wellness tips

Share

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.

Share

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.

Related tips
How many ways can you get up off the floor?
Squatting and the knees
Shoulder-blade position and neck, arm and upper back pain
S-T-R-E-T-C-H and feel better
Foot flexibility important to reducing hip and SI joint pain

Share

Staying limber is key to avoiding the closing down of one’s life due to physical limitations

When I was attending the University of Toronto in Physical and Health Education I remember listening in on a conversation that two of my friends were having. They were arguing about what limits our function more, the lack of strength or the lack of flexibility. Both made very valid points, and at the time I could not determine a winner. They agreed to disagree.

Now, after studying how people move in my corrective-exercise practice for close to 20 years (yikes!), I think that a lack of flexibility closes down more lives than a lack of strength. And I think that more frequently than not, the lack of flexibility leads to the loss in strength, usually more so in the opposite muscle to the tight one. (Tight hip flexors lead to weak glutes for example).

Strength-declines follow flexibility-declines, because people tend to stop doing activities which become awkward due to a lack of flexibility, such as getting down onto the floor. Strength is then lost due to disuse. If one does not move regularly through the existing range-of-motion, often all the muscles around a joint become tight impeding function further. Which then decreases strength further. And of course, the less flexibility one has, the less available motion there is to strengthen.

If there is very little slack in the system, it no longer takes much to pull a joint out of its optimal axis of rotation. If the give in the system is no longer adequate, pain is more likely to occur. Simply restoring adequate range of motion can go a long way to decreasing pain, because it puts slack back in the system and makes it more forgiving.

Also too much tightness creates too much compression at the joint, potentially adding to a wear problem within the joint itself, particularly if that joint is not in its optimal alignment.

In most weight-training programs, the emphasis is placed on lifting heavier weights, as opposed to increasing the range of motion. The usual way of progressing the squat, for example, would be to increase the weight as strength improves. But usually people compromise their range of motion as the weight feels heavier and heavier.

The best way I have found thus far to increase flexibility without compromising on the strength-training component of an exercise program, is to work the exercise to the maximum range of motion without allowing any compromise in form, and set up the exercise in a way that forces maximum range of motion with every repetition.

I use box squats to force the full range-of-motion on every repetition. I use stackable stools as my “box”, and determine the least number of stools my client can sit on while leaning forward as if to get up, maintaining a neutral spine, feet flat on the floor etc. Usually this is lower than most people tend to squat to in a gym. The exercise is to stand up, then sit down for the appropriate number of reps using a weight that is challenging and yet does not compromise form.

The first priority goal for progressing is to lower the “box” by taking away stools as flexibility improves. Usually this makes the exercise significantly harder, so increasing the weight is not necessary. If the box cannot be lowered because doing so would cause the low back to round or the knees to roll in, the weight can be increased instead.

For most people that are not accustomed to exercise, the starting weight is their bodyweight. I find often on set 3 or 4, once the tissues are good and warm and the joints are well lubricated, I can take away a stool, thereby increasing the range of motion. The long-term goal for weighted squats is to get to 1 stool (about 9 inches from the floor) or slightly lower using a step, as long as the spine can be held in neutral throughout the range of motion for any weighted squat.

The long-term unweighted goal is to be able to squat to the floor and feel able to stay there for extended periods of time. The low back will round in this position, which is fine for healthy backs.

For those that regularly do squats in the gym, forcing the range-of-motion in this way will mean a huge decrease in weight. But in my opinion, gaining that range-of-motion is a far worthier goal than pushing a heavy weight, as it will translate into an ease in movement in daily life, and far less pain as the slack in the system is restored. And let's face it. How useful is it really, to be able to squat a gazillion pounds through a short range of motion anyway? Do you regularly carry your fridge on your back?

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:
10 body positions that should be relaxing
How many ways can you get up from the floor?
Squatting and the knee

Share

It is common knowledge that when doing squats the knees should stay behind the toes in order to prevent knee problems. At least that is the knowledge that has permeated the fitness industry. Is this true?

Squatting is the movement we do when we sit down on a chair and get back up again. In many parts of the world, squatting right to the floor is common practice. People may squat while cooking over a fire, while reading the newspaper, or while using a squat toilet. In my opinion, squatting to the floor regularly is very helpful in maintaining happy hips, knees and ankles.

In the gym when we squat, we sit down momentarily on an imaginary chair, and when our thighs are about parallel to the floor we stand up again. Squats are one of the key movements exercise professionals teach their clients, and they are fantastic for strengthening the lower body.

I have been in the fitness industry for close to 20 years now, and I can’t count the number of times I’ve heard that when squatting one must keep the knees behind the toes in order to protect the knees. This rule is very ingrained in the psyche of personal trainers as I have heard the line repeated frequently in the gym. And in the past, I too have tried to shape my clients’ squats to follow the “knees behind the toes” adage, with very unsatisfactory results.

Most people’s lower legs are too long to keep the knees behind the toes even when one limits the range-of-motion to thighs parallel to the ground. This instruction forces strange movement patterns that are awkward and incorrect in my opinion.

The "knees behind the toes" requirement fixes the angle at the ankle; the longer the lower leg, the higher the ankle angle. This forces the hips very far back, and to avoid falling over, the only way to compensate is to bend the hip joint much more than usual in order to get the center of gravity back over the feet again. This movement looks more like a deadlift (bend) than a squat. In the diagram to the right, the foot and knee are butted up against a wall, and one can easily see how there is far more bend at the hips than at the knee and ankle. The spine is at a much flatter angle than the lower leg.

The other common compensation is to actively arch the back a great deal, which can irritate the facet joints and over-use the erector spinae muscles in the back. The spine should remain neutral for most of the range of motion. If one is squatting to the floor, the low back will probably round at the bottom unless one is extremely flexible. (*Squatting to the floor is fine with no weight, but if you are carrying extra weight, only squat as deeply as you can keep your spine neutral. A rounded low-back while carrying added weight is asking for trouble).

Our knees are meant to bend to the point where the back of the thighs can easily rest on the calves. With adequate flexibility, one can kneel on the floor like this putting a fair bit of pressure through the legs without any problem. The knee joint is open, so the thigh bone (femur) and lower-leg bone (tibia) are not rubbing on each other at all in this position. Any strain in the knee area would come from tight muscles, tendons, and fascia. Flexibility is the limiting factor in this case, and that can be slowly improved over time. The limits put on a squat should be determined by one’s own flexibility rather than an arbitrary rule like “knees must stay behind the toes”.

Olympic lifters regularly pass through the front squat position with a very heavy bar, and their knees are often past their toes. They have the flexibility in their legs and back to be able to do the movement without a problem.

One should think of squatting like folding up an accordion. One stays over the center of gravity (the feet), the knees hinge forward tracking over the toes, the hips hinge back, the trunk goes forward again. The spine parallels the shin angle, remains neutral, and is not contorted at all since the hinge is at the hips. This is what we naturally do when we sit down and get up from a chair, so this is the best place to begin a squatting practice.

I find I now often use the cue “knees and nose in front of the toes” when teaching unweighted or back squats, and when the center of gravity is balanced throughout the entire foot the result is usually a fine squat with no deviation from neutral spine – exactly what I’m looking for. I stop their descent just before their low back begins to round, and have them push back up through the whole of their feet.

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 body positions we should all find relaxing

www.wellnesstips.ca

Share

Feeling down or anxious and want to feel better soon? Do some exercise.

Considering how good one can feel after exercise it is amazing how few of us do it. Besides strengthening and lubricating our bodies, exercise actually changes our brain chemistry.

Even mild exercise like a half-hour walk will increase the happy hormones like endorphins, adrenaline, serotonin and dopamine, and those hormones will stay elevated for a few hours post exercise.

Not only do we feel happier after exercise, but also calmer, so exercise is also a great way to lower anxiety levels. We usually feel better even after one exercise session!

Research has shown that regular cardiovascular exercise seems to work as well as Zoloft, a commonly prescribed SSRI antidepressant, for reducing major depression in those over 50, without any of the negative side effects.

This particular study was concluded after 4 months, but when the groups were reassessed for depression again at 10 months, the exercise group was doing better than the medication group in terms of relapses.

Those that exercised on their own after the study was over had fewer depressive symptoms than those that did not. In addition to improved mood, the exercise group gained the other benefits that exercise offers, such as better stamina and a healthier circulatory system. Perhaps the first prescription a physician tries for depression should be exercise for 30 minutes, 3 times a week.

Besides the chemical changes in the brain that improve mood and lower feelings of anxiety, getting an exercise session done makes us feel better about ourselves simply due to the sense of accomplishment.

We feel more confident, we feel we are doing something good for ourselves by getting into better shape, and perhaps we are socializing with friends, all of which can make us happier. Over time we look better, which further improves our confidence. And exercise provides a healthy coping strategy as well as a distraction from the negative thought-patterns that feed anxiety and depression.

It is pretty tough for most of us to be motivated enough to exercise 3 to 4 days a week, but when one is feeling down it is even harder. And if one is clinically depressed, just getting out of bed can seem like the hardest thing in the world.

So, how do you move from knowing it might be helpful to actually heading out the door for a walk, or into the gym for a work out?

1. Your goal is to exercise regularly for the long haul – not to give it up in a couple of months. So what activity do you like to do and can see yourself doing for years to come? Something you can integrate into your life like your daily shower? Do you like badminton? Bike riding? Yoga? Walking?

2. Ask a friend to join you each time for your walk, work-out or exercise class. Or hire a trainer. Simply knowing you have committed to meet someone will get you out the door even if you don’t feel like going. And the social aspect will help a lot too.

3. Commit to at least going to the gym and changing into your exercise gear. Most likely once you are there, you will be able to do at least a few minutes of exercise. Or even easier, commit to putting on your walking shoes, walk out the door and keep walking for 7.5 minutes, then turn around and come back. That’s it. Then do it every day.

4. For most people, exercise is something that is scheduled around all the other stuff that must get done in a day. Everything else is the priority and exercising only happens if there is time. Change that around and schedule everything else around your exercise sessions.

The people around you will soon realize that you are not available at particular times because you are exercising, so they will stop bothering you during those times. This is kind of like the “pay yourself first” idea when it comes to money management.

4. Get a dog. Dogs need to be walked a couple of times a day, so this will get you out walking regularly. Furthermore you will discover a whole new community of friendly people in your neighbourhood that you probably did not even know existed.

5. Measure your mood before and after your exercise on a scale of 1 to 10, and see how you do over time. Seeing results can often help you continue.

6. Realize that lack of motivation is not the problem. The problem is not being good at managing your behaviour.

You may not be motivated to clean up after yourself but you do because you're wife's boss is coming for dinner tonight. In this case you choose to do something different than what you "feel like doing" because helping her out is the right thing to do.

So with respect to exercise, you may not be motivated, but recognize that you are able to do it and are choosing not to. Then change your choice.

7. Treat exercise like a professional athlete does. It is their job to stay in shape in order to play their sport. And even though most of us don’t get paid the big bucks to stay in shape, we can try to view exercise in the same light. It is our job to stay in shape to keep our brain and bodies working well so we can fully enjoy doing the activities we want to do.

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:
Creating new habits
Exercise and learning
Conditioning for the sport of business

www.wellnesstips.ca

Share

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.

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 organ adhesion or 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) Dontigny 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.

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
Foot flexibility important to reducing hip and SI joint pain
Walking, sacroiliac dysfunction and hip pain
Posture, leg-length discrepancies, musculoskeletal pain and organ function
Pain and stabilizer vs mover muscles

To subscribe go to www.wellnesstips.ca

Share

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!

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
Foot flexibility important to reducing hip and SI joint pain
10 body positions we should all find relaxing
S-t-r-e-t-c-h and feel better

Share

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.

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

Related Tips
Are you a chest gripper?
Walking, sacroiliac dysfunction and hip pain
Posture, leg-length discrepancies, musculoskeletal pain and organ function
Pain and stabilizer vs mover muscles

To subscribe go to www.wellnesstips.ca

Share

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.

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

Related Tips
Foot flexibility important to reducing hip and SI joint pain
S-t-r-e-t-c-h and feel better!

Share

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.

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

Related Tips:
Foot flexibility important to reducing hip and SI joint pain
Walking, sacroiliac dysfunction and hip pain
Creating new habits

To subscribe go to www.wellnesstips.ca