movement

What Physios don’t want you to know

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And osteopaths, chiropractors or any other manual therapist.

Unless they are making special claims for their technique,  which they can back up with evidence,  the truth of the matter is that all manual therapies are doing one of three things-

  • Breaking down adhesions, scar tissue and restrictions, whether in fascia, muscle or connective tissue
  • Resetting the joint position sense and neural signalling around the affected area
  • Improving fluid flow and drainage of the tissue.

That’s it, that’s all we do. However, the reason you need to keep a good osteopath or physiotherapist on speed dial is because the real trick is knowing which one needs to be done, what tools and techniques should be used when, how and where, as the true cause of the problem may not be at the place it hurts.

One classic example of this, that many have suffered from and lots fail to treat effectively,  is plantar fasciitis. The too familiar pain lancing into the sole of your foot when you first stand up, it is caused by inflammation and microtearing in the fibrous tissue running along the foot, generally near the heel. Traditional treatment is to brace, stretch and possibly inject cortisone, all of which take time and often fail to address the question why it failed in the first place.

A better complete approach, using the above concept,  is to not just treat the foot locally,  but look away for restrictions and signalling issues elsewhere as well. Only then,  once the underlying issue is addressed,  can real recovery and progress be made.

Gym free exercise of the day.

2 minutes breathing practice while swinging arms and legs to open the joints.

3 X 30 seconds skipping on the spot, imagining a rope if space / equipment restricts.

5 x 1 minute Burpee superman interupt. 30 secs recovery between sets.

Squat down, thrust legs back to pressup position,  lower your chest to the floor then take hands up above the head to full extension. Raise opposite hand and leg off the floor. Repeat for the other side, then hands to chest, push up, legs back in to squat position and jump up.

2 minute breathing practice, with stretching.

Notes-

The objective of the warmup is to check and prepare joints for range of motion,  followed by getting the cardiorespiratory system ready.

The core of the workout is to get every muscle in the body firing to stimulate a high level of intensity. By lifting the arms and legs off the ground,  you break the fascial tension that can be used as a spring rebound mechanism,  so it becomes harder.

Scaling if you are unable to do burpees or pressups would be 3 standing air squats with a pause at the bottom, followed by 3 kneeling pressups with hand / leg lift. If the pressups are still too challenging,  wall pressups (pushing off the wall) followed by arm / leg extensions. If in doubt, try the one you think you might fail at to push yourself.

One foot in front of the other 

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The oft quoted line is “A journey of a thousand miles starts with a single step”

What’s conveniently ignored is the subsequent steps. The ones up hills, through blizzards, rain and so forth. Inevitably our mythical mystic would have encountered these but they are brushed under the metaphorical mat unless pertinent to the retelling. 

A better narrative might be the one that admits such adversities and encourages progress and learning in spite or through the challenges. 

The trick is to maintain momentum, use easy moments to help carry over the harder ones and to accept that all things must change, all things have an end. 

In a running race, use the down and flat to recover, in a lifting competition, tactics, in the pool, don’t fight the water when tired and in life, take delight in the simple pleasures before the fading light. 

Semper Pergendum Sine Timore

Forward without fear! 

Why walking in their shoes will give you new insights.

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To understand someone better, it is said that we need to walk a mile in their shoes.

This is perhaps a little extreme but as with many statements, there is a lot of truth buried in there.

Walking in their shoes, or at least picking them up and looking closely at the wear patterns, both inside and out, will tell you much about the person’s interaction with the world. Do they currently have a prescription orthotic, or some form of insole? How has the outsole worn? Are both sides worn in the same way? Can you see the way the foot turns and loads inside the shoe?

By observing and considering the information provided, it can be possible to start gaining a better insight into how the person moves and hence any potential issues they may be adapting for.

If necessary, stand up and attempt to physically mimic their movement, and what leads them to that positioning.

Feeling it in your own body can be an eye opening experience and one that may hugely enhance your own practice.

Here’s why your six pack won’t make you a better runner. 

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Most core exercises are a waste of time. They will not make you a better athlete. In fact, they could be slowing you down and creating injuries. 

Why? Because for athletic performance in any discipline, one of the most important functions is the ability to connect your upper and lower body effectively and efficiently without shortening your front. 

The function of the abdominal muscles is to link upper and lower body, provide stability to the lumbar spine and pull the rib cage down during certain motions. 

A short anterior (front) from too many crunches or planks will reduce your hip mobility, create an unwanted curve in your back and reduce the power you can produce. 

To overcome this, by all means do your stability and integration work, preferably under professional guidance to give dynamic feedback but then lengthen and mobilise the front again (for example cobra stretch or warrior poses if you have no spinal or other issues). 

By having a long and fluid front, to work with a strong back, you’ll be closer to optimising your performance and breaking that PB. 
And of course, if in doubt, seek guidance from an experienced professional. 

Pain is not normal

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Pain is the body telling you something is wrong. It is driven, as with most things, by only a few factors – Degeneration, disease processes or dysfunction. However, as we age, we tend to normalise it, put it down to getting older, one of those things or to be expected. We are even told this by medical professionals, which reinforces the myth.

Aging happens, it is better than the alternative. Some of the processes of aging are unavoidable but many are not. By attempting to eliminate those triggers we can control, through correction of function and awareness of degeneration, then the pain left is triggered by either a disease process or changes which have already occurred. With the miracles of modern medicine and the bodies inherent desire to heal itself, even the majority of these can be improved with time, patience and external intervention.

Prevention is always better than a cure and the necessary activities to prevent degeneration are all things that we know. Eat a nutritious, well balanced diet, maintain a sensible weight, exercise regularly and moderately including resistance work. Dysfunction can be reduced or prevented by considering the way we use our bodies and becoming aware of our senses more. We are sensory creatures and yet spend so little time in our bodies that we recognise only those signals that are big enough to break through to our conscious awareness.

You do not need to live with pain unless there is a known and unavoidable reason for its presence. Even then, osteopathy and allopathic medicine can both help, together with self driven changes to give you back control. With a good working diagnosis and a plan, the future can look far brighter.

5 points to being pain free:

1) Get a diagnosis of why you have pain. If you don’t understand why, you can’t change the triggers
2) Start a treatment plan that you are actively involved with
3) Get your life patterns in order. Change diet, exercise or other factors that can influence the pain
4) Engage with the pain and take control, mentally and physically
5) Practice mental and physical activities within a pain free framework every day

The Camford Clinic
http://www.the-camford-clinic.co.uk
01420 544408

5 easy ways to stop back pain

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Over 70% of adults will suffer from back pain at some point and this number is rising every year. We all use our backs every day without thinking about it until they hurt.

Whether its from acute discs to muscle spasms, trapped nerves to torn ligaments, there are lots of ways for them to go and some easy ones to prevent it, without resorting to pills and surgery. Techniques doctors don’t always have time to tell you but save you time, money and worry.

  1. Move regularly. Your back is often painful if you sit for too long. The muscles go weak, the ligaments holding the bones together stretch and pain is the end result. Instead, walk a bit more, sit a bit less and use those muscles. Exercise doesn’t have to be gyms and furious sweating, simple moves at home will do it.
  2. Lift Properly. Whether it is a bag of shopping, a suitcase out of the car or a small child, we often lift very heavy objects without thinking and without doing it properly. Even if you can only manage a few of these items, they will massively reduce the risk. There is a simple way to remember lifting:
    1. Stop: Stop and think about the lift. Is it too heavy, too bulky?
    2. Face: Move to face the object. Twisting, bending and using the spine is the fastest way to cause lots of damage quickly.
    3. Brace: Pull your tummy muscles in. They are orientated so that they help support the spine safely but we often neglect to use them.
    4. Legs: Bend your knees, back straight and lift by pushing your heels into the ground and driving through your bottom.
  3. Stretch. If we spend too long sitting down, all the muscles at the front of us shorten, all the muscles at the back lengthen and we develop imbalances that cause pain when we try and stand up. Simple stretches can make an enormous difference to how you stand and move.
  4. Lose weight. If you are overweight, every step you take creates excess load on all your joints, even the ones in the spine. Your back has to take more force in the wrong directions, increasing the risk of it hurting.
  5. See an Osteopath. If in doubt, see an expert. Preferably before it starts hurting and you need the emergency appointment. Osteopaths are able to see where it might go and help free you up, allowing you to enjoy life without worrying.

Try these before its too late and you’re laid up.

Movement

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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.

T4 / Rib 4 Problems

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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

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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.