Tag Archives: injury

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Re-balancing the Body: Addressing the Hip (Flexors), Groin (Adductors) and Knee

Intentionally moving more throughout the day or implementing a stand-up work station is one of the most proactively potent things you can do to potentiate better overall health; but especially to the neuro-musculo-skeletal system.

We see patients do this all the time and then rave about the difference it has made; only regretting not doing it sooner.

If for whatever reason, movement modifications like the stand up desk is an obstacle, mobilization techniques like the one demonstrated below (a personal favorite & go-to) can work wonders towards opening up those hip flexors & lengthening those shortened adductors.

Movement Monday: AP Lunge

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Mastering the Air Squat: Mastering Strong, Pain Free, Functional Movement

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Movement Monday: Air Squat

Stand with feet approx. shoulder width apart.

Stand up straight with ears lined up above shoulder, lined up above hips, lined up above knees and ankles.

Brace the core by inhaling through the nose, breathing diaphragmatically (with your belly, not your chest), and upon exhalation create approx. 20% tension in the area between your ribs and pelvis (360 degrees, your core).  You are now braced. This does not mean to hold your breath, but a little bit of tightness and tone in the abdominal region.  For some bracing and being able to breathe while bracing may be the starting point.  This should be the staring point for all subsequent movement; the air squat and beyond.

Begin the movement by hinging at the hips, with the hip being the fulcrum and lever arms being your femur (thighs) and torso (abdomen and chest). Both of the lever arms should remain as straight as possible throughout the movement.  The hip hinge is executed by sticking out your backside and pushing it posterior.  You can counter balance by increasing your hinge and keeping your arms out in front of you (as seen in the demo above).

Ideally we want to work on maintaining the braced core, maintaining a straight torso (if not slight extension) and lowering your backside down to the point where the hamstrings are parallel to the floor and the shins are perpendicular to the floor.  Once you reach your personal depth, you should be able to pause, and then in a controlled fashion, rise back up while maintaining balance, and the straight spine.

That would be ideal.  However, we all have our personal baselines and starting points.  Find yours and work at improving it.  It may just be getting comfortable with bracing the core and beginning the hinge.  That is fine, that is the start of proper movement which, with practice will protect you and provide power as we move through life each day.

If you notice that the knees translate forward as you descend, to the point where they are becoming even with or moving anterior to the toes below, you have an anterior dominant squat which can wreak havoc on the knees and neglects relying on the optimal intended core and glute strength.  Do not proceed to drop deeper into the squat until you can do so without knees staying behind the toes.  Once you have improved balance, core stability, and activation of the glutes, you will be able to continue your decent correctly.

The “Chair of Death” exercise shown above can be implemented as a means to keep you in check as you practice mastering this essential, functional movement.

Get moving.

 

Running Essentials (Vol. 1)

Being a runner myself, and working with a good amount of road warriors leaves me sympathetic to some of the wear and tear suffered due to this (sometimes) healthy addiction.  While injuries and causes come in all shapes and sizes, there remain various foundational issues that can be applied universally in order to curtail potential issues along the kinematic chain.

Hyper contraction of the hip flexors is a common issue in our society mostly due to the amount of time we spend seated.  In the car during a commute, at a desk glued to computer or a couch glued to the television, around the table while breaking bread with family and friends, even putting in miles on the bike; these all lend themselves to a shortening of the front side hip flexors.

Two immediate issues created by this are a higher propensity for low back pain, and a longer stride out in front while running, which leads to a higher risk of injury due to the increased instability that accompanies a longer lever arm.

Low back pain is perpetuated by shortening and tightness in the chief hip flexor, the psoas.  This muscle has its origin on the lower lumbar spine and when over contracted, will pull down on the lower spine when standing, creating discomfort, and the perception that standing causes pain.  In actuality, while the discomfort is indeed experienced while vertical, the catalyst can be the shortened psoas due to bouts of long, uninterrupted sitting.

Tight hip flexors become an issue while running as it can lead to a longer stride out in front.  The further that leg lands out in front of you, the less stability.  This can interfere with an optimal strike, pronation, and ankle and knee stability.  Unless you are a sprinter or huddler this also is a less efficient way to run.

Modifying gait is a multi-pronged task, with frontside dominance being a key factor.  The flipside to this shortening of the hip flexor is the lengthening and weakening of the antagonist hip extensors, mainly the gluteus maximus and hamstrings.  These posterior chain muscles are designed to move us efficiently and powerfully through life, including while running.

Again we look to front side dominance now being a logical contributor to strain and aggravation to the posterior structures and tissue including the hamstrings, piriformis, SI joint and surrounding ligaments.

Easiest way to begin to avoid this is by breaking up the long, uninterrupted sitting.  Obviously total avoidance of sitting is not possible, but in most cases breaking it up is.

Try to get up and move AT LEAST twice every hour or utilize the increasingly popular and available stand up desk.  Set a silent timer on your phone as a reminder to get up every 15-30 minutes.  Not only will you create more of a balanced state between your hip flexors and extensors (advantageous for low back pain and running) but you will be metabolically awakening your system, which can help control blood sugar/insulin, as well as weight.

Another way to combat this is by working on your movement pattern and neurological firing to the hip extensors.  If when you squat your knees track forward past your mid foot, you are exhibiting front side dominance.  A good way to work on this is to practice getting into a squat with your toes underneath a chair.  The seat of the chair will serve as a barrier to your anteriorly drifting knees and force you to utilize and fire the gluteus maximus, the main hip extensor and power generator during a proper stride.

In directly addressing the actual tightened hip flexors, a foam roller works well with the quadriceps.  However the psoas (and adductors) become more difficult to release due to their positioning and may take the assistance of a trained practitioner in order to reap optimal results.

(The facial expressions and sound effects produced by patients undergoing the psoas release in our office serves as an attestation as to the necessity of the treatment.)

The front side dominant, tight hip flexor issue is obviously not the end all be all when it comes to addressing any problem a patient may present with, nor are the methods mentioned the complete package for doing so.  However, more often than not, there is some hip flexor involvement with low back pain or lower extremity issues in runners and non-runners alike.  Therefore the suggestions mentioned above are a solid addition to any athlete’s preventative or maintenance program, in order to intelligently reduce the risk of potential injury.

Be well and go get it.

Picking Protein: Weighing the Whey

The mission to achieve optimal health is an evolving journey.  A key component of that journey is finding the best source of nutrients.  In many instances this becomes a case of the least offensive option.  Something that’s going to give you what you’re looking for without leaving too large a trail of collateral damage behind.

Rarely do I find this to be more true than when it comes to protein powder.  Now, in an ideal world all of our protein would safely and conveniently be derived from grass fed animals, free range chickens and eggs, wild fish, etc.  Unfortunately this is not the case and due to convenience, availability and lack of consistently strong alternatives, supplementing with a protein powder is something many (self included) find themselves doing.

All day, everyday we are constantly using protein to carry out life’s functions.  This constant turnover makes it imperative to obtain an adequate amount from an outside source in order to thrive.  Add consequences of life such as elevated stress, physical activity, injury or a virus to the equation and the need for a sustained quality protein source grows .

My personal search for the “best” appears to be a never ending process.  It is a process that also accompanies the search for the best nutritional choices and supplement supply for myself and my patients.  Just when you get comfortable with a product, new research emerges or your own school of thought changes.  Even worse, a report surfaces that your go to product contains traces of antibiotics or metals (true story).

Being that individually we lack the time, knowledge and overall resources to whip up our own concoctions, we will always be at the mercy of a third party manufacturer who to varying degrees, has that bottom line on their mind.  It is our choice and has become my professional and personal duty to avoid the comfort of blissful ignorance and stay diligently abreast on the latest information pertaining to what we put in our one and only body.

One of the most popular, powder protein sources is whey.  And while I personally have not used whey in a couple of years as I try to refrain from dairy products, I do recognize that it does possess many endearing and attractive qualities highlighted by its superior bioavailability.  What I’ve listed below are some buzz words and guide lines to look for if selecting a whey product.

The list is by no means perfect and can be hard to use as a checklist to satisfy all criteria.  It is however a good starting point as you decide which factors are most important to you.  This list has been loosely compiled from research.  Feel free to interject or add your own suggestions as we continue on that quest for the perfect products.

•             NON-DENATURED

WHY:     Traditionally, even the most expensive whey products available (isolates, ion exchange and hydrolyzed) are by-products of cheese manufacture. The milk goes through a heating process at high temperatures (163 degrees F) which damages the whey proteins.

Many manufactured whey proteins are also high in MSG (manufactured glutamic acid), which is toxic to neurological patients. In fact, typical whey protein powders may be detrimental to patients with neurological disorders because they contribute to an excess of glutamate in the body which can damage the nervous system, especially the brain.

True non-denatured whey protein on the other hand, is not a by-product of cheese manufacture; it is a “native” whey protein, which means it is not manufactured at all. It is the optimal natural precursor of glutathione (powerful antioxidant, antiviral, antimicrobial, detoxifier, etc.). It contains exceptionally high levels of non-denatured Cysteine and Glutamine, the amino acids required for intracellular glutathione production.

•             COLD PROCESSED/MICROFILTERED or ULTRAFILTERED

WHY:     Native Whey protein is obtained through a very specific process that differs from standard whey protein: the proteins are extracted directly from skimmed milk using membrane technologies, preferably COLD PROCESSED or at low temperature (microfiltration and ultrafiltration). The state of the art low temperature process removes casein and lactose to leave only the purest, most biologically active whey protein.

•             NO GROWTH HOMONES or GMOs

It is important to use whey protein from herds that graze on disease-free, pesticide-free, chemical-free, natural grass pastures and the milking of the cows are not subjected to any chemicals, hormones, antibiotics, or injected pathogens.  While some of these may be removed during the filtration process, some remain and can now wreak havoc within your own body.

•             NO ARTIFICIAL SWEETENERS and LOW CARB/SUGAR

•             CONCENTRATE v ISOLATE

Protein isolates are proteins stripped away/isolated from their nutritional cofactors.

Isolates are exposed to acid processing to eliminate the fat, which denatures protein, leaving them deficient in key amino acids and nutritional cofactors.

When you remove fat, you actually remove components of its immune supporting/boosting properties.  Fat provides not only calories; most foods rich in healthful fat – including nuts and seeds like almonds and chia – are carriers of antioxidants, such as vitamin E and phytosterols.

Overall you’re left with an inferior whey protein if you take the fat out.