Exercise: Dynamic Warmup and Mobilisation

The terms ‘stretching’ and ‘warmup’ are often used interchangeably, however they are not necessarily the same thing. Stretching and warming up both serve their own purpose in any exercise regime. In my previous blog, I highlighted the importance of stretching and clarified that stretching should be done after exercise and physical activity. Before exercise, mobilising the joints and performing a dynamic warm up is where you should start.

When in doubt just remember MES:

According to former NSW State of Origin player David Williams:

“Warming up the muscles and mobilising your joints before any strenuous physical activity or exercise, is vital for the body to move through its full range efficiently and effectively whilst greatly lowering the risk of injury.”

David Williams aka Wolfman
Click image for animation

Dynamic Warmup

A mobilisation technique or ‘dynamic warmup’ involves easing your joints into full range of motion. This prepares the muscles for movement and wakes up the body’s nervous system. By mimicking movements that you are about to perform in your work out, you are gradually increasing flexibility and blood flow to the areas that will be moving in your sport or activity.

Focus on major muscle groups and the muscles used most in your activity. For example, if you are about to go for a run, you should focus on mobilising your hips, knees, and ankles. If you are a swimmer, you should mobilise your upper back, neck, and shoulders.

Click image for animation

Things to Remember

When doing a dynamic warm up, remember to focus on symmetry. Always do equal amounts of movement on both sides of the body.

Start at a low level of movement and then slowly increase intensity until your joints and muscles feel ready to go.

Remember that some joints will have more range of motion than others. Injuries, ageing, and even genes can restrict some of our joints, so don’t try and force a joint past its natural range.

Sources

Williams, D., 2021. Performance Coach [Interview] (28th June 2021).

Taylor, K.-L., Sheppard, J. M., Lee, H. & Plummer, N., 2009. Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), pp. 657-661.

Published by Sydney LaVine June 29 2021

Exercise: Stretching Before or After?

“Should I stretch before or after I exercise? Or both?”

This is a frequent question asked by my clients when we are talking about movement and exercise.

My job as a massage therapist is to assist my clients with sore muscles, sports injuries, and stress management. Regardless of what ailment a client presents with, we always discuss what they are doing for daily exercise. In this day and age, we all know that habitual exercise is crucial for our health and well being. Reasons to be physically active everyday include:

  • Feeling more energized
  • Burning more calories when at rest
  • Improving overall appearance
  • Ability to withstand stress
  • Improved sleep
  • Speed up recovery from injury or surgery
  • Decrease the risk of illness and injury
  • Keeping focused
  • Building up cardiovascular endurance
  • Improving flexibility and range of motion

The ability to perform daily exercise, requires our joints to be healthy enough to cope with consistent movement. Maintaining our flexibility, joint range of motion, and joint health comes down to the wonderful combination of exercise and stretching. Stretching our muscles has been proven to:

  • Improve your joint range of motion
  • Maintain joint health
  • Improve athletic performance
  • Decrease risk of injury (1)

Now that we have a better understanding of why stretching and daily exercise are so important, when should we stretch?

Stretching should not be considered a warmup. By stretching cold muscles, you increase the risk of injuring yourself. Instead, consider performing mobilisation techniques, which I will cover in my next blog. Stretch after your workout when your muscles are warm. Remember to focus on the main muscle groups that were used during your workout session. (2)

Research shows that stretching before a workout does not reduce muscle soreness in the days after. Other results show that lengthening the muscle and holding the stretch immediately before a sprint may slightly worsen performance. Consider skipping stretching before any intense activity, such as sprinting or track and field activities. Pre-event stretching may decrease performance and create weakness in the hamstring strength. (3)

Gentle stretching at the end of any exercise also gives you a great chance to catch your breath, be still, and reflect on the hard work you just achieved!

June 20th 2021

By: Sydney LaVine

Sources

  1. Harvard Health. (2019, August 26). Retrieved from Harvard Health Publishing: https://www.health.harvard.edu/newsletter_article/why-we-should-exercise-and-why-we-dont

2. Stretching is not a warm up! Find out why. (n.d.). Retrieved 6 19, 2021, from https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

3. Taylor, K.-L., Sheppard, J. M., Lee, H., & Plummer, N. (2009). Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), 657-661. Retrieved 6 19, 2021, from https://sciencedirect.com/science/article/pii/s1440244008000790


We are open

As a primary health provider we are open during the latest Covid19 outbreak. We ask that you wear a mask and you must register using the QR code when you enter the clinic. You are allowed to attend an appointment if you are coming from outside the northern zone of the Northern Beaches

WE are OPEN NORMAL HOURS

During the Covid19 crisis, as Primary Health Providers, Mona Vale Chiropractic Centre is open as normal. We understand that this is an incredibly challenging time for all of our patients. We are here to support you in any way that we can. We are following all government recommendations in keeping our clinic environment to the highest health standards.

3 exercises to prevent low back pain

These 3 exercises are termed ‘the Big 3’ by spinal researcher Dr Stuart Mcgill. The exercises are performed in a neutral back position – a spine sparing position and it helps to build muscular fitness along with stability and control throughout the spinal column. Spinal stability is what creates a strong core.

You do not have to be in pain to perform these exercises. These are actually best used as a preventative method to prevent back pain! Although if you are in pain, they are still a great way to help you get your core switching on again.

Some things to note:

·   The exercises must be performed daily

·   The best time is mid-morning or dinner time. Not upon waking – as this is when the spinal discs are at their fullest and therefore less room to move

·   Reps and sets are important to what you can tolerate. There is no point trying to push through excruciating pain. Find your level and then progress

·   Try and ensure that all 3 exercises are performed in a pain free posture for your spine.

1. Bird dog

Position yourself on all fours. Raise your right hand forward while simultaneously extending your left leg back, until both are parallel. Bring both arm and leg back into the resting position and then repeat with the opposite arm and leg. This is one rep.

Make sure your pelvis has minimal rotation while performing this exercise. The value of this exercise is coordinating upper back, lower back and hip movement all together.

Perform 1 set of 8, followed by another set of 6, with a final set of 4.

2. The side plank

Lie on your side, resting on your bent forearm, with your legs straight out

Lift your hips off the floor and hold for 10 seconds. You should feel your abdominal muscles and obliques (side) working. This exercise also works the quadratus lumborum (QL), a major spine muscle that plays a role in spine flexion and rotation. This exercise gets the  QL and oblique muscles working together in coordination.

Perform 3-4 holds per side of 10 seconds each. Repeat for 3 sets, but with each set, reduce the reps by 1.

3.      The curl up

The Mcgill curl up is not like your traditional curl up. There is no movement from lumbar spine.

Start by lying on the ground, with 1 leg bent up and the other leg straight (the painful side should be the one with the straight leg). Place both hands under the small of your back, this will ensure minimal movement through the lower back.

Lift your head off the ground by a few inches and then hold it there for a count of 10. The goal is to perform this without any movement in the lower back. If you feel your lower back rounding, then your head or shoulders are too high off the ground.

During this, you should feel your abdominal muscles brace – this is the spinal stability

Repeat another 5 times for a total of 6 reps. The recommended volume is 1 set of 6, followed by another set of 4 and the final set of 2. You do not need to hold the curl up for more than 10 seconds, rather to progress you can increase the reps.

Conclusion

I recommend using these exercises every day as the best preventive measure to avoid lower back pain. If you do have back pain, they are also great to perform as they can be done in a pain free position. The key is being consistent, once a day and before any exercise.

Mitchell Roberts – Chiropractor

Disc injuries, what actually happens?

Disc injuries are a very common presentation to the chiropractor. We often hear a patient say they have previously had a ‘slipped disc, which sounds like a very painful injury! The good news is that it is actually not possible for the disc to slip out of place, as it held together through some very strong ligaments to the surrounding vertebra. I have detailed below some of the most common disc injuries. I also discuss a disc bulge, a very common phenomenon that does not always lead to low back pain.

 

In the lumbar spine, there are many different structures that can be the cause of one’s low back pain. Some of these causes can be from the vertebral joint, muscles, ligaments, nerves and the intervertebral disc. It is very important to ensure a thorough history and orthopaedic/neurological examination can help identify the cause and thus the appropriate treatment and exercises provided.

 

Anatomy of the intervertebral disc:

The discs are located between the vertebra and act as a shock absorber and also help distribute the load through the spine during day to day movement.

There is a total of 23 discs in the human spine – 6 in the cervical (neck), 12 in the thoracic (mid back) and 5 in the lumbar (low back). The disc is made up of a tough outer layer of cartilage (annular fibrosis) which is weaved together like a basket of 15-25 layers. The inner layer is called the nucleus pulposus, which is a gelatinous centre. (A common analogy is a jam donut. The nucleus is the jam and the outer layer is the dough).

Below, I am going to discuss a disc bulge, herniation and finally an annular tear. These definitions and classifications came about through a meeting of several professions/groups (Fardon, 2001) to clarify and standardise disc injury terminology.

Disc Bulge:

With a bulge, the structure and integrity of the disc is still intact. There is a general enlargement of the disc beyond its natural boundary although the contents of the disc are still contained.

 

A disc bulge can often cause no pain at all. In fact, a 2015 review by Brinjikji found that in people with no back pain at all, 30% of 20 year olds had a disc bulge, with it increasing to 84% of 80 years olds having a disc bulge. A bulging disc is in fact not a diagnosis, it is more of a descriptive term for the shape of the disc contour.

So why is there such a high percentage of individuals with no back pain having disc bulges? The answer being, what structures does the disc touch, irritate or compress. Often a disc bulge is not the source of the pain, rather an incidental finding on imaging.

Disc Herniation

A herniation is defined as a localised displacement of disc material beyond its limits of the intervertebral disc space. Herniated discs result from damage to the tissue structure, resulting in  leakage of contents. They are classified based upon their shape – either an extrusion or protrusion.

The symptoms of a herniation vary from a minor ache in the lower back and buttock, to a more severe pain that radiates down the leg, pins and needles, numbness and weakness. Often the patient leans to one side – to take pressure off that area of the disc that has herniated.

Please note that in rare circumstances, a herniation may cause a loss of control of bowel and bladder functions, which is a medical emergency.

 

  • Protrusion – A broader base, defined as being wider that it is tall.

 

  • Extrusion – has a thin ‘neck’ and the extruded material is longer than it is wide. A sequestration can also occur, if the extruded material breaks off at the neck.

Annular Tear

A tear can result to the outside layer of the disc, which can cause local inflammation/swelling which hence irritates the surrounding spinal nerves, resulting in sciatic pain. There is no herniation of the disc contents. It should be noted that some tears can show up on scans in asymptomatic people and thus can be an older injury that has recovered.

 

Do Discs heal?

The answer is yes, discs do heal and 60-90% of lumbar disc injuries can be treated with a conservative approach, such as chiropractic treatment. (Chui, et al,. 2015).

Based upon all the different type of injuries that can occur to the discs, it is important to make sure a thorough history and examination is performed. Sometimes an MRI may also be needed to show the extent of the injury and be graded. From then on, we can get a clearer picture of what the recovery time will be like for such an injury.

Mitchell Roberts  – Chiropractor

 

References:

Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, J.G. Jarvik. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology Apr 2015, 36 (4) 811-816

Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29(2), 184-195.

Fardon, D. F., & Milette, P. C. (2001). Nomenclature and classification of lumbar disc pathology: recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine, 26(5), E93-E113.

 

How to make our spinal discs stronger

It has long been thought that the constant pounding of running can cause degeneration of the lumbar disc, however this theory has recently been debunked. A 2017 study from Deakin University in Victoria has found that people who regularly run or walk have stronger and healthier discs in their spine compared to people who do not exercise.

 

It was shown that through running or brisk walking, the disc showed improved hydration, increased protein content and growth of the disc. The control group for the study were sedentary, non-active adults – whom showed no change in disc characteristics.

One important factor from this study is that the brisk walking and running groups both showed the same amount of improvement in disc health. So, you don’t have to be a runner to improve the health of your discs, walking is fine as well!

 

The authors concluded that the response of the disc to running is very similar to the response of muscle in resistance training.

 

What if I have a disc injury?

If you have a disc injury, movement is good for it! It allows the disc to recover through getting nutrition to the disc to allow for repair. If minimal movement occurs at the disc, healing will be therefore very slow.

 

 

Why is this so?

Discs get their nutrition through diffusion from the bony endplate of the vertebra above and below. The way this diffusion works is through movement. The constant loading and unloading of the spine through walking or running allows for the flow of nutrients to the disc. In sedentary individuals, the diffusion of nutrients is poor due to the lack of movement, hence why degeneration and dehydration of the discs is more likely.

 

So the take home message is to move more to strengthen and improve your back health. It also doesn’t have to be intense running, a brisk walk is also as beneficial. Walking with a disc injury is also an important part of the recovery, as it allows for the disc to receive nutrients to allow for repair to occur.

 

Belavy, D. L. et al. Running exercise strenghtens the intervertebral disc. Sci. Rep. 7, 45975; doi:10.1038/srep45975 (2017)

Mitchell Roberts – Chiropractor

Is it safe to exercise when you have the cold/flu?

With winter here, it is that time of the year for the cold and flu season. Getting sick and taking time off of training / exercise can be a real setback for anyone who has put in the hard work throughout the year in achieving their fitness goals.

The question often arises, ‘how do I know if training will make me even more sick’? A general rule is the “neck check”. If you have symptoms in the head or throat, it should be ok to do light / moderate intensity exercise. If the symptoms are below the neck, it is best to rest.

Following the neck check rule, you can exercise when suffering from:

 

  • Runny / stuffy nose
  • Watery eyes
  • Mild headache
  • Mild sore throat

It is important to remember that you need to keep the intensity to moderate. Do not try and attempt a record weight or perform reps to fatigue. Stay hydrated and ensure adequate rest after exercise.

 

 

Avoid exercising when suffering from these below the neck symptoms:

  • Chest congestion
  • Nausea
  • Fever/chills
  • Coughing up mucus
  • Joint/muscular aches
  • Diarrhea

The benefit of exercising throughout the winter months – it helps to prevent respiratory infections. A 2012 study from Barret et al, found that moderate aerobic exercise of 30-45 minutes duration can half the risk for respiratory infections. Examples of exercises can be walking, running or cycling. So one of the best preventative techniques for avoiding the cold/flu this winter is to get moving!

  1. Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial. Barrett et al. Ann Fam MedJuly/August 2012 10 no. 4 337-346

Mitchell Roberts – Chiropractor

The 3 best exercises to prevent low back pain

A question I often get asked in clinic is what are the best exercises to perform to prevent low back pain. The below exercises are my ‘go-to’ for prevention of low back pain. They have been termed ‘The McGill big 3’ – named after the researcher Stuart McGill.

Stuart McGill is a spinal biomechanics researcher from The University of Waterloo, Canada. These role of these 3 exercises is to create spinal stability and endurance – which is essential for creating a stable foundation for the lower back.

The exercises aim to tighten up the front and sides of the core, while supporting the spine and remove gravity from the equation. The exercises are of a low intensity and are safe to perform.

Curl up – 3 sets of 10-12 reps

Bird dog – 3 sets of 10-12 reps

Side bridge – 3 sets of 8-10 seconds holds, each side.

If the above rep scheme is too hard, you can always modify it by reducing the number of reps and work your way up to the noted rep scheme.

It is also recommended to do these exercises before training as well, as it has shown to tighten and stiffen the core post performing them.

Perform these exercises once a day, not into pain. If you do have questions, pain or discomfort when performing these exercises, come in and see us and we can either correct your technique or advise you on alternative exercises.

 

References:

McGill, S.M. (1997) The biomechanics of low back injury: Implications on current practice in industry and the clinic. J. Biomech. 30: 465-475.
McGill, S.M., Low Back Disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, Illinois, 2002.

Mitchell Roberts – Chiropractor 

My knee/shoulder clicks, does that mean I have arthritis?

I often have patients presenting to me complaining of repetitive pain-free joint clicking (crepitus) of their knee or shoulder. This can often cause anxiety as they associate this clicking with arthritis and joint degeneration. It tends to be more common in the morning and after a period of inactivity, though reduces with movement / once warmed up.

A 2017 study by Robertson et al found that knee crepitus lead to worry, anxiety and eventually fear-avoidance behaviour – meaning they stopped doing their regular exercise because of the sounds.

Joint clicking

 

Thankfully, joint crepitus is entirely normal. A 1987 study by McCoy et al found that of 250 normal knees studied (no prior injury and pain free), 99% had knee crepitus! 

So what is causing the noise? First off, it is not bone on bone – as this would be very painful and uncomfortable. The noise is fluid moving within the joint and/or tendons/ligaments rubbing and flicking against the bone on the outside.

The role of health practitioners should be to educate patients and eradicate their fear that no damage is being caused by the sounds.

Knee Crepitus = Normal 

The concluding message is that clicking and creaking in joints is very common and is not a sign of joint damage – as long as there is no associated pain or swelling. If you do have any concern, come in and see us at Mona Vale Chiropractic Centre for a thorough assessment.

 

McCoy G, McCrea JD, Beverland D, Kernohan G, Mollan RB. Vibration arthrography as a diagnostic aid in diseases of the knee. J Bone Joint Surgery (Br) 1987; 69-B, 2: 288-293
Robertson CJ, Hurley M, Jones F. People’s beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study.Musculoskelet Science and  Practice. 2017 Apr;28:59-64

Mitchell Roberts – Chiropractor