Anatomy, Equine, Injury and Rehab, Injury Management

Equine Acupressure: To the point of it!

You may be asking what is acupressure and how can it help my horse? If so then the following post will help answer this question.

Equine acupressure has the same roots and theory as acupuncture. It involves the application of pressure from fingers rather than the use of needles making it safe and noninvasive (acupuncture in the UK can only be performed by equine vets). It can be used as a stand alone treatment or integrated into a sport massage to help support your horses health.

Acupressure is based on traditional Chinese medicine, which offers a method of natural healing by trying to maintain the innate balance of the body. Acupressure uses invisible lines of energy flow called meridians, and along these lines are specific points which can influence the body when pressure is applied. There are 14 meridians connecting organs with other parts of the body. It is thought that energy (Chi) that flows along these meridians can get blocked causing symptoms to develop. By applying pressure the balance and energy flow can be restored. Chi (energy) is composed of Yin and Yang, which are two dynamic forces that are the opposite to each other. Yin is seen to be represented by water, wet, cold, nourishing, and dark (to name a few), whereas Yang is fire, dry, hot, active, red and consumes. When Yin and yang are in balance chi is flowing harmoniously and the body is healthy, however when they are not in balance there is disharmony and disease develops. Acupressure can help restore balance and act as a preventive.

Acupressure can have the following benefits

  • Releases natural occurring pain relieving chemicals in the body
  • Reduces inflammation and swelling
  • Increases blood flow allowing an increased rate of recovery from injury
  • Increase energy levels and wellbeing
  • Decrease anxiety
  • Encourage relaxation
  • Help joint lubrications and movement

When working on equine clients I often integrate acupressure points into my bodywork (massage) sessions to help create a bespoke and more holistic approach. I frequently find horses relax hugely with use of acupressure by their eyes softening, heads lowering, muscles relaxing and often dosing off. This allows me to be more effective in treating areas of discomfort as well as supporting the horses overall health.

If you would like to discuss the potential use of acupressure in your horses treatment then do contact Pollyanna using the form below


Anatomy, Biomechanics, Human, Injury Management

Feet the foundation of movement: Part three keeping your feet happy

In the the first blog of this series we looked at anatomy and function of the foot and then proceeded to discuss some common injuries in part two. This part looks into exercises that can help keep your feet supple and strong for everyday life.

Video on exercises to help keep your feet supple and strong

I hope the video was helpful if you have any questions then do please get in touch

Biomechanics, Equine, Horse & Rider, Injury and Rehab, Injury Management

Horse Pilates: Encouraging core engagement through movement

In the run up and during lockdown my clients and friends have increasingly been using the words Horse Pilates to describe part of what I do to help horses move better. To the point that even the Daily Telegraph have used that term in an article published recently. So I thought a blog post about Horse Pilates was needed.

What is Horse Pilates?

Human Pilates was developed by Joseph Pilates. He develop it when in the UK to help injured soldiers from the War to recover. Pilates believed that mental and physical health are closely linked and this is something that can be taken and applied to horses. Pilates is a low impact set of exercises aimed at strengthening muscles while improving postural alignment and flexibility. Any fitness level can benefit and Pilates exercises should be part of any training or rehab plan for a horse.

The focus of Pilates exercises are on the core. However it should also include other areas such as the hips, abdominals, back, inner and outer thigh. The core is the foundation and these other areas are all connected and need to be able to function as a whole.

In regard to horses what we term carrot stretches were a series of movements developed by Hillary Clayton and Narelle Stubbs and can be coined as the first form of Pilates exercises for horses. These exercises help develop the deep core and spinal muscles. They are a combination of stretches, stabilising exercises and lifts which are the first port of call to develop core. However with any exercise caution should be taken that it is the correct exercise for your horse and therefore consulting a professional to help is really important.

Intermediate & Advanced Pilates

Hilary Clayton and Narelle Stubbs exercises could be termed your beginner Pilates for horses as with human Pilates beginner exercise should still be practiced by intermediate and advanced students as it makes sure the deep core muscles are functioning and that the global muscles have not taken over, which often happens in very athletic inviduals. If this happens then the individual is more open to injury and it would be the same in the horse. However a horse can be stretched further so including straight line pole work and walking backwards would be the next step up. The horse can be progressed further by introducing raised poles (cavelletis) and lateral movement such as stepping under. Pole work on circles and in trot would progress things even further, shoulder in from the ground all increase the demand and complexity of the movement.

By working with your horse from the ground you can also develop your partnership with your horse. You don’t want to be doing lots of reps. This isn’t about increasing cardio fitness but about developing finer movements that are controlled. As the horse is able to control their movement through the use of its core muscles then its ability to work under saddle will greatly improve. Their balance will be better and there will be improvement in dealing with a rider on board. This is also a key time to work on yourself and develop your core strength. Your horse will appreciate this hugely.

So every horse can benefit from Pilate type exercise being added to their exercise regime. However professional help should be sort to guide you as the owner as to what would benefit your horse. If you would like to discuss things further do contact Pollyanna.

Anatomy, Biomechanics, Human, Injury and Rehab

Feet the foundation of movement: Part two Injuries

In the last blog we introduced the anatomy and function of the foot (Part one anatomy and function). With this knowledge it can be seen that the foot is quite a complex structure and with so many components you would think quite a lot can go wrong. If you think how often you walk, run or jump and the forces going through your feet it is quite immense, and yet our feet seem to tolerate this on a daily basis. However there are occasions where trauma occurs or our feet just can’t recover as they should. Below are some common injuries your feet might experience.

Plantar fasciitis

Plantar fasciitis is one of the most common forms of foot pain. It is common in runners and older adults. It is often associated with biomechanical issues due to excessive pronation or supination. It is an overuse injury and what we would term a tendinopathy. You may have experienced tennis elbow or Achilles tendinopathy. Which is a similar condition just affecting a different part of your body. Tendinopathy in short is when the tendon is not healing in the normal manner, it can fray, become thickened and be painful.

Flat feet or high arches can increase the risk of plantar fasciitis. Tightness in the calf muscle, hamstrings and gluteals can also increase the risk. Plantar fasciitis has a gradual onset of pain which is often located on the medial aspect of the heel and experienced after activity. However when it becomes more severe pain can be experienced when weight bearing and on activity. Periods of inactivity during the day can also increase the pain when commencing activity again. Stretching the foot and fascia also can cause pain.

Stress fractures

The common bones in the foot that can suffer stress fractures are the calcanous, navicular and metatarsals. Calcaneal stress fractures are common in runners, military personnel, ballet dancers and sports that involve jumping. Having poor heel cushioning, overstriding and a heavy load can all increase the risk. The onset of pain is insidious in nature and aggravated by weight bearing. There is localised tenderness to the medial or lateral border of the heel.

Navicular stress fractures are the most common stress fracture in the foot. It can occur in sprinters, jumping sports and hurdling. It is an overuse injury and is thought to be due to training errors and impingement of the bone between other tarsal bones. Decreased dorsiflexion in the ankle is thought to perhaps bring about an increase in compensatory dorsiflexion in the foot increasing the stress placed on the navicular. Individuals often experience a midfoot localised ache, radiating along the medial aspect of the medial longitudinal arch. It often gets better with rest.

Metatarsal stress fractures occur with excessive loading of the forefoot and muscle fatigue. Forefoot pain is experienced and aggravated by activity. Pain gradually worsens with activity and tenderness over the metatarsal is present. Stress fractures don’t always present themselves on x-ray straight away so can be harder to diagnose than a complete fracture. However if one is suspected then management strategies can be implemented until diagnosis is confirmed

Metatarsalgia

Metatarsalgia is an inflammatory condition of the metatarsal phalangeal joints. It is caused by excessive pressure over prolonged periods of time. It is associated with high arches, excessive pronation of the foot, clawing/hammer toe, tight extensor tendons of the toes, prominent metatarsal heads and Morton’s foot. Pain is aggravated by forefoot weight bearing and affects the mid stance and propulsive phase of walking. Pain is gradual in onset and local tenderness over joints is present. Passive flexion of the toe causes pain and a v shape between toes can also be an early sign.

Bunion (Hallucis valgus)

This is when the big toe deviates laterally, it is more common in women and older people. There are a number of factors that can lead to the development of a bunion constricting footwear like high heels, excessive pronation of the foot, long first metatarsal (big toe), trauma to the medial and plantar ligaments and trauma to the medial sesamoid bone. As the deformity develops so does the pain over the medial border of the big toe this can be relieved by removing footwear or wearing wider shoes.

Toe Clawing

Toe clawing is not necessarily a painful condition but suggests that the long flexor tendons are tight. During the propulsion phase of gait the long flexors contract to stabilise the toes, if the foot is unstable the long flexor tendons excessively contract causing the toes to claw at the ground to maintain stability. If this continues then it could affect other areas of the foot or body as they compensate.

The above are just a few examples of injuries that can develop with feet. There are many others. The majority of the above injuries can be avoided by performing exercises and taking other everyday precautions. Part three of this series will address these solutions to help you maintain happy feet.

If you have concerns about your feet then either consult your doctor or Pollyanna would be happy to answer any queries you might have where she can

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Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part Two: Road to Recovery

Willow Road to Recovery

In part two we discussed Willows history and issues that were causing her complex lameness, which you can find more detail in Case study Part One: Complex lameness. In this part we are going to discuss what treatments were used and Willows progress.

Treatment

Willow’s treatment was started very gently. In this case less is more. Willow is also a very receptive and expressive horse, which as a therapists is brilliant as she leads her own treatments. It is so important to listen and respond to a horses reaction. In this case Willow directs me on duration and areas she needs working on. Willow is also very responsive to acupressure points.

Her treatment began with Bladder 25 to help strengthen her lower back, address any stiffness or pain in this area. Willow responded by lowering her head almost to the ground and softening her eye to the point that she almost went to sleep. This allowed me to massage through her hind quarters to release further tension and relieve pain. Willows neck and poll muscles were also released through a number of soft tissue techniques. As well as her adductors on her inner thigh. This caused increase tone and activation through the TFL and quadriceps.

To finish of the session 5 gentle dock pulls were included on both sides to help strengthen and activate the TFL and quadriceps. A number of belly lifts were also performed to help activate the core muscles and stretch through the back.

Initial Outcome

Just from the above treatment and exercise Willow showed immediate improvement. Firstly her TFL (tensor latae fascia) and quadriceps started to activate. Had increased tone and secondly she was far less sensitive through her back and hindquarters. Her movement seemed eased but was still showing signs that were present on initial assessment. However the goal of making Willow more comfortable was achieved.

Continued Treatment

The original plan was to come and treat Willow little but often to allow her body to make small adjustments and to not overload her system with change. So visits were made twice a week for about two weeks. During this time I was fully aware that the country might go into lockdown and that I wouldn’t be able to come up to physically treat Willow. So Willow’s owner was taught how to do some of the key techniques that were helping Willow the most and given equipment to allow progress if I couldn’t be there. Willows owner was also doing some of acupressure points on a daily basis in between my treatments.

So in the second treatment acupressure point Bl 25 continued to be used along with the introduction of Bl 21 which helps with atrophy, gastrointestinal issues, edema , back pain and general weakness. Each session I added a new point Bl 11 (helps strengthen bones and joints, nourishes and facilitates blood flow, benefits joint problems and also helps neck and spinal pain), Bl 19 (helps with hip pain and gastrointestinal issues) and lastly Bl 23 (helps with general weakness, lower back pain and estrous cycle). The owner was also taught these points as treatment progressed. Willow responded well to all these points

Massage through Willows back, hindquarters, neck and poll were also carried out to help activate muscles and release tension that has developed due to compensatory mechanisms. Again Willow responded well over the two weeks

Exercises

Initially dock pulls and belly lifts were introduced. Gradually the number of repetitions were increased and this was something Willows owner performed between sessions. In the second treatment weight shift directed through the shoulder was introduced this along with dock pulls were to encourage Willow to use her stabilising muscles. To start the main aim was to develop Willows core to give her a stronger foundation to develop more global muscle strength.

Willow was introduced to some foot pads. Just one placed under a fore foot to start and then moved to a hind foot. The foot pad was placed under for as long as Willow would stay. This was often a couple of minutes. This was again to encourage Willow to use the finer muscles to stabilise herself.

Before I got to progress Willow further lockdown occurred. However with guidance Willows owner was able to progress her exercises gradually. Walking over a pole in straight lines was introduced then progressed over a week to a figure of out over a pole. These progressions occurred over a 3 week period from initial treatment.

Willows owner continued with all the above acupressure points, exercises and pole work by week 4 she was walking over 2 poles in a row with several repetitions. By week 5 Willow was introduced to slightly raised poles done in hand exercises. Willow is also on a track for the summer months so poles and obstacles to step over were introduced to encourage her to use her hind quarters more throughout her daily life. By week 6 straight line trotting in hand was introduced. By week 7 3 poles on a circle at walk was performed with no ill effect.

Progress

Walk up 3 months after initial assessment

Willow showed great improvements in her walk and confidence by week 2 of initial treatment. She was also getting increased turnout time. By week 3 she was back out on full turnout and her Bute had been gradually decreased as well. Within a month Willow was out 24/7. Willows feed was also changed to help increase weight and muscle mass by phasing in Copra and Speedi beet into her seaweed, brewers yeast, lucerne and chaff. Gradually the lucerne was phased out and replaced with Agrobs Leichengrass. There were two aims with these changes one was to reduce any feed stuffs that might cause increase in inflammation (hoof friendly) and to help increase condition.

The above photographs show a vast improvement in muscle mass and posture. The video further up also shows huge improvement in movement patterns. Willow will always have some sacroiliac issues but with careful management she should be able to lead a happy and comfortable life.

If you have any concerns about your own horse and lameness then do consult a vet or contact Pollyanna with any queries and she will try and help the best she can.

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Anatomy, Biomechanics, Human

Feet the foundation of movement: Part one anatomy and function

Feet are an important part of our lives. They continuously absorb a lot of force to allow us to move and balance in a number of ways. When feet are doing their job life is great but if there is something wrong then daily life can be affected hugely. Do you take care of your feet, understand how they work or want to know more about these incredible structures then continue reading?

Today we are going to discuss the anatomy and function of the foot. Part two will look into problems that may arise with feet and how they can affect the rest of the body. In part three and to conclude the series then ways to keep your feet healthy for pain free movement will be discussed.

Anatomy of the foot

The foot is quite a complex structure compared to the rest of a human body. It is made up of 26 bones, 30 joints and over a 100 muscles, tendons and ligaments all working together to create an apparatus that allows movement, and stability while bearing the weight of the whole body.

The foot is separated into three regions the hindfoot, midfoot and forefoot. The hindfoot is made up of the talus and calcanus. The talus articulates with the fibula and tibia to form the ankle joint (talocrural joint) and the calcanous is your heel. The midfoot has five tarsal bones, which are wedge shaped and help form the arch of your foot. The forefoot contains the metatarsals and phalanges which form your toes.

Function of the foot

As noted earlier the foot bears the weight of our bodies. When walking the pressure on the feet increases twofold and then fourfold when running. This is a huge amount of pressure in such a small structure. As a result the foot needs to be able to absorb and distribute weight. It also needs to be able to help with propelling the body forward in our chosen gait. The foot has three arches the medial longitudinal, lateral longitudinal and transverse arch. These arches allow weight to be distributed throughout the foot as well as allowing the foot to make adjustments to uneven terrain. The medial longitudinal arch is the primary load bearing and shock absorbing structure of the foot. It forms the instep of the foot.

The plantar fascia makes up the primary passive component (along with the bony structures) of the medial longitudinal arch. It covers the sole and side of the foot. Active toe extension stretches the fascia which adds tension to the medial longitudinal arch. It helps stabilise the foot especially in the push of phase of movement. Other structures such as muscles help stop the arch from lowering to much when weight bearing and likely protects against stress related injuries.

The foots ability to repeatedly transform from a flexible and shock absorbing structure to a rigid lever type structure is really important in our ability to move and weight bear. If there is a problem in the foots structure then our ability to weigh bear and move is compromised and our everyday living is profoundly affected. In the next post injuries that can arise with feet will be discussed.

If you have any queries about injuries to your feet then don’t hesitate to get in touch to discuss your concerns or book an appointment

Biomechanics, Equine, Injury and Rehab, Injury Management

Case Study Part One: Complex Lameness

Willow the complex case of lameness

This case follows the assessment and treatment of a 19 year old horse, Willow. It shows the complexity of a case that has multiple factors interacting together and that by viewing the horse as a whole all these factors can be addressed in an efficient and effective way. This first part introduces Willow’s history and the problems that were being experienced by her. The second part will discuss treatment used and the outcome.

History

Willow is an Irish cross (possibly thoroughbred with some Arad), she is 19 yrs old, 15.1hh in height and of a slight build. Willow has had hock surgery and been owned by the current owner for 9 years.

I have been giving Willow bodywork session for the last year and she also receives McTimoney chiropractic treatment from a very good practitioner. Willow has exhibited an unlevel pelvis on a number of occasions. This is potentially linked to an underlying issue within her sacroiliac joint, which could be a result of previous activities or injury. Willow had been ridden western style and potentially barrel raced in the past. With her current owner she is hacked and schooled at a low level. Willow has been barefoot for the last year.

Willows issues

Over the winter Willow lost a bit of condition and then the mud came. Willow seemed to find the mud particularly difficult to deal with. Willow developed some heat in her right fore and lameness. After a vets visit an abscess was ruled out. However it was noted that her gait was abnormal. Not just in her right fore but the hind legs as well. The vet placed Willow on restricted turnout on a firm flat surface for 4 weeks with Bute and then review her progress.

Willow’s owner asked me to come and help make Willow more comfortable. On initial assessment Willow showed a complicated lameness, by this I mean there were a number of potential issues going on. Firstly you had the forelimb lameness which was likely to be secondary refered lameness. There was also axial lameness going on, which can be harder to identify. Willow also showed left non weight bearing lameness in her hind due to the flight pattern and placing it along her midline when stepping through, this also affected her cornering to the left. She was also hesitant to place her left hind hoof down. Willow also walks on 3 tracks and has a slight head bob down suggesting a hind limb lameness. Lastly Willow’s right hind has a slight wobble when transferring weight onto it.

Willow on initial assessment

Closer look

On palpating, Willow showed a decreased tone and atrophy in her hind quarters specifically the quadriceps and gluteals bilaterally. Willow also showed decreased activation through her tensor fasciae latea and quadriceps on her right hind, this would explain the shaking through this leg when starting to weight bear. Willow was particularly uncomfortable through the lumbar and sacral area when palpated. Her neck showed tightness bilaterally but more so on the left.

The above introduces the issues that Willow has experienced. In part two we will discuss treatments and how Willow progressed. If your horse presents as lame always consult your vet before getting hold of a bodyworker. If you have any questions or concerns then please do get in contact with Pollyanna.

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Equine, Horse & Rider

Case Study: The unexpected project of Richie

At the end of last year an unexpected addition joined the herd in the form of Richie. Richie is an 8 year old Irish Sport Horse with some Belgium warmblood. He is 16.3hh with lovely big round hooves, wide chest and deceitfully short in his back. Richie is a sweet natured gelding that is easy to handle and very friendly. He is very food orientated which should help with any training undertaken. Richie is a lovely individual to be around.

So the big question is how Richie came to join the herd? Richie was on a hunt yard but showed signs of not coping, this was in the form of ditching riders by putting the brakes on and dropping the shoulder. He also did this in schools. As far as I know Richie had done some showjumping in Ireland and possibly hunting before coming over to England to hunt. Richie was given a last chance at the hunt yard but started to show signs of not coping again. As a result he was sent back to his owner. Due to a number of circumstances Richie came to join the herd.

Original Plan

So the plan was to take things slow with Richie, allow him to settle into herd life. He had already had a couple of months off with his owner but I felt the extra time would allow Richie to open up, relax and be a horse.

It was planned in the new year (2 months time), that ground work would be started. With very basic in hand work such as walking, poles, walking backwards, stepping under with hind quarters, core exercises (belly lifts, pelvic tucks) and stretching. Lunging would be introduced gradually starting with walking and then introducing small amounts of trot and eventually canter over 6 weeks. During this time Richie would be measured and fitted for a saddle to then start ridden work. Ridden work would start very basic with walking for 5 min and then gradually adding small amounts of trot and pole work. This is when the plan hugely depends on how Richie is responding and will be reviewed at this point.

How the Plan has gone so far

As everyone knows things do not always go to plan when working with horses, however Richie has shown he wants to be doing something. I came to this conclusion due to a number of things. Richie was very interested in the work the other horses were doing. He got to the point that he would come and join in by jumping out of his paddock. When I did start basic ground work he was very engaged to the point that when I took him back to his paddock he still wanted to continue. As a result the original plan was implemented a month earlier than planned. Ground work went well and lunging was introduced however it soon came apparent that Richie was very good on one rein but was very confused as to what he is meant to do on the other. So far Richie has shown that he is highly engaged but there are moments that he doesn’t know what is being asked of him. The fact that we don’t have a fixed timescale to get Richie to being a regular hacked, schooled or jumped horse means that we can give him the time to process things and understand what we are asking of him.

Trust

One of the key elements I want to work with Richie on is trust. I want to build a bond that allows him to trust me and for him to want to look after his rider. I am trying to create an environment were he can express his emotions without repercussions or having to fit in with a timetable. In a hope that we can take the stress response away. The main problem with Richie is that we don’t know what triggered his previous behaviour. We don’t know whether there was something specific that caused him to offload his rider or whether it was an accumulation of stress due to not being able to cope with his job. As a result I have stripped things right back to be as natural an environment as possible. He is turned out 24/7 with a small mixed herd. He is not clipped and is barefoot. He is handled every day but in a manner that is not demanding anything of him. He does get hard feed twice a day as do other herd members and hayed morning and evening. The herd have free range of about 8 acres. I regularly watch how the herd interacts and Richie plays with the others, participates in mutual grooming and communally sleeps when the others do. Richie regularly lies down to sleep. Richie also likes to watch over the two foals that have recently joined the herd and are currently in an adjoining paddock.

Watch this space for future updates on Richie’s progress.

Human, Injury Management

Reflexology: Does it tickle?

One of the many questions I get asked is, “Does it tickle?” No it shouldn’t, as it is all about the pressure points in the foot, which when stimulated provide physical and emotional wellbeing.

History of Reflexology

Reflexology has been practiced throughout history from different ages and cultures. It was practiced in Egypt, where there is evidence documented on the walls of tombs. India also seems to be a place where reflexology started its early days. The Buddhist monks took their techniques to China and then onto Japan, teaching along the way.

Benefits of Reflexology

Reflexology can bring many benefits including;

  • Detoxifying the body
  • Relaxation
  • Increase circulation
  • Stimulates the nervous system
  • Provides pain relief
  • Balances energy in the body
  • Helps during pregnancy

What to Expect in a Treatment

Reflexology is a holistic and non-invasive therapy performed on the feet, with varying degrees of pressure to promote physical and emotional wellbeing. It stimulates the body’s own natural healing powers. Reflexology is to treat the whole person, body, mind and spirit.

A first appointment will include a conversation about your medical history, needs and what you want from a treatment.

However if you have the following conditions then you may not be able to have reflexology

  • Pregnancy- in the first 3 months or if you have a history of miscarriage
  • Epilepsy
  • Diabetic
  • Cancer- Doctor approval needed

Once your history is complete then your treatment is started with effleurage to warm the soft tissues up. This is followed by working on the pressure points in your feet, which will not be painful but should feel relaxing.

After a treatment, your body is in the process of healing, as a result you may feel some of the following positive reactions

  • A feeling of warmth
  • A feeling of complete calm
  • Pain releif
  • Increased flexibility

Other common and normal reactions can be

  • Tiredness
  • Thirst
  • Needing the loo more frequently
  • Increased perspiration
  • Cold like symptoms
  • Feeling emotional

Some people have no reactions to treatments but if you do they will occur within 24hrs after treatment but will subside after 48hrs.

If you would like to find out more about reflexology or discuss your needs then contact Francesca on 07709 431659 or email on dollytrolley32@hotmail.com

Human, Injury Management

Lower Back Pain

At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement