Wobbly sticks and string

Posted by

Most people have seen a tensegrity model. These are clever constructions of sticks and elastic that use balanced tension and compression to created self supporting shapes.

(Image taken from http://dotensegrity.blogspot.co.uk/2011/01/make-your-own-tensegrity-model.html)

It is possible to consider the body as a tensegrity model, where the bones, muscles and ligaments all act together to support, articulate and move.

Although simplistic and missing huge elements of the effects of fascia, organs, inflammation and so forth, it is a useful analogy to hold, especially when trying to educate patients.

Recently, I have been considering the lumbar spine and the need for good abdominal support around it. The metaphor I use it that of a wobbly stick attempting to link upper and lower halves of the body. The pelvis is a fairly stable, solid object and the thoracic spine is well held with the ribs. This leaves the cervical spine (a wobbly stick with a block on top) and Lumbar spine to do a lot of work. Therefore, we need plenty of active muscles recruited to provide stability, support and movement.

So, no matter how much we may train that six pack and work to get well toned abs, if we cannot recruit them during activity, its fairly pointless.

I have 3 basic exercises I start with for every patient and, if they can do those, move to the next level. These are:

Pelvic control: The patient lies supine, slides one heel up the couch or floor, whilst attempting to maintain a level pelvis, the ASIS not deviating significantly posteriorly. Recruitment of the TA is particularly useful in this.

Cat crunches: On all 4s, the patient pulls their navel towards the spine, attempting to keep everything else still. A count of 5 and release slowly. This helps recruit deep obliques and the thoracolumbar fascia attachments.

Gluteal raises (trendelenburg drops). The patient stands sideways on a step and allows one leg to drop. They raise it back up again, using the opposite glutes, minimising recruitment of QL or lumbar erector spinae if possible.

Once they’ve got these, then the neuromuscular paths are working better and we can progress to more dynamic tests.

No more wobbly stick, less back pain.

Thoughts on taping

Posted by

2

Having recently attended a very interesting taping course, I have been thinking more about possible mechanisms of function.

If you have not worked with modern kinetic tapes, they are woven cotton strip, normally 5cm wide, with an adhesive backing. The materials used in manufacture mean that the tape has the ability to stretch, allowing it to support or follow the skin. This also means that it has less ability to support or inhibit motion, since there is less strength in the cloth.

The tape can be applied either under tension or free, which apparently gives it different functionality and there is some evidence that it is effective, not just in supporting injuries, but also in reducing eodema and bruising.

It is the method of function that interests me, as unlike the older zinc oxide white tape, which is used to immobilise and support an area, this is used to guide and improve movement.

Others are doing far better research on this, but my overall impression of this tape is that, rather than guiding a muscle or joint through the physical properties within the material, it is improving neuromuscular feedback and athletic perception of the affected area, in turn leading to better patterns. I also suspect that it is dynamically guiding the fascia, around the structures, which in turn is improving the allowed function there. And, as we know, the fascia can connect many apparently unrelated structures so again, complete examination is required to ensure the most effective placement.

With these thoughts in mind, I am considering the use of kinetic tapes more in my practice and attempting to be more creative with their application.

The use of compression wear in recovery from injury

Posted by

Many people use compression wear for racing, training and recovery. However, I’ve been thinking about using for recovery from injury.

As of yet, I haven’t been able to design a suitable controlled trial but we have been trialing it in clinic with some athletes and other active clients.

We noted that it seems to help improve recovery time in people with both calf injuries and tendonopathies. It appears that the compression wear (in this case compressport calf guards) helps reduce buildup of oedema when worn overnight and support the muscle during everyday activity during the day.

We are going to continue trialing this and hopefully will have sufficient day to draw a more solid conclusion soon but i thought i’d put it out there for general consideration. We are also going to try the quad guards for hamstring and quad injuries if suitable clients present.

Movement

Posted by

We need to move, we evolved through movement. Its just that with our current life choices, we don’t move enough. We have cars, internet shopping, sofas, take away food. We no longer need to hunt, track, think or work for dinner. Our survival no longer depends on moving.

If you watch a child, they move naturally and gracefully. No one has taught them to keep a straight spine and bend at the knees when lifting, they just do.

And if we look closer at their movement patterns in comparison to ours, we can see that they initiate their movements from the centre, the torso, long before the limbs are used. This is where they know they have power, not in the shoulders, arms or legs but starting, rooted in the core. As adults, we have learned that our arms and legs are strong and neglect the trunk, the point where it is all connected.

A common set of movements, sometimes known as the primal movement patterns are, in developmental order:

Flex
Twist
Push
Pull
Squat
Lunge
Walk
Run
Play

We should become like children again and do these every day. Only then will we start to find out how we are restricted and what we need to change to get the best from our bodies.

80:20

Posted by

1

There is an idea called the Pareto law. This says that 80% of the work takes 20% of the time. It can be used in almost any situation, from business management to problem solving, personal training to writing a book. I use it to illustrate a patients recovery plan (and will try to cover this in a post soon).
I also think it applies to our area, not just in terms of treatment processes, but in terms of techniques.Far too many people don’t use their training, expertise and experience sufficiently when working with clients. Instead they fall back on what they know works and do the same thing for everybody. (80% of problems can be solved with 20% of our skill). But every body is not the same. Each client is unique and each time we see them they have changed.

From a therapeutic perspective, this means that we need to reassess and reinterpret them each time, not just do the same thing and hope it will work.

When carrying out a fitness program, this also stands. We can draw up a framework for the series of sessions but need to be flexible enough to modify it as necessary. We should and need to concentrate on what they are saying, how they are responding and whether we are achieving their goals. In either mode, we especially need to take into consideration current research and thinking to ensure we are up to date with what the experts are doing. As with every other part of life, we need to remember the loop: observe, think, apply. Only then will we be doing the best for our clients and ourselves.

T4 / Rib 4 Problems

Posted by

1

I have recently been thinking about the connections between the ribcage and shoulder pain. From this, I have noticed a couple of connections.
The main one is dysfunction around rib 4 either side leading to pain in the same side shoulder and arm. This has typically presented as pain next to the scapula, tension in trapezius and radiating pain down the triceps into the forearm. The patient typically has a history of desk based work or driving, with the pain often coming on waking or after coughing / sneezing. Examination shows restricted thoracic spine and tenderness on the ribs, both sternally and on the spine. Having tried to research this, I struggled to uncover much that enlightened me, other than a chiropractic diagnosis of T4 syndrome, which doesn’t really match and often seems rather vague.
My view is that the symptoms are actually caused by fascial tension and pain related muscular spasm, so fascial release, gentle manipulation and soft tissue treatment can have an apparently miraculous effects on some people. I also do some cranial / functional work anteriorly to re-centre and balance the ribs / fascia.
From this, it has been useful to be able to rapidly assess the motion of the spine. Although a detailed examination is always important, it is useful to be able to have a rough guide as to where you should be looking.

Supine, where the patient lies passively and you use their bent knee to create rotation in the spine, blocking at the pelvis, ribs and shoulder to isolate the main sectors. This is following a simple standing active examination, where the patient attempts the main spinal movements of flexion, rotation and sidebending.As an extension of that, I started getting patients to attempt “monkey”. This is an Alexander technique standing posture, which is meant to demonstrate balance within the spine (my perspective). The most important thing to know about Alexander technique (other than it is really rather good and a couple of lessons from a good teacher is worthwhile, I recommend a number of patients to my local teacher) is that it is all about intention and the mind being in charge of the body, so speed is always controlled.To move into a version of monkey posture ask the patient to do the following:

1) Get them to stand comfortably, feet parallel (check, lots externally rotate to minimise loading in the glutes)
2) Bend the knees slightly
3) Bend forward at the waist, spine straight
4) Let the arms hang loose
This is a german video of a man sitting down, but if you stop half way, its monkey.
What I noticed is that most cannot bend solely at the hips without looking down and treating any thoracic restrictions allows them to move much better.
The reason for all of this is to demonstrate treatment further away from the area of complaint and to look for other areas of compromise in their movement patterns. They may also find cervical and lower limb problems start to surface. Once this has been physically demonstrated, it is easier to achieve compliance in terms of future treatments, exercise pescription and general understanding of their body.
And for a positive patient outcome, this can be used as part of their ongoing exercise plan.

Tonight we dance: Lower back pain, tango and movement

Posted by

1

My friends recently bought a wii for their family and watching them play a dancing game, I noticed something that had been slowly dawning on me for a while.

One of them seemed a little more fluid than the other but as they are all very fit and active, at first I couldn’t understand why.

The answer appears to  lie in the lumbar vertebrae and their apparent lordosis. One of them had a slightly more lordotic spine, with more resulting anteriorisation in the pelvis than the other.

From that, the pieces fell into place. Shortening in the quadriceps and psoas had led to a slight increase in the anterior tilt of the pelvis, in turn reducing the available motion in the lumbar spine.

This pattern can commonly be seen in the wider population, especially those presenting clinically. On examination, we will generally find tight glutes, shortened psoas, a slight medial rotation to the thigh, hypertonicity in the superior insertion of quadratis lumborum, an anterior tilt to the pelvis and restriction motion in one or more planes in the lower lumbar spine. If active, they may also report hamstring problems.

Clinically, resolving this can have several approaches, depending on the level you wish to work. Posteriorise the pelvis (one colleague uses MET of the hamstrings, another does it manually side lying), lengthen the quadriceps, stretch or release any psoas restricitons and work on any QL points. Other, more distal, areas can then be incorporated to address the underlying issues that the body was adapting around. This is where it becomes interesting and the individual practitioners preferences come to the fore.

Once treated, this can often be prevented from returning by regular stretching and, interestingly, regular dancing or hoola-hooping! Both of these activities help keep the spine mobile and fluid, encouraging good movement patterns and core integration. And Tango? Particularly for the ladies, this elegant form of dance requires excellent upper body posture, with the ability to stabilise and extend the pelvis and leg smoothly.

As ever, all problems are individual and should be investigated professionally. None of the information above is a diagnosis or treatment plan.

Foot strike, thinking backwards?

Posted by

3

There are lots of discussions at the moment on running, foot strike,injury and so forth. These discussions have probably been around for as long as people have gathered to talk about the science of running.

Which is odd, as we have been running for far longer and seem to have got it pretty much right for the majority of that time.

We talk about heel striking, forefoot striking, a midfoot pattern and all combinations in between. Yet it is inevitable that the foot is going to strike the ground, Gravity always wins!

Why not, instead, think about how the foot pushes off again. That, to me, requires far more thought as it has to happen consciously. And a good push off has to have come from a solid foot strike.

Rather than concentrating on how the foot strikes the ground, think about the feeling of the correct area of foot pushing off, the forefoot driving away, the force passing through it and propelling the runner forwards. For this to occur, all the muscular chains have to fire correctly.

So perhaps we should turn it upside down and think about driving forwards, not striking, and see if that makes a difference.

By all means wear minimal shoes, learn to run barefoot (it is bio-mechanically highly efficient when  learned properly) and look after your body, but flip the idea upside down every now and then.

Program design in fitness

Posted by
Following some recent research, I have been thinking about the way we approach fitness training.There is some evidence that there are 2 modes in the body and we need to activate both for the best output. There is the short time, high intensity work and then the long, slow output.The problem is, when we train with people, we don’t focus on these, we fall onto the middle ground. It’s easy. We don’t need to work hard, we don’t need to push the client. But then they don’t improve, they get disheartened and our reputation isn’t enhanced.

Instead of taking them for a jog around the park, change it up. Make them sweat, push them hard. Use the primal patterns, look at complex movements if they are capable of them. And if they’re not, get them ready.

And then guide them to being more active every day (the long slow stuff). Help them change their diet so they eat clean.

They will see changes and you will enhance your reputation too!

Blood pressure and treatment

Posted by

An article in New Scientist in November 2010 noted that a group of researchers had successfully managed to lower a group of patients blood pressure by 10mmHg. This is significant because, as they stated, this reduces their risk of stroke and earlier death by approximately 30%.

It seems to work by affecting the nerve supplying the kidneys. Which got me thinking that, if they were able to reduce the pressure via the nerves, surely maximising the health of the nervous system would also have the same effect.

This is not a random and unsubstantiated claim that Osteopathy can do this directly but we do know that treatment affects the nervous system and therefore if we can maximise patient health, then maybe this would have a knock on effect, helping the neural supply to the kidney as well. In fact, whilst at college, I was aware of a fellow student who was measuring the effect of cervical manipulation  on the blood pressure of the patient, but I am unaware of her outcomes.

Of course, the best thing to do would be conduct a nice randomised controlled trial but as with many things osteopathic, this would be difficult to do, if for no other reason than the funding.

However, it is something to bear in mind as we treat.

We should, of course, always bear the patients blood pressure in mind when we are treating, since it is a risk factor in cervical manipulations and, as potential primary care practitioners, we may be the first person the patient has been to see for years.

Out with the syphg and onwards to better health!