Don't get punked by your body.
Seriously, your body is laughing at you when you chase pain. Just when you think you have tried everything, maybe it is time to think outside the box. There is nothing to lose except pain.
Rarely is the site of pain the cause of the pain. It may seem counter intuitive, but the part of your body that is yelling at you is not what I, or you, or any therapist should be focusing on. Pain is simply a way for your body to communicate with you. "Please change your habits" "Houston, we have a problem"
Recently, I have had a lot of new and seasoned clients approach me with knee pain so I wanted to take a few minutes to talk about the good ole patella.
The patella, aka knee, is embedded in the tendons of the anterior thigh muscles (quads) and forms the patellar ligament that originates on the tibia. Your patella lies over the hinge joint formed at the knee that provides flexion, extension, and very slight rotation of your lower leg. Your knee is very mobile and weight bearing for sure, but we can't give it too much credit. We must give attention and credit to what is going on above and below the knee. If the hip and ankle ain't having it, we know the knee is going to suffer.
Things to look at when experiencing knee pain:
A. Mobility and Stability in the hip: losing range of motion (ROM) in the hip can lead to the knee taking a beating. Spend time taking your hips through extension, flexion, rotation, ab/aduction.
Click here for a great dynamic hip warm up.
B. Ankle Mobility: decreased ROM, especially in the dorsiflexion plane, leads to the knee picking up a lot of slack. Dorsiflexion is crucial, because it allows your shin bone (tibia) to move forward freely and if our tibia is stuck in a vertical position, this will in turn decrease our ability to create force in the hips, and even create a "flow-on" effect up the chain to the knee, thighs, hips, and lumbar.
Everything is connected and everything matters.
Take Care. Move Better
You have all felt it: that burning, or sometimes aching pain between the spine and shoulder blade. We try to rub our traps fearlessly and dig into our rhomboids, but you might wonder why this doesn't bring lasting relief.
I introduce to you, serratus anterior.
Serratus anterior is one of many muscles that resides in the realm “sensori-motor amnesia”. It is compliant and gets the job done, but rarely begs for attention. The Serratus Anterior originates on the upper nine ribs and the fascia between the costals, then flows in front of the shoulder blade and attaches to the anterior vertebral border of the scapula. It's primary job is to help bring your shoulder blades forward aka "protraction" with assistance from pec minor and upper fibers of pec major. When this trifecta shortens, it can often result in stooped posture and rounding of the shoulders. Serratus anterior also rotates the scapula upward and also assist in breathing. Energetically it may be associated with movements such as: handstands, pushups, downward facing dog, and of course, we can't forget throwing a mean "big swing" in a boxing ring.
So what can strengthening and freeing up the serratus do for your body?
1. Solid deep breathes: who doesn't love breathing? In all seriousness, the serratus also acts as a breathing accessory muscle by helping the ribs expand back and out to the side, which means deeper breathes that makes our nervous system happy. This is especially critical during strenuous workouts. The body needs to process energy and oxygen quickly and if your serratus is glued down, those bigger muscles are going to have a hard time working.
2. Neck Relief: If the serratus muscle is struggling or slacking, guess who is picking up the work...you got it, the neck. This can lead to a number of problems, but what I see the most is forward head posture and compression of the cervical spine and all kind of headaches.
3. Range of Motion: who doesn't want better range of motion? Along with other muscles, the serratus anterior is a shoulder mobilizer. A healthy, supple serratus will provide optimal humeral and shoulder function, and this will allow the arm to articulate with much more freedom. Freedom is great
4. Better Performance: need I say more? golf swing? freestyle stroke? throwing a right hook? or do you just want to breathe better?
How do I build strength in my serratus? Great question.
there is more, but this is a great beginning start. Make sure that your shoulder blades don't wing out and don't let those shoulders round forward.
But how do I find or activate my serratus anterior? another great question.
1. Standing Wall Press: Stand facing a wall at full arm's distance, place palms shoulder height on the wall. Lean forward as if you were doing a standing wall plank. Now, without bending your arms, drop your chest toward the wall. You should feel your shoulder blades come together (retract) on your back. Now, push the wall away from you, and you should be feeling the shoulder blades go wide apart (protraction).
I truly believe in the power and change that exceptional bodywork can have. I also believe that nutrition and what you consume is not only a direct impact of your fascia and tissue quality but can extend the benefits of what we do in each session, unequivocally. Food is medicinal. I am a huge advocate for self care, but if nutrition is faulty, you are missing a big piece.
So does diet matter? Absolutely, But not nearly as much as how stressed we are about it.
Often, this stress comes from our why. Why we do what we do.
What we eat has become a source of stress for a lot of us, and we look to science and the latest studies to tell us what is best, healthiest, cancer-preventing etc. I wish we paid more attention, from a nutritional standpoint, to what gives us joy and pleasure, de-stresses our system and makes us feel good inside and out. If you eat healthy sometimes, say yes to french toast and pizza every so often, enjoy your ice cream with immeasurable joy and try not to obsess or shame yourself when you do indulge, then you probably have a relatively healthy baseline, your fascia is probably healthier than most and this is a recipe for “normal” or average amounts of pain.
Whether you’re preparing for or recovering from an injury, optimizing health, or working towards an athletic or performance objective, you already know how important nutrition is as you work toward those goals. Just orient your goals from a positive place of low-stress- your nervous system will thank you and your fascia will reflect this.
So last week, I met with a colleague who knows a thing or 1,000 about mobility. We talked a lot about adductors, and well, to be honest, he is onto something for sure. I mean, look at the picture, those are straddle goals folks.
Call it magic, call it hocus pocus, call it what ya want but I call it the body just doing its thang. The hip adductors are some outstanding muscles consisting of: Pectineus, Adductor Brevis, Adductor Longus, Adductor Magnus, and Gracilis. Always overlooked but that doesn't stop their busy job of giving you powerful movement.
So what do they actually do and why are they always a wreck? I am so glad you asked... great question! Lets get right into it! Besides the obvious adducting, they play a prominent role in flexing, internal rotation, and extension of the hip...whew, that's a lot. I would be a mess too. If you know anything about the amazing Tom Meyers and "Anatomy Trains", they are a intricate part of the Deep Core Stabilizing Line of the body, Anterior Oblique Line, and Lateral System of movement.
Now that we have clarified that "adductors lives matter", let's not forget the role they play in amplifying force and stabilizing the body, especially during task as "simple" as walking. If your trunk muscles, primarily your abdominal region, is lacking strength or poor activation the adductors will take over for stabilization. They become the prime leader of force generation...this pisses them off causing tightness and pain.
When you squat, do you knees cave inward? Yes, I know what you are thinking, "but Sara, shouldn't we look at the ankle mobility or knees?" Absolutely we should! But my first question back to you would be, "but why? why is the mobility of the ankles and knees so crappy?" Let's keep going up that chain...hint hint, the adductors.
Now, let us put this all together. Stand up real quick, put your feet together. Place your hands on your core, one on the front and the other on the side. Squeeze the knees together. Did you feel your abdominals contract? You should have, thats the connection
Come see me, lets work together to un-mess those adductors, then go see my friend Michael for some amazing adductor education, mobility bombs, and drills to make sure we are reaping all the benefit we can from those amazing muscles.
Whether you’re training for a race or use running as a part of maintaining your fitness, it can take a toll on your body. When you exercise and stress the body and don’t give yourself enough rest or recover properly you can burnout real quick. As a runner it’s not only your mileage and the intensity of your runs that you need to take into account—how’s your sleep, stress at work/home, nutrition to fuel your exercise, daily movement habits, what do your rest days look like?
Let’s dive into the importance of post-race care
There is good reason massage therapists are part of a runner's entourage- especially post-race. Science has proven that massage can’t “flush toxins or lactic acid” but what massage does do is apply moving pressure to muscles and other tissues such as tendons, ligaments, and fascia (which sheaths muscles like casing). The energy from that work does soften the fascial structures in the body and makes those muscles relax. It also helps to mitigate adhesions and reduce the buildup of scar tissue which will ultimately allow optimal range of motion. That's especially great news for runners, who rely on limber joints and muscles for pain-free peak performance.
While there’s many things you can do for post-race recovery out there, but what’s missing are self-assessments to help you understand why you are sore or not recovering from your race or long run that you can do to keep yourself in check.
Post-Run/Race Recovery Assessments
Tightness and restrictions, especially in lower extremities, might be impacting your running performance – let’s look at two quick tests and mobility to help alleviate the restrictions
Post-Race Recovery Assessment 1: Forward Bend
Stand with your feet together right under your hips, knees straight, and try to reach down toward the floor. Keep your spine tall, some people will create a false sense of range by flexing their spine. If your fingertips don’t reach the ground, you likely have hamstring or low back tightness that can impact your posture during running, which could either lead to early fatigue and possibly injury. Alternately, if you can palm the ground you don’t have enough tension in your hamstrings and are missing strength & stability in your glutes and hips. Hamstrings are a pretty resilient group, while they should be able to achieve proper range of motion, they should not be a super flexible.
Post-Race Recovery Assessment 2: Lunge Test
Here we are checking hip flexor (quad and psoas) and ankle mobility. Tight quads can induce large anterior pelvic load. Stand with your feet shoulder width apart. Take a big step forward with your right leg. Make sure your front foot is in neutral (arch is not collapsing toward the floor), your left glute is squeezed tight, and your hips are squared forward. Now slowly drop your left knee straight down to the ground. You should be able to do this keeping an upright torso and tall spine, without the hips twisting and without the front knee falling in toward midline. Switch sides
Post-Race Recovery Mobility
Now that you know where you’re feeling tension, try these two techniques to address the tightness and speed up your recovery!
Your Quadratus Lumborum muscles (QL) are found on either side of the lower back and are crucial in stability of the low back, especially when seated. Connecting the lower spine to the pelvis, the QL is a busy muscle, its actions include bilateral flexion, extension of the lumbar spine, respiration (helping the diaphragm to contract), and it’s an elevator of the hip.
If we get a tight and grumpy QL, we have to look at the bigger picture. This muscle never works alone, and if he is overworked and overlooked it’s because his neighbors are not doing their job. Many of you may know about these muscles in relation to back pain, and they are often the source of great discussion when trying to identify lower back issues. However, they are sometimes unfairly blamed as the sole culprit for pain and we can easily forget that the QL is just one part of a whole system of muscles that work together to support, stabilize and mobilize the spine.
In order to look after our QL we need to understand its relationship with the muscles around it, its anatomy and what we can do to strengthen it and release it. So, let’s do a quick crash course of anatomy. The QL is found on either side of the lumbar spine. They attach to the iliac crest (top of the hip bone), the transverse processes of the L1- L4 (lumbar vertebrae) and the twelfth rib (your last rib).
What can you do to make the QL happy?
Work Your CoreThe QL is often overworked when we are sitting. So anybody out there who works in an office chair, this is especially important for you. A strong core is very important in stabilizing your lower back when sitting for long periods of time. If your core is not that strong, your QL (the marathon runner of muscles) works overtime in supporting us. This means it gets tight and tired. So work on your core to protect your QL!
Work Your Glutes
Your deeper gluteal muscles (medius and minimus), among many other things, help to stabilise your pelvis during walking. So the QL and the glutes work together to stabilize our posture when moving. If your gluteal muscles are weak, again your QL will overcompensate.
Work Your SpineThe erector spinae are a group of muscles that run along either side of your whole spine. They extend the spine and when only one side is contracting, bend your spine to the side. Immediately you’ll recognize the identical actions as our QL. They are very close co-workers. If your erector spinae are weak, again your QL has to take up the slack.
As humans, it’s a fundamental trait to our survival. We adapt to our surroundings. We fall back into patterns, if just feels normal and comfortable.
Sadly, it is a trait that can throat punch us. I would argue, when we become settled and comfortable we get “soft” and vulnerable. You start to see things as your are, not how the world is. PERCEPTION. This is a perfect time for injury to sneak itself in. With that being said, pain is also perception. 10/10 subjective. Hear me out, Rick Flair walks up and pops you in the face, I’d cry and you may laugh. Same external stimulus, different response.
Pain is your body’s way of begging for change! Changing how you move ultimately will change how you think 🤯 brain and body are really good friends.
How can we make change?
Simply put: get out of your own way. keep it simple, it really is that easy
• get on the ground, move with your kids, sit and read
•Exercise outside: go hike, go rock climb, paddle board. Get out of the Sagittal plane
• hop to your car after work? I don’t know, you may make friends?
• stop taking the elevator, maybe walk sideways up the steps
• kneel or stand at your office desk
•squat during office meetings, again you may get some weird looks
As you are reading this, get off your seat (I assume you are sitting) and drop into a squat with feet flat on the floor, now stay there for 5 minutes.
Humans were designed for movement. Movement is ancient. Hiking, running, dancing, squatting, climbing, throwing, these are all movements our bodies are built for.
Mobility is the most critical piece of the programming. One more time, mobility is the most important piece of the programming. When I say “mobility”, I do not mean the 5 minutes before class that you unintentionally roll around on the foam roller. I am speaking to finding your weakness in range of motion and being disciplined in addressing them. Before you pull the trigger on me and say “But, Sara, well, what about strength training, endurance, gymnastics, and all the other foundational movements of CrossFit? Yes, those are critical and we should be keeping things varied. It is not just about how strong you are, but how strong are you in good positions? How efficient are you in endurance so it doesn’t affect your cardiovascular system aka your heart! But, for me, functional movement at its core comes down to mobility. It is the meat and potatoes of CrossFit, and I would argue, of life.
I am so passionate about this topic, because for me, mobility and getting into certain positions (mainly squatting) was a HUGE limiting factor. It is something that I still manage and is a challenge for me. I believe to my bones, that if people focused more on moving well and getting into better positions, there would be far less injuries and much more longevity of life and in the sport. You may have to strip your ego a little and re-educate your muscles in different positions, but trust me, it will pay off.
With most of our population being desk jockeys and being involved in sitting hours of the day, our hips, core, legs, shoulders, chest and pretty much our entire body can become tight and having a huge impact on mobility.
This next week, I challenge you to take 10 minutes of your day…10, that is it and dedicated it to movement. Just get on the floor with your kids, or stay after and grab a coach for some direction!