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Hi Everybody!

Welcome to the second Powers Physio newsletter!
Apologies to those of you you who didn't receive the first one. I have had some glitches with 'greylisting' of email addresses and emails being returned to sender. These problems have hopefully been taken care of now, but for those first time readers, my website, www.powersphysio.co.za, is now up and running and I will be sending out a monthly newsletter on health and injury related topics. I have taken the liberty of subscribing all clients to the newsletter, but if you would like to unsubscribe, please click on the link at the end of the newsletter.

August has been a month for new things. The first was the arrival of a new colleague, Natalie Cordiglia, a qualified physiotherapist and pilates instructor, who will be helping me out teaching pilates classes.
The second new arrival was my beautiful new Balanced Body Allegro Reformer, a piece of machinery used for individual pilates sessions, which will hopefully be a wonderful adjunct to rehabilitation of injuries.
On the new knowledge front, I attended a course in August run by Dr Duncan Reid, a highly qualified physiotherapist from New Zealand. The course focussed on the clinical examination and management of the thoracic and lumbar spine and sacro-iliac joints, and included manipulative techniques and osteopathic approaches.
So as August draws to a close, and we approach National Back Week (6-10 September), and I practise my new spinal techniques, and learn new back rehabilitation exercises on the reformer, I thought it was fitting that the focus of this month's newsletter be Healthy Spines.

National Back week is run every year in early September and has a different theme each year. This year the theme is Scoliosis. You will find information below on what to look out for in your children, and what can be done to help, as well as some helpful hints on postural and stress-related back pain, correct desk set-up and pause exercises to do at work.
On the topic of ergonomics, just a reminder that I supply all Ergotherapy Solutions products, including Get One Chairs (www.ergotherapy.co.za/getone.php) and have one in the practice should you wish to test it out, as well as ergotilts, footrests and Tempur products (www.ergotherapy.co.za/products_ergotilt.php).
For anyone interested in joining pilates classes to rehabilitate and strengthen their spines, more information on the benefits of classes, as well as class cost and timetable can be found on my website (www.powersphysio.co.za/pilates).
And lastly for anyone wanting to keep up to date with my latest news and photos, please link up with my business page on Facebook, Andrea Powers Physiotherapy (http://www.facebook.com/pages/Cape-Town-South-Africa/Andrea-Powers-Physiotherapy/136204336413554).
Enjoy reading and take care until next time!
(edited from the South African Society of Physiotherapy press release, for Back Week 6-10 September 2010)
Would you know if your child had scoliosis?
“Scoliosis is defined as a lateral curvature of the spine–that is, a curve to the left or right side-of more than 10 degrees,” explains SA Society of Physiotherapy President Magda Fourie. “While it may appear at birth or soon after, it commonly appears as the child grows up, usually in adolescence. Far more girls are affected than boys, but fortunately it only happens to two or three children in every hundred.”
Although in some cases, scoliosis is caused by other conditions such as trauma from an accident or the side-effect of an infectious disease, most cases (80%) are what the scientists call ‘idiopathic’-basically, no-one knows what causes it, although genetic factors have been recognised to play a role.
“The fact that the cause is unknown means that we can offer no guidance on how to prevent it,” says Fourie. “The most important advice we can offer is to be alert for signs of scoliosis and get your child into treatment as soon as possible. The earlier the medical professions can intervene, the better the outcome is likely to be as it is a deformity that lasts for life and results not only in discomfort and pain, but also problems with lung function and psychological distress."
Signs of Scoliosis
• Shoulders are held habitually at different heights
• The left and right rib cage may be at different levels
• One shoulder blade is more prominent than the other
• The head is not centred over the pelvis
• The waist appears to be tilted to one side or the other
• One hip appears more raised or the hip-bone sticks out more
• The skin over the spine itself may have changes in appearance or texture – dimples, changes in the colour and even hairy patches may appear
• The whole body leans to one side.
One of the possible treatments is surgery, but this is obviously something to be avoided if possible, especially as there is increasing evidence to suggest that surgical intervention is not the ideal treatment. While surgery can be helpful in very curved spines, recent studies suggest that in the long term the patient is likely to experience more stiffness and pain.

Physiotherapy intervention
Physiotherapists play a vital role in managing scoliosis, mainly through specific exercise programmes which help to decrease the progression of the spinal curvature, as well as decrease the incidence of surgical intervention. In many cases, the patient will also need corrective bracing, but your first port of call should be manual therapy and exercises. Specific exercises can strengthen the muscles around the spine to prevent the curve from increasing, while manual therapy stretches and loosens the back, and relieves pain. So consult your physiotherapist for advice on diagnosis and continued management of scoliosis!
If you suffer from back pain, you are not alone. It estimated that four out of five adults will experience lower back pain at least once in their lifetime. And neck pain is not far behind!
There are numerous conditions that cause back and neck pain, thus the most important thing is to get a proper diagnosis so that you know what you are dealing with. But whether you have a pathology or not, we all need to look after our spines, and there are some basic things that we can address on a daily basis to help maintain a healthy spine:
Keep active and maintain a healthy weight: General exercise on a regular basis strengthens bones and muscles, giving you the functional strength for everyday living
Practise correct manual handling techniques: Bend at the knees when lifting objects, and use the muscles of your legs, not the muscles of your back. When moving extremely heavy objects, push rather than pull the item.
Avoid high heels: Flat shoes with cushioning put less stress on the back, especially if you spend a lot of time standing or walking.
Take regular breaks: If sitting or standing for long periods of time, take a break at least once every hour, and if driving for long periods, stop and stretch every couple of hours.
Strengthen your stabilising (core) muscles: Doing some type of core strengthening exercise such yoga or pilates, or specific mat-based exercises prescribed by your physiotherapist that target your inner stabilising muscles, can prevent and help alleviate spinal pain.
With our increasingly sedentary lifestyles and computer-bound work situations, posture-related back and neck pain are a huge part of our lives. We mostly don't realise the amount of strain we are putting on our spines in the working day, sitting for hours on end in the same, often incorrect, positions. Reaching for your computer mouse, sitting rotated off-centre, hunching forward at your desk or cradling the phone between your shoulder and your ear while you type, are all unnatural positions that may lead to aches and pains.
Correct desk set-up is the first step to eliminating postural problems, and is aimed at maintaining your spine’s natural curves when sitting, and thereby reducing strain. Below are some ergonomic workstation guidelines, as detailed by Ergotherapy.Solutions (www.ergotherapy.co.za):
(see image at end of newsletter)
1) Feet rested flat on the floor: in order to be at the correct height in relation to the work surface, a footrest is recommended for shorter users.
2) Hips slightly higher than knees
3) Seated as far back in the chair as possible 
4) Armrests: rest arms on armrests and keep elbows close to your body, and shoulders relaxed down.
5) Monitor: top most line of monitor display at approximately eye level.
6) Viewing distance: as far as possible while still seeing the screen clearly
7) Keyboard: keep the keyboard in close proximity; keep your shoulders relaxed, and your wrists in line with your forearm
8) Mouse: keep the mouse in close proximity and alongside the keyboard
As the year progresses and deadlines become tighter, you may find yourself spending longer hours at work, hunched over the computer and not taking breaks. Stress can compound our postural problems by manifesting itself physically in the form of clenched jaws, lifted shoulders, tight necks, and slouched postures, all of which can lead to more problems, such as tension headaches.
Preventing this is often as simple as taking regular breaks and changing position. Try not to sit still for longer than an hour at a time without doing some movement. Movement decompresses the strained areas and increases blood flow, which prevents prolonged strain on muscles, joints and nerves.
Try doing these exercises every one to two hours, repeating each one 2-3 times to relieve postural stress
Shoulder rolls
Roll your shoulders forwards and then backwards.
Chin nods
Keeping your eyes looking forward, nod your chin in towards your neck and hold 5-10 secs.
You can progress that by keeping the chin nodded and dropping your chin down towards your chest. Hold 10-20 secs.

Shoulder shrug
Lift your shoulders toward your ears as high as you can, hold for 3-5 secs, then drop them down totally.
Shoulders, chest and back stretch
Start by reaching your arms out to the sides at shoulder height and moving them backwards as you lift your chest up and arch your back. Hold 10-20 secs. You can progress that by grasping your hands together behind you, turning them around and pulling down while lifting your chest up and arching your back. Hold 10-20 secs.
Side bends and rotation
Reach your left hand down towards the floor and hold for 10 secs. Change sides. Then hook your arm over the back of your chair and rotate your body around to look as far over that shoulder as is comfortable. Hold for 10 seconds. Change sides.
Neck stretches
Ear to shoulder: Drop your left ear to your left shoulder and then let your head drop slightly forwards to feel the stretch on the right side of your neck. Hold 10-20 secs. Change sides.
Nose to armpit: Turn your head to the left side and drop your nose down as if to smell under your left armpit. Take your left hand on the back of your head and gently pull forwards to feel the stretch on the right side of your neck. Hold 10-20 secs. Change sides.
Poor posture and stress can lead to muscle and joint pain due to the strain placed on certain areas of the body, and this is treatable by physiotherapy interventions of massage, mobilisations, dry needling and exercises. Often over time muscle dysfunction can occur, where some muscles have shortened and become overactive, while others may have lengthened and weakened. Specific exercises to strengthen the weak muscles, stretch the tight muscles and improve the stability of the affected area can correct this situation and prevent worsening of a problem so that more drastic measures such as surgery can be avoided.
With a holistic approach and more than ten years' experience, Andrea strives to identify the source of clients' symptoms and return them to full health and pain-free function, whether in everyday life or on a competitive sporting level. Offering thorough assessments and a hands-on approach, she treats all general physiotherapy conditions involving muscle, joint and neural problems, ranging from back and neck pain to post-operative orthopaedic conditions. Her special interest in sports injuries and rehabilitation is complemented by her certification as a pilates instructor.

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