The Mysterious Pain

Spine Flexion

Oh woe – spinal flexion

I had a client come this week with low back pain among other things. She dutifully pulled out her latest MRI results for me to study. I had to tell her that:
a) I’m not medically trained to interpret lab results (although I find them interesting, always ask for a copy and then google the hell out of it)
b) I’m not allowed to “treat” specific ailments as a personal trainer
c) MRI results can be very misleading.

Let me explain.

First of all, when we have a pain, we really would love to know the source of that pain. We go to the doctor and ask for a diagnostic test so that we can “see” inside the body and thus, find the culprit. Once that culprit is identified, we can treat accordingly. Some treatments include:

  • rest
  • anti-inflammatories or other pain relieving drugs and injections
  • surgery
  • physical therapy
  • massage or other hands-on manual therapy
  • exercise

Officially (and legally) I fall into that last category. Restorative Exercise™ is still exercise, even though we define “exercise” and “movement” separately and I consider what I do more analytical than a traditional strengthening protocol.

As well, sometimes when we think we have an answer, we stop looking. That becomes “the story” and also sometimes, our excuse. I can’t do “x” because I have a slipped disc – even if that slipped disc happened many years ago. The story becomes our history. It starts to define us, and then we behave differently than if we didn’t have that story. We move differently, make different choices. Also, it is well known that many people will exhibit pathological findings on an MRI and be non-symptomatic, or, be symptomatic with no pathological implications on MRI type diagnostics. So just how reliable are those tests?

As a low back pain sufferer myself for decades, I know that exercise in the traditional sense did not alleviate my symptoms. I was told that Pilates would help by strengthening the core. I took Pilates classes and loved them. I became a Pilates teacher. I had a regular Pilates practice. I also had regular back episodes where about once a year I would spend a week lying on the floor in agony. I assumed that I was just not strong enough, or I wasn’t doing my exercises enough times per week or enough hours per day. I would work harder, become stronger. I could do some pretty advanced moves in the Pilates repertoire. I would often be called to demonstrate things in workshops. So why was my back injured? I too requested diagnostic imaging. This found much degeneration in the lower back vertebrae among other things. I was “falling apart.” So what to do?

I tried all the things on the above list, and more. Nothing worked for long. The core strength I acquired by my Pilates training served as a band aid to “brace” the spine and keep it strong while the muscles were there protecting it, but one false move (or more like many, built up) and kapow! Back on the floor in agony. The episodes came less frequently, but they still came.

Once I discovered Restorative Exercise™ it made sense to me on many levels. I started practicing it, and eventually I stopped practicing Pilates. I didn’t even have my spine in mind, the pain was such a part of my life that I never even considered that I was doing RE™ specifically for back pain. I just started aligning myself according to the bony landmarks, discovering where I was unable to achieve this alignment and why, and then going off in that direction, exploring my boundaries and limitations and weaknesses in a way I never had before. Then after a few years, I realized I’d not had my pain episodes in a long while. I hadn’t been bracing or holding or workout out or doing ab strengthening exercises, and yet – no back pain. Weird!

This continued until one day a colleague invited me to her Pilates studio to do a workout. It had been a few years since I’d done any Pilates. I was mildly curious to see if all the RE™ and walking I’d been doing would hold me in stead for the kind of workout I used to do. I admit I might have been a bit competitive in the class, but I did hold my own and was happy to see that even though I hadn’t been practicing the same type of work, my muscles had not lost tone for doing other kinds of things.

And then the next day happened. Kapow! Back on the floor in agony. For a while after this, I blamed flexion – the rounding of the lower back that is inevitable in roll downs, roll overs, rolling like a ball etc. I just assumed that my lower back was toast and that flexion was doing me in.

Early this year I went back to my second RES™ week. This is where you spend a week at the Restorative Exercise Institute and study and learn and immerse yourself in all things alignment. Katy Bowman led a class in…spinal flexion. OMG – I was so confused. Do I do the class and just take my chances? Excuse myself and watch? I didn’t know what to do, but trusted that I could stop if things got dicey. Well things got very interesting, but they never got dicey. I had a bit of an epiphany that day as I explored (carefully and thoughtfully) lumbar flexion. I discovered that because I had a hyper mobile segment in my low back, I also had a hypo mobile segment. This means that one part of my back moved too much, and one part didn’t move enough, putting too much stress on that part that could move. This took years of study and a very subtle and advanced practice to discern. I don’t think a beginner could expect to make such subtle distinctions about themselves. It’s possible for anyone to do eventually I believe, but you need to slow WAY down and start to listen to your body like you never have before.

Once I made this discovery I started putting some flexion back in the rotation of exercises. The things I’d been avoiding become possible again. And then recently I had another epiphany. The problem was not flexion per se, but the pressure I was creating by flexing. Often times in Pilates (and other modalities) you are cued to suck in the belly, (navel to spine) or tilt the pelvis, rolling vertebra by vertebra through the low back with a strong posterior tilt to initiate. Most of us modern people spend a lot of our day sitting on our tailbones, in a posterior tilt. I think that the movement was too extreme on one area, but more than that – it was the increase in pressure along the spine that caused the pain. We aren’t used to thinking of loading or pressure when it comes to our bodies. We are used to thinking of moving. “When I move this happens.” “It hurts when I do this.” So we stop moving, take that (perfectly reasonable) movement out of our repertoire and thus the muscles that create the movement atrophy and the health of those tissues gets worse…and we feel worse…leading us to more diagnostics and ever more invasive treatments.

Thinking in terms of what is being loaded and how (there are different kinds of loads and different ways to create them) and pressure differentials within the body’s spaces (and in my case, within the discs) can be an eye-opener. And a game changer.

https://www.painscience.com/bibliography.php?brinj
https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php
http://www.hopkinsmedicine.org/news/media/releases/costly_diagnostic_mri_tests_unnecessary_for_many_back_pain_patients

 

Snack Homework part 2

As promised, here are the remaining 10 snacks with a brief description. Read about the first 12 here. Don’t forget to use my affiliate link if you care to support my work. I appreciate it! Just use the green Alignment Snack link at the bottom right of this post.

A Balanced Approach to Hip Strength – have a chair handy and use either the seat or the chair back. Standing, squatting and one legged squats (hard), alternating with anterior shoulder work using yoga strap. A lesson in knee alignment in squat. Standing #4. Nice demo on Double Calf Stretch or forward bending. Listing with forward bends. Posterior arm hold.
Not easy, not a beginner snack – recommended for those who are already proficient in squatting and listing.
Can’t Get Enough of Shoulders – (this is the free Snack!) Rhomboid push up, interspersed with yummy shoulder stretches in quadruped and seated positions. Some inner thigh stretching seated. At around the 21:00 there is an interesting lesson on bone health/aging. Differentiating between scapula and arm movements. Posterior arm stretch.
Everybody Needs a Little Shoulder Bolster – you’ll need a bolster or equivalent (rolled sleeping bag for eg.) Most of lesson is done supine (lying down). Starts with everyone’s favourite: Psoas Release (a cheer goes up in every class when I announce this exercise). Some great talk on cardiovascular health. A great lesson on floor angels. Finger stretches. External rotation of the shoulder. A really hard hamstring stretch (have a strap handy for it). Stacked cobbler. Thoracic stretch on the bolster. This is a personal favourite – a great snack and Katy is talkative, which is a good thing! Listen and learn!
Let’s Do the Twist – Trunk mobility. Yoga block and half dome handy. (Can use a book and a rolled blanket.) Deconstruct the twist. Very important skill! Crescent stretch. Prone Inner Thigh Stretch. Prone Quad Stretch. Bonus material after the class plus a surprise guest appearance. This Snack is delicious!
Quads and Hams – lesson on floor sitting protecting knees. Strap Stretch. Prone Quad stretch. Happy Baby (upside down squat with some squat talk). Thigh stretch kneeling (this is a good one). Lesson on quad muscles and orientation during gait, knee health.
Rhomboid Madness – Rhomboid push up. This is an exercise that creates a lot of confusion, and it’s actually very simple, you just rarely move your scapulas this way. So this is a good one if you want to study it a bit further. Some chat on breast cancer/health. Tricep press up (hard!), a few different Finger stretches, Tricep Lowers (hard!), twist with arm Windmill. Bonus material after the class: 2 min. chat on Bone Density and exercise.
Stretching the Standing Muscles – Calf Stretch with head hang and shoulder stretch (multitasking!), Double Calf Stretch (flat and on the dome), Listing on a block with concentric/eccentric lateral hip, Double Calf Stretch wide with lateral hip shifts, List on block with Forward Bend (hard!), List on dome round side down (unstable, balance challenge), Soleus stretch. This is your basic stance exercises so a great Snack for everyone. There is a lot of listing in this Snack, so if you are a beginner your lateral hips might be sore afterwards!
Take a Load off Your Chest and Your Hips Too – You’ll need a bolster or equivalent. Psoas Release (ahhh!) with Floor Angels. Hand Stretches. Thumb stretches (really!). Cobbler stretch for hips, Hip Internal rotation. ALL this with the bolster under the shoulders, so a very restful Snack.
Twisting the Night Away – Deconstructing the twist. A nice lesson on finding your twist boundaries. Starts with spine mobilizing, hip flexing, leading into the first twist with knees together. Full twist with focus on various body parts. Twist variations. Rhomboid Push Up. Seated Twist. V sit stretch. This one is very twisty!
Just a Dab of Abs – what’s the difference between coordination and strength? Tricep Press Up. Cobbler, hand stretch. Prone Quad stretch, Plank on knees with positioning cues, lowering from Plank. This Snack differs from all the others in that it is the only one you hear the other class participants, mostly laughing at their own attempts. Supine, Happy Baby hip opener. Lifting from Tricep Press Up into Plank (groans from the crowd). Luckily this class is less than 20 minutes long. Bonus Material after class: Do you have tight traps (shoulders)? How do you fix that? Bonus Bonus Material – What’s the difference between Movement, Natural Movement, and Exercise? This 5 minute speech is worth the price of this Snack!

And…just as I finish up this Post, Katy Bowman announced on her Facebook Page that MORE Snacks are coming! So quick, buy all these and get busy!

Hanging for Shoulder Health

Shoulders are particularly poor in health in our culture. We use arms and hands and shoulders a fraction of their potential. Arms are usually internally rotated as the default norm, which means the humeral head is rolled forward and in in the glenoid fossa of the scapula.

Typical forward head of a "gamer" showing rolled forward shoulders.

Typical forward head of a “gamer” showing rolled forward shoulders.

The scapula (shoulder blade) sits on the rib cage, so the position of the rib cage can also effect the shoulder positioning and if the ribs are thrust, or sheared, in an attempt to stand straight and appear in good posture, the scaps will end up too close together passively, which shortens the Rhomboids and changes the orientation of the glenoid fossa, making a natural arm position practically impossible. So ALL THIS needs to be addressed when you have shoulder issues, which is everybody right?

So first of all, drop the ribs until they sit over the pelvis and not out in front of it. Broaden the scaps using the Rhomboid Push-Up. Other exercises in the RE™ repertoire that can assist in a healthier shoulder are Thoracic Mobility, Thoracic Stretch, Head Hang, Head Ramp, Windmill, Floor Angels, hand stretches, Posterior Arm Hold, Posterior Block Hold, and MORE!

But the grandest of them all is the hanging series. This is where you really start to get your arms to open up and do what they were designed to do, which is to hold your body up. As well as carrying, reaching, holding, etc., (not typing or diving cars, which are not natural, but where we spend the bulk of our time), we are meant to use arms to pull us up trees, hills, climbing rock faces. Do you have what it takes to grasp onto a ledge and pull yourself up? This requires tough hand skin, strong arms, a weight ratio that does not exceed that strength, hip mobility (to get the legs in position to assist and push up from below).

The ability to hang our body weight from our hands is developed over time as our tissues adapt to this new job. We start by first hanging partial body weight from door frames, at shoulder height or lower if necessary. As the chest and arm tissues adapt to the list of exercises above, we can start hanging our body weight from above, first with feet on the ground and then as a full body weight hang/feet off the ground. Scaps are allowed to be elevated at first, and then depressed so that their stabilizers are involved in organizing your weight. And let me tell you – IT FEELS GREAT! I think it feels like the arm joints are yawning and getting more oxygen. Which in fact, they are!

If you don’t have a chin up bar, any branch of a tree will do (providing it is sturdy enough and won’t break, damaging the tree and possibly you!). I thought I’d share my hanging set up. I put it on my back porch, so I can hang outside. I used a plumbing bar, although varying your hanging bar would be a good idea, so that you get used to different diameters and different textures. I plan on having more than one hanging station eventually, so I started this way. TRX mounts at about $40 each (Cdn) and 3′ of galvanized chain on each side. The 3′ bar was less than $13.00.  Altogether this cost around $100 and will give me years of pain pleasure.

The end of the bar showing the hardware through the bar and a double end clip attaching galvanized chain

The end of the bar showing the hardware through the bar and a double end clip attaching galvanized chain

The TRX brand mount is very strong.

The TRX brand mount is very strong.

Plumbing pipe end

Plumbing pipe end

Eventually I can progress to longer hangs, one arm hangs, swinging. It’s new territory, or at least one most adults haven’t explored since they gave up monkey bars. Kids will climb quite reflexively given the right environment, so it’s a great skill to cultivate. Don’t be in a rush and don’t be frustrated if you never achieve a full body weight hang or a pull up. You can gain a ton of shoulder health just by progressing through the steps you can do. So, along with brushing my teeth, calf stretching and hanging are just part of my day. Make them part of yours.

Attach the bar into the ceiling making sure you are finding the joists! Mine are 2' apart, but the bar is 3' long.

Attach the bar into the ceiling making sure you are finding the joists! Mine are 2′ apart, but the bar is 3′ long.

Here’s where I got my TRX mounts: http://www.trxca.com/trx-suspension-trainers/new-and-cheap-trx-xmount-26-off.html
All other hardware (chains, bar, clips etc.) from Home Depot. Canadian Tire also has all the stuff.

 

Snack Homework!

Over there on the bottom right of your screen is a link to the Restorative Exercise Snack’s page. This means I’m an affiliate and every time someone uses that link to buy a Snack, I get a kickback. It’s a very generous way that the Restorative Exercise Institute gives back to its community. This enables me to buy more online courses whenever they come out. I’m not getting rich but hey – it really helps! So why should you click on that link you ask? Because you can buy a half hour workout taught by Katy Bowman herself for $5. US. FIVE DOLLARS! So it’s a total no-brainer as they say. You will get a link emailed to you with a zip file to download to your computer. Yes that’s right – you get to KEEP these classes forever. You can download them and take them on vacation or to the cottage. Or if you miss your regular class or walk, hey, do a Snack! I really like listening to Katy bantering, because she’s the kind of person who drops pearls of wisdom every time she banters.

So I thought I’d start you off with a brief description of 12 Snacks to help you choose. They typically have a subject (neck, shoulders, balance etc). I’ll do another post soon with the remaining 10 Snacks. The first Snack is available FREE  – it’s called Can’t Get Enough Shoulders. So go try that one and then start downloading!

It helps to have a half dome, yoga block, bolster and strap for some of these classes. If you don’t have them, you can probably find substitute items around the house. Don’t let that stop you.

Within Reach – quadruped lesson including rib cage position, elbow pit definition. Rhomboid Pushup, shoulder stretches, tricep lowers, hand stretches, psoas release, TWIST! with arm stretch. Great great snack for everyone but especially people who don’t use their upper body optimally (computer users anyone?). Wonderful snack – a MUST.
Walk This Way – Stand This Way – Entire class standing. Lateral hip in gait lesson. Listing, Leg stretches, squat, standing #4. Not a long list, but you will be working hard!
Hips Don’t Lie – They Sit – which starts with a nice demo and instructions on how to find neutral pelvis and what a rib thrust looks like. Various seated hip stretches (sitting on block), twisting, lying supine cobbler hip stretch. Very nice!
Balance Using Lateral Hips – a lesson on *optimal gait* AND *how to climb stairs without sacrificing your knees*. Katy gives a great lesson here.  At about the 20 minute mark, one of the students asks a question and Katy answers it at length (all the time standing on one leg).
The Backbone’s Connected to the Other Backbones – This one starts with a lesson on hidden hyperkyphosis (dowager’s hump that you might have and not know) and where the movement to address it needs to come from. This is followed by thoracic mobility to get that part of the spine more mobile. Of course, Katy explains it all so well! This snack is done mostly lying down.
Don’t turn off the snack after the lesson has ended – there is bonus material at the end! – all about Muscle Cramping.
Leg Goes Forward, Leg Goes Back – Hip Extension! Psoas lesson! All about metabolism! Hamstring stretches! Quad stretches! Apart from a kneeling lunge, this is another one done mostly lying down; mostly supine, some prone.
A Real Pain in the Neck – How nice to spend a half hour stretching the muscles of the neck! You know you need it. A lesson on the pectoralis (chest) muscle, and the rib position.
Frankie Says Relax the Psoas – Lesson on the location and function of the Psoas muscle (using skeleton). Psoas release, lunge, rib drop. If you do Yoga, this Snack has a portion on Down Dog you might find interesting!
Adductor Madness – Pez dispenser with legs up, lots of leg lifts (concentric quads!), cobbler, pretzel stretch, and ends with rhomboid push up and tricep lowers…this is good value – lots of exercises. Katy keeps up the pace on this one. This is a good one for someone who wants a challenge and isn’t ready to spend 30 minutes just doing one or two exercises mindfully.
All Around the Thighs – standing stretches, calf stretch, double calf stretch, quad stretch, #4 stretch, lunge with some modifications. Helps to have a chair nearby.
All Fo’ the Pelvic Flo’  – a great one! A lesson on the correct function of the pelvic floor. Just get it. You’ll need a bolster or a cushion. V sitting, leg extension prone (great lesson on walking with hip extension versus spine extension). Bridging with foot lifts, cobbler. Stay tuned after the class for Bonus Material – all about the armpit “Egg Hole” (breast health!) Super duper Snack!
Gotta Get Down to Arm Swingtown – arm swing (in gait) lesson. Shoulder stretches, listing, finger stretches. Do you really need those walking sticks?

 

Why you want to come to the Pelvic Floor Workshop

Wouldn’t it be nice if when you delivered a baby, the midwife or the doctor handed you the manual for the body that would map out your entire life so that you could prevent many illnesses and optimize the function of the body you just delivered? Well guess what – that manual exists! It’s known as the Whole Body Alignment Course and is offered by the Restorative Exercise Institute. People who have studied and certified in this method are known as Restorative Exercise Specialists™ and can help people who didn’t get a manual at birth to deal with things that have gone awry in the meantime.

The pelvic floor creates the bottom of your trunk cylinder. Looking down into the pelvis from above it appears as a muscle bowl. So many things depend on the function of the pelvic floor that it is incredibly important to not only your own personal health, but the survival of the species known as Homo Sapiens. (Although perhaps when every pelvic floor is kaput, maybe we’ll have that cloned baby in a lab thing working.)

Your sex life, your digestion process, elimination of waste when you want to, not eliminating waste when you don’t want to, keeping your organs where they belong, normalizing your menstrual cycle, conceiving a baby, maintaining a pregnancy, giving birth vaginally, are some of the things that rely on an optimal functioning pelvic floor to some or a great extent.

Creating an environment for optimal flow of oxygen to these tissues, creating a biomechanically correct position for the bones and muscles of the pelvic floor will help eliminate (sorry) some of the issues you may be having. And if you are one of the (very few) lucky ones without a pelvic floor disorder, wouldn’t it be nice to get the manual for the pelvic floor so you can prevent them in future?

I’m doing a Pelvic Floor Workshop in Toronto’s east end on June 14, 2015. Won’t you join me?

PelvicHealth_May_2015

 

Feet and the Pelvic Floor

I just finished another foot workshop. I love doing them because they are literally your foundation and also the foundation of all the work that follows, typically the pelvic floor. So yes, next up is a pelvic floor workshop (my second!). I thought I’d write a post about how feet and the pelvic floor are related, and why you can’t really address one without the other.

Let’s establish some very basic anatomical details:
1. Your hip joint is made up of the ball and socket of the femur and the acetabulum. The femur is your thigh bone. It ends in a “ball” which sits in a rather deep socket made up of your pelvic bones.

2. Your knee is in the middle of your leg and this joint is formed by the bottom of the femur (thigh bone, see #1) and the top of the lower leg bones, specifically the tibia. The top of the tibia is like a plateau. In fact, it’s called the Tibial Plateau. Poetic eh? The back of the knee is what we’ll be looking at today.

Here's what the back of the knee of the average person looks like. The red dots are indicating the hamstring tendons. With the feet in turn out, the hamstrings almost face straight back (this person probably walks with more turn out than she is showing here).

Here’s what the back of the knee of the average person looks like. The red dots indicate the hamstring tendons. With the feet in turn out, the hamstrings almost face straight back (this person probably walks with more turn out than she is showing here).

3. Your ankle is at the bottom of the leg, between the lower leg and the foot, and it is made by the two lower leg bones (tibia, fibula) and the top bone in the foot called the talus. The talus is a magical wonderful bone. It has no muscular attachments (the only bone in the body with this distinction!). It supports your whole body like a keystone in architecture. The talus in turn sits on the heel bone (calcaneous).

4. Of course your foot is at the bottom of the leg and is comprised of 26 bones, 33 joints, and basically three arches; one arch on the inside of the foot (often collapsed or “pronated”), one on the outside and another one across the ball of the foot called the transverse arch. (This last one is often also collapsed.) The foot is considerably more complex than the hip or knee.

Let’s get personal. I’m going to introduce you to my pelvic floor. My pelvic floor has done a great job for me over the last 5+ decades. It has birthed two children and held in my internal organs pretty effectively. I’ve not had any really serious issues with my pelvic floor (no prolapses). I’ve had some incontinence following the birth of my kids, but only when I jump around on trampolines (not that often) or laugh really hard (unfortunately not that often) or sneeze really hard (about 100 times a day). I’m willing to bet that most of my female clients have some degree of the same issues and haven’t even mentioned it because “it’s normal.” Most people wouldn’t consider what I’ve just described as a Pelvic Floor Disorder. That has to be more complicated/severe/advanced/painful right? Well, that is incorrect. Peeing when you sneeze or laugh is not normal. It’s common, but not normal. So what if you have the same problems, or perhaps something more problematic, such as a prolapse (unfortunately very common as well) or pain in your pelvic floor? What has that got to do with your feet?

The soles are your connection to the earth, and that fact has many ramifications. For one, there is traction between your foot skin and the ground, unless you are in the nasty habit of wearing those contraptions otherwise known as “shoes.” Then your foot skin is in traction with a sock within a shoe. But whatever. How your foot meets the surface of what you are walking on will affect the joints listed above (ankle, knee, hip). The best biomechanical situation for your feet is with the feet facing straight forward in the direction you are going. This enables the ankle to articulate on it’s correct axis, or plane (which is forward and back, not side to side). But if you walk with your feet pointing out (even a few degrees) the movement that should occur at the ankle occurs below the ankle where the talus articulates with the foot bones, creating an overuse situation that may result in lax ligaments (ankle sprains anyone?).

The foot is made to articulate in all manners of ways with those 33 joints, to accommodate all manner of surface variants, so all these movements aren’t damage making in themselves, but in their frequency of use. Because we walk on flat surfaces pretty much 100% of the time, this turned out position will end up creating the shapes of the bones of the legs, and changing the orientation of the joints of the knee and hip as well as the ankle! Pretty radical eh?

Now the muscles of the pelvic floor are connected to the hip joint (both literally and figuratively) in that the position of the femur in the acetabulum (thigh bone in the hip socket) will change the resting tension of the pelvic floor. Add to that a chronic tail tucking position (which does NOT allow normal hip extension, which would engage the posterior butt muscles and create normal tensile loads on the sacrum – which is a heavy duty pelvic floor attachment site) and we’ve got some major mechanical flaws that will inevitably end up affecting the function of the pelvic floor.

Starting with the foot position, let’s get those feet facing straight ahead. And then have a gander at the back of the knees. You will notice that the grooves which are your hamstring tendon attachments are not facing straight back the way they should. They face more toward the sides, away from the midline, or laterally. So to get them facing back again, so the knee is also articulating on its correct axis, we need to externally rotate the femurs. This will end up affecting the foot position again – the medial (inside) border will lift off the ground. Only with diligent practice at mobility drills and walking on a variety of unlevel, uneven surfaces will the foot gain back the mobility it needs to evert the forefoot back to the ground – and VIOLA – ARCHES!

With the feet aligned you can see the hamstrings are pointing out to the sides. You can't even see the outside one on the L leg.

With the feet aligned you can see the hamstrings (black lines) are pointing out to the sides. You can’t even see the outside one on the L leg. The feet are flat but pointing straight ahead.

So there you have it, to get the arches back, and the resting tone in the pelvic floor, you need to start with the feet and work your way up to the hips. My foot workshops end with this external rotation, but it’s a concept that is very challenging to do without some guidance – the health of the knee can be compromised if done incorrectly. So please see a certified Restorative Exercise Specialist before you try it. There are also more detailed instructions in Katy Bowman’s books (links in sidebar).

Now the femurs are externally rotated. The feet lift up on the medial side. Eventually, when the feet are more mobile, they will come back down with this hip/knee arrangement: alignment complete!

Now the femurs are externally rotated (the right one needs more!). The feet lift up on the medial side. Eventually, when the feet are more mobile, they will come back down with this hip/knee arrangement: alignment complete!

By the way, it’s been 3 years since I corrected my foot orientation and began walking with correct hip extension. My pelvic floor is a lot stronger. I can sneeze 100+ times now and no leakage. Cool right? And that was accomplished without one kegel. Not one.

Shoe Review: Lems

IMG_3356

I was sent a gratis pair of Lems shoes recently, much to my surprise. I actually thought the email was spam and was about to trash it, but a quick search for company staff led me to believe this was on the up and up. They even let me choose model and colour! I went for the black Primal (called Shade). I’m a size 11 and ordered 44, as per their sizing chart, which was perfect. Of course, they requested I review the shoes on the blog, but my opinions are completely my own and I review honestly.

I have to say, Lems had been high on my list of must-try shoes for some time. Restorative Exercise Specialists™ are quite happy on the whole with this brand and it is recommended among our group highly. But of course, not every shoe works for every foot, and buying a shoe online is always a gamble – especially if you are shipping internationally (Lems is a US company – their shipping rate is 9.95 for one pair domestic and a whopping – unrefundable – $24.95 for shipping internationally). If you are cheap like me, you wait until you are in the States to buy.

My last pair of kicks were Altra, reviewed here. I was happy I started out my zero drop adventures with this brand as it is rather cushy (it’s meant for running) and helped with logging lots of miles on sidewalks in the urban jungle that is Toronto as I transitioned. The soles are starting to wear out so these Lems came in the nick of time. I haven’t logged a lot of miles in them yet, but enough to formulate an opinion.

All of Lems shoes are Zero Drop – industry speak for no positive heel. This is an absolute MUST of any shoe I buy. I wouldn’t even consider anything with a positive heel. If you need to ask why – read this. Or this. How about this. And then get this book. And this one.

Got it? Heels bad!

One of the selling points for this shoe is their wide toe box (also the reason I bought my Altras). If you wear Correct Toes (which the company also sells – and I recommend them highly) this shoe will accommodate your foot + Correct Toes. One cold day I tried toe socks + Correct Toes and this was a bit too much. I have since read that the company suggests removing the insoles if you are wearing Correct Toes but I found they fit fine unless I also tried to add all that extra fabric of toe socks (double fabric between four toes).

IMG_3355

Tracing of my foot with the shoe beside it. The shoe should cover the tracing. If any part of the tracing sticks out, the shoe is not wide enough.IMG_3353

 

 

 

 

 

 

 

 

 

 

 

 

 

Another selling point is how flexible they are. We know the less a shoe does to interfere with the natural movement of the foot’s 33 joints, the better, especially over varied terrain such as a park or hiking trail, rocks at the beach etc. A stiff soled shoe will prevent your foot from moulding to the surface it’s on, and shift the load to the ankle to deal with – which of course is not equipped to move in all those planes and this results in sprains, or worse; falls. So a nice flexible sole like the Lems’ is not just a welcome design feature – it’s a matter of foot health and safety.

Flexible!

Flexible!

Right out of the box I noticed the shoe had a strong off-gassing kind of smell – they are marketed as microfibre and open weave mesh – 100% vegan. Whether this was the result of being in a shoe box during transit…I don’t know, but I left them in a spare room for a few days (it was still too inclement outside) until the smell dissipated.

They have a slight toe spring (I believe .5″). This is an angle where the toe end of the shoes rise upward from the ground. I’m not sure why this is part of the design of this shoe – it’s slight enough that it’s not a deal breaker for me, but I’d like to see it go. The toes are meant to lie on the ground, and lifting them up places an unnatural load to the ball of the foot (metatarsal heads). Of course most shoes have a tremendous amount of toe spring, so this shoe is a step in the right direction and certainly better than most out there. And the soles are flexible enough that when the foot is in them, the toes spring less.

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Reflection on my dining room table showing the toe spring.

I’ve worn these barefoot now and really like the feel of the shoe in bare feet. It’s comfortable right out of the box. Remember when you had to “wear shoes in?” What a ridiculous concept! Yesterday I wore them sans socks in 18 degree weather (64F) and found them to be a little sweaty, so in super hot weather I’ll probably go with a thin pair of socks.

I think these shoes are good looking design wise. I’ve had lots of compliments on them already. Not everyone loves the white soles but I do. I would recommend them with no reservations to anyone ready for a fairly minimal shoe. The company also offers zero drop, minimal, flexible dress shoes (great for the office) and a great looking boot (that’s next on my wish list). I’m going to enjoy wearing these shoes this spring/summer! They are perfect for my foot and my current urban environment. Thanks Lems!

OH! One more thing – my cat wanted to thank you for the box. It was very tasty!

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Transitioning to a Minimal Bed

All my friends know about my penchant for things Japanese. I love the stores Muji and SouSou and this song. I love their rain boots and Japanese literature old and new. I love anime movies, Tamagotchi…the list is long.

So when I found an importer of real Japanese Tatami right here in Toronto I was ecstatic! Tatami are rice grass mats, used as flooring in traditional Japanese homes and often in martial arts studios. Apartments and rooms are described by how many mats they hold, for example, a “seven mat room” is approximately 10’x13′. To see pictures and learn more, link here.

There are many importers and makers of mats but the real mats are unique. They are 5.5cm high and no wood filler or styrofoam goes into their making. They are made with rice grass all the way through so they are all natural and smell lovely. They are quite heavy and don’t fold. They are meant to sit on the subfloor and be the wall-to-wall flooring in the room.

The showroom at Tatami Imports (note dining tables - one in back with the legs unfolded, and the one in front legs folded ready to be moved against the wall)

The showroom at Tatami Imports (note dining tables – one in back with the legs unfolded, and the one in front legs folded ready to be moved against the wall)

As well as the mats, Tatami Imports also carries the traditional Shikibuton, or futons. They are different than the futons you get at the futon store. Thinner and stuffed with soft cotton, they are no more than a layer of comfort between you and the floor. They fold up when not in use and can be stored away.

Kitten Soetkin tries out the Shikibuton (futon)

Kitten Soetkin tries out the Shikibuton 

Unlike North American homes with many rooms, each dedicated for a specific purpose, traditional Japanese rooms were multi-purpose. So the dining table legs would fold up, the table leaned against the wall, and out from the cupboard would come the futon and bedding. Thus one room could serve as living room, dining and bedroom. I love that idea – that a room could be devoid of permanent furnishings and could morph into whatever you need. Once you try living in a room that is not filled with “stuff” you quickly realize how wonderful it is to have space around you, and only the things you need at hand, nicely organized.

Of course this fits into the whole Restorative Exercise™ paradigm of natural movement, less furniture, floor dwelling to eat and work and relax. So I was hell bent on getting myself some tatami and a futon and making over my spare bedroom into a room that would be multi-purpose – both a studio for private clients, and a second bedroom.

That dream finally became a reality and I have my peaceful beautiful room. During the day I fold my futon and sheets and store them away and have a big space to do my exercises in or teach clients.

My studio for private or semi-private lessons

My studio for private or semi-private lessons

I started sleeping on the futon as an experiment to see how sleeping on the floor would feel. Readers of Katysays.com will know why. (Read this post for more information.) A mattress is essentially a cast, something that allows you to maintain a position for a long period of time that would not be comfortable otherwise. I tend to sleep on my left side about 95% of the time, since my first pregnancy. The first night on my futon, I woke up sore and turned over uncomfortably to my right side. The fact that I didn’t have 10″ of foam under me meant that I felt the weight of my hips and shoulders on the floor. The mats have more give than hardwood, but they are still harder than a mattress. Then invariably, I would get sore on the right side and flip back to my left. This went on all night and in the morning I was tired, cranky and sore! But I was not about to give up, because the thing was – I moved all night long and didn’t stay stationary on that left side.

Why is being stationary a bad thing? Well think of side lying – your spine is dropped on one side in the lumbar (low back) and cervical (neck) areas, all your weight is compressing one hip, one shoulder is displaced and one arm is pinned and getting less blood flow. Not to mention what’s going on internally (organs and circulation). Often those shoulder and hip pains are so stubborn because you spend so much time in one position all day and night. And I’d been lying on that left side 95% of the time for over TWENTY FIVE YEARS! I was not about to give up after one night!

So I persevered. After a few more nights, I didn’t wake up to turn over, or only slightly so. I woke in the morning with no aches and pains. I started using more sleeping positions that the one or two previously. I slept better and longer. I started really looking forward to going to bed. Maybe it’s memories of sleepovers or camping, but it feels child-like and fun to sleep on the floor. Plus my cat thinks it’s awesome (my husband probably less so but I’m hoping to convert him). There is one surprising thing that I didn’t foresee: getting up in the morning is literally getting UP in the morning – from the floor one must fold one’s creaky old limbs and push yourself up to standing, unlike before when all I had to do was to swing my legs over the edge of the bed to the floor and be half way to standing already. Ah, the benefits of getting up and down from the floor!

My cosy room all made up for bedtime.

My cosy room all made up for bedtime.

Thinking of Airbnb’ing my new room – how much would you pay to sleep on the floor? 😉

One of my friends works on the computer all day. She asked my opinion on a video going around that had a nice upper body loaded/twist exercise as a 30 second quick fix-it for the desk bound. While the exercise felt pretty good to me, I doubt whether a lot of people who spend all day in a chair would be able to actually accomplish it without possible injury (specifically to the shoulder – see my last post), so if you really wanted to do this exercise, it should be taken in steps. (As an aside, would you do this in the middle of your office? I would but I’m the person who squats on the subway platform).

So what is the quick “fix it” solution for the desk bound?

Of course you already know the answer – the quick fix it for years of being sedentary is to stop being sedentary. You’re welcome! Next!

Ok I know, that’s not a very helpful answer. But here’s the thing: we’re still thinking that “not being sedentary” equals “exercising“. We replace our desks with treadmills and bicycles in the hopes that exercising more will offset those hours of sitting. This belief starts at a young age, when we expect our kids to sit quietly for schooling, offset with brief interludes of recess (unstructured play) and “exercise,” i.e., gym (structured play). So all you need to do to offset those hours in front of the computer is 30 seconds of stretching recess, right? I do think any break in sitting is well worth it, but it helps to start to broaden your scope of movement opportunities.

My flippant answer above is really the truth – stopping being sedentary is something you can do right now, this very minute. Sitting in and of itself is not the problem. Sitting in the same position all day is the problem. If you were to stand, before long there would be a rash of standing injuries – if you were to stand immobile all day. The answer is to move – and movement can be small and varied. For example, change your chair to one without back support. (Keep in mind these suggestions might be extreme for extreme cases, and should be transitioned to appropriately.) “Outsourcing your muscles’ work to furniture” is a line that Katy Bowman uses to describe the fact that we don’t use muscles to sit just because we are sitting – most of the time our muscles are turned off and the chair is supporting us passively.

Set your computer up on something (a couple of boxes) and stand sometimes, interspersed with sitting. Change your position a lot. If you are lucky enough to work from home on a laptop your opportunities are endless. I’m writing this squatting on a yoga bolster with my laptop on a stool. If you can stand for part of the day, place something under your feet such as a half dome (calf stretch) or Yoga Tune Up balls or tennis balls, a cobblestone mat (my favourite – and you can buy a boot tray or jelly roll pan and fill it with river rocks from the garden store – or the beach – for a cheaper and wonderful alternative).

Think of the joint positions your feet, knees, hips, spine, shoulders, neck and head experience the most and start varying them. Most of our work is done with the arms in one position all day long, with very little movement at the shoulder. The fingers are almost always in flexion. I see many people who spent their working lives at a desk who can no longer straighten their fingers all the way. Start stretching your fingers! Raise your arms above your head now and again. This video by Daniel Vitalis shows his workspace, it would be a great goal to integrate one or all of his ideas. I especially love his hanging bar but you could use a door frame and you don’t have to lift your feet off the floor to gain shoulder health.

Another thing we don’t move very much is our eyes. Daniel shows one way to vary our focal point by moving a remote keyboard far from the screen, but you can achieve a varying focal point as easily as looking out a window often and focussing on the furthest point you can see.

Think of these ideas as giving your future self a gift. If only we could look into a crystal ball and see ourselves at age 65, 70, 75 – that would probably be motivating. A lot of the ills that we consider a natural, inevitable result of aging are actually the result of years of mechanical mis-use. And it’s never too late or too hard to start moving more.

ps something to look forward to is the Katy Bowman/Mark Sisson collaboration – a comprehensive multimedia course called Don’t Just Sit There! Together they tackle the public health problem that is the sedentary office environment.

Notes on Shoulder Health

This post is in response to a reader request for more details on the RE™ approach to shoulder health. In order to have this discussion, it is necessary to talk first about shoulder anatomy.

Shoulders and feet are pretty much my favourite topics anatomically. They both have a lot in common: they are complex structures that are both fundamentally underused and overused! We can stand on our feet all day, or run a marathon (overuse) but we can’t spread our toes or lift them individually (underuse). We type/hold a steering wheel, carry bags and lift weights (overuse) but we don’t have the strength to hold up our own weight, nor can we achieve full range of motion (ROM) in the shoulder without spinal distortion (underuse) leading to friction and wear of the spinal discs. There is huge potential to increase the health of the tissues in both feet and shoulders from their current state.

I’ve had a lot of problems with my own feet and shoulders, so I’ve spent years trying to understand and rehabilitate them. I was successful at it (ongoing) and look forward to having not just pain free feet and shoulders, but really incredibly strong structures with full ROM.

If I ask you to point to your shoulder, you’d point to the area where your arm meets your body. This is the glenohumeral (GH) joint, where the humerus (upper arm bone) sits in the glenoid fossa. This is a concave or dish-shaped structure on the side of the shoulder blade, or scapula. Our arms don’t hang on our ribs, they hang from the scapula, which sits on the ribs. Thus, the position of both the ribs and scapula will need to be assessed for proper shoulder mechanics.

GA205 (1)This is a picture of the L scapula from the side, the bean shape of the glenoid fossa is the socket part of the ball&socket jt. Please refer to the wikipedia page for some more pictures/animations.

The nice thing about RE™ is that we have alignment points or markers; objective placement of the bones that allow us to see just what is going on. So we would start with placing the rib cage in a position that would allow for a correct relationship between the rib cage and the scapula…

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and then we would put the scapula in anatomical neutral. At first this is done with some difficulty, because the resting muscle tension in 99% of us precludes our ability to do this easily. (I’d go so far as to say 100% because I’ve never seen anyone with a neutral scapula on a neutral rib cage but they might exist.) NOW we can see what the arm is doing!

One of my favourite exercises for assessing all this in the RE™ repertoire is called the Rhomboid Push Up. Don’t get caught up in what it’s called. It should be called “Full shoulder assessment allowing us to see residual tension residing in all structures from the trunk to the fingers in a partially loaded position” but that’s an awfully long name. The nice thing about RE™ assessment tools, is that they are also the prescription. If you can’t do it, do your best until you can do it better, which might take a while but I think it’s the only thing you can do to really truly get to the bottom of what is keeping you from optimal health of the shoulder (or whatever body part you are addressing, and in RE™ there is no isolated body part – as a matter of fact, if you came to me with a shoulder issue I’d start at your feet and lower legs!).

The ball part of that Ball&Socket joint is of course, the head of the humerus.

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This is a L humerus. The ball part articulates with the socket part on the scapula, but the scapula has other structures that the head of the humerus can rub against, particularly in a situation where things aren’t residing where they should be. There are muscles, tendons, ligaments, nerves and bursa also residing in the spaces around the head of the humerus that in an ideal situation slide around without impingement. It’s this impingement that can be a creator of many problems, pain and torn tissues.

So getting this bone to be optimally situated within its socket is key. Typically the humerus lives a little too far forward and rolled inward (called internal rotation) than it should. This changes the orientation of the ball and socket articulation and can create problems for those structures I mentioned before.

Try this: stand up and face a mirror. Let your arms dangle by your sides. In the most relaxed state you can achieve, where there is no muscle engaging to hold your arm in the socket some way, where does your elbow “pit” face? This is the crease on the inside, opposite the pointy bit of the elbow joint.

Now look at your hand – which way is the palm facing? Is the back of your hand in view?

In an optimally placed humerus, the elbow pit faces front – towards the mirror, and the thumb faces forward. Can you move your arm so that this is the case? Can you do that without moving your scapula also, or did it move too? How much work are you doing to keep your arm in that position? It should be there by default, in a relaxed state.

Now turn to the side and still looking in the mirror, start to raise your arms to the front and see how high you can reach them, all the while keeping your eyes on your spine. At what point does your spine have to extend in order to get your arms higher? Back down to the point just before that happened: this is your true ROM in shoulder flexion. Oops, are you using your abs to hold your ribs down while you raise your arms? Stop doing that, and see if you can raise your arms without creating tension anywhere else. My bet is that you don’t get very far.

So far we’ve addressed the arm in its position as it hangs down from the body, but our arms were made for more than just swinging by our sides. If you study the muscles that attach the arm to the trunk, you will notice that they are proportioned and positioned to organize the trunk and lower body weight as we hang from our hands. We are primates, and hanging and swinging is part of our birthright. We will reflexively grasp and hang on as infants when given the opportunity. It is the traction that is provided from hanging our body weight from our hands that provides the opportunity for optimal positioning of the scapula and optimal length in the chest and trunk musculature. You can stretch your pecs till the cows come home, but only with a hanging practice will you enjoy the real state of health that your shoulders are capable. As mentioned in this post, hanging will encourage remodelling the bony and ligamentous structures of the scapula to provide more space and thus decrease or eradicate impingement.

It is important to progress slowly and carefully when it comes to hanging. Start by hanging from a door frame with your hand at shoulder height (or lower if necessary) only partially leaning away from the hand. It is traction you are after, or a pulling out of the humeral head. After a slow progression you might eventually hang your full body weight with feet off the ground. Eventually you work towards a one arm hang and swinging from bar to bar. That might never happen for me with the poor shoulders I started with, but I can go as far down that road as safely possible and still reap untold health benefits, and so can you.

P1030674Try hanging like this from your doorframe or bannister post several times a day. The closer your feet are to the post, the more weight on your arm. Step out and come in gradually. I usually start people mid-way from the wall and vertical.

Using my affiliate link to the right, you might want to try a Shoulder themed Alignment Snack or two. Let me know how it goes.

ps in Episode 13 of the Katy Says podcast (14:19), she answers a listener question about hanging and a torn labrum. Her answer: “It’s not helpful and it wouldn’t be the appropriate step.”