Tuesday, November 13, 2007

Saturday, October 27, 2007

(Post # 57) Knowledge vs Wisdom

What is the difference between knowledge and wisdom?

Knowledge is information which can be relatively correct or incorrect.

Wisdom in the other hand is the integration of information, experience and logic.

Thursday, October 25, 2007

(Post # 55) Knee vs Ankle Dysfunctions

See if you can answer these questions...

Why is it that knee surgeries are so much more common than ankle surgeries?

Doesn't the ankle hold more body weight than the knee?

Isn't the ankle joint smaller than the knee joint?

Isn't the ankle one of the first joints to get the stress that comes from gravity and ground forces?

How often have you heard people getting ankle replacements?

I need everyone to participate and send me your answers at backtofunction@gmail.com

(Post # 54) Back Pain

Guidelines for treating your back pain:

  1. Exercise daily.
  2. Exercise should not increase back pain.
  3. Walk every day for at least 20 minutes.
  4. Reduce the amount of sitting a much as possible.
  5. When sitting change posture every 20 minutes.
  6. Avoid full spine bending for the first hour after rising from bed.
  7. More repetition of less demanding exercises will enhance endurance and strength.
  8. No method of exercises fits all individuals.
  9. Be patient and stick with the program.
  10. Remember to lift properly, by bending hips and knee and not the back.

Friday, October 19, 2007

(Post # 51) On Your Bones... Ready?... Go!

Traditionalists will tell you to:
  • Take Calcium, Tums will do.
  • Do exercise, any will do.
  • Take hormones. Horse urine? or wild yam? any will do.
  • When all fails take Fosamax.

...and you may ask...

What about tums and indigestion?

What about hormones and cancer and heart disease?

What about Fosamax and osteonecrosis (bones that are dying and rotting) ?

...and they say...
  • only a small percent get those side effects.
  • if they happen we will deal with that later.

So I am going to ask you...

  1. Are you walking at least 20 minutes every day?
  2. Are you doing three dimensional, multi-directional, against gravity, free from any artificial stability exercises?
  3. Are you eating a balanced diet of healthy proteins, whole grains, organic vegetables and fruits?
  4. Are you avoiding refined foods, sugars and sodas?

If yes, great!

If not, let's get started!!!!

(Post # 50) The Last Straw That Broke His Back

(Post # 49) Protect Your Discs

Tuesday, October 16, 2007

(Post # 48) Just a Thought

It is Important to know what you are doing

but it is more important to do what you know.

(Post # 47) Pelvic Floor Dysfunction

Pelvic floor dysfunction is a very common problem affecting 1 in 4 women.

Between pregnancy, childbirth, hormones, inactivity, and too much uninterrupted sitting (at the desk, computer, driving, reading, etc.) I predict this already high percentage of women getting the dysfunction is going to get much higher in the coming years.

Symptoms vary but the most common are:

  • Bladder incontinence
  • Bowel incontinence
  • Sexual dysfunction (lack of feeling or sensation)
  • Pelvic floor pain

The traditional way tells us to Squeeze!...Squeeze!...Squeeze!

I believe this approach is very limited at best.

What can you do to treat or prevent this problem?

In order to stimulate, strengthen and give endurance to the pelvic floor muscles you need to:

  1. Lunge in every direction (front, back, sideways, front diagonal and back diagonal) x 20 every day
  2. Squat with different foot position (feet together, feet 1 foot apart, 2 feet apart) x 20 every day
  3. Walk 20 minutes every day
  4. Only then will Kegel exercises (contract the pelvic floor muscles and hold 4 seconds x 20) will be effective.

Monday, October 15, 2007

(Post # 46) More on Exercise and Breast Health

Physiological Effects of Exercise on Breast Cancer Risk

• Decreased Lifetime Exposure to Endogenous Estrogen
• Decreased Number of Menstruations/Ovulations
• Decreased Level of Ovarian Estrogen Production
• Decreased Levels of Endogenous Estrogen in Blood
• Less Conversion of Androgen to Estrogen in Fat Cells
• Decreased Breast Density
• Risk Four Times Lower with Less Breast Density
• Increased Immune Function
• Increased Natural Killer Cells Fight Tumor Initiation

--American College of Sports Medicine

Sunday, October 14, 2007

(Post # 45) Alcohol and Breast Health

Breast Cancer Risk
(1 drink = 5 oz. wine, 1.5 oz. hard liquor, 12 oz. beer)
• 1 drink per day = 11 percent increased risk
• 2 drinks per day = 24 percent increased risk
• 3 drinks per day = 40 percent increased risk

Effect of Alcohol on Breast Cancer Risk
• Increases blood triglyceride levels
• Increases estrogen levels in blood circulation
• Increases liver detoxification of toxins in alcohol
• Decreases liver’s processing of excess estrogen in blood
• Causes long-term liver damage Prevents liver from
removing excess estrogen from blood
• Decreases immune function
• Increases blood levels of carcinogen acetaldehyde
• Decreases absorption of cancer-fighting nutrients
• Decreases antioxidant activity in the blood
• Can increase weight gain through excess calories
• Higher body fat increases breast cancer risk

--American College of Sports Medicine, Certify News

Friday, October 12, 2007

(Post # 43) Just a Thought

Don't ever let a miserable moment go to waste!

We can always learn from it.

Tuesday, October 9, 2007

(Post # 42) Myths and the Problems they Cause # 3

Myth #3: Stretching before exercising will prevent sports injuries.

After studying the work of Dr Siff and Dr McGill, both professors of biomechanics , I realized I was not alone in believing how wrong this common misconception is.

If you were a sculptor trying to give shape to a piece of clay, metal or glass, you would first warm it up or melt it, otherwise it could crack and brake when you tried to bend it. Well, the body is no different.

These are steps I recommend for a safe and effective work out:
  1. Before playing sports or doing exercises, you need to warm up for 5 minutes with any of the following: Gentle progressive fast walks, mini squats, short lunge matrix or any exercises that would increase you heart rate and circulation.
  2. After the warm-up you are now ready to do your sport or exercise routine.
  3. After you finish, you need to slow down with a gentle 5 minutes walk, run, or lunge matrix.
  4. Only after you have finish your slow down, should you stretch or mobilize your body as a cool down.

Sunday, October 7, 2007

(Post # 41) 13,000 Yoga Related Injuries

According to the Consumer Product Safety Commission there were over 13,000 Americans treated in an emergency room or doctor's office for yoga-related injuries in the last three years.

All these injuries are thought to be caused by specific yoga poses, lack of preparation, age, and/or unqualified instructors.

I believe that some of these factors may contribute to these injuries, but I also believe that the problem is caused by not asking the right questions:

Why am I stretching?

How do I know I need flexibility rather than stability?

If I have loose or unstable joints, would yoga help me or hurt me?

Can too much yoga create so much flexibility that it becomes instability?

I am posing these questions because I believe yoga can be very beneficial for the right person, for the right reason, when combined with the right amount of stability training and with the right the instructor.

Saturday, October 6, 2007

(Post # 40) Wisdom from Pooh Bear

Pooh: Oh bother! Why am I sitting on this tree stump trying to make my leg go straight with Piglet hanging onto my ankle?

Owl: So Rabbit and I can calculate how strong your leg is.

Rabbit: Extending a Piglet twenty times means you have a strong leg for a bear.

Piglet: It is hard to hang on. I hope I don't fall off when you make your leg go fast.

Eeyore: This all looks very boring to me.

Pooh: But this is not what the leg of a Pooh Bear does.

Owl: And what, may I ask, do you mean by that?

Pooh: Well, the leg of a Pooh Bear likes to balance while reaching for a jar of honey, likes to squat down to play sticks with Piglet, likes to lunge back during tug-a-war with Eeyore, likes to climb the three steps to visit with Owl, likes to jump over logs in the forest with Tigger and likes to play hop games with Rabbit.

Tigger: Oh, thank you, Pooh. I like jumping with you, too...that's what Tiggers do best, you know.

Owl: May be if Piglet lets go of your ankle and you get up off the slump we can see what the leg of a Pooh Bear can do.

Rabbit: But there will be nothing to calculate, nothing to count, nothing to time, nothing to measure.

Pooh: It seems if you let my leg do what it likes, you could measure it while it likes what it does.

Tigger: You mean like jumping with me, hopping with Rabbit, tugging on Eeyore and squatting with Piglet?

Eeyore: Everyone is always tugging on my tail.

Pooh: and specially balancing while reaching for a jar of honey...just the thought of all this makes me very hungry, indeed.

Owl: Maybe there is a way to measure all the things your leg likes to do. I really enjoy it when you climb up the steps into the tree to visit me...maybe next time we can count the steps.

Rabbit: I would like to see how far and how fast we can jump together...that's what we do best, you know.

Eeyore: I'll bet you will want to lunge as far as you can to see how far back you can pull me by my tail.

Pooh: I wonder how long I can balance and how far I can reach for a jar of honey?

Rabbit: It seems like there is going to be a lot of things to measure if we are going to measure all the things the leg of a Pooh Bear likes to do.

Piglet: But what am I going to do now that I am not hanging onto the ankle of a Pooh Bear?

Pooh: Oh, Piglet, now you can hang onto the hand of a Pooh Bear and the rest of your friends and join in on all the fun.

--Gary Gray.

Sunday, September 30, 2007

(Post # 39) Understanding The Mechanics of Pain

There are four ways that pain can be activated:

  • Normal stress on abnormal tissue: Example: Walking (normal stress) with a degenerated knee (abnormal tissue).
  • Abnormal stress on normal tissue: Example: Healthy person (normal tissue) who sits with a slouched posture (abnormal stress).
  • Abnormal stress on abnormal tissue: Example: Sleeping on stomach (abnormal stress) with a pinched nerve in the neck (abnormal tissue).
  • Chemical stress: Inflammation, infection or trauma.

Saturday, September 29, 2007

(Post # 38) Are You In Balance?

Are you flexible?

Are you stable?

Are you strong?

Are you fast?

Do you have endurance?

I am not talking physically... I am talking emotionally.

Sunday, September 23, 2007

(Post # 37) Some Times Provoking Transformation Is The Best Help We Can Give

A man found a butterfly cocoon. One day a small opening appeared and the man watched the butterfly as it struggled to force its body through the small hole. It appeared that it had gotten as far as it could and could go no farther. The man decided to help the butterfly, so he got a pair of scissors and snipped off the remanding bit of the cocoon.The butterfly then emerged easily, but with a swollen body and tiny, shriveled wings. The man continued to watch the butterfly, expecting that at any moment the wings would enlarge and expand to be able to support the body, which would contract in time.

Neither happened. In fact, the butterfly spent the rest of its life crawling around with a swollen body and shivered wings, never able to fly.

What the man had not understood was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature's way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved freedom from the cocoon.

Some struggles are exactly what we need in our life. If nature allowed us to go through life without any obstacles, it would cripple us. We would not be as strong as we might otherwise be.

And we could never fly...

-Author unknown

Saturday, September 22, 2007

(Post # 36) Simple

"Any intelligent fool can make things bigger and more complex.
It takes a touch of genius...to move in the opposite direction."
-Albert Einstein

I would like to suggest an alternative to those who are suffering with simple back pain (pain that is less than 8 weeks):

  • Walk every day for at least 20 minutes.

  • Move around and gently stretch 1 minute for every 30 minutes of sitting.

  • Change posture within a neutral position.

  • When working, try changing position as often as possible.
  • When lifting, get your pelvis close to the object first and then lift.
  • If the above is not enough, find a good therapist or trainer who would teach you the right type of exercises.

(Post # 35) Myths and the Problems they Cause

There are two main exercises that are often prescribed for lower back pain and dysfunctions: sit ups and back extensions. They're both recommended on the assumption that back pain is caused by weak muscles.

Although weak trunk muscles are part of the problem and sit ups and back extension exercises do strengthens some of the trunk muscles, they're also the most destructive exercises for the spinal disc.

Just look at this chart to see how much excessive load there is on the spinal disc.

According to the studies on spinal disc pressure by Dr. Nachemson, there is 210% of your body weight of pressure into the spinal disc with sit ups and 180% of your body weight of pressure with back extension.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Friday, September 21, 2007

(Post # 34 ) On Walking

Walking is the most underrated treatment for lower back pain and its dysfunctions. With every step we take, the lower spine goes from a neutral position into a mild extension movement. This causes the spinal disc to be mobilized into its natural position, where it gets hydrated with water and nutrients and where the spinal load gets evenly distributed.

Thursday, September 20, 2007

(Post # 33) Exercise & Breast Health

I believe that walking must be a part of every treatment for neuromuscular pain and dysfunction. There is now evidence that brisk walking can reduce the risk of breast cancer by 20 percent. For those who already have the disease, walking three to five hours a week may reduce the chance of dying from it by as much as 50 percent.

For more on this see February issue of Medicine & Science in Sports & Exercise (official journal of the American College of Sports Medicine).

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Wednesday, September 19, 2007

(Post # 32) The Silent Lymphatic System

The lymphatic system is part of our immune system. It is composed of lymph vessels, nodes, glands and lymph fluid. It is always working in silence removing toxins, carcinogens, bacterias, viruses, pesticides that we get from foods, etc. It's one of our best tools against cancer and disease, but it needs to circulate, move and drain to work properly, and since it does not have a pump like the cardiovascular system, it relies on muscle contractions, body movements and breathing.

So how can we help our lymphatic system to work at its best?.

Here are some suggestions:

  • Exercise for at least 20 minutes a day or 10 minutes twice a day every day (walking, biking, swimming, working out or whichever activity you enjoy).
  • Drink plenty of clean water.
  • Get plenty of rest.
  • Eat healthy proteins, organic vegetable and fruits.
  • Reduce stress by practicing silence.
  • Get massage therapy.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Monday, September 17, 2007

(Post # 31) Posture It's a Pain!

Can poor posture cause pressure and stress on the kidneys, liver, stomach, lungs, pancreas and the many other organs, vessels and arteries? I am not sure. But I do believe that poor posture creates pain and dysfunctions, such as bulging disc, herniated disc, degenerative disc disorders, spinal arthritis, and nerve compressions among many others.
For more on this read post # 7.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Thursday, September 13, 2007

(Post # 30) The Emotional Nervous System

Both physical pain and emotional distress are felt through the nervous system. When you feel dissatisfaction with your lifestyle, your job, or are involved in a toxic relationship, or are experiencing any type of emotional stress, your nervous system gets affected. When physical pain is experienced in addition to emotional pain, it adds up to an already overloaded nervous system and the pain feels stronger than if emotional issues were absent.
There may be occasions when a person, consciously or subconsciously, uses physical pain to distract the mind from emotional pain. Pain threshold is lowered by emotional pain and focus is on the physical pain to avoid dealing with emotional issues.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 29) What is the Difference Between Mobility and Flexibility?

Mobility is how effectively and efficiently our body moves throughout the range of motion. Flexibility is how much range of motion our body has.

Mobility and stability training are an essential part of any rehabilitation and training program.
Flexibility on the other hand, is something that may or may not be needed depending on your body, rehab and training goals.
Remember: Too much flexibility will cause instability.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Monday, September 10, 2007

(Post # 26) What is the Difference Between Rehabilitation and Training?

I believe that rehabilitation is the removal of the cause of pain and dysfunction, restoration of function and rebuilding of the body. Training is the creation of specific mobility, stability, endurance, strength, flexibility, power and speed based on our physical needs and goals.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Sunday, September 9, 2007

(Post # 25 ) On Training

"Efficiency is doing things right; effectiveness is doing the right things."--Peter Drucker

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 24) What is Chain Reaction

A series of events or actions in which each event or action is the result of the one preceding and the cause of the one following.
It is important to keep this definition in mind when training because if we train our body by artificially stabilizing or restricting body parts or movement patterns, we may disturb the chain reaction that needs to happen before and after that action.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 23) In Motion

"Move to the dance of life--As our dance partner, life insist that we put ourselves in motion, that we learn to live with instability, chaos, change, and surprise. We can continue to stand immobilized on the shoreline, trying to protect ourselves from life's insistent storms, or we can begin moving. We can watch our plans be washed away, or we can discover something new." -Margaret Wheatley

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Saturday, September 1, 2007

(Post # 22) Rehabilitation and Training Progressions

Rehabilitation and training progression does not always mean pushing forward, sometimes the right thing to do is to back off or to progress on some aspects and regress in others. Sometimes we need to start in a non-functional way, then move into a pre-functional system and only then to a functional method of treatment and/or training.

Here are some of the treatment and training progressions:

Exercise: The type of exercise we need to use might be isometric(muscle contraction but no joint movement) or dynamic(muscle and joint movement).

Position: The position that we need to put our body or body parts may be neutral, mid-range or, end of the rage.

Quantity: We can always change the quantity depending on our physical response, adaptation, energy level and our rehab and training goals.

Frequency: We need to find the right amount of resting time between rehab and training sessions so we can properly rebuild, restore and recover.

Level of difficulty : Avoid making the exercise more difficult without a good reason, meaningful plan and a purpose.

Direction: The more directions an exercise is performed the better results we will have.

Range of motion(R.O.M.): Just like quantity and frequency, range of motion can be modified to fulfill the goal in mind.

Ground levels: We can modify the height we are standing on or stepping into by using different level steps, so the body can gain dynamic strength when performing activities at different surface levels, which require changing our body position in relation to the ground, such as going up and down stairs, hiking, climbing, running in uneven surface, etc.

Environmental stability: When we introduce external or environmental instability to our rehab and training program, such as a balance board or stability ball, we stimulate our body's neuromuscular system and gain physical stability.

Resistance: Weight and/or resistance should only be applied when we have complete control of our body weight in motion.

Speed: Speed should be the last progression unless we have very good reason to do otherwise.

I want to thank all of you that wrote e-mails and comments. I will be back soon.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 21) Rehabilitation and Training a Continuum

I believe that in rehabilitation and training there is a continuum from non-functional to more functional. For practical reasons I also believe that is helpful to separate them into three main types of treatments and training: Non-functional, Pre-functional and Functional.

Non-functional: Requires no action; such as passive movements, rest, ice, compress, elevate, massage etc.

Pre-functional: Semi-active treatments and training that are composed of stabilized movement such as floor exercises, gym machines, stationary bike, etc.

Functional: Active treatments and training that use three dimensional and multi-directional movements, have no artificial stability and work against gravity and ground forces.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Thursday, August 30, 2007

(Post # 20) Nerve Mobility and Sports Injuries

Can some our sports injuries be associated with the ability of the nervous system to move properly?

Can achilles tendonitis or a hamstring tear be caused by the inability of the sciatic nerve to move and glide freely?

Think for a moment how our brain is connected to the spinal cord and how the spinal cord is connected to the lumbar nerve roots; such as the sciatic nerve.
The sciatic nerve travels near the hamstring, behind the knee, all the way to the toes innervating all of these muscles. To test the sciatic nerve to see if a spinal disc is compressing it and not letting it glide, a clinician would perform a test which would put our leg in a position very similar to many sports moves therefore put our nerve roots under tension.
If there are restrictions in the lower spine the nerve roots may give the wrong information to those muscles not to relax on time, or not to relax at all.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 19) What is the Difference Between Balance and Stability?

What is the difference between balance and stability?

Balance is how well you are able to control your body without movement against gravity.

Stability is how well you are able to control your body during movement.

So one is static and the other is dynamic.

They are both important, but if you are going to fall, think which one will protect you more?

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post # 18) What is the Most Vulnerable Part of Healing

What is the most vulnerable part of healing?

The most vulnerable part of healing is when we feel better and we forget about lifting properly, keeping a good posture, changing postures every 20-30 minutes of sitting, walking as a therapy for 20-30 minutes, and doing the work that got us better and we fall in the trap of I am too busy, I don't have enough time, etc.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

(Post #17) Uncertainty

Uncertainty is uncomfortable,

Certainty is ridiculous.

Wednesday, August 29, 2007

(Post # 16) Challenging Traditional Physical Rehabilitation and Training

Physical Rehabilitation and Training:

Lets keep it Functional-- multi-directional, three dimentional, against gravity, free from any artificial stability.

Lets keep it Simple-- no fancy exercises, try to train as close to real life and/or sports requirements as you can.

Lets keep it Effective-- train to fulfill a need and train with a purpose.

Lets keep it Efficient-- engage most amount of movement patterns and body parts with each repetition.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Tuesday, August 28, 2007

(Post # 15) Factors that can Influence Pain and Dysfunction

Physical activity
  • Misuse--often mistaken for overuse. All tissues respond to load; not only will they get damaged if the load is too much or weakened if the load is too small, but become dysfunctional if there is not enough rest in between engagements.
  • Disuse or lack of use will atrophy most tissues in the body including bones, cartilage, ligaments, muscles and tendons.


  • Dissatisfaction with job and/or lifestyle.
  • Patient consciously or subconsciously uses physical pain to distract his/her mind from emotional pain
  • Patient involved in toxic relationship
  • Poor diet or nutritional deficient. The lack of needed nutrients, vitamins, minerals and enzymes in the body can contribute to conditions such as weak bones (osteoporosis), weak cartilage, weak ligaments, weak tendons, etc.
  • Lack of adequate nourishment inhibits the body's natural healing response.
  • Hormonal imbalance may weaken bones, cartilage, ligaments and tendons.
  • Hormonal imbalance can cause conditions such as systematic joint instability by making ligaments too lose.
  • Diabetes by itself, may cause conditions like tendonitis and bursitis.
  • Genetic predisposition can be the cause for diseases like rheumatoid arthritis, degenerative osteoarthritis, osteoporosis, scoliosis, etc.

(some of this factors can be backed up with science but others are just my clinical observations)

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Monday, August 27, 2007

(Post # 14) Referred Pain

What is referred pain?

Pain that is felt in an area other than the lesion.

Why is this important?

A patient is treated for thigh pain, and receives treatment for the quadriceps muscle. The reason? Pain is felt there. After endless treatments of stretching, strengthening, ultrasound, electric stimulation, etc,...etc...etc..., she gets to the right clinician who performs a functional assessment. It becomes clear that resisted knee extension (which is one of the test that test the quadriceps' contractile ability) shows negative proving that the function of the quadriceps muscle is not disturbed. Further examination, this time of the lumbar spine, shows that the patient is not able to perform lumbar extension (backward bending) without pain, and that repeated lumbar flexion (forth ward bending) increases the pain, which is referred into the thigh (L-2 dermatome). We can conclude, that the lesion lies in the lumbar spine, most likely nerve root L-2, and not in the quadriceps muscle.
Although this is just one piece of the puzzle, we can now create a plan to figure out the best treatment approach for the lower back and for the entire kinetic chain. Here is a list of some but not all of the treatment option we can explore:

  1. Trunk stability exercises.
  2. Nerve mobilisation exercises (nerve flossing).
  3. Walking 20-30 minutes.
  4. Sitting habits (finding a new neutral zone for the spine every 20-30 minutes).
  5. Lifting habits (training the legs by doing squats).

And remember to listen to the body by asking: are you better? worse? or no change?

Thank you David for your comment.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment on the box.

Sunday, August 26, 2007

(Post # 13) The X-ray, a doubtful assistance?

Can an X-ray be a substitute for functional assessment?

No, a characteristic shared by the moving soft tissues is their radio-translucency (their ability not to be seen in a x-ray). The tissues that I am talking about are joint capsules, ligaments, fasciae, muscles, tenons, bursae, spinal discs, dura mater, dural sheaths, and nerve roots. Any of these structures can cause pain. None of them inflame or other wise, can be diagnose on the x-ray. If a soft tissue causes pain, the x-ray can show only one of two things. First, it may reveal the bones are normal; therefore it allows the patient to be open to a misplace diagnosis of neurosis or psychogenic pain (pain caused by the mind). On the other hand the x-ray may disclose some symptomless abnormalities or natural degenerative changes which is then incorrectly regarded as the source of the pain. In this case the x-ray is positively misleading.
So be skeptical of those clinicians that will give you a diagnosis, without giving you a thorough functional assessment first.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

Saturday, August 25, 2007

(Post # 12) Dr Cyriax the Father of Orthopedic Medicine

My biggest hero Dr James Cyriax MD once said

"All pain has a source"

"All treatment must reach the source"

"All treatment must benefit the lesion"

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

(Post # 11) To Treat or Not to Treat

Needless to say, there can be no justification for physical treatment unless that treatment is known to accelerate the natural history of the condition or to assist in the recovery of function. I believe that all patients are entitle to comprehensive guidance and education in the appropriate strategies to assist in the healing process and to regain normal painless function.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

Friday, August 24, 2007

(Post # 10) 11 Factors that can Inhibit Healing

Factors that can Inhibit Healing

1. Poor blood supply – especially tendon lesions where intrinsic blood supply may be poor.

2. Lack of initial protection and reduction of swelling (first few days).

3. Lack or not enough early mobilization – gentle natural mobilization encourages good quality repair (starting within the first week post-injury).

4. Prolonged inflammation: anything that prolongs or re-triggers this phase will cause poor healing – for instance infection, a hematoma, or excessive premature mobilization.

5. Inadequate use of steroid medication – decreases tensile strength of healing lesions, slows the rate of wound closure and vascularisation.

6. Nutrition – lack of nourishment inhibits the body’s response to injury and healing.

7. Diabetes – mechanical problems and metabolic defect impairs wound healing.

8. Increased or too much deposit of collagen or scar tissue.

9. The grade of mobilization or physical activity must be appropriated for the stage of healing. If too aggressive too early, or not enough stresses are applied to repair tissue, the end result can be the same – poor wound healing and function.

10. Inappropriate behavior in dealing with pain and its consequence--letting fear of pain paralyze your lifestyle, leading to fear-avoidance beliefs and behaviors such as: lack of movement, becoming inactive, low self-efficacy, low self-reliance, anxiety and depression.

11. Inappropriate behaviors on the part of the health care practitioner – encouraging patient to adopt sick-roles, obtain sick leave, and offering passive, clinician-led treatment strategies, which help to maintain low self-efficacy and clinician dependency.

I know I got a bit technical with this one, but for some of you it can be very useful.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

(Post # 9) Three Stages of Healing

From my perspective here is why its important to keep the nervous system moving, so it does not become adhered and dysfunctional when injury and healing goes through the three progressive phases:

Inflammatory phase....prepares tissue for repair....we need to protect tissue.

Repair phase....rebuilds the structure....we need to gently move tissue.

Remodeling phase....provides the final form for the structure....we need to move tissue to its end-range.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

Wednesday, August 22, 2007

(Post # 8 ) The Sensitive Nervous System

In my opinion, one of the most comprehensive textbooks on the assessment and treatment of pain and dysfunction is The Sensitive Nervous System by David Butler. One of the many great points I got from this book is the need to encourage those in pain to stay active and to keep the fear of pain from paralyzing their lives. To do this effectively, first establish a comfortable level of activity or a functional baseline. Then gradually increase the activity level whether it is five minutes walking, swimming, or riding a stationary bike, even if five minutes does not seem like much, it will keep the nervous system moving and healthy while the surrounding tissues repair and heal.

Tuesday, August 21, 2007

(Post # 7) Myth and the Problems they Cause

Myth #2: Posture must be completely straight all the time!!!

I am the first to admit that at the beginning of my career I also bought into this theory.
It was frustrating for me as a therapist but specially frustrating for my patients. They had the best intentions of maintaining a straight posture but would give in after just a few minutes because of lack of muscle endurance or because they would get distracted by the computer or book they were reading and would go right back to old habits.

So I asked myself...

Is a sustained straight posture good for the spinal disc?

Is asking patients to sustain a good posture on will alone a reasonable approach?

Is there a better approach?

I believe good posture is a combination of different postures within a neutral zone, where ears are on top of shoulders, and shoulders on top of hips, and the spine in neutral position.
We must find a different neutral position every twenty to thirty minutes for the pressure of the spinal discs to get redistributed and evenly loaded and unloaded.
We must build strength and endurance of all muscles, specially those of the trunk, so we do not rely on will alone but also in the strength and endurance of those muscles.

Let others know about this blog and let me know what you think at backtofunction@gmail.com or write a comment in the box.

Monday, August 20, 2007

(Post # 6) Myths and the Problems they Cause # 1

Myth #1: Sit ups for lower back pain.
Although this concept has been disproved many times before, it keeps being recommended by many therapist and trainers. It is based on the assumption that all lower back pain is caused by weak abdominal muscles when in reality every back pain is different, and every back pain responds to different treatments. Different pain responds to different approaches like: stability exercises, nerve mobilization exercises, end-range stretching, strengthening of the trunk muscles, static and dynamic posture correction, gate correction, lifting techniques, and some may need a combination of all or some of them.

Saturday, August 18, 2007

(Post # 5) Help from Socrates

To help us answer the questions in the last post, I would like to follow Socrates, the father of Western philosophy, the one that taught Plato and Aristotle that through questions you have the potential to discover, learn, teach and get as close to the truth as possible, to ask the following questions:

How do you know you have pain?

How do you feel it?

How does pain travels to the brain?

Can we at least say that nerves are involved?

Which structures have the potential to compress them?

If you have pain in the shoulder and arm muscles, but can only induce the pain by moving the neck, where is the problem?

Can we say that the problem may be in the cervical spine (neck) and is only referred to the shoulder and arm?

How is it that someone who has lost an arm in an accident can still feel pain down an arm that is not longer there?

Is it possible that the cortex (sensory part of the brain) may be misinterpreting the location of the dysfunction?

Can the lack of functional understanding be the reason why most doctors, therapists, trainers and us may be confused by the cortex?

Thursday, August 16, 2007

(Post # 4) Tissue Dysfunctions

About every other year there is a tissue that comes in style.

Whaaaat? you ask. And yes, you are told that: your pain is caused by a tight psoas, No!... by a tight piriformis, No!...by a weak core, No!... by a disc, No!..by a bone out of place, No!... by a psiatic nerve, No!... by facet joints, No!... by weak abs, etc,etc,etc.
Well, what are we suppose to do with all this confusion?

Here is a description of most common dysfunctions:

Spinal Dysfunction—usually caused by disc displacement or restrictions.

Joint Dysfunction--lack of range of motion, due to displacement, instability or restriction.

Nerve Dysfunction--Inability for the nervous system to move and glide freely with movement.

Neuromuscular Dysfunction-- caused by inactivity, misuse, or wrong method of training.

Tendon Dysfunction--usually caused by joint injury, instability or misuse.

Bursa Dysfunction--usually secondary to other dysfunction such as joint instability or neuromuscular dysfunction.

(Post # 3) Physical Dysfunctions

It is crucial to identify the different types of physical dysfunctions so we don't make common mistakes such as stretching an unstable joint when the right strategy is to stabilize, or strengthen a restricted part when the right strategy is to mobilize or stretch.

Here are the four main different types of physical dysfunctions:

Instability : The inability to control a neutral position of joints or body parts during movement, therefore causing pain and dysfunction.

Displacement: Joint, spinal disc and meniscus displacement can cause disturbances in normal resting position, obstruct movement in the direction of the displacement and cause pain by compressing and/or stressing nerve tissues.

Restriction: Lack of range of motion caused by dysfunctional joints, muscles and nerve tissue.

Weakness: Neuromuscular dysfunction that is caused by lack of use, inactivity or injury.

Wednesday, August 15, 2007

(Post # 2) Understanding Pain

To treat our pain safely and effectively, we must first identify the type of pain we are dealing with.

Here are the different types of pain:

Chemical Pain
  • Pain is constant, regardlessof the position we adopt.

  • It is caused by inflammation.

  • Movement makes it worst.

  • It may be helped by anti-inflammatory medication.

  • We may need to use the RICES concept (Rest, Ice, Compress, Elevate and Stabilize).
Mechanical Pain
  • Pain is intermittent, it comes and goes depending on the position we adopt.

  • Pain will improve if we do the right type of movement or therapeutic exercise.

  • It does not respond to medication.

Tuesday, August 14, 2007

(Post # 1) Back in Motion

The purpose of this training is to teach you how to identify, treat and prevent pain, injury and dysfunction so you can safely and effectively train your body perform better and get fit. In order to do that we need to understand the following:

1. Types of Pain
2. Mechanics of Pain
3. Factors that influence pain
4. Injury and healing Phases
5. Factors that influence injury and healing
6. Physical Dysfunctions
7. Tissue Dysfunctions
8. Rehabilitation and training Principles
9. Rehabilitation and training Stages
10. Rehabilitation and training Goals
11. Rehabilitation and training Strategies
12. Rehabilitation and training Guidelines
13. Rehabilitation and Training progressions and Modifications
14. Rehabilitation and Training exercises