There is a variety of questions I ask an injured athlete when he comes to me for treatment and I will share with you, one of the essential ones. The sports knowledge of sports medicine wisdom is growing daily at a rapid rate and it is difficult to catch up on all the details. Moreover, I see too many medical professionals getting lost in that jungle, which ultimately affects the patient’s treatment in a negative way. Do not get me started on the hipster diagnosis, ‘hip impingement’ or the abuse of Magnetic Resonance Imaging (MRI), in modern practice. It is quite shocking at times, how little, Medical Professionals, actually know about the physiology of a condition. Although not always possible of course, I try to keep the patient’s physical issue as simple, and black and white as possible. In order for the patient to have a quick rehab, they need to be fully aware of what is happening to their body, as well as why it is happening (so called, ‘patient education’).
I had a great teacher during my time studying for my Physiotherapy degree, who had an effective approach to any condition. He was like a cook who built himself a big kitchen, full of knowledge, which consisted of a variety of different medical approaches, ranging from osteopathy to homeopathy and more. Depending on the patient, he picked only the necessary ‘ingredients’ that were needed to sprinkle into the ‘soup of treatment’; in order to achieve the best result possible with that specific patient. Too many professionals make that mistake and think that every patient with the same condition can be treated in the same way. It does not always mean that they will not succeed over time, but invariably at a painfully slow rate. I am all about effectiveness, getting the person as quickly and happily back to his beloved sport. That is my professional obsession and I really enjoy working with motivated people who, ‘have their heart in the right place,’ so to say.
In general, I enjoy working with athletes, since most have the right mind set to a problem. That is not always the case though, namely with a 70-year-old lady I have been treating for over two years now. She continually had horrific accidents and was left with many neurological issues, that caused her to accrue a long list of symptoms. These symptoms compounded issues, caused frequent falls and even broken bones. With such a long list of problems, you need to keep a cool head and start at the most important issue. This was her inability to lift her right foot properly, causing her to trip and fall. I admire her, because she would train at such an incredible high intensity, but with little results and increase in movement. However, that is not what it is all about. It is only about the correct effort we put in, the results will follow. All her doctors had put her in a negative state of mind, telling her that she will never regain function of that muscle etc., but her high effort, day in and day out, left no chance for the body but to adapt. Now, due over time, to electro muscle stimulation through Compex, as well as correctly guided weekly strength training, she has got back to a state of more body control and confidence in daily life. I much prefer to work with a person who has a low physical ability, but the right mind set, than a high calibre athlete who is a lost cause between the ears.
Next to the right state of mind (see other blog post, ‘How to deal with injury and sickness’), I want to focus on a basic, but often ignored element, to proper strength training. Exercises ranging from swimming, to biking and running, as well as injuries.
Hold your pants, it is called:
Mobility.
“Wow look at that guy, such a genius!” – Correct, it is no secret, but why is it then that I see half of my patients coming in with bad mobility, resulting in physical problems, from big toe to neck issues?
In order to get a full grip of it we need to define mobility.
The good old Oxford Dictionary does it like this, “The ability to move or be moved freely and easily.”
While that is true, we need to consider all the factors which affect mobility.
While everybody is thinking of muscle length, which we can alter by 60+ seconds muscle stretches (Sorry, 20 seconds won’t do anything to increase muscle length), you are only scratching the surface here son!
Osteopaths go as far as to say that stiff muscles do not exists. They blame it all on the adjacent joint positions, which in return, affect muscle tension and ultimately length, over time. I am somewhat in the middle, between the classic physiotherapy thinking of, ‘just pull that thing into original length again’ and the Osteopaths. In practice and with countless different joints in my hands, I felt that when I started to release the joints first, the muscles often took care of themselves. Take the classic ‘office neck’ tension, which can cause headaches, migraines and proper pain. Mostly on one side of your neck and shoulder blades.
The best example is a frustrated patient that came to me over a year ago. Let’s call him Ned Flanders. Mr. Flanders came to me with a ‘makes-me-want to-run-away-aura’ at the first session and I quickly found out why he was acting that way. Ned is a CEO of a large company in Switzerland and has been struggling with severe neck pain for over two years. He has been ‘shopping’ at a huge variety of Medical Professionals, ranging from Neurologists to Chiropractors, Traditional Chinese Medicine and two other Physiotherapists. I listened to what he had to say and spent a good amount of time digging into his past. I asked for the types of treatments he received and noticed they all forgot the most basic one, which you would use with any knee patients, but somehow people seem to think the neck is totally different in that sense.
After the physical assessment and some other check-ups, I gave him two exercises to take home. I did not want to see him for another two weeks and told him to do these every single day, 15 minutes in the morning and evening. If he didn’t do it, I would have to refer him to a colleague of mine, since there would be no hope for our working relationship. Ned Flanders was used to being the ‘Captain of the Ship’ as a CEO and I needed to make sure that he fully trusted me and immersed himself into the approach. He needed to feel that he did not have to carry the load of fixing himself anymore. Right there, I started with the first part of the foundation to improve anything, the mind.
Exercise number one was to release joint and muscle tension of the shoulder, neck and spine area.
Exercise number two was to strengthen the trapezius descendens (stiff neck muscle, you all know on top of your shoulders) in a concentric/shortened way. That was crucial, since the muscle spent up to 14 hours daily in an elongated/eccentric position which will cause any muscle to be ‘going up the walls’. In addition to that, that muscle is often so weak that it cannot handle the load of being stuck in a constant position for such a long time. How long can your quads hold a deep squat? Try it for a full working day and tell me if they are stiff or not!
Two weeks went by and Ned Flanders came back to me. I saw it as a 50/50 chance of him returning to me and actually doing the exercises. He entered the room with a big smile and that is when I knew we had ‘cracked the nut’. His neck pain had significantly decreased, despite the same workload and projects at work, as did his quality of sleep. We progressed from there to the next stages needed, in order to get Ned to 100%, which we achieved over time.
What do we learn from that?
Do not overcomplicate your aches and pains, but always stay aware. Always consult a doctor if your issue does not resolve within a week or so. Do not be that guy that drags the problem over months and then wonders why it takes so long to bounce back from the injury.
On a weekly basis, check your foundation of mobility. Especially, if you get strong muscle stiffness in a certain area, that did not result from your 12 x 1km ‘all out’ run session!
Here is a short list of mobility topics that you should consider:
Joint mobility - Restore by, ‘as freaky yoga exercises as you can find’ and foam rolling. The key is variation. We want to be in joint positions that are exactly opposite of your daily position, such as ‘desk bend forward’, ‘bike bend forward’ and ‘swimming tumble turns forward’ – One key movement pattern is extension in your spine.
Muscle mobility - 3-4 x 1+ min holds of the shortened muscle. Start easy, just feeling tension is enough and progress half way when it starts to release. 10 second ‘berserker’ pulling, will do nothing but cause you an eventual muscle tear, if you fancy that?! Always make sure you take at least two hours of downtime after high intensity exercise, before you give your muscles a strong elongating stretch. We do not want to pull, on already tired muscle fibres, to find out how much they can actually take, before they let go!
Nerve mobility - This is something that needs to be guided by a professional, since it is difficult to differentiate between muscle tension and nerve related tension. The basic idea is that the nerve is stuck in a sheath, which can get stuck to the adjacent nerve. That can cause irritation and assumed ‘muscle tightness’, which it is actually not. Classic examples are 100m sprinters who sit a lot, get a lumbar spine blockage, which causes their nervous system in their calves and heels to ‘go bananas’, resulting in Achilles issues and so forth.
Take away message:
Break your routine of movements as much as possible. Quickly go through a typical day of yours and see yourself objectively and what position you are maintaining, most of the day. If you are leaned forward a lot, mobilize yourself in extension. If your hip is constantly bent, stretch it out the other way and open it. If you stand a lot, meaning you will shift on one leg most of the time, make sure you keep each hip/low back and attached muscles as free and happy as possible.
Hope that helped.
Until next week,
Cheers,
Matti