When discussing athletic performance, we think of coaches, strength and conditioning specialists, trainers, and so on, but my role comprises the foundation. Power, balance, and mobility are certainly trainable, but if your body is not fully normal to begin with, training will only get you so far. If performance prowess is your goal, you need normal nerve conduction, nerve extensibility, strength, mobility, biomechanics, etc. first. (Having no symptoms doesn’t mean everything is functioning normally.)
Consider jumping. If there’s even a slight derangement (painful or not) in the lumbosacral spine, the electricity supplying necessary muscles can be impeded. Tiny malalignments in the foot, ankle, knee, hip, or spine joints can affect strength, mobility, balance, and movement patterns with jumping. Abnormalities with muscles or tendons themselves (rare) will also impact jumping.
My expertise is in ensuring people have normal physiology before they go train to make it exceptional. (There are, of course, some allowances.) Perhaps most importantly, I teach people how to self-assess and self-treat so they can always perform with optimized physiology. It takes only minutes. I believe that many “off” days are due to minor, transient joint malalignments - which can easily be self-detected and corrected if you learn how. --Laura
I gravitated to the McKenzie method because it makes sense - and works. That is why most patients require many fewer visits than with other conservative care approaches, including "traditional" physical therapy. The McKenzie method is predicated on the simple fact that most orthopedic problems are mechanical and therefore can be resolved with a few specific movements (done repeatedly). I cringe when I read most of the orthopedic information out there, including the academic information I learned during my physical therapy doctoral program. It really is no wonder back pain is the number one disability worldwide and there are so many people in pain in the US (despite the wide variety of conservative and invasive treatments available). Plain and simple, I look at the body very differently than most clinicians - and treat differently, too. Nearly all of my patients come to me after having tried other interventions and with diagnoses that I frankly find incorrect. My passion for this extends beyond my office; my goal is to become a faculty member with the McKenzie Institute one day so that I may spread this reliable assessment and treatment approach to as many clinicians - and patients - as possible. --Laura
The primary law with tendons is first clinically (not via imaging) ruling out that it’s not a joint problem masquerading as a tendon problem. Joint misalignments (spine and extremities) can cause pain in tendinous areas and inhibit muscles, which unfortunately leads many clinicians to treat innocent tendons. If the “tendon” is taking forever to heal, it’s likely not the tendon. Tendon/muscle pathology comprises a small proportion of problems.
When it’s indeed a tendon, rehabilitation is relatively straightforward. A tendon’s collagen often needs to be remodeled to become functional again. This is accomplished by regularly (several times per day) loading the tendon for a few months. It may never look normal again, however. Causes why the tendon became dysfunctional initially should be addressed, and proper spine and extremity mechanics should be ensured.
The load a tendon needs is individual-specific. I find the load that creates pain (about 6/10) for 15-20 minutes following the exercise - which may be isometric, concentric, eccentric, or ballistic. Once a load doesn’t meet that criterion, the load is increased so it’s effective. Tendon rehabilitation is largely about 1) ensuring it’s a tendon, 2) educating the patient, and 3) encouraging briefly painful self-management with limited office visits. -- Laura
Ever wonder why, with all the technological medical advances in orthopedics, our population doesn’t seem better? In conservative care, there’s been electric stimulation, ultrasound, laser, and less techy modalities such as tape and soft tissue tools. Outside conservative care, we’ve gone so far as to make injecting steroids, fusing spines, electrifying nerves, and removing and replacing whole joints commonplace!
Perhaps the worst offender is the MRI. Imaging is certainly warranted in a few situations (as is surgery), but it’s current widespread use isn’t. Not only is this expensive for society, but overreliance is bad medicine: MRIs cannot reliably demonstrate cause and effect regarding symptoms and they often create needless fear in patients’ minds that they’re degenerating.
The human body has an amazing capacity to heal itself; orthopedic issues such as fractures, tears, disc herniations, sprains, etc. are regularly alleviated with time, not medical intervention. However, when a body’s independent healing falters, learning the right movement (and learning which to temporarily avoid) is key. Immobilization is rarely necessary. A clinician who uses her ears and brain to thoughtfully understand a patient’s problem should realize that a self-management protocol based on movement – nature’s best remedy – is almost always the best medicine. -- Laura
Check out this short article at Time.com. It emphasizes the point of seeking opinions from several medical professionals if you are not improving.
A Nebraska Woman Thought She Had a Runny Nose. It Was Actually Fluid Leaking From Her Brain
A mechanical examination begins with a methodical verbal history, typically producing one or two diagnoses to prove or disprove during the examination. Key information I elicit includes location of all/any symptoms, mechanism of injury, injury duration and trend, and activities that worsen/improve symptoms.
In the mechanical exam, I care precisely about tests’ effects. I examine the effect of upright posture. I check active and passive movement at the affected joint(s). If the patient has an extremity complaint, I always look at spine motion too. I often check nerve tension (arm or leg). The patient performs something that generates symptoms, such as squatting or lifting a bag - a “functional baseline.” Strength is also tested: for all upper body complaints I test roughly 8 arm muscles. With all lower body complaints, I test 6 leg muscles. With distinct extremity problems, I additionally strength test the specific muscles at those joints.
Next, most importantly, the patient performs repeated movements in the direction I have determined and we reassess relevant findings (symptom behavior, motion, nerve tension, strength, and/or functional baseline). Based on cause/effect, other directions may be tested. Before leaving, one specific movement is chosen for the patient to perform frequently at home. --Laura
In orthopedics, the core comprises a specific group of muscles in the trunk/pelvis. (Others use core generally to mean trunk.) Core muscle strength is beneficial. Just as arm, chest, and foot strength are beneficial! Core muscles are not exemplary. They’re no more our “foundation” than our foot muscles or those running the length of our spine.
Many erroneously treat orthopedic low back pathology by strengthening the core. Assuming core muscle strength can be accurately assessed, if one or more of them is weak, the question is why. Muscles become weak (and painful) from pulls/tears. However, these are very rare when it comes to the large muscles of the core. (Tears follow a consistent, predictable pattern, too, which should make them obvious to an attentive clinician.) Pain can create weakness, but absent a clear tear, the pain usually originates from something other than the muscle.
The number one reason any muscle is weak (the large majority of cases) is because its electricity from nerves has been inhibited – either at the spine or extremity joints. It’s a joint problem. Therefore, in most cases strengthening a weak muscle (or entire group!) is simply attacking a symptom, which won’t fully resolve the problem. -- Laura
Treating symptoms (and signs) alone will not fix a problem. Yet I consistently see people consistently attacking their symptoms. In many cases this has even been advised by a healthcare professional. Examples of signs and symptoms include: pain, tightness, achiness, weakness, clicking, locking, numbness, stiffness, buckling or giving way, tingling, and imbalance.
The question is always: what is causing this/what is the diagnosis? Why does your back hurt? Why is your foot numb? Why is your knee giving out? Why is your calf tight? Why does your shoulder ache? Why is your quadriceps or grip weak? Why can’t you balance on your left? Why is your pelvis rotated? Why is your neck stiff?
There are many diagnoses that create each of these symptoms, such as nerve impingement (at the spine or in the extremities), misaligned joints, torn structures such as muscles, and dysfunctional tendons. Very often the cause is located away from the symptoms. And even these causes have causes - which need to be addressed, like changing sitting posture to prevent nerves from being pinched in the spine. An expert diagnosis from a professional who understands all the possible diagnoses and then finds and treats the cause is warranted. -- Laura
Joint derangements are about 80% of all orthopedic problems. Derangements are when a joint isn't sitting properly, leading to pain, stiffness, tightness, and so on. They are usually rapidly reversible! Unfortunately, people are often given structural diagnoses instead (here, it's an AC sprain) or told they have a muscle or tendon problem.
Since joint derangements comprise the LARGE majority of orthopedic problems, McKenzie experts are trained to look for them first. If a joint derangement is found, we use repeated movements to restore joint alignment. This patient had shoulder pain and limited movement following a car accident. One movement fixes her symptoms (bringing her arm across her body) - and one movement worsens her symptoms (bringing her arm back away from her body). McKenzie experts are trained to find WHICH movement is best for you and use that one movement as the treatment approach. -- Laura
Mechanical pain isn’t a new concept - it’s the most common kind of pain. Besides pain, tightness, numbness, clicking/locking, and tingling are also possible symptoms. The bad news is usually mechanical problems are diagnosed incorrectly as structural problems (eg torn meniscus). The good news is almost all are fixable - if you find a clinician who can diagnose and treat them, like a McKenzie expert.
Mechanical problems are those that, simply, can be fixed with movement. Examples include pinched nerves, dysfunctional tendons, pulled muscles, and frozen shoulders. However, the biggest subset of mechanical problems is joint derangements. Derangements (misalignments) are when something (somehow!) obstructs the joint, such as a fat pad; a herniated/bulging disc; a bone fragment; or a piece of meniscus, labrum, or cartilage. Treatment for muscles/tendons involves tissue remodeling movement; joint derangements require specific movements to restore proper alignment.
Outside of mechanical problems there are structural, chemical/inflammatory, and nervous system problems, among others. Most healthcare providers and patients conclude that symptoms are from a structural issue because of unreliable orthopedic tests and MRIs. Orthopedic tests are false positives in the presence of mechanical derangements and MRIs consistently show abnormalities that are irrelevant. An expert mechanical exam is needed. -- Laura
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