New Ligament Found in the Human Knee? So What?

The Anterior Lateral Ligament (ALL)

All over the internet on social media websites such as FaceBook and Twitter there's a popular buzz about a new found ligament "discovered" in the Human knee. This was from a study by some Belgium surgeons who found a consistent presence of the ALL in all but one of forty-one cadavers.
In reality, a Dr. Paul Segond, a French surgeon was the first to document a description of the ligament back in 1879. Obviously, like the conquistadores of Europe "discovering" the Americas, this "discovery" is more like a renaming. In the Belgium study, it states that probably about 97%-100% of us have this ligament. Previously many have thought of it as an oblique band of the lateral collateral ligament (LCL) or a lateral extension of the knee joint capsule.

What does this new "discovery" mean?

Honestly, nobody really knows. But there's some speculation that the ALL has a role in anterior cruciate ligament (ACL) injuries and its potential role in limiting internal tibial rotation as seen in positive pivot shift testing. For now we can just guess based upon our current understanding of the biomechanics of the knee along with the rest of the body.

My Take On This:

If the ALL checks internal tibial rotation and if it's injured, like all ligamentous injuries, the common approach is to facilitate the agonist muscle around the ligament to check further stretching/tensioning of the ligament. For example, the ALL limits internal tibial rotation and the biceps femoris contributes to the opposing external tibial rotation movement; so it makes sense to condition the muscles that externally rotate the tibia: biceps femoris, TFL, vastus lateralis. Theoretically, if the ALL limits the tibia moving internally on the femur, it can also limit the femur moving externally on the tibia and addressing the muscles that internally rotate the femur may also help stabilize an injured ALL: TFL, ischiocondylar adductor magnus, anterior gluteus medius/minimus.

But regardless of these specific muscles that directly affect the transverse plane of the knee and counters the internal tibial rotation tension that the ALL restricts, you'd also want to assess the function of the popliteus:

Popliteus

The popliteus actively contributes to unlocking the knee, internally rotating the tibia, and externally rotating the femur. Its actions of rotating the tibia internally and rotating the femur externally actually create more tension on the ALL. And what muscle do I see pretty much all the time being facilitated and loaded with gnarly trigger points post-knee surgeries? The popliteus, of course. Disengage the popliteus and you decrease the tensional load on the ALL. Pretty simple, huh?

But if you really want protect the ALL, ACL, the menisci, the patella-femoral joint and all the other structures around the tibia-femoral and tibia-fibular joints, assess what is going on up north at the pelvis. The pelvis-femur complex is like the steering wheel and everything below are like the wheels. If your steering is out of alignment, your wheels get much more wear and tear for every mile driven. This is a whole other story and blog post altogether but it is highly recommend to address the function of the pelvis and hip complex in three planes of motion.

Hopefully you got something out of this post and perhaps it helped spark some outside of the box thinking. Please share this with others since no one else appears to be writing about the ALL other than it's some "new" ligament discovered.
;-)

November 2013 Specials

For the month of November, 2013, our special this month is a "Get 3 for the Price of 2" where you get three sessions for $350.00 (about 33% savings). Also, for new patients/clients, save $15 off the normal hourly session rate ($160/hour). Contact me at mjocs@aol.com if you're interested.

Rika Keck interviews Michael Jocson on the Talking Alternative Radio

Here's a link to a radio interview I did earlier in the year with Nutrition, Health, & Fitness expert Rika Keck of NY Integrated Health

Check it out:
Michael Jocson Interview

And thanks for listening :-)

Treat & Train Program at MJ Physiotherapy

The diaphragm: Breath is the first movement we address in the Treat & Train Program

Whether you have an injury or pain or neither, there’s always something to improve with your posture and the way you move.  We are constantly working against and with gravity and over time this can take its toll on our body, as well as our overall health. With movement, we have breath; with breath, we have Life. And to be able to move freely with little to no restrictions can enhance our Life experience. Don’t believe me? Just go sprain your ankle and see how quickly that can affect your quality of Life….

With the Treat & Train Program at Michael Jocson Physiotherapy, you can have reassurance that your program will meet your needs since it is based upon an individualized assessment, which looks at your structure and function. Every session is an assessment in and of itself; every exercise, every movement is an opportunity to learn more about your self. One of my goals in this program is to teach you to become the best therapist and trainer for your number one client,…..You!

This is a monthly program* which consists of up to two sessions per week (total of 8 per month**). More sessions per week can be added and priced accordingly.

Each session generally includes three aspects:

1)   Corrective Phase – This involves any corrective stretches, repositioning, manual therapy, mobility, or neuromuscular re-education activities.

2)   Training Phase – Individualized training program

3)   Recovery Phase – This involves decompression procedures such as stretching, repositioning, and/or manual therapy as necessary.

Although these three aspects logically build upon each other, they occur simultanuously (ie. Every movement is corrective, training, and recovery).

Who will  benefit from this program?

Everyone

To get started on your Treat & Train Program at Michael Jocson Physiotherapy contact me at mjocs@aol.com or FaceBook: www.facebook.com/michael.jocson.92

* Payments are to be made during the first week of every month

** Any unused sessions for the month must be rescheduled within a two week period; if not possible, those unused sessions will be forfeited.  

Posterior Mediastinum. Say What?

Okay. I know just from reading the title of this post many may start thinking this is going to be some sort of anatomy lesson with medical terms they’ve never heard of, nonetheless pronounce. No worries though, the word “mediastinum” is a term to describe the chest wall. For you science nerds who want to know more, go here. For the rest of us, just understand that this post is all about the chest wall, and more specifically, the chest wall around your back. And even more specific, the upper back. To have lower back pain is common and so is neck pain, but look who is in the middle,….the upper back.

The upper back is the middle man between the lower back and the neck and what lies on the upper back as if it is a saddle? The scapulae (shoulder blades). We can call the rear chest wall the posterior mediastinum and we can also include with it the posterior thoracic wall (for some anatomy nerds, they’ll point out that the two are separate but for simplicity’s sake, we’ll group them together). The thoracic spine (the spinal aspect of the upper back) with the rib cage attached to it plays a major role in dissipating loads from the lumbar and cervical spine as well as the shoulder complex. This area is also greatly involved with our breathing. Just look at any young child after they’ve been running around and you’ll see just how well the thoracic ribcage is involved with breathing.

I remember when I was in physical therapy school, we were taught that an excessive amount of kyphosis (a natural curvature of the thoracic spine) was not “good” posture and that “strengthening” the muscles around the upper back and shoulder girdle would take a load off of the neck and lumbar spine and shoulders. What was not as common (or at least emphasized in school) was the opposite, which is considered a flattened thoracic spine kyphosis (or flat spine for short). Both excessive (“hunchback”) and deficient (“flat back)) thoracic curvatures can contribute to aberrant stress to the rest of the body.

The posterior mediastinum and stress

Right around the posterior mediastinum and the posterior thoracic wall is the sympathetic chain which is a part of the sympathetic nervous system (SNS), or the “fight or flight” aspect of our autonomic nervous system. The sympathetic chain has connections to our organs that feed them info about stress. All the soft tissues of the upper back can affect the sympathetic chain. For example, a lack of mobility of this area can increase the amount of tension and thus stress to the nerve tissue. Of course you’re not going to die from this, but in theory, it’s an extra physiological load on your bodily systems. It is common for people to lack flexion in this area and an increase in extensor tone of the spinal muscles can facilitate a sympathetic stress response with an over active diaphragm muscle which in turn functions more as a postural stabilizer as well as a respiratory muscle. The result is a deficient breathing pattern where the anterior and superior aspects of the lungs and chest wall are expanded leaving the lateral and posterior aspects “flat”. Take a deep breath right now and notice how much you raised your shoulders or sat up tall (extension) with your inhalation. I bet you didn’t feel any air going into your upper back?  Not convinced this area is important? Check out this link where a study of patients who underwent surgery for instrumentation for scoliosis correction and had damage to the sympathetic chain and experienced changes in temperature perception and perspiration.

When you perform a lot of overhead weightlifting activities, you’re basically facilitating a constant stress response as far as posture is concerned and decompression of the area is necessary to balance the soft tissues and lessen the tensional load on the sympathetic chain. One simple self-help way to decompress is to improve your ability to flex the thoracic spine.

Seated Wall Reach

Sit up against a wall with your buttocks and lower back up to about bra strap level in contact with the wall. Pull your knees towards you with your feet as close to your hips as comfortably as possible. Place your arms over your knees and reach forward. Exhale and reach forward. Inhale and remain where you are. Every time you exhale, reach a little more forward and every time you inhale, imagine filling up the upper back area up with air (which should be comfortably off the wall with the reach movement). Perform 4-5 breaths and then rest. Perform 3-4 sets of this.

Now that you are armed with this new information, you can apply it to any exercise; especially exercises where the spine is in full extension and loaded. Just imagine filling the posterior chest wall up with air every time you inhale to help mobilize the area and offset any common stiffness of the upper back.

October is National Physical Therapy Month....

Not only is October National PT Month but October 29th is also the one year anniversary of Hurricane Sandy and as many of you who know me, that experience has changed my Life and practice. If it wasn't for Hurricane Sandy, I probably wouldn't have a practice in Manhattan right now.

So in lieu of this being October, I am offering a really sweet deal for new patients and old ones whom I haven't treated within the past six months. This is for those who always thought they couldn't afford my services but were interested in the type of work I do. For more details, please contact me at mjocs@aol.com.

Quick Video For Neck Pain

Ever notice when you have some neck pain or even a stiff neck and it becomes difficult when you drive, especially when you have to park or back up?

Recent Review From A Patient

Below is a recent review from a patient who was so kind to share:

"A year ago, I was diagnosed with a frozen right shoulder which was recalcitrant to the usual medical management

and physical therapy.  Five months later without much progress, I decided to have surgery which helped with mobility but not the persistent pain despite
NSAIDs, icepacks, Percocet 2 tablets every 4 hours and more intensive physical therapy.  Another 4 1/2 months passed and I was in a standstill, I could barely raise my arm to shoulder level and still in so much pain. The goal is for me to raise the arm above the head to get cleared for work. It was then that I decided to find Michael as recommended by a  previous patient who has been raging about him.   I then googled Michael's name and found out about his office in Manhattan. It's quite a travel from Queens and payment is on a cash basis. At that time I was desperate, I was out of job for 9 months and was told that I will lose my job as a Nurse Practitioner in a local hospital in Queens if I do not return in another 3 months. I called Michael that day and immediately started on an entirely new physical therapy experience. He treated me as a whole human being and not just "a part". With few maneuvers, Michael diagnosed that I have left hip weakness that is more likely contributing to my shoulder problem as a "compensatory mechanism".

Within 3 sessions I was able to raise my right arm above my head and eventually tapered off all of my medications. In two months I was finally back to work and managing with the home exercises that Michael taught me. I am still seeing Michael once a week while am adjusting to my workload but doing just great!"

 

Merla Repato, RN, MSN, CCRN, APRN-BC

Occasional Sacroiliac Joint Discomfort

You may not have any "significant" complaints of sacroiliac joint (SIJ) pain (that area where your tailbone meets your pelvis), but you can seem to reproduce some discomfort when you're in certain positions such as after prolonged sitting activities such as sitting in front of your computer such as what you are doing right now. Now let's say that when you fully slouch, or tuck in your butt, you start to feel some discomfort in the SIJs; and let's say you move your pelvis in the opposite direction where you're sitting taller and sticking your butt out and you also feel some discomfort. I bet if a therapist stuck their thumbs in that vicinity, they'd find the "speed bumps", or areas of fibrosis, which is  the body's response to excessive, prolonged soft tissue stress where it thickens the involved tissues. The sacrum and the ilium of the pelvis move all over the place and their structure (form) and the muscles around them (force) provide for stability in what's called form & force closure. When the positioning of the joints are less than ideal or if certain muscles are not working when they need to be, you get a case of "instability". And instability of the SIJs can be compensated everywhere else throughout the body. Just imagine the stereotypical "sexy" woman gait pattern where the hips sway excessively side to side and how this can contribute to possible ankle sprains, knee pain, low back, neck, and shoulder issues as well.

Now getting back to that discomfort in your SIJs when slouching and sitting up tall:

From the above picture, you can see the relationship between the gluteus maximus (butt) and the opposite side latissimus dorsi ("lats"). For example, look at the right butt and go diagonally up towards the left shoulder; you'll notice how the muscle fibers flow together in an oblique fashion. This "butt" and "lats" relationship provides for force closure (stability) of the SIJ (in this example, the right SIJ). Whatever side discomfort you feel, contract that side buttock muscle and the opposite side "lat"(tighten your armpit or press your hand down into your lap); maintain your butt & lat contraction (while breathing), and slouch or sit up tall as you did before. What you'll notice is that your discomfort should be gone. This is because you're using the muscles in a way to protect the joint.

The genus of our body is that everything works together. The "butt & lat" relationship relates to how we developed the ability to walk where the opposite arm and leg move together. We run into problems when we no longer perform activities that stimulate our nervous system. In other words, we get lazy. And when we're lazy, we lose function,...the old "use it or lose it" phenomenon .

You'd be amaze at what your body can do once you spend some time exploring its potential....
You've got muscles. Now go use them.

;-)

Reference:
Vleeming, A et al. Movement Stability & Low Back Pain: The essential role of the pelvis. Churchill Livingstone, 1997: pp.231-233

If You Like To Run: Work Your Hips!

I've treated a lot of runners over the years and one clinical pearl of advice I can give to running enthusiasts is to condition their hips. Every running injury I've ever treated had a component of hip dysfunction. Hip dysfunction could be in the form of hip joint hypo- or hyper mobility, muscle weakness, or instability. Or it can be something as simple as a lack of coordination of firing the right muscles at the right time.

Regardless of what kind of hip dysfunction is present, I'd recommend adding some kind of supplementary hip specific mobility, stability, strength, power, and proprioceptive training into your program.

The following picture is from the book Human Locomotion: The Conservative Management of Gait-Related Disorders by Thomas C. Michaud on page 133:

It's interesting that he mentions that some of "the best long distance runners possess leg morphology that distributes mass closer to the hip joint." This is due to the high metabolic costs during running of accelerating and decelerating the lower legs. He cited a study where the authors added weight to the feet and found that it more than doubled the metabolic costs of locomotion:

Martin P, Heise G, Morgan D. The Relationships between mechanical power, energy transfers, and walking and running economy. Med Sci Sports Exerc. 1993; 25: 508-515.

And with long distance running, it's all about energy efficiency. As one fatigues, the body compensates, chances of injury increase.

The bottom-line:

If you like to run, work your ass.

Fascia & the Turkish Get Up

I made this quick video in response to a recent FaceBook discussion brought up by Joel Crandall of PhysioCareCenter in Los Angeles, California regarding the Turkish Get Up (TGU) movement. His question was brought up at a study group where a few were RKCs who were not able to answer his question of why some people say to dorsiflex the ankle of the bottom extended leg during the beginning of the movement. Some other RKC/StrongFirst trainers responded on the FaceBook thread that it's not so much the dorsiflexion of the ankle that's important as is the emphasis on pushing the heel away from you to create a stable point in which the movement can be transitioned. I talk about the possibility of the fascia creating the stability at the pelvis from the positioning of the extended leg from some courses that I took with Guy Voyer, DO.

I do want to emphasize that I am NOT a RKC/StrongFirst certified trainer nor do I currently train the TGU movement but I do study movement, health, and everything in between and I have and continue to treat injuries as a living. This is just me sharing a different perspective of the TGU relating it to the fascia. Enjoy!

The Iliacus: a LCF

From my training in Neurokinetic Therapy (NKT) with David Weinstock, David refers to the iliacus as a "LCF", which stands for Lower Cluster F**k, because of its common involvement as a facilitated compensator for so many other muscles throughout the body. For example, it is very common for the iliacus to compensate for a psoas or gluteus maximus or abdominal oblique muscles that aren't working as effectively as they can be.

So why is the iliacus commonly facilitated?

I don't know exactly, but my best guess could be it's location. The iliacus is a deep muscle that inserts to the upper two-thirds of the iliac fossa and inserts onto the lesser trochanter of the femur; it also has connections to the anterior aspect of the sacrum.

This means that it has its hands on several different joints: coxa-femoral, femoral-coxa, sacroiliac, and iliosacral. These joints are a part of the pelvic-hip complex which can also be viewed as a mid-point between the lower body and the upper body. Whenever there's a mid-point, there has to be a common ground, or "middle path" (as the Buddha would say), where a balance between the forces above and below take place. This balancing is a dynamic process and because the nervous system moves towards "stability" and avoids "instability", it tends to facilitate the deeper muscles (or muscles closer to the joint) in order to create a crude sense of stability through increasing joint compression when it senses an "unstable" process. From my experience, whenever I see a facilitated iliacus, it's common to see a compressed hip joint, an anteriorly rotated ilium, and a forward sacral base ipsilaterally. This can present itself clinically as femoral-acetabular impingement (FAI), forward sacral torsions, and/or iliosacral instability which presents symptomatically as pinching in the groin, hip pain, SI joint pain, low back pain, difficulty bending, walking, negotiating stairs, etc.

What happens if the iliacus is "inhibited"? No muscle is ever really fully inhibited; for lack of a better word, let's understand that when I say "inhibited", I mean a muscle that's not firing as effectively as it can be. David Weinstock mentions that it's rare to find an inhibited iliacus. But when you do, there's usually several layers of compensations going on. I usually see a multi-system overload and the "inhibited" iliacus is just the icing on the cake. Locally, it can be something as simple as positioning and functioning of the involved joints. For example, when there's a restriction in hip flexion and/or a restriction in anterior rotation of the ipsilateral ilium, the iliacus may test inhibited. To verify limited hip flexion involvement, one could muscle test the hip in less flexion after testing the involved iliacus in a shortened position and if it tests strong, limited hip flexion may be contributing to the inhibited iliacus due to arthrogenic inhibition. One can also test the psoas muscle and its inhibition is another way to verify hip flexion restriction. For iliacus inhibition due to limited anterior ilium rotation, one can test the quadratus lumborum and latissimus dorsi; these would test inhibited while the psoas would test strong. 

Sometimes we assume just because we are a more sedentary society and that we tend to sit a lot that the iliacus is always in a shortened position and that it can more easily be recruited in times of instability and over time it can develop trigger points, be facilitated, and even after a while, get "tired"and become weak due to fatigue. We never really know unless we assess its role in relationship to the rest of the body and overall tie it together with its integrated function during movement. Without movement the iliacus would never be considered a "LCF".....

Red Velvet Chocolate Marshmallows

My son and I were watching the Cooking Channel the other night and there was some show that had a lot of dessert-type of dishes and one popular dessert is red velvet cake, cupcake, and many other variations. At the time I was thinking of making some marshmallows since I haven't them in awhile and then the lightbulb went off: Why don't I make some red velvet marshmallows?

Last year I had already posted a recipe for chocolate coconut marshmallows so a red velvet one would be similar with some obvious changes. Here's the ingredients I used:

Great Lakes Gelatin (orange can) - 6 tbs
Organic sugar - 1 1/2 cups
Organic red beet - 1/2 medium size (peeled & chopped)
Organic dried coconut chips (or flakes) - 1 cup
Organic powdered cacao - 3 tbs
Organic vanilla extract - 2 tsp

While I was making this, I realized that I used way too much cacao and that's why the marshmallows didn't turn out to be as red; but the extra cacao made a real deep chocolate flavor.
I basically used beet juice and coconut milk instead of water to mix with the other ingredients. To make the beet juice: place chopped beets into blender and add just enough water until covered. Blend. Pour blended mixture into a cheesecloth or nut milk bag, or do what I do if you don't have any of those, use a fine mesh strainer and strain the liquid (discard the beet solids). To make coconut milk: do the same as with the beets. Mix the beet juice and coconut milk together in the same container. Take one cup of this and let sit with the gelatin powder for about 10 minutes. While that is sitting, in a skillet or saucepan, heat another cup of the beet juice/coconut milk with the sugar to a gentle boil, or at least to a little thickening. Add the cacao powder and vanilla extract and boil some more. Next, pour this into the gelatin mixture and user a hand mixer to blend until desired thickness. This may take about 10-20 minutes depending on the power of the mixer you have but you don't want to mix too long that it's gets too thick. Pour the mixture into a greased container (I used a square glass pyrex greased with coconut oil), flatten and smooth the mixture, and store in the refrigerator for at least a few hours before eating.

Before serving, I sprinkled some sea salt onto a plate and coated the top surface of the already squared-cut marshmallows to give that sweet, chocolatey, salty taste, but that's just me. In the above picture I put the marshmallows into my Lunchbots container for work and as you can see I also have the green container of Great Lakes Gelatin in which I mix with orange juice as a post-work-out drink (I didn't want anyone to get confused which can to use for the marshmallows).

Enjoy!

Glenohumeral Internal Rotation Deficit (GIRD)

This is just a quick video where I demonstrate that limited glenohumeral joint internal rotation ROM is not necessarily from a "tight posterior joint capsule" that requires joint mobilization or stretches to improve internal rotation. If you do so without understanding and checking the relationships of the rest of the body to the involved shoulder complex, you risk creating a joint instability issue. I'm calling out physical therapists, chiropractors, or any bodyworkers, that do this type of treatment and probably have no idea that they're actually doing more harm than good for their patients....

Adverse Neural Tension

This was a quick video I made after work last night regarding a patient with symptoms of adverse neural tension of her right arm. Adverse neural tension means simply that the nervous tissue is being compromised somewhere along its span in the body to the point of expressing symptoms of numbness, tingling, or even pain. In this case, the patient had been to several medical specialists and had plenty of diagnostic work-ups that were all without any answers.
Enjoy...

Oil Pulling: Clean your mouth!

Here's a video from an osteopath and CHEK Holistic Lifestyle Coach, Alistair McGee, from the UK about oil pulling, a potentially effective, and yet simple technique for oral hygiene.

Bodywork at Michael Jocson Physiotherapy

When one thinks of "bodywork"there's usually images of the client lying on the table while the bodyworker paves away at their body leaving them feeling like mush, relaxed, and rejuvenated. This conventional way of thinking of what bodywork is has more of a passive priority where the "bodyworker" does most of the work in realigning and affecting the neuromusculoskeletal systems while the client basically lays there and does relatively nothing. In our modern-day, stressed-out society, the "passive-biased" bodywork is needed in a de-stressing capacity and it's preferred by the public since who wants to have to think more about anything in addition to the daily grind BS we all deal with everyday? To actually have to pay Attention to our own bodies and to actively do something to change our habitual ways of moving for the greater good of our Health takes a lot of commitment and most would rather pay money to have someone else make them feel better.

Perhaps it's time for a paradigm shift? There's nothing wrong with passive bodywork; it can help, and it does feel good, but for many of us, learning about ways in which we can sort of be our own "therapists/bodyworkers" by being more aware of our postural tendencies and movement habits and their consequences and taking Responsibility to make the appropriate changes at each given Moment....wow. Imagine that: being able to unload overly loaded aspects on the fly so as not to go beyond the given capacities of the soft tissues to the point of compensation into an injury.
In other words, injury prevention through enhanced Awareness.

In my practice, I assess your alignment/posture in three planes in various positions, and during various movement patterns as well as at rest. I teach you about what I find as far as where you are right now with how you are presenting to me how you stack your body up and willfully move from there. It becomes more of an art rather than a science because there are several variables that can affect how you move and my job is to expose as many of them to you so that you can make the appropriate changes. For example, what you do for the majority of the day (as far as movement) does affect the structure and function of your body. Your body adapts to whatever stress you place upon it. So if you sit at a desk all day, your body will conform to make sitting as easy as possible; the same goes for if you're very active, where the body (actually, your nervous system), will attempt to be as efficient as possible where the brain is not so much concerned with specific muscles as it is with movement patterns and will choose the easiest path to get the job done. The problem arises when we've adapted so much to a sedentary lifestyle that it accelerates the breakdown of our tissues and a "forgetting" of primal movement patterns, and prevents us to do more than what we're used to. My take on this is that it's never too late to make beneficial changes once you understand where you presently are, what faculties are available, how to use them effectively, and a vision of where you want to realistically be.

In other words, I help You earn the right to carry your Body throughout Life.....

So if you're looking for a "massage" and don't want to take any Responsibility for your Health,...please do not call me for an appointment. But if you want to be your own therapist,....I've got an appointment waiting for you ;-)

Pelvic Floor Question

Nanna from Iceland sent me a question recently regarding the pelvic floor and training. Since I haven't been making videos lately, I decided to film a quick response. Enjoy!

Got Training?

I don’t just treat patients; I train clients as well.

And when I train clients, I teach them awareness of their body with movement. And with that awareness, they discover what areas tend to work more and what areas tend to work less. For example, everyone knows about running, right? Maybe not, but when you observe someone who says they “run”, they’re actually “jogging”, which is a slower pace form of running. And when they run, there’s actually specific areas that take more stress then others. For example, it’s common to see the calves, shins, heels, and/or lower hamstrings do a lot of work and the glutes sent on vacation somewhere. Where’d they go? I don’t know, but they’re not functioning on that “runner”. My point is that most people go on auto-pilot when exercising and when they over-do it, they start to experience some kind of discomfort and/or pain that may “go away on its own”, or actually worsen over time if they keep ignoring it.

One simple test I do with clients is to have them perform an exercise, such as running, and to stop when they start feeling an increase of muscle activity in a predominant area such as the calf or even when they start noticing an increase in pressure on the heel, etc; The point is to have them stop when they reach a point of excessive demands on a specific area not to the point of discomfort or pain but when it grabs their attention more than when rested. This point would be what I call their threshold and I would design a program with the goal to increase it so that they could do more of their activity but with less chances of overuse to a specific area.

Obviously there’s more to it than threshold testing. Once I’ve examined their mechanics and tweaked variations of their movements to pin-point what I call the “Golden Nugget”, or primary area of dysfunction, I further investigate specific muscle imbalance relationships in a more stable, less-threatening to the nervous system position such as lying on the table. From here, we work on any specific relationships that may be affecting the client’s movement capacities. In other words, I guess you can say we work on their “weakest links”, improve them, integrate them with the whole body & movement skills, and then challenge them to sink it into the nervous systems movement repertoire.

My take on training (in no particular order) is Awareness, Variety, Consistency, and Newness.

Yes. I do train clients.

Is ice the best answer for acute injuries?

Is ice really necessary after acute injuries?

Throughout our lives we are taught certain “absolutes” that are rarely questioned and simply assumed to be “true”. In physical therapy school, I was taught the basics of human physiology in how the body responds to injury where the initial inflammatory reactions are to be addressed with the RICE principle of rest, ice, compression, and elevation. With almost two decades of clinical experience, I have to question the application of ice post acute injury. An inflammatory response brings increased blood flow to the injured site in order to facilitate the healing process. The increased blood flow creates heat and warmth to the soft tissues and the application of ice/cold counters this response. I find that the most benefit from this is the temporary numbing effect of any pain experienced. And if any of the initial swelling does go down, it is more so temporary where the injured limb swells up again later on. Does ice actually hinder the healing process and have we been blindly following the RICE principle without challenging it? We were taught to get the swelling down as soon as a possible and that’s why ice is issued. Prolonged swelling prolongs the inflammatory response and delays healing (so they say). But what if the application of ice is the culprit in prolonging the inflammation?

What’s been working for me?

I find what helps the swelling of acute injuries best is the following:

1)   Rest

2)   Compression – either with an ace wrap or sleeve or with kinesiology tape

3)   Pain-free movement of the involved body part as well as its neighbors

4)   Elevation

5)   Drinking more water with some sea salt

6)   And what I find to be the most effective approach to facilitate the healing process as well as reduce the acute swelling: dry needling with acupuncture needles……

Obviously, sticking yourself with acupuncture needles is not the most practical approach and requires professional assistance but the first five are very realistic. You can still use some ice, in my opinion, if you have a lot of pain. And if you do have a lot of pain , you still may want to get it checked out by your doctor to rule out more serious pathology such as fractures.

Above is is a picture of my sister-in-law who had sprained her ankle the day before this picture was taken. I treated her with electro-acupuncture followed by application of kinesiology tape. Where prior to treatment she had significant difficulty putting weight on her right leg making walking unpleasant, she was pain-free and walking normally the next day. And immediately after treatment she noticed how much easier it was to weight bear on the right and less pain.

Train Like A Boss

The Boss, or “El Jefe”, is the one who is in charge and most importantly, the one who is responsible for whatever show he is running. Whether it’s success or failure, the Boss is the leader who takes the praises or takes the fall. How many of us train like a Boss when it comes to exercise, diet/nutrition, and overall health? To keep things simple, let’s stick with just exercise. Training like a Boss in the gym isn’t about how much weight you’re lifting, or how intense, or even how loud you can grunt during a set. Training like a Boss is taking full Responsibility for every exercise, every rep, every set, every workout, and being accountable for the results, good or bad. Training like a Boss is knowing what you can and cannot control when working out. You can control your awareness of your technique/form, which exercises, how much resistance, how many reps/sets, what kind of tempos, how much rest in between, as well as how much is enough. What you cannot control is the behavior of others in the gym or what they think of you. A Boss isn’t easily distracted from the task at hand. A Boss gets it done. A Boss learns from his mistakes, regroups, and gets back on his feet again. A Boss knows what he’s capable of and yet understands he’s only scratched the surface of his Potential. A Boss is bold enough to explore untamed areas and has the only expectation of expecting the unexpected. A Boss has a systems analysis which is constantly checking and rechecking for constant improvement (kaizen). A Boss is never alone and does his research with the help of others. A Boss has coaches as well as coaches others since he understands the interdependence of it All.

So the next time you go to the gym, be the Boss. Be the Boss of You….

Whatever you do, pay Attention. Assess and reassess and apply what was learned. Own your thoughts. Own your actions. Have goals and work towards them. So what if others in the gym are watching you? You the Boss, so show them the Way….