Physical therapy

Flag Girl

This is Flag Girl Amanda.

Driving home from my 10 minute morning hill sprint with dog Ruby and my 9 year old son, I happened to see Amanda doing some Prisoner Squats at the side of the road.

Amanda is a Flag Girl with the city’s sewers crew. I parked my car and high tailed it over to chat with her about what she was doing. With my son and dog in tow, I told her what I had witnessed. She explained that she had been in a motor-vehicle accident on March 27, 2012 and since has been in a lot of pain. She had gone through all the required active rehabilitation for the soft tissue damage. However, since the physical treatments that were covered by insurance had come to an end she had to become self-sufficient and consistent with doing the prescribed exercises throughout the day on her own. She quickly showed me the list of exercises on her phone.

Yay, Amanda!

Because her job requires for a lot of standing she finds that the immobility is what contributes to her pain. As a result she does whichever exercises she can while on the job.

I can’t tell you how happy I was to see this. On one other occasion I noticed a Flag girl doing some lunges and now wonder if it was Amanda then also!?

I’ve often wanted to contact the city and offer to give a workshop on how workers can help themselves throughout such long days of mostly stationary work – because standing around (though at least there is movement), can be equally difficult on the body as sitting at a work-station all day. In addition, I think that long hours, like what Amanda does can often leave workers fatigued by days end and the last thing they want to or feel motivated to do is think about doing a ‘workout’. So what if people in this situation could be shown (and convinced) that some, focused exercises done with precision, specific to their needs could do a world of good!

This is why I love the 4 Minute Morning concept as well as Stretch B4 Bed idea too. Each session doesn’t have to be an event, but rather a few minutes of focused attention, a moving meditation, which is what Yoga is; time spent inwardly focusing and becoming aware of our physical being, which subconsciously trains our body to function correctly when we are not able to be focused inwardly…like, most of the time!

Here is a little video of what I saw Amanda doing that morning. She re-created the moment for me so I could post it here. Of course, my preference would have been to catch her spontaneously, but this will give you the gist.

I just wanted to reinforce here, how beneficial and necessary micro-breaks are for all of us, regardless of injury or as daily maintenance. I think our culture has gotten a lot carried away with the more is better philosophy with regards to exercise. We need to step back and focus more on how our body functions and less on doing exercise for the sole purpose of looking a certain way.

What If Working Your Butt Off Is Making It Bigger?

A top-down view of a skeletal muscle

Image via Wikipedia

I’ve been trying to compose this post for quite some time now. I feel that there is a need for a basic explanation of how our muscles work. Maybe it’s already been written, but I just haven’t found it.

So here goes…

The subject is complex beyond belief and I would err should I give it a simplistic explanation; however, this is for those with very little background in the subject. So forgive me – to all the professionals who may shudder at the following post.

Months ago I innocently left a comment at BodyRock about modifying a workout because my aim was to narrow my hips not expand them.  A few people commented-back: What? You can narrow your hips? So I promised to explain this, but in order to understand it we need to go back a ways. I don’t believe in the ‘bottom-line’, we need back-story and must be well informed to process the bottom-line otherwise we’re just like a fish flailing in a puddle of shallow water – it might look like we’re swimming but we’re so far from doing the same sport.

It can take a lifetime to really get to the root of the following, as with any subject – it is remarkable how the layers continue to unfold as if looking through a microscope. It brings to mind the Origami artist, and in particular Eric Joisel, who “could spend more than 100-hours folding a single piece of paper in order to create his amazing pieces of art.”  Not everyone has passion for details but what if everyone could be more interested in everything they do – from what we eat to how we move, for starters.

The Pilates Method, Feldenkrais, Alexander Technique and Emilie Conrad’s Continuum Movement are a few methods that I have spent time studying over the years, some in more depth than others.  When given the chance, these exceptional methods teach functional movement from the foundation.  These methods aren’t meant to be a ‘workout’ but rather the exercises are tools to better comprehend healthy movement patterning, which in the end can only support ones’ workout or sport.

My task is to explain the following for readers who have no background in physical movement and have spent very little time focusing on how their body actually functions. To have succeeded will mean that your eyes won’t have glazed over.

As the title suggests, what if you’re literally trying to work your butt off by doing exercises that you have been led to believe target a certain muscle group, such as doing endless squats in the hopes of minimizing your gluteus maximus?

What if the infinite number of side leg lifts you’re doing, in the hopes of slenderizing your ‘saddlebags’ is actually giving them the appearance of becoming over-full?

Or what if the long endurance walks or runs you do are not giving you the results you are after?

What if, what you’re doing isn’t very effective at all but you console yourself by saying, “well, at least I’m doing something”.  True, some is better than none, but what if, that ‘some’ is literally a waste of time by making things worse?  And by worse I mean dysfunctional movement patterning.

The spin-doctor in me will tell you that there is no such thing as a waste of time, because it seems to be that through failure we learn the most…with the assumption, however, that through failing we search for another solution, rather than just accepting our fate.

You get the idea…there’s a lot of what if‘s.

Oftentimes, we turn to exercise to tighten loose areas of the body.  Everyone seems willing to put in even a little bit of time to tighten body parts.  Yet, very little time for stretching and lengthening muscles. This is the root of the problem.

In order for muscle fibres to function properly they have to be healthy.  So, what exactly is a healthy muscle, anyway?  A healthy muscle at rest should feel like a bag of water, not a bag of steel; however, ‘Butt of Water’ just doesn’t sound all that sexy and doesn’t have much shelf appeal.  Surrounding the muscle is more tissue called fascia.  This might gross you out, so fair warning, but whether you eat chicken or not (perhaps you have prepared some for dinner at some point), when you peel the skin from a raw chicken you may recall a sticky transparent film, which clings to the skin and the meat.  That transparent film is called fascia – and of course it reacts differently when alive.  It surrounds all of our muscles, nerves and organs.  For our muscles to function properly this film of fascia must slide and glide smoothly over the the muscle fibres, nerves and organs.

Alison Coolican, RMT explains that “the sliding happens three-dimensionally, rotationally, up and down.  So in the forearm the tubes of muscles surrounded by fascia must all slide against each other when your forearm twists to allow for lengthening and twisting of the tubes.  The fascia and the muscles are all connected and exist more in a fluid state, some connections are very loose and airy (more sliding) and some are tight and organized (takes more strain)  the muscle fibres must move smoothly below the fascia.  Injury and repetitive movement (whether with correct alignment or not) can impact this fascia/ muscle glide relationship.”

An unhealthy muscle/ fascia relationship would be one whereby the tissue has been, from correct or incorrect repetitive movement or injury, forced into a dysfunctional pattern.  This dysfunctional pattern thereby impacts the correct anatomical patterning of the skeleton in movement.  Have your eyes glazed over yet?

Consider that the body is made up of guy wires (muscles and tendons) which are meant to stabilize our skeleton providing support and function. Over years these structures become over tight in some areas and weakened in others and therefore can affect the way our structure appears and functions.

Personal example: My bowed legs.  BUT as a child I had very straight legs.  Here’s what happened. I started gymnastics at age 4, Ballet and Track from age 7.  By the time I was 18 my legs had started to bow slightly.  At 21, having spent a lot of time teaching Aerobics/ Step/ Spinning and bodybuilding I had over-developed the lateral aspect of my quadriceps and buttock muscles and over lengthened my inner thigh muscles by working on improving my middle ‘Russian’ split.  I had created an imbalance.  This imbalance caused a painful knee condition called Chondromalacia (Patelofemoral syndrome). Which meant that my femur (the thigh bone) would grind into the underside of my patella (knee cap).  The remedy was to re-create balance by strengthening the medial side of the quadriceps (Vastus Medialis Obliquus – VMO) and Adductors, and to stretch the lateral, over tight muscles.

My over tight muscles and fascia were dysfunctional. My skeleton was not functioning as it should, hence the aberration at the knee cap. Later this sticky fascia caused more dysfunction at my right hip and so on.  If something is stuck at one point the body will compensate elsewhere.  Moishe Feldenkrais said it best:

“Force that is not converted into movement does not simply disappear, but is dissipated into damage done to joints, muscles, and other sections of the body.”

Long story short, the physiotherapy worked only to the extent that I truly understood what I was doing and that I took it on as a daily job – this was the beginning of daily body maintenance, I just didn’t know it yet.

For a moment, let’s return to the bowed legs and dysfunctional movement patterning. When I’m out and about I watch how people move – their mechanics. It’s not a judgement, it’s just what I see and I don’t analyze it all the time. When I see people running or cycling, I watch their alignment.  Sometimes I cringe, because I see faulty mechanics which is being repeated and I can feel the pain that will ensue. And other times I see mechanics that make me stop, take my breath away and hear myself say, wow.  It’s rare to see movement that is pure and effortless but you’ll know it when you see it, as you will know it when you feel it.  Have you ever heard someone point out an athlete and say, he or she runs like a gazelle?

Let me just say that even with the gazelle-like athlete, there can still be injury and dysfunctional movement patterning- there is no perfect – just the aim towards it. Our aim with movement, art, literature, what-have-you, is that “once we accept our limits, we [must] go beyond them.” (Albert Einstein).  So in my opinion, from experiencing a lot of physical movement I have found that refining movement is on going.  Knowing that I swim, people come up to me from time to time and state (more than ask), “Boy, I just can’t swim for exercise – don’t you find it boring?”  I am amazed by this because it is often very accomplished athletes who say this.  People whom I imagined would know about refining.  Each stroke for me is a new combination of possibilities – the accuracy of the kick, placement of pelvis, rib cage and head to the rotation of the arms and angle of pull…who has time for boredom, my neurons and synapses are on overdrive. This is not some mindless activity. If we show interest in what we do, we learn from it and can add on and continue to refine.

Which takes me to the next point, but I’m sure your eyes are beginning to glaze over, so I will return with “What If: Part 2” another day and go into more detail about the narrowing of the hips comment.

M. Feldenkrais, Awareness Through Movement, (NY: Harper & Row, 1972), p. 58.

Body Alignment

Posture types (vertebral column) classificatio...

Image via Wikipedia

Body Alignment and Exercise

It’s important to have good body alignment, not just when we exercise, but whenever we move our body.  When our muscles contract they pull on the tendons, which move our skeleton.

Good body alignment supports efficient muscle contraction, which in turn supports our balanced skeletal structure.  We cannot have one without the other.

Aside from the proven physiological health benefits associated with exercise, the entire point of exercise is to strengthen and stabilize the skeleton enabling it to function effectively.  Not paying enough attention to this basic principle loads too much pressure or stress onto unsuspecting joints, pulling us out of functional alignment, which can lead to pain or injury, and sometimes an unflattering physique.

The primary reason most people exercise is to look better and improved health takes a close second.  If our goal is to look better then why do we punishingly force ourselves to execute movements without paying attention to how they are performed?  It’s because we are thinking too much on completion as opposed to the precision of movement.

Most people I know are hard workers and are willing to try just about anything for the end result.  But what if all that hard work turns out to be for nothing?  What if mindless or forced repetition with poor body alignment is causing more damage than good?

What is the solution? Like any type of movement, if you do not know what correct body alignment is, how can you monitor yourself?  Enter the domain of the expert: Personal Trainer, Physiotherapist, Registered Massage Therapist etc. These professionals reinforce, remind, and educate the client on proper technique and body alignment, be it for daily function or athletics.

Clearly I am biased, but in general, I believe in learning from an expert.  And it is quite clear how I feel about putting health first.  We all know that without our health we have nothing.  Unfortunately, it is often the case that before we come to this realization and do something about improving our health, we suffer serious illness or injury.

The following is from personal experience as an example.  Having taken the mandatory swimming lessons in public school, I have always been able to swim at a recreational level.  Two years ago I joined a masters swim group, which met once per week for an hour of drills and stroke improvement.  Being a ‘land athlete’ all my life I was nervous about joining this group, but getting over this fear and really learning how to swim was another goal to strike off my to-do list.

When refining or learning something for the first time, there are many layers and many A-HA! moments along the way.  So, what does any of this have to do with body alignment?  In a group class there is only a certain amount of individualized attention a coach or trainer can give each student.  As a beginner swimmer, the amount of feedback I got from my coach was more than adequate.  However, as I put these corrections into practice, I developed some elbow and shoulder joint irritation.  I started swimming a second day a week (for half an hour) at a moderate intensity, just to practice these corrections.  I later found out, that I misunderstood some of the corrections and was doing something else entirely wrong.  But this is what I am talking about when I give the ‘layers’ analogy.  We learn more and make progress, only to discover there is an entire other layer of lessons waiting, and more lessons beyond those.  Learning is an endless process, which for me is what makes learning so exciting.  I cannot imagine it would be very fun if we did everything perfectly the first time.

When checking in and complaining about these new pains with my registered Massage Therapist, it was he who identified the problem and was able to give me direction as how to correct my technique.  What is fascinating to understand is that my technique was faulty because of a very small, over-tight, muscle (teres major), which affected the mechanics of my shoulder from rotating properly.

About five months ago I stopped going to the masters swim group and instead started meeting a swim coach once every three weeks for a half hour of technique drills.  The rest of the time I have to be strict about going to the pool to practice on my own.  The point is that without these individual lessons that focus on my particular needs, and the support from a registered Massage Therapist, I would continue to irritate my elbow and shoulder joints because of the high frequency of incorrect repetitive movement.

This brings me to my second point about short-duration training.  None of us can expect to push our bodies for long periods of time without losing form as a result of fatigue.  Generally, a person who is more fit can train longer, but it is still possible to be fit with poor technique.  It all comes back to balance.  Are you stretching enough to counter all the strengthening and tightening?  Are you stretching properly?  Are you forgetting to stretch some parts of your body just because you don’t know how or because you don’t even know they exist?

In a nutshell: focus on precision of movement.  Exercise consistently and for short periods of time.  Stretch your body daily.  Get professional advice and support from certified and registered practitioners.  And most importantly give your body ample time to rest and recover between intense workouts.

Stretch Your Body

Stretching exercises

Stretch Your Body every day.  Do Yoga, Pilates, traditional sports stretches or other.  Whether you spend 4 minutes or an hour or more a day stretching, when done properly, your body will respond positively to the attention.  Too much focus on tightening and strengthening without lengthening the body’s musculature and connective tissue can have a negative effect.  Likewise, it is easy to overstretch areas that are already flexible leaving the problem areas unattended.  I did exactly that in my early twenties, which caused a very painful knee condition called chondromalacia.  I recovered from it with a lot of help from physiotherapy and massage.  I learned a lot in the process.  Doesn’t it always seem that we learn best from painful personal experience.  I spent a lot of time doing rehabilitative stretching and strengthening and walking around with ice packs strapped to my knees.  As a result stretching has played a significant role in my body maintenance routine ever since.

I highly recommend seeing a professional for advice specific to your individual needs.

I believe that therapeutic massage, myofascial manipulation and active-release therapy among other techniques are necessary to support our over-worked, over-stressed and over-exercised bodies.  I think that most people view massage as a luxury, something to do while on holiday or at a spa rather than as a form of body maintenance.  To get the most from any type of physical therapy, one must collaborate with the therapist as a working relationship.  Tell your therapist that you are keen to make improvements, so ask questions.  Work with them to figure out what type of repetitive movements (or lack of) might be contributing to your muscle soreness or joint pain for example.  Do not leave their office without at least one stretch that you will practice daily.  Careful not to overwhelm yourself with more than three stretches at a time, because you probably will not do them.  The next visit the therapist can reassess and give you another stretch to work on.

I know not everyone can afford massage therapy, I guess that is why it still falls in the luxury category.  But, you can access affordable massage by looking up the teaching colleges.  The students need real bodies to practice on and the price can be very affordable so that you might be able to make it a monthly appointment.  My Registered Massage Therapist did her training at WCCMT and can vouch for its credibility.  They have a student clinic that you can check out as an example. www.collegeofmassage.com/newwestminster/

I haven’t been to Utopia Academy in Vancouver, but as another example of what a student clinic is like, you can check it out here. www.utopiaacademy.com