How To Be Healthy In 2017

The New Year is around the corner and that means hoards of people will soon be flocking to the gyms, health food stores, and supplement shops with every intent that 2017 will finally be the year that they get fit, healthy, and lose weight.

By now, however, we all probably know that the ever-popular New Year's resolution is mostly fallacy. It's no surprise that a quarter of individuals don't even make it past their first week of working on their goals.

With that being said, January is still a fantastic time to kickstart new programs and lifestyle changes. Sure, most people don't follow through their goals by the time the year is over, but that still leaves adherence rates up compared the other eleven months.

So what can be done to keep to those goals? Here's a few tips..

1) Micro-Goals over the Big Resolution

The main issue you've all probably heard discussed before is the lack of realism or attainability that comes with creating that one huge, daunting resolution. You want to run a marathon? Lose all that weight? Do a bodybuilding competition? Well, great, but what about all the stuff between here and there?

Health and fitness professionals are taught a lot about the importance of creating short-term goals, but it's a facet that's still often overlooked. However, those micro-goals are really the only good way to maintain your motivation and create attainable stepping stones when it comes to the big end-result. So this year, sure, pick a resolution, but have weekly goals in the meantime to help you on the way there.

2) Chip Away Slowly

You used to deadlift three plates per side every day, so let's start with that after a year off from the gym. You want to eat healthier, so how about we flip that diet plan of your's completely upside-down? New to exercise? Time to start hitting the gym six times per week!

You know where we're going here. The best case scenario here is that you simply won't be able to maintain the volume of change (or weight) you've placed upon yourself in such a quick period. The worst case scenario is you throw out your back deadlifting or send your body into some sort of metabolic dysfunction by screwing with your food intake.

Make those changes slowly and gradually. Start small, build upon it, and modify as you go to suit your needs, not the internet's.

3) Address Your Deficits Before Removing The Vices

John Berardi posted a great article about fixing broken diet plans, and the first step in creating a healthy food program for his clients is to address nutritional deficiencies before removing unhealthy items. Doing so will help them maintain their energy, keep their hormones in check, and help with appetite.

I'm willing to expand this with other health habits as well. It makes much more sense for your psychology and motivation to add to your lifestyle early on rather than take away. In the grand scheme, it may be easier to hit the gym twice per week for a while before quitting smoking cold turkey. Add more vegetables to your diet before taking away cheesecake. Start biking to work before giving up alcohol.

It makes perfect sense once you think about it. Changes to lifestyle and habit should be positive. By adding good habits to the mix as a first step, even though it's work to do so, it creates more of a positive feeling than cutting things out will. And remembering our first-year psychology class (you know, the one that made you understand the world and everything in it), positive feedback produces the best outcomes.

4) Focus On Feeling Good

Lastly, I like to tell clients, whether through the gym or the ones seeing me for Athletic Therapy, to focus on how their body feels. Most people who are going into healthy resolutions have an image in mind; one of a slim body or big muscles. However, let's be frank. Those results are a long time coming, and the fact that they are can be demoralizing. Even when it comes to more attainable milestones, such as weight or circumference, you'll still typically see plateau's and results that are inconsistent with your true progress.

I'm not saying that you shouldn't track these results, though, but I like to ask clients if they can feel progress first and foremost. What's more, that's the question which is likely to produce the most immediate and consistent results. Is your energy up? Has your mood improved? Is your body in less pain? Do you feel stronger? When it comes down to it, those more-subjective ways of tracking progress are better indicators of your overall health than the mirror, scale, or measuring tape.

In the end, the whole New Year's resolutions deal will continue to forever be a crap-shoot. Many will make their goals, many more won't. Just remember to set yourself some realistic milestones, plenty of short-term goals, ease into the changes slowly, and give to your body before you take. And finally, make sure you feel good doing it.

Muscle "Knots" (Are Not All Trigger Points)

We've all experienced knots, kinks, aches, and pains in our muscles. "Knot" is typically the predominant layman's term for specifically tight spots in muscle tissue. However, the term "trigger point" has also made its rounds through popular schools of thought, recently becoming a big thing in the fitness industry rather than solely in the therapy world.

We need to avoid trying to define all symptoms under one umbrella term, however. "Knot" is a catch-all, non-specific term while "trigger point" is a very specific condition that cannot be applied to all muscular pain. People commonly confuse the presence of fascial adhesions and scar tissue as well. How do we define it all?

Trigger Points

Firstly, let's tackle the well-known myofascial trigger point...as best as we can, anyway. You see, there's actually very little consensus on the cause or even the existence of trigger points. Nonetheless, there does exist a phenomena that clinicians define and treat as trigger points, and so here's the best explanation I can provide.

Trigger points are localized points in muscle and fascia that become tightened and hyperirritable. It's generally believe that they arise due to neural responses to injury and/or joint instability. Contrary to common belief, not every tender spot in muscle is a trigger point, the condition having a few requirements before we can consider its presence:

1) Trigger points cause and are found within a taught band or rope-like length of fibers within the muscle. 

2) Trigger points will cause referred pain away from the site of the point itself, such as one found in the back of the shoulder causing dull pain lower down in the arm.

3) The trigger point, upon stimulation, will cause localized twitching - but not contraction - of the muscle.

Not all trigger points are active enough to exhibit these symptoms until manual pressure is applied. However, this should be enough to help you stop identifying everything as the same and to cease trying to treat every bump in your muscles with a lacrosse ball. That being said, how do we define other tender, restricted spots of muscle tissue?

Scar Tissue and Adhesions

Whether it be a result from acute injury or repetitive stress, scar tissue and adhesions tend to form in the muscle and fascia as well.

If you've ever taken a close look at scarring on the skin, you have a good idea of what muscular scarring is like; irregularly formed, stiff, and lacking tensile strength. The same occurs in muscle after said damaged tissue heals. Areas where scar tissue has developed and not been addressed may cause dysfunction of the muscle itself, restrict range of motion, affect strength, and potentially be a cause for pain.

Likewise, fascia can become damaged as well. Being the layers of connective tissue that separate muscle from organs, muscle from skin, and muscles from other muscles, this damage can also affect kinetic function and be tender and palpable as well. As fascia attempts to heal, it does so in the irregular fashion that we see with scarring, and these adhesions develop that restrict the ability of muscle to glide effectively.

Being irregularly-formed tissue, simply applying pressure to these points like many of us attempt to do thinking that they are trigger points is an ineffective method. Scar tissue and adhesions must be "broken" apart and then the areas restrengthened by movement. However, when it comes to breaking down these points, even the the popularized self-massaging from foam rollers probably doesn't provide enough pressure to assert physical changes within the tissue.

Summarizing, trigger points are a thing, but can't be identified as every nodule you feel in the muscle. Scar tissue and fascial adhesions exist that must be considered. Foam rolling and self-massage techniques probably don't exert enough focal pressure to achieve therapeutic effects. And, as always, exercise and range of motion drills are likely going to be the most effective method for treating these irregularities within the muscle, supplemented when needed by therapeutic manual techniques.

Hip Mobility for Spinal Health

We hear health and fitness professionals rave on about the importance of hip mobility all the time, but rarely hear much of an explanation for it. The ability for your hips to move through range of motion is crucial for the structural stability of the spine, though. I'll speak on the two most major movements at the hip - flexion and extension - and how dysfunctional range of motion here may negatively affect the back.

Flexion

An inability to reach optimal flexion at the hips is the most-commonly pointed out issue on this subject. Flexion is the movement that occurs at the hip when you bring your knee to your chest. When lacking in range, it can heavily impact your ability to properly perform many exercises at the gym, resulting in the amount of notice it receives.

The most major example of poor hip flexion affect the spine is during the squat. Normally, when sinking into a squat, the spine should maintain it's neutral lower curve. However, if the hips are not able to complete the movement themselves, the spine will compensate and round out into flexion itself - the entire pelvis rolling forward - to reach the bottom of the squat. We commonly know this as "butt wink".

 

This is the most obvious example of this dysfunction, but the thing to realize is that if this large mechanical error occurs at the gym, it's probably occurring at a lesser - but much more frequent - degree as well during the rest of your day. That means you have excessive spinal flexion when bending down to pick up boxes, when seated in chairs, and possibly even walking and running. 

(Let's side-step and remember that genetics may play a role here, and you may simply be anatomically unable to flex your hips as far as others. In these cases, you still want to work on maximizing the range you have, but may need to accept that your squat won't be as deep as some.)

Extension

The other major movement we see at the hips is extension - the leg pushing back and behind you. Just as with flexion, which a lack thereof can increase flexion of the spine, lack of extension at the hips can make the back compensate in the same way.

This habit isn't as often caught in your typical gym setting, as increased spinal extension isn't often perceived as looking dysfunctional like flexion. However, excessive compensatory extension of the back (most often seen with running athletes) can lead to lower back pain just the same; compression of the vertebral spaces and hyperactivity of the erectors of the spine being significant causes.

Increasing Mobility and Precautions

When it comes to hip flexion, the limiting factors of range tend to be soft tissue and bone. Restrictions of the ligaments as well as tension through the hamstrings are frequent barriers, as are the anatomical limitations that are discussed in the article that I linked to previously.

As for extension, there isn't so much a barrier to the movement, rather there being a lack of muscular stability for it. When the core isn't stable enough to hold the spine steady during the force created by extension of the hip, this is the case where you'll see the form break down and the spine move to follow. However, this is trainable.

As a final note, if you're thinking that you need to work on your hip mobility more now, let's remind ourselves to be gradual and that over-mobilizing can quickly lead to more injuries than it corrects for. Take it gradual, people!

Your Tight Hamstrings

It seems like every other client and athlete that I see has a complaint about their tight hamstrings.

The tension that a lot of people feel is relentless and just won't let go. They stretch and stretch all day long. Bending down to touch their toes, sitting and reaching, on their backs with a band, but nothing works!

Why are these things so tight and why can't we get them to be flexible?!

Hamstring Tension

I read this excellent article by Eric Cressey on the true reasons for hamstring tightness. One of the most enlightening points that it makes is the fact that your hamstrings are very unlikely to be truly shortened.

You see, the hamstring muscle group performs two major actions: knee flexion and hip extension. If our hamstring tension was really caused by shortening of the muscles, then that would essentially require us to be in both of those joint positions (simultaneously) on the regular. Do you spend every day on your knees for hours? (No jokes, please.) No? Then you probably don't have a hamstring lengthening/shortening issue.

So that being said? What causes hamstring tightness? There are three main things: Protective tension (compensatory tightness), neural tension (most significantly, sciatica), and an injury to the muscle (whether it's an acute strain or tendinitis).

Most of my clients who have this issue have it due to the first option; protective tension. More often than not, they're lacking proper activation of the glute muscles to initiate hip extension and stabilize the hip joint. As a result, the hamstring has to not only compensate for the ability to extend the hip, but it also has to increase in tension to try and make up for the lack of stability that the body senses at the joint. As the fix, I spend a lot of time reeducating the action of gluteal hip extension. Obviously, this isn't the only compensatory mechanism for why the hamstrings are tight, but it's the most common one that I find.

Similarly, if the reason for the tension is neural or due to injury, we need to fix the root of the problem in these cases as well before the hamstrings will truly be able to release their tension. If there's sciatic involvement from either the hips or the lower back, then some sort of intervention to relieve the stress on the nerve is required. If there's been an acute hamstring strain or built-up scar tissue, then time, manual massage, and proper strengthening will help accelerate recovery. If there's a chronic tendinitis, then that brings us back to the compensation issue which needs to be corrected.

Hamstring Stretching

In the meantime, is there anything we can do to help decrease hamstring tension while attempting to correct these mechanics?

Well, from my experience, I'm finding that static stretching for this area is less and less effective. Like I touched on before, if the hamstring isn't truly shortened, then why bother trying to truly lengthen it?

Instead, I'm starting to employ more dynamic stretching (even after exercise) in order to promote the muscle to neurally relax under tension and let go during repetitive stretch rather than prolonged. My clients have reported feeling that these methods have made them feel like the muscle is under decreased tension and have relieved pain more than holding the stretch ever did.

 

All in all, this goes back to my philosophy that simply stretching and mobilizing is never the answer to the problem. The base mechanics always need to be addressed before the issue is resolved. So, if you fall in this category of someone plagued by chronic hamstring tightness, take a moment to consider the reason for it.

How Your Eyes Relate To Your Head and Neck Pain

Try this at home: Sitting comfortably, find the muscular soft spot at the top of your neck, just below the base of your skull. Use the pads of your finger tips to slowly strum through the tissue and gently sink into the tissue. Now, move your eyes around. You should feel the muscles twitching underneath your touch. Fascinated now? Keep reading.

I've treated clients with concussion symptoms and whiplash quite a few times now. To some degree, there's always some involvement of the eyes in their symptoms, whether it's pain, disorientation, or inability to focus. Most of us would never have thought about the importance of the eyes with these movements before, but when you think of it, it makes sense.

Wuuuuhhh?

Eye movement, like every other movement of the body, is initiated by muscles. The muscles of your eyes are small and sensitive, due to the fine control needed for sight. Of these many muscles, the suboccipitals in your neck (sub=below; occiput=the base of the skull) are of high clinical significance.

I've talked before about how pain and spasm work. You experience an injury, your brain senses pain and instability, it causes spasm of the muscles to protect the area, more pain results, and we cycle through over and over again.

When it comes to the topic at hand, when the neck or head experience trauma (such as a concussion or whiplash from a car crash), the suboccipital muscles are among the structures that are sent into this protective spasm. As well-meaning as your body is by doing this, this contributes greatly to the symptoms that follow. As tension increases and the strength and motor control of those muscles is lost, many people will become plagued with symptoms such as migraines, vision problems, eye pain, neck pain, and more.

So to alleviate your symptoms, what can be done. Massage? Yes, but also no. How many of you with these conditions have tried that with only semi-successful results? The pain may go away for the rest of the day, yet it returns soon enough.

Like with any other injury, massaging those suboccipital muscles is only half the work. Remember, the problem is that these muscles are spasming, weak, and lacking motor control. Manual therapy will take care of some of the spasm, but strengthening and reteaching control of the eye movements is mandatory to fully rehabilitate the condition.

Since cluing into these relationships, I've since incorporated eye-tracking assessments and exercises into my rehab programs for clients with neck and head injuries, and these methods have had the most drastic effect on patient recovery over anything else. Once we're able to restrengthen the eye muscles, the spasm and tension in the neck settles down, and symptoms start to subside.

Like I said, the relationship between the eyes and these conditions is not an obvious one, but it's very understandable once brought to light. I'm happy to have found these conclusions, as being able to relieve these life-altering symptoms in shorter time has been very rewarding.

Why Planks Are Not Enough

I've seen and talked to numerous people with complaints of low back pain that can't seem to understand why they are afflicted with such; after all, they always do planks to strengthen their cores.

I've seen many people with severe low-back pain who figure that it must be due to something other than muscular strength. They can hold a strong plank for minutes on end and keep going forever. It couldn't possibly a core problem. Well, I'm sorry to say to everyone, planks are not enough. Why?

Strength vs. Endurance

After the first couple minutes of holding a plank, it is no longer a core strength exercises; rather, it's a core endurance one.

Now, core endurance is an essential aspect to health, but more often than  not, the need strength exceeds the need for endurance in these muscles. Whether it's picking boxes up, lifting weights, or nearly any other activity, the core needs the strength to stabilize the spine under these shorter, higher-resistance loads rather than needing to stay activated under excessive lengths of light-resistance.

Planks for muscular strength are a beginning level exercise only. As soon as a client can maintain a strong plank for 1-2 minutes, they are well-past the point of this exercise being useful. It's time to move on.

Single vs. Multi-Plane Movement

Planks also have a bit of a disadvantage in that they address stabilization in a single plane of motion only. Sure, you can flip onto the side and side-plank for the oblique muscles as well, but the benefits here have limits as well. By training stabilization using resistance at only one angle, you're training your core to only be strong and stable at that angle. As soon as you experience any resistance coming at you from a diagonal direction, you're no longer conditioned to bear the load.

Joint Movement

Again, planks on their own are a beginner-level exercise only. They do the job at an early stage to teach us how to use those core muscles to stabilize the spine and prevent movement against resistance.

However, the demands on the core system drastically change and increase as soon as we add joint movement into the picture. Adding arm or hip movement to the mix increases the level of activity required by the core muscles due to change in joint position transferring additional kinetic forces towards the spine. That being said, if you're not training your core to stabilize during joint range of motion (such as with the deadbug), then you're not training your core to be effective as soon as you try to transition to any functional activity.

To reiterate, I very rarely give planks to clients except in the case of very low-function individuals (or if it's an additional part to a larger workout plan that is already challenging the core). It should be considered a first step only.

Clients always require an increased demand as they progress towards returning to activity or higher performance. With that in mind, they require a highly-varied core routine just like every other muscle group does (as the gym-rats out there will understand). Adding weight to the plank, adjusting core exercise angles, throwing in joint and limb movement, and even progressing to plyometric-type impact exercises to challenge the core are are essentials at some point in the plan. It doesn't matter if the individual is a rehab client, an experience gym-goer, or a high-performance athlete; these principles remain sound.

Do You Need Traction?

I recently had someone ask me if I thought it'd be worth it for them to purchase their own traction table for at home.

I've also talked to clients who said that they previous paid their last clinic for weekly traction - and almost no other treatment. Sometimes, the timeline went all the way up to nine months! Did this form of treatment help them to resolve their back pain?

Mmm...kinda.

Weeeeeeeeeeeee!

Mechanics

Traction can definitely help to relieve back pain. Is it going to cure it for good, however? Will it correct the mechanics that caused the pain? Likely not.

There are a number of ailments that can afflict the spine. For example, a disc bulge may be pressing on a nerve root. Arthritis may be developing between the vertebrae. There could even simply be a strain to one of the muscles supporting the spine. Any number of things.

Now, traction can be a fantastic tool for relieving the pain experienced by these conditions. Decompressing the spine would relieve how much the disc bulge is pushed on the nerve root. Arthritic changes inside the joint would become spaced apart and less agitated. Traction is even reported to alleviate muscle spasm.

So yes, spacing the vertebral joints apart can absolutely relieve symptoms of a myriad of back issues. However, has this done anything to correct the problem that caused those symptoms in the first place? Of course not. You haven't actually changed anything within the joints.

Spinal Rehab

Recovery from spinal conditions involves restrengthening of muscles, retraining proper motor habits, and stabilizing the joints to prevent future recurrence. True, traction is a great in helping to relieve pain just long enough to be able to move oneself through the recovery stages, but if the posture and biomechanics are not addressed, then recovery will not occur.

That being said, it should be important to know that, firstly, you need much more than traction to fix your back. Other aspects need to be considered. Secondly, once we address the roots of the pain and correct for them, there should be no reason why month upon month of traction is ever necessary. By moving through a proper rehabilitation routine, more results will be achieved in shorter time. In fact, research shows that traction is most effective in treating short-term, acute injuries.

In brief, traction is not a one-shot magic bullet. It's simply more of a painkiller. A painkiller that takes fifteen minutes to swallow while you're hanging upside down. Once in a while, it's worth it, but like morphine, don't abuse it. (For your wallet's sake.)

Acute Injury and Exercise - Don't Delay!

By this point, we all know that exercise is an important part of rehabilitation. However, many people seem to believe that exercise doesn't belong in the recovery process until a later stage in the healing process after the initial injury. I talked before about why resting hurts, but let's discuss this more.

It's fascinating to me to think that exercise shouldn't be priority in any injury state. If you think about it, it's really the only form of recovery that we, as human beings, are technically evolved to utilize. Cavemen didn't have massage and ultrasound. Heck, as recent as a few hundred years ago we were still putting leaches on our skin to cure fevers. At the end of the day in human history, people recovered because they continued to work their bodies and force their muscles, bones, and joints to adapt and heal. Modern-day modalities are fantastic, but they are just tools to aid the process. Movement, inherently, can do much more than these tools can.

Maintaining Motion

When we have an acute injury, no matter how simple or severe, continued movement and muscle contraction is key to recovery. If you tear a muscle or ligament, immobilizing the injured area is going to lead to further complications due to allowing the muscle to atrophy and inhibiting circulation to the area. Furthermore, avoiding movement does little to discourage your body to cease its spasm response.

Always, when I see a new injury occur, whether it's an ankle sprain, should sprain, or groin tear, I initiate an early-rehab process involving basic movement of the joints. If you roll you ankle, for instance, then you should still be flexing your foot up and down (within whatever range is pain-free) to promote proper scar tissue alignment and allow blood flow to the area.

When All is Gone

But wait, you say, what if the pain is so severe that any joint movement at all is agonizing? Well, then we modify. If  pain is severe, inflammation is incredible, and function is non-existent, then we still want to initiate the body's inherent healing response.

For example, if you have a massive groin tear and can barely move your leg at all, then we simply don't move it. That doesn't mean that we're not going to work it. If it takes putting a few pillows between your legs just to have you give them even the most minute squeeze with the legs to have some contraction in the injured muscle, then that's what we'll do. 

And what that will do, is more than you may think. Those contractions, regardless of how small, will allow the tissue to know which direction to align its healing fibers in. The pumping of the muscle will bring circulation to the area and help move excessive fluid and swelling out. Activating those muscles will also help and minimize the amount of muscle tone that is lost while movement isn't possible, decreasing the amount of secondary complications and rehab time later on.

Don't Wait

Hopefully you can see why delaying on exercise when an injury occurs will, certainly and absolutely, delay your recovery. By not partaking in some form of movement for rehab - no matter how big or small that movement is - you're allowing disorganised scar tissue to develop, letting the muscle atrophy and lose tone, and inhibiting blood flow and nutrients to the area. Exercise is always medicine. It always has been and always will.

Treat the Whole Chain - Necessities of Recovery

There's no manual on the human body. You can't just open a troubleshooting guide to find out how to fix a piece that's not working properly. As such, I'm not a fan of calling the body a machine. Rather, it's this moist, fleshy mass of tissue and organs that sometimes comes together to work properly. (Yes, "moist". Deal with it.)

How do I look?

That being said, when a piece breaks down and pain is experienced, we don't have the luxury of focusing our attention on that piece alone to try and correct the issue like car mechanics do. If one segment is out of whack, then, guaranteed, others are as well.

Compensatory Mechanics

We all know by now that, when injury occurs or bad motor habits are left unchecked, that the body will compensate by lengthening, shortening, tightening, and restricting in other spots; thus, maintaining functional integrity.

Because of this type of mechanism, spraining an ankle, for instance, means that the overall issue won't stay isolated at that one joint. Because of that sprain, the body will favour one side with a limp, resulting in a lateral hip weakness on the opposite side. That weakness can then be cause for poor knee tracking, SI joint instability, spinal tension, and more. And do these things require years of being unchecked to occur? No. Try a week or two instead.

Intervention

With that knowledge, how can we expect to correct the issues by only targeting the site of the most pain? Here's a good example of how working globally is a necessity when it comes to correcting dysfunction.

I have one client who had discomfort in their hip. We determined that there was an imbalance around the hips that resulted in one side becoming stuck in a hypomobile position. What we did, for the first treatment, was mobilize the joint manually, provide mobility exercise prescription, and then started working on stability for those lower-chain muscles surrounding the area.

So the hip felt great. However, what happened next was that the spinal erectors tightened up by the time of the next treatment. As we promoted more movement through the pelvis and began activating the hip and core muscles to stabilize the area, we were promoting more movement through the rest of the kinetic chain and creating more mobility through the entire spine at the same time. Thus, even though we were strengthening the core, we were also forcing the back muscles to start activating more than they were used to. As tone and tension increased in the lower back, the tension creeped up all the way to the top, exacerbating neck tightness as well.

Sidenote: When we're talking about headaches and 

pressure, we're usually looking at these guys here.

Does that mean we did something wrong during that first treatment? No. It just shows that the body can very effectively compensate for a dysfunction, but when you suddenly intervene in that dysfunction and start to return a joint to its proper mechanics, you need to keep providing similar retraining to the entire chain, both above and below that area.

Significance for Self-Help

These thoughts hold more significance that just for clinicians who are treating a client's injuries. The principals apply to every individual who is trying to address their own fitness and health. 

I talked about "foam roller syndrome" before and how a reliance on self-releasing only the site of pain on a daily basis signals that there are mechanical errors not being addressed. That's exactly what I'm talking about again here. If you are constantly experiencing lower back pain, then constant work on your lower back along will not fix the problem. Neck pain? You need to do more than simply stretch the neck muscles all the time. 

The point here reiterates the time-tested rule that you can't chase pain and expect to chase it away. When there is a dysfunction, it's important to look up, down, and away from the dysfunction and correct the kinetic chain as a whole. Zoning in on one spot will feel great on the first day, but if you stop the efforts there, you can expect the pain to return just as bad - or even worse - soon after.

From Turf to Table

Well, I'm working my own practice now.

After four years of school, a national exam, and a hell of a lot of prep work, I finally opened my new clinic. As business grows, it's coming with its rewards..and lessons.

During the majority of my time in school and the couple years that followed, most of my work experience was on the sports field. In essence, my scope of practice between the field and clinic are the same. Respond to the injuries, treat the pain, rehab the injuries, and progress my clients to their return to activity.

The work life on the field is high-paced and demanding. You would think that moving to the clinic would be a refreshing change and much easier job. Yeah, no. The clinical life comes with many of its own challenges. I wouldn't call either job necessarily harder than the other, but that's just it; "easier" really doesn't exist.

Time Constraints

Firstly, yes, the fast-pace lifestyle of the field can be stressful. When you have a 10-minute intermission and seven players in line to see you, you need to be on your toes to give them what they need in a restricted amount of time. Often, you have to make some tough calls and prioritize the injury needs of some players over others in order to get your team back on the floor in as optimal order as possible. Bad bruise on your arm? Sorry, I have a thrown-out back and two fresh ankle sprains to manage. Come back to me after the game.

Pictured: The third blown-out knee in the game, probably.

On the flip side, now that I'm in the clinic, I have nothing but time to spare with my clients. However, this puts a different kind of pressure on. Athletes on a team are so eager to get back on the floor - adrenaline rushing in their veins in higher volume than blood - and half the time they'll feel better the moment you put your hands on them, even if you haven't done anything yet. (A lot of them don't seem to feel pain.) Clients in the clinic, on the other hand, have just as much time to think as you do, and so all their own focus is on their pain and sensations. With that being said, there's the extra stress of missing something or not being maximally effective with a treatment technique; stresses that you realize weren't there before when none of your athletes ever had the time to think about it.

Motor Patterns and Compensations

Yup, so athletes get injured. A lot. Every game, there's going to be something new happen, and it often feels like you're in a hopeless loop of never-ending accidents and players in pain. Arrggh, why doesn't it stop!

That's the nature of sport. Crap happens. However, the good thing about all of these constant injuries happening in your presence is that you can do something about them immediately! I'm talking within five minutes of them occurring. Do I get that convenience in the clinic? Not at all.

When an acute injury occurs, there is the traditional, tried-and-true protocol of RICE: rest, ice, compression, and elevation. You can minimize the secondary tissue damage by minimizing excessive swelling, ensure that a player isn't going to hurt themselves more by discontinuing activity, and get them on early rehab exercises as early as the next day. Range of motion, proprioceptive training, and strengthening in those first few days does amazing things for recovery by making sure that damaged tissue heals and reorganizes itself in the proper patterns and line of pull immediately.

When it comes to clients who book in at the clinic, it's once in a blue moon that someone books in for an injury that was sustained just the day before. More often than not, these people have been in pain for months - if not years or decades. Their injured tissue has healed in haphazard directions, they've developed poor motor habits around their conditions, and muscles have become strong, weak, tight, and loose in compensation. It's not longer a matter of simply getting the injured joint moving; now we have to pick apart months and years of improper motor training. A sprained ankle four years ago can cause a limp, resulting in a hip weakness on the opposite side, compounding into knee and back pain and so on.

That toe sprain has completely mangled your neck.

Never Easy, But Always Fun

As you can see, both the field and clinic worlds have their challenges that contrast but don't trump one another. You can't call either job easier. However, I love both sides of my professional life. The slow, controlled pace of the clinic as well as the exciting, non-stop action of being on the field. A healthy balance keeps things interesting, and my job is definitely a lot of that!

How Do Pain and Spasm Work?

I had a client this week ask me why the body seizes up so violently when it experiences injury, even when the muscles that are seizing up weren't the ones that were damaged. You've sprained a ligament at your AC joint, so why has your entire upper back and neck become so tight and restricted?

As I've mentioned before, the body has this fantastic mechanism when it comes to protecting its joints. Normally, when it detects instability around a joint, the brain signals the muscles to tighten and tone in order to guard the joint from harm. However, when the instability is severe or when the body experiences an acute, traumatic injury, this tension becomes spasm.

Spasm is an involuntary muscle contraction and is how we define this "seizing up" of muscles when we experience injury. The body is desperately trying to do whatever it can to maintain the integrity of the joints by minimizing any further harm. Unfortunately, this spasm is very often even more debilitating than the injured structure itself. Why is that?

The Pain-Spasm Cycle

What happens is this delightful process known as the pain-spasm cycle. First, your body experiences pain. As we know, the body now tightens and spasms up in response. However, this tension has made the pain even worse. As a result of the increased pain, the body throws in even more spasm, and the cycle continues.

This is essentially the physiology of any injury and the reason why it's so hard to find relief. This cycle can be an extremely debilitating process and is tough to break. But it CAN be broken, and that's where I come in to do my job.

Breaking the Cycle

How do you break a cycle? Well, you remove one of its pit stops, of course. Through whatever means are used, if you can reduce either the pain or the spasm, its counterpart, by principle, will become alleviated as well. This is the purpose of modalities that therapists use. Massage and needling, for instance, help to relieve muscle tension and decrease the amount of pain that a client has. On the flip side, electrical stimulation machines are also used solely to block the pain signals from the tissue to the brain, causing the brain to allow the muscle to relax and cease its spasm.

However, these modalities are often not enough. Even IF the symptoms can be completely alleviated through a treatment (spoiler: most often, they're not), the symptoms can easily return. The way that I explain to my clients is this: Regardless of muscle tension and pain, there is going to be some degree of dysfunction or joint instability remaining from the injury. By not correcting these issues or by leaving behind even a small amount of pain and spasm still, the symptoms are likely to return full-force.

And how do you correct that? Movement. Athletic Therapists recognize that treating the tissue ourselves is only half the battle and that the rest of the work is up to yourself to stop the problem from coming back. Strengthen the muscles around the joint. Create stability. Rebuild the trust between the brain and the muscles that movement can be done safely and pain-free. This is only way to truly correct a dysfunction and prevent this painful boomerang effect.

The most useful medical tools.

These principles are well-known to most medical practitioners, but it seems that it's often missed by the public. By offering this understanding on how exactly pain and spasm work and how to correct them, hopefully it will prove to be a valuable resource to motivate people as they move through their recovery process and back to health.

Case Study: Why Not To Over-Mobilize

I've got a case study for you, and it's a great example of why we need to be careful to not take mobility principles out of context. (Look at me, kicking that horse again. Get used to it.)

The Client

In this instance, I had an adult recreational hockey player in to see me for treatment. He had a history of shoulder injuries, some shoulder pain, and ongoing neck tension and headaches following his weekly hockey game. He exercises regularly, but doesn't often workout his upper body at the gym due to his lifestyle demands not requiring it.

In short, my plan of attack was to do some moderate soft-tissue release through his traps and neck, give him some self-mobility exercises to do before hockey, and some stabilization movements to strengthen his scapular and deep neck muscles. From the rehab side of the world, basic basic.

We tried this approach for two sessions in a row, a week apart. In both cases, my client felt great all week.

Oh wait, except for the two days after his weekly hockey games. Then the pain was like none other.

What Went Wrong?

I'll tell you what went wrong. My client was very responsive to the stabilization exercises and could feel himself standing taller and his shoulder sitting back much better all the way through. However, by increasing his shoulder and thoracic mobility (both through the treatment and through his home exercises), we inadvertently created instability that his muscles weren't yet ready to fully compensate for. 

He described the pain after the second hockey game as "piercing straight from the back to the front" of his thorax. Essentially, after we freed up his joints and increased the movement happening through his thoracic spine and ribs, we created a need for the muscles in the area to work harder to maintain stability, Unfortunately, the strength and endurance in those muscles weren't yet there, and pain resulted for the days after the demand was placed upon them.

So after puzzling this one out, our third session was spent exclusively on strengthening exercises. We purposely avoided doing any hands-on soft-tissue release or joint mobilizations (aside from his self-mobility drills) to try and create a better foundation for stability first. After that treatment, he went to his hockey game and reported, finally, a relief in pain in the days following.

The Takeaway

This is a great reminder to be cautious with the amount of mobility and soft-tissue release that we're providing to our clients (whether you're an Athletic Therapist, a chiropractor, or personal trainer) or even to yourself. Rapidly releasing muscles and freeing up joints does not automatically translate to good health. It must be balanced with proper strengthening to allow the muscle to compensate for the increase joint movement, and those muscles will continue to need further conditioning in order to endure any extended workload demands. Even the best of us will still overshoot when it comes to these principles, but all's good as long as we can take care to reevaluate and not try to maximize range of motion in too short of time.

Looking at Smoking's Effect on Pain

I have a client who is troubled by nerve pain stemming from her neck. We're making some good progress with her rehab, but this week, I called her out on one of her bad habits: smoking.

What does smoking have to do with her neck, though? Well, I'm an educated professional, so I took the time to research and find out.

Nicotine and Pain Research

As I found, research to do with nicotine and pain hasn't been extensive, probably due to "SMOKING CAUSES CANCER" being just about all we realistically should ever need to know about the stuff. 

Regardless, there were many small studies that I could find that examined the relationship on nicotine and pain. Unfortunately, many of them conflict with each other and can't seem to come to a consensus. However, there were a couple conclusions to draw.

Don't People Say Smoking Dulls Their Pain?

It's true that, often, people turn to their cigarettes to deal with pain - both mental and physical. It's true that some studies have found nicotine to bind to certain receptors that potentiate pain and help to block pain signals. However, this effect, from what I can find, is not long-lasting. Also, most of the research done on this subject has used habitual smokers as their tests subjects, meaning that these individuals were already addicted to nicotine in the first place. So that raises the question: Could there be an effect of nicotine on pain outside of the window where this initial pain-relief effect occurs? It's quite possible that pain may have been potentiated in the first place by withdrawal symptoms. Also, it's been suggested that an increased pain tolerance in smokers may actually be due to detrimental damage to nerves, rather than simply being harmless signal blocking.

Nerve Pain

Studies about smoking and neurogenic pain (such as sciatica or whiplash pain), on the other hand, has shown some more definitive conclusions. 

The first study I found wasn't completely reliable, as it only used two individuals as subjects, but it was interesting that both subjects rated their pain to be significantly higher directly while they were smoking. Patients with fibromyalgia and diabetic neuropathy also reported an exacerbation of symptoms when smoking than when not. Finally, one very appealing experiment looked up close at the sensitivity of nerves, using rats as the subject. This one found strong evidence that nicotine very much increased the hypersensitivity of nerves that have undergone injury or irritation, meaning that if a preexisting nerve condition exists, the pain would definitely be more severe.

Conclusion

It's still not easy to say exactly what the effects of smoking on pain are. Like I said, there's strong evidence that pain tolerance in habitual smokers increases when they get their fix, but the mechanism of how it works may be due to some rather unhealthy effects. However, the research definitely seems to agree more when it comes to nerve pain, with nicotine found to increase pain and other symptoms of neurological disease.

To conclude, smoking is bad for you. Go tell everyone.

Stop Snapping Your Gym's Bands From Trying To Stretch Your Shoulders

I was working at the gym tonight, doing my last-minute tidy, and, as is usual these days, had to untie all of our bands from their apparent homes attached to squat racks and cable machines. Not that there are very many of them left. We seem to be going through a lot of them in the past year or so. Do you know why?

"Mobility!"

One of the most seemingly trendy exercises to do these days is to use resistance bands to stretch and mobilize. Unfortunately, (or fortunately, for fitness equipment manufacturers), this means a decreased shelf-life for all the bands in your gym due to consistently being stretched to their maximum elastic length.

But, I'm an open-minded person. Maybe there's some merit to stretching with bands as opposed to other things. Absolutely, I've found some use with joint glides using bands (in the therapeutic setting), but for stretching itself, this is different. After my gym shift, I popped into my clinic to experiment in private.

The Verdict

Ok, mobility peeps. You may not be happy, but, as I concluded, the line of pull for stretching your lats and rhomboids using a band:

...was functionally no different than this:

Gasp!

In fact, using the pillar (or doorway, squat rack, pole, or anything else), actually gave me a better stretch. If you're wondering why, it's because the pillar doesn't stretch as well...like the band does. There's a reason everyone has to take their resistance bands to their end ranges - because that's the point where the band stops stretching. Doesn't it make sense to use something that just won't stretch in the first place for the assistance?

But Wait!

Well, maybe the gentle stretch of using the band is better, because those gentle pulses into the stretch help the muscle relax more.

Except no. Muscle spindles don't work like that. In order for the nerves in your muscles to allow the muscle to relax in a lengthened position, they must be overridden with consistent lengthening, not intermittent.

What About Training Overhead Range Of Motion?

Ok, I'll concede a bit here. Bands could be used to pulse through shoulder flexion and increase range of motion for overhead work. However, I'm still not a fan. With the band remaining uncontrolled in the lateral plane (moving side-to-side), you're essentially tractioning your shoulders at random angles, which could work out fine, or it could aggravate that old shoulder injury from football ten years ago.

Instead, here's my favourite exercise for shoulder flexion (and t-spine extension) done safely and controlled, via Eric Cressey.

Have I Missed Something?

Again, I'm open-minded. After experimenting, I went home and ran some Google searches on band stretching and mobilization to see if there was just something I was missing or doing wrong. Unfortunately, I couldn't find any source that cited the physiological benefit of bands over stable structures for assisted stretching. The best support for it was Kelly Starrett's videos, but even he seems to prefer the method, to my understanding, for the versatility of stretching different ranges rather than for a "better" stretch itself.

Yet, I do still invite the enthusiasts out there to challenge me on why we should be using these methods (besides just looking cool), and I'll absolutely listen. To this point, however, I remain unconvinced.

Making the Case for Mid-Season Rehab

"I'll just power through the rest of the year and get healthy again during the off-season."

I'm good, Coach! There are three whole ligament fibers still in there!

If you've worked with sports in any capacity with athletes over the age of 18, you've encountered this attitude time and time again. Or maybe you're one of these athletes yourself. You got hurt in the first game but feel well enough to continuing playing the week after with only a bit of pain, so you tape yourself up and consign to go and get rehab after the season is over.

This attitude isn't restricted to the traditional multi-game season either. Maybe you're a runner, body builder, or gymnast with that one, big competition coming up in a month. You're training hard and rigorously; there's no time to for stupid little rehab exercises.

In reality, there's actually a big problem with athletes who won't seek treatment in the midst of their sport season. I understand their thought process - in that they either don't have time or don't want rehab to interfere with their training progress or practice - but I far from agree with it. Just because you have someone to tape your ankle, get your back cracked or massaged once a week, or started wearing a back brace doesn't mean it's ok to neglect the actual rehabilitation and retraining of your injured joints.

So what are the reasons to not wait until the season is over to get better?

You're Going to Get More Injured

This one is an obvious one. Regardless of the fact that you have tape or a brace to support the area that you hurt, the structure that was injured is, by nature, now prone to further injury. Even if the tape is good enough to protect your ankle during the game (pro-tip: there's a likely chance it's not!) what about after the game when you return to work or your family? The chances of you reinjuring something, whether during sport, work, or life, are always multiplied after every injury and even moreso after each reoccurence. With that being said, why risk it if there is something to be done?

You're Developing Bad Motor Patterns

So you finally did make it to through those few more months and to your physique show, despite straining your back earlier. It was thanks to that back brace you had at work and that you wore your weight-lifting belt during even the lighter days at the gym. Now that it's all over, now is a good time to hit the clinic.

Except, now that you've waited so long, you've increased your timeline of recovery due to developing poor motor habits by compensating all this time. Whether it's having that back brace that eventually made your core weaker, that limp that mangled your hip strength, or the fact that you just straight-up stopped reaching over head with that arm to protect your shoulder, the adaptations that your body has made around the injury have only become more and more ingrained the longer you put your rehab off. What once may have been a simple couple weeks of rehab for the ankle sprain is now two months of recovery because your hip weakness has now started causing both back and knee pain.

Look at this photo and try to tell me it's ok to walk around like this.

Rehab Will Improve Performance, Not Interfere

This last one is, again, a seemingly-obvious one, but it still doesn't seem to resonate with people who have a less-than-paralyzing affliction. Honestly, I think it may stem from the belief that there's no point in rehabing something that's just going to get more hurt again the next day, but that's an awful way to think.

Anyhow, I digress; you're performance at your sport isn't exactly going to improve amidst an injury, and it's definitely not going to suffer because you added some daily rehab exercises to your training plan. I'll revisit the whole "power through it" mentality, and while that's an admirable philosophy, it's important to remember that every additional ache or pain is going to affect your performance to some degree - whether it's the ankle sprain from three weeks ago meaning you can't run as fast, the back strain preventing you from lifting as heavy, or the shoulder instability resulting in you having less shots at the hoop before needing to come off and ice.

All in all, this isn't a groundbreaking train of thought. I'm pretty sure that all of us - athletes, coaches, parents - know that we're better off seeing help sooner than later, but we get stuck in this mentality of dealing with it later because there's more important stuff in the now. It's a mentality that we're much better off with phasing out, however, for the sake of both your health and your performance. Don't be a hero; be smart.

Is Self-Releasing Your Trigger Points Helpful?

The new cool thing to do in the gym is self-trigger point release. You may be doing this yourself already and, if not, you've definitely seen other people doing it. Before working out, you dig into your muscle using a lacrosse ball, tennis ball, or the like in order to find those points of tension and release them before lifting. There are countless videos on Youtube on how to do this, so that won't be the topic of conversation. In fact, let's talk about why it's probably unnecessary to be releasing your trigger points in the first place.

Firstly, there are two types trigger points that you need to be aware of. The first one is active trigger points. These are the ones that you know you have. They cause the stiffness of the muscle, decreased range of motion, and stabbing, referred pain when you try to stretch or contract the muscle. Often, you will even be able to observe the visible muscle twitch that comes with one of these.

Latent trigger points, on the other hand, exhibit all of these same symptoms, but only with manual pressure is applied to them. This means that, unless you start poking around in the muscle, you're unlikely to ever know you have one in the first place.

Now, this will relate back to when I wrote my scathing article about mobility, as the same principles apply. I talk a lot about "protective tension" of muscles. When a joint isn't completely stable by means of muscular strength, the body will make muscles around the area stiffen up and increase in tension in order to guard the joint from injury, effectively creating the stability that was previously lacking. Trigger points are one example of this stiffness, with the painful, active trigger points typically resulting from more acute injuries or mechanisms that shock the body into needing to guard against injury; latent trigger points, on the other hand, usually sneak up on you due to more of a chronic instability.

I guarantee that you have more trigger points than you realize.

Now, about releasing trigger points. If you have an active one that's causing you pain, decreasing your range of motion, and making daily activity too painful, then absolutely, it's time to do something about it. Whether you self-release it yourself using a lacrosse ball or see an Athletic Therapist of Chiropractor to have it taken care of for you, there's no good reason to not address these.

On the other hand, releasing latent trigger points that weren't previously causing you pain is a different story and is where we can run into trouble. Remember what I said about protective tension? Well, if you have a latent trigger point that's not causing pain or impeding activity, chances are that it's a point that's creating that protective stiffness in a completely functional way. In fact, it could be the only thing that's preventing you from experiencing pain or injury.

So indeed, these latent points are a sign of some degree of instability that we should be mindful of, and they could predispose to later injury for sure. With that in mind, gradual releasing of these points coupled with targeted stabilization training is definitely a healthy practice. However, if you think about the logic of protective tension, consider what may happen if you start releasing too many of these asymptomatic spots of tension too quickly. At best, you won't get much for results at all. If the muscle already more or less had full range and strength, releasing those points might not change anything. At worst however, there could be some less desirable results.

Firstly, what could happen is an acute injury that results from a lack of protective stability. For instance, if you release the upper traps and completely relax them before you do your workout at the gym, you may accidentally injure a ligament while lifting by exceeding your range of motion when, normally, the trap muscle would have been stiff enough to prevent that damaging movement.

So you release the tension and are extra careful during your workout instead. That resolves the issue, right? Well, no. Remember, the body desires stability and knows when it's lacking. If you take away one of the foundations that the body has to create that stability, it will react with more tension in order to make up for it. What this means is that after a day of having that muscle loose and relaxed after digging in with the massage ball, the muscle may bounce back with even more tension than before, with even the possibility of active trigger points developing. And now we come full circle in a chronic loop where we're stuck needing to do those releases before every workout, as now we've created a pain-spasm cycle in our body.

So, should you never touch those trigger points on your own? Mmm..it depends. As I said, if you have painful, active trigger points, then by all means, you should get those taken care of. (And address the issue of why you had it in the first place.) If you have numerous latent ones that don't cause pain or dysfunction, I'll be realistic and say that it's probably fine to leave them be. It's fine if you do work them out once in a while (Hell, getting a massage feels great!), or to release them in conjunction with proper stability exercises for the purpose of properly stabilizing the joint with your own strength, but there's no reason why you should get yourself stuck chronically releasing them before every workout. (Hey, where have I heard that before?) Moral? If you're going to do something, do it carefully and progressively, not blindly and aggressive.

Why Resting Hurts

"I went to the doctor about my sprained ankle and he told me stop exercising completely for three weeks."

Sound familiar? Advice like this is all too common. After experiencing an injury, the immediate inclination - whether it be your own or at the doctor's advice - is to keep the injured limb completely immobilised and rested to allow it to recover. Unfortunately, this pro-tip from your medical professional is less "pro" and more "I'm not sure what your limit should be, so let's just play it safe." In fact, immobilization (complete rest) of a joint has been shown numerous times to result in a slower recovery from injury.

I stubbed my toe!

But when you sustain an injury, moving hurts? How can restricting movement be bad for you?

1) Scar Tissue

When you cut your skin well enough, you'll see a scar form. This is a normal healing response. However, if you've noticed, that scar does not quite act like regular skin. It's quite stiff and less stretchy. Well, the exact same thing occurs in muscle, tendon, and ligament tissue when they get damaged.

So, when we get a good injury, the damaged is eventually bridged by this scar tissue. This is good, because we've now bridged the gap. It can be bad, however, because scar tissue does not form neatly. While the fibers of muscles and ligaments are nicely arranged and run in the same direction scar tissue forms haphazardly and without organization.

======= - Muscle, tendons, and ligaments

######## - Scar tissue

This messy arrangement of fibers results in decreased pliability of the tissue, lower tensile strength (damage resistance against stretch) and increases the risk of reinjury.

The counter to this is, of course, movement. By putting the injured area through early range of motion, we're promoting these fibers to arrange themselves along the fibers of the muscle as their growth follows the lines of stress.

2) Muscle Tone

This is an easier one for people to get their heads around. If you don't use it, you lose it!

Muscle tone and strength begins to decrease within the first week of immobilization, meaning that if you completely avoid moving your ankle and walking for those three weeks post-sprain, your muscular strength will suffer.

Pictured: A more extreme - but not rare - example.

And we're not talking only the muscles immediately surrounding the area. Joints way above or below the area that you've hurt can also take a beating in the recovery stage if not managed properly. It's all too common for young athletes to allow their hip muscles to become weak from favouring one leg, resulting in knee and back problems years later. (It sounds like a tangent to link an ankle sprain to low-back pain years later, but we clinicians see this constantly!)

3) Blood Supply

Angiogenesis is the formation of new blood vessels. During injury, your blood vessels undergo understandable damage your body is going to need to develop new vessels to continue supplying that area with nutrients.

What promotes this formation? You guessed it: movement! Not only will muscle contraction cause more blood to pump to the area in the first place, but it will also help your body to create new capillary beds within the tissue to help that supply reach its destination. In contrast, you can imagine that removing this equation through complete rest is going to deprive the affected area of the blood - and nutrients - that it needs, resulting in longer periods before fully healing.

Putting It To Practice

So, am I recommending that you should hit the gym and do heavy, 1RM squats the day after tearing your quad muscle in soccer? Yeah, no. It's absolutely important that we decrease the volume of load at an injury site during the acute phase and gradually return it back up as recovery proceeds. However, early movement is always going to be one component to maximize the speed of the recovery.

What I'll typically  recommend is range of motion exercises after the first 24-48 hours without any resistance, such as ankle-ABCs or air-curls with the arm. If someone can't completely weight-bear on their leg, then I give them a crutch or cane to allow them to do so at least partially, creating at least partial activation of the regular muscles. From here, we just progressively add on to their range of movement, the resistance, and complexity of the movement until they reach their full recovery.

So just remember this. Whatever your injury, there is something to be done about it pretty much immediately. Don't go rushing to quit the soccer team or cancelling your gym membership, because much of the recovery phase is going to be spent doing your regular activities; just to a lesser volume.

Those three weeks of rest all are well and good, so long as you don't mind them tacking on an extra three to get back to 100%.

Subscribe to the Weekly Updates

Do you like the content that you're reading? Sign up to receive the weekly blog update from Cain Exercise Rehab directly to your email!

Click Here!