Have you been going to different practitioners trying to find the answers to your sore knee, hip, back, or shoulder? Are you getting enough sleep at night? Are you feeling stressed, managing your nutrition?
Have you blamed a muscle or body part for your patients’ sore knee, back, or shoulder?
We as practitioners need to stop trying to find an easy solution to pain. This is something all of us are guilty of, at one point or another. A patient is presented to us with a problem that has been affecting them for weeks, months, years – it’s only natural that we want to make them feel better as quickly as possible. As a consequence, promises of quick fixes have led many people to bounce between practitioners trying to find that one solution to their pain.
On the flip side, patients need to take responsibility for their own education and understanding of their pain.
At uni, we are taught that the body is made up of levers. There are uses for this model but when it comes to chronic pain, structuralism is not always the answer.
There may be movements that feel like they cause an immediate reaction (back pain when bending over to pick up your keys or tying your shoes). However, contrary to social media/family/friends/next door neighbours, the answer is not going to be a single area that “didn’t activate” or “is overused”. This has led many to believe if you’re hurting in this spot, you need to work on that area to make it feel better. This unfortunately, has led to many of the problems practitioners and patients alike face when addressing pain.
If pain is not structural, where does it come from?
This is difficult to answer as there really isn’t an answer.
Introducing… The Biopsychosocial Model!
The biopsychosocial model asks us to consider the biological as well as the psychological and social aspects of your, or your patient’s, lifestyle.
We can consider biological factors like inflammatory markers, nociceptor sensitivity, pathoanatomy, or neuropathology, however, this does not create a holistic image when we look at pain. Following a traumatic incident, there is upregulation of nociceptors and inflammatory markers near the trauma site that acts as a protective alert system to tissue damage in the area. The body is meant to heal itself and these inflammatory markers help to do that. This is what makes us more sensitive to movement. It is important that biological factors are taken into consideration when treating patients, however markers such as tissue damage are not the only explanation for what makes patients perceive pain.
This is where the biopsychosocial model is utilised to allow us to better explain pain. The BPS model incorporates contributing factors that help explain why an individual may feel varying degrees of sensitivity day to day. @hannahmoves has an incredibly effective tool for explaining how we utilize the BPS model with our patients as seen below
Poor nutrition, stress, anxiety, fear avoidance, poor sleep, training volume and past experiences will all contribute to how your patients feel day to day. It’s important that we address all of these factors when it comes to communicating with our patients, not just focusing on a single issue. Explaining pain science and incorporating motivational interviewing techniques with our patients is how we ensure long term results.
How do we relate this to a patient experience?
Take for example this scenario; a patient books in for a consultation with a history of non-specific lower back pain. They are a young professional used to training in the gym 4-5 days per week with preference to HIIT-style group classes. They have seen doctors for scans, chiropractors, physios, and osteopaths, and have yet to come across a consistent answer that will fix their problem.
The difficulty with this scenario we see all too often is that there is no real answer and trying to educate someone that after several weeks, months, or years of bouncing between professionals, is a challenging task. Scan reports can be useful in some instances for diagnosis but they can not explain a sensitivity experience. The holistic view of understanding pain science helps us understand our patients.
Being able to better understand the multi-faceted nature of pain, how and why it occurs, will help every allied health professional (and their patients) become better practitioners.
How do we become better at what we do?
Continue your educational journey and listen to your patients. There is always going to be something to learn but finding the right resources can be tough. Education is not just for practitioners but for anyone experiencing pain.
Stop blaming muscles, start blaming your movements
Your scapulars have 17 muscles connected to each of them. Your pelvis is connected to over 30 muscles. Over 100 muscles are connected to your foot. Reducing your movement down to muscles can get very messy very fast. You have over 600 muscles in your body and only about 206 bones in your body. Start giving more love to the movements of your bones. It will make your life easier.
So when breaking down a human movement remember to always start proximal before moving distally (I explained this in my previous blog). So for movements involving your hips we always look at what the sacrum and spine is doing.
Is it tucking/Counternutating enough while squatting (posterior pelvic tilt)? Is it extending/ Nutating the right amount during a hinge (anterior pelvic tilt)? Is your hips and ribs stacked through the whole movement? These same principles apply to your sternum and scapula but will be talked about on a later date.
Remember….. strength IS a Skill
What is Strength?
Strength is all about force production. In the world of barbell sports it is about how much weight you can lift, squat, snatch, clean and/or press. In the physiology world it is about how well your Central Nervous System (CNS) can stimulate the most amount of large muscle fibres in the least amount of time. This means there are two major factors: your CNS (coordination) and the size of your muscles.
This is where the difference between strength building and strength expressing exercises become really important.
Let’s use my favourite lift as an example. We use Low Bar Squats to express our strength but High Bar, SSB and Front Squats to build it. The reason why is because the more upright your squat is the more force is going through your legs and less through the muscles around your spine. Your legs (quads and glutes) have a much larger capacity of growth compared to your erectors.
This is where the fun part comes in: training. Just like every other skill that you do practice indeed makes perfect and the cool thing is that this practice, especially when done right will also help grow these important muscle fibres. So if you want to get better at squatting, yes you do want your quads to get bigger but only doing leg extensions isn’t the best way to get there, doing more squats is.
I met Tom about 8 months ago on referral from my coach to sort out issues I was having with my knee post-surgery squatting. I tried really hard not to make this solely about squatting but couldn’t help myself, we talk about movement dysfunction what that looks like for strength athletes and what to be aware of when it comes to lifting. Tom has done wonders for me and many others and his approach to training is amazing. So hopefully you enjoy his wisdom while drowning out my rambling nonsense.
By now most of you would have heard of this duo once or twice in the context of rehab and/or performance. This blog is to cut through the fluff and help you get a better understanding of what everyone (including us) keeps talking about.
Breathing is the key
Stretching ≠ improving mobility
You need to be stable to be mobile
Mobility vs flexibility – what’s the difference?
Mobility is different to flexibility. Flexibility is passive and Mobility is active. I am a perfect example of this. When someone puts me into position I have a ton of passive internal rotation of the femur, but when I try to get there myself I cramp really fast.
Remember stretching only has a short term effect. The real thing that will improve your mobility is learning how to move properly. We all know by now that we are stuck in certain patterns and postures. For example, I am super extended with a duck butt (anterior pelvic tilt). What that means is that my center of gravity is naturally tipped forward. This adds more pressure on my ankles and decreases my dorsiflexion. I can do all the ankle stretches in the world, but until I learn how to get out of my duck butt by learning how to stack I might as well hit my head against a brick wall.
Are my ankles tight or am I just shit at squatting?
The majority of the time people blame their ankles on their poor coordination. Remember squatting like every movement is a skill, just like how a musician has to practice for years to be good at their craft we too need to practice getting into positions. The most important factor for getting into these positions is being able to stay stacked and subsequently use the prime movers of the exercise.
The stability we talk about is in the context of strength-skill and force production, and less in the terms of bosu balls. The more stable you can be, the less energy is lost unnecessarily. This is where I introduce to you a new concept called ‘proximal to distal’. I mentioned it before in the ankle mobility example.
Put it simply, the more stable your spine can be, the more force you can transfer through your hands and/or feet. Or put it another way: the less stable the hip and scapular the more jacked up the ankles and forearms are. This is mitigated through a good quality rib-cage and pelvic stack.
So what is a stack?
A stack is when you are able to get into and maintain a neutral spine throughout a movement. An effective brace is only properly utilized when you have stacked your hips and ribs over one another. Take a look at the examples below, can you spot which one is incorporating a proper stack?
The most effective way that we teach people how to stack their hips and ribs is through breathing drills. Now, I know what you are thinking: “I have been breathing my whole life, why the hell do I need to be taught how to breathe”. Throwback to my previous blog, we know that we are stuck in certain positions. Breathing drills are a great tool that we use to ‘reset’ our posture. It teaches you what neutral feels like and allows you to know how to brace properly. This is explained further in our Training Fundamentals course that is available on our website.
Hopefully this will help you to do some problem solving of your own – if you have a pesky ankle or wrist, focus on getting stronger rather than stretching till the cows come home.
Most of us use exercise as a method of maintaining our mental health. If we start experiencing pain in our back when we run, squat, do push ups, pick up our kids of the canine, feline, and primate variety; we tend to not want to do those things anymore and our mental health can suffer from that.
So I’m going to paint a word picture for you:
“But Michael, I like doing group fitness because it takes my mind of things and I don’t have to think about what I’m doing”
I hear this one a lot. What I also hear a lot is….
“I don’t do squats, it hurts my knees”
Okay, so you enjoy the group-based environment but you are unable to partake in certain exercises because of knee pain? Why don’t you get someone to have a look at those knees, hips, ankles, back or whatever else could be the cause of that knee pain?
“Use it, or lose it”
“Motion is lotion”
Your body is a lot to think about. You do enough thinking during the day when trying to organise meetings, projects, kids, clients, orders. Why should you add something else to the mix and stress you out further?
Moving efficiently is all about making small wins for yourself and changing your mindset about movement-based challenges. Once we’re able to get a roll going with these small wins, the fundamentals are going to feel so much better and you’re going to experience far less stress. Couldn’t feel your hamstrings during a deadlift but now you can? You had back pain but managed to feel your glutes firing and that back pain has disappeared? That’s a success right there. It gets you pumped. It gets me pumped. These wins will echo into your daily routine, reducing the stress and anxiety of your daily grind.
My biggest challenge in the mental health field is trying to get people to care about how their body moves and have fun while doing it. If your body moves well, you’re much less likely to end up in pain. If you’re not in pain, you’re going to want to keep moving. You keep moving, you hit your health and fitness goals, your brain will thank you for it.
Strength training and moving well is not just good for your pain, it’s good for your mind.
We all grew up being told to ‘stand up straight’ and to ‘stop slouching on the chair”. Nowadays sitting has been described as the new smoking and stand up desks are selling out faster than hot cakes.
What if I told you that these beliefs are possibly causing more harm than good?
Stop labeling your posture as good or bad
Posture only matters when load is involved
You are the only person in control of your body (hopefully)
Okay before I do a deep dive into this topic, let’s define posture.
Posture is the default movement patterns and positions that your body likes going into.
Everything in nature is inherently lazy. Your body prefers to be in certain positions because it is comfortable, and that is completely normal. So labeling a posture as good or bad could be leading you into something called “guarding behaviour”.
What is guarding?
We all have seen those videos of cats overreacting when jumping onto alfoil on the kitchen bench (if you haven’t, stop what you are doing right now and look it up). From now on that cat is going to expect a rude shock whenever it jumps on the counter top – and actively avoids it. You are the same. You learn that a particular movement may cause discomfort so you actively avoid doing it. Let’s use pushing your knees over your toes as an example. The problem lies in the fact that you are not made of glass, you are not fragile and you ARE MEANT TO MOVE.
“Motion is lotion, rest is rust”
Dr. Anne Schuchat
By not moving your knees over your toes what happens is that the muscles in this case your quads atrophy (shrink) and sensitize. This means that when you go to use your knee – your muscle fatigue quickly and starts to hurt. Due to this extra sensitization, what would normally be a 3/10 pain ends up being a 10/10 pain; Unfortunately this can spiral. That is when a good health professional (like one our amazing EP’s) educates you on how to desensitize this area.
When does posture matter?
When force transfer is involved. Be it running a marathon, squatting 300kg or simple picking your kid off the floor. These are times when having a stacked neutral posture matters. If you are able to properly load the prime movers of the exercise it means that you are able to do the activity more efficiently without overloading the secondary/ supportive muscles. There are people who are naturally flexed AKA kyphotic, others who are extended AKA lordotic, and some who are both. The first step is to figure out what posture you have. A good way to know this by looking at your lifts. If you are good at squatting chances are you are probably flexed. And if you are good at deadlifting you are probably extended. After you have figured out what posture you have the next step is to learn how to stack, breath and brace. This is a whole other can of worms that needs to be opened on another day.
So why am I telling you this?
To empower you to take control of your body. At the end of the day you are the only person who can make positive changes to your life and body, our job is to facilitate this positive change not do it for you. If you are struggling with any of these topics send us a message or comment below and one of our exercise physiology brisbane coaches we’ll be in touch.