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Back pain and sports injuries

Published by Chris Chin on September 15, 2011 Respond

Low back pain can occur at any sport or recreational activity and at any level. One of the aims of participating in sport is to obtain and maintain a certain level of fitness and health, so low back pain is something to be avoided. Once it occurs, people tend to exercise less and become less physically active in all other aspects of their life. It may also contribute to stress and depression as any severe or chronic pain can do especially if there is a loss of income involved or loss of an opportunity to compete in an important career forming event. If your career or reputation is based around sports coaching, exercise trainer or educator then it is even harder to take time off  because of back pain. I have seen sports people who have had to give up the sport they love or their sporting career because of their backs and related injuries.

Apart from managing their back pain, I help them to return to a certain level of activity in their chosen sport. Sometimes this is not possible if they participate in contact sport or their sport or exercise program expects them to use a posture or movement which causes Hip Rib Impingement and risks further damage to their back. They may choose to go back in a coaching role hopefully imparting what they have learnt about the mechanics of back pain to their charges.

I have presented my theory of the mechanics of Hip Rib Impingement in a poster presentation at a Sports Medicine Australia conference in Alice Springs in 2004 and received a lot of positive feedback from sports physiotherapists who have often  found tender and trigger points on the hips and ribs of their patients. As there are so many exercises and their variations around that can cause Hip Rib Impingement, I was encouraged to put as many as possible in my book in a way that is easy to understand. To make things clear, I have placed ticks and crosses on most of the illustrations so that there is no confusion as to what exercises, postures or movements can cause low back pain. My patients with back pain were the greatest source of information of what exercises cause or exacerbate their back pains. Thats it from www.drchrischinbackpain.com

Apart from low back pain, Hip Rib Impingement may also explain why some cyclists and rowers develope stress fractures of their ribs and why some runners and football plays develop groin pains, tight iliotibial bands, hamstrings and subsequent knee injuries.

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Back Pain and Fibromyalgia Rehabilitation

Published by Chris Chin on August 31, 2011 Respond

A vital part of treating patients with fibromyalgia is patient education, functional rehabilitation  and cognitive behavioral therapy. The passive treatment provided by laser acupuncture will only provide temporary relief unless the patient is able to change the way they think about the mechanical  factors that have been contributing to their pain and be encouraged to change them. Some patients may not be ready to participate in the rehabilitative process ( precontemplative ) and others are not prepared to put any effort into the healing process hoping for some instant magical cure. Unfortunately, as deconditioning of the neuromuscular system is part of the illness, we need to be able to convince the patient to strengthen their muscles without exacerbating  their pain. This process can be divided into 9 parts:

1     breathing technique

2    avoiding hip rib impingement

3     avoiding groin impingements

4    avoiding chest wall compression

5    avoiding shoulder impingements

6     avoiding neck impingements

7     safe stretches

8     pacing

9     safe strengthening exercises

The breathing technique I recommend is similar to the  reverse abdominal breathing technique often taught at Yoga or Qi Gong. In reverse abdominal breathing, the abdominal and pelvic floor muscles should contract with inspiration. Studies have shown that the diaphragm, intercostal muscles , the lateral abdominal muscles and pelvic floor muscles all co-contract . This means that when one of these groups of muscles contract, all the others also partially contract automatically. When this occurs the spine is braced or stabilised. This was what the system was designed to do. The co-contraction also increases intra-abdominal pressure thereby increasing venous return to the heart. This reduces the risk of fainting compared to the commonly taught abdominal breathing.

The main modifications to reverse abdominal breathing are that the patients should breath in and out only through the nose and to hold their breath as long as comfortable in inspiration. They should breathe out as little air as possible on expiration and breath in as deep as possible during inspiration. In this way more CO2 is retained and this increases O2 availability to the tissues (similar to Buteyko Breathing Technique ). I call this technique Posture Breathing as it corrects spinal posture, prevents hip rib impingement, chest wall compression and has the benefits of both reverse abdominal breathing and Buteyko breathing.  I will describe the Air Bag Technique in the next Blog at www.drchrischinbackpain.com

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Low Back Pain History

Published by Chris Chin on June 24, 2011 Respond

When patients present with a history of back pain, hip pain or sciatica ( pain radiating down the legs ), I always ask if they remember the original incident that first triggered the pain. I also ask about movements or situations that aggravate their pain on a daily basis. Invariably the movements or postures would have a significant hip rib impingement component. You would expect people to develop low back pain from major accidents such as a fall or a motor vehicle accident but a surprising number of people are unable to determine what have triggered their pain.

Obvious movements include bending over lifting a load with or without twisting, bending over to pick something off the floor or getting out of the chair and limping for the first few steps. Common postures include sitting on lounge chairs or couches which have sagged, prolonged driving in a car or truck. Sometimes, people have not associated their pain with any precipitating factors. This is because there is often a delay between the hip rib impingement incident and the onset of pain. Sometimes they don’t feel the pain until they use the affected muscles such as when they go for a run or play their favorite sport.

A classic example of this is when runners get a “stitch”  at their side, ” tight hamstrings” or leg cramps partway through their run. A lot of people wake up in the middle of the night or  the morning with pain and this could be because of a saggy unsupportive bed or more often due to how they sat at their couch watching TV the night before.

A number of people have suffered low back pain since their childhood or early teens without an obvious precipitating factor and on further questioning they have also suffered from non-specific recurrent abdominal pain as children. It may well be that hip rib impingement in children presents as abdominal pain or even “period” pain and then moves to present as back pain as their musculoskeletal structures changes with growth. This could also be a contributing factor in the development of scoliosis.

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