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Solving the mystery of: Chronic shoulder tension

Chronic shoulder tension. Knots in your upper back. Stiffness, headaches, neck pain. Sounds familiar? Yep- we see chronic shoulder tension a lot in clinic- but allow us to explain why simply treating the shoulder isn’t going to solve the issue.

Firstly, muscles don’t work alone.

Our body moves and functions through a combination of movements in a coordinated group of muscles, ligaments, fascia, tendons and joints. Back pain is our bread-and-butter as chiropractors, and we know from both research and experience that pain in the back doesn’t necessarily mean a problem in the back. That pain could be caused by a problem somewhere completely different- something that often causes a bit of confusion when you come to see us for pain in one area and we end up treating somewhere completely different.

Chronic tension shoulder tension office work pain hurt headache back Emsworth chiropractic chiropractor osteopath osteopathy headache neck migraine muscle business Hampshire injury posture latissimus bodybuilding strength stamina stability exercise training health fitness sport

Here’s why…

Let us paint you a picture. You work in an office. You’re stuck at a desk all day, sitting on your behind, slouched and worn out by 5PM. Your shoulders are tight and sore, and you can feel the knots building up in your upper traps, giving you a thunderous headache by the end of the day. Now, you know those knots and tense muscles are going to cause problems of their own, so you had an upper back massage two days ago and they should be feeling better… but they’re not. So is the problem the upper traps and shoulders, or is it something else?

Chronic tension shoulder tension office work pain hurt headache back Emsworth chiropractic chiropractor osteopath osteopathy headache neck migraine muscle business Hampshire injury posture latissimus bodybuilding strength stamina stability exercise training health fitness sport
The latissimus dorsi muscle- isn’t it a beauty?!

Let’s look at the latissimus dorsi.

It’s a muscle that originates from the spinous processes of T7-L5, the iliac crest around the top of the pelvis, the thoracolumbar fascia in the middle of our back, the lower border of the shoulder blade and the lower 3/4 ribs. (Yep, it’s massive!) All those fibres attach to the humerus (the long bone in the top of your arm). Why are we talking about a muscle in the lower back? Surely a muscle in the lower back controls the lower back, right? Wrong. The lat dorsi actually serves to extend, adduct, flex and internally rotate the shoulder, and lends a mere helping fibre or two to extend and laterally flex the spine. (In case you’re interested- it also helps with our lung function and breathing. Safe to say, it’s a pretty important muscle.)

So, back to you sat at your desk.

You’re slouching, your lumbar spine is curved and unsupported, so your latissimus dorsi is stretched beyond the norm and the fibres can’t fire properly. As a result, the muscle can’t complete the role it’s supposed to, the upper trapezius steps in to help and is left to do all the hard work controlling the shoulder itself (Just like that last project your boss asked you and Jane to do together and Jane left it up to you to do all the hard work- thanks Jane….) This leads to imbalance and weakness in both the lats and lower traps not to mention a very grumpy upper trapezius. You’ve tried treating the site of the pain (with that amazing back, neck and shoulder massage) and it feels better for a day or two afterwards but then it comes back.

Chronic tension shoulder office work pain hurt shoulder tension headache back Emsworth chiropractic chiropractor osteopath osteopathy headache neck migraine muscle business Hampshire injury posture
The Posture Oblique Sling Source: tonygentilcore.com

It’s fairly obvious by now that the problem with your tight and knotty upper traps isn’t caused by your shoulders- it’s something further afield.

So we have to look elsewhere- we look at your lower back and find that your latissimus dorsi is, surprise surprise, not happy with life. Now we’ve found that we also need to look at the Posterior Oblique Sling.* The POS includes the latissimus dorsi, glut med (in the back of the hip) and the thoracolumbar fascia (in the middle of our back.) *NB When we talk about one of the “slings” in the body, we’re talking about a specific group of muscles, fascia and ligaments which all work together to stabilise and mobilise the body.

Guess what we find when we examine you?

Your lat dorsi isn’t firing properly, which is throwing off the stability in the posterior oblique sling. Your lower back is stiff and restricted, and you can’t laterally flex properly- further compounding the problem with the latissimus dorsi (remember us saying it helps with lateral flexion of the lumbar spine?) So you can see how you’re caught in a vicious circle of dysfunction creating more dysfunction, and, in your case, leading to chronically tight shoulders that just never seem to get better!

The above is just an example of a classic case we often see in clinic.

Now, there are approximately 640 muscles in the human body, all intricately involved with the others in a chain of movement, that can have a chain of consequences if something in that chain misbehaves. To state the obvious again- each person we see is an individual, and the way dysfunction comes about is different for each person, as is the way in which the body adapts to that dysfunction.

As chiropractors, our job is to work out what’s going on and why (and then work with you to get it better) and this often involves looking at areas that might be quite far afield from where the actual pain is felt- but as you can see, there’s a reason for that.

Back pain children chiropractic Hampshire Emsworth babies shoulder tension
Source: simplebackpain.com

P.S. Poor posture affects kids too!

So where to begin? How can you improve your posture and reduce pain and problems? We’d suggest starting with some simple exercises, and downloading your copy of “Understanding Pain” which will help you get to grips with chronic pain, what’s going on in your body and how you can take back control!

Alternatively, and perhaps best- is to seek professional help and get a diagnosis and treatment plan put in place. You can get started by booking your appointment today.

 

Five top tips for avoiding sailing injuries and back pain

Living and working in Emsworth and Langstone, you’ll know that sailing is an inherent part of our community here (so much so, we’ve included some photos taken by Philippa of our lovely harbour!) As such, it’s not uncommon for us to be treating professional or recreational sailors in clinic, and whether you compete professionally or just enjoy a turn about the Solent, sailing poses as much a risk of injury as with any sport.Sailing windsurfing sport water exercise fitness health sail sailor boat boating yacht yachting dinghy barge windsurf chiropractor chiropractic physiotherapy physiotherapist osteopath osteopathy injury exercise health hampshire langstone emsworth fareham Sailors often compete in extremely difficult conditions, battling high winds and rough seas, and as such the risk of injury during sailing is 8.6 per 1000 hours sailing when training, and 2.2/1000 otherwise.  In a study on the 2003 America’s Cup, researchers found that the upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%), and the most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). (1)

Who is at risk of injury?

Mastmen are at greatest risk of acute injuries, helmsmen most commonly injury the upper-limb through steering, whilst grinders and bowmen are at the greatest risk of injury from repetitive strains.  High repetition activities such as hiking, pumping, grinding and sterring are major causes of overuse injury, even in the most experienced of sailors.  Windsurfers are also frequently admitted to hospital suffering from chronic lower back injuries as a result of “pumping” the sail.

 

Sailing windsurfing sport water exercise fitness health sail sailor boat boating yacht yachting dinghy barge windsurf chiropractor chiropractic physiotherapy physiotherapist osteopath osteopathy injury exercise health hampshire langstone emsworth fareham
Windsurfing in Emsworth- photo taken by Philippa!

It’s not just the professionals who are at risk of injury, as novice and recreational sailors commonly encounter acute injuries such as contusions or abrasions after colliding with the boom or other equipment whilst performing manoeuvres. (1)  Not only that, but there are other perils to consider:  tripping over ropes, winches and cleats; being swept overboard or falling down open hatches!

 

How and why do sailing injuries occur?

[clickToTweet tweet=”What are the main contributors to #sailing #injuries? Find out here! #Chiropractic” quote=”The main contributors to sailing injuries are: Heavy weather (23%), tacking (17%), jibing (13%), sail change (12%) and alcohol (7%)”]

  • Injuries may result from a lack of general fitness, overuse, overtraining, or macrotraumatic accidents.

  • Lack of warming up, stretching, and cooling down may also increase the risk of injury.

  • Muscles are placed at high risk when performing explosive, powerful moves, such as those frequently required when sailing.

  • Shoulder and arm injuries are common through constant handling of the mainsheet, and the sudden, strong movements in hiking may lead to back and knee problems.  (Remember Sir Ben Ainslie’s back injury? This was caused by repetitive, high strain hiking out!)Sailing windsurfing sport water exercise fitness health sail sailor boat boating yacht yachting dinghy barge windsurf chiropractor chiropractic physiotherapy physiotherapist osteopath osteopathy injury exercise health hampshire langstone emsworth fareham

  • Inadequate leg strength and poor hiking technique are thought to predispose the knee to injury.

  • Boats can be difficult to navigate around and result in crew members having to adopt awkward positions, often resulting in rotating, hyperextending, locking, or twisting of joints.

  • Incorrect lifting technique (more advice on this here!)

  • Postural problems are common in the majority of the population, and these inherent issues can lend themselves to musculoskeletal problems.

  • Poor fitness training may exacerbate common muscular imbalances associated with changing forces on opposing muscle groups while sailing.

If ignored, it is easy for these issues to progress into a chronic problem, the possible severity of which could impact on your participation and enjoyment in the sport.

So what can be done about it? Five simple steps to avoiding sailing injuries!

  1.  A robust exercise regime is crucial, which should focus on all aspects of physical fitness in order to ensure that your body can cope with the demands of sailing.
    – Cardiovascular training
    – Strength training (Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. )
    – Flexibility training
    – Core stability training
    – For more advice on bespoke rehabilitation plans, please email us at acorn@acornhealth.org.uk or visit our Langstone clinic.
  2. Research has shown that aerobic training and fitness is directly related to an improved reaction speed to wind shifts, as well as enhanced endurance, decision making, and concentration, particularly in the later stages of races. Mental and physical recovery is faster for those who are physically fit. Suggested types of aerobic exercise that are most appropriate for sailors are rowing, cycling, swimming, stair climbing, or running.(3)/li>
  3. Regular checkups can help ensure joint movement and function is maintained, as well as provide an opportunity for assessment of joint strength and function.  Not only will this help reduce the risk of developing injuries, but it can also speed up recovery should you become injured.
  4. Technical skill and expertise is important– if your technique needs improvement, seek out advice and informed coaching to help minimise the risk of developing an injury as a result of poor technique.
  5. Taking frequent breaks and changing positions during long periods of sailing. This will help prevent postural stresses and strains from occurring and is a healthy spinal habit we all should follow.

Whilst we have focused on musculoskeletal injuries, there are a number of other safety measures to take into consideration. Above all, always wear a life jacket when sailing. In the UK, there were 35 sailing or water-sport related deaths at sea in 2014 alone. Safety at sea should always be taken seriously.

Want more advice or information on this topic? Email us at acorn@acornhealth.org.uk or call the clinic on 01243 379693.

Boat sailing acorn health chiropractic

References:
1. Neville, V., Folland, J.P. (2009) The epidemiology and aetiology of injuries in sailing.  Sports Medicine. 39(2) 129-145.
2. Nathanson, Mello, Baird “Sailing Injuries and Illness – Results of an Internet-based survey” Wild Env Med 2010
3. Allen, J.B., De Jong, M.R. (2006) Sailing and sports medicine: A literature review. British Journal of Sports Medicine. 40(7) 587-593.

The Acorn Health PROMs: A Case Study

We’re not talking about the BBC PROMS, or in fact anything to do with music. We’re talking about Patient Reported Outcome Measures (PROMs), and they’re far more exciting than the BBC version (in our humble opinion).

Patient Reported Outcome Measures are the tools with which healthcare practitioners and clinicians can better understand the impact illnesses or conditions and treatment are having on our patients’ daily lives.  At Acorn Health, we utilise Care Response, a system which gathers the data for us and is supported by the Royal College of Chiropractors.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Why is it we often wait to get help for something until the pain becomes so intense we can’t do what we want to do?

We don’t collect PROMs purely for our own benefit, it’s also for yours. We want to understand how your pain or problem is affecting your daily life- are you able to wash and dress yourself without pain? Is it stopping you from having a social life? Is it preventing you from working?  Not only that, but we want to know how you feel about your pain. Are you worried it’s never going to get any better? Perhaps you’re scared about whether being physically active is going to make it better or worse and had to duck out of that golf game you had lined up.  These are all very common concerns (so don’t worry if you’re having them- we all do!) and by understanding what your concerns are and how your pain is affecting you, we can provide a more accurate and more appropriate course of treatment for you.  The responses to these questions will also indicate to us whether you are at a low, medium, or high risk of the problem becoming chronic (lasting for a long time) and this can mean that we need to provide you with very specific advice and information in order to prevent this happening- and yes, it can be done!

PROMs are starting to sound really good, aren’t they?

PROMs health chiropractic pregnancy baby childbirth paediatricsAnother fantastic thing about PROMs is that they can tell us whether the treatment plan we have together decided upon is having the effect we want or not.  Often, when pain decreases it can be difficult to remember just how bad it was (Remember that saying about giving birth? If we remembered how bad childbirth was we’d never have more than one child!) That being said, PROMs give us a way to determine your response to treatment based on your original responses to the questionnaire.

The story of patient X: Utilising PROMs in clinical practice

So how do we put PROMs to use in clinical practice, and how do they help inform our decision making and improve the care we provide our patients? We’ve got a case study here to explain it.

A bit of background- this Patient (let’s call them Patient X… sounds all mysterious and technical doesn’t it!) Anyway, Patient X had sustained a lower back injury in a road traffic accident more than a decade ago and had suffered with recurring episodes of lower back pain which, as seen by the chart below, were having a significant impact on their ADL’s (activities of daily living- things like washing, doing housework and sleeping) as well as their social life (going out to see friends, going to the gym, playing sports), the pain was a 6/10 and it was also making them anxious, depressed, having quite a severe impact on their working day and they had very little ability to cope with, control or reduce the pain themselves.  All in all, not a very pleasant situation to find yourself in, but these results are fairly common in the patients we see in clinic. So much so, in fact, that Philippa takes a special clinical interest in chronic pain management– but that’s a story for another time.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s initial responses

The questions on the initial form are part of a validated assessment tool called the Bournemouth Questionnaire, and the answers are scaled on a 0 – 10 linear scale, 0 being “the pain has no interference” and 10 being variations of responses such as “completely unable to carry on” or “extremely anxious/extremely depressed.”  As you can see, this patient was also at medium risk of chronicity due to some concerns they had about their back pain and what it meant for them, as they were worrying about it a lot of the time and felt that it was never going to improve.

We normally complete an outcome questionnaire after 2 weeks but in this particular case it was after 4, and Patient X completed this questionnaire which asked how their pain has changed, and also assesses the impact this pain is having on their lives at that time.  This is where we get a bit geeky and excited- bear with us while we explain why.

Yes, as you can see below, Patient X’s pain level had increased at the time they completed the outcome questionnaire because (by their own report) the “Sciatic nerve in left leg has been irritated since last weekend” after spending a weekend doing a lot of heavy work in the garden…. they knew it wasn’t the best idea (!) However, despite the fact that they’d been doing quite hard physical work and had a slight flare-up as a result, they still reported they were “much improved” as a result of treatment, and their Bournemouth Questionnaire (the one that tells us how the pain is impacting on your day-to-day life) had reduced from 52/100 to 34/100 (which is computed as a 34.62% improvement!)

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor
Patient X’s outcome at 1 month

How is it possible that the pain could actually have increased, but Patient X felt better? Well, as we do with all our patients, we had a lengthy chat with Patient X about their pain, and how it was impacting them, and how they could manage it more effectively, as well as what we could do to help.  Studies have shown that in some specific cases, a pain management course is actually more helpful than physical treatment, so we always include pain management as part of our treatment programmes. The more control you have over your pain, the less pain you feel. So through understanding pain and knowing what’s going on, what the cause was (in this case a mechanical issue with how a joint in the lower back was moving) what it isn’t (lower back pain is very rarely serious) and what to do about it (treatment and active self-management), Patient X felt less pain as they were less threatened by it, understood what was going on, were less concerned by the pain and able to move more normally without fear of pain.

After speaking to Patient X to establish what they felt had changed, the overall message was “I know what’s happening now, and I know what to do about it.” Woohoo!  This is why it’s absolutely critical that we convey the right messages to you and help you to understand your pain.  As practitioners, we also know that pain in itself is a really unreliable indicator of the severity of the underlying issue.  To use our favourite analogy- think how painful a papercut can be despite the fact it’s a fairly minor injury. Pain in itself is just a symptom and studies have shown it does not relate to the severity of the underlying problem- in fact, some studies show that pain related fear is more disabling than the pain itself!

To understand more about pain and what causes pain, this should be your next bit of reading: Understanding Pain.

Let’s get back to Patient X, who today completed their final outcome assessment.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Patient X’s outcome at discharge

As you can see, the pain has dropped now to a 3/10. Those sections where Patient X reported were a 9/10 (ability to complete ADL’s and impact on social life) have dropped to a 3/10 and 2/10 respectively, impact on work was initially 7/10 and is now 0/10, anxiety and depression are both down from 7/10 to 1/10, and ability to cope with, control and reduce the pain was initially a 7/10 and is now a mere 2/10!

Whilst plenty of naysayers might say “Sure, but they’re not pain free and their Bournemouth Questionnaire isn’t zero.” If you had an illness or disease that lasted several years, would you take a few pills and expect it to be cured? No.  Realistically, you’d hope that it would be better, as it is for this patient.  Recovery takes time and is something that cannot be rushed. If you recall, Patient X’s problem had started over a decade ago, so we’re delighted that two months later the pain has improved this significantly. Not only that, but Patient X reports feeling “much improved” as well so we know they’re happy with how they’ve progressed- which gives us all sorts of warm fuzzy feelings. Hooray for job satisfaction!

So what happens now? At this stage, we’ll see a lot less of Patient X as they are formally discharged from care. The pain is now PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthyso minimal and intermittent that after discussing it with them, they’re happy to manage it themselves at home with stretches, exercises and lifestyle modifications (such as taking regular breaks from sitting whilst at work).  We’ll check up on them in a few months to review their exercises, identify if there are any issues that have crept back on and this also gives us an opportunity to discuss their progress with them and if they have any further concerns.  Of course, we’re always at the end of a phone or email, Facebook, Google+ or Twitter if they (or you) want to get in touch in the meantime!

We never guarantee 100% cure as nothing in medicine can. No pill, no operation, no treatment. There are no guarantees. What we do say at Acorn Health is that we will always give you the very best treatment and care, in accordance with the latest research guidelines and current evidence base.  We can also say (thanks to another fancy PROMs questionnaire) that we have 100% satisfaction rates from every patient we’ve seen since we opened back in 2014, and that makes us very happy indeed.

PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor golf golfing sports exercise fitness healthy
Acorn Health Outcome Satisfaction Results

So there’s a little overview and case study into how PROMs are put into use in clinical practice, and why we utilise them! If you’d like to know more, or would like to get in touch to book your own appointment, you can contact us using the form below.

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PROMs patient care health expert chiropractic chiropractor Emsworth Fareham Hampshire back pain neck pain headache joint care musculoskeletal NHS GP doctor

Tis the season for… fall prevention

It’s officially winter, and whilst this brings slippers, warm fires, mulled everything and of course Christmas, it can often spell a hazardous period for those most at risk of a slip or fall.Falls fall elderly ice snow weather cold falling Emsworth chiropractic Philippa McKernan chiropractor Hampshire Chichester Sussex Havant Waterlooville

Who is most at risk of falling?

Physical changes to our bodies, coupled with underlying health conditions and sometimes even our medication can mean that as we get older, we’re at increased risk of falling.  In fact, falls prevention is an important issue as falls are the leading cause of death due to injury among the elderly and account for 87% of all fractures in the elderly.

Falls fall elderly ice snow weather cold falling Emsworth chiropractic Philippa McKernan chiropractor Hampshire Chichester Sussex Havant Waterlooville
Source: Learnnottofall.com

Older people are more likely to have a fall because they may have:

    • Poor vision
    • Poor balance
    • Muscle weakness
    • Long term health conditions (such as heart disease, low blood pressure or dementia)

Interestingly, it is not necessarily the frail elderly who are most at risk of falling. Vigorous older persons living with more home hazards  (such as loose rugs, dimly lit rooms or shower trays without slip matting) are more likely to fall than frail older persons with home hazards!

Falls are also a common cause of minor injury in pregnant women, but the truth is everyone is at risk of falls (how many times have you tripped rushing around at home, caught your foot on a rug or slipped over on a patch of ice?)

What to do if you have a fall

If you are hurt:

  • If you are hurt but able to move, getting up too quickly or in the wrong way could make an injury worse.
  • Keep calm, if there is someone nearby ask them to call for an ambulance.
  • If you are alone, try to get someone’s attention by calling out for help, banging on the wall or floor, or using your emergency call button.
  • If possible, crawl to a telephone and dial 999 to request an ambulance.
  • Try to keep yourself warm. If you can reach a blanket or towel, put this over yourself (particularly your legs and feet).
  • Stay as comfortable as possible, try to change your position at least once every half an hour or so and wait for help to arrive.

If you are unhurt:

  • If you are unhurt and can get up safely without help, roll over onto your side, then rest again to allow your blood pressure and body to adjust.
  • Slowly get on to your hands and knees, and crawl to a sturdy piece of furniture (such as a bed or chair).
  • Put your hands on each side of the piece of furniture and slide one foot forward so that it is flat on the floor.  Keep your other knee bent so your knee is on the floor.
  • From this kneeling position, slowly get yourself up and turn to sit on the bed or chair.

Ten top tips for fall prevention

  1. Route planner: Think about the best route to your destination and don’t rush on the way there. Allow yourself some extra time to make your journey.
  2. Don’t rush: If your destination involves a trip outdoors, avoid rushing or taking shortcuts over an area where there is snow or ice. Walk slowly, and never run over icy ground.
  3. Centre of balance: Take small steps to keep your centre of balance beneath you.
  4. Risk reduction: If you are in the “at risk” category, minimise your trip hazards at home.  This could mean installing handrails, removing loose rugs, and always keeping the stairs and hallway clear of objects such as books or shoes!)
  5. Shoes: Appropriate footwear is a must, indoors or outdoors.  Flat footwear with rubber soles provides better grip and traction than leather soles or high heels. At home, avoid slip-on shoes such as mule slippers.
  6. Handrails: Use handrails where possible to support yourself.
  7. Resist your pockets: Don’t put your hands in your pocket- keep them both free for balance.
  8. Watch out for cars: If getting in and out the car, hold on to the vehicle for support.
  9. Carrying sensibly: Avoid carrying your children or lots of heavy shopping bags, particularly on stairs.
  10. Use floor mats: Wipe your shoes when entering a building to remove moisture on the soles of your shoes. This not only reduces your risk of slipping, but means others walking behind you are less likely to slip on a wet surface too!

Do you know someone who is at risk of a slip or fall this winter? If so, please do share this information with them.  If you’ve had a fall and are in need of our assistance, you can call us on 01243 379693 or book your appointment online here and start your journey to a pain-free festive season!
Falls fall elderly ice snow weather cold falling Emsworth chiropractic Philippa McKernan chiropractor Hampshire Chichester Sussex Havant Waterlooville

Horse and Rider

A good rider knows that they must work in unison with their horse. To create fluid movements it requires symmetry, balance, coordination and stability. This doesn’t come easy, and requires training on both parts as a poor rider can ruin a good horse.Professional horse jumper

At Acorn Health we see patients that are involved in a variety of equestrian activities, including carriage driving, showjumping, cross-country and dressage. In addition to this blog post, we have prepared a brief video to help you reduce the impact of back pain whilst riding (see below), but first please read our hints and tips!

Lower back pain is a common problem in horse riders, due to the static position we adopt when riding – especially in the untrained rider. These problems reveal themselves through dysfunction and altered movement in the hips, pelvis, and lower back from the result of poor core stability, lack of flexibility, and instability in the saddle. There are some simple steps to prevent this.

If you only have a few minutes, scroll down to the bottom to read our top tips to improve these problems.

Restriction in the movement of the hips is a common problem, and this can affect the pelvic movement and motion of the lower back. The pelvis moves in a complex, multidirectional way when riding, if one area is not moving enough, another area will be moving too much to counteract this. Good core stability is vital to allow and support these movements. Insufficient movement through the hips can cause stiffening of the lower back and buttocks so the upper body may become loose (causing head bobbing or bouncing shoulders), or the lower body may become unstable (leading to flapping legs). An example is seen in the video below.

If you feel out of balance in the saddle, this may be because you are tipping forward through the pelvis. This in turn causes your seat bones (the ones you sit on) to angle backwards.  The result here is that the lower back hollows, and the hips are unable to move freely at this angle.  When this happens your body will immediately attempt to compensate for this, usually through recruiting other muscles to stabilise the area- commonly, the inner thighs or hip flexors (the muscles in the front of your thighs) will become involved, and this can lead you susceptible to yet more muscle and joint strain.

The image in the video demonstrates tipping forward through the pelvis causing hollowing of the lower back. The correct position of the pelvis in the saddle, and rotating backwards through the pelvis causing flattening of the lower back and protruding stomach.Hacking with horses

Importantly, these imbalances in the rider can also affect the way your horse is able to
move. Putting pressure on your horse’s back means that he will find it difficult to use his back and legs in the correct way. This impacts on your horses ability to swing their shoulders through the paces, and can cause them to have back pain too so over time, you will both perpetuate each other’s lower back issues.

Many riders find that their hamstrings (in the back of the thigh) and their quadriceps (in the front of the thigh) become shortened as a result of the position we adopt in the saddle.  Ensure you muscles are functioning at their best by adopting a good stretching routine.

What are the most common postural faults in riders?

  1. The “en avant” position. Leaning forward in the saddle and balancing the majority of the weight in the stirrups.  This is most commonly seen in show jumpers and cross-country eveners. Riding too much in this position also means you will be unable to provide the correct aids to your horse, and are already out-of-balance in the saddle. The pectoral muscles in the front of the chest become tight and sore, further encouraging rounded shoulders. Due to this imbalance, should the horse spook, you may find yourself thrown forward on to his neck or coming off over his shoulder.
  2. Riding too short or too long.  Stirrup length should be measured and adjusted on a regular basis. Why? As you become more flexible, your body will change and as a result subtle changes will adapt the length of the muscle.
  3. Tight hip flexors.  Tension through the front of the thigh will automatically lead to tension in the lower back, causing weakening of the abdominal muscles. A common mistake is to adopt a position in the saddle similar to the position we adopt when using an office chair. When the hip is over-flexed, the lower back hollows as a result which is a key contributor to lower back pain.
  4. Dropping the chin. Constantly dropping the chin to look at the horse causes strain of the muscles in the back of your neck, and weakening of those in the front. This in turn can lead to headaches, neck, and upper back pain. A rider should always be looking up and ahead, not down at the horse.

Top tips for reducing back pain in the saddle:IMG_8878

  1. Stretch. Riders rely on their quadricep muscles to bear the weight of their body, and the calf muscles must work to keep the heels down in the saddle.  This tends to lead to hamstrings becoming tight but weak, calves becoming long, and quadriceps shortening. Maintain suppleness and flexibility through your hips by stretching on a regular basis (not only before you get on the horse!)
  2. Focus on your core stability.  Yoga or pilates exercises will help teach you balance and coordination by encouraging your core muscles to work correctly, allowing you to maintain the correct posture in the saddle.
  3. Ensure your saddle has been fitted correctly.  A poorly fitting saddle can cause discomfort in the horse and affect its movement, often encouraging the horse to move asymmetrically to avoid pressure and pain from the saddle.
  4. Commit to physical fitness.  A lot of riders use riding as their only conditioning activity, but a well-rounded fitness programme (which includes core stability, stretching routines and cardiovascular exercises) will help improve your overall fitness and stamina, and reduce injury while riding.

Please see the full video with guided help here.

Prevention is better than cure

As the old proverb said, ‘prevention is better than cure’.  So what’s the simplest thing can we do every day to prevent musculoskeletal pain?

With every patient we find the root cause or underlying issue of the problem and treat it accordingly to patient preference and clinical evidence and research. The most common problem I see from children to adults…

The most effective way of getting you out of pain quickly is self management. We provide a personal back pain toolkits and show you how to do stretches to ease pain and prevent pain or injury in the future.

Prevent back pain with these three simple steps.

One.

Include stretching into your daily routine, or go to a regular yoga class. Think of preventing back pain like preventing tooth decay – it’s as easy as brushing your teeth.  We love using foam rollers in clinic- a great addition to your stretching routine.

Two.

Use ice immediately to reduce swelling and inflammation on a new injury. Use heat on a recurring injury to reduce pain. You can use paracetamol to help prevent swelling and pain as well.
Three.

Research shows a 20 minute walk everyday will reduce the risk of back pain by 10-50%. Similarly if you are sitting down all day, get up to move about or stretch every 20-30 minutes (this also has the helpful side-effect of improving your concentration).

If you would like more hints and tips about prevention of back pain or musculoskeletal injury please read our blog page that details particular injuries and more helpful tips.

Kinesiology Tape for sports injuries.

Focus on Tennis Elbow.

Guest Blog: Calcium and Osteoporosis.

Contact us for more information or to book an appointment.

E: acorn@acornhealth.org.uk T: 01243 379693