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Rethinking Chronic Pain

Chronic pain is a significant problem for many Mandurah residents, and can interrupt your ability to do the things you enjoy. In general terms, chronic pain can be defined as pain that has been present for longer than 3-months. Thankfully, over the past decade, research in the field of pain science has helped us to understand more about chronic pain, and how we can more effectively treat it. Chronic pain is a lot more complex than previously thought, and although we have been good in the past at treating the physical components to pain, the neurological and brain components to chronic pain have not been as well addressed.

What we have learnt about chronic pain is that after a long period of being in pain, our pain system can become over-protective and hypersensitive. This means that we can continue to feel pain signals (perhaps with certain movements), even after the physical component causing the pain has long since resolved. This may explain why some people suffering from chronic pain have normal x-ray/scan results!

So what can we do about it? Well, one of the simplest, and most effective ways to help chronic pain is to better understand what is happening. The short video below titled ‘Tame the Beast’ really helps to explain it well.

There is no single effective treatment for chronic pain, but what we do know, is that people get better with a combination of different types of treatment. This generally includes hands-on manual therapies, exercise and education on pain.

Is My Child’s Schoolbag Too Heavy?

The start of the school year is often when we get an influx of rightfully concerned parents, worried about the weight of their child’s school backpack. Current recommendations suggest that a child’s backpack should not exceed 10% of their body weight.

Although back pain in children is a lot less common than in adults, there are a number things we can do as parents to ensure our children stay pain-free, with happy healthy spines!


Here are some simple hints and tips for correctly selecting and fitting your child’s back pack:

  • Ensure the backpack is the correct size. When the shoulder straps are adjusted, the bottom of the backpack should be above your child’s waist – not hanging over the buttock.
  • Get an adjustable backpack. Every kid is different, so make sure the backpack can be adjusted to suit your child’s frame, and change as they grow!
  • Look for features such as a moulded frame and/or hip strap, so that the weight of the contents can rest against your child’s pelvis instead of their shoulders and spine.
  • Ensure their backpack is fitted correctly. It should be snugly fitted over both shoulders and should comfortably fit the contour of their back. Don’t have the backpack hanging low off their shoulders.
  • Fill their backpack appropriately. Pack the heaviest items closest to their spine, which will help balance the load. Also using the backpacks compartments if you have them, will help stop the load moving around.

I hope you find this information helpful. If you are concerned or just want a spinal check-up for your child, feel free to contact us at the clinic to book a chiropractic appointment.

3 Exercises to Improve Your Hip Strength and Mobility

Perhaps second only to shoulder rotator cuff issues, persistent pain and stiffness at the hip joints is one of the most common non-spinal complaints we treat in the clinic. Patients often describe stubbornly tight and painful hips that don’t respond to standard hip stretches. Due to the inherently stable nature of the ball-and-socket joint, months of intense ‘static stretching’ will often provide little benefit, and instead exercises that improve correct muscle contraction and movement patterns are the key to improving functional hip range of motion.

There are many underlying conditions that can account for poor mobility and flexibility, but for the majority of people, a program of home exercises in conjunction with your chiropractic treatment, can go a long way towards improving your hip range of motion, strength and overall function.

As always, it is advisable to first see your health practitioner before commencing any exercises described in these blogs. Some conditions can be aggravated with certain exercises, especially if performed incorrectly.

1. Reverse Active Straight Leg Raise

This exercise is fantastic for improving hip flexion in combination with hamstring flexibility, which is important for correct hip biomechanics. Start by  lying flat on your back with both legs elevated at 90 degrees. Be sure to activate your core muscles, ensuring your lower back stays flat against the floor. With a resistance band or rope around one leg, slowly lower the opposite leg down to ground level. Alternate between both legs, aiming to perform 2 x 10 reps.

2. Single Leg Hip Lift

This exercise is another that is excellent for those with tight hip flexors, and again combines flexibility with strengthening, to improve mobility. Start by lying on your back, with one hip pulled tight up against your chest. The knee is bent 90 degrees with the foot flat on the floor. Next, lift your hips up as high as possible, without arching the lower back. You should feel your glutes (buttock muscles) activating with this movement. Hold the position for 5 seconds, alternating between legs to do 2 x 10 reps.

3. The Psoas March

This is a great exercise to improve lumbopelvic control and hip flexibility. Lying on your back, raise both your legs with your hips and knees both bent at a 90/90 position. Be sure to keep your lower back flat against the ground by activating your core muscles. Slowly kick one leg out straight, whilst keeping your other leg stationary, and maintaining your lower back position. You can alternate from leg to leg, aiming to complete 2 x 10 reps. As you progress, you can add resistance band between both your feet to increase difficulty.


Shoulder Bursitis – what is it and how is it treated?

Shoulder bursitis most commonly refers to inflammation of the subacromial bursa, which is a fluid filled sac, that sits at the outer-front aspect of the shoulder. Subacromial bursitis, is one of the most common complaint

s we see in the clinic, and it typically presents as tenderness at the outer aspect of the shoulder, more so when raising the arm, which confines the subcromial space, where the bursa is located. (1)

What is the bursa? Why is it sore?

The bursa is a thin, lubricated cushion, and acts as a barrier at points of friction, between bones and surrounding soft tissue structures. There are about 160 of them around the body, and they vary in size depending on location and the nature of the forces being applied across it. The bursa sac is made up of synovial membrane, which both produces and maintains the synovial fluid within the bursa. (2,3)

The subacromial bursa sits below a bony structure of the shoulder, called the acromion, and provides a cushion barrier between the bone and the rotator cuff muscles that run directly below it. (3)

Bursitis (or inflammation of the bursa), occurs when the synovial membrane  becomes inflamed, causing it to thicken and produce an excess of synovial fluid, causing the bursa to swell and become painful. The most common causes for this are excessive friction on the bursa, a direct injury, or an underlying inflammatory condition, such as rheumatoid arthritis. You can also get bone spurs (osteophytes) that grow down from the bottom of the acromion, narrowing the subacromial space that the bursa and rotator cuff tendons sit within. (3)

When the subacromial bursa becomes irritated, it can thicken and cause what it sometimes referred to as Shoulder Impingement Syndrome, which is a painful pinching of the soft tissue structures that sit in the small space between the acromion and the shoulder ball-and-socket joint. This space is call the subacromial space. The tendons of the rotator cuff muscles can also become inflamed, resulting in tendonitis, which contributes to the pain. (4)


How is shoulder bursitis treated?

Most patients generally respond well to a combination of stretches and rehabilitation

exercises provided by their health practitioner, to strengthen the muscles that support and control movement at the shoulder. This helps treat the current bursitis and tendonitis, and minimise the risk of future irritation. Manual therapy techniques including joint mobilisation/manipulation and soft tissue techniques are also often incorporated into most treatment plans.

In the initial phase, rest from activities that are causing aggravation, such as lifting, reaching and overhead work is helpful. Your practitioner can also advise you on activity modification, or changing the way you perform repetitive tasks, in order to reduce irritation on the bursa and tendons. Your doctor may also prescribed you an anti-inflammatory medication to reduce the inflammation and swelling of the bursa. In some cases, a corticosteroid injection (anti-inflammatory) into the bursa, in conjunction with an aspiration (or draining) of the bursa can be beneficial. (5)

Surgery (acromioplasty) may be considered in cases where there is significant bone spurs impinging on the bursa and tendons, that is not improving with conservative treamtment. Surgery will generally include removing part of the acromion and sometimes the bursa itself, such that there is more space for the soft tissue structures. (6)


Will it happen again?

Subacromial bursitis is very common, and can often recur, if the causative factors haven’t been addressed. Most bursae will settle with anti-inflammatories, but it is important to correct postural and movement patterns that are causing it to become aggravated in the first place. If there is significant spurs, and conservative measures are not resolving it, then symptoms will likely recur until this is surgically addressed.

If you are suffering from bursitis, feel free to book an appointment at the clinic for a full assessment and appropriate course of treatment.



  1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. Review. PubMed PMID: 15163107.
  2. van Holsbeeck & Strouse. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. AJR Am J Roentgenol. 1993 Mar;160(3):561-4. PubMed PMID: 8430553.
  3. Anastasios Papadonikolakis, Mark McKenna, Winston Warme, Brook I. Martin, Frederick A. Matsen, III; Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder. The Journal of Bone & Joint Surgery. 2011 Oct;93(19):1827-1832.
  4. National Institute of Arthritis, Musculoskeletal and Skin Diseases, “Shoulder Problems.” May 2010. Accessed March 8, 2012.
  5. Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Review. PubMed PMID: 17682625.
  6. Donigan JA, Wolf BR. Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone–does it really matter? A systematic review. Iowa Orthop J. 2011;31:121-6. PubMed PMID: 22096430; PubMed Central PMCID: PMC3215124.

5 Easy Stretches for the Busy Office-Worker

I see a lot of desk-bound office workers at the clinic, who often present with similar symptoms of neck and shoulder pain, and stiffness in the mid to upper back. The human frame is designed to move, and long hours in one fixed position are not going to help things!

Here are 5 easy stretches that you can do while at work, to keep mobility in the neck and upper back:

1. The Chin Tuck

No, this is not a cosmetic plastic surgery procedure. The chin tuck is a postural position of the neck that takes load off some of common pain generating structures in the neck, as well strengthening the stabilising muscles of the neck, that encourage good posture.

Simply tuck your chin back a few centimetres, to represent a ‘double-chin’. Try not move your head downwards, but more a backwards sliding position. You can add to this, by having your head against a headrest and pushing into it with light pressure. This will help to strengthen the neck muscle.

2. Scapular Setting:

This is another important postural position, that reduces load on the neck, and encourages activation of the upper back muscles, that support the shoulder blades. In a seated position with your elbows by your side, gently draw your shoulder blades back and down together. You should feel the muscles at the base of the shoulder blade working. Be sure avoid shrugging your shoulder blades upwards.

3. Shoulder Rolls:

Move your shoulders in a backwards circular pattern as shown. This helps to improve mobility in the shoulder girdle, and also resets the muscles at the top of your shoulders (upper trapezius), if you find yourself hunching.

Slow, wide circles generally work best.

4. Upper Trapezius Stretch:

Sit on one hand with your palm facing up, ensuring you are sitting up straight and not slouched. Turn your head 45 degrees to the opposite side. With your other hand, grasp the back of your head and lightly pull down, such that you are looking towards your armpit. You should feel a stretch across the top of your shoulder. By altering how much you turn your head, you can target slightly different muscles.

5. Upper Back Rotation:

In the seated position, rotated your upper body as far you can, keeping your pelvis straight. You can hold onto the side of your chair to get some extra stretch. Repeat this slowly from side to side a few times, to keep movement in the thoracic spine. Turning your head to the same side also helps with overall mobility in the upper spine.

4 Simple Exercises to Improve Your Core Stability

There are countless rehab exercise programs floating around, promising to improve core stability and cure low back pain, much of which all revolve around the same basic principles. That is, strengthening the transverse abdominus, gluteals, and lumbar extensor muscles, that aid in supporting and controlling movement in the lumbopelvic region. It has been shown that this can reduce low back pain, and it should make an integral part of your treatment regime. (1) (2)

Core stability exercises don’t need to be hard and complicated. In fact, I have found clinically,  that people get better improvements with exercises that are simple and easy to perform, and therefore more likely to be done on a regular basis! There is actually still some uncertainty in the research as to the effectiveness of specific core stability exercises over general exercise for reducing low back pain. (3) (4)

Here are 4 core stability exercises that I get all of my patients with lower back pain performing, especially if I suspect there is a deficiency in activation of the core muscles.

1. Anterior Pelvic Tilt (Transverse Abdominus Activation)

The transverse abdominus can be a difficult muscle to contract, and performing a pelvic tilt can be a helpful way to get it firing. Lie on your back with bent knees and your feet flat on the floor. Try to pull your bellybutton down towards your spine, while at the same time clenching your buttock muscles. You should feel your tail bone rolling up off the floor. Hold this for a 10 seconds, relax and then repeat. You should be able to perform this while still breathing. It is helpful to also perform this during day-to-day activities such as sitting at the desk and walking.

Image taken from Physitrack®

2. The Dead Bug

While lying on your back, bring your legs up in the air with your hips and knees both bent to 90 degrees. Bring your arms up, pointing straight up vertically over your head. Ensuring you keep your back flat, slowly lower your opposite arm and leg away from each other towards the floor. Make sure nothing else moves as this motion occurs. Return back to the starting position and perform on the opposite side.

Image taken from Physitrack®

3. The Bird Dog

Get into an all-fours position on your hands and knees, with your hands directly under your shoulders, and knees under your hips. Tighten your abdominal core muscles. Extend your opposite arm and leg out straight from your body, ensuring to keep good control in your torso. Avoid twisting in the hips and pelvis. Bring them back in, and repeat on the opposite side. This can be a difficult exercise in the beginning, and in a lot of cases I start with people just elevating one arm or leg at a time, until core strength and motor control improves.

Image taken from Physitrack®


4. The Side Bridge on Knees

Start lying on your side and push yourself up onto your elbows. Bend your knees and lift at the hips until your body is in a straight line running from head to knees. Hold this position for as long as possible, then slowly lower and repeat.

Please keep in mind, these exercises may not be suitable for everyone. It is advisable to consult your chiropractor or other health professional before starting any new exercises. How many repetitions to perform is different for everyone, but generally try starting with 2 sets of 8-10 reps.

For more information on low back pain and how core stability training may help, feel free to contact me at the clinic for more information.


1. Akuthota, Venu, Andrea Ferreiro, Tamara Moore, and Michael Fredericson. 2008. Core stability exercise principles. Current sports medicine reports 7, no. 1: 39-44.
2. Hodges, P W. 2003. Core stability exercise in chronic low back pain. Orthop Clin North Am 34, no. 2: 245-254.
3. Education, Field Coaching, and Exercise Science. 2012. On rethinking core stability exercise programs. Australasian Musculoskeletal Medicine: 9-14.
4. Wang, Xue Qiang, Jie Jiao Zheng, Zhuo Wei Yu, Xia Bi, Shu Jie Lou, Jing Liu, Bin Cai, et al. 2012. A Meta-Analysis of Core Stability Exercise versus General Exercise for Chronic
Low Back Pain. PLoS ONE 7, no. 12.
Images taken from Physitrack®

I have hip bursitis. What is it, and what do I do about it?

When people talk of having hip bursitis, it is most commonly the greater trochanteric bursa, which located on the boney knob near the top and at the outside of the femur (thigh bone). The bursa is a fluid filled cushion that reduces friction between the boney knob and the tendons and muscles that run over, and control your hip movement.

Hip bursitis occurs when this bursa becomes inflamed, and apart from local pain in the area, it can radiate pain down the outside of the thigh. People generally have difficulty walking, climbing stairs, getting up from seated positions, and lying on the affected hip. Research over time has suggested that hip bursitis is usually the result of another problem around the hip joint, often a damaged muscle or tendon. If tendons have become thickened or under more tension, this can increase friction across the bursa, causing inflammation. DIrect trauma onto the bursa, such as with a fall, can also trigger hip bursitis.

In summary, symptoms may consist of:

* Pain and tenderness at the outside of the hip

* Pain worse with prolonged inactivity

* Pain worse with repetitive activity

* Pain radiating down the outside of the thigh

* Pain at extreme range of motion of the hip

In rare cases, the bursa can turn septic, meaning it is infected. This will generally present as redness, warmth and swellling over the area, in conjunction with a fever. If you have these symptoms, seek medical attention urgently for further testing and antibiotic treatment if necessary.

Often the diagnosis will be made by your chiropractor, physiotherapist or GP, based on physical examination findings. Prior to treatment, an ultrasound me be need to confirm the diagnosis and asses for any other conditions at the hip joint that may be contributing to your symptoms, such as a muscle or tendon injury.

Treatment for Hip Bursitis:

The goal of treatment is to control the inflammation of the bursa and correct any causative factors that aggravating it in the first place. Getting the inflammation under control may consist initially of rest and activity modification, applying ice to the bursa, and taking some anti-inflammatory medications.

Manual therapy treatments such as the that provided by your chiropractor or other health provided may also help to settle pain, and reduce tension from muscles lying across the bursa. They will also address causative factors such and posture, poor hip stability and other biomechanical triggers that may be initiating the bursitis. Management usually focuses on a program of strengthening and conditioning exercises of the muscles that control stability and proper biomechanical motion at the hip joint.

In cases were symptoms don’t settle, aspiration or drainage of the bursa, often in conjunction with a cortisone injection are often helpful.

If you are suffering with hip bursitis and need more information, feel free to contact us at the clinic to discuss how we can help.