Clapham Osteopathy and Functional Movement

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.

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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.

Explosion in the Vegetable Aisle – In Praise of the Big Ass Salad

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Real men don’t eat salad. But if they did, they’d eat BIG ASS salads. Side salads? Pfft. Let’s face it, when eating out, if you get a choice of sides, say fries or salad, are you really going to pick the salad? No siree, fries all the way. And for a starter, who orders a salad? Okay, I admit, I’m a bit of a sucker for anything with cheese in it, so a beetroot and goat cheese salad or mozzarella, basil and tomato, yeah I could do that. But a green salad? Highly unlikely.

Given these views, you might be surprised to learn that I’ve eaten pretty much the same thing every day for the past few years that I’ve lunched at home. And being that, as of this writing,  I’ve been working from home for quite a long time, that is a lot of lunches! Could it be? Well, given the title of this piece, I think it’s pretty obvious where I’m going with this. Yes folks, my daily lunch is none other than a salad. But let’s be clear, these are big ass salads that I’m talking here. Perhaps even BIG ASS salads, but for the sake of not having to hit the caps lock key any more than I have to, let’s just leave that as ‘big ass’, shall we?

Part of the reason for this (some might say) extreme salad consumption is that I went low carb towards the end of 2015, so I needed an alternative to the typical sandwich ritual that so many of us share. Then I found out I was sensitive (intolerant? foodist, even?) to gluten, furthering my need for a sarnie substitute. Enter the big ass salad!

One of the biggest knocks on salads is that they’re not filling. Surely you’ll be hungry an hour after eating one, right? Well, maybe, but honestly, I’m pretty much hungry an hour after I eat most anything. There are a few exceptions to this rule, such as a massive steak and chips (especially in Argentina!), an entire New York pizza pie, and anything and everything at Thanksgiving.  The important thing to note is that a big ass salad, with the proper ingredients, can be filling, satisfying, and – let us not forget – healthy.

For me, the keys to a successful big salad are the two Vs: volume and variety. This is a big ass salad after all – emphasis on the big – so naturally, it needs volume. I like my salads to go to 11, piled high on the plate and spilling over the edges. Remember, this thing’s gotta fill you up!

The old adage ‘variety is the spice of life’ has never been more apt. For me, a successful big salad needs to have at least 10 ingredients. Why 10? I suppose keeping with the Spinal Tap reference, I could say 11, but that’s just getting a bit silly, so I’m sticking with 10.

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First, there are the staple veggies:

  • leaves – Whatever you like. Lettuce, rocket/arugula, baby spinach, watercress, etc. Whatever you prefer. I often keep multiple types on hand, and use a mix.
  • tomatoes – I prefer cherry, baby plum or grape, as they’re sweeter and tend to have more flavour than the big ones, particularly the supermarket variety.
  • carrots – I usually grate one in as it’s easier to pick the pieces up with a fork unless you can slice them super thin.
  • beetroot – I always have some of the packaged cooked ones around, as they’re really simple to use. Forget about cooking them from scratch unless you’ve got some time, as they take forever.
  • cucumber – Sue hates these, so I only use them if the salad’s just for me.
  • avocado – Gotta be ripe! Nothing worse than a rock hard avo. We always have a few in different stages of ripeness so there’s usually a ripe one on hand when it’s needed.
  • spring onions – Get a little zing with some spring. Scallions to us Yanks.
  • peppers – Red, yellow and orange are sweeter than green, so my preference.
  • radishes – These are great to add a little peppery crunch. They seem to keep a nice long time in the fridge too.

Then there’s the protein. This is key for a big ass salad, otherwise, let’s be honest, it’s just rabbit food. Depending on your tastes, you can go loads of different ways with this. Some ideas are:

  • tinned fish – I like tuna, but sardines, mackerel, etc. also work. Tinned salmon is usually the wild kind, so that’s a good option as well.  In fact, any tinned seafood or fish can be used.
  • smoked salmon – This always feels very civilised! The nice thing about the thinly sliced packages is that you can keep emergency supplies in the freezer, and thaw them out in a couple of minutes by sitting them in hot water.
  • fresh meat or fish – Fry up a thin steak or nice piece of fish, slice it up, and you’re good to go.
  • leftover meat – Yesterday’s roast chicken, beef or lamb, shredded or cubed, works a treat.
  • bacon – Yeah baby! The meat product you hate to love, but you know you do! (sorry vegetarians, more for us) Get good quality bacon. I go for cuts without sugar whenever I can.
  • hard-boiled eggs – A great option for vegetarians and carnivores alike. So much nutrition packed into these things. We always have a few boiled eggs at the ready in the fridge, but they’re quick to make if you haven’t planned in advance. Often I’ll add an egg in addition to another protein.
  • cheese – Another vegetarian staple. I don’t know how you vegans live without it! Cube up some cheddar, crumble some feta, shave some parmesan, take your pick. I’ve never met a cheese I didn’t like. (Though I confess that I’ve never tried Casu Marzu  – Sardinian maggot cheese – and don’t know if I would.)

The fun stuff, the extras that give your big salad extra flavour and/or texture

  • nuts – The captains of crunch! I find walnuts tend to go particularly well, but use whatever you like.
  • sun-dried tomatoes – Tomatoes taken to a whole new level. These are so ridiculously flavourful, just a few chopped up will go a long way.
  • olives – Aaaah, concentrated salty goodness!
  • beans – Chickpeas, lentils, red or black beans can add body and flavour (not to mention gas).

The good (for you), the bad and the ugly. These are optional ingredients that I tend to primarily add for their nutritional benefit. In actuality, though, they can taste pretty nice.

  • seaweed – A bit of an acquired taste, but can add a good touch of seafoody saltiness. There are a number of different types you can choose from such as dulse, wakame and sea spaghetti. If it’s dried, make sure to soak it first to soften it up.
  • sprouts – These also come in a variety of types: alfalfa, lentil, even quinoa and broccoli. I like to add a handful of these, as they’re really nutritious.
  • sauerkraut – I know this sounds weird, but I actually make my own kraut at home, as the fresh stuff (not the kind you buy in the supermarket) is a natural probiotic, so good for your gut!
  • Seeds – Some of these little guys, particularly pumpkin, flax, chia and hemp, are high in Omega 3s, as well as adding a bit of crunch.

Finally, the dressing. An absolute essential, a good dressing ties the whole salad together without overpowering it. My golden rule with dressing is NO BOTTLES! Store-bought dressing is nearly always filled with sugar, industrial seed oils, and other crap you neither want nor need. And it’s bloody easy to make your own! I tend to go for a simple oil and vinegar concoction, with a 2:1 ratio of oil to vinegar. I use extra virgin olive oil with sherry, balsamic or red wine vinegar, depending on my mood. Sometimes I’ll use lemon juice in place of the vinegar, which works particularly nice with fish and seafood salads. You can easily play around with dressings, adding other ingredients such as fresh herbs (especially basil!) mustard, soy sauce, a bit of mayonnaise or cream for creaminess, etc. Oh, and don’t forget the salt and pepper or even the coolest salad could wind up bland.

When preparing the salad, I like to chop or grate the ingredients up quite fine, adding them to a big bowl as I go. Then I pour in the dressing, toss it all up, and scoop it onto a plate. A big plate. And there you have it, the big ass salad: a tasty, filling and healthful meal that just happens to look like an explosion in the vegetable aisle. Enjoy!

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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.

To Your (Gut) Health

Microbiome. Microbiota. Beneficial bacteria. Gut bugs. Call it what you will, you’ve probably read or heard somebody talking about this subject recently. But did you know that gut health is correlated with everything from Parkinson’s disease to cardiovascular health to skin conditions like eczema and psoriasis, to anxiety, depression and cognitive function?. There is more and more evidence that the vast quantity of microscopic critters in our guts can play a huge role in our physical and mental health, both positive and negative.

This is achieved via another term you may have heard of: the gut-brain connection. Gut microbes influence how we digest and metabolise the precursors of important neurotransmitters like serotonin and dopamine. Then there is a direct line of communication to the brain, through the vagus nerve, which has receptors near the gut lining that allow it to keep a check on our digestion. Microbes in the intestine can therefore release chemical messengers that alter the signalling of the vagus nerve – and, as a consequence, the brain’s activity.

These pathways are not one-way streets, however, as brain activity can also influence the gut flora composition. Stress can increase inflammation, for instance, which can then affect the microbes in our gut. The result can be a feedback loop. Gut, brain, gut, brain, gut.

Humans used to eat a huge quantity of fermented foods as fermentation was one of the few ways to preserve fresh foods for later.  This would have included pickled vegetables, dairy (yoghurt and cheeses) and meat. However, the advent of packaged foods and refrigeration has lead to the reduction and even, sometimes, elimination of this category from our diets.

Over the past 10 years or so, the idea of feeding and maintaining our gut microbiome has become increasingly mainstream. It seems clear that today’s Western lifestyle featuring vast amounts of stress, poor sleep, antibiotics and nutritionally-depleted diets are impacting the type and amount of microbes present in our guts, leading to a variety of health problems. This has led to a booming probiotic supplement industry that aims to help increase the number and variety of microbes. We believe that even though probiotics can be helpful to deal with specific conditions – we always take a supplement to increase resilience when travelling –  it is better to include fermented foods as a mainstay of the diet.  So we regularly eat home-made sauerkraut, pickles and kombucha. Of course not everyone has the time and inclination to make all of these from scratch (even though basic fermented veggies are dead easy!) but fortunately some of the commercial products out there get the job done handily and tastily (Okay, not sure if that’s a real word, but if not, it should be.) UK friends, check out the kefir made by our friends at Ki, straight outta Vauxhall!  (Shameless plug alert)

Ki Kefir is a new sustainable & organic company based in South West London, hand delivering traditional and powerful kefir to your door. Frustrated with buying kefir without the powerful kick of life it should have, we decided it was time for Londoners to get their hands on a real kefir, full of probiotic goodness that’s exceptionally powerful and really makes a difference to your gut health. Unlike many shop-bought Kefirs who use a powdered (lab-made) bacteria to make kefir,  at Ki we make it the traditional way with living cultures. This ensures the highest quantity and most diverse range of good bacteria. Our kefir also contains a cocktail of vital vitamins and minerals crucial for good health, including B12, K2, calcium and magnesium. It is made with the finest organic milk from grass-fed cows in Sussex. We are also a minimal waste company, packaging our kefir in glass and offering local deliveries.

To find out more about Ki you can visit www.kilondon.com
Instagram: @ki.kefir https://www.instagram.com/ki.kefir/?hl=en
Facebook: ki.kefir.london https://www.facebook.com/ki.kefir.london/

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.

 

Is Sunscreen the New Margarine?

tub of sunscreen on beachCurrent guidelines for sun exposure are unhealthy and unscientific, controversial new research suggests—and quite possibly even racist. How did we get it so wrong?

In this article, author Rowan Jacobsen discusses how our obsession with protecting ourselves from the sun is contributing to many health issues. Studies have shown that supplementing with vitamin D is not very effective, whereas moderate amounts of sunlight exposure is. But that’s only the start. Sunlight triggers the release of a number of other important compounds in the body, including nitric oxide, serotonin and endorphins. It reduces the risk of prostate, breast, colorectal, and pancreatic cancers. It improves circadian rhythms. It reduces inflammation and dampens autoimmune responses.

 

Read the full article, Is Sunscreen the New Margarine?