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As you wander through your bedroom in the early morning, reaching for shelves that seem to shift as you approach, you realize how helpless you are without your eyesight. Instead of walking, you carefully scootch your feet step by step, hands forward like a zombie, into the inky outline of a bathroom door. Now it may come as a ‘duh’ kind of question, but why would we do this? Why would we modify our behavior to accomplish a goal that could easily have been accomplished much faster and efficiently if we just marched right through the dark towards what we thought was the bathroom? I’ll allow these gifs to speak for me:   We modified our behavior based on those memories of SLAMMING our toe into that damn table one too many times, just as we modify our behavior when anything incredibly painful happens to us. Remember that time you sprained your ankle when trail running? I’m sure you learned to be more careful with your steps! Remember that time you played volleyball for four hours and woke up like a train rolled over you, backed up, then body slammed you? Sure you do. You remember. Your body remembers. And, due to these memories, we do our best to make good decisions to avoid these painful problems in the future. The reason I’m telling you these stories is to paint a picture that our body and mind remember injuries, and that these injuries that may have occurred decades ago are still affecting our bodies today. Don’t believe me about your body remembering injuries? Research shows a good ability to predict osteoarthritis in patients decades before it occurs… the main predictor is if they’ve had a knee surgery or injury.1,2 That osteoarthritis is your body’s ‘bad memory’ of your bad night you messed up that knee. And your mind remembers injuries just fine as well… just think of one of your many injuries and I’m sure it’s as vivid as a firework on the 4th. Growing from these painful metaphorical and literal memories is a major challenge, and that challenge is met daily with the help of proper physical therapy treatment; to reset your body’s movement and your mind’s pathologically-based control of your body in order to imprint a new patterning system that accommodates your injury. In short: Unlearn old patterns. Build new ones. Grow. Let’s go through a typical case of how I teach my patients to build these new patterns: Bob Smithy Jones Fake Name Jr III comes into the clinic with back pain due to paratrooping since he was 5. He’s now 31 and his lumbar spine is comprised mostly of Legos and popcorn. He likes to deadlift small horses and fight yoga instructors to pass the time, but his lower back isn’t letting him do the things he loves. Bob is desperate. He knows he has to live with this spine for the rest of his life and is concerned with what the future holds. After going through a thorough physical movement and manual assessment, I see half a dozen regions that are contributing to Bob’s pain and dysfunction. His mechanical memories are leaping out at me from each of my assessments, and his compensations are showing me exactly how he has been subconsciously “avoiding stubbing his toe” for decades. His mental memories are evident every time he guards, takes a sharp breath, or shows hesitation when trying a new exercise. The good news is, the more time I spend with him, the more I can help him! Breaking these movement dysfunctions down, one by one, session by session, into compartmentalized pearls of digestible information for him to relearn movement is the treatment program. Some of these memories need to be processed with manual therapy, stretching, and motor control training. Some of these memories need to be processed with a good dose of strength training. Through time, grit, and trust, these memories no longer have their teeth around the throat of Bob’s aspirations. The “memories” such as osteoarthritis will always be there, but with the dozens and dozens of pearls in his toolbox, he is able to manage and grow into a new version of his old self. He is also better able to step back and contextualize the different types of pain he feels and is less fearful of his future. This is growth. Our mind is a powerful thing. Our bodies are equally powerful. Each of them twist together into a complex story that many times involves loss, pain, fear, and sadness. As a working clinician, I see this day in and day out, which is why I am so motivated to help my patients’ minds and bodies learn new movement memories they need to better live the lives they deserve. With work, these old movement memories are reprogrammed into a new movement system that can give a fresh capacity to the function of the previously painful and weak movement patterns. Thanks for reading, Marcus Rein, PT, DPT, CF-L1
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Last week I outlined some mobility restrictions that are likely the culprit if you have pain or trouble with squat pattern. Hopefully you have tried those mobility exercises out, even if you think you are flexible. There is sometimes a lingering asymmetry here and there from past injuries and such. So, you checked your mobility and you have the ideal mobility for a squat. What else could it be? The “butt wink” is a pelvic reversal or loss of the lumbar curve at the bottom of the squat. A few things can cause this—bony architecture and tibia to femur ratios, lack of mobility usually in hip flexion or internal rotation, and/or poor motor control throughout the squat pattern. I will not get into the debate of the first possibility. Yes, we are all unique snowflakes, but let’s make sure our mobility and control are up to par before we blame our parents. To be sure you are setting yourself up for success, check and see if your foot placement is ideal for your bony make-up and mobility. This is best done on your hands and knees with a partner watching and preferably filming. Make sure that your hands are below your shoulders. Rock forward and backwards the finally settle at the center—ask your partner to confirm that you are actually centered. From here, slowly push your hips back as if moving to child’s pose.  Watch your pelvis; when you notice that is starts to rock backwards, this is where your butt wink starts when you are standing with this foot distance. Now widen your knees out a few more inches and repeat. Did the pelvic reversal look the same, better or worse? If better, a wider stance in the squat would work better for you. If worse, stay narrow. If the pelvic position was the same, check in with how your hips felt during each of the two foot positions. Say in the wider squat you felt a bit of pinching, then stay narrow. Top picture: no butt wink, so a good foot position. Bottom picture: butt wink, so I will likely have a pelvic reversal with a squat to this depth or deeper.   Going a step further, you can move to your forearms to mimic the forward inclination of the torso during a squat. Perform the same steps. In the picture below, this is right before I start to have a pelvic reversal, so this is my target depth with loaded squats.  After finding the correct foot placement, stand up and try a few more squats. Is the butt wink still there? Yes: if you are in the correct foot position and have ideal mobility, keep reading! Many of the athletes that I treat fall into these categories: Very flexible and can squat with their booty to their ankles Report feeling tightness in their hamstrings, even though they can bend forward and put their palms on the floor Have back pain with squats that increases at the bottom of the squat, often one-sided but not always Always sore in the quads after squats, rarely glutes or hammies Does this sound like you? Here are two of my favorite exercises to start working on motor control of the lumbar spine, hip and pelvis under load as well as posterior chain strengthening. The tempo goblet squat: This exercise forces anterior stabilization by adding a weight at the chest. The deep core must fire to offset the kettlebell. With a 3 second count lowering to the box, motor control of the lumbopelvic area is even more challenged. Additionally, squatting to a target allows the athlete to sit back more in the squat, engaging the glutes and hammies. This is often a new input for these athletes who are quad dominant. Check it out here: Goblet Box Squat The banded bird dog: Practicing moving your extremities while under the load of a small band is important before you try to move big weight. The bird dog requires hip and midline control with movement, made a bit harder by adding a band. Again, having a partner for a form check or performing this by a mirror is ideal. Many people will have a movement fault and not even realize! The goal is to keep the back and torso in the neutral position throughout. As soon as your form falters, take a break. Check it out here: Banded Bird Dog Add these exercises to your strength days and/or warm up a few times each week. Maintaining your core and pelvic control throughout the range of motion is the first step to easing back pain and improving your strength in the squat! If you try to self-manage for a few weeks and still see no change, let us know. We would love to help you here at Athletes’ Potential!
Dr. Jackie, PT, DPT, OCS, CSCS Flexibility is an important aspect of fitness, along with muscular strength and endurance, and aerobic capacity. However, it is not uncommon to find athletes who are unable to bend over and touch their toes! This is most likely due to sitting most hours of the day and attempting to reverse the changes by ten minutes of stretching at the gym. In the past decade, there has been much discrepancy in recommendations about stretching: how long, what kind, which muscles? Does it depend on your sport of choice? Before or after a workout? There have been countless studies published, even in the past year, with varying results. However, they all agree on one thing: Do not perform static stretches prior to exercising. WHY NOT? Static stretching alters the (microscopic) length of the muscle which can alter, and likely decrease, its firing potential. Stretching may also activate tendon structures that inhibit muscle action. Both of these proposed mechanisms will decrease power output. “Then how should I warm up?” Warm-ups are essential to performance and injury prevention. They are useful for increasing the core temperature to decrease stiffness of muscles and alerting the neurologic system to the events about to take place. This should be achieved with specific, dynamic exercises rather than static stretches or laying on the foam roller. Runners—Studies found that a dynamic warm-up increased performance of endurance runners, meaning they ran longer without exhaustion1. This warm-up consisted of movements such as high knees, butt kicks, leg swings and hopping. Total time: 4 minutes. Notice, I said nothing about running. Those athletes warming up with running had comparable results to those not warming up at all. Check out Dr. Danny’s post specifically addressing running warm-ups. Weightlifters—Other studies found that just ONE set of static stretches decreased 1RM performance by 5.4%2. That would decrease your 400 lb back squat by 21.6 lb! When performing sets for reps, static or ballistic stretching decreased amount of reps by 17-20%3. That’s 2 less reps in your 10 rep set. The most effective was a specific warm-up of 20 reps around 30% 1RM, then appropriately building to working weight. For Olympic Lifts, additional dynamic warm-ups may be warranted, specifically for the overhead movements. One of my favorite drills is thoracic rotation, performed in between light warm-up sets: CrossFitters—You fall somewhere in between; Choose your warm-up type based on the workout of the day. The same theme holds true: specific, dynamic warm-ups! Sport-Specific Athletes—Dynamic, sport specific warm-ups are the most effective to prepare for practice or competition. This includes running, cutting, jumping, ball handling, throwing or whatever your sport demands. Begin at a slower pace and then work up to competition speed movements. Your workout is over, you ran your fastest 5K, PRed your back squat or scored the winning goal... NOW you stretch. To address the earlier question: When, how long, what kind, which muscles? To receive any benefit, hold static stretches for at least 30 seconds but 2 minutes may show better results. Static stretches can work but they take a few weeks for sustainable differences. PNF (proprioceptive neuromuscular facilitation) stretches have been shown to be superior to static stretching. These can be done with a buddy or by yourself using bands or straps. A common form of PNF to increase range of motion is contract-relax. You have likely seen it before:
This would also be the appropriate time to work with the foam roller or PVC pipe on the muscles that are sore or may be lacking flexibility. Of course, the cartoon at the top is wrong. Touching your toes IS everything. Every athlete should have the flexibility to bend over and touch their toes whether or not they are warmed up. Inefficient muscle length can lead to compensation by other muscles. This causes joint pain, tendonitis, faulty movement patterns, poor form and then decreased performance or injury. Stretching is also great to incorporate into rest days. A light warm-up, then your favorite stretches or maybe your least favorite if you have some restrictions. Self-management is 100% possible when it comes to flexibility and recovery! Take the time to take care of your body and it will perform better. Remember, at Athletes’ Potential you can supplement your stretching and take recovery to the next level with full-body cryotherapy and NormaTec compression boots. Call us anytime to schedule an appointment! Thanks for reading, Dr. Jackie, PT, DPT, CSCS References
Midline stabilization is heralded as the foundation of safe and successful weightlifting. But have we been ignoring a part of the “core”? The pelvic floor is a topic that tends to be avoided. Most people do not casually discuss urinary frequency over coffee or admit to their coach that they pee every time they perform double-unders. Men- if you think this one is just for the women, stick around! I only realized the prevalence of leakage after CrossFit HQ posted a video following regionals. All of these women were saying “It’s ok, I pee during workouts too. It’s normal!” Please do not confuse normal and common. Urinary incontinence may be common in certain populations, especially of heavy lifters, but it is absolutely not normal. The pelvic floor includes a group of muscles that attach from your coccyx (tail bone) and sacrum to your pelvic ring.  These muscles are important for bowel and bladder function, organ support, and stability of the pelvis. Although pelvic floor dysfunction (PFD) was thought to be largely a problem of women, it is becoming apparent that men have similar issues. The pelvic floor may seem very foreign and uncomfortable to discuss, but when it properly functions it can improve your workouts. Here’s how: I like Mary Massery’s description of the core as a “soda-pop can”. The front of the can is the abs, the back is the multifidi, the pop top is the glottis and the bottom of the can is the pelvic floor. The core pressure is maintained by a functioning glottis and pelvic floor, with the diaphragm acting as a pressure regulator.   When you take a breath in, the diaphragm descends. This requires the pelvic floor muscles to descend and lengthen. When you exhale the diaphragm rises and the pelvic floor rises and tightens. In fit individuals, (notice I said individuals and not just women), a common pelvic floor problem is overactive muscles. Very strong back or abdominal muscles can cause increased inward pressure. It’s been shown that when your deep abdominals contract, so does your pelvic floor. Imagine squeezing the can from both sides with the pressure maintained. The bottom and top will have to withstand more pressure and bulge. If your abdominals are always squeezing in then your pelvic floor is always pushing up to withstand the pressure. It’s overworked! The diaphragm is pretty darn good at its job. If it does not work, we have a bigger issue on our hands. So often, when something’s ‘gotta give’- it’s the pelvic floor. When all of these muscles work in concert, your canister and the force it can produce is maximized. Thus, your workout improves. A conversation about breathing techniques regarding the glottis and diaphragm is essential to training the entire core. Here I am simply touching on one contribution but remember it does not work alone. Keep in mind, PFD can also manifest in ways such as pelvic pain, painful intercourse, low back pain, urinary frequency or even the dreaded butt wink. It is not just urinary incontinence. “ Pelvic floor pain is only caused by pregnancy, right?” Wrong. There has been no correlation shown between PFD and post-partum women. Sure, some moms experience issues but again, it is not normal for any population. Weakness and/or tightness of the pelvic floor can be caused by poor postural habits, extended periods of sitting, over training of the abdominals and pregnancy. Excluding pregnancy of course, men are susceptible to all of the other risk factors. “Ok, so I pee on myself at the gym and it’s not normal. What do I do to stop it?”
Thanks for reading! Dr. Jackie, PT, DPT, CSCS References: Sapsford, Ruth R, Hodges, Paul W. Contraction of the Pelvic Floor Muscles during Abdominal Maneuvers. Physical Medicine and Rehabilitation, 2001, Vol.82(8), pp.1081-1088. Healthyplace.com Presentation at CSM 2016 by Mary Massery: referencing Massery 2005 & 2006. |
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