Back Pain - Ugh What Can We Do?

Most people have back pain. We are not living in an ergonomic society so let’s get some answers.

* What mattress and pillow is best?

* How should we be sleeping?

* How can we improve posture?

Video Credit: On the Couch with Nici


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The MRI & Disc Bulges

MRIs are considered the gold standard on identifying structures within the body. However, sometimes, there can be different perspectives to the same fact.

Case in Point by Physiotherapist - Jack Allen

John, a 40-year-old Caucasian patient came to me for a pre-op evaluation. He was a healthy male who frequently exercised outside of his working hours.

John also had a passion for gardening and it was during squatting while planting when he noticed a pulling sensation on the outside of his right thigh. This remained a constant issue for the next three weeks until he sought medical advice from an orthopaedic surgeon.

An MRI was performed which revealed disc bulges at L4/L5 and L5/S1 (lower back).

As bulging discs are often an incidental finding on the MRI (especially in patients over the age of 40), the surgeon recommended John to see a physiotherapist first. If his condition does not improve, surgery would then be an option.

Physiotherapy Evaluation

The MRIs that John brought along in his initial appointment clearly showed presence of the disc bulges. As we continued to talk, John revealed that he did not have a history of back pain and currently did not experience any localised or radiating pain. John’s only symptom was the strong pulling sensation on the outside of his thigh whenever he squatted. To some people, this might appear as a minor problem but to John, it affected his passion.

During the physical examination, John was noted to have a good squatting form but subjectively could feel the pulling sensation. John also had a full range of movement in his lumbar spine although certain hip movements were limited secondary to tight lower limb musculature. We performed all the special tests to assess the integrity of his sciatic nerve which all turned out to be negative. On feeling the quality and movement of the different levels of his spine, nil pain or restrictions were noted.

So What Was Wrong?

However, what we did find was that John had pain on feeling his right IT Band (a strong, fibrous band that runs from the outside of the hip to the outside of the knee), TFL (a small muscle that connects the ITB to the pelvis) and his VL (the outside quadricep muscle). John was also found to have poor posterior chain strength (muscles along the back of the leg) in comparison to his lower limb anterior chain (muscles along the front of the leg).

I explained to John that I believed his squatting issue was unconnected to his spinal disc bulges. I demonstrated on an anatomy model how his overly tight musculature pulls on his ITB while squatting and how this produces the pulling sensation.

The Treatment

I treated John using a combination of manual therapy and exercise within the session. Deep tissue techniques and dry needling were used to loosen the tight structures and gluteal bridges were given to activate his posterior chain.

At the end of the session, we re-assessed and John found the pulling sensation to be halved. A home exercise program was devised and after two more sessions, John could squat freely and return to his passion.

What Do MRIs Say Then?

A famous study found that MRIs identified disc bulges in 30% of pain-free 20-year olds. This highlights that a person is never defined by his MRI!

In the above case in point, John's disc bulges (as seen in his MRI) could just represent normal wear & tear.

A combination of manual therapy and exercise was just as effective at solving his problem, which originated from his overly tight musculature.

This post was written by Jack Allen. The name, age and details of this patient were also changed for privacy reasons.

Back Pain Myth Busters

Low back pain is a common ailment that about 80% of adults experience at some point in their lives.

This pain may happen again over time if not rectified and may also progress to chronic low back pain, which lasts for more than 3 months.

Today, we are busting myths and reinforcing what the latest evidence says is best for your back.

Myth #1: Moving will make my back pain worse

FACT: People fear twisting and bending but it is essential to keep moving. Gradually increase how much you are doing and stay on the go.

Myth #2: I should avoid exercise especially weight training

FACT: Back pain shouldn’t stop you from enjoying exercise or regular activities. In fact, studies have found that continuing with these can help you get better sooner - including using weights where appropriate.

Myth #3: A scan will show me exactly what is wrong

FACT: Sometimes it will but more often it won’t. Also, even people without back pain have changes in their spine, so scans can cause fear that influences behaviour, making the problem worse.

Myth #4: Pain equals damage

This was the established view but more recent research has changed our thinking. Modern physio takes an holistic approach that helps people understand why they are in pain.

Back Pain Treatment at PhysioActive

At PhysioActive, we will undertake a full assessment of your back and pain. This will involve questioning to allow us to fully understand your pain in relation to your life, work and leisure activities. We will give you an explanation for your pain in a way that you will fully understand it.

Back pain can be acute or chronic, and these two types of pain are managed differently. It is important that you know which type of pain you have and why. We can then give you guidance on what you specifically need to do to manage your back pain. This will include exercises and may also include treatments such as spinal mobilisations, electrotherapy, massage and pain management strategies.

The most important thing is to do the right type of exercises/movements for your particular problem. The aim of exercise is to maintain, restore or optimise the normal range of movement in your spine. Exercise is the most important therapy!

For the past 15 years, I suffered intense low back pain. Being averse to fancy painkillers, I always resorted to simple home remedies such as applying and massaging my back with different types of oils and ointments. While that provided some temporary relief, the pain did not vanish. Rather, it got more intense turning much needed restful nights into restless painful torturous moments. Soon, sleep deprivation and the ensuing pain began to interfere and affect my professional and social life.

With a firm resolve to tackle this escalating pain, I started researching alternate remedies. Through an acquaintance, I got know of PhysioActive and immediately contacted them. My physio's counseling carefully explored my pain history and she customised an appropriate therapy to treat my condition.

Today, I no longer have the kind of excruciating lower back pain, which I suffered in the past. Every morning I do 4-5 different types of exercises prescribed by her, which takes 4-5 minutes to complete. Thanks to my physio, I can now sleep peacefully on my back and sides without any pain. So, low back pain can be treated with physiotherapy. Do not silently live with it. Instead, seek help and if in Singapore, do give PhysioActive a call. They are the best painkillers!

- Leena Palekar, Patient at PhysioActive


The myth buster resources were developed by a working group of CSP members comprising representatives of the Musculoskeletal Association of Chartered Physiotherapists, the Physiotherapy Pain Association, the consultants’ group and physios working in the NHS and the private sector.

This article is also written in collaboration with Gail Craig.

Managing Acute & Chronic Pain

What Is Pain?

Pain, although unpleasant, is normal. And it is perfectly normal, once you have it, to want to get rid of it. Even though pain is unpleasant it is your body’s way of protecting you in times of injury or disease. Pain helps you make decisions about what you should and should not do. When you are in pain you move, think and behave differently. Think back to when you have cut a finger; you probably kept your finger still. By holding it straight, your pain reduced. This sort of pain is important as it allows you to protect your body whilst it heals.

Pain generally occurs when your body’s alarm system alerts your brain to actual or potential danger of injury by issuing a “warning.” For example, if your hand touches a hot surface your body reacts by pulling your hand away to prevent you from getting burned.

Acute Pain

This pain is usually linked to a problem that can be fixed. If you break a bone, cut a finger, or suffer from a tooth abscess, you have acute pain. This pain will resolve when the bone is fixed, the wound healed or the abscess drained. Acute pain is a sign that something is wrong and something should be done. The pain only lasts while the problem is there. Pain killing medication will generally help relieve acute pain.

Chronic Pain

So what about Chronic (or persistent) pain? This is pain that has lasted for longer than 3 months. It affects approximately 20% of people. It impacts people’s lives, from causing minor restrictions to complete loss of independence. It is different to acute pain. In chronic pain, the most up-to-date research tells us that something different is going on: the pain is no longer serving a useful function. This pain is a real sensation, but no longer helpful.

No physical cause of pain

Often, no obvious physical cause can be found for chronic pain. This can be frustrating and confusing – after all, you know you have pain. In many cases even the best scans are not able to identify the part that is hurting from parts of you that are not hurting. Even when doctors can pinpoint physical changes on the scans or X-rays (for example, arthritis, a disc problem) it is still impossible to say whether these are the actual source of your pain or not.

Chronic pain conditions

Most chronic pain conditions are not life threatening e.g. low back pain, arthritis and recurrent headache. They may start as acute pain associated with a problem such as a slipped disc, operation or injury. The pain may be continuous or occasional, you may feel more sensitive to pain and it may sometimes be prone to flaring up or getting worse very quickly. However, when the problem has been sorted the pain doesn’t seem to switch off. The pain system is no longer working normally. It has become “wound up”, sensitive and flares up easily.

Is there a cure for chronic pain?

Even though there may not be a specific diagnosis it does not mean the pain is not real but just that there’s nothing nasty to worry about. However, there is no cure for chronic pain. This pain generally does not go away with rest; warm baths or massage and some types of medication are not very effective. However, these things may give temporary relief.

Things that would usually settle or treat an acute pain are often not successful in treating chronic pain. This is because the problem is within the pain system, rather than being located in any specific part of your body. The pain system does not appear to be functioning normally.

Living with pain that won’t go away can be discouraging at best and unbearable at worst. But it is important to remember that there are treatment options that can reduce your pain and improve your quality of life. Your doctor may recommend the use of over-the-counter or prescription medications, in addition to other therapies like physiotherapy or exercise, to manage your physical pain.

However, if you are living with chronic pain, overcoming the emotional challenges can be the hardest step in the coping process. The following list can help you cope with your chronic pain.

However the first step is to change your attitude towards your pain- this is the first and most vital step. A change from “being a patient” to “being a person who has a chronic condition” is vital. Being/starting to feel in control and knowing how to manage your pain is the next step.

How To Manage Chronic Pain

1. Accept the Pain

Chronic pain should not be ignored or taken lightly. If you have been living with chronic pain, it is important to recognize it as a problem, learn about your condition, and see your Doctor/Physiotherapist to talk through treatment options.

2. Get involved

Take ownership of your pain relief. Understand your treatment plan, engage with your Doctor/Physiotherapist and be an active partner in your own health care. The accountability will help you overcome emotional challenges and keep you motivated to continue improving your overall health and quality of life.

3. Learn to set priorities/goals

Living with chronic pain can put the rest of your life on the back burner, as relieving pain becomes your top priority. Make a list of things in your life that you would like to do, whether it is exercising more frequently, visiting with family and friends, or traveling. Setting priorities and goals other than pain relief can help you enjoy life a little more, while also keeping you determined to relieve pain in order to achieve those goals.

4. Set realistic goals

Coping with chronic pain can be daunting, particularly as you try to resume everyday activities that once were easy and normal. Managing your pain in small steps can give you a sense of accomplishment, and also help you achieve your larger goals more effectively.

5. Recognise Emotions

Living with chronic pain can be stressful and is just as much an emotional issue as a physical one. Recognizing how your emotions affect your pain, and vice versa, can help relieve your pain and make everyday living more enjoyable. It can be difficult to manage things at home, work, with friends and family as well as many other things that can be difficult. You may not feel you have any control over the pain and don’t feel able to cope with it.

How do you feel about your pain?

Experiencing pain can lead to feelings of anxiety or fear about what might be causing the pain; especially where there is no obvious cause. It may feel like damage is being done to your body and you may feel some concern about what the pain might mean- what damage could have been done and what the future might hold.

Feeling pain can also make you feel tense, especially if you expect the pain to come back or get worse. You may feel easily angered and hostile towards people who you may meet that don’t understand your situation or how your pain affects you. Some people even feel anger towards the pain itself. When things aren’t going so well it can lead to feeling bad tempered, anxious, frustrated and having troubling thoughts. You may feel hopeless and very down about feeling this pain, which can result in depression.

The pain itself or worrying about it may cause difficulties with sleeping. You may be kept awake or find it difficult to stay relaxed. Being tired and having a sleepless night can make people feel more upset and bad tempered.

How do your feelings and thoughts affect your pain?

Our experience of pain always stays with us; we have a kind of memory for it. For example, if a person comes across pain every time we carry out an activity or task, then it is unlikely that they will continue with it, or for that matter, ever return to it. The more often we associate something with pain, the more we are likely to actively avoid it.

Thinking of pain before it happens can make it feel worse. A feeling of pain may even be set-off just by thinking of a past experience of pain. Depending on the situation, a person’s threshold for feeling pain may be altered. Sometimes what would feel a little painful may become excruciating and vice versa.

For example, during a rugby match a player may be injured but not feel significant pain until after the match. This is caused by a hormone called adrenalin, which prepares our body for action during circumstances that we perceive as risky.

Similarly, during an enjoyable activity that makes us feel good, pain is often dulled by chemicals called endorphins; there is often less of a focus on any pain experience. However, on the other hand, a person who is feeling very anxious, tense and wound-up in another circumstance may not be able to tolerate even the slightest touch. In these scenarios how a person feels has affected their perception of pain- a persons thoughts and mood can make a difference to how they feel pain.

6. Learn to relax

Persistent pain is a stressful experience, but it is important to find ways to relax the mind and body. Not only can stress make the pain worse, but it also causes other physical and emotional side effects. Find ways to relax in your own way- there are many things you can try:

• a good balance between rest and exercise (Pacing)
• massage
• regular use of heat or cold packs
• stretching
• deep breathing exercises
• relaxation
• distraction
• feeling more confident and having a positive mood
• having fun and socialising all help to gradually reduce your pain

To some people it may be as simple as just going outside to play with your dog.

7. Exercise

There is no need to fear or avoid exercise, even if you live with chronic pain. In fact, moderate exercise can actually help to decrease pain by building and toning muscles, increasing endurance and strength and improving your attitude and self-esteem. Your Physiotherapist can structure a specific regime for you. We can also use a device called a TENS machine which some people find helpful in giving them some pain relief.

8. See the total picture

Following the steps above will hopefully help you to realize that your pain does not define who you are. Concentrate on what you are able to do, not what you are not able to do. Chronic pain may be part of your life, but feeling confident in your knowledge and management of the pain can help put the rest of your life back on track.

9. Reach out

Millions of people suffer from chronic pain and don’t share their experience with others out of guilt, embarrassment or pride. Sharing what you’ve learned about successfully managing your pain can help others find their path to pain relief and encourage them to seek help and much needed support.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Gail Craig, Grad Dip Phys, MCSP, HPC registered - Spinal Physiotherapist, Manual Therapist, Women’s Health

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (

Overcoming Work Related Back Pain & Musculoskeletal Injury

At PhysioActive a very large percentage of our clients present with musculoskeletal injuries. This includes neck- and shoulder pain, lower back pain, headaches and elbow and/or wrist pain as the result of work related injury.

Common patterns of complaint are morning stiffness for 15-30mins after getting out of bed and progressive muscle tension towards the end of the day. Rest usually alleviates pain and muscle tension. Common causes of such complaints can be divided into external factors (ergonomics) and internal factors (condition of one’s own).

Risk Factors

External Factors

Internal Factors

Usually it is a combination of external and internal factors leading to health problems. But how exactly can these factors lead to pain? What is the mechanism behind it? This can be very easily explained with the help of the ‘Load and load capacity model’.

Poor Posture At Work

Every human being has a certain load capacity, physically and emotionally. If the daily load (sitting, typing, stress etc.) exceeds the load capacity, then we overload our body, e.g. resulting in back- or neck pain. Muscles have to work too much and get exhausted resulting in muscle spasm and pain. Joints get chronically overloaded resulting in joint pain. This will lead to further compensation mechanisms creating even more tissue pain. This is a vicious circle which is almost impossible to escape without professional help.

So depending on the level of external- and internal factors the pain can vary in intensity. The usual pattern seen in our clinic are patients complaining about spinal problems on and off for years. And there lies the risk of severe and chronic degenerative changes of the spine, called Spondylosis. This is a non-reversible condition and depending on the severity, patients may require surgery. That’s why it is so important to start with prevention and take action before chronic symptoms set in.

What Can I Do To Prevent Back Pain At Work?

Whilst some organisations undertake a formal corporate ergonomics programme, there are several easy steps to take yourself. Serving to reduce symptoms at work or even prevent them from occurring altogether. Including:


Posture At WorkThe preferred sitting posture is obviously an upright neutral position with a good lumbar support as shown in the diagram. Shoulders should be slightly pulled back and the head should not be shifted forward. This maintains the natural curve of the spine and prevents excessive loading of the lower back. However, to keep this posture, the back muscles (core muscles) need to be active and if not trained people experience muscle ache already after a few minutes in this position. Therefore achieving comfort in this position is a gradual training process.

Important note!
No matter how perfect you sit the human body is not able to maintain only one position for hours. One sided loading will fatigue the spinal muscles and overload the joints, thus leading to back pain. Hence regular changes of your posture are the solution. You may even sit slouched for a while as long as it is not for the whole day!

Workstation Set-Up

In order to be able to sit with the above posture, your work place equipment needs to be adjustable to your height. The position of the screen should be always at eye level and straight in front of you to avoid continued downward/upward or side movement.

Mini Rest Breaks

You should take regular breaks from your desk every 30 minutes – take the time to walk around or do workplace exercises and stretches.

Work Place Exercises

There are very easy exercises which you can do in a sitting or standing position. At PhysioActive we can show you a number of exercises to keep the spine and the muscle flexible to prevent stiffness and tension.


Having strong core muscles to support your back is the most important issue in preventing (and reducing) back pain. A regular program of 20mins 3 times a week is already sufficient to get strong core muscles. Having an optimal work place set-up and progressively changing your posture habits will make back pain vanish from your work!

If you’re suffering from a workplace or desk related injury, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive director Denis Mecklenburg B.Sc. - Physiotherapist, Sports Therapist, Golf Therapist.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (

Treating Trigger Points & Myofascial Pain Syndrome

Most people have heard about trigger points, but nobody really knows what it means.

In common language a trigger point is a “knot” in the muscle, which triggers pain locally and/or on a different area of the body. It can also limit joint movements.

In recent years, scientific research has shown that the muscular system is often the source of pain in the body.

Myofascial pain syndrome (MPS) is one of the most common overlooked diagnoses in patients with chronic pain. Up to 85% of all patients with chronic pain have an underlying MPS. The hallmark of MPS are myofascial trigger points.

How do I get a trigger point?

The cause for trigger points is very common and occurs frequently in our modern society:

➢ Poor posture

➢ Overuse in sports

➢ Stress at work or home

➢ Repetitive movements (eg. use of computer mouse)

Muscles are constantly working too hard and/or long, thus creating tight spots, which develop into trigger points.

How do I know that I have a trigger point?

See below for common statements from my patients when they first see me:

• “I have had pain in my neck and back towards the end of my working day for many months. I tried regular massages many times, but they never really helped. At first my pain is better, but it returns again very soon”

• “I’ve been training very hard for the past 4 weeks for the upcoming 10k run. Suddenly I felt pain in my calf after a run and it isn’t disappearing anymore. I tried a regular massage, but it doesn’t help”

Persistent and sharp burning pain that may even radiate to other spots in the body are well known symptoms of trigger points.

Is there any treatment for trigger points?

Yes, there is! Even after years of having pain from trigger points, there is a way out.

There are two common and well proven treatment techniques:

1. Manual therapy
The manual technique is the treatment of muscles and connective tissues with specific hands on techniques.

2. Dry needling

A sterile acupuncture needle is used to improve the local circulation and interrupt the referred pain.

However, the success also depends on your contribution. The therapist treats the body parts that provoke the heaviest pain. If the pain is too much for you, you may interrupt the treatment at any point by simply saying “stop”. Therapy is teamwork between patient and therapist to get the best and fastest result. After a trigger point therapy you should stretch all your treated muscles 2 or 3 times a day for 30 seconds. Heat can also reduce the post treatment soreness.

Other methods include exercises and modalities such as heat, electrotherapy, laser, shockwave and ultrasound.

How can I prevent recurrent trigger points?

Trigger point therapy can eliminate the trigger points and with it the pain, but one important aspect is often forgotten: the cause of the problem.

If you continue sitting in a poor position in front of your computer or you keep running with a poor technique, the trigger points are likely to come back and it will be a never-ending- cycle. Your physiotherapist will give you instructions on what to do to prevent this from happening.

A few other simple tips to keep your muscles in good shape:

➢ Relaxation (enough rest, warm pack, hot shower, Jacuzzi)

➢ Stretching on regular basis

➢ Rolling on a massage roll

Thanks for reading!

If you’re suffering from muscle pain or trigger points, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.

This post has been written by PhysioActive physiotherapist Brigitte Lichtenberger B.Sc. - Physiotherapist, Manual Therapist, Footreflexolgist.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (

Shoulder Pain Symptoms, Prevention & Treatment

Shoulder pain is a very common complaint and can have a variety of causes. The most obvious cause is a trauma to the shoulder after a fall. More common ones are non-traumatic injuries due to overuse or misuse from activities that are performed too often, with too much weight or force, and with poor techniques. Common examples are overhead sport activities, and heavy and prolonged lifting or carrying. Shoulder instability, muscle imbalance and poor posture play one of the most important roles in non-traumatic injuries.

Basic Shoulder Knowledge

The shoulder is one of the most complex joints in the human body. It has by far the greatest range of motion, which makes it a rather unstable joint and therefore more prone to injuries and wear and tear. The shoulder girdle consists of the upper arm bone (humerus), the shoulder blade (scapula) and the collar bone (clavicle), which are all connected by joints. The ball shaped head of the upper arm bone fits into the rounded socket of the shoulder blade. This socket is called the glenoid and is covered by capsular tissue called the labrum, which helps to enclose the head even better.

The most important stabiliser of this construction is the rotator cuff. It consists of four muscles, which cover the head of the upper arm and keep the rotator cuff solid in the glenoid. Injury to the rotator cuff is the most common injury in the shoulder, either in sports or daily activities.

Symptoms Of Rotator Cuff Injury

Injury to the rotator cuff can vary from inflammation of the tendon (tendonitis) after a strain, to more severe injuries like a partial or complete tear. The most common cause for that is an impingement of the tendon between the shoulder roof and the head of the humerus. Repetitive movements and activities with heavy load can also lead to an inflammation. This often happens when the rotator cuff is too weak or the joint is too flexible, which results in instability of the shoulder.

Often, the pain occurs spontaneously without any known reason. It starts with a dull ache after activities, but subsides usually quite quickly. This is the reason why shoulder problems are initially ignored until the ache develops into severe pain, which is present not only during activities, but even at rest and during the night.

Complete tears of the rotator cuff usually give a sharp, sudden pain and are caused by a forceful movement. In this case you should immediately see a doctor. If the tendon is worn out, for instance from intensive racket sports, a complete tear can happen during very light lifting activities but does not result in sudden sharp pains. This happens often to people above the age of 50.

Other shoulder injuries include:

Prevention & Quick Relief Treatments

If you experience pain in your shoulder, either after a trauma or spontaneously, you should follow a few easy rules for quick relief and to ensure it doesn’t get worse. It is important to get rid of the inflammation.

If the inflammation is only mild, usually a combination of anti-inflammatories, rest, ice, and light mobilisation exercises (such as pendulum exercises) are enough for you to get better within a week.

Pain not going away? See a doctor or physiotherapist. After a thorough examination, the specialist can pin point the cause of the problem and advice on the necessary treatment. Depending on the severity of the inflammation, the doctor will prescribe either anti-Inflammatory medication or will give an injection into the shoulder to relieve the pain and inflammation. Mostly, if a full thickness tear is present, the tendon will be surgically repaired.

Benefits Of Physiotherapy

Physiotherapy is another very useful tool to help with shoulder pain. To reduce the pain and inflammation, the physiotherapist can use modalities such as Electrotherapy and Ultrasound. Additionally, he can use specific hands-on techniques. But even more important are the active exercises that are aimed towards regaining the normal range of motion and strengthening the stabilising muscles of the shoulder. The physiotherapist is an expert in the anatomy and physiology of the shoulder and will provide you with an exercise program that will help you achieve these goals. This will result is an optimised movement pattern of the shoulder, which will avoid further impingement.

Shoulder Pain

Muscle Strains

Muscle strains are divided into 3 different grades. Depending on the grade of the strain, the tissue has different healing times.

Grade I (Mild strain): Overstretching of a few muscle fibres with tears that are only on micro level. No palpable defect in the muscle. Movements are usually only sore for a short while and there is no bruising. The healing time is approximately 1-3 weeks.

Grade II (Moderate strain): This means a partial tear of the muscle fibres. There is a definite palpable defect in the muscle belly. Movements are usually still possible and there is moderate pain and bruising. Healing time takes about 3-6 weeks.

Grade III (Severe strain): This is an extensive tear or complete rupture of the muscle fibres. There is a very large palpable depression in the muscle. The muscle may be torn away completely. Movements are very painful and there might be extensive bruising. Healing time after a Rotator cuff repair is about 8-12 weeks. Returning back to racket sports will take up to 6 months.

Preventing Shoulder Re-Injury

Prevention of re-injury is very important because once the tendon is damaged, there will be some degree of degeneration and weakness. There are a few easy guidelines to optimise the condition of the shoulder and prevent re-injury:

Don’t take shoulder pain lightly and ignore the symptoms. Treatment of acute shoulder pain usually has a good prognosis. If your complaints haven’t subsided after one week, you should seek help from a medical specialist. Once the pain is chronic, the healing process takes much longer and risks for further, more severe injuries gets much higher.

If you’ve experienced a shoulder injury, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive director Denis Mecklenburg B.Sc. - Physiotherapist, Sports Therapist, Golf Therapist.

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (

Living With Scoliosis – What You Need To Know

What Is Scoliosis?

Living With Scoliosis In Singapore

Scoliosis means a side-to-side (lateral) curvature of the spine usually combined with a rotation of the vertebras.

Frequently Asked Questions

1) How do I know if I have scoliosis?

Look at your posture from the back from top down:

• Head not centered to the body
• Uneven shoulders (either one is in front of the other or one’s higher than the other)
• Uneven shoulder blades: one is more prominent or higher
• Uneven waist angle: the gap between arm to trunk is wider on one side
• One hip is more prominent than the other or the hips are not leveled
• The spine line is not straight

Now perform the Forward bend test:

• Standing with the feet together, then bend forward as far as you can with your palms together, fingers pointing at between your toes.
• Look at the back, one side of the back (either upper or lower back region) will be higher than the other side

2) Is scoliosis caused by bad posture, or by not taking enough calcium?

• In most cases, scoliosis is caused by genetic factors which lead to uneven growth of the spine;
• It can also be caused by problems of other parts of the body, such as one leg being shorter than the other, or back muscle spasm;
• Birth defects and some diseases such as cerebral palsy, Marfan syndrome can also cause curvature of the spine;
• Degeneration of spine may sometimes cause scoliosis too;
• So, bad posture may lead to scoliosis due to muscle imbalance, which is not the same with scoliosis caused by bone deformities. In this case, the curve shall disappear if taking an X-ray in lying.
• Lack of calcium weakens the bones, but it does not cause scoliosis.

3) Does scoliosis cause back pain?

• The curvature of the spine itself does not cause pain, as the body adapts to the way the spine grows;
• However, because the muscles and soft tissues (ligaments, joint capsule etc.) grow unevenly on the sides of the spine, the imbalance of them may cause pain;
• Secondly, over time, in order to achieve certain movements in everyday activities, the body develops compensatory faulty posture and muscle imbalance that leads to pain.

4) Can I exercise if I have scoliosis?

• Yes, one can usually participate in any type of exercises; but due to the posture changes in scoliosis, some movements will be harder to achieve, and some will be restricted due to the lack of flexibility or muscle control;
• Exercises endurance sometimes can be affected by reduced lung capacities but this is rare in idiopathic scoliosis;
• Exercises do not have any adverse effects on the curve;
• If exercises that did not hurt before are now giving you pain, please tune down on the intensity of exercises for a few days. If the pain does not go away, you may need to consult a Dr. or a physiotherapist.

5) Can swimming help reduce the curve of scoliosis?

• Swimming is frequently recommended for patients with back problems because the spine is less loaded in the pool with the help of buoyancy;
• Swimming is good for general strengthening of back muscles; it is also good for breathing function. As scoliosis involves uneven development of the spine and muscles, swimming would not be able to specifically help reduce back pain caused by scoliosis, it does not help reduce the curvature too.

6) Do I have to have surgery if I have scoliosis?

• No. Surgery is usually only indicated when the curve is bigger than 50 degrees, or is severely affecting one’s quality of life;
• Majority of scoliosis cases do not require surgery;
• Surgery needs to be considered if the curve is still worsening in spite of bracing and exercises, and is reaching or beyond 50 degrees;
• One must be aware that there are complications after the surgery such as stiffness, muscle weakness and possible broken rods;
• Surgery should be delayed as much as possible in growing children in order not to stunt the growth of the spine;

7) What else can help control scoliosis besides surgery?

• Besides surgery, the most commonly used treatment are bracing and physiotherapy;
• The purpose of using a brace is to control the progression of the curve, not to eliminate it;
• Physiotherapy works to strengthen the weak muscles, to improve the flexibility of the shortened & tight tissues, which helps slow down the development of muscle imbalance and joint stiffness;
• The stiffer the curve is, the more strongly physiotherapy is recommended addition to the bracing.

8) How many types of brace are available for scoliosis?

• In general, there are 2 main types of braces: hard brace and soft brace;
• Hard braces are made of thermoplastic. Like what its name suggests, it is hard and wearing hard brace limits spinal movements, therefore the individual’s sports participation would be greatly affected; it also creates much stiffness of the spine, weakness and tightness of the spine muscles;
• Common types of hard braces are Boston’s, Charleston’s, and Milwaukie’s etc.
• Soft brace on the other hand, allows movement of the spine when worn. Therefore, the spine is much more mobile during and after the treatment, there is also much less muscle imbalance and joint stiffness of the spine;
• Both hard and soft braces are effective before the bones of the spine reach maturity, which is between 13-15 years old for girls and 15-17 years old for boys; and both braces need to be worn regularly throughout the day (16 hours per day);
• Hard braces are usually much heavier and hotter to wear and results in a poorer compliance compared to soft braces;
• Soft braces are lighter and more comfortable to wear, it is more cosmetically acceptable as it can be well hidden under the clothes; it also allows better posture & muscle development;
• For people who participate in sports like dancing, gymnast, running or badminton, soft braces are of a much practical choice.

9) Can I move or exercise like before if I wear a brace?

• If you are wearing a hard brace, due to the weight and movement restriction, you will have to change the way you do sports or exercises; for example, if you used to run, you probably will have to run for a shorter distance or run at a slower speed;
• Exercises that require many trunk movement will likely to be difficult;
• You may tired out sooner too because of the pressure on the rib cage which affects chest expansion during breathing;
• You may need to exercise at a cooler time of the day as it will be hotter to exercise with the brace;
• You need to be careful with the skin condition at which the pressure is applied to control the curve; this too may affect how much and the kind of exercise you can participate in;
• So…most likely, if you need to exercise like before, you need to keep the brace off.
• If you are wearing soft brace, there will be minimum movement restriction, it is less hot and, less skin problems;
• All land exercises are encouraged as exercising with the brace on speeds up the curve correction;
• Soft brace allows much better muscle retaining and joint mobilization, which has a great impact on curve correction retention after the brace treatment is over.

10) What exercises are good for scoliosis?

• Exercises that are designed to work specifically on muscle imbalance, posture faults are more beneficial than general exercises like swimming, jogging, generic yoga & back stretching exercise; the reason is that general exercises usually fail to stress the “imbalance” in scoliosis, either for strength or flexibility;
• Swimming is good to unload the spine and improve the breathing function; it may also help to reduce back pain that results from excessive loading or tension;
• Correct breathing techniques are important as rib cage deformity is common in scoliosis;
• In order to specifically work on the muscles affected, the curve of the scoliosis needs to be assessed, the posture changes need to be analyzed in details;
• After the study of the curve type and the posture changes, specific movement can be taught and implemented to work on the faulty muscle and posture development;
• The exercises can then be progressed with resistance or more repetitions.

If you’re suffering from scoliosis, please click to find out more about the available physiotherapy treatments. Alternatively, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive’s resident sports therapist, Tian Li Feng MMS, B.H. - Sports Therapist, Manual Therapist and Scoliosis Specialist.

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Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (

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A Patient’s Guide To Frozen Shoulder

Frozen shoulder or adhesive capsulitis is one of the most common causes for pain in the thickening and contraction of the shoulder joint capsule and formation of adhesions, which cause pain, and loss of movement characterize frozen shoulder. It is common in diabetics and commonly affects the non-dominant arm. The causes of frozen shoulder are not fully understood. There is no clear connection to arm dominance or occupation. A few factors may put you more at risk for developing frozen shoulder.

Most common causes for frozen shoulder are:


Phases of frozen shoulder:

There are 3 commonly recognised phases of frozen shoulder.

Diagnosis of frozen shoulder:

Frozen Shoulder


The focus of treatment is to control pain and restore motion and strength. Conservative management of frozen shoulder aims to restore the normal range of motion.

Pain relief:


Physiotherapy treatment for patients with this condition is vital to hasten the healing process and ensure an optimal outcome. Physiotherapists use a combination of manual therapy and a personalized home exercise program aimed at improving the range of motion.

Surgical management:

If the frozen shoulder does not respond to non-surgical treatment, then surgery to release or stretch the scar tissue is an option. The most common methods include shoulder arthroscopy to release the adhesions.

Manipulation, under anaesthesia, is a procedure that allows the surgeon to move the arm to break up the adhesions.

If you’re suffering from a frozen shoulder, get in touch with your local PhysioActive clinic to arrange an appointment.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Ram Peruvemba MPT, BPT - Physiotherapist, Manual Therapist, Sports Therapist

Thoughts or questions?

Leave a comment below, say hello on Twitter (@physioactivesg) or visit us on Facebook (