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Just read Christopher McDougall's article in NY Times about barefoot running training. I like the exercise he mentions in the article to train your body to run barefoot better. His general recommendation seems to be that we should be running on our forefeet. I agree with this mechanically but realistically it hasn't worked for me. My calves are entirely too weak to do this. I've strained them many times trying.

As a result my current running style is something of a hybrid of what he recommends and the old heel strike pattern. I use a rolling foot strike technique to get the job done in my Converse sneakers. Seems to work for me. Part of this technique involves a lateral foot strike which rolls inward. I believe this dampens stress to the foot. It seems a gentle way to run.

I think it's important to keep in mind that many people are built differently and bring different histories to their running. Some are heel strikers, some are toe strikers and everything in between. The bottom line though is that you should avoid injuries by understanding how your walking/running style may be contributing to pain. I cover this in my upcoming book, Fixing You: Foot & Ankle Pain. I wish there was one clean answer to foot injuries and running style but, frankly, all of us are built differently and this must be reflected in our walking/running styles.

 

When working with patients with chronic pain, I can identify the biomechanics behind their pain. Those mechanics are featured in my books. But all too often, no matter how diligent my patients are, they cannot correct the strength or range of motion differences we've identified at the roots of their pain. Why not?

We have a pretty clear idea about how muscles contract and how they stretch. If we act according to those ideas, we should be able to improve strength and range of motion fairly easily. But you and I both know, it isn't that simple. Often it takes days, weeks, months, or even years to get certain muscles stronger.

I've recently been exploring how our nervous system is used in movement. Also, I've been looking into our fascial system. Fascia is connective tissue of varying types that wraps around and connects every structure in the body. Turns out there are lines of fascia traveling through our body that can impact how our muscles function. There is a great book detailing these lines by Thomas Myers.

I'm also exploring Somatics which has been an interesting addition to the idea that we function in systems of movement rather than in isolation. I've come to believe that instead of just releasing patterns of muscles using this approach, we are also releasing these lines of fascia. In Somatics this is achieved by linking the brain to certain muscles.

Yet another neural and/or fascial approach I've been studying is Total Motion Release. This technique was discovered by Tom Dolanzo-Baker and is right up my alley of using movement to fix the body. His approach also targets systems of movement and seems to be affecting the neurofascial web within our bodies.

These systems seem to affect our biomechanics in terms of strength and range of motion. They also affect pain. The question is whether the pain is a result of the poor biomechanics or is separate from it. Could the biomechanical problems outlined in my books also be a symptom of poor neurofascial balance or performance? When I eliminate people's pain by fixing their biomechanics, am I really affecting this deeper web in some way? There are more questions than answers. I'm not sure if we'll ever know for sure. I'll continue using these systems to help my chronic pain patients though.

I'd love to hear your thoughts...

My shoulder and elbow pain book was just mentioned in a nice article in the Denver Post by Linda Buch. I love Linda's holistic approach to her answers. This article answered a question by a gentleman recovering from shoulder surgery (biceps tendon and rotator cuff repaired; bone spur and arthritis removed) and wanted to know what strengthening exercises he should perform now that his rehab is over.

The assumption here is that rehab addressed all the problems in the shoulder system. Especially when I hear about multiple types of damage to a shoulder joint such as the one described here (involving muscles, tendon, bone, ligaments, and the now the joint capsule) my first thought is there is more going on here than just a shoulder joint not working well. My second thought is this person either has a very high tolerance for pain or little awareness of their body mechanics (or both) to have this much damage. So we need to step back for a second and look at his bigger picture.

The more I work with difficult chronic pain patients, the more I appreciate the interconnections of the human body. The shoulder system's foundation is the scapula. Poor function of the scapula leads to stress of the shoulder joint. But what is affecting the scapula? Turns out everything. The scapula's orientation is strongly influenced by the rib cage which can become depressed on one side. The tissues creating this depression attach to the pelvis, altering its orientation. The pelvic orientation can be influenced by the foot. There are many other mechanical influences I could mention too.

When we think about these connections, we typically think in terms of the bones that connect these areas. If we know a little anatomy, we might also be able to connect muscles across this span. Recently I've learned about fascial connections of these areas. But what is the underlying connection even between all these tissue systems? I think it is our nervous system including the peripheral nerves that control our limbs and the central nervous system (brain and spinal cord). In the future I'll be writing more about the nervous system's control of these tissue systems (as I learn more myself!).

The nervous system is where I am beginning to look for answers and where I believe my treatment is going. Changes here can happen quickly which then alter these tissues quickly (and therefore pain).

I'd love to hear your thoughts on the subject!

 

I was just working with a gentleman yesterday with chronic pain. During and after our treatment he commented that, "I don't feel the miracle yet,". Fixing chronic pain will not be a one-time miracle shot most of the time (although it happens occasionally). This is because fixing chronic pain is not only about addressing the tissues that are causing the pain but the habits that are causing the tissues to work improperly.

Neurologically, we've wired our brain to use certain movement pathways when performing various tasks such as sitting, reaching, walking, and others. Those pathways have become engrained  so that whenever we begin to perform a task that may be similar, those engrained automatic pathways take over the movement portion(s) of those tasks. We don't even have to think about it. But that's the problem. Those pathways, while innocuous early on, have become a source of problems because they constrain variation in movement. It's much like sledding down a hill. The first few runs are fun but once you've developed a deeper path, it becomes difficult to prevent the sled from falling into it and even more impossible to come back out of it once you're in.

The first step is understanding you're in the rut. The next is figuring out an alternative to that rut that causes less pain. The last step is becoming aware of each time you're about to fall into that rut and using your alternative pathway instead.

In the case of back pain while standing up from sitting, you might find that each time you stand up, you are leaning forward at the hips and keeping the back arched or straight. Next time try allowing the spine to round more as you stand. You will find it takes more leg strength and feels really weird-but less painful. That's your cue that you should try this more often and eventually replace your old straight-back pattern with a new rounded-back pattern.

The brain will pick up on this new pattern immediately. Each time you use it, it will become more engrained. After just a short period of time (perhaps a few days), this will become much easier for you to remember and do. That's when the miracle happens, because you've just rewired your brain to develop a new habit, one that fixes your pain rather than contributes to it.

Often you will need the help of a practitioner to not only correct the injured tissues but teach you the connections between your habits and your pain. If you're just having tissue work done, again and again, then you haven't addressed those detrimental habits.

This will take effort on your part. Our nature is to find the easiest way out of a problem. Our bodies are wired for this efficiency as well. Unfortunately the easiest way is not necessarily the best way when it comes to fixing chronic pain.

What are your painful habits?

I've recently begun to understand how rib cage positioning is affected by the muscles attaching to it. What I didn't expect to find is just how much rib cage positioning affects scapular positioning, thereby affecting neck pain. If you've read my books about neck pain and headaches or shoulder and elbow pain, you understand how important it is for the shoulder blades (scapulae) to rest and move correctly.

Until now I've only been able to understand this from a scapular point of view. Then I realized that scapula positioning is often affected by the orientation of the rib cage. And now I'm beginning to see how the trunk muscles (specifically the latissimus dorsi, internal obliques, and external obliques) are affecting the rib cage and thereby the shoulder blades and neck. I also now understand how to release these muscles to free up the shoulder blades.

I learned this technique through practicing the Trauma Reflex Protocol created by Thomas Hanna (developer of Hanna Somatics). A few days ago I measured a client's (with right side neck pain) scapulae and found the right side to be depressed. I then measured the rib cage and found the right side also to be depressed. I taped the right scapula into a corrected position and then re-measured the rib cage. It had also risen!

Yesterday I saw a woman with chronic right-sided neck pain after an accident whereby she fell on her right shoulder several years ago. It's never been the same since. We measured her range of motion which was painful to the right side. The scapulae were sitting too low (depressed). I also found she had a right-sided Trauma Reflex pattern. After releasing the muscles of her right rib cage we re-tested. The right shoulder sat slightly higher and she instantly had more range of motion in her neck with significantly less pain.

This is an exciting connection because, although I understand the mechanical causes of most neck pain and know the exercises to correct those mechanics, sometimes it is not enough. This has always stumped me. But now I have a deeper understanding of  the underlying causes of the depressed scapulae.

I'd love to hear your experiences with your neck pain or headaches. What have you tried? What's worked? What hasn't?