Movement Compensation

This blog is all about life long, pain free activity. I'd have to say that the number one enemy to that is compensation. For the purposes of this post, the definition of compensation is:  A movement in which you change where the stress of the body is because of an inadequacy in another area.  It's literally the "silent killer" to your body. Why? Compensating adds overall stress to the body which leads to injury and early degeneration. 

Now here's the bad news....we all do it and we don't even know it!   Whether it's while sitting at your desk at work or during deep overhead squats, you compensate in some fashion. However, the secret to life long health and well-being is addressing your mobility and stability shortcomings to minimize the stress on your body.

Example.

A crossfitter comes down with lower back pain after a few months of training; he doesn't know one specific moment that lead to his injury but he feels the pain days after he deadlifts.  He also wonders why he can't squat below parallel like the other people at his gym and can't seem to have very good deadlifting technique.  He enters my office and we clean up his lower back with muscle and joint techniques like active release technique (ART), graston technique and chiropractic joint manipulations. He's feeling better after 5 treatments but "it's still in there", aka it still hurts a bit. So we perform a full body functional compensation assessment (we call this the selective functional movement assessment or SFMA).

We find that his hips and upper back are pretty inflexible. This would be an example of a compensation. Any time he tries to squat low, he doesn't have the hip flexibility to do so.  And anytime he tries dead lifting, he doesn't have the hip flexibility to keep his back upright.  Therefore the stress of the movement goes to the low back and the darn thing won't feel better until we get the hips and upper back moving better. Every time this guy works out, his low/mid back receives twice the load that a similar person with flexible hips and upper back.

If he had better hip flexibility, he could keep his back more straight!

 So we addressed the hips and upper back with corrective exercises and manual therapy, and after 4 more visits the low back is pain free, and suddenly the man is able to sit lower in his squats and have a personal record in his Squat snatches and isn't worn down after dead lifting anymore!

notice the angle of spine is a nice 45 degrees!

 The way to break your own compensation patterns is to have your own compensation assessment, then address them through manual therapy and corrective exercises like we outlined above.

 To have your own personal 'compensation assessment' to identify any possible future injuries visit us at www.Mobility-4Life.com

The Formula

I was at dinner the other night with some friends and someone asked me what I could possibly do about his bad shoulder? knee? back?  He asked me these questions with a tone that suggested he didn't think there was anything to do.  He said he'd been to other doctors and they said there wasn't anything to do.....just stay off of it.

Well I invite you to consider there's another way.  There are more options out there than people are aware of.  For us, we have a general formula to how we treat all of our patient's at Health-Fit.  It works wonders for everything from TMJ pain to toe pain and everything in between.  The formula?

1) Decrease Pain
               -there are lots of ways we do this; adjustments, manual therapies, electric muscle stimulation, kinesiotape, rest, nutrition, etc......   Really anything that gets you feeling better.

2) Increase Global Range of Motion (Flexibility)
               -Active Release Technique (an advanced muscle therapy), Adjustments, Corrective Rehab exercises, etc.
 What we see is that people compensate from other areas of their bodies where they are very stiff, so they end up putting too much stress on their 'painful' area.  We address this so we can interrupt the cycle.  I.e. When your lower back hurts because your hips are too tight and whenever you move it ends up putting too much stress on the low back.

3) Increase Motor Control (Stability)
               -Corrective Rehab exercises are the main component of this category.
 Now that we have you moving better, let's hold on to it.  Ever wonder what's the point when you stretch really hard, get a little bit more flexible, then the next day you're back to the same flexibility level you were at previously?  Well when you have more stability of the areas of your body that aren't suppose to move much (check out Blog Post #1 - The Joint by Joint Theory), you can hold onto the flexibility that you've gained.


Numbers 2 and 3 are what end up making the long term difference...i.e. keeping the pain away long term.  It leaves your body an efficient mechanical machine that can take a licking and keep on ticking.



Consider that when the woman on the left walks up the stairs, exercises, or anything, that she's putting more stress on her low back and on her knees because she lacks the flexibility in her hips/hamstrings/ etc when compared to the woman on the right.  Of the two.....who do you think is going to need a hip replacement first?

When I played baseball in college, I always wondered why I couldn't seem to go more than a few weeks without arm pain when guys like Derek Jeter can go decades without creating the same overuse injuries that I seemed to create.  If you want to be able to be active for a lifetime, pay attention to the formula and follow it.  When inflexibilities and pain show up, address it before you start compensating and wearing out other parts of your body.

For your own Mobility assessment please visit us at  www.Mobility-4Life.com

Ankle Flexibility

(exercises at the bottom)

If there's one spot on the body I could pick to have great flexibility, it'd probably be the ankles.  Why? The ankles are the number one shock absorber in your body. You will without a doubt drastically increase your risk of injury by having decreased ankle flexibility during activities like running,  jumping, squats or truly anything.

But it's a specific kind of flexibility called dorsiflexion that really matters.  Dorsiflexion is a fancy way of describing how your foot moves forward and backward at your ankle. If you can really picture it, compare how far your foot can moves forward while running to how much a spring on a shock absorber compresses.  The higher the range of motion, the more shock absorption there is = the less stress on your lower body.

Now my fear is that people will read this and think, well I've sprained my ankles a million times so I'm sure the range of motion is fine.  Unfortunately that's probably not true.  Someone like me, who has sprained my ankles a bunch of time, ends up having more flexibility (laxity we'd really call it) of the side to side motion of my ankles, which isn't helpful, and tighter from front to back.  So because of that my ankle range of motion (in dorsiflexion) is decreased.  Bottom line = I have decreased shock absorption so when I run a Turkey Trot (5k) which I alluded to in my last post, I'm left with sore calves.  And if I ran 30-40 miles/per week like some of my patients, I would very quickly develop a lower body overuse injury.

So what to do?

Come see me!  Lol.  Or at least get evaluated by a sports medicine professional to see if there are any joint fixations or scar tissue that might be leaving your ankles tighter than they need to be.  

There are also corrective exercises that can be done by yourself to increase your ankle dorsiflexion range of motion.  Such as:

1) Half-Kneeling (front foot) Ankle Mobilizations

2) Standing Split Stance Ankle Mobilizations

   

I'd recommend doing a 30 second warm up of one of these before everything your active.

To check out more visit www.Mobility-4Life.com

Turkey Day

  

I really look forward to this time of year.  Thanksgiving is my favorite holiday.  At this time on Thursday I'll be with my family up in Fairfax, Virginia waiting to gorge myself with too much food and washing it down with as much pie as I can stand.  A bit gluttenous, but oh well. 

One thing I'm really happy to have on Thanksgiving is my family's tradition to participate in a 5k 'Turkey Trot' on Thanksgiving morning.  The whole family gets out there and runs for 3.2 miles to get a good work out in before the rest of the calorie infested activities of the day begins.

 I invite all of you to find your version of my 'Turkey Trot' on Thursday morning. Whether it's a special Thanksgiving home Crossfit style workout, a local race, a bike ride or something else active that everyone in the family would enjoy. The last few years for Christmas, we've sat down as a family and designed workouts for us to participate in (including cousins, aunt's, uncles, etc). It's been a great way for us to bond that doesn't expand our waistlines. I never thought I'd see the day when Uncle Tom from Buffalo would be doing burpees!

What are some other ideas you all have had as far as staying active during the holiday seasons?  Please leave comments and share what you like to do.  As also feel free to contact me at drscotthoar@gmail.com, or call 561.997.8898 to schedule a new patient exam if your in the Boca Raton, FL area. To check out more visit www.Mobility-4Life.com

Joint by Joint theory

Welcome!  This is my inaugural post for this blog.  I'd like to dive right in with Gray Cook and Mike Boyles 'Joint by Joint' theory.  For anyone interested in knowing how to move well and pain free, I suggest googling it.   It's basic premiss is that when we move our bodies, there are certain regions that should move a lot, and certain regions that should move much at all.  Why?  They were designed that way.  Take, for example, the hips and the low back.  When we do an activity like squatting, so much of the depth we get while descending is ideally coming from hip flexion.  Ideally not much comes about through lumbar spine flexion.  Why?  If you have 100 pounds on your shoulder, or are doing countless reps, you're adding significant stress to your low back.

I recently presented on this topic to Crossfit East Boca and I got the question, 'why is it that I can't seem to have good dead lifting form, and after I perform the exercise my low back is always sore?'.

Why?

Like stated earlier, during a complex activity like dead lifting, ideally, just like squatting we get our depth from hip flexion.  The CrossFitter in question probably has a lack of mobility (or flexibility if you prefer) from his hips and hamstrings, so he's not able to maintain ideal form during a dead lift.  Now he can still perform the movement, but he's going to compensate.  He's going to get a lot of his dead lift depth from his low back, drastically increasing the stress in that region and decreasing it from his hips and glutes (the intended target).  That's why the next day his low back is sore.  If he continues this without addressing his hip mobility he's going to end up with a low back injury.  Whether that ends up being a herniated disc, arthritis, degeneration, or one of the more fancy diagnosis, it really doesn't matter.  The core problem is the lack of hip/hamstring mobility.

So based on Cook and Boyle's theory, there is a pattern of alternating mobility and stability requirements throughout the body.  The foot requires stability (otherwise you end up with flat feet), the ankle requires mobility, the knee requires stability (otherwise you end up with Iliotibial band syndrome), the hip requires mobility, the low back requires stability (otherwise you end up with some version of back pain), the upper back requires mobility, the shoulder girdle requires stability (otherwise you have a separated shoulder), the shoulder requires mobility, the elbow requires stability (otherwise you get golfers or tennis elbow) and so on.

This is a big post because it's really the basic premise behind so much of the coaching/instruction/education that will follow.  We'll make it fun to look at, but at the same time, this is an important theory to understand.  Exercise over a lifetime without giving up your favorite activities requires efficient movement.  To move efficiently you must be mobile in the right areas, and stable in the right areas.  We'll explore this much more in depth in the future and we all keep moving!  Happy exercise people! To check out more visit www.Mobility-4Life.com

Deep Tissue Laser Therapy

Alright everyone, I just have to tell you about the latest treatment modality we added to our practice.  It's called the Class IV Deep Tissue Laser.  It's been unbelievable.  The speed of recovery from injuries and the variety of conditions it treats is shocking.  Today I'll go a little into what the deep tissue laser could mean for your pain or injury.

As it states on the website of our LiteCure laser:

"Deep Tissue Laser Therapy accelerates your body’s own natural healing process through photo-bio-stimulation. Laser therapy provides concrete benefits to your patients and your practice. Laser therapy is effective in treating chronic conditions, acute conditions and post surgical pain."

We had a 15 year old girl come in recently with stress reactions in her feet (the pre-cursor to stress fractures).  Now typically treatment for that injury involves stuff like ultrasound therapy, a walking boot, crutches, and no tennis for multiple months.  We treated her with 5 sessions of the Deep Tissue laser.  After the 5th session, she said her foot wasn't bothering her anymore so we took another MRI to check on them.  GONE!!!!

It's really revolutionized our practice.  I have to admit a part of me feels a little weird about it.  What makes manual therapy so amazing is the hands on approach right?  My hands and my abilities are what get's patients better.  Now this instrument comes in and changes the game.  I feel like I'm being outsourced. Lol.  Truthfully though the treatment is amazing when utilized hand in hand with the manual therapies and chiropractic treatment


A few weeks ago I tore up both of my calves while working out a little too hard.  I was limping around like an idiot.  It really doesn't look good when a sports medicine doctor is limping.  So I did 2 laser treatments per day and within 4 days I was back to 100%.  Crazy.

Class IV Deep Tissue Laser therapy can get great results with everything from acute sprain/strains, tendonitis, tennis/golfer's elbow, shoulder and knee pain, recent surgeries and even chronic arthritis.  If you're interested in deep tissue laser therapy for your ailment visit www.Mobility-4Life.com

Movember

 
 This month Health-Fit Chiropractic and Sports Medicine is participating in 'Movember' a movement towards Men's health awareness - specifically of prostate and testicular cancer awareness.  During Movember the 3 doctors of Health-Fit: Kevin Christie, Scott Hoar, and Larry Masarsky will be growing mustaches without triming or shaving them at all for the entire month of November.

We will be accepting donations all month as we raise money to fund men's health research initiatives.  You can check out the 'Movember' movement at  http://us.movember.com/

To check out more visit www.Mobility-4Life.com

Upper Back Flexibility

How Upper Back flexibility will save you


In my last post I mentioned the contributing nature of the thoracic spine(upper back) towards shoulder movement.  What I didn't touch upon was that the thoracic spine is highly involved in all movements of the neck, shoulder and lower back.

I see it literally every day where someone comes in with a stiff upper back, yet their complaints are of shoulder, neck or low back pain.  So let's think about an example of how that happens:

Every time you reach overhead, approximately 25 percent (completely made up number) of the range of motion comes from your thoracic spine.  So when you have a stiff back, 100% of the stress will go on the shoulder joint.  Eventually it gets overwhelmed.

Your driving and you turn to check your 'blind' spot you turn your head as far as you can.  That involves a 15-20%(even more made up) contribution in range of motion from your upper thoracic spine.  Again when you don't have the range of motion in your back, 100% of the stress from that movement will go to your neck.

Eventually all this stress on the neck will lead to pain.  The specific diagnosis is disc bulge, sprain/strain, facet disorders, etc... however the problem is the lack of contribution from the thoracic spine

So the point is that a stiff upper back completely beats up your neck, shoulders and low back.  So how does this happen?

For the most part we live in a sedentary society (even if you still exercise an hour a day) that involves entirely too much sitting.  As you sit in chairs with poor psoture for years at a time you start losing the flexibility in your upper back because your not really using that range of motion (unless you get regular chiropractic treatment or are otherwise involved in regular yoga).  When you don't use it, you lose it.......lol.

So now for the good part, what to do about it:

I'll show you the first two steps we take in my office.  1) Thoracic Spine Foam Rolling and 2) Quadruped reach backs.

1) Thoracic Spine Foam Rolling

2) Quadruped Reach Backs

As always, if you have any pain or injuries be sure to consult a local health professional.
To check out more visit www.Mobility-4Life.com

Shoulder Pain

Possibly the most common patient I’m getting these days is the shoulder pain patient.  “It hurts every time I reach overhead......” or “ twist my arm back”.  I’ve been joking around with my Crossfit patients that I’m going to write the New England journal of Medicine and propose a new diagnosis called, “Crossfit shoulder”.  It’s that deep pain in the front of your shoulder that shows itself during overhead squats/kipping pullups, etc.  So today I decided to blog about the shoulder.

The shoulder is the most exposed joint in the body.  Why?  It has a better range of motion that any other joint.  Think about it, it moves in 5 different planes!  Really, I think the shoulder is amazing.  It really takes a very specific mechanism of injury to dislocate it, and it has an unbelievable range of motion.  During more cynical times, however, I’ve heard it described as a golf ball on top of a tee that is tilted about 45 degrees.  Because of that, it’s the soft tissues’ (muscles as opposed to bones) job to create stability.  So you need proper muscle function for a truly healthy shoulder.  

Here’s the problem.

Extended exercise, sleeping with your arm over your head, or just poor nutrition can cause decreased oxygen deliverance to the soft tissues of your shoulder, which leads to adhesion (fibrotic buildup) of certain muscles which will cause a shift in the ‘centration’ (the ability to stay centered) of the shoulder joint.  That’s why you feel pinching or tightness in your shoulder muscles around the joint.  

So what do we need to do?

You have a number of options.  Number one- if the shoulder is already in pain, you need intervention.  I recommend a manual therapist (chiropractor/message therapist/physical therapist) that does soft tissue techniques such as Active Release Technique (ART) or Graston technique to restore the elastic properties of the muscle to normalize the ‘centration’ of the shoulder.  

Shoulder Treatment

Number two -  Most people don’t realize the contribution of the thoracic spine (upper back) on shoulder motion.  During an overhead movement like overhead squat, the thoracic spine has a great deal of extension (or backward movement) that allows the shoulders to go back.  Without thoracic extension, all the stress of the overhead movement goes right on that shoulder.  The problem is that people don’t typically address thoracic extension so deficiency is extremely widespread.   There are plenty of manual therapies, correction exercises, stretches that one can learn to address thoracic extension deficiencies.  

Shoulder Exercises 

Upper Back Flexibility

Turkish Get-Ups

If you or someone you know has shoulder pain and would like to avoid surgery, please visit www.Mobility-4Life.com