Patient Education

It is important to be aware of the fact that a large number of conditions we see and treat as physiotherapists are often preventable with proper education, and exercise.
Below are some basic things that you need to understand about your body, and few tips on things you should or should not do in your everyday life to prevent strains
and injuries.


Posture refers to the the position of the spine and other peripheral joints being in the ideal position. A good posture minimizes the amount of stress on the joints and muscles and requires the least amount of energy to maintain.When viewed from the side (lateral view), your ears,shoulders,hips and knees should form aligned. If we view the spine from behind (dorsal view), it should appear straight as all muscles and joints are balanced


Postural changes:

Occur over time due to prolonged positioning or repetitive movements.

These activities create imbalances in the muscles that can pull the spine out of alignment thereby creating poor posture.


Abnormal posture:

In certain cases can also be due to structural changes in the spine and has very little to do with muscle imbalances.

An example can be in a child that is born with an abnormal spine curvature progressively getting worse as the child grows.


Another example would be postural changes due to the vertebrae collapsing in older people with osteoporosis which develops into a hunch back.

Seeking the advice and management of a spine specialist is necessary in those cases.


Tips on maintaining good posture



When sitting, the feet should be flat on the floor. The hips, knees and ankles should be at 90 degrees. This may require a change in chair height or using a foot rest.

Children doing homework should always sit at a desk and have a set up as described above, however, sitting on a ball can help with good posture and also stimulates core muscle strength. It can also be used when playing video games or watching television.


Standing Posture


Some tasks require us to stand in one position for a long time. Activities such as ironing, washing dishes or cooking can all have a negative effect on posture and create pain.

If you do have to stand in one position for a prolonged period try putting your foot on a thick book or footrest. This will change the way the weight is distributed through the feet. Change feet after 5 minutes.

Carrying groceries or heavy items

When attempting to lift anything heavy, try and get an idea of how heavy the object is before lifting. This will avoid surprises on something that is too heavy or to lite. When lifting the object, always try and bend at the knees and keep the stomach muscles tight. Keep the object as close to you as possible to decrease the amount of rotation of the spine.
Never bend and twist at the same time.
Groceries should be lifted out of the car carefully. Again, try not to bend and twist and keep the stomach muscles tight when lifting. Do not carry too many bags at one time, rather do multiple trips with less weight.
When walking with the groceries, always attempt to have balance between both sides. Having too much weight on one side will put uneven pressure on the spine and cause the muscles to contract unevenly which could lead to a back strain.

Sleeping Positions and Beds

Physiotherapists are often asked to recommend beds and sleeping positions for patients with back or neck problems. There is so much to choose from that it becomes a difficult choice to make. There are, however, a few pointers we can give to make the process easier.


  • The mattress should be firm and supportive, but not too hard as to be uncomfortable.
  • When looking for a new mattress, always involve your partner. It should be comfortable for both of you.
  • Try and arrange with the store a return policy. Finding the correct mattress may take time and there is a difference between trying it out for 5 minutes and sleeping for 6-8 hours. If the mattress is not correct for you after a couple of nights, there should be an exchange option
  • The lifespan of a good mattress is usually 7-10 years, even if the manufacturers warranty says 20 years.
  • Make sure the base on which your mattress rests is hard and provides good support. This may require extra reinforcement with a wooden plank.



Pillows are often a difficult (and expensive) requirement for sleeping to get right.

  • Feather pillows are not recommended as they change shape during the night and do not give enough support.
  • We usually recommend a supportive pillow that keeps the alignment of the spine in a neutral position.
  • One medium sized memory foam type pillow is usually ideal for sleeping on your back or sides.



  • For extra neck support, roll up a bath towel into a firm roll. Place the roll inside your pillow case at the base of the pillow. You have now made your own (inexpensive) orthopedic pillow. You can also adjust the height of the roll by rolling tighter or using a smaller towel. This can be used in side lying and supine positions.

Sleeping positions

Sleeping positions can be very important when suffering from back and neck pain. There are certain positions that should be avoided to prevent abnormal stress and strain, whilst others are ideal for placing joints, discs and muscles in relaxed positions.
Never sleep on your stomach (prone position). This results in your lumbar spine being forced into extension and puts the joints and discs under strain. The neck is also in a rotated position which causes imbalances.

  • Try sleeping on your side with the hips and knees slightly bent. This is sometimes also called the foetal position. It can be made more effective by placing a pillow between the knees to ensure the spine is kept in a neutral position.
  • Side lying with a pillow is also ideal for women in the later stages of pregnancy when lying on their back becomes difficult and dangerous due to the baby pressing on the main arteries and lungs.
  • Lying flat on your back (supine) can be a good position for people with back and neck pain. However, depending on the posture, it may need a pillow under the knees to decrease the curve of the lower back and put it in a more neutral position.
  • For severe disc or lower back pain, try lying on the floor with the hips and knees bent up at 90 degrees each, possibly on the couch. This opens the disc space and often provides relief from severe pain.

The role of Muscles

There are 3 types of muscle fibers in the body. These are classified as cardiac muscle fibers, smooth muscle fibers and skeletal muscle fibers.

  1. Cardiac fibers are only found in the heart muscle and are controlled to contract automatically to produce a heart beat.
  2. Smooth muscle fibers are also under the control of the automatic systems of the body, which means we have no voluntary control over them. These include the muscles of the digestive system that help move food along the intestines and muscles around organs and glands. Exercise has no effect to strengthen these types of muscle fibers.
  3. Skeletal muscle fibers are the muscle fibers we use every day to move and control the body. They can actively shorten and lengthen and are under our voluntary control. Exercise can benefit these types of fibers by increasing their size, strength and endurance and it is this group of muscles that physiotherapists target as part of a rehabilitation program.

In this group, there are 2 types of voluntary muscles that we control and that have different functions in controlling our body. These are called stabilizing and moving muscles.

A stabilizer is a muscle that provides support and a firm base for the body. Those types of muscles do not shorten or lengthen and cannot be seen to move. They are also known as the core muscles of the trunk and are usually weak in patients with spinal problems. These muscles respond well to Pilates type exercises and bio – feedback therapy.

The “mover” muscle group is more widely known. These are the muscles we can see on the body and when they contract we can see movement of a joint. This is also the muscle group that would be trained in a gym set up. When it comes to physiotherapy, we can strengthen this group of muscles from the faintest flicker of a contraction to good and functional strength required for daily living.

The importance of strong muscles

Muscles attach to bones and over joints. They produce movement and help in joint stability. Weak muscles result in a loss of joint stability because the muscles cannot keep the joints in the correct position. This can lead to injuries of teh bone, tendons or ligaments.

Execerise therefore becomes essential in teh rehabilitation process to regain normal muscle functioning and take stress of joints and ligaments and tendons.
Use it or lose it.


Correct exercising tips


It is important to start and finish any form of exercise with warm up and stretching because this will increase blood flow to the muscles and increases elasticity of the tissues in preparation for exercise. At the end of exercise, stretching is important to prevent stiffness and muscle soreness.

All soft tissue have the ability to stretch and change length. These include muscles, tendons and ligaments, fascia and skin. Nerves cannot be stretched as this could cause damage to conduction. They can, however be made to slide easier through the surrounding soft tissue with special nerve exercises that your therapist can demonstrate. To be able to change the length of soft tissue, a stretch should be held for at least 30 seconds and can be held for up to 5 minutes. The stretch should not be “bounced” as this activates a small muscle contraction and can lead to injury.

The stretching sensation should not be painful as this will start a protective muscle reaction, however it should push well into discomfort to get the changes in length required.


For a muscle to get stronger it has to work harder than it is used to working. It is also essential to contract the muscle through the entire range of available movement to achieve good results. One cannot get good strengthening of a moving muscle by just tensing it, however core muscles that are used for stability can be exercised in this way.

To increase muscle size, one should do exercises with heavy weights and low repetitions. An example would be 3 sets of 6-8 repetitions.

To increase muscle tone and endurance, exercises should be done with medium weights, but much higher repetitions. This would be 5 sets of 20-25 repetitions.

Core muscles are those in the back and neck that provide stability for the body. They do not really move anything, but keep the body tight while moving. These are usually trained via Pilates exercises and are also important in preventing back pain.

What is osteoporosis?


Bones are continually changing their density according to the demands of the body. If the body requires additional calcium, it can pull the calcium out of the bones. Similarly, if the stress on bones increases, then the body can deposit extra calcium into the bones to make them stronger.
This give and take process is happening throughout our life and the balance is maintained by factors such as hormones, exercise and sunlight (for Vitamin D which is essential for calcium absorption). Phosphorous is another element essential in the exchange of calcium in and out of the bones.
As we age, the balance of calcium absorption/production changes due to hormone changes or decreased activity levels. This leads to more bone being absorbed than being produced resulting in osteoporosis.

Three stages of bone density:

  1. Normal bone density
  2. Osteopenia – bone density decreased but not to a level of osteoporosis
  3. Osteoporosis – very low bone density and risk of fractures occurring.

These changes in bone density can be controlled by correct diet(higher calcium intake), supplements(calcium and vitamin D), hormone treatments, exposure to sunlight and weight bearing exercises.

The Effects of Smoking on Bone and Spinal health

During our day to day activity our cells are constantly working to produce energy for all our vital functions and to help repair small traumas and injuries. For this process to work properly, the cells need the correct nutrients (from our diets) and oxygen (from breathing) to be able to continue this work.

Smoking tobacco produces many gases including carbon monoxide (CO) which is then inhaled into the lungs. Carbon monoxide is absorbed into the bloodstream much easier than oxygen (O2) by as much as 200%, which means that there is less essential oxygen, required for metabolism, reaching the cells. This results in decreased tissue repair and ineffective normal metabolism. Studies have shown that this can have very serious health effects on the body and can include:

  • Cancer
  • Heart disease
  • Strokes
  • Spinal and joint pains
  • Decreased circulation to arms and legs
  • Poor and slow recovery from injury and surgery
  • Fertility problems
  • Poor bone density
  • Skin changes

The best advice is to stop all forms of smoking, including cigarettes, cigars, pipes and sisha. This will improve oxygenation and circulation throughout the body and help with normal metabolism. This will have a positive effect on acute and chronic pain conditions, including back pain and headaches as well as decreasing the risk of developing the more severe pathologies.

Excess Weight and Bone and Joint Health

Excess weight places more compression on the joints in the back, hips and knees. With time, this will lead to damage to discs and cartilage creating osteoarthritis. The excess weight will also pull the body out of normal alignement and thereby causing muscles imbalances with some muscles having to work harder than they should, and others not being used and weakening.

In many cases, losing weight will significantly decrease symptoms of pain in these areas and prevent or reduce damage to the joints. A balanced diet and monitored exercise are therefore essential.


What to do when you have an acute injury?

The basic principle is called the R.I.C.E concept.

R – Rest. Stop all activity and don’t move the injured area.
I – Ice. Apply ice on the area with cloth between ice and skin.
C – Compression. Bandaging and pressure to control swelling
E – Elevation. Lift injured area to control swelling.

Be sure to consult your doctor.


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