movementintegrity

[movementintegrity]

Can you relate?

I want you to meet Lindsey.  In some ways her story is tragically typical of my clients by the time they step through the door at Movement Integrity.  Almost two years ago Lindsey started to develop back pain. While originally it presented as just a dull ache in the middle of her back, as time progressed, so did her pain.  Eager for solutions, Lindsey sought the help of a chiropractor who was able alleviate some of the pain but could not stop it.  She saw her regular physician and was referred to physical therapy. She worked hard but in spite of their best efforts the pain continued to worsen.  She was missing work at least once a week because her body’s betrayal made it unbearable to leave her bed.  Activities as mundane as cleaning came with the punishment of incapacitation. She could barely get through a workout without having to stop, and that was after modifying almost every exercise.  Pain was her constant companion, 24 hours a day.  The only question was whether or not it would fluctuate enough to stop her.  

The doctors had ordered X-rays and MRI’s but they continued to come back “normal” time after time.  They had already tried prescribing muscle relaxers and other pain medications, but Lindsey did everything to not take them.  She wasn’t ready to live a continuously medicated existence.  The doctors had resorted to discussing injections or even exploratory surgery. WHAT?!?!  Lindsey was fed up and understandably so.  You see, what makes Lindsey not so typical is that she’s not in her 70’s, 60’s, or even her 50’s.  Lindsey is a young and vibrant 24 year old fresh off a collegiate soccer career.

Lindsey had always been an athlete, playing sports almost as soon as she could walk.  She eventually got so good that she was invited to play soccer at University of California, Riverside.  It was here that her battle with health began.  By the end of her career she had accumulated a total of five surgeries, all on her right knee.  In spite of near constant rehab for three meniscus tears and two ACL repairs Lindsey never gave up.  She continued to play soccer, be active, and worked out with a trainer even after her competitive career had come to an end.  Then the pain started…

With the end of her rope approaching quickly, Lindsey took her chiropractor’s advice to schedule a movement analysis at Movement Integrity (he’s a pretty smart guy!).  When I first met with Lindsey I saw that she was very guarded with her back.  With each ginger movement I could tell that she was trying to protect her back, but little did she know that every move she made was just making things worse.  During our “sit-down” Lindsey shared everything that she could remember about her long and frustrating road to MI.  I got to know her, her pain, and her life. The moment that stopped me in my tracks, however,  was when she told me that she was getting married in March.  I started to put the pieces of her desperate puzzle together.  She was spending at least one day a week in bed, couldn’t be active without excruciating pain, and had the most important day of her life coming just around the corner.  At this point the odds of her being in pain on her wedding day was astronomical.  That right there was when I set my first goal for her.  She would be pain free at her wedding.

What most of my clients aren’t aware of is that I have goals for them, too.  Most of their goals are to do a certain task, or complete a certain workout, or decrease their pain.  My goals are often related to gaining mobility in a certain joint, being able to deep squat, or finding enough stability to complete a specific functional movement. With Lindsey my goal was completely different: Come hell or high water I refused to let her back get in the way of the best day of her life. At the end of her movement analysis and consultation I had a game plan.  While I still didn’t know the root cause of her back pain, I saw a lot of movement deficiencies that I could correct.  As painful as her back was I knew fixing even a few of these movement patterns would have us headed in the right direction.  

As I sat there with my Lindsey to-do list, feeling more like a novel than file in my hand, I could tell that she was motivated to do anything that would help her back.  She was bordering hypermobile, her glutes were completely shut off, she had virtually no core stability or strength, she lacked mobility in her ankles (especially her right) and her 5-surgery knee was a basketcase.  She also hung on my every word as I told her that I was very hopeful that I could help her.  We decided to start with 2 visits a week and a daily home exercise program.  I warned her that this road is a lot of trial and error.  We would have to find what works and what doesn’t and that there might be setbacks. She completely understood and just hung on to the hope that she might, one day, be pain free.

Well, it turns out that one day came sooner than expected.  After 3 weeks of seeing Lindsey we celebrated, with cake, her first two weeks of being completely pain free.  That means that after just one week she experienced no pain for the first time in almost a year and a half. She hadn’t taken any pain pills, she got out of bed everyday and went to work, and even cleaned her house without any repercussions! I’ve been seeing Lindsey for almost 5 months now.  She has completely returned to normal life.  We have had setbacks along the way, but instead of putting her in bed it has only taken an extra session with me or a few alternative exercises to have her back to normal.  

I’ll never forget one day she walked into my studio with the pain on her face.  She was tense, her demeanor was sad, and she could barely move.  One hour later she was practically skipping out of the place with a glowing face. It just took activating the right muscles and calming down the appropriate muscles to balance her back out. She still has to be aware of her movements and we continue to work on progressions to gain strength, stability, and mobility.  However, her visits are now workouts on most days (she sweats) instead of just corrective exercise.  

She can go days at a time without doing any of her activation or corrective exercises at home and not regret it.  That is the sign that not only are we truly correcting her issues and not covering them up, but that we are developing a permanent solution. This is what I work for. This is what I live for. In retrospect, neither of us have any idea how she lived with such debilitating pain for so long.  But as with all of my clients who come to me in pain, I’ve learned that it’s just about survival.  We tend to think that “this is just how life is” and there are no other options, so we deal with it.  

My advice to you is that there are options. I’m the first one to admit that I can’t fix everyone, but I can improve everyone in some way, shape, or form.  So if you are in Lindsey’s boat and are tired of living with pain, an old injury, or just want to improve your quality and quantity of life then give me a call.  We move, then we move well, then we live well.

[movementintegrity]

Blogging and Braces

So I knew this was going to be a challenge as I have never blogged before and writing has never really been “my thing.”  So I have learned that I suck at blogging since I haven’t done it in a while.  But to be honest it was not out of laziness, it was out of indecisiveness.  The reason I started a blog is because I had too much to say for a Facebook post or a tweet, but I guess even when I have the space I have a hard time deciding on a topic!  I am constantly trying to think of topics and decided I just need to pick one!  So today I’m picking braces (not like brace-face, but joint braces).  I guess since I spent a year doing my Master’s Thesis on a specific knee brace I have a good reason to pick this.

I have considered myself an athlete my entire life, and a pretty competitive one at that.  So I've been through the times of “doing what it takes” to keep playing.  That often means figuring out how to play through injuries or come back from them earlier than recommended.  I've also been doing athletic training for a number of years and have learned that it is generally our job to keep athletes safe but to also keep them playing.  Many times this means using a brace (or in the AT world- taping) for that little extra support to keep risk of injury or re-injury to a minimum.  I did this for years for myself and other athletes.  I taped my own ankles and have taped hundreds of others.  I've worn knee braces and worked with MANY athletes who “needed them.”  And I've had client after client show up with a self-prescribed brace because something hurt or they had a previous injury.  

I used to support the use of braces, but the more I learned the more I started to question them.  Any of my clients can tell you this, as any of them who showed up to me with a brace or asked about using a brace generally got the response of “Why?” as well as a facial expression that I generally cannot control.  Now I attempted to not shut down the idea up front but tried to find out their reasoning behind it.  More often than not the reasoning was that it made them feel better. Okay, I’m all up for that, but what are you doing to help the problem?  Because I can 100% guarantee that the brace isn’t fixing your problem, in fact I’d lay a lot of money down that it is making the problem worse.  We have a rule in the Athletic Training Room at the the high school, if you don’t come in for treatment everyday during the week, you don’t get taped.  Now before you run off and say we are putting those athletes at risk let me explain.  Many athletes don’t want to spend time getting treated because they just don’t understand it, all they understand is that when you tape them they feel invincible.  Well 1) If you aren’t going to put in the time and effort to heal yourself by coming to treatment then why should we put in the time and resources to tape? (I’m also calling BS on your “injury” if all you want is tape) and 2) if you made it all week without getting treatment or tape then odds are you don’t need it.....for practice or the game.  (and side note as a personal opinion, being taped doesn’t make you look cool or tough.  It makes it look like you can’t handle your sport). Anyway, the point is that if you are going to rely on an external source to give you temporary relief, then you need to be putting in the time and effort to fix your problem (I have the same outlook for pain medication and cortisone shots but we’ll save that for another day).  Going back to what I said earlier: you are just making the problem worse and laying the foundation for new problems as well.  Here’s the layman science....

Problem #1- Compression

Many braces are simple compression sleeves, that means it’s just a tight-fitting garment with no fancy straps or laces or velcro.  Even the more elaborate braces still have a sleeve component to them.  There is 1 reason that science suggests that these braces work and other reasons why they are making your problem worse.  They work for you because it increases your proprioception.  Proprioception is a fancy word that means you can feel where your body parts are without looking at them.  So if you closed your eyes you could tell me that your knee is directly below your hip and whether it is bent or straight.  By wearing a tight fitting garment, this increases your “feel” of your joint so you are more aware of it.  This, in turn, allows you to pay more attention to your joint and you can more quickly be aware if your joint is going into a position it shouldn’t.  Make sense?  The reason that it makes your problem worse is because of how it affects your muscles.  Science has come to different conclusions on this based on time wearing the brace and some other factors, but basically when you wear compression it de-activates your muscles in a way.  Now they aren’t turning off obviously, but they are not as active as when you are not wearing a brace.  A good example is a massage (which is compression).  How do you feel after a massage? Loose and relaxed, right?  That is exactly what the compression of the brace is doing.  So the solution to this problem isn’t to throw away your brace and then yell at me when you get hurt.  The point is to undo the bad that is caused.  For every time you wear your brace, you need to be doing some rehab exercises to make sure those muscles aren’t atrophying from the decreased activation and are in fact getting stronger so that we can start to fix whatever problem you are having that is causing you to wear the brace in the first place. Another way to think of this is “if you don’t use it, you lose it.”  Allowing the muscles that surround the joint to weaken is only going to put more stress on the actual joint.  Now that’s a little counter intuitive, isn’t it?

Problem #2- Range of Motion (or lack thereof) 

One of the ways that a brace assists your injury is by limiting how much the joint can move.  This is important for a ligament that is injured and cannot do it’s job.  For example, an ACL (among other mechanisms) prevents your knee from hyperextending.  Therefore one of the jobs an ACL specific brace will do is prevent full and/or hyper extension of the knee, therefore doing what the injured ACL cannot.  This sounds great, right?  Well it is for the ACL, but the problem is that a brace can’t do just 1 specific movement like that. Many ACL braces limit how much flexion (bending) your knee can do as well, but flexion isn’t a problem for the injured ACL.  So now you are limiting a range that doesn’t need to be limited.  Well your body is a pretty smart cookie and is very resourceful, so if it can’t get all the flexion that it needs from the knee then it is going to find it elsewhere.  Elsewhere is most often the joint above the problem...in this case the hip.  So now you are asking your hip to do even MORE flexion than it already is.  If it can’t do that then it will keep on moving to other parts of your body....low back...ankle.....anywhere.  The point is that limiting the important range comes at a price, and that price needs to be addressed.  This ^^^ was the the entire theory behind my Master’s Thesis, and to be honest the results were not in favor of the brace companies.  If you have questions about those results I would be happy to explain them to you in person so you don’t have to read through insane numbers or really big words.

Both of these problems with braces come back to the same thing....you need to FIX  the problem and stop MASKING the problem.  What happens the day you forget your brace or it breaks?  Well you think you can pull off one workout without it right?  Well unfortunately you’ve been training your body how to move with that brace.  And as adaptable as your body is, it takes time to retrain.  So you’ve lost the added proprioception you have trained yourself to be used to and on top of that are going to allow your body into ranges of motion that it hasn’t been trained in.  That sounds like a winning combination to me.  

There is a time and a place for a brace, just like there is a time and a place for pain medication.  But it’s not all the time.  This topic happens to be one of my favorites to explain to people and it is much easier to explain when you have a specific example.  So if you have been or are considering wearing a brace of ANY kind, let me know.  I’d be happy to explain to you the pros, the cons, and how to fight any of the ill effects that will come from wearing it.  Just so there is clarity, this includes back braces for lifting and orthotics :) 

Get at me!

[movementintegrity]

Jack and His Back

 In the summer of 2014 I had been working with a client for quite a while when she asked "What do you do?" (referring to Movement Integrity and this "new" thing I had started).  So I attempt to explain it to her the best way that I can and she tells me she has a friend that she thinks should see me.  So, in comes Jack.  Jack is in his mid-40's, tall, seems in generally good shape.  He sits down and we begin to talk about why he is here.  Jack used to be a very active athlete, but 10-12 years ago Jack came down with an infection in his spine/vertebrae.  It was a fluke incident, but caused a lot of problems.  He was hospitalized for a week and then continued with aggressive IV antibiotics and treatments for months. He recovered, but spent the next year in a back brace and completed 6 months of physical therapy.  Unfortunately, even after all of that he was left with debilitating back pain.  His doctor told him that the bone was compromised from the infection and that wouldn't change; he would need to manage it with pain medication and just live around it, so that's exactly what Jack did for more than 10 years.        He spent the first 5 years after the infection doing little to no physical activity.  He put on 25 pounds from the lifestyle change.  After 5 years of no exercise but still having pain, Jack decided it was time to make a change.  He began some simple and low impact exercise.  He did some weights at the gym and was told he could only ride the bike for cardio, absolutely no running. Jack saw many different doctors over the years and they all told him the same thing: there was nothing they could do about his pain and that he could not run.  Well, the athlete in Jack would rise up from time to time and he would give running a try, but he could only run on the treadmill for a couple minutes before having to walk because the pain would be too bad.  It would also lead to painful flare ups in the following days.  He had pretty much decided that running was a thing of his past.

      So now Jack is sitting in my office, I'm sure thinking that he is telling this story again just to be told that there is nothing I can do for him or "sorry it didn't work."  I was going in with an open mind, I might not be able to fix him, but I know I can help him.  This is how Jack's story progresses:

Visit #1:  I do a movement analysis on Jack (details of that will be in a future story) and he is on his way.  Most of the work in this first appointment is done by myself, reviewing the results of the movement analysis together and piecing the puzzle together on what the different issues could be.  Everyone has movement issues, so it's my job to figure them out and then prioritize them.  I concluded that Jack's top priority was to work on the mobility in his hips, spine and shoulders.  In a close second to that would come working on stability of his hips, pelvis, spine, and shoulder blades.  So I put together a series of corrective exercises for Jack to do on his own at home since he does not live close enough to come in for regular appointments.

Visit #2:  About a week later after his initial visit, Jack returns to learn his new home exercise program.  We go through each corrective exercise so he knows what he should be doing and feeling.  His normal exercise routine is adjusted to comply with his new goals that I have set for him.  He in instructed to return in 4-6 weeks.

Visit #3: A little over five weeks later Jack returns for his 3rd visit in total.  We do another movement analysis to follow up and compare to his first.  This gives me the information I need to know if we are headed in the right direction or if changes need to be made.  Jack's analysis shows me that improvements have been made, but he told me that before we could even get started.  He reported that his back pain had decreased overall, the pain subsided more quickly when he would attempt to run on the treadmill, and he was being woken up less at night from the pain.  He did report that he was experiencing aches and pains in his hips and knees, but he was expecting this.  I told him in the first visit that we would be chasing the pain through this process.  As we corrected his movements we would be "waking up" muscles and joints and forcing them to do things they had been hiding from for years.  Therefore, some discomfort was going to be expected until those structures were wide awake and strong enough to handle what we were asking them to do.  We progressed Jack's corrective exercises and he was told to stay in touch with me and we would re-evaluate if necessary.

Update:  Jack and I have continued to keep in touch and I check on him regularly.  Today, Jack has noticed a substantial decrease in his pain after activity or sitting too long.  His overall back pain has decreased.  And what Jack thinks is most important: he can now run for over 30 minutes without pain and has no flare-ups in the following days.  

     Jack has not been back in for another analysis, but still stays true to his corrective exercise routine and can also do his normal gym routine as well.  I take that to mean that he is happy with the progress he has made.  I guess going form an athlete to not being able to run for 10 years is extremely frustrating.  So being able to run for 30 minutes is quite the feat.  I personally think that he still has a lot he could improve on to feel even better, but if he is content with the progress he has made, then I did my job.  I helped someone who had a problem that doctors had told was helpless.  

This is an example of what MI is all about.  Someone who had a problem and had no idea that the way they moved was exacerbating it.  A 10 minute analysis is all it takes to tell you a whole lot!  

[movementintegrity]

So....what do you do? And why?

     Movement Integrity has officially been around for a little less than a year and a half, but the idea of it has been stirring in my head for a long time, I just don't think I really realized it.  So this is the story of how Movement Integrity came to be....

     I worked as a student athletic trainer all throughout high school and have continued to work at the high school since I graduated.  I don't want to be an athletic trainer for life, but I love doing it for the small amount of time each year that I am there.  I love the spontaneity of the injuries and coming up with solutions to help the athlete.  Most of all though, I have always loved the evaluation process of being an athletic trainer.  I loved the special tests, the analysis, and putting all the pieces of the puzzle together to figure out what exactly the injury was.  Once that was done you get to decide how to treat the athlete and how to prep them so they can continue to play safely.

     I received my Bachelor's Degree in Kinesiology with a focus in Athletic Training.  I knew going into college that I loved AT, but didn't want to do it for life.  I didn't want the hours of the ATC (Athletic Trainer Certified), and to be honest the pay isn't all that great.  So I stuck with the field to find out what I could do as a career that I loved as much as the aspects of AT. So I decided I should be a physical therapist.  I can work with athletes, assess injuries, and fix them!  Keep in mind that 90% of Knes majors start college thinking they are going to be PT's, so I was in great company.  Next step, get a job in a PT clinic, so I do that.  I worked there a year before the clinic closed, but it only took 6 months for me to realize that I did NOT want to be a PT.  I don't want to see people weeks or months after their injury and have a doctor tell me what I can and can't do (let alone the insurance companies, ugh).  I was frustrated with the athletes who wanted to be better so bad that they wouldn't listen and do too much too soon.  I was equally as frustrated with the non-athletes who wanted to be better but didn't want to work for it.  Apparently there is a secret magic wand you earn in PT school and wave over them...instant healing (insert sarcastic eye roll here). So here I am nearing the end of my bachelor's and all I know is I don't want to be a ATC or a PT, so I decide that I wanted to be a Physician's Assistant.  I could do that in an Orthopedic Surgeon's office so I could still deal with injuries.  Well, I applied to PA schools, went on some interviews, and figured out I didn't want to be a PA.  I don't want to be in an office, seeing patients with injuries that are weeks old, and then pass them off to a physical therapist to fix.  Lame!  

     So where does this leave me?  I worked my way through college teaching fitness, and while I was apparently good at it, my heart just wasn't in it like it was with injuries.  So I decided to go back to CSU Fullerton to figure it out.  I really like my biomechanics classes during my undergrad, so I'd go back and study that while I figured the rest of my life out.  BEST. DECISION. EVER! I realized through my 2 years of working on my Master's why I wasn't satisfied with any of the other career choices.....they weren't complete.  Athletic Trainers, Physical Therapists, and Orthopedists (PA, DO, or MD) only got to start the process, and they have such tunnel-vision on the injury that they lose sight of the big picture.  This isn't their fault, it's how they're trained.  As soon as the injury isn't obvious anymore then they consider their job done.  On the flip side, working in the fitness industry and with the healthy athletes taught me that there is so much more to being successful than working hard.  There is so much more science to it than that.  But to be honest, healthy people were boring to me.  Weight loss isn't a passion of mine, becoming a better athlete isn't all that intriguing to me either.  But I repeatedly saw "healthy" people and athletes not be successful because of injury.  The most frustrating part of this was that they were "cleared by their medical professional" and considered released to full activity.  I slowly started to realize that doctors don't know everything.....LIGHTBULB! A physical therapist, a doctor, or an athletic trainer's job is not to get people back to 100%, it's to deal with the issue the patient is complaining about and get the issue to go away.  This isn't to downgrade these medical professionals because they are a priceless asset, but they are trained to treat the issue.  Once the issue goes away they release the patient back to their sport or exercise program.  It dawned on me one day when we were talking about PT in one of my grad school classes.  The professor asked "how many of you have ever done physical therapy?," and about 90% of us raised our hands because, after all, we are all washed up athletes.  Then he asked, "how many of you felt that you were 100% better when you stopped PT?," and I don't think 1 person kept their hand up.  That's when the "good enough" concept hit me, all those professions I had considered before were just trying to make you "good enough" to keep going in life.  None of them were trying to fix the problem.  Now the professor pointed out what the problem was, but he quickly went back to whatever the topic of class that day was.  I couldn't tell you what we were talking about because my mind was going 100 mph at that point.  I was ready to run out of class and write my business plan right then and there.  So we acknowledged that there is a problem with the process of injury, recovery, and performance, but we weren't going to do anything about it? Everyone had already picked their side of the fence.  They either liked injuries and rehab or they liked performance and exercise.  Leave it to me to want to walk the line.  Challenge accepted.  It literally dawned on me at that very moment that I had found my true passion.  The world needed a link between rehab and performance.  We needed someone to pick up the pieces when someone was considered "good enough" to be done with rehab, but it's pretty obvious they aren't ready to go play 90 minutes of full contact soccer, of suit back up for 48 minutes of football, or run 13 miles because they have a cross country meet next week.  So there it was lying in front of me, my calling in life.  The only problem was there was no where to go apply for the position of "link between rehab and performance specialist."  So I made it up instead.  

[movementintegrity]

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