Articles in Category: Training and Performance


on Tuesday, 02 April 2019. Posted in Newsletters, General Health, Sporting Injuries, Training and Performance

Shoulder Pain

Shoulder injuries are one of the most stubborn injuries I deal with as a practitioner. They happen very gradually and linger for a long time. Not excruciatingly painful but definitely annoyingly dull and achy is how I would describe it.

Here are 5 things you should know about shoulder pain:

1.They are highly treatable if addressed early

People with shoulder pain usually do not seek early medical attention. It is the type of pain where people tend to ignore initially because of its subtleness BUT ignoring the pain will not make it go way. In fact, it will usually continue worsening the longer you wait to seek care. The earlier you see a practitioner, the better it will respond to physical therapy and regain its range of motion.

2.Treat your shoulder blade while treating rotator cuff injuries

The shoulder blade serves as a platform for the muscles of the shoulder (rotator cuffs). When there is an injury to the rotator cuffs, it is directly related to how well the shoulder blade is working too. A weak and unstable shoulder blade will produce an unstable base for the rotator cuffs hence possibly causing the muscles to be compromised therefore leading to injury and weaknesses. So it is important to include shoulder blade stabilising exercises on top of rotator cuff strengthening. 

 Shoulder Projections

Shoulder Projections

YouTube Link:

 3.Frozen Shoulder is more common in middle aged women

Frozen shoulder happens when the lining of the joint within the shoulder is inflamed. The gradual thickening of this area results in the stiffening of the shoulder and it becoming more painful with movement. No one knows the exact cause of a frozen shoulder but women between the ages of 40-65 years old have a greater prevalence.

 4.Sleeping position is important

While taking some time to recover from a shoulder injury, it is important that you find a sleeping position that is tolerable. If you are a side sleeper, try sleeping on the non-painful shoulder. Taking pressure off the affected joint will reduce irritation to it. If your shoulder pain is near the front, sleeping on your back can help evenly distribute your weight and again keep pressure off.

 5.Shoulder pain can be a referral

Most shoulder pain is highly likely to be musculoskeletal in nature but sometimes other conditions can also cause referral into the shoulder. If your shoulder pain is unexplained and does not change when you move your neck, shoulder or arm there is a high chance the problem is coming from somewhere else (such as gallstone, heart or blood vessel problems and lung problems). It is important to be checked out by your medical practitioner for further examination.



Written By Iris Tan
B.App Sc (Chiropractic) M.Clin Chiropractic

Bike Fitting

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in Sporting Injuries, Training and Performance

Bike Fitting

By Don Williams


Cycling is becoming quite the popular sport in Brisbane. You only need to go to just about any local café in the city or around the bayside suburbs and esplanades to get a sense of how many people are getting involved in this sport, some more seriously than others.


Unfortunately we do get to see quite a lot of trauma cases at Institute of Sports and Spines due to car bike interface disorders, referred to more usually as collisions. Usually the cyclists fare worse than the drivers, but not always so. The disputes will rage long and hard over whether cyclists should or should not be on the road and who is generally at fault, so we will leave this debate alone.


Additionally though, we do see quite a lot of injuries which are overload or postural in origin who come into the clinic. Many of these injuries are preventable with correct bike position and set up, or by addressing imbalances and weakness in the system.


Many people would think that correct bike position is just a case of getting a bike that you can get your leg over and everything else should be just fine, however, there is a lot more to it than that.  Generally, on top of the basics of getting a frame that is the right size, alterations in seat height, forward and backwards position of the seat, handlebar width, stem height, relationship of the stem to seat height, pedal cleat position, crank length and angulation of the shoe can all have an impact on whether a ride along the bay on the weekend is an enjoyable or painful experience. At the higher end of the performance spectrum, this may have a significant impact on the power output, aerodynamics and general comfort allowing you to race to your full potential or falling short due to these deficiencies.


At Institute of Sports and Spines, we use cutting edge technology combined with years of clinical experience to help you overcome your injuries and enhance your performance needs.


We utilize a Wahoo Kickr stationary trainer so that we can accommodate road bikes, and all range of mountain bikes from 24’ to 29ers. We can also accommodate bolt through axles or quick release.  The trainer is extremely quiet and allows us to tie in power based assessments with your bike fit.


 Bike Fitting 1 Bike Fitting 2


Our video capture system is from Silicon Coach.

Bike Fitting 3 Bike Fitting 4


We utilize “Dialed in Motion” and “Silicon Coach Pro”, software to dynamically capture your position when riding under load from multiple camera sources in high definition giving us a very clear assessment of your true riding technique. We then assess the angles and position of all the relative joints to allow us to make changes to optimize your position.


We often have people discussing the Reutal System and its claimed accuracy.

Without being too critical, whilst the accuracy of the motion sensors in that system may be accurate to the millimeter, the placement of the markers on the body delivers the same inaccuracies of palpation that are inherent in the placement of markers or sensors in any system. Our view, having a clinician with years of experience in injury diagnosis and management melded with years of experience in cycling will yield great results in helping you achieve the fit you want. There are a number of places in Brisbane using the Reutal system, some are doing a fantastic job, others less so, and with some centers charging upwards of $400 more consistent results should be expected. Once again, the places who are doing a great job are usually combining technology with years of experience.


The whole point of a bike fit is to make you sit more comfortably (which will let you ride harder and longer) and to help you ride more efficiently. The transmission between the motor and the bike if you will.


Bike Fitting 5


Our process takes around 2 hours. It is very detailed and personal. You will have a pre-fit interview and assessment, to find any problems that may exist. 

Then we use HD Video motion analysis software your riding position. During the fitting we will assess the shoe, arch support, cleat position, saddle, stem length and height. We can then make changes and give you a detailed report of before and after fitting.


Your customized report has all the setting for your bike and your body measurements so that should you need to change back to the original settings or are looking to buy a new bike and want all your measurements to give to the bike shop, they are all at hand.


If you would like further information about bike fitting and assessment, call our friendly reception team for details.

Communication and Recovery

Written by Don Williams BSc, MChiro, ICSSD. on Thursday, 04 February 2016. Posted in Sporting Injuries, Training and Performance

Communication and recovery

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation Cert DNS. Memb: FICS, CEA


When I sat down to write this article it was initially intended as a discussion piece for a forum and website that I contribute to for elite athletes, however, after thinking about the issues involved, I really think it applies to the general population equally as much.


One of the challenges when managing patients/clients is ensuring that communication is adequate between all the parties involved in the management of the person with the complaint. For the general population this may include a GP, a surgeon, a Chiropractor, a personal trainer and a Remedial Massage Therapist, as well as the personal with the complaint. For athletes, there could be additional players including technique coach, strength and conditioning coach and team managers etc.


So let’s imagine a scenario where Michelle injures her knee. She has been training with a trainer at her local gym and gets regular massage with a great therapist.

After the injury she ends up seeing Jakob at Institute of Sports and Spines who diagnoses her with a significant tear of the meniscus and refers Michelle off for an MRI to confirm his suspicions. The scan confirms the major tear and Michelle will require a surgical approach to resolve the situation. Jakob then refers Michelle to a surgeon for management and also writes a letter to the GP. Currently in our healthcare “hierarchy” in Australia, a GP referral is required for the specialist visit and surgery to be covered under medicare.

Unfortunately this GP thinks that all Chiropractors are idiots and as a result, refers the patient to another surgeon. This surgeon is unaware of the other links in the chain in regards to where the complaint was first assessed and diagnosed and does not communicate with Jakob about the surgery and what was actually done in the operation.  Once the surgery is complete there is conflicting advice and Michelle doesn’t end up doing effective post-operative rehabilitation and ends up reinjuring the knee as a result of the breakdown in communication.


The above scenario is an unfortunate but common incident that we see in practice.

At the nuts and bolts level, the breakdown in communication is to blame and if all parties involved were to step back and really have a focus on what is the best way to manage the client/patient to get the best possible outcome then this sort of situation would arise much less frequently.


In an “optimal scenario”, the surgeon sends a post-operative letter and synopsis which guides an effective rehabilitation program so that Jakob can develop and implement a rehabilitation plan for Michelle to progress through the early clinical phase or rehabilitation and back into functional training and gym work. It is important to note that at times, a simple surgical intervention may be planned but once the surgeon commences the operation, the injury turns out to be far worse than anticipated or the approach may be different which can at times vastly change the required rehabilitation program. In Michelle’s case, a simple debridement of a meniscus would see a relatively simple recover and rehabilitation plan, however, if there was stitching and repair of the torn meniscus, the rehabilitation would be slower and more complex.


The healthcare landscape in Australia is rife with egos and opinions and often this ends up with the patient outcome of goal taking a backseat.


In the example given above, if solid communication was at the forefront, then the GP and surgeon would communicate back to Jakob what was done and any specific requests or advice given to ensure that early rehab was effective and targeted at getting the best outcome. This would then allow Jakob to give targeted feedback to the trainer and other therapists involved to ensure that everyone was on the same page to achieve a great outcome for Michelle.


It is important to note that the breakdown in communication is not always any particular party. I have chosen one aspect here, with a GP breaking the chain to highlight where co-referrals can compound issues. Our team at Institute of Sports and Spines have a great network of GPs, surgeons, radiologists, trainers and other therapists who we deal with regularly and have a tremendous amount of respect for. We certainly appreciate the communication and mutual respect which we have which we believe is one of the cornerstones for good patient outcomes.


The major plus of living in a big city is the ability to have a variety of practitioners with a range of specialisations and special interests available at hand to be able to better manage our clients/patients. When all the parties involved recognise their strengths and weaknesses and utilise the available pool of resources our management and outcomes of patients are greatly enhanced.