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Exercises should be a regular part of our daily activity and weekly routine. As a chiropractor, we always advise our clients to maintain a healthy lifestyle and physical activity is a habit that we constantly encourage.

There are many benefits such as healthy muscles, bones and mobile joints. It also helps us burn calories and increase endurance. Exercising also has immediate benefits such as better sleep at night, better skin and a better ability to cope with stress and the demands of daily life. In a long term perspective, exercising can reduce the risk of heart disease, diabetes, high blood pressure and high cholesterol. All this leads to a reduce risk of dying prematurely and becoming obese.

A common question posed by clients is how often they should engage in physical activity, what is considered an intense exercise or something lighter and more casual. We is recommended that you engage in activities for at least 30-60 minutes a day for 5 days a week. We always remind clients that it is not necessary to exercise for an hour straight. Even a 10-15 minute session 4 times a day, is equally as effective.

When it comes to the intensity of exercising, if you are able to speak easily, it is considered a light to moderate exercise. It is good to try to raise your heart rate but again, it is not necessary. Having some light cardio and then moving to postural, spinal exercises is ideal. This prepares your muscles for exercises and keeps the blood flow active.

Another common misconception is that exercising should be intense and difficult from the start. Do not over stress your muscles and joints! This is how injuries occur! I always recommend that clients start at an easier pace and with lighter weights. As your coordination improves, so will your balance, overall muscles tonicity and movement patterns. This is a much better way to approach and start exercising.

A simple/basic workout routine for your spine can consist of
1. ‘Dead Bug’ exercise: same side and opposite side X 15 times
2. Bridging: hold for 30 secs X 3 times
3. Squats: 10 times
4. Planks: 30 secs X3 times
5. Side planks: 30 seconds X3 times

This is a skeleton spinal workout routine for the most beginner of clients. You should try to do this set twice a day. As time goes on and as your form improves, you can slowly add weights, increase the number of repetitions and the intensity (how long you would hold a position).

If you have questions or would like to start exercising but have a concern regarding your spinal health and posture, you can always give us a visit. At Healthworks, we will love to help you find a routine tat suits you and your needs. Till then, happy exercising!

Headache is a common nervous system disorder with a prevalence of 48.9 %. Tension headache is a primary headache in which it is responsible for the prevalence of 26.5% among other headaches. Contrast to migraine, in tension headache, women are only slightly more affected than male (the female-to-male ratio of TH is 5:4) and the average age of onset (25 to 30 years) is delayed. The peak prevalence occurs between ages 30 to 39 and decreases slightly with age.  A few studies have shown that absenteeism resulting from tension headache can be as high as three times more than that seen in migraine.

Till today, clinical and neurophysiological studies have not been able to determine the exact cause of tension headache. However, studies have indicated that there are possible factors that may trigger this disorder.

Factors for Tension Headache
1) Deficiency of Vitamin B12
2) Deficiency of Vitamin D
3) Poor posture
4) Poor management of stress
5) Lack of quality sleep

Symptoms of Tension Headache

1)  Lasting from 30 minutes to as long as seven days
2) Minimally two of the following four characteristics:
– pain is found both sides
– pressing or tightening quality
– mild or moderate intensity
– not exacerbated by routine physical activity, eg walking or climbing stairs

Management
The best non-pharmacological therapies for tension headache are physical therapy, biofeedback, and cognitive-behavioral therapy. Relaxation, exercise programs, and improvement of posture are critical components of physical therapy. Several other treatments, including massage, manipulation, acupuncture, and osteopathic manipulative medicine, have also shown improvement in both acute and chronic presentations, using measures such as increasing range of motion of the head.

Here at Healthworks, with our skills and experiences, our chiropractors and physiotherapist are equipped to help you with your headache. If there are any question regarding the information of this article, please contact us at myhealthworks.com.my or call/ WhatsApp us at 018 9828539.

Diagnosing and Managing Chronic Ankle Instability

The ankle joint consists of many bones, ligaments and tendons that plays an important role in maintaining its stability. Consequently, ankle instability happens if any of the related bones, tendons, or ligaments are compromised. The tibia and fibula are intimately joined by the interosseous membranes. These two bones also share connections with the ligamentous complexes of the foot so that any sprain on the ligaments can also potentially cause a distal fracture in the bones of the lower leg. Additionally, the tendons from the muscles of the lower leg—mainly the Achilles tendon and the peroneus longus and brevis, are closely associated with the bones of the foot. Injury to these tendons will likely result in ankle instability.

Mechanism of Ankle Instability

Due to the complexity of the ankle joint ad surrounding structures, any injury to the bones, tendons and ligaments can result in instability. For example, any impact on the heel of the foot from jumping from a higher to lower level will produce a vector of the force directed into the distal tibia. And this can cause fracture and dislocations of the tibia or fibula and cause ankle unsteadiness. Such an injury to the tibia causes an increase in contact stress between the tibia and talus and is an important pathomechanical factor in unstable joints.⁴ Additionally, the fibula may also have a profound effect on ankle stability.

Damage to the tendons and ligaments supporting the ankle joint can also cause ankle instability. Lateral ankle instability can cause laxity of the superior retinaculum which the ligaments wraps around the proximal ankle joint. This laxity can cause a peroneus brevis split and, in turn, this split results in chronic ankle instability.

Diagnosis of Ankle Instability

When a person present with ankle instability, the first step is to determine whether the injury demands emergency care. During first line of care, the physician should asses the history and etiology of the injury. Most of the ankle injury is ankle sprain and is usually ligamentous or may include bone fractures. With fractures, the person will experience bony tenderness on palpation of the posterior edge of the distal tibia and fibula, or on the medial and lateral malleolus. Inability to bear weight on the affected foot immediately after the injury are also the signs of fracture that requires immediate emergency care.

With ligament injury, the lateral ligamentous complex is more prone to damage due to the anatomical position of the ankle in plantarflexion and inversion. Because of this, most of the ankle sprain occurs while the ankle is in plantarflexion and inversion.

Physiotherapy Management for Ankle Instability

Once the diagnosis of ankle sprain is made, conservative management is always preferred. During the early stage of mild sprain, RICE protocol are usually implemented. For Grade 1 and Grade 2 ankle sprain, a form of immobilization using ankle brace will provide stability to the ankle and provides the ability to walk and climb stairs without further injuring the ankle. When ankle instability is due to compromised integrity of the tendons, management is aimed at correcting the cause of the pathology. Exercise therapy has been the mainstay of treatment to improve the outcome in cases of tendon laxity.

Early functional rehabilitation of the ankle should include range-of-motion exercises and isometric and isotonic strength-training exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training exercises should be incorporated. Advanced rehabilitation should focus on sport-specific activities to prepare the athlete for return to competition. Although it is important to individualize each rehabilitation program, this well-structured template for ankle rehabilitation can be adapted as needed.

Many researchers have examined the effects of various training regimens on the characteristics of chronic ankle instability and the symptoms of acute ankle sprain. The available research regarding rehabilitation of ankle injuries and chronic ankle instability focuses on a wide variety of exercises and programs. Many experts have succeeded using a type of balance board to improve strength and balance measures in subjects with acute injury and CAI. Others have found that incorporating a variety of coordination-training exercises produces significant improvements in measures of strength and proprioception.

Here in Healthworks, our physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

Diastasis Recti is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Diastasis recti is very common during and following pregnancy. This is because the uterus stretches the muscles in the abdomen to accommodate the growing baby. This condition varies each time with each individual and is vital to keep it in check to prevent other complications that may arise.

Another method to diagnose Diastasis Recti would be heading over to your primary care physician, OBGYN, physical therapist for a definitive diagnosis. Confirmation of rectus diastasis can be made using computed tomography (CT), magnetic resonance imaging, or ultrasound but these tests are usually not necessary.

What are the types of treatment?

Firstly, Diastasis Recti usually resolves on its own within the period of 6 to 12 months.  However, there are some treatment options that might help with a faster recovery. Most commonly, alternative treatments are prescribed. In some studies, preventative exercise protocols include walking and abdominal core strengthening or corrective exercise protocols that include core strengthening, aerobic activity, and neuro-muscular re-education is beneficial with closing the gap.

There are also various surgical methods that are prescribed according to the severity of the condition, and is usually based on the symptoms and physical findings. Many patients with diastasis recti will have discomfort at the level of the defect that is aggravated by movement. In addition, the appearance of the abdominal wall is noticeably distorted in patients with diastasis recti especially when there is contraction of the rectus abdominis muscles.

Over here at Healthworks, we have experienced chiropractors and physiotherapist to help you with this condition. If you have any questions regarding this article, feel free to contact us at contact@myhealthworks.com.my or call/ WhatsApp us at 018- 982 8539.

The recent Movement Control Order in Malaysia has caused most of us to stay home and start working from home. Many of us came into this unprepared. We did not have the right tables, the right chairs and since then we may have started feeling old pains exacerbated or even new pains. Worse than bad ergonomics (right posture and right furniture), we have also suffered from prolonged sitting with irregular work hours. We no longer take walks to our colleague’s desk for a chat, walk to and from our car, walking to work.

It has been proven that sitting for more than 6 hours can be damaging to your body and the overall diseases could be compounded and cause damage that is worse than smoking.  Here are some things that can happen when you have been sitting too long. Some of which we see regularly in clinic and others that happen and indirectly affect your health.

Direct effects that we see in clinic regularly:

1. Tightness in upper back, shoulders and neck
   This is could lead to HEADACHES
2. Stiffness in lower back and hips
   Stiffness in your lower back and hips are due to sitting and your hip flexors shortening when you have been sitting for too long. Especially when you have a posterior tilt which leads to number 3
3. Weakness in glutes and eventually legs
   When the glutes are inhibited by sitting all day, you lose your stabilization muscles. In a long run, your legs lose muscle mass and when we go back to regular exercising and walking, you could feel more pain than relief.

Indirect effects:

1. Weight Gain
2. Anxiety and Depression
3. Cancer risk
4. Heart disease
5. Diabetes risk
6. Varicose Veins
7. Deep Vein Thrombosis

With this said, it is extremely important to keep moving during this time. To get up every 30 mins and move around for 30 seconds. If you can have a regular routine everyday to exercise or to move around, that would be perfect. We will discuss simple spinal exercises in our next blog.

If you have questions or would like to start exercising but have a concern regarding your spinal health and posture, you can always give us a visit. At Healthworks, we will love to help you find a routine tat suits you and your needs. Till then, happy exercising!

Rotator Cuff Impingement is a type of injury that causes shoulder pain where a tendon inside your shoulder rubs or catches on nearby tissue and bone as you forward flex or abduct your arm. It usually affects the rotator cuff tendon that connects the rotator cuff muscles that stabilizes the shoulder joint to the humerus.

The estimated prevalence of shoulder complaints is 7–34% with about 14.7 new cases per 1000 patients per year seen in clinics. Of all the shoulder disorders, shoulder impingement syndrome (SIS) is the most commonly reported, accounting for 44–65% of all shoulder pain complaints.

Who gets Rotator Cuff impingement?

Rotator Cuff impingement syndrome is commonly seen in people who are involved in activities and sports with frequent overhead motion like swimming, badminton, squash, basketball and volleyball. The constant rubbing of the rotator cuff between the humerus and top outer edge of the shoulder leads to swelling and further narrowing of the space which leads to pain. Besides that, RC impingement can also result from an injury, such as falls and motor vehicle accidents.

Examination

There were two clinical test can be performed to assess Rotator Cuff Impingement

The first is called the “Empty Can test”. The patient stands up with his shoulders in 90°abduction, 30° horizontal adduction and in complete end range rotation. The therapist fixates his hands on the upper arm of the patient and provides a downward pressure while the patient tries to maintain his position.

The second test is called the “Hawkin’s Test”, the patient stands with the shoulders abducted to 90° and internally rotates the forearm. The presence of pain with movement is an indicator of a possible pathology.

Physiotherapy Management

The aim of physiotherapy management is to reduce pain and swelling of the tendons to achieve normal range of motion and improve the strength of the shoulder. Rest and ice should be implemented at the acute phase of injury to decrease pain and inflammation. It is very important that patients need to avoid activities that increases pain and symptoms. Physiotherapist should guide the patient on when to resume those activities again based on the recovery rate on each individuals.

Physiotherapist can use techniques like muscle release to improve range of motion and prepare patient for strengthening exercises when the pain and inflammation reduces. It is important for patient to do exercises in a correct order; starting with stretching and range of motion exercises and then muscle strengthening exercises.

It has been shown that exercises are effective and support the improvement of shoulder impingement compared to no treatment or placebo.

The following suggestions are to include in the rehabilitation of shoulder impingement:

1. Gentle Muscle Release
2. Isometric Exercises to reduce pain
3. Stretching and range of motion exercises
4. Kinetic Chain Exercises
5. Correcting Technique and training errors
6. Correcting scapula-humeral rhythm and glenohumeral instability
7. Resistance training to increase mobility

Here in Healthworks, our physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

What is PCL injury?

PCL injuries often occur as part of the knee injury and is the least common ligamentous injuries among the four major ligaments of the knee. PCL injuries often occurs in isolation due to the structural positions. Most of the patients able to tolerate the PCL deficient knee and continue their daily activities but there will complications if its left untreated. Studies have indicate good outcomes of non-operative management in terms of returning to high levels of play and functions.

Basic Structure and Function of PCL

The Posterior Cruciate Ligament is made of tough fibrous material and function to control excessive motion by limiting joint mobility. The main function of PCL is to limit the posterior translation of the knee, resist hyperextension and provides a rotational axis and stability. It originates from the medial aspect of the medial femoral condyle and branches into two bundles before inserting into the posterior aspect of the tibia.

Causes

A PCL tear occur when a direct blow to the front of the knee or leg below the knee and this puts a significant amount of stress on the PCL. When the PCL stretches to the point of mechanical failure which is considered a tear. This commonly happen when someone is tackled in football below the knee from the front and the person lands on the knee forcefully with their knee bend. It can happen in a motor vehicle accidents as well when there is a head-on collision and hard strikes directly against the knee.

Non- Operative Rehabilitation

When considering non-operative management for PCL, it’s important to discuss short and long term goals with the patient for optimal decision making.

Basically, to allow ligament to heal in a neutral position, there are a few essential precaution and guidelines to follow:

1. Avoid hyperextension for 12 weeks
2. Prevent posterior tibial translation for 12 weeks (no hamstring strengthening)
3. PCL brace is to be worn x 12 weeks
4. PCL loading occurs at higher knee angles. It is prudent to use smaller knee angles (0-50 degree) before progressing to larger knee angles (50-100 deg.) because PCL forces generally increase as knee angle increases.
5. When working on improving the ROM, prescribe exercises from a prone position to limit the effect of gravity.
6. Limit WB initially to restore joint homeostasis if the injury is accompanied by effusion and joint bleeding.
7. Limit isolated hamstrings contraction at greater than 15 degrees knee flexion for at least 16 weeks as it was found to increase the load on PCL.

When might surgery be required?

Surgery for a ruptured posterior cruciate ligament is often required when other structures in the knee are also damaged. For example, the anterior cruciate ligament, medial collateral ligament or lateral ligament sprains.

Also, if you have rotational laxity in your knee. This means your lower leg twists more than normal in relation to the upper leg (femur).

Post-Surgical PCL Physiotherapy Rehabilitation

Post-operative PCL repair rehabilitation is one of the most important aspects of PCL reconstruction surgery. The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.

Your rehabilitation following PCL surgery focuses on restoring full knee motion, strength, power and endurance. While protecting the healing repaired ligament in the early phase. You’ll require proprioception, balance and agility training that is individualised towards your specific sporting or functional needs.

Here in Healthworks, the physiotherapist will perform a thorough assessment regarding your injuries and design a general guidelines and precautions. If there are any queries regarding this article, feel free to contact us at 018-9828539/ 03-6211 7533 or drop us an email at contact@myhealthworks.com.my

As many are now working from home, it’s important to check if your are sitting correctly in your new work environment.

In order to avoid and reduce back pain and other muscles related soreness, please follow these sitting posture guidelines.

It is an exciting day where all moms -to-be are about to meet their babies after a 10 month long waiting period. For most mummies, getting back into shape is probably a struggling concern and for some, regardless of the effort, their ‘mummy tummy’ is just not going away.

Doing specific abs exercises seems to be making it worse not to mention the lower back pain associated with it .

Diastasis Recti is a common post partum condition in which the abdominal muscles are separated by the ligament(linea alba) and it might cause a bulge in the middle of the abdomen where the two muscles separate. Diastasis recti is very common during and following pregnancy.

This is because the uterus stretches the muscles in the abdomen to accommodate your growing baby.  This happens mostly with pregnancy or a larger weight gain which can happen with males or females.

Having Diastasis Recti may cause you to notice the protruding belly and a general feeling of weakness in your core muscles. Other signs of diastasis include incontinence that continues more than eight weeks postpartum (separated abs can often cause pelvic floor dysfunction, which can lead to urine leakage, constipation and pain during intercourse), lower back pain and a four-months-pregnant look.

How do I know if I have a Mummy Tummy?

You can perform an easy test by lying on your back with your knees bent and feet on the floor. Put one hand on your belly, with your fingers on your midline at your navel. Press your fingertips down gently, and bring your head (shoulders stay on the ground) up into a mini crunch-like position. Feel for the sides of your rectus abdominis muscles, and see if and how far they are separated. Separation is commonly discussed in terms of finger widths — for instance, two or three (or more) fingers’ separation.

Stay tuned for Part 2 of this article.

Stuck at home wondering what can you do to help your spine? Here are some ways you can still give your back the best when you can’t get to your chiropractor, physiotherapist or spinal expert. These are in no way going to replace the importance of healthcare or seeing a specialist. These are just some simple ways you can try to help your spinal health while staying home.

Here’s some food for thought:

Think about what you are eating!
If you have the option, try sticking to plant-based proteins when you can. Things like chia seeds, lentils and beans are good options. They also can keep in the pantry for long and doesn’t rot. You can get a good amount of fiber, vitamins and minerals in the process. Meat based proteins can cause inflammation if you are sensitive. Green leafy vegetables in general are very good to work against inflammation in your body. They contain healthy minerals and can help strengthen your spine.

Try eating foods with healthy Omega-3 fatty acids. This can promote bone and tissue health. It also helps with reducing inflammation. Foods such as salmon, tuna, mackerel and sardines are good providers of these healthy fats. You can also supplement Omega-9 fatty acids with avocados and good olive oil. Salads served with tomatoes and extra virgin olive oil are also good. Healthy nuts such as walnuts and almonds can also serve as healthy snacks and give us good fatty acids.

I’m sure some of us are wondering about dairy products and calcium intake to improve bone health but remember, dairy products also have a lot of cholesterol. Calcium can be found in other food products such as leafy green vegetables. Take some time to shop the fruit section. Look for fruits with high pigments such as strawberries, oranges and blueberries. Just remember that fruits also equal to sugar.

So you would want to balance it out with movement and exercise. As for carbohydrates complex carbs are better in this time. Such as oats and whole meal bread.

Maybe take the time to try cooking a curry! Curries have many herbs and spices: mainly turmeric which helps in repairing damaged tissue. Many curries include ginger and cinnamon as well. This does not exclude western herbs. Herbs like rosemary and basil help fight inflammation and can be easily incorporated into our meals. If you are a fan of tea, you can strengthen you immune system and reduce inflammation by drinking oolong & green teas.

Try avoiding certain types of foods as well especially fast food or overly processed food. Also try to avoid sweet beverages and soft drinks. These types of food are high in sugar and saturated fats and are bad for our overall wellbeing as well as promoting inflammation. With less movement and exercise, we should also be wary of our carbohydrate and white grain intake such as white bread and rice.

Let’s make good healthy food decisions this season while staying home. In fact, these can be made into healthy eating habits that we can follow all year round. This can help us protect our spine as well as keep healthy in addition to exercising and visiting our local spinal experts.