Monday, 18 December 2017

Removing Pain - An Example Of Pain Expectation

I had an awesome experience regarding pain psychology and coaching this week. I've already written before about how pain can be amplified purely due to expectations of pain, but it's always great to have some real-world examples rather than only scientific studies.


I had a chronic-pain client come and see me in the past week after a particularly-stressful time period. As a result, her pain sensitivity through her neck and upper traps was through the roof, and she recoiled from only very light pressure from my hands.

Knowing that it wouldn't be productive to simply try and force my way into her muscle tissue and use physical means to get my client to relax, I instead did some education on pain.

I used this great example from Dr. Jarod Hall, on Facebook where he talked about how he experienced a splinter poking him in the back in a sauna. However, due to being in the hot sauna, his nervous system interpreted the "poke" sensation as "burning" due to the expectation of what kind of a sauna would typically cause. Yep, the body can be that easy to trick!


With that being said, I was able to use that experience to teach my client on how it's unnecessary to expect pain, especially when the oncoming stimulus isn't an appropriate one. By coaching her through self-talk to convince her that the pressure from my hands, while perhaps not being the most comfortable, wouldn't cause her any physical harm or damage, her pain sensitivity decreased dramatically. And just like that, without any other physical intervention, I was immediately able to apply more pressure to those sensitized area than ever before!

Remember, pain isn't all in your head! But the head sure can affect things!

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Tuesday, 12 December 2017

Sleep and Pain

In the big picture, Canadians don't seem to do too bad in terms of sleep. Two thirds of adult Canadians are getting the recommended 7-9 hours of sleep. A third is still a very large number, though, and overall sleep quality may still be an issue. We all know the typical effects of sleep deprivation; the decreased mental function, the irritability, the mood swings. However, can sleep affect pain as well?

If I just never wake up, I'll never feel the pain.

The short answer is yes. It's been well-documented that poor sleep and increased pain have a strong correlation. Testing responses to specific stimuli before and after sleep deprivation in subjects has definitely shown an increased output of pain to all types of different pain sources. Heat, cold, pinprick, deep pressure, and other types of provocations all show these results.

However, when looking at sleep deprivation and the cascade of other symptoms it provides, it brings up another questions. Could these related conditions be the true cause for pain sensitivity? Indeed, some studies are finding that sleep disturbances are do have a more indirect link to pain, suggesting that increased pain perception is more-related to those depressive symptoms and how much attention to pain that these individuals may have.

So, perhaps we're looking at is a type of central nervous system fatigue. As I've discussed before, both physical and mental illnesses can propagate these chemical changes in the brain and contribute to pain.

No matter the cause, it's clear that poor sleep and pain ARE related, and unfortunately, this relationship is cyclical. Poor sleep heightens pain levels, and it doesn't take much thought to understand that chronic pain results in even more sleep disturbances.



Treating this, obviously, is a complex thing, and could very well require a comprehensive medical team, rather than one therapist, including sleep specialists, psychologists, and more. On my own, as an Athletic Therapist, what I can do is try to begin breaking that pain-sleep cycle, just like the pain-spasm cycle, and provide a bit of relief at a time in order to slowly improve sleep quality as the client and I go.

Sleep on that.

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Wednesday, 29 November 2017

Breaking Down the Buzzwords - 6 Blog Topics to Read

Buzzwords are every media-mogul's bread and butter. Need proof? Just look at how quickly everyone and their grandma eats up any news article with "Trump" in the headline.

Ok, enough about politics. I'm supposed to be writing about things that are healthy for you. (Ok, last one, I'm sorry!)

I came so close to posting a Trump meme as well, but I
stopped myself and went with a funny cat photo instead!
Your welcome.

Just like the nutrition and diet enterprises thrive off buzzwords such as "gluten", "cleanse", and "clean-eating", so does the healthcare and fitness realm have its own shortlist, at any given time, of words and phrases meant to strike a chord and turn the population into click-hungry internet trolls.

Pictured: A troll

Obviously, these trending topics make for easy game when it comes to looking for new blogging jumping points, so here's a collection of posts from the past couple years that break down each buzzword, both for better and for worse.

Fascia


"Myofascial release" is the new thing to do to get your body feeling great! Right? Well, it seems like many fitness enthusiasts are treating fascia like it's an evil entity that needs to be utterly destroyed. (Spoiler: It's not!)

Functional Training


Functional training is where "fitness is headed", by the sounds of it. Enough of isolated movements! Give me more squats on a BOSU! Let's stop and ask ourselves, though, where does "functional" begin and where does it end?

K-Tape


Ok, so maybe Kinesio tape isn't quite in the headlines the same way as it was for the couple years after London 2012. However, it still seemed worth it to revisit my own, quick, review on the application.

Mobility


The fitness industry seems to be preaching about proper joint mobility these days. Is there a benefit behind greater mobility? Is any amount too much? Is a conservative approach better? Lastly, what else, besides mobility, needs to be considered?

Posture


Forward heads and rounded shoulders are being demonized more and more in mainstream media. Is there really anything to be concerned about, though?

Trigger Points


Get that lacrosse ball and grind out those trigger points. Find that painful spot in your shoulder and press into it until it basically dies! Wait, is that right? Is every painful nodule a trigger point, or are our bodies more complicated than that?

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More Pain, More...Pain?

A lot of you reading this may subscribe to - and possibly live by - the "more pain, more gain" rule. The harder you workout and the more sore you get, the more strength and size you gain. The harder you run through the burn, the faster you become. Transferring this train of thought to the rehab realm: the harder you dig in there, the better you'll recover.

http://serre-humour.com/

Whether it's through traditional massage, Graston, cupping, active release, or some other form of modality, does a higher intensity of the treatment correspond to increased recovery? In other words, does a more painful session somehow equate to less pain once a client leaves? (Even if the client can "take it"?)

Well, let's consider the reasons why people may believe that "going harder" results in an increased benefit. For instance, when it comes to tight muscles, scar tissue, adhesions, and the like, the common believe is that these modalities are physically breaking down those restrictions. Unfortunately, as I've pointed out in the past, massage does not break down muscle or scar tissue. Rather, these treatments are providing a new sensation to the nervous system in order to allow the tissue to relax and release its tone in the region.



That being said, given that this effect is nervous system-driven, more or less pressure may sometimes be required. Pain tolerance, while not all in your head, can dictate how much of an effect you experience from treatment. With that in mind, however, it can mean that a highly-sensitive person can get the exact same result from a very light massage as a very highly pain-tolerant individual with a more aggressive session of active release.

With all of this being the case, I can't say that I'm very comfortable with trying to give anyone a "harder" session of soft-tissue work than they can take. Some discomfort is to be expected, of course, but if I'm causing excruciating pain, I don't see how that can result in the pain relief that I'm striving to achieve. In fact, the intensity of these treatments might actually work to increase pain-sensitivity, acting in the exact opposite direction of what the goal is!

Does this diminish the usefulness of therapists, however? Of course not. It's still my job to be able to gauge each individual's reaction to different sensations and deliver an effective treatment that remains within their tolerance. When it comes to modality application, just call me a Conservative.

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Tuesday, 21 November 2017

Stable Shoulders (At All Angles)

I've already spoken at length in the past of the importance of keeping your shoulder stabilizers healthy and methods of doing so. We're being neglectful if we think that simply working the delts, pecs, bi's and tri's are all that are needed. However, while you shouldn't simply isolate the large muscles, doing similar isolation of the smaller ones as well are typically not going to be enough to keep your shoulder optimally functional either.

A common training/maintenance error I see is, while many people are mindful when it comes to warming up and strengthening their stabilizers, there's a tendency to still remain in isolated ranges of motion. For instance, even if you're exercising your rotator cuff muscles on the daily, like so...


...is that properly teaching those muscles to be stable and functional in movements like this...


...or this?



Your shoulder doesn't remain in a lowered position with your elbow at your side, so why would you restrict your stability training to that one range? Individuals who need to recover from injury, train for performance, or even just maintain function for every day life need to be hitting their stability work from multiple angles from the shoulder being down at your side to being overhead.





The shoulder is a highly-mobile, multi-angle joint. If you have a range of motion available, make sure the musculature is conditioned to be supportive in each of those angles. You want to be able to keep using those things.



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Tuesday, 14 November 2017

Brain-Body Trust

Here's another scenario:

You're an avid weightlifter who hits the gym five times per week. You regularly do squats, deadlifts, and many others of those exercises that gym rats know and love.

Gains.
However, despite your ability to deadlift twice your bodyweight, one morning, you simply bend down to tie your shoe and you completely put out your back. You're in excruciating pain for the rest of the week which lingers to a lesser extent for the next month or so before you go and get it treated. All the while, you've been doing what you can at the gym but have been avoiding deadlifts and have been extra cautious when bending over to pick anything up on a daily basis in order to protect your back. Every time you try to bend down, you recreate that most-painful sensation and it needs to be avoided. Finally, you decide to go get treated. (Perhaps even by an Athletic Therapist!)

Promotionpromotionpromotion.
Treatment goes great. After one or two sessions, the constant pain is no longer a bother. You have your homework to condition and strengthen your core and protect your spine. You go on your way out of pain - except when it occurs the next time you go to deadlift again. Although your therapist told you that the tissue is all healed and the inflammation is gone, that bending motion, alone, still elicits tension and pain through your back as soon as you square up to lift heavy.

So here's the question: Even after receiving treatment and home exercises, after the tissue is healed and the inflammation is gone, once you've gotten strong enough that you core should be stabilizing your back without a problem, this one movement still causes you pain. Why could that be?

Pain science is a fascinating field and I'm not about to go into the neurobiology and in-depth psychology of pain today. However, I will quote the Pain Science Podcast that I listen to in this.

"Pain is a conditioned response," and "Pain is an output, not an input".

If you know of the Pavlov experiment, this is like how he was able to trigger salivation in dogs every time he rung a bell. Essentially, all physiological responses, pain included, can be conditioned to occur whether the stimulus is appropriate or not. This is related to when I talked about pain avoidance habits and how they can propagate pain rather than prevent them. After such a prolonged period of time of an individual telling their nervous system that bending down is going to cause pain, the nervous system is now trained and hyper-reactive, sending out pain signals every time that movement is performed even after healing has occurred.

Not kidding. This picture is how pain can work.
This is actually a common occurrence. Clients who should be out of pain are still experiencing it due to their nervous systems, basically, working against them. In a way, although there is not actually anything wrong with those tissues anymore, the brain no longer trusts that particular movement pattern and will have a sympathetic response every time that it's attempted.

Stupid nervous system!
This case I'm discussing is, in reality, actually one of the more simple ones. In severe chronic pain cases, those inappropriate pain triggers can extend to nearly every movement and even light touch to the body!

In any of these cases, careful rehab considerations to both the physical and psychological side of the recovery are required. It's the responsibility of the therapist to guide the client through those movements - or other stimuli - very carefully to progressively allow the nervous system to adapt and trust the pattern again. At the same time, coaching a client away from expecting pain is important, otherwise it may leave a barrier that the individual might never overcome. 

Pain is a funny thing and pain patients are kind of like the Murphy's Law of healthcare: Expecting the worst can cause the worst to happen. However, responsible therapists can recognize these barriers; no person should be trapped by their pain.

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Tuesday, 7 November 2017

The Advantage Of Active Rehab

In the wake of hiked ICBC rates due to an uncontrollable flood of payouts as well as an audit into unethical professional fees to do with claims, it has been a thought of mine recently that there is something not quite working with an insurance system that should be easily covering its costs due to the nature of what it is.

Now, there are many directions to point the blame. One of the articles above discusses how much autobody shops are milking the insurance company with hiked rates, and I'm sure there are therapy clinics who aren't much better in terms of ethics. There's the increase in legal fees as well, due to ICBC's fight against offering higher and fairer initial settlements. We won't even get into the political discussion of what role certain provincial parties may have played in creating this mess.


Whatever the reason, I'm mostly concerned with solutions to the problem. One way that I can see it - one that would save much in terms of time and money on the side of both the insurance companies, the legal teams, and the clients - is the shift towards more active approaches to injury rehab.

I don't often feel the need to talk about the importance of exercise for recovery since, to myself, it's a no-brainer. However, I remind myself that the world we live in isn't necessarily one that's focused on exercise and movement the same way that an Athletic Therapist is. But I digress...

It's easy to find evidence for my case. Studies are easily comparing the difference between active rehab (which includes movement and exercise prescription) to passive rehab (which is treatment-centered only) and consistently shows an improvement in client-condition and function when you get people moving.



The implications of this are easy to figure out. With more control of recovery being given to clients - by way of prescribed home exercises - the result is more-optimal recovery through means of fewer appointments and thus, less money! 

So while saving ICBC from paying a few less $70 appointments isn't quite comparable to the thousands of dollars that car shops might be milking, if the trend catches on, it can make a difference. And obviously, this doesn't solely apply for motor vehicle injury claims; individuals paying out of pocket for their recovery would of course appreciate paying a little less.

The advantage is clear. Exercise rehabilitation is the way to go!

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Tuesday, 31 October 2017

I Don't Know It All

I admit it! I'm not perfect! While I wish I could know every minute detail about human anatomy and physiology to a "T" and call myself an expert on everything that is rehab, the reality is that this is not the case.

Don't worry, this isn't me going on a depressive rant and feeling sorry for myself. (That's what Valentines Day is for.) This is a productive admittance of the limitations that all medical professionals have but don't always like to verbalize.

We also don't always like to admit our Valentine woes, either.
The thing is, there is a LOT to know about the body, and as humans (Yes, therapists are humans! Gasp!) we can't perfectly log, file, and access that information without flaw like computers. Speaking for myself, I'm probably pausing every fifth or so new assessment that I do with clients in order to check a reference. (If you follow my social media, you've probably seen my textbook collection. And to tell you the truth, it's a very small collection compared to others out there.)

Yes, I need another bookshelf. Nerd problems.
Thankfully, I've been gifted with clients who are perfectly fine with me, as their clinician, taking a minute to check a reference. In their words, they're happy to know that I'm absolutely sure on what I'm doing rather than just trying to guess, and the anecdotal message I get is that they wish more medical professionals (doctors included!) would do the same more often.

Frankly, my opinion is that any clinician who claims to always be 100% sure without a fault and never needs to reopen a textbook probably, in fact, knows the least. (Or is just being irresponsibly stubborn.)

What's more, this piece of humble pie goes a bit further. What if that textbook doesn't give me the answer that I need? Well, it sometimes hurts to have to go to my client and say it, but ethically, I have no choice: "I am not entirely certain on what this is."

At least it tastes like cherry!
The saving grace here, again, is the trust that this level of honesty instills in my clients. Knowing that I'm not going to feed them false information, I'm often allowed the chance to have the client return to, at the very least, see if whatever treatment I performed worked. If it does, then we know that we're on the right track and can keep plucking away. If not, it's time for a referral.

To sum it up, no Athletic Therapist, chiropractor, nurse, or even doctor can have the answer 100% of the time. Perhaps some people there expect us to, but I feel like the majority of the population understands the raw amount of information out there. As long as we clinicians are honest with our limitations of knowledge, it seems like the public will accept that as a sign of integrity and be willing to work with us.

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Sunday, 15 October 2017

Happy World Spine Day

October 16 is World Spine Day! Today, organizations and people, worldwide, join together to raise awareness of spinal health and illness.



Listed below is a compilation of back health-related articles written both by myself as well as outside sources. They're all very informative and easy to read, so please take a look and empower yourself with some knowledge!

Cain Exercise Rehab Posts

One of my earliest posts outlining the basic functions of the core as an "anti-movement" system and the reason why the medical community is vigourously recommending against sit-ups.

It's common for weightlifters to fit their ab workout at the tail-end of the session following training another area. However, here's my reasoning on why it's beneficial - for the long-term and for the workout - to do a few sets of core exercises before the rest of the workout instead.

A short article (with video) on how to train your core to stabilize during the much-neglected range of hip-extension for when you walk or run.

Weight lifting belts are a crucial element for weightlifters who are pushing those heavy one-rep maxes or doing fatigue-sets. However, what happens when a person becomes over-reliant on the support?

Traction is an extremely popular alternative treatment for back pain, but here's a short discussion on whether or not there are sound benefits for the long term.

Planks are what the media is currently pumping out as the solution for spinal health and tight abs. However, this is more out of the simplicity of the exercise for the purpose of quick explanation. In reality, planks are only going to get you so far.

This may be one of the most important articles to read! If you have had imaging that revealed degeneration or other concerning problems in your back, click this link!

Source

External Sources

You've probably seen some variation of this headline in the past. However, rather than fear-mongering for likes, this writer dug up the research debunking the claims of "text neck".

Dr. Stuart McGill discusses many popular forms of back pain treatment and why they're likely ineffective - or even counterproductive! Don't worry, he also gives solutions to the problem.

An investigative journalist scours the research to come to her own conclusions on what is actually proven to be beneficial for the spine and what is not.

Spinal fusion is still commonly prescribed by doctors much too early in the process of finding a solution for back pain. More often than not, it only results in more problems down the road.

One more article from Stuart McGill as he debunks the most common back pain myths and offers helpful alternatives to address your pain and injuries.



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Tuesday, 10 October 2017

Let's Talk Mental Health

Yesterday was World Mental Health Day.


It's my job, as an Athletic Therapist, to take care of the physical side of health, but through that, I run into the overlapping cases of depression, anxiety, eating disorders, self-confidence issues, and more. Often, my clients trust me enough to open up to me, and hopefully we, as a society can continue to do so more and more.

Below is a quick compilation of mental health and psychology-related posts that I've written in relation to my Athletic Therapy work as well as sport and fitness in general.

I didn't write on the mental health aspect of addiction, but with addiction being a mental illness itself, I'm including this post to talk about the benefit of active rehab measures in order to avoid these negative outcomes.

A passionate article I wrote about the importance that I discovered when it comes to building confidence and ability in youth for the benefit of their mental health in future years.

I discuss the importance of careful language when treating clients. When reeling from the mental distress of an acute or chronic injury, it's vital to not cascade the issue with poor word choices.

Discussing some of the mental health changes that occur when it comes to chronic pain that may impede the recovery process.

Fatigue of the CNS can easily result in detrimental changes to the physical body. What's more, we are finding more and more than mental illness, among other things, can propagate this central fatigue, highlighting the importance of mental health for the sake of the physical.

Again, I talk on another factor that mental illness can affect. While pain tolerance can be affected by mental health, we cannot consider these effects to be all "in your head".


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Random Thought On Exercise Adherence

As an Athletic Therapist, I'm obviously always concerned with how to keep my clients adherent to their exercise plans in order to accelerate their recovery. It's not always easy, especially when that client's motivation was low enough that they barely made it to my office in the first place.

It's funny, though, some of the methods we employ to try and keep ourselves motivated. One common thing I've noticed that people attempt to do to keep themselves true to healthy habits is bargaining the use of passive habits in order to achieve them. Allow me to explain..

Once in a while, I see a client who floats the idea of adhering to their rehab plan by doing their exercises during "down-time" to make it easy, such as while watching television. Unfortunately, not a single client who has said this has been able to maintain their routine. Where is the disconnect here?

I'm too snuggly-wuggly comfy to exercise right now!

Well, it could simply be the fact that using those passive activities is only going to motivate our psychology toward more passive habits, rather than the other way around. When it comes to exercise in general, our brain is going to activate these exercise-related habits when it experiences related stimuli that normally goes along with them. (ie: When the "switch is flipped" when you walk into a gym or get up early for your run.) Since your brain is going to have trouble associating passive activities, such as television, with activity, the chances of developing those habits are slimmer.

As well, this is speculation, but perhaps trying to bargain passive methods in order to stay healthy is a sign of poor self-efficacy. Maybe someone who attempts to use these tricks, in reality, has poor confidence in the first place that they will adhere. And as we know, self-efficacy is vital when it comes to lifestyle changes and without that sense of control, success rates are low.


In short, the clients of mine that are the most successful are the ones who are intrinsically motivated enough to set aside time to, well, get'er'done!

Does this mean that a person is a lost cause if they're not one of these go-getters who's ready to go guns-out and balls-to-the-wall with their recovery, however? OF COURSE NOT!



This article was written based on topics collaborated on with of Sasha Tanoushka, owner of Verus Systems Therapy. Sasha is a member of the BC AMFT and AAMFT  ( American Association of Marriage n Family Therapists  ). She's completing her MA in Marriage And Family Therapy through Northcentral University. She's worked extensively with families and individuals over the years in both community sports, martial arts, kids' clubs and ladies' community groups.

She has a particular interest on neuropathy and works with several therapeutic modalities but has a particular leaning towards Satir, Bowen and Gestalt.

Follow her on Facebook!


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Tuesday, 3 October 2017

Pain Tolerance - It's Not All In Your Head

"When you asked me to rate the pain, what happens when someone just has really, really high or low pain-tolerance?"

This was a question posed to me by a new client, and a very understandable question at that. If a client has really low pain-tolerance, does that mean we need to ignore their pain level when treating them in order to make progress? If tolerance is high, are we doing more damage to them by pushing too hard without them being able to set proper limits? Again, if tolerance is low, is that person just being soft?

"I'm smiling. Are you smiling?"

The quick answers: No, pain tolerance is not all in your head. No, you're not a wimp. And no, we are not risking going too hard or too soft with treatment and exercise because you're tolerance is higher or lower than the average person. I digress...

What Affects Tolerance?

There are too many things that affect pain tolerance to try and go in depth to them all. There is a slew of cultural differences when it comes to perception of pain which can be affected by age, sex, or race alone!

Psychological factors also affect this tolerance. Again, I'm not saying that the perception is all in one's head. Rather, certain aspects of one's psychology, such as perception of controldepression or anxiety, and expectations of pain can all cause physiological changes within the nervous system and propagate pain sensitivity.

Finally, looking at a more at the peripheral sites of pain within the body, the reactions occurring at the nerve endings, during inflammation responses, and communications between the immune system and nerve cells all affect pain sensitivity and can become more or less reactive, depending on a person's condition. It's complicated. I spent an entire night trying to make sense of the biochemistry of it in order to summarize it in my blog and ultimately had to give up. I promise that the science is there, though!

Need-to-know!

The Affect on Treatment and Rehab

So with that being said, we circle back to the question about the effectiveness of rehab and treatment when pain sensitivity and tolerance are higher or lower. If pain is preventing us from massaging a muscle hard enough to make a change, where is the benefit? If a client is insisting to keep going harder when you're already, essentially, on top of them with all of your weight, are we not going to hurt them more?

Well, as I covered in the past, the system that these treatments target isn't the muscular one. When we massage, when we exercise, we're addressing the nervous system itself, and so we're doing the body a favour by working within those limits (or lack thereof) of sensitivity and pain tolerance.

To a limit. Please don't actually try to break
someone's back because they asked you to..

With that being said, if someone is highly-sensitive and can only tolerate very light touch, then those are the means that we'll stay in. By treating or exercising within that high level of sensitivity, the goal is to try to reverse some of those physiological changes contributing to it in order to, gradually, decrease the sensitivity and allow the client to eventually be able to accept more pressure.

On the flipside, if someone is highly-tolerable to pain, then yes, the treatment does become a bit tougher and more aggressive to try and meet their needs, but you don't have to worry about causing damage. Like I've noted before, the amount of force you would require to actually deform or damage tissue would be roughly the equivalent of a steamroller.

Don't try this at home.

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Tuesday, 26 September 2017

Foot Joints and Running Health

It's trail running season! Runners at the grade school, post-secondary, and recreational level are all out and gearing up for races. City marathons, cross country meets, and more will soon begin.

Many people assume that, to train for running, you simply need to run, but I've spoken at length on important weight-training tips for distance runners as well. After all, do you think that any other type of athlete - be they a wrestler, boxer, football player - only repeatedly performs their sport as training? No, I thought not.

Additional training, however, does not simply mean heavy lifts and explosive forces. The health of each joint of the lower limb needs to be considered in order to have longevity as a runner. There's an important balance of mobility and stability that must be maintained.

Take the foot. You've heard the importance of foot health for most of what you do in life, as it's obviously the first line of defence - so to speak - when it comes to impact forces as you walk and run. This doesn't necessarily mean it's as simple as wearing supportive shoes for good lower limb health, though.



The foot has 26 bones to it. That's a lot of joints! That being said, pliable mobility (allowing the joints to move, glide, and compress) is vital in allowing those joints to absorb shock and impact, as is strength of the muscles of the foot in order to prevent those forces from being too damaging to the tarsal joints.



Modern-day running - specifically, the footwear - has taught the Western world to bypass the majority of these impact-buffering joints by running heel-first. As a result, these forces are greater by the time they reach the knee, hips, and back than they would be if a forefoot strike was used, resulting in an increased injury risk.

However, with the birth of minimalist running, Western runners attempted to make a quick switch back to forefoot running in order to benefit their joint health and performance. This is all and good, but it needs to be remembered that the body takes time to condition itself to new mechanics and activities. After a lifetime of stiffer, highly-supportive footwear use, the joints of the foot are, conversely, going to be stiff and immobile as well. Furthermore, the muscular strength in the foot may be lacking due to years of disuse. As a result, while the foot may now be diverting much of the impact away from traveling up the chain in too-great amounts, the foot's own joints may not be durable enough to accept that force itself. This is why there was a spike in new and previously-uncommon running injuries as soon as minimalist running became popular.


The takeaway here is that, like the rest of the body that you train for performance, the feet must also be carefully conditioned for the uses you intend of it. Adequate mobility through the toes, forefoot, and midfoot as well as enough muscular stability are key if you want to prevent the high-impact of running from developing into pain. That being said, changes to running and training routine must also be gradual and progressive, just like a routine for training any other joint. You need some variability to shock the body into improving, but be kind with how quickly you introduce it.

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Tuesday, 19 September 2017

What Are Shin Splints?

If you haven't had them yourself, you've at least heard of them. Shin splints: the bane of existence for many runners. This delightful condition involves stabbing pain in the inner shin region, exacerbation from running and impact, and can often include radiating pain traveling through the entire calf muscle.



Medial tibial stress syndrome is a condition so common that it affects nearly 10% of all runners. However, surprisingly little is known about it. Often, people boil the pain down to muscle strains, tendinopathies, or stress fractures, but these internet diagnoses are inaccurate.

For the longest time, I, myself, considered MTSS to be something that it wasn't out of error. Among many professionals, it was thought to be periostitis of the tibia - inflammation of the top layer of the bone caused by traction from muscular tension. Unfortunately, upon a journal search for this article, this theory was quickly proven wrong.

As it turns out, science still hasn't completely agreed on the etiology of MTSS. There is one prevalent theory that just cropped up during the new century.

One pair of researchers was able to demonstrate a pathology to do with bone remodeling as related to shin splint pain. As you may know, bones are not a lifeless tissue. The body's cells are constantly breaking down bone and replacing it with new. Usually, this is done at a healthy, even rate, but in examples such as osteoporosis, the breakdown occurs more quickly than the regrowth, resulting in the frail-boned condition.



In the case of shin splints, the breakdown of bone tissue increases when the bone is subject to new and sustained mechanical stress, such as an unconditioned individual who suddenly starts to overdo the pavement running. This is done in order to remodel the matrix of the bone tissue and allow it to adapt to the new stressor, but in the interim of this remodeling being complete, the bone structure is unable to accommodate the stress. As a result, microdamage to the bone itself occurs.

It's like a highway that's in the middle of being converted into a traintrack, except the train has already started being run along the route during the construction. The structure is going to take a beating!

Yeah, something like that.

In terms of the recovery from shin splints, even though many practitioners may not have had the reasoning correct, many of the same rehab and exercise methods still stand. Weakness or excessive stiffness of the calf muscles still must be addressed in order to allow the muscle tissue to transmit forces properly, rather than directing them back into the bone. Hip muscle activation is still key to ensure the impact can further travel up the chain rather than remaining in the lower leg. Finally, gait and footwear should not be disregarded, due to improper loading through the foot and leg resulting in increased fatigue to structures that are needed to buffer impact forces.

So, just remember to be conservative when increasing your training volume, be mindful of your form, and change your shoes regularly. Keep all this in mind, and....


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Tuesday, 12 September 2017

Plantar Fasciitis (And The Nerves That Imitate It)

I thought that this would be a good post to make, as I've now encountered a handful of clients with this issue. Individuals have come to see me with complaints about plantar fasciitis that has been persistent to any amount of stretching or foot massage.



In these instances, my typical process was to assess the injury but have difficulty replicating their pain using any ranges of motion or muscle testing at the foot, ankle, or knee. Pain with pressure was common, however.

After attempting to treat the plantar fascia with no benefit, I had to flip switches and try something different. Having some experience with this before (and with the wonderful handiness of the internet) I zoned in on testing a couple nerves instead.


Most people assume that nerve pains follows the trend of always beginning centrally near the spine and extending down the length of the limb. However, it is only a trend, not a rule. If entrapment of the nerve occurs further than the spine or in several, less severe areas separately, then the symptoms can absolutely manifest at only the end of the limb, like in these "plantar fasciitis" cases.



Both the sciatic and the saphenous nerves have the potential to cause plantar pain that many people may think to be fascial. (Both can be dull, diffuse, or burning pain.) However, upon proper testing where we put the nerve itself on stretch, we were able to determine the root of the cause. Without fail, after treating these clients up at their hips or back instead, we were able to relieve the pain.



Just a good example that therapy and rehab isn't as easy as chasing the pain. Often, you have to go quite a ways up the chain in order to find the cause. In these cases, finding that cause can be a hard thing for clinicians to do, considering that protocol wouldn't normally involve having to rule out joints as high as the spine in cases of foot pain. However, therapist or client, it's important to keep in mind that the body works as whole.

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Tuesday, 5 September 2017

Rest and Wait?

This will be a familiar scenario. You or someone you know experiences an injury, whether it be acute or chronic, having onset gradually over a length of time. Because of the pain, you consign yourself to resting from all activity until the pain recedes. But will it?

The problem with prolonged rest for an injury, as I wrote a bit about before, is that it causes the body to adjust to inactivity. Sure, the tissue may heal, but it without being exposed to any of the types of stimuli that you wish to return to, the chances of it being able to perform those activities are decreased.

To put it into different terms, we know that the body specifically adapts to the demands we place upon it. If that demand is immobilization, then that's what the body adapts to during the entire healing process. If rest is all that you do in order to recover, you have a much higher chance at reinjury as soon as you try to return to activity since the tissue has become unconditioned for it.



What's more, if you do nothing but refrain from any exercise or activity, then it also increases your innate fear of that injury and the pain it causes. Fear-avoidance habits can be quite quick to develop and can cascade into a problematic cycle of further pain and dysfunction.

All in all, absolute rest is not the answer to pain. Graduated exercise is key to help the tissue to reattain its full function and capacity as well as helps to prevent the fear of pain from inhibiting movement and delaying recovery. The sooner you can commence an active recovery/rehab program, the better. Exercise is the best medicine.

That and laughter.


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