One of the biggest mix-ups is assuming that where you feel pain must be where the problem is. We know this isn’t always true; for example, one of the early signs of a heart attack can be pain in the left shoulder, not the chest. With musculoskeletal pain, the same kind of mismatch can happen.

So what do most people do? They laser-focus on the sore spot. They rest it, stretch it, poke it, strengthen it—or they pull back from sport, exercise, or work to “protect” the area. But if the true cause is actually elsewhere, all that effort becomes a kind of well-intentioned detour. It wastes time, money, and emotional energy, and it can leave people feeling frustrated and stuck.

At NWPG, we see this every day. Around 80% of the time, the source of a patient’s symptoms is not in the place that hurts. Research on Regional Interdependence backs this up too: the body is interconnected, and pain often shows up downstream from the actual issue.

Another common belief is that pain and tissue damage always arrive together, hand-in-hand. But modern research paints a different picture. Especially with accumulated strain—tiny stresses stacking up over days, months, or even years—there’s usually a big buffer between when tissue starts feeling pressured and when real damage begins. The brain often sends a warning signal (that familiar “ouch”) long before anything is actually injured.

We also see a lot of confusion around scans. It’s easy to assume that anything that shows up on an X-ray, ultrasound, or MRI must be the culprit. But studies consistently show poor correlation between imaging and pain. Plenty of people have “abnormalities” on scans and feel perfectly fine. Others have significant pain with squeaky-clean imaging. What you see on an ultrasound scan or any other scan doesn’t reliably match what someone feels.

This all circles back to the role of the brain. It’s constantly sorting and interpreting signals from the body, trying to keep you safe. When your system is overloaded, the brain’s warning message is pain—its way of nudging you to change course before genuine damage happens. But if those warnings go unheeded, that’s when injuries like muscle tears, tendon issues, and postural strain can show up.

Seen this way, the brain is less of a troublemaker and more of a guardian—one with a remarkably early detection system. And when you start understanding pain through that lens, it becomes much easier to make meaningful, long-term shifts in both comfort and function.

How to fix pain

Do you want to find the answer to the pain you are experiencing? Book an appointment today!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

If this is always true, why can we feel pain when we have not injured ourselves? 

For example, we feel neck or back pain after sitting for a prolonged periods or a trivial action like reaching for a towel causes severe back pain?
How is this possible if pain = damage? This is confusing.

What The Research Shows

The research tells a different story:

One study ( Brinjiki et al) showed a high rate of ‘pathology’ in lower back MRIs in over 3000 subjects without any pain or dysfunction – and this was in people ranging from 20 to 80 years old.

In the shoulder, many studies have painted a very similar picture. One study (Grisih et al) found that a remarkable 96% of subjects who reported no pain or issues had at least one identifiable ‘pathology’ on their ultrasound scan. 

So you can see that tissue damage does not lead to pain in many cases, and pain can arise without  evidence of tissue damage. This is precisely why we constantly remind our patients that ultrasound scans don’t tell the full story.

The general understanding of pain and injury needs to be updated so that people can overcome pain more easily and get back to living their (best) lives.

A New Understanding of Pain

The new understanding of pain is that it is an output signal created by the brain, as a warning sign. It can be out of proportion to the injury. This serves to change behaviour to prevent further damage, which is often required to fix the problem.

The issue is that most people don’t understand this, and remain stuck with a painful condition because they are fearful to move in case it causes more tissue damage. The problem with this is that people are thinking about local structures, not the whole body. There are compensations and protective mechanisms that can develop in other areas of the body that can contribute to your pain…. Where your pain is located is not necessarily where it comes from.

For example, someone can get knee pain because they had a recent back pain episode that affected the way they walked. The back pain improved, but the knee persisted because of secondary protective mechanisms that have not resolved.

A Whole Body Approach

This is why we look at the whole body and how it works together. We want be as thorough as we can and find all the contributors, both local and remote for your pain. This will enable you to get back to the things you love doing without the pain you have been suffering.

We use a 7 step process (the ridgway method) that will find the main drivers of your pain and fix them quickly. It is scientific, objective and based on the latest neuroscience research. 

If you’re not open to a new understanding of pain, you will remain stuck and restricted by your pain and fear of movement. Are you really willing to let your pain dictate your quality of life? 

Or are you looking for a new approach to regain your lifestyle, independence and get on top of your pain long term?

If you’re ready to take control of your life, book an initial consultation with us. We’d love to help you!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

Background and History

Mrs B is a 58 year old nurse who recently presented to our clinic with a 9 month history of right buttock, posterior thigh and calf pain, as well as intermittent numbness in the calf and bottom of foot.
The pain had developed slowly without any specific incident. Of note, Mrs B had suffered a period of left heel pain 3 years prior. At the time, Mrs B had been managed in a moon boot on the left side for 8 weeks to reduce pressure on the foot for what had been diagnosed as plantar fasciitis. She had also been experiencing left hip pain, but these 2 pains had resolved before her more painful right buttock and leg pain had started.
Mrs B had trialed treatment with Physios, Osteos and had been having Pilates, the latter she felt actually aggravated her condition. She had also had cortisone injections into the facet joints of her lower back, which had not helped.

Investigations

Mrs B’s MRI, taken 5 months previously, showed forward displacement of the L4 segment, disc bulging, facet joint degeneration, as well as compression of lumbar nerve roots (see excerpt below).

How Mrs B Was Impacted By Her Condition

Mrs B’s pain was worse in the mornings, and she often waked on turning in bed. She could not sit for more than 20min before the pain worsened, and she was also unable to walk for longer than 10-15min.
She had struggled to maintain her part time nursing, and had taken afternoon shifts because the pain was not as bad at that time of day. She was not able to do as much for her family and her children were helping her out with most of her home duties (not necessarily a bad thing!).
Mrs B had also stopped her regular walks around the Maribyrnong River with her friend due to the pain.
She was taking 2-3 Panadeine daily and also 2 x Nurofen.
She rated her functional ability at 50%.

Assessment

Mrs B presented with some postural compensations, ie she was standing in an altered state due to her pain. The anterior pelvic tilt posture was placing more stress on her lower back.
She had reduced reflexes on the right side (S1), but no loss of power in the specific nerve supply areas (myotomes). Her lumbar range of movement was restricted by muscle guarding, as was her right hip flexion, hamstring range and thoracic rotation. The latter 4 movements formed the basis of her key movement signs, the tests we use to measure her response to treatment and her progress. These were all tested to the first point of reactivity, which is a more sensitive and reliable way to test movement, as it tests the protective response within the nervous system and is not reliant on a patient’s symptoms.
Mrs B also exhibited adverse nerve tension in the left upper limb, and both lower limbs.

We performed a whole body assessment (WBA) for Mrs B as part of our systematic whole body problem solving process. We found many areas of muscle knots and stiff hypomobile joints in the neck, thoracic and lumbar spines.

The Treatment and Problem Solving Process

We first needed to clear Mrs B’s adverse neural tension, so that she would then respond to treatment more readily and it would be easier to find her primary contributors to her condition.

We then performed treatment trials on all of the unhappy muscles and joints we found on the WBA, using Mrs B’s hamstring as the main movement test. That is, we released the relevant muscle or joint while Mrs B actively straightened her hamstring (hip in 90deg flexion). Any improvements in hamstring range were recorded as percentage improvements for the particular structure on which we trialing treatment. We would retest all of Mrs B’s movement signs at the start and end of each session, so that we could plot a progress graph.

Process of Elimination

We came up with a list of 16 structures which were all affecting Mrs B’s key movement tests related to her sciatica and back pain. We then worked more on each of these to release them further and test if they were still part of her condition, again using her key movement tests, until the tests reached an optimal range without muscle guarding or reactivity.

We arrived at 3 structures that were having the most effect on Mrs B’s movements. They were the left Piriformis muscle, the left plantar fascia and the T8 segment, with a left to right bias on the transverse process. These were the primary contributors to her condition as they all improved her key tests related to her sciatic condition.

We also started Mrs B on a range specific exercises for her Tr Abd, as she was not activating this well, and also the right gluteal muscles. They were also activating poorly.

Results

As we got towards the end of the problem solving process, and not earlier, Mrs B’s symptoms finally began to ease, which coincided with her movement test improvements. Her leg pain started to reduce and she was no longer experiencing the catching pain that had troubled her intermittently over many months.
She began to sleep better, then walk further without pain. She also started to reduce her medications.
On her last review, she was extremely happy with her progress and most of her pain had resolved. She was off all her medications, and had resumed walking around the river with her friend, who had commented that she was struggling to keep up with Mrs B!
She was waking up in the mornings feeling great, and was now happy to resume morning shifts at work.
She self rated her functional capacity at 85-90%!

Mrs B’s progress above shows a steady improvement in her key movement tests, with some regression between sessions.

Summary

This was a very satisfying result both for Mrs B and her Physiotherapist. The protective responses that made the most change in her condition were on the opposite leg. It was theorised that the episode of plantar fasciitis she had last year had contributed to the tension on that leg, and she was most likely placing more weight on the right side.This would have loaded the structures on the right more, leading to her pain.
This case highlights the benefits of using a systematic whole body problem solving approach, as where your pain is may not be where the problem is.
It also highlights the fact that MRI scans don not always correlate with a patient’s symptoms. If Mrs B had a repeat MRI on her lumbar spine, it is unlikely to be any different, yet her pain has resolved. Pain is an output sign created by the brain, and when we address the primary protective responses in the body, there is no need for the brain to create the pain. It is dependent on tissue pathology in many cases.
Careful and thorough assessment and problem solving is needed for each person because each case is individual. People with the same symptoms may have totally different primary sources of their pain.

To ensure the problem does not recur, we have taught Mrs B self management strategies and corrective exercises that she can do at home.

“You have a 5cm DRAM.”

While it’s common to hear this from your nurse or physio after giving birth, what does it actually mean? And if you do have a separation, should you be worried? In this article, let’s demystify the meaning of having separated abdominal muscles – and what it means for you.

What is DRAM?

This condition has many names, but it essentially boils down to this:

Diastasis = separation of normally joined parts

Rectus Abdominis = the muscles that make up your abs (the part commonly called the “six-pack”!)

Between your abdominal muscles is a thin area of connective tissue called the linea alba. This tissue will be stretched during pregnancy by your growing baby, sometimes resulting in extra space between the two sections of your abdominal muscles. But this shouldn’t make you concerned – this is a normal part of the pregnancy process as your body makes room for your baby.

After giving birth, this distance in the abdominal muscles will often reduce and even disappear entirely for some women in the first six weeks. However, in 50% of cases, this separation can persist as a noticeable gap down the centre line of your abdominal region.

This can present in a number of ways. You might notice that when you tense your abdominal muscles, there’s a gap down the middle. Or even that your belly muscles can bulge out (also known as “tenting” or “coning”) or sink in through the centre when you sit up out of bed.

However, the most accurate way to get it assessed is to see a Women’s Health physiotherapist. They can measure where the separation is occurring, how wide it is, and most importantly, whether it’s a problem that needs to be addressed.

Should I be concerned?

Not necessarily! When it comes to DRAM, the most important thing to assess is, “is this separation affecting my core strength and daily life?” Smaller DRAMs less than 2cm don’t have an impact on your core strength or back function, which means that leaving it alone will have no long-term negative effects.

Larger DRAMs can mean your core is weaker and you will have more difficulty doing certain activities. If you are experiencing difficulty moving from lying to sitting up, lifting objects, or engaging your core muscles, then it is best to get yourself assessed. If a DRAM is found, it can often be easily addressed without invasive intervention.

What can be done to treat my DRAM?

Once your Women’s Health physiotherapist has assessed how your abdominal muscles are working, there are a range of treatment options.

Abdominal binding in combination with specific core strengthening have been shown to be effective in the recovery period after your baby’s birth, especially with caesarean deliveries.

Your Women’s Health physiotherapist can teach you are correct postures and lifting technique so your body remains protected and injury-free as you care for your newborn.

A physiotherapist prescribed regime of core stabilising exercises to regain strength and control in your abdominal muscles is the best solution. In particular, retraining your transversus abdominis (deep core) muscle has been shown to reduce bulging or tenting. The key is making sure the exercises are specific and set at the right level for you. If the exercises are too demanding, then it can lead to overloading and create pain in the back and elsewhere.

Key Takeaways

You might experience a lot of fear and uncertainty after being told you have a DRAM. You might feel concerned about long-term injuries or how your belly might look. Having a DRAM of any size is not a cause for concern. Smaller DRAMs often require no treatment at all and larger DRAMs can be improved with the right advice and treatment.

The team at NWPG can help you get on the right track. Call us at the clinic or book in online for a thorough assessment with our Women’s Health Physiotherapist today.

As your pregnancy progresses, your body will undergo significant physical changes. This is a natural part of the journey as your body prepares to deliver a newborn into the world. However, in up to 50% women, these body changes can result in a debilitating condition called Pregnancy Related Pelvic Girdle Pain.

The impact of Pelvic Girdle Pain can not only affect you physically, but emotionally and psychologically as well. You might struggle with everyday function and work. You might feel exhausted and powerless. You might rely on pain medication to get through the day.

Fortunately, there are things that can be done to treat this problem. The sooner you start treatment, the less likely the problem will persist following your baby’s birth and beyond.

How Do I Know If I Have Pelvic Girdle Pain?

Pelvic Girdle Pain is localised to the pelvic region, in the space between your lower back and hips. You might feel pain around your tailbone at the back or even around your pubic bone at the front.

If you have Pelvic Girdle Pain, you will commonly experience pain and restriction with the following:

• Standing on one leg
• Going up and down stairs
• Turning over in bed
• Walking on sand
• Wearing heels
• Squatting low to the ground
• Doing housework
• Caregiving

Why Am I Getting Pelvic Girdle Pain?

There are many factors that influence Pelvic Girdle Pain. The joints in the body naturally become looser during pregnancy to allow the pelvic bones to move and slide apart when it’s time to give birth. However, this extra joint mobility can lead to excessive stress and strain building up in the sacrum (tailbone) and pelvis when it normally wouldn’t.

Your natural body posture also changes during this time. As your baby and belly grows, your pelvis is drawn into an anterior tilt position.

This posture creates further tension on joints of the spine and sacrum. That, combined with the laxity in these joints, can lead to a feeling of instability, weakness, and pain around the sacrum and pelvis.

What Can I Do If I Have Pelvic Girdle Pain?

The first thing you can do straight away is to change any habits that may be aggravating the condition.

• Wear comfortable, supportive shoes when on your feet. Avoid wearing heels as this will further accentuate any anterior pelvic tilt position.
• Take the time to rest and be off your feet. Even that can help relax the tension that has built up in the joints and prevent the pain from getting worse.
• Avoid standing on one leg where possible – for example, sitting down to put on pants and shoes rather than standing. Keeping your weight even between both legs when you stand to prevent one side being overloaded and aggravating the problem.
• Learn how to stabilise the pelvis with specific exercises prescribed by a physiotherapist. Keeping your strength intact over the period of your pregnancy can not only reduce Pelvic Girdle Pain, but even lower the risk of injury and pain after your baby is born.
• Using support garments such as a belt or compression shorts can also help the recovery of this condition. Providing external support to the loose pelvic joints can create a feeling of comfort and stability and improve function. Our Women’s Health physiotherapist can help you fit these garments and advise what’s right for you.

Key Takeaways

Pelvic Girdle Pain is a common but treatable condition of pregnancy. If you notice pain in the pelvic region during your pregnancy, seek treatment with a Women’s Health Physiotherapist as soon as possible, as symptoms can often worsen as your due date approaches.

We can help you reduce pain and get you on track. Call us at the clinic or book in online for a thorough assessment today. The last thing you want is debilitating pain to be on your mind when your baby arrives!

In this article, we will demystify some of the symptoms you may experience if you are going through menopause — because the more prepared you are, the more you can mitigate the risk of chronic pain and injury in the years following. Healthy aging is key!

What Is Menopause?

Menopause occurs when the body stops producing eggs and the hormones associated with reproduction are dramatically reduced. If you haven’t menstruated in 12 months, then you have entered menopause. It can begin in women as early as their 40s, however the period of fluctuation in hormones can be anywhere between 4-6 years. For some, this has minimal effect except for an end to monthly menstruation. However, for 80% of women this change in hormone production levels (especially in estrogen) will cause symptoms throughout the whole body.

The Musculoskeletal Impacts Of Menopause

Migraines/headaches

High levels of estrogen can trigger headaches and migraines in some women. The good news is that declining levels of estrogen post-menopause can reduce headache frequency overall. However be mindful that as your hormone levels fluctuate during menopause, your headaches may be triggered more often in the short-term.

Bone health and osteoporosis

Bone density in women is strongest during their 20-30s and estrogen levels are especially important in maintaining this. However, as estrogen levels drop, bone loss increases, with an average of 10% bone mass lost in the first five years post-menopause. This means the risk of osteoporosis is far higher in women after menopause, making bones frailer and more prone to fractures, especially in the spine, wrist, and hips from falls.

Muscles

Estrogen provides a protective effect on muscles, which is why women typically suffer less muscle strains than men throughout their lives. Unfortunately the reduction of estrogen during menopause leads to a decline in both muscle mass and strength, which means you may experience more pain or sustain injuries more frequently even though your level of activity hasn’t changed. Not only that, but it can also cause weakness in your core and pelvic floor muscles and lead to instability, poor posture, and even incontinence.

Joint pain and inflammation

Estrogen has been shown to help reduce inflammation in the body. If you already have a pre-existing inflammatory condition such as arthritis or a tendinopathy, this can become exacerbated post-menopause and cause more pain and restriction in your daily activities.

How To Minimise The Effects Of Menopause

Maintaining a good level of physical activity has been shown to counteract many of the negative musculoskeletal effects of menopause. This can be walking, swimming, cycling, gym classes, Tai Chi, strength training, pilates — just remember that consistency is key to reap the benefits to your health. If you can do some form of exercise for 30 mins most days of the week, then you are on your way!

Bone density can be maintained by ensuring adequate calcium and vitamin D levels in the body for bone production. Regular weight-bearing resistance exercise (i.e. exercise on land involving weights) also stimulates bone strength as well as counteracts the muscle loss that occurs menopause and aging. If you are experiencing specific weakness of core and/or pelvic floor muscles, consider getting a specific assessment and exercise program prescribed by a physiotherapist.

For most people, exercising more and being aware of your body changes will go a long way to attenuating the worse symptoms associated with menopause. However, if your symptoms persist and impact your quality of life, menopausal hormonal therapy may be an option to help adjust to the sudden decline in estrogen levels. This is best discussed with your GP to ascertain whether this is the right option for you.

If you are suffering from muscle aches and pain, we can help get you moving pain-free and prescribe an exercise program to keep you there despite the hormonal fluctuations in menopause. The earlier you start, the easier it is to keep the gains as your body undergoes these significant changes!

References

Introduction to Women’s Health APA Lecture Series

Bondarev, D., Laakkonen, E., Finni, T., Kokko, K., Kujala, U., Aukee, P., Kovanen, V. and Sipilä, S., 2018. Physical performance in relation to menopause status and physical activity. Menopause, 25(12), pp.1432-1441.

Chidi-Ogbolu, N. and Baar, K., 2019. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Frontiers in Physiology, 9.

A few years ago I started to notice some mild tingling in my feet, which would come and go, but was more apparent after a long run or a hard training session around Princess Park( I was in a running group back then, and our coach liked to push us!).

As a Physio, I sort of knew what this may be, but it wasn’t affecting me much so I just kept doing what I was doing.

Then in 2019 we renovated our house. Most people who’ve been through this know how stressful it can be, and although we had a great builder, I was quite involved in the whole process. There was a lot of physical work to do, like moving and getting rid of furniture, putting together flat packed furniture( I will outsource this next time!) painting and landscaping, as well as the stress of moving out temporarily and managing the budget. I was still running a lot at this time, because I felt it helped me relax and I enjoyed it.

But soon I started to develop back pain, which would often radiate down the back of my legs on both sides. I remember coming home from work back then, and feeling much worse than the clients I was treating! I also remember umpiring at my son’s tennis games and having real difficulty standing for a set of tennis…my back and legs would be aching, and often my feet would be tingling.

The pain was also affecting my running, in fact I had to stop completely and go to walking on several occasions due to acute episodes. I remember one weekend after a flare up, I couldn’t walk more than 2 km, whereas 1 week earlier I had run 18km! ( 18km is not that far when you’ve done 6 marathons!). I was often tired and cranky at the end of the day, and it was even affecting my relationship with my wife and kids… mainly because I was tired and in pain… and a pain to live with!
 

I had an xray in 2019 and later in 2020 an MRI of my lumbar spine. The results of the latter are below. It looks pretty bad doesn’t it? Essentially I had a forward slip of the L4 vertebral segment on the L5, severe facet joint degeneration at that level, and stenosis(narrowing) of the spinal canal due to disc bulging and swollen facet joints. This really did explain most of my symptoms, especially the tingling in feet and legs, which was nerve irritation.

My doctor had referred me to a spinal surgeon, and cortisone injections were on the cards.

So what did I do:

1. I didn’t panic or catastrophise! With my knowledge of pain and the body, I knew there are a lot of contributors to pain signals being created by the brain, and stress/anxiety is a big factor!
2. I made more time for meditation and managing my mental health, and was more conscious of overdoing and overthinking! This calmed my central nervous system( completing the renovation and settling into a beautiful house also helped!).
3. My colleagues assessed my posture at work and found that I was over straightening my thoracic spine(mid back) when  was leaning over to treat. My back was too straight because I thought this was the right thing, but it was placing more load on my spine, contributing to my pain. Making some postural changes here, working on motor control (thoracic flexion movements) and having my thoracic spine treated regularly made a big difference.
4. I reduced my running volume, slowed down my pace, focussed on more recovery between sessions and worked on my core, back and gluteal strength.( I also started drinking Mangosteen juice daily, known for its anti- oxidant and anti inflammatory properties).
5. I had regular tune ups with the team and regular massage, which prevented strain in my body accumulating, and allowed me to slowly build more strength and capacity for load.
 

It did take some time for things to settle and to build load capacity again, but if you give your body the right conditions(including your positive thoughts and beliefs), and have the right guidance…you can overcome many physical conditions. This also shows that you cannot make decisions about your health based only on scan results, because often they do not correlate to symptoms. There is now lots of evidence to support this. If I had another MRI now the results would not be much different… the same degenerative changes would be there… but I’m essentially pain-free, enjoying my running again…. and my wife and kids are happier!:))
 

If you have recently had a spinal or joint scan and are a little concerned about it, feel free to contact us at the clinic and we’ll be happy to discuss it with you.

Hip pain can present itself in a myriad of ways. It can feel like pinching at the front of your joint, a deep, dull ache in the buttock, or burning pain on the side of the leg. It can even be felt as referred pain in the groin and knee region or present with associated stiffness and tightness across your whole leg. Lateral hip pain is a particularly common problem – prevalent in women between 40-60 years old and in 25% of the general population (Williams and Cohen, 2009).

If you have a hip problem, it can affect many of your day-to-day functions negatively, for example:

• Putting weight on the leg
• Walking, or taking large steps
• Getting in and out of a car
• Sitting or driving for long periods
• Sporting activities like running, change of direction, kicking a ball, etc.

So What Structures Can Be Involved?

Your hip is a ball and socket joint made of the head of the femur sitting in the pelvic acetabulum. While it has good mobility in all directions, it is also one of the most stable joints in the body. There are numerous muscles, tendons, and ligaments crossing the region and if any of them become dysfunctional, it can set off a host of problems in your hip. Here are the common structures that can cause hip pain:

• Glute maximus, which is the main power muscle of the leg and helps generate force in many activities
• Smaller muscles like the glute medius, tensor fascia lata, and piriformis, which help stabilise your hip joint and pelvis
• The gluteal tendon, which is where your gluteal muscles attach to the hip bone itself
• The psoas and iliacus muscles, aka your hip flexors, which originate from the spine and attach the hip bone
• The sciatic nerve, which passes through under the piriformus muscle before it travels down the rest of your leg
• The labrum, which sits inside your joint to help keep the ball in the socket
• The trochanteric bursa, which helps the tendons glide smoothly over your hip joint

However it is important to remember that the hip joints connect closely with the pelvis and spine, so it is common for dysfunctions in these areas to present as hip pain – this is a good reason to make sure you explore thoroughly for the source of the pain before settling on a diagnosis. In our clinical practice, we have found sources of hip pain coming from problems in the spine and trunk, but also areas as remote as the foot or the shoulder. When diagnosing the cause of an injury, it is best to leave no stone unturned!

Let’s Get Specific: Gluteal Tendinopathy

The gluteal tendon connects your gluteal muscles to the side of your femur. When this tendon degenerates, this is called gluteal tendinopathy and can often present as pain and tenderness on the outside of the hip, as well as any number of symptoms mentioned earlier. You might also notice pain and stiffness upon waking up in the morning that improves with activity and then becomes painful again as you cool down.

This degeneration can result from repetitive movements of the hip that cause compressive force over the tendon – typically when the leg crosses the midline of the body (e.g. when crossing your legs or when your knees knock together) (Segal et al 2007). This compressive force, if persistent and beyond the tolerance of the tendon, will cause microtrauma and degeneration (tendinopathy) to occur.

Fortunately, gluteal tendinopathy can be fixed! Read on for info about how.

How Did This Happen To Me?

The reasons for why injuries happen are always individual to your lifestyle and activity. A sedentary office worker presenting with hip pain will have a very different cause than the runner who is running a mileage of 80km per week. Among our clients, the most common reasons for hip pain to occur are:

• Sudden increase in training loading
• Poor postures, like slouching or crossing legs
• Asymmetries in strength and stability around the body
• Poor technique in training and sport
• Structural deformities in the ball or socket of the hip which result in impingement with certain movements

Do’s & Don’ts

The basic rule of thumb: do not push through pain. Pain is a warning signal coming from your brain that tells you when your hip is not happy so when you push through pain, you risk aggravating your condition. Here are examples of activities and postures that can put stress on your hip:

• Sleeping on your side
• Sitting with crossed legs
• Standing with uneven weight on each leg
• Stairs
• Wearing heels
• Running
• Overstetching (if you feel more pain after stretching, this is not the intended effect!)

If any of these positions aggravate your problem, do your best to modify or avoid them where possible.

What Can I Do About My Hip Pain?

The good news is that you don’t have to put up with it! If you are experiencing hip pain, there are a few options for you to start fixing your problem straight away. Watch our video series on gluteal tendinopathy – it includes more information as well as key exercises to try at home. Exercise and strength work have been proven to improving function and decreasing pain, so keep moving where possible (Mellor et al. 2018).
If you are not finding improvement on your own, it is best to speak to a health professional you trust and get it checked out. Remember, the problem may not be coming from the place you are experiencing the pain! If you would like more personalised advice, our physios are available to answer your questions so feel free to call our clinic on (03) 9370 5654.

References

1. Segal NA, Felson DT, Torner JC, et al, Multicenter Osteoarthritis Study Group. Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 2007;88:988-92.
2. Williams BS, Cohen SP. Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg. 2009;108(5):1662–70.
3. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercises versus CSI use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BJSM 2018; 52(22):1464-1472.

In our experience, most people who present with pain or injury have postural imbalances that contribute significantly to their problem. Improving posture, strength and mobility can help you move more freely with less pain and stiffness.

What we find in our assessments

1. Tightness and trigger points in the muscles at the front of the chest and shoulder: usually the pec major and minor, upper trapezius and levator scapulae (which run from the shoulder blade to the neck) and biceps.
2. The shoulder joint is often sitting forward with posterior tightness in the joint capsule and weakness in the muscles that stabilise the shoulder blades and bringing them back towards the midline.
3. Restricted movement in the neck and thoracic spine, particularly rotation and extension and reduced  movement in the ribs.

Why is this important to know?

This posture results in an increase strain of the neck muscles because the head is pitched forward and it takes increased muscle activation to keep your eyes level.
Decreased mobility in the thoracic spine and ribs reduces capacity for breathing and full movement of the diaphragm.
These immobile and weak dysfunctional regions can also contribute to pain in other, more remote areas of the body.

Why does this happen?

Poor posture has become more common because many of our modern work tasks  involve prolonged  sitting and computer based work. We don’t move enough and our head and shoulders are held fixed and slumped forward.
A generation ago more people had manual jobs which required being on their feet, changing positions and moving between work areas. This constant movement allowed for better mobility in the neck and shoulders and strain did not build up to the same degree because of static loading.
Prolonged static postures cause a accumulation of strain in our bodies. When the amount of strain exceeds a safe threshold, our brains are alerted to send out protective guarding responses which can lead to feelings of pain and stiffness.
This protective guarding cycle leads to poor movement patterns due to pain and relative immobility.
All these are warning signs for us to change our behaviour or seek help.

What this looks like

What you can do about it

The first step is to change your posture so there is better alignment between you neck, shoulders and pelvis in standing and sitting. Good cues are to sit tall, draw in your chin and square your shoulders. In standing, try drawing in your tummy and standing tall.

If this does not help to reduce pain, careful assessment and then treatment to improve joint stiffness, nerve gliding, muscle tightness will reduce the protective guarding response initiated by the brain,improve mobility and reduce pain.

Along with careful systematic assessment and treatment, we also suggest three simple exercises to improve posture and joint mobility. The video below will take you through how to do these.

1. Step in front of an open door with your elbows and shoulders level and the forearm supported by the doorway frame. Gently lean forward and let your shoulders open up and feel a  stretch in the front of your shoulder and chest. Make sure you keep your neck neutral and relaxed as you perform this exercise. Hold for 10 seconds by five repetitions.
2. To improve the thoracic rotation sit in a comfortable chair with your feet flat on the ground to keep your pelvis stabilized. Gently turn your shoulders, turning your spine using your arms on your thighs to assist. Make sure you breathe normally and don’t strain. Hold the  stretch for 10 seconds and alternate from left to right
3. Sit on the floor with your knees bent and feet flat on the ground. Reach behind you placing your palms on the ground with your arms straight. From this position gently lift and open your chest while squeezing your shoulders back and your shoulder blades together. Feel a stretch in your chest and in the front of your shoulders. Feel the shoulder blades squeeze together. Do five stretches holding for 10 seconds.

These are three simple exercises that when done regularly help to gently and progressively stretch away from joint stiffness caused by prolonged sitting and working a desk or computer.
These exercises work both on mobilising joints and muscles and places a steady stretch on the connective tissue around joints which gradually adapt over time. These exercises work very well over time and should be incorporated into a daily stretching or warmup program.
Remember that mobility is the key to good health and as a consequence you have more freedom of movement, can exercise more effectively and just feel a whole lot better.

How you can self test

Do a quick scan of your mobility by first looking at your posture in the mirror. Is your head forward with your shoulders slumped and rounded?
Try turning your head to either side and then your trunk and reaching overhead. How far can you go? How comfortable is the movement?
If indeed you do feel your movements are restricted or painful, it may be worthwhile to start these exercises.
If you continue to have problems with pain or stiffness and  would you like more information about managing these issues.

Feel free to call us at Northwest Physiotherapy Group, either through our website or message us through our Facebook page.

We are here to help!