Recently I had a day where I was doing a lot of evaluation on clients. I do that a lot. People come to me with aches or pains and are trying to figure out where it comes from. One of the favourite parts of my job is trying to figure out the actual source of the issue rather than where the pain is coming from. If you’re not assessing, you’re guessing.
I’ve been doing this for twenty years. Thankfully over that time I literally have hundred of examples of where pain comes from, and many of the places are common sources. So I’m writing this article as a starting point to where I often find the major source of an ache or problem is in the three main parts of the body. It might not be where you think it is!
As I’ve said before, pain is just a signal. There’s something wrong with the body or it’s alignment or movement that needs attention. And with most people when it comes to aches and pains, there are three areas they manifest most. Those parts are:
Shoulders or upper arms
Feet and ankles
Pretty common, right? I’d say the majority of people I see have one of these areas affected. Which is why it’s been so easy over the years to figure out what could be going on.
I almost labelled this article as “Most of the time it’s BLANK” because that is absolutely what happens. Ninety percent of the time pain in one of these areas comes down to one main muscle. So if you’re having pain in one of these areas, read on and I’ll be able to give you some insight.
As I’ve said before, this is not a diagnostic process. These are simply the first locations I will go to when discussing pain in a particular area, and through my years of experience I find that they are most often the culprit towards stiffness, pain, or dysfunction. There are over six hundred muscles in the body, and it is incredibly complex. So what you’re experiencing could be from somewhere else. These are good places to start checking.
What I’m going to do is go through all three areas, the muscle involved and then what you can do about it. The next part of this article will deal with the solutions and what you can do to help yourself if one of these areas is affected. Let’s get started:
AREA OF THE BODY THAT HURTS: Shoulder or upper arm, sometimes when rotating or lifting.
MOST OF THE TIME IT’S: Latissimus Dorsi, most commonly called the lats.
This muscle is one of the largest in the upper body, and originates in several different places. The reason that this is on the list is because it directly affects several different areas of the body in movement. This list includes the shoulder blade, rib cage, upper arm and even the lower back. It is even assisted in some movements by other muscles.
When working with people pain will most often manifest underneath the shoulder blade or mimic rotator cuff issues where pain will travel from the upper back down the upper arm. This is because of the way the lat helps to stabilize the shoulder blade along with some of the muscles of the rotator cuff. It is also the prime mover for a ton of physical movements that require pulling.
If you’re doing a lot of things like rows, pullups, deadlifts in the gym it can become an issue. For regular people, doing externally rotated movements and having them loaded or even things like sitting with your shoulders around your ears can cause this muscle to become overactive (trying to pull your shoulders down) and painful. So desk workers, take note.
I always advocate that people emphasize pulling movements over pushing movements, especially if they are recovering from postural issues. This is a massive part of addressing these problems.
AREA OF THE BODY THAT HURTS: Lower back or hips.
MOST OF THE TIME IT’S: Quadratus Lumborum
This muscle in my world is called the QL, and is part of a system of deep abdominal muscles, even deeper than ones like your abs and your TVA. And it does a lot of stuff. Not only is it a muscle that affects inspiration because of attachment to the diaphragm, but it is used when laterally flexing (ie bending sideways) and extending the spine (ie leaning back).
It also greatly helps with stabilizing your pelvis and when it is affected, has trigger points that hit the back outside of the hips and also the middle of the lower back just above your butt. So when you’re experiencing lower back pain, it’s a big player and very common for me to see in pain when people are having problems bending, rotating and sitting.
Because it is a very deep muscle it gets used a lot in combination with your other trunk and core muscles, especially because it attaches to your lower lumbar spine. Now, your “core” (or trunk muscles) have not only many layers but they all work together to create movement and protect your spine and hips. So isolating one muscle is difficult, but it is possible to address it while dealing with a few other areas.
If a physio has told you to “strengthen your core” then odds are they meant this muscle.
AREA OF THE BODY THAT HURTS: Ankles or Feet.
MOST OF THE TIME IT’S: Soleus
The soleus I like to call the forgotten stepchild of the calf. Many people know about the big meaty gastroc at the top of the calf just below the knee. However, the soleus is below it. It ties directly into the ankle because it inserts as part of the Achilles tendon and it travels all the way up the lower leg on the outside.
It is a massive contributor to things like walking, running, jumping and even climbing stairs. Part of the reason for this is because it takes load off the larger calf muscle when the knees are bent. In fact, at a 90 degree bend (ie sitting down) the soleus takes over completely.
The issue here is that most people don’t strengthen this muscle properly. So you end up with a very strong gastroc and then when the soleus needs to work, it can’t as effectively. This can lead to ankle pain and even lower limb issues through the knee. Remember that your feet and ankles take an incredible pounding if you are active, and it is easy to have one part slightly out of alignment or weak.
Many people forget about calf strength and foot strength, and for any athlete or lifter it is important to take care of these areas. They are your link to the ground!
SO WHAT DO I DO?
In my next article I will discuss the solutions to these areas and what you can do to help yourself with stubborn tissue and chronic problems. Until then, do a quick self assessment of these areas. Are they tender when massaged? When you’re stretching them, do you feel a restriction (especially on one side)? Is there a movement I’ve described that gives you pain?
As I mentioned, this isn’t a definitive list. It’s a good starting point. These three muscles are incredibly common for contributing to pain and stiffness, which is why I call them the Big Three. I could probably have called this article the Big Ten, but there’s only so much room. These are the top.
Remember that finding the source of the problem by isolating it should always be a first step towards recovery. As always, if you need any help, or have any questions feel free to reach out. I hope that you found this useful and stay tuned for my next article!
So this year due to the pandemic I decided to take up a new sport. Well, at least one I haven’t played since I was thirteen. Soccer. Which has been an interesting journey to say the least.
After a partially torn quad, vertigo and now yesterday I can say that my body is definitely not used to the forces involved and has had a hard time adapting. Which is what prompts this article.
I’ve been working with injuries for two decades now, and one thing that people don’t realize is how often I have hurt myself. Usually through sport of some kind, but sometimes just doing stupid things that happen. One example is when I tore a meniscus falling in my driveway on an icy day because my dog pulled me the wrong way. Stuff happens. But sometimes when I go over the laundry list of musculoskeletal things I’ve done to myself it actually boggles the mind. There actually isn’t a part of my body that hasn’t been injured at one point or another except my head and neck and I had three concussions as a kid so maybe that doesn’t count. Active child, go figure.
So what do I do when I actually hurt myself? I realized this could be a good guide for those of you who still happen to get aches or pains and while I love our medical system, waiting for service isn’t exactly an option sometimes – even seeing your GP these days can take months. I decided to put together this quick summary of my thought process and how I approach things. I hope that it might help the next time you do something dumb and aren’t sure what happened. Here’s an easy checklist to follow:
Step One: Find the source.
Usually this is pretty easy. Ow, that hurts. But sometimes it can be a movement or a type of pressure that hurts. For example, this morning when I got out of bed my right leg couldn’t bear much pressure, and definitely couldn’t experience shear in the knee. First thing I always do is check other places. Ankle? Good. Hip? Good. Back? A bit stiff from diving around but still okay.
Press on the area – is it tender? Is there swelling? Is the pain continuous or only during movement or load (ie standing up, lying down or a certain position). Are any of my muscles around it stiff? Make a list and see what you can isolate to investigate further.
I only knew about this when I got out of bed and a bolt of pain shot through my leg. Going downstairs was also quite a challenge. No visible contusions (yet, those can take a day or two). No immense swelling. Pain is isolated to my right side.
Great. So it’s my knee. Now we move on to step two.
Step Two: How bad is it?
Can I put pressure on it? Sort of, just not stable. Can I move it through a partial or full range of motion? Yes, although there is a range that hurts more when I do that. Is there a particular movement or pressure direction that causes pain. Yes, acutely with forward shear and also lateral movement. Like holy crap that hurts.
Problems are stairs, any excessive range while walking or stepping (this is called forward shear) and it is really not happy if I plant my foot and rotate.
What parts of my knee experience that? Now, this may require some knowledge of anatomy, which I am lucky I have. You are all lucky enough to have a phone available with the entirety of Grey’s Anatomy available at the type of a button. So what’s on the outside and base of my knee? And what experiences pain with lateral movement?
With my knowledge I know that it is one of about three things: lateral meniscus bruising or tear (the spongy part between your knee bones), an ACL or LCL sprain (middle and outside support ligaments) or possibly a tibial plateau issue because the pain is in the top of my tibia. However, if it was a fracture I know pain would be acute and immediate so I can rule that out, as I can any sort of tear because that would have me almost immobilized.
So that narrows it down to a ligament sprain or a meniscus bruise. It would take me months to get imaging to confirm that so we treat that and go from there. Thankfully as knee injuries go these are relatively minor, just annoying.
Step Three: What do I do from here?
98% of the time the answer to this is rest it, elevate it and take ibuprofen for pain. Even if you go to the hospital. Avoid movements that cause pain and support it when you need to. Here’s a simple guideline: a strain or sprain will take anywhere from a few days to two weeks to go away. A serious sprain or partial tear more like 2-4 weeks and something really serious (ie a break or fracture) it can be six weeks plus. But if something was that bad hopefully you’d be at the hospital already and getting a cast.
Often over the first 24-48 hours swelling will kick in and things will change. Inflammation, contrary to popular belief, is not a bad thing – it is locking up the area so the body can start to heal it. Using things like ice has been shown to slow that process. After about a day or two, start with heat and massage for blood flow. This can easily be done with heating bags and self-massage. That’s always the first step.
If things don’t resolve in a couple of days or seem to be getting worse, then it’s time to get checked out seriously. But for what I think this is, it isn’t a big deal. It’s only been about sixteen hours so that may change this week.
Step Four: What caused it in the first place?
People forget this step all the time, and then for some reason manage to re-injure themselves. Gee, I wonder why.
I play goalie for my soccer team. It requires a lot of diving, sometimes onto my knees and yesterday I blocked a couple of key shots as well directly with my knees and also got kicked hard in the foot. Any one of these things could cause the issues I’m having today (we still lost, but whatever). So avoiding deep knee compression and forward shear through the joint is a good idea for a little while. In a couple of days, with any luck I’ll be fine. After next game my soccer career is done so with any luck I’ll be okay for next game. But I’m also not stupid, and if something hurts I don’t risk it at the age of 46. Neither should you.
I can’t say that enough – IF SOMETHING HURTS, DON’T USE IT. I put that in caps because athletes are stupid. Give it a day or two to rest and heal and try again later. Your life isn’t going anywhere and if you take a couple of days off, there are lots of other activities you can do. This morning I did an upper body workout because I didn’t want to use my legs. No problem.
Now, just because you read this – please don’t be stupid. If you’re in a lot of pain and can’t move a joint or see massive bruising or discoloration, go to the hospital and get imaging. Something really bad is best treated early on rather than waiting. But in my experience, being proactive and at least trying to figure things out on your own is vital. Or, if you have a practitioner (I happen to know one) who can figure it out or at least suggest some options, contact them. They should be happy to help. Unfortunately most GPs have little knowledge about skeletal injury through no fault of their own and will simply refer you out anyway.
Anyway, please wish me luck with my knee rehab and in the soccer playoffs next week. I hope this helps some of you think about things properly the next time you have an injury and please feel free to reach out to me if you have any questions about anything! Also, feel free to share it with others if you find it useful.
At this time of year, there are droves of people heading to gyms with a firm resolution to get in better shape and lose weight, get strong or finally run that race. New Year, new you – and this year you’re going to make it stick. I want you to be successful.
Unfortunately, there’s also a lot of fitness professionals and facilities who prey on these people and are trying to land them as new clients by any means necessary. They will promise free classes, free months, free back massages just to get you into the door of their place and try to sell you into a program or membership or package.
Most people equate fitness as something that has to be difficult in order to make progress. In reality, nothing could be further from the truth. So when you’re about to start that new fitness program or change your habits, ask yourself these three things and you’ll be much more likely to stick to them long term and achieve the goals you set out:
Have I Done my Research?
When finding a new facility or possibly hiring a professional, everyone is offering bargains and deals. In fact, just a couple of days ago I received an unsolicited message from a spammer asking ME if I wanted to join his group classes for free for a month.
Your workout space should fit not only your personality (if you’re new to fitness, going to the local Iron Gym might not be a good idea), but also your ability to go as frequently as possible (ie close to home, work or in between somewhere) and your budget. Also, acknowledge to yourself if you prefer working out by yourself (so strength training or spinning at home might be for you) or as a group (HIIT training, Crossfit or yoga).
If you’re hiring someone, everyone is giving consultations for free. First thing I suggest is to trust a referral from someone who HAS GOTTEN RESULTS that are similar to your goals. Next you have to see if their philosophy and personality are things you will get along with. Last is budget – if a trainer asks you to sign up for a year of sessions on the spot, walk away.
Finding a good fit for you means you are likely to go more often because you enjoy it, not because you feel like you have to. If you don’t want to be there, you’ll find an excuse to stop going and that is what you want to avoid.
Is what I’m Doing Appropriate for Me?
Joining a new group exercise class that promises high intensity training and quick results is typically the first stop for many. Unfortunately, group classes are rarely scaled or supervised properly unless they are small groups (ie about a 4 participant to 1 instructor ratio).
You also might be put into a room with people who have been doing intense exercise for years and asked to do the same thing as they are doing. This can involve things like heavy dynamic movements, tons of repetitions using bodyweight, or complicated sequences that will exhaust you quickly, making you think it is good for you. You’ll sweat, feel exhausted and get caught up in the moment where you’re encouraged to probably do way too much, way too hard, way too SOON. And then get discouraged and quit, or get injured and quit.
There is a period that your body goes through when it is introduced to new stimuli (like a new movement or environment) called neural adaptation. I call this subconscious competence, almost like riding a bicycle. At first, it is difficult and you fall or feel unstable. Then your brain and nervous system learn to adapt to the movements and you acquire more balance. This is also a fundamental principle of strength training. Think of it as gradual learning for your muscles, which are controlled by your brain.
As the difficulty of a movement goes up, the harder your nervous system has to work to recruit things, giving you less possibility to control any individual component. Again, this is where proper coaching comes into the picture and learning something that sounds simple like a squat, can be very important.
For experienced exercisers, this window is smaller. For new exercisers, it can be quite large. Far more than a quick explanation or watching other people doing it and trying to emulate it. In new classes, make sure you’re doing things that you can manage, and if that means every other rep then so be it. Go at a pace that you can manage and NEVER go to muscular failure.
Another quick mention for those of you who were “in shape” years ago. You’re not now. Therefore your body needs time to re-adapt to movements you haven’t done in a long time. You will adapt faster, but not instantly.
Am I Listening to my Body?
As I’ve said before, pain is your body’s way of saying STOP IT. Especially acute pain, which is generally a signal that you should stop immediately, like putting your hand on a hot stove.
Even after a workout, if you feel shaky or lightheaded and have trouble walking to your car or more importantly, driving it – you may have done too much during that session.
Feedback to either yourself or whomever you’re working with is essential for this. My clients report to me the day after every session, even if they are fine. Recording what you did, how long and how much is also vital to make sure you can go back and adjust if need be.
This can also be a question you need to ask when it comes to your diet. If you’re considering making changes, start recording what you’re eating, but include a section where you write down how the food you eat makes you feel and when you’re eating it. Most people can progress quite well just by reducing or eliminating the big three (alcohol, sugar and starchy carbs).
Some need a more involved protocol or elimination diet. If a food makes you feel crappy – why are you eating it? If you’re eating because of the HALT method (habit, angry, lonely or tired) then reconsider why you’re doing it.
If you ask yourself these three questions when you start back in this New Year, you’ll be set up much better for success. The last thing you want is another year of gym fees disappearing because you gave up in February. And as a professional, I want you to be as healthy and fit as you can possibly be. Just make sure you’re asking the right questions, doing the right things, and listening to your body along the way.
Have a wonderful 2020, and as always, if you have any questions, my inbox is always open at firstname.lastname@example.org!
It’s a New Year and everyone is excited about 2020. Lots of perspective about where you were ten years ago. Ten years ago, I moved to my current city and had to start my practice back up from nothing – not knowing a soul in the city besides my girlfriend. Thankfully I met a ton of great people and today I’m thriving and well.
One thing I read about a lot in January is people wanting to get back into good habits, which 90% of the time means the gym. They resolve to lose weight, set goals and really kill it for this new decade ahead. Well, not to be a David Downer, but here’s the truth: 70 percent of them will fail by mid-February!
Here’s a couple of strategies I always tell my clients (and anyone who asks me) that over my two decades doing this job I have always found more effective than resolutions.
- Focus on health FIRST, weight loss or body changes after that.
So many people want to get into shape, they decide to go on the latest fad diet or new book they read over the holidays. This usually leads to drastic changes that aren’t sustainable once you get back into your normal routines. Or, life gets in the way and then you have to take a break and get discouraged and quit.
Here’s my strategy to fix that – focus on HEALTH first. Getting healthier means eating better (cleaning up your nutrition), exercising moderately but not all out, and then focusing as well on things like sleep, overall stress reduction and creating positive habits that make you feel better, not worse.
The good thing is, that if you do these things that weight loss and better body composition will come along as a by-product. It’s guaranteed over time.
2. Make one change at a time.
If I was going to prioritize what you should change, it would go in this order:
Eat better. Sleep better. Cut down on stress. Exercise.
Yes, exercise is LAST on that list. Why? Because exercise means ADDING something, not REMOVING something. For example, eating better can mean simply eliminating sugar and alcohol. This will have a profound effect on most people. All you have to do is simply NOT EAT IT. Sleeping better means that you simply have to NOT watch that last episode of Netflix and go to bed earlier. Stress reduction means you have to NOT react poorly to when someone gets you upset or things don’t go your way.
Exercise is important, for sure – but if you simply eliminated starchy carbs, alcohol and most sugars from your diet you would lose ten pounds in a month. I’ve seen it dozens of times.
So change one thing – make it stick for at least 2-3 weeks – then change something else. And that brings me to my third point:
3. Focus on long term change and goals.
I tell my clients all of the time, we want to PREPARE you for what you are going to experience in 3-4 months. In the spring, you will be going outside more. In the summer, you may take up a new activity. For my athletes, they are typically in an off-season mode and focusing on re-establishing enhanced strength for upcoming seasons.
Think about where you want to be in six months. It is kind of like if your car starts to slide in the mounds of snow in my city. You look into the turn and focus on what’s ahead, not on what is going on around you. And inevitably you will come out of it straight and further ahead. Don’t worry about January, except for establishing the proper habits (with SMALL CHANGES) that you can be consistent with over time.
I hope that you all have a fantastic first couple of weeks of 2020 and if you ever want any information or to ask questions, I’m always happy to help you! Reach out at email@example.com, on Linkedin or find me at @strengthottawa on Twitter.