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?

The "Educated" Expert: When common wisdom is neither common, nor wise

So I was reading a prominent local paper the other day and they had a section where there is a health "expert" offering advice.  The article was describing how important it was for children (did not say what age) to be flexible for improvement in sport performance.  The article had a picture of a cute little kid hitting a baseball.

Now, I'll be the first to tell you that I am not an authority on the topic of flexibility, but I have read numerous articles and scientific papers on the topic (written by people that are more brilliant than I am.)  Based on the principles from  many of these articles, I would vehemently disagree with the notion that kids need to improve flexibility.  Most children are fairly flexible already, and increasing flexibility may lead to decreased stability/mobility and subsequent injury.  What I believe most kids need to work on for improved sport performance is improved coordination and skill development.  Besides, how many kids do you know would want to sit and passively stretch as opposed to throw or hit a ball?   


Seeing as this is a local paper that many people read, a large number of people who read these articles will take this and become their own "expert" and blindly lead their kids to believe that increased flexibility will improve sport performance.  Sometimes common wisdom is neither common, nor wise...

The "Not So Rotator" Rotator Cuff

Rotator cuff injuries are commonly diagnosed.  Most of them, with no specific diagnosis as to which rotator cuff muscle(s) are the problem.  More importantly, for rehabilitative purposes, we should have a better understanding of what this "rotator cuff" actually does.


When we learn about the rotator cuff in anatomy class, we look at the four muscles that make up the rotator cuff:  supraspinatus, infraspinatus, subscapularis, and teres minor.  We tend to look at these muscles in isolation.  For instance, we see the supraspinatus as a ABductor (lifting the arm away from the body), the infraspinatus (and teres minor) are external rotators (pointing thumbs backwards with palms facing to the sky) and that the subscapularis is an internal rotator (allowing us to reach into our back pocket).  Unfortunately, this has guided many rehabilitative programs based on simple/isolated movements for each individual muscle.

If you look at the shoulder joint from a biomechanical standpoint, these muscles do very little of the isolated movements.  This is due to the fact that out big muscles around our shoulder do the "heavy lifting" or gross movements while the "rotator cuff" group acts as stabilizers.  Even more important is how they perform this stabilizing function.  When the "rotator cuff" group contracts in concert (all muscles contract at once), they provide a tremendous amount of COMPRESSION for the shoulder joint (holding it in place) while the "heavy lifters" do all the movement.  In my opinion, the "rotator cuff" should be renamed the "compressor cuff" 

There is utility to doing isolated rotator cuff exercises (you know the ones I mean...the ones that you always see people doing at the gym with the therabands).  However, their utility is limited and really should be used as the basis for simple"compressor cuff" rehabilitation.  Once activation and stability is achieved through simple exercises, progressive exercises offering challenges in different movements and planes should be added to make sure the "compressor cuff" is providing COMPRESSION (and thus, increasing stability) through an entire range. 

No Such Thing as Muscle Memory

This muscle memory that everyone tells me about.  I'm not exactly sure what it means?  Who came up with this concept/term?

I've been told that if you return back to training after a brief absence, your muscles will "remember" what to do and how to perform.  They will "remember" how to hypertrophy (get bigger). 


Here is the thing...your muscles are not smart.  In fact, I'd say your muscles are quite stupid.  They have no memory, and they do not remember how to do things. 

You do however, have a brain and nervous system.  Your brain is quite clever.  Your brain stores movement patterns, your brain "remembers" how to perform complex tasks.  Your brain is connected to your muscles by nerves.  Your brain receives feedback from your muscles about length and tension, as well as sends signals to your muscles to undergo contraction (and relaxation). Your brain is responsible for balance, coordination, speed and movement (being drunk is a great example of how movement and coordination is controlled by the brain...not that I condone experimenting to prove my point!)

The brain is like the guy pulling the strings on the marionette.  The muscles simply do what they are told! 


There is no such thing as muscle memory.  Muscles are not smart...but your brain is quite clever!