(Post # 120) Dosage!!!... Dosage!!!... Dosage!!!

YOU CAN HAVE:

The right exercise...

With the right tool...

With the right technique...

For the right reason...

For the right body part...

At the right time...

At the right angle...

BUT IF YOU HAVE THE WRONG DOSAGE YOU ARE GOING TO MAKE A MISTAKE.

REMEMBER... NOT ENOUGH LOAD AND THE TISSUE WILL BECOME WEAK... TOO MUCH LOAD AND THE TISSUE WILL BREAK DOWN...SO WE NEED TO FIND THE RIGHT AMOUNT AND QUANTIFY IT.

(Post # 119) qUESTIONS tO tHINK aBOUT

WHEN SHOULD WE USE FUNCTIONAL TRAINING (Movement Training)?

Functional Training is best used when we want to:

1. Rehabilitate non-surgical orthopedic, neuromuscular and sports injuries.

2. Prevent injury and dysfunction.

3. Improve movement and sports performance.


WHEN SHOULD WE USE STRUCTURAL TRAINING (Muscle Training)?

Structural training is best utilized on the following situations:

1. First stages of rehabilitation after surgery.

2. When we don't have the muscle strength to start a functional movement.

3. If we are dealing with a condition or disease that does not allow us to train functionally.


(There is much more to functional training and structural training than the basic description given above)

(Post # 118) Any Clown can Push, Push, Push

Some of this clowns have the heart in the right place, but their knowledge is very limited.
Their concept is to push, push, push at all cost, as long as 10% to 20% of their athletes survive the poorly designed overtraining and win competitions, the other 80% that get permanent injuries and dysfunctions get overlooked or just dismissed as "collateral damage".

This sad story goes some thing like this..

Clown: "Go faster".

Athlete: "I am trying".

Clown: "Try harder"

Athlete: "I am in pain".

Clown: "You are not trying hard enough, just put some ice and take some ibuprofen".

Athlete: "I have been putting ice and taking ibuprofen everyday for while, but the pain does not stop and is getting worse".

Clown: "Just go and see a doctor".

Athlete: "Doctor say I need rehabilitation".

Therapist: "You need to take time off so we can rehabilitate your body properly".

Athlete: "I am not sure I can, my coach wont be happy and I don't think he would let me slow down".

Therapist : "If we don't do rehab right, therapy at best will only delay surgery".

So in another words the story goes something like this...

Ice + Advil ... and when that does not work...

Advil + Pain killers... and when that does not work...

Steroids shots ... and when that does not work...

Surgery ... and when that does not work...

More aggressive surgery... and when that does not work...

More surgeries and more pills...

The athlete is finished!

(Post # 117) Can Pills, Shots and Surgery be the Solution for Back Pain and Dysfunction?

Here is the problem...

1. There is an average of 60 % more pressure on the spinal discs when we are sitting than when we are standing.

2. Most people sit between 6 to 8 hours per day (driving, watching TV, using the computer, eating, reading,etc.)

3. Most people sit with poor posture.

4. Most people do not move often enough.

5. Most people lift with their backs and not with their hips and legs.

6. Most people exercise the trunk muscles "core" by doing some type of sit-ups and "supermans", which puts between 1000 to 1200 pounds of pressure to the spinal discs (Stuart McGill PhD 2006).

7. Most people exercise with machines, isolating muscles and blocking their proprioceptors and most of their stabilizers.

And then, after all this, when people develop spinal problems, such as, bulging disc, herniated disc, spinal stenosis, spondylolisthesis, etc., a common approach is to go from ibuprofen to pain killers and when that doesn't work, to go from steroids to epidural injection and when that doesn't work, to go from laminectomy (surgery) to spinal fusion (surgery) and when all that doesn't work, they are told to get more surgeries and more addictive pills.


Here is a better approach to prevent this from happening:

1. Walk with arm swing at least 20 to 30 minutes everyday (dog walking is OK but it does not count as therapeutic walking).

2. Sit with your spine in neutral (not too slouched nor too arched) and change you posture within a neutral zone every 30 minutes.

3. When lifting, keep your spine in neutral, use your legs (bend your hips, knees and ankles joints) and keep the object close to your center of gravity, in other words your belly button.

4. Floss your sciatic nerves 10 reps 2-4 times per day every day (See post 60).

5. Build neuromuscular endurance by speed walking, opposites (bird dog) exercises, planks (don' arch your back...keep it in neutral), squats, lunges and balance reach.

6. Avoid exercises that are harmful to the spinal discs such as: sit ups, prone leg raises, superman exercise (lying flat face down and raising both legs and arms up), knee to chest stretches, toe touch stretches and spine twisting stretches and don't put your self in danger with dumb exercises such as standing on a exercise ball.

7. Eat often and eat a balance diet of protein, complex carbohydrates, vegetables, fruits and clean water.

8. Rest, restore and recover through good night sleep, active rest and therapeutic massage.

9. Be patient. Although you may progressively feel better, it may take six to twelve months before you see results and get better.

(Post # 115) Keeping a Journal

Keeping a journal is one of the most important keys in getting better.

Here are the five thing you need to write:

1. Date.
2. Time.
3. Activity performed.
4. Length of time that activity was performed.
5. Location of symptoms and intensity before, during and after.

This information, integrated with the traffic light guide, can help you discover which activities and at which intensity they can be incorporated in you life.

Here is the traffic light guide:

Better after activity? -- Green light -- Go on !!!

Pain during activity, but no worst after it? -- yellow light -- Proceed with caution !!!!!

Worse after activity? -- Red Light -- Back off, by reducing the intensity, resistance, speed, repetitions, but don't stop !!!!!!!!!!

So, keep journaling and keep moving.

(Post # 114) A Quick View Into Nerve Mobilization and "Nerve Flossing".

(Post #113) Red Flags

One red flag by itself is not enough to get concerned, but three or more and you need to DEMAND a thorough examination with a CT scan or MRI as they may indicate serious disease or pathology.

Here are some of the most common red flags:

1. Unexplained weight lost.

2. Night pain with or without night sweets.

3. Pain that does NOT respond to movement.

4. Family history of cancer or suspected disease.

(Post #112) Think Before You Lift

Lifting incorrectly is one of the most common causes of lower back pain and disc dysfunction.

Before you lift, stop and ask yourself:

1. Did I get my spine in neutral (mid point between flexed and extended lower back)?

2. Did I brace by tensing all trunk muscles between 30% to 80% (abdominal, back and side muscles)?

3. Did I squat or lunge before lifting, so that I used my hips, knees and ankles and not the lower back?

4. Did I bring the object close to my trunk?

(Post #111) Don't Kill the Grass

Lets say that every day, you get the mail out side your home, and that to get there you need to walk over the grass, and that every day you walk in a straight line over the same path, what happens to that grass? It won't have enough time to recover and it will die.

Now lets say that everyday you take a different path... well then, the grass will have enough time to recover and regenerate, the same goes with joints, ligaments, tendons and muscles.

So, my suggestion to you is:

1. Modify your exercises as much as possible.

2. Change the body positions within a neutral zone as often as possible.

3. Tweak the range of motion, distance, depth, ground level, environmental stability, quantity, frequency, direction, level of difficulty, resistance and speed.

Read post # 22 for more on progressions, modifications and tweaks.

(Post 110) The Symphony of Human Movement

When human movement is in balance, it is like a beautiful symphony, where the brain, cortex, spinal cord, nerve roots, propioceptors, stabilizers muscles, mobilizer muscles, joints and ligaments work in synchronicity creating effective, efficient, protective and healthy motion.

But when this symphony is out of tune and out of synchronicity, we then have:

1. Propioceptors that don't get properly stimulated and can't communicate.
2. Stabilizers that don't hold joints in their neutral position while mobilizers create movement.
3. Muscles that don't fire on time, therefore can't protect the body nor create efficient movements.
4. Joints, nerves, tendons and muscles take the uneven, unhealthy and damaging loads.

So to to keep your symphony in balance, you need to train...

1. Mobility
2. Stability
3. Endurance
4. Strength
5. Power
6. Agility
7. Speed

By using ...

1. The three-dimensions.
2. The ten directions.
3. Gravity.
4. Ground forces.
5. Progressive resistance.
6. The right tools for your body, your goals and your sports.
7. Different environments.

(Post 109) "Sticky Nerves"

What are "Sticky Nerves" or in some medical terms "Adherent Nerve Roots?

1. Nerve roots, spinal cord and sometimes brain tissue that is adhered to other tissue such as bones, spinal discs, muscles and fascia.
2. Nerve tissue that is entrapped by other structures like spinal disc, calcium deposit and sometime muscles.

What are the symptoms?

1. Pain, burning and restriction that is often confused with by muscle pain and tightness.
2. Burning sensation on legs when speed walking and running.
3. Wrist and arm pain often misdiagnosed as carpal tunnel.

What causes it?

1. Inflammation from misuse and overuse.
2. Injury or trauma.
3. Poor training methods.

What can you do about it?

1. Learn to mobilize or "floss" your nervous system (see post 60 for sciatic flossing).
2. Walk 20-30 minutes everyday.
3. Swim 20-30 minutes.

(Post 108) Joint and Spine Instability

What is it?

Inability to keep the joints and spine in neutral position due to:

1. Poor propioception.
2. Lack of endurance and strength in the stabilizer muscles.
3. Loose joint capsules and ligaments.

What are the symptoms?

1. Pain that may move around.
2. Pain that is inconsistent.
3. Pain that comes and goes.
4. Pain that is resistant to traditional treatments.
5. Pain that persist for many years.
6. Disc and joint dysfunctions.
7. Clunking, clicking, popping and grinding sounds coming from spine and/or joints.
8. It may affect one or more areas of the body.

What causes joint and spine instability?

Instability may be caused by:

1. Injury and/or trauma.
2. Degenerative joint and spinal changes.
3. Born with loose ligaments and joint capsule.
4. Poor sitting, standing and moving posture.
5. Poor training methods.
6. Poor stretching methods.

What can you do to improve your joint and spine instability?

DO...
1. Practice therapeutic walking (walking with swinging arms, free hands and at a good pace)for at least 20 minutes every day.
2. Keep a good sitting, standing and moving posture.
3. Balance in a wobble board for the count of 20 breaths 10 times.
4. Practice balance reaches on a stability pad, 20 per side.
5. Do trunk exercises, such as planks, opposites, lunges and balance reaches 10-20 reps / 2-4 sets per day.

DON'T DO...
1. Sit ups.
2. Stretch.
3. Twisting exercises.

(Post 107) Propioception

What is it?

My definition of propioception is, the conscious and unconscious awareness and perception of our body, position, movement and environment through our neuro-musculo-skeletal system.

What are the symptoms of poor propioception?

When our propioceptors are not working properly and are not in balance...

1. Muscles can't protect the spine and joints.
2. Muscles can't stabilize the body and its parts.
3. Muscles can't react fast enough to protect us from a fall, accident and/or a sports injury.
4. Muscles can't help us keep a good posture when sitting, standing or moving.
5. Muscles can't react fast enough to change direction or position in sports.

What causes poor propioception?

1. Injury.
2. Pain.
3. Physical dysfunctions.
4. Inactivity.
5. Poor training methods.
6. Some neurological disorders.
7. Walkers for babies and kids inhibits propioception development.

What can you do to improve your propioception?

1. Practice therapeutic walking (walking with swinging arms, free hands and at a good pace)for at least 20 minutes every day.
2. Keep a good sitting, standing and moving posture.
3. Balance in a wobble board for the count of 20 breaths 10 times.
4. Practice balance reaches on a stability pad, 20 per side.

(Pain 106) Phantom Pain

"Phantom pain feels like it's coming from a body part that's no longer there. For decades, doctors believed this post-amputation phenomenon was a psychological problem, but experts now recognize a physical cause for this pain — and that it actually originates in the brain.

Most people who've had a limb removed report that it sometimes feels as if their amputated limb is still there. This painless phenomenon, known as phantom limb sensation, can also occur in people who were born without limbs. Phantom limb sensations may include feelings of cold, warmth, itchiness or tingling — but should not be confused with phantom pain. Similarly, pain from the remaining stump of an amputated limb is not the same as phantom pain.

For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies."

--Mayo Clinic

(Post 105) Pregnancy and Low Back Pain

According to Obstetrics, Normal and Problem Pregnancies by Steven Gabbe, Fourth Edition, the most widely read textbook on Obstetric Medicine...

Back pain in pregnant women can be prevented to a large degree by:

1. Avoidance of excessive weight gain.
2. Exercise to strengthen back muscles.
3. Good sitting and sleeping posture.
4. Sensible shoes, not high heels, should be worn.

(Post 104) Tennis Elbow

What is it?

It is an inflammatory or degenerative dysfunction of the common extensor tendon of the elbow.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor shoulder, elbow, wrist and hand mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.
9. Trauma.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over the elbow with referred pain down the forearm to the base of the hand.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to play, type or work as long or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at the site. This may indicate bursitis.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive isometric, eccentric and concentric strengthening exercises.
Step 4. Continue walking and cycling as much as the pain will allow.
Step 5. Progressively start exercising 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Exercise with mild resistance (squeeze rubber ball, open hand against elastic resistance) 10 to 20 minutes
Step 8. Star playing tennis or your sports, beginning slowly for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 103) Rotator Cuff Tendenitis and Tendonosis

What is it?

It is an inflammatory or degenerative dysfunction of the rotator cuff tendons, which are four tendons of the shoulder.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor shoulder mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.
9. Trauma.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over the shoulder with referred pain down the arm to the base of the thumb.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to play or work as long or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at the site. This may indicate bursitis.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive isometric, eccentric and concentric strengthening exercises.
Step 4. Continue walking and cycling as much as the pain will allow.
Step 5. Progressively start exercising 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Exercise with mild resistance (push, pull and lift) 10 to 20 minutes
Step 8. Swim, beginning slowly for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 102) Achilles Tendinitis and Tendonosis

What is it?

It is an inflammatory or degenerative dysfunction of the achilles tendon, which is one of the strongest and largest tendons of the body, it attaches the calf muscles to the heel bone.
There may be some micro-tears, partial tears and initially some inflammation.

What causes it?

There are many causes:

1. Overuse and/or misuse.
2. Poor training methods.
3. Poor body and movement mechanics.
4. Poor feet mobility and/or stability.
5. Lack of neuromuscular propioception (perception of your body in time space and the environment you are moving in).
6. Poor synchronicity of movement patterns and body parts.
7. Systematic steroids.
8. Some antibiotics.

What are the sings and symptoms?

1. Pain that is present before, during and/or after activity, it is felt over a 2-3cm area of the tendon between the calf muscles and the heel bone.
2. Swelling that may be present at the painful site.
3. As the pain progresses, you find that you are unable to run as far or as fast as before, and that the pain may persist for an hour or two after exercise.
4. Occasionally, there may be a small, very tender nodule at 0.5cm in size. This may indicate a small tear.

What are the recovery steps?

Start with step one, and gradually as your body allows it, progress to the next step every few days or weeks.

Step 1. Remove the source.
Step 2. Ice packs (7 to 10 minutes 4 times per day) and gentle pain-free movements (20 to 40 reps 4 times per day).
Step 3. Progressive eccentric and concentric strengthening exercises (calf raises and depressions on a step). Start with both legs together, and build up progressively until you can manage 3 sets of 15 single leg calf raises twice a day (90 calf raises a day). Do these on a staircase or a stable aerobic step.
Step 4. Continue swimming and cycling as much as the pain will allow.
Step 5. Progressively start walking 10 to 20 minutes.
Step 6. Speed walk 10 to 20 minutes.
Step 7. Jog 10 to 20 minutes
Step 8. Run, beginning slowly on grass and at the beach for 5-10 minutes, and build up your normal training over the next 2-3 months.
Step 9. Train all the muscles and joints the body with stability, mobility, strength and endurance exercises.
Step 10.Warm up before every training, game or activity.
Step 11.Cool down after every exercises or training sessions.
Step 12.Take at least two days for active rest between training and game sessions (Wednesday and Sunday).
Step 13.If the above steps don't work, you may need to see an orthopedic or sports medicine professional.

What is the recovery time?

Average recovery time is 2-4 months but it may take longer according to severity.

(Post 101) On Asking The Right Questions

When we don't ask the right questions we end up asking....

Why is it that every time...

I try to swim longer distance, my shoulders (rotators cuff) and back hurts?

I try to run faster, my knees (meniscus), ankles (Achilles tendon) and feet (plantar fascia) hurts?

I try to lift heavier weights, my back (spinal discs) and neck (nerve that goes to and under the shoulder blade) hurts?

I try to exercise, my sciatic nerve and back hurts?

I try to golf better, my neck, shoulders and elbow (golfer's elbow) hurts?

I try to play tennis better, my feet, ankle, knees and my elbow (tennis' elbow)hurts?

So lets start asking the right questions such as...

What is the right type of...

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.

(Post 100) Back in Motion...

Getting Back in Motion is a process...There are stages, steps, strategies, hurdles and many physical and emotional ups and downs.
At the beginning of this process, you enter the first stage which we will call "feeling better". At this stage, you temporarily feel less pain, you have good and bad days, you move a bit better, and feel a bit uplifted, but then a flare up or a set back shows up, and you feel temporarily discouraged, but if you keep up the hard work you enter the second stage which we will call "getting better". At this stage, you feel less pain, move better and start to have good days more often, but a few more set backs and flare ups show up and you feel briefly frustrated and discouraged, but with hard work and patience you enter the final stage which we will call "staying better". At this stage you no longer feel pain, you can move and perform better and the risk of relapse is eliminated.

Is this process worth it?

Can you enjoy your life, family, friend and activities when you are in pain?

How will you be physically and emotionally in five, ten or fifteen years from now if you don't take care of your body and mind now?

...You now have 100 posts that can guide you and hopefully encourage you to MOVE beyond pain and dysfunction so you can enjoy a more comfortable and complete life...Good Luck.

(Post 99) What You Can Do About that Painful Ending

If you have back pain with or without sciatica and you are willing to do the work necessary to get better, here is what I recommend you do...

1. Walk with arm swing at least 20 to 30 minutes everyday (dog walking is OK but it does not count as therapeutic walking).

2. Sit with your spine in neutral (not too slouched nor too arched) and change you posture within a neutral zone every 30 minutes.

3. When lifting, keep your spine in neutral, use your legs (bend your hips, knees and ankles joints) and keep the object close to your center of gravity, in other words your belly button.

4. Floss your sciatic nerves 10 reps 2-4 times per day every day (See post 60).

5. Build neuromuscular endurance by speed walking, opposites (bird dog) exercises, planks (don' arch your back...keep it in neutral), squats, lunges and balance reach.

6. Avoid exercises that are harmful to the spinal discs such as: sit ups, prone leg raises, superman exercise (lying flat face down and raising both legs and arms up), knee to chest stretches, toe touch stretches and spine twisting stretches and don't put your self in danger with dumb exercises such as standing on a exercise ball.

7. Eat often and eat a balance diet of protein, complex carbohydrates, vegetables, fruits and clean water.

8. Rest, restore and recover through good night sleep, active rest and therapeutic massage.

9. Be patient. Although you may progressively feel better, it may take six to twelve months before you see results and get better.