Do your knees swing in towards each other when you bend them ?

Many people notice their knees doing this instead of staying in line with the lower leg and foot.  This can be a problem.

Why?  Well as the knee swings inwards it puts more pressure on the inside edge of the knee, including the medial collateral ligament there, which has to try to resist and control that pressure.  There could also be consequences for the meniscus or disc, which will have uneven pressure on it.  Both can be painful, with knock-on effects on the foot, which will tend to roll inwards increasing the pressure on the inner side of it.

Imagine a leg with this knee problem like bending a stick.  On the outside of the stick’s curve the wood is stretching – this is the side of the ligament I mentioned above.  On the inside of the curve the wood is being compressed – this is the side of one of the discs, the one being compressed.

Problems may only surface after many years as the abnormal forces slowly take their toll.  But the effect can be more sudden in the case of someone using their knees to control large repetitive forces as in sports such as skiing or cycling.

So what can you do about it?  Here are 3 ideas:


Strengthen your abductors – the muscles that move your leg out to the side.

This can be done lying on one side and slowly lifting your upper leg, holding it up for 5 – 10 secs, and slowly lowering it.  Repeat 10 times.  Then try another set.  If you use a gym, you might be able to use a machine to help.


Strengthen your adductors – the muscles on the inside of your knee.

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Posted in Adults, Legs and Knee

Back Pain – “Could it be my kidney?”

It’s only natural  in the search for a self diagnosis that we point the finger at any organ in the painful area.  So if it’s at the front of the chest you think heart, and just the worry might be enough to give you palpitations!

I’ll just say right up front that I’ve never yet seen a person with back pain which didn’t come from a joint, nerve or muscles.  And that’s a good thing as it has meant that treatment and recovery was a relatively simple matter. But cases of kidney related back pain are out there.


What you’d be looking for with kidney issues

Basically, if any of your internal organs is playing up and in trouble you’re going to have noticed other symptoms associated with the function & purpose of that organ.  With the kidney we’re talking about issues with peeing.  For example, changes in how often you go, discoloured or cloudy urine or pain peeing.

Of course, these have to be seen in context.  After all, everyone is going to get more yellowy urine if they’re de-hydrated.  Color changes happen with some supplements and foods – beetroot will turn it reddish!

Pain location is important, except for one teeny problem which I’ll come to in a minute.

kidneyTextbooks show actual kidney pain comes round the side of the lowest part of your rib cage from the back and then wraps round to the front on your upper abdomen. This often deep and vague; not easy to pinpoint or touch and often gnarly whatever position you’re in.

The teeny problem is that pain is often felt in different areas to the actual source.  So it can refer to the low back and even the shoulder.  And because kidney & ureter function (the ureter is the tube carrying the urine out from the kidneys) are linked, it can be in the area below the belly button or in the testicles in men.  A variety of these pain patterns is shown in red/pink in the diagramme.

Then there are the so-called constitutional symptoms.  These are general symptoms that don’t say what’s wrong, but just show that someone is unwell.  These include fevers, night sweats, loss of appetite, nausea, vomiting, dizziness and tiredness.

But it’s the big picture that counts here.  It’s not enough to fixate on just one of these without other symtoms and use that as the reason for a Google search to scare yourself.  It’s the overall collection of clues that counts, and one symptom doesn’t make a collection of anything…

Posted in Adults, Back and Hip

The best exercise for Achilles tendinosis?

Well, l I’ve got a question mark there in the title of this subject for three good reasons.

The first is that the research and reports about this are not conclusive – how often is health related research cast-iron??  The second is that no one exercise is good for all sufferers of tendon related issues.  What works for one person, will be ineffective for someone else!  And the third is that your Achilles pain may not actually be from the tendon itself.  Other structures near the heel could be to blame, so you need a correct diagnosis to begin with.

Having said that, if you’ve had a nagging Achilles tendon problem for weeks (and probably months), which is worse when running or jumping, there’s a good chance you’ve got Achilles tendinosis.  Chances are that you’ve already seen someone about it if it’s that bad, in which case you might already know what’s to come…


What is tendinosis?

Basically, a condition in which the fibres of the tendon become rather disorganized and less able to cope with the huge forces through it when your calf muscles are being used.  So further aggravation of the tendon is more likely, and for reasons that are still not quite understood, the repair process seems to get disrupted so that it takes forever to come right in some people.

An Achilles problem can start with a specific event or trauma, or gradually through very repetitive actions, often involving strong calf muscle contraction and high loads like jumping or running.  This can gradually and cumulatively inflict micro-trauma which most of the time would almost go unnoticed as it may only create minor soreness.  But over the long term the regular trauma accumulates and outstrips the recovery rate of the soft tissue, until one day you become aware of a pain for no obvious reason.

The single exercise that seems to be recommended – and which worked for me – is eccentric heel drops.  ‘Eccentric’ is just another let’s-make-it-hard-to-remember name for a strengthening exercise during which the muscle being used is actually lengthened!

So an example would be looking down at your dinner compared to looking at the ceiling.  Looking up involves your neck extensor muscles contracting and shortening, which is why the neck will get shortened on that side.  This is called a concentric contraction.

But the eccentric contraction is during looking down.  This uses the same muscles, but this time working to stop your head falling down into your spaghetti!  Only the back of the neck and the same muscles will be getting longer.


The exercise…

So, find some steps and stand with just the front of your feet on the step towards the edge so that both heels are well off the edge.

  • Using both feet, (or even better, using any banisters and your arm strength), raise yourself onto your toes.
  • Now lift the foot on the good side slightly off the step.  All your weight is now on the side of the problem.  Hold it there for a count of three, then slowly lower your heel down all the way as far as it will comfortably go over the edge.
  • Aim for 10 repetitions, but stop when you feel your calf or tendon beginning to play up or tighten.  Increase the number at your own rate. You shouldn’t push it to the point that you created a lot of soreness.
  • If it’s really irritable and weak, try doing what I did.  Because my tendon felt particularly irritable I started using both feet as I was worried that putting all my weight just on one side would be too much.  Then I progressed to a single foot exercise after it felt stronger.  I also extended the count from 3 to longer as it would allow.
  • If you’ve got any, you can use banisters and your arms to get to the start position.

Just to finish off, I would suggest stretching the calf after wards.  You can find plenty on the web, but here’s an easy one.

Sit on a cushion with your behind right up against a wall, with feet on the floor and knees bent.  Then on the affected side, Move the foot on the affected side so it’s pointing up towards you, and begin sliding that heel along the floor.  As the knee  get closer to the floor, you’ll feel a tightness in the calf.  Hold it at the point of mild tightness for a few seconds, bend your knee again, and repeat the process until you feel you’ve gained some stretch.

Posted in Adults

4 easy exercises for a stiff upper back

Gyms, running or walking are great for working out our lower bodies, legs or specific muscles,  but our upper backs often get forgotten or are under challenged.  It’s an important area, not least because of its connection to  healthy neck and rib movements.

So why not try these exercises in between all that sitting or whilst you watch t.v?


The snake wriggle

Sit with feet flat on the floor, preferably on something with a bit of spring like a mattress or sofa, cross your arms & hold onto your shoulders.

Now try to produce a continuous & rhythmic side to side motion through your upper back – so it does a snake-like movement.  The bounce in the sofa or mattress will help produce some recoil & spring that helps with the movement.

As a variation, try taking in and holding a deep breath whilst doing this.


Freestyle no-arms “air swimming”  (like air guitar!)


Sit like before, but this time imagine doing the free style swimming movement with your shoulders.

This is similar to the snake wiggle above, but it adds an extra dimension of rotation with each shoulder describing circles in a forwards-backwards direction.







Painting  overhead circles with straight arms

straight arm circles

This is a good one for those with rather curved and stiff mid backs, and for people who hardly ever use their arms above their heads anymore. Often shoulder tightness with overhead movements and upper back stiffness go hand in hand.

Sit down, straighten your arms and link your fingers.  Imagine you’re holding a paint brush and you want to paint a large circle on the ceiling above your head.  If you have a stiff upper back which curves forward your body might try to compensate for the lack of movement there (and in your shoulders) by making your lower back arch back more.  Don’t let it!

If it’s a mission getting your arms up there and it feels quite stiff and tight, don’t force it.  Work at those circles slowly and see if you can gradually persuade the arms and upper back to move further up and back .  Try to widen the circle as you go along.

If you get any nasty pinching in the shoulder, stop.  This is probably a separate shoulder impingement problem which doesn’t need aggravating.  If you have this condition, we can usually help, so do call.


Sideways bending & rotating



Sit on a firm surface with your feet on the floor, and hold onto your elbows. Now simply use the muscles of your back to bend your back to one side as far as you can & hold that position for a few seconds.  Try not to use your feet to help – just your back muscles.

The rotation part (illustrated) is simple.  Instead of bending to one side, you simply twist your shoulders round as far as you can to one side & then the other. Hold the end position for a few seconds. Repeat as much as you like till you feel you’ve got more or easier movement.


What else?

Well, if you want a more natural, sociable or fun way of moving your upper back, then swimming, racket sports or any sport involving random twisting, bending and turning of the spine or use of the shoulder will help.

Paddle boarding also comes to mind – assuming, of course, that you use the correct technique involving a spinal twist to power your strokes rather than just your arms.



Posted in Adults, Back and Hip

A slouched upper back can reduce your neck & shoulder movements.

If you’re one of those whose upper back slumps & sags forward and down, try this little experiment.

Sit in your normal slumped position, & turn your head as far as it will go to one side.  Notice how it feels.  Stop right there – don’t move your neck.

Now lift your chest a little & try to make your neck longer – without tipping your chin up.  Notice how your head will turn a bit more without that same level of discomfort.

I’ve had patients complaining of low neck pain turning their heads to reverse the car, and this one simple adjustment to posture is sometimes almost all that’s needed to eliminate or greatly reduce the pinching feeling.

In the next blog:  some ways to improve your shoulder and thoracic mobility

So what about shoulder mobility?  What’s the connection with a slouched upper back?  Well the problem is related more to upper backs that are both curved forward (‘kyphotic’, to use the technical term) AND stiff.

Shoulder flexion – i.e. moving your arms forwards and straight up all the way above your body is only possible if the upper back also bends back slightly for the last part of the arm raise.

So if your back is too stiff that’s going to be harder to do. You’ll feel a tightness at the front of your shoulders as they struggle to do all the movement without your back’s help, or you’ll ‘cheat’ by arching your lower back more – not the best if you suffer from low back pain too!

But hey, what’s the problem?  After all, unless you’re a basketball or netball player, how many of us actually need to raise our arms straight up high on a daily basis?

Actually, over the long term the effects can be more insidious and give a pinching pain just raising our arms up to lift, put on a jacket or brush teeth and hair.  That’s called impingement syndrome and is another story in itself…

Posted in Adults, Arm, Shoulder and Neck

Moles & melanomas – know your ugly ducklings and your a b c…

Okay, perhaps you’ve been to a skin clinic for a check up, but for some of us it could be months or years before we remember to book in a follow up.  So in the meantime why not get into the habit of checking yourself?


THINK A – B – C – D & E!

A  is for asymmetry, or a shape that isn’t round.

B is for border.  Watch out for… one that is notched, uneven or a bit indistinct.

You can see both A & B in this rather large & evil looking one.  But many will start out smaller.

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Posted in Adults

Think you might have a disc problem?

Hi everyone – however many that may be…

Suddenly I seem to be seeing a lot of people with disc injuries, ranging from relatively mild to one particularly bad case that will probably end up needing surgery.  Luckily most don’t and they get better, though progress can be slow because of its properties and position jammed in between your spine.  You can’t exactly take it out and give it a rest!

If you can identify with any of these symptoms, you might also have a disc problem, but before you get depressed, remember that many are mild and most get better!

Tingling, pain or numbness running down the arm, the outside back of the leg, or in the toes; central low back pain worse with long periods of sitting or standing; a long period of discomfort (more than an hour) in the morning on waking; leaning to one side to avoid pain; pain coughing, sneezing or bending over.


If any of that sounds like you, then you may find some of these tips helpful

  • Get treatment!  Now, okay, I would say that, wouldn’t I?  But not without good reason.  Treatment can help because you need as much movement and flexibility in othe parts of the spine so that as little stress and pressure goes on the part with the damage.  Yes, I know a lot of physical problems do get better by themselves…. eventually.  But  eventually can be a longtime.  The “She’ll be right” attitude is admirable, but why chance a needless extension of pain?
  • Don’t allow anyone to manipulate (i.e. ‘click’) your spine where the damaged disc is.  I’ve heard of cases where that’s been done because the over confident therapist thought they could ‘put it back in.”  Yeah, right!   What happened in these cases was that the disc injury was worsened and pushed along the scale from mild to severe!  Manipulation is okay (and I use it in these cases), but only as long as it’s for other parts of the spine.  Good technique is also essential.
  • Avoid sitting for long periods.  Get up and move around from time to time.

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Posted in Adults, Arm, Shoulder and Neck, Back and Hip, Sciatica

“So what is the difference between an Osteo and a…?”

“… a chiropractor and physio?”

Such a common question which could be answered by talking about differences in philosophy, but that probably wouldn’t shed much light on the actual differences in treatment.

I see a lot of patients who’ve had first hand experience of different kinds of therapy, so my answer comes from what they’ve told me.  But before I get started, please remember that these are broad generalizations and I’ve certainly heard of  therapists of one variety working very differently from the descriptions below.

Physios on the whole, seem to do a certain amount of soft tissue work, (not a lot), and usually include a lot of homework for the patient to do in the form of stretches or strengthening exercises.  Strapping and taping are common with visits to the physio as are the use of devices like ultrasound.  Some are licensed to provide manipulation, but many aren’t and don’t.

I’ve often heard that a typical chiropractic session is short, often no more than 10 minutes. Chiropractic seems to  focus on manipulation (clicking of joints) as the main tool of choice and not much, (if any), soft tissue work.  A course of treatment may be fairly frequent to start with – more than once a week, and quite a few people visit their chiropractor on a regular basis as part of a kind of lifestyle maintenance plan.

And osteopaths?  Well, within each 40 minute appointment I’ll spend half an hour on treatment. I hardly ever see a patient twice within the week unless they’re in a lot of grief when waiting a whole week to the next appointment can seem an eternity.  Some osteopathss have shorter consult times, some longer, but 40 is probably around average.

Like many (but not all) osteopaths, I do use manipulation – not by itself and certainly not on everyone.  There are other more gradual techniques for getting joints to move normally which I use on a daily basis.

Patients  get some some homework from me, but the main focus of what I do  is the half hour or so of rolling up the sleeves, & getting into the  work of direct hands-on treatment that is quite broad; not just focusing on the part that hurts.

Strapping and taping are not my thing.  It’s not that I’m against them, it’s simply because I don’t often feel thet’re needed – and it’s not my real expertise.  But when I  feel someone needs specialist support or very a very detailed rehabilitation programme, I’ll happily refer them to someone who does a lot of that kind of thing day in, day out.

I hope this helped clear some of the fog around this question!

Posted in Adults

Trampers & Hill Walkers – Knees Aching?

I made a discovery very late in the trip after many days out int the Nelson Lakes area in late December and early January this year.  It’s one I wish I’d cottoned onto much earlier, as it probably would have resulted in better tramping performance for less discomfort in the knees after each day. The pain, an ache, wasn’t so much inside the knee or deep down, but below the patella, or knee cap.

I’m not sure exactly how or why I suddenly came to this realization, but it was this:

Going uphill I was constantly relying on and overusing my quadriceps muscles for each upward step.  Those are the front of thigh muscles which are used to straighten the knee when it is bent.  So, I’d put my foot forward and up for the next step, and just sraighten the knee on that side to power myself up.

What I was not using enough were my gluteal muscles, especially the gluteus maximus.  Now that sounds awfully like the name of a Roman Emperor or commander of a Roman legion, but it is in fact, the muscle which pulls your thigh backwards, or downwards and backwards if you use it to help you go uphill!

And then I thought about it some more, and it made sense as I’d already discovered when doing my weekly runs that I tend to over-swing my hips – again a cheat way of bringing the leg forward when going uphill instead of powering through using this buttock muscle.  So I began to use the gluts and, well maybe it was a bit in the mind, but it did feel as if an extra cylinder had just been added to my engine!

I’m now making a deliberate effort at using the gluts together with the quads when tackling any hills or steps on wooden walkways, and it feels as if that muscle is just waking up to the novelty of being useful.

I wish I’d known this earier, but at least this discovery promises to make tramping more comfortable and perhaps even extend the lifespan of my knees.  So the next time you’re on the trail uphill, think about how you’re handling it.

Of course, the real problem for me and many others is long descents, and if anyone discovers the secret of accomplishing these with ease, please let me know and I’ll spread the word.


Posted in Adults, Legs and Knee

Carpal tunnel from waterblasting!

rafisprayingAnd in both hands at the same time!

As anyone who’s come to our Torbay clinic knows, we have a lot of rough textured concrete out front – perfect for the mud and dirt to settle in & turn  a drab dark grey colour, and lots of paths round the house too.   So when I saw $100 off a powerful water blaster  recently, I couldn’t resist.

I got started and went at it hard for perhaps around two hours solid, just swopping hands now and then as they tired.

Folks, this was me not following my own advice to patients to break up activities with different ones rather that go hard at it for hours on end doing one thing!

29 09 15_1129Now here’s the thing: for safety reasons these machines don’t allow you to lock the trigger handle like a petrol pump – you have to keep squeezing the handle very firmly if you want to spray. Added to that is the vibration that comes through your hand  from that water pressure racing through the nozzle.

After a couple of hours I noticed that  if I tapped anything with my fingers, or tapped them against each other, I felt a strange but painless ‘twang’ vibrate through the front of the hand.  It was the kind of vibration you’d expect from a very taught wire or musical string.  No pain, just  that odd feeling in most of the front of the hand except the little finger.

And this is where carpal tunnel usually strikes as it corresponds to the area of sensation registered by the median nerve in the hand.  The little finger is spared because it’s wired up to a different nerve (the ulnar nerve).

So why did I get this?  Continuous gripping and squeezing over a long period of time plus the vibration is enough to cause ischemic compression of the nerve.  In other words, the nerve gets squeezed and compressed by the surrounding contracting muscles and gets strangled of blood itself.

You can see what I mean here.  Try pinching your wrist (back and front) between your fingers of the other hand.  Now make a tight fist of the hand attached to that wrist.  Notice how tight the area around the front of the wrist becomes, and how it tends to bulge outward from the pressure?  It’s even worse if the hand is also bent down or up.

Anyone who uses something requiring a strong grip is at risk, and more so if there are high vibration levels.  Office workers resting their wrists on the desk whilst bending the hand upwards to type are also vulnerable.

I was lucky because this was just a ‘taster’ for me.  In serious cases carpal tunnel can be become an extremely painful burning sensation spreading up the arm from the hand.  It’s common in pregnancy from increased fluid pressure in the wrists (a bit like swelling in the ankles) & usually goes when the pregnancy’s over.  But in the more severe cases of compression under the ligaments that cross the front of the wrists, the solution is usually a relatively straightforward surgical procedure to reduce that pressure.

Most cases I’ve seen have gone with a few treatments.  And the usual symptoms have been  pins and needles at night, often relieved by shaking the hand and arm.

Mine went after an hour or two, but I learned my lesson, stopped and handed over the rest of the blasting to our reluctant teenage son.

Posted in Adults, carpal tunnel

How long has your kid had that knee pain?

rafikneeSo, the long Kiwi summer hols are done & dusted…  This is my first post of the ‘new’ year, but March is knocking on the door already!

There’ve been a few typical holiday injuries rolling in through the clinic doors- bad necks from strange beds, bad backs from being dumped in the surf (including me!), and a couple of wrenches from trying to snatch luggage off airport carousels or out of car boots.

But knee pain in kids is what caught my attention recently with a front page story in the North Shore Times (5 Feb).  This was about 15 year old Eliszabeth Moata’ane who’d been having knee pain for a month when it suddenly got a whole lot worse.

In the end she could hardly walk for the pain, and was having to crawl down the stairs.  It turned out to be bone cancer, & she now faces the prospects of a course of chemotherapy.

Which leads to this very important message for all you parents out there:


Never ignore knee pain in a child or adolescent

It can be fatal if left untreated too long!


But what if it’s just a growing pain or play injury?

Read more ›

Posted in Children, Legs and Knee, Teenagers and Adolescents