See Ya Later, Functional Training! Let's Go Applicability!

While the hype seems to have decreased a little bit, at least in my tiny corner of the world, the term "functional training" is still thrown around as a hot-word. It seems like every fitness instructor and trainer is now specialized in it. (Is it still special when everyone is doing it?)

I've had my rant about how out-of-context the term "functional" has become in the past few years. If an individual is a long-distance road runner, do they need to be doing instability BOSU squats? Does a basketball player need to do handstand push ups? Does grandma require the ability to do 10 minutes of burpees?

This will help my golf swing!

As I went on about before, functional movement has been misconstrued, lately, as meaning any compound movement up to and including the most complex circus acrobatics you can think of. But if we're talking function, shouldn't we be thinking less about how many muscle groups we can hit in one exercise and more about the function that the training is intended for?

Enter: Applicable Exercise!

When clients discuss the thought of switching to more functional training, I jump in and suggest "applicable training" as an alternative. I can immediately see the gears and bells all lighting up in their heads. No longer are they imagining unnecessarily complicated balance exercises on unstable surfaces or handstands for shoulder stability. Instead, they now picture themselves doing exercise more closely replicating their desired activities, such as the sport they like to play, the hikes they like to go on, or the gardening that they love to do at home. Whatever the activity, there are specific movements, joint directions, and energy systems that accompany them that need to be considered.

This switch of focus bodes well not only for training in the gym, but also for rehab. As previously discussed, making rehab homework more specific to a person's lifestyle and activity is not only more enjoyable for the client, but will be much more successful!

For you in either the health or the fitness worlds, I challenge you to try and substitute "functional" for "applicable" when it comes up in conversation or at work. It's very interesting, the change in thought-process that this simple switch can trigger.

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Is Running Bad For Your Joints?

You'll be hearing me celebrate the return of running season for the next little while. Running is a fantastic exercise and sport, and I'm more than happy when I see both experienced and brand new runners partaking. However, is running a healthy activity?

It has generally been the common consensus that running is bad for your joints, whether it be for your knees, your hips, or back. Thus, it's often the reason (or excuse) for many people to not partake in any running. It makes sense; too much impact on the joints could totally cause some arthritic development or degeneration in the spine. As we understand it, this is basically the definition of how osteoarthritis onsets, right?

The research journal search was actually extremely easy here. As I was able to find out, between both old and new studies, long-term studies, and cross-analyses, running was almost always found to be unrelated to any development of osteoarthritis in the knee, hip, and spine. At the worst, some studies suggested it to be merely inconclusive.

In fact, one brand new piece of research even found that, as far as intervertebral discs go, running actually promoted more strength and better disc health as opposed to contributing to degeneration!

So what's going on? What actually causes arthritis? Well, recent skeletal examinations are now suggesting that osteoarthritis development has more to do with a lack of physical activity rather than too much of any particular type. This was strengthened by the fact that degenerative joints correlate highly with the morbid obesity seen in many modern-day skeletons.

Furthermore, there may even be mechanisms that actually protect runners from degenerative changes from their spot. While the overall impact and force going through the joints is higher during a running gait, there may be some evidence suggesting that the decreased contact time with the ground actually works to counteract any damaging effects.

All this being said, no, running is not the joint-destroying, pain-inducing activity that many out there believe it is, and there's even the possibility of being a runner if you already do have arthritis. Keep in mind, running, like ANY other activity, can cause injury, whether it be from an accident, poor conditioning, or training error, so don't forget the importance of proper training.

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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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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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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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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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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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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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The Top 6 Band-Mobility Mistakes

I have this tendency to go off on the reasons of why most band-mobility work that we see at gyms these days is so unnecessary. I'm going to sidestep, however. Like everything, these band drills have a time and place, so allow me to provide some guidance on the most common errors we see.

1) Becoming Addicted To Short-Term Benefits

The biggest issue with these mobility exercises that everyone is doing these days is that they are being widely performed with no long-term plan in mind. Individuals at the fitness clubs are working on regaining the same degrees of range of motion before every single workout. If you're spending this much time on gaining those degrees of range, then you should absolutely be doing the subsequent work to make sure it stays! Otherwise, you're simply bailing the boat without plugging the hole, so to speak.

This brings us to our next fact:

2) Freeing Up Ranges That You Aren't Strengthening In

How do you maintain range of motion once you free it up? You strengthen and stabilize the soft-tissue around it by training IN that range. It blows my mind when I see people at the gym spending 20 minutes working on their overhead shoulder flexion, yet they're only pushing half-reps on the shoulder press.

I can't wait to never do an overhead press!

Not bothering to do the necessary work to strengthen those ranges of motion, at best, means that that range is never going to stick and stay available to you. At worst, you're going to hurt yourself. Which leads us to...

3) Freeing Up Too Much Range Too Soon

Going back to the stabilization point, if you don't strengthen within a range, that range is useless to you. On the same train of thought, if you mobilize a joint too aggressively and your range drastically increase, there's a risk even if you do try to strengthen there; that risk being that if there's not enough existing stability already, then the joint may fail you if you try to lift too heavy or stress the joint into that range. Think of that joint as a Jenga tower. If you're removing blocks to increase its movement, you need to reinforce and balance it out to prevent collapse.

And at the same time have hours of family fun!

4) You're Mobilizing Past The Limits Of The Joint

Another problem we run into is when people are trying to mobilize into ranges that aren't even supposed to be mobile. My favourite example is when I see individuals using those bands to stretch their shoulders behind them into extension.

Taking this photo actually made my shoulder sore, but I did it for you!

News flash: You don't do any activities or exercises in that excessive range (except for those ones that you should probably be avoiding anyway). Furthermore, your joints do not appreciate being pulled that far.

At points such as this, we've completely stopped gliding the joint along its surfaces or stretching the muscle tissue. By this time, all that you're doing is stretching the ligaments. Last time I checked, you don't want to stretch your ligaments.

5) You're Trying To Mobilize When Mobility Isn't The Problem

You have trouble getting into a deep squat, so let's mobilize those hips into flexion! Right?

Wrong! Probably.

So often, I see people thinking that they're lacking the ability for their joint to fully glide, and so they waste time trying to increase those ranges. But wait, can you pull you're knee into your chest? If so, then the joint can glide just fine. If anything, you probably have a problem with muscular spasm and tension.

So, before grabbing that band, take a moment to assess where the problem is actually coming from.

6) Not Understanding How Joints Move

Lastly, once you've completely determined that, yes, you have an actual joint restriction, that you will definitely strengthen in the increased range, that you won't stress your ligaments, and you have a long-term stability plan in mind, let's mobilize that joint!

But let's mobilize it properly, mmkay?

My best example of this is one that I see constantly: the hip extension stretch with the band pulling back on the hip.

Here's the thing, which I will so artfully articulate in my MS Paint diagram here. When the limb goes in one direction, the joint surface that is moving does not necessarily go the same way.

This example is quite easy to visualize. When the hip flexes forward, the head of the femur moves back in the opposite direction. Oh-so coincidentally, the direction that the femoral head moves is the opposite way that people seem to enjoy pulling on it with their bands. Counterproductive, as you can see. Here's the right way to be doing that exercise.

These same principles apply to every other joint. Unfortunately, not every joint glides in an as-easy-to-picture fashion. So please, if you're going to force a joint surface in a specific direction, please do your research correctly or speak to a professional.

Band mobility definitely has it's place in certain rehab and training plans. It's a temporary measure only, however, as the subsequent training should involve strengthening to stabilize that newly-acquired range so that it sticks around. Know the joint that you're trying to mobilize, understand the joint's limits so that you don't unnecessarily stress them, and only increase the range if you require/intend to use it.

Does Symmetry Matter?

I've had a few clients who see me regarding an injury or condition who have expressed a lot of worry over their muscular asymmetry.

Symmetry is a big concern in the fitness world; particularly in the circles of physique, fitness, and bodybuilding competitors who rely on the aesthetic of it for their performance.

However, when it comes to our health, fitness, and function, does symmetry really matter that much?

The answer is, frankly, nope.

You see, outside of the gym, our lifestyles don't really allow for the perfectly equal use of our limbs between left and right and the promotion of a symmetrical body-type. You have a dominant hand, a dominant leg, a preferred sleeping position. Without the focus of isolated exercise to specifically target the growth of individual muscles, it's unlikely you'll attain that perfect mirrored figure.

Does that translate to pathology, however? Probably not. Obviously, if there's a severe discrepancy such as a smaller quad due to a 6-month limp or one arm that's smaller after recovering from a fracture, those are more clinically significant. When it comes to a typical population group, though, smaller differences between left and right will usually be negligible.

Take the shoulders, for instance. I've heard many individuals remark on the fact that one of their shoulders - and thus, the entire arm - hangs quite a bit lower than the other other and worry about the implications of the "muscle imbalance" behind it. This is a perfectly normal occurrence though, with the dominant arm often - maybe even nearly always - hanging lower due to the more-constant reaching and lengthening of the musculature on that side.

And this isn't an isolated circumstance. Development of traps on one side, tone of spinal erectors, asymmetry of the abdominal muscles, and more. These discrepancies do not signal poor health; only habitual differences between sides. When flexing in the mirror, do not be alarmed by those subtle differences. You don't not need to be equally sized, toned, or flexible on both sides.

Don't get me wrong; I still will always note these asymmetries when examining a client who sees me in my clinic, as perhaps they are part of a larger problem that I haven't quite picked up on yet. However, it's important to keep those notes in the back pocket until needed, as it'd be useless to get hung up on every small change right off the bat. It's good to remember to not get hung up on how alike left and right look and to just focus more on each joint's ability to perform it's required functions overall.

In the words of Eric Cressey:

Your Tight Hamstrings

It seems like every other client and athlete that I see has a complaint about their tight hamstrings.

The tension that a lot of people feel is relentless and just won't let go. They stretch and stretch all day long. Bending down to touch their toes, sitting and reaching, on their backs with a band, but nothing works!

Why are these things so tight and why can't we get them to be flexible?!

Hamstring Tension

I read this excellent article by Eric Cressey on the true reasons for hamstring tightness. One of the most enlightening points that it makes is the fact that your hamstrings are very unlikely to be truly shortened.

You see, the hamstring muscle group performs two major actions: knee flexion and hip extension. If our hamstring tension was really caused by shortening of the muscles, then that would essentially require us to be in both of those joint positions (simultaneously) on the regular. Do you spend every day on your knees for hours? (No jokes, please.) No? Then you probably don't have a hamstring lengthening/shortening issue.

So that being said? What causes hamstring tightness? There are three main things: Protective tension (compensatory tightness), neural tension (most significantly, sciatica), and an injury to the muscle (whether it's an acute strain or tendinitis).

Most of my clients who have this issue have it due to the first option; protective tension. More often than not, they're lacking proper activation of the glute muscles to initiate hip extension and stabilize the hip joint. As a result, the hamstring has to not only compensate for the ability to extend the hip, but it also has to increase in tension to try and make up for the lack of stability that the body senses at the joint. As the fix, I spend a lot of time reeducating the action of gluteal hip extension. Obviously, this isn't the only compensatory mechanism for why the hamstrings are tight, but it's the most common one that I find.

Similarly, if the reason for the tension is neural or due to injury, we need to fix the root of the problem in these cases as well before the hamstrings will truly be able to release their tension. If there's sciatic involvement from either the hips or the lower back, then some sort of intervention to relieve the stress on the nerve is required. If there's been an acute hamstring strain or built-up scar tissue, then time, manual massage, and proper strengthening will help accelerate recovery. If there's a chronic tendinitis, then that brings us back to the compensation issue which needs to be corrected.

Hamstring Stretching

In the meantime, is there anything we can do to help decrease hamstring tension while attempting to correct these mechanics?

Well, from my experience, I'm finding that static stretching for this area is less and less effective. Like I touched on before, if the hamstring isn't truly shortened, then why bother trying to truly lengthen it?

Instead, I'm starting to employ more dynamic stretching (even after exercise) in order to promote the muscle to neurally relax under tension and let go during repetitive stretch rather than prolonged. My clients have reported feeling that these methods have made them feel like the muscle is under decreased tension and have relieved pain more than holding the stretch ever did.

 

All in all, this goes back to my philosophy that simply stretching and mobilizing is never the answer to the problem. The base mechanics always need to be addressed before the issue is resolved. So, if you fall in this category of someone plagued by chronic hamstring tightness, take a moment to consider the reason for it.

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.

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.

Treat the Whole Chain - Necessities of Recovery

There's no manual on the human body. You can't just open a troubleshooting guide to find out how to fix a piece that's not working properly. As such, I'm not a fan of calling the body a machine. Rather, it's this moist, fleshy mass of tissue and organs that sometimes comes together to work properly. (Yes, "moist". Deal with it.)

How do I look?

That being said, when a piece breaks down and pain is experienced, we don't have the luxury of focusing our attention on that piece alone to try and correct the issue like car mechanics do. If one segment is out of whack, then, guaranteed, others are as well.

Compensatory Mechanics

We all know by now that, when injury occurs or bad motor habits are left unchecked, that the body will compensate by lengthening, shortening, tightening, and restricting in other spots; thus, maintaining functional integrity.

Because of this type of mechanism, spraining an ankle, for instance, means that the overall issue won't stay isolated at that one joint. Because of that sprain, the body will favour one side with a limp, resulting in a lateral hip weakness on the opposite side. That weakness can then be cause for poor knee tracking, SI joint instability, spinal tension, and more. And do these things require years of being unchecked to occur? No. Try a week or two instead.

Intervention

With that knowledge, how can we expect to correct the issues by only targeting the site of the most pain? Here's a good example of how working globally is a necessity when it comes to correcting dysfunction.

I have one client who had discomfort in their hip. We determined that there was an imbalance around the hips that resulted in one side becoming stuck in a hypomobile position. What we did, for the first treatment, was mobilize the joint manually, provide mobility exercise prescription, and then started working on stability for those lower-chain muscles surrounding the area.

So the hip felt great. However, what happened next was that the spinal erectors tightened up by the time of the next treatment. As we promoted more movement through the pelvis and began activating the hip and core muscles to stabilize the area, we were promoting more movement through the rest of the kinetic chain and creating more mobility through the entire spine at the same time. Thus, even though we were strengthening the core, we were also forcing the back muscles to start activating more than they were used to. As tone and tension increased in the lower back, the tension creeped up all the way to the top, exacerbating neck tightness as well.

Sidenote: When we're talking about headaches and 

pressure, we're usually looking at these guys here.

Does that mean we did something wrong during that first treatment? No. It just shows that the body can very effectively compensate for a dysfunction, but when you suddenly intervene in that dysfunction and start to return a joint to its proper mechanics, you need to keep providing similar retraining to the entire chain, both above and below that area.

Significance for Self-Help

These thoughts hold more significance that just for clinicians who are treating a client's injuries. The principals apply to every individual who is trying to address their own fitness and health. 

I talked about "foam roller syndrome" before and how a reliance on self-releasing only the site of pain on a daily basis signals that there are mechanical errors not being addressed. That's exactly what I'm talking about again here. If you are constantly experiencing lower back pain, then constant work on your lower back along will not fix the problem. Neck pain? You need to do more than simply stretch the neck muscles all the time. 

The point here reiterates the time-tested rule that you can't chase pain and expect to chase it away. When there is a dysfunction, it's important to look up, down, and away from the dysfunction and correct the kinetic chain as a whole. Zoning in on one spot will feel great on the first day, but if you stop the efforts there, you can expect the pain to return just as bad - or even worse - soon after.

How Do Pain and Spasm Work?

I had a client this week ask me why the body seizes up so violently when it experiences injury, even when the muscles that are seizing up weren't the ones that were damaged. You've sprained a ligament at your AC joint, so why has your entire upper back and neck become so tight and restricted?

As I've mentioned before, the body has this fantastic mechanism when it comes to protecting its joints. Normally, when it detects instability around a joint, the brain signals the muscles to tighten and tone in order to guard the joint from harm. However, when the instability is severe or when the body experiences an acute, traumatic injury, this tension becomes spasm.

Spasm is an involuntary muscle contraction and is how we define this "seizing up" of muscles when we experience injury. The body is desperately trying to do whatever it can to maintain the integrity of the joints by minimizing any further harm. Unfortunately, this spasm is very often even more debilitating than the injured structure itself. Why is that?

The Pain-Spasm Cycle

What happens is this delightful process known as the pain-spasm cycle. First, your body experiences pain. As we know, the body now tightens and spasms up in response. However, this tension has made the pain even worse. As a result of the increased pain, the body throws in even more spasm, and the cycle continues.

This is essentially the physiology of any injury and the reason why it's so hard to find relief. This cycle can be an extremely debilitating process and is tough to break. But it CAN be broken, and that's where I come in to do my job.

Breaking the Cycle

How do you break a cycle? Well, you remove one of its pit stops, of course. Through whatever means are used, if you can reduce either the pain or the spasm, its counterpart, by principle, will become alleviated as well. This is the purpose of modalities that therapists use. Massage and needling, for instance, help to relieve muscle tension and decrease the amount of pain that a client has. On the flip side, electrical stimulation machines are also used solely to block the pain signals from the tissue to the brain, causing the brain to allow the muscle to relax and cease its spasm.

However, these modalities are often not enough. Even IF the symptoms can be completely alleviated through a treatment (spoiler: most often, they're not), the symptoms can easily return. The way that I explain to my clients is this: Regardless of muscle tension and pain, there is going to be some degree of dysfunction or joint instability remaining from the injury. By not correcting these issues or by leaving behind even a small amount of pain and spasm still, the symptoms are likely to return full-force.

And how do you correct that? Movement. Athletic Therapists recognize that treating the tissue ourselves is only half the battle and that the rest of the work is up to yourself to stop the problem from coming back. Strengthen the muscles around the joint. Create stability. Rebuild the trust between the brain and the muscles that movement can be done safely and pain-free. This is only way to truly correct a dysfunction and prevent this painful boomerang effect.

The most useful medical tools.

These principles are well-known to most medical practitioners, but it seems that it's often missed by the public. By offering this understanding on how exactly pain and spasm work and how to correct them, hopefully it will prove to be a valuable resource to motivate people as they move through their recovery process and back to health.

Case Study: Why Not To Over-Mobilize

I've got a case study for you, and it's a great example of why we need to be careful to not take mobility principles out of context. (Look at me, kicking that horse again. Get used to it.)

The Client

In this instance, I had an adult recreational hockey player in to see me for treatment. He had a history of shoulder injuries, some shoulder pain, and ongoing neck tension and headaches following his weekly hockey game. He exercises regularly, but doesn't often workout his upper body at the gym due to his lifestyle demands not requiring it.

In short, my plan of attack was to do some moderate soft-tissue release through his traps and neck, give him some self-mobility exercises to do before hockey, and some stabilization movements to strengthen his scapular and deep neck muscles. From the rehab side of the world, basic basic.

We tried this approach for two sessions in a row, a week apart. In both cases, my client felt great all week.

Oh wait, except for the two days after his weekly hockey games. Then the pain was like none other.

What Went Wrong?

I'll tell you what went wrong. My client was very responsive to the stabilization exercises and could feel himself standing taller and his shoulder sitting back much better all the way through. However, by increasing his shoulder and thoracic mobility (both through the treatment and through his home exercises), we inadvertently created instability that his muscles weren't yet ready to fully compensate for. 

He described the pain after the second hockey game as "piercing straight from the back to the front" of his thorax. Essentially, after we freed up his joints and increased the movement happening through his thoracic spine and ribs, we created a need for the muscles in the area to work harder to maintain stability, Unfortunately, the strength and endurance in those muscles weren't yet there, and pain resulted for the days after the demand was placed upon them.

So after puzzling this one out, our third session was spent exclusively on strengthening exercises. We purposely avoided doing any hands-on soft-tissue release or joint mobilizations (aside from his self-mobility drills) to try and create a better foundation for stability first. After that treatment, he went to his hockey game and reported, finally, a relief in pain in the days following.

The Takeaway

This is a great reminder to be cautious with the amount of mobility and soft-tissue release that we're providing to our clients (whether you're an Athletic Therapist, a chiropractor, or personal trainer) or even to yourself. Rapidly releasing muscles and freeing up joints does not automatically translate to good health. It must be balanced with proper strengthening to allow the muscle to compensate for the increase joint movement, and those muscles will continue to need further conditioning in order to endure any extended workload demands. Even the best of us will still overshoot when it comes to these principles, but all's good as long as we can take care to reevaluate and not try to maximize range of motion in too short of time.

Making the Case for Mid-Season Rehab

"I'll just power through the rest of the year and get healthy again during the off-season."

I'm good, Coach! There are three whole ligament fibers still in there!

If you've worked with sports in any capacity with athletes over the age of 18, you've encountered this attitude time and time again. Or maybe you're one of these athletes yourself. You got hurt in the first game but feel well enough to continuing playing the week after with only a bit of pain, so you tape yourself up and consign to go and get rehab after the season is over.

This attitude isn't restricted to the traditional multi-game season either. Maybe you're a runner, body builder, or gymnast with that one, big competition coming up in a month. You're training hard and rigorously; there's no time to for stupid little rehab exercises.

In reality, there's actually a big problem with athletes who won't seek treatment in the midst of their sport season. I understand their thought process - in that they either don't have time or don't want rehab to interfere with their training progress or practice - but I far from agree with it. Just because you have someone to tape your ankle, get your back cracked or massaged once a week, or started wearing a back brace doesn't mean it's ok to neglect the actual rehabilitation and retraining of your injured joints.

So what are the reasons to not wait until the season is over to get better?

You're Going to Get More Injured

This one is an obvious one. Regardless of the fact that you have tape or a brace to support the area that you hurt, the structure that was injured is, by nature, now prone to further injury. Even if the tape is good enough to protect your ankle during the game (pro-tip: there's a likely chance it's not!) what about after the game when you return to work or your family? The chances of you reinjuring something, whether during sport, work, or life, are always multiplied after every injury and even moreso after each reoccurence. With that being said, why risk it if there is something to be done?

You're Developing Bad Motor Patterns

So you finally did make it to through those few more months and to your physique show, despite straining your back earlier. It was thanks to that back brace you had at work and that you wore your weight-lifting belt during even the lighter days at the gym. Now that it's all over, now is a good time to hit the clinic.

Except, now that you've waited so long, you've increased your timeline of recovery due to developing poor motor habits by compensating all this time. Whether it's having that back brace that eventually made your core weaker, that limp that mangled your hip strength, or the fact that you just straight-up stopped reaching over head with that arm to protect your shoulder, the adaptations that your body has made around the injury have only become more and more ingrained the longer you put your rehab off. What once may have been a simple couple weeks of rehab for the ankle sprain is now two months of recovery because your hip weakness has now started causing both back and knee pain.

Look at this photo and try to tell me it's ok to walk around like this.

Rehab Will Improve Performance, Not Interfere

This last one is, again, a seemingly-obvious one, but it still doesn't seem to resonate with people who have a less-than-paralyzing affliction. Honestly, I think it may stem from the belief that there's no point in rehabing something that's just going to get more hurt again the next day, but that's an awful way to think.

Anyhow, I digress; you're performance at your sport isn't exactly going to improve amidst an injury, and it's definitely not going to suffer because you added some daily rehab exercises to your training plan. I'll revisit the whole "power through it" mentality, and while that's an admirable philosophy, it's important to remember that every additional ache or pain is going to affect your performance to some degree - whether it's the ankle sprain from three weeks ago meaning you can't run as fast, the back strain preventing you from lifting as heavy, or the shoulder instability resulting in you having less shots at the hoop before needing to come off and ice.

All in all, this isn't a groundbreaking train of thought. I'm pretty sure that all of us - athletes, coaches, parents - know that we're better off seeing help sooner than later, but we get stuck in this mentality of dealing with it later because there's more important stuff in the now. It's a mentality that we're much better off with phasing out, however, for the sake of both your health and your performance. Don't be a hero; be smart.