Tuesday, 22 November 2016

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.


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.

Tuesday, 15 November 2016

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.

Tuesday, 8 November 2016

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?




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.)

Wednesday, 2 November 2016

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.