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 in a realistic way.

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).

My Aches and Pains… At age 26, as a physio working with, and on people every day, I started noticing that my low back would tighten up and that my feet and hips would be aching by the end of the day.  I found myself lying on the floor in the clinic trying to crack my back in between every other patient.  When I got home all I wanted to do was sit down because my hips were so sore.  After my indoor soccer games I would be hobbling around because my boots gave me blisters and my mid foot felt like I was getting stress fractures.  To top it off, if I sat too long, my neck would tighten up and I was cracking it way more than I should have been.  Finally one day, at age 28, I was working with a client and picked up a light IKEA chair and suddenly dropped to my knees.  I wasn't sure what happened but my spine would not allow me to be vertical.  I crawled onto my treatment table and asked my client to go get my receptionist.  I physically could not get off that bed for 6 hours.

It was at that point that my body became the project.  I was tired of helping others feel better all day while experiencing significant discomfort myself.  I was young, in good shape and had a strong core, so why was I having so much pain?  I was determined to get to the bottom of everything.  It took me a few years and a number of 'aha moments,' but now at 34 I feel like I have my body largely under control.  I rebounded from the back pain relatively quickly, then actively sought out the root causes of my issues, and now I much more confidently understand them and am able to control them.

Where I started… While I was stuck on my treatment table for 6 hours, I started by loading up on pain killers and muscle relaxants to allow me to get home.  I then followed the steps laid out in my previous article 'Principles to follow when your back is sore.'  Having my partner do IMS on my hips and low back made by far the biggest difference and got me back to work in three days.

With the back injury behind me I was determined to understand 'why' for all my issues and figure out what I needed to change….I was obviously doing something wrong.  I started by comparing myself to my clients, looking for common trends in pain patterns, posture, flexibility and what did or didn't help them.  I compared my physical characteristics to both of my parents and considered the problems they have had and decided to start with the issue that had affected me the longest….my feet.  My mother had had three foot surgeries at that point and I was damned if that was going to happen to me….she related way too much to my mid foot pain for my liking.

I have extremely high arches, a narrow heel and a wide forefoot.  In my teens I had chronic tendonitis issues in my Achilles and blister problems on the balls of my feet with court sports like basketball.  Soccer and rugby cleats were never comfortable and my feet routinely hurt during and after matches.  I tried heel lifts, extra cushioned shoes and orthotics but nothing really helped.  For many years I just resigned myself to pain being a part of my active lifestyle, but no longer was that OK in my mind.  I cracked open my anatomy books and started studying the intrinsic muscles in the foot to figure out where my deficiencies laid.

Long story short I determined that the muscles in the bottom of my feet just weren't strong enough and that my calf muscles were being way over worked.  I discovered that doing IMS on four of my calf muscles completely changed how my foot felt on the ground (gastrocs, soleus, tibialis anterior and peroneals).  For about a week after IMS my feet felt loose, free and strong, but it never lasted.  So I started trying to tape my feet up in a way that would provide artificial strength with the same pull as my weak muscles.  I came up with my Toe Spreader tape job which felt amazing!  I felt lighter in standing and for the first time felt my feet propel me forward as I was walking.  It was a strangely amazing feeling.  I wanted them to feel this way all the time, but the tape job only lasted a couple days.  I also noticed that the tape felt great standing and walking in bare feet, but not so much in my shoes.

With my newly found freedom from foot pain, I started taping my feet all the time and searched for shoes that would protect my feet but give me the barefoot feeling.  This was about the time that the Vibram Five Finger shoes just came out, so I started wearing my 'monkey feet' to work.  I loved them, but got tired of having hot sweaty feet and explaining them to everyone so I kept looking and discovered the Vivo Barefoot shoes by Terra Plana that had a thin, flat sole, a wide toe box and looked quite nice.  The combination of switching to these shoes and taping my feet sent me on a journey of physical self-discovery over the next 5+ years.

Walking down the linoleum lined floors in the quiet hallway near my office I noticed something I had never noticed before.  My heels were getting mildly sore and my feet were making an awful slapping sound as I walked in my new shoes.  I discovered that without the elevated, cushioned heel and stiff sole of my old shoes, I needed to walk differently.  My old shoes were encouraging me to walk poorly and throwing off my whole posture and mechanics.  Walking down this hallway in my Vivo's without my feet taped became my test.  I needed to walk quietly and not pound on my heel.  Taping my feet helped a lot, but it started to feel like cheating.  I needed to learn how to balance my body properly over top of my feet while I was walking so that they would provide a natural rocker, weight transfer feeling instead of a pound-slap (click here for related article).

Trying to walk differently is a mentally challenging exercise, one that really makes you think about how you hold and use different parts of your body.  It really made me start analyzing my and all my clients' posture and movement.  I discovered a strong linkage between how people posturally hold their mid back and how their feet interact with the ground, which became the topic of my article and video titled 'Everything your mother taught you about posture is WRONG.'  I discovered that most people's attempts at 'chest up, shoulders back and down' resulted in them actually holding their torsos in a position that was leaning backwards.

It is really hard to use your butt and hamstring to push you forward, if your torso is leaning backwards.  I was a big culprit of leaning backwards.  I discovered that my body compensated for my forward head posture by simply hanging my pelvis forward; this kept my head relatively over top of my hips, but squished my low back and allowed my mid back to stay weak and lazy.

Because my torso was hanging backwards, when I went to walk I would step forward and my foot would hit the ground well in front of me on my heel; this position would not allow my foot and ankle or my glutes and hamstrings to work well in pushing me forward.  I was effectively impacting and pulling myself along; this pattern of movement over time lead to me developing weak feet, weak glutes and a weak mid back as well as tight calves, tight hips and a neck that still lurched forward.  I had to learn how to properly stack my body up in proper alignment, and then how to move, and more or less keep it that way.  Standing, sitting, and walking properly were hard because my postural imbalances and habits were almost 30 years in the making, but I went about it systematically.

How I Did it… Hypermobility

The first thing I had to realize about myself was just how hypermobile I was; this is a factor that most people that don't poke and prod people for a living likely wouldn't take into account.  There is this unspoken assumption among people that we are all put together the same way.  You become familiar with how your body works simply because you know no other way, but what you grow to understand as you move other people's joints around, press on their ribcages and try to teach them how to move, is that some people are genetically 'loosey-goosey' and others are stiff planks.  The simple experience of standing or sitting still is fundamentally different for different people.  You can read more about this topic in my article 'What does it mean to be hypermobile? A gift and a curse wrapped into one.'

I never really considered that I could move a lot more than your average person.  I know that I always felt stiff and tight in various places, so I never considered myself flexible by any means.  By comparing myself to others and spending a lot more time looking at my posture in a full length mirror, I came to realize that I was in fact quite mobile and that my posture sucked.  If I looked straight on in the mirror, I looked OK, but if I caught my side profile, I started understanding why my neck and back hurt.  My head and pelvis hung forward and I always seemed to catch myself standing with my feet crossed?!  And I couldn't for the life of me stop clenching my butt.  I further started to embrace the concept of what Diane Lee would call 'Butt Grippers' and 'Back Grippers'


Simply becoming aware that I was subconsciously clenching my butt as I stood and trying to consciously stop it probably got rid of half of my hip soreness, but it didn't answer the question 'why was I clenching?'  I came to realize that it was partly my hypermobility, partly how I was holding my mid-trunk and partly my high arched feet.  When I taped my feet, I stopped just standing on the outsides of my feet, which made me clench less and have less hip pain.  The trouble with taping my feet became that when I walked, the increase torque I was creating with my legs was causing my pelvis to sway forward and my torso lean backward.  I started to become acutely aware that if I used my diaphragm and abs to support my lower torso when I walked that I would walk almost twice as fast with half the physical effort, quadruple the mental effort and almost no pain.

Realizing that posture is much more than the 'chest up, shoulder back and down' cue that most people relate to was a big revelation to me.  I understood how my feet and shoes were affecting my hips and how my gut and butt needed to learn to work together better, not just get stronger.  I started taping a LOT of my clients' feet with great results, but quickly understood that this is WAY too much information to unload on anyone interested in changing their posture and movement patterns.  My and your posture are decades in the making and take months to years to properly change, but awareness and persistence go a long way.

I progressively got better and better at standing and walking, but it still wasn't happening that naturally.  The more I corrected the position of my feet, hips and trunk, the more I realized that my body was really just accommodating my neck.  Being a tall, lanky kid, I developed a head forward position at a young age, which means my upper back is slightly more rounded and my neck juts my head forward.  I realized three things:

  1. that our brains have a head righting reflex that wants to keep our eyes looking straight forward and our heads over our hips
  2. that our bodies are inherently lazy in dealing with gravity and
  3. that our bodies follow the laws of physics and take the plane of least resistance when you attempt to stand up tall.

If your upper back is rounded, that will relatively force your head to look down and it is easier to accommodate your need to look forward by leaning your torso backward than it is to muscularly hold yourself up straight.  Because your body is full of many joints and hinges of relative stiffness, attempting to stand up straight can be like having two buttons you want to push in, but you can only use one finger and every time you push one in, the other pops out.  If you don't think about it, your body will do what's easiest.  If you want to change your posture you have to learn how to control the loose hinges and move the stiff ones, otherwise the loose ones will get looser and the stiff ones will get stiffer until something inevitably starts to break down and hurt.  Most people fall into this trap in one way or another because gravity is the most persistent force on Earth and our lives require us to sit or stand still for long periods of time.

How you should do it…  My mantra to my clients has become Awareness first, then Release, Re-educate, Rebuild.

Start by watching how people around you stand, sit, walk and move and start looking primarily at your side profile in a mirror.  Is your back really flat or really rounded?  Is your butt sticking out or tucked right under you?  Do you look like you are in the military or a slouchy teenage boy?  Know where you are starting from and don't assume that just because you can stand, sit, walk and breathe, that you do any of them well.

Find someone like a physio to be an objective eye for you and point out your deficiencies in a constructive way.  Also try to determine if you are relatively hypermobile, stiff as a board or somewhere in between.  The hypermobile people end up in a paradox of choice trying to find the correct posture because they have some much movement available while the stiffies don't understand how anyone could move the way I am suggesting.  Your experience will depend where you fall on the spectrum of mobility.

As far as releasing painful, stubborn alignment and postural issues, Intramuscular Stimulation (IMS) is by far the best tool I have found for freeing tension and pain from the body (Click here for a comparable technique in the US).  IMS can help open a window to help you learn to move better, but its' results will not last forever if you continue your poor movement patterns.  Watch some of the videos below to understand 'Why Things Hurt' and how to build the fundamentals of good posture and movement.

Understand your Pain:

Why Things Hurt (click here for Backs, Shoulders, Knees, Elbows, etc.)

Understand your Posture:

How to Sit

How to Stand

Practice exercises to make the end goal easier:

  • The purpose of the following exercises is create body awareness as it relates to movement and to create connections in your body.  Don't worry about how many sets or reps you are doing, instead pay attention to what you are doing and how you are doing it.
  • The goal of these exercises is to help you discover movements and muscle groups that you can then use more effectively for day to day movements like walking, sitting, pushing and lifting.  They are also the building blocks of proper form for strengthening exercises.
  • Understand and master the following principles of movement and you will suffer from far less tightness, stiffness and pain throughout life

The concepts below will be found in the various playlists found here and at the bottom of this post

Step 1: Discover your hip to torso relationship

Step 2: Learn your hip to pelvis relationship

Step 3a: Learn to use your gut and butt together 3b: then in verticle

Step 4: Learn how to use your feet

Step 5: Learn how to use your foot, hip, leg and core

Step 6: Learn how to do it all together

Step 7: Learn how to bend and squat*this list is not exhaustive, there are more resources in the video library, but these seven steps are a great place to start

*I used to go to the gym all the time when I was younger.  I would say I was physically stronger then, but I am functionally stronger now.  I have made life my work-out and have learned to hold my body together as I lift my kids, go up stairs, lift heavy boxes, etc.  If you can put in the mental time to figure out your body, you will save yourself physical time having to go to the gym to get strong.  Creating efficiency of movement is the answer for people that just don't have time and/or desire to go to the gym.

I will be posting a series of case studies of people that have eliminated their chronic pains by simply learning how to move better.  If you are in pain, start by watching some of my Why ____Hurts videos and then progress to the movement exercises.

The human body is fascinating….enjoy learning about it!

If you have questions please leave them in the comments below.

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