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The Posterior Oblique Sling

The Posterior Oblique Sling

29 May 2024

The posterior oblique sling (POS) comprises the latissimus dorsi and contralateral gluteus maximus which is connected through thoracolumbar fascia, erector spinae, multifidus and bicep femoris. This activation pattern provides stability of the lumbopelvic region by transferring force through the trunk. For insistence, erectus spinae generates force whereas the multifidus creates stability. The posterior oblique sling is thought aid recovery from lower back pain (LBP) and is often a fundamental part of rehabilitation despite minimal research on the topic (Kang and Hwang, 2019). However, most recent research suggests patients with LBP have abnormal motor recruitment in the lumbopelvic region (Kim et. al, 2014); therefore, activating the POS may offer spinal mobility, stability and prevent LBP (Kang and Hwang, 2019).

Prone hip extension (PHE) is a useful measure to assess and activate the POS. In healthy individuals, one should be able to maintain neutral lumbar and pelvic position during PHE, however patients with LBP have been found to have altered lumbar and pelvic movement. This in turn can cause lumbopelvic dysfunction, spinal instability and postural disturbance (Kim et. al, 2014). For example, Kang and Hwang found patients with LBP often have delayed onset of gluteus maximus and earlier onset of bicep femoris (Kang and Hwang, 2019).  When the gluteus maximus does not activate, there is a loss of pelvis control which can cause the contralateral latissimus dorsi to become dominant. Therefore, to aid lumbopelvic control, practitioners can manipulate the PHE to focus on the less dominant muscle (Kim et. al, 2014).

Lee et. al altered the PHE technique to assess the impact this has on POS. The PHE was compared to abdominal drawing in maneuverer prone hip extension (ADIM PHE). The ADIM PHE had increased contralateral latissimus dorsi and ipsilateral gluteus maximus compared to hip extension, whereas PHE had increased ipsilateral erector spinae and ipsilateral bicep femoris ((Lee et. al, 2020). Lee et. al also compared PHE to PHE with hip abduction and knee flexion. They discovered the contralateral latissimus dorsi, ipsilateral erector spinae and gluteus maximus electromyography was higher with phone hip extension with hip abduction and knee flexion than PHE (Lee et. al, 2019). Therefore, depending on the clinical presentation of the patient, practitioners can isolate specific muscle groups within the POS. PHE with hip internal rotation and shoulder internal rotation and shoulder extension with 1lb dumbbell was found to be the optimal PHE variation for POS activation to aid recovery with LBP (Kang and Hwang, 2019).

This research highlights the importance of using PHE as an assessment and treatment tool to identify weakness within the POS and then adapting the PHE to support recovery from LBP.

Reference List

Kang, D. and Hwang, Y.-I. (2019). Comparison of Muscle Activities of the Posterior Oblique Sling Muscles among Three Prone Hip Extension Exercises with and without Contraction of the Latissimus dorsi. Journal of The Korean Society of Physical Medicine, 14(3), pp.39–45. doi:https://doi.org/10.13066/kspm.2019.14.3.39.

Kim, J.-W., Kang, M.-H. and Oh, J.-S. (2013). Patients With Low Back Pain Demonstrate Increased Activity of the Posterior Oblique Sling Muscle During Prone Hip Extension. PM&R, 6(5), pp.400–405. doi:https://doi.org/10.1016/j.pmrj.2013.12.006.

Lee, J.-K., Hwang, J.-H., Kim, C.-M., Lee, J.K. and Park, J.-W. (2019). Influence of muscle activation of posterior oblique sling from changes in activation of gluteus maximus from exercise of prone hip extension of normal adult male and female. Journal of Physical Therapy Science, 31(2), pp.166–169. doi:https://doi.org/10.1589/jpts.31.166.

Lee, J.-K., Lee, J.-H., Kim, K.-S. and Lee, J.-H. (2020). Effect of abdominal drawing-in maneuver with prone hip extension on muscle activation of posterior oblique sling in normal adults. Journal of Physical Therapy Science, 32(6), pp.401–404. doi:https://doi.org/10.1589/jpts.32.401.

Athlete lifting a barbell in a dimly lit gym
Musculoskeletal Disorders in Menopausal Women

Musculoskeletal Disorders in Menopausal Women

8 May 2024

Menopause causes a deficiency in oestrogen which can result in an increased risk of cardiovascular disease, cancer, cognitive decline, chronic obstructive pulmonary disease, diabetes, metabolic syndrome, depression, sleep disturbances, vasomotor symptoms, migraines and musculoskeletal disorders. The most common musculoskeletal disorders in menopausal women are osteoporosis, sarcopenia and osteoarthritis (Dijk et.al, 2015).

During the menopausal transition, there is an increase of muscle degeneration which can progress to sarcopenia. The decrease in oestrogen and testosterone leads to ‘neuromuscular junction insufficiency, myofiber loss, mitochondrial dysfunction’ (Buckinx and Aubertin-Leheudre, 2022) and reduced muscle regeneration.  These physiological changes increase fat deposits in muscle and increase the difficulty in achieving hypertrophy and maintaining muscle mass (Buckinx and Aubertin-Leheudre, 2022). The prevalence of osteoporosis in menopausal women is extremely high, as more than two million women have osteoporosis in England and Wales. After the menopause, prevalence rises with age from approximately 2% at 50 years to more than 25% at 80 years’ (Peto and Allaby, 2013) This is likely due to the osteoclastic resorption activity increases and the osteoblastic activity decreases, resulting in more bone being absorbed than being formed (Ji and Yu, 2015).

There is an abundance of research illustrating the impact menopause has on osteoporosis and sarcopenia, however there is limited evidence on the impact of osteoarthritis on musculoskeletal disorders (Watt, 2018). However, Richmond et. al found oestrogen receptors in articular cartilage which potentially demonstrates a relationship between oestrogen and articular cartilage health. Zhang et al. discovered that oestrogen has a positive impact on cartilage. These studies illustrate there is relationship between oestrogen and cartilage however unable to identify an explanation for the clinical significance (Hame and Alexander, 2013). Lower back pain (LBP) is also more common in postmenopausal women than men who are within the same age group. This is most likely due to oestrogen deficiency causing postmenopausal women to have increased prevalence of disc degeneration; therefore, resulting in increased risk of spondylolisthesis and facet joint osteoarthritis. Also due to higher rates of osteoporosis in postmenopausal women, osteoporosis related spine fracture, especially at thoracolumbar junction, can cause LBP (Wang, 2017).

There is a wealth of research showing the importance of menopausal women participating in exercise to reduce the risk of musculoskeletal disorders and prevent the worsening of symptoms (Grindler et. al 2015). For example, Mendoza et. al found that exercise reduces osteoarticular pain in postmenopausal women with fibromyalgia or breast cancer (Mendoza et. al, 2016). Research suggests a combination of high impact exercises and weight training is optimal to increase muscle mass and bone density, alongside medical intervention such as hormone replacement therapy and supplementation. Metcalfe et .al found the combination of adding calcium, hormone replacement therapy and weight bearing movement increases bone mass density and muscle strength for post- menopausal women. The weight bearing movements included stair climber or stepping alongside resistance training and balance exercises to reduce the risk of osteoporosis, sarcopenia and fractures (Metcalfe et. al, 2001). Hettchen et. al 2021 also demonstrated the positive impact exercise has on early postmenopausal women with osteopenia or osteoporosis and disorders related to menopausal transition. The exercise regime included a combination of high intensity training, jumping sequences and velocity resistance training (Hettchen et. al 2021).  The evidence illustrates the importance of physical activity for menopausal women, however more research is required to see the impact menopause has on other musculoskeletal disorders.

Reference List

 

Woman jogging outdoors in a teal top
Working from home checklist

Working from home checklist

5 May 2024

Man working at a home desk beside a window with a laptop and lamp
Photo by Ian Harber on Unsplash
Office jobs can often result in several injuries, including back pain and repetitive strains, to name a few. Now, in light of the pandemic, these injuries have been transferred from the workplace to home, with many of us now adopting the working from home life. The most prevalent injury in the workplace is back pain, with sedentary office jobs causing this to develop from long periods of physical inactivity, incorrect posture, and poorly designed workspaces.
Making the shift to working from home offers us an opportunity to address these injury risk factors and make work as comfortable as possible. But what do we suggest?
  1. Create an ergonomic workspace. The word ergonomic has been thrown around a lot in recent months and refers to a space designed for efficiency. This includes positioning everything you will need for your working day, whether that be pens, phones, or a water bottle, within an arm’s reach. How does this help prevent injuries? Well, if you can reach anything you need by reaching out your arm, there will be no need for you to lean and stretch, potentially causing strains. An ergonomic workspace also means adjusting your monitor height, ensuring the screen brightness is optimal and adjusting your desk and chair height to ensure maximum comfort.
  2. Choose the correct office chair. This is one of the most important points of the working from home checklist. The correct office chair can be the difference between back pain and no back pain. A good office chair will promote proper posture by having an adjustable height, an adjustable backrest, and adjustable armrests, alongside lumbar support and the ability to swivel.
  3. Practice good posture. Following on from a good office chair is practising good posture throughout the day. When sitting for extended periods of time, we often subconsciously slouch or lean, which can cause severe back pain if not corrected. Using correct posture reduces the gravitational pressure that is placed on your spine, improving comfort and reducing the risk of back pain.
  4. Take frequent short breaks. Short and frequent breaks minimise the length of physical inactivity during the day. Even if this solely involves standing for five minutes every hour and stretching your back and legs, this can have a profound impact on the incidence of workplace injuries.

If you are still experiencing back pain even after taking these suggestions into account, there may be something deeper going on, and it is worth you coming in to get this checked out by the team at Opus. An assessment from one of our sports medicine specialists may identify exercises and changes you can incorporate into your daily life that will ease any pain your are experiencing.

Why is sports medicine so valuable?

Why is sports medicine so valuable?

1 May 2024

Athlete throwing a medicine ball on an artificial pitch
Photo by Gordon Cowie on Unsplash

Sports medicine emphasises the importance of physical activity in promoting excellent physical and mental health benefits, but by nature, there is an inherent risk of injury. Addressing both athletes and non-athletes, sports medicine works to bridge the gap between exercise science and medicinal practice for the prevention and treatment of sporting injuries. Sports-related medical practices can vary from strength and conditioning for injury prevention to treatments such as injections, rehabilitation and osteopathic manipulation. But why is this so important?

Injury prevention

Exercise is one of the best things we can do for our body; however, injuries are common and can often impact our daily lives. The most common causes of sports injuries are improper or poor training practices, wearing improper sporting equipment, being in a state of poor health, or incorrectly warming up and stretching before participating in exercise or sporting events. Sports medicine focuses on preventing injuries through education and by:

  • Developing a fitness plan that incorporates strength training, cardiovascular exercise, and flexibility/mobility,
  • Addressing any underlying issues that may result in recurring injuries,
  • Ensuring you use the correct equipment and perform exercises in the correct way to prevent injury,
  • Encouraging participation in adequate rehabilitation following a sports injury,
  • Looking at alternative treatment options, such as regenerative medicine, if you suffer from recurring injuries at the same site. 

Shorter recovery times

Returning to sports following an injury can often be a lengthy and difficult process; however, having your recovery overseen by a sports medicine specialist can significantly improve this process. Physical therapy is a crucial component of sports medicine and assists recovery in the following three ways, shortening recovery times:

  1. Provides pain relief. The first priority following injury is to reduce pain and discomfort as much as possible as this often limits your ability to move freely and use your muscles. Physical therapy techniques, including taping, electrical stimulation, and ultrasound, can assist in reducing this pain in the short-term, shortening the recovery process whilst you focus on rehabilitation.
  2. Improves mobility. If an injury arises, you are often immobile for a period of time which can have a drastic impact on your mobility. Sports medicine can help you regain this lost mobility using strength exercises and stretching, enhancing your recovery. Moreover, if needed, our specialists may suggest the use of crutches to help promote movement in the short-term.
  3. Avoids unnecessary surgery. Surgery is the final option if all other recovery techniques have been exhausted, as it can often be career-ending for athletes or result in lengthy recovery periods. Sports medicine may prevent surgery by offering injury prevention. However, if surgery is still required, sports medicine is crucial in recovery. 
Our team of sports and exercise medicine experts at Opus will work with you to rapidly assess, diagnose and plan your treatment and rehabilitation. Get in touch to find out more about how our expertise and skills can assist you in your treatment and recovery.
Why exercise is good for your joints

Why exercise is good for your joints

29 April 2024

Close-up of a person's flexed forearm and elbow
Photo by Towfiqu barbhuiya on Unsplash
It comes as no surprise that exercise has an endless list of benefits for our body; it reduces the risk of heart diseases, helps maintain your blood sugar and insulin levels, improves your mental health and mood, and increases strength and flexibility whilst reducing pains and combatting fatigue. However, the benefits of exercise for our joints is often overlooked.
The most common example of the advantages of exercise for our joints is in people with arthritis. Let’s look at this in more detail.
Arthritis is a common condition that results in substantial pain and inflammation to the joints, with over ten million people in the UK alone suffering from this condition. It can affect people of all ages and is categorised into different types depending on the location of the inflammation. The most prevalently discussed types of arthritis are osteoarthritis and rheumatoid arthritis, both of which we provide treatment for at Opus. We discuss the types of arthritis in more detail here.
During exercise, people with arthritis and joint pain describe a significant reduction in their pain alongside a notable increase in their range of motion. But how does physical activity exert these effects? Below are five benefits that exercise yields and how this is advantageous to the joints:
  1. Synovial fluid lubricates the joint. Each joint in the body is surrounded by soft tissue, also known as the synovial membrane, that is capable of producing fluid. This fluid acts as a lubricant, enabling the bones at each joint to slide past one another in a smooth motion. During exercise, the circulation of this fluid is increased and, therefore, reduces any pain at the joint.
  2. Blood flow increases. During physical activity, our heart increases at a much faster pace. This results in an increase in blood circulation throughout the body, including at the joints. This exposes the synovial membrane to an increased and steady supply of both oxygen and nutrients.
  3. Joint-repair genes are switched on. This is a relatively unresearched area; however, studies have shown that genes play a significant role in joint repair, with these being activated by physical activity and joint movement.
  4. Cellular waste is removed. During exercise, a process called autophagy is triggered. Autophagy refers to the biological process in which damaged cells are broken down and removed. The build-up of these cells at the joint can often cause severe pain and limits movement; therefore, ensuring these are removed can instantly decrease the pain experienced.
  5. Increase in muscle mass. It is no surprise that exercise strengthens muscles, ligaments, and tendons in the body; this includes those surrounding the joints. When these elements are strong, they behave like a brace, protecting the join from harm. Moreover, physical activity also increases your overall range of motion, enabling your joints to withstand more pressure.
At Opus, we can assess the root cause of your joint pain and recommend specific sports medicine-backed exercises to lessen this discomfort. Beyond this, we also provide regenerative treatments that may provide long-term pain relief. Get in touch to discuss how we can assist you on your journey.
Why are injuries so common in athletes?

Why are injuries so common in athletes?

25 April 2024

Group of women sprinting on an outdoor athletics track
Photo by Jonathan Chng on Unsplash

Sports injuries are extremely common, with figures estimating that amongst the younger population alone, over 3.5 million children and teens are injured each year as part of organised sports or physical activity. This does not even account for unreported injuries. Given their prevalence, it is important that we understand why injuries are more common amongst athletes and those that regularly participate in sporting activities so that we can prevent and treat these accordingly.

A sports injury can occur as a result of several scenarios, including accidents, impact, insufficient training, improper equipment, lack of conditioning, or poor warming up and stretching, to name a few.
Although joint injuries represent the most common site of damage, accounting for both sprains and strains, any part of your body can get injured during physical activity. When we exercise, a significant number of our muscles and tendons are involved; therefore, the chances of developing an injury are much greater.
Moreover, especially during competitive sporting activities, we tend to stretch our bodies and push ourselves farther than we usually would, resulting in us moving in ways that we often wouldn’t. Although this can be harmless, in some instances, this leaves our muscles and tendons torn, damaged, and in pain.

In athletes, the above factors are exacerbated, with the most common sports injuries amongst this population being:

  1. Strains: A strain is defined as an injury to either a muscle or a tendon that primarily results from overuse, force, or stretching. The severity of the injury depends on the nature of its cause, with strains ranging from a simple overstretching of the muscle or tendon to a partial or complete tear.
  2. Sprains: Alongside strains, sprains represent the most common type of injury across all sports, being especially common amongst athletes. A sprain is characterised by a torn muscle or ligament that results from overuse or excessive force, whether that be a collision, a fall, or other causes.
  3. Knee injuries: Damage to the knee joint is most common in contact sports and is usually caused by a sprain, strain or tendonitis. There are a vast number of different conditions that may result from an injury to the knee, including ACL tears, MCL/LCL ruptures, runner’s knee, IT band syndrome and jumper’s knee, anterior knee pain, and patella-femoral maltracking.
  4. Fractures: The most prevalent fractures seen amongst athletes are fractured wrists, hands, collarbones, and bones in the ankle and feet. The highest rate of fractures is seen in contact sports, such as football and rugby.
  5. Tennis elbow: If you experience persistent pain around the outside of your elbow, you may be suffering from tennis elbow. This injury primarily results from overuse of the forearm due to a repetitive or strenuous activity; however, it may sometimes occur following force to the elbow.
  6. Plantar fasciitis: Do you have pain in the bottom of your foot? Or around your heel and arch? This may be plantar fasciitis. Plantar fasciitis is one of the most common causes of heel pain and arises following inflammation of the thick band of tissue that runs across the bottom of your foot, connecting the heel bone to the toes. This injury is most common in endurance athletes, such as runners
  7. Back injuries: It is estimated that 80% of UK adults experience back pain at some point during their lives. Back pain is most common in athletes that participate in sports that have frequent hypertension of the lumbar spine, including gymnastics and football. The primary issue with back injuries is that athletes can cause strain to other parts of their bodies if they change their techniques to reduce the pain experienced.
  8. Concussion: Injuries to the head and neck represent the most frequent catastrophic sports injury, with concussion being the most common athletic head injury. In the UK, an estimated 8.5% of all concussion-related hospital admissions are of sporting origin.
At Opus, we treat a range of sports injuries with our novel techniques, including elbow, hand and wrist sports injuries, shoulder injuries, foot and ankle damage, knee injuries, shin splints and stress fractures, hip sports injuries, neck and back pain, and sprains and strains. Contact us today to discuss your needs and how we can assist you on your journey.