From posture to Pilates: dealing with the root causes of pain

For more than six months, I struggled with a tendon injury. I couldn’t run because of the pain but I continued walking and swimming, hoping it would heal. A casual chat with a physiotherapist led to an assessment, revealing I had simply been doing the wrong things.

Many of us believe now that exercise is the panacea to all kinds of aches and pains. But, often – as in my case – you can be doing the wrong exercises and putting further strain on injuries that need a mix of rest and specific exercises to recover.

The rise of popularity of rehabilitative exercise classes are helping people of all ages with chronic and acute injuries in their back, legs, arms, shoulders and neck. These classes are usually run by a physiotherapist or a physical therapist who will first assess each participant and then guide them through a series of exercises to improve strength and flexibility of all their joints and muscles.

Tomás Ryan is a physical therapist in Co Tipperary (solutions2injuries.com). He says it's most important to understand the cause of the pain before giving advice.

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“I’d see a lot of lower-back pain, knee, shoulder and neck pain in sports people and the general public,” he says. “The biggest mistake people make if they have an injury is that they overload the joint or muscle by continuing to do exercises that aggravate the injury. It’s important to take out the aggravating factor and start doing the right kind of exercise that helps the injury heal.”

For example, sciatica pain – which extends from the back into the leg – is exacerbated by sitting with outstretched legs or sitting up in bed reading. “This overstretches the sciatic nerve, producing pain which doesn’t allow recovery,” says Ryan.

Long-term poor posture combined with a new activity – for example, starting a new gym class or clipping a hedge or painting a ceiling – can lead to the sudden onset of pain. While the onset of pain can seem to come from nowhere, there is often an amount of wear and tear that has contributed to the injury. Holding stress in the body over a long period of time can also can lead to the sudden onset of back, shoulder or neck pain.

Class action

Once Ryan has identified the specific injury and given his clients an initial rehabilitative programme to do at home, he then encourages them to join a class that will strengthen their joints and muscles while also helping to prevent further injury. “It’s important that these exercises are pain-free. It’s okay to feel fatigue but not pain,” he says.

His own rehabilitative exercise classes are a mix of Pilates and other rehabilitative techniques. “I have a few farmers in my class whose daily work involves a lot of lifting and bending. For them it’s important to learn to breathe properly so as not to tense their muscles, to identify potential weaknesses and avoid injuries by improving flexibility.”

Chartered physiotherapist Jean Taylor runs clinical Pilates classes in Greystones, County Wicklow (physiogreystones.com). Before people join the weekly hour-long classes, she assesses each participant to identify any individual issues. Often she recommends her own clients to join these classes, after a number of one-to-one sessions.

All participants start at beginner’s level before moving on to intermediate and advanced classes.

"People run the risk of injury if they join a class without an initial assessment. In the clinical Pilates class, participants like the fact that I know what their specific problems are," says Taylor, who did her Pilates instructor training with the Australian Physiotherapy and Pilates Institute.

“All the exercises in the clinical Pilates classes are pain-free and one hour a week looks after their flexibility,” she adds. Taylor’s clinical Pilates classes include repeated movements of the hips, knees, ankles, shoulders, elbows, wrists and all spinal joints in standing and lying positions. “We target all joints every week,” she says.

Pain build-up

Taylor says that while most people come to her with acute pain in their backs, necks or limbs, the injury has often built up over time. “Often they have been getting stiff over the previous six months but they haven’t noticed. The biggest mistake people make is that once the pain has reduced, they go back to doing the same things and in a very short time, the problem recurs.”

She agrees that injury can happen as a result of poor posture over the long term. “It can happen to someone who uses a phone or laptop with too much neck flexion for long periods of time or mothers feeding their babies in bad positions or always carrying their toddlers on the same hip or even watching television from a low couch with a television to their right or left.”

According to Taylor, a clinical examination is always the best first step. “Sometimes, we see people with referred pain in their wrists from their necks. Patients may have injuries as they lack core strength and flexibility in their spine and peripheral joints. As physiotherapists, if we are happy with what we find after clinical examination, we progress with treatment. If not, we refer to a doctor who may organise tests and scans.”

Éilis Kinsella, a chartered physiotherapist who works with Jean Taylor at Applewood Physio and Pilates in Greystones, says that understanding pain is also crucial to recovery. “Pain is a sign that something is not right. Patients are always advised to avoid activities that cause pain and that they should not feel pain when doing their rehabilitative exercises. Muscles can spasm for various reasons, but when we are injured they often contract to protect the site of injury. An unfortunate side effect of this is pain. We work on reducing spasm and relieving the pain, before starting the rehabilitation process.”

Taylor says that, as people age, it becomes even more important to do exercises to maintain flexibility and strength and prevent injury. “Low-impact activities such as walking, swimming or cycling are really beneficial for your heart and lungs but aren’t enough to maintain strength and flexibility in your spine and peripheral joints.”

She also advises people not to return to sport or fitness classes until the injury is healed. So, for example, with a calf tear, the injured muscle must be restored and be equal in strength and flexibility to the calf muscle in the other leg.

And, my tendon, well it’s not back to normal yet – but the important tip at the physiotherapy assessment to wear heeled shoes to reduce strain on my calf muscle so that the tissues can repair was something I would never have worked out on my own. Also, she advised me only to walk on flat ground for now and get up from my desk every 20-30 minutes to walk about for a minute or two. Once the pain fully abates, I plan to join a rehabilitative exercise class to regain strength and flexibility so that I can return to my normal levels of activity.

IDA KELLY

Ida as been going to weekly clinical Pilates classes for four years. “I had mid- and lower-back pain and I was picking up injuries very easily,” she says. At the time Ida was the full-time carer of a family member, which involved a lot of lifting. “I went to a physiotherapist, who worked on my back and gave me exercises to do at home, which I found worked really well. At each session, she would check to see that I was doing the exercises correctly.”

After some one-to-one sessions, her physiotherapist recommended the clinical Pilates classes. “I realised that my flexibility wasn’t good, but going to the classes, I have become much stronger. In the classes we are using muscles that we don’t use in daily life, so that keeps everything more flexible. We also focus on our breathing with every movement.”

Ida, who now works in administration, has had very little pain in her back since. “I adapt the posture and movements we do in the Pilates class when lifting and sitting at my desk. I walk four or five times a week and I find the Pilates and walking work very well together.”

DARA McMAHON

Dara ad been suffering from carpal tunnel syndrome in her wrist and experiencing a lot of pain, tingling and numbness in her hands when she went to a physiotherapist for advice. “I had been attending a surgeon in St Vincent’s Hospital and was scheduled for surgery on my wrist,” she says. “I couldn’t lift anything or even wipe a countertop. I didn’t want surgery but had tried lots of other therapies with no benefit before I finally went to a physiotherapist.”

The physiotherapist assessed and diagnosed the cause of her arm and wrist pain as referred pain from her neck. “She worked with me for six months, doing gentle exercises in her clinic and at home. I realised that if I had had surgery on my wrist, it wouldn’t have helped the problem.”

Following physiotherapy, Dara, who is a singer and singing teacher in Greystones, Co Wicklow, started attending weekly clinical Pilates classes. “As a singer and singing teacher, I’m very aware of body alignment and breathing, and I do exercises and physical warm-ups and stretches with my students.

“By attending the Pilates classes, I have regained strength in my arms and upper body. I’m pain-free, and going to the weekly classes keeps me flexible. It also helps that the physiotherapist running the class knows what issue everyone has and can individually modify the exercises to suit us. This gives us a lot of confidence.”

INJURY PREVENTION FOR OFFICE WORKERS

– Adjust your desk and computer screen for comfortable sitting or standing position.
– Sit supported, with muscles relaxed.
– Get up and walk around regularly during the working day.
– Take a walk during your lunch break.
– Join a fitness class that puts emphasis on strength and flexibility in all the joints and muscles in the body.
– See also Working Well in the Office, a leaflet produced by the Irish Society of Chartered Physiotherapists.