I have spots available at our home clinic in Gordon Head on Wednesday mornings and Saturday afternoons/evening. You can book online here and click on “book an appointment”.
I’m very excited to announce that I will be taking a Mat Pilates Teacher Training course in April. The skills that I learn in the course with be very helpful for teaching good core strength and proper movement pattern to my clients. I find myself being drawn more and more into the benefits of good movement patterns as often I find that pain and dysfunction occur when we move in patterns which our bodies do not function well in. As I mentioned in my previous post, evolution has designed us to move in a certain way. Some areas are much more stable than others. One teacher said that it is a simple decision when we choose how to move. It is like coming to a crevasse and you have two bridges. One is a strong cement bridge and the other is an old unstable wood bridge. Which would we choose to cross. My job is to reveal those options to you so you can be empowered to make the right choice.
Be Strong + Move well = Less pain.
With any condition that a patient comes in to see me with, I feel like it is always important to have a philosophy to refer to when helping a patient to feel better. It might be neck, shoulder, back or hip pain. It might be headaches, numbness and/or tingling, loss of range of motion of a body part or perhaps an issue with balance or function. There are many ways to help with re-establishing good movement or posture patterns and/or functional retraining when there is an activity that the patient wants to return to. Very often, in my experience, it is when we deviate from good movement or postural patterns that symptoms may arise. Our bodies need to learn again where it should be, whether it is posture or the way that we move. My greatest success with helping the body to move better in a pain free manner is to look at how the body is supposed to move. There are lots of hints and clues with our physical evolution.
Take the shoulder for example. Good movement of the shoulder involves movement of the surrounding ribs, shoulder blade, collar bone, the vertebrae of the upper back with control and stability of the surrounding muscles and ligaments. Everything has a job as the shoulder joint is properly stabilized no matter what direction it moves. One teacher of mine talked about the importance of just allowing the body to do what it was designed to do. It is my job to look at how each part is working during a movement, to make sure that everything works properly. A small dysfunction in one area can cause pain in another area. As owners of the body in pain, we are drawn mainly to where it hurts, making it difficult to assess where the dysfunction is originating. In my own experience, I experienced significant discomfort in one area, to which the treatments I received was focused mostly in the symptomatic area, and it wasn’t until we discovered that the function of another area needed to be improved. Once the function of that area improved, then it significantly helped with the symptoms that I was experiencing. There was a thought put out that sometimes you need to put the symptoms aside for a brief moment and just see how the whole region is working.
With all of the above in mind, I have adopted the philosophy of looking at how the whole system is working. Often the easiest part of treating is the short term effect of removing the symptoms with soft tissue release and mobilizing a joint to allow better movement but I like to move past that to teach the patient to improve their posture or to learn to move in the manner in which we were designed to move so that if we find that there is a return of the symptoms, then the patient knows how to remedy the situation. A classic example is working in front of the computer and falling into a slouched position and feeling upper back and neck pain. During a treatment, I will show the patient the optimal position to hold the body where it is strongest and least like to experience pain or dysfunction.
Learning about ourselves and how we are meant to move and hold ourselves is the secret to reduced pain, mobility, flexibility, strength and endurance.
I am now back and working full time at the clinic. My hours are Tues 8-2, Wed 2-8, Thursday 8-2 and Friday 11-7. You can book online any time here
I’ve gone in for some heart surgery in late August and going to be on the mend until mid October or so. I have a locum in to fill in for me at Good To Go Sports Therapy. His name is David Fredbjornson and you can book in with him at goodtogo.cliniko.com/bookings
See you all in October.
During the Myofascial Release courses that I have taken, a common comparison was made between the fascia in the human body and a tent. I think it is a great example of how Fascia maintains structure, function and stability in the human body. It holds us together and allows us to move and be flexible, yet strong. The function of the skeletal system and the fascial system act like the poles of a tent and the ropes that hold up a tent. The poles are the skeletal system that create the shape of the tent but it is the importance of the tension of the ropes, which are the fascial system of the body, which maintains the integrity and holds the shape of the tent. Without the ropes, the tent, even with the poles, will fall over in the presence of an internal or external force. It is the fascia, which allows the tent to hold it’s shape and provide the function.
An example of dysfunctional fascia, which may be adhered and/or shortened would be like pulling one of the ropes too tightly. Think of the whole tent being pulled to that side. The same thing can happen with the body which adhered, shortened fascia can pull the body out of it’s center of gravity causing dysfunction, instability, weakness, reduced range of motion and pain. There are various causes of fascia that can become short, dehydrated and dysfunctional. When it comes to shortened fascia, everybody presents differently. It can begin at child birth or be present after even a minimally invasive surgery.
It’s finding the fascial restrictions that pull the body out of it’s center of gravity. The philosophy is to find the pain but look for the cause elsewhere as the cause and effect may not be in the same area. As a therapist, I’ve learned to treat without feeling that I know what it happening. There is a process, but I have to learn to be a good listener to find where the cause is.
When a person has had surgery, whether it be abdominal, cranial, shoulder, back, hip, knee or any joint surgery, often a neglected portion of the recovery is Myofascial Release of joints and tissues affected by the surgery. Adhesions can occur in the joints or tissues as a result of the surgery itself or the period where the person has to keep themselves, or a portion of their body, immobile during the healing phase immediately after the surgery.
I became acutely aware of this necessity after my heart surgery, where I had a heart valve replaced. To do the surgery, they had to cut through my breast bone to access the heart and do the surgery. So for the next month, I had to keep my arms and shoulders pulled forward. I wasn’t able to open up my chest and bring my arms up and stretch them back while the sternum repairs itself. As a result, all the tissues around the front of my chest, my upper abdomen and the front of my neck were put in a shortened position for an extended period of time. All the tissues in the front will become adhered to each other and keep the tissues shortened which dramatically alters the center of gravity with the body and the shoulders and neck/head are pulled in a forward position. This is just a quick example of the effects of immobilization after surgery but doesn’t include the effect of the scar tissue created by the surgery itself.
I have seen the same effects with shoulder surgery, back surgery, hip/knee/ankle surgery. A bit portion of the rehab process is the return the joint or body part back to it’s normal mobility with myofascial release and strengthening. A body just wants to move in the manner in which it’s designed to do. That’s the best way to return a body to normal. The techniques are different for scar tissue release, for soft tissue release and for release of tissue surrounding the joints like ligaments, tendons or the capsule that surrounds joint. All can shorten, but all can be returned back to a good functional range of motion.
The principals of Myofascial Release are adhered to (pardon the pun) to create an increase of mobility that is gentle, effective and creates a long term effect. Every release will last a while but it’s so important that the patient has a full understanding of how they are presenting and how they can maintain the work that we do at home. It should never be about depepnding on the therapist to “fix” you. We assess the condition, educate, we begin the process to facilitate and allow the patient to help maintain the progress with home exercises.
Of the Fascial Release Course I attended, probably one of the most important things I brought home was reiterating the importance of stretching the fascial tissue to it’s stretch barrier and holding it until it lets go. That sometimes the stretch may have to be held for 3-5 minutes. When we complete the fascial release, we want it to stay there. Very often, the question I get from patients is, how do we get it to stay there so it doesn’t bounce back. I can give stretches to do at home to maintain our progress but it’s my job to release the specific fascial adhesions so that the home stretches are effective. To fully understand what fascia is, and what we are working with, we look at what makes up fascia.
Fascia in the body is described as: Fascia is a specialized system of the body that has an appearance similar to a spider’s web or a sweater. Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as, all of our internal organs including the heart, lungs, brain and spinal cord. The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one continuous structure that exists from head to toe without interruption. In this way you can begin to see that each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.Fascia plays an important role in the support and function of our bodies, since it surrounds and attaches to all structures. In the normal healthy state, the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When one experiences physical trauma, emotional trauma, scarring, or inflammation, however, the fascia loses its pliability. It becomes tight, restricted, and a source of tension to the rest of the body. Trauma, such as a fall, car accident, whiplash, surgery or just habitual poor posture and repetitive stress injuries has cumulative effects on the body. The changes trauma causes in the fascial system influences comfort and function of our body. Fascial restrictions can exert excessive pressure causing all kinds of symptoms producing pain, headaches or restriction of motion. Fascial restrictions affect our flexibility and stability, and are a determining factor in our ability to withstand stress and perform daily activities.
Fascia is comprised mainly of three things: Elastic fibers, Collagen fibers and Ground Substance that surrounds the Elastic and Collagen fibers. With fascial adhesions, it’s the collagen and elastic fibers that become bound to each other, greatly affecting the elasticity of the tissue, affection local movement, where ever that tissue is in the body, as well as movement and function of other areas of the body, as the fascial system is continuous throughout the entire body.
As an example, having a fascial restriction in the low back is like wearing a wet suit, leaning back, and having glue poured on the wet suit at your low back, and letting the glue dry. The glue will continue to pull you back and somewhere else in the body will have to compensate for that pull so your are balanced. It’s the systemic response to a local fascial adhesion.
Someone once said that releasing Fascia is like cooking stewing beef cubes. You can do it quickly and throw it into a pan on high (hard stretch for short periods) and it will cook but it will still be really tough or you can slow cook it at a lower temperature for a longer period of time and get a much better result (more pliable, elastic tissue as a result).
So as I locate a fascial adhesion, I apply a stretch only to the barrier. I could push harder, but I just go to the barrier and wait. During the stretch heat will be created that will warm the tissue, allowing the collagen fibers to stretch. You can feel the tissue slowly softening and elongating over the 3-5 minutes. But you just wait for the tissue to naturally lengthen. By doing this, the tissue will reform under the heat, same as plastic does under heat, and as you let go gently, the tissue will now remain in that lengthened position. Now the patient can go home with specific stretching to maintain that lengthened tissue with any other exercises given for that specific condition that they’ve come in for.
It’s taken some trust and open mindedness to adopt this treatment philosophy but I’m so grateful that I did as it has dramatically helped patients with mobility, strength, stability and reduced pain as a result.
I heard the perfect analogy for what fascia is in the body, from a structural standpoint. Take a jar and put all sorts of little things in it like golf tees, marbles, string, pencils and fill up the jar with it. Then pour in this liquid, to the brim of the jar, that will set, but remains 70 – 80% liquid (as that is what we are). When this liquid sets, it will also be very structurally strong as well as being fluid. Almost like a super-jello. So now in the jar, you have all those items listed above and poured between those spaces is this liquid that will set. When it sets, you can crack the jar and this structural jello will hold the shape of the jar with all the items listed above set within it. What the items listed above represent are our cells and to a larger scale, things like our bones, nerves, muscles, brain, arteries/veins and holds them all in the shape that is what we are.
It is an extremely strong, 3 dimensional, gelatinous web that surrounds everything in our body that allows us to move but also holds us in our shape. It is crucial that it maintains that fluid content in the same way that it is crucial that leather maintains that moistness to remain soft and flexible. If for some reason parts of our fascial system loose that fluid content, it becomes dry, it loses it’s flexibility and pliability and as the fascial system is continuous through the entire body, can affect the biomechanics through the entire body. There is never a predictable way that it can affect the body.
Fascia can lose it’s fluid content for many different reasons including trauma, surgeries (joint replacement/abdominal surgeries/child birth), inflammatory responses (IBS, Crohns,Pneumonia) and chronic longer term shortening of tissues (poor posture, sitting), microtrauma to muscle tissue from heavy activity like biking, running, weight lifting. Shortening of the fascia may have occurred recently or may have occurred as long ago as a traumatic childbirth. The body is able to compensate for where ever the fascial restriction are for a long time before the presentations may occur.
Two of the most common major presentations of fascial adhesions that I see are low back pain from adhesions occurring at the front of the pelvis/hip regions and back/shoulder/posterior neck pain occurring from adhesions forming at the front of the neck and chest area pulling the head and the shoulders forward. When you are pulled forward by fascial adhesions at the front of the body, the muscles that pull you back up (whether they be the low/mid/upper back or the back neck or shoulder muscles) become strained, fatigue and ultimately produce pain and spams.
The main mantra with this work is find the pain but look for the cause elsewhere.
In our original training, we were very symptoms oriented and it took a leap of faith to pull myself away from that to move towards this philosophy but it has been so affective. Deal with the fascial restrictions so the body can move in the manner to which it was designed to do. Just let the body move like it should. That’s what it really wants to do.
How does one release fascia back to it’s original property? That’s worth another blog entry. 🙂
I’m just back from Vancouver having done a 3 day course on Myofascial Release for the Pelvis. From a structural/ biomechanical standpoint, the pelvis is the center of the universe, being the transition between the weightbearing legs/hips and the spine/ torso.
What the course reaffirmed for me is that the skeletal system swims in a pool of connective tissue and the skeletal system relies on the healthy state of the connective tissue to move in the manner to which it is designed to. The pelvis is an extraordinarily strong structure but is the fascia that surrounds it pulls it out of position, then it can be the surrounding, weaker systems that can be affected, such as the spine or the hip or knee and even ankle.
Imagine if the pelvis is pulled forward and to the left. Obviously we are not going to have our entire body leaned forward and to the left. So what does the torso do to pull us upright? It’s these compensations at the weaker structures, like the spine, that produce the symptoms. It really all is about cause and effect. Often the cause doesn’t produce symptoms but the effect does. In this case, pelvis is the cause (pulled forward and left by the fascia (connective tissue)) and the spine is the effect as it pulls in the opposite direction to pull us back level and the pain is produced around the spine.
The properties of this connective tissue is savable for another post.
During a really good sale, I picked up a Goretex jacket. Nothing too fancy, just a light shell but it does a really good job of repelling water so it keeps me super dry. What I’ve learned is that I need to continuously wash the jacket to keep oil and dirt off, as they can prevent the jacket from functioning properly. If you have a Goretex Jacket, I strongly recommend going to the store where you bought it and ask about cleaning it as there is a specific product that you can buy to wash the jacket with. It’s a detergent that you put in with the jacket as you wash it like you would normal clothes. It makes a profound difference to the performance of the jacket. If you’ve had the jacket for a while, just washing it may not be enough. There is also a spray that you can purchase to give your jacket that brand new off the rack performance. If you find that the jacket doesn’t bead water like it used to, or that the jacket “sweats” on the inside passing moisture to what you are wearing underneath, it’s the perfect time to do it. The jacket should last you a long long time.