Healthy Holiday Tips!

As 2014 comes to a close, you can expect a number of people with resolutions for the New Year.  Here are some health tips you can focus on:

1.  Focus on GOOD MOVEMENT

There are tons of training techniques and exercises with too narrow a focus (ie. biceps curl.)  Think more about the types of things you are doing in life and use those as your training tools.  Practicing good lifting, carrying, pushing and pulling will help guide your program for the New Year!

2. Always keep practicing

Some people do the same exercise program and find that they get bored after a while with the same exercises.  If you find you are bored of the same exercises, focus on improving technique, tweak a few things with these exercises and you will find it will improve your performance.  In my program, I am always looking to improve my pull ups, my squats, my deadlifts.  I know when I do a bad rep and when I do a great rep. 

3. Have a bit of fun with your exercise

No need to go to the gym and be intimidated by all the fancy equipment and all the people there.  No need to rely on an expensive machine that limits you to one defined movement.  You can use stairs, dumbbells, kettlebells, weighted vests, or even just using your own body weight.  This equipment (or lack of it) gives you more freedom to do thing that you would do in sport or for your daily activities.  If the gym isn't for you, try an exercise class, or yoga, or swimming.  Do something active with friends.  Whatever you choose, make sure you are enjoying it! 

4. Try something you aren't good at

Its always good to try something new.  How will you know whether you like it or not if you don't try it?  It can be scary trying something new, but once you take the first step the rest of the journey gets a lot shorter!

5. Take care of yourself

Everyone gets busy, but make sure you are taking time to take care of yourself.  Whether it is chiropractic, massage, acupuncture, or meditation, make sure you are taking some time for yourself through the year.  It is really a small investment in time and money that will have a huge impact on your future and your ability to remain healthy.


All the best for the holiday season! Looking forward to 2015!

The Crowbar Effect and Low Back Pain

Sometimes I like going back through some of the research articles I have previously read.  I find that I can always refresh or learn something new/again from many of these articles.

One of my favorite articles explains a "Crowbar Effect" that occurs in the low back with slouching.  This is exactly what most people experience when they sit! 

When we sit in a slouched position, the pelvis rotates posterior (hips roll backwards) and spine moves forward as we lose the lumbar curvature in the back.  As the curvature is reduced, the back stiffens and is akin to a "bar."  Ligaments that attach from the spine to the pelvis act as a fulcrum around L5 causing the proposed "Crowbar" effect.



They also propose that two conditions must be fulfilled for the crowbar effect to occur:

1.  Loss of lumbar lordosis (lumbar curvature)

2.  Body weight placed behind the ischial tuberosities (those bony bumps you sit on).

If you look at figure 4 in the article, it has some great diagrams to show "good" and "bad" sittinng.

If you work at a desk job, or you happen to do a lot of driving (sitting) this article pertains to you! 

The article can be viewed for free here

3 Exercises You Should be Doing Every Day to Improve Your Health

These are my 3 exercises to improve or maintain your health

1.  "Shoulder Blades in back pockets"  

Most people tell you to "sit up straight" or "stand up straight" by sticking your chest out and putting your shoulders back.  The problem with this is that most people tend to over-correct and reduce or minimize the curve in their thoracic spine (mid back).  In fact, if you have "pinched your shoulder blades together" you can sometimes feel stiffness or pinching in the mid back. 

I prefer showing people to slide their shoulder blades towards their back pocket.  Like magic, their shoulder blades flush against their rib cage (reducing scapular winging), and their mid back slouching automatically becomes corrected.  Most people even notice the curve in their neck becomes more normal with this exercise. 

2. "Pick up something off the ground"  ie. Deadlift

When most people pick stuff up off the ground, they tend to do so by bending the back (typically forward flexion of the lumbar spine). 

I aim to show people how to minimize bending of the back and maximize bending of the hip.  The hips are an ideal joint to use as they have a tremendous range of motion.  They also have large muscles (glutes) attached to them which are much more efficient at lifting (heavy) items as opposed to the low back muscles. 

3.  Deep Squat

Deep Squatting is very important for maintaining range of motion as we age.  You don't have to lift heavy weights to go into a deep squat (although if you are weight training, it is good to develop strength through full range.)  For range of motion (particularly the hip joint), if we don't use it, we can lose it.  This is a great way to defend against arthritis of the hip.  Cartilage in the hip (and the rest of the body) does not have a blood supply and thus needs to be "squished" to bring fluid/nutrients into and out of it.  For this to happen, we need to put joints through full ranges of motion. 

The Simple Cure for "Text Neck"

There has been an explosion over the topic "Text Neck."  There is a (scientific?) article that stated that people who text are at risk for putting their neck under undue stress.  This model crunches numbers and states that every inch we move our heads forward we put increasing force through our neck. 

The good news!  There is a simple cure!  Move your head and neck (and don't text for hours!) No need to sit up straight, keep your shoulders back, keep your eyes level.   JUST MOVE!  Don't be one position for a prolonged period of time!I have no doubt that the text neck posture does put some increased stress through cervical facets (the joints in your neck).  The cervical facets are angled like shingles on a roof.  When our neck is bent forward (such as reading a book, or when staring at a computer for hours, which is probably worse than texting) the joints get compressed.  Over a significant amount of time, this may cause degenerative conditions through the cervical spine. 


I would agree that the text neck posture is not a good position for your neck to be in, and if you minimize the time your neck is bent forward, it will reduce forces through your neck.  I think people are more at risk for other serious issues with texting such as texting and driving, or not paying attention to where you are walking while texting.

Please don't text and drive!

Stop trying to teach people "Perfect form." There is no such thing!

There is no such thing as perfect form, only good technique. There is no "one size fits all" for exercise and athletics. Seem like semantics? 

I was asked this question from a trainer once:  "If you had a 16 year old baseball player that threw a 90 mph fastball, but his throwing motion looked funny, do you tell him he needs to change the way he throws?"  If you do change his mechanics, how will that affect his velocity? 

I see this at the gym all the time.  People trying to "correct" each others form.  For example, I was resting by the squat rack today and someone was trying to teach someone how to squat.  They were telling them that they need to narrow their stance, and point their toes straight forward, and keep their knees from going over their toes, and to stick their butt backwards, etc.  I don't think it even occurred to these people that they may have a different shaped pelvis, different femur/tibia lengths, different ankle mechanics.  This is exactly why some people can squat comfortably and almost sit their butt on their heels, and why others have trouble getting thighs to parallel. 

When I am teaching/coaching someone exercises, I often give them as few instructions as I possibly can.  For squats, my instructions are usually as simple as; "let me see you squat."  If corrections need to be made to technique, we start by make alterations from there. 

The moral of the story is that everyone does things differently.  We should stop trying to make everyone do things the same way.  We should allow them to work within their limits and try to improve on technique with every session. 

Health is not "Self Help" Help me...Help you

I love my job!  I love helping people (get out of pain) and to teach people how to move better and be healthier.

I am not one to brag, as many who have seen me for treatment can attest to.  However, I am good at what I do.  One of the reasons I am good at what I do is because I am constantly learning.  I consider myself an expert in the field of health.

This is why I went to school for 9 years.  This is why I have done countless hours of continuing education.  This is why I read up-to-date papers and articles on topics pertaining to health. 

I do not give advice about things that I know very little about.  I will never tell a rocket scientist how to build a better rocket.  I will never tell an engineer how to build a better bridge.  Why is it that people feel it is appropriate to offer health information when they are not in the health field? 

Just the other day, I overheard a lady lecturing numerous other people to "eat more bananas if you are getting cramps."  How can she offer this advice without knowing someone's medical history?  Or without knowing the anatomy or physiology of muscle?  Where did she get this information?  Probably something that her mother told her when she was getting muscle cramps.

A gentleman was talking to another guy about various stretches he needed to do to get rid of his back pain?  Maybe the stretching was appropriate in his case, but why is it appropriate to pass this along to other people. 

Health should not be self help.  If you do not work in the health field, please refrain from offering your opinions and advice.  My advice:  seek professional help. 

Stop working out in the 80's. Stop isolation and muscle group training

I know it takes time for paradigm shifts to occur, and I do believe that strength and conditioning is going in the right direction, but I still see people in the gym that are stuck in the 80s with their training techniques.  Here are a few questions for you if you are still training muscle groups and trying to do isolation exercises.


1.  Can we really "Isolate" a particular muscle?
It is actually impossible to "Isolate" a particular muscle.  Even the most strict bicep curl would require core stabilization, leg activation, scapular stabilizers and forearm flexors and extensors.  How can we really call this exercise an "Isolation" exercise. 

2.  Is there a time and place for isolation exercises? 
I suppose that for the initial stages of rehabilitation, or if you happen to be terrible at coordinating movements, some "isolation" exercises may be beneficial, but I would highly recommend taking the training wheels off and progressing as quickly as possible.

3.  Is there a benefit to training muscle groups? 
If you were a body builder (and I know a few people who are) then I can see this as being a good way of training.  For most people who are training for strength, fitness, or weight/fat loss, I think it is a lost cause.  People need to shift their thinking to training movements (pushes, pulls, lifts, drags/carries, tosses/throws).



It is ironic that most gyms are full of equipment/machines that minimize movement and variability.  These machines are typically only good for one movement or "muscle group" (and are often very expensive for gyms to buy).  It is also ironic that people are so scared to use anything other than machines for fear that they are going to injure themselves.  However, if you happened to get out of bed this morning, go up or down stairs, carry groceries or a bag and tie your shoes, without injury, you qualify for access to the other parts of the gym where you can practice good movement and work to achieve your fitness goals.  

 

5 Reasons you SHOULD NOT stretch if you are STIFF

There appears to be a common belief that if you are stiff, you need to stretch or increase flexibility.  These beliefs are unsubstantiated and often come with little evidence that stretching is good for you. 


Before I go on, I should qualify that I am not against stretching.  If there is a functional reason to increase flexibility (more importantly, mobility) then I would recommend stretching.  However there are a lot of reasons that we would want to maintain or even increase stiffness.  Here are some of those reasons:

1.  Increased stiffness increases power output

Increasing stiffness increases power output.  This is important for athletic performance and for daily activities.  Think about it this way; if you were to hit a baseball for distance,  you would prefer to hit it with a bat and not a pool noodle.  Why?  The bat is more stiff than the pool noodle and is better suited to transmit force to the baseball.  Our body is the same way.  Most of the time with activity, our goal is to "Stiffen" our core to transmit force to our limbs so we can kick or throw a ball, or even push open a door. 

2.  Stiff muscles are like springs.  More stiff = more speed   

I find it interesting that with most athletic events, I see people stretching before a game.  I would agree that this would be appropriate if someone was too stiff, but there is an optimal amount of stiffness for athletic performance and why would you spend time trying to get rid of it?  Muscles in the body act like springs.  A stiff spring would be better at producing increased speed as opposed to a loose spring (like a slinky).  Again, I qualify, there is an optimal amount of stiffness.  Too stiff is no good, but neither is too loose or flexible.

3.  Increasing flexibility increases the chance for injury

This should just make sense.  If something is too loose or wobbly it makes it difficult to control.  The joints in our body are controlled by muscles (and passively by ligaments and joint capsules).  If a joint wobbles around it increases the chance for injury or irritation of said joint.  Imagine driving down a bumpy road with a car with loose steering.  It would be difficult to navigate the car.  If the steering was more stiff, it allows for more responsiveness and more control.  However, too stiff is not good either.

4.  Muscles don't really stretch much

Most of the time when we stretch, we believe that we are stretching out muscles.  However, we forget about all the other tissues we are stretching including tendon, ligaments, nerves, fascia, collagen.  In the chain of tissues we are stretching, muscle does not get stretched as much as we think.  For example, if you stretch you hamstring in a typical hamstring stretch, the deep ache you feel in your hamstring is likely the sciatic nerve that is being stretched and not actually the hamstring.  It would be like stretching an elastic band and a rope together.  Both will only stretch so far, but the rope would limit the stretch of the elastic band.




5. Joints tend to stiffen up after injury

Joints try to stabilize themselves after there is injury to surrounding tissues.  This is a common response to pain as increased movement typically causes increase pain (particularly if the joint itself is the pain generator).  Isn't it interesting as therapists often prescribe stretches to "loosen up tight joints" when the body is trying to stiffen up to reduce movement of said joints? 

Stiffness should not be seen as evil.  I believe that more needs to be done to harness stiffness to improve performance and activities.  Stretching is not a bad thing, however I find that it is often over-prescribed and poorly executed.  

Pain alters Movement, and Movement affects Activity. Stop being in pain

It is pretty clear that being in pain alters the way we move and the things we do.  Why do people seem to think that if you just ignore the pain, that things will be fine.  Could it be possible that ignoring pain can make things worse...a lot worse?

 

It is difficult for an observer to measure pain, but it is pretty clear for someone who experiences it.  When we experience pain, it is our brains perception that something is not working properly.  You brain responds by altering the way we move to avoid being in pain.  This is why you limp when you sprain your ankle.  Your brain senses that there is damage to soft tissue in the ankle, and weight bearing will make it worse.  Hence, you will look to move to limit weight bearing on the affected ankle.

So altering movement to avoid pain changes the mechanics throughout the rest of the body.  Going to back to the sprained ankle example; more stresses are placed on the uninjured limb causing muscles to work harder, joints to be under more stress, ligaments to be more strained, while on the affected limb, muscles tend to atrophy, ligaments and joints tend to stiffen with a lack of movement.

Due to the changes in movement about the lower limb, it also affects how we move through the torso and the upper limbs.  Stresses are changed through the spine and we even alter the way that we use our arms. 

We do whatever we can to not be in pain, so why don't people take care of themselves.  I hate the whole notion of "no pain no gain" and really does not have much application to health or fitness.

If you are in pain, you need to look to correct the problem and stop the cascade.  If you move better, you will feel better.  

Breathe much? You are doing it wrong!

It seems really simple. Breathing:  It is an essential part of life.  If you aren't breathing, you probably aren't reading this right now.

If you are reading this, can you tell me whether anyone has shown you how to breathe?  Let's find out.  Go ahead, take a deep breath in...What happened?

Likely you stuck your chest out, tilted your chin up a little, tried to expand (probably more elevated) your ribs and maybe even pulled your belly button towards your spine.

Here lies the problem. We only have 3 breathing muscles in our body.  None of them are named trapezius, levator scapulae, erector spinae, pectoralis, biceps, etc.

So what are these magic breathing muscles?  The diaphragm and the intercostals (internal and external).

The diaphragm attaches to the bottom of the ribs and when we breath in, it flattens pulling air into the lungs.  The diaphragm should not change the shape of the spine (this is what the erector spinae and associated muscles do!)  The intercostals (mostly external intercostals) expand the ribs outwards (not upwards like you just did when you took a deep breath in, those are your overactive trapezius muscle). 

So when you breathe, your diaphragm should move down and your ribs move out.  Try this...do you find it difficult?  We have been ignoring our breathing technique for a long time now.  You will have to consciously practice if you want to improve.

So if you suffer from tightness in upper back and neck, it might be because you are using those muscles to breath, instead of using them for what they were made to do. 

"That's The Worst Case I've Ever Seen..."

 

I've been hearing the same thing over and over again from patients.  "I've been told that this is the worst case that they have ever seen..."  I find it a tad bit odd.  Does everyone with "the worst case" happen to end up in my office? 
I'm not sure why these patients are told this.  I had a young man (less than 40 years old) in the office the other day saying that "he had the worst case of arthritis in his knee that the doc had ever seen!"  I found it a bit odd for a few reasons;  first, he was relatively young for severe arthritis in the knee (cartilage is pretty spongy when we are younger).  Secondly, he had not suffered significant trauma to his knee.  Third, he had full range of motion.  Lastly, he had not had X rays (not that this is a good way of observing arthritis, but it does give you some information.)  He did have some crepitus that sounded like grinding, but it was not "bone on bone" as it was described to him. 

I get patients with "severe" arthritis in their back and neck.  Some of them have the X rays to prove it (as mentioned, X rays are not the best way to determine how bad someones arthritis is), yet they appear to have minimal pain and decent range of motion.  More importantly, they are able to perform all the activities and/or sports that they would like to continue to do!  So why are they told that they should be in pain?

I think that people need to be enabled.  We need to stop telling them they are in bad shape. That "this is the worst I have ever seen." I think that people are looking for someone to help them get to where they need to be.  We should not be telling them what they cannot do, but how they should be doing the things that they want to be doing!  Lets stop enabling patients to be in pain and give them a helping hand!

The "Knife in the back" pain

What is that "Knife in the back"/Between the shoulder blades/hurts to breathe pain?  It happens to most people after coughing, sneezing, lifting something light or when you are simply getting off the couch. 

This is the costovertebral/costotransverse joint.  It was found a while back that these joints can be pain generators.  Some of the descriptions that people use include; feeling like you have been shot with an arrow, sharp/stabbing pain with deep breaths in (or out), a constant dull achy pain with rest and sharp pain with sudden movement. 


The "rib" joint(s) have two attachments; transverse processes of the throacic spine vertebrae, and the vertebral body.  These joints can become painful when they pinch on themselves (kind of like a "dogs ear" on a book when you close a book and pages get pinched in between.) 

Treatment for costovertebral/costotransverse joint pain is simple and quite effective assuming you rule out the red flags.  Heart and lung conditions as well as other visceral conditions can mimic CV/CT joint pain.  If these conditions have been ruled out, adjustments to these joints can be quite effective for pain relief and restoring normal function. 

Let's define the "Functional" in Functional exercises

There seems to be tons of catch phrases in health and fitness.  It seems that if you happen to use the term "functional" in front of some exercise, it makes the same exercise better.  Like stating that the "functional" bench press is better than the bench press. 
What does the term functional mean?  The term functional describes having a purpose or relating to the way something works or operates.  So a functional exercises should relate to something that mimics a task or movement that we do in our sport or life.

So can an exercise like bench press where you are on your back pushing weights in front of you be functional?  I believe it can, but it isn't for everybody.  It may be functional for a mixed martial arts fighter who may be on his back pushing his opponent away from him, but utility is even probably limited in this aspect (the MMA fighter would be dealing with something that moves and changes its weight distribution, not a static weight with a bar).

A squat can be a functional exercise.  It is something that everyone does daily.  From getting up out of a chair, to lifting a box off the ground, it is a movement that we can practice and improve upon.

So keep in mind, a functional exercise pertains to movements that we do regularly (in sport or life).  We should be doing exercises that include lifting, carrying, pushing, pulling, turning, twisting and dragging.  The term functional should not be used to make an exercise sound better than it is. 

How am I suppose to know if you are in pain?

Pain is an interesting topic!  It is the majority of what I deal with in practice on a daily basis.  People come to see me because they are in pain.  But pain is extremely difficult to measure.  How do I actually know you are in pain?  How do I know what your pain feels like?  Pain is an experience.  It is different for everyone.  Despite numerous people telling me that they have an extremely high pain tolerance, how do I know how high it is? And what are we comparing to your pain to?  There is no magic gadget that can tell me how much pain you are in, or the type of pain you are experiencing.  However, it is my job to figure out exactly what they are experiencing. 

Having experienced pain a patient describes can help understand what they are going through.  For example, if you have never had back pain, how can you know what a patient is going through.  If you have had back pain similar to what they describe, it is easier to understand what they are feeling (and how you can treat it!) 

There are also pain scales that can help determine how much pain you are actually in.  Research has shown them to be reliable and they can be a good tool to compare YOUR pain to YOUR pain.  For example, if you were a 7 out of 10 pain yesterday and are suffering from 4 out of 10 pain today, it helps to quantify a reduction in pain.  Your pain however cannot be compared to MY pain (remember, pain is an experience). 

Pain is simply (maybe over-simply) our brains interpretation of our experience.  This is why when we watch a TV show and we see someone injure themselves, we wince.  Isn't that strange, there is no perceived threat, but our brain interprets how painful the injury must be (for the person suffering) and we respond accordingly! 

So if someone tells you that the pain is just in your head, the technically aren't wrong...they maybe have not had the same experience as you! 

The Concept of Core training: Starting from scratch. A Case Study

I am continually amazed at how difficult core training actually is.  It also amazes me that there are so many ways of coaching/teaching core training.  Unfortunately there is no "cookie cutter" method to give to everyone.  I've found with my own training, I am learning and improving daily with subtle changes.


Training core is a lot more than doing sit ups, planks, bridging etc.  It is a bit like teaching someone to throw a ball, or to play a musical instrument.  For some people, the aforementioned tasks may be challenging, and it requires a lot of time to learn and expand on the basic skills.  For others, it is almost an innate ability, but even these people can continue to practice skills and improve on performance.

Recently, I was working with a tremendous multi-sport athlete who had an innate ability to to perform on the field.  However, due to medical procedures that were performed years ago, he was finding that his performance training in the gym was suffering, and he felt it was limiting his on-field performance.  He told me his goals were to improve his strength in the gym and to be able to do at least one pull up.  When I assessed him, I was shocked to find that despite being an incredible athlete, he was unable to properly activate his core in a timely manner to perform his lifts in the gym (imagine trying to "crack a whip" but not being able to get the "crack"  This is an example of poor timing).  I was also stunned to find that despite appearing quite strong, he was unable to perform a single pull up.

He agreed to work with me for 8 weeks, so we started our first few sessions without any weights.  We spent most of the time working on identifying what the core muscles are, how to activate them, and when to tune them UP (and even more importantly, when to tune them DOWN).  After 2 weeks of no weights, we started some resistance training.  We focused on quality over quantity.  I would let him do as many reps as he could do while maintaining his core.  As soon as his core would fail, I would end the set and offer enough rest so he could perform another set.  We worked for a number of weeks on quality of movement.  Sometimes we had poor sessions, sometimes we had great sessions.  I always let his performance dictate what we could accomplish. 

I will never forget getting a text from this him late one evening; "JUST DID MY FIRST F#*@ING PULL UP!  SO STOKED! Thanks for your help!"

I still find it hard to believe that some people have trouble tuning their core, but have an innate ability to perform on the field.  Is it possible that there potential on the field is limited by weakness?  Or am I playing with fire and changing movement patterns that maybe should not be changed?