Tugging on a hose (nerve) will not be effective if something is compressing it. Several things can compress nerves in our bodies. In contrast, if a nerve is adhered to something, tugging it (typically called flossing, stretching, or gliding) is indicated. I tell patients with nerves that aren’t moving as well as we’d like that we first check to see if someone is “stepping on the hose.” If we investigate and find that to be the case, we work to remove the compression. If we rule that out, then we can start to glide the nerve to increase its length. Performing gliding without investigating potential compression will often get you nowhere - just like pulling on a hose while someone’s foot is on it won’t get you anywhere. -- Laura
Try to get to, and understand, the “why.” Why is my leg restless? Why is my patellofemoral joint hurting? Why is my bowel irritable? Why is my head aching? Why is my nerve pathological? Why is my IT band painful?
We unfortunately do not have an answer 100% of the time, but it’s close. And there is usually at least a strong hypothesis. It may take more than one clinician. If you strike out with one, try another. Once you uncover the “why,” you can treat that. -- Laura
We wash our hands to prevent infections, wear helmets to minimize head injury, and brush our teeth to reduce disease and decay. There are tips to preventing musculoskeletal problems as well. I put it succinctly recently: Move your joints. In all directions. Quite often.
Learning the basic tenets of prevention goes a long way. My goal is to help patients with their current problem and, just as importantly, to teach them what is occurring so that they can minimize or prevent recurrence. Advice to stay active, flexible, and strong to prevent injury is valid. What is lacking in my experience, however, is nuanced advice on maintaining joint balance and health. If people had a basic understanding of how joints worked, and some daily or weekly prevention strategies, a lot of aches, pains, and “injuries” that come on for no reason could be avoided. (Most musculoskeletal complaints, after all, cannot be blamed on major, or even minor, trauma.) -- Laura
Rolling an ankle impacts more than ligaments and tendons. The ankle joints (there are several) are obviously involved - and possibly the structures that get injured. Before I jump to the conclusion that pain and tenderness on the lateral (outer) aspect of the ankle is coming from the lateral ligaments, I move the joints to assess the effect. The joints of the ankle can create pain anywhere near the joints. If a joint is indeed the culprit, most will resolve rapidly with directional preference exercises. If a ligament is to blame, then traditional treatment of a ligament sprain is indicated. Looking for the problem that usually gets better the fastest not only makes diagnostic sense, but also benefits the patient. Who doesn’t want to get better as fast as possible? -- Laura
You need to investigate the source of your complaint - and not make assumptions. A spinal curve, flat foot, bowed leg, askew elbow, elevated shoulder, etc. may or may not be related to your current complaint. If your abnormality, or deformity (we all have them to some extent), has been around for years and your complaint is new, the odds that they are related decreases. If you noticed they occurred at the same time, the odds increase. Too often people make assumptions without understanding how to repeatedly move the body to test for any relationship. -- Laura
When reaching hard enough, will you feel pulling in your hamstrings? It’s likely. Tendons and muscles (unlike other structures) will usually allow you to eek out another centimeter in pursuit of your toes, which you’ll feel. But “feeling it there” does NOT mean that is necessarily the limiting factor. To touch your toes you’ll need sufficient hip mobility, low back mobility, and sciatic nerve length for starters, not to mention mid back mobility and even arm length! Whereas so many (I want to say most) fitness professionals and medical clinicians alike make assumptions such as this, I critically assess why someone cannot do something. We move your body in various ways repeatedly to understand the source of a complaint or functional deficit. And by the way: it’s usually not your hamstrings.
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