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.)

Flexion

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!

Extension

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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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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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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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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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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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 1^st and 2^nd 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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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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