Sunday, 21 August 2016

Referred Buttock Pain from the Lumbar Spine and Chiropractic

Lumbar spine abnormalities with or without lower back pain can refer pain to the buttock. Any of the innervated somatic structures of the lumbar spine, such as muscles, ligaments, facet joints, intervertebral disks and spinal nerves may cause pain in the buttock. Abnormalities of the intervertebral disk and facet joints are the two most common structures that cause refer pain to the buttocks. Spondylosis and spondylolisthesis may contribute to the buttock pain.

Patients usually complaint of diffuse buttock ache with different severity. The slump test which involves forward bending of the neck and upper body while straightening the leg in a seated position, may reproduce the buttock pain. Positive slump test is an indication of increased neural tension due to nerve damage or secondary to lumbar spine abnormalities. However, a negative slump test does not rule out the possibility of referred pain from the lumbar spine.

Areas of tenderness and intervertebral segments with restricted motion may be noted upon palpation of the lumbar spine. The segmental range of motion can be restored by mobilization or manipulation of the lumbar spine. The signs and symptoms can be reassess immediately after treatment or prior to next treatment to rule out referred pain from lumbar spine abnormalities.

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Tuesday, 16 August 2016

Chiropractic and Calcaneal Stress Fracture

Calcaneus, the heel bone, is the second most commonly involved tarsal in stress fractures. There are two main sites where the injury most commonly occurs, the upper part of the posterior margin of the os calcis or adjacent to the medial tuberosity. Calcaneal heel spurs can be found at the medial tuberosity. Calcaneal stress fractures can be associated with marching on hard surfaces among the military. Repetitive stress exerted on the calcaneus can result in a stress fracture of the heel bone. However, calcaneal stress fractures also occur in runners, ballet dancers and jumpers.

Weight-bearing activities, in particularly running, are known to aggravate the insidious heel pain. Palpatory tenderness of the posterior calcaneus on the inner and outer sides is noted. The pain can be reproduced by applying a compression force on both sides of the posterior calcaneus simultaneously. Lateral X-ray of the calcaneal may reveal a sclerotic appearance which is parallel to the posterior margin of the calcaneus. A focal area of increased uptake can be shown on the isotopic bone scan.

Calcaneal stress fracture with significant pain should reduce the activity level or in certain severe cases temporary non-weight bearing relative rest may be needed. Gradual introduction of increased weight-bearing is required once the pain has subsided. Stretching of the tight muscles such as calf muscles and plantar fascia is needed to decreased abnormal stress being put on the calcaneus. Joint mobilisation to ensure full range of motion in the ankle and tarsal joints is important for recovery. Soft heel pads or orthotics can be recommended to prevent reoccurrence of the injury.

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Thursday, 11 August 2016

How to Stretch the Muscles in the Upper Back

A Sedentary lifestyle tends to create muscle tightness of our postural muscles. Prolonged computer work, poor work station ergonomics and stressful bad posture can result in forward head posture and rounded shoulders. These muscle imbalances in the upper back and neck can cause muscle tightness and pain. Rhomboid muscles are rectangular muscles that lie between the midline spinous processes of C7 through T5 and the inner border of the shoulder blade. The main actions of the rhomboids are retraction, elevation and downwards rotation of the shoulder blade.

There are a few different ways to stretch the rhomboid muscles.
  1.       Sit on the floor and bend both of the knees slightly, keep both of the heels in contact with the floor.
  2.       Hold on to the back of your thigh with your hands.
  3.       Try to lean back toward the floor and round your upper back until a gentle pull is felt in the upper back. Hold the stretch position for 30 seconds.
  4.       Breathe normally and slowly return to the starting position. Repeat the procedure 2-3 times.

The following procedure is effective in stretching the rhomboids and upper back muscles.
  1.       Stand facing a doorway with the right shoulder in line with the left side of the door frame.
  2.       Grab the inside of the door frame at shoulder level or above head level with the right hand.
  3.       Keep the right arm straight and both feet planted on the ground, lower the buttocks toward the floor in a squatting position.
  4.       Feel for a gentle pull in the right upper back and hold it for 30 seconds.

Saturday, 6 August 2016

Iliopsoas Muscle Stretching Exercises

The iliopsoas, a muscle complex that contributes to hip flexion, plays a major role in the speed of sprinting. Most of the research in the literature neglected this major hip flexor and this has been limiting our ability to enhance athlete’s sprint performance. The understanding of the biomechanical components of sprinting is necessary and it is important to focus on this hip flexor as iliopsoas may have the greatest influence on sprint speed of any segmental body movement. Stretching of a shortened muscle can reduce the risk of injury during sports activity.

Dynamic Stretch for Iliopsoas
Stand near to a wall or other supporting object to stabilize the body during the stretch. Flex the hip and knee, bring the knee as close to the chest as possible while keeping the lower back straight. Then bring the hip into extension with an additional force exerted at the end of the hip extension. Perform this motion for 15 seconds and repeat the same procedure on the opposite leg. The trunk needs to be upright and avoidance of internal and external rotation of the hip throughout the whole stretching exercises is needed to prevent injury and to isolate the iliopsoas muscle.

Static Stretch for Iliopsoas
Start in the lunge position with the leg of the iliopsoas being stretched behind the body with the knee slightly bent. Slowly lowered the hips until you a moderate stretch is felt in the iliopsoas muscle. Maintain the stretch for 30 seconds. Or while in this position with the iliopsoas elongated, oscillated downwards for 15 seconds.

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Monday, 1 August 2016

Back Extension Exercises and Lower Back Pain

Exercise 1 – Pelvic Bridging (isometric, supine)
Lie on your back with your hips and knee bent, lift your hip into a bridging position. This position consists of hip and back extension. Hold the position for 5 seconds and rest in the initial position. Repeat the exercise.

Exercise 2 – Back Extension (isometric, prone)
Lie on your stomach with the pelvis positioned at the edge of the table or on the anterior hip pad of the Roman chair. Stabilize the lower body. Hold your upper body up so that the upper body is straight and horizontal. Maintain the position for 5 seconds.

Exercise 3 – Back Extension, Dynamic (isotonic, prone)
 Lie on your stomach with the pelvis position on the anterior hip pad of the Roman chair or on the gym ball. The Roman chair is set at an inclination of 60 degrees. Place your hands behind the head and stabilize the lower body. Start in a position with your upper body maximally bent forward. Slowly extend and straighten your back into an erect position. Hold the position for 5 seconds and rest in the initial position.

The above-mentioned exercises activate the hip extension and back extension muscle groups, especially the thoracic and lumbar musculature. An effective exercise-based rehabilitation program for lower back should include high repetitions of dynamic thoracic/lumbar/hip exercises over a period of time to strengthen the muscles and soft tissues to support the spine. The activation of the back muscles can be increased by changing the position of the limb and trunk or by using unbalanced supporting base.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Wednesday, 27 July 2016

Back Extension Exercises and Lower Back Pain

Lower back pain is very common among our population nowadays as we are adapting to the sedentary lifestyles. Lower back pain is one of the main causes that people are absent from work or school. Conservative management of the lower back pain has shown significant promising results. However, exercise-based active rehabilitation programs are needed to minimise and prevent the reoccurrence of lower back pain.

An effective rehabilitation training program requires a variety of exercises to strengthen the back muscles. It is important to perform the exercises on a daily basis to yield the best result. According to the literature, exercise-based rehabilitation program plays a major role in the later stage of recovery as it can reduce the intensity of lower back pain, decrease functional disability, improve back extension strength, mobility and endurance.

There are several back extension exercises designed for rehabilitation of the injured low back, prevention of injury and fitness training purposes. Extra care must be taken when performing the back extension exercises as a high activation level of lumbar paraspinal muscles may lead to abnormal forces exerting on the spine. This may lead to unfavourable lower back injuries and causes pain. The back muscles, known as the posterior spine muscle chain, include the hip extensors and erector spinae muscles of the lumbar and thoracic spine. Most of the back extension exercises focus on the erector spinae muscle of the lumbar spine.

For more information or enquiries, please contact us at 03-2093 1000 or visit our website at

Friday, 22 July 2016

Tendinopathy of the Hamstring Origin

Hamstring origin tendinopathy is one of the causes that will result in pain in the buttocks region and the back of the thigh. An acute tear of the hamstring with inadequate treatment or an overuse injury of the hamstring may result in tendinopathy of the hamstring origin near the ischial tuberosity. 
Overuse injuries of the hamstring is more commonly seen, especially in sprinters.

The onset of the pain is usually insidious after a session of sprinting, or there may be a sudden onset of sharp pain. There is often a local tenderness on hamstring upon palpation. Stretching of the hamstring muscle and resisted contraction of the muscle may reproduce the pain. The injured and painful site may be found at the attachment near the ischial tuberosity, within the tendon or at the musculotendinous junction.

Management goals for this condition include reduction of inflammation, healing of soft tissue injury and rehabilitation stretching and strengthening. Reduction of inflammation and soft tissue healing can be improved with ice, manual therapy and therapeutic modalities. Manual therapies such as deep transverse friction, stretching, trigger point therapy to the area of palpable abnormality are effective in releasing muscle tension.

Significant muscle tightness and weakness of the hamstring muscles can present in chronic hamstring origin tendinopathy. Stretching and progressive strengthening of the muscle are needed to prevent reoccurrence of the condition. The antagonist muscles such as rectus femoris and psoas are shortened and tight in chronic tendinopathy cases. These muscles need to be stretched as well.

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