Something that really grinds my gears is how dismissive the average human has become of their pain. It’s almost universally accepted that “getting older” is a scapegoat for physical pain and creating limitations on your life. I will accept that our body changes as we age, and that can invite new obstacles into our lives, but that doesn’t mean we can’t overcome them.
Aging doesn’t require you to start groaning when getting into or out of a chair, but to many people it has become the standard. It also doesn't require you to stop doing the things you love because “I’m in my 30s/40s/50s/60s” or whatever age. If you want to continue living the life you love, I have news for you…..It’s possible.
Yes our bodies change, but with the right tools we can do it gracefully. Quality sleep, resistance training, and recovery tools can be your best friend and a great asset at any age. Resistance Training alone has shown to lower all cause mortality by 15%! (https://pubmed.ncbi.nlm.nih.gov/35599175/)
Here are some things I think could change your life for the better:
If you would like support incorporating these things in your life, I would love to help!
Recently I had an old injury flare up. It was getting progressively worse, and quickly snowballing into something that was difficult to maintain with self care. It began to interfere with daily activities, so I scheduled an appointment with a friend and fellow acupuncturist. During the appointment I got some acupuncture and bodywork that worked wonders in managing my pain, but that isn’t what had the biggest impact on my physical health during that appointment. Talking to someone about my regular self-care was a game changer. I take pride in my self care routine. I exercise regularly and use self massage techniques daily, but when life gets busy or stress gets introduced to our lives, our routines are shifted. During my treatment I was reminded of the breathing practice that had faded into the background and my yoga/recovery sessions that gradually became less frequent between strength sessions. It’s ok to evolve your practices and skills, but we shouldn’t disregard the things that are working for us.
This is why it's important to keep regular appointments. They keep you accountable for your health. I talk to patients all the time about how important the time BETWEEN appointments is to your health. As practitioners, we do the best we can to give your body the best treatment we can when you are in the clinic room, but that time is only a small fraction of your day, week, month, etc. The care you take between sessions is the real game changer. Regular appointments are important to keep you engaged with and reminded of the skills you have to manage your own physical health. They can also highlight areas that may be overlooked, or practices that may be most beneficial or the best use of your time. My advice is to pick a frequency that works best for you. It can be weekly, monthly, bi-monthly, etc. Use those visits to make sure you are staying on track with your physical health. Ask questions, get new ideas, remember old ideas that had an impact. Don’t let your health be something that just happens to you.
Breathing is a fascinating subject. It is both a subconscious and conscious act. Often people do not think about their breath, but it still occurs. Consciously you can alter your breathing pattern, and many people use breathing techniques to help regulate their emotions, anxiety, stress, etc. This is a psychophysiological aspect of breathing. It’s important to remember that these effects are a 2 way street. Changing our breathing patterns can change our stress levels, and our stress levels can change our breathing patterns. Getting “stuck” in a dysfunctional breathing pattern can influence our nervous system and reinforce and prolong those emotions of stress and anxiety. The psychophysiological effect is only one dimension of breathing. There is also the biochemical dimension and the biomechanical dimension.
Biochemical dimension relates to the oxygen and CO2 levels in your body. Common dysfunction for this area is “over breathing” or hyperventilation. Dysfunction here can lead to hypertonic/tight muscles and muscle fatigue. One example of over breathing is short rapid breaths. Short rapid breaths are also a common response to stress/anxiety, so you can see how these two aspects of breathing are connected. Stress is not the only trigger for short rapid breathing, but it is something to consider. This imbalance of oxygen and CO2 creates some stress on the overall breathing control system as well. This can also affect your motor control.
Lastly is the biomechanical dimension of breathing. The dimension covers movement and posture. The way we hold our bodies can dictate our breathing patterns. Sitting down in a shoulders forward, head forward, slouched position is not going to put us in an ideal position to get a full deep inhalation. This position may encourage a shorter chest breathing pattern, which could encourage recruitment or increased effort of muscles in the neck and upper back area. These patterns can become habitual and affect the other two dimensions of breathing, leading to hypertonic/tight muscles, imbalance of oxygen and CO2 in the body, and eventually pain.
There are many things to consider when evaluating breathing patterns. It is important to have a functional breathing pattern to avoid the things mentioned above, but it's also important to keep in mind that breathing is fluid. It should be responsive, adaptive and appropriate. You don't want your breathing pattern while sleeping to be the same as when you are running a 100m. Ok, that’s an extreme example, but when things like mouth breathing or upper chest become excessive and habitual they should be addressed.
A great entry point to a breathing correction is diaphragmatic/belly breathing. Lying on your side or on your back with your hand on your stomach.
I’ve talked about the joint by joint approach in a previous blog. Now, let’s explore the ankle specifically. The ankle is a hugely important joint. When missing adequate range of motion and stability, it can derail your movement throughout the entire body. Dysfunctional ankle motion can affect your running, walking, and other basic movements like squatting. It can also lead to pain not only in the ankle, but in your knees, hips and back. I’m going to discuss some ways to assess this issue, and a few ways to address this issue.
First let’s talk about the basic movements of the ankle:
Ankle inversion: This is when the ankle rolls inward and the bottom of your foot faces towards the midline of your body.
Ankle eversion: This is when the ankle rolls outward and the bottom of your foot faces away from the midline of your body.
Plantarflexion: This is when your toes point downward. (i.e walking on your tiptoes)
Dorsiflexion : This is when you flex your ankle upward (i.e point your toes towards your nose).
Restriction to any of these movements can lead to dysfunction in movement patterns, but I want to focus on the common restriction that affects most lower body patterns, and that is Dorsiflexion.
The normal motion for a closed chain (feet on the ground/weight bearing) dorsiflexion is just about 400. This means if you are in a squatting or lunge position you should be able to reach 400 between your shin and your foot, with your foot flat and heel on the ground.
How do we assess this? Well, I include a squat in my assessment. If you are able to complete a squat and meet the functional criteria. We can assume that there is no issue with dorsiflexion. The squat requires adequate range of motion of several joints. Using the squat allows me to rule or several issues with one movement if it hits the marks. If you are unable to complete a squat and meet the functional criteria, then we have to dig a little deeper to rule in or rule out problematic areas.
A quick check for someone who is unable to squat to knees at 900 is to put a slight lift under the heel. If they are able to squat with the heels slightly elevated (1”-2”) we can assume that there are some issues with dorsiflexion because lifting the heel requires less dorsiflexion to achieve a full squat. You may notice that it's common for people to lift their heels and shift their weight to their toes when squatting. This can increase the force on the knees, and over time can lead to knee issues and pain. Another “work around” the body uses for lack of dorsiflexion is eversion. When dorsiflexion reaches its limited end range, it can cause the ankle to evert which allows for a little more dorsiflexion from the ankle. Great! Right? Not exactly. Eversion in the foot when squatting will cause collapse of the arch in the foot and again change the direction and amount of force on the knee. Knee issues can become hip issues, and hip issues can become back issues.
Once assessed and the issue is recognized, what can be done to increase the motion? Addressing muscle tension that may be limiting the movement is where I like to start. Most commonly the calves (gastrocnemius and soleus) are a major factor in limitations. These muscles run along the back of the leg and attach at the heel. When shortened they pull the foot into plantar flexion. Addressing the length:tension ratio in these muscles can go a long way in helping restore full range of motion. Usings soft tissue tools like a foam roller, a lacrosse ball, etc. can assist in releasing tension. Seeing a professional for acupuncture or massage therapy could also be a good option.
Next, when treating this issue myself I also give some attention to the muscles on the front side of the leg. The tibialis anterior sits on the lateral side of the leg next to the shin bone (tibia). This muscle's origin is the lower leg and its insertion is on the foot. When this muscle is tight it pulls the foot in slightly which lessens the space in the ankle joint itself, giving less room for the joint to move in its full range. Soft tissue work, manual therapy, or acupuncture are also great options for addressing this.
Using some active stretching techniques can also help address that length:tension ratio and give great results in restoring ankle range of motion.
Calf stretch: In a split stance using a wall or post for support. Keep your foot flat on the floor. Drive your heel into the ground while pushing the knee forward towards your second and third toes. Remember these are active stretches, we want to stay engaged to the end range pushing the heel into the ground.
Banded Calf Stretch: This stretch is similar to the first. The set up and keys are the same, but we are adding a band. Anchor the band at a low point behind you and wrap it around the front of the ankle. Create tension in the band and complete the movement as above. The added band will help create space while completing the stretch.
*Both of these can be done with the toes slightly elevated 1”-2”, using a weight plate or a board as support.
These simple tools can help you make great improvements. Remember if you are having pain during or after movement it’s never a bad idea to reach out to a professional. Muscle tension is a major player in joint restriction, but it’s not the only player. Every person is different and history of injury can also affect outcomes on a case by case basis. Physical obstructions like hardware from surgical repair, or bone spurs will definitely affect the outcome measures.
Thanks for reading!
The human body is a complex thing. It has multiple systems and moving parts working together on a constant basis. Often when someone has pain, it’s narrowed to a specific area. “My back hurts”, “my knee hurts”, “My neck hurts”, etc. This is the location of the pain, but maybe not the source/root of the problem.
When addressing pain it’s important to address the body as a unit. There are of course exceptions to this rule. If someone has a broken bone, torn ligament, or other traumatic injury, then yes, focus should be on that specific area, but don’t overlook how that injury can affect the rest of the body. When addressing musculoskeletal pain in the clinic, my first goal is to help reduce the pain to the area. This can be done by managing swelling and improving blood flow to the area to help repair any tissue damaged or under stress. When the pain is managed the next step is to have a look at the body as a system. I prefer movement assessments that utilize the joint by joint approach.
The joint by joint approach looks at the body as a group of stacked joints, alternating stable joints and mobile joints. All joints require some degree of both stability and mobility. Individually specific joints may need more mobility, while others need more stability. Working from the ground up:
An important skill to addressing these issues is knowing which joints to address. If you are having low back pain…is it being triggered by lack of mobility in the hips or thoracic spine? Or are you lacking stability/strength in the lumbar spine and core? If lack mobility in the joints above and/or below the pain is the issue, packing on piles of core strengthening exercises are unlikely to solve the problem. Conversely, all the bodywork and mobility drills a person can handle is unlikely to solve the problem if it’s coming from lack of strength and stability. Often, but not always, it’s a little of both that gets results.
This is important to keep in mind when recovering from acute/traumatic injury. Often the focus is on the injury. As I mentioned above, broken bones, muscle tears, etc. should be addressed first, but the body will also adapt to dysfunction if that injury requires casting or surgical intervention that limits weight bearing or movement restrictions while recovering.. If you tear a ligament and damage your knee, have it repaired and end up in a brace for a few weeks, what does that mean for the rest of your body? You now lost the function of your knee while it’s recovering. The body will adjust and attempt to “pick up the slack” in areas away from the injury, putting more stress on other muscles and joints. When the cast/brace is removed, or you are able to return to full weight bearing activities, often the body will continue with the new learned movement caused by the injury. Part of your rehab and recovery should be checking in on the movement patterns and functions of those other joints that could be affected and addressing those along the way.
This can be an issue that is sometimes overlooked in the recovery process. This is why you find people that have had multiple procedures, injections, and surgeries and are still dealing with that nagging pain. The body is a whole and should be treated that way.
Tendonitis is a term that you may have heard before, and is a fairly common injury. A tendon is the connection between the muscle and the bone, and tendonitis is inflammation or irritation of a tendon. This injury is typically caused by overuse or repetitive action. While it can occur in any tendon in the body, it occurs in some areas more often than others, giving the injuries to those areas their own names. Golfer’s elbows, tennis elbow, swimmer’s shoulder, jumper’s knee, etc. all fall into the tendonitis category. Left unaddressed tendonitis can progress into tendonosis. Tendinosis is a chronic condition that leads to degeneration of the inflamed tendon. Tendinosis is more severe than tendonitis and more difficult to treat.
The goal is to avoid either of these conditions from occurring in the first place, but if you do end up experiencing tendonitis here are some things to think about. Tendonitis is inflammation of a tendon. Inflammation is commonly defined as a reddened, hot, swollen, and often painful or stiff area of the body. This is true as a description of what inflammation looks like, BUT also remember that inflammation is a bodily process controlled by your immune system. The body is trying to repair or heal itself. Keep this in mind while recovering for several reasons. One, you want to eliminate what is triggering the inflammation if possible. In a repetitive motion or overuse injuries this can be addressed by assessing movement patterns and posture. Second, you don’t want to stifle the inflammation process itself, this is how the body heals.
Once the tendonitis occurs, it's time to start focusing on healing. Kelly Starrett said in a training I attended “There are no fast healers. You either heal at the rate of a human being… or slower.” It’s something I think about for myself and treating patients. There are alot of great tools and treatment modalities in the work, but nothing is going to bypass the body's healing process. However we can optimize it! Let’s talk about some ways to do that.
As I mentioned, inflammation is a necessary part of the healing process that should not be blocked, but it should also not be left unmanaged. When an injury happens in the body, white blood cells are sent to the area as part of the healing process. Fluid from the blood cells leaks into the area which causes the signs of inflammation (redness, swelling, pain). We can manage this by encouraging circulation to the area. Increased circulation can help flush the area and decongest the tissue. This can be done with manual techniques, such as massage, acupuncture or electro-acupuncture, as well as movement. If the area is painful to touch, body work on an area above the injury could also be beneficial in improving blood flow to the injury. For example, massage or electrostimulation to the thigh could be beneficial in treating achilles tendonitis. Will acupuncture “fix” tendonitis? No, it will not magically repair the tendon, but it can help optimize your recovery by helping your body do its job more efficiently.
Now let’s talk about self-care. Yes, going to a professionally trained healthcare provider is very important for assessment and treatment, BUT the treatment should not stop there. Realistically, how often are you going to be in that treatment room? Once, maybe twice a week for an hour. What about all those other hours during the days and weeks you are recovering? Don’t put your healing on hold and only optimize your healing for the time you are in the office. There are plenty of things you can do at home or work throughout the day to keep that road to recovery from growing longer. (This is a very basic and abbreviated list)
On a final note, you may have noticed I didn’t mention icing the injury. This wasn’t a mistake. Ice is something I rarely if ever recommend for an injury. If you are interested in learning why, check out this article here.
The American College of Sports Medicine defines Delayed Onset Muscle Soreness, or DOMS, as pain that develops 12-24 hours after exercise with the greatest pain between 24-72 hours after exercise. If you have spent anytime in the gym you have likely experienced this at some point in your life. DOMS can occur when the body is adapting when you are new to exercise or raising the intensity of a workout. Along with high intensity workouts, eccentric exercise has been linked to higher instances of DOMS. Eccentric exercise is when the muscle is tense during lengthening. i.e running down hill puts tension on the quads as they are lengthening and absorbing the impact from the ground. It’s important to note that DOMS occur AFTER the workout. If you are having pain during a workout. If you are having pain during a workout, that is something that should be investigated further to prevent injury. Delayed onset muscle soreness is exactly that…..soreness, but it isn't only that. It can present as tenderness to touch, stiffness and slight swelling. This part of muscle repair. When you are strength training/exercise you are causing tears and breaking down the muscle, as the body repairs the muscle it grows bigger/stronger. Because DOMS is the result of muscle repair, many people have a “no pain, no gain” mentality and believe that soreness after a workout is the sign of a good workout. I don’t subscribe to this line of thinking. It is possible to build muscle with a moderate intensity workout. Unless you are brand new to exercise (and sometimes even if you are brand new) DOMS in my opinion can be a sign the intensity was a little too much.
Here are some methods I use to prevent DOMS from occuring in the first place:
I'm always available for questions.
Thanks for reading!
Whether you have personally used one or not, you have probably seen a foam roller at some point in your life. They are in most gyms and common in rehab facilities, but a question I often get is, do they even work? The short answer is yes, but not in the way most people think.
Foam rollers, or the dozens of other tools used for mobility work, are often explained as literally rolling out muscle “knots” or “adhesions”, inferring that we are in some way physically ironing out or flattening our muscles with these tools. This isn’t really the case. Foam rollers can release muscle tension and increase mobility, but it’s a neurological response that gets us the results. Foam rollers and all of those other tools help us communicate with our bodies and send signals to our brain, which causes a physiological response in the body that will release an area of tension. It’s important that we check in with our bodies regularly, and a foam roller is a great way to do that. I personally keep mine in the living room and use it daily, even if it's only for 5-10 minutes.
Now, let’s talk about some guidelines. First, we want to stay off of any bony areas. You want to be in the meaty areas of the muscles. I.e, stay away from elbows, knees, rolling directly on the spine, etc.
Next, more isn’t always better. Remember we are not trying to physically crush those “knots” in our muscles, that’s a misconception that has led to using more force than our bodies can handle. We only need to use enough pressure to elicit a response from our nervous system. This means we should be able to breathe throughout the practice. If you find yourself holding your breath and bearing down, you are using too much pressure. You want to get close to that line, but not cross it.
The goal should be to improve to the point that this process is not painful. Tissue should not be painful with moderate compression. If you work consistently over time, you should be able to achieve this.
Finally, I want to emphasize that using a foam roller is not the be all and end all of self care for muscular health. Does foam rolling work? Yes. Can it help increase mobility and range of motion? Yes. Does it help decrease pain caused by muscular tension? Yes. Should it be the only self care practice used for improving or maintaining mobility, muscular tension and body health? Absolutely not.
Foam rolling has its place in the selfcare world. It is a great introduction to self care because it can be done in small doses, give you great results, gives your body feedback, and help you build consistency, but it should be paired with other modalities. Active stretching and strength training should be incorporated to help reinforce the progress made with your foam roller. Once we gain that range of motion and mobility, we have to use it or lose it.
Thanks for reading! If you have any questions, please don’t hesitate to reach out.
As the awareness and interest of alternative healthcare continues to grow, so do questions surrounding it. Some questions that have been popping up frequently in my world are about dry needling. What is it? Is it different from acupuncture? Where can I go to get it? Well, let’s dive into it.
First things first, if there is dry needling, does that mean there is “wet” needling? Yes! “Wet” needling uses a hollow needle to inject a substance into the body. “Dry” needling uses a thin, solid, stainless steel needle, and nothing is injected. This is where the term “dry” comes from. Dry needling and Acupuncture are very similar from a procedural standpoint. The needles used for dry needling are actually the same needles used for acupuncture. It’s sort of an “all squares are rectangles, but not all rectangles are squares” situation. Acupuncture is technically dry needling, but not all dry needling is acupuncture.
Acupuncture is an ancient medicine, used literally thousands of years ago. It’s based on a system of meridians that are mapped throughout the body. Acupuncture is used to treat pain, disease, and general maintenance of health in all of the body’s systems. The eastern philosophy behind acupuncture focuses on the flow of energy in the body.
Dry needling on the other hand focuses specifically on the neuromuscular system and treats muscular tension and pain. The location of needle insertion is centered around trigger points or motor points. Needling close to these points can engage the nervous system, sometimes creating a twitch response within the muscle, theoretically releasing the trigger point and relieving the tension and pain it’s causing. Both acupuncture and dry needling can be used to manage inflammation as well.
While many of the insertion points used during acupuncture treatments fall on the body’s meridian pathways mentioned earlier, there is a style of acupuncture that uses “ashi” style locations. “Ashi” basically means “tender spots” or “by feel”. This style is very similar to dry needling and commonly used to treat muscular pain syndromes. This creates a gray area that complicates who is allowed to perform dry needling.
The scope of medical procedures are regulated by the state. In states like Oregon (where I live), acupuncture AND dry needling are only within the scope of a state licensed acupuncturist or a medical professional licensed in medicine and surgery. Other states in the US allow dry needling to be performed by physical therapists and chiropractors as well. Keep in mind that all clinics and practitioners are individuals. Treatment and needling styles can vary from clinician to clinician. It’s important to find someone that you trust, getting a referral from someone within your circle is always a great place to start.
Thanks for reading! If you have any questions, please don’t hesitate to reach out. Hello@pointofactionpdx.com