Tuesday, 27 June 2017

Self-Testing Your Hip Mobility

I did a post a while back regarding the importance of hip mobility for spinal health. I discussed the implications of lumbar spine compensations should the hips not be able to flex and extend properly.

BU T - how common is a lack of these ranges in the hips, really? In that article, I noted that most losses of hip flexion are purely soft-tissue restriction (those darn't hamstrings) while compensations of the spine during extension are likely just due to instability in the core.

In my experience, I've seen very few clients who have a deficit in hip mobility at the joint-level itself in flexion and extension, save for for traumatic accident victims, post-surgical clients, or the elderly.

This isn't to say that it doesn't happen. That being the case, however, considering how many people are aggressively trying to mobilize those ranges at the gym all the time, I'm here to show you some quick ways to self-assess whether you're one of the people who actually requires it. (Pro-tip: You're most likely not one of those people.)


Lay down on the floor (not a squishy bed) on your back. Rotate your pelvis all the way forward and make a big gap between your low back and the floor (anterior rotation) and then rotate it back so that the lower back is flattened on the floor (posterior). Now, find the spot directly in between those two end-ranges, which will be your neutral position.

From here, you want to make sure that your hips don't leave that neutral position. Focusing on keeping the pelvis where it is, pull one knee at a time all the way into your chest.

You'll probably notice that you got your knee somewhere between 90 and 120 degrees from the floor. Surprise! You have optimally mobile hip flexion!


Self-testing your extension will follow a similar pattern. Standing this time, find the a doorway or pole that you can have half of your body up against. Standing with your back to it (one butt-cheek on, one off) find your neutral pelvis position again. Place a hand in the small of your back to ensure that the distance between your back and the surface stays consistent while you extend the free leg back behind you, stopping when you feel your back forced to extend.

An average distance is anything past 0 degrees and up to 30, so if you were able to make it any distance at all, then you're healthy!

My Point

What I'm getting at here is just a demonstration that true flexion and extension hypomobility issues within the joint itself are not common. If you can't flex your legs far, you likely have excessive hamstring tension (removed by the bent knee when we tested). If you're spine deforms in extension, you probably just have an unstable core that's unable to withstand the force generated by hip extension when done dynamically.

If any range in the hip joint is lacking, it's probably rotation, but I'm going to get to that in a future post.

With all that in mind, it's probably time to abandon the banded hip mobility workouts and just start addressing the soft-tissue again like back in the good ol' days.

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Tuesday, 20 June 2017

Psychological Barriers of Recovery

Pain hurts..obviously. So when presented with a method of managing and removing that pain, it should be easy to do what needs to be done to comply. Experience, however, tells us that this is not the case.

We've seen it. The individuals who simply won't seek help despite being in chronic and excruciating pain. The ones who make their appointments but cancel the majority of them on a whim. Those who show up, but simply won't adhere to their exercise rehab plan enough in order to progress in their recovery.

I'm feeling to "blah" to go to my appointment today..

I often joke about the "fantasy client"; the one who always shows up on time and never misses a single day of their exercises. These clients are few and far in between.

Why is this? If there's a road to healing, why are are so many people reluctant to take it? Well, there are several psychological barriers to recovery, and it won't be possible to try and touch on them all. There are some common ones that I see in my practice, though.

One big one is a lack of client education regarding the condition and treatment; therefore, a lack of trust in the process for recovery. I find that many people, while seeking treatment, are almost just going through the motions due to consciously knowing that they have to try and get better, yet subconsciously having little faith in succeeding. I've seen many clinicians experience a downfall in this realm in that there is minimal communication on what's happening and how things - whether it's the body or the treatment - work, resulting in poor success rates in the rehab.

There's also those who would like to be pain-free again, but are weighed down by thoughts of unattainable (or at least perceived-so) situations about their lives and bodies which might make recovery seem like it has less meaning. What I mean by this, for example, could be an elderly lady who has back pain she'd like to be rid of but is less motivated because she still won't regain her 20 year old figure. The retired athlete who no longer has a competition goal to work toward. The spinal cord injury patient who can't expect to regain his full nerve function again.

As an Athletic Therapist, how do I work around these barriers? It's my job to help clients get better despite their other facets of life, not to try and fix their entire personal situations (which I couldn't do if I tried). Instead, it's important to help these individuals pave their own ways to success through over those hurdles.

My method isn't complicated. Education, obviously, is key. Client understanding of their injury is important in order to understand how the healing is going to work, and so I spend an ample amount of time making sure I explain exactly what is happening with the individual's body and what our treatment aims and mechanisms are. This is one of the most surefire ways to give clients faith in the process and maintain their perception of treatment efficacy.

Goal-setting, as well, is vitally important during the healing process. Sure, maybe the client isn't going to be training for professional hockey ever again, but maybe he'd like to aim for that biking trip with his son. That elderly lady may not regain her 25 year old figure, but how about a goal of walking (or running) that next city 10k race? Those long-term goals are help to re-perceptualize the process to help the short-term ones have more meaning.

As I said, it seems like a no-brainer that if you want to be rid of pain, it should be easy to adhere to the process; but that's in theory only. Often, people need help and guidance in order to increase their perceived efficacy of the treatment and to adjust their goals to something attainable, but still meaningful.

Health: It's not all in your head, but the head is sure part of it!

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Tuesday, 6 June 2017

Athletic Therapy and the Opioid Crisis

I heard a terrifying statistic on the radio last week: The rate of individuals in British Columbia who are dying from the fentanyl epidemic is greater than that of the AIDS epidemic at its zenith throughout all of Canada.

Vancouver Sun

Ok, that's f****d up. What, as a society, are we doing about this?

Well, I'm an Athletic Therapist; not a doctor, not a drug councilor, not a political expert. There's a lot on this topic that I'm in no way qualified to speak on. It’s someone else’s job to address childhood trauma, poverty, and those other socioeconomic factors that contribute to addiction.

But there is one facet to this epidemic that is relevant to this health and physical rehab field that I reside in, and that factor is education and intervention for pain management.

One of the huge factors that we've found has contributed to this crisis that we're in is that, for so long, mainstream society has relied heavily on opioid prescriptions for pain. It's clear, now, that we need to find alternatives for pain, and fast.

My profession revolves around providing conservative, non-invasive, and long-term management for pain and the mechanics behind injury. Most cases of back pain should be manageable without chronic use of painkillers. Statistically unsuccessful surgeries such as spinal fusions and knee arthroplasties need to be phased out in favour of conservative rehab. Exercise, in general, is even shown to be an amazing tool for conditions that are defined by chronic pain such as fibromyalgia. And we haven’t even gotten into the correlation between exercise and mental health.

In fact, Canada's Physiotherapists, a profession with many close parallels to Athletic Therapy, are creating an entire campaign based around using them as an alternative to surgery and pain!

Athletic Therapists are experts when it comes to movement, and the body has an amazing inherent ability to heal itself and manage pain, provided that we’re allowing it to move and function properly. Don’t get me wrong, opioids as a prescription painkiller do play a vital role in modern medicine, and we shouldn’t be trying to abolish it, but we do need to start replacing it as a management method where it’s shown to be unnecessary. With four people per day in BC dying from overdose, it’s our responsibility, as clients and clinicians alike, to raise awareness to this transition.


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