Stephen Timms, Author at Praxis Physiotherapy

Pilates: Reforming our back pain rehabilitation (Part 1 of 3)

by Stephen Timms | Jun 3, 2019 | Lower Back, Pain, Reformer Pilates

With our 30 day pilates challenge starting today, we thought we would take a look at why we love pilates so much for our patients, and what some of the benefits are. Part 1 looks at how pilates affect those with chronic lower back pain. Part 2 looks at the difference between mat and reformer pilates and part 3 looks at how often is required to see the benefit of pilates.

SUMMARY:

Back pain is extremely common, multifactorial, and often reoccurs
Strengthening interventions appear better for long term suffers of lower back pain
Pilates has been shown to improve muscular strength and endurance of key pelvic and postural musculature associated with lower back pain
Specifically, pilates promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles
As little as 2 sessions per week for 6 weeks has been shown to see improvements in pain and function for those with longstanding lower back pain, even after stopping pilates

Chronic low back pain (CLBP) is one of the commonest musculoskeletal problems in modern society (Anderson 1999) and is a highly prevalent in both the sporting and general public. CLBP is experienced by 70%–80% of adults at some time in their lives (Crombez et al 1999) and as such, the costs associated with LBP and related disability are enormous, causing a major economic burden for patients, governments and health insurance companies (Dagenais 2008).

Lower back pain has been one of the most extensively studied musculoskeletal conditions as a result of the prevalence and debilitation nature. Its management comprises a range of different intervention strategies including surgery, drug therapy and non-medical intervention like rehabilitation (Paolucci et al 2018). Within Physiotherapy, exercise therapy is probably the most commonly used intervention for the treatment of patients with chronic non-specific LBP due to its plausible biological rationale and low cost.

Whilst general conditioning programs to train strength and endurance of the spine musculature have been shown to reduce pain intensity and disability (Rainville et al 2004), the popularity of pilates (both mat and reformer) has helped provide an accessible and supervised form of therapeutic exercise.

EVIDENCE FOR PILATES

The Pilates method, using functional exercises aims to improve muscular strength and endurance. Specifically, the pilates method have promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. Using the principles of progressive overload, your body adapts to the incremental loading week after week and consequently results important postural control improvement. In 2009, Curnow and colleagues showed that the Pilates method improves load transfer through the pelvis, something that intuitively helps those with CLBP.

However, a systematic review (Patti et al 2015) reported evidence that Pilates method-based exercises are more effective than no treatment or minimal physical exercise interventions in the management of chronic nonspecific LBP. Further, they pointed out that the effects of the Pilates method are only proven for patients with chronic nonspecific LBP in the short term.

A recent study by Natour and colleagues (2015) showed that the group of participants that were practicing Pilates method resulted statistically better compared with the a non exercising group who only used inflammatory medication. Those who were in the pilates group used less pain medication at 45, 90 (conclusion of the Pilates method), and 180 days, 90 days after the conclusion of the exercise program.

In conclusion, Pilates as an exercise choice is more effective than minimal physical exercise or drug based interventions in reducing pain and disability in the short-term period. There is agreement that exercise “helps” in the treatment of chronic pain, but it is still not clear exactly which factors or particular kind of exercises may be responsible of such improvements (Natour et al 2015; Patti et al 2015). Praxis Physiotherapy has always been a strong proponent of movement and loading early in rehabilitation (more on this in later blogs!).

In the next instalment, we discuss the difference between mat and reformer pilates and perhaps find some more answers regarding which exercise regime reigns supreme!

Check out all our other reformer pilates services on our website

Until next time,

Prevent. Prepare. Perform.

References:

Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(91789178):581–585.
Crombez G, Vlaeyen JW, Heuts PH, Lysens R, Crombez G. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329–339.
Dagenais DC, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal 2008;8(1):8‐20.
Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. V., & Santilli, V. (2019). Chronic low back pain and postural rehabilitation exercise: a literature review. Journal of pain research, 12, 95.
Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004;4:106-115
Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., … & Palma, A. (2015). Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine, 94(4).
Curnow, D., Cobbin, D., Wyndham, J., & Choy, S. B. (2009). Altered motor control, posture and the Pilates method of exercise prescription. Journal of bodywork and movement therapies, 13(1), 104-111.
Natour, J., Cazotti, L. D. A., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.

Kicking Goals! Praxis looks at AFL kicking mechanics

by Stephen Timms | May 24, 2019 | Return to Sport, Sport, Team Praxis

KICKING

As per usual the Praxis team delved into an area of clinical interest to better understand the demands of our athletes. Last session we discussed throwing technique which you can read about here.

SUMMARY

There are differences in kicking techniques when accuracy or distance is the focus.
More accurate kickers had tended to be more “head over the ball” with significantly:
greater hip flexion in both limbs
greater knee flexion in the support limb throughout the kicking movement and greater anterior pelvic tilt at heel contact
Longer kick distances were associated with:
greater foot speeds and shank angular velocities at ball contact,
larger last step lengths, and
greater distances from the ground when ball contact occurred.
To increase kicking distance:
increasing foot speed and shank angular velocity at ball contact, increasing the last step length, and
optimising ball position relative to the ground and support foot are recommended.
Injuries to the quadriceps are often associated with kicking

Given our longstanding association with AFL clubs around Brisbane, this week we looked at kicking kinematics (joint angles and relationships) with respect to both accurate and long kicks. Further, we discussed how to best rehab someone with a kicking based injury and helping them return to their chosen kicking sport (AFL, Rugby, Soccer, Gridiron etc).

ACCURACY:

The first paper we looked at was from Dichiera and colleagues (2006). Their study involved kicking an AFL football 15m at a target. They found that accurate kickers focussed more on larger hip flexion, anterior tilt and stance leg knee flexion. This best can be described as a “head over the football” approach.

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They hypothesise that knee flexion is an important limb length adjustment mechanism which lowers the centre of gravity. During kicking, an increased stance leg knee bend would lower the centre of gravity somewhat throughout the movement. Lowering the centre of gravity is one way of increasing the stability of the body, a principle which is emphasised in many other areas in sports biomechanics.

DISTANCE:

Kicking for distance was associated with greater foot speeds and shank angular velocities at ball contact, larger last step lengths, and greater distances from the ground when ball contact occurred in a study performed by Ball (2008). This was more of a “lean back” strategy utilised by the kickers. Knee angular velocity at ball contact was measured at almost 1400 degrees per second! That kind of speed understandably places the knee extensors (i.e the quadriceps) at greatest risk for kicking injuries.

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Ball (2008) outlined some basic coaching instructions to guide those seeking larger distances in their kicks. He suggested:

increasing foot speed and shank angular velocity at ball contact by increasing approach speed such that the hip of the kick leg is moving faster towards the target during the last step.
increasing the last step length but this step should be proportional to approach speed as over-striding is likely to be detrimental to the kick
Optimising ball position relative to the ground and support foot was also recommended though contact too high may result in a high kick, not a long kick.

From a physiotherapy perspective, we discussed:

Players have adequate hip extension range as to not to not overload lumbar spine and hip extensors (e.g hamstrings) especially in the presence of larger running and sprinting volumes typical in AFL and soccer
Hip flexor strengthening to improve the drive of swing leg through the kick and running
How to best reintegrate an athlete who sustained an injury whilst kicking back to full training and competition
Preventative exercise such as jump lunges and reverse nordics for quadriceps tissue resilience
How lumbopelvic control can help a kicker with both accuracy and distance

In summary, another Brisbane winter’s morning was successfully utilised by the Praxis team. We hope you enjoyed the read! For any injuries that you or your teammates need assessed and sorted fast, contact us.

Until next time, continue to Praxis What You Preach

– Team Praxis

Prevent. Prepare. Perform.

References:

Dichiera, A., Webster, K. E., Kuilboer, L., Morris, M. E., Bach, T. M., & Feller, J. A. (2006). Kinematic patterns associated with accuracy of the drop punt kick in Australian Football. Journal of Science and Medicine in Sport, 9(4), 292-298.
Ball, K. (2008). Biomechanical considerations of distance kicking in Australian Rules football. Sports Biomechanics, 7(1), 10-23.

Congratulations Nancy!

by Stephen Timms | May 19, 2019 | Uncategorized

GRADUATION

A massive congratulations to our resident remedial massage guru Nancy! She recently “doffed the cap” during her graduation ceremony. Nancy successfully completed a Bachelor of Health Science (Myotherapy) at the Endeavour College of Natural Health.

Myotherapy involves an extensive physical evaluation and an integrated therapeutic approach in the treatment of affected muscles, joints and nerves. Nancy gains an in depth understanding of human biology, musculoskeletal anatomy and function. Through extensive practical classes and clinical experience, graduates such as Nancy learn to conduct testing and physical assessments and apply a variety of practical skills such as myofascial release, dry needling, joint mobilisation and trigger point therapy.

Nancy continues to service her loyal massage followers on Tuesdays and Fridays at our Teneriffe location (91 Commercial Rd). You can book online here.

Well deserved Nancy – we are all proud of you!

– Team Praxis

Prevent. Prepare. Perform

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Throwing Injuries

by Stephen Timms | Mar 16, 2019 | Return to Sport, Shoulder, Sports Injury, Team Praxis

THROWING

This week in professional development session, our physio team delved into throwing techniques and links to injury. Proper throwing mechanics are important to understand as they may enable an athlete to achieve maximum performance with minimum chance of injury (Fleisig et al 2012).

Throwing, tennis serving, cricket fast bowling and golf swings are all excellent examples are how the summation of the bodies forces can result in massive outputs of power. Although force to a ball or other projectile is applied directly by the hand, a ‘kinetic chain’ of the entire body is used.

Mid Potion Achilles Tendinopathy Location

One essential and shared property of these activities is they utilise the kinetic chain to generate and transfer energy from the larger body parts to the smaller, more injury-prone upper extremities. These activities are all also notorious for high rates of injury. The kinetic chain principle asserts that in a coordinated human motion, energy and momentum are transferred through sequential body segments, achieving maximum magnitude in the terminal segment.

This kinetic chain in throwing includes the following sequence of motions: stride, pelvis rotation, upper torso rotation, elbow extension, shoulder internal rotation and wrist flexion (Fleisig et al 2012).

According to Agresta and colleagues (2019), Risk factors for shoulder pain are:

Workload (spikes or high volume)
Age (younger athletes are more prone to injury)
Throwing technique (e.g lack of follow through, elbow varus and shoulder external rotation torque)
Reduction in shoulder range of motion (particularly shoulder internal rotation in preseason)
Reduced preseason strength (supraspinatus and prone external rotation strength)
Reduction in thoracic rotation
Previous injury

Whilst we love a nerdy discussion on intrinsic vs extrinsic risk factors and specific rehab options as much as the next person, sometimes you just need to get outside in the sun and FEEL the task you are poring over!!

The key phases of throwing are loosely depicted in the below photos by our Praxis Principal and former 1st Grade Cricketer, Stephen (adapted from Escamilla et al 2007):

Click on the photo to slow the sequence

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One of the final key questions from the day was: Who out of our physiotherapists has a “custard arm” and who has a “bullet”?? So if you or someone you know is in a throwing sport, have a chat to us today on (07) 3102 3337 or book online to ensure you have an injury free season ahead!

Until next time, Praxis what you preach

Team Praxis

Prevent. Prepare. Perform

Praxis in the Alice

by Stephen Timms | Feb 11, 2019 | Uncategorized

ALICE SPRINGS

Cam and Steve finish their week at the National Indigenous Cricket Carnival (NICC) as the central Physiotherapists representing Cricket Australia and Praxis. The NICC has been created to further advance and develop Indigenous cricket. The competition provides greater playing opportunities in Alice Springs, but also forms a deeper connection with Australian cricket’s high performance pathway.

They were busy providing their expertise to over 10 male and female cricket teams who didn’t have a travelling physio accompanying them to Alice Springs. With over 150 consults in a week and 12 hour days as a minimum, our principal physio’s leave the tournament a little weary but proud of the standard they maintained during their stint in the Red Centre.

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During the week of the championships, a special screening of Walkabout Wickets, a documentary commissioned by Cricket Australia commemorating the 150th anniversary of Australia’s first cricket team to go on an international tour. There was a preview screening aired in the Alice Springs’ Todd Street Mall as well as on Channel 7. The documentary will be free to stream for the next few weeks on 7Plus. Stephen was fortunate enough to be on that tour providing physiotherapy services for both the national men’s and women’s indigenous sides .

Both Cam and Steve are back in clinic on Wednesday looking forward to living the Prevent Prepare Perform mantra at our HQ in Teneriffe.

Until Next time