I am going to be straight with you. I am not the smartest Physio, nor am I the best. I don’t do anything that is unique. There is nothing really that is new, just repackaged and reinterpreted.
What I do practice is the “art” of physiotherapy.
When I teach you an exercise, I want you to feel the difference immediately. When I mobilize your joints, I want it in just the right direction. When I massage a muscle or move a nerve or tweak your technique or give you a cue, it is the subtle differences that make all the difference.
So when I give you something to do like an exercise or stretch or activity, remember that I want it just right…
…how do you know if it is right? It works! It will feel better!
I call this my “30 seconds rule”. You will know in 30 seconds if it will be helpful or a waste of time.
My challenge to you is to think about the exercises and cues you use and see if it makes your performance better or worse… Because if you are worse, perhaps you need to reconsider how you are doing it :)
I am going to try write more quick entries because I have a long list of long articles on the back burner… And people keep asking when I am going to write more.
So today’s post is about when I told a patient we are going to go lift now…during his initial assessment. Read more of this post
During the recent seminar I ran, we met Nicole. Nicole has given me permission to write this blog because of the beautiful illustration of how various parts of the body interact and can cause pain.
Nicole has been chasing her pain around for a while. It started with some ankle soreness which became back pain which became right hip pain. Looking down the barrel of an MRI for a labral tear…but no incident or accident. She couldn’t squat or move well because of the pain. The standard hip tests seem to indicate pain in the anterior hip like a labral tear.
But what I do is a bit different. I look to see how she squats and what moves well and what doesn’t…and I discovered that her ribs aren’t working well…don’t know why yet, just that they aren’t working properly – we were in a seminar remember, not in a consultation :)
Anyway, I found where her movement first deviates from normal…and it was in the left side of her ribs…The term “Thoracic Ring” was coined by Linda-Joy Lee (www.ljlee.ca), probably in a similar way to how the pelvis is called the “Pelvic Ring” – if you think of the 2 ribs and 2 spinal bones and the breastbone or cartilage the ribs join onto, they form a ring…what you do to one side affects the other side. But most people know what ribs are so I still persist with that when speaking with the general public ;)
So back to Nicole…
When she squats, you will see that the first 2 squats show her shifting off her sore right side. When she “corrects” the rib on the left, she squats better and accepts weight onto the right side. There is a bit of a pause in the video because I am asking her to squat “evenly” – the fact that she can’t tells me that there is a bit more work to do to unravel why she is doing this.
What you don’t see in the video is that by **THINKING** about supporting that rib, she can take that pain in the right hip away. When she lay down to do some “quadrant testing”, her pain was there without the “correction” and when she or I “corrected” the rib, the pain went away. So to my way of thinking, is it really a torn cartilage? I didn’t even touch the hip itself!
There aren’t that many people who can assess this way…I was luck to be among the first in Australia back in around 2006/7…there are a few more now since then…but, as always, the proof is in the results…
I also like to show videos like this because quite simply, I expect results like this every day I am with my clients. I love the challenge and the pressure to “get it right”.
So the take-home message is this: Just because something hurts, it doesn’t have to be the REASON why it hurts. Nicole’s hip hurts but there isn’t something “wrong” with the hip…it seems like there is something wrong with the coordination in her ribs!
If you have an interesting story to tell, please let me know below.
I see a lot of athletes – both high level and recreational – as part of the work I do. To develop your body, you need to overload your body – the old SAID principle…Specific Adaptation to Imposed Demands. If you don’t believe me, check out the photos of how different sports will cause your body to develop differently (or at least choose different body types) here. But it is a fine line between enough stimulus to develop and too much load which will cause breakdown and injury…
…and injuries occur. They always have, they always will. Nothing is without risk. I just like to minimize the risks as much as possible.
The following blog post is about how I like to minimize the risks of re-injury for my patients who are injured.
I receive messages basically every day from people by locally and from afar asking for advice. I do my best to help everyone I come across but I thought I would answer this one in a blog post…well, because James suggested I could! Thank you James :)
Read on after the break to see what he wrote to me and what my suggestions were…
At GCS, we want you to get strong AND Stable…and have fun!
This is a common myth…just get stronger and you will have good stability!
But it is the old poodle and the dog scenario…a poodle is always a dog but a dog is not always a poodle. In other words, if you have good stability, you can become strong. Just because you are strong, it doesn’t mean you have good stability.
This post hopes to explain the reasons why this is.
“Core Stability” – why do so many people get it WRONG!?
One of my pet peeves is how health and fitness professionals and the general public throw around terms like “stability”, “core stability” and “unstable joints”. This blog post hopes to address some of these issues and shed light on why there are so many well-meaning but simply incorrect education out there about how to develop good “core stability”.
Kat Dalecki, Australian CrossFit Regional Athlete for Reebok CrossFit GCS, demonstrates how to do strict Muscle Ups.
Points to note:
1. From the dead hang, Kat is in complete control on the way up and down — no hinging or wasted movement, flexed/flat spine throughout — it doesn’t change angle very much at all.
2. Her shoulder control and stability means that she doesn’t jar her shoulders at the end of the Muscle Up. She also doesn’t lose control in the bottom of the ring dip which is where lots of athletes come unstuck
Progressions to Consider:
1. Strict pullups on rings
2. Reverse transitions — use a box, jump up or keep your feet on the floor and get to the top of the muscle up or the bottom of the ring dip. You then go from the bottom of the ring dip (with your thumbs on lateral chest wall) to tracing your thumbs where the underwire of a bra would be to the sternum. From there you can go back to the start or continue to practice.
3. Strict Ring Dips
4. Negatives — eccentric loading throughout the whole movement. Again, use a box or jump up into the final extended position. Then lower slowly to the bottom of the ring dip. Then slowly lower back down to the ground.
5. Strict Muscle Ups with a band
If you can avoid kipping for now and just work on your strength, technique, and positions, you will go further in the long run ;)
Please post your comments, questions or links to other examples below! Thanks!
Kat Dalecki, Australian CrossFit Regional Athlete for Reebok CrossFit GCS, demonstrates how to do strict Toes To Bar (TTB).
Points to Note:
1. Kat maintains control of her spine and speed throughout the movement — no “hinging” at the thoracolumbar junction, no flicking of the legs, no kip, no throwing the head back etc
2. The slower the movement, the harder it is. Kat can do these because of her great “strict” strength
3. Her mobility allows her to achieve these movements with grace, elegance and strength…she works on her mobility — it is like a chipper-style workout — just keep going, keep chipping away at it
Some Progressions to Consider:
1. Dead hang in “hollow” or Flat back position. Too many people start with extended thoracolumbar junctions and whip back and forth from there. Like the “hollow position” on the ground, you should be aiming to achieve the same on the bar.
2. Controlled Knee Raises. Keep working on your ability to keep your back flat in the dead hang. You will flex your back during the movements — that is ok…but you be feeling lots of work in your abs, not strain in your back. Progress by lifting your knees higher and higher until you can get your knees to your chest.
3. When you can hold your knees to your chest, try to extend your legs out slowly without swinging on the bar. This requires excellent hamstring mobility. Control the descent into the dead hang with hollow position.
4. When you can do 5 of the exercise above, try to raise up with bent knees and lower with straight legs (eccentric loading)
5. Work up to straight leg Toes to Bar.
If you have any mobility, flexibility, stability or injury concerns, please see your health professional as these may hamper your performance and/or increase your risk of injury.
Kat Dalecki doing 55kg squats for peak EMG measurements
Science on the Squat… controversial (for some) – It would seem that weight all on the heels is WEAKER and results in less activation of your hamstrings and quads!!!
For a while now, I have been wondering about the cue to remain on your heel, wriggle your toes etc etc. Apparently this is to increase the “posterior chain” activation…but pulling you toes up activates your anterior muscles…So, to end the speculation, I thought I would try a preliminary experiment to see if it was worthy of further study – don’t be rough on me – I acknowledge that this is not a high quality study but it was an interesting one to see if it was worthy of further study.
Method:
I did the following twice – once for biceps femoris and once for quads (I only had a single channel surface EMG unit)…1. 55kg squat is just below body weight for Kathryn Dalecki
2. 5 reps to warm up
3. 5 reps with weight on heels, toes up
4. 5 reps with weight evenly through the foot with ball of foot and big toe definitely down, weight through the centre of the logo on the tongue of Kat’s Reebok Nanos
Biceps femoris and quads (VMO/rectus femoris bias) were measured for peak EMG during the concentric (drive up) phase.
My theory was that evenly distributed weight would activate the posterior chain more…which would also increase the quads activation…plantarflexion of the 1st ray is a key component of the foot stability mechanism and activates and stiffens the posterior chain via the plantar fascia into the Achilles tendon.
Results:
1. Hamstrings peaked between 192 and 212 with toes up, between 232 and 250 with even foot
2. Quads peaked at around 280 with toes up and around 340 with even foot
Conclusions:
1. It is likely that an even foot distribution leads to better recruitment of hamstring and quadriceps muscles during a bodyweight squat
2. Toes up cue results in less activation of hamstrings and quads
3. Gluts would be interesting to assess with EMG – next time!
4. Further study on this is warranted
5. One subject does not make a solid conclusion and the study design can be improved etc etc etc – don’t hate on me, it was just to see what happened – I understand the limitations!
6. Try it for yourself!!!
So, place your feet on the ground. Keep the weight even throughout the whole foot ensuring that the big toe pad and ball of the foot (aka first ray), the ball of the outside of your foot and heel is in contact with the ground the whole time. If you do this, the centre of mass should be on the front of your ankle crease. I am looking forward to seeing if this makes a difference in activation in the sedentary, amateur, athletic and professional populations :)
Any comments, questions or discussion is welcome :)
