Tuesday, 25 April 2017

Can't Get A Leg Up?

I was at a rock climbing competition on the weekend. (Competing in a sport rather than running a treatment table, for once!) I actually ended up having the same discussion with a few people that night regarding their difficulty with being able to reach their legs up high in order to complete some technical climbing routes. (High knees are important, if you were unsure.)

This isn't just a problem for climbers. An inability to attain optimal hip flexion will affect your stride as a sprinter, your routine as a gymnast or diver, your ability to get a high box jump in CrossFit, and more!
Little do people often realize, however, that this lack of hip flexion isn't exactly a result of the hamstrings simply being short and tight. If it was really a mechanical restriction from the hamstrings preventing you from getting your leg up, then you wouldn't be able to pull your knee to your chest or drop into a squat either.

Like a wrote about before, this inability to flex the hip without assistance is usually due to protective guarding of the hamstrings, as opposed to shortening. This is something that usually results from a lack of hip stability and glute activation, from my experience.
A typical trend in a lot of active people is the dominance of their hamstrings over their glutes, meaning that when they extend their hip back, the hamstring is initiating the movement when it should be the larger, stronger glute max doing so. Now combine this with the instability of the lateral rotators that we see so often (glute med, glute min, piriformis). The hamstrings end up being, shall we say, neurally primed more than they should because the nervous system can sense that the glutes aren't keeping the hip as stable as it wants themselves. This means that when we're trying to do a high knee raise, the hamstrings refuse to relax and and up contracting against the motion.

So if static stretching and lengthening of the hamstrings isn't going to work, what is the fix? Well, activation of the glutes and training to hamstrings to relax under tension is a good start. Enjoy!

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Wednesday, 19 April 2017

Is Your Core Strong Enough For Your Squat?

A friend called me on Easter Sunday with a bit of an urgent need. He's a good friend, so I came into the office for the holiday. The issue? He threw out his back squatting.

This individual is a very strong, powerful weightlifter, but this wasn't the first occurrence of this type of injury. I had to give him a bit of a hard time, however, as I knew he hasn't been keeping his core conditioned for the heavy lifts he does. Unfortunately, he's far from being alone in this situation.

As I so commonly drone on about like a broken record, core strength is essential for activities of daily living and for keeping the spine healthy during weightlifting and sport. Truly enough, though, with careful attention to form, exercises such as squatting without a strong core is still possible. Especially with back squatting, with the bar sitting at the back of the body to focus the weight through the hips to make it easier to engage the more powerful lower-chain muscles, people tend to neglect the need for trunk stability. What's more, with the arms out to the side with the back squat, we are able to achieve activation of the lats which assist with spinal stability through their connection to the thoracolumbar fascia (which essentially covers the entirety of the lumbar spine).

However, switching to the front squat, with the weight lying to the front of the body and the forces threatening to deform the spine a bit more - and with the lat engagement removed - any deficit in core strength quickly becomes apparent. Back or front, though, injury risk is still prevalent without a well-conditioned core complex.

You see, the final muscle group that's around to try to pick up the slack is the spinal erectors. They're very quick to strain or spasm as soon as they're left alone to bear the weight of a barbell, and most back injuries during squatting occur during those instances that the other muscular systems fail and the erectors are forced to overcontract to try and guard. 

Unfortunately, the going trend is for many gym rats to simply rely on the use of weightliftings belt in order to substitute for core instability and protect their back. This is fine (and probably in best interest) during maximal loads, but becoming dependent on this crutch for submax lifting is doing you no favours unless your intent is to resort to wearing your belt home, to work, and during every other aspect of life as well.

When it came to my client, once we mobilized his (several) joint fixations and settled down the acute spasm, the next step was to emphasize the importance of core stability in neutral hip and spine positions. Once he's ready to return to lifting, I had to recommend he keep his squatting firmly in the submax range while he works on improving his core strength. Until his trunk stability is up to par, there's simply just no point in attempting to increase the weight that the legs can push, less he begin to push weight that threatens to reinjure him again. Essentially, his legs are under maintenance instructions while the core catches up to the game.

Don't let things lead to injury. Do some planks. Do some deadbugs. Don't rely on the weightlifting belt to protect your back because you probably won't be wearing it when you go to pick up your kid.

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Tuesday, 11 April 2017

Positivity in the Clinic Space

There's a definite difference in the progress my clients will make depending on the emotional spin that I put on their conditions. Picture that you're in the therapy clinic having your injury assessed. Which of the following sounds better to you?

" You have a pretty major problem going on right now that needs to be addressed."


"There's definitely some work that needs to be put in here, but your outcome looks good."

Or: "Sorry, we're gonna need to cut it off."

Both are fairly common kinds of attitudes that clinicians - whether it's an Athletic Therapist, chiropractor, or physiotherapist - take towards their clients. There's a difference, however. The first instills more fear and dependence on the practitioner; the second generates more optimism and empowerment toward a positive outcome.

This sort of topic traces back to my previous post about honesty and transparency when working as a clinician. As healthcare practitioners, there is a responsibility on our part to deliver information to clients in a way that is going to encourage them to progress in their treatment rather than instill fear and avoidance habits of their conditions.

We've all seen this tactic used distastefully, in that a practitioner will use fear-mongering language in order to create a sense of dependence for the client to constantly keep coming back, which is poor ethical practice indeed. However, it's incredibly easy for well-meaning professionals to unintentionally do the same as well. Fairly enough, someone's back injury might really be a major problem. It's just important to remember that the message that we send, though, dictates the client's belief and self-efficacy when it comes to being able to recover from those injuries.

At the end of the day, it's an easy concept to understand. For instance, with one client of mine who has chronic stress and anxiety that causes her to be unmotivated to do her rehab exercises, my instructions to her this: Do not think, "I have to do the exercises, but I'm not feeling well enough," but rather, "I'm not feeling well, but the exercises will make me feel better."

Psychology 101: Positive reinforcement.

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Tuesday, 4 April 2017

Running Posts That You Should Read

It's spring running season! Track and field leagues are getting off the ground, recreational runners are back on the trails, and city 10K's and marathons will soon be hitting the streets.

To mark this time of year, I'm taking this week to compile together my posts to date on running training and health. If you're gearing up for training, competition, or just beginning to run again for your health, take your time with these reads.

And pull off the 'photogenic runner' like a boss!

5 Weight Training Tips for the Distance Runner

School cross country team? Running your first 10K at the end of the month? Here's a few training tips to optimize your prep time and avoid injury from the pavement-pounding.

6 Weight Training Tips for Sprinters

Is sprinting on the track more your forte? There's a lot of crossover between the training for long and short distances, but there are definitely some key differences to consider in order to maximize your performance.

Core Stability and Hip Hyperextension

Lower back pain is a common issue among runners of all ages and sizes. This is partially due to a neglect of core stability through one specific range of motion.

Your Tight Hip Flexors and You

Tight hip flexors are another common ailment of the runner, as well as a variety of other athletes. Stretching may not be the thing to help you, however.

The Shin Splints Troubleshooter

The all-dreaded shin-splints. Here's a general troubleshooter to help you find some relief and get back to the trails.

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