involves introducing stationary squats and lunges, longer walks and core

exercises that also involve activation of the outer abs. This is progressed in the fourth stage which

involves adding weights, more load, dynamic movement and may involve sit ups and returning to

interval running and training. It usually takes about three months (at least) to get to this stage. The

connective tissues in the pelvis and the pelvic floor muscles need time to recover before being

subjected to the pressure associated with bouncing, running and harder ab exercises like sit ups and

plank.

So, if you’re pregnant and need guidance or are in pain, call us now to see one of our Women’s

Health Physios. If you have just had your baby, or have had your family but have never been

assessed, feel free to see us and we will guide you every step of the way.

Until next time,

Kath Cowen

The post What is post natal physiotherapy? appeared first on Active Physiotherapy Newtown & CBD.

Well…it turns out, if you’ve been in pain, exercise becomes super-critical at ensuring you achieve an ENDURING improvement in your issue. And even though hands-on work feels really nice, it isn’t as effective as when you combine the hands-on work with exercise.

How often have you heard a friend or family member say “Oh, I went and saw practitioner x, and it was really good that day, but the next day, the pain came straight back”? or “my Osteo wants to see me 3 times per week for the next 6 weeks”? Pretty often huh? That’s because something is missing from the treatment algorithm, and this missing link is causing the treatment to not be enduring.

The secret sauce that’s missing is EXERCISE. Targeted, specific exercise that is bespoke to your needs.

Physiotherapy research into pain and rehabilitation over the last 20 years has highlighted the importance of exercise in getting people to recover from having a pain episode. Let me explain.

When we have musculoskeletal pain, as most of us will have at some point in our lives, it’s unpleasant. Feeling and sensing pain is a combination of a neurological input from the body part that “hurts”, for eg, your low back, coupled with an output from the brain, which senses danger. The end-result of what we know as pain, is the final sensation that your brain registers, after it has put together lots and lots of information about what’s happening. Some of this information is important, and some is trivial, but the brain does its best to make sense of it all.

To make things a touch more complicated, exactly where you feel your pain, and where the pain is being generated in the body may not always be one and the same place. Most people have heard about sciatica or referred leg pain. Sciatica is a description of referred pain in the leg, which commonly arises from a disc injury. In this instance, there is absolutely nothing “wrong” with the person’s leg, but the leg pain can be very intense indeed. The pain generator in this case is the lumbar disc, and this is where management of sciatica needs to be targeted to.

So….one of the first things your brain does when it senses pain is tighten up the muscles in and around the area it senses the pain coming from. These muscles that are tightened up (or neurologically upregulated for the medical whizzes in the room!) are our movement muscles. You know these ones, they’ve got names like biceps, triceps, hamstrings etc. These are the muscles that get bigger when you hit the gym and are the muscles that move us through space and allow us to manipulate our environment (for eg open a door or lift a box).

Why does this happen? Well, what the brain tries to do here is protect the body region that it perceives the pain as coming from. It doesn’t want it to move, as it senses that something is “not right”. People can feel this because we have receptors for pain and stretch in our soft tissues and it’s quite clear to perceive – perhaps a muscle feels tight, doesn’t stretch like it used to and maybe causes you to move differently. Patients regularly describe this to us when they come in for treatment.

However, there’s something else going on when your brain senses pain and it happens without your brain even knowing it……what’s that I hear you ask?

Well…. If allowed to go on long enough, there is a neurological downregulation of your deeper core muscles. These are muscles you probably haven’t heard of with names likes rotatores, multifidus and transversus abdominus. These muscles are CRITICAL to you moving and feeling well. The function of your deeper core muscles is to hold up your skeletal frame, despite whatever loads or positions you put it in.

Ever wondered why, when you throw a tennis ball, you don’t just throw your whole body “out” at the same time. Surely, there’s a large force and you really twist your upper body heaps don’t you? Well, the reason is, when functioning optimally, your little core muscles of your neck, shoulder, rib cage, torso and hips all stabilise your body, allowing your big powerful movement muscles to throw the tennis ball. After you’ve finished that task, those muscles control you returning back to your usual skeletal and joint position. Make sense?

Ah…can you see the problem now? Didn’t I say that in the presence of pain, your core becomes down-regulated? Yep – so think of these little muscles getting sleepy and easily becoming fatigued.

So now we have two problems in the system don’t we? We’ve got pain….which is awful and which we can feel…but we’ve also got this down-regulation of our critical muscles which help us move, which we can’t feel. This is because there are no sensors for weakness in the body.  Oh oh….”Houston we’ve got a problem”.

Remember my examples earlier in this blog about seeing your chiro or osteo and only feeling better for the day you were treated? And then everything going “out” again ( their language, not ours!)….well…..can you see know how this occurs? If you have a “sleepy” core, it doesn’t really matter if your helpful practitioner, “fixes” you does it? Because by the time you’ve got back in the car, got home, emptied the dishwasher and run around with the kids, it’s all gone problematic again – that’s because your deeper core muscles aren’t firing and so can’t hold whatever changes your practitioner has made to your body.

That’s where exercise comes in…wonderful stuff!

When we ask you to perform a particular core or functional or strength exercise, what we’re REALLY doing is asking your brain to “tune in” to that particular muscle or groups of muscles. Tune in brain, find that muscle, send a message to it – “Wake up!”

And then what’s really common in exercise prescription? Reps and sets right? It might be your ol’ 3 x 10 reps? Or we might ask you to hold this muscle on for 10 seconds? Or 20? Or even 30 seconds? This all depends on lots of factors I won’t get into here. But what we’re doing here is asking your brain to find this muscle once, twice, three times, lots of times again and again so as to make the neurological message between the brain and muscle really “connected”.

When you do this daily, something really interesting happens – somewhere between 1- 3 weeks, the brain/muscle connection seems to kick into gear and start doing it itself – hey presto! You’ve got a optimally functioning muscle!

Once that muscle is working, it can now take the load of your everyday life and allow you to move easier and more optimally.

Of course, you might need one, several or many many muscles to be rehabilitated with exercise when you come and see us. That’s why we take an hour with your first consultation, to understand what’s really going on with your movement and your body. Then we formulate a plan to make you strong again, helping you move better and hopefully reducing your pain. One muscle at a time. And that is why we give those pesky exercises all the time!

Until next time gang, stay safe and keep moving!

Dr John.

© 2021 Evolution Physiotherapy Pty Ltd. No part of this article can be reproduced without express written permission by the author.

The post Why do we give you exercises when you come and see us? appeared first on Active Physiotherapy Newtown & CBD.

But what about physiotherapy – is there any proof that it works? What do we know about pain? What is does to the body? And what to do to help it go away and to move better through our daily lives?

I’m glad you asked!

A bit of historical context first.

Physiotherapy originated from the need to provide rehabilitation to soldiers returning from World War 1. At the time, a cohort of nurses took it upon themselves to rehabilitate these War Veterans using exercise and movement. By the end of World War 2, physiotherapy was a stand alone profession, working closely with doctors, surgeons and the hospital system, to rehabilitate returning injured soldiers.

Physiotherapists use a combination of manual therapy, soft tissue techniques and most importantly exercise and education with the aim to strengthen patients and improving their functional capacity.

So we’ve come to our first difference that distinguishes physiotherapy from chiropractic  – and that is this: Physiotherapists are trained to assess and rehabilitate individual muscles and whole movements, whilst chiropractors are not.

That’s right….chiro’s get ZERO training at college to assess or manage muscles and their function.

“But muscles are important, right?” I hear you ask?

Absolutely they are….we have many important core muscles in our body, ranging from behind our throat, deep in our shoulder blades, in our tummy and spine and in our pelvic floor.

These muscles help to hold us up….and guess what? In the presence of pain, these important muscles get a bit sleepy (or neurologically down-regulated for the science buffs!)

What does that mean? It means that, when you’re in pain, your core muscles don’t work as efficiently as they would when you’re in a pain-free state.

And furthermore, us physio’s believe that, you really need to get these muscles firing again, in order to achieve normal function across the different joints of your body. For more information, see Professor Paul Hodges and Professor Lorimer Moseley’s work.

So….if you have pain you can rest assured that some of your muscles will be tight and sore ( you will be able to feel these…) and some of your muscles will be sleepy and weak ( these you will NOT be able to feel).

In order to resolve your problems, you will most likely need to have these sleepy muscles “woken up” in order for them to control your movement and return you to full function again.

And it’s physiotherapists who have the expertise to find these little sleepy muscles, wake them up and get them to work with the rest of your body.

When it comes to research, physiotherapists have dozens of solid research articles that prove that your muscles become weak in the presence of pain, whether this pain comes from a stroke, arthritis, back pain or after surgery. We also have a mountain of proof that exercise is the best medicine for pain. Physiotherapists are proud of our record of research, which can give our patients confidence that they are getting world’s best practice when they see a physiotherapist.

I’m sorry I can’t say the same thing about the other guys.

Until next time,

Dr. John Panagopoulos

The post Difference between chiropractic and physiotherapy – Part 2 appeared first on Active Physiotherapy Newtown & CBD.

“What do you think is going on in my body?” and…..

“How long will this take to get better?”

However, the most commonly asked question we get in the clinic is this:

“What’s the difference between a chiro and a physio?”

Now, this is a good question. Why? Well the chiropractors are known to traditionally treat spine problems. And everyone agrees that physios are good at sports injuries.

But is it as simple as this? Of course not.

And that’s why there is confusion.

The confusion really starts with the claims that each different type of provider makes.

The chiropractors believe that all body ailments, from a sore ear, to low back pain, to arthritis and controversially even autism, can be linked back to a “subluxation” in the spine. That is, chiro’s claim that, because something is “out” in your spine, that you can get a disease or even autism.

So….in order for your chiro to “fix” you, they need to manipulate, or crack, your spine to adjust the subluxation “back in”. The chiro’s believe that this adjustment then allows the nerves to communicate better around your body and in this way, you’ll feel better.

Sounds great, right?

There’s only one problem with all this.

It is all baloney

You see…chiropractic as a technique has been around for 114 years. It is described as starting with a gentleman by the name of D.D. Palmer in Iowa in 1895, who noticed a partially deaf person looked like they had a verterba out of place. So Mr Palmer performed an manipulation of this patient and it is described that the next day, the patient could hear fully again.

From here D.D.Palmer devised a set of manipulations for all the different bones in the body, and opened an office and a college to teach these two years later.

Unfortunately, in the 114 years since, there has been not one research paper that can show us, the greater medical community, and you, our patients, that any of this works.

There have been no papers to proof the concept of subluxation exists.

No proof that, even if subluxation exists, that it is the cause of any pain or disease process.

And no proof that manipulation of any subluxations causes any improvements in chiropractic patients.

For more information on this, follow these links:

https://sciencebasedmedicine.org/the-end-of-chiropractic/

https://theoutline.com/post/1617/chiropractors-are-bullshit

So if chiro doesn’t work, does physio? For the answer to that, click on “The difference between chiro and physio – Part 2”.

Until then,

Dr. John Panagopoulos

The post The difference between chiropractic and physiotherapy – Part 1. appeared first on Active Physiotherapy Newtown & CBD.

Up to 80% of people suffer from low back pain at some point in their lives. Thankfully, most low back pain resolves within 6 weeks with simple, conservative treatments and advice.

Low back pain has recently been found to be the leading cause of disability worldwide. Low back pain is more disabling than any other medical condition and this begs the question: why is LBP so common?

Well….the short answer is that modern life has resulted in humans becoming more sedentary and more deconditioned. Our muscles help to support our spine and, if our muscles get weak or “de-activated” we can begin to feel pain. This may even occur in the absence of any pathology. A good example of this is sitting too much. Prolonged sitting is not very good for our low back as it causes your gluteal (or butt muscles) to become stretched around the back of the hip. If left in this position long enough, it appears that the brain simply allows these muscles to “switch off”. Indeed, these muscles don’t necessarily activate when you next need them (perhaps when lifting or playing sport).

So get moving! All exercise is good for your low back – from walking, swimming, cycling, lifting weights and playing golf. It’s so important to get moving and perform activities which you enjoy!

Should I get a scan to see what’s inside my back?

In the case where you have hurt your back, it’s tempting to ask your doctor or physiotherapist for a scan to have a look at what is causing your pain. As most low back pain is caused by things such as weakness or mild joint irritations, nothing of any clinical importance will show up in your scan. Depending on your age, the scan will most likely find some “degeneration” of some sort, but us physio’s consider these to be the “kisses of time”.

What this beautiful saying means is that over time, our tissues age with everyday loads of normal activities and these little bits and bobs found in scans are just normal.

So the answer to the questions is “No”. In most cases, you will not need a scan in the case of low back pain.

What’s the best treatment?

Your doctor may prescribe you some pain relief if your low back pain is very strong and these might help you in the short term. However, to gain a better understanding of what has lead to your low back hurting, your doctor may also ask you to see a physiotherapist.

This is the best option for an enduring relief of pain and return to full function.

Your physio will take a history to understand what has happened to you in the past. Then your physio will perform a full examination of your spine, hips, pelvis and body to see how well your joints are moving. They will also test how well you can perform simple tasks like squatting to see how well your muscles are firing. Your physio may touch certain muscles and joints to see if they move well or are sore.

You will be given a diagnosis of your problem and a plan for rehabilitation will be described to you, as you will be a part of the solution. Your physio will use gentle techniques designed to reduce your pain as soon as possible. A simple effective exercise and postural regimen will be implemented to get your muscles, joints and nerves moving well again. Depending on your goals (playing golf or running marathons for example) your exercises will be tailored to get you back doing what you love best!

The post Reflections on Low back pain appeared first on Active Physiotherapy Newtown & CBD.

In the meantime, if you have any Women’s Health issues you would like to have assessed, feel free to book in with Jane Le Fevre or Kath Cowen who are highly skilled in this area and happy to help!

Until next time,

John

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As some of you may know, I’m nearing the end of my PhD and some of my research has been getting out there into the scientific world. I was recently invited to write an article on the excellent blog site www.bodyinmind.org. The good folks at body in mind are some of the world’s leading thinkers on pain – how it works, what causes it and how we can manage it. The philosophy behind the blog is that it’s crucial for researchers to get their important knowledge of pain out there into the community, to patients, doctors, physios and people in pain. So all the articles are written in an easy-to-read manner with minimal science gobbledygook!!!

If you’re interested in what I’ve been up to, feel free to follow the link below:

http://www.bodyinmind.org/lbp-and-trunk-pain/

Happy reading!

John

The post Easy to read research appeared first on Active Physiotherapy Newtown & CBD.

•    golf
•    cricket
•    cycling
•    athletics
•    dance
•    all football codes

The clinical staff at Active Physiotherapy have all participated in competitive sports to different degrees and are comfortable managing the initial first aid stages of severe sports injuries to the rehabilitation and technical phases of return to sport.

Please see our clinical staff section for more detailed sports coverage experience.

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For our first blog, I’ll draw your attention to new research coming out of Melbourne showing that, in an emergency setting when people are in acute pain, acupuncture combined with standard pain killers (like Panadol) is just as effective as strong painkillers (like Endone). Given both Panadol and acupuncture have virtually no side-effects and strong pain killers do have side-effects (such as constipation and dizziness), this is great news for all patients who suffer from pain.

Of course, this is crucial news for patients who cannot take medication (pregnant women) but, really, if there is a safer and effective option shouldn’t we all use it?

Here’s the link to the story in the SMH: http://www.smh.com.au/national/health/acupuncture-as-effective-as-drugs-in-treating-pain-trial-shows-20140329-35qec.html

All of our therapists at Active Physiotherapy Newtown have been using acupuncture for pain relief for many years and it’s great to see research is vindicating our progressive approach to healthcare.

Until next time,
John Panagopoulos

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