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Chronic SI joint pain is no fun, so here are some techniques to try to realign the pelvis and get rid of the pain.

Before we get to the topic at hand, I want to announce that my long awaited nutrition course entitled “Why the Food Guides are Wrong: How to Find Health and Lose Weight”, is now available online. By the end of the roughly two hours it takes to go through the course, your confusion over food and what is healthy to eat will have disappeared because the lens through which you look at food will have changed. Suddenly the conflicting nutrition messages that are everywhere won't be a problem anymore and you won't be pulled from one diet to another depending on what diet guru you happen to be listening to at the time. Everything will seem so obvious that you will wonder how you could have possibly been confused before. I echo Paul Chek’s suggestion that food is the drug we take three times a day. Eat poorly and your health will be taken from you. Eat right and your health will be restored.

The feedback I have received from people that have attended the course in the past have included sentiments like "life changing", and "I didn’t really expect to learn anything, but found out I didn't know anything at all", and “I don’t think I’ll bother taking the other nutrition course I signed up for - I now know all I need to know”. People have come up to me months after taking the course and thanked me for the presentation and changing their lives.

The introductory offer is $39USD, which includes the slide presentation and lecture, as well as additional reference materials and resources that you can print off to help you get started. Sign up by going to http://WellnessTips.digitalchalk.com.

Now to the topic of SI joint pain. Thursday I was sitting at a coffee shop in a business meeting with a colleague without the “butt lift” that I need (one side of my pelvis is slightly smaller than the other, so I usually sit with a pad under one sit bone to keep my pelvis level), and I felt my SI joint go out of alignment. Instantly I was back to that left-sided low-back pain I had felt on a daily basis many years ago. That night I was lying in bed thinking how ironic it was that the following day I would have no time in my day to fit in a chiro appointment to realign my pelvis and resolve my pain, because it was jammed with people coming to see me to fix their back problems. Aarg! I don't have time for back pain! I decided that surely I knew enough about the SI joint to fix myself, even if I couldn’t assess myself properly to determine exactly what had happened. So at three in the morning I was crawling around the floor in the dark with my cat, trying to fix my back.

If the SI joint hurts, chances are mighty good that the pelvis is out of alignment. The pelvis forms a ring, with the two outside bowl-like bones (iliums) hugging the triangular sacrum in between them in the back, and the transversus abdominis muscle completing the top of the ring, the pubic bone the bottom of the ring in the front. The sacroiliac joints are held together with very strong ligaments, but the joints are supposed to move a bit as we move. If the pelvis ring distorts to any greater degree than is appropriate for the SI joints, pain can result.

For those of you interested in the technical stuff, keep reading, and those of you that just want to get to the exercises, skip to below.  My pain was exactly where it used to be - left SI joint, and I remembered over ten years ago, when I took Diane Lee and LJ Lee's low back, hip and pelvis course (which changed my life by taking me out of chronic pain), Diane Lee told me that my right sacral multifidus (very deep muscle that stabilizes the spine and sacrum) had atrophied greatly and was not firing at all.  With nothing pulling the right side of the sacrum back, the sacrum would then be free to rotate to the left within the iliums, and this in turn would create an inflare of the left ilium (ASIS moving medially), and an outflare (ASIS moving laterally) of the right one, as they are tugged out of place by the ligaments attached to the now faulty positioned sacrum. Lying on my back, I felt my sacrum, and sure enough I had to go further to hit bone on the right side than the left, indicating to me that probably my sacrum had rotated to the left. And if the sacrum was rotated left, I figured my lumbar spine probably was as well. Please note the image on the left shows a nicely aligned pelvis, and the image on the right shows a right inflare pelvic distortion.

I needed to pull the left ilium back out, and rotate the sacrum and spine back to straight. So I lay down with my left side about 6 to 8 away from a wall, bent the knee of my left leg and pushed it into the wall for 10 to 15 seconds, activating my left external hip rotators to try and correct the left inflare. After repeating this a few times, and I turned my attention to my sacrum. I got into an elbow plank, body straight, legs straight, toes firmly connected to the ground, and I lifted my right foot reaching it back to activate the right multifidus, but more importantly to activate the left psoas via the left foot stabilizing me, since it attaches to the front of the spine and would be very powerful in rotating it back to neutral. I did as many 10 second holds as I could manage while maintaining excellent form. I then did the Don Tigny knee brace a few times on each side to ensure my SI joints were in their best position and I finished off by doing some Swiss ball supermans, to make sure I was connectng to my multifidus and other deep local stabilizers properly. I then went back to bed. The next morning my back felt much better!

If you have SI joint pain, these mobilizations may help, but please understand that there are many pelvic distortions so there are no guarantees. If you decide to try these, you are making the choice to try these without being assessed first. They may not be right for you at all if your back pain is more complicated than simply an SI joint problem. To be safe, see a physical therapist to find out if these exercises are appropriate for you. I think the may work if your distortion is an obliquity of the pelvis - an inflare/outflare distortion. If you do find these mobilizations helpful to realign your pelvis, do them before you do your stabilization exercises. If your SI joint continually goes out, you are doing your stabilization exercises correctly and you have been doing them for a while, there is probably an underlying problem such as an anatomical leg length discrepancy or smaller hemipelvis on one side that is putting constant stress on the SIJ and needs to be sorted out. Call Neurosomatic Educators at 1-866-597-3772 to find an Integrated Neurosomatic Therapist near you to find out if this is why you can't get better.

1) Don Tigny knee brace: Lie on your back in a doorway, one foot on the door jamb, knee pointing slightly out to the side, other leg reaching into the other room. Push through your heel into the doorjamb using your buttocks and hamstrings. Push for 6 seconds, rest for 6 seconds, repeat 6 times. Move over to other side of doorway and do the other side. This alone may do wonders for SI joint pain. If this has helped, leave out exercise 2 and 3 and skip to the Swiss ball superman.

2) Inflare correction: Do on the SORE side. If both sides are sore, don't do this at all. Lie with sore side about 6 to 8 inches away from a wall, knee bent, foot on the floor, other leg straight. Push side of knee into the wall, activating the hip muscles on the sore side. Allow your trunk to rotate the other way. Push for 6 seconds, rest for 6 seconds, repeat 6 times or more.

3) Plank: This is a VERY challenging exercise so evaluate your abilities carefully before attempting this! You can modify it by doing a plank from the knees if you need to. Get into an elbow plank (or high plank on the hands if you prefer), making sure the trunk is straight from the shoulders to the toes or knees. The hips are not hiking way up into the air. If you are able to, lift and reach the leg of the side that is NOT sore, without allowing anything to move in the pelvis. You should feel the front of the hip working hard on the sore side. This will work even better if you can turn the tops of the toes under like a yoga up-dog to do this, but very few people have that kind of flexibility. If you can't lift the leg, push the SORE side toes or knee into the floor for 6 to 10 seconds, feeling the front of the hip working. Hold the position for 6 to 10 seconds, rest for 6 to 10 seconds, and repeat if possible. Do NOT do the opposite side. If both sides are sore, just do a plank without lifting your legs.

4) Swiss Ball Superman: Balance your belly on a small Swiss ball such that you have even weight between your hands and feet, and your spine remains neutral. Anchor those toe pads down and feel the connection to your pelvic floor. Lift the "not sore" leg and reach it back without allowing your trunk to rotate or side-bend on the ball, and without allowing the ball to move. If you are successful, lift the opposite arm off the floor and reach it forward without allowing any movement in the trunk or ball. Hold for 6-10 seconds and repeat. If your trunk or ball is moving, you are not stabilizing correctly, so try smaller movements, and check to make sure you are holding in your pelvic floor. Sometimes it helps to do the "easy" side a few times, to teach the brain how to connect for the "hard" side. If both sides are sore, do both sides equally.

I suggest finishing off with the Don Tigny knee brace again. If these exercises work, do them a few times a day. If you have longstanding SI joint pain and the bones simply won't move, see a soft-tissue therapist before trying again.

There, you see? Sometimes pain serves a purpose. Forced me to think hard, and I think I learned something useful because of it. Movement practitioners out there, feel free to comment and let me know if you think I am completely out to lunch on this, or if you have found anything else that works well that you would like to share. And those with SI joint pain, feel free to let me know if these ideas work for you … or if they don't.

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In order to maintain our ability to participate in the physical activities we enjoy throughout life and to keep leg, hip and back pain away, we need to be able to get up off the floor at least three different ways.

From a physical ability perspective, the toilet was a dastardly invention. We are designed to poop by squatting right down to the ground, so before the toilet, from the time we learned to squat poop as a child until the time we died, we had the flexibility and strength to do so. We pooped often enough to keep ourselves adequately limber to squat low, and strong enough to easily get up from that position.   Now a-days many of us stop getting down onto the floor altogether once the kids are past the toddler age. The chair is about as close to the floor as we get. Then some years later we find ourselves on the floor for some reason or another, like looking for something that rolled under the sofa, and we realize that getting up off the floor is suddenly quite hard work.

In those intervening months or years of no floor time, our leg muscles have tightened up to the point that we can’t bend our knees, ankles or toes as far as we used to, and we have lost the strength to easily get up from the floor. So we rely on our arms to either pull ourselves up onto the furniture, or we push our hands down on our thighs to get our trunk up. And then the grandkids come along, and we want to be able to crawl around the floor with them like we did with our kids, but somehow the effort is too much. We attribute it to ageing and accept this as an inevitable part of life, and we try and keep up with the grandkids while staying on our feet. But for some, even that is challenging, as the knees, hip or back hurts.

The question is whether the knee, hip, or back pain is the reason for the lack of ability or whether the lack of ability is the reason for the knee, hip or back pain. More frequently than is acknowledged, the lack of ability in terms of flexibility and strength is the underlying cause of the pain. If the pain came on gradually as opposed to a sudden trauma such as a car accident or fall, it is quite possible and even likely that the pain is due to being too tight and/or too weak. Interestingly enough, if one is flexible enough to squat right to the ground and stay there comfortably, it is easier to recruit the correct muscles in the right order when getting up, which would reduce the chances of getting low back, hip and knee pain. One of the biggest mistakes well-meaning adult children do is move their parents out of a home that has stairs into a home that does not, thinking that a stair-free environment will be easier on them. But having stairs keeps one able to do stairs, and once there are no stairs to climb on a regular basis, the ability to climb stairs is lost. Soon stepping up or down a curb becomes a problem, and getting into or out of cars is impossible without help. And so the life closes down even further.

This gradual loss of function is not an inevitable part of ageing and can be avoided all together. The saying “If you don’t use it you’ll lose it” is true, but so is its opposite, “If you use it you will regain it.” The miracle of our bodies is that with consistent, appropriate daily practice targeted to one’s current ability, function can be regained.

I believe everyone should be able to get up from lying on their back on the floor in at least three ways. They are listed here from easiest to hardest:

1. Bend technique: Rolling onto the belly, pushing up onto all 4s, lifting the knees off the floor and using the hands on the floor to push the hips back until the heels are down, and rag-dolling up to standing.
2. Squat technique: Doing a full sit up, pushing oneself forward onto the feet
   into a low squat, and standing up by pushing the feet into the floor, and keeping the chest higher than the hips at all times.
3. Lunge technique: Getting onto the knees, lifting one foot forward, pushing through the whole front foot and back toes to stand up. One should be able to do this on both legs.

In my experience, many people are impaired in their ability to do the squat and lunge technique due to a lack of flexibility in the hips, knees, ankles and toes. Many don’t have the strength in the abdominals to do even one full sit up from the floor in order to get into the squat position, and many don’t have the strength in the buttocks and legs to push up to standing from the floor without using the arms. I’ve seen this in people in their early 20s, so this is not only a problem for those in middle age and beyond.

For some people there are good reasons why certain techniques should not be practised (if you have an acute disk problem, the bend pattern and the very bottom of the squat may be problematic for example), so see your doctor for clearance. Then hire a trainer who can help you stretch your tight muscles and strengthen you to the point you can do these movements effortlessly. And watch how your life expands!

Very soon I'll be offering my nutrition seminar online - people have told me they leave the course with complete clarity on how to know whether or not a food is healthy to eat. And months later when I run into those that have taken the course, I am told what a difference the information has made to their lives. So look out for it soon!

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Butt gripping is a common unconscious habit that may be at the root of low back, SI joint and hip pain.

Do you have chronic low back or hip pain? If you are female, did you notice that you developed your back pain during pregnancy or after giving birth? Maybe a fall or car accident triggered the back pain and now it is ongoing? Whatever the initial cause it may be worth checking yourself to see if you are a butt gripper. Butt gripping is a term coined by Diane Lee and Linda Joy Lee, used to describe a back stabilization strategy that involves squeezing the buttocks together. This habit is completely unconscious, and is a common strategy the brain uses to try and stabilize the spine if the muscles that are supposed to do the job are not functioning as they should, or if there are significant digestive issues that may be causing gas. Butt grippers are easy to recognize in other people - not only do they look like they are squeezing their butt cheeks together, but they also frequently walk like a duck with the toes pointing out.

Sometimes it is more challenging to recognize the habit in oneself. If you are not sure, have a friend help you. Lie on the floor on your back, completely relaxing your leg and buttock, and have your friend pick your leg up and hold it bent to 90 degrees, at the knee and at the ankle. Your friend can then try and move your upper leg side to side. It should swing completely freely with no movement in the pelvis at all if you are not butt gripping. If the leg moves stiffly as if one were churning butter, or if the pelvis moves with the leg, that means the buttocks are hanging onto the leg and you are indeed a butt gripper. Check both legs, because occasionally the problem can be one-sided.

Why would this habit increase low back and hip pain? Try squeezing your butt cheeks together hard, and walk across the room. Notice how your legs cannot swing freely, and how you need to rotate your spine in order to move a leg forward. This puts extra wear and tear on the vertebral joints - not good. Contracting the piriformis, a deep rotator muscle in the buttock that runs from the sacrum (triangular bone at the bottom of the spine) to the big bump on the outside of the upper leg bone (greater trochanter), puts a strangle hold on the bottom of the sacroiliac joint, compressing it and creating pain. Furthermore, because the sacrum is a triangular bone and butt gripping squeezes the bottom part of the joint, the top of the SI joint opens up making it unstable. And with the sciatic nerve being so close to the piriformis muscle in the buttock, occasionally overuse of this muscle will create sciatic pain.

Although not in the right place to mimic piriformis properly, the bungee cord in the photo simulates a butt gripping strategy, and one can clearly see how this opens the top of the SI joint. This might also destabilize the joint between the top of the sacrum and the lowest vertebrae, and possibly the lumbar spine further up. Also, the piriformis might pull the front of the lower sacrum forward, unlocking the SI joint, destabilizing it. Massaging the external hip rotator muscles will help temporarily, but until one stops using a butt gripping strategy the pain will not go away permanently.

In order to stop butt gripping permanently, one must replace the butt-gripping stabilization strategy with one that is more optimal. Ideally we want to create a ring of support around the top of the pelvis by using the deepest abdominal muscle called the transversus abdominis. Notice in this photo how the bungee cord simulating the action of transversus abdominis, closes the SI joint, and how using this muscle would stabilize the pelvis in a way that does not compromise the ability of the legs to move freely. This muscle, along with co-contraction of multifidus and the pelvic floor form the optimal way to stabilize the low back and SI joint.

Find transversus abdominis by getting onto all 4s, letting your belly hang out, pulling in the tissue just above the pubic bone, feeling a slight muscle contraction there, and holding it while breathing. The contraction should be well below the belly button. Drawing the navel to the spine activates the wrong muscle according to Real Time Ultrasound research, and therefore does not provide the needed stabilization to the spine. One should be able to hold this deep, low contraction and breathe quite easily. Once you can find this abdominal muscle, lean back so your butt cheeks open. Then try finding your connection to transversus in various positions including sitting and standing. Transversus should be on at very low intensities pretty much all the time, so build up hold times rather than contracting and relaxing it.

Frequently practice finding transversus abdominis in standing, and then practice letting go of your buttocks so your legs can swing freely. Teaching your brain to use your body differently can take a few weeks to a few months of diligent practice, so be patient. Best practice for a minute 6 times an hour rather than an hour a day, so set a timer to beep at you every 10 minutes. Over time as your brain learns a new way of stabilizing your back and pelvis your pain may very well dissipate. This is tricky stuff, so do find a good physio or CHEK practitioner to help ensure you are doing this correctly.

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The following body positions most kids can relax in easily, but as adults we may stop being able to do them if we allow our muscles to shorten. That lack of flexibility impairs our ability to move properly making us more prone to injury. So if “relaxing” is not the word you would use to describe these positions, working towards being able to do them easily again may just change your life.

Here are my initial ideas on positions I think we should be able to do throughout our life. Do these in bare feet for best results, and keep any stretch mild.

1. Squat to the Floor We should be able to easily spend time in a deep squat keeping our heels down without falling backwards, body leaning between the legs as if we were pooping in the woods. If you cannot do this, try holding onto a sturdy post and lower yourself down leaning back just enough to keep your heels on the floor. You can always sit on a low step-stool for extra support and to make the position more relaxing. Keep your knees in line with your toes, ease into a stretch and wait for it to dissipate. In addition to pushing through your feet you can use your arms to help pull you up when you are done. (Please note: NEVER do a squat to the floor with added weight. Avoid if you have a disk problem in your back.)

2. Tripod Split Squat 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. Make sure you switch sides to work on both legs. This is the ideal position for lifting heavy objects off the floor as one can straddle the object being lifted thereby keeping it close to our body, the spine has a neutral curve, and it forces the use of the legs rather than the back to get up. But it requires good toe flexibility which is usually the limiting factor in this position. If this is too painful, work on your toe flexibility by going onto all 4s, tucking your toes under and leaning back until you can sit on your heels. Toe spreaders can also be very helpful.

3. Kneeling Come down onto all fours, tops of the feet down, but turn your hands around so the fingers are pointing back at your knees, palms down. Gently lean back to get a mild stretch in the forearms. When this range of motion is lost we lose the ability to weight-bear through our hands. When you have had enough of that, take the hands off the floor and sit down fully on your ankles and heels to stretch out the tops of the feet and front of the lower legs. If you can't sit all the way back, put your hands on the floor and lean back as much as you need to get a stretch. Once you can sit comfortably like this on the floor, you will be able to interact much more easily with babies and toddlers. Also being able to get up and down from the floor easily will keep your legs stronger than they otherwise would be.

4. Cross-legged sit with forward bend Sit down on the floor and bring one heel into your perineum, and the other heel just in front of that foot. Your knees should be wide and your legs should feel relaxed. If not, try sitting on a phone book or pillow so that your knees are lower than your pelvis. Now lean forward and if possible, rest your elbows and forearms on the floor in front of you, keeping your sit bones down. If not possible, rest your hands on the floor. Avoid the temptation to look up, which would shorten the back of the neck. Most likely you will feel a stretch in the hip of the forward leg, and possibly the inner thighs and low back. Switch the feet to keep the other hip limber too. (Avoid bending forward if you have a disk problem.)

5. Seated forward fold Sit tall on your sit bones on the floor with your legs stretched out in front of you. If possible, gently fold forward keeping the knees soft and collar bones wide, until you feel a mild stretch in the back of your legs. Some people are able to relax with their chest on their thighs, while many of us may not be able to fold forward at all. If you are sitting behind your sit bones, sit on a phone book or pillow to raise you enough to make it possible for you to relax on your sit bones. Sitting on a block with your back against a wall to provide some support may be a very good starting point as one can easily relax and spend time in that position. (If you have a disk problem you need hamstring stretching, but this is not the best choice for you. See a physio, CHEK Practitioner or personal trainer who can teach you a hamstring stretch that keeps your spine in neutral.)

6. Supine butterfly with T-Y-I relax Lie on the floor on your back and lean the soles of your feet into each other, heels close to the perineum, possibly creating a stretch in your inner thighs. If the stretch is too great for the inner thighs, play with the distance your heels are from your perineum, or use pillows for support under your knees. If your head is tilted back to reach the floor, use a pillow so you can keep the plane of your face horizontal. Hopefully eventually you won't need the pillow. Rest your arms out to the side like the letter T, raising them up as high as you can while keeping them on the floor. Perhaps you will be forming the letter Y with your arms and trunk. The goal is to eventually have your upper arms up against your ears like the letter I, yet relaxed on the floor and feeling no stretch in your chest or armpits.

7. Supine torso twist Lie on your back with your arms out to the side, knees bent, feet on the floor. Push through the feet to lift the pelvis up, and place it on the floor slightly to the left. Drop the knees to the right towards the floor, keeping the shoulder-blades down, possibly feeling a stretch in the left side and buttock. Ideally you should be able to relax with the legs on the floor in this deep twist. If you cannot, put pillows under your legs to support them so that you can relax, but still feel a stretch. Do the other side as well.

8. Ankle across knee torso twist Lie on your back with your arms out to the side, right knee bent, foot on the floor, left ankle resting on the right thigh so the left knee is pointing out to the side. Slowly drop the right knee down to the right side so that the left foot ends up on the floor and you can hang onto it with your right hand. The left knee should just hang away from the body. You may feel a stretch in the front or side of the left hip. Use pillows for support if needed. Do the other side.

9. Supine C stretch Lie on your back with your legs stretched out, and your hands clasped overhead. Move your legs and arms to the same side so you are taking the shape of a banana, but do not allow your pelvis to rotate. Cross the foot of the leg that is on the outside side of the curve over the foot of the inside leg, relax and feel a gentle stretch through the lateral line of of the body. If you feel any discomfort in your pelvis, try holding in your pelvic floor as if you were stopping the flow of urine and draw in the tissue just above the pubis. Notice any differences side to side.

10. Sphinx with lower legs up Lie on your belly and come up onto your elbows, forearms and hands facing forward, elbows at 90 degrees, while keeping your pelvis on the floor. Keep the back of the neck long, chin drawing into the front of the neck slightly. Try to arch your upper back by keeping the collar bones wide, lifting your sternum up and through your arms and feeling a stretch in the belly. If this is comfortable for your low back, try bending your knees so the flats of your feet are facing the ceiling. This position should be quite restful, but if your low back is bothering you, only come up as high as is comfortable, and try supporting your pelvis by drawing in the tissue just above the pubis. For some, lying on the floor with the forehead on the hands may be all that can be initially tolerated. Find the position you can relax in and progress from there.

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A stroke occurs when there is a disruption of blood flow to the brain which starves the brain tissue of oxygen and nutrients, and causes that part of the brain to die. A disruption can be caused by either a rupture of the blood vessel (an aneurism) or a blockage within the vessel.  The larger the blood vessel that is involved, the larger the area of the brain that is affected. Strokes cause speech impediments, paralysis, unconsciousness and even death. Because the left side of the brain controls the right side of the body and vice versa, dysfunction as a result of a stroke occurs on the opposite side of the body. A heart attack is essentially the same thing, but the blood vessel that is blocked is in the heart, causing a part of the heart to die.

Before the discovery and understanding of the implications of neuroplasticity, the belief was that recovery from a major stroke or other brain lesion would only be minimal, since it was believed that certain parts of the brain controlled certain functions, and once a control centre for a particular function was disabled, nothing much could be done about it. Now we know that the brain is capable of reorganizing itself to such a great extent that remarkable recovery of movement as well as speech function is possible with the right therapy.

Edward Taub, a behavioural neuroscientist pioneered a method of stroke rehabilitation called “Constraint Induced Movement Therapy”, and thousands of stroke patients have recovered function to the point of being able to care for themselves and continue their careers.

Taub believes that part of the problem post stroke is learned; the patient quickly learns to stop using the limb which has lost function and relies instead on the “good” limb to do everything. If the brain is not challenged to try to use the affected limb, it will not change in order to learn to use it again. So Constraint-Induced Therapy involves immobilizing the “good” limb by using large, stiff mittens and slings so the patient is forced to use the limb affected by the stroke.

People go into therapy for two intensive weeks, and they are given simple tasks that mimic life activities starting with large motor movements, and with success moving gradually to fine motor skills. A patient may come into therapy with some ability to move an arm and extend a hand, and leave with the ability to do up buttons on a shirt. Absolutely astounding progress in just two weeks! Even people that had strokes many years ago can benefit from this kind of
therapy.

Patients wear their mitts and slings on their unaffected limbs 90% of the day while in therapy, and may start with exercises like wiping pots (the pot constrains the hand initially and helps teach the circular movement), wiping a table, putting large pegs into peg boards, picking up large balls, and later they put pennies into piggy banks for example. They learn to use a fork to pick up food and bring it to their mouths. Eventually skills are timed, so patients learn to be accurate and fast. By doing intensive work over two weeks, they get mass practice with incremental increases in difficulty which causes enormous brain (cortical) reorganization or plastic change. Function may not be quite what it was before the stroke, as neurons that are learning to take over a task may not be as effective as the ones that they are replacing, but all the same, it is possible to regain function to the point of giving someone back their life.

About 40% of those that have a left hemisphere stroke have damage to Broca’s area and therefore have speech deficits. How does one put a mitten on a tongue and jaw to help those who have lost speech function? Language rules are implemented into card games. As language skills improve, the rules become more stringent. The game is something like "Go Fish" with pictures of objects on them, where each in turn asks for the card they are seeking from a particular person. They would request the card with the rock on it, for example. Initially the only rule is they cannot use hand signals but must verbally request the card somehow. If they can't think of the name of the object they want, they can describe it instead. Once they have the pair they can discard it, and the person that gets rid of all their cards first wins.

More advanced versions of the game involve precisely naming the object they are looking for, or cards including colours and numbers so more
description is required. The participants that obeyed the rules of the game 3 hours a day for 10 consecutive days had a 30% improvement in
communication compared to the control group which got conventional therapy that involved repeating words.

This therapy works best if it is done all at once - mass practice over 2 weeks - rather than less frequent therapy over a longer duration.  It seems the brain needs to be deprived of the alternatives in order to be forced to rewire itself.

This kind of therapy is useful not only for strokes, but also for those with movement and speech problems caused by cerebral palsy, spinal cord injuries, brain tumours, Parkinson's, and multiple sclerosis.

I think the concept of forcing the brain to learn to move the body differently would be useful in physiotherapy and exercise rehabilitation as
well, since poor movement patterns lead to joint problems and pain. By finding a way to completely block the unwanted movement pattern and forcing the brain to use a better movement strategy, perhaps we can more quickly and more effectively break bad habits, rehabilitate injuries and possibly prevent some from occurring in the first place. I have figured out a way to block a quadricep strategy in a lunge pattern, but still need to work out how to block other poor movement strategies and force good ones in other movement patterns like the squat, bend, upward scapular rotation and gait.

The information in this post is from the fabulous book by Norman Doidge, M.D. entitled The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.  I absolutely loved this book, as it provides so much hope for those suffering from a huge variety of problems ranging from depression and cognitive issues to balance problems, to sight impairments to motor control impairments. One learns about the scientists at the forefront of neuroplasticity research, and the patients they have helped.

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Frequently hip and sacroiliac joint pain can be the result of toes that don’t extend enough which causes a flat-footed walk, resulting in the pelvis tilting forward, and over-use of the hipflexors in walking, unlocking the SI joint.

I wrote a post a couple of years ago about how hip pain and SI joint pain can be the result of a pelvis that is tilted forward forcing a very effortful walk, and an unhappy wearing of the hip socket. Through working with people in bare feet, I’ve recently noticed a common pattern in people with SI joint and hip pain - many have very poor flexibility and openness in the feet and toes, and I think it is at least possible if not quite likely that this lack of toe flexibility is forcing poor walking mechanics and a poor pelvic position, leading to SI joint and/or hip pain.

While kneeling on the floor, toe pads down, one should be able to easily put full weight through the toes by sitting on one’s heels. The toe fold should be about 90 degrees. One should be able to control the muscles of the toes, spreading them all apart. Also the tops of our feet and ankles should be open enough to be able to tolerate kneeling and sitting back on one’s heels. Better yet, one should be able to grab the floor with the tops of the toes, pulling the toes forward until the ankles are flexed to about 90 degrees and then sit back on the heels with the toes turned under. Quite a painful experience for most of us! In standing, when the feet are on the floor, all the pads of the toes should be in good contact with the floor. Because we tend to spend most of our life in shoes, many times shoes with very inflexible soles, it is not surprising that we lose foot and toe flexibility.

In walking, all the toes should be in contact with the ground at push-off, lightly pushing the body forward just before the swing phase of gait. This activates all the muscles in the back of the leg in sequence, starting with the toe flexors, then the calf muscles, followed by the hamstrings. After the toe push, the leg swing should be quite passive with the leg feeling like it is hanging from the hip socket and swinging like a pendulum. If the toes are not in contact with the floor or there is a lack of flexibility in the toes making it impossible to use them to push, gait is changed completely.

With the toes are taken out of the equation, the walker is less able to push and is therefore more inclined to move the leg forward from the hip joint instead by using the hipflexors and the quads, making the swing phase of gait active and effortful. Once this manner of walking becomes a habit, the hipflexors and quadriceps tighten and shorten which tilts the pelvis forward, changing the angle of force through the hip joint and making it impossible to dangle the leg from the socket during the swing phase. So instead of a welcome period of decompression in the hip socket every time the foot is off the ground, the leg is compressed into the joint continually because the hipflexors are pulling the leg bone into the socket during the swing phase, and the leg bone is pushing up into the socket during the stance phase. This constant pressure can cause the joint to wear, especially since the pelvis is tilted over the leg putting the force through a less ideal part of the joint.

Sacroiliac problems can also result from a lack of toe push because the when there is little to no activation of the hamstrings (back of the thigh), there is little to no tension put through the sacrotuberus ligament which is important to SI joint stability. Combine this lack posterior stability with overly active hipflexors and quads from a pelvis that is overly tilted forward, and the SI joint is quite likely to unlock, causing pain and dysfunction.

Furthermore, an anteriorly rotated pelvis makes it nearly impossible to have a proper heel strike, causing the foot to land almost flat. One is supposed to hit the ground with the back of the heel, then roll over the foot and push off the toes keeping the back line engaged and the SI joint stable throughout the entire stance phase. A flat-footed landing shortens the stride necessitating the hipflexors to move the leg creating a shuffling look to gait, and makes it harder to find the toes for push-off. The lack of toe off combined with the lack of heel strike both feed into each other and potentially making gait worse and worse over time as the pelvis is pulled further into anterior rotation (think of the pelvis as a bucket pouring water out the front).

In the past I’ve recommended hipflexor and quadricep stretches (and low back stretches for those stuck in lumbar extension) which is definitely very important, but if the toes and ankles are inflexible I’m not convinced the correct pelvis position can be maintained and proper gait restored. So I would add calf stretches (particularly the straight-leg calf stretch or gastrocnemius) and the toe stretches described above. Toe spreaders are a great idea - the kind used to put toe polish on are perfect to start. Once they are no longer painful to wear and walk with, one can graduate to "intermediate" toe spreaders, and then finally to “advanced” toe spreaders, which will really help open the feet. Also rolling the bottom of the foot on a golf ball or dowel rod can stretch and loosen the plantar fascia. Strengthening glute medius posterior so the opposite hip joint can be held high enough to allow the leg to passively swing is very important as well.

Once the appropriate muscles are loose enough to make it possible to hold the pelvis in the correct position the hard work begins, as one must teach the brain a different way of walking. Regularly concentrating on the landing on the back of the heel, then rolling over the foot and pushing off the toes, along with feeling the swing leg hang from the hip socket is what will do it.

Trainers that give their clients lunges or split squats should ensure that their clients can extend their toes far enough to be able to evenly split their bodyweight between the two feet. At the bottom of the lunge, the back toes, both ankles, both knees and the forward hip should form a 90 degree angle, with the trunk being vertical. Inflexible toes force the weight forward onto the front leg causing the pelvis and trunk to tilt forward potentially straining the front knee and overusing the quad. A symptom of the problem is a back leg that is quite straight, and a heel that reaches back. Someone that can’t extend the toes enough and put weight through them is unable to bend the knee enough to keep the pelvis upright, forcing the ribs forward. Some people compensate for this by over arching the low back in an attempt to keep the ribs over the pelvis, but this does not change the fact that the pelvis is in a poor position and the weight is unevenly split between the feet. Regularly having clients to do lunges with the pelvis tilted forward in this way further ingrains a poor pelvis position, which can contribute to problems in gait.

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All adults should be involved in a strength training program due to the multiple health benefits. "Time Under Tension" is a technique that is useful in ensuring you get the results you want from your weight-training program.

I remember being a fly on a wall many years ago, listening in on a conversation between two exercise physiologists at the University of Toronto, arguing over which is more important for overall health, a weight training program or a cardiovascular training program. I think weight-training program wins the argument hands down, especially when one considers that if the exercise program is designed well, the participant will be getting a cardiovascular workout at the same time. So unless you are training for a particular athletic event such as a triathlon or 10km race, why bother spend all that extra time doing cardio? Most of us have better things to do with our time, and furthermore, aerobic training tends to break down muscle tissue which is counter-productive if you are trying to build strength.

As we age we tend to get weaker, and it is frequently a lack of strength that limits our function and closes down our life. The average 75 year old has difficulty carrying a 10lb bag of groceries much more than a block. Putting aging parents into a home that has no stairs is a big mistake in my opinion, because within a few months, they will not be able to do stairs at all, and will have more difficulty with curbs and getting in and out of cars etc. Our bodies respond to the demand imposed upon them, and if the demand is decreased, our strength will diminish. Use it or lose it!

Thankfully, the reverse is also true. Increase the demands on the muscles, and the body will get stronger. It is NEVER too late to begin a strength-training program and reap the benefits, which include:

• increased muscle strength and endurance, which translates into an
  ability to do things more easily, and to better enjoy life
• increased bone density, important in preventing osteoporosis
• improved balance and coordination
• increased calorie burn (1 lb of muscle burns 50 calories per day, so put on 10 lbs of muscle you burn 500 extra calories per day)
• decrease in body fat
• improvement in body shape
• improvement in mood
• decreased blood pressure because of improved muscle blood flow, which opens capillary beds
• decreased insulin resistance (important for type 2 diabetes / syndrome X)
• improvement in blood lipid profiles (lower triglycerides, higher HDL levels)
• improvement in digestion
• decreased fatigue levels
• improvement in sleep
• improvement sports performance

For strength training to be effective and in order to prevent injuries the exercises need to be done correctly and medical history and postural habits need to be considered, so hire a CHEK Practitioner or a qualified personal trainer to select the appropriate exercises and teach you how to do them right. The biggest mistake women tend to make, is to wave around itty bitty weights and expect to get a shapely body. To get stronger, the exercises must be CHALLENGING by the end of a set. Doing a set of 12 repetitions of bicep curls with 2 lbs is a complete waste of time. Women are frequently afraid of lifting heavy weights because they think they will get too muscular, but due to the low amounts of testosterone that women have, it simply won’t happen. Lifting heavy enough weight will create shapely, toned muscles - exactly what most women want. The biggest mistake men tend to make is to try and lift too heavy a weight, thereby using momentum to lift the weight rather than the muscle, resulting in less of a training effect. Using a slightly lighter weight that can be controlled throughout the entire range of motion will squeeze more tension out of the muscle resulting in better results. Only if one is training for a power or speed sport is it necessary to heave weights around very quickly. (Having a coach experienced in this type of training is highly recommended if power or speed training is what you want, as good technique is critical for injury prevention.)

Time-Under-Tension can be a useful method to ensure that the exercise is challenging enough to actually cause a training response, and is an interesting way to change up a tired 8-12 rep, or 15 to 20 rep weight-training program. By manipulating the speed of the repetitions and the time the muscles are
working, one can target specific goals, such as muscle endurance, body shaping (hypertrophy), strength and power. Movements must be done smoothly and with control, with no rest between repetitions, and with a weight that is heavy enough to be very challenging by the end of the time in question in order to maximize results. Beginners will have more success avoiding injury by moving quite slowly (at least 3 seconds up and 3 seconds down), and as exercise technique and fitness improves, and exercise goals dictate, exercise tempo can be increased. Beginners will gain strength on a muscle endurance program, as they are at the lowest level of their strength-gaining potential. After about 3 months their tendons and ligaments will have adapted adequately to progress safely to a hypertrophy program as long as exercise technique is good.

Although the times above are approximate, and ideal times may vary slightly depending on the individual, they do provide a useful starting off point. So, if your goal is to put on muscle mass or shape your body, you need a bare minimum of 30 seconds of time under tension to achieve that goal. If you are rushing through 10 reps at a tempo of 1 second up, 1 second down, you will be done in 20 seconds which is not enough time to get the results you want. So, next time you are in the gym, set a timer to a minute, do the movements slowly and with control with a weight that will tire you by the time the minute is up. Training according to time by adjusting exercise tempos and set times instead of repetition numbers ensures enough time under tension to get the results you want. Pay attention to rest times as well. Don't forget to raise the weight as you get stronger to keep the exercise challenging, and to change the exercises you do every four to six weeks.

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Car accidents frequently result in whiplash type injuries, where the head and neck are violently thrown forward and then back again upon impact, injuring the soft tissues of the neck.

Although vertebrae and disk injuries do occur often in this kind of a scenario, sometimes nothing obvious comes up on imaging tests, and the patient is left with neck pain without a concrete reason as to why. In other situations, the accident victim may feel surprisingly okay immediately post accident, and then a few weeks to months later may develop neck pain. In this scenario it may be harder to prove to insurance companies that the neck pain is actually a result of the car accident, even though there is a very understandable explanation for this pain pattern.

Our spine is meant to have three curves in it, one at the neck (cervical spine), another in the opposite direction over the ribs (thoracic spine), and finally another arch in the low back or lumbar spine. Just as having spinal curves that are too exaggerated can create painful problems, so can having segments of the spine that have straightened out. Whiplash-type scenarios frequently result in a straightening of the cervical spine in the neck. This makes the accident victim far more susceptible to developing disk herniations in the cervical spine, which can impact both upper body and lower body function.

After a violent whiplash, the muscles of the neck are severely traumatized. The head weighs between 12 to 20 pounds, depending on the size of the individual, and when the head is tossed forwards and then backwards with such force, and the muscles of the neck are unable to control the speed with which this heavy weight is being thrown around, the muscles become injured. The muscles frequently go into spasm and over time, tighten up, resulting in not only inadequate movement, but also compression through the vertebrae, squashing disks and narrowing the spaces through which nerves and blood vessels travel. When the deepest anterior neck muscles (longis colli and longis capitus) tighten up, they will pull the cervical spine straight. It may take a few weeks post trauma for the neck to straighten, but if this is not treated, the whiplash victim may eventually have disk problems, and potentially radiating pain into the arms, or TMJ (jaw) issues. Because the deep neck muscles also play a proprioceptive role in determining our position in space, injury to these tissues can be implicated in dizziness as well. (Of course, the cranium gets a major shake-up in a whiplash as well, so in my opinion it is important to examine and correct the position of the cranial bones as well.)

People frequently seek treatment from massage therapists that do an excellent job of releasing the muscles of the posterior neck, but unfortunately only a few massage therapists also treat the anterior muscles of the neck, which are just as badly injured, and also in desperate need of treatment. Massage therapists need to have training on how to move the trachea (breathing pipe) over, and how to avoid the carotid artery (blood vessel to the brain) to get right down onto the anterior surface of the cervical spine to release these muscles. Whiplash victims that complain of difficulty swallowing, dry mouth, dizziness, headaches, or a permanent tickle or lump in their throat, or whose posterior neck pain does not resolve once the posterior muscles are released, may need to get their longis capitus and longis colli treated as well. Certainly anyone who has lost the curvature in their cervical spine (obvious on X-Ray) should seek out someone who is able to release these muscles in order to restore the normal curve to the spine.

The superficial anterior neck muscles are also very important to treat in whiplash cases, as many of these muscles also attach to the jaw, and are involved in talking, swallowing, and can affect the function of the jaw, potentially creating TMJ problems. If the whiplash was at an angle, tension right to left in the neck muscles may be different, causing the floating bone in our neck (the hyoid bone, located at the fold in the neck) to be pulled in one direction or the other. Imbalances in the digastric, infra and supra hyoid muscles can also impact swallowing and jaw function, not to mention potentially impeding thyroid function. So, if you have suffered a whiplash, do make sure that as part of your treatment, you seek out someone that can release ALL the muscles of your neck, including the ones in the front.

Furthermore, for a more complete recovery, a motor-control based exercise program geared to learning how to recruit the neck muscles in the right order would be helpful, so that the outer neck muscles like the upper traps, levator scapula and scalenes learn to relax when they are not needed, reducing the likelihood of the muscle spasm coming back.

I am pleased to announce that I just passed my Paul St. John Integrated Somatic Therapy test, so I am official with respect to being able to treat these muscles, along with any other pain issues you may have. I have been providing personalized corrective exercise programs for over ten years now, so I can provide the complete package - both structural integration (massage) and exercise. So if you are in the Vancouver area, and would like me to help you, please do contact me by replying to this email. It would be my honour.

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Travell, Janet G MD and Simons, David G MD Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual (2-Volume Set) Lippincott, Williams & Wilkins, Baltimore, 1999.

McKenzie, Robin and May, Stephen Cervical and Thoracic Spine: Mechanical Diagnosis and Therapy (2-Volume Set) Spinal Publications, New Zealand LTD, Raumati Beach NZ, 2006.

Clark, Randall & Jones, Tracy Neuro ALP 1 Manual Neurosomatic Educators Inc. 2007.

Elliott JM et al. Characterization of acute and chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2009 May;39(5):312-23.

Pleguezuelos Cobo E et al. Postural control disorders in initial phases of whiplash. Med Clin (Barc). 2009 May 2;132(16):616-20. Epub 2009 Apr 22.

Armstrong B et al. Head and neck position sense. Sports Med. 2008;38(2):101-17.

Jull GA et al. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008 Sep;31(7):525-33.

Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004 Oct 1;29(19):2108-14.

O’Shaughnessy T. Craniomandibular/temporomandibular/cervical implications of a forced hyper-extension/hyper-flexion episode (i.e., whiplash). Funct Orthod. 1994 Mar-Apr;11(2):5-10, 12.

Copyright 2009 Vreni Gurd

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Maybe we should start each school day (and work day) with at least 20 minutes of aerobic exercise - it improves concentration, comprehension and learning.

This week CBC news (Canadian Broadcasting Corporation) put out a very interesting story about City Park High School in Saskatoon, that put treadmills and exercise bikes into a math classroom, and before doing any math, the kids strapped on their heart-rate monitors and did 20 minutes of moderate intensity cardiovascular exercise. This is an alternative school for those with learning difficulties, and over half the students have ADHD. They couldn't sit still, many had behavioural problems, and they couldn't learn. Well, the cardio equipment went in the classroom in February, and by June, pretty much all the kids had jumped a full grade in reading, writing and math. After doing the exercise the kids were suddenly able to sit still and focus on what they were learning, and they were able to understand what they were being taught. The exercise altered their brain chemistry enough to make learning possible, AND it greatly improved their behaviour.

With physical education frequently being cut out of curriculums to make time for academics, this should give pause for thought. Taking 20 to 40 minutes a day for sustained physical activity improves learning and grades in academic subjects more than actually using that time for the academic subjects themselves. Sustained aerobic exercise of between 65 to 75% of one's max heart rate wakes up the frontal cortex of the brain, the part that is needed for behavioural control. (To figure out your child's correct heart-rate zone, subtract his/her age from 220, and take 65 to 75% of that to get the target heart beats per minute.) Exercise causes the brain to create more nerve cells (neurogenesis), makes those nerves stronger, and helps them withstand stress, and improves neurotransmitter function, which helps the brain work better. Dr. Ratey, one of the key researchers in this area, noted not only improvements in those with ADHD, but also in those with bipolar disorder and schitzophrenia as well.

Alison Cameron, the grade 8 teacher at City Park School, noted that between February and June, the attention span of her students increased from 10 minutes to 3 hours. Many of the kids got off ritalin, and the kids were coming to school every day so she had the opportunity to actually teach them, which also improved learning. The students reported feeling happier, less angry, and definitely smarter, which improved their confidence levels, and made them realize that they would be capable of succeeding in life if they applied themselves.

In this day and age where we are moving less and less, sitting at the computer more and more, and children are less frequently allowed outside to play on their own, we need to ensure that kids get daily physical education, and beyond that, we need to make sure that every child and teen is actually moving enough during PE. In most PE classes, 80% of the kids are standing around waiting for their turn, or simply trying to avoid participating. It takes at least 20 minutes of sustained activity three times a week to make the difference in behavioural and academic performance, and that should be an important focus of school PE class in my opinion.

We are meant to move, and if we don’t we are not as resilient and we can’t use our brains maximally. So parents, if you want your kids to be smarter and better behaved and your school does not provide adequate movement time for your kids, perhaps family-based physical activity should become a priority. Creating the exercise habit young will also help them maintain a healthy body weight, and set them up for a life of good health.

If you would like to see the CBC documentary, click here. I think it is an amazing, hopeful story.

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Poor posture not only leads to musculoskeletal pain, but can also impair organ function.

I discussed in another post how our function determines our posture (habitually sit in a slouched position and our posture hardens into having rounded shoulders and a forward head), and today I want to discuss the other direction - how our posture determines our function (how well our body works.)

I’ve just returned from a fabulous Integrative Neurosomatic Therapy course presented through Paul St. John’s clinic in Clearwater Florida, where this point was driven home. Poor posture does not only cause musculoskeletal pain, but can also impair organ function. Think about it. If one stands with one’s ribcage tilted to one side, the organs that sit on that side (like a kidney) are going to be squashed, which could very well impair its function. If one stands or sits with a collapsed chest and rounded upper back (the posture common to those suffering from depression) the diaphragm can’t descend properly with each breath, which may impact the lungs, and prevent proper oxygenation of the blood. Not only that, but the entire digestive tract would be squeezed making it harder to digest and assimilate one’s food. Also, with the chest tipped forward like that, the major blood vessels (aorta and vena cava) as well as the esophagus, (the tube the food goes down to get to the gut) may wind up slightly kinked as they go through the hole in the diaphragm designed for those vessels, potentially irritating the vagus nerve, which is near by. So maybe your acid reflux is not an acid problem but a postural problem! A flat cervical spine (neck) may be the root cause of a thyroid issue, because the area in the front of the neck may not be getting adequate blood.

If there is a functional or anatomical leg-length discrepancy that results in the pelvis being tilted in standing (one hip higher than the other), there will be a corresponding tilt in the opposite direction somewhere higher up in the spine to ensure that the head is sitting straight, and that the eyes are level. This is why frequently those will low back problems also have neck problems, and why leg-length discrepancies are often a primary cause of scoliosis. The areas that are tilted are vulnerable to wear-and-tear and injury, such as disk bulges, SI joint problems, hip degradation and pain (usually on the longer leg).

According to Friberg who studied army recruits and verified his findings on Xray, up to 60% of us have an anatomical leg-length discrepancy of 5mm or more. I had previously believed that most leg-length discrepancies were functional - a muscle imbalance problem in the pelvis - but if one takes the pelvis out of the equation by just examining the legs in standing, the numbers with anatomical leg-length differences are extraordinarily high. Many of us have a small hemi-pelvis - one side of the pelvis is smaller than the other, meaning that while sitting the pelvis is tilted. A high hip/pelvis in either sitting or standing may also result in squished organs on that same side. Anatomical leg length differences and smaller hemi-pelvises are very common structural issues that can cause all kinds of pain and possibly disease processes, they are easy to fix through shoe lifts (not heel lifts!) and butt lifts, and are generally not looked for at all by most health practitioners. Not everyone with a leg-length discrepancy is in pain, (those that are using appropriate stabilization strategies will be more able to dissipate the forces away from the joints), but a tilted pelvis will affect wear at the joints (hip, SI, spine, even possibly knee and foot) over time, increasing the potential for pain at some point. Children should be checked because if caught early enough before the epiphyseal plates in the bones close, a shorter leg can actually catch up with proper shoe-lift treatment.

So, who is your structural integrator? We all need a functional medicine doctor, a dentist, and I would argue, we need someone to help us with our structure. Integrated Neurosomatic Therapists are trained to look for leg-length discrepancies and smaller hemi-pelvises, and can help restore good structure through massage therapy techniques, by releasing tight muscles that are holding bones in a poor position. KMI Practitioners and Rolfers are also structural integrators and can help us realign our posture through massage. Corrective Exercise Specialists such as CHEK Practitioners can also help you improve your posture by suggesting particular exercises that will strengthen weak muscles, thereby bringing your body back into alignment. Yoga, with its emphasis on good postural alignment, can also be very helpful.

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

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