Monthly Archives: January 2012

5 tips for happy shoulders

Lots of people get sore shoulders. Some of them are swimmers, some are throwers, some do ironman, and some just iron. Shoulder problems happen to teenagers, twenty year olds, and those in their 40s, and they happen for a variety of reasons. The good news is that there are things people can do to help get their shoulders better, and most of those things involve exercises which people can do themselves.

At the Queensland Sports Medicine Centre, we’ve collated our favourite exercises for people who have sore shoulders. Each exercise takes 30 seconds to perform. We recommend completing each exercise twice for a total exercise time of 5 minutes.

1. Sleeper Stretch (added by Sarah Grimstone)

One of the classic reasons for sore shoulders is a lack of shoulder turn in or ‘internal rotation’. This can be simply check by standing in ‘Scarecrow Position’. Standing upright with your arms out to the sides, elbows bent to 90 degrees, turn your palms as far down to the floor as you can and measure the angle of your forearms to the floor (and to each other). This measurement of internal rotation has been observed for 30 years as a key predictor of risk for shoulder troubles.

If you notice that your turn in is different on one side, the sleeper stretch is a proven way to help improve this:

  • Lie on your side with your lower arm out in front of you and your elbow bent
  • Use your upper arm to push down and internally rotate the lower forearm
  • When you get to the limit, roll your body forward onto your lower arm to add to the stretch. [A trigger ball can be applied under the lower arm to increase the stretch further]
  • Hold for 30 seconds


2. Happy Clavicles (added by Laura Schwab)

Happy Clavicles is a Postural Cue to promote good shoulder and shoulder blade positioning. It involves:

  • Sitting or standing upright
  • Chin Tucked
  • Imagine the space between your two collarbones at the front of your sternum.
  • Try to create a ‘smile’ using the ends of your collarbones by raising your sternum skywards.
  • Hold for 30 seconds


3. Supraspinatus Activators (added by Tammie Dare)

Supraspinatus is one of the most commonly injured muscles in the rotator cuff. Almost everyone who gets a sore shoulder has some kind of involvement of the supraspinatus whether primary or secondary. Here is a great exercise to get it going at an early stage:

  • Standing with ‘Happy Clavicles’
  • Lift the arms out to the side a small way (15 degrees) as your start point
  • Side raise from 15 to 45 degrees while holding ‘happy clavicles’
  • Repeat for 30 seconds to activate and relearn the correct motion


4. Turn Outs (added by Dolph Francis)

Turn Out exercises involve retraining the Infraspinatus muscle. This muscle is also commonly injured in shoulder problems.

  • Lie on your unaffected side with a rolled up towel under the arm to be exercised.
  • Hold Happy Clavicles
  • Use a light weight in your hand and ‘turn out’
  • Repeat for 30 seconds

5. Seated Row (added by Adam Russell)

Seated Row is the first of the basic gym exercises to be done in shoulder rehabilitation therapy and is the signalling point that you can return to strength and conditioning. This exercise can be done at home using tubing as resistance.

  • Sit at the equipment, or stand if using tubing. Choose a load that your body can do easily at first to ensure you learn the correct activation sequence.
  • Hold happy clavicles.
  • Holding your resistance, activate your shoulder blades to ensure you have control at the back.
  • Draw your elbows back until your elbows come in line with your body.
  • Repeat this for 30 seconds.

Sleeping Position

What Sleeping Position is Best?

Sleep is the best form of recovery for active people. Without sleep our mental and physical capacity slowly gets worse and training and performance can suffer. For some people the positions they sleep make their body sore enough that sleep is disturbed or even stopped. This article reviews the current views on sleep position and bedding to enable ever athlete to make night time the right time for recovery.

Back Sleeping

Back sleeping is ideal for those who don’t have a risk of snoring and have flexible enough hips to allow them to lie flat without their backs over-arching. Most people find that the can only last a limited time in this position, and many like to have a small pillow tucked under their knees, or cross their legs in order to bend one knee.

When sleeping on the back, a small to medium pillow is recommended. Many people feel like they a larger pillow, and while they may get to sleep more peacefully, they often wake with a sore neck.

Trying to train your body to cope with a smaller pillow when on your back teaches your body to get better at holding a straight position. Try just resting on your back in bed at first – without trying to go to sleep. You may find you learn how to cope better and better in this position.

For people with extension related back pain (spondylolysis and stress fractures), this position usually provides an increased risk of discomfort.

Side Sleeping

Side sleeping is usually described as the most common sleeping position. Pillow selection is critical here. The aim of a pillow with a side sleeper is to fill the gap between the bed and the side of your head. This is probably the thickest a pillow should be, and is therefore not much use in other positions of rest. A good idea is to use two thinned pillows in place of one large one. This allows you to use the two pillows under the neck when side sleeping, but switch to one when you are on your back.

Side sleeping is usually the least injurious position for neck and back pain, but can place undue stress on the shoulder you are sleeping on if you don’t take the opportunity to roll over in the night. Your body is designed to move, even in your sleep.

Stomach Sleeping

Stomach sleeping gets a bad rap from sleep experts, but is the most comfortable sleeping position for many flexible people. In truth there are not many who truly sleep on their stomach’s where many will sleep on their belly’s with one leg hooked up. A well placed pillow under the hips here will make for a comfortable and sustainable position especially when combined with a small pillow tucked under the chest to allow the head to comfortably be turned to one side.

A pillow is not recommended under the head at all in this position, however if one must be used – a very thin one is the main option. Stomach sleepers also generally like to have a firm bed.

Bed Selection

Bed selection based on sleeping posture has been found to correlate with sleep quality in a 2010 study of beds. 27 patients were given beds to use for 12 weeks based on their sleep position, and asked to rate their risk of pain and quality of sleep over the trial period. The results showed that choosing your bed firmness based on your sleeping posture decreases pain and increases sleep quality.

Using this simple guide, you can sleep to the fullest of your potential. Remember to move in your sleep, and as you move, shift your pillows accordingly. All positions are good positions if you are suited to them. Sleep well, and stay active.


Jacobson B, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied Ergonomics [serial online]. December 2010;42(1):91-97.

Fong T, Choice Magazine Mattress Survey, Choice Australia, May 2010

Avoid getting knee capped

Pain arising from the knee cap can be frustrating for the athlete. For the approximate 2.5 million runners who are diagnosed with it over a given year worldwide it is a significant trouble. More than 75% of them will have recurrent problems with it, and end up with chronic pain [1].

Up to now, the majority of treatment has aimed at short term successes, while long term solutions have been harder to come by [1]. New research into the longterm management of PFPS shows that the gold standard treatment principles include:

1. Act Locally
PFPS is associated with force loads through the patella. These loads are higher in women than men, and higher in those with weaker vastus medialis oblique muscles. It is thought that this muscle has the greatest effect on motion of the patella and the femur. Recent studies suggest that it is VMO’s control of thigh motion rather than the knee cap that is the reason for its value in minimising pain [2].

For the injured person that means we should work hard on strengthening the vastus medialis muscle with a load bearing, slow, controlled strength and conditioning program from your QSMC physiotherapist or Aspire Fitness & Rehabilitation Exercise Physiologist. You will be given key cues to ensure that you maintain an ideal position of your thigh bone during these exercises.

2. Footwear Matters
People with increased mid foot mobility (dropped arch / flat foot) are at a higher risk of PFPS. Foot orthoses prescribed to treat people with PFPS are known to produce positive clinical outcomes [3].

The podiatrists at QSMC believe that it all begins with good quality footwear. Up to a point, you get what you pay for with brands like Asics, Brooks, and New Balance leading the way in running shoes for the last decade. In recent times, Nike has made a resurgence in technical running shoes as well.

Independent of the choice of brand, choosing a shoe that provides an adequate amount of motion control, especially in and around the arch has been shown to minimise risk of PFPS.

QSMC podiatrists Nathan Eadie and Nick Sprenger may also advise some people to get orthotics where clinically indicated.

3. Core Stability
Evidence suggests that people with PFPS may be weaker around their hip and core [4]. This leads the ‘at risk’ runner to an increased amount of hip ‘internal rotation’ and ‘adduction’ when their foot strikes the ground [5]. At QSMC, our clinicians will ensure that you have the right kind of therapeutic exercise program to activate and strengthen the muscles around your hip, trunk, and upper thigh in order to minimise the leg ‘turn in’ during running and other sporting activity.

With these three simple thoughts in mind, you can minimise the chances of getting PFPS and maximise the recovery process for those with symptoms. If you are already suffering PFPS, or for a general preventative checkup, contact QSMC for the latest in assessment and treatment protocols to get your knees back on track.

1. Davis, I.S., Patellofemoral Pain Syndrome: Proximal, Distal, and Local Factors, An International Retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. Journal of Orthopaedic and Sports Physical Therapy, 2010.

2. Souza RB, P.C., Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain. . J Orthop Sports Phys Ther., 2009. 2009 ;39:12-19.

3. Sutlive TG, M.S., Maxfield SN Identification of individuals with patellofemoral pain whose symptoms improved after a combined program of foot orthosis use and modified activity: a preliminary investigation. Physical Therapy, 2004. 2004;84:49-61.

4. Bolgla LA, M.T., Umberger BR, Uhl TL, Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. . J Orthop Sports Phys Ther. , 2008. 2008;38:12-18.

5. Boling MC, P.D., Marshall SW, Guskiewicz K, Pyne S, Beutler A. A, Prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort.Am J Sports Med. , 2009. 2009;37:2108-2116.

Exercises for Back Pain

The recent floods in South East Queensland and ensuing clean up have given sore backs to a lot of Brisbane locals in the month of February. This article reviews the current concepts of treatment for low back pain.Diagnosing the mechanism of low back pain helps guide management and leads to improved outcomes for the patient [1]. In many of the ‘mud armies’ cases, the cause was a forward bending motion including lifting. This is a common cause of back pain, and best outcomes are achieved from a combination of mobility techniques and strength & conditioning programs [2]. These may include:

1. Cobra: Arch backs in Prone Start by resting on your stomach. While maintaining a relaxed belly, gently push up through your arms to arch your lower back. Stop after a gentle resistance is felt, and then return to resting on your stomach. Repeat 10 times [3].

2. Knee Rocking

Lie on your back with your knees bent. Rock your knees gently from side to side. Repeat 10x each side [3].

3. Neural Mobilisation / Hamstring Stretch

Lie on your back with a towel wrapped around one foot. The ends of the towel are held in the hands. A stretch band may be used as an alternative. Pick up your foot and stretch your heel into the air. Hold with the towel while gently straightening the knee to achieve a stretch in the back of your leg. Relax and repeat knee straightening ten times [4].

4. Manual Release of Side Bend

Some people who get acute back pain will get a side bend or list along with their injury. People who get this are helped by their QSMC physiotherapist performing a release on their back which aids in straightening the lumbar spine [5]. This more complex problem can be easily identified by looking at yourself in a mirror and examining the position of your shoulders relative to your hips. For those who have a side bend issue, specific manual treatment from your QSMC physiotherapist will help to alleviate the problem.

5. Core Stability Training

One of the most researched methods of relieving low back pain risk long term is the use of core stability training. QSMC physiotherapists advise learning how to contract the transverses abdominus muscle during ‘at risk’ activities to minimise the force load through the lumbar spine.

A simple cue to activate this is to lie on your back with your knees bent and attempt to draw your belly button in towards the floor. It should not be straining motion. With practice, this contraction can be performed during activity and in a variety of positions. QSMC physiotherapists may refer you to pilates classes or to an Aspire Fitness & Rehabilitation exercise physiologist for more advanced training if clinically indicated.

Armed with these five actvities, people with back pain caused by lifting mechanisms can alleviate their initial symptoms and minimise their risks for ongoing troubles. If you have any further queries or would like assistance with managing your back pain, please do not hesitate to contact us at the Queensland Sports Medicine Centre on 3891 2000 or via email at


1. Long, A., S. May, and T. Fung, Specific directional exercises for patients with low back pain: a case series. Physiother Can, 2008. 60(4): p. 307-17.

2. Kent, P., H.L. Mjosund, and D.H. Petersen, Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain? A systematic review. BMC Med, 2010. 8: p. 22.

3. McKenzie, R., Acute low back ache and exercises. N Z Med J, 1994. 107(983): p. 318.

4. Coppieters, M. and D. Butler, Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual Therapy, 2008. 13(3): p. 213-221.

5. Laslett, Manual Correction of an Acute Lumbar Lateral Shift: Maintenance of Correction and Rehabilitation. Journal of Manual and Manipulative Therapy of New Zealand, 2009 17 (2): p. 78-85.

Bridge to Brisbane

Train for the Bridge to Brisbane for FREE

QSMC would like to invite past and current clients of the clinic to train with us for the 2011 Bridge to Brisbane for free.  Everyone is encouraged to participate, just choose the 10km or 5km course then run or walk your way into the RNA showground and across the finish line.

Over the 12 weeks leading up to the event our Aspire Fitness & Rehabilitation trainers will be delivering specific running training sessions each Monday and Friday to all QSMC clients who register.

Registration opens 12 June 2011. Your fee of $30 for the 10km run or $25 for the 5km run will raise valuable support to this year’s beneficiary, Legacy. Legacy is dedicated to caring for the families of deceased veterans and today is assisting over 100,000 widows and 1900 children and dependents with a disability.

What better way to keep you fit and healthy over the colder months than having the race as a goal with the added benefit of raising valuable funds for such a worthwhile charity.

Register for the race online at  then contact Jasmine at Aspire Fitness & Rehabilitation so that we can register your attendance for the Bridge to Brisbane 2011.

Pilates at qsmc

QSMC are continually striving to achieve an industry leading clinical service for our valued clients. Over a period we have reviewed our Pilates program and have made updates to the physical environment, equipment and internal structures. As part of this process we wish to announce a change of name to more accurately depict the objectives of the QSMC Pilates service.

We are excited to reveal Movement Conditioning and Pilates as the new name.

We are fortunate to have staff with enormous clinical experience.They are renowned across Brisbane for their ability to integrate their physiotherapy skills to enhance the movement retraining goals for clients. After much collaboration, we feel Movement Conditioning and Pilates is the ideal improved service name to reflect this.

Efficient hip, pelvic and trunk control will remain the primary focus of the team. It is crucial to achieve this balance to promote musculoskeletal health and strength, both key ingredients to pain-free living.

Irrespective of whether we are young, old, male, female, elite athletes or weekend warriors, our pelvic floor muscle group is one of the key areas.  One of the important functions of pelvic floor muscles is to control any increase in intra-abdominal pressure (IAP). IAP increases occur often through the day including coughing, walking up stairs, running, jumping and especially when performing your favourite abdominal curl or plank exercise at the gym. Unfortunately 30 % of us don’t coordinate our pelvic floor muscle group well enough to counteract increases in IAP. (2003,Bo et al.) This has been proven to contribute to developing lower back pain especially with any inefficient performance of movement patterning. Our Physiotherapists are able to use Trans-abdominal Real-Time Ultrasound to assess and re-teach this coordination.

As part of improving clinical service for our clients the Movement Conditioning and Pilates program has developed a comprehensive power point program. Your individual program tailored to your needs is sent straight to your email address. This service is available now and is especially important for those clients who have not attended recently. We would encourage you to take advantage of receiving this great cyber tool to get you motivated and back on the conditioning track.

We appreciate your ongoing support of the Queensland Sports Medicine Center and look forward to further advancements to our clinical service to improve your function.

Kind Regards,
The Movement Conditioning and Pilates Team.

An Uncommon Cause of Back Pain

Low Back Pain is common.  Uncontrolled or overloaded forward leaning is the most common cause.  In this group, a lumbar disc is often implicated as the site of injury.  These injuries tend to cause pain with leaning forwards, sitting, driving, and coughing / sneezing.  But what happens if the disc is not the cause of the pain?  QSMC Physios explored the potential explanations.

In a recent interesting clinical case, a client presented with back pain that did not fit the common discal profile of injury.  While leaning forward was part of the mechanism, there was a more specific area of pain associated with local swelling just to the side of the spine on one side.  There was no radiation of pain nor was there any discomfort with coughing and sneezing which is so typical of discal back pain.  The key aggravating factor was maintenance of slumped posture.

Further investigation and clinical reasoning implicated the ilio-lumbar ligament (ILL) as the site of pathology in this case.  The ILL is a broad, five part structure which binds the lowest two lumbar vertebrae to the pelvis.  Some parts of it are tightened in forward bend, and others tightened when leaning backwards.  While uncommonly injured, the structure is critical to the stability of the spine and pelvis.

The good news in this case is that with careful history taking and assessment, the correct management can be delivered.  Treatment of ILL sprains include manual therapy, taping and restriction of painful activities eg. slouched sitting.  With less than a week of treatment there was a drastic reduction of symptoms.  In six weeks, there was a complete return to normal activity.

If you or someone you care for is troubled by single sided low back pain which is irritated by slouched sitting and yet doesn’t hurt with coughing or sneezing, maybe the Ilio-lumbar ligament is involved.  Ask your physiotherapist about it today.

Tendinopathy Update

Tendon problems present a great clinical challenge for the sports medicine team. Recent research and its clinical applications help us to manage tendons more effectively. The take home message is that clinicians can’t afford to treat all tendon injuries with the same recipe.  David Bick from QSMC talks us through some of the key things to note when seeking treatment for a tendon injury.


Tendons can break down in two different parts of the structure.  Some tendon injuries occur at the mid-substance of the tendon, while others take place at the connection of the tendon onto the bone.  David says ‘This simple method of differentiating a tendon injury has huge effects on treatment’.  A mid-substance injury to a tendon will often respond well to mobilising or stretching the tissue.  An insertional tendinopathy will more often be aggravated by stretching and hence it is avoided early in treatment.

Reactive Behaviour

‘It’s not just the area of the tendon injury which helps guide treatment’ David continues.  ‘The behaviour of the symptoms gives us insight into the processes going on inside the tendon, and that further influences how we should treat it’. For example, an 18 year old with thickening of the Achilles tendon after a 4 day basketball camp is likely to have a reactive tendinopathy.  Often the tendon sheath or paratendon become irritated by repeated efforts of high intensity exercise in a short span of time.

The good news about a reactive tendinopathy is that with the right treatment it tends to recover quickly as the patient’s collagen is intact.  The timeline for this recovery may be as short as 2-4 weeks when coupled with the correct techniques, medication, and advice from your team at QSMC.

Degenerative Behaviour

A different presentation of tendon injury may involve a more gradual onset pain.  Consider a 44 year old female runner with an Achilles concern who is preparing for the Gold Coast Marathon.  This tendon loses collagen and therfore fails under continual load.  Careful management of training volume is required to give the tendon time to settle.  Intervention requires eccentric exercises to stimulate collagen production and hence repair the tissue within the tendon that responds to high load. This injury is more likely to take a much longer timeframe in order to rebuild the damaged tissue.  This can be as much as 16-26 weeks of gradual and progressive loading.

David Bick concludes ‘At the end of the day, it is the new scientific knowledge that helps us educate our patients with a clearer path on the the road of recovery’.  For more information on tendon healing, and diagnosis of which type of treatment you need, contact the team at QSMC on 3891 2000.