Strengthening (Cont.)

Stretches are exercises to make tissues longer so things can work better. Tissue that is tight may be muscles, tendon, ligament or fascia, depending on your particular situation. In order to get the most out of the time you spend stretching (and to keep you from making things worse), follow a few basic rules:

  • Go slowly: Ease into and out of a stretch. Some of the tissues don’t have many sense organs so your brain is slow to get the message of how much strain is on an area. Go slowly so you don’t unknowingly go too far.
  • Gentle to moderate intensity: You should feel some stretch but not painfully so. If the stretch hurts it will trigger a reflex that tightens the muscles to prevent you from moving – not useful if the idea is to move more.
  •  Once you reach the optimum point of the stretch for your body, stop and breathe. Breathing makes everything in the body move a little, so each breath adds a very gentle nudge to your stretch.

How far you move will vary day to day and even week to week depending on multiple factors. Be sure you have the right form and feel the stretch in the right place. If you do that, long term progress is inevitable. If you focus on how you are stretching and where you feel it -  instead of being distracted or talking to someone - your brain will acknowledge much more quickly that those joints can do those movements. As a result, you will use the joint more during the day, adding to your speed of progress.

Strengthening

freeimages.com/CathyKaplan

freeimages.com/CathyKaplan

Strength is defined and maintained in many ways. In general strengthening means being able to do more activity with some part of your body.  Most of the strengthening exercises we use at Great Plains focus on getting particular muscles or groups of muscles to improve functioning by:

  • Getting you to use more of the cells in your muscles at the same time so you can lift or pull harder
  •  Improving the endurance of the muscle cells so they let you do more things for longer periods
  • Making the muscles cells bigger so you have more muscle

Strength increases in response to a challenge – muscles without challenge equates to losing strength. That’s why sitting around makes you weaker. But how you challenge your muscles can make a big difference in how quickly you get results. Too little or too much can slow you down and waste your time. To get the most out of your exercises there are a few general principles:

  • Be regular. Daily (especially same time of day) at first to get things going. After several weeks taking two (2) days off a week is okay.
  • Use good form. Don’t rush through, flinging your body parts around, as you will only use the parts of you that are already strong. Strength exercise should be challenging – to the muscles that need to be challenged, not the ones that are doing fine.
  • Breathe! The whole idea of doing the exercises is so your body parts can be relied on to do what you need done in life eventually. That means they need to be able to do their part while you go through your day. A life where you breathe all the time. You don’t want to have to hold your breath to go upstairs because you trained your glutes to only work when you hold your breath do you?
  • Know that from a therapy perspective there is an endpoint. For most problems you don’t have to do these for life, once the muscles work well again you will use them automatically during the day and that will keep them strong. (Provided you keep moving. If you take up residence on the couch all bets are off!)
  • Things improve stepwise – not steadily. You will have a period of big change and then it will seem like nothing for days and weeks. Then it all improves in a hurry again. It is not a steady improvement. When you think you are not getting stronger your body is actually busy making all the proteins and enzymes and blood vessels it needs to be stronger, but you won’t notice that until it is all done and your system comes online all together. Continuing to exercise during those periods stimulates the body to keep making all that internal stuff you need for strength improvement.

Where’s the Manual – Part 4

L0014606 Hand from “Anatomia Humani Corporis”, Bidloo, 1685 Credit: Wellcome Library, London. Wellcome Images http://wellcomeimages.org Hand Engraving 1685 (?) By: Gerard de LairesseAnatomia Humani Corporis Bidloo, Govard Published: 1685 Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

L0014606 Hand from “Anatomia Humani Corporis”, Bidloo, 1685
Credit: Wellcome Library, London. Wellcome Images http://wellcomeimages.org
Hand Engraving 1685 (?) By: Gerard de LairesseAnatomia Humani Corporis Bidloo, Govard
Published: 1685
Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Next on the list of parts to consider are the soft parts and how to help them. These include the ligaments, tendons, muscles, and fascia. To help you remember:

  • Ligaments hold one bone onto another
  • Tendons hold muscles onto bones
  • Fascia surrounds all the pieces of the body and provides a web for them all to interconnect with.
  • Muscles provide the actual force to do anything – they are the only tissue that can change length in a controlled way and also generate force.

Many of the most common injuries are of the ligaments and muscles. When you injure a ligament it is called a sprain, if you injure a muscle it is called a strain. The difference is important because ligaments (and tendons) are tough strong cables but they have very poor blood supply. This means when you get a sprain the area has a lousy system of draining out waste or getting new materials in to rebuild. Consequently sprains swell as the injured tissue leaks fluids that can’t be carried away and they are slow to heal. On the order of 16 weeks to get back to full strength, if you are nice to them.  Muscles, on the other hand, have a lot of blood supply so they swell a lot at first but settle down in the first 4-7 days and they heal fully in 6 -8 weeks or so.

Injuries to muscles and ligaments are so common that there have been hundreds of techniques developed to help these injuries. The most common is massage of many sorts. What the various techniques generally have in common is to stroke, compress and stretch the injured fibers in ways that push blood and nutrients into the area, push waste materials out, and align the fibers so they can heal in a manner that puts them in the best position for their task. There are literally dozens if not hundreds of specific massage systems in use. No one technique is better than another but no one is the best for all injuries so you just have to try and see if it helps you. If not then try a different technique. Most therapists are practiced in several methods and techniques so they can handle a variety of injury needs. These techniques have long been recognized to help speed return of function and diminish the pain of strains and sprains.

Some techniques focus on altering the tensional pattern generated by the ligaments and fascia. The idea is that having the proper length and flexibility in the tissues allows the body to have the best mechanical advantage in movement tasks at any time. Rolfing, myofascial release, and Craniosacral therapy fall in this category. Which specific tissues and how you can assess them varies among the techniques but they all involve a practitioner positioning and holding a client in a manner that applies a force on the tissue in question, usually a light force, for a sustained period so the tissue can change its length.  They all can assist a client in regaining better overall functioning and movement.

Another category works with changing the body’s perception of how much tension to maintain in the muscles and ligaments.  Strain Counterstrain is one of several techniques based on the concept that receptors in the body are set to keep some fibers in muscles and ligaments too short and so the body is keeping discreet areas tighter than they should be relative to the tissue around them. Think of it like having an patch on your jeans that is sewn in a little too short, the entire leg hangs a bit funny even though the patch is just on the knee. In these techniques the problematic tissue is positioned so it can no longer exert any force for 90 seconds or so while the nervous system resets the fibers’ resting length.

The consistent thing with all these techniques is that they require a competent practitioner to help you. While they can in some cases be done by a person on their own body, generally the client needs to relax and have the tissue manipulated by someone else to get the best results. Techniques that help people do things for themselves is the topic for next time.

Where’s the Manual – Part 3

Joints

Photographer Gabor Granat from freeimages.com

Photographer Gabor Granat from freeimages.com

Last time I explained some of the techniques for moving the bones of the body to improve the mechanical function of a person. This post is about techniques that focus on the joints, the interface between bones. The position of joints and the forces on them are a major component of determining how we can move. For example, if you have one stiff joint, say your ankle or knee, then in order to walk you have to make adjustments through the entire body. You limp. So addressing how the joints are aligned, moving or the tension on them can be a very effective way to address many movement problems.

Joints have a lot of sensors in them to tell the nervous system what is going on – how much pressure at the joint, how stretched are the ligaments, is the compression rising or decreasing and many other things. Many of the techniques that treat the joints are aimed at taking advantage of changing the output from these sensors so the body can make a larger change. Specific joint techniques include Ortho-Bionomy and Positional Release and mobilization. Plyometric training and vibrational plates are things people may do themselves that take advantage of joint movement.

Ortho-Bionomy and Positional Release are methods of determining and changing the resting position of joints to relieve the overall strain in the body. The practitioner will gently move one or several joints at a time testing to find optimal release and then keep the client there for a short time, usually 30-90 seconds, until the overall effect has been achieved. This is repeated for various joints in the body until the problem has been solved. The specific tests, treatment positions and order of treatment differ in these techniques but overall this is how they are applied.

Mobilization is much as described in the last post, the practitioner grabs a bone and slides it in the joint. The difference is one of focus, in this case the practitioner is looking to use the bone as a lever to stretch the ligaments and other structures around the joint so there is more freedom in it. This can be very effective for things like a frozen shoulder or a tight hip but it does make the joint ache for a while afterwards if done correctly.

Plyometric training is strength training that makes a client do rapid, repeated movement at a joint in alternating directions. Think of hitting a tennis ball with a racquet – first your shoulder joint has to move back as it meets the force of the oncoming ball then it has to push forward to hit the ball back. This back and forth force training strengthens the structures of the joint, neural control of the muscles around the joint and balance and coordination of the rest of the body to keep the joint in the right place in space. It is an important part of rehabilitation after joint surgery.

Vibrational plates have gained popularity recently as a way to improve strength and function by vibrating the body and challenging the sensors in the joints and affecting the endocrine system. The jury is decidedly out on whether they help in a significant and lasting manner but the reasoning behind them has some validity. They do feel interesting and may show value yet, but how best to apply them to training is far from clear at this point. And the machines are very expensive.  Workplace studies have long recognized that excessive vibration of the body at certain frequencies and amplitude is hazardous to long term health but manufacturers generally design their machines to avoid frequencies and amplitudes we know are harmful.

Where’s the Manual – Part 2

Photography by DCarson924 at www.freeimages.com

Photography by DCarson924 at www.freeimages.com

In working with the human frame the various techniques can be roughly subdivided into ones that work with the bones, ones for the joints, ones for the soft tissues (muscles, tendons, ligaments etc.) and ones to improve the nervous system’s control of the whole affair. There is overlap in these but it’s a useful way to learn the major focus of techniques.

In this blog I will take on methods of changing bone alignment, the relative position of a bone to the ones beside it. Of course that means a change in the joints also because that is where bones meet one another, however, these techniques focus more on the bone position rather than the joint relationships. (I will write about the joint relationship techniques in the next post.)

The most familiar to people is having the bones of the spine moved, the stock in trade of Chiropractors. Technically it is called manipulation or mobilization and involves putting a force directly to the bones of the spine, or vertebrae, to move them. How much force and in what direction is where various techniques differ. Some will use a high velocity thrust to “crack” the back and often times an audible “pop” or “crack is heard and/or felt. (There is no good proof of what causes the actual noise but it probably comes from a variety of causes depending on the situation.)  Other techniques use grades of mobilization which involve various degrees of a softer force applied to the area of concern. This is applied repeatedly until the movement of the bone is achieved. Still lighter and more focused force can be used with a small tool called an Activator. This is a small spring loaded hammer used to put gentle but focused mechanical force on a small area (about ½ inch across) to push on a specific part of a vertebra. All of these involve the practitioner actively applying force to move the vertebrae while the client is passive. The techniques are fast and can frequently provide quick pain relief. Because they are passive techniques they often require the client to be seen several times before the changes stay with the client for prolonged periods.

Muscle Energy is an Osteopathic technique in which the practitioner positions the client in a specific alignment and then the client performs a gentle contraction against the resistance of the practitioner. Due to the positioning and the direction of the contractions the bones are then pulled into a better orientation. This results in the bones moving as well as retraining the muscles to help it maintain the improved orientation.  This takes more analysis and skill on the part of the practitioner to do well than mobilization but often requires fewer sessions to maintain the desired changes.

All of these techniques can be applied to the other bones of the body and are very useful in restoring full function in areas with many small bones such as the hands and feet. Each of these techniques has its advantages and shortcomings and the challenge for the practitioner is to know which the best is for the client.

Where’s the Manual

Photography by pll www.freeimages.com

Photography by pll www.freeimages.com

Most people don’t read them anyway but when you need to find out how to take care of something you own it is nice if it comes with a manual on how to fix the thing. Too bad our bodies don’t. The good thing is that there are a lot of different ways to take care of the mechanical problems our frames encounter. The bad news is that most of us don’t really know what they are or how they work.

 

In the next few posts I will be explaining some of the techniques used to help the human mechanical structure work better and how these techniques fit into the context of helping our ability to handle imbalance. Let’s get started.

Like any repair manual we will start with the parts list –

Bones –

These pieces provide the hard parts to do movement – they are the levers so you can actually get things to move through space. There are around 210 of them in an adult human; the exact amount varies by age and individual. The places where the bones meet are called joints (or fulcrums if you think of the bones as levers.) The bones do a lot of important things beyond just providing levers but we are going to keep it simple here.

Ligaments –

These are the tough cables that keep the bones connected to each other. You don’t want one end of a bone sliding off its contact with another bone if you want to get anything done. Sliding the end of a bone off of where it should sit on another bone is called a dislocation and is very painful. Why? Because you had to damage the ligaments in order to give the joint enough slack to let things slide. When you damage a ligament the injury is called a sprain.

Tendons –

These are the fibrous tissue that holds a muscle to a bone. They are made mostly out of the same material as ligaments and contain a lot of little sensors for sending information to the brain about how much force they have through them and other information to help your brain know what is going on in them. When someone “tears” or “pulls” a muscle it is often in the area where the tendon and muscle are joined. In some places the tendons are long cables like the ones going down your forearm and wrist to your fingers and in other places they are very short and broad as in the attachment of your quadriceps on the front of your thigh to your thigh to the middle of the femur is sits upon.

Also note that tendons and ligaments aren’t just attached to the surface of the bones but they have fibers that go into the substance of the bone itself. As a result it is not uncommon to actually pull a piece of bone off when a tendon or ligament gets pulled on too hard.

Muscles –

These are the guys who get all the press coverage for doing the work. And in a strict physics sense they do. Muscles can generate force but only by actively making itself shorter. That’s it; a muscle cannot make itself longer once it has shortened. Once you bend your elbow with your biceps muscle it cannot push the forearm back out to straighten the elbow. In order to make the elbow straight the biceps has to quit working (relax) and then you have to use other muscles like the triceps to pull the elbow straight. Because the biceps is attached to the bones above and below the elbow it will get stretched out when the triceps moves bones to get the elbow straight but the biceps is coming along for the ride, it is not helping to lengthen itself. That is why stretching can also be a strengthening exercise because you have to contract one muscle to stretch another. Hatha yoga is a good example of this.

Here is the big thing to remember about what muscles do – they only pull on things, usually bones. This idea is often forgotten by trainers and therapists to the detriment of their client.

Important as they are, muscles are useless without the other parts. If you just had muscles you would be a quivering mass that slowly flopped through the world. Or, as the creatures with bones would call you – lunch.

So, the brief summary of the hardware is

Bones, which are stiff and hard, are connected to each other and kept in the correct relationship to each other by Ligaments. Bones also have Tendons attached to them and on the other end of a tendon is a Muscle which can shorten itself and thus pull a bone through space and stretch out the muscle that moves the bone the opposite direction.

When people have a mechanical problem with moving it is usually because one or several of these components are damaged or the coordination among the parts is out of whack so things are not in the right place at the right time to create the needed movement. Interventions like massage, Muscle Energy, manipulation, myofascial release, and many others that do not begin with the letter M, all aim to change how one or more of these components functions and/or the coordination between the components. In the following posts I explain some of them for you.

Are We Even?

I can confidently say that we are not even.   Nowhere close to it.   And thank goodness because if we were all even and balanced we would be dead.

It has been some time since I wrote about how our visceral and musculoskeletal systems are organized mechanically but the upshot of those posts was that the mechanical neutral of one is not in the same place as the mechanical neutral of the other. One of them is never at complete rest. One dominates and then the other but it’s a constant push-me pull-you arrangement. (Not the only ones we have in us but the largest in sheer size and strength)  The trick to having a comfortable life with this arrangement is in how well we slide back and forth between these intrinsic sets of forces in our organism. How are they bound together to each other and how can we exert the most efficient control over the generation and transfers of force to do what we want to do? Big questions for sure but I think important ones to consider if one wants to make life easier.

So let’s start with the easy stuff by looking at one concept underlying all this – Balance or more accurately – Imbalance.

Photographer Taro Taylor www.freeimages.com

Photographer Taro Taylor
www.freeimages.com

Consider a tightrope walker. Up on a thin wire that sways and twists our daredevil friend takes a step out and shifts and wiggles a little until she has balance – the forces to swing left are equal to the forces to swing right, the push of her weight down is equal to the push of the taut wire up on her feet and she rests quiet and still on the wire. But that will not get her any further. She is balanced but to move ahead she has to become imbalanced. She has to use her muscles to create pulls on her bones that are not countered equally by gravity pulling her foot down or by the resistance of the air in front of her leg so she can step forward. In doing so she shifts out of balance and puts new strains on the wire that she counters and matches to find a momentary balance from which to launch a new round of imbalances again and again until she reaches the firm platform on the other end of the wire that will be much more forgiving of her small imbalances. Like all of us, she has to consciously create and manipulate imbalance to move through space. The thin, movable wire gives her a narrow and unforgiving set of choices to work with to find the correct imbalance. Her control and mechanical ability to use her body to carry out her thinking for such a long time makes her feat so admirable.

Imbalance is how we move through space. Being even is not a good thing if you want to participate in the world. The key is being able to control our imbalances, selecting just enough force in the correct direction. This is linked to how well the mechanical structure in our body is able to carry out those selections accurately and effectively. The generation, control and implementation of our ideas that propel us through life depend on our ability to deal with imbalance.

Problems with our ability to move as we wish often stem from our inability to control the imbalances we need to create or deficits in our structure to generate the imbalances we need in the way we need them.  The Alexander Technique, which I have described over the last six posts, is one way of addressing how to deal with the control aspects of imbalance in a very effective manner. There are also many very effective ways of enhancing our ability to manipulate imbalance by improving the mechanical structure of the body. Over the next few weeks I will look at several techniques for improving the mechanical ability of the body to move. Some of them may be familiar to you by name but I want to look at how they can be used when seen through a lens of enhancing our ability to manipulate imbalance. I have found in my practice that sometimes I get very different results than would be expected once I change my reason for using a technique from restoring static mechanical balance to improving the ability to generate imbalance.

Benefits for Patients

Photographer Dave Tuepah www.freeimages.com

Photographer Dave Tuepah www.freeimages.com

One of the most noticeable impacts for students of the Alexander Technique is an improvement in the ability to do large motor tasks with greater ease and accuracy. By teaching people how to observe and change the entire movement task by using Primary Control they can learn or relearn movement tasks in a way that lets them adapt to their current specific set of mechanical limitations. The result is more efficient movement with less wasted effort and energy.

As patients are better able to reason what movements are required to complete tasks and how to use Primary Control to achieve that goal, balance and timing improve. With greater accuracy comes motor planning and adjustment that more closely matches the environment and needs of the movement task. By definition, integration of sensory data with motor planning is coordination and its improvement is a natural consequence of the Alexander Technique.

Patients who move in a manner that places less mechanical strain on their body and improves their overall coordination and use of the correct body part in tasks means there will be less injury to the body and swifter recovery. Such a result translates to less medical intervention. Even more useful is that patients learn how to examine and change movements during a recurrence of symptoms. They can therefore actively self-treat early. Research shows that back pain patients who receive Alexander Technique lessons along with other therapy interventions not only report better results but improvement is still maintained one year later. This is in direct contrast to interventions that do not include Alexander Technique training.

Basic Concepts of the Alexander Technique – Part 2

The Alexander Technique is a useful therapeutic adjunct addressing chronic patterns and adaptations that predispose patients to musculoskeletal problems and poor overall functioning.  A good example is weak respiratory function or excessive tension and strain which needlessly increase metabolic demands and tissue strains without improving function. The Technique also teaches patients how to help themselves discover and prevent habits and misuse that can cause their problems and so provide a long term preventive intervention for musculoskeletal problems.  In the last decade, research has demonstrated that people who have received lessons in the Alexander Technique have improved success with recovering from back injury in the short and long term, better respiratory function, decreased joint pressures and better mechanical performance in activity. In addition, the procedures Alexander developed for how to consider and balance stimulus, movement and thinking have significant usefulness in enabling people to constructively approach learning in any arena.

Actors, athletes, and performers of all kinds have utilized the Alexander Technique since its creation, as their livelihood depends on movement control and easily learning and adapting to new patterns. They have found that the Technique provides a methodology that works very well to help them learn and adapt. Unfortunately, despite the endorsements of a number of physicians and scientists during Alexander’s lifetime, the Technique was never taught in the medical arena. It was regarded as primarily having to do with posture because patients who learned to move better inevitably developed better posture. The attitude that the Technique is only about posture is changing as new studies are demonstrating the effectiveness of the Technique for dynamic movement problems. At its core, however, the Alexander Technique is an educational methodology and falls outside the paradigm in which most medical personnel are trained.

Image by photographer Carien van Hest http://www.freeimages.com

Image by photographer Carien van Hest http://www.freeimages.com

Within the medical community physical therapists have a unique position – they are charged with improving movement ability in clients no matter the cause, including habitual movement patterns that have led to dysfunction and failure of structures in the body. A patient’s overall body use must be addressed as well as the specific structure that is damaged. Otherwise the patient is left to fend for themselves using subconscious guidance (“well, this feels right”) and generally inaccurate ideas about how to use everything that is not injured to support the exercise or motion they have been told to do. This internal self-guidance often leads to new problems elsewhere in the body structure. It is analogous to having a tire wear out from poor alignment on a car. The tire must be replaced (direct intervention) but the car must also be realigned properly (change how the car uses the tire) and the driver educated to avoid things that damage the alignment (alter the controlling program) in order to prevent a repetition of the tire damage. The Alexander Technique gives physical therapists an excellent means with which to help re-educate patient’s thoughts and actions that will help them change and improve their habitual movement, leading to overall better health.

Basic Concepts of the Alexander Technique

How you use yourself, the overall general balance and coordination of the organism that is the human body, determines what you can do and how you do it. There is no isolated movement or thought process in the human, everything happens on an integrated neuro-mechanical framework that must balance, support, control and compensate for any activity.  For most people, most of the time, integration and balancing is done subconsciously and patterns that arise to organize and control this are habits – programs that run immediately once a decision is made to accomplish a movement or thinking task. But if those habitual programs are based on incorrect information, or a person has sustained changes in the physical structure of the body without updating the underlying control programs, difficulty will inevitably ensue.

Photo by Philippe Ramakers http://www.freeimages.com

Photo by Philippe Ramakers http://www.freeimages.com

One hundred and twenty years ago, F.M. Alexander faced these problems when he experienced difficulties with his voice.  He solved them by discovering how to consciously evaluate, recalibrate, and re-educate himself on how to use his whole body in every activity. With careful observation and personal experimentation Alexander determined that before intentional movement most people tended to engage in preparations and motions that did nothing to assist the action at hand and actually created significantly more bodily tension than was necessary. He realized that these phenomena degraded a person’s ability to accurately and consistently move and function at optimal performance.  According to Alexander, the degradation arose from a lack of knowledge regarding how to correctly use the underlying mechanisms of the body to control overall coordination.  Alexander developed a means for correcting these problems using discussion, demonstration and guided movement in order to teach people how to consciously change their initial responses to the movement stimulus. Additionally, the individual followed a rational decision process in a manner that would allow them to make their movements more accurate and precise by exercising conscious control over the underlying tensional balance in the body’s structure. This process is now known as the Alexander Technique.