Blog Archives

Getting Old Sucks: the march towards stenosis

Old
photo: susafri
My favourite part of being a physiotherapist is the perspective I gain by working with a broad array of people: young people, old people, active people, sedentary people, successful people and those just starting out.  I find it fascinating to try and see the world through these people’s eyes as I get little glimpses into their lives during our thirty minute appointments each week.  The relationships people have with their own bodies are a very curious thing to me.

Some people literally behave like their bodies are simply vehicles to walk their heads around; they have little to no awareness of how or what they are doing physically and are blinded by cognitive factors like stress and anxiety.  Others treat their body like a temple and seek help when they detect even the slightest change from their normal, homeostatic state.  Many people’s relationships with their bodies are a product of to their early childhood sports combined with their recent fitness endeavors.  Your early sport and movement experiences are responsible for molding your general postures while your more recent fitness endeavors will create the lens that you see your physical self through.

Some people choose personal trainers, others choose Yoga classes and some are determined to work out at home with programs like Foundation, or P90X.  Your choice of activity will affect your perception of what physical health means to you.  You may get focused on strength or flexibility or endurance or speed.  I see many people in my practice that were active teenagers, but are now in their early 40s with two kids and are trying to rediscover their bodies; unfortunately many people get hurt during this phase because their bodies are 10-20 years older than they physically remember and their choice of activity was based more on familiarity than need.

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Yoga & Stretching Injuries: Why people get hurt on their quest for bendiness

Yoga
photo: coordinator_tarun

I’m not sure about the rest of the world, but I live in Vancouver, BC and it seems like everyone is either doing Yoga or feels that they should be for some reason.  Its’ popularity has steadily grown over the past ten years to include a more and more diverse group of people.  Business men, athletes, seniors and kids have all joined in the sun salutations and downward dogs in a quest for flexibility and inner peace.  For the most part I think this movement is great, but as a physiotherapist I see countless injuries, postural issues and persistent pains that have their roots in people’s regular Yoga routines.  There are a lot of great things about Yoga, but it is not meant for everyone and you can have too much of a good thing.  In this post I discuss some of the negative consequences of Yoga, not to scare you away from it, but to help you go into it armed with the awareness of how not to hurt yourself.

Before you decide to start any new type of exercise you should ask yourself ‘what am I trying to get out of this?’  Many people blindly feel that Yoga is the answer to flexibility and although it can be for some, it can be an awkward, uncomfortable path to injury for others.  Flexibility is partly genetic, but largely a product of what you do all day; how you stand, sit, walk, breathe and feel will and does affect your flexibility.  It is a misconception that you are stiff because you don’t spend enough time stretching.  You are stiff because you either don’t move enough or you don’t move very well, or both.  Stretching more is simply not the answer.  In fact, I would say that there are millions of hours wasted every day by people stretching in attempt to get more flexible. 

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Posted in Blog, Fitness, Pain, Posture Tagged with: , , , , , , ,
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What does it mean to be hypermobile? A gift & a curse wrapped into one


I grew up as a long and lanky kid playing every sport that was available to me.  I loved team sports and got deeply into soccer and rugby.  If I knew then, what I know now about my body, I would have stuck to volleyball and swimming.  Don’t get me wrong, I thoroughly enjoyed the sports I played, but I routinely felt like I had been hit by a truck afterwards and still have two wonky shoulders to show for it.

I am what you would call hypermobile.  That means that the soft tissues that help hold my skeleton and joints together are relatively looser and more flexible than the average person.  It is a genetic trait that a large number of people have, but most have no concept that the way they are put together is not “normal,” or the same way everyone else is put together.  It does go both ways, some people would be deemed hypomobile, implying that their spine and joints are relatively stiffer than the average population.

My estimation of the incidence of pain and injury as they correlate to genetic joint mobility:

Being loose jointed may sound like a positive genetic attribute, but let me assure you it can pose a lot of problems for people.  Gravity can become particularly annoying when you are hypermobile, especially if you have a job that requires you to sit or stand still for any length of time.  We are the only creatures on Earth that are built to stand and walk upright on two feet- that biomechanical feat requires a skeleton that provides both structural stability to vertically stack your body, and functional mobility so that you can move freely.  Hypermobile people are built to move and have to work a lot harder than everyone else to stack everything up and stay still.  Read More

Posted in Blog, Pain, Posture Tagged with: , , , , , , ,
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Movement: Your body is the car and you are the driver

2010

Imagine handing the keys of a finely tuned, bright red Porsche 911 to a 16 year old boy, first time driver and saying have fun!  Now imagine telling him 15 years later, after he has been in a few accidents, scratched the paint and  destroyed the clutch that he should have driven more carefully because this is the only car he will ever own for the rest of his life, that he will now have to go for regular tune ups and will probably have to get an artificial clutch and a titanium tire sometime in the next 30 years.  Oh yeah and your shocks will get worse and worse every year.  I hope you had enough fun driving in the first 15 years to make the next 40 years worthwhile!  Sorry I didn’t teach you to drive better!

We watch our kids struggle to reach the gas pedal for years then blindly let them grind the gears of their own bodies through their adolescence.  We put them into sports in key developmental years that unknowingly teach them how to move a particular way and may mold their posture for the rest of their lives.  We tell them to stand up straight with little context of what that means and we start binding their feet with stiff little shoes before they can even walk.

Children are resilient, moldable little sponges that should be given some direction and opportunity to become good drivers in their own bodies.  The trouble is that most parents aren’t particularly good drivers and their kids think that they are invincible until they reach their mid twenties.

Babies can move, but very little of it is intentional.  Most of their movement is created by a series of reflexes that move an entire limb as one unit.  The back extensor muscles develop before the abdominals as the baby figures out how to lift its head up and arch its back. Read More

Posted in Blog, Education, New Moms, Posture Tagged with: , , , , , , , , ,
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Breathing: more than just keeping you alive

Breathe
There are a lot of systems that function subconsciously in your body that you likely take for granted and very rarely, if ever think about; among the most important of these is breathing.  It is an amazing physiological process that allows you to draw oxygen from the air and filter it into your blood stream to keep you alive.  Your brain and spinal cord automatically just do it for you.  You breathe faster when you run and slower when you sleep; it’s a great deal, your body just figures it out how much oxygen you need and alters your breathing rate for you.  The drawback of not being an active participant in your breathing pattern is that you can lose touch with what is ‘normal’ for your body and be unaware of how things like pain, stress and posture are affecting you.

A basic understanding of the biomechanics of breathing and posture will help you understand what I mean.  Your ribcage and thoracic spine are the structural foundation of your torso. The rigidity of it protects your organs and supports your shoulders and neck, while the mobility of it helps you breathe, twist and move.  Your lungs line the inside of your ribcage.  In order for you to draw air into them, your ribcage needs to expand slightly and your diaphragm needs to contract and pull down; this will create a negative pressure and air will be pulled in.  The elastic recoil of your ribcage and diaphragm passively push the air out to complete the breathing cycle.  This keeps you alive.

The diaphragm

There is a difference between being alive and breathing well.  Just because you can breathe, does not mean you are doing a good job at it.  Just because you can stand, doesn’t mean you have good posture.  Just because you can walk, doesn’t mean you are using your body properly. 

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Posted in Blog, Fitness, Mid Backs, Posture Tagged with: , , , , , , , , ,
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Core Training: When less is more

Big Myth:
–    If you have low back pain that means your “core is weak” and a “core strengthening” program would help you.

Sometimes the above statement is true, but just as often it is absolutely not.  There is not a direct correlation between low back pain and core strength.  In fact, many people that have incredibly strong “core” muscles suffer from regular low back pain, which is because strength is only one element of having good posture, alignment and movement.  It is the overall muscle balance in your body and your relative ability at controlling movement that is the true sign of good core stability and a preventative factor to low back pain.

Many, many, many people are stiff as hell, many of these people have low back pain and many of these people think that their planks, crunches and strength program will make them better.  Well I am here to tell you that there is a good chance it will make them worse.  Granted some will get better, but the most efficient way to improve your strength, flexibility, alignment and pain is to first learn a bit about your body type before pursuing any type of new program.

From a very young age, as you were learning to function in the vertical position, you have been developing strategies for how your body deals with gravity.  You picked up some by watching how your parents stand, walk and move.  You picked up others from your gymnastics classes and soccer practices when you were six.  The hard fall you had on your butt 20 years ago likely altered things and that car accident 5 years ago probably created some compensations.  Long story short, your posture, flexibility, movement and breathing patterns are a cumulative product of everything you have done up until today. Read More

Posted in Blog, Fitness, Low Backs, Pain, Posture Tagged with: , , , , , , , , ,
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What is my core? Depends who you ask

The word core has been very popular for quite a while now in the health, fitness and rehab worlds, but there isn’t really a true agreement as to what it actually means; it really depends on who you talk to.  If you ask physiotherapists, most will focus on the deep, subtle, picky muscles like your transverse abdominus.  If you ask strength and conditioning coaches, most will strive to build bracing stability using the obliques.  If you ask a Pilates instructor, most will focus on breathing and dissociation of movement.  Finally if you ask a lay person, most will just pat their stomach and say ‘I know I need to work on my core,’ without really knowing why.

You can watch the associated video at the end of this article.

So who’s right and who’s wrong?  The answer is you should be able to selectively use your body for whatever task you ask it to do.  The picky little muscles should work subconsciously while you stand, sit, walk and breathe.  The bracing muscles should work when you pick up or push something heavy and you should be able to bend, twist and stretch if you choose.  The people that are wrong are the ones that think their method is the only and best thing for everyone.  Typically the personal trainers need to be introduced to the Pilates instructors and the Pilates instructors need to do some personal training.  Most people have a need to work on something, but it is a misconception that building more strength and stability is always the best option.

Some people are naturally strong and stiff as a board while others are loose jointed with low muscle tone.  The first and best thing you can do for yourself before you attempt to do more of anything physically is to learn about your body type and learn what type of exercise would give you the most benefit.  Read More

Posted in Blog, Fitness, Low Backs, Posture Tagged with: , , , , , , , , , , , ,
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Shoes: good support or coffins for your feet?

Shoe Coffin

I will preface this post by saying the best thing I ever did for my feet, my posture and my pain was to stop wearing traditional shoes.  I am very hypermobile and have very high arches in my feet and throughout my athletic life I have been slowed down by foot pain and blood blisters on the balls of my feet and big toes (sorry for the details).  I had tried all different types of shoes, orthotics and tapes, so in 2008 I decided to start working in only socks most of the day and never turned back.  Going barefoot taught me a lot about my own body and how I was creating my own hip and back pain.  The feedback I was getting from my feet helped me become aware that I was standing entirely on the outsides of my feet and how that related to the tightness and aching in my hips.  From the ground up, I progressively became aware of how one part of my body was affecting the other and I have been able to successfully strengthen my feet, loosen my hips and eliminate almost all of the chronic issues I was having.

You will find the Why Feet Hurt video at the bottom of this post.

Being a physical therapist, seeing 14 people a day with different body and foot types, has allowed me to test my posture and movement principles within myself and on my clients.  I have helped a lot of people discover how their feet affect their bodies and their bodies affect their feet.  I have learned that how you hold your upper body can be the root cause of your bunions and how you use your hips can dictate if you pronate or supinate in your feet.  There is very much a trickle up and a trickle down effect on posture, alignment and movement.  Read More

Posted in Ankles, Blog, Feet, Posture, Shoes Tagged with: , , , , , , , , , , , ,
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How to Sit: The Plight of the Desk Jockey

Who taught you how to sit?  I’m guessing nobody, you probably just figured out how to do it by trial and error when you were a baby.  You learned how to stay upright and eventually not fall over while resting on your butt; that was a major milestone when you were 8 months old, but you haven’t been given much credit for it later in life, have you?  Unfortunately, it’s later in life that you are going to need to be good at it, because chances are you are going to be spending multiple hours a day staring at a computer screen.  It is time you learned how to sit properly.


*Movements and postures demonstrated well in the video at the end of this post

Our bodies are built to deal with the vertical load of gravity, but at the same time are inherently lazy when it comes to holding everything up properly.  We have a tendency to get engrossed in what is visually in front of us with little regard to how we have positioned our bodies to allow our eyes to see what we want to see.  Your brain has a head righting reflex that tries to keep your head looking straight forward in the easiest way possible; unfortunately this usually comes at the expense of your neck and back.

The goal of sitting properly is to effectively vertically stack your torso and head on top of your pelvis and hips in a nice gentle S-curve.  The odds of you doing this properly are stacked against you for a few reasons.  First, most people have one, two or three of the following: forward head posture, an overly braced lower torso, and/or really flexible or really stiff hips.   Second, most chairs are not designed very ergonomically and promote slouching more than support.  Read More

Posted in Blog, Posture Tagged with: , , , , ,
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How to Stand: Postural Pulp Fiction

The goal of standing is to vertically stack your spine with a gentle S-curve from your tail bone up to the base your skull.  If you look at your side profile, you should be able to draw a straight line down from your earlobe, through your shoulder, the mid line of your torso, your hip, knee and ankle.

This is my Pulp Fiction video/post (the video captures the movements you need to learn).  I am showing you the ending first, so you know what you are working towards.  You may find yourself coming back to this frequently and will progressively find it easier and easier to accomplish.  To start with, standing the way I am describing may feel weird and be really hard, but will look a lot more normal than it feels.  It will challenge everything you are bad at and your brain’s perception of what is vertical.  A mirror to look at your side profile can be an important tool to help you see what I am showing you, but you need to learn to progressively feel it instead of having to see it.

Step 1 is to learn to use your diaphragm to support your torso upward and stop leaning backwards.  Imagine there are two half balloons inside the lower part of your ribcage that you can inflate by taking a deep breath into your lower back ribs.  This should lengthen and stretch the lower part of your thoracic spine.  It may also feel like it tips you forward.  This is the part of your back that was accommodating your neck, but we are going to try and stop that.  If you look in the mirror, you will likely see that it is your head that is forward and that your trunk is now actually quite vertical instead of tipped backward.  Read More

Posted in Blog, Posture Tagged with: , , , , , ,
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