SIT-UPS

Recently a patient said to me: “can you believe a friend of mine did his back doing sit-up’s?


"That’s right I think” he said when I asked if his mate did the sit-ups with his feet locked under underneath something.


Now abdominal crunches are one of the easiest and best postural strengthening exercises but if you lock your feet when you’re doing them it’s risky.


The reason is a muscle called Psoas major which makes your hip bend up but it’s also attached to the front of your lumber spine bones. So it also pulls your spine toward your hip if your feet are locked under something.


It’s a little hard to explain in words but hopefully my dodgy stick men below illustrate what I mean. (If you can't see them clearly in your browser, click on the box / link below). From the blue arrows you can see the abdominal muscles pulling the chest towards the pelvis in the first diagram (resulting in downward pressure (red) on the lower back while lying). In the second diagram you can see the Psoas muscle pulling the back towards a fixed leg (blue) resulting in upward force on the spine (red). Two opposing forces on the spine result in compression down the spine. If you’ve got an unstable spinal disc, there is potential to hurt you.



So don't stop your crunches (with bent knees) but keep your feet free!

SHOULDER BURSITIS

By Brendan Dax • October 27, 2025
Bursitis is one of the many causes of impingement pain of the shoulder, giving restriction and pain when lifting the arm. Bursae are small sacks of fluid and when inflamed in the shoulder, take up too much space, getting squashed when raising your arm causing painful pinching. Like all musculoskeletal problems, this is a problem of mechanics. Something doesn’t move properly. From a manual physiotherapy perspective, bursitis, like all shoulder impingement problems usually responds well to joint mobilisation. In all my years of treating shoulder impingement almost all presentations have associated neck/upper back spinal joint stiffness. Manual mobilisation (loosening up) of the neck/back and shoulder joints will always yield improvement, unless there is structural damage. Having seen 100s of acute onset (within the previous two days) shoulder problems in the industrial sector, I can assure you that most of them come in with chronic, stiff upper backs that they’ve had for ages. True bursitis usually responds as well to a guided Cortisone injection. Bear in mind if the neck and shoulder joints are still stiff the jab may not solve the problem. If you have shoulder pain that has not responded to injection and/or seeing a Physio who just uses machines and/or exercises, consider manual physiotherapy from someone like me, before we all retire!

Fat Pad Impingement

By John Doe • August 1, 2024
Keen soccer player Ms. K presented with sharp pain just under the kneecap. It was very sore when running and going up and down stairs. She had fat pad impingement of her knee. The fat pad is “cushion” structure sitting below the big tendon that joins the kneecap to the shin bone. It can become swollen from the kneecap squashing into it through sport or impact. Although not a severe structural injury, it can be very restrictive due to the pain. “Fat pad impingement” is a common presentation for stop start sports participants. In the old days it was common with the staff in English castles who were scrubbing floors (housemaid’s knee!). Simple taping is usually very effective, and I often enjoy the look on the sufferer’s face after they go up a step after being taped (and it doesn’t hurt!). Management of knee stiffness, strength, relative rest and return to normal activities then begins. Untreated it can persist for a long time and will invariably lead to loss of strength in the knee and possible further problems from this. Avoid power activities of the knee that hurt: stairs, ladders, hills, squatting and sprinting as well as kneeling (AND no scrubbing floors!).