I just finished delivering a keynote speech and two hands-on clinics at the first annual Yoga Source conference in Simi Valley, CA this past weekend. What a great time! The theme of the conference was “The Healing Arts” and centered around a somatic understanding and application to yoga and healing. The mastermind behind Yoga Source and this conference is Jeni Winterburn–a vibrant, intelligent and spunky Brit. She has created a very special approach to yoga, whose principles very closely match my understanding of the body and healing. The two clinics I put on were “Fixing Neck & Upper Extremity Pain & Headaches” and “Hip, Knee, and Foot Pain for Runners”. If you missed it this year, I highly recommend you sign up for next year!
I was recently working with a woman with a 20-year history of back pain and who had thrown it out in December of 2015, 3 months ago. Her MRI showed L4/5 spinal stenosis and a herniated disc. She had since received two epidural shots which helped but she still had significant pain down her left leg and low back pain. She came in on crutches and did not weight bear on the left leg.
When examining her, I discovered that her left hip was higher than the right by about two inches and the left rib cage was lower than the right by about one-and-a-half inches. This is what I call in my back pain book a left sidebending problem. She also had a significant trunk shift laterally to the right, similar to the picture below.
When asked to walk without the crutches, she was reluctant to put weight on her left leg. The reason became abundantly clear as it caused the lateral shift to increase when stepping on that leg. She was also somewhat flexed forward and attempts to stand taller increased her sciatic pain. This is a hallmark of extension problems which I also describe in my back pain book.
This woman gave me pause as I’ve never successfully reduced a lateral shift before. I rarely see these issues so I don’t have much experience diagnosing the root causes. Lateral shifts either reduce on their own or they don’t. There are some that can be manipulated back but I’ve never had success with that technique.
Our first session we corrected the left sidebending problem and she left with a level pelvis and rib cage. She was able to maintain the correction however the next visit, she stated she was still in the same pain. The shift had not realigned on its own as I had hoped. So with the sidebending problem corrected, we moved on to the second pattern–the extension pattern. We performed a neuromuscular release for this issue which relaxed her muscles significantly. Unfortunately when she returned there was no change in her pain or her lateral shift.
Next we worked on changing how she stood up. We looked at this because when she was lying down, her shift disappeared. I was hoping to find a mechanical loophole to allow him to stand up taller without triggering the shift. We also performed dry needling to his lumbar spine and the back of her left hip, the side where she felt her sciatic pain. Surprisingly none of these muscles were tender and the needles went in without so much as a yawn from the patient. This should not have been the case as those muscles would typically be expected to be in spasm and therefore react to the needles–not so. In fact, the needles higher up on her lumbar spine were the most tender.
However this did mark our first break through. She stated she had 25% less pain upon returning for her next appointment. So we performed the dry needling again, this time abandoning the hip muscles and venturing further up the spine. As we moved into the thoracic paraspinals, she became more sensitive and we stopped at about T7 level. She noted that the thoracic needles seemed to irritate the sciatica a little. Strange as the nerves that comprise the sciatic nerve are found in the lumbar spine, not the thoracic spine. What tissues would we be affecting in the thoracic spine that would then interact with the lumbar nerve roots?
I then suspected the latissimus dorsi which runs from the pelvis, lumbar and thoracic spine to the the shoulder blade and upper arm bone. When I palpated trigger points in the latissimus dorsi, she felt sciatic pain down her left leg. We found a similar issue with the left serratus anterior, a scapular stabilizer. Why in the world would the serratus and lats be referring to the sciatic nerve? Then I visualized that because she was shifted to the right, the left latissimus must be shorter, probably in spasm. I hypothesized that the left serratus and latissimus were in some way, locking in the right lateral shift, preventing it from releasing. So we targeted these muscles, working out trigger points that referred to the sciatic nerve.
The next appointment, she looked like a new woman! She was not on crutches and her right shift had reduced by at least 50%! She stated he was feeling 70% better and was beginning to have hope that this episode would finally resolve. I was very happy for her and excited that we had possibly discovered the secret to fixing lateral shifts.
She was not a fan of the dry needles so the next appointment, we just worked manually on her left lats and serratus ant, working out trigger points and stretching. That night she decided to go sit in her hot tub which always made her feel better. The wind blew the large hot tub cover down the drive and she got out and dragged it back up to the tub–a testimony to how good she was feeling.
Unfortunately that set her back to zero again and she came into the clinic in agony. The shift was back to its usual severity. She was at her wits end and decided to pursue surgery as she had been in pain for 3 months now and just didn’t want to try again. This is unfortunate as I believe we had revealed the muscle groups that locked her lateral shift into place.
Fortunately for science though, one of my other therapists also had a person with a lateral shift who was not progressing after several visits. I told her to try targeting the latissimus dorsi and serratus anterior on the side away from the shift which she did and had miraculous results. In two more treatments her patient was approximately 90% better!
Could this be the key to fixing a lateral shift? I would need more patients to refine my thinking but it’s looking hopeful! So, if you know of anyone with a lateral shift, please send them our way to so we can get them better!
This also goes for trigemminal neuralgia and occipital neuralgia patients as I’m working on promising treatments for these patients as well.
We recently rolled out our own 12 Days of Christmas tips on our Facebook page and thought I’d put them together here. Enjoy!
Do you really want to read through another series of #12DaysofChristmas themed posts during this busy time of year? Likely not. So our first gift to you is that there will be only 6 Days of Christmas tips on how to stay healthy and mobile during the holidays! There, we’ve already saved you lots of precious time to be with your loved ones or get your shopping done.
On top of that, here’s the 1st Day of Christmas tip- A friend of mine, who’s an emergency room doctor told me Thanksgiving is a busy holiday for injuries because people become a little careless. So, assuming you’ve made it through Thanksgiving stitch-free, consider yourself lucky and be careful with the decorations. Turns out that around 200 people a day are treated for injuries related to holiday decorating—can you believe it? So slow down and be safe, not sorry!
Day 2 of the #12DaysofChristmas done in 6 DAYS for your convenience!!
Got tight hamstrings, hip pain, sciatica, back pain, foot or ankle pain? Try this unique Hamstring Push exercise I’ve developed in my clinic. It’s helped so many patients with chronically tight hamstrings and other problems associated with them! All it takes is a door and 5 minutes.
Day 3 of the #12DaysofChristmas in 6 installments ONLY!
Okay admittedly this tip is really benefiting me too, but if you need a powerful gift under $15 the Fixing You: Back Pain 2nd edition book will be hugely helpful for anyone you know who has back or sciatic pain.
These issues can be easier to fix than you might think—no matter how long you’ve had them. Any of the Fixing You books will be a tremendous gift that will keep on giving long after the holiday.
Well, we are over the hump (on hump day no less!), Day 4 of the #12DaysofChristmas done in only 6 DAYS!!
Are you starting to feel OVERWHELMED? Stress often causes people to feel more neck pain or headaches. If this describes you try this simple exercise: Get on your hands and knees and rock back so you’re sitting on your heels, resting your head down on or near the floor. Stretch your hands forward to feel a nice stretch in your shoulders or armpit area. Really go for the stretch and enjoy it while taking at least 5 deep breaths in this position. Now sit back up and see if your neck pain is diminished.
If you found this helpful, this stretch is featured in my neck pain book.
Day 5 of the #12DaysofChristmas!! How you all doing out there?? Take a little time for yourself to be BE GRATEFUL. I know this time of year, things may get crazy. Or maybe you’re a little depressed because it isn’t crazy enough. Either way, be grateful for everything and everyone in your life.
Be grateful for your ability to get up each day and have the opportunity to begin a brand new life.
Be grateful for the choices you have. Focus on at least one thing that is good in your life today.
Keep revisiting that feeling of being grateful.
Day 6 of the #12DaysofChristmas and our last tip for the holiday season – Be Rich. My grandfather had a saying when things were going really well or he was just relaxed. He’d say, “It’s just like being rich!” meaning it just can’t get any better—there’s nothing to worry about. Today, indulge yourself in a special treat, whether it be a cup of hot cocoa, a special scarf you’ve had your eye on, or just sitting down to start a book you’ve been looking forward to.
Take a deep breath while indulging, close your eyes and know that if you can have this one special moment, life is good—you’re rich! Begin focusing on these good things in your life that make this time possible.
I’ve been playing around with a hamstring lengthening technique I’ll call The Hamstring Push that lengthens the hamstrings without actually stretching them. “Why,” you might ask, “would I not want to stretch my hamstrings to lengthen them instead?”
Well, as a physical therapist, I see lots of low back pain, sciatica, ankle, foot, and hip pain patients whose pain is worsened when stretching the hamstrings–even if they would benefit from lengthening the hamstrings. Pain is made worse because the muscles through which the sciatic nerve travels–the hamstrings, calves, and back of the hip muscles–are often in spasm or otherwise neurologically receiving messages for these muscles to contract. There are many reasons for this mostly stemming from standing, walking, sitting, bending or sleeping habits.
How you use your body creates preferred neurological pathways of muscle contraction. When these habits are used over and over again, the muscles often remain activated (by your brain) in anticipation of being used yet again. This creates neurological tension in the muscles whereby if you attempt to stretch them, they reflexively return to their pre-stretched length. This is because the muscles (actually brain and corresponding nerves) have learned to maintain this length and tension. Stretching then can cause more pain because of this reflexive contraction.
The key then is to lengthen the muscles instead of stretching them. “What’s the big diff?” you might wonder. The difference is that to lengthen the muscles we inhibit the neurological signals that are causing them to contract. Hanna Somatics is a good way of achieving this however I’ve got a perhaps faster way of doing this yourself without the help of a specially trained practitioner. The technique is presented in the video below:
The Hamstring Push above is using something called reciprocal inhibition. Reciprocal inhibition is a phenomena whereby muscles that oppose contracted muscles are inhibited to allow the contracted muscles to move the joint. For instance if you are contracting the biceps muscle on the front of your upper arm to bend the elbow, the triceps on the back of the upper arm is inhibited to allow elbow joint to bend. If the triceps were not inhibited, it’s likely that the biceps would have to work much harder to bend that elbow because the triceps may become activated as well.
So in the case of The Hamstring Push above, you will contract the stomach muscles to help push the hands forward into the door which helps inhibit the opposite muscles, the low back spinal muscles which is the area where the sciatic nerve begins. By contracting the top of the thigh muscles, the quadriceps, to push the knees down, you are then inhibiting the hamstring muscles on the back of the thigh. And by activating the muscles on the front of the shin bone, the anterior tibialis muscles, by pulling the toes back toward your nose, you are inhibiting the calf muscles and the plantar foot muscles on the bottom of the foot. Doing this for 20 seconds for 2 sets seems to be enough to allow the hamstrings (as well as all the other muscles we mentioned to lengthen by inhibiting their contraction neurologically.
Try this out to see if it helps you lengthen your hamstring muscles.
Throughout my years as a physical therapist, I’ve noticed that no two people respond exactly the same way to stressors. Nor do they respond exactly the same way to treatment of their problems. Why?
Recently the physical therapy program at Regis University opened up its cadaver lab for 2 hours to physical therapists to brush up on our anatomy. I’d forgotten that unique formaldehyde cadaver lab smell which imbedded itself into my nose and clothes! It has been 20 years since I’ve stepped into a cadaver lab and, just like the smell of home-made bread can take you back to your childhood, the smell of formaldehyde transported me back to my graduate studies.
My goal for this experience was to make sense of the anatomical relationships that I was experimenting with in my clinic. Here are a few things I learned.
Variety is the Spice of Life
Earlier this summer, I was admiring some of our beautiful flowers at home. In particular I was studying our coreopsis. From a distance, all the flowers looked the same. But as I sat quietly watching them, I noticed that actually there was amazing variety between flowers and, looking more closely, even between the petals of the flowers.
One of the lessons I learned in this cadaver lab is that we are very similar to these flowers. While we all have a similar shape outwardly, as we look closer, we begin to see more differences. Our inner landscape is much the same too displaying endless variety from one person to another. It’s no wonder, therefore, that one person can be gifted in one sport and not in another. These differences, I imagine, such as in the width and thickness of the pronator teres muscle, can mean the difference between a 14th ranked professional tennis player and the 1st ranked. It struck me how these differences help explain the edge some top-ranked athletes have over their competitors, not to mention why someone might develop an injury while another won’t when performing the same task.
Fascia and the Hip Adductors
These past few years I’ve been very interested in fascia and have been following Thomas Myers and Robert Schleips work. I’ve included some of my ideas of how fascia affects chronic pain in the second edition of my back pain book. So I was excited to revisit this tissue with a fresh and more functional perspective. I was blown away by the blending of muscles nerves and ligaments with respect to fascia. Fascia, by the way, is connective tissue in the body, binding all structures and tissues together. It’s even capable of contraction. When I was in PT school, we really didn’t focus on fascia as a structure. Instead it was a nuisance to cut and peel away so we could see the muscles.
What I realized is that, especially at the origins and insertions of our muscles, fascia seems to become particularly dense, interacting with many other tissues. One area that interests me is the relationship between the adductors of the thigh (the muscles that move the leg toward our midline) and the hamstrings (the muscles in the back of our thigh). This is because I’ve been realizing that chronic hamstring problems seem to have a large component of adductor tension as well. So I wanted to understand this relationship better. What I observed was a massive blending of strong fascial connections between the origins of the adductors and hamstrings at the pelvis. Remember, these cadavers had already been dissected and poured over by students for a semester and so much of the fascia had been removed long ago but there was enough left to give me an appreciation for what was once there. In my mind, this corroborated my emphasis on adductor function when working with chronic hamstring problems as tension in one area can lead to tension in another adjacent area. Additionally fascial connections extended to the head of the femur as well, helping me understand why the adductors would also be an important area to address in sciatic or hip pain.
The Smaller Muscles Have Larger Variety
One of the lessons I’ve learned throughout the years is that stubborn pain is not often caused by the usual suspects. So we must look in unusual places to understand these problems.
Two muscles that I’ve homed in on regarding nagging pain are the pronators quadratus and teres in the forearm and the popliteus muscle in the back of the knee. It seems these little guys are wreaking havoc in these joints. What I was surprised to find was these muscles could be very different in their thickness, width, and insertions. I found some pronator quadratus muscles inserted closer to the elbow joint and some were much further away. I found some pronator teres muscles were narrow and thin while others were wide and thicker. Still in others the popliteus muscle, like its brothers the pronators, had varying areas of insertion and thickness. In my mind this helps explain why some people have a propensity to have chronic elbow or knee problems while others recover so quickly.
A Trigeminal Neuralgia Answer!
In the last 15 minutes of the lab, the anatomy professor entered the room and I made a beeline his way. One of my burning questions this past year has been to understand why I’ve been successful in helping people with trigeminalgia by fixing their shoulder function. What I learned was that the sensory nucleus of the trigeminal nerve extends down to the second or third cervical spinal levels (C2 or C3) within the spinal cord (the image to the left is from this source). This nucleus is called the spinal trigeminal nucleus and one of its subnuclei (subnucleus caudalis) is responsible for pain signals.
If you’ve read my neck pain and headaches book or other blog posts, you’ll remember that the levator scapula muscle attaches from the top corner of the shoulder blade to C1-C4 (I actually saw this muscle insert into C5 and perhaps C6, in one of the cadavers in the lab!). What I also saw is that this muscle (and others) attach to the outer fabric of the spinal
cord (the dura mater) via fascia (see image to the right from this source). So working with the levator scapula, also affects, to some degree, the spinal cord. I experimented with this by tugging on a few cadavers’ levator scapulae in the lab and watching the dura mater move. If this is happening, then why not also extend its influence to the the spinal trigemminal nucleus? After all, look at how these structures are attaching to the dura mater.
I also observed the many fascial attachments from the levator scapula and other deeper cervical muscles to the base of the skull and spinal cord through the foramen magnum (the hole at the base of the skull through which the spinal cord travels). So, in my simple way of looking at things, I think this helps explain how the trigeminal nerve is affected by fixing shoulder blade function.
Everything is Connected
Especially after having my eyes opened by Thomas Myers’ work with fascia, I was better able to appreciate the web that is our body. Fascial connections are everywhere and are meaningful. Sometimes they are thick connections and sometimes they are tenuous wisps of fascia. Nevertheless, while the individual connections may seem insignificant, the volume is staggering. And just like a single spider web may be easy to snap, bundle them together and you get a strand similar in strength to steel. I have a newfound appreciation for the diversity and interconnectedness of our movement system.
I’m so thankful for this cadaver lab experience for these and so many other discoveries!
I recently saw a woman in my clinic complaining that the left side of her head hurt. Not just a headache but also the muscles throughout her face, around her ear, eye socket, teeth, palate, jaw and the back of her head too. She complained that it felt as if a large hook were in the left side of her mouth painfully pulling her lips and cheek to her left ear. She also complained of the feeling of broken glass in her nose. Her sense of taste had been altered. She was very sensitive to light and sound too and complained of dizziness and nausea. This had been going on relentlessly for several months after a yoga session she attended. The pain was constant in her jaw and face and spread to the other areas of her head when it became worse. She had a very difficult time sleeping and had to lie “just so” in order to finally fall asleep. She said that sometimes she would have to wear a mask to keep breezes from touching her face as it would send her into waves of pain.
She had been to several neurologists and other doctors who agreed it was trigeminalgia—basically an irritation of her trigeminal nerve which fed different parts of her face (See the great image above from the guardian). The trigeminal nerve is mostly a sensory nerve which carries information from her face to her brain. She had been given a series of medications to control the pain and irritation but she didn’t want to control it, she wanted to fix it. She didn’t want to take medications.
Her past history involved several car accidents when she was little which left her with chronic migraine headaches and general neck stiffness and pain. She told me that since those accidents, she never liked having both arms over her head. No doubt, she neglected to tell this to her poor yoga instructor!
Several years ago she had a traumatic blow to her left shoulder which dislocated it and was repositioned in the ER with no further treatment. Earlier in the year, I was working with her knee, she was feeling so good she decided to try yoga again. It just so happened that I told her on her last visit that I thought I could help with her chronic migraines if she wanted to give it a go. After that I hadn’t seen her for months until recently. I had thought that somehow I had made things worse but instead she had developed this condition for which she had been trying to find answers. Because I worked with her knee, she thought I was a “knee guy” and never thought I could also help with her latest issue too (she saw this recent issue as unrelated to her migraines). Physical therapists help with conditions from head to toe.
Her doctor finally sent her my way in desperation. After going through her history, I believed I knew what was happening. I then evaluated her, which confirmed my suspicions. During our evaluation, I found I could press anywhere on her left arm or hand and elicit different patterns of pain in her face and head. This was news to her as no one had ever looked at this before. This is due to the fascial connections between the arms and neck/head area (See image below: Fascial Arm Line–posterior). I also found that the right side had a similar finding as the left, although she reported no symptoms on the right side (this also was news to her). I found several other issues, many of which are outlined in my neck pain & headaches book.
One detail that shone through her history and tipped me off to the root cause was that this occurred after a yoga session during which her arms were raised over her head. While it’s easy to dismiss this detail if you believe there are no significant anatomical connections between the shoulder and the neck or skull, I see daily evidence these connections exist and are very impactful in terms of pain generation and so it wasn’t a big leap to suspect shoulder girdle dysfunction as a root cause of the irritation. I can certainly understand how most doctors would not suspect this as a irritant to the trigeminal nerve as there is no anatomical text that describes it. Yet I see it frequently as evidenced by the successes I have with difficult headaches and neck pain and now perhaps two trigeminalgia cases (see the very first unsolicited testimonial I received just three weeks after I released my neck pain book from someone who I think had trigeminalgia. It’s the first testimonial on the page).
After her first treatment session three things happened that were new to her since this began several months ago: 1. the pain had decreased significantly and had leveled off. 2. that night she slept through the night with no pain. 3. she had forgotten to take her pain meds for an hour and a half—something she never missed for months because the pain would be screaming back if she didn’t take her meds every 30 minutes. These were all good signs.
Our second treatment reproduced our first and she was feeling more relief during the session. “It’s like when you have a sand castle and pour water on it and see it melt away” she said of the pain. These are the descriptions I like to hear. They confirm we’re on the right track. I’m definitely not a “No Pain, No Gain” physical therapist. I taped her shoulder blades in place which I had also done the first treatment (I’ve just added a video of this technique to both my shoulder and neck pain book videos to help people recover faster from their issues. They can be found in the “Bonus Videos” portion of the videos for those books).
I saw her for 10 sessions before her insurance visits ran out. Overall she eliminated almost all of her pain including the hook in the face and broken glass feelings, the sensitivity to light and sound were nearly gone, there was no more dizziness or nausea, she was sleeping much better and now understands why it all happened in the first place. I wish I could’ve seen her to the end but that happens sometimes in physical therapy when you work with insurance. That’s why it’s crucial that we educate our patients as much as possible about their condition and how to think about it. She can now use her body in a way that feeds her rather than breaks her down.
I thought this was an interesting case because the trigeminal nerve is a cranial nerve–meaning it originates in the brainstem. How would working with her shoulder affect this nerve? I’m not sure, however I wonder if there are fascial attachments from the cervical spine that somehow travel through the foramen magnum (the hole where the spinal cord exits the skull) and interacts with the cranial nerves either directly or indirectly. Or possibly it affects where the cranial nerves exit the skull to feed the face. Either way, it gives hope that other similar cranial nerve issues may be impacted via treating the shoulder girdle. I’d love to experiment more and visit a cadaver lab to explore these potential connections!
I hope this gives some hope to those of you with perplexing pain conditions. My premise in working with every patient is that there is a solution. We just need to uncover it–even if I’m not the person with the answer.
Recently I was a contributor for a Q&A on Sharecare–a site to post questions to medical and fitness professionals and receive answers. This Q&A session was on Twitter and so my responses were limited to Twitter’s 140-character limit. I found it difficult to give a meaningful answer under those constraints so I thought I’d elaborate my answers here.
Q:What are some stretches that can help alleviate or prevent carpal tunnel syndrome?
My Twitter answer: Child’s pose, modified to reduce symptoms can potentially help by stretching the shoulder blade depressors.
A better answer: Okay, a little explanation here. Carpal tunnel syndrome results from the compression of the median nerve that feeds the hand. However the median nerve can be compromised at any number of areas of the arm, including the wrist (carpal area). I think the diagnosis is misleading because, even if there is compression at the wrist, that doesn’t mean there are no other areas of compression in the arm or shoulder blade area also contributing to the irritation.
In my experience, shoulder blade dysfunction may be setting up the median nerve to be hyper-sensitized so that small pressures on it can create carpal tunnel syndrome. Typically the problem with the shoulder blades is that they have become depressed–they’re sitting too low. An easy exercise to begin correcting this is what I call the All 4’s Rocking exercise in my neck pain or shoulder pain book. While this exercise results in the arms being overhead and increasing symptoms, it ultimately can help fix the root problem–that of a depressed shoulder blade. In the case of carpal tunnel syndrome, I would do only one arm at a time and for brief periods of time to reduce irritation to the median nerve.
Q: What can seniors do to minimize risks from falling?
My Twitter answer: First identify whether you have balance issues and where they originate from–eyes, joint stiffness etc.
A better answer: Balance is a product of three systems working together–the eyes, the inner ears, and joint proprioceptors. Joint proprioceptors help you understand where your body is in space even if you’re not looking at it. So a deficit in one or two of these systems can contribute to balance problems.
If all is well with the eyes and inner ears, I’ve found that most balance issues gradually occur in response to a fear of falling backwards. In this case, weight is shifted forward to the forefoot and eventually the body begins to hinge forward at the hips to avoid the feeling of falling backwards. The knees, ankles, and lower back tend to become very stiff, offering few options through which to correct balance. Developing flexibility in these areas, safely practicing weight shifting toward the heels, and learning how to absorb perturbations from the ankles and knees to correct balance are the top three areas I begin working with to help people restore proper balance.
Q: Is it safe to continue high-impact exercises as one ages?
My Twitter answer: Depends on your definition of high-impact. History is the best indicator for this. If you haven’t been doing it then likely no.
A better answer: To be honest, I didn’t read this question closely enough. On second read, it sounds like this person is already engaged in what they believe are high-impact exercises. From my perspective, I would say go ahead and continue but to make sure you don’t have undiagnosed osteopenia or osteoporosis first. You don’t want to suddenly create a fracture to deal with.
Secondly, I see many people who grow older doing the same workout week after week. Unbeknownst to them, this is a recipe for injury because the body is not given variable ranges of motion, loads, or movement patterns to maintain suppleness. So I would caution that if you’ve been doing this high-impact workout (or any workout) for more than 6 months, to change it up a little and try something else to lengthen and strengthen your body like yoga or Pilates. You can always return to your workout later if you like. Your brain likes variety so feed it a little bit.
Q: How do I protect metatarsal pain/issues when running?
My Twitter answer: This often has to do with over pronation/supination, foot strike patterns, and potentially hip weakness.
A better answer: There’s a ton of variety in how each of us is built as well as how we do things, including running. So there is no one-size-fits-all solution here. However tight calf muscles can contribute to over-pronation stress at the foot thereby causing metatarsal pain. Stretching these muscles can be tedious. What I recommend to most people who have tight calf muscles is to try wearing a dorsal night splint (this links to the one I recommend in my clinic). Typically the reason the calf muscles are becoming tight is due to the toes or foot pointing away from you (plantar flexion) while sleeping. Then when you wake up, your calves are tighter than when you went to bed, forcing you to start all over again with the stretching. Dorsal night splints can be a powerful tool to help you maintain length of the calf muscles, thereby reducing stresses to the foot and ankle.
Regarding the hip, if the thigh bone isn’t controlled well by the gluteal (butt) muscles, excessive or uncontrolled internal rotation can occur here which eventually feeds into over-pronation of the foot. This can also contribute to metatarsal pain. Improving gluteal muscle performance would be helpful in this case.
Q: What are exercises one can do with arthritis?
My Twitter answer: There are a few issues that feed pain from arthritis. In general gentle stretching can help.
A better answer: This is a big question because not only are there different types of arthritis but it can be located in many different joints affecting what you can do. In general, working in the pool in, say, a pool aerobics class or just walking, swimming or goofing around a little would be a less stressful way to get exercise yet reduce load to the affected joints.
Since your doctor is the person most familiar with your issues, you should run it by them for recommendation to play it safe.
Q: Can high heels cause arthritis?
My Twitter answer: High-heels can create muscle imbalances that contribute to pain in arthritic joints.
A better answer: Arthritis can be caused by excessive wear and tear to joints. Often muscle imbalances or poor movement strategies contribute greatly to this wear and tear. High heels can cause the calf and foot muscles to become short which, when not wearing high heels, can cause excessive strain at both the knee and the ankle (and indirectly to the hip and back). Also in high heels the subtalar joint of the ankle is not weight bearing on the surface it was designed to wear bear on, which may contribute to more wear and tear at the ankle. Lastly, excessive pressure is placed on the metatarsal heads of the feet (the balls of the feet) which can damage this area as well.
Q: What does hip-popping during exercise indicate?
My Twitter answer: This may indicate an arthritic issue, labral tear, poor tracking of the femoral head or tight hip flexors.
A better answer: Actually this is a pretty good answer. There’s not much to add here other than if you have any of these issues, your gluteal (butt) muscles might not be working well contributing to any or all of these problems.
One of the most common questions I hear as a PT is “I have back pain, so what should I do about it?” What I realize now is that there’s a lot of confusion about this and most other diagnoses.
The bottom line is that if there was one solution to back pain (or any other pain), it would have been discovered long ago and we’d be done with understanding how the body works. To my knowledge there is no single solution. This is because the body is complex, we all lead unique lives, have singular genetics, and different emotional experiences which makes for lots of variety and therefore potential causes for back pain.
This even holds true for diagnoses such as a bulging disc. I think what people need to understand is what most diagnoses are really telling you is the name of the tissue that’s complaining–nothing more. Usually the culprits lie elsewhere.
To give you an idea of what I mean, I was recently asked by an exercise instructor what might cause knee pain in her client. Well there are many potential causes of knee pain: flat or high-arched feet, tight calf muscles, poor walking patterns, rotated thigh bones, poor gluteal (butt) muscle function, a tilted pelvis, tight hip flexors, tight hamstrings, structural problems such as ligament tears, or simply poor movement habits. Notice almost all of these had nothing to do directly with the knee. By the time I got through with this list, the instructor’s eyes were glazed over (I’m sure you feel the same!). And that’s just knee pain, a fairly simple joint in the body. Just think what more complicated areas must be going through!
So diagnoses like back pain, SI joint pain, cervical/neck pain, back strain, bulging discs, hip bursitis, tennis elbow, tension headaches, migraines, sciatica, plantar fasciitis, ITB syndrome, or patellofemoral syndrome really mean very little. Basically you’re being told which tissue is hurting. Instead what we really need is a diagnosis that tells us how or why something is painful.
Part of all this confusion is that healthcare providers often fall into the trap of focusing only on the tissue that hurts. After all, your doctor said, “You’ve got a disc bulge” not “You’ve got a flat foot that is rotating your knee and thigh inward, which is dropping down that side of your pelvis and turning off your gluteal muscles, which is creating excessive arching on that side of your spine, which is causing you to have back pain”. In my experience the second explanation is the more accurate diagnosis, not to mention one that we can actually work with.
I don’t really expect other health care professionals like doctors or massage therapists to know these root causes though as that isn’t really their specialty. But it is the job of a physical therapist.
Magazines and other sources don’t help much either by trying to narrow down the solution to cute or catchy bite-sized pieces: 3 Moves to Beat Your Back Pain Now!, The Tennis Elbow Cure!, 5 Reasons Chocolate is Great for Your Headaches! and other types of articles (Did the title of this article make you look?). These give readers the impression that their solutions must be just as simple. Sometimes they are–but not often.
Can you imagine stuffing all those causes for knee pain into one article? Remember journalists for magazines or newspapers or even most bloggers are not healthcare professionals. Their job is to write an interesting article—not fix people’s pain. There’s a big difference.
A simple search on the internet shows that there are a lot of people writing about pain– these writers, however have become the gateway to your understanding of your own issues. Unfortunately many of these people don’t really have any experience helping others with pain. Therefore the answers most people are getting are usually a bit skewed.
Because understanding why pain is happening can be complicated (or at least not summed up in 250 words or less) the real reasons pain happens, never get much press. I can attest that it’s very difficult for me to get my message out to the public, mostly because it’s not simple or sexy enough (let’s face it, both of the people reading this blog might be struggling to even finish it—sorry Mom and Dad, I’ll try to make the next one shorter). It makes me think there must be others who have good answers for chronic pain but they either aren’t writers, can’t catch the ear of the media, or they can’t convey their information in a creative, concise magazine article.
I wrote my back pain book and my other books in the most concise and effective way I could. In them, you’ll find most of the roots to your own pain. One of my goals with all my books is to help you understand how your body works so you can fix it. Once you understand this, you’ll be able to manage your body and eliminate pain forever. I encourage others who have consistent success to write their books as well.
That’s my two cents. I sincerely hope you find solutions to your pain. I truly believe they are available if you look in the right places (hint: begin with my books!) and ask the right questions.
I thought I’d put this little video together for those of you interested in moving through my book more quickly. Basically there are two tests that are pivotal in your understanding of your back pain. This video explains where to find them in the book and what they are. If you understand how these two tests are working on your body, you’ll have a HUGE understanding of how to fix your pain.
I hope it helps!