Where So Many Physios Go Wrong

Where So Many Physios Go Wrong

I’ve always loved this quote by author and psychiatrist Dr Gordon Livingston. It’s a short but challenging sentence I’ve used to great effect mentoring new physios. It’s also one of the reasons behind our 3 visit rule.

“If the map doesn’t agree with the ground,
the map is wrong”

It encourages you to think outside the box. Really look and understand what you see in front of you.

Whether you realise it or not, you have been taught to follow maps you’re entire life. As a child your parents provide you with a mental map to follow. They show you right from wrong, provide you with values…gave you a direction to abide by.

University is no different.

It teaches you the theory. Provides you with a thought process to follow. A path to adhere by.

What happens when the problem does not stick to the rules?

You see this all the time in our clinics.

In fact…

Less than 30% of the patients fit exactly ‘what the textbook says’

Many physios and chiros fall into the trap of pigeon holing problems based on what they learnt at uni. They stick to and ‘trust’ the process.

Question is,

  • What if your injury or tightness does not follow the rules
  • Have you suffered other injuries that might be involved
  • What if your body is different?

 

At what point do you stop, realise you’re lost and recalibrate?
Create a new guide based on what you actually see

I can tell you this…

If the theory applied does not match your body exactly, you won’t get better!

80% of the Time There Will Be a Curveball

You will have symptoms which don’t respond to traditional thinking and treatment.

One of the patients I looked after the other week is a perfect example.

He had been suffering Achilles tendonitis for close to 6 months. He had tried every textbook approach

Physio and treatment
Had an injection
Stretched,
Rested
There was no change!

As is often the case…

In taking a more detailed history it turned out he had broken his femur causing the hamstring to stop working properly. This affected the tibia, changed how the ankle worked and put stress on the achilles.

Unless the hamstring starts working the achilles will take the load and the tendonitis won’t go away.

Bottom line is this…

If It’s Not Getting Better…You Are Looking At The Wrong Map

You need to find the right one!

This is why there is a 3 visit rule in all of the clinics. In combination with asking the right questions this ensures you have a path to follow. It also means you can quickly julietta in canada change direction if you’re heading the wrong way. Not seeing positive changes.

If the plan isn’t working, you don’t stick to it just because. You alter the approach based on what you see.

I’ve seen Achilles problems stem from a spinal issue, a shoulder problem, a neck problem, an opposite side ankle problem. It’s simply because everyone will compensate in their own way.

Remember the quote,

If the map doesn’t match the land then the map is wrong. The theory needs to fit the patient, not the other way around.

This approach works

It’s a big reason we get the results you’re after. It’s why we stand by the 3 visit rule. If you want treatment with direction you have two options…

Contact the clinic on 98995512 between 8 and 5 on workdays

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5 Strategies You Need To Train Regularly…Without Pain

5 Strategies You Need To Train Regularly…Without Pain

Why Many People Break Down Because
They Train Like Athletes
Without Realising

If You Train 6-8 Times Per Week This Is You

One critical element many physios don’t pay enough attention to is workload history.

Understanding exactly how much volume and load you are putting through your body.

More than twice a day patients come into the clinic having developed a little ‘niggle’ over a period of say 2-4 weeks. Both knees are sore, shoulders ache or the body just doesn’t feel normal.

It’s becoming a clear trend…

People are Training Like Athletes But Ignoring Recovery

The result of this,

You build up an increased volume.

You put your body further into need for recovery every training session.

You end up broken!

The most dangerous situation is not following ONE coaches program. If you train at multiple locations or do additional training on your own is anyone either monitoring or scheduling recovery?

It’s very easy to get caught up in how you feel on a day versus what is objectively enough work before you rest.

Let’s look at an example…

Say you have a coach or trainer you see each week. You also jump in on a few F45 classes. Then because it’s a nice day you go for a run with a friend on the weekend.

The run is your recovery right?

Doing something like the bay run for fun i not recovery. A 7km like this is a mild form of aerobic exercise.

The idea is not to tell or advise you to stop or slow down.

But…

If you are doing between 6 and 8 sessions a week
YOU MUST PLAN FOR RECOVERY

People who are not athletes but are still training like them always end up in the clinic. As I mentioned earlier they present with…
– both knees sore
– both shoulders are sore
– their muscles ache in general

They often feel tired all the time. Even though they train harder and harder, they don’t seem to be getting any fitter or stronger.

If this is you then you have two options…

You need to stop training so much
You need to put way more focus on recovering properly

Still not sold on how critical planning recovery is ?

Let’s look at it this way…

6 Sessions Per Week For 3 Months Equals
72 Workouts Without Recovery

It becomes a dangerous place if you are not reversing the after effects of loading your joints and your muscles.

There are no real positives…

The accumulation of so much volume adds up. This becomes unbelievably clear the more you understand how the your metabolism and the physiology of your body works.

As much as I love talking science I don’t want to get to technical on this.

Instead I want show you…

How To Deal With High Training Volume
5 Essential Action Steps

1. Program Your Recovery

You have at least 2 programmed recovery sessions. Programmed recovery sessions mean doing nothing, it means going home, it means going to the beach, not going for a long sand run, it means going to the beach and lying in the sun with sun screen.

It means going to the park and having a picnic, it means reading a book.
This is programmed recovery session, this allows your body to recover, allows you to absorb at least some vitamin D, if you have some nutritious meals or some food, that’s also going to help also replenish your stores of energy.

At least 2 recovery sessions per week of you are doing 6 -8 sessions per week.

2. Make sure you understand why you are training?

Are you doing 6 or more sessions per week because you are obsessed or because you have a goal.

You have to be very real with yourself on this matter. If you have no aspirations to actually compete or do anything like that, do you need to train as often?

If it’s because you train for fun, awesome!

However…

If you are someone who feels like they will go crazy if you don’t go to the gym today. You feel you have to train. You need to be very careful.

This is not a good place to be mentally. It means that you are creating a psychological need to go to the gym rather than a training purpose need.

3. Make sure you are get some mobility or
body work done once a fortnight minimum

Think about it this way…

What’s going to happen if you don’t want to get some sort of muscular release? You don’t find a way to move you fascia and muscle tissues in a way you have neglected…

Let’s look at how this accumulates…

Say you perform over the period of a week 6 squat sessions which also involve lunging. Then also performed 3 deadlift sessions. Plus you do plenty of work through your biceps, heaps of chin ups and overhead bodywork.

Unless you are superhuman and don’t have any imbalances you have just developed more dominance and movement dysfunction.

You may already understand this, but dominance means the muscle groups you use more of. This varies person to person but one example is someone being quad dominant.

Thinking back to the example above…

This person is more likely to engage their quads during deadlifts as well as squats. That’s almost…

10 Training Sessions a Week on One Muscle Group…Without Even Realising

Add a weekend run to your squat and deadlift workout. Or maybe a weekend ride. Repeat this week after week.

Within 6 months you’re going to see me because your knees are too sore to train properly.

It’s a really simple fix…

Moving the tissue, getting some blood flow in there, stimulate the nervous system…

Get Dry Needling or Active Release Every Two Weeks
It will give you training longevity!

Try add this to your recovery after the next two weeks of training.

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Because the clinics are busy you need to schedule appointments in advance. If you get in now you should be able to organise something in two weeks.

The last two points focus more on the chemical side of recovery…

4. Understand the principle of food intake

The food you consume needs to reflect your training volume. The more you train, the more you eat!

Whether are you going to count calories, measure meals or whatever works for you…make sure you are ingesting enough calories to allow your metabolism to sustain itself.

This applies whether you’re training for weight loss or performance. Not maintaining a healthy metabolism will cripple any chance of achieving your goal.

All the athletes I work with have someone regulating what and how much they eat. If they don’t I refer them to Flex Success.

Finally…

5. See a Naturopath

This is very important for your micronutrients and diet health.

If your diet isn’t working correctly, then you won’t be able to absorb the nutrients you need from the gut lining.

These are micronutrients are what allow…
The health of your cell lines with omega 3
Your metabolism and biochemical cycle to actually work correctly
Your ability to flush out lactic acid, synthesize protein and release B12 into your cell

These types of things are critical. If they are not satisfactory it will slowly chip away at the functioning of your body and the health of your cells . All of a sudden you will start to feel tired, depleted, sore and unmotivated to actually get back into the gym.

Usually it’s for no apparent reason. But…
It’s often blamed on over training.

You’re not necessarily training too hard. It’s just your micro nutrient levels are not where they need to be.

There you have it…

If you’re training regularly treat your body like an athlete
Pay close attention to your recovery

Don’t allow your training volume to accumulate and DO NOT FORGET to reverse the muscular tension you have built up.

Let us help you keep training without developing pain…

Have Kids Ruined Your Core… If Your Back Constantly Aches, Your Hips Feel Rotated And You’re Embarrassed To Run You Need Have Your Separation Checked

Have Kids Ruined Your Core… If Your Back Constantly Aches, Your Hips Feel Rotated And You’re Embarrassed To Run You Need Have Your Separation Checked

If after having children you struggle to control your bladder when you run, worry about sneezing and refuse to skip because it’s just embarrassing then you need to have your separation assessed.

Even if your kids are nearly 10 years old!

This is what I found with one of my recent patients in Bondi.

But it’s not why she came in!

She needed to…

Figure Out How To Eliminate Constant Back Pain

There was nothing severe about it, just a constant tightness.

She brought the recent xrays her normal chiro made her get…the spine was in great condition. Way better than mine. There was,
        no scoliosis
               no obvious degeneration
                           no glaring bone deformity

It was fairly straight and uncomplicated. So why the constant back pain?

At 43 years old, she was…

Fed Up With Waking Up Feeling  Like An Old Woman

Before coming to Balance she was seeing her chiro every month, sometimes more. They believed the pain was a result of her ‘twisted pelvis’. Getting it adjusted helped but it always seems to come back.

To me…the twist seemed more like a compensation pattern than the root of the problem.

As we were discussing how her body moves and feels in general I discovered she still pees a little when running or sneezing unexpectedly.

To me this is a massive hint…

She Had A Core Issue

Now knowing of her lack of bladder control I immediately focused on assessing what was wrong with her core.

She had what we call a diastasis rectus abdominus.

Even 9 Years After Giving Birth She Had Abdominal Separation

It was 2cm and 3/4 more on the right side compared to the left. A difference between sides of the body is always a big problem.

This right internal oblique also tested weaker. Another  asymmetry. No surprise she also feels the back pain more on the right!

Her body has been forced to work around this issue for 9 years. Walking, running, in the gym and  with everyday activities her body has found a way to compensate for this core issue.

You know how she compensates…rotating the pelvis.

Until she addresses the core imbalance treating the hip will only ever be a temporary solution.

You may be thinking…

Why did the Obstetrician and the midwife nurses not say anything about the separation in the abdomen?

She was definitely surprised they didn’t!

Whilst I could argue they should have mentioned it, honestly it is not life threatening and not that bad.

However…

If Separation Isn’t Addressed Soon After Giving Birth It Will Become A Problem Later

At the end of the first appointment we had our diagnosis. I explained to her how the twisted pelvis and back pain she couldn’t get rid of was a direct result of the abdominal separation and muscles on the right side of the tummy not working.

She now had a clear explanation of what was causing her pain and why it hadn’t been getting better.

As I was treating her to help relieve the discomfort in her back I explained the specific plan of attack…

Treat the Pain For Relief and
Integrate Specific Corrective Exercises To Eliminate The Cause

We followed this approach for two weeks. Each time reassessing and making sure we were following the right path. It was improving steadily which is always a good sign.

A month later she booked in for a review. She was so excited to tell me it hadn’t felt this good in such a long time. I reassessed everything, the back and pelvis, the separation, the core. The difference was significant.

The best news…

There was no reason I needed to see her again.

This is just one of the cases I’ve seen recently where problems have developed in women who haven’t addressed common post natal issues. Whether it’s pelvic floor dysfunction, abdominal separation or asymmetries in the core…you really need to get it checked.

A few simple but targeted exercises with a little specific treatment can prevent niggles like ongoing back pain from ever becoming a problem.

If you have kids and know you don’t have full control your bladder let one of our physios assess your separation and core control. The longer you wait the harder it can be to reverse the compensation. Just call the clinic on 9899 5512 and ask for one of the julietta in canada physio’s who specialise in post natal care.

 

3 Exercise Progression For Strong Stable Hips

3 Exercise Progression For Strong Stable Hips

It’s a simple but highly effective combination you can implement immediately

When it comes to stability training the focus is usually on your ‘core’…Being able to control the position and motion of your trunk over the pelvis. Using those central muscles to absorb and transfer forces to produce athletic movement.

I don’t believe the ‘core’ can work efficiently if the hips don’t play along.

Instability there can be the catalyst for ongoing problems…

Above the joint it can lead to SIJ dysfunction, low back and even shoulder pain. Below it’s directly linked to shin splints, ITB syndrome and knee pain.

In reality the hip does way more than just providing stability up and down the chain. It works in multiple planes also requiring mobility, strength and power.

For simplicity sake I want to zero in on movement coordinated by a group of 6 muscle…

Your Hip External Rotators Are Essential In Stabilising
The Pelvis, Knee And Ankle

They’re also critical to safely perform many physical tasks from walking, climbing stairs and running to squatting and lunging in the gym.

How often do you hear a coach screaming ‘keep your knees out!’

I want to give you my three step progression to identify, switch on then integrate inactive hip external rotators back into functional movement.

Before I give you the exercises there’s a little trick you need to know..

The Degree Of Hip Flexion Determines Which Muscles Are Working

To figure out which external rotators aren’t doing they’re job use the first exercise and test the varying angles. You will likely find one or two positions are much harder to perform…that’s where you need the work!

Do not go straight to the last exercise just because it hits every angle.

There’s a priority system behind the exercise progression you must follow…

  1. You need to challenge the muscle in a supine or sidelying position
  2. Progress to half kneeling
  3. Integrate with standing variation.

2 QUICK TIPS:

  • Stability requires endurance…use an appropriate rep range (sets of three won’t help)
  • There’s no need to keep loading the exercises just get the muscles working

Here are the exercises…

1. Clams

clam-exercise

Do not skip this exercise… Even if you think it’s easy

Chances are you’re cheating!

The key here is setting up in the right position…and then maintaining it!

All the time I see people trying compensating any way they can

  • Lower back arching as pelvic floor lets go
  • Pelvis rolling back and forwards
  • Spine collapsing to the floor

Keep your hips and shoulders stacked, find the weakest angle and get these little muscles firing.

 

2. Half Kneeling  Band Resisted Hip ER

hk-hip-er

Coming into a half kneeling position we are now adding trunk stability into the equation. The movement is the same we just have more variables to deal with!

You changed the orientation to gravity, added band resistance and your hips now need to work with your core to maintain a stable pelvis and torso.

Still try to work with the right degree

The band resistance doesn’t need to be heavy. Remember you’re just trying to activate the muscle. There’s no glory in trying to build to a heavy 1 RM Hip ER.

3. Single Leg RDL

single-leg-rdlThis exercise we’re finally getting specific on ensuring these muscles work in the fashion we generally need for most sports and physical activities.

You would have noticed the two previous exercises work your hip ERs through movement. In reality they function in more of a stabilising role. The contract both concentrically, eccentrically and at tim isometrically to control knee alignment not move it.

This is a fully integrated exercise for your hip ERs. They need to control the knee in relation to the foot as well as function in maintaining pelvic alignment as you move in and out of hip flexion. You’re making them work and integrate at all angles from close to end range hip flexion right into extension.

If can perform this exercise perfectly with no compensations your hips are good to go. It’s time to start lunging and running knowing that you have a stable base to build strength, power and speed improving athletic performance.

 

Exercises Are Only Problematic If They Are Poorly Prescribed… Why Most People Misinterpret The Jefferson Curl

Exercises Are Only Problematic If They Are Poorly Prescribed… Why Most People Misinterpret The Jefferson Curl

Coaches, chiros and physios all seem to miss the fact this movement is not a strength exercise! It’s not designed to load spinal flexion.

It’s time to set the record straight…the for and against of using this exercise

3 Reason You Should Learn The Jefferson Curl Before You Blow a Disc In Your Spine

Is Your Spine Intolerant To Flexion?

Every day I see patients who have a ‘flat spot’ in their lower back as they bend forward. To me, this is an indicator of either…

– a previous either a history of back pain or,
– an increased risk of injuring their disc.

You need to be able to flex your spine.

If you struggle to do this it’s not a matter of avoiding it. You can’t live without spinal flexion.

Instead of continually hurting your discs, would it not make sense to learn to flex each vertebra one at a time…

This focus on motor control teaches the brain to understand a movement that should automatically occur, be reflexive.

A Jefferson curl starting at the neck then slowly curling your entire spine one vertebra at a time is brilliant in helping the brain understand how the spine should move into flexion.

Do You Need To Learn How To…
Simultaneously Maintain Spinal Movement And Center Of Gravity?

This control is critical every time you want to pick something off the ground.

When you flex your spin, your hamstrings need to engage to maintain centre of gravity. Basically they are the anchors stopping you from falling forward every time you lean forward.

The goal is not to build strength in the hamstring but teach them how to eccentrically load in conjunction with the spine.

Note again it’s about the movement and coordination of muscles. Not strength!

Can You Eccentrically Control Your Spinal Erectors?

For your spine to stay stable, you must be able to lengthen the spinal erectors under tension.

This will only occur if you allow your core structures to take over. As you breathe out to flex the spine your…

– Lower abdominals
– Lower obliques
– Pelvic floor
– TVA

…all have to engage to create enough spinal flexion!

At the same time…your lumbar and thoracic erectors have to eccentrically load firstly and then secondly so do your multifidus.

Multifidi are usually the ones that fail.

It happens near when you bend and rotate to pick something off the floor because you haven’t taught them how to eccentrically load. This is where people end up hurting their L4, L5, S1 discs.

The Jefferson curls is a great because it…

– teaches the multifidus and spinal erectors how to eccentrically load

– helps you understand how to breathe for movement control

– help the hamstrings understand their role as anchors

– facilitates engagement of TVA

If you don’t know how to control this common movement, how are you going to pick anything up off the floor?

In saying that…

You Just Can’t Give This Exercise To Everyone

If you don’t know how to use your hips properly…

You’re never going to be able to engage your hamstrings correctly
You will always incorporate too much of a knee bend

Before You Even Contemplate a Jefferson Curl You Must Be Able To Hip Hinge

If you don’t you’re always going to rely on their quads. The problem with this, it’s not going to allow your posterior chain to eccentrically load. This puts pressure on the front of your hips first then straight through your discs.

Lifting weights without knowing how to hip hinge means it’s only a matter of time before you’ll start seeing lower back and disc problems.

The ability to hip hinge takes priority over using a Jefferson curl to learn motor control of flexion.marapr13_hw_hiphinge

Even Then It’s Not Your Go To Exercise

I will never prescribe this exercise until I know you can perform a regressed non weight bearing variation. I use band assisted roll up (sit up). It’s orientation to gravity is different so the challenge isn’t exactly the same, but it does follow the same movement pattern.

If you can’t perform this exercise I’m not going to add more variables and increase the challenge by having you stand up and do a Jefferson.mixmatch-july-rollup-400x400

The Biggest Reason To Avoid A Jefferson Curl…
PAIN!

If it’s aggravating your symptoms this exercise is way to advanced for you. Do not push through because you need to learn the movement pattern. Stop immediately, regress and then build up to a Jefferson.

Remember You’re Not Doing This To Build Strength
Focus On Movement Control And Save Your Spine