Blog Archives

Case Study #1: How a 34-year-old physiotherapist overcame his foot, back, hip & knee issues

I get asked by my clients all the time: ‘what made you want to be a physio?’ So I figured I would make myself Case Study #1 in a series that I am writing to help you relate to pain, injury and rehabilitation in a realistic and practical way.  My short answer to clients is usually ‘I’ve been an active athlete my whole life and have always been very good at hurting myself so I spent my fair share of time in physio.  I was quite familiar with it and always had a fascination with the human body so it was a natural progression for me after my Human Kinetics degree to go into Physiotherapy.

This article will summarize the lessons I have learned from both hurting myself repeatedly and working with people in pain every day.  I will outline the path I took to overcome some chronic issues that are very common to people of all ages and the things I try to teach to both my parents and my kids.

Brief Background …

I tend to refer to your teens and twenties as your invincible years.  You can punish your body without experiencing that much consequence because the pain, stiffness and soreness doesn’t last long enough to deter you from doing the activity again, or to change your behaviour significantly.  I was a long, lanky kid that played a lot of soccer, rugby, baseball, track & field, water-skiing, wake-boarding, basketball and volleyball.  I sprained ankles, broke my wrist, and dislocated my shoulder many times, but I kept on going.  Now at 34, after being a physiotherapist for ten years, starting a business and having three kids in three years, I have come to realize that I am the cumulative product of everything I have done up to this point and that I better take care of my body because it’s the only one I’ve got for the next 60 years (Click here for related article). Read More

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Why Shoulders Hurt

01.12.2011O
Your shoulder is brilliantly designed to allow your arm to reach, grab, throw, push, pull, etc., etc., etc., but I’m sure if you have experienced shoulder pain in your lifetime you might argue that there are some flaws in the blueprints.  I have seen shoulder pain bring some of the toughest guys to their knees and frozen shoulders put women’s lives on hold for 1-2 years.  I personally, have dislocated my shoulder multiple times and eventually had surgery on it in 2001.  My shoulders and I are not friends, but I have learned how to keep my enemies close and under control.

Knowing what I know about biomechanics and anatomy, I would still have to support the idea that the shoulder is extraordinarily designed, but I would make the case that it should come with a detailed instruction manual of how to actually use it properly.  Your shoulder is a complex ball-in-socket joint that’s function is intimately tied to the posture and alignment of your ribcage and thoracic spine.  ‘Normal’ movement in your shoulder requires the ball to spin in the socket, the shoulder blade to slide over your ribcage and your torso to remain in a relatively stable position; a problem in any or all of these factors will lead to dysfunction and eventually pain in your shoulder.

It is not hard to determine what structure in your shoulder may be damaged and hurting, but it can be harder to understand why you damaged anything in the first place.  Sometimes why is easy.  You may have tried tackling a two hundred pound Kiwi rugby player determined to run through you and your shoulder lost the battle like mine did, but most of the time ‘why’ is more complex than you would like.  Shoulder pain usually involves a combination of factors that over time lead to the insidious onset of pain.

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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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Pregnancy, Pain & Posture: a video progression to restore movement

As I write this post, my wife is 32 weeks pregnant with our third child in three years, so I dedicate this one to Katie….you, and your body, have endured more than most can imagine.


Our boys

I will concede right off the bat that I am not a woman and have not been pregnant, but I have worked with and treated women at all stages of pregnancy, including immediately after C-sections and women 20 years later that are still trying to get their bodies back.  From what I have seen, there is no other experience a person can go through that is both physically and mentally more challenging on your body than getting pregnant, having the baby, and making it through the first five years in one piece.

Medicine has come a long way in making sure that the mother and baby are physiologically OK from conception through to the birth, but there still remains a significant lack of proper support and education for women when it comes to pain, posture, movement and physical function both during and after pregnancy.  The most important factor to consider is that most women don’t have great posture, movement mechanics or strength before they get pregnant, so this issue it not solely created by pregnancy, but merely exposed by it.  Most women are not used to carrying 10-30lbs around all day, or having to bend and pick things up off the floor sixty times a day, or hunching over breast feeding time and time again.  These are physical demands that would be hard on anyone, but particularly hard on someone whose body has changed so dramatically in a relatively short period of time and is functioning on very little sleep.

If you haven’t already please read everything your mother taught you about posture is wrong or how to standRead More

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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

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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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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

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The Deep Inner Unit: "light core"

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

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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

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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

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