Wednesday, August 14, 2013

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

Monday, August 12, 2013

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.


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

Saturday, August 10, 2013

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.

Friday, August 2, 2013

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!