Gluteal tendinopathy AKA – Hip bursitis

A common injury we see presenting to the clinic is pain on the side of the hips – commonly referred to as hip bursitis over the years. The name has changed over time, from hip bursitis, trochanteric bursitis to now commonly referred to as gluteal tendinopathy. Our understanding of the tissues involved has also evolved, which I will go into further detail below.

Often the most common complaints is that it hurts to sleep on the involved side – and thus causes a lot of interrupted sleep. The bursa that sits on the side of the hip is often blamed, though this is now known to not be the main cause – rather it is a symptom. The main pathology is the tendon of the gluteal muscle – which sits on top of the bursa – it is weak. As a result, the tendon thickens and pain generators are active – causing the tendon to become sensitised.

Gluteal tendinopathy is more common in women than men, especially after menopause. It can also affect people who do activities that involve a lot of running, jumping, or twisting of the hips. Some of the symptoms of gluteal tendinopathy include:

  • Pain on the side of your hip that may radiate down your leg
  • Difficulty sleeping on the affected side
  • Difficulty walking, climbing stairs, or getting in and out of a car
  • Reduced range of motion of your hip joint

What causes It?

The main cause is overloading or too much compression of the tendon. This can happen when you:

  • Stretch your hip too much or too often – across your midline
  • Cross your legs when sitting or lying down
  • Stand with your hip tilted to one side
  • Wear shoes that are too high or too low

The interesting thing about gluteal tendinopathy is that you can do these things for years and you will have no symptoms. Although there could be a time when the tendon becomes fatigued – often due to an increase in activity over a short period of time and that can flare up the tendon.

How can it be treated?

The first thing we need to do is desensitise the tendon – that is stop irritating it! The number one thing to do is to stop stretching it! A lot of people think stretching the tendon will help, but this just irritates it. The next thing to do is stop the leg from crossing your midline – which means the tendon is not stretched or compressed.

Seeing a chiropractor can help by providing education and also:

  • Hands on treatment to mobilise and manipulate your joints and soft tissues
  • Exercise prescription to target your gluteal muscles and other supporting structures
  • Advice on how to progress your activity level safely and gradually

Gluteal tendinopathy can be a chronic and debilitating condition, but it does not have to be. With proper management and care, you can reduce your pain, improve your function, and enjoy life again.

Call 99975773 to book in to see one of our chiropractors so we can fix your gluteal tendinopathy today!

Mitchell Roberts – Chiropractor

Tennis Elbow

Over the past 2 years, I have seen an inrease in tennis elbow presentations to the clinic. This is likely the result of a number of people taking up tennis as a new sport during the lockdowns as it was one of the few sports you could still play, all be it – singles (Hence a lot of people who normally play doubles were now playing singles, therefore htting the ball twice as much as normal)

What is tennis elbow:
The injury is a tendinopathy, with the technical name being lateral epicondylopathy – or what used to be referred to as epicondylitis (-itis meaning inflammation, although studies have shown that there is actually no inflammation at the site of pain, hence we no longer use this name). It is located on the outside of the elbow.
At the cellular level, a breakdown of the tendon can be seen, where it joins onto the bone. Often what happens is the tendon adapts by thickening to try and be stronger. As a consequence, pain occurs as the tendon tries to adapt.

In simple terms – it is a breakdown of the tendon fibres where it attaches to the bone – because the tendon is not strong enough.

What can cause it:
It can be due to overuse, or an underuse of the tendon/muscle. The classic example is someone that has never played tennis before, suddenly starts playing tennis 4-5x a week and therefore the tendons in the forearm/elbow become fatigued very quickly, due to overuse as the tendon was not conditioned for the exercise. Thus, the big uptake in community tennis over the past 2 years has seen an increase in presentations to the clinic with elbow pain.

What symptoms does it produce:
Most people get a dull ache on the outside of their elbow, which is very frequent. The pain is worse when gripping items – such as a tennis racquet, opening doors or jars. It can at times cause pain at night in bed and often the patient can wake with a stiff elbow.

Location of tennis elbow pain
The area where the pain originates from

Tennis elbow is not an injury that resolves quickly. Unfortunately, it can sometimes take up to 6-12 months and can reoccur. The best way to reduce pain and prevent from occuring again is through strengthening exercises for the forearm extensor muscles. Manual therapy such as muscle releases and joint mobilisation can also be very beneficial in reducing pain in the short term.
Often we see is associated neck and shoulder pain, due to over compensation. The patient starts to avoid or change the way they move/use their forearm muscles / elbow and hence there becomes more strain on the neck and shoulders. This is why we often assess and work on shoulder and neck mobility as well during treatment.

What can you do right now to reduce the pain:
An isometric exercise is the easiest and simplest way to get the muscle working and strong again. In the picture below, the elbow is supported on a table and while holding a weight (1-2kg, it does not have to be heavy) with a soft grip, extend the wrist upward and hold it for about 20-30 seconds. Often you will feel some mild pain, which is ok. Perform 3 sets of this daily, especially before doing exercise where you will use the elbow.
Once you get strong with the isometric exercises, you can progress to exercises with movement.

Isometric wrist exercise for tennis elbow
The wrist extended, holding for 20-30 seconds

If you are suffering from what you believe to be tennis elbow, call us on 99975773 at Mona Vale Chiropractic Centre to book and appointment and we can assist you with the treatment and rehab of your elbow.

Mitchell Roberts – Chiropractor

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.


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


  1. Harvard Health. (2019, August 26). Retrieved from Harvard Health Publishing:

2. Stretching is not a warm up! Find out why. (n.d.). Retrieved 6 19, 2021, from

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

Boost your Immunity

Keeping our immune system strong helps us stay well in times of stress. This includes rest with adequate sleep, regular exercise, drinking water and eating well and regularly.
There are times in our lives where our stress levels are very high. We should all be aware that with the current Covid19 crisis we are all experiencing extreme anxiety and stress.  We are functioning at heightened levels that as a family, community and country we have never experienced before. This will put pressure on our immune system.
Vitamin C and Vitamin D are good supplements to take to help our bodies in such times. Vitamin C is found in some very familiar foods including Broccoli, Cauliflower, Kale, Kiwi-Fruit, Citrus Fruits, Pineapples, Strawberries, Cranberries, Blueberries and Watermelon.
Vitamin C benefits our bodies in growth and repair.  It aids in absorption of iron, the healing of wounds, the maintenance of cartilage, bones and teeth. Vitamin C also boosts our immunity.
Vitamin D, commonly known to be sourced by sunlight, is important in our bodies regulation and ability to absorb calcium.  It is also important for the maintenance of phosphorus levels in our blood. Vitamin D deficiency is associated with an increased susceptibility to infection.
We need both Vitamin C and Vitamin D daily, ideally in small to moderate levels regularly.
Because our immune system defends our body from foreign organisms, promoting and boosting a healthy immunity helps to keep us well.  This is essential in these times of heightened stress.

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.


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



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.



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