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I.T. Bands by Osteopathic Therapist, Isaac Lynn

If you’re using a roller to release your IT Band, we hope you have one of these handy!

ITB1

A 2008 study by Chaudhry and Schleip [1] demonstrated that it would take 925kg (for the Americans, thats 2040lb) of force to produce a 1% compression/shear of the ITB. This is a massive amount of force that is never going to be generated by a foam roller at the gym.

As Osteopaths, we are often asked about rolling tight ITB’s. While there may be a helpful component in decreasing tension of the superficial fascia of the outer thigh, it often fails to provide any long term relief, and has a low ‘pain to benefit’ ratio.

My favourite analogy is that the ITB works like a banjo in that, the ITB itself is a taut, thick band and, like a banjo string, is highly resistant to manual forces applied to it.

ITB2

The tuning levers on a banjo perform a similar function to the TFL muscle in the hip. Increased tension through the TFL muscle works to tighten the ‘string’ of the ITB, and can lead to complaints such as knee pain, stiffness through the thigh and pain through the hip.

So instead of spending hours rolling out the ITB, I prefer to use a firm ball between the hip and the wall to gently roll out the TFL muscle, which in turn will decrease the tension in the ITB.

As with most musculoskeletal issues, decreasing tension through the ITB is only effective if the underlying cause is addressed. There are many different causes for ITB tightness ranging from weakness through the hips and glutes, all the way to foot and ankle mechanics. If stubborn ITB tightness has been a struggle for you, book an appointment to see what the root cause of the issue is and get on top of it!

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Running Tips by Osteopathic Therapist, Gabriel Linger

A few things to consider when tackling a longer run where you will be pushing yourself – whether it be a marathon, a half marathon or even a 5km jog.

Up to 80% of runners get injured each year (1). Studies have shown that the more fatigued you become during running the more likely the chance of injury is (2,3 4). While this might just seem like common sense its worth understanding just how running injuries occur.

Here are some of the main changes we see though the different parts of the body and how they might affect you.

The longer you run and the more tired you get, the more your form suffers. We all know that feeling of pushing out the last few kilometres. When you start to get tuckered out, your foot flattens out as your arch drops. This flattening has been correlated with shin splints (5, 6, 7, 8), plantar fasciitis (9, 10), knee pain and even lower-back pain. This can be a precursor to changes in the biomechanics of the knee. As you become tired your knee tends to bend a bit more and also coming into the mid line, making you a bit more knocked kneed. This all works to increase the amount of force that is going through the knee cap (patella-femoral joint). If this happens for too long, we often see the most common running injury, aptly named “runner’s knee” or patella femoral pain syndrome (11).

Next, let’s jump up from the knee to the hip. Fatigue has been shown to increase the amount side to side movement through the hip. Too much of this movement will put stress on your hip itself and also your lower back (11,12).

When you run you also tend to increase how far you lean forward (2). This can switch off your all powerful core and can decrease the amount of arm swing you use. Your arm swing helps keep your core and glutes switched on.

The final thing to note, when you start getting tired during running, you tend to increase how far you stride, which also decreases your step rate. These two things can exacerbate all the previously mentioned symptoms (2).

So, what can you do? Simply take a bit of a self-check when you start noticing you’re getting weary on your run:

1. Look down to see if the knees are falling in
2. Keep your torso in a nice upright position
3. Make sure than you’re not taking long strides – you can think either about taking smaller steps, or more steps – whichever works better for you
Ref.

1. Van Gent R. N., Siem. D., Van Middelkoop. M., Van Os. A. G., Bierma-Zeinstra. S. M., & Koes. B. W. (2007) Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 41(8):469-80

2. Benson, L (2015, October) Running in an exerted state: mechanical effects. http://lermagazine.com/article/running-in-an-exerted-state-mechanical-effects

3. Corte, N., Greska, E., Kollock, R., Ambegaonkar, J., & Onate, J. A. (2013). Changes in Lower Extremity Biomechanics Due to a Short-Term Fatigue Protocol. Journal of Athletic Training. 48(3), 306–313.
4. Dierks TA, Davis IS, Hamill J.J Biomech. (2010). The effects of running in an exerted state on lower extremity kinematics and joint timing. Nov 16;43(15):2993-8

5. Wesley. R., and McCullough. M. (2014) Review of Medial Tibial Stress Syndrome: A Comparison of In Vivo and Computational Methods. Austin J Biomed Eng;1(5): 1025
6. Wilder R., and Seth S. (2004) Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. ; 23:55–81

7. Yates B, White S. (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 32(3):772–780

8. Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine, 2(3), 127–133.

9. Tahririan, M. A., Motififard, M., Tahmasebi, M. N., & Siavashi, B. (2012). Plantar fasciitis. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, 17(8), 799–804.

10. Gautham P, Nuhmani S, Kachanathu SJ. Plantar fasciitis: A review of literature . Saudi J Sports Med 2014;14:69-73

11. Meira, E. P., & Brumitt, J. (2011). Influence of the Hip on Patients With Patellofemoral Pain Syndrome: A Systematic Review. Sports Health, 3(5), 455–465

12. Cooper NA, Scavo KM, Strickland KJ, Tipayamongkol N, Nicholson JD, Bewyer DC, Sluka KA. (2016) Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J. (4):1

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Pain Perception and Predictive Coding by Osteopathic Therapist, Gabe Linger

Is Pain Perception a Mirage?

Pain is the body’s way of telling us we are in danger and automatically we move differently to protect ourselves. However, just like a mirage, our perception of pain may be misleading.

More and more we are finding that medical imaging like MRI, the gold standard for imaging, doesn’t always correlate with the clinical symptoms of the pain a person experiences (Janardhana, et. al 2010). This can be frustrating for both client and practitioner. To better understand why we may be feeling pain, we need to have a closer look at what is actually happening in our body.

Until recently, the theory was that pain always worked via a “bottom-up” model. For example, when I bend forward my back hurts; this is because the force going through the joint or muscle is causing my nerves to signal to the brain that there is potential damage in the area. What has now been shown in scientific studies, and what the bottom up model leaves out, is that previous experiences influence the interpretation of our pain messages. For example, the last time I bent forward, it hurt my back, so this time will be the same. This is called ‘predictive coding’. That is the brain predicts what is happening based on previous events and sends that message about pain to the body.

So, we have messages coming from the body up to the brain and from the brain down to the body. As these messages cross over the brain compares whether what it predicted is similar or different from the information coming up from the body. Because our brains are as efficient as possible, where the differences between predicted and “actual pain” is small then then the brain’s prediction based on previous experience is what you will feel. In this case back pain when you bend forward. If there is a big difference between the messages from the brain and the body, the message from the body will reach the brain and new and updated information will be sent that reflects what is “really” going on.

With chronic pain we have “central sensitization”. This essentially means that brain is more confident with the messages it is sending down. This is because the pain has been there for a while, even though there may not be much, if any, tissue damage in the painful area. So now we need a bigger difference between the messages the body is sending to the brain and the predictive coding from our brain for a change in our perception of what is really happening in the body to take place.

At Intrinsi we can use movement which is not painful, but still works on moving the “sore” joint/muscle to update the brain’s perception of what is happening. We offer graded exercises that are specific to the painful movement that will allow slow and progressive changes in the way your brain perceives the body and its surroundings. This also rehabilitates the muscles to start performing as the need to achieve the proper movement pattern. This will allow you to get back outside in the beautiful spring weather and start moving pain free again!
Reference:
Janardhana, A. P., Rajagopal, Rao, S., & Kamath, A. (2010). Correlation between clinical features and magnetic resonance imaging findings in lumbar disc prolapse. Indian Journal of Orthopaedics, 44(3), 263–269.

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Ice Baths by Isaac Lynn

The dreaded ice bath. Often a staple part of a sporting teams recovery process, but how much benefit are those freezing minutes providing? Is leaving the Ice bath looking like a winner of a Smurf lookalike contest any better than a 10 minute walk?

A study that appeared in The Journal of Physiology during February this year, compared the effects of cold water immersion to active recovery after exercise [1]. A wide held belief is that immersion in cold water after exercise decreases recovery time through reducing inflammation in the muscles. Theoretically this makes sense as our muscles get hot and sore after running, but there is more to inflammation than just heat.

Having tested markers of inflammation in muscles after exercise, the researchers found that there was no significant difference between those that used cold water immersion and those that cycled gently for 10 minutes [1]. This isn’t to say that cold water immersion after exercise provides no relief, but that you can have the same levels of relief from ‘active recovery’. This can include anything from a gentle walk or cycle after a workout to a few easy laps of the pool after a swim.

So for the polar bears out there that love jumping in the Ice baths, go for it! for those of us less likely to float in ice cubes, adding 10-15mins. of gentle exercise after a workout will give you the same effects with a lot less shivering!

1. The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. Peake JM et al. J Physiol. 2017 Feb 1;595(3):695-711

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Hip Pain and How Intrinsi Can Help by Gabriel Linger

We’ve all felt that tight hip feeling, whether it be in the front, side or back, after having a long session at the computer or Netflix…. sometimes both in the same day. The hips have a close relationship to the lower back which crazily enough becomes the mid and upper back. Having the mobility, but also the strength through the hips can help both hip and back pain.

Prolonged inactivity of muscles can cause them to atrophy (essentially waste away) which, as shown in a study, took only 5 weeks for up to 12% of the muscle to waste away without any activity (1) but this process can start a lot sooner.

Sitting at a desk has the hip flexors at a shortened range while keeping the bum in a lengthened position. Not a bad position if we’re about to jump, however, sitting at a desk for 8+ hours a day, (this includes driving to and from work, sitting at work and then sitting down on the couch/ table at night) 5+ days a week is going to cause a few problems. Problems associated with pronlonged sitting do not just include feeling sore and tight, but can, according to one study lead to an increased risk of diabetes and cardiovascular disease (2). An Australian research paper (3) showed that even if we did the recommended amount of physical activity (traditional gym work outs which tend to be in one plane of motion, forward and back) it still wasn’t enough to combat the detrimental effects of sitting for so long. They suggested movements which incorporate all 3 planes of motion and use a wide variety of movement.

That’s where we come in…
The Osteopathic Therapists here at Intrinsi are able help relieve your pain through a number of different techniques, give you strategies to keep you moving more while at work, and provide you with some at home exercises.

Here are a couple to try out for yourself:

Isaac kneel photo

Sitting hip flexor stretch 
1. Sit on the side of a chair in a way that one leg is free and you are able to drop your knee to the ground.
2. Bend your kneewhile keeping the toes curled.
3. Sit up straight and lean back until you feel a stretch in the front of your hip.
4. Drive your opposite knee forward to increase the stretch (at a rate of 1 per 2-3 seconds).
5. Repeat this 10-15 times per session.

Here at Intrinsi we also have the amazing Natural Movement Centre. Here, you are taken through a large variety of movements in all 3 planes of motion, from crawling to rolling, jumping, hanging and balancing. Incorporating the 3 planes of motion, we can start to use the muscles the they were designed to be used, and give the body what it craves the most, varied movement.

For more information on our Natural Movement Centre and how we can help you in your journey to becoming pain free, click here.

For an educational video on hip mobility and strength click here.

 

1. Berg, H.E., Eiken, O., Miklavcic, L. et al. Eur J Appl Physiol (2007) 99: 283. doi:10.1007/s00421-006-0346-y
2. Wilmot, E. G., et.al. (2012) Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia, 55(11), 2895-2905.

3. Owen, N., Healy, G. N., Matthews, C. E., & Dunstan, D. W. (2010). Too Much Sitting: The Population-Health Science of Sedentary Behaviour. Exercise and Sport Sciences Reviews, 38(3), 105–113. http://doi.org/10.1097/JES.0b013e3181e373a2

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