By Robyn Edge & Gilbert Magne
Robyn Edge attended the Congress of the World Federation of Training and Therapy in Madrid Spain last fall and came back with some of the latest insights in rehab. One of the systems looked at was fascia and how we tune our therapy to get better results.
This is the second of this 3 part series. The first of our three part series discussed everything and anything fascia! What is it? Why it’s important? What happens when it’s not healthy? What do you feel or experience as symptoms when this is the case? What can we, your therapists, do to help manipulate the fascia to help you move better, feel better, heal and prevent injuries? You won’t need to have read the first article to understand this one, but it may be of interest to you so here’s the link .
In this second article we dive into we’ll discuss what happens to the fascial system when it’s in distress. Trigger points. Referral pains. Muscle knots. All those issues that create pain and dysfunction for us. Part 3 is coming in the next few weeks. Let’s jump out of the technical stuff about fascia and move into the stuff that matters to you: the muscle knots, the symptoms, the aches, the pains. What does it all mean!?
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Again, this can be a bit of a denser article. If you want the quick info, skip forward to the summary sections. If you like the details read on!
A muscle can be described, basically, as many individual fibres grouped together in bundles with many bundles grouped together. Holding all these parts together is, you guessed it, fascia! Fascia encases each fibre then each bundle and finally all of the bundles or the whole muscle. This wrapping ends up making the tendons at either end of the muscle which attach the muscle to the bones. At a microscopic level, individual fibres have moving parts that create the contraction of a muscle. For the contraction to happen the muscle fibers need energy and nutrients as well as the ability to get rid of the byproducts of using that energy and nutrients.
We all know that in order for our bodies to function all parts require adequate supplies of blood. A muscle receives blood supply from an artery; this blood brings in oxygen and nutrients. Veins take away byproducts from the muscles once oxygen and nutrients have been used. Both the arteries and the veins enter/exit the muscle at the same place. Once the artery enters into the muscle, it branches off into smaller and smaller vessels called capillaries. These capillaries provide each fibre of the muscle with what it needs and take away what it’s already used up.
Nerves usually enter at the same place as the blood supply and branch off in a similar way. Each skeletal muscle fibre is supplied by a single nerve ending. As the nerve approaches the muscle fibre, it splits again and becomes the motor end plate. The nerve is what brings the message to cause a muscle contraction. The combination of the nerve ending and muscle fibre is terms a motor unit. This contraction causes movement.
Skeletal muscle, or the muscles that we use to move our body, work on an all or nothing principle. This means groups of muscle fibres within a specific muscle are either on or off. The amount of tension we create in the muscle is dependent on how many fibres of the muscle contract at one time. The heavier and harder the task, the more bundles we will need to recruit. The more practice we have at this harder task, the more efficient and synchronized our body gets at contracting and relaxing the muscle bundles. Under less intense conditions the motor units of one muscle take turns, meaning some are working while others are not so that the task can be accomplished for longer with less effort.
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Muscle gets its commands from the nerve, its supplies from the artery and it gets rid of it's garbage via the veins. All this is to allow us to contract and relax a muscle which allows us to move. The more we train, the more synchronized the contraction and relaxation of the muscle is, the more efficient we become at our task at hand.
In our previous article "What is this thing called Fascia?", we touched on the nitty gritty details surrounding fascia. Fascia involved with the muscles is called myofascia. When it gets injured or strained, it can become shorted, condensed and tight. Pesky nodules of tension manifest as a result; you can sometimes feel them. These are called trigger points.
We’ve all heard of them. We’ve all felt them. We’ve all commented, “Pretty sure that trigger point is giving me a headache”. Other times we say to ourselves, “my elbow is painful but I can’t reproduce that pain when I push on where I’m feeling the pain.” But what does that actually mean? What is a trigger point? It is a localized spot of tenderness in a palpable nodule located in a taut band of muscle. Sometimes these tight bands cause a specific pain pattern when stimulated. This is called referred pain.
These hypersensitive localized spots vary in size depending on the size, shape and type of muscle they belong to. Their consistent quality is tenderness with applied pressure. Pain/symptoms may be due to the active trigger point or it may build up over time from latent or inactive trigger points.
There are several factors influencing trigger point development. Some of these include: age, genetics, posture, demands placed on the musculoskeletal system, weight gain or loss and how we developed as kids.
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Trigger points are sensitive nodules in muscles that have a bit of a different environment compared to the rest of the muscle.
In 1957, Dr. Travell found that trigger points generate and receive small electric currents. We know in order for our bodies to move, electric signals go along the nerve pathways to the motor end plates (where the nerve meets the muscle fibre). In a relaxed non-contracted state, the electrical signal of a muscle is nil. With a trigger point, a small part of the muscle stays in a contracted state and we see a small localized spike in electrical activity. Meaning, the muscle is always on at that location.
HOW DO TRIGGER POINTS ACTUALLY FORM?
The exact cause is still unknown as to why trigger points form. We know changes occur within muscles that house trigger points. There are a few theories about why they occur and each addresses these notable changes. Trigger points manifest where muscle fibre and motor end plates become overactive.
It helps to understand how a muscle contracts in the first place. When the brain wants a muscle to move, it sends a message along the nerves that goes to the muscle fibres. Once that message gets to the end of the nerve, acetylcholine (ACh) is released. ACh triggers muscle activity, which takes energy. Energy is supplied by the blood and is stored in the mitochondria of the muscle fibre. Calcium ions released by another structure of the muscle fibre (sarcoplasmic reticulum) cause the muscle fiber to shorten.
Each of the theories with regards to trigger points involve a different part of this process. Which theory is correct? We aren’t sure but the changes seen in the muscle housing trigger points are consistently noted by researchers as follows:
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The amount of communication from the nerve and the constant contracted state of the muscle fibre contribute to why trigger points develop. There are many theories why trigger points develop but these factors are consistent findings.
TRIGGER POINT CLASSIFICATION
WHAT DOES THIS MEAN FOR YOU?
Painful trigger points restrict your ability to function for a few reasons:
REFERRED PAIN PATTERNS
Referred pain patterns can produce pain in more than one place. Pain can be felt locally at the trigger point and/or in locations further away from the muscle and trigger point. As an example, trigger points that create pain in the upper traps can send pain up the back of the neck and head to the forehead above the eyebrow. This is why we tend to ask questions about where and what your pain is doing.
Understanding what increases the pain and where you feel the pain sensation is helpful to your therapists. Referral pain tends to be broad, diffuse, nauseating pain that is not painful to the touch in the area. Asking the muscle to contract or stretch can increase the intensity of this pain, ie. shrugging the shoulders or stretching the head to the shoulder makes that forehead pain stronger.
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Pain can be felt locally at the trigger points nodules or at a distant, but predictable location when a trigger point is activated.
Here are a few examples of more seen referral pain patterns:
FASCIAL LINES INTERRUPTED
Unlike our muscles which have a start and end point, fascia is continuous. Yet, we can separate it into sections based off of the direction and function the fascia has in our bodies. We won’t go into the details about these lines, but we’ll highlight a few examples for your understanding:
Different treatment techniques and movement practices influence the fascia along these lines. Part 3 of this article series (coming soon) will discuss some techniques and movement strategies.
If these lines, or chains, are healthy, every tissue within that chain moves well. What happens when we interrupt or interfere with that continuous connective tissue? Surgeries, incisions, scrapes, cuts, or tears all interfere with the structure and function of the fascia.
When the fascia gets damaged it heals with a scar. Like what we see on our skin, like a new scab, this tissue is tight, tough and stuck together. This is all a part of the natural healing process that occurs. This is a good thing! We are binding back together. Scar tissue is the building blocks of these tissues and has to be there in order for us to heal.
Scar tissue becomes a problem if the body doesn't remodel it to be like the rest of the tissue. Movement gets interrupted when tissues don't match. For example, if the tissue direction is up and down but a scrape or incision is in the opposite direction to that, how well will that tissue move? What does this mean for you? Less mobile, and less extensible. Picture a piece of lumber with the grain in it all moving in a one direction, with a wood knot right in the middle of that wood grain.
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We move well when there are less friction or interruption points in our body. We move well when all of the fibres are aligned, are adaptable and are working with each other instead of against each other.
The good news is, like trigger points, we can work through and improve these binds in the fascial lines. In Part 3 we will show you options to healing and optimal function of these systems. We will also discuss what techniques, practices and strategies best influence the fascial system. That way you can make sure you’re getting the most out of your workouts and movement practice.
Gimberteau, Jean-Claude. (2017) Endoscopic exploration of human living matter. What are mobility, suppleness, and flexiblity and how to improve them? World Federation of Athletic Therapy and Training. Madrid, Spain.
Goodman, C.C., Fuller, K., & Boissonnault, W. (2003) Pathology Implications for the Physical Therapist, 2nd Edition.
Myers, Thomas W. (2014) Anatomy Trains, 3rd Edition.
Niel-Asher, Simeon. (2008) The Concise Book of Trigger Points, 2nd Edition
Sue Falsone. (2017) How important is myofascial in sport? World Federation of Athletic Therapy and Training. Madrid, Spain.
By Robyn Edge & Gilbert Magne
Robyn Edge attended the Congress of the World Federation of Training and Therapy in Madrid Spain last fall and came back with some of the latest insights in rehab. One of the systems looked at was fascia and how we tune our therapy to get better results.
The first of a three part series discussing everything and anything fascia! What is it? Why it’s important? What happens when it’s not healthy? What do you feel or experience as symptoms when this is the case? What we can do to help manipulate the fascia to help you move better, feel better, heal quickly and prevent injuries? Stay tuned for parts 2 and 3 coming in the next few weeks. Let me be the first to welcome you to the world of fascia!
This article is a bit more dense and scientific than usual. If you would like the condensed version of the information, skip forward to the TAKE HOME MESSAGE part at the end of each section. This will give you a synopsis of the main take away points. If the details are interesting then read on!
The buzz word of 2017: fascia. Older definitions will tell us it's a tissue in the body that wraps and separates the different parts of our body (muscles, skin and organs). To me this sounds like isolated compartments with the fascia being the divider. Which would prevent systems and tissues from working together.
Let’s flip that thinking. Fascia is the connective tissue that gives us structure. It connects through all layers of our body. From the skin to the fatty tissue to every muscle fiber to the depths of our internal organs and into our bones.
It is the stuff that determines where all the other stuff goes and how it functions. Fascia is the connective tissue that was, until recently, ignored. How could we (the scientists and therapists) throw away something so vital to how we move? Because we focused on the obvious. The veins, the vessels, the arteries, the striated muscles, the organ function. These are much easier to label and separate from other parts.
These structures are well seen and understood because their movement is obvious. Yet, we are starting to put the puzzle pieces together as how important fascia is for the entire system. Fascia fibres are everywhere and responsible for movement. This is unlike the traditional thought that our cells hold that responsibility.
As far as we know, fascia’s responsibilities can are as follows:
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Fascia is a continuous structure that connects everything in our body. It help us have shape and structure, and it helps to absorb and disperse forces as we move our bodies in all kinds of ways. It also helps tell our brains what is happening to parts of our bodies in an automatic/subconscious way .
Structure for Dynamic Shape
Fascia is the stuff that gives us shape, it holds us together and gives us structure. If we didn’t have this structure in our body, we would be puddles of tissue and bones on the floor!
In order for this to happen, the system has a closed loop of tension. Meaning, the fascia in our body, everywhere, always has a certain level of tension to it. It’s like a thick elastic band that is always tight to some degree.
We know this to be true when we observe what happens when cutting an incision to the skin. Tissues on either side of the cut pull away from one another. To bring the edges together to heal, we need tension to pull them.
This tension has to be present in order for this tissue to function. We may think that being tense, tight or stiff when we move to be undesirable. But it's all about relativity. Some tension is good! Too much tension is restrictive thereby limiting the efficiency of the body as a whole. But we need some tension to actually move.
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Our fascia is always under a certain amount of time, like an elastic band always being slightly pulled. This tension helps towards its functions. Without this closed-loop of tension, we would not be able to move how we do.
A dancer, gymnast or pianist can gain advantage from being mobile. Think about how many more keys a pianist can reach with a very mobile hand. Or how well a gymnast can perform maneuvers with a very mobile spine and hips.
Now consider the opposite end of the spectrum with a condition such as scleroderma. This is a condition with overproduction, hardening and/or thickening of connective tissue. This occurs in many places throughout the body. Which could include in isolation or in combination: the skin, the blood vessels, organs and digestive system. This results in restriction and lack of proper function among other things.
Tissues are always under tension to some degree. So, we need to be aware of this when attempting to change the length or mobility of these structures. Like too much tension or pull on an elastic band, the fibres of fascia could get injured. This is the last thing we want to do when attempting to gain length to a structure that is already under tension. That being said, our tissues are incredibly adaptive and can change when stimulated. Our bodies are in a constant state of change, harnessing that change to optimize it is the goal of movement. So we can change it with activities like yoga, tai chi, pilates, functional exercise, mobility exercises. Or we can use treatments like acupuncture, cupping, dry needling, ART (Active Release Technique) and massage. This will be discussed further in part 2 and part 3 of this 3 part series.
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We have many tools available to us when attempting to modulate the fascia, cupping, acupuncture, massage. But bottomline? The best answer is to move! We own very adaptive bodies; change will happen if effort to create change occurs. If you don’t move it, you lose it. It’s just that simple!
Take an elastic band that already is tense and pull on it quickly from one or both ends. What happens? The band will likely fray, split or rupture. This is not what we want! We want to encourage increased pliability and length of the fascia while the tissue under tension remains the same, or decreases. If we snip an elastic band that is under pre-tension, there will be a quick recoiling of the band. This is what happens in our bodies.
Structure and force absorption
How does something give us rigid shape but move and with ease? Dynamic fractalization. OK, what?! Let’s break that down. Our bodies need to be rigid structures otherwise we end of as puddles on the ground. But we need some degree of fluidity and mobility otherwise we would move like the Tin Man. Dynamic fractalization is a system characterized by constant change, activity or progress.
Remember geometric toys kids would play with to understand physics of tensegrity?
Geometric structures separated by strength lines allow movement in all dimensions of space. Triangular structures move in relation to each. With any movement they immediately align themselves with the traction. There former position disappears and a new shape appears. Then, as if by memory, they return to their normal position. The tissue undergoes translation, traction, stretching. But returns to its normal position. This is elasticity.
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When move or stretch, the fascia adapts to these changes. But it also has the ability to go back to its original shape when stop the movement or stretch. This helps us to maintain our normal shape while we are adapting to new amounts of movement.
Yet, these structures also move in relation to each other. There’s a slipperiness between the layers to allow movement. How can it work with fast, forceful movements AND soft, subtle movements? How does this happen? How can it do both? This is not yet well understood. But dynamic fractalization and differing levels of pressure in the hydraulic systems of the fascia can help explain this.
Picture five pieces of tissue paper stacked on top of each other. These are layers of fascia. Now imagine each layer is glued together. I’m not going to succeed at pulling those layers off of one another no matter how much effort I put into it. What if honey was between the layers? I’ll have more success gliding these layers on tissue paper apart without ripping them. But it’s still going to take me a long time with a lot of effort to do so. Now what if I had a liquid that was more viscous like olive oil? Increase the amount of viscosity of the fluid between the layers, increase the amount of glide and slide each layer has in relation to the next. Fluid dynamics! It’s the stuff between the layers that might be the most important!
Tensegrity. A force transmits to all elements of connected structure. These are long crosspieces linked by prestressed elastic cables already under tension. We get stability when the opposing forces of tension and compression equal out. This allows us to maintain shape, solidity and movement independent from gravity. A structure built by tensegrity gets its stability from spreading out and balancing the stresses on the whole system.
Such structures are thus stable in all directions. All forces impact all components of the fascia. So that the slight increases in tension on any one fibre translate to others, even the furthest away. Every fibre is a player in the game. It all has to move together!
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Our system is stable yet nimble. Rigid yet adaptable. Because of this adaptable combination, we are able to move and be mobile yet keep our human shape and form. If we didn’t have tensegrity, we might be puddles of humans on the floor!
Fluid transport and Communication
The skin has said to be the largest organ in the body, but the title should be given to fascia. It it has a lot, a LOT, of connection to the nerves of the body. So it sends a lot of information from the periphery to your brain. What kind of information? Some of this information includes: touch tension, compression and temperature. The brain uses this information to track the status of the different areas of our bodies.
Our body strives for equilibrium. This gathered information helps our brains to perceive problems and make corrections to our system. Usually we feel like this information is all coming from muscles, but we are also receiving a lot of info from the fascia.
Among its many roles in the body, hyaluronic acid (HA) is the fluid found between the layers of fascia. It’s main role in this case is to provide lubrication allowing each layer to glide and move on top of the next. If we have a normal amount of fluid in our bodies, we’ll have a normal amount of HA. Which means we’ll have an increased likelihood of gaining movement.
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Increasing the slipperiness between the layers of tissues in our bodies will allow us the potential for better movement. Running through mud is a lot more effort than running through water.
Fluids can be seen moving along the fibres of the fascia like dew drops running off of blades of grass. Transportation of these fluids move from fibre to fibre as the dynamic fractalization of the fibres occurs.
Why is that important? The higher level of hydration we have in our bodies at all times, the more likely we are to have better movement. Better movement leads to less tension and stiffness. When we move better, we have improved circulation, our systems will flow with ease and our health improves.
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Try this yourself! Pay attention to how well you move when you are not well hydrated versus when you are fully hydrated. Do you notice an increase in ease of movement?
Stay tuned for Part 2 where we’ll discuss what happens to the fascial system when it’s in distress. Trigger points. Referral pains. Muscle knots. All those issues that create pain and dysfunction for us.
Falsone, S. (September 2017). How Important is Fascia in Sport? Presentation at VIII Congress of the World Federation of Athletic Therapy & Training. Universidad Camilo Jose՛Cela, Madrid, Spain.
Guimberteau, Dr. Jean-Claude. (August 28th, 2014). Strolling Under the Skin. Video File: https://www.youtube.com/watch?v=eW0lvOVKDxE
Guimberteau, Dr. Jean-Claude (September 2017). Endoscopic exploration of human living matter. What are mobility, suppleness and flexibility and how to improve them? Presented at VIII Congress of the World Federation of Athletic Therapy & Training. Universidad Camilo Jose՛Cela, Madrid, Spain.
Myers, T. W. (2014). Anatomy Trains (3rd Edition). Elsevier Ltd.
University of California Television. (July 27, 2017) The Role of Fascia in Movement and Function - University of California Television. Video File: https://www.youtube.com/watch?v=raCBeQ-gXfs
By Robyn Edge and Gilbert Magne
With the New Year comes the frequent topic of discussion: “What’s your New Year’s Resolution?” Stats have shown that about 40% of people make resolutions every year. I’ve often heard something like: “I want to lose 20 lbs”, “I want to shed 2 inches, eat healthier or exercise regularly”. Yet, the success rate of completing those resolutions is around 8%! That means the failure rate of these New Year’s resolutions is 92%! Somethings tells me that we are missing something if we have this annual tradition that fails with such flying colours. What can we do about this?
Before even choosing your resolution always start with WHY? Ask yourself why it is you want to do your goal. Once you understand why you are doing something, it helps to remind yourself of the purpose, the deeper meaning to you. Try this: ask Why 3-5 times. Choose a goal and ask yourself why 3-5 times to find out your true motivation.
Example: I want to eat healthier this year. Why? Because I am tired all the time and want more energy. Why? I want to have more energy so that I can play with my kids when I get home from work instead of falling asleep on the couch. Why? Because I feel like I don’t spend enough time with my kids. Why? Because I want to have a good relationship with them and eventually with my future grandchildren.
This helps bring in the original goal into context and allow us to understand our true motivation. Sometimes we discover things about ourselves or our deeper motivation we did not know what's there.
Something to also consider, does this mean we need to change our life, or need to focus on we have already? "what if we made goals that were more about loving what we have rather than chasing what we don't?"1 We can focus on what we are doing well, and expand on it. We don't necessarily need to overhaul everything do!
The next step is choosing a resolution. A better approach is to choose specific goals that are based on doing something easily attainable. We thrive on success, so when we achieve our goals we are more likely to continue working on the next one. What helps with this success is choosing behavior based goals instead of outcome based goals. What does this mean?
Outcome goals are the objectives we want to achieve, or the intended result. The challenge with these goals is that we have no direct control with accomplishing them.
Behavior goals are the steps to take to achieve our desired outcomes. These are the things we have complete control over. They are actions that we do everyday or every week.2
Let’s take an example of: I want to lose 10 pounds in 10 weeks. This is an outcome based goal. This is the picture we have in our head of where we want to be. To change it to a behavior based goal, we focus on things that move us toward that goal one step at a time. What can we do to help us get there? Here are some examples:
Once you’ve achieve one of these goals, you then start working on the next step/goal and piece by piece you work toward getting the results you want. It’s important that you do one of these at a time. We try to do everything at once, then we start missing one or two things and we give up because we are off track. Since we missed the workout, what’s the point of eating well! The downward spiral begins and all the balls we were juggling in the air come crashing down on top of us. It’s crazy how our brains will fight against change.
How do you know if your behaviour based goals will get you where you want to be? If you aren’t sure where to start, that’s where a coach would be helpful in providing guidance in choosing the next goal. You could also work with a structured program to help you move along step by step.
It’s also important to plan for when you fall off the wagon. Life happens: you get sick, the kids get sick, you go away on a trip, don’t have access to a gym... This always happens, and definitely happens to me on a regular basis. Know these will happen at some point and decide ahead of time what you will do. I recommend starting fresh, call it a “Clean Slate”. Each day is a new opportunity to take a step toward our goals!
Say you are faced with a day when you are just tired and don’t want to go to the gym, or you only have 15 minutes instead of the usual 45. Give yourself permission to change the activity that day. Instead of lifting weights like you planned, maybe you walk on the track that day, or take a bike ride around the neighborhood. Or if you do end up missing it altogether, the next day is a fresh start, so you can get to it then!
It’s also important to remove as many barriers as possible to achieve our goals. If I join a gym that’s a 20 minute drive away, I’m more likely to not have enough time to fit a workout into my busy day. If I choose gourmet recipes that call for special ingredients and my grocery store doesn’t stock it, it makes it very difficult to follow the recipe. That said, for some people the challenge actually helps motivate them, because it keeps it challenging and exciting!
So if you are noticing that you are consistently missing one of your goals, try to see if there are patterns or consistent problems. Think of these challenges as opportunities. Maybe that class you signed up for is right after work, and because you often work overtime you end up missing it (and since you missed last week, no you don’t want to go back…).
Make sure you have everything you need, and limit the amount of decisions you need to make. If you plan on working out first thing in the morning, have your workout clothes laid out the night before. That way you can jump right into it when it's time.
If you are trying to fit some healthier smart carbs into your meals, make sure you have them ready in the pantry. And while you're at it get rid of any of the old temptations.
A next piece of the puzzle is strategies to stay on task. Everyone has a different personality and tendencies that motivates them to stick to the plan. Some people irritated by plans, others like a strict schedule, others need something to keep them accountable. An interesting approach to this was brought forward by Gretchen Rubin, who has been researching these ideas to match our tendencies. You can find more info on this here.3
Here are some examples that have worked for others:
If you’re not sure how to choose the best strategy for yourself, use your previous experiences or successes from the past as a good example. When you were consistent with something, what was it that kept you engaged at that time? That can give you some ideas on what works for you.
In the end, as you can see there is no one right way to do things. Each person’s needs will be different from the other. We can watch out for common pitfalls, and change our track when we veer away from our course. Try different options, see what works.
We have several options at Precision Movement & Therapies to assist you if needed. We have exercise classes available to help you get moving. We have physio, chiro and athletic therapy to help you get out of pain. We have a dietitian for questions about nutrition. Or, we have Procoach software for those that want a structured program to improve their health.
How about you? Have you been one of the 8% who achieved a resolution? What did you do that worked well to achieve it? If you didn’t achieve it, what happened to get you off track?
By Robyn Edge & Gilbert Magne
This article is a reflection of what I’ve been going through over the last few months about how to be a better communicator with you. It wasn’t until a few years into my career that I realized a large part of my job is to be a teacher. My job is to assess movement, evaluate injuries, construct rehab programs, and treat with manual techniques. But it’s also to motivate, communicate and teach! If I can’t communicate to you what the problem is, how to solve it and how to move better, what’s the point of all the work we are both putting in?
Perfecting how to teach is a two way street with each client. Sometimes I forget not everyone learns in the same way. I'm a fan of body awareness, trying to get people to connect their brains with their bodies experience new ways to move. But, everyone moves and understands their body and how they move. How I see your movement is different than how that movement feels for you. Teamwork!
I was listening to you, but I’m still confused.
Have you ever walked away from a therapy session, a workout class, a bootcamp, a yoga class where your therapist/instructor went on for a few minutes with well articulated instructions only to say to yourself, “Ok, so you want me to do what?”.
Have you even gotten detailed cues and you get completely confused? This is your therapist's fault for not working with you to determine how you best understand how to move.
You and I have to work together to optimize communication of what we say and what you hear. You and I use two different languages which does make it difficult to communicate from time to time.
I think, “I want this person to activate their serratus anterior as the prime stabilizer of the scapular so when they move their glenohumeral joint overhead, they are recruiting the scapular stabilizers and rotator cuff while getting appropriate scapulohumeral rhythm through full range."
Whereas you think, “I’m going to press this weight over my head.”
We have to work together to figure out how best to understand one another. What is our common vocabulary?
Have you experienced that “ah-ha” moment when you understand exactly what your therapist wants you do to? How good does that moment feel?! Proper cueing and attentional focus help achieve these moments. These moments of good communication and understanding have staying power. That’s how you best transfer the skill/movement into your everyday life as compared to leaving it at the gym. I want us to have more of these moments.
Let’s focus in...or out.
What happens when you feel like you’re not getting or receiving the message? Communication falls apart and you might feel your therapist isn’t paying attention. Or, your therapist might not be using the right cues to get the right effect.
Here's a mouthful: "Attentional focus is as a conscious effort to focus attention through explicit thoughts to execute a task with superior performance."
In simpler terms, focusing on a task to make it better. When it comes to movement, this focus can be either what is happening inside the body or outside the body.
As examples, your therapist could guide you how to do a single arm chest press:
Some studies have found external cues produce better performance with less errors than internal cues. This indicates a higher degree of automaticity and less conscious interference. This means you will have a much higher likelihood of leaving your session with a much better understanding of how to move. Not only is the movement better, the effects last longer. And isn’t that the point?!
Why does External Cuing work?
One of the theories out there believes that if we focus internally, it interfers with automatic processes of movement. Our movement is automatic and subconscious. On a day to day basis, we don't think about how to move, we do what we want to do! If we focus on an external targets, the motor system can self-organize without our brain getting in the way. This means external focus allows for a more natural or automatic movement. While internal focus seems to interrupt the movement.
External focus allows your brain/body to figure out how best to achieve the goal. Your body explores different ways to get where it you are asking it to go. Internal focus wants you to focus on one aspect of the movement at a time while at the same time remaining aware of the movement as a whole. Your brain gets overloaded and can make movement achievement more difficult. So, external cues do a better job of communicating the most important aspects of the movement.
So the question is how do we best use external focus and cues to achieve the best outcome from the movement? How do we individualize and change the cues to compliment where your ability level is with each movement? How do we make sure each movement is purposeful with maximal effectiveness for you?
The 3 D’s of External Cueing
We, as therapists, can work within 3 key features of external cues:
Cues should tell you which way the movement has to go. Using our example of the tall plank again, I could say “drive your back towards the ceiling” or “push yourself away from the ground”. In both examples the direction is the same but the frame of reference is different. This is where personal opinion comes into play. Not everyone processes these two directional references in the same way. Some prefer to push towards or push away, this is personal preference and which one helps the most.
If I asked you to push a ball away from your chest versus pushing the same ball towards a wall 20 feet from you what would you do differently? We would do them both in different ways. We can use close cues or far cues depending on what we need the movement to do. Pushing away from your chest is a close cue, whereas pushing at the wall is a far cue. Choosing which distance cue works best for you is dependent on level of experience with the task at hand. I’ve found when I teach a new skill or movement using distances closer to the body are easier to learn.
As your experience with the task improves, we can add more elements like speed and power. Ad it may be appropriate to increase the distance of focus (ie. moving towards the ceiling instead of away from your body).
Verbs are words of action. Movement is an action. Using the right verbs when describing a movement only makes sense. Words like explode, push, press, drive or accelerate can describe how the movement should be performed.
Analogies are important when describing a movement. The two together, verbs and analogies, tell you the pace and the execution of the movement. “Accelerate off the line like a jet taking off”.
Choosing visual words are much more effective than recalling abstract words or concepts. External cues that use active verbs, analogies and words that evoke images will be more memorable. So they are easier for you to apply to the movement when you’re on your own at home, in daily living or at the gym.
The Language of Movement
Effective communication is a two way street. Communication has three components:
For this to work, you have to be paying attention to what I’m saying and I have to pay attention to what you’re doing and saying in response.
Bottomline, you and I need to work together to make sure we are understanding one another. We get success when you to come in ready to give your attention to the tasks, and I am adaptable based off of your responses. This is how we will get the most out of our time together!
These ideas also apply to our previous article written about the crossover effect. This would apply if you're sidelined with an injury or you are noticing you are more in control of a movement on one side but not the other. The article on crossover effect talks about how your body can also adapt by working on the opposite side.
What are your thoughts on these ideas? Have you found yourself responding more effectively to certain kinds of cues? Have you noticed you move more better with certain therapists or instructors because of how they cue you to perform? Let us know your thoughts on these ideas and especially let us know if there are ways that we can be more effective.
How shovelling can hurt you and how to prepare yourself for the inevitable task: Factors to consider and a few exercises that will prepare you best!
By Robyn Edge and Gilbert Magne
Let’s face it, we live in Winterpeg Manisnowba. Living between the snow piles is part of our everyday life from the months of November to April. Skating, skiing, tobogganing, snowshoeing and all the other activities between are the joys of winter. Navigating the blizzard, bundling up to stay warm and shoveling are the downfalls of winter. We dread it but the reality is we can prepare for it so it doesn’t defeat us. Or we let it push us under the blankets on the couch for a few months out of the year while we hibernate.
If you have a driveway/walkway, you will have to shovel at least a few times throughout the season. How are you going to prepare for this challenge? How are you going to ensure you can get through the task of shoveling without injuring yourself?
Shoveling is a Workout
Shoveling and snow removal is all too often taken for granted or with a very casual approach to it. We forget that shoveling can take anywhere from 20 minutes to 2 hours depending on the amount of snow that has fallen. Ask yourself something: when was the last time you performed a cardiovascular task for upwards of 2 hours? Why do I ask you this? Because shoveling IS an aerobic activity that stresses your heart and stresses your whole body. It is common to experience muscle soreness (DOMS) from shoveling, especially if this is your yearly workout. And you could experience injuries from shoveling if your effort outweighs your abilities. To avoid some of this, you need to prepare your body.
Shoveling can be a vigorous workout as it is aerobic exercise and should considered as such. Aerobic exercise stimulates the heart rate to increase delivery of oxygenated blood to the working muscles. Breathing rate increases to increase the exchange rate in your lungs of oxygen and carbon dioxide. And this is only your cardio system. Muscles will also be working in ways they haven’t been since the previous year’s blizzard.
Consider The Same Things as an Athlete does before the Big Game
Like any activity, what are some things you should be taking into consideration before starting. Here are a few things you should think about before slinging some snow:
Some potential injuries with shoveling
Inadequate strength, lacking endurance, and poor technique are some reasons why injuries can occur with shoveling. Prevention is key. Proper pushing, carrying, and lifting technique work best when you are able to move your body in the right way.
Shoulder injuries: this is often due to ineffective use of the whole body when lifting or pushing. If we rely on using the arms to do the work as compared to engaging a strong, wide and stable base from our legs, tension from our core and work from our whole body, we can strain the rotator cuff, the chest muscles, the neck and the bicep.
Back injuries: this is also often due to ineffective use of the whole body. The core is the connection point between our upper body and our lower body. It needs to be stable and in a neutral and supported position to help transfer strength from your lower body into the upper body so the task is easier. It’s very important to maintain a neutral spine position, as compared to a slouched forward position, and a proper hip hinge to protect your back. Use those hips! They are the most stable joint in our bodies and some of our biggest, strongest muscles cross them.
Heart problems: because this is an activity that is usually more strenuous than we are used to, it taxes the cardiovascular system. And this is not only if you are older! We've seen seemingly fit people get heart attacks in their 30s! Allow enough breaks and rests and allow your body to handle the stress of this activity. Shoveling can trigger angina or a heart attack. If you have a family history of early heart problems, you should be particularly careful due to increased risk, and make sure you pace yourself. If you feel ANY of the following you should call 9-1-1 and get medical attention: chest pain or pressure (angina); dizzy or sick to your stomach; shortness of breath, gasping; very rapid or pounding heartbeat; excessively sweaty or cold and clammy; nausea, tense and nervous. For further info: http://www.heartandstroke.ca/heart/emergency-signs
Other tips to avoid injury
Be strong before your start! Among it's many health benefits, strength training gives you more capacity to do these types of tasks.
It’s all in the hips...and legs...and core...and shoulders.
We’ve come up with an exercise routine that addresses the injury risk factors associated with shoveling. We want strong shoulders and legs and a stable core. These working together are what you need to remain strong and stable when lifting and pushing snow. Part of the challenge with shoveling is the lifting and twisting involved. Adding the weight of the snow, and now we've amplified the stress on the body. Do this a whole bunch of times with improper technique and your body will say it’s had enough!
Research has shown the core responds best to practice stability challenging movements for a longer period of time. For example, holding a plank for 30 seconds. Because shoveling is an endurance event, we recommend holding these positions for a longer duration. The exercises listed below will help you gain strength and proper technique in your legs and arms so your lifts and pushes can be more effective. When performing these exercises, you want to feel your muscles become fatigued without losing proper form. Having an outside set of eyes can verify that your technique is correct.
Our sample generic exercise routine
Everyone’s needs can be different. The following is a sample program that works on the primary muscle groups used.
Core Circuit: Our goal is to build core endurance and bracing in a neutral position. This is best done daily.
Holding for 10-15 seconds: move from one to the next then repeated the circuit 6 times.
McGill curl up, birddogs, plank rocking, sidebridging, clamshell
Strengthening circuit: Our goal is to work the muscles we’d use pushing and lifting/throwing. This is best done 2 times per week.
Do controlled repetitions for 6 reps, using a weight that you find creates a 7/10 effort.
Split stance lift; Single arm press stepping forward; Split stance Deadlift; Suitcase carry;
Working your cardio by doing intervals is the most efficient way to work the heart and lungs. This can be done on any cardio machine or outdoors with running, cross country skiing, snowshoeing etc.
How we lift or push matters!
There are different positions that can stress or strain our body. Pushing the snow as much as you can is best. Keep it to smaller loads/shovel fulls. When you do need to lift, try to keep the shovel in front of you. A good rule is if it’s between your feet it means you are not twisting. Also try to have the weight of the shovel as close you as possible.
Consider taking a few minutes inside before you put on outer layers to get your muscles and joints warm. You will find yourself in many forward bend positions so it will benefit you to move in the opposite direction as apart of your warm up. This will prepare your body to move in the desired ways. Your goal with this routine is to encourage mobility and activate the muscles you will be engaging with moving with proper technique.
Try the following exercises to warm up:
Wall angels; Standing lumbar extensions; Hip hinging, Short stop squats for glut activation; Tubing pull aparts
Pay attention to how your body is feeling as you work through clearing the snow. Start easy and then go faster. This allows your body to adjust to the demands. Your body will feel general fatigue as you use it but you shouldn’t be feeling stress or strain in isolated parts of your body. Here are some areas of strain, meaning you are either over or underusing parts of your body, or your technique is not as effective as it could be. Having the awareness to tell the difference and knowing what you can do for yourself right then can help you nip it in the bud. The following are some general suggestions but you may benefit from getting a complete assessment at the clinic.
If you are having trouble with any joint pain, or pain that lasts for hours, you should get it checked by health professional.
Your heart rate will remain elevated for some time. You will continue to perspire as well. Cool down is the time you want to focus on allowing those mechanism to go through their natural process. Sitting on the couch the second you come inside will result in your body stiffening up. You’ve done a lot of bending forward, so to balance the stress to the body, it’s advisable to spend a bit of time moving your body in the opposite direction. The can be the back extensions on the floor or standing, or even going for a 10-15 minute walk around the block.
You don’t have to hibernate if you don’t want to.
We are seeing some light snow fall these day, now is the time to try some of these suggestions while the snow is light and the temperatures are tolerable. The bigger snow falls don’t come for at least a few more weeks so you’ve got roughly 4-6 weeks to get some of these exercises in to help you get ready for this inevitable task. If you aren’t sure of your technique or you want to do some preventive work with us one-on-one in the clinic, let us know! Injury prevention is apart of what we do!
by Dana Weber
So you have just been injured (maybe an ACL tear or something similar) and you’re wondering “would eating differently help my recovery?”
If your nutritional intake isn’t currently optimal (as like most of us) the answer is YES! Even if you are eating optimally though, your nutritional needs might be different now that you have an injury.
Seeing a Registered Dietitian soon after the injury can be incredibly important to your recovery. The dietitian will screen you for nutrient deficiencies, energy balance, and tailor recommendations to your needs to help you get back on your feet (so to speak).
Here are a few tips to help you recover from your injury, whether you need to have surgery for it or not:
1. Protein: Protein is a very important nutrient for building muscle. It provides the building blocks for cellular growth and repair, like those found in muscle, skin, and nails. It is also used to make enzymes and hormones. Protein is basically the structural and functional component of our body! Without boring you with the details, it is needless to say that protein is very important! It can also help us recover faster from surgery, injury, and illness.
Your proteins needs are slightly higher than normal when injured or sick. Try to aim for 20-30g of protein at each meal (at least 3 times a day).
What does this look like though? Here are examples of the protein content in several common foods:
Should I take a protein supplement powder? We usually do not need these types of products and should focus on meeting our protein needs from foods itself. We don’t need as much protein as some people like to believe we do. Our body can only handle so much at a time! The average man typically needs 60-70g of protein/day and the average female needs 50-60g of protein/day. When suffering from an injury or recovering from surgery, you will need a bit extra.
2. Consume Anti-inflammatory foods: When we are injured or recovering from surgery we likely have quite a bit of inflammation near the injured site. Some foods and nutrients can help reduce inflammation! Some of these foods include:
Should I take supplements? Again, it is best to focus on eating nutrient dense foods instead of relying on supplements. Large doses of anything, even vitamins and minerals, can be damaging to our body and organs. Discuss taking any supplements with your doctor or a Registered Dietitian first.
3. Avoid Pro-inflammatory foods: Just like some foods can help reduce inflammation, some foods can promote it. It is best to try to limit these foods while recovering:
4. Complex Carbohydrates: It is important to meet your energy needs. These needs may change while you are injured and can depend on changes to your activity level and mobility. While recovering, it is important to fuel your body properly with complex carbohydrates. By doing this, your body can use the protein you consume for repair! Carbohydrate and calorie needs can differ drastically from person to person. Great complex carbohydrates include:
Important Pre-Surgery Advice: If you are taking any supplements or natural health products, talk with your surgeon and anesthesiologist on whether these are safe during surgery. Some can interact with the anesthetic. You may be required to stop taking these products 2-3 weeks prior to surgery.
Questions or Comments? Please let us know below!
by Gil Magne and Robyn Edge
When was the last time you had to think about breathing? Breathing is subconscious, part of your brain is always telling your body to breathe. Like an app running in the background. We don’t have to think about it, it just happens!
Our lungs don’t move by themselves to breath. They rely on muscles to change pressure to pull in the air and push it out. This allows us to take in oxygen and get rid of carbon dioxide.
There are different muscles helping us breathe and there are different ways of breathing. We can breathe from our belly or we can breathe from our chest. To breathe from the belly we use the diaphragm. The diaphragm attaches to the low back and the deep core muscles that provide our spine with stability. This connection forms the top and the sides of the core like a can. The bottom of this can is the pelvic floor. When they work well together these muscles give us stability and strength for our whole body. More pressure from the diaphragm means more stability and strength in our core. As an added benefit, it also decompresses the spine!
But, if you breathe from the upper chest, this can create a lot of tension in the neck and shoulders because those muscles are designed to move the neck or shoulder. Of course they get tired, tense, sore, stiff, achy if they are doing a job 24 hours a day that they are not designed to do AND trying to do their job at the same time. This leads to tension headaches, tight shoulders, limited spine movement and poorer posture.
Why would we breathe from the upper chest in the first place? In a stressful situation the body responds with a “fight or flight” reaction. For our ancestors, this used to happen when a lion jumped in front of us! In those situations, our body needs the most amount of oxygen to fight our way out or hightail it out of there! The body responds to stress from any source in the same way. Whether it’s a lion, bad traffic or a boss getting on our case, the same stress reactions in the body occur. If this stress is present on a regular basis, and we breathe from the upper chest, that can become our default pattern.
With practice, we can break the habit of improper breathing and retrain the diaphragm how to do it’s job again.
How do we change how we breathe? The first step is awareness. You can lay down on you back, put a hand on your upper chest and the other on your belly. Now notice what moves and when. When does the upper chest move and in what direction, how about the belly? We want the upper chest to be calm and the belly to rise when you breathe in and fall when you breathe out. Start in a relaxed position (lying on your back or stomach), and practice breathing with the diaphragm. Then progress to more challenging positions like sitting, standing, walking, while exercising. The more often you practice the belly breathing, the more carry over it has to how we breathe the rest of the day.
When we breathe in this way, it causes an increase in our intra-abdominal pressure. Our core muscles react by tightening up, which leads to improved stability in the spine. Athletes that lift weights use their breath to be able to lift even heavier. In yoga and stretching, the way we control our breath allows us to move further into ranges of motion. Controlling how we breathe as we do different exercises can give us an advantage when we perform them.
Our breathing is the foundation of our movement throughout the day. It sets the tone of our body and determines how we move and stabilize ourselves through our normal daily activities. Working on our breathing can have a significant effect on our aches and pains, how we move and what we are capable of doing.
Have you ever noticed that your breathing has affected how you move or what you can do? Let us know! What were you able to gain when you started incorporating your breathing control into exercises?
Is it Runners Knee, Jumpers Knee, tendonitis or Just a Pain in the Tendon? And what should I do about it?
by Robyn Edge and Gil Magne
Getting better from knee injuries depends on figuring out the problem. It’s important to match the injury to the treatment. Finding out what is stressing the area, causing pain, should be done by a trained therapist before starting rehab. This article is looking at if the tendon is the source of the trouble and how we approach it’s healing.
Jumper’s knee is often seen in people who do lots of jumping (ie. basketball, volleyball, racquet sport, ultimate frisbee). Pain is felt just below the knee cap, partly on the bone and partly on the tendon. Runner’s knee is pain felt around, under or on the sides of the knee cap. Tendon pain is located on the tendon between the knee cap and the shin bone. Often this is called tendonitis, which is used as a bit of a catch all phrase. In the end, what we do for both of them is similar.
Tendons are made up mostly of collagen tissues which adapt differently than muscle and so need to be treated differently when injured. Often, people choose to play through the pain in hopes the pain will go away on it’s own. The result is an abnormal tendon, which has too many nerve endings and too much blood supply in the area. This means normal activities cause stress and pain on the area.
The treatment to remedy this problem is to stress the tendon with the right amount and kind of exercise. This stimulates the tendon cells to become stronger, and gradually it heals and becomes normal.
The best place to start is isometrics (holding a position while flexing the quad muscle without moving). This has been shown to help decrease pain and adds starts to load to the tendon that needs to get stronger. While you are doing this, you should also be reducing any extra load you are putting on the tendon. You will need to modify what and how much you are doing that is using the knee. For a short period of time, doing less stairs, running, etc is best until the tendon has had the chance to heal. When the tendon is ready, you can restart higher intensity activities to slowly build up your tolerance.
Next we want to progress to heavy and slow exercises. The body responds to this by building up the area and making it stronger. You want to progressively increase how heavy you make the exercise, and also gradually increase the speed of the movement when you can. Start with simple exercises that just use the knee then move on to more functional exercises that use the whole body.
Because the body is continually healing, these exercises need to be done on a regular basis. Studies have shown that doing the exercises twice a day is sufficient, but if you wanted to do more, it doesn’t hurt.
So how do you know if you are healing or causing a new injury? A good rule used with success is to do the exercise until it becomes uncomfortable but not painful. So on a scale of 1 through 10, 2-4 on 10 is OK, any more is too much and would be a good time to stop. Also, if you feel the discomfort for longer than 20 minutes after you have exercised, that’s another sign you did too much. Likewise, if there is no discomfort at all, you are not doing enough and probably will not be getting the body to respond and heal itself.
At this point, we guide you to start to build your power and reactive type exercises. But only once you have enough strength to tolerate this! These are things like running and jumping. Being gradual is important to make sure we don’t step back with our progress!
Don’t expect quick results, however, you should progressively be able to move more and more weight. It is important to do these exercises each day to ensure continually stimulation. Less than that and the tendon will take longer to heal.
Finally we’d get you back to the sport you want to get back to. Again, progressively doing the things that were previously painful, letting the body build up tolerance in order so you can do them fully.
Progress is usually measured in weeks and months with these things, depending on how long you’ve left it before getting treatment. So you definitely need to be patient and stick with the exercises for a good while.
These same guidelines also apply to other body parts like the Achilles tendon, tennis elbow, golfers elbow or the rotator cuff, we’d just change the exercises to load the tendon that’s affected.
Have you had this type of injury before, what’s worked for you? Let us know if you have questions in the comments below!
by Robyn Edge and Gil Magne
So I’ve got ACL surgery, now what? You’ll get specific instructions from your surgeon on what you can and can’t do with regards to your repair. This will include using crutches, ice, stretches, basic strengthening, and medication use.
Beyond the specific rehab for your injury, there is also more you can do to optimize your outcomes for recovery. In this article we will talk about:
Crossover training is an effect that exercising a muscle group on one side of the body leads to strength gains on the other of the body. Studies have shown that while your left arm is casted, exercising the right arm every day leads to maintaining the strength and muscle function of the casted arm even if you aren’t doing anything with it! But, those in the same studies that did not exercise would lose a lot of strength and muscle in the casted arm. Although your muscles aren’t doing anything when in a cast, the nervous system is still being trained.
After an ACL surgery muscle loss is going to happen, so working on the opposite side while healing the surgery side will lessen these losses.
Science doesn’t know the exact way this training works in the body, but it is believed that the majority of the effect of the training is happening at the brain level. Training the one side of the body causes the opposite side of the brain to also fire, leading to increased/maintained strength on the untrained side. Keeping the parts of your brain that tell those specific muscles what to do active allows for overlap in those regions of your brain.
These exercises can be as simple as isometrics (pushing against something and getting a muscle to flex without actually moving your joint), but the more you do that involves movement, the better results you’ll get. So we can use this for any injury that requires you not use a part of your body while allowing it to heal. You work the opposite side while the injured side is being protected, and this will lead to your recovery being much faster once you’re are able to move the injured arm or leg.
So this is useful if you had surgery or casted from a broken bone. What if you just pulled a muscle or sprained a joint? You can still benefit from doing these exercises. Muscles around an injury don’t work as well due to pain. So these exercises also help to wake those muscles up. Back to our ACL surgery example, you can do single leg exercises like bridges, leg press and leg raises on the good side, which will lead to faster recovery on the surgery side.
The next step is to get your body ready for doing the movement.
Motor imagery is the practice of thinking of the movement without any actual body movement. This can be done in two ways. You can view yourself as an outside observer, almost like you’re watching yourself in a video. Or you imagine being inside of your body, feeling everything that might be expected during an actual situation. Ask yourself, then think about, what has to move and how do you move if you wanted to jump. What does it feel like to push off of the ground, rolling off your toes as you jump into the air? If you’re not sure where to start you can move on your uninjured side and pay attention to what you’re feeling and how it looks.
This is training your brain to practice before you get to those motions. So, this is preparing your brain, getting it ready to learn how to move. If you’re not sure what it looks or feels like, we can use videos to help show you (ie. walking well after being on crutches, bending down well after a low back injury). Using these tools like this will help avoid or change the patterns that would have contributed to the injury in first place!
With ACLs, the common pattern for injury is the knee falling inward when you squat or jump, bike. So you would work on thinking about controlling the knee with these motions.
And finally, what about Nutrition! Healing the body requires nutrients and energy. Our friends at Precision Nutrition have set up a good article on the subject here.
Their basic points are that depending on the point of your healing process your are at, there are certain food and supplements that can help your body do its best job at what it’s doing at the time.
The earlier you can start all this the better! If you are not quite sure what to do, our athletic therapist, physiotherapist, dietitian are ready to provide guidance and specific recommendations based on your specific injury and situation.
What did we miss? Do you have any questions? Let us know in the comments below!
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by Gil Magne
Here’s a story I hear from time to time from frustrated patients with persistent low back pain: “I don’t know why I have back pain, I have a strong core… I do crunches everyday!” OR “I’m able to lift heavy things but when I go to put on my socks or pick up something from the floor it just kills me!”
Some interesting studies have shown that people with persistent back pain, tend to have stronger backs than people without a history of back pain! This seemed to show that if you have back pain, you tend to overuse your back and hence why you could be having pain. Makes sense right? If you were to go and do 100x more reps of any particular exercise, the muscles that you are using will be where you are feeling the burn/pain, but will also get strong as a result of this extra work.
So what else might be going on with your back that is causing your pain even though you may be strong? Here are some factors we take into consideration when assessing you and your back to help zone in on your problem.
The way you move: Maybe you’re moving and using your back more than other joints and muscles that could be taking that stress better. Often when someone is overusing their back, they aren’t moving their hips well, or a stiffness in the foot/ankle, or upper back as a limiting factors., If you are having trouble with specific tasks such as lifting, or walking, etc a movement assessment would point us in the right direction for what would need to be corrected. This type of assessment allows us to see how you use your whole body in unison to complete the tasks of your daily life.
How much you move: Maybe you’re moving or in a posture in a way that is repetitively stressing your spine in one direction. The spine often gets irritated by repetitive movements and would have a hard time recovering if your are continuing to load it in the same way!, If my door swings open and hits the wall, it will leave a mark. I can fix the mark, but how long will that last? If I don’t fix the door hitting the wall, it will just continue to leave a mark on the wall! Sitting with poor slouched posture, standing with poor stability, leaning over to one side are all examples of what we see regularly that can contribute to repetitive stressors on the spine leading to aches and pains.
Your core endurance: Your core is likely strong enough, but has a lack of balanced endurance. Strength is an indicator of how much you can can move or lift, and endurance is how long or often you can do it. The way we should be using our core to limit the stress on the spine is steady and controlled over time. This core acts like a buffer and shock absorber for your spine, and if the endurance is lacking, then you may find that over time with repetitive tasks you start stressing and irritating your back because you are unable to keep up with the right way to move. If you are finding that you are OK if you do a handful of repetitions, but then seem to have trouble after a certain amount of time, this might be part of the problem. So testing your endurance and comparing left to right and front to back would help give us an idea.
In our future posts, we will go over each of these components to see what you can do to improve them. To find out what YOU need for YOUR back, we could figure it out by putting you through a movement, mechanical and endurance assessment at the clinic.