FUNCTIONAL FLEXIBILITY: Complex Made Simple
by
Lenny Parracino PT, FAFS
Whether training for golf, football, baseball, or any sport, most athletes realize the benefits from a strength training program, yet rarely recognize the importance of a flexibility program. Flexibility is the foundation of what we do! In fact, without flexibility the body will not exhibit optimal levels of power, strength, cardiovascular fitness, or muscle endurance. Flexibility is the cornerstone of rehab, performance, and preventing injuries. However, flexibility programs seem to be less popular, most likely for a variety of reasons – one being research shows mixed reviews which often leads to confusion.1 When reviewing the principles (or lack thereof) behind most research it is easy to understand why the mixed reviews exist. As professionals, it is important that our decisions on what technique to choose be determined by a principle-based approach that is specific to each person’s intended need, not an arbitrarily designed guideline. To assist in determining what technique to choose, we will first explore three primary principles that should be considered, followed by a strategy to assess and address your patient’s / client’s functional flexibility.
Three Primary Principles of Functional Flexibility:
1. Individual and Task Dependent
2. Three-Dimensional
3. Mobility / Stability System
Functional flexibility is flexibility that allows us to function better. It allows one to perform tasks optimally and efficiently.2 The exact function is individual and taskdependent. 3 Therefore, general stretching techniques designed for muscle origininsertion will not provide us with an optimal functional outcome. Instead, the practitioner must appreciate the function of the muscles during the task. In other words, what a muscle does is task driven not textbook driven. This doesn’t make the textbook authors wrong, their right relative to the position, motion in which they concluded function at that time. When the body changes angles, positions, etc., its function changes; this is why for flexibility to be functional the techniques must look like the intended function. Therefore, we need to understand how the muscles, fascia, tendons, ligaments, nerves, joint capsules, and joints are moving three-dimensionally during the exact task; not only how much motion but also how well. This is the principle of mobility-stability, the right amount of motion with the right amount of stability in all three planes specific to the individual (not textbook) and intended task (all tasks require different levels of motion-stability).
To help simplify this complexity, we would like to share a practical strategy applying our three principles. This strategy can be used practically during your next assessment / evaluation…
First and foremost, understand each unique individual and task. Once you understand the individual’s current condition, limitations, concerns, and what they want to do, assess the intended task with as much authentic function as possible. The key is in understanding what they want / need to do and what they currently can do successfully. From here build a strategy to lead them in the right direction as quickly and safely as possible. For example, start with level one and only move to level two and three as needed per individual, per task.
Level One: Task specific. Assess the ability to perform the exact task. For example, walking, lunging, squatting, pivoting, stepping, reaching, running, balancing, picking up a specific object, sitting while reaching with right hand, etc. If this produces pain, discomfort, and/or lack of confidence, create authentic support to assist in the task. For example, one may reach forward at knee height from a split standing stance and feel low back stress. What if you changed the height of the reach to waist height? Same discomfort or less? If less, is it the back or the hips inability to allow the back to be successful from the range first assessed? Become a detective by changing body angles, positions, heights, drivers, ranges, etc. before leaving the intended task. Figure out a way to gain success in what they want/need to do. If this fails, progress to level two (although level two will look like level one).
Level Two: Task with outside support. Subtly add outside support or points of stability to the intended function. Using our example, simply add outside support such as in a True Stretch or a doorway. The outside support will allow you to position your patient / client in a specific range or zone to then apply authentic drivers. As their driving motion, use your palpation skills to assess the entire chain reaction searching for the “weak-link.” This is the application of the motion-stability principle. Then the body perceives stability it will exhibit mobility, providing it’s there. If one suspects the mobility is not there and desires to assess structural tissue texture, tension level three can provide information regarding the suspected structure (not exact function).
Level Three: Structure specific. Provides an environment for a structural assessment such as a plinth or table. This deviation from the exact functional task must be understood as a deviation and the results then correlated and integrated back into function, if function is the desired outcome.
Traditionally many techniques have been taught to start from the symptom or structural tightness to level three eventually getting to level one. In this paradigm shift, we allow the exact function to dictate how far away from function and into isolated structure we go. This strategy saves time but most importantly gives hope to your patient / client – function feeds function. Although function is complex due to its always changing nature, we can simplify function by simply following function. Use what your patient / client is saying, what they have experienced, and how they are moving as your guide to improving their wellbeing. When we apply the principles of Applied Functional Science (convergence of physical, biological, and behavioral science), flexibility takes on a new meaning. Functional flexibility recognizes the individual as a whole. Once you understand the dynamics of the whole, you derive, at least in principle, the properties and patterns of interactions of the parts.
1 Journal of Bodywork and Movement Therapies (2003) 7(1),1
2 Gray G: Functional Video Digest. Functional Flexibility Enhancing Life. V2.11
3 Gray G: Fast Function. Flexibility, Mobility. 2006
Wednesday, May 12, 2010
Thursday, December 3, 2009
Vit D and pregnancy
Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
New York Times: Vitamin D Shows Heart Benefits in Study
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.
The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
The Transmission of Epidemic Influenza (The Language of Science).
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?
John Cannell, MD
This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.
Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
The Vitamin D Council
585 Leff Street
San Luis Obispo, CA 93422
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman. Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean?
We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make.
Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D.
The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled. Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm.
It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D.” What are they really saying?
First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs.” If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Amazing study just presented at American Heart Association meeting
Dr. Tami Bair and Dr. Heidi May, of the Intermountain Medical Center in Utah, report yet another study showing that your risk of heart attack, stroke, congestive heart failure and death are dramatically increased by Vitamin D deficiency. In a presentation at the American heart Association meeting, they found that people with low levels (< 15 ng/ml) had a 45% increased risk for cardiovascular disease, 78% greater risk of stroke and double the risk for congestive heart failure, not to mention a 77% increased risk of death, compared to people with Vitamin D levels > 30 ng/ml. All that disease and death occurred in only 13 months of follow up for the 27,000 people in the study.
New York Times: Vitamin D Shows Heart Benefits in Study
So how many Americans died this last year from Vitamin D deficiency? Ten thousand? A hundred thousand? More? How many will die next year? Someone is responsible. Medical scientists who want more money before recommending that Vitamin D deficiency be treated have to assume responsibility. I am all for more studies but we have to act now, like we did with cigarettes. Remember, no human randomized controlled trials exist showing cigarettes are dangerous, so we have much more and better science than we did when we warned about smoking. If we fail to act on the dangers of Vitamin D deficiency, someone will end up with blood on their hands.
The Great Disappearing Act
We are currently witnessing one of the great mysteries of the natural world. The H1N1 outbreak is rapidly disappearing, despite a wealth of potential victims without antibodies to the virus, and yes, in spite of plummeting Vitamin D levels. In several weeks, the CDC will announce that perhaps one-third of Americans were infected in the last nine months and now have Swine flu antibodies, leaving the majority of the population still susceptible.
But this H1N1 virus is rapidly refusing the invitation to infect the two-third of Americans who are mostly immunological virgins and will soon recede until the next widespread outbreak, which may come this spring or next fall and winter. When H1N1 returns again, I predict it will cause more illness and death than it did this fall despite the fact it will attack a population with more H1N1 specific antibodies. Measles, another virus thought to transmit via respiratory secretions, would never forego the opportunity to infect so many virgins.
Influenzologists have no idea why this Disappearing Act happens. Dr. Edgar Hope-Simpson believed the reason lay in the mode of transmission; the current outbreak is ending despite a wealth of potential victims because the people transmitting the flu are suddenly no longer contagious. I recommend Hope-Simpson’s book:
The Transmission of Epidemic Influenza (The Language of Science).
I also believe that only a small population was transmitting, not all those infected. If these good transmitters – and not all the sick – usually spread the virus, and their transmission period is limited, the epidemic would end shortly after the good transmitters lose their infectivity. Why they lose their infectivity is yet another mystery, but a mystery that fits the epidemiology of influenza.
Cannell JJ, Zasloff M, Garland CF, Scragg R, Giovannucci E. On the epidemiology of influenza. Virol J. 2008 Feb 25;5:29. Review.
Another incredible Disappearing Act, one that usually follows the introduction of a pandemic virus, is the rapid and usually complete replacement of seasonal flu with the pandemic one. It is as if the pandemic virus murders the seasonal flu. We will have to wait to see if that happens worldwide with this pandemic, but in the USA it has already happened. Last week the CDC reported that more than 99% of all influenza viruses identified in the USA were Swine flu. Only 1 of 1,874 influenza A viruses identified last week was seasonal flu. Where did the seasonal flu virus go?
John Cannell, MD
This newsletter may be reproduced as long as you properly and prominently attribute it source. Please reproduce it, post it on Internet sites, and forward it to your friends.
Remember, we are a non-profit and rely on your donations to publish our newsletter, maintain our website, and pursue our objectives. Send your tax-deductible contributions to:
The Vitamin D Council
585 Leff Street
San Luis Obispo, CA 93422
Monday, October 12, 2009
More good news about Vit D supplementation
Older adults with insufficient levels of vitamin D die from heart disease and all-cause death at greater rates than those with adequate levels of the vitamin, according to a recent study.
Also according to a new study, many pregnant women who are supplementing with vitamin D are still presenting as vitamin D deficient. This suggests that current recommendations for D supplementation may be still too low. Vitamin D insufficiency during pregnancy is associated with childhood rickets and longer-term problems including schizophrenia and type 1 diabetes.
And finally, patients on atorvastatin, a drug used to lower cholesterol, who were simultaneously supplemented with vitamin D, demonstrated lower blood serum levels of the drug and its metabolites and yet LDL and total cholesterol levels were also decreased.
Sources:
1. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
2. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study
3. Statins and Vitamin D–Conflict or Concord? Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
Also according to a new study, many pregnant women who are supplementing with vitamin D are still presenting as vitamin D deficient. This suggests that current recommendations for D supplementation may be still too low. Vitamin D insufficiency during pregnancy is associated with childhood rickets and longer-term problems including schizophrenia and type 1 diabetes.
And finally, patients on atorvastatin, a drug used to lower cholesterol, who were simultaneously supplemented with vitamin D, demonstrated lower blood serum levels of the drug and its metabolites and yet LDL and total cholesterol levels were also decreased.
Sources:
1. Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
2. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study
3. Statins and Vitamin D–Conflict or Concord? Prospective Study of Serum 25-Hydroxyvitamin D Level, Cardiovascular Disease Mortality, and All-Cause Mortality in Older U.S. Adults
Tuesday, September 29, 2009
Chronic Pain and the often overlooked glut muscles
Chronic Pain and the Often Overlooked Glut Muscles
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
Most people look at the abdominal wall when they have chronic low back or pelvic problems. They do endless amounts of crunches and Pilates type movements to strengthen their core. While this does build strength, it doesn’t address an often overlooked group of muscles which includes the external rotators of the hip and the gluteus muscles. For ease, I’ll call them the butt muscles.
When the butt muscles are weak (inhibited) they can cause multiple problems for the musculoskeletal system. Let’s look at the gluteus maximus as an example. This muscle attaches to the outside of your upper leg to a thick band called the iliotibial band. Its other attachment is at the top of your pelvis and to the small pie shaped bone at the base of your spine that forms the foundation of your spine, called the sacrum. It crosses the sacroiliac joint and the hip joint. It’s nearly always involved in sacroiliac pain, lumbar spine pain and hip pain.
You can notice the gluteus maximus muscle working when you walk with a long stride. If you place your hands over the lower portion of your buttocks and walk with a short stride, you will feel very little muscle contraction. Now lengthen your stride and you will feel the muscle contract when you toe off and when your heel strikes the ground. This is actually a good way to keep the muscle strong. Walking in heels prevents long strides and contributes to inhibited butt muscles.
Getting out of a chair or car and climbing stairs are other common uses of the butt muscles. When they are weak, you have to lean forward to shift your weight more over your knees in order to get up.
Why is the strength in these muscles important?
When these muscles are weak there will be a slow lengthening of the sacroiliac ligaments which causes pain and pelvic imbalances that become chronic. If this occurs, there will usually be muscle tightness running up your back even up to the neck muscles.
What are the symptoms of weakness of the butt muscles?
1. Chronic pelvic problems
2. Chronic knee pain
3. Stiffness to the lower back
4. Restriction in neck rotation
5. Difficulty sitting for long periods of time
6. Difficulty getting out of a car or up from a low chair
What can you do about this?
First you have to have your pelvis, hip, foot and thoracic spine tested for any structural imbalance. Then the muscle needs to be tested for its proper function and corrected if it cannot contract properly. Once the muscle is able to function properly, simply walking with long strides may be enough to keep the muscle contracting properly. If this is not enough, then specific exercises can be prescribed to help allow for proper biomechanics of the butt muscles. Unfortunately, all of the machines at the gym don’t take into account the way the butt muscles actually function when walking and they often work the hamstring and low back muscles more than the buttock muscles which leads to further imbalance.
If you have chronic problems or know someone with this type of problem, please talk to me about it. Often treating this group of muscles helps with many problems at once, from the foot to the neck.
As always, your referral is my greatest compliment.
Kevin Colling, D.C. 503-808-9145
¬¬
Friday, August 21, 2009
Hips- The Powerhouse to the Entire Body
HIPS
The Powerhouse to the Entire Body
The hips provide power to the entire body. When they are working correctly they are your best friend, but when they are inhibited they quickly become your worst enemy. The hips affect joints as far away as the elbow and the ankle. An improperly functioning hip can easily contribute to low back pain (disc bulges/herniations), knee injuries (ACL, tendonitis), shoulder injuries (impingement, rotator cuff) and elbow injuries (tennis and golfer’s elbow).
The hip joint is a tremendously mobile yet stable joint. It connects the femur (thigh bone) to the pelvis via a deep cup called the acetabulum. It has 17 of the thickest, strongest muscles attached to it and these muscles are held together by fascia which functionally links the hips to pretty much the entire rest of the body. The secret behind the power of the hip is its ability to load and unload in all three planes of motion. This allows the hip to control motion of the kinetic chain. Let’s use the knee as an example of how the hip has an effect down the kinetic chain. Most traditional rehabilitation stresses the quadriceps and the hamstrings, but these muscles really only control knee motion when the knee is flexed close to 90degrees. This excludes them from being the primary stabilizer during everyday activities like walking. The hip muscles, on the other hand, are well designed to control the three dimensional motion of the knee because they are oriented to slow down the motion of internal rotation, adduction and flexion of the knee. This takes tension off the ligaments of the knee (especially the ACL).
Now let’s look at an example of how the hip has effects up the kinetic chain. The hip helps protect the rotator cuff of the shoulder and the ligaments of the elbow. In this case it’s the muscles in the front of the hip that do the work. Namely, the iliopsoas, abdominals and adductors… When I see tennis players with elbow pain in my office, I always examine their hips. This is because they play a significant roll in stabilizing the body for movement. To see how the hips influence the shoulder stand up and take a long step forward with your left leg and then raise your right arm out to the side to shoulder height. Did you feel tension at your hip? This means that the muscles of the front of the hip are loaded and ready to contract. Now sit down and lift your right arm up. Did you feel the same tension? Probably not, because the flexed position of the hip inhibits its ability to contract and properly stabilize the body.
As you can see proper hip function is essential to injury prevention and optimal performance. It is important to keep the hips strong in order to stabilize the rest of the body. But be careful! Not all training exercises are the same. Most of the traditional exercises used to build abdominal and gluteal strength actually inhibit the ability of the hip muscles to contract at the right time. And activities like prolonged sitting actually promote faulty capsular patterns of the hip. Your training program should be unique to your needs and functional goals and should promote both mobility and stability. Whether you are an active or inactive person your hips are a key piece of a pain-free life.
Dr. Colling has extensive training an experience dealing with hip biomechanics. If you would like an evaluation, have an injury or would like advice on how to properly train your hips for optimal performance, please call 503-808-9145.
The Powerhouse to the Entire Body
The hips provide power to the entire body. When they are working correctly they are your best friend, but when they are inhibited they quickly become your worst enemy. The hips affect joints as far away as the elbow and the ankle. An improperly functioning hip can easily contribute to low back pain (disc bulges/herniations), knee injuries (ACL, tendonitis), shoulder injuries (impingement, rotator cuff) and elbow injuries (tennis and golfer’s elbow).
The hip joint is a tremendously mobile yet stable joint. It connects the femur (thigh bone) to the pelvis via a deep cup called the acetabulum. It has 17 of the thickest, strongest muscles attached to it and these muscles are held together by fascia which functionally links the hips to pretty much the entire rest of the body. The secret behind the power of the hip is its ability to load and unload in all three planes of motion. This allows the hip to control motion of the kinetic chain. Let’s use the knee as an example of how the hip has an effect down the kinetic chain. Most traditional rehabilitation stresses the quadriceps and the hamstrings, but these muscles really only control knee motion when the knee is flexed close to 90degrees. This excludes them from being the primary stabilizer during everyday activities like walking. The hip muscles, on the other hand, are well designed to control the three dimensional motion of the knee because they are oriented to slow down the motion of internal rotation, adduction and flexion of the knee. This takes tension off the ligaments of the knee (especially the ACL).
Now let’s look at an example of how the hip has effects up the kinetic chain. The hip helps protect the rotator cuff of the shoulder and the ligaments of the elbow. In this case it’s the muscles in the front of the hip that do the work. Namely, the iliopsoas, abdominals and adductors… When I see tennis players with elbow pain in my office, I always examine their hips. This is because they play a significant roll in stabilizing the body for movement. To see how the hips influence the shoulder stand up and take a long step forward with your left leg and then raise your right arm out to the side to shoulder height. Did you feel tension at your hip? This means that the muscles of the front of the hip are loaded and ready to contract. Now sit down and lift your right arm up. Did you feel the same tension? Probably not, because the flexed position of the hip inhibits its ability to contract and properly stabilize the body.
As you can see proper hip function is essential to injury prevention and optimal performance. It is important to keep the hips strong in order to stabilize the rest of the body. But be careful! Not all training exercises are the same. Most of the traditional exercises used to build abdominal and gluteal strength actually inhibit the ability of the hip muscles to contract at the right time. And activities like prolonged sitting actually promote faulty capsular patterns of the hip. Your training program should be unique to your needs and functional goals and should promote both mobility and stability. Whether you are an active or inactive person your hips are a key piece of a pain-free life.
Dr. Colling has extensive training an experience dealing with hip biomechanics. If you would like an evaluation, have an injury or would like advice on how to properly train your hips for optimal performance, please call 503-808-9145.
Wednesday, August 19, 2009
Chiropractic costeffective and safe
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Media Contacts:
Caitlin Lukacs: (703) 812-0218 | clukacs@acatoday.org
FOR IMMEDIATE RELEASE: August 12, 2009
New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders
A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.
“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.
Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.
The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.
Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:
* A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
* A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.
* A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.
The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients. To find a chiropractor near you, visit www.acatoday.org.
Chiropractic Symposium and Expo '09
1701 Clarendon Blvd. Arlington, VA 22209 | 703 276 8800 | Copyright © 2009 ACA
Media Contacts:
Caitlin Lukacs: (703) 812-0218 | clukacs@acatoday.org
FOR IMMEDIATE RELEASE: August 12, 2009
New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders
A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.
“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.
Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.
The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.
Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:
* A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
* A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.
* A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.
The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients. To find a chiropractor near you, visit www.acatoday.org.
Chiropractic Symposium and Expo '09
1701 Clarendon Blvd. Arlington, VA 22209 | 703 276 8800 | Copyright © 2009 ACA
Monday, July 20, 2009
Auto accident safety
I normally talk about functional biomechanics in my posts, but since the summer months entice us into road trips, I wanted to take this opportunity to briefly speak about motor vehicle accidents, how to keep you and your child as safe as you can and how to prevent chronic injury.
Motor vehicle collisions are a major cause of injuries in the United States. They are the leading cause of preventable death in children and they are a leading cause of chronic pain, decreased range of motion and degenerative joint disease (osteoarthritis). What can we do to be safe? Well, there are a number of things we can do to prevent accidents and to minimize an accident’s effect on our body. I’ll mention some of the important ones here:
1. Wear a seatbelt. It’s best worn over your pelvic bones and across your shoulder/chest away from your neck. Seatbelts decrease the risk of injury by 42% without an airbag. (Airbags by themselves are only 12% effective)
2. Child restraints- Use a child seat that has a high rating for safety. Follow instructions for rear facing, forward facing and weight limits and where the straps should lie on the child. Infants and toddlers can easily fly out of the seat if the straps are not on correctly.
3. Booster seats- the only booster seat that improves safety is the high back booster seat. It decreases injury by 70%. Just a booster without the high back is no more effective than a seatbelt alone.
4. Airbags are effective, especially side impact airbags. It’s unfortunate that side airbags are optional, but you should get them if at all possible. Never place your hands or feet on the airbag. Place hands low on the steering wheel. Airbags can cause multiple fractures.
5. Head restraint- Adjust the head restraint to ensure it actually prevents your neck from bending backwards. Many head restraints are positioned too low.
6. ABS- automatic braking systems allow you to steer while you are braking. Look to where you want the car to go not for what you want to miss.
7. Electronic stability control- is an excellent safety option, so buy it if you can. It helps stabilize the car in case of skidding or hydroplaning.
8. SUV’s- because they are a larger vehicle they can provide an advantage over smaller cars, but they are much more likely to be involved in a roll over crash that results in death. SUV’s are less maneuverable so they are in crashes more often. SUV’s are designed to be driven slowly.
9. If you know you are going to be in rear ended by another car, it is best to shrug your shoulders, brake hard, and look at the top of the windshield.
10. Do not drive while text messaging or utilizing a cell phone. Avoid all other distractions.
Hopefully some of these tidbits have been helpful to improve your safety on the road. However, if you are in an accident, it is extremely important to seek care as soon as possible. When a problem is caught early it is much easier to resolve than a problem that has been left untreated for a long period of time. Even low impact, seemingly minor accidents can cause injuries. Research shows that 9% of Americans have chronic neck pain because of an automobile accident. Chronically tight muscles and restricted joints lead to decreased range of motion, painful movement and osteoarthritis. Our joints are designed to move. They have limited vascularity so they depend on motion to bring in nutrients and take away waste products. If a joint doesn’t move properly, it will begin to break down. This leads to arthritis and bone spurs. Seeking high quality care that addresses these issues is critical to full recovery.
I have much more valuable information about auto accident recovery, so if you would like a consultation please feel free to contact me. 503-808-9145.
Motor vehicle collisions are a major cause of injuries in the United States. They are the leading cause of preventable death in children and they are a leading cause of chronic pain, decreased range of motion and degenerative joint disease (osteoarthritis). What can we do to be safe? Well, there are a number of things we can do to prevent accidents and to minimize an accident’s effect on our body. I’ll mention some of the important ones here:
1. Wear a seatbelt. It’s best worn over your pelvic bones and across your shoulder/chest away from your neck. Seatbelts decrease the risk of injury by 42% without an airbag. (Airbags by themselves are only 12% effective)
2. Child restraints- Use a child seat that has a high rating for safety. Follow instructions for rear facing, forward facing and weight limits and where the straps should lie on the child. Infants and toddlers can easily fly out of the seat if the straps are not on correctly.
3. Booster seats- the only booster seat that improves safety is the high back booster seat. It decreases injury by 70%. Just a booster without the high back is no more effective than a seatbelt alone.
4. Airbags are effective, especially side impact airbags. It’s unfortunate that side airbags are optional, but you should get them if at all possible. Never place your hands or feet on the airbag. Place hands low on the steering wheel. Airbags can cause multiple fractures.
5. Head restraint- Adjust the head restraint to ensure it actually prevents your neck from bending backwards. Many head restraints are positioned too low.
6. ABS- automatic braking systems allow you to steer while you are braking. Look to where you want the car to go not for what you want to miss.
7. Electronic stability control- is an excellent safety option, so buy it if you can. It helps stabilize the car in case of skidding or hydroplaning.
8. SUV’s- because they are a larger vehicle they can provide an advantage over smaller cars, but they are much more likely to be involved in a roll over crash that results in death. SUV’s are less maneuverable so they are in crashes more often. SUV’s are designed to be driven slowly.
9. If you know you are going to be in rear ended by another car, it is best to shrug your shoulders, brake hard, and look at the top of the windshield.
10. Do not drive while text messaging or utilizing a cell phone. Avoid all other distractions.
Hopefully some of these tidbits have been helpful to improve your safety on the road. However, if you are in an accident, it is extremely important to seek care as soon as possible. When a problem is caught early it is much easier to resolve than a problem that has been left untreated for a long period of time. Even low impact, seemingly minor accidents can cause injuries. Research shows that 9% of Americans have chronic neck pain because of an automobile accident. Chronically tight muscles and restricted joints lead to decreased range of motion, painful movement and osteoarthritis. Our joints are designed to move. They have limited vascularity so they depend on motion to bring in nutrients and take away waste products. If a joint doesn’t move properly, it will begin to break down. This leads to arthritis and bone spurs. Seeking high quality care that addresses these issues is critical to full recovery.
I have much more valuable information about auto accident recovery, so if you would like a consultation please feel free to contact me. 503-808-9145.
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