The ‘big three’ misdiagnoses haunting back pain sufferers

The only thing worse than back pain is prolonging it with incorrect misdiagnosis. Yet this is a common reason why regular back pain progresses to Chronic Back Pain.

Too many people self-diagnose their pain or, even worse, make an Internet diagnosis. They then become attached to the diagnosis.
They often fail to get a second opinion when treatment isn’t helping, and become resigned to their fate.
But it all starts with misdiagnosis, and the ‘big three’ misdiagnoses which mislead back pain sufferers are:

Believing it’s a disc problem:
Around seven out of 10 people, if put under an MRI, would show some kind of disc issue. Our bodies aren’t perfect. For example disc bulges are incredibly common yet don’t necessarily cause pain or discomfort.
Debilitating disc problems are less common than people think. People are too quick to believe it’s a disc. With proper analysis they often find it’s something completely different, such as gluteal tightness, nerve spasm, lower spine joint tightness or even stress.

People often assume a shooting ‘nerve-like’ pain emanating from the back is sciatica – it’s a favourite of the ‘self-diagnosed’ – but nine times out of 10 sciatica is not the issue.
Problems which can masquerade as sciatica include lower back biomechanical issues, hip pain and even knee issues. None will improve while you wrongly mistake these complications for sciatica.

Stress fractures:
Stress fractures can be debilitating and commonly impact sportspeople and those performing physical manual labour. But a funny thing happens to people who suffer from stress fractures – they then fall into the easy routine of blaming any other body issues on the stress fractures, even after it has healed. Meanwhile, they are missing other issues such as shoulder pain, knee problems or neck pain.
Believing that a healed injury is still troubling you is a common trap. It’s almost always something else, even if it appears to be mimicking that old familiar pain of a previous injury.

Five fitness secrets we all can learn from elite athletes

You don’t have to be an elite performer to benefit from Olympic training secrets.
Weekend cyclists, runners, triathletes and golfers can all improve performance and cut down on injury time by emulating some of the principles driving elite athletes.
Years of working with elite athlete have taught me there are five simple things athletes do which the rest of us don’t:

1. Not trying to ‘ride out’ injuries: Athletes are great at listening to their bodies and will seek an expert quickly if they have an injury. Sure, we all know inspirational stories where athletes pushed through incredible pain and adversity. When a medal or a ranking is on the line they can do amazing things. But they are way more in-tune with their limits and capabilities than we are. When something goes wrong they do not push their luck – they don’t try to ‘ride it out’. By contrast, weekend warriors in their thousands make small problems much worse by being macho or refusing to give in and betting that ‘riding it out’ is the only way.

2. Rehab exercises are also preventative: Athletes take rehab very seriously, but the rest of us tend to skimp on rehab exercises once the pain goes away. The secret athletes know is that rehab exercises are also preventative exercises. Even if your body is feeling better you may continue to enjoy significant benefit from those rehab exercises.

3. Recovery is essential: We may think of recovery as a beer and a sit down, but even a short recovery routine can help. You may not need the ice baths favoured by elite athletes, but anyone can benefit from using the correct warm-down recovery routine after training and playing.

4. Change a treatment if it’s not working: Too many people continue getting the same treatment when there is no change. Elite athletes expect results quickly, and so should we. You should see a change in three sessions or less. That’s how quickly athletes expect a response and it is a good rule of thumb for anyone. Seek a second opinion if there is no positive change after three sessions.

5. Sleep: Just ensuring regular sleep may make a big difference. Elite athletes are serious about sleep because it’s so important both for mental and physical recovery. You won’t find them rushing to join the ‘sleepless elite’; the famous world leaders and captains of industry who supposedly only need a few hours. An improvement in sleep often has tangible benefits in performance, but again it’s important to have an awareness of your body.

Have you returned to work with ‘holiday back’?

Many people come back from holiday feeling worse than when they left, because they have developed back pain.
The biggest culprits are sleeping in different beds and over-exercising.
Sleeping in a bad bed can cause issues such as low back pain, upper spinal discomfort, neck strains and even headaches. A different pillow can also cause these problems.
Running on the beach is the other big issue. Even regular runners develop problems due to poor footwear support and running too far.
If you have holiday back pain, try the following (if the pain is debilitating or not improving then it’s best to seek out physio treatment):

So how can you lessen your chances of picking up a ‘holiday back’ in the first place?

1. Mobility: Back pain can make you feel seized up and stop you moving. But mobility is the single most important thing for beating back pain.
Be careful not to sit down for too long at a time. Get up at least once an hour. Ensure you do some walking on holiday and generally maintain a good degree of mobility.
2. The 20% rule: Holidays allow more exercise time, tempting us to over-do it and leading to injury. But it’s best to restrict that exercise to only 20 per cent extra on what your body is used to.
It’s ok to do extra exercise, but the body responds to gradual change, such as the 20 per cent rule.
3. Realistic New Year’s resolutions: People often set the bar too high on New Year’s resolutions, which means the resolution either ends up abandoned or causing injury. Fitness resolutions should be realistic, such as considering a three minute high intensity training regime. Anyone can do these exercises at their own level and it will make a positive difference.
4. Keep the beach running casual: Beach running can be one of the joys of summer, but needs to be moderate. Running bare feet on sand is hard on the body, and we see ailments caused by beach running every year. Take it easy and save your serious running for good running tracks and proper footwear.
5. Get a second opinion if treatment isn’t working: The last thing we need is holiday injuries to trouble us into March and April. If a back problem isn’t showing improvement within three physio treatments it’s time for a second opinion.

Kusal Goonewardena
Elite Athlete Sports Physiotherapist
Melbourne University Olympic and Winter Olympic Team

The 3:21 Workout

The 3:21 Workout Three minutes a day, for 21 days. This is the routine that was created for those who are super busy.

You may not have enough time to commit to exercise.
You may not have the correct equipment.
You may not know where to start.
This routine is simple, to the point and you do not need any equipment. You can do it at home, or you can do in a hotel room, or you can do it where ever you please.

How can it benefit you?
It will help improve arm strength, it will help you improve leg strength, it will help condition your body to anticipate more exercise (so the body isn’t shocked if you start doing other forms of high intensity exercise over long periods of time), core control, fitness and help your cardio vascular health.

What do you have to do?
You will do six exercises for 30 seconds each. You will push yourself to 85% with each exercise. You will NOT push into pain during the 3:21 Workout. And if an exercise is not tolerable you will not persevere through it… You will change it slightly so you can tolerate it and still continue at 85%. Three minutes a day for 21 days straight.

Why 21 Days?
For best results we recommend you do this routine for 21 days straight. The old adage is true – it takes 21 days to break a habit…We are instilling a nice habit to help you body be healthier.

So what are the 6 six exercises?

Sit ups | Push ups | Squat jumps | Star jumps | High knee running on the spot | Shadow boxing

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You can change the order of the routine depending on what you want to address:

Upper body strength
Shadow boxing
Push ups
Star jumps
Sit ups
Squat jumps
High knee running on the spot

Lower body strength
Squat jumps
High knee running on the spot
Star jumps
Shadow boxing
Push ups
Sit ups

Good luck & keep healthy!

Kusal Goonewardena
Elite Athlete Sports Physiotherapist
Melbourne University Olympic and Winter Olympic Team

Five Steps to Prepare Your Sports Medicine Team for a Major Tournament

For major sports tournaments the sports medicine team have to be as prepared as the athletes competing in them.
There are 5 major steps to help you achieve success for your athletes and team you represent.

Step 1
Work out what the teams goal is. Our sports med team goal was “Help Melbourne University win the Australian University Games”.
Whatever decisions we had to make guided us towards our goal. This helped filter out unnecessary work.
It’s important to keep the goal clear, concise and to the point. And most importantly EVERY member in the sports med team should know the goal verbatim.

Step 2
Create a plan of action to achieve your goal.
We created seminars for all of our athletes to help them prepare for the games. What to expect, how to prevent injury and what exercises were most important were some of the things we covered.
We then provided assessments for our athletes who were competing – personalised analysis of each athlete (their bio-mechanical strengths and weaknesses were recorded and made them aware of ways they could improve this).
We then looked at all the teams that were representing Melbourne University and divided up the teams amongst the sports medicine staff.
Each member was in charge of their own precinct.
To deliver success our plan was simple: 1. Be Remarkable 2. Go the extra mile.

Step 3
Put together the best team who can deliver steps 1 and 2.
Important characteristics for your team: they have to be the BEST at what they do. They need to be talented. And if they don’t have the experience yet then they need to have a POSITIVE and ENTHUSIASTIC attitude to learn, work and deliver success alongside their senior sports med staff.

Step 4
Execute your plan.
Day by day before and during the games, keep on track with your overall goal, weekly goals (before the games) and daily goals (during the games)
Review your targets and keep the team accountable. Speaking to everyone  individually and reviewing their role/goals improves accountability. The key here is that other team members can help out, if one team member is falling behind/finding their work load too much or have too many injuries to cover etc.
Once again ‘1. Be Remarkable 2. Go the extra mile.’

Step 5
Enjoy the process. Enjoy the journey. Work hard but enjoy every single moment you are out there. Your athletes are doing their very best and you will help them achieve higher accolades because you are being the best that you can be. Don’t leave anything in the tank…Push yourself, enjoy the moment and celebrate every little win along the way. Whatever happens you have done your very best for your athletes. And that’s all that matters.

Kusal Goonewardena, Elite Athlete Sports Physiotherapist, has been the head of sports medicine at the University of Melbourne since 2008. Melbourne University have finished in the top four best sports universities in Australia every single year. This year Melbourne University won the national championship again, winning back to back in 2012 and 2013. He was in charge of 7 sports medicine staff who helped 440 athletes achieve their best.

4 Ways To See Improvement After Injury

I’ve still got pain…Am I improving?

Recovering from an injury can be stressful, annoying and time consuming. If you are recovering from an injury, your symptoms may be the only thing you have to measure your improvement on. Worse still, sometimes you may be unsure whether you are improving at all.

So how can you tell whether you are getting better or not?

There are 4 things I ask my athletes to look out for after the rehabilitation process has begun. You are on track if:

  1. 1. There is a decrease in the INTENSITY of your symptoms
  2. 2. There is a decrease in the DURATION of your symptoms
  3. 3. There is a decrease in the FREQUENCY in which the symptoms occurs
  4. 4. There is a decrease in the TIME TAKEN to recover AFTER an exacerbation of your symptoms

If your function is improving BUT you still have your symptoms keep the above 4 points in mind. If you are improving on all four factors then that’s great- you are on track. If you are only improving on 1 or 2 of the above factors- keep your head up high- you are still improving.

So keep focus on the functional tests that your practitioner has planned out for you. As long as your function improves that IS the key. Your pain and symptoms tend to drop at a certain threshold (More on this in a later blog post). Keep improving your function and in due course your symptoms will disappear.

Be a Better Practitioner and Be Objective

To get the best results a practitioner must measure what they want to improve in/for their athlete. Being objective means that you measure what YOU see, what YOU feel, and what YOUR tests have shown.

Measure what YOU see, YOU feel, and what YOUR tests have shown.

There are many practitioners who use a ‘pain scale’ but ultimately this only provides for an objective measure on a subjective question. Confusing? To simplify it, the pain score was determined by your athlete. NOT you. You may get a score but this is something your athlete provided you.

So how do we make this more objective? How about we determine what objective ‘tests’ cannot be done due to the pain. The following are good suggestions:

1. Can walk only 250 metres before having to stop for 5 min before being able to walk again.
2. Can sleep for 2 hours and have to wakeup and walk 4 min before being able to sleep again.
3. Symmetrical running gait at 50% running speed for 5 min. Asymmetrical running pattern at 75% running speed for 1 min.

All the tests above can be re-produced, re-assessed, re-measured.

If you can be objective then you are providing your athlete with a TRUE blueprint of what your assessment, analysis and diagnosis of their problem is.

Your objectivity then leads you to provide them with a higher level of care. Why?
When they ask you, “How am I doing doc?” You can confidently answer, “You are doing well because 1. your test ‘A’ has improved by 20% 2. your test ‘B’ has improved by 60% and this means that overall you have improved by an average of 40%”

Therefore being objective enlightens your athletes, makes you a better clinician and creates a pathway that helps them understand your treatment. This leads to trust, which leads to an increase in care and this leads to better results.

Be a Better Athlete, Improve your Posture

Posture seems to be such a trivial thing. Parents are great at reminding, “stand up straight” or “stop slouching”. Wise words and sometimes they go unheeded.

Wise because it is important to have good posture DURING the activities that you partake in. More often than not, elite athletes have excellent posture. They stand, walk, run and carry themselves meticulously. However it is when the body is under load, either by training, competing and opposition pressures that their posture has to perform.

What is good posture?

Is it standing up straight, shoulders back, spine erect—looking like you are standing to attention?? NOPE.
There are 2 ways to improve your posture:

1st – stand up ‘tall’. Imagine a piece of string pulling you up from your head. We naturally elongate. You are NOT standing to attention. You are simply standing tall with your shoulders relaxed back not pulled back.

2nd – Have a neutral pelvis. There are 2 ways people stand – first is with the bum ‘sticking’ out’ – many dancers do this because their pelvis is tilted forwards through habit.

The second is people stand with the bum ‘tucked’ in. In this scenario the pelvis is tilted backwards.

Another way of looking at it — Imagine your pelvis to be a fruit bowl that needs a to be kept level. Do not let your fruit-bowl tip forwards (anatomical term -anterior pelvic tilt) or tip back backwards (anatomically – posterior pelvic tilt). When its level it is neutral.

How quickly can you improve your posture?

It takes approximately 3000 reps of motor learning. Motor learning is mastering a task so that the brain does it automatically.This can be achieved if you complete 200 reps per day for 15 days.

Don’t be concerned – you will get through 200 reps quickly. Create cues during the day to improve your posture eg. when checking your watch, seeing yourself in the mirror, reminding team-mates, taping your back, etc.

All these add up. If done correctly within 15 days you will notice a difference. After 30 days it will feel awkward to even slouch.

Good luck and improve your personal best.