RTS Physio BLOG
Does Walking Cause You Pain?
One of the first things I try to observe with a patient is how they walk. This seemingly simple movement tells me a lot about a person’s movement patterns and I can often correlate their symptoms to the patterns I observe. While we generally walk in a straight line, walking involves a series of coordinated rotations in the shoulders, spine, hips and ankles. Unfortunately, injuries, habits, shoes, etc. can alter those rotations creating patterns that feed into our sore back, hips, shoulder, neck, feet, etc. Walking should be an unconscious and painless effort. However, being intentional with three aspects of walking, head position, arm-swing and foot placement can loosen up those sore joints and increase your tolerance to walking and standing.
A common postural deficit and root cause of much shoulder dysfunction is the winging scapula. The scapula, “wings,” when its medial border lifts off of the ribcage and sticks out. In this position, the scapula is no longer sitting properly on the ribcage, is out of position, and has now upset the length-tension relationship of all of the 17 muscles that attach to it. At best, this posture weakens the shoulder. At worst, this posture predisposes the shoulder for rotator cuff tears and dislocations.
Sorry to all you powder hounds, but I am dreaming of warmer weather and snow-free trails. This is the time of year I start to plan my spring and summer adventures and think about the physical capacity I will need in a few months. Specifically, late winter is when I get organized about my cardiovascular fitness and ramp up my endurance training. I know I am not alone in this effort, as this is the time of year clients start to seek me out to get ready for their summer sports. To maximize your endurance, “ramp-up,” you should focus on training in heart rate zone 2, get a movement assessment to address those nagging injuries, and optimize your breathing while exercising.
We all have problem areas, regions of our body that are starting to push back against the miles of physical activity or conversely years of inactivity. Whatever the case, these areas, that were once pain-free, are now angry. The upper back and neck is one of those spots for many people. This problem area covers from the base of the skull, fans out to the shoulders and extends down to the upper-back and shoulder blades.
For neck pain, I don’t usually strengthen the neck directly and when I do stretch my neck musculature, I am very gentle with it.
The 40+ year old athlete needs all of the advantages they can squeeze out of their body, and that’s why we workout. However, this age group starts to run into a wall of fatigue and/or injury with workouts that they didn’t have a problem with just 5 years prior. While you cannot outrun time, you can slow it down with the proper exercise recovery strategies. Recovery modalities are activities or gadgets that hasten the body’s natural recovery processes. Below are 5 strategies I employ to shorten the my recovery time after a hard workout.
Knee pain can often manifest in people by their early teenage years, extending into adulthood. While many of my patients are convinced their pain is due to a more sinister structural injury, patella femoral pain syndrome is more often than not the culprit. Patella femoral pain syndrome is caused by the patella (knee cap), moving out of alignment and bumping into the end of the femur as we extend and flex our knee. This physical contact with the femur irritates and inflames the cartilage underneath the patella.
I love being in the woods during the summer. When the snow melts and the trails firm up, I prioritize getting out on my preferred hiking trails. On any given day, I can be found hiking with my dogs, getting in a quick trail run, or rucking(hiking with a weighted backpack) long distances. Now that I am a 50+ year old athlete, I have to spend time both preparing my body for all those trail miles, but also recovering from each and every workout. To prepare for my trail season I strength train, work on my breathing and then I progress my mileage slowly. Additionally, I focus my daily recovery routine on my feet, ankles and low back. Below you will find my 5 rules for preventing overuse injuries as you log those trail miles this summer.
Repeated exposure to sauna appears to induce a physiologic response in our bodies that is similar to moderate to vigorously intense cardiovascular exercise. A large ongoing observational study of 2,300 men in Finland has demonstrated some amazing cardiovascular health benefits with sauna use. Men that engaged in sauna use 2-3 times per week where shown to have a 22% decrease in risk of sudden cardiac death and those that used the sauna 4 or more times per week were shown to be 63% less likely to experience sudden cardiac death. The same study showed that frequent sauna users were 40 percent less likely to die from all causes of premature death with even when the population studied was controlled for age, activity level and other lifestyle factors.
The benefits from sauna that have such a dramatic effective on a person’s lifespan will also benefit the aging athlete’s desire to keep getting after it. The basket of positive physiologic reactions to regular sauna are mediated by our body’s cardiovascular and hormonal responses to heat exposure. Frequent use of sauna will help the aging athlete improve their cardiovascular endurance and maintain their muscle mass, while also accelerating the injured athlete’s return to sport.
Pelvic floor dysfunction, defined as dysfunction of the musculature forming a diaphragm or outlet at the bottom of the pelvis, has largely been studied due to its affect on incontinence and women’s health. However, we all have pelvic floor musculature and incontinence is not the only, not even the most widespread symptom of pelvic floor dysfunction. SI joint (sacroiliac joint) and low back pain, due to pelvic floor dysfunction is very common among males and females of all ages.
I know your back pain. I don’t have a vertebral fracture or central canal stenosis (both suck) or any other involved injury or pathology. But my back hurts. No real injury or pathology, just the human condition that our vertebral discs degenerate throughout the spine. I know my discs have degenerated because my low back is stiff when I wake up. My back gets stiff the next day after a workout. Sometimes, if I sit too long, my back takes a few steps to loosen up. With the exception of acute injury or disc pathology, all low back pain comes from faulty spinal mechanics. As we age, our the vertebral discs degenerate, moving our already extended lumbar spine into excessive extension. This excessive spinal extension causes joint irritation and/or nerve root irritation. To deal with a stiff, aging back you have to move, and in very specific ways. First, you must restore lumbar spine flexion, then rotation.
My shoulder hurts! Now what? If your are in an extreme amount of pain and/or have numbness and tingling in your upper extremities, it is time to call in a professional like myself. That said, if your pain is mild and you haven’t lost a tremendous amount of range of motion, you may be able to deal with this injury on your own. However, short of a rotator cuff repair, immobilizing a shoulder is a very bad idea. The most important concept to remember when dealing with shoulder pain is that shoulders need to move and without movement they can get pathologically painful very quickly. Progressive movement and exercises are essential to making shoulder pain go away and restoring functional movement.
Depending on your perspective we are either knee deep (pun intended) into the ski/snowboard season or preparing for the hot dusty trails of summer. Perhaps you need to keep your knees, hips, ankles, and low back from sending up the white flag or perhaps you have a specific performance metric improvement in mind, you should split your stance on low body exercises. This modification to your leg day will pay dividends in improved strength and performance. The lunge or split squat (yes there is a difference if you are a training nerd) is a training movement/position I have always recommended to my downhill and trail athletes as a way to maintain their muscular endurance, strength and balance.
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