This is a very in depth question but I will do my best to keep it short and simple.

To understand that pain doesn’t equal damage you need to wrap your noggin around pain itself. Pain is, 100% of the time, an output of the brain. It does not come from the tissues but from the brain interpreting data and evaluating whether said data is harmful to you. Pain acts a protective mechanism. It is there to stop you doing dumb things and hurting yourself. The brains takes into account not only the signals from tissues, but also draws on past experiences, emotional state, current stress levels, thoughts, beliefs, attitudes…the list goes on. The brain and central nervous system (CNS) does an incredible job in processing all this data in an instant, but occasionally it makes mistakes and can give you the sensation of pain when really there isn’t any damage happening.

Tissue damage commonly goes hand in hand with acute pain, but not always. You sprained your ankle, it hurts like a b#$%* but typically heals up in a few weeks and you’re encouraged to stay active. On the flip side you can bend over one morning to tie your shoes and your back seizes up, again hurts like a b#$%* but it doesn’t necessarily mean tissue damage. You haven’t slipped a disc, there’s no nerve root compression it’s just painful and stiff, and takes a little time and TLC to get back to doing the things you love. The brain, for whatever reason, doesn’t like that bending move even though you’ve done it a thousand times before, and it locks up the low back. Tight muscles, stiff joints and super wired nerves can give you a great deal of misery.

There’s a really interesting case about a construction worker that ended up with a metal pole sticking straight through his boot. The guy was in agony, screaming the house down. They got him to hospital and cut the boot off. Turns out the pole had gone between his toes. Didn’t break any bones, didn’t even pierce the skin. Once he saw it he calmed down and very soon wasn’t feeling a thing. But because he thought he would have a gaping hole in his foot, his brain had conjured up the pain! Now ask him at the time and he would have sworn on dear old Nana’s life the pain was real, not in his head. This is a case of the brain misprocessing data, and creating the output of pain.

This is a very complex topic but there are some great Youtube videos that break it down nicely. Check out ‘Understanding Pain in less than 5 minutes, and what to do about it!’ and also ‘TEDxAdelaide - Lorimer Moseley - Why Things Hurt’.

In terms of severe low back pain, an almost countless number of things, but there are a few main ones we see at Queen Street Physiotherapy.

Here are the main nasties/red flags we look out for in low back pain.

There are other red flags which physio’s look for, but the above are the more serious ones that need urgent attention.

There are a lot of great products out there that can help ease back pain.

I personally love a hot pack and my trusty trigger point ball.

Heat can help locally at the site of pain, makes it feel warm and snug. But also can decrease the ‘pain signals’ getting to the brain by giving the nerves something else to report to the brain…in this case, heat.

My trigger ball also gets a good workout. Triggering tight musculature around the low back can help a lot. I go for my glutes and ITB, but also the bigger muscles in the back, QL and erector spinae. If you don’t know these you’ll need to be shown by your physio. And if the trigger ball is too intense you can use a foam roller instead.

If you missed last month's article from Queen Street Physiotherapy on whether exercise and movement is bad for back pain, check it out below.

Stay tuned for another article from the Queen Street Physiotherapy team in January. 

In the meantime, if you have any questions regarding this interview, treatment of back pain or other health issues please do not hesitate to contact Donovan and the rest of the team by visiting the Queen Street Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, podiatry, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.

Absolutely not. The right exercise has been shown hands down to be the best rehabilitation for just about any injury or niggle. The real question should be, ‘What is the RIGHT exercise?’ This is where things can get a little complicated and it’s like asking, ‘How deep’s a hole? Or how long is a piece of string?’ It really depends on you, your injury and your personal circumstances. At Queen Street Physiotherapy we can advise and guide you on the right types and amount of exercise.

But for a very basic baseline you want to exercise within a tolerable pain limit (i.e. it’s a bit sore but I can do the exercise without it getting worse) and you want to reach small milestones along the way. Typically that will reduce the swelling/inflammation, achieve pain free range of motion, gentle return to activity, then a full return to performance. And your activity or performance is very dependent on you. It might be rep level sport, or gasping for air in a PT circuit wishing it was time for that post workout cappuccino. 

For most acute injuries, typically 48hrs, but the consensus is evolving.

The old acronym RICE (say it with me…rest, ice, compression, elevation) has now been given a shiny new upgrade to POLICE (protect, optimal loading, ice, compression, elevation). And it’s the optimal loading part that’s key.

Early movement, early rehab, early exercise equals faster and better recoveries. The best example of this is a knee replacement. The morning after you’ve been cut open, bones and joint removed replaced with titanium then stitched back together again, you’ll have a nasty physio like me getting you to stand up and walk around…while you’re still drugged up, in your flattering surgical nightie and connected to a bunch of drips and beeping machines.

Why? Because we know it’ll be that much better later down the track.

In regards to getting back into exercise, whether you have been absent due to injury or you have just had a large break due to the hectic nature of life, the key is to take it slowly but keep it on a daily basis.

Generally we have all done some form of exercise at some point in our life, whether it was in a sporting team, a PE class at school, or a group fitness session.

The first place to start is by simply walking.  Increase your endurance and your physical capacities to handle 30 mins of brisk walking.  Stretches to your lower limbs should be performed prior & post walking that include stretches to your calves, hamstrings, quadriceps and gluteals.

If you are still unsure, the professional staff at Queen Street Physiotherapy can advise you on all your stretches or exercise program.

Not all lower back injuries have a singular diagnosis and a sequential rehabilitation program. Lower back pain management strategies need to be designed specifically for your particular injury and lifestyle. First and foremost, a physiotherapist can reduce your immediate pain with treatment including manual therapy, massage therapy and strapping. Alleviation of pain will be your paramount concern and is an important first step in your rehabilitation.  Physiotherapists can advise you on the duration of your rehabilitation and treatment needs, which will vary for each individual and injury. It is also important to be aware of the correct techniques for activities and daily living to support your injury throughout the rehabilitation phase. A physiotherapist can advise you:

Stay tuned for Phill's next interview in December. 

In the meantime, if you have any questions regarding this interview, treatment of back pain or other health issues please do not hesitate to contact Phill and his team by visiting the Queen St Physiotherapy website.

Queen St Physiotherapy offers ergonomic advice, custom made orthotics, running assessment, hydrotherapy, dry needling, remedial massage, exercise and stretching programs.

Cramps. They are the death of every cyclist. 

We have enlisted the help of Physiotherapist, Sean McCoola from Maximize Health Group to give us some tips on how to better manage cramps.

Sean brings experience to his clients from 18 years as a physiotherapist and has a particular interest in sporting teams and rehabilitation programmes.

Sean sat down with us earlier this month to give us his top 4 tips on stopping cramps. 

Take it away Sean.

At Maximize Health we are often asked by the cyclists we treat about cramps and how to stop them.

Below is a discussion and guide to what we have seen work over the years. The simple reminders below will enhance performance and aid general well-being and if you fit the pieces of the puzzles together for you, it may even stop cramps for your cycling endeavours.

Studies have shown that cramps are associated with high intensity activity and muscle fatigue. Yes, no proverbial Sherlock!

This directs you in the first instance to get your training and race plans suited to you and your current sustainable exertion level.  And then address other factors below including hydration, stretching, electrolyte balance and nutrition which are often quoted as areas to address to avoid the possibly devastating effects of cramping while out on the bike (e.g poor race performance, pushing the bike home), or after the event/training (jack knifing in the car when driving home from the charity ride).

My advice is to increase your awareness of when the cramps occur for you and then experiment with the factors leading up to the occurrence.

Sorry guys and gals there are often no quick and easy answers for the road warriors.

Hydration continues to be a major topic in the discussion of cramps. I take a wide gauge view at this and recommend that appropriate hydration needs to be an everyday activity especially if training loads are high and frequent and when coming into summer months and/or humid conditions. Some cyclists are heavy sweaters, and this loss in fluid is often associated as a major contributing factor to cramps. 

Hydration levels are imperative for optimal performance and getting this part of the puzzle to fit for you may also reduce cramps.

Another risk factor for cramping demonstrated in studies is low or irregular rates of stretching.

Don’t get too hung up on the bio-physiology but go by the rule that if muscles are tight (shorter than optimal resting position) and/or if they have trigger points (localised areas of increased muscle firing that resets and increases the resting tone of the whole muscle), this seems to increase the chance of cramping.

Optimal muscle length will also reduce discomfort and improve performance. Winning all round! Unfortunately some riders will just have to stretch and address trigger points more than others.

We all need electrolytes to maintain correct muscle function to help maintain life as we know it.

There is little scientific evidence stating that electrolyte levels play a significant role cramping.

Optimal electrolyte balance may assist in cramp prevention, but how much is enough?

Once again this will come down to experimentation for individuals. Test the various input options (Drinks, gels, salt tabs or food) for brand, concentration levels, timing etc.

There are now companies doing sweat tests for the salt/sodium levels in your sweat. But a general guide is if you have the white ring or streaks around your neck on your jersey after you ride you are possibly sweating out electrolytes, including, sodium/salt in higher than optimal levels, and this may need to be addressed.

What we put into our bodies leading up to and on race/training days may affect cramping incidence.

A balanced diet must help performance and general health and well-being. “Balanced” will mean different things to the individual and depend on physical and even mental load.

I believe the overall and longstanding aim is for you to give yourself the right amount of energy to fuel your body for tasks you are giving It, in acceptable input formats to promote continued health to train at your desired increased intensities for longer.

As always folks, tips like these may not be fully comprehensive for your situation and seeking out a health professional is a worthwhile exercise if cramping persists and is affecting your ability to bring your 'A' game.

This discussion is by no means exhaustive and there are many other cramp prevention strategies that may work for you (my Mum swears by camphor in a sock by your feet under your bottom sheet in bed overnight to prevent calf cramps).

What we have found over the years is that if you address the above factors and fit the pieces of the puzzle to your situation it will at the very least improve your performance and enhance your health and well-being.

Now on your bikes and enjoy.

Thanks Sean. Stay tuned next month for another article from Maximize Health Group.

In the meantime, if you have any questions regarding these tips, prevention of cramps or other health issues please do not hesitate to contact Sean on +61 7 3343 5494 or [email protected].

The Facts (Nominal Defendant v Rooskov)

On 18 May 2005, Nigel rode his mountain bike to the local bowls club. Whilst at the bowls club he drank approximately 6 to 8 schooners of beer. Between 3.30pm and 4.30pm that afternoon he left the bowls club on his bike to ride home. He was not wearing a helmet.

It was a fine sunny day and Nigel was riding along the left-hand side of the roadway. He was riding downhill on a straight section of the road. As he was riding along, he heard a whistling noise from behind him, a screech of brakes and was then struck from behind. A vehicle hit the rear, right-hand side or back of the bike (Nigel was not sure which). This caused him to careen off the road. Nigel was thrown from his bike and landed in a ditch. He was knocked unconscious and sustained severe injuries to his back in the accident.

Nigel was found by people passing by who called the ambulance and police. He was transported to Wollongong Hospital for treatment and was subsequently diagnosed with a severe concussion and post-traumatic amnesia.

The Decision

One of the main issues at the trial was whether Nigel had been struck by an unidentified motor vehicle. It was argued by the Nominal Defendant that he lost control of his bicycle and ran off the road.

Nigel initially reported that he was struck by a vehicle. This was noted in the ambulance records, police records and initial hospital records. However, at the hospital his memory of the accident became vague and he expressed doubt about what had happened. He reported that to nursing staff, doctors and the police.

A police officer attended the scene of the accident that evening. He examined the scene and took a number of photographs. He also took photographs of the bike and noted there was no damage sustained to the bike. He did find skid marks located at the accident scene but dismissed them as being unrelated to the accident. The officer gave evidence at the trial that he was of the view that Nigel had not been hit by a motor vehicle.

Nigel’s father, a retired police officer, attended the accident scene two days after the accident and undertook his own investigations. That included taking a detailed sketch plan of the accident site with details of all relevant measurements of the area and the skid marks located at the accident scene. He also reported that the skid marks were very dark at that time and faded over the course of the next week.

Nigel gave evidence at the trial in which he maintained he had been hit by a vehicle. This was despite the fact that he later lost his memory whilst in the hospital and became unclear on what had happened.

Despite the evidence of the police officer at the trial, the judge held the following view:

“The difficulty I have with the skid marks is that they were consistent in location and presence and time with the sworn evidence of the plaintiff and consistent with versions he had given at various times….”.

Nigel’s evidence, the records given to the various medical personnel and the skid marks, persuaded the judge that Nigel had been hit by an unidentified vehicle. The judge awarded damages to Nigel for his injuries in the sum of $586,781.24 but deducted 5% of his damages because he was not wearing a helmet.

The Nominal Defendant appealed the judge’s decision. They argued that Nigel was not hit by an unidentified vehicle. The court of appeal did not agree with the Nominal Defendant and held that the original assessment made by the trial judge was correct.

Nigel was successful despite the fact he sustained a head injury, had a poor recollection of events after the accident and the investigations undertaken by police were not favourable to his case.

Cycle Law Opinion

The trial judge did not accept the evidence of the police officer at the trial. The fact that Nigel’s father also investigated the accident scene shortly after the accident assisted Nigel to win his case.

Nigel’s loss of memory in relation to the accident whilst he was in the hospital was not enough to persuade the judge that Nigel was incorrect when he initially stated he was hit by a vehicle. There was sufficient evidence contained in the various records to show that he did initially report he was hit by a vehicle. Further, the location of the skid marks at the accident scene were consistent with Nigel’s version of events.

Head injuries in accidents are more common than you might think and memory loss can be a side effect of a head injury. However, this does not mean you will lose your case even if there are no witnesses to the accident.

The graph below is the percentage of the types of injuries sustained in accidents from 1 July 2007 to 31 December 2016, including head injuries.

When head injuries are compared with other types of injuries they actually represent the fifth most common type of injury sustained in accidents.