Beth (as we will call her) was an energetic nurse in her mid-thirties with two young boys to chase around. She was an elite runner in her early twenties, but these days walking a few blocks was a painful chore and picking up her kids was nearly impossible. Pregnancy had done a number on Beth…twice. She had endured the slow nine months of body changes. She had powered through the labours and deliveries and ended up with two lovely little boys to watch grow and thrive, but her body as a result decided to stop cooperating with her desired lifestyle. She went from competitive running, to running a few times a week with discomfort, to just chasing her kids around in pain, to simply walking being a painful task in a period of just a few years.
When Beth first walked into my office she had “tried physio, massage, chiro, core training, prolotherapy and IMS” for her back problems with mixed success. IMS (intramuscular stimulation) had provided her with the most relief, but she still sat in front of me with a dysfunctional body so she obviously needed something more or different to help her get her body back. Her goals were simple: walk without pain, play with her toddlers and generally live an active lifestyle. I had to push her to include running on that list because she had resigned herself to the idea that she would never run again at the age of 37.
To look at her, Beth was a thin, lean looking runner with a big smile on her face and a positive attitude, even though her body had crapped out on her. She appeared to have all the pieces, so why was she still having so much trouble? Therapists had massaged her, needled her, stretched her, cracked her and strengthened her but she still couldn’t even walk without significant discomfort in her back. Read More
If you have ever had your back ‘go out’ on you, you will appreciate the following post and may just learn something about how to fix your nagging back issue. Back pain can take many forms and is hands down the most common issue that brings people in to physiotherapy.
“It hurts when I bend over to brush my teeth”
“I can only sit for 10 minutes before I have to move”
“Walking triggers a pain deep in my butt”
“I bent forward and couldn’t get back up”
It happens to the best of us. I have seen lazy, overweight people with back pain; insanely fit personal trainers with back pain, elite athletes, new moms, desk jockeys and I have personally suffered from it on occasion. You can have the strongest core in the world and still be susceptible to hurting yourself or experiencing pain in or around your back. In this article I have outlined the most important factors as to WHY backs hurt because back pain requires an explanation of what is going wrong as opposed to a diagnosis of a condition. You can also watch the video Why Low Backs Hurt.
Step 1 to Understanding:
Things happen for a reason. You don’t just catch back pain like you can catch a cold. It usually is related to something that you have done or are continuing to do poorly, like stand, sit, walk, breathe, bend or lift. An accident or acute injury can set pain into motion, but how you deal with the injury, pain and mobility after the fact is the important part. You are a product of everything you have done or been through up to this point and if that product has left you with chronic back pain then something has to change. You may need someone to loosen something for you, you may need to learn to move more efficiently, you may need to lose weight, or may even need surgery.
I treat a lot of the top Seniors level (35+) tennis players in British Columbia, many of whom compete in the national and world championships every year. These are not professional athletes, but very active adults with full time jobs that work hard and play harder. The combination of work + age + sport inevitably results in aches, pains and unfortunately injuries.
The top five things that tend to bring tennis players into the physio for servicing are:
1. Tennis Elbow
2. Rotator Cuff Impingement
3. Knee Pain
4. Torn Calf/Achilles
5. Low Back Pain
Below I will briefly touch on some of the principles you should follow in dealing with these injuries as they relate to tennis, age and work.
Lateral elbow pain does not necessarily follow the “if it hurts, ice it” rule. Nine times out of ten the root cause of lateral elbow pain stems from your neck and the back of your shoulder. It is usually an irritation of your C6 nerve root in your neck and the radial nerve in your arm…that being said, if your elbow is hot, red and swollen, go ahead and ice it, but don’t expect just ice and rest to fix the problem. Hands down the best way to fix tennis elbow is to go for IMS acupuncture to calm down the nerve irritation. Once the arm feels better have a physio teach you how to move more efficiently so your swing doesn’t create too much strain on your neck and shoulder. You may also need a tennis pro to adjust your technique and/or your racquet.
Suggested articles: Elbow Pain: why it can last so long & how to fix it properly Why Elbows Hurt
Rotator Cuff Impingement
Most shoulder pains are some form of an impingement (which implies a pinching of one or more of the tendons of your rotator cuff).
– 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
Your deep inner unit consists of four muscle groups that should work subconsciously to stabilize your pelvis, spine and ribcage under low load postures and movements like standing, bending and walking. Accidents, injuries and developed muscle imbalances can cause portions of the deep inner unit to not do their job properly; the result can be pain and/or compensation from other muscle groups to try and brace to hold everything together. Some of your other stronger muscles can make up for the deep inner unit, but this usually leads to too much compression on the joints and immobility in the area. You function best when your body can use the little muscles to do light stuff and the bigger muscles to do harder stuff. You can get away with purely building strength in your outer sling muscles, but you will be prone to breaking down more often if the little guys aren’t firing.
The four muscle groups are your pelvic floor, transverse abdominus, multifidus and diaphragm. They form the bottom, front, back and top of your abdominal and pelvic cavity. Recruitment of these muscles is more about thinking than doing. They provide gentle compression to stabilize so your bigger muscles can move you. I don’t like to re-invent the wheel so the best resource to learn about recruitment of these muscles can be found on Diane Lee’s website here: Training the deep muscles of the core
Although becoming aware of these muscles and consciously training them can be very important, they are supposed to act subconsciously and if you align your body in the proper way they will likely fire on their own. I find it is the compensation strategies people choose in their posture that are inhibiting these deep inner unit muscles and that helping a person unlearn bracing strategies helps to fire up the deep inner unit more than trying to focus on them alone. Read More
IMS stands for intramuscular stimulation and is an anatomy specific form of acupuncture performed by specially trained physiotherapists and some doctors. It has its roots in traditional Chinese acupuncture, but is fundamentally different in many ways. IMS uses Western medicine’s understanding of the neurophysiology of pain and Dr Chan Gunn’s assessment techniques of identifying underlying nerve irritations to treat chronic pain issues. The technique does use acupuncture needles, but not in the way someone practicing traditional acupuncture would. Traditional acupuncture focuses on pre-mapped out points in the body that relate to different organs and meridians of energy running through the body. Fine acupuncture needles are then inserted into a number of these points and the person rests with them in for 10-20 minutes. It can be very useful for the right condition, but it is not as specific or as purposeful as IMS.
To understand why IMS is performed the way it is you should have a basic understanding of how your body experiences pain. If you haven’t already, please read the article titled Why Things Hurt: Explain Pain.
When a physiotherapist performs IMS he will first assess your basic posture and movement patterns to look for some common signs of underlying nerve irritation. The most common one is to palpate for tender bands or knots in particular muscle groups. He will look for restriction of movement in major joints such as your hips and shoulders and note the appearance of the skin and muscle tissue on either side of your spine. When there is an underlying nerve irritation in an area, the skin can start to look like the rind of an orange peel, feel thickened and respond differently to light touch. A person may develop goose bumps easily and/or have areas of coolness or hair loss. The therapist will take all these things into account when determining where to treat you. Read More
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
Chest up, shoulders back and down is the best posture
Most people think of posture as simply the need to keep your chest up and your shoulders back and down. Sounds like a simple feat right?! Then why will most people admit that they think they have bad posture? The answer to that is because good posture is not a simple thing, it is actually a learned, coordinated skill that encompasses the whole body. We are what we repeatedly do and our posture is a reflection of our childhood, our sports, our jobs, our emotions and our attitudes.
There is a continuum of flexibility and mobility among the population. Some people are naturally very loose jointed and hypermobile while others are compressed and stiff as a board. Where you end up on the spectrum seems to be partly genetic and partly personality. The people that fall in the middle or the average/normal people tend to have the least pain and injury problems. The further a person strays in either direction from the average the more and more posture, movement and pain problems they tend to develop. There is not one perfect posture for everybody, but there is a norm that we should all be trying to achieve no matter which side of normal we are on.
“Stiff as a board” “Normal” “Loosey-goosey”
Our bodies are brilliantly built to deal with gravity as a constant downward force, unfortunately most people don’t know how to use their bodies properly or efficiently and end up with muscle imbalances, pain and dysfunction. Posture should be looked at as a life skill not a genetic trait we can blame on our parents. A very basic understanding of anatomy and biomechanics can save people a lot of grief throughout life. Read More