Tuesday, 30 May 2017

The System Treatments Target (Isn't The Muscular One)

Have you ever had to tenderize beef? It can take a good amount of work to actually get it to soften enough the way you want it. And this is dead meat. It has no bloodflow, muscle tone, outer wrapping (skin) or reflexes to resist the deformity.

That being said, how can we expect to be creating actual mechanical changes to our own muscular tissue using only a foam roller or our hands?  Look at this picture of a cadaver and see how tightly-packed all of that "soft" tissue is! It's not thin and compartmentalized like anatomy textbooks make it look. It's a giant mass of hard, stiff, muscle. Ain't no cylindrical piece of foam changing the structural makeup of that.

So why do we pay clinicians money to massage us? Why do we foam roll? What's with those trigger point balls? Well, if we can't directly affect the muscular system, there's another system that is extremely responsive to these methods...

The nervous system.

The brain: The strongest muscle.
The nervous system is what controls muscle tone, tightness, spasm, cramps, and essentially every other muscle thing that muscles do. We won't go overboard with the exact neuroscience and types of receptors within the tissue, but here we go. When you go in for a massage for a muscle that's seized up or too tense, what the therapist is essentially doing is overriding the stimuli that cause the nervous system to believe that it needs to be tight and contracted, initiating a relaxation effect. It's sometimes quicker, sometimes a more gradual process, but at the end of the day, the nerves are the only true structure affected by mechanical pressure; that is, unless you run over the person's leg with a steamroller. (The above link cites another study demonstrating the absurd amount of force actually required to deform human tissue.) This is the reason why contract-relax techniques and modalities such as electrical stim are able to exist with the same end-goal as massage of muscle relaxation and decreased tone.

Even when it comes to scar tissue built up in a muscle, the treatments that any therapist does is simply promoting the healthy tissue to mobilize better around the scarring. (Long-term changes from exercises-induced bloodflow and tissue stress might have a different effect, however.)

For this reason, I don't subscribe to the belief that massage has to be excruciatingly painful to be effective. In fact, I see it as counterproductive if you're triggering enough pain to create a new spasm response. Also, this is the benefit of exercise rehab in conjuncture with treatments such as massage, mobilizations, or muscle stim. Once we remove the (allegedly) dysfunctional situation of a muscle when it's hypertonic, in spasm, or in too much pain from an oversensitive nervous system, we can then go in to retrain the body's mechanics to work around the physical structures that exist in an optimally-functional manner.

End of the story, the treatments you receive at the clinic, whether it's massage, stim, mobilizations, or contract-relax stretching, are still incredibly useful; just not for the reasons that you thought. The peripheral nervous system reigns with much more power than we're often inclined to think, and I think that by switching gears to focus on the effects of that system as opposed to having tunnel-vision on the muscles and ligaments themselves that we'll be able to advance our abilities in the healthcare and fitness fields.

Bonus Trivia!

We're talking about the nervous system, so take a look at this Michaelangelo comparison and mull it over.

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Tuesday, 23 May 2017

I'm Not Ready For Exercise

"I'm not quite ready for exercise rehab yet."

I've been told these words before. Potential clients are often seeking treatment elsewhere, are waiting for surgery, or are simply trying to find a working medication before commencing an exercise rehab program with the idea that they need to find alternative pain relief first before coming to see me.

Honestly, I understand where this is coming from. For many people who are unaccustomed to regular physical activity in the first place, the word "exercise" carries a certain stigma that creates nerves and anxiety - especially when a high amount of pain is currently present.

It's a social bias, really, and one that is likely propagated by media and pop culture. When people think "exercise", their heads often immediately go to Rocky montages, Arnold videos, and "hardcore" Youtube workout clips. Fairly enough, modern ideals tell us that exercise means heavy squats, deadlifts, and Olympic lifting, but this misconception may be impairing recovery for many individuals.

Ignore the grinding in your spine and give me 100 more!

I think it's obvious that I don't expect someone with debilitating back pain to be ok with being thrown into an intensive barbell workout routine. However, the idea of even basic exercises is intimidating to many people seeking pain relief, especially if those people are in severe chronic pain. When every movement hurts, how can they be expected to follow a strength program with a sets-and-reps scheme?

The thing to realize is that "exercise" does not necessarily mean big movements with heavy (or any) weights. As an Athletic Therapist, my job is to use exercise to retrain the body to manage pain. The fact that you're in a large amount of pain already does not condone not doing it; it means we modify the movement until it doesn't hurt. By not intervening into the the existing problem with exercise, how else is the body going to change its (potentially) pain-causing habits?

Often, with low-functioning clients, exercise won't even entail much movement at all. With many individuals, you'd be amazed at the progress made by some of the smallest muscles contractions; seated core bracing and diaphragm breathing to alleviate back pain, chin tucks and shoulder setting to stabilize the neck; even eye movements to help with whiplash migraines!

So no, I'll argue that no one should feel barred by exercise. (Certain bed-ridden and immobilized conditions being the exception, of course.) The right therapist will always be able to provide you with something at your level that you can do, regardless of that level being high or low. Your body is it's own best medicine.

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Tuesday, 16 May 2017

Coaching Sport, Coaching Confidence

As a coach to young athletes (track and field and cross country), I of course strive to see them succeed. I’m overjoyed when they win, I help pick them up when they don’t, celebrate a championship, and am sad to see the end of each season.

Spectrum Track and Field Coaches - 2017

However, there’s something above anything else that motivates me to return every year. Something that I celebrate long after the season ends. That thing is the confidence and sense of identity that sport – any sport – provides to individuals.

I’m sure we all remember that non-stop identity crisis that being a teenager entailed, trying to make it through high school while fighting battles of self-esteem and confidence. I sure recall it, and I remember that sense of invisibility and trying to find a way to identify myself as an individual. (Good grades weren’t exactly what I was posting on Facebook to brag about.) The fact that I was a runner was one of the main things that I rode on in order to feel distinguished from the crowd. Even though I wasn’t a particularly great runner (competitive-wise) during my teenage years, it was still a physical ability that helped me stand apart from others in order to feel accomplished.

Circa 2008. Gawwww....

I won’t pretend to be a psychologist by trying to delve into the science of human development, but I speak from experience. As I transitioned from athlete to coach, I’ve had the pleasure of seeing many parallels to my athletes and my own story. While I’ve had plenty of athletes routinely come out on top and enjoy award-winning success, there’s been an even more rewarding experience that’s come out of my time as a coach. Being a track and field coach, I’m able to offer a chance to participate in sport to students who have never been athletes before. This has allowed me to witness some very timid, meek, and unconfident individuals (potentially feeling that same sense of invisibility I mentioned) develop confidence and pride in this new activity and begin to use it as that identifying aspect of their character. (Not to mention how sport participation will help to combat problems with body-image. But that’s something to talk about in so many different posts.)

Asking The Expert

"As adults we want to be operating ideally from what is known as a 'congruent' state. This is where we respond to a situation and not react! There's a difference. Children tend to react, and we can find ourselves doing this in our adult day to day living. 
One of the methods [for helping clients progress in communicative and social ability] … is to bring the client to a place of congruence.  Congruence is achieved by addressing several layers of our lives. Picture that iceberg as it stands out above the water. What we see is pretty impressive, but icebergs have far more beneath the surface, literally!The top of the iceberg has functional behaviour and needs: bills, schoolwork, social engagements. But as you slowly work down the layers of the iceberg you eventually get to the ' under the surface ' areas that [are described] as core; our yearnings and our connection with our self and our creator.
Being alive to those deeper often buried yearnings has a direct correlation with our communication style and our congruence! Remember congruence is the goal! Sport is often an area that can enrich a person's life significantly. Self-confidence, physical strength, endurance and appearance all improve with sport participation."
Sasha Tanoushka (Bio listed below)

For these reasons, when coaching youth sport, I put particular effort in this area of development. The athletes who regularly come 1st and 2nd in their races aren’t the ones that have the most to gain and in fact, the reason that I love coaching track and field more than anything is because I can attract those individuals who are brand new to sport and exercise altogether. This allows me to provide some sort of intervention in that potential identity crisis. I’m never going to try to change who they are, but I see building confidence in an ability to physically to perform (even if it’s not to a first-place title) as an avenue to help these young people feel like they have enough distinctiveness and individuality that it can allow them to feel a sense of belonging – without abandoning their existing core personalities.

Lastly, I don’t believe that if I miss these kids before they grow up that it’s too late. I firmly believe that any age is a good age to begin building on that value of confidence in one’s physical ability; I see it happen all the time, in fact. The 40 year old lady who becomes a runner, the previously-overweight man who now loves recreational baseball, or the retiree who fell in love with hiking – they all instill that sense of identity in who they are as a person and help to allow them to love and be confident in themselves as a whole. Physical literacy plays such a huge role in our personal wellbeing, and being able to tap into that, whether for ourselves or as a professional to others, makes the world of difference.

And that’s the reason I coach.


Sasha Tanoushka 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.

She can be contacted at: birdibost@gmail.com 

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Tuesday, 2 May 2017

Upper Trap Dominance

Spring and summer are upon us and baseball season is here! Not only that, it's also home renovation and yard work season, all of which mean that your shoulders better be in good shape for all the work that they're in for.

If you're already hurting, then it's a good thing you're here to read on.

One of the most common things I see on clients who come in with shoulder injuries (especially the chronic, overuse ones) is the dominance of the upper trapezius muscle. Like many large, easy-to-engage muscles of the body, the upper traps like to act as the overbearing workaholic that does all the work for everyone else in the office. Pulling, lifting overhead, and more, these muscles have a tendency to initiate many large movements at the shoulder that smaller muscles are initially intended to take charge of.  It's too the point that I (mostly) joke about just severing the nerve to the traps to see if can correct things that way.

This habitual dysfunction is a learned one, most likely from our desk job lives and sedentary behavior. (Being seated with arms elevated to high will shrug the shoulders up and result in increased tonicity of the traps.) Past that, poor education about body mechanics and constant reinforcement of using the incorrect muscles at home, at work, etc. grinds these habits in deep as we get used to using the largest and least-fatigueable of the shoulder muscles to do all the work. They're also muscles that are quick to spasm and guard in response to injury (such as whiplash). What's more, the popularity of weighted shrugs at the gym doesn't help, and removal of them from workout routines is, so often, one of the first instructions I give individuals in my office.

Why this is a problem is that this increased activity of the upper traps usually correlates to a weakness of the smaller scapular stabilizers (such as your serratus), both of which result in an excessive upward rotation of the shoulder blade and destabilization of the shoulder girdle.

While remembering that textbook perfect posture is not a realistic thing to have to worry about, if you do experience pain, these mechanics may be involved. Structures can be impinged from the incorrect shoulder positioning, you could have spasm through the upper traps causing neck pain, and you may be finding that your shoulder isn't handling well against impact and trauma.

With this in mind, you can see the importance of keeping those muscles beneath and below the shoulder blade strong and engaged while keeping the upper traps relaxed and ready as a complementary muscle to movement rather than the prime driver. And for crying out loud, stop shrugging at the gym; the only thing it helps is your ego.

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