Clapham Manual Therapy and Functional Movement

Coronavirus and your immune system

coronavirus and masked womanFour weeks into lockdown and we are well into our new routine here in Clapham: daily meditation and exercise followed by video calls with patients, a daily walk, and more time for study, reading etc.  We are also preparing for the possibility that we will contract COVID-19 at some time over the next year. We are approaching this as though we were training for a race or other athletic endeavour. We are not hoping to get it. However, with the reality of a vaccine being at least 18 months away, it seems unlikely and undesirable, considering the effects on the population’s mental, financial health that we can all stay on strict lockdown until then.  We, therefore, want to spend this time preparing our immune systems to be in the best possible shape to mount an effective response to the virus.

Although the knowledge of this pathogen is evolving from day to day, we know that there is a vast difference in the effect it has, with most people getting mild symptoms easily treated at home, but a few suffering very badly and needing intensive medical support. Why is there this difference? The answer is multifactorial and may relate to the amount of the pathogen they were exposed to i.e. viral load, which may explain the number of medical staff treating COVID-19 patients without adequate PPE that have succumbed. But the other factor is the response of the infected person’s immune system, which has a genetic component but is also related to a person’s current state of health and metabolic function.  Almost everyone who is getting seriously ill is suffering from an underlying condition or conditions such as heart disease, diabetes or obesity. It is known that all of these have a lifestyle component and are hitting people at increasingly early ages.  Therefore, there is much we can do whilst in lockdown to improve our health and immune systems.

In short, the things that you can do to improve your immune system response are also things that will improve your metabolic health and resilience. So here are some ideas split into three groups: nutrition, exercise, and psychological. Now, none of us is perfect, and doing all these things all the time may be too much, so we believe in the 80:20 rule, especially in lockdown: try and do as much as you can (80%), but don’t beat yourself up too much when you trip up (20%).

Nutrition – immune health starts in the gut!

  1. If you are overweight or obese, this is the time to try and tackle this problem as it really does increase your risk of a poor outcome with COVID-19. This is often related to insulin resistance.  If you want help with diet or exercise, Jack has a wealth of experience.

  2. Even if you are of normal weight you need to think about your diet and try to eat as healthily as possible.  Much of the immune system is in the gut lining, so if you are constantly bombarding this with too much sugar, alcohol and processed food, this puts the system on alert, starting the chronic inflammation which is the underlying factor in most lifestyle diseases.  So do try to eat real and nutrient-dense food to get sufficient micronutrients for the normal physiological function of your body.  We focus on unprocessed meat (including organ meats) and fish, with plenty of vegetables and a moderate amount of fruit and fermented dairy.

  3. There is also some evidence that industrial vegetable oils drive inflammation, so another reason to avoid processed foods which are full of these. Cook with butter, olive oil, coconut oil or animal fat.

  4. Many of us now have more time under lockdown to get into the habit of cooking meals from scratch. If you do want a comforting sugary treat, make it yourself from real ingredients.

  5. It is also important to support your microbiome, so we make sure to eat fermented foods such as kombucha, kefir, and sauerkraut every day

  6. We have increased our use of supplements as an insurance policy, but supplementation is not a substitute for a nutrient-rich diet. We are currently using:

    1. Vitamin D

    2. Vitamin C

    3. Fermented cod liver oil

    4. Astragalus

    5. Turmeric

    6. Magnesium

    7. Zinc

  7. We also use intermittent fasting as this can boost immunity and enhance longevity via autophagy. We generally skip breakfast, resulting in a 12-16 hour intermittent fast, and since lockdown have added a weekly dinnertime to dinnertime (24 hour) fast.

  8. Don’t drink too much. Alcohol is not great for the immune system. Sometimes the reduction in stress from a glass of wine is more important, but don’t overdo it.

  9. Stop smoking – this shouldn’t need any explanation


Exercise has an effect on the immune system but it is a Goldilocks situation. Rather than HIIT or long runs, both of which can contribute to an inflammatory state that can suppress the immune system, focus on lower-intensity activities such as walking, mobility, breathwork, and bodyweight training.

Check out our new video where Jack puts Sue through a bodyweight training session, offering some ideas on how to improve your fitness without much space or proper gym equipment. Also don’t forget that Jack can help design you your own workout by video, or if pain is stopping you from exercising, both Sue and Joel are offering video calls to help you.


Our mental state literally affects our physiology, and increased stress levels suppress our immune system, so we do need to try and keep fear under control at this difficult time:

  1. Breathing and or mindfulness. Check out the breathing video we featured in the last newsletter.  Diaphragmatic breathing can stimulate the spleen, the home of your immune cells.  It sits under the lower ribs on your left side so encouraging the movement here may improve its function.

  2. Limit consumption of news and social media. We do need to stay abreast of world developments, but ration it to maybe once a day, and try not to focus on the things that you can’t do anything about.  That fear and stress amp up your cortisol levels and suppress your immune system.

  3. Watch some comedy or put on some music and dance instead.

  4. If you are not in a vulnerable group, try not to obsess about contracting COVID-19, but do be concerned about not passing it on.

  5. Try some gratitude, even though the world is in a difficult situation, trying to focus on a few small good things can be really helpful for our state of mind, as without effort we do tend to focus on the negative.

  6. The Greek philosophy of stoicism, which advocates facing challenges with grace, humour and perspective may be of help.

  7. Maintain virtual contact with friends and family. We’ve been arranging a few ‘quarantini’ dates (remember the 80:20 rule for drinks) with friends near and far.

  8. Cold showers can give your immune system a boost, as well as wake you up!

  9. Sufficient sleep is a huge factor in immune function.  Some people find that lockdown is giving them the chance to sleep more as they are no longer ruled by the tyranny of the alarm and the commute, but for others, anxiety levels may be increased and make sleep harder.  It’s important to follow good sleep hygiene rules, and try to avoid caffeine and alcohol close to bedtime, and if you still need a little assistance try herbal remedies such as valerian, reishi mushrooms, magnesium or 5-HTP rather than sleeping pills, which don’t provide true restorative sleep and may leave you feeling knocked out the next day.

mona lisa with a mask

Kathy Dooley: Restoring Authentic Breathing and Core Control

This article was originally published By On Target Publications, and can be found here.

I am very proud to call myself a chiropractic rehabilitative specialist. Rehabilitation requires rebuilding patients from the ground up, starting at the reflexive stability with which we were genetically gifted.

However, my patients are shocked on the first visit, when I point out their suboptimal breathing patterns and lack of core control.

I always get the same retorts: “but I breathe all day. How can I not be good at it?”kathy-dooley-breathing-crunch

“I do tons of crunches and ab work how can my core not be strong?”

It’s hard to admit that we exist in a sub-optimal state of movement. But many of us do.

It’s important to understand that we did not start off that way.

We are the best movers we’ve ever been within the first 4-13 months of our lives. This is when our nervous system didn’t mimic, nor try to derive compensations, for movement. The reflexive stability to earn movement was passed down through our DNA, and at this early stage, our bodies knew better than to interrupt perfection. So, the baby struggles and fails, on repeat, until he figures out the stable way to move.

The longer we live, the stronger our cognition develops. We mimic the behaviors of those in our environment, as more opportunities arise for our innate perfection to be interrupted. And since we amazing humans don’t prefer failure, we derive compensations around our failures.

Make no mistake. Aches and pains are not failures. They are attempts to succeed in the face of failure. This is why aches and pains must be approached as simple compensations, veering away from our innately perfect stability.

In order to tap back into that inborn perfection, one has to regress to achieve the dynamic stability earned at 3-4 months of age. This includes the baby’s boring days of learning how to build trunk stability in positions on the belly, prone, and on the back, supine.


I have the honor and pleasure of co-owning a mid-town Manhattan clinic and gym, Catalyst SPORT, where our utmost principle is: never rob trunk stability to gain fitness. In the eyes of our clinicians and trainers, nothing is more crucial than the maintenance of trunk stability. Trunk stability is the stable platform for all human movement around its center of mass: the lumbosacral spine.

But, trunk stability is not reborn through traditional, widely used core exercises crunches or sit ups. Watch a baby. You’ll never see her do a crunch, especially on repeat for 100 reps.

Babies build trunk stability through breathing.

At 3-4 months, the baby does the boring and endless task of earning trunk stability through the proper building of intra-abdominal pressure. All day, every day, they spend months coordinating the abdominal muscles to build trunk stability around the lumbar spine, in order to support the center of mass relative to the ground.

Think for a second about that. Unless the nervous system is interrupted, the baby refuses to move on an unstable platform. So, he works on trunk stability for thousands of repetitions per day. He knows that ambulation on an unstable platform will only get him hurt.

He doesn’t think about it. He doesn’t walk around his road blocks. He earns every ounce of his strength. When was the last time you did tens of thousands of reps per day, for months straight . . . of anything?

Most likely it was in your first year of development.

At Catalyst SPORT, we start all workouts with breathing correctives, either in supine or prone positions. We know that our clients initially used breathing for core stability at the strongest time in their development. Thus, we use proper breathing to build a stable foundation upon which to build fitness and rehabilitation.

Clients may not be compliant with breathing drills. In that case, it is necessary to remind them that they are amazing humans, who create compensations around potential failures. The auto-pilot breathing patterns they’ve developed may not be the optimal ones they utilized as babies.

But, in infancy, they develop the fastest and with the maximum amount of stability. Thus, regressing to the way the baby breathes can tap us into the trunk stability we earned when we were at our peak of development.

Prone breathing, often deemed “crocodile breathing,” is utilized to tap into posterior abdominal expansion. A stretch sensation is often felt and seen around the lumbar spine, which clients report a feeling of relaxation and stability.

This can be progressed into a prone-propped breathing, as seen in the baby at 3 months. Often deemed “tummy time,” this breathing and resting position is crucial for developing proper spinal extension patterning on breathing. This transfers into proper extensibility and load-sharing with spinal extension in movement.

Also at 3 months, the baby breathes in the supine position, developing proper coordination of crucial inhalation muscles like the thoracic diaphragm and exhalation muscles like the transversus abdominis and abdominal obliques. The four sagittal plane spinal curves are maintained, while one expands the abdomen into a 360-degree push-out on inhalation. Exhalation in performed in a controlled release of air, much like a tire releases air from its valve. This creates core stability around the lumbar spine to permit limb ambulation on a stable platform.

This position is often called “supine 90/90,” with the knees and hips flexed at 90 degrees. The heels can rest on a ball or chair, but ideally, they would suspend in the air, as seen below.

Prone and supine breathing are simple. But, they are not easy positions for most people, particularly those suffering from pain in the spine or limbs.

Typical rehabilitative and personal training strategies may be tempted to focus more on what hurts or what is missing. But without trunk stability, the entire platform wobbles around the center of mass. If breathing is what we used as a baby to stabilize the platform than it must be our primary focus of all corrective and performances exercises.

On Movement

“As kids, we move a lot without thinking, but as grown-ups, we think too much without moving.”

This quote comes Erwan Le Corre the founder of MovNat.  We all know that kids move: They play, they run, they jump, they crawl, they spin, they climb. They literally cannot stop moving until we manage to grind it out of them. This is a disaster.

Meanwhile, adults do the opposite. We sit around all the time. We go to the office and plunk down on our butts. We barely find the time to go to a gym in order to walk on a glorified hamster wheel and lift some heavy pieces of metal once or twice.

But we adults also simply spend too much time in our heads thinking and planning and never acting. And in doing so—in thinking without acting—we’re actually less cerebral. The person who thinks and acts is more in tune with their brain than the person who thinks and over-thinks and ruminates and over-ruminates.

Ours is a neuromuscular system. Brain and body are one. You can’t separate them. Can’t do it physically, can’t do it metaphorically. They are one.

Because “moving” isn’t just about exercise. It’s also essential for cognitive function and mood.  In evolutionary terms, the initial function of the brain was to allow creatures to move – thinking was the icing on the cake.  There is a type of sea squirt that, in adolescent form, pulses through the ocean looking for the perfect rock to settle on for the rest of its life.  Once found, it then autodigests its brain as it is no longer necessary, which seems to say something about the hazards of being a couch potato.

We all need to move often and well so that these patterns become ingrained in our nervous system, and that we do them intuitively. We should go for long walks as a habit. We should take the stairs rather than the elevator, and stand, rather than sit, on the tube not as a conscious decision but as an instinct. It is important to make an effort to build this structure into our society, especially as labour-saving devices are decreasing the absolute need to incorporate movement into our lives.  Therefore, it needs to be a conscious choice.

Exercise aside, there are loads of ways of incorporating more movement into our daily lives. Here are just a few:

  • Standing on one foot whilst brushing teeth. Also, try brushing with your non-dominant hand.
  • Stand on one leg to put on your socks.
  • Squat or half-kneel whilst doing things. Even sitting on the floor is better than folding ourselves into a chair, as we will naturally shift around a lot into different positions.
  • Practice different ways of standing up from lying down or seated.
  • Pick up things off the floor with your toes.
  • Do calf raises when washing dishes or other chores.
  • Get off the bus or train one stop early and walk the rest of the way.
  • Take the stairs or at least walk up the escalator.
  • If you arrive early to an appointment, walk around the block instead of sitting down and waiting.

Getting up in Asia

Sue and I have recently returned from a 5 week trip in East Asia. The primary focus of the trip was assisting the amazing Immaculate Dissection teaching team in Tokyo and Taipei. For avid travellers such as ourselves, however, flying that vast distance without taking the opportunity to sample more of the region’s wonders would seem like madness. And so we added a week in South Korea, another one (hiking) in Hokkaido and a few days exploring Osaka. I won’t spend any more time on the holiday-making part of the trip as that would require an entire lengthy post to itself, except just to say that we had a fantastic time!

If you are a health, fitness or wellness professional, you should really check out an Immaculate Dissection seminar. These series of 2 day seminars bring gross anatomy to life through unique body painting whilst exploring powerful assessment techniques and corrective exercise. You won’t believe how much knowledge can be packed into 2 days!

In addition to anatomy, palpation and muscle testing, every ID seminar focuses on a few key exercises. The primary exercise ‘dissected’ in ID II: Lower Extremity Concepts is the get-up, both the well-known Turkish get-up and a variation called the Czech get-up that mimics an infant’s developmental progression. Like so many in the health and fitness world, we love these exercises! There’s a good reason why, if only allowed to choose one exercise, many would choose the get-up. In fact, here are 20 reasons:

  1. Promotes total body stability in all 3 planes of motion

  2. Trains the ability to get down to and up from the floor with ease, important for health and often lost in later life

  3. Trains the ability to move the upper body from the core and not the neck

  4. Promotes cross lateralization (getting right brain to work with left side)

  5. Takes your body through all the phases of gait so a great diagnostic, especially for runners

  6. Ties the right arm to the left leg, and left arm to the right leg

  7. Gets the upper and lower extremities working reciprocally

  8. Promotes reflexive stability of the trunk and extremities

  9. Stimulates the vestibular system, which contributes to balance

  10. Stimulates the visual system, which contributes to balance

  11. Stimulates the proprioception system, which contributes to balance

  12. Develops a front/back weight shift

  13. Develops upper body strength, trunk strength, and hip strength

  14. Closed and open chain shoulder stability

  15. Thoracic extension and rotation

  16. The ability to perform a good get up on each side should be a prerequisite for bilateral loading exercises such as a deadlift or squat

  17. Stability in two different leg patterns – lunge stance and squat stance

  18. Single leg hip stability during the half kneel and lunge phases

  19. A great warm up and self-assessment tool – try performing a controlled get-up on either side to check how your whole body is feeling before you train

  20. So easy to perform, even your dog can do it

Okay, you’ve probably guessed that number 20 is a big old fib. But, to be honest, I could probably add a few more to this list without being too repetitive. In actuality, get-ups are a little complicated, especially at first. But part of the reason for this is also one of the most significant benefits of the exercise: that it isn’t just one single movement pattern, rather, it’s an impressive combination of sequencing stability and mobility throughout all segments of the body. Each component of the get-up is an exercise in its own right, and the transitions between components are integral and challenges in themselves. Basically, there’s a lot of exercise bang for your buck!

Sue and Jack in phase 1 of the TGUBut with these rewards comes a risk. In this case, it’s the high frequency of points in the routine where faulty movement patterns or lack of core stability can present a real problem. Of course, no exercise should be performed with bad mechanics, but one with as many steps as the get-up comes with that many more chances to do something wrong. This is why it’s so important to break the exercise down and practice each section of it until the full flow can be performed correctly. We often give clients and patients the first phase of the get-up by itself as it’s a great core exercise and, if done well, can help correct many neck and shoulder problems. However, if done badly using the neck or momentum to propel the body upwards, it can make upper body issues worse.

In summary, if you’re not doing this exercise, you should be. And if you don’t know how to, or are feeling a little shaky about your form, we’d be happy to show you. Just book in a session at Backs Etc. and you’ll soon be gettin’ down with the get-up!

Anatomy of Core Stability

An excellent video visualising the anatomy of core stability and how to establish that stability through uniform activation of all the muscles that make up the core. A very relevant video as core work is one of our staples at Backs Etc.

Movement Matters

Sue McCall testing legMost patients begin their journey at Backs Etc receiving a combination of manual therapy and exercise protocols designed to retrain basic movement patterns. Some may wonder what is actually happening when a patient is being treated on the table, and why we emphasise exercise and movement retraining. Does the hands-on therapy physically lengthen muscles and connective tissue that have become contracted and fibrotic, thus changing their structure? Or is treatment more of an interaction with the nervous system, improving its ability to control the body, thus reducing pain?  (If you’re interested in reading more about pain, see our posts here and here.) Does a muscle feel tight because it is physically shortened, or is it from changes in neurological control? We have always believed it to be the latter, which is why NeuroKinetic Therapy® (NKT) is one of the main tools used at Backs Etc. Sue’s adventures dissecting cadavers at St Andrews medical school have solidified our belief in this.

First off, working on dissections of various body types, it’s clear that there are deep layers of superficial fascia (AKA fat) covering the muscles in even the skinniest of us. What this means is that manual therapy is not directly affecting muscles and joints, especially those deeper inside the body. It is like the pea affecting the princess through the layers of mattresses, not impossible but hard to do. The only thing we can directly affect is the skin.

Furthermore, muscles, tendons, and other connective tissues are so strong that the force a manual therapist can exert is unlikely to change the nature of the tissue. In the four elderly cadavers that we worked with, the muscles looked completely healthy, with no evidence of fibrosis, trigger points or adhesions.  In fact, the only adhesions found were caused by surgery or injury. From their case histories, it was apparent that they likely had aches and pains and restricted joints, but this would be coming from their nervous system and not the physical structures. The experience of pain is primarily due to the overall level of threat that the brain is experiencing, rather than an indication of tissue damage.

Therefore, when opting for manual therapy, understand that it will not necessarily be physically changing your body. What it can do is bring increased blood flow to an area which can improve the body’s ability to heal itself. It may also feel therapeutic and relaxing, which can be extremely important in these stressful times. The interaction with the nervous system using therapies such as NKT allows tight muscles and joints to relax as the brain receives more positive sensory input and so and reduces the threat level. This is why NKT has been so successful for us at Backs Etc. It is designed to correct the fundamental issues stemming from the way the brain and nervous system are interpreting sensations and inputs.

However, this is just the beginning, you need to consolidate these neurological changes by moving and breathing well on a daily basis.  Exercise utilising quality controlled movement patterns and proper breathing technique will improve muscle function, mobilise your joints, and consolidate the changes initiated with the therapy and can positively affect the structure of your tissues much more than passive hands-on therapy.

Jack McCall trainingWe offer functional fitness sessions with Jack, our trainer at Backs Etc, as we believe that poorly executed exercise habits – excessive ‘balls to the wall’ pushing through pain, lack of quality movement, and poor breathing habits, are the root causes behind the majority of pain and injuries.  Taking some time to learn good movement patterns, and then practising them regularly and incorporating all the elements of a balanced exercise program, is the key to avoiding the revolving door of repeated injuries or chronic pain. We strongly believe that your exercise program should enhance your longevity and fitness and not be the cause of pain and injury, and we’re here to help you achieve these goals.


Scottish Doctors Are Now Issuing Prescriptions to Go Hiking

person hikingBeing active out in nature can have positive benefits for both physical and mental health. And now some doctors in the Shetlands have begun issuing “nature prescriptions” as part of an initiative to address health issues without drugs. We love hiking, so this is one prescription we’d eagerly look forward to having filled and refilled!


Read the full article, Scottish Doctors Are Now Issuing Prescriptions to Go Hiking.

Joint Noises, Popping & Clicking: Should You Worry?

man cracking knucklesThis article, from the talented folks at GMB, offers a good explanation of joint pops and clicks. As they say, you don’t need to get too concerned if there isn’t any pain. However, pops or clicks may indicate poor motor control in the joint which can lead to problems down the line. At Backs Etc, we utilise NKT, breathing and exercise to get your joints working the way they are supposed to.

Read the full article, Joint Noises, Popping & Clicking: Should You Worry?

To Stretch or Not to Stretch

Woman stretching

Must. Stretch. More. This seems to be a mantra for so many of us, and it’s no surprise why. From a young age, we’ve had the message drilled into us that we must always stretch before and after exercise, when we wake up, when something feels tight, etc. Stretch, stretch, stretch. Of course, there absolutely is a time and place for stretching, but it shouldn’t necessarily be done willy nilly. Many of our patients and clients have developed habits of endlessly stretching and rolling tight muscles as a form of self-therapy and treatment, a habit that is encouraged by many trainers and other professionals. We would like to highlight two reasons why this may not be helpful.

  1. The tightness and tension we feel is just a sign that a muscle is dysfunctional.  It’s a Goldilocks problem in that it can be held overly shortened, or overstretched.  Both states will feel tight, but the overstretched ones will not respond well to more stretching. For example, many people complain about tight hamstrings, yet are able to touch their hands to the floor in a forward bend. Here the hamstrings are overstretched and the tightness is a message from your nervous system asking you to stop stretching out and possibly tearing the muscle.  In this case, an activation exercise to shorten the muscle is going to be a much more effective strategy.

  2. If a muscle is short and tight, it is due to the body creating tension to help maintain postural stability.  The first priority of your nervous system is to keep you safe and stable, and it sometimes shortens muscles to do this, creating a scaffolding of support. This is especially true when you are not breathing well and unable to generate good core stability. This can lead to tight hip, mid back, neck and/ or jaw muscles.  Attempting to loosen these patterns without getting to the root of the problem is futile, as you are trying to defeat your nervous system’s prime role in movement control.

In both cases, we often hear patients describing that foam rolling or massage feels good for a few hours or even a day, but then the symptoms return because the underlying cause has not been addressed. So your brain recreates the stability strategy it has got used to even if it is not optimal.

At Backs Etc we use NeuroKinetic Therapy to assess the strategy your brain is using to keep you safe and stable, and then design a treatment plan incorporating both stretches and activations that work with your nervous system.  This leads to normalisation of the tensions and tightness in the muscles so that you don’t feel the need to constantly stretch, roll or massage them.