Archive for Exercise

Sitting is the new smoking

First of all, I owe you an apology. I have not been updating this blog or sending out my email newsletter in over a year.

The major reason is that in September of 2014 I started a 6 year program to become an osteopath. The volume of material we are responsible is huge, but I am loving it. And when I am done, I think I will be an amazing therapist. BUT because of that the blog and newsletter fell by the wayside.

I would like to start again to fulfill what I promised you. It won’t be weekly – the next two weekends I am in courses – but I will endeavour to send something at least once or twice a month that hopefully you will find informative and useful. If there are health topics you want me to discuss, please let me know.

Now on to your tip. You probably have already heard that sitting is the new smoking. We now know that sitting for prolonged periods of time is dangerous to our health, making us prone to blood clots, leading to embolisms, heart disease, and stroke. Prolonged sitting even seems to impact blood-sugar regulation, making us more prone to diabetes. Even if we do an hour of exercise a day, it does not erase 8 hours of sitting.

This isn’t great news since our world seems to be designed around sitting, and many of us sit at office jobs all day. So, what do we do? Is there anything that can counteract all that sitting?

The simplest solution is to set an alarm and get up out of your chair at least once every half-hour and walk around for at least 2 minutes. Much more impactful though, would be to get up, then lie all the way down on your yoga mat that is on the floor beside your desk, then stand up again, and repeat that 3 or 4 times. This will bump up the heart rate, and ensure great blood-flow through your entire body. Do this, and it will erase that half hour of sitting.

And the bonus is: if getting down onto and getting up from the floor is NOT easy for you, it will become easy for you, which will mean increased range of motion and strength, and therefore better ability to do many tasks of daily living!

If you live in the Vancouver Lower Mainland, come on out to our free seminar called “The 6 Movements You Should Be Able to Do”. Learn why being able to do these movements increases life enjoyment, test yourself to see how well you can actually do the movements, and learn how to get better at them! Please register at Eventbrite.

Please do keep the comments coming on my blog. If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc. If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related Tips:
How many ways can you get up from the floor?

10 positions we should all find relaxing



Aviroop Biswas et al. Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis Ann Intern Med. 2015;162(2):123-132..

World Health Organization Physical Activity

Copyright Vreni Gurd 2016


www.wellnesstips.ca

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Another movement we should all be able to do. Can you?

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Do you regularly shoulder-check when you drive? If not, is the reason you don’t that it hurts, or that you can’t?

I was biking home from work the other day along a not-too-busy street, and I wanted to turn left onto another not-too-busy street. So as usual, I shoulder-checked before making my turn, and was surprised to find I couldn’t turn my head as far as I normally can, and even more surprised to feel a jab of pain at the end of the range.

Taking a hand off the handlebars to allow me to twist my upper back and look further was out of the question because I was slowly cranking up a steep hill, and I needed to pull the handlebars with both my hands.

When slowly biking up a steep hill, the last thing one wants to do is stop completely and put a foot down, as it is tough to get going again.

So while I kept cranking I listened, and not hearing anything coming, I started my turn, only to slam on my brakes as a surprisingly quiet car zoomed passed me.

SHEESH! Okay, my bad. I know, I know. I did a stupid thing, took a chance and got lucky. Sorry mommy, I won’t do it again.

Shoulder-checking is something we all need to be able to do, especially if we drive, bike, ski, skate, snowboard, race, play team sports etc. Many sports like golf, tennis, and baseball require being competent at twisting. And not being able to shoulder-check can actually be dangerous – I can attest to that!

Our neck should be able to twist 60 to 80 degrees, and our thoracic (rib) spine should be able to twist about 30 degrees, so that gives us between 90 and 110 degrees of available rotation. 90 to 110 degrees!!!

So if we keep our ribs still, we should be able to turn our head until our chin is almost lined up with our shoulders, and if we twist the ribs too, we should be able to see something pretty much directly behind us, thanks to our peripheral vision.

The lumbar spine is not meant to twist, and twisting the low back while rounding it can cause injuries, so if you are twisting, make sure you have an arch in your back!

So, how well can you twist? Can you twist the same amount to each side?

If we have pain with twisting, it is worth seeing a manual therapist – a chiro, physical therapist, massage therapist etc. to address the cause our pain.

If we do not have pain, then to improve our range of motion we need to do a variety of twist stretches and mobility exercises, both from the top down and from bottom up.

Make a goal of improving your ability to rotate, and work at it each day. No equipment is needed, and you can do it in your pajamas, so as Nike says, “Just Do It!” If you need help, find a competent corrective exercise specialist or trainer. If you are in Vancouver, come see us!

Please do keep the comments coming on my blog.

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
6 movements we should be able to do, Part 2
How many ways can you get up off the floor?
10 positions we should all find relaxing
Squatting and the knees

Copyright 2013 Vreni Gurd

To subscribe go to www.wellnesstips.ca

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6 movements you should be able to easily do (Part 3)

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Part 3 in this series of movements I think we should all be able to do. Part 1 and Part 2 are here. So, what is your assessment? Can you do them all? Let me know in the comment section.

Sit up from a reclined position

How do you get out of bed? Do you sit up in bed then swing your legs over the side and stand up? Can you sit up without using your hands to help?

This is also a basic movement that we should all have the strength to do, but I find many are not able to do this. If one is lying on the floor I think one should be able to sit up, then push oneself onto one's feet into a squat position and stand up.

That said, there are many reasons why this movement might be unsafe for some people. Anyone diagnosed with osteoporosis should avoid flexing the spine, and anyone with a disk problem would do well to avoid it also. Anyone with a back problem should check with their physio or doctor to be certain this movement is safe.

Also I have noticed in my practice that many people's bellies "tent" up along the center line as they attempt an abdominal curl. Any ab curl, crunch, or sit up would be a bad idea if this is happening. There should be no abdominal bulging along the center line of the belly while doing any activity.

This abdominal bulging is an indication of a rectus diastasis, or a splitting of the fascia down the midline of the abdominal wall. Doing anything that creates that bulging is might make the split worse, potentially requiring surgery.

Most people should be able to work on this movement, but use common sense. If you are not sure, consult a doctor.

Walk 2 blocks carrying 2 bags of groceries that weigh at least 10% of your body-weight in each hand (I don't figure you need a video for this one.)

For most people, this is probably adequate for comfortable living, but depending upon what one enjoys doing, one may need to be able to carry heavier amounts.

Children are the perfect graduated weight-training program! They grow and get heavier, and they squirm, which can make carrying difficult.

Carrying heavy things for a few minutes from one place to another (from the store to the car, or from the car to the door) is something we often need to be able to do, so if you are injury-free, practice walking while carrying something heavy frequently enough that you remain strong enough to do it.

There you have it! Six movements that you should be able to do. Can you do them?? If not, get some help! If you live in Vancouver, contact us by replying to this email. We will figure out what level you are at, and build you up from there.

If you don't live in Vancouver, buy the Anti-Aging Exercise Solution DVD. The movements are not identical but should improve your flexibility and strength, and there are 3 levels to choose from depending on your ability.

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
6 movements you should be able to do (Part 1)
6 movements you should be able to do (Part 2)
How many ways can you get up off the floor?
10 positions we should all find relaxing
Squatting and the knees

Copyright 2013 Vreni Gurd

To subscribe go to www.wellnesstips.ca

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6 movements we should be able to easily do (Part 2)

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Here are a couple more movements that should be no problem at all if we have adequate flexibility and strength. If you have difficulty with either of these – you simply cannot do them or you have pain, perhaps these can be goals for your fitness/movement program, and as you improve, marvel how they make life’s activities easier. If you missed Part 1 of “6 movements we should all be able to easily do”, click here.

Watch the videos, but please use your common sense with respect to trying the movements. Hire someone to help you learn to do these movements properly as technique is key to avoiding injury. A planned progression can be created to help you regain your ability if you know you cannot do them. And these movements may not be appropriate for everyone.

Kneel to stand

This movement should be easy if you can do the tripod split squat, but involves more balance due to the transfer of weight to the forward leg. This movement involves moving forward as well as up, so it is easiest to imagine a trajectory of about 45 degree angle as you get up.

One starts with one knee and toes on the ground, the other foot forward and on the ground. Bring the pelvis forward so your body-weight is over the forward foot, then push down through the floor with the forward leg, and push the body forward with the back toes to stand up. The work should be felt in the buttocks and upper hamstrings of the front leg.

It can be helpful to have a walking pole, or even pretend to use a walking pole in the opposite hand to the forward leg. As energy is exerted by the forward leg to stand up, the opposite arm is pushing down and back through the pole (or imaginary one).

Getting up from the ground in this manner is one of those basic movements that everyone should always be able to do easily with both legs. This movement would also ensure the ability to step up onto a high step or rock, or step over a small fence.

The movement can be made easier by putting a step or small platform under the back knee, and can be made harder by putting a step or small platform under the front foot.

Lift something that weighs at least 20% of your bodyweight out of the trunk of your car

Twenty percent of your bodyweight is an approximation – the amount of weight that you need to be able to lift depends on your needs.

What do you need to be strong enough to lift, to make your life easy? Do you lift big bags of dog food, kitty litter, cases of wine, or a cooler of food out of the trunk of your car? How much do these items weigh? Is it a struggle, or can you manage these lifts easily?

If you travel frequently, consider how much your suitcase weighs, as you need to be able to lift it off the conveyor belt without injuring yourself. The conveyor belt adds a rotational force to the lift as well, making this activity risky if you are not strong enough.

Lifting technique is important to preventing injury, and taking advantage of your body weight to help with the lift can make the lift far easier. Practicing deadlifts in the gym can help teach you the technique.

First bring the object as close to you as possible. The key to this movement is keeping the spine neutral, arms sucked into their sockets. Reach the buttocks back to the point one feels a slight stretch in the back of the legs, then grasp the object, keeping it close to the body.

Anchor the heels to the floor, feeling the connection up the back-leg line to the sit-bones of the pelvis, and use that line-of-pull like a guy-line on the top of a tent pole, to pull the wheel of the pelvis around until you are upright.

There is no efforting by the low back to lift the object. Although the spinal muscles will be active, the effort comes from the back of the legs. By reaching back into the back-leg line in order to counteract the weight of the object being lifted, the body almost acts like a teeter-totter. Get enough body-weight behind, and the object is lifted quite easily.

Knees are slightly bent, shins remain vertical, and the butt reaches back to the point of slight stretch. Spine remains neutral, arms stay sucked into the arm sockets, and as the pelvis-wheel rolls around to upright, it also moves forward to take its place under the ribs again.

It feels like a strange contradiction. Even though the weight is heavy and effort is required to lift it, when the mechanics are right there is an ease about the movement. There is effort, but the movement flows and just feels right.

Remember that training movements is far more important and useful for good function than training muscles. Getting stronger by getting good at these different movement patterns will translate into more ability to do what you want day-to-day.

If you are in the Vancouver area and want us to assess your movement patterns, descend the movements to the point you can do them correctly, and then build them back up from there, please contact us by replying to this email. If you are not in the Vancouver area, consider purchasing the Anti-Aging Exercise Solution DVD. It covers some of these movements and variations on others, and is a great place to start.

Please do keep the comments coming!

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
6 movements we should be able to easily do (Part 1)
How many ways can you get up off the floor?
10 positions we should all find relaxing
Squatting and the knees

Copyright 2013 Vreni Gurd

To subscribe go to www.wellnesstips.ca

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6 movements you should be able to easily do (Part 1)

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These are movements that should be no problem at all if our body is functioning well. If you have difficulty with any one of them – you simply cannot do them or you have pain, there are body dysfunctions that should be addressed.

Our bodies are meant to move, and when movement becomes a problem due to a lack of strength or flexibility, our lives can close down as we find ourselves no longer capable of doing the things we want. Stairs become a problem, getting in and out of cars or chairs difficult, or we have trouble carrying groceries home.

Training movements is far more important and useful for good function than training muscles. One can strengthen the quadriceps on a leg extension machine, but that teaches the brain nothing useful about how to use that strength. Getting stronger by getting good at these different movement patterns will translate into more ability to do what you want day-to-day.

Most often the reasons people have trouble with these movements is they have lost the flexibility to do them. As that flexibility improves, there is more range-of-motion to strengthen.

Please watch the videos, but use your common sense with respect to trying the movements. Hire someone to help you learn to do these movements properly, and create a planned progression to regain your ability if you know you cannot do them.

This is exactly what we do in my business, Wellness Works Integrated Health Services. We assess your movement patterns to figure out where you are having a problem. We descend the movements to the point you can do it correctly, and then build them back up from there.

If you are in the Vancouver area and want help improving your movements, please contact me by replying to this email. If you are not in the Vancouver area, consider purchasing The Anti-Aging Exercise Solution DVD. It covers some of these movements and variations on others, and can be a great place to start.

Instead of making this post super long, I thought I’d break it up into three posts over the next three weeks, so today I’ll cover the first 2 of the 6 movements I think we should all be able to do.

Squat to floor and stand up again

This is a movement that we used to do daily to poop, from the time we were able at about age 1, until the time we died. The invention of the toilet ended that. Many of us are no longer able squat that low due to a lack of flexibility, or we can’t get up from there keeping the trunk parallel to the lower legs (chest higher than the butt) on the ascent.

The usual cheat is to lift the butt up first so the trunk is parallel to the ground instead of the lower legs, and then straighten up. If lifting the butt first is the strategy being used, that indicates a lack of strength in the front of the thigh muscles (quadriceps).

Being able to do this movement correctly ensures adequate slack in the myofascia which would likely reduce the incidence of low back, hip, knee and ankle pain.

One would have adequate strength and range-of-motion to do most day-to-day activities, like climbing stairs, getting out of chairs and even low car seats.

The key to success in this movement is to keep the front of the hips and the front of the ankles soft throughout the range of motion. Simply ensure that your centre of gravity is right over the feet and lower yourself down with ease, bringing the trunk between the knees to ensure that center of gravity is maintained.

If the front of the ankles are firing, your weight is too far back, so bring your knees and body forward until the ankles quieten.

If the ankles are soft, feet relaxed, it is okay if the heels are not firmly on the floor. As you push through the feet to stand up provided the ankles are soft, the myofascia on the bottom of the feet will soften onto the floor as you come up.

Contracting the anterior lower-leg muscles (tibialis anterior) to force the heels down will cause a tug-of-war over the knee cap, as lower leg would then be pulling the knee cap down towards the ankle as the quad is pulling the knee cap up the leg.

The knee cap, being pulled in both directions would end up being scraped over the fold of the knee joint – ouch! So keeping the ankles and feet soft is key.

This movement should be done with a sense of ease. The descent is more an “allowing” than a battle. The ascent is accomplished with a push down through whatever part of the feet are on the floor. It should not feel “effortful”. Good movement is efficient, not difficult.

Start with a height that is manageable (a chair?) and slowly work towards lowering the height over weeks and months of practice, until it is possible to squat fully to the floor.

We find stackable stools work great for this purpose. Every time you succeed in reducing the number of stools for your sit to stand, you have gained that much more flexibility and strength.

In my humble opinion, being able to squat all the way to the floor with no added weight is far more useful in terms of improving function than squatting to the point where the thighs are parallel to the floor with added weight. I know many people that can do half squats with lots of weight, but are not capable of squatting to the floor with just their body weight.

I would not advise squatting with added weight lower than one can keep the back neutral. A flexed (rounded) spine under load is more vulnerable to injury.

Tripod split squat to overhead lift

This movement is particularly useful for lifting items off the floor, as it keeps the back neutral making it less vulnerable to the weight lifted.

This movement requires excellent flexibility in the toes, ankles, knees and hips, as well as adequate strength to get up from the low position while carrying whatever needs to be carried.

It is important to be able to do this movement equally well leading with either leg in order to maintain good muscle balance between the two sides of the body.

Straddle the object to be lifted, and from the squat position above, drop one knee to the floor and sit on the heel of that foot. This position is comfortable and stable as you have created a triangle on the ground with the points being one knee, the toes of the same leg and the other foot.

From here, maintain neutral spine as you grab the object, then holding it close to your trunk, stand straight up again, keeping even weight through both feet.

The common mistake here is to lower the back heel down just when beginning the lift. Stay on the back toes until almost completely upright.

If the weight is kept close to the body on should also be able to lift it over the head and put it on a high shelf.

Next week I’ll discuss two more movements I think we should all be able to do, and that I’ve noticed many people have difficulty with.

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
How many ways can you get up off the floor?
10 positions we should all find relaxing
Squatting and the knees

Copyright 2013 Vreni Gurd

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Is your head on top of your body or forward of it?

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A forward head can be the root cause of all kinds of problems in the body, including headaches, jaw pain, neck and shoulder pain, and back pain.

It makes good sense that the body works best if all the blocks are stacked up properly. Pelvis right over the legs instead of in front or behind, ribs over the pelvis instead of tilting backwards, and head over the ribs so the ear is lined up over the shoulder. Seems obvious, but most of us don’t seem to live there regularly.

Our professions often mean that we are spending a lot of time sitting at desks looking at computers, which tends to pull our heads forward. We often relax by slumping into a sofa and watching TV, which curves our upper back, also bringing our head forward. Probably for most of us, we spend far more time sitting than standing.

Over time our postural habits “harden”. If we are constantly holding a particular posture and are not moving the body through the opposite range of motion, we will lost the motion we don’t use.

Soon we realize that we are uncomfortable lying on our back in our beds without that pillow, as to get our head to touch the mattress we would need to tip it way back, sticking our chin in the air, which might pull the mouth open making it uncomfortable to breathe. There is a huge gap between our neck and the bed. So we stuff a pillow in there so our face is parallel to the ceiling and we can be more comfortable.

But simple discomfort is not the only issue that a forward head can cause. As Paul Chek states, “For every inch that the head’s center of gravity is shifted forward, the lower cervical spine is subsequently subjected to compressive forces equivalent to a one-time additional weight of the head.”

Most heads weigh between 12 and 20 pounds, so if one's head were 3 inches forward, that would put between 36 and 60 pounds of extra weight on the lower cervical (neck) spine, which is extremely fatiguing to the muscles at the back of the neck.

The pull on the back of the head is also known to cause chronic headaches. These muscles that must deal with this constant load become exhausted, and their blood flow proportionally diminishes as the muscle contraction increases.

This lack of blood flow is often the primary source of muscle pain in the neck region. Releasing trigger points in the posterior neck muscles, especially splenius capitus, and the insertion points of levator scapula, traps, SCM and the occipital muscles can help, but unless one gets enough rest to allow blood-flow to return, the problem can become chronic.

Over time, the pain may migrate lower as more muscles become involved. As certain muscles tighten under the strain, their opposites lengthen and weaken, extending the problem further into the body.

For example, as the shoulder blades are pulled up to try and support the forward head, the muscles that pull the shoulder-blades down weaken.

In order to remain balanced in the standing position, we need to have our weight centered over our feet. So if the head is forward, the ribs tend to tilt back, and the pelvis will often tilt forward leading to problems in the lower back, hips and legs as well.

Because we need to keep our eyes level to the horizon in order to be able to see properly, as our head moves forward, it also tends to tilt backwards on the neck.

The area where the neck and cranium meet is a very busy place, and there should be a space of about 6.5 plus or minus 2.5mm between the base of the skull (occiput) and the 2nd vertebrae (spinous process of C2). When this space is reduced to 4mm or less, the nerves and blood vessels in that space can be mechanically compressed.

When the back of the skull and the top vertebrae (OA joint) get too close together there is potential for compressing the vertebral artery and vein as they exit the transverse foramen of the top vertebrae to make their way into the cranium. Impaired blood flow into and drainage from the brain is never a good thing. (The vertebral artery is the thinner one at the back, threading through the holes in the vertebrae.  This drawing is from Gray's Anatomy.)

This lack of space has been shown to be associated with higher incidence of vertigo (dizziness), possibly due to a compromised vertebral artery. If you notice you always get dizzy when you look up at the ceiling or airplanes in the sky, this is a warning sign that those blood vessels may be quite compromised and doing something to restore a better head position might improve the situation dramatically.

Besides blood vessels there are nerves that are in this tiny space as well. The greater occipital nerve itself can have a diameter as create as 3mm, so that does not leave much wiggle room. The nerve roots that exit from the top two vertebrae would be particularly vulnerable to mechanical forces due to forward-head posture.

Forward-head posture can create significant problems within the head too. Try sticking your head further forward, keeping your face looking straight ahead. Can you feel a stretch in the neck under your jaw? As the head goes forward, the jaw is often pulled back, which may altar one’s bite, leading to TMJ problems.

The hyoid bone in the front of the throat will be pulled up in forward-head posture, which may contribute to snoring and possibly even sleep apnea.

Notice also how as you push your head forward, your tongue drops a bit in your mouth, and as you pull your head back, more of your tongue contacts the roof of your mouth.

If your head is permanently forward and your tongue is lower in your mouth, this may encourage the habit of pushing the tongue against the front teeth with every swallow, eventually protruding those teeth forward impairing the bite.

Okay, I think I'll stop there. I won't go into the impact of forward head on the dura (fascia covering the spinal cord). I’m hoping it is clear that forward-head posture has a significant impact on the whole body, and that doing what is needed to bring the head back into its proper position can greatly improve pain syndromes and body function.

How far forward is your head? You can figure this out with a ruler and a plumb line (a piece of string with a key tied to the end), and a friend. Stand up, and put the ruler lightly in the sternoclavicular notch (the soft gushy V right above your breast bone at the bottom of your neck). Hold the string on the front of your cheek right on the bone, letting the plumb line hang, and have your friend read off the ruler how far forward your head is.

Might be more accurate if your friend does the whole thing, as often reaching your hands up towards your face will alter your normal head position.

Often awareness of body position can help, particularly when seated. Making sure one’s work environment is ergonomically correct is critically important.

The chair needs to be raised so that one can sit tall on the sit bones, shoulders resting on the ribs, elbows at 90 degrees. The monitor should be in front of the eyes, so the head does not need to be tilted down to view it. The feet should be resting on something that allows the ankles knees and hips to be at 90 degrees.

A good orthopaedic assessment can be helpful in determining the best approach to reducing forward-head posture. Sometimes it can be as simple as getting used to being in a different position – bringing the pelvis back over the legs, which would straighten the ribcage providing a upright platform for the head.

Most people would need a personalized stretching and strengthening program to bring the body back into alignment. For example, tight muscles at the pelvis will definitely impact head position, and which muscles need to be stretched and strengthened is a very individual thing.

In others, the upper back is stuck in too much curve, and the spinal segments would need to be mobilized the spinal and the back extensors would need to be strengthened.

A simple stretch that can be done is to lie on the floor or in the middle of the bed on the back (use a small pillow if you need one), and reach the arms straight out to the side, slowly raising them up towards your head like a snow angel. When you start to feel a stretch, wait until the stretch dissipates. Do this daily. The goal is to have the upper arms resting on floor comfortably next to your ears without feeling any stretch at all.

People with too much upper back roundness would probably also need stretching of the back of the neck and strengthening of the deep front neck muscles (longis colli and longis capitus). These neck muscles are tricky to strengthen without instruction, so seek out a CHEK Practitioner or physical therapist to help you.

If you are in the Vancouver area and would like help with this, please reply to this email. We would be happy to assess you and take you through an exercise program personally designed just for you. We also have gift certificates available if you want to give the gift of good posture and good movement to a friend or loved one.

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc.

If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
Take your space and improve your posture
Whiplash, neck pain, and the muscles of the neck
Reduce neck strain
Respiration, the BIG boss

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Gray, Henry Gray’s Anatomy: The Unabridged Running Press Edition Of The American Classic 1974.

Bradly K.C. The Posterior Primary Rami of Segmental Nerves, Aspects of Manipulative Therapy, Glascow, et al. Editors 1980: 59-64. Churchill Livingstone.

Walther DS AK Applied Kinesiology, Vol. 2: Head, Neck and Jaw Pain and Dysfunction, the Stomatognathic System 1983; 344-345. Systems D.C.

Rocobado M. Biomechanical Relationship of the Cranial, Cervical and Hyoid Regions. J Craniomandibular Pract. 1983 Jun-Aug;1(3):61-6.

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Zohn D.A. Musculoskeletal pain : diagnosis and physical treatment 1988; 183-184, 186-187. Boston Toronto; Little Brown and Co.

Travell J.G. and D. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set) 1983: Willliams and Wilkins.

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Running Pain-free

I was asked to write an article on running. Here are some ideas that I think may help runners improve their ability while staying pain free.

Standing Posture
Because posture is the place from which movement begins and ends, having good static posture will greatly enhance running ability, while having poor static posture will be detrimental to running or any other sport for that matter, and may even be the cause of injury.

If our posture is poor and the joints cannot maintain a proper axis of rotation, the joints may suffer wear and tear. Imagine a garden gate that is not hung straight – the hinge on that gate is not properly aligned. It squeaks with use, and if the gate is continually used in its poorly aligned position, the hinge will eventually wear out. Our joints are the same.

If our static posture is good, the muscle balance about every joint in the body will be even, meaning that the joint can maintain its instantaneous axis of rotation throughout the range-of-motion. Good posture is the foundation for great running.

To get into the best posture possible, stand up, feet shoulder distance apart, and move your pelvis forward and back until you have found the place where you can feel the weight of your trunk going through the leg bones and out the feet into the floor. The thigh and buttock muscles are relaxed.

Then pick your ribcage up off of your pelvis as best you can, making yourself as tall as possible. Relax your shoulders and arms on your heightened ribcage. You may feel a sensation of decompression in your lumbar spine, and you may be aware of a muscle in your lower abdomen turning on.

Now, lift the base of your skull at the back of your head as high as you can, so that you are as tall as you can be throughout your body. Try to separate your shoulders as far away from each other, so you are also as wide as you can be.

The end result of this effort should be that your pelvis is directly over your legs, your ribcage is directly over your pelvis without tilting forward nor backward, and your shoulders are sitting squarely on the platform of your ribs, and your head is directly over your ribs, with the plane of your face vertical.

Practice this as you go through your day, as you sit, and as you walk. The feeling should be that your legs are floating under you as you walk, not that you are using muscle effort to move your legs.

There is a definite sense of ease. Experiment with how this sense of being as tall as possible creates ease in your running. This will assist in activating your deep stabilizers, which will keep your back and pelvis healthy while you run.

If you want a better understanding of how the deep trunk stabilizers work, and specific exercises to target them, feel free to purchase our exercise DVD – we included a whole section on it, as well as exercises in the work-out geared to help strengthen this area.

Adequate Flexibility
Having good flexibility in the legs and trunk will help you run faster, as you will be able to increase your stride length. Poor flexibility may put you at risk for muscle pulls and tears, particularly in the calves, hamstrings and possibly quads if you are a sprinter.

Tightness in the quads (front of the thigh) and TFL / IT band (side of the upper leg) is often the key reason for knee pain in runners, as the tightness pulls the kneecap out to the side so it is no longer sliding properly in the knee groove.

Furthermore, tightness in the front of the hip area makes it impossible to get adequate hip extension while running, so the glute
max, the main powerhouse muscle needed for running would not be firing adequately. Impossible to run fast without the glutes!

Tightness in the inner thigh will pull the knee into the midline, leading to instability in the hip (gluteus medius weakness), potentially creating hip, knee or ankle pain.

And tight hipflexors, quads, calf, shin, bottom surface of the feet and toes can be a primary cause of Achilles tendon problems as well as plantar fasciatis (pain on the bottom surface of the foot and heel).

To run well, one needs to be able to rotate the trunk and pull with the arms, so anything restricting those motions will lead to overuse of something else further down the chain to compensate for the lack of motion above.

Muscles and fascia might be tight, joints at the spine, ribs and sternum may be restricted, and organs, nerves and blood vessels may be tethered, all of which may compromise motion in the trunk.

Strength
For the performance-minded runner, increasing strength is important to developing power, which is needed for increasing speed.

Increased strength can also be converted to muscle endurance, which will allow you to run faster for a longer period of time. Being strong is helpful in preventing injuries, as long as you are strong without compromising flexibility.

The ability to strengthen up is often limited by tightness in the opposing muscle (as I suggested earlier). Strength-training in a manner that improves flexibility simultaneously is the most efficient way to train.

If you want some ideas on how to do this, some of the exercises in our DVD are designed specifically to increase strength and flexibility at the same time.

Muscle Endurance
Muscle endurance is defined as the number of times one can contract a muscle, as opposed to strength, which is defined as how much force can a muscle generate once. Clearly, muscle endurance is extremely applicable to running.

 Even when looking at a 100 metre sprint, each foot hits the ground 40-50 times. This can hardly be classified as “strength”. Even in the gym when training muscle endurance, the rep range most usually considered is 15-20 repetitions, which is too low, even for sprint training.

It is muscle endurance that is going to get you through your run. It will allow you maintain proper running mechanics throughout the distance and therefore keep you injury free.

Running Technique
Learning proper running technique will make a huge difference to running efficiency as well as to preventing injuries. Developing the essential motor patterns to correct running is well worth the effort, and more time should be spent on this initially than on increasing mileage.

Increasing mileage using poor form will simply engrain bad habits that become harder and harder to change with every kilometer you run. By practicing good technique, you are running smarter, and in the long run, you will run better, longer, faster.

The best way to do this is to run barefoot or in minimalist shoes as they will force you to avoid landing on your heel, improving running mechanics immediately as your bodyweight will be more over your foot as your foot strikes the ground.

If the heel hits first, the foot is landing too far forward of the body, and
the heel acts like a break slowing you down, because the ground reaction forces
going back up your leg are pushing you backwards.

These forces can be up to ten times your bodyweight, and are therefore often responsible for Achilles, ankle, knee, hip and occasionally low back issues.

By pawing back with the leg and landing on the midfoot instead of the heel, the braking effect is minimized, speed is increased, and injuries are reduced.

Take a lesson from a good running coach who has experience with minimalist shoes. If you are a runner with a heel-landing technique, it will take a long time to make the switch.

The first run in minimalist shoes should probably be only about 5 minutes long. Resist the temptation to up the mileage too fast. Going too far too soon will only result in injury and frustration.

Hiking with a pack on uneven terrain in minimalist shoes will help the foot and lower-leg musculature become stronger and more flexible – good training that will maintain cardiovascular fitness while you are trying to learn a new technique and can’t put in lots of running mileage.

Over time as you gradually improve your technique, you will probably find that you are able to run more comfortably, probably faster, and that those lower-leg irritations disappear.

Please do keep the comments coming! If you want to search for other posts by title or by topic, go to www.wellnesstips.ca.

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Yessis, Michael Explosive Running: Using the Science of Kinesiology to Improve Your Performance
McGraw-Hill Companies, Inc, 2000)

Dr. Cucuzella, Mark, Principles of natural running

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Copyright 2012 Vreni Gurd

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Consider the fascia to get past knee pain

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Understanding how fascia works will alter movement protocols when addressing musculoskeletal pain issues. Here is how this new understanding might alter physical therapy for the knee.

Interesting how things shift when a paradigm that one has believed for a very long time comes crashing down.  There is no going back.  The other way of looking at the world simply no longer makes any sense, and the illogicality of it makes it hard to understand how anyone at all can live under the old belief system.

This has happened to me on two previous occasions, and when the other paradigms fell, both times I felt very alone.  Almost everyone I knew was still living under the old belief systems, and many thought I had lost it when I started to suggest there was another, perhaps better way.

The first paradigm that fell for me was the idea that allopathic medicine was the best way to treat all ailments.  Although it can't be beat for acute care, I realized that treating symptoms instead of causes, and treating a disease instead of the person with the disease was not going to work well for chronic conditions.

The second paradigm to fall for me was with respect to diet – the ideas that eating fat makes one fat, and that animal fats were extremely harmful, whereas vegetable fats were healthier.  I spent many years on a very low-fat diet. I'd have bread with jam or honey, without butter, and I bought low-fat everything.

After studying nutrition in general, and the biochemistry of fats in particular, I realized how completely backward those ideas were. Furthermore, I realized that the advice to lower saturated fats, and choose vegetable fats was likely to harm the health of far more people than it would help. 

I couldn't understand how this could be the nutrition gospel that was being disseminated by everyone, from governments via food guides, to physicians, even  to dietitians. So I researched how this nutrition advice came into being, and that explained everything.

Even though intellectually I understood that pastured saturated fats were not harmful, it did take me a while to "get it" emotionally. It is hard to switch away from the "society approved" low-fat diet to one that includes higher fat meats, cream, cheese etc. But when I did not get fatter eating more fat, I became more comfortable with the idea.

I decided to start my blog in order to attempt to counter the mountain of wrong information out there.  I was worried about people I cared about eating a diet that I felt might harm them, and it took me a long time to realize I can't make that my business as all I do is damage important relationships.

And I created my "Why the Food Guides are Wrong" nutrition course to help people see the other paradigm on how to eat.  Suddenly everything becomes crystal clear – there is no more confusion about what food is healthy and what is not. If you want to learn more about the course, click here.

Now the studies are coming out thick and fast that support the notion that quality saturated fats have been demonized for no reason, and cholesterol is not the enemy.  How many years it will take before the food guides are altered to reflect the science is anyone's guess. 

This third paradigm that muscles move bones has been problematic for me in my practice for many years, and I actually feel relieved that the science agrees with my experience.

I had noticed in my practice that it is not only possible but frequently desirable to activate one end of a muscle, while the other end remains quiet.  That does not fit with the old mechanistic lever concept which would entail the entire muscle being activated driving force along the length of the muscle and into the bone.

Dr. Tom Findley, in his editorial in this month’s Journal of Bodywork and Movement Therapies explains the change in concept this way:

“The point is that in real bodies, muscles hardly ever transmit their full force directly via tendons into the skeleton, as is usually suggested by our textbook drawings.  They rather distribute a large portion of their contractile or tensional forces onto the fascia sheets.  These sheets transmit these forces to synergistic as well as antagonistic muscles.  Thereby they stiffen not only the respective joint, but may even affect regions several joints further away.  The simple questions from musculoskeletal textbooks regarding “which muscles” are participating in a particular movement thus become almost obsolete.  Muscles are not functional units, no matter how common this misconception may be.  Rather, most muscular movements are generated by many individual motor units, which are distributed over some portions of one muscle, plus portions of other muscles.  The tensional forces of these motor units are then transmitted to a complex network of fascial sheets, bags, and strings that convert them into the final body movement.  “

When motor units within a muscle are activated they get thicker which tightens the fascial bags that contain them, which in turn directs the forces wherever the fascial connections are – not necessarily only along the line-of-pull of the muscle.

I think research will continue to map exactly where the various fascial connections go in the body, as that has a direct impact for rehabilitation and movement practice.

Physical therapists and movement teachers spend a lot of time getting their patients and clients to strengthen particular muscles and stretch others, which is important.

I think this new knowledge will result in physical and movement therapists paying far more attention to teaching people to relax certain muscles, thereby reducing tension through particular fascial connections in order to lower tensile strength going through painful joints.

For example, I have noticed that those with knee pain frequently over-activate the muscle in the front of the shin (anterior tibialis), which tightens the fascial bag in the lower front leg, pulling that fascia down towards the foot.

When the quad (front of the thigh) is also activated, particularly when the knee is quite bent, the tension over the front of the knee joint is increased dramatically, as the quad fascia is pulling up towards the hip at the same time as the shin fascia is pulling down towards the foot.

I believe people activate the front of the lower leg in an effort to keep the heel on the floor, which I propose is usually unnecessary. 

The other reason one may not be able to relax the ankles is that one is not fully centered over the foot, but is instead trying to use the shin muscles to stop from falling backwards.  Getting one's weight directly over the feet should resolve that issue and make it possible to relax the feet and ankles.

When moving from a seated position to standing with relaxed ankles, even if initially the heels are not on the floor, as the weight of the body comes over the feet the heels will come down as the fascia along the bottom of the foot and calf is passively stretched.

If the muscles around the ankle including those in the front, are relaxed, and the foot is simply sinking into the floor, the tension over the knee is reduced as the fascia is not being pulled down towards the foot.

When we go up stairs, we place our forefoot on the stair and sink into it, keeping the muscles around the ankle relaxed. This same concept should be also be applied to squats, lunges, step-ups and deadlifts in my opinion, as it will reduce the tensile force around the knee.

Obviously this won't fix all knee pain, but I have had good success with this concept for a few months, even before the Fascial Research Congress confirmed that there is merit to the idea.

If you want to search for other posts by title or by topic, go to www.wellnesstips.ca.

Related tips
Our body web

3rd International Fascia Research Congress, Vancouver BC, March 28-31, 2012

Enig, Mary; Know Your Fats: The Complete Primer For Understanding the Nutrition of Fats, Oils, and Cholesterol Bethesda Press, Silver Spring, MD, 2003.

Felton C. et al. Dietary
polyunsaturated fatty acids and composition of human aortic plaques
Lancet, 1994, 344:1195

Copyright 2008/2012 Vreni Gurd

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Our body web

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I just spent the last 4 days at the 3rd International Fascia Research Congress, so thought I would attempt to share this new way of looking at the body.

What is fascia, and why should we care about it? Because it is the tissue that holds our body shape. There is so much fascia in the body that if we took out the muscles, the fat, the blood vessels, the organs, the nerves – everything in the body except the fascia, we’d be able to recognize each other with no difficulty.

Fascia is everywhere, and connects everything to everything else. So why the sudden excitement over a tissue that has always been there?  Because most frequently anatomists have cut it off to better view the other body parts that they were interested in examining.

Some fascia has been considered important for a while, such as the IT band, and the thoracolumbar fascia, which support the side of the hip and the low back respectively. 

For this reason, anatomy books do show that fascia, but most of the images are devoid of fascia, and if you went to BodyWorlds, the muscles were all separated out, hanging as separate pieces which does not represent what is really happening in the body.

Think about the magic that is our skin and the tissue just underneath.  We can pick up a pinch of skin and roll it under our fingers, and when you let it go, no matter what direction you moved the superficial tissue, it pops back into place. 

The fractal grooves in our skin are a reflection of the 3-dimensional spider-web-like, flexible, dewy tissue underneath, designed in a way that allows for movement in any direction via watery sliding fibres and stretch.  Take a look at this video clip to get a feel for what the superficial fascia under the skin looks like.

Veins, the bluish tubes that return deoxygenated blood to the heart, are collapsible, yet the loose superficial fascial web keeps them open while we move and  stretch our bodies.

Human movement does not work entirely as a muscle-lever system as we had previously thought.  Such a lever system would probably result in very robotic movements, but we are capable of very smooth, coordinated movements.

Muscles don't really begin and end – they continue via the deep fascial system something like sausages linked together through their casings.  This means that when we stretch or massage a particular muscle, we will affect many of the muscles within that connective tissue.

You can prove this to yourself easily.  Stand up and bend over, and note about where your fingertips reach with respect to your legs or feet.  Then stand up again, and roll the bottom of left foot only on a golf ball for about 3-5 minutes. 

Bend over again, and what do you notice?  Most people notice that the left fingertips are reaching further than previously.  Even though you only worked the tissue on the bottom of the foot, you have magically become more flexible in the entire back-line of the body on that side!

Fascia not only connects muscles lengthwise to each other, but also glues certain muscle bellies that sit beside each other together.  This allows forces to be transferred laterally (or obliquely or whatever) across muscle bellies as well.

Depending on the movement we are doing, different layers of our muscle-fascia system move us by sliding over each other as needed. 

The ability of the fascial-web system to spread forces out and to dynamically create tension exactly where it is needed, when it is needed in order to move the body makes for a movement system that is far superior and more representative of how we actually move than a mechanical lever system ever could be. 

I wish I were able to find online a copy of the video we saw of a fresh dissection, showing the slide and glide as a leg is moved.  What I saw did not match at all how I had previously imagined movement to work. 

Obviously the movement was passive rather than active but still I did not expect to see so much sliding of layers of myofascia over each other.  What I had in my mind previously was muscles stretching and shortening but staying rather static.  I did not imagine the sliding.

Individual muscles can be useful to designate a particular area of the body, but when it comes to function or treatment it is helpful to consider what is happening in the entire muscle-fascia system involved rather than each muscle individually.

So, instead of learning anatomy by memorizing origins and insertions of muscles that don't really exist as independent functional units as we previously believed, perhaps it would be easier, more accurate and useful to study movement patterns like  the squat pattern, lunge pattern etc., or fascial planes that organize movement, such as the inner-leg line, the side line etc.

3rd International Fascia Research Congress, Vancouver BC, March 28-31, 2012

Copyright 2012 Vreni Gurd

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Muscles can push

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We all know that muscles “pull” the bones like levers to make us move, but muscles can also “push”, which can be helpful to keep in mind when trying to resolve postural-pain problems.

The statement about "muscles" being able to push is not entirely accurate but if I’d said “myofascia can push”, I’m guessing many of you might not know what I’m talking about. And yes, I know. You can’t push a string. But hear me out.

Each hinge-joint for example, has muscles on the front of it and the back of it, one of which will bend the hinge, and the other which will pull the hinge straight. Hinge joints include the knee, the elbow, and the talus joint at the ankle.

The hamstring muscles at the back of the thigh bend the knee by pulling the lower leg backwards towards the thigh, and the quadricep muscles in the front, straighten the knee by pulling the lower leg forward.  This is simple lever mechanics.

However, because we are not machines and our bodies adapt to how we use them, muscle lengths can be altered from their functionally-optimal length. 

Here is a simplified example to help you understand how muscles can push joints:

If we do not kneel on the floor and sit on our heels as frequently as we bend over from the hips to pick something up from the floor, the body, being economical like it is, decides that since the full range-of-motion in the front of the thigh is not being used we don't need it, and over time the quad muscle (front of thigh) will shorten.

Now the quadricep (fascia) on the front of the knee is tighter than the hamstring (fascia) on the back of the knee, and when we stand we are more likely to lock our knees out, which pushes the joint back, resulting in the shin bone leaning back.  So hyper-extended knees signal the possibility of tight quads.

If you have a pliable rod which you have wrapped in plastic, and you tighten the plastic more on one side, the rod will bend like a bow. The tight plastic is pushing the rod into the more extensible side.

So, if someone stands with their hips forward of their ankles, the muscles behind the hips are tight, pushing the hips forward (external hip rotators, hip extensors).  

If one's pelvis is rotated to the left in standing (right side forward), the muscles in the back of that right hip are tight or overly contracted, pushing it forward creating a rotation.

If one's ribs appear shifted left in relation to the pelvis, the muscles and fascia on the right side of the ribcage are pushing it over (serratus anterior), and that muscle/fascia could use some stretching or massage.

If one's pelvis is shifted right in relation to the feet, the muscles and fascia on the left side of the pelvis are tight are pushing the pelvis right, and could use some stretching or massage.

If the ball of someone's shoulder appears forward on the ribcage and there is shoulder pain, look for tightness at the back of the shoulder and stretch that (infraspinatus, posterior shoulder capsule).

The shoulder case is interesting to me because it was always drilled into my head that a shoulder that is rounded forward is due to a tight pec minor (chest muscle) pulling the shoulder forward.

So I would always give pec minor stretches, and more often than not the results were less than satisfactory, occasionally making the shoulder pain worse.

Following through on the idea that tightness from the back is pushing the shoulder (humeral head) forward, it makes sense that stretching and loosening the front would make things worse by creating a bigger imbalance front to back.

In order to "push" the ball back into the socket, strengthening the muscles at the front of the shoulder would probably be helpful, specifically subscapularis.  Often in these cases, the push muscles (pecs, delts, triceps) are weaker than the pull muscles. 

Chest strengthening would need to be done very carefully, as we would want to avoid further stretching the front of the shoulder capsule. I use three different strategies for this. 

  1. Dumb bell chest press is done on the floor so the elbows do not descend below the body resulting in a stretch of the anterior shoulder capsule.  I often don't even allow the elbows to reach the floor, and have occasionally put blocks or towel rolls on the floor so the elbows only descend to the height of the shoulder.
  2. I use a close-grip dumb bell chest press to start – hands no more than shoulder-distance apart, and only widen the motion when pain is reduced. Elbows start alongside the ribs, forearms vertical.
  3. Chest press and shoulder press are done starting with the palms facing each other, and as the arms reach skyward, the palms turn and face behind the head as far as is comfortable with no strain. The external rotation of the arm at the end of the range of motion stretches the lats and the chest, seems to reduce over-protraction of the shoulder-blade, and also seems to help sink the arm deep into the socket potentially stretching the posterior shoulder capsule.

Pec minor is a small chest muscle that runs from the ribs to the coracoid process of the shoulder blade (sticky-outy bit that one finds if one searches, just under the collar-bone by the shoulder). Pec minor does not attach to the arm or to the ball of the shoulder.  When it is tight, it pulls the shoulder blade up and "over" the shoulder giving the appearance of the shoulder rounding forward.

In order to discern whether the problem is a tight pec minor as opposed to the ball of the shoulder being pushed forward, check the shoulder blade in the back.  If the bottom point is sticking out, and if the shoulder blade appears high, pec minor stretching is probably in order.

Please do keep the comments coming on my blog. If you want to share this article, go to the blog post and scroll to the bottom and click on the “share this” icon. If you want to search for other posts by title or by topic, go to www.wellnesstips.ca.

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Copyright 2012 Vreni Gurd

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