Tagged: rehab

5 Ways to Reduce (Or Prevent) Injury

In my practice I deal with injured people on a daily basis.  As a result I’ve compiled a pretty extensive knowledge of not only injuries but what causes them – and therefore how to prevent them.  Many of you out there right now are walking into a major injury and are simply ignoring it or don’t know any better.

It is in the nature of athletes and people with certain personalities to embrace hard work.  There’s nothing wrong with that.  However, when it results in a setback or the loss of ability to move forward in a program then it can bring frustration and the worst situation – having to stop working.  I always tell my clients that the only way progress will stop is if they stop it.  Well, having a bad injury is one way that you don’t have a choice.

I’ve compiled a list of the top 5 ways that you can reduce or prevent these types of injuries.  I hope that you take them to heart and use them to be mindful so that you don’t end up having to call me.

  • Warm Up Thoroughly

This should really be a no brainer, but one of the worst habits I see from any athlete is that they simply neglect warming up their joints before subjecting them to loads.  In order to be able to fire properly, muscles need both blood flow and also neurological input.  If you’re lifting weights, this means moving the joints you’re planning on using and also practicing the movements.  If you’re doing cardio work this means doing a dynamic movement pattern sequence and also taking it easy for the first little while if you are doing a hard workout.

Athletes typically warm up for AT LEAST 15 minutes.  This also doesn’t mean static stretching or cardio – it means dynamic movement and preparation.  Factor this into your workout time and give it the attention that it needs, don’t ignore it or rush through it.

While you’re doing your warmup, you can also take stock of how you’re feeling, which leads us to:

  • Acknowledge your Readiness.

Remember that ability to perform is fueled by nutrition and other factors.  Did you sleep well or not?  Are you hydrated?  Is it the end of the day or the beginning?  How focused are you on performing today?  Is there something else stressing your nervous system?  Are you distracted or focused?

Not every workout has to be a top level workout.  Some days you’re going to be able to give 100%, and some you’re simply not.  Being smart and realizing this before you start hard work can save you a big problem during and after the workout.  If you’re not able to give it all, then save yourself for the next workout.  You can still do what you need to do, but realize that pushing yourself at that stage may not be the most prudent thing.

Along with this important tip follows:

  • Don’t Ignore Warning Signs

Your body will tell you clearly if there is something going on you need to pay attention to.  If you warm up and something is still stiff or restricted, or if you are feeling acute pain through a joint range, you may want to think twice about working that area hard.

So many athletes think that if they aren’t sweating and killing themselves then it isn’t worth it.  I’m here to tell you that’s false.  High level coaches realize that it is the long road that makes a difference so if you have one of these signs starting to crop up – or have a chronic issue – you’re better off addressing it now and taking care of it, because your body is literally telling you to slow down or stop.

  • Work Smarter, Not Harder

There is a lot of misinformation in the fitness world, and probably one of the top ones is that you need to train to failure.  I can cite multiple sources where improvement comes with much reduced load, and others where rep ranges don’t factor into progress.  You can stop after 1 set or a few less reps and the difference in results are minimal – but the reduction in injury potential is large.  A good strength coach knows the signs of good lifting and not overloading their athletes, and you can learn this too.

Your progress should be linear and programmed as much as possible, factoring in the above from workout to workout.  A short delay for one workout is much better than a long one for a 6-12 week recovery period.

Also realize that progress is long term, not short term.  Many of us want results right away and think mistakenly that forcing something to adapt to change is the right approach.  Your body doesn’t work that way.  Instead of wanting results in two weeks, focus on two months or even two years.

  • Recover Properly

Recently I wrote another article HERE on the Red Headed Step Child of recovery.  In summary, most people neglect things like sleep, nutrition and even proper cooling down and taking care of their tissue post workout.  This also means maybe taking an extra rest day if it is needed in between hard workouts.

This is a component of good fitness just like nutrition or anything else that can contribute to the well being of your body and improving it.  Yet it gets ignored on a regular basis.  Please make sure to factor recovery time into your schedule and adhere to it.

By following these simple principles you should be able to continue to improve, feel good with each workout and not have to go through the ordeal of rehabilitation.  If you have already gotten there, feel free to message me for ideas on how to enhance your recovery and make sure that it doesn’t happen again.  You can find me on Facebook, my web site http://www.srottawa.com and on Twitter @strengthottawa.

Have a healthy and injury free day!

Does Your Back Hurt? Part Two

Last time we discussed the origins of back pain and some quick fix solutions if you have issues in this area.  For this article I want to get into a bit more detail on what you can do to be more aware of your back issues and some real solutions in terms of restoring mobility and keeping your muscles firing well.

First of all, most people will tell you that the reason you have back pain is because you have a weak “core”.  What does that mean?

In simple terms this means that the muscles that support your spinal column, especially as it relates to your pelvis in the lumbar area, are weak and need strength.  Most practitioners will have you start to work on things like spinal bracing movements, hip stretches and lower back strengthening.  However, this brings me to my first point when it comes to back pain, and one of the most important principles:

You need to know what the source of the issue is!

Imagine a person with a weak ankle due to spraining it several times as a kid.  This person stops being active and loses a lot of their ability to fire their leg and back muscles, and eventually every time they take a step their body is slightly tilted to take load off the ankle.  This throws off the pelvis slightly each time, and this throws the lower back out of line and therefore causes the supporting muscles on one side to fire too much.  If the ankle is the source of the issue, strengthening the muscles in the midsection will help, but it doesn’t ultimately fix the problem.  It’s like taking an Advil for a headache.

So rule number one is get properly diagnosed.  I don’t diagnose, I tell people what in my experience things are and (99% of the time I’m right), but it is always confirmed by another party preferably with doctor in front of their name after they get referred.  Many practitioners will not look past the pain area – find one that will.

I’ve had clients come in with back pain that we have resolved by treating their shoulders. Or feet.  Or even simply practicing walking properly.  It can be that simple.

So what is the “core”?  Well, the way I explain it to clients is that you want to stop thinking of “core” and start thinking of SPINE.  More specifically you want to start thinking of how it relates to your pelvis (mostly) and also things like your rib cage and shoulder complex.  There’s many more muscles involved than just your TVA, or just your lower back.  In the deep abdominal area alone there are five layers mostly overlapping each other.  And, when you move one joint, you affect every muscle that crosses over it – and your spinal column is made up of lots of joints.  If you move your hip, you’re affecting your spine.  If you move your shoulder, you’re affecting your chest, back and shoulder (and a bunch of other things).  Take this into consideration when performing any type of mobility movement.

Before I get into how to strengthen these areas (which will be for Part 3), I want to instead address mobility.  This is the ability to move these joints without strain or compromising the muscles that control them.  Typically this requires movement without a ton of load or force behind it.  One of the biggest pieces of advice I can give here is:

Respect your body and allow it to move (or not move) as it wants to – don’t force it.

One major flaw people make with mobility work is that they push their muscles too hard and create even more strain.  Instead of thinking of it as stretching, I invite my clients to instead think of it as allowing their muscles to achieve a longer range of motion within the involved joints.  This goes across both sides of the muscle, the long and the short. If you lengthen or shorten a muscle too much, it is weak in that position and will often fire in order to try to get out of that position – which defeats the whole purpose of lengthening one side while you shorten another.

For example, if you are in a typical hamstring stretch you are lengthening the back of the leg, but you are also shortening the front (allowable to a certain extent until your knee reaches terminal extension).  Always move within a point of mild resistance – never pain.

With the lower spine, the usual culprits for lack of mobility are the hip complex (especially in the front of the body) and the spinal erectors.  General ranges that are restricted are spinal extension, pelvic movement, hip rotation and extension and lateral flexion (ie side bending – but be careful here – I don’t side bend anyone until they are much better).

So here are the top 5 mobility movements I prescribe to pretty much everyone with back pain as a start.  Remember that as with any exercise program, a mobility program also needs to be tailored to you specifically – don’t necessarily take this as gospel.  It is a good start for most of the population.  As with anything else, if it makes your body uncomfortable or causes pain – DON’T DO IT.

Number One: The McKenzie position.

mckenzie

Use movement to start, but sparingly.  Holding position for 5-8 minutes can be just as effective.

Stuart McGill, who is one of the most prominent back care specialists in the world advocates this as the number one movement, and I do as well.  Place the hands under the shoulders and extend up, moving slowly until pressure is felt in the lower back and focus on dropping the hips into the ground.  Repeat with movement but can also be done as a static hold if you have facet issues.

Number Two:  Cat/Camel position

catcow

Focus on moving from the pelvis and pushing the tailbone up – repeat movement up and down.

This can also be a good transition into childs’ pose for upper back mobility.  Focus on moving the entire spine starting from the tailbone, not just the upper back as many people tend to do.

Number Three: Kneeling Hip Flexor stretch with movement

hipflexor

Instead of holding static, raise up the same arm as the leg you have behind you and push the hip slightly forward and back, oscillating gently. 

This movement may be difficult for those with knee problems.  If you cannot get onto one leg a good modification is to do it standing up with one leg behind you.  Oscillate the hip forward and back.  Another fantastic stretch along this line is one popularized by Kelly Starrett – you can see it here but it is very advanced and should be modified for most people.

Number Four:  Windshield wipers with feet on the ground

sidelyingknee

Move the knees side to side keeping the feet on the ground.  I also have clients extend their arms to the sides in order to lengthen out the rib cage and pecs if they can.

For some people with advanced back problems this gets removed immediately because it can cause tilting.  Also, if you have diagnosed SI Joint issues please take this one out until they are resolved.  This puts rotational torque through the hips, which for many is a good thing but for some is not.

Number Five: Standing Glute/Piriformis stretch.

glute standing

This can be done at work – just make sure that you don’t have any knee issues.  

This movement can also be done lying down, but is more effective standing.  Again as with the others, don’t hold position, lift and lower the knee until a pull is felt in the hip/glute area.  If one side is tighter, do that side twice.  For example, if your left is tighter you would go left, right then back to left.

This covers 85% of the bases for most people who have issues.  Again, for some with severe mobility issues all of these might have to be modified.  Feel free to comment or message me for modifications if you need them.

So the next question begs – how often?  My recommendation is always twice a day to start, ideally morning about twenty minutes after rising so you have moved a bit and established blood flow, and then before bed or after work – whatever works for your schedule.  It can be a great way to decompress at night and focus on yourself after turning off all of your electronics and is a great way to establish good sleep hygiene.  Think of this as general maintenance and even just by doing these movements – within what your body will allow – you can experience some relief almost immediately if you have the beginnings of problems in your spine.

Oh, and if you tell me you don’t have time, this whole routine takes about 5-10 minutes.  You have the time.  You choose not to use it in the right way.  Choose to help yourself.

In Part Three I will be going over exercise.  Again, we often think about “core” work as something simple and straightforward but for most people finding out what area needs the most help is essential.  This can allow us to build an exercise routine that will work for that individual and bring a solution to the issue.  Like I said in Part One here, if you’re at Stage One then these should help a lot.  Stage Two or Three might need some help.  but you’re starting in the right place.

If you liked this please feel free to subscribe on my main page, comment and share on Facebook and on Twitter at @paradigmottawa.  I look forward to any feedback you may have.

What Did You Accomplish This Year?

A pretty simple concept post this week for my readers.  Often when I’m dealing with clients I find one of the most important things for them is to get them to think long term, ie set annual goals and stick to them consistently throughout a calendar year.

We also tend to not give ourselves enough credit.  It’s so easy to think of what you haven’t got versus what you have.  If you’re healthier, fitter and most important happier at the end of the year, you’ve really won most of the battle.

So if you’re reading this post, I want you to think back to January of 2015.  You can even check your social media to see where you were at (one of the perks of it).  People today simply don’t think long term and then don’t give themselves proper credit for things they have actually accomplished.  One of my main goals in life (and hopefully yours too) is to always be pushing forward and trying to improve personally and professionally.

Here’s some examples from my own list, and I’ll also share some accomplishments I feel I had with some of my clients without naming any names.

  • Managed to correct a woman’s misdiagnosed tennis elbow in about thirty minutes applying common sense.
  • Allowed a client to bike in the mountains, which was a huge life goal for her after years of chronic pain and immobility.
  • Allowed a woman who had chronic fibromyalgia to experience pain free days for the first time in eight years.
  • Was able to successfully rehabilitate a tibial plateau fracture to the point where the client can now run, jump and play sports (something she was told she shouldn’t do ever again).
  • Took a running client to a 13 minute marathon personal best.
  • Dealt with a couple of very rare conditions (I won’t get into details here) but they have really allowed me to increase my level of care and knowledge.
  • Have managed to get several people into the best shape of their lives at a fairly advanced age and dealing with chronic hip, back and neck issues.

On a personal level:

  • Welcomed my second daughter into the world who is a busy little bug and now that she can move around gets into anything and everything. She’s going to be an athlete for sure.
  • Began working on my first course and book, to be fleshed out and hopefully presented for the first time in 2016.
  • My band has taken off and I’m much more comfortable behind the microphone by far – check out getoffmylawn.rocks if you want to check us out or book a show.
  • Currently symptom free from my previous heart condition and hoping that remains the same.
  • I weigh exactly the same as I did twenty years ago.

Dave4

So when you look back on your year, give yourself a pat on the back for what you have accomplished, no matter how small and insignificant it might seem.  Then sit down and put together some goals for next year.

Think back on what you have done to mold the future and what you want to be.  The best way to do this is to set some really high standards and do your best to meet them.  Even if you don’t, by the time the end of next year rolls around you might be really surprised at what you have done versus what you haven’t.

If you want to share any of your upcoming goals, I’d love to hear what they are!  Feel free to spread this around on social media and maybe we can start a trend of goal planning.  Until 2016, I am so grateful for all of my loyal readers, friends and clients and next year will just bring bigger and better things!

The Downers of the Downward Dog

This was inspired by a client of mine who wanted to restart yoga after a bad back injury.

What if, as a trainer I told you that we were going to do an exercise that did the following:

I want you to lengthen out your posterior chain as much as you can, throw both of your shoulders into extreme extension, put yourself into spinal flexion (even if you can’t properly tilt your pelvis) and stretch out your hamstrings and calves as far as they can go (thereby also yanking hard on your sciatic nerves) – oh, and do it while loaded with up to 70% of your body weight, and the load increases the further you get into the exercise.  So for a 150 pound female that would mean their shoulders and knees are loaded in extension with up to 105 pounds on their spine and other joints.

Does that sound like a good idea for anyone, let alone people recovering from injury?

The funny thing is, people in yoga classes do this almost every day.  It’s called a downward dog.

downward-dog-technique1

Now, before the yoga community absolutely freaks out and starts thinking I’m bashing the movement, I’m not.  All I’m doing is providing a practical analysis of what people are required to perform to get into this position.  I’ve had a client recently with severe back issues try to get back into yoga and the one movement she had immense trouble with (not surprisingly) was this one.   I’ve also attended yoga courses where thankfully the instructors were aware of the limitations of this movement and realized that not everyone should perform a downward dog – in fact several of my most respected colleagues actively discourage it since they have realized what it does.

On the flipside I’ve also been to yoga classes where the instructors did absolutely NOTHING except for sun salutations over and over again.  You can guess which class I didn’t go back to.

BKS Iyengar, one of the foremost yoga teachers in the world asserts that this asana stretches the shoulders, legs, spine and whole body; builds |strength throughout the body, particularly the arms, legs, and feet; relieves |fatigue and rejuvenates the body; improves the immune system, digestion and blood flow to the sinuses, and calms the mind and lifts the spirits.”  (ripped from Wikipedia) – and it does all of these things.

But what people need to realize as a whole is that some movements that you perform in a typical yoga class are very hard forceful strength movements.  Simply because it is packaged as something healthy and therapeutic doesn’t mean that it is.  Just like any other type of exercise, it needs to be tailored to the person participating in it.  A 200 pound deconditioned person has absolutely no business getting into this position and here’s why:

Here’s what people need to be able to do into order to successfully perform this movement:

Put your arms overhead fully or even behind the torso while internally rotated.  This requires a healthy rotator cuff complex, the rib cage to be able to move and the shoulder blade to be able to move with proper rhythm.  One loaded movement I often have clients do to test this area is a loaded shoulder extension (think a front raise but over the head with a cable) at various angles in order to engage the entire shoulder complex.

Hinge the hips with proper pelvic movement so that the lower spine isn’t flexed forward putting strain on the lower spine with load – while it’s flexed.  Think loaded Romanian deadlifts, and even things like good mornings (I have a bias against these because of where the load is placed but whatever).  Just because your hands and feet are on the floor doesn’t mean there isn’t a ton of pressure going through the lower spine in this position.

Fully extend the knees and dorsiflex the ankles as much as possible – general limits here are thought to be 30 degrees but most people have much, much less than that.  Generally here in a squatting position I look for the ability of the knee to travel forward properly and therefore dorsiflex the ankle.  Can you squat low?  Or does your person have longer legs relative to their torso?  Are they recovering from a knee issue that might be contraindicated to full knee extension (like a meniscus injury?).

There can be many restrictions in this area and it also has the highest risk of issue due to the excessive load people will put on their knees in order to force themselves into a straight legged position.  The restriction might also come from hamstrings, calves or somewhere else, not even the ankle.

So here’s my question:  Can or should you do all of these things and hold them for time?  No?  Maybe this movement isn’t for you.

What people need to realize is that even though it is relaxation based and supposedly “stretching”, yoga is still force on joints.  Sometimes a lot of it.  Another common flaw of the downward dog is that people will generally run away from weakness.  This means that if they are weaker in the shoulders and have trouble there they will dump more load into their lower body in this position.  If they are weaker in the lower half they may dump more load into their upper body.  I have seen this often in classes.  And it can cause a serious problem if suddenly the load shifts by 20-30% into the wrong area suddenly due to a weakness somewhere else.  However, due to the nature of the position there isn’t any way to get out of it.  Except for compromising by say, lifting your heels or bending the knees or even elbows to put load elsewhere.

So what are some good modifications?  Well, like in any other loaded position if you can take the load off a bit, then the person can attempt the range of motion without the excessive joint force.  For example, a person with good shoulder mobility but poor posterior chain range and pelvic movement might want to perform a simple hip hinge with their shoulders extended and brace their upper body against something.  Prenatal classes often recommend this.

modified_downdog-600x396

Another option might be to intentionally elevate the heels and bend the knees as I expressed earlier.  You can also bend only one knee or alternate sides.  For less force on the arms and shoulders, lower the body and rest the forearms on the ground.  These are all modifications that can easily be suggested in a class but often aren’t.  During a busy class most instructors just don’t have the chance to go around and suggest individual modifications to people.

Or here’s a thought – don’t do it.  There are ways to work up to this movement, just like any other yoga movements but so many people make the mistake of jumping in and following along, and then wonder why they are sore the next day and never want to go back.

The good news is that with my modifications to her positions and telling her to skip downward dogs my client successfully navigated two yoga classes and has been able to get back in touch with something she previously enjoyed but couldn’t do.

Don’t get me wrong, I’m a fan of yoga.  I’m a fan of anything that keeps people moving, enjoying loaded positions to develop strength and will over time develop additional range of motion.  I’m also a big fan of the relaxation side of the practice and allowing people to be in a parasympathetic state, even if it is only for five minutes at the end of class in savasana.  It’s something most people should do a lot more of.  The reason I’m writing this is to make sure that if you are about to jump back into yoga because you think it is a good way to ease into exercise again – it might not be depending on the class.

As always, if you have comments feel free to comment here or email me at paradigmfitnessottawa@gmail.com.  Good luck with your future practices!