Clapham Osteopathy and Functional Movement

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.

 

Why It’s Good To Be A Slacker

‘Eat a balanced diet’. ‘Ensure a good work-life balance’. Balance your budget’. Notice a trend here? Balance seems to be considered a pretty important thing. Indeed it is, and perhaps nowhere as important as its role within our bodies. Without it, many of our basic motor functions get pretty damn difficult. Just ask anyone who’s suffered from Labyrinthitis, Benign Paroxysmal Positional Vertigo or Ménière’s Disease.

But even without suffering from one of those disorders, many of us struggle with poor balance. Our ability to balance is a combination of sight, vestibular (ear canals) and proprioception (our body’s ability to know where it is in space, even with our eyes closed). As we get older, our proprioceptive and vestibular systems decline, along with reflexes and coordination, resulting in diminished balance control. This is why so many elderly people fall down and break their hips or other bones. And that is one slippery slope we’d like to avoid!

So how to do that? Train your balance and coordination of course. The trusty old phrase ‘use it or lose it!’ applies here, I’m afraid. But the good news is that there are far more fun ways to train your balance than just standing on one foot. The brilliant folks at GMB recommend a programme consisting of jump spins, walking around with eyes closed (but shins beware!), as well as more advanced hand balancing techniques.

Here at Backs Etc., our training programmes often contain floor-based exercises that require a degree of balance control, as well as balance-challenging resistance exercises like single leg deadlifts and Bulgarian split squats. But one great tool that we’ve only recently started using is the slackline.

Jack on a slackline

Similar to a tightrope, the slackline is stretched between two trees or other anchor points with the aim being to balance and walk along it. Unlike a tightrope, though, the slackline is a flat webbing, usually around 2 inches wide, making it easier to learn than a traditional tightrope. As the name implies, the slackline is not tensioned as tight as a tightrope. Because of this, the line moves up and down and side to side as you walk on it. The real skill then is to anticipate these slight movements of the line and move your body to compensate for them, improving your balance and core strength. Anybody first attempting to balance on a slackline will experience a violent shuddering back and forth of the line. This is due to the brain trying frantically to overcorrect the sideways motion of the line. This is similar to the way a driver may oversteer the opposite direction when skidding, causing a car to spin out of control. Fortunately, slacklining is much safer than driving!

So, besides improving our motor control and balance, what are some of the other benefits of slacklining?

It’s a full body workout. I mentioned core strength earlier, but slacklining requires the complete use of your entire body, engaging all your muscles and focus to prevent you from falling off the line.

It can boost memory function. A 2011 study in the scientific journal Hippocampus said, “slacklining led to an increase in the structural and functional plasticity of the hippocampus, an area of the brain responsible for navigation and memory”.

It can improve your posture, help you jump higher, and improve lower-limb rehabilitation.

It’s inexpensive. You can buy a good quality slackline for £30-£40.

It’s portable. Take it to the park and stretch it between two trees.

It’s fun! (need I say more?)

It’s worth noting that slacklining is pretty challenging. I’ve been using ours for about a month or so and I’m still pretty bad. But I notice little improvements regularly, and that feels nice. It’s also encouraging knowing that every time I step on it, I’m making positive changes for my body and mind. Being a slacker has never felt so good!