The Bodywise Blog

Patello-Femoral Pain Syndrome is one of the most common sources of knee pain out there. It’s characterized by improper motion of the knee cap relative to the upper and lower leg bones. PFPS usually presents with pain around the knee cap during weigh-bearing and bending as well as generalized weakness in the area. PFPS is primarily an alignment issue.

The knee cap has a very specific path it is supposed to follow during knee bending. If the tissues that attach to the knee cap don’t pull with proper force and in proper proportion, the result is poor tracking of the knee cap, increased wear-and- tear and pain. PFPS tends to just get worse with time, and can lead to other issues of the knee as well, including but not limited to chondromalacia patella which is a softening and wearing away of the articular cartilage on the under-surface of the knee cap. Poor alignment and stability at the foot, ankle, knee and hip are the usual culprits leading to PFPS.

The good news is, in many cases, most of if not all the issues leading to PFPS can be corrected through bodywork and corrective exercise, that is to say, non-surgically.Varying combinations of imbalance can lead to a knee cap that’s too high (patella alta), too low (patella baja), tips to one side or towards the top/bottom (patellar tilting), rotates to one side or most commonly, tracks to one side. With lateral tracking (by far the most common tracking variation), imbalances among the quadriceps, groin and ilio-tibial (I.T.) band are the usual suspects.

Refer to my article on Self-Mysofascial Release for tips on how to release these areas. Areas to strengthen include the outside of the hip, the hip rotators and most importantly, the portion of the inner muscle of the quadriceps (thigh) group that’s closest to the knee, the vastus medialis obliquus.After doing all the release and strength work, all that remains is improving hip, knee, ankle and foot coordination through dynamic, unstable and multi-planar exercises. This usually does the trick. If you think you may have PFPS or want tips on how to address it, contact me.

Shin splints are an interesting condition… mainly in that they’re not an actually condition. “Shin splints” is a generic term for a number of different conditions that cause pain of the lower leg. Different types include: anterior tibial shin splints, posterior tibial shin splints, stress fractures, periostitis and tendinitis. The cause and treatment varies depending on what type you have.

Perhaps the most common type is anterior tibial shin splints. With anterior tibial shin splints, the muscle on the front of the shin becomes tight and painful, often limiting activity. Often times anterior tibial shin splints arise from running or other high impact activities, particularly those performed on an incline, like uphill running. Generally speaking, anterior tibial shin splints are caused by tightness of the calf muscles which not only makes the anterior tibialis muscle have to work harder to lift the foot but actually impairs it at the same time. This leads to tightness, cramping, and inflammation of the anterior tibialis and its tendon.

Contributing factors to anterior tibial shin splints includes hyperextended knees, poor ankle stability, flat feet and knock knees. Treating them is usually pretty simple. Stretch the calves, strengthen the shins, get better footwear with adequate arch support, and REST. Throw in some stability-building exercises for the ankles and hips and you’ll likely be home free. However, some cases will prove more stubborn and require additional interventions.

Sit up straight. Shoulders back. We’ve all heard it before, but why is it important? Posture isn’t just about looking better and more confident… it’s about our bodies working better. To better understand how this works, we have to know a little bit more about how muscles work.

Interlace your fingers and slide your fingers apart and together. Your fingers represent the protein filaments involved in muscle contraction and relaxation and this visual gives you a basic idea of how muscles move. Muscles are at their best, at their strongest, when there is not too little overlap (a stretched muscle) or too much overlap (a shortened muscle). They have an ideal length and an ideal tension at which they and the surrounding tissues function best.

In poor posture, we have chronically shorted and chronically lengthened muscles which alter the way our bodies work, increasing the stress to our soft tissues and to our joints. For every shortened muscle, there will be at least one lengthened muscle, though usually many. These shortened muscles are prone to over-activity and often not very strong. The lengthened muscles are typically weak and under-active. The problems don’t end there.

These weak or under-active muscles are unable to perform their designated functions effectively, so the body must compensate. In a phenomena known as synergistic dominance, the body selects muscles with similar or shared functions to compensate for the weakened muscles. They’re never as efficient at those particular functions as the primary muscles and often become strained or overused as a result.

All these altered muscle lengths, tensions and functions also alter the mechanics at the joints which these muscles affect. This can lead to increased wear and tear on our joints. The combined effect of all this dysfunction is altered muscle recruitment patterns, increased tissue stresses, and a predisposition to injury. So what do we do about it?

Unfortunately, it’s not as simple as sit up straight, shoulders back, chin up. Shortened, over-active muscles inhibit opposing muscles through a phenomena known as reciprocal inhibition. This means that when you attempt to pull those shoulders back, it will be difficult to do so using the proper muscles because the tight muscles which are holding your shoulders forward are inhibiting them. So what do you do? The process for correcting posture is a long one, but it can be done. It’s a three-step process. First, you have to stretch and/or release those shortened, overactive muscles to allow proper functioning of the inhibited muscles. Next, you need to target the lengthened and inhibited muscles for strengthening using specific exercises. These two steps give one the ability to maintain good posture, but that doesn’t mean we know how. In the final step, we must re-train our nervous systems to operate in ideal posture. This is where the whole sit up straight, shoulders back stuff comes into play. This is where it’s actually useful.

To have your posture assessed and for more details on how to improve your posture, contact me for a free consultation.

Thoracic Outlet Syndrome (TOS) is a condition whereby blood vessels and/or nerves are impinged at the area around the base of the neck and/or the top of the shoulder. Symptoms include pain, numbness, tingling or coldness in the arm, hand or fingers. Frequently the symptoms are similar to Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome (CTS) is impingement of the median nerve at the wrist. TOS can present with identical symptoms and is often mistaken for CTS. With TOS, blockage can occur an numerous locations other than the wrist, though primarily between the scalene muscles of the neck and/or between the collarbone and first rib. Other areas that can cause similar symptoms but aren’t technically TOS are spinal nerve impingement in the neck, and nerve impingements at the elbow and forearm. One of the most common complaints with TOS is waking up with numbness in the arm or hand.

Thoracic Outlet Syndrome is usually easily corrected by addressing muscle imbalances of the neck, shoulder, and arm, addressing repetitive stresses and improving rib/spine mobility. However, it is common practice in the allopathic medical community to address TOS surgically by removing the first rib. You read that right… removing a rib.

If any of the above symptoms sound familiar to you or you’ve received a diagnosis of TOS or Carpal Tunnel Syndrome and would like a free evalutation, give me a call.

Stress headaches. Sinus headaches. Tension headaches. Migraines. We’ve all heard the terms before, but what’s the difference? In short… nothing. All of these common ailments are really the same thing… migraines. That is to say they are all caused by what’s known as the migraine mechanism. The difference is in their symptoms.

In the migraine mechanism, blood vessels in the brain become inflamed and dilated, causing decreased blood pressure to the brain. This can cause myriad symptoms, ranging from your stereotypical throbbing migraine to visual artifacts or something as innocuous as “cloudy” thinking. It’s all migraine.

The causes of migraine are many… far too many for a simple article such as this. There exist what are known as migraine “triggers.” These are substances, foods, or even actions which increase the likelihood of having a migraine. Each of us has our own trigger threshold and we all respond differently to our own unique triggers. As long as the aggregate of our trigger exposures remains below our threshold, we have no migraines. Once our trigger load goes above threshold…. bam! Migraine. Some triggers have an immediate effect, others can take days or even a week to have their effect. While we may all have our own unique migraine triggers, some are more common than others.

Among the most common triggers, and those over which we have the most control, are the dietary triggers. There are hundreds of potential dietary triggers, but among the most potent are caffeine, alcohol and monosodium glutamate. Any alcoholic beverage is a potential trigger, but red wines are the most notorious, as they contain high levels of sulfites, a notorious migraine trigger. Caffeine is perhaps the most potent of the migraine triggers and one of the most commonly consumed. The irony here is that caffeine is a staple ingredient in over-the-counter migraine/headache remedies. The caffeine causes constriction of those dilated blood vessels in the brain, affording temporary relief. Unfortunately, caffeine, in addition to being a migraine trigger, is a rebound drug… that is to say while it make relieve the headache you have NOW, it makes you more likely to have a WORSE headache LATER. It’s a vicious cycle. Monosodium glutamate, or MSG, is a common food additive. It’s an effective flavor enhancer and is thought it some culinary circles to be the sole way of acheiving what’s known as “umami”. There are five cardinal flavors: sweet, salty, sour, bitter and umami, or savory. MSG is also thought to be the most potent dietary migraine trigger of all. It’s also a known carcinogen among other things. Restaurants and food manufactures must clearly state if they add MSG to your food. So if you receive no such warning, your safe, right? Not so fast. They have to advise you if they’ve added MSG… they don’t have to tell you if MSG naturally occurs in whatever they’re serving you. Soy sauce contains MSG, as does any other fermented soy product. In fact, the entire family of so called glutamates are migraine triggers. MSG also is a naturally biproduct in hydrolyzed proteins, a common food additive. It’s harder to avoid than you may think.

So what do we do about it? Well, it’s a process… a highly effective, if not lengthy, process. It involves elimination of triggers with their gradual reintroduction so as to be able to identify your own most potent triggers, then eliminating those permanently. Also involved is raising your trigger threshold, making migraines harder to get. The techniques behind all of that are beyond the scope of this article, but can be found in an awesome book called Heal Your Headache, by Dr. David Bucholz. I can’t recommend it enough. Happy reading.