Common Training Troubles – Neck

I spent time this week working with two separate clients to help them manage their neck pain and stiffness. Both of these individuals get headache symptoms when their neck gets bad, so they’re very motivated to make improvement.

Sitting atop the rest of the body, your head and neck are subjected to a lot of different loads and forces, depending on how you move and carry yourself. Think about it. Through your vision and balance mechanisms, your head is always trying to right itself and stay level. If your pelvis is unlevel, you have stooped, forward posture, or your overall movement is off-balance and erratic, your head and neck are going to have to compensate.

Additionally, because of our jobs and technology like computers and smart phones, most of us spend time in a position of forward head carriage, which overloads the muscles of the neck and upper back. Any time the head or neck is out of neutral alignment, some muscles are getting an opportunity to shorten and tighten, while others become overstretched, creating muscle imbalance.

It’s usually not very effective to address problems at the extremities without discussing the body’s central stability and power centers of the core and pelvis. I’m going to assume you’ve been reading my earlier columns, and have taken a good look at your overall posture and alignment, while working to develop good neutral spine and pelvic positioning and core function.

When exercising, always remember to perform a progressive warm-up beforehand, and be sure to get medical approval before starting a new fitness program. Because the neck can be particularly sensitive or unstable, I always recommend very slow and careful progression of any movements. Be sure to stop if you feel anything negative, like pain, dizziness or numbness or tingling in your limbs.

Knowledge – More than any other area of the body, it’s important to know exactly what is going on with your neck. Because of the high degree of mobility of the joints in your cervical spine, and the complicated spider-web of muscles and other connective tissue in the area, there is a lot that can happen in this region, and a lot that can go wrong. Without any prior knowledge, I’ve had clients who’ve had X-rays of their spine reveal significant misalignment of the bones in the neck, with advanced degenerative changes, including bone spurs, reduced joint spaces and so on.

In instances like this, I’ve heard the rationale of ‘if it isn’t broken, don’t fix it’, meaning that if the person with the degenerative neck isn’t experiencing pain or discomfort, why change anything. My rationale is always the same. It’s only a matter of time before the stress that has caused the physical changes to the neck results in some kind of serious, acute incident. Why not get a thorough assessment by someone you trust, and begin to change your lifestyle and exercise habits to improve your neck, rather than letting it get worse? This includes focusing on your posture and head position as much as possible.

Treatment – I fully appreciate how fragile you can feel when your neck gets very bad and you’re experiencing sharp pain and headaches. If you’ve already had a thorough diagnosis and are aware of problems with the bones, joints or disks in your cervical spine, it can be very daunting to try to exercise your neck. However, just like any other part of the body, if you don’t use it, your neck will get less and less healthy.

For acute neck issues you may need to ice the injured area, or possibly taking anti-inflammatory medications. I also recommend the help of a good physiotherapist or chiropractor to manage the acute injury. Very gentle flexibility and range of motion activities, can really help to loosen a painful neck. For chronic tension in the muscles, try applying heat, or rolling the muscles on a roller or small ball.

Prevention – One of the best ways to avoid neck problems is to pay close attention to your overall body alignment during your daily activities. For example, I use an excellent ergonomic chair and keyboard when I sit to write my columns, and take frequent micro-breaks to move my body and reset my alignment. When you’re exercising, always use good body position and core function strategies to improve your movement efficiency.

Another key point is to remember to focus on balanced flexibility and strength in your neck. Regularly performing light range of motion movements and stretches should help your mobility, and it’s very easy to perform gentle strengthening exercises in a variety of directions using only the pressure of your hand. Of course you want to be sure that your cervical alignment is healthy and stable before doing any resisted work with your neck, so as to avoid any risk of injury or complications.

–Rob Williams is a kinesiologist, elite personal trainer and posture specialist. He has been practicing for 16 years and currently operates an exclusive private training studio Mixx Fitness Studio, with a team of 10 trainers, as well as a multi-disciplinary posture facility, Performance Posture Clinic. Rob is an accomplished writer and speaker in the fields of fitness, posture and nutrition, and can be contacted at Williams Health Group.

Common training troubles – Ankles

As an ex-soccer and football player, my feet and ankles have taken their fair share of abuse. I’ve had broken toes, sprains, strains and numerous other injuries. Even though the majority of these problems are no longer an issue, I still have difficulty with my ankles, mostly because of impingement in the joint at the front of the ankle.

One of my good clients, Jeff McCord, has also been struggling with ankle problems. After a recent accident, Jeff now gets intermittent pain in the front of his ankle joints. Everything might seem fine, and then he’ll make one wrong move (usually the rear foot when Jeff is lunging) and he’ll get a sharp, stabbing pain at the front of the joint. Other favorite activities like water skiing are next to impossible because of the anterior shear forces that jam his ankle joints and cause pain.

For Jeff, regular stretching, strengthening and maintenance of the alignment of the bones in the ankle and throughout his body are important to improving the function of this joint. Fortunately he gets help with this from some great practitioners. Without this management, muscle imbalance in the lower legs would increase the likelihood of this issue becoming a more chronic, painful condition.

Problems at the ankles and feet frequently arise in people who’ve had recurring ankle sprains, or other injuries that weren’t rehabilitated properly. Like any other joint in the body, trauma and immobility will compromise function and increase the chances of re-injury. By bringing awareness to the importance of diagnosis, treatment and prevention, hopefully I can help many people to manage ankle injuries, and stop even more people from ever experiencing one.

When exercising, always remember to perform a progressive warm-up beforehand, and be sure to get medical approval before starting a new fitness program.

Knowledge – Anyone can have ankle issues, and there are many conditions that could be involved. Because of the number of bones in the foot, as well as the need for the ankle joint to move freely in many directions, while under the load of your body, it’s possible to create serious injuries from small missteps or faulty movements. Most of us have ‘rolled’ an ankle at some point in our lives. Most of the time there is no real injury, but serious damage can happen in a split second.

If you have suffered an ankle injury, or struggle through life with ankle pain or immobility, it’s definitely worth getting an accurate diagnosis of which structures are involves. With my own ankles, the hyper-mobility in the joints can allow either ankle to become misaligned when doing something as simple as jogging across the street. I know what happens, what causes it, and what can be done about it. If I ignore the problem it can last for days or weeks and cause me constant discomfort. Usually a single joint manipulation by my chiropractor corrects the problem and I don’t have any further troubles.

Treatment – Ankle issues can be more common than you might expect. And you may not know it, but many people actually end up having ankle replacement surgery if the problem is bad enough. Assuming you’re not a candidate for surgery, there are numerous approaches to management and rehabilitation that can be very effective and help you get back on your feet in no time.

Depending on the exact cause of your ankle pain, you may have a slightly different treatment approach, but it’s an excellent idea to start with reducing the inflammation. This is usually done by icing the injured area, and possibly taking anti-inflammatory medications. Sometimes the help of a good physiotherapist or chiropractor is necessary to manage the acute injury, followed by flexibility and range of motion activities, as well as balance, proprioception and strength exercises. Fortunately there are advanced products like the Ankle Foot MaXimizer (AFX) to help properly strengthen all of the smaller muscles around the area.

Prevention – I used to have more trouble with my ankles and feet, but this has been reduced since I started to really pay attention to my alignment when standing and walking, and my overall foot function. I regularly strengthen the smaller intrinsic muscles in this area, and perform as many barefoot activities as possible. Sometimes these are as simple as doing one-legged toe raises. If you’re going to try this, diligent attention to your ankle and foot alignment is essential.

Another key point is to remember to focus on balance in your training. When I get carried away with too much calf training and not enough training for the muscles in the front of my lower leg, I know I’m always at increased risk for my ankles to act up. Keeping all of the muscles in the lower leg flexible and strong goes a long way. It’s also important to pay attention to your footwear to make sure that old, worn out shoes aren’t promoting poor alignment.

Common training troubles – Hips

I’ve been moving around the body a bit when discussing common trouble areas, first starting at the lower back, then addressing the shoulders and knees, and arriving this week at the hips. Each week I’m getting a growing number of emails from readers looking for help and guidance with their own specific issues.

Some of the people who have emailed, and a number of my current clients, have hip troubles. The issues range in severity, but all should be properly managed. Because the hip joint is so large and central to the body, it supports a lot of weight and takes much of the load during walking, running, and sports. When one or both hip joints become dysfunctional for any reason, movement patterns are often interrupted and other serious issues develop.

My good friend Bobby Lenarduzzi was referred to me almost 5 years ago because of hip pain. After a world-class soccer career that ended two decades ago, Bobby hadn’t done much regular exercise aside from jogging.

When he was diagnosed with a congenital joint condition, Bobby trained hard to get in good shape in order to delay surgery as long as possible, and improve his post-operative outcome. After a necessary hip replacement surgery he has again worked very hard on his rehab. Bobby is now very fit and athletic and credits his training for this success. He’s also seen a positive change in his overall outlook and motivation despite his hip condition.

Because his other hip is showing signs of similar issues, Bobby knows he must maintain his strength, flexibility and overall athleticism. With one artificial hip, and another that will likely need to be replaced in the future, Bobby is getting in better shape every day.

When working your hips, always remember to perform a progressive warm-up beforehand, and get medical approval before beginning a new fitness program.

Knowledge – Hips can be tricky. Although this is a relatively simple joint in terms of it’s anatomy, the function of the joint can be influenced by many factors, and there are numerous things that can go wrong. There are also congenital conditions that can cause the hip joint to be less stable than ideal, which often results in early degenerative changes. No matter how it starts, if you’re dealing with hip trouble, be sure to get a thorough assessment by a trusted practitioner. Once you’ve determined the cause, an effective management strategy can be put in place for your hips.

One reliable indicator of hip function, and the health of the hip joints, is the available range of motion during rotation. A healthy hip joint will have a decent amount of rotation, both inward and outward. This is often assessed in a position of hip flexion, with the subject lying on their back. Total range of motion of 70-80˚ or more is ideal. Usually there is more rotation outward than inward, and the movement should be relatively smooth and pain-free. If there is restricted mobility in any/all of the four directions, or pinching pain in the joint during movement, there can be an increased risk of joint issues.

Treatment – Whether you’ve had a new diagnosis of hip problems, or you’ve been struggling with painful joint degeneration for years, I believe that improved flexibility and strength can reduce pain and dysfunction. When you couple this with better body position, core function and movement quality during all activities, you can’t help but be successful in improving your overall comfort and mobility.

Start by taking the time to stretch all of the muscles around your hips, legs and pelvis. Simply balancing this muscle tension can reduce the compressive forces at the joint and reduce inflammation. Then, find ways to perform the most basic strengthening exercises, as long as they fatigue your muscles but don’t cause joint pain. Even little 3” squatting movements can strengthen and stabilize your body and help your joints. Focus on core stability, balance and symmetrical body position as much as possible to limit any tendency to compensate for a weaker hip.

Prevention – I feel the best way to address the topic of prevention is to look at what we’re doing with Bobby to delay further degeneration of his ‘good’ hip. I know Bobby won’t mind me revealing that he isn’t the most flexible guy around. Today we spend a good portion of our training sessions focusing on mobility in his hip joints. As we continue seeing progress in his flexibility and joint mobility, we also work on his posture, functional strength and athletic movement quality.

We carefully manage the rest of Bobby’s body with regular chiropractic care for his structural health, and Active Release Technique^tm for his soft tissues. This doesn’t mean that everyone with hip pain needs a team of trained practitioners working on them weekly, but it emphasizes the importance of diligent care of your body for optimal function.

Common training troubles – Knees

After my last columns on the problem areas of the lower back and shoulder, I couldn’t decide what should be number three on my list of common training troubles. One of my clients helped me to decide that knees should get the nod.

A year ago Wayne Deans’ right knee was swollen, painful and debilitating. After an MRI his doctor told him he had no cartilage left on the joint surfaces, and he needed joint replacement surgery. I’m going to share how he’s been able to avoid surgery so far, and at 66 years old, is currently very active and 100% pain-free.

The knee is a relatively simple hinge joint, but it does have its share of problems. Because of the amount of stress we impose on our knees through weight-bearing activities like running, cycling, golf and skiing, the internal structures of the joint can become damaged and worn. This leads to painful, progressive conditions like arthritis. In Wayne’s case, years of high-level competition in hockey, squash and triathlons had taken their toll.

In addition to wear and tear, acute knee injuries are common. Torn cartilage or ruptured ligaments can happen to anyone, at almost any time, and will often need surgical repair. I’ve had a major knee reconstructive surgery myself, as a result of a soccer injury. It was performed 25 years ago by Dr. Brian Day, and because I saw the top surgeon and was diligent about my rehabilitation, the knee has been 100% functional since.

In the case of Wayne, myself, and dozens of other clients, the most important aspect of managing knee injuries is to minimize the stress to the joints through proper body position and movement strategies, while optimizing strength and flexibility in the legs.

Always remember to perform a progressive warm-up before training or sports, and get medical approval before beginning a new fitness program.

Knowledge – It’s pretty hard to address a complicated, painful joint condition without knowing exactly what is causing the problem. A good practitioner can often accurately diagnose a knee condition through a detailed history and careful assessments, however appropriate imaging like X-ray or MRI is sometimes necessary. Once you’ve determined the cause, an effective management strategy can be put in place.

When I first injured my own knee, the sports medical practitioners in my hometown put me through almost 6 months of passive treatment, like ultrasound, etc. Every time I would try to play sports I would re-injure the knee and it would swell up like a balloon. Finally I came to Vancouver to see Dr. Day and in 2 minutes he told me that my ligament was ruptured and I would need surgical repair. All the therapy in the world wouldn’t have made a difference. The right diagnosis was essential.

 

Treatment – Just like the other areas that I’ve discussed, if you do have a knee problem, whether acute or chronic, try to get an assessment and treatment by a qualified practitioner that you trust. Once you’ve learned the cause of your issue, I’m going to bet that a good portion of your treatment plan will include strengthening the muscles that support the knee joint, and stretching the muscles that surround it.

Even in a condition like Wayne’s, where the joint is seriously worn and the bone-on-bone contact is causing pain and inflammation, a simplified approach of improved strength and flexibility can yield great results. Where he used to have a 6-8” deficiency in the flexion of his right knee, Wayne has worked hard to achieve full range of motion, getting his heel to his buttocks. We’ve also re-programmed how he stands and moves to properly utilize his muscles and joints. Through a combination of better body position, core function and movement quality, Wayne now uses the correct muscles, which keep his knees healthy rather than harming them.

Prevention – What can you do if you’ve never had a serious knee issue, and want to avoid them? As far as I’m concerned maintaining strong, flexible legs should give you the best chance of living your life with healthy knees. Of equal importance is making sure you move your body in a way that doesn’t cause wear and tear. I’ll use Wayne as an example again. As part of my assessment I determined that every time Wayne transferred his weight onto his right leg, his glute and hip musculature was less active than it should be. This allowed his pelvis to slide too far outward, rather than staying in line with his body, and put too much weight forward onto the ball of his foot. This shift of the pelvis off-loaded his strong, stable hip joint and transferred excessive load and rotational stress to the knee joint. Every step was aggravating his knee. Changing this pattern has been a big part of his success.

Common training troubles – Save your shoulders

When it comes to keeping your body healthy and pain-free, there are a few target areas that I feel should get a little more attention than others. The lower back, which I discussed last week, has to be number one on the list. Shoulders are a close second.

The shoulder is a fairly complicated and unstable joint. It doesn’t have a lot of security provided by the bony structures, so it relies on soft tissues like the small rotator cuff muscles to help keep it safe and strong. I would estimate that 80-90% of my training clients over the years have presented with some degree of shoulder problems. Sometimes this is from an acute injury, but most often it’s a problem that has developed slowly and nagged them for a long time.

Throughout my own sport and exercise career I’ve probably had more issues with my shoulders than any other body-part. A lot of this involved injuries caused by soccer, football or heavy weight training, but I’ve also had a lot of chronic pain from tendonitis, impingement and so on. The thing that I’ve learned from dealing with my clients, and my own issues, is that the majority of chronic shoulder problems don’t usually originate at the shoulder joint.

To effectively prevent, manage and improve shoulder problems, it’s important to understand how the shoulder joint works, and how the function of the rest of your body is contributing to any problems you might have. With this understanding you can proceed in the right direction toward building strong, healthy shoulders.

Always remember to perform a progressive warm-up before training or sports, and get medical approval before beginning a new fitness program, especially if you have a history of lower back pain or injury.

Knowledge – As mentioned earlier, it helps to be knowledgeable about your existing condition, and the rest of your body, when you’re trying to improve your shoulders. Having a thorough assessment by someone with a good working knowledge of shoulder mechanics and overall body function can be invaluable. Because of the shape and mechanics of the structures in the shoulder, avoiding certain positions or movements could be important for you, but not for someone else who has shoulder pain for an entirely different reason.

In a lot of cases shoulder pain can result from compromised spacing inside the shoulder joint. This space, which is usually around 10mm in a healthy joint, can be reduced significantly by poor posture, muscle imbalance or faulty movement patterns. This can cause pinching of tissues like the rotator cuff tendons, producing inflammation, tearing and even rupture.

A simple test of flexibility and joint range of motion can usually reveal this condition. If you learn that one or both of your shoulders is in this state, there are a number of simple maintenance exercises to improve it.

 

Prevention – Once I learned what was causing the issues with my own shoulders I was able to train and play hard without problems. This has helped me to implement successful prevention and rehabilitation programs with many of my clients. Maintaining good posture is a huge factor in avoiding shoulder issues. By keeping your spine, ribcage and shoulder blades in the right position, your arms are fee to move without putting stress on your shoulder joints. Good flexibility throughout the body is also essential for shoulder function. Anytime your muscles restrict your movement, your joints usually suffer. Keep the muscles that surround and attach to your shoulder blades loose and balanced to ensure fluid motion at your joints. This can be done with stretching, massage or rolling out your muscles.

Another major factor in shoulder maintenance is the movement strategy that you use when pushing or pulling. At all times, focus on generating force from the center of your body. This should come from the middle of your chest when pushing, and between your shoulder blades when pulling. Doing this will engage the larger muscles and take strain off your shoulder joints.

Treatment – If you do have shoulder problems, whether acute or chronic, try to get an assessment and treatment by a qualified practitioner that you trust. I know from experience that Active Release Technique, known as A.R.T^tm is a remarkably effective treatment for long-term shoulder problems. If you start to feel pain in your shoulder joints during or after activity, be sure to rest the area immediately and do what you can to reduce inflammation to the injured tissues. I offered suggestions for this last week, including icing the area right after the injury occurs to reduce the level of pain and inflammation, trying homeopathic remedies or nonsteroidal anti-inflammatory drugs and/or pain-killers for comfort. Unfortunately too many people ignore shoulder issues when they’re small, which is how they become more serious.

 

 

Common Training Problems – Low Back Pain

Anyone who plays sports or exercises regularly has probably experienced a variety of common body ailments or pain syndromes. It’s pretty hard to use your body to it’s fullest potential without running into issues like shoulder pain, or lower back pain. In my own athletic and exercise career I’ve managed a good number of these injuries, and thought it might be helpful to share some insight.

Lower back pain is a very common condition. A prevalent statistic is that 80% of people will experience some degree of low back pain in their lives. Based on my own personal and professional experience I’ve got to think that the number is at least that high, if not higher.

The thing about back pain is that it can come in a variety of shapes and sizes, and for a lot of different reasons. My own back pains over the years have been related to pelvic malalignment due to a leg-length discrepancy. When I don’t train as regularly as I should, or I try to lift too heavy, I sometimes tweak my lower back and disrupt the alignment of my spine or sacrum (part of the pelvis). This happened to me recently and I spent most of the last weekend face down with ice on my back.

There are a number of things we all can do to help prevent lower back pain, as well as reduce the severity of an acute incident. With a good working knowledge of your own lower back you should be able to minimize the impact that back troubles have on your life.

Always remember to perform a progressive warm-up before training or sports, and get medical approval before beginning a new fitness program, especially if you have a history of lower back pain or injury.

Knowledge – Whether you’re trying to achieve great results with your fitness training program, improve your golf game, or avoid back pain, it helps to be knowledgeable about your existing condition. This knowledge usually comes in the form of baseline testing or assessments. Avoiding back pain is a lot easier if you know what movements or activities might be more stressful to your back, based on your own unique structure and anatomy. This is part of the rationale that we use during assessments at my training studio and posture clinic. Awareness of the condition of your spine, imbalances that exist or functional weaknesses can give you the knowledge that you need to fortify your body, or change your movement patterns. This, in turn, can help you to avoid problematic activities and back troubles. Even a test of flexibility and core muscle strength can shed a lot of light on potential weaknesses that might leave you vulnerable to lower back injury. I urge you to learn as much as you can about this important area of your body.

Prevention – There are a number of strategies for preventing lower back pain. Regular low impact aerobic exercises, like walking or swimming, are excellent for keeping muscles active and balanced while building strength and endurance. Building a strong core stabilization system is also very important. The core acts like a protective belt around your entire mid-section, and when it works properly it will enhance your movement while reducing stress to your body’s bones, joints and other tissues. Strength in your other muscles will help to make movement and lifting much less taxing on your lower back. It’s also very desirable to maintain good flexibility in your hips and upper legs, to allow for good postural alignment and un-restricted movement. And remember that being overweight puts additional strain on your lower back, as well as other joints and structures of your body, so work hard to maintain a healthy weight for your body.

Treatment – If you do experience an acute episode of lower back pain, try to get an assessment and/or treatment by a chiropractor, physiotherapist, or other qualified practitioner that you trust. The right treatment can reduce a seriously troublesome lower back episode to nothing more than a day or two of mild discomfort. I know this from my own repeated experience, and I can’t understand why people wait weeks to see if their pain goes away on it’s own. If you can’t see a practitioner right away, be sure to rest the area immediately and do what you can to reduce inflammation to the injured tissues. Icing the area right after the injury occurs can make a big difference in reducing the level of pain and inflammation. Many specialists also recommend nonsteroidal anti-inflammatory drugs and/or pain-killers for comfort. There are also a number of homeopathic remedies that might help. Overall, it’s important not to over-react, but to take the matter seriously.