3-D Soft Tissue Therapy: A deeper understanding of the healing process

In my last two posts on soft tissue therapy, I went into the scarring process in relation to an injury. If you have not already, please take the time to read those two posts, as this post is really the last part of the series.

In the first two posts, I described the healing process from a traumatic injury of sorts and left off starting to describe the FIBROTIC PROCESS.

When an acute injury begins on the linear process of healing, the body responds to that area only. However, with the fibrotic process is cyclical and affects the entire fabric of the connective tissue. Unlike the scarring process which ends, the fibrotic process will continue until the main cause of the irritation is discovered.

The irritant in the fibrotic process, such as repetitive stress, excessive pressure-tension (i.e sitting for long periods of time), postural stress starts a chain reaction in the tissues as follows:

1. Activation of microphages
2. Increase in tissue vascularity
3. Increase in fibroblastic activity
4. Increase in connective tissue
5. Increase in myofibroblastic activity
6. Shrinkage of connective tissue
7. Abnormal motion

Again, this cycle will continue until the irritant is found.

With the scar tissue, we see that lack of ROM is due to the elasticity of the scar as well as the surrounding adhesions; however, the fibrotic process is a change in entire soft tissue region.

A case study would be the difference between a rotator cuff tendinitis caused by too much overhead throwing activities that is caught early, R.I.C.E'd, and taken through the proper therapy as opposed to the 'idiopathic' frozen shoulder or adhesive capsulitis where the fibrotic process has taken over and changed the texture of the entire shoulder capsule where there is little ROM, pain and chronic inflammation. For more info on this, click here. Its a good article by the American Family Physician Newsletter.

Working with clients or patients, its so important to take a detailed medical history in regards to injuries. One of my lacrosse players who trained with me this summer was having some knee issues so we did a little soft tissue work on him to see if we could get a little more ROM in his ankle. I asked him on multiple occasions if he had injured his ankle to which his reply was "I don't think so"; however, I knew something was wrong. The difference of ankle motion in his right foot to his left foot was pretty big. Well, my athlete returned back to college and unfortunately sprained his ankle a few days ago. It was severe enough that they took him to the doctor for x-rays. The x-rays revealed that he had a break in his right ankle from a while ago that had healed but the injury had calcified. WELL THERE GOES MY ASSESMENT OF HIS ANKLE. The feeling was a definite osseous end feel; however, the soft tissue surrounding it was a bit like working on a rope that has several knots in it that prevent it from really stretching out. It's a hard feeling to explain but I confirmed the unusual lack of ROM in the right ankle by checking it against the left ankle. Definitely not the same.

These palpation skills are something that I will go into a little more in depth. I believe that it is an experience that you need to have. The feeling of healthy tissue and dysfunctional tissue is VERY different. As a soft tissue therapist, you learn, through tactiile "observations" what it feels like.

I hope this look into the soft tissue healing process helps. As a soft tissue therapist or really anyone who works the body, we need to understand the process that many of our clients and patients are experiencing. As our knowledge deepends, we are able to tap into that knowledge base so that we can apply the Principles-Strategies-Techniques to our individual clients.

I will continue on this soft tissue journey soon by discussing some strategies and techniques for assessing soft tissue.

In Health,

Will

Again, I would like to thank Lenny Parracino CMT, FAFS for his guidance, knowledge and wisdom in regards to the soft tissue system. Thank you, Lenny!!!!

Confessions of a Blogger in Wonderland

Well, today was an interesting day. I woke up at my normal 4:30am to do walk my dogs, get ready for work, etc. I made my way in and stopped to get a cup of bold coffee then made my way into the gym to teach a yoga class. Typically, I have about 30-45 minutes of prep time before I start my class and I usually either mess around for a bit with a few poses or go through a short yoga practice to start my day.

Well, today was a little different. As I was going through my mini-practice, I suddenly had a revelation. "What the heck am I do this for?" I realized that I had lost track of why I was practicing. Was I practicing just to practice yoga? Was I just "warming-up" for my class? At that moment, the answers that I was giving to myself really did not make sense other than going through the motions. My realization was that I had not set any intention for myself for that day. Just doing something just to do it. I think that's fine sometimes, but I think what gets me into trouble is when I am just doing things just to do them and then I get caught in a rut. This action then becomes a habit, and I find myself losing interest and then really getting myself into a rut of doing NOTHING.

Well, I thought as a Soft Tissue and Movement Therapist, I really should practice what I preach. When I go into a session with anyone, I make it a priority to set an intention. It usually helps that the client or group of athletes has a common goal. From there, we can develop some strategies and then movement sequences, whether it be a post-rehabilitation or performance enhancement. I find this extremely beneficial to me and the person I am working with as creates a framework, but like I stated before, when this does not happen, well, its a little more "higgledy-piggledly" as my grandmother used to say.

This morning, I realized that I was going about things in a higgledy-piggledly way. I have been "working out" just to work out and it was without a clear purpose. Initially, I find the novelty of an activity the most exciting part of the process and I still do think its exciting, but I would not go as far as to think it's the most exciting anymore. What's the most exciting to me now is taking that activity, say yoga, and really digging deep into it. "What is my body able to do? What is not able to do? Can I become even more flexible than I am now? Can I learn to control my breathing through yogic training? " This is all so important in the grand scheme of having some intentions for my actions. Here are some the answers to the above questions:

• I do not know what my body is fully able to do because I have never tested it to that point.
• I believe the things that I am CAN DO are far more in number than those that I cannot do because I haven't tried a lot or spent enough time focusing on it; therefore, what I cannot do is not a logical question.
• I can definitely become more flexible (mobility and stability-wise) as well as become stronger.
• My breathing can be much better and I believe yoga is a great system for learning that.

To me, identifying where I can improve is a starting point. It's a place where I can start to go to a goal. For me, I am aware of of where there are weaknesses and tightness in my body. If I want to truly become more flexible, I will "clear" those areas first then move onto improving those areas. There are MANY techniques how to find that flexiblity. As far as being stronger, I can always be a stronger but I do not think its going to necessarily have to be in the form of solely lfiting weights. There is a lot of wisdom behind bodyweight exercises and tweaking them. I also think there should be a reason for me getting stronger. For instance, I have never been able to do a press to handstand because lack of shoulder and core strength and stability. Well, that's a reason to go lift weights. Will my shoulders look more ripped? Yes more than likely, but I like to think of that as a byproduct of function and not a primary objective. However, to each his own. If you want ripped shoulders that look great and you are willing to work for that goal, I say more power to you.

At 3-D Optimal Performance, we stand for maximzing the areas of your life in mind/body/spirit. There is no difference. If we optimize one, we are going to be optimizing the other two. However, intentions based on principles do pave a road, and not necessarily to hell.  I like to use a passage from "Through the Mirror" by Lewis Carroll. It goes:

Alice: Which way should I go?
Cat: That depends on where you are going.
Alice: I don't know which way I'm going!
Cat: Then it doesn't matter which way you go!

Our intention based principles will lead the way for us. However, if we do not have those, then we may be chasing our tails. Again, sometimes, we need to chase our tails but KNOWING that we are chasing our tails is the key. When I chase my tail but do not realize it, I find myself in a rut.

I check in with myself daily, and more than once per day. I urge you to do the same. That way, we both know what we are doing, how we are doing it and most importantly, WHY we are doing it.

In Health,

Will

3-D Hip: Overview of Acute and Insidious Onset Injuries

A while back, I went over the 3-D hip and included a focus on the iliopsoas and the ligaments of the hip capsule. I also went through the Chain reaction biomechanics of the hip. If you dont find the hip interesting, I strongly urge you to reconsider that. The hips are truly the powerhouse of the body. Typically, I find that soft tissue in the hips are some of the most hypomobile of the body which can cause all kinds of issues in the body, especially the back.

When we look at the hip, we can see a very complex structure but this complexity also has a simple side as well. Because of the complexity, we unfortunately see quite a bit of injuries. Unfortunately, this year, I've seen my fair share of hip injuries. Within the first 6 weeks of the fall season, I have seen: sports hernia, osteitis pubis, internal snapping hip syndrome, adductor strain, ASIS apophysitis, gluteal medius strain and various other back problems that I think stem from the hip issues. Unfortunately, I did not see any of these atheletes in our athletic development/injury prevention program with the exception of one and he insisted on playing about 30 games of lacrosse while going through his rehab program for an adductor strain from the previous sports season. What I have become very good at is understanding the hip and many of the issues that affect it, so I will go through a little overview of some of the injuries commonly seen as well as the though process that I use in post rehab and injury prevention situations involving the hip.

Introduction to "I am Will's Body" muscle function series

Many, many years ago, Reader's Digest published an amazing set of articles by J.D Radcliffe. These articles were originally entitled "The body and how it works." This series of articles took a very different look at the body as the author would become the body part, like the heart or liver, and speak in the first person, as the organ. Wonderful. It was such a new way at looking at the body. Instead of memorizing facts about the heart, it was if the heart was talking to the reader in a an autobiographical way. These articles were published later as "I am Joe's body". Here's the first paragraph of the Liver article:

"Joe frets about his teeth, hair, lungs, heart; he is hardly aware of my existence. I am Joe’s liver.* When he thinks of me at all, he has no trouble visualizing me. I look like what I am supposed to look like-liver. The largest organ in his body, I weigh three pounds. Protected by ribs, I pretty well fill the upper right part of Joe’s abdomen"

Introduction to 3-D Soft Tissue Therapy - Part 2

In yesterdays post, I touched on the healing process of soft tissue in the body. It's an amazing process that I believe that we take for granted a lot of the time. We just expect the body to "do its thing" without an appreciation for the process; however, maybe a lack of appreciation of the process stems from a lack of understanding. Functionally, speaking, we must allow the body to heal so creating an environment of optimal healing is of the utmost importance.

A DEEPER LOOK AT THE HEALING PROCESS

There is definitely a simple complexity in the soft tissue healing process. Let's take an injury that unfortunately, I have had more than my share of experience with. This year, my football players have been afflicted with Acromioclavicular Joint (AC joint) sprains. They have mostly been Grade 1's but there was one pretty nasty Grade 2 that required that we take the athlete to the hospital to make sure it was nothing more than an AC joint sprain. The area of injury was the ligament soft tissue that connects the acromion to the clavicle. Sometimes we will see a superior displacement of the clavicle and you can see the discontinuity in the form of a little ridge. I tell my boys that their days of modeling tank tops is over. (Lame, I know)

Introduction to 3-D Soft Tissue Therapy - Part 1

(Technical level: Beginnger-Intermediate)

When I went through massage school a few years ago, I can say that I loved learning about the soft tissues of the body more than anything else, and what got me was that my teachers said "This is just the beginning." Three years later, I look back and I'm still learning about the soft tissues of the body. What's amazing is that we are just starting to tap into the knowledge about and wisdom of the soft tissues of the human body.

As I learned more and more about the soft tissues, I also learned that there were literally hundreds of different methods to facilitate healing of the soft tissue like Swedish Massage, Deep Tissue Massage, Active Release Technique, Graston Technique, Bowen Therapy, Lomi Lomi, etc. The list really does go on and on. The interesting thing is that all of these modalities have a place in soft tissue therapy. However, many people get wrapped up in the TECHNIQUE and forget the PRINCIPLES OF FUNCTION. If we do not anchor ourselves and techniques to the Principles of Function, then we are doing something just to do it. The technique should be applied to the individual if appropriate, not applying the individual to the technique (if that makes any sense).  The interesting thing is that when we start to anchor ourselves to Principles of Function, our "toolbox" is only limited by our imagination (and scope of practice). Let's take a look at the soft tissue of the body, our Principles of Function and then see what we can come up with as far as appropriate techniques.

WHAT IS THE SOFT TISSUE SYSTEM?

The soft tissue system consists of the muscles, fascia, ligaments, tendons, nerves, joint capsules, circulatory and lymphatic structures. Unfortuately, many the soft tissue system has been largely ignored even though it causes more pain and dysfunction than any of the other organ systems.

3-D Movement Focus: Power Yoga (Strength and Flexibility)

In 1996, my amazingly cool aunt, Tracy, introduced me to Yoga. I was in high school and thought I knew it all. Well, stepping onto the yoga path, I came to realize that I still know very little over 10 years later, but it has been a great journey.

Yoga to me is an amazing movement practice. One of my first teachers and colleagues, Paula D. Atkinson, said that "Yoga is MAGIC" and I believe her. The great thing about yoga is that can be anything you want it to be. It can primarily be a physical, mental or spiritual practice OR all three. It just depends on the yogi or yogini.

3-D Knee: Patellar Tendinopathy - Understanding, Post-rehab and Prevention

Lately, a number of my athletes as well as adult clients have been afflicted with knee pain. I think I mentioned in a previous post that knee pain, in my opinion, is second to lower back pain in occurences. I have also had terrible knee pain, that at times was so bad it woke me up at night. I know from experience how debiliating it can be and I have empathy for people who have suffered or are suffering from it so I am dedicating this post to understanding, post-rehab and prevention.

SNEAK PEAK OF 3-D FIT AND FUCTIONAL

Well, I had the privilege of attending an amazing celebration of academics, athletics and arts this weekend at the high school where I work. I tip my hat to the administration and all of the parents who were involved in this event. Great job!

During the event I was able to chat with many people who were (surprisingly enough) following the blog. Wow! Thanks to all. Well, what I was getting a lot from the conversations was that people wanted a "new workout" or wanted to get back into shape. I think thats great and I'm definitely up for doing that. Another Principle of Function is that Function is VARIABLE, so when people are getting workouts from magazines, they are getting a VERY broad spectrum workout. Usually, the workouts are pretty good but lack a really individually functional touch that will be address the various personal variables in a persons life such as goals, schedule, pre-existing movement dysfunction, etc. These must be addressed if the person really wants results.

3-D Behavioral Science - Focus on Drivers

It's amazing to me to observe human behavior on a daily basis. I am intrigued with the psychology and neuroscience behind it so I will dedicate a post every once in a while to it.

I fancy myself an amateur neuroscientist as I think every person who works in the Allied Medical field should be as well. As providers of health care, our understanding of human behavior needs to be more than the average citizen. To understand someone in Mind, Body and Spirit is to understand than as whole being. Afterall, that is who we are.

Introduction of Applied Functional Science

Applied Functional Science is the convergence of Physical Sciences, Biological Sciences, and Behavioral Sciences that consists of the Principles-Strategies-Techniques process for functional assessment, training and conditioning, rehabilitation, and injury prevention that is practical for any and all individuals regardless of age or ability.



Applied Functional Science is based on scientific truths that serve as the foundation of the process. These principles, integrated with neuromusculoskeletal Chain Reaction™ biomechanics, lead to powerful strategies that guide the decision-making process.


Applied Functional Science strategies are employed to properly and successfully manage transformational environments, utilizing effective and efficient techniques for desired purposes.


For more information on Applied Functional Science, go to www.grayinstitute.com . If you are really serious about learning Functional Rehabilitation, Training and Conditioning and Injury Prevention, consider becoming a Fellow of Applied Function Science with GIFT program. It is the best program out there with amazing faculty and colleagues.

The Wisdom of Pooh-Bear

Pooh: Oh bother! Why am I sitting on this tree stump trying to make my leg go straight with Piglet hanging onto my ankle?


Owl: So Rabbit and I can calculate how strong your leg is.

Rabbit: Extending a Piglet twenty times means you have a strong leg for a bear.

Piglet: It is hard to hang on. I hope I don't fall off when you make your leg go fast.

Eeyore: This all looks very boring to me.

Pooh: But this is not what the leg of a Pooh Bear does.

Owl: And what, may I ask, do you mean by that?

Pooh: Well, the leg of a Pooh Bear likes to balance while reaching for a jar of honey, likes to squat down to play sticks with Piglet, likes to lunge back during tug-a-war with Eeyore, likes to climb the three steps to visit with Owl, likes to jump over logs in the forest with Tigger and likes to play hop games with Rabbit.

Tigger: Oh, thank you, Pooh. I like jumping with you, too...that's what Tiggers do best, you know.

Owl: May be if Piglet lets go of your ankle and you get up off the slump we can see what the leg of a Pooh Bear can do.

Rabbit: But there will be nothing to calculate, nothing to count, nothing to time, nothing to measure.

Pooh: It seems if you let my leg do what it likes, you could measure it while it likes what it does.

Tigger: You mean like jumping with me, hopping with Rabbit, tugging on Eeyore and squatting with Piglet?

Eeyore: Everyone is always tugging on my tail.

Pooh: and specially balancing while reaching for a jar of honey...just the thought of all this makes me very hungry, indeed.

Owl: Maybe there is a way to measure all the things your leg likes to do. I really enjoy it when you climb up the steps into the tree to visit me...maybe next time we can count the steps.

Rabbit: I would like to see how far and how fast we can jump together...that's what we do best, you know.

Eeyore: I'll bet you will want to lunge as far as you can to see how far back you can pull me by my tail.

Pooh: I wonder how long I can balance and how far I can reach for a jar of honey?

Rabbit: It seems like there is going to be a lot of things to measure if we are going to measure all the things the leg of a Pooh Bear likes to do.

Piglet: But what am I going to do now that I am not hanging onto the ankle of a Pooh Bear?

Pooh: Oh, Piglet, now you can hang onto the hand of a Pooh Bear and the rest of your friends and join in on all the fun.


--Gary Gray, PT
 
(Borrowed from http://www.backtofunction.blogspot.com/)

Introduction to the 3-D Knee

(Technical level: Beginner-Intermediate)

Greetings all!!!

I will have to say that I'm very fortunate to have all the friends I have in my life. These friends have helped me when I was down and couldn't manage to do things on my own. My family is the same way. They both take hits for me. I feel blessed, and sometimes I feel like I take advantage of their generosity.

Well, the knee is the same way. The knee is the hit taker for the hips and the ankle. It's "caught between a rock and a hard place with no place to go." When the foot or the hip are not doing their jobs, the good ole' knee steps up and picks up the slack for them. However, because the knee is so generous it can even take the hit for a gunked up thoracic spine or a weak core musculature.

I find that in my practice, the biggest complaint is lower back pain followed by a very close knee pain. Knee pain comes in so many forms from a plethora of reasons like structural deformities, trauma, overuse, etc. I strongly believe that many of these injuries can be prevented or the serverity of the injury lessened with a knowledge and application of functional anatomy and Chain Reaction Biomechanics.

FUNCTIONAL ANATOMY:
I've heard the knee described as a "poorly designed structure." WHOA!!! Everytime I hear that I ask people why they say that? The answer I usally get is some derivation of "it's so easily injured" or "it's unstable". Well, I personally believe nothing could be further from the truth. The WISDOM of the body and WISDOM of whoever designed the body, definitely did not stop at the knee. If we look use our Applied Functional Science 3-D glasses, we can see the magic of the knee. Here's a quick anatomical snapshot of the knee:

Bones: Tibia and Femur and Femur and Patella
Major Ligaments: Anterior and Posterior Cruciate Ligaments (ACL and PCL), Medial and Lateral Collateral Ligaments (MCL and LCL), Patellar Ligament (aka Patella tendon)
Cartilage: Extenal and Internal Firbro-cartilage or the MENISCUS (plural: Menisci) and Hyaline Cartilage
Bursae: 14 various bursae located throught the knee complex
Nerves: Innervated by the Femoral, Obturator and Sciatic nerves
Major Muscles that cross the knee: Quadriceps, Hamstrings, Gluteus Maximus, Tensor Fascia Latae, Sartorius, Gracilis, Poplitieus, Gastrocnemius



CHAIN REACTION BIOMECHANICS:
Looking at the knee we see that it is a 3-D joint that moves in 3 planes of motion. However, the knee is interesting in that many people only see and appreciate the flexion/extension motions of the knee. I believe that is because those two motions are the ones that we PREDOMINATELY see, but that does not mean that the other motions are not as important if not more important to the knee and throughout the body. Here's what happens at the knee in walking in the front leg.

Sagital Plane: Because the ankle is going through dorsiflexion and the hip is going through flexion, we have KNEE FLEXION or bending.
Frontal Plane: Because the  foot is going through eversion and the hip is going through adduction, we have KNEE ABUDCTION or shifting in towards the midline of the body.
Transverse Plane: Because the foot and lower leg are internally rotating and the femur is internally rotating but the the tibia is rotating faster than the femur, we get KNEE INTERNAL ROTATION or rotating inward.

These movements in the frontal and transverse planes are more subtle especially the frontal plane motion but the motion should be there. If not, we may be getting into a situation where the other two planes are having to absorb the frontal plane motion in their plane and overtime, that can lead to an overuse injury. Yes, the knee can be its own best friend and take a hit for itself but just in another plane of motion. Crazy, huh!?!!?

As the leg in wallking goes to being the back leg, the sagital and frontal plane motions are reversed, but the transverse plane motion remains the same.

Now this is not as complex as it seems. The body moves in a rhythm. When the natural rhythm is off, then you get into a place where something has to take the hit for the dysynchrony. In my experience, its either the lower back or the knee that is taken the hit for the foot, hip or thoracic spine.

As I stated before, there are MANY injuries that can happen to the knee. Tendonitis, ACL tears, patellafemoral pain syndrome, IT band syndrome, bursitis, etc. The list goes on and on unfortunately. Having a basic understanding of the knee and its biomechanics, allows us to create functional strategies and techniques for prevention, training and conditioning and rehabiliation if necessary.

FUNCTIONAL STRATEGY AND TECHNIQUE:
This is not a subsitution for medical advice. Check with your physician before you begin any new movenment program.

Let's say that an athlete with knee tendonitis has been cleared by a doctor and PT to return to activity at a decreased level but still needs to continue some work to decrease the pain further and strengthen the muscles of the knee. Well, would it help to go right to the knee and focus on it? Well, with what you know, the knee is the friend who takes the hit for its friends the foot and hip. It's stuck between a rock and hard plaace with nowhere to go. Yes, continue having the athlete ice their knees if the tendonitis is persistent and reduce unneccesary physical activity. We have our athletes use THE STICK, which is basically a tool that you can use to self-massage. (Click on the link to learn more)

To begin, I'd choose either the foot or the hip to start. Because i have been discussin the hip, lets pick that one. A GREAT way to get started is the KNEELING MATRIX. (will post as soon as I can find my digital camcorder cord). The kneeling matrix will focus on the mobility of the hip. I suggest you put either a foam mat, towel, blanket, yoga mat (triple folded) under the knee so that you will be smashing your knee into the hard floor for a extended period of time. Hold each stretch for at least 30 seconds and then do 10-15 oscillations from mid to almost end range. After you do that for BOTH legs, go through a very simple and easy LUNGE MATRIX. Just step between intial and mid range reaching both hands down and away from your knees about 12 inches. This lunge matrix will help to mobilize the hips and load and unload the neuromuscular system.  If any of these lunges hurt, stop that lunge immediately. Do not aggregate that knee anymore.

After you do that work, you can ice and rest. This is a very basic but powerful strategy and technique that you can use.

I hope this introduction helps. The knee is really a great friend as I'm sure many of you are to your friends. Sometimes, we have to understand where our friends are coming from to be able to assist them better and vice versa. There may be times when you are asking for a lot from your friends and they put a lot of energy and effort into assisting you and other times it may be the other way around. However, as we tap into our wisdom, we realize that after a while, someone is going to get worn down from assisting their friend in need. At that time, the worn down friend needs to back up, take a moment to rest and then devise other strategies that will help our friend in need. Maybe we have given them all the help we can and its time to go in a different direction.

Our knee is the same way. Sometimes it needs a time to rest, heal and have its friends the foot or hip, take a look at themselves and say "Hey! I am not doing all I can to help the rest of the body and my little buddy the knee is really getting beat up. What can be done for us to make us more successful? Maybe if the person we live inside would mobilize then strengthen us in the 3 planes of motion, we could be a better help to everyone." You would be surprised what a little 3-d loving will get you.

Happy Thursday!

Will

3-D Hips with a focus on the capsular ligaments

(Technical level: Intermediate-Advanced)

In case you haven't noticed, I'm a HIP guy. Not the "cool" hip though. However, I am trying.

As we make our way through the body, I thought the first station we should stop at is the Hip and my last two posts have been about the joint itself and then I started digging into the muscles with the iliopsoas. This post, I am going to dig a little bit deeper with the anatomy of the  ligaments of the hip and their 3-D functional function.

When we loook at the hip, we see a bunch of muscles that are very important to its function. We even take a good look at the hip joint itself and the arthrokinematics or joint motion as it relates to function.  I unfortunately came to an understanding of the LIGAMENTS of the hip capsule very late in my career. Of course, throughout my education, I understood the "ligaments connect bone to bone" phrase,and I left it at that. Well, that was a huge mistake for me because ligaments do so much more than just that.