What's the take away here? Simply resting a groin strain until the pain is gone is not an adequate recovery protocol. Without addressing the important factors described in this blog, you will likely suffer from future ailments, such as hip impingement or hernias, due to the poor hip mechanics adopted by the body during the healing process.
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"MOST patients will get quicker results, go to surgery less often, and have decreased risk of future pain if imaging is not done prior to treatment."
The Best Core Exercise You Probably Aren't Doing.
What The Core is And How to Train It
There are a lot of good exercises out there to strengthen your core, the problem is not many people are doing these exercises because there is a poor understanding what “core” means, and how the “core” functions in human movement. So let’s clear up this confusion first.
I typically tell my patients that you have 3 cores; a core for the neck and shoulder complex, a core for the lumbar spine and torso, and a core for the hips and pelvis. Granted, this is a bit of a misnomer, because all three of these “cores” are continuous with one another through chains of muscles that all work together to perform the same function, which is to create a stable spine for the arms and legs to move about. So your “core” actually runs throughout the entire torso from hip to shoulders and into the neck, a much larger area than the abs, which most aesthetically focused exercises target.
A secondary purpose of the core is to control rotational forces that result from day to day activities, the main one being walking. When we walk, as our left foot comes forward, our right hand also comes forward creating rotation in the spine which can be damaging to tissues (discs, cartilage, ligaments) if not properly controlled. The control of this motion is mainly done by our obliques and paraspinal muscles (tiny muscles that attach directly to the bones of the spine) and must be trained in order to protect us against repetitive use injuries, and therein lies the problem. You won't be training these muscles by doing frontal plane (think flexion/extension like a crunch of leg lift) exercises typically seen in the gym.
There are two types of exercises that train our core to be more resilient to this rotational force, anti-rotation exercises like the pallof press, and controlled rotation exercises like chop and lift variations. However, there is one exercise that not only focuses on controlling rotation, but improves shoulder and hip stability, helps create coordination of the core system, improves mobility in the wrist and hips, requires no equipment, and most importantly, it gets you down on the ground so it’s very safe!
This exercise is quadruped crawling. It sounds much easier than it really is, and in order to perform these exercises correctly, it requires great hip mobility, a strong core, and coordination of the entire system. It’s a fantastic neurological exercise as well because it requires the teamwork of so many muscles working together.
So how do you perform this exercise correctly?
The most basic rule with crawling is to keep the butt low and keep a neutral spine. You can start on your hands and knees, or hands and toes, but as you crawl resist the urge to let the butt raise up high like you would in a “bear crawl”. Move very slow and controlled, moving the opposite hand and foot/knee at the same time so they leave the ground simultaneously and are placed back down simultaneously. Imagine a ball being placed in the small of your back, and as you move, try to keep the ball from rolling off the low back. Variations include forward and backward patterns, side to side patterns, box patterns, and transitions from one style to another.
You may need to condition your wrists if you don’t gain enough mobility and strength in the wrists. You may also need to work on hip and knee mobility so you’re not over stressing those joints. These are not always quick fixes, but by not addressing these mobility restrictions you will be at a high risk of injury in your daily life anytime you get into an unfamiliar position, such as falling. When you’ve built up enough resiliency in the wrists, shoulders, knees, and hips, the crawling variations will tie your core together better than any isolation exercise will ever do.
So next time you are looking for a good warm up or cool down core exercise, ditch the sit-ups or these “core” machines, and practice some crawling patterns for 5-10 minutes. You’ll be surprised at how challenging these exercises can be.
Dr. Scott Dunaway is a Doctor of Chiropractic located in Clarksville Tn and owner of ChiroStrength. He specializes in treating injuries associated with repetitive overuse habits by combining chiropractic adjustments, Active Release Techniques, and global movement assessment and corrections. To schedule an appointment call the clinic at 931-321-1414 or submit the new patient form on www.ChiroStrength.com
Rolling your IT band is getting you nowhere
“Runner’s knee” is a common phrase used around the running community and is often correlated with a sensation of tightness on the outside of the leg and pain on the outside of the knee. The Iliotibial (IT) band is the commonly accused culprit for this condition, and the most common do-it-yourself approach to fixing this problem is using a foam roller on the painful leg.
Because foam rollers have been shown in the literature, at least initially, to increase range of motion and reduce pain in muscles, it’s a reasonable approach. However, the IT band is not muscle, it’s what’s called fascia, and it reacts differently.
The IT band has deep attachments to the femur (the long thigh bone) and is very strong, but not very elastic. It’s so strong in fact, that you, or any manual therapist, will never be able to “lengthen” this tissue. However, a therapist can improve tissue movement at the junction between different hip and leg muscles which the IT band crosses, but the ‘shearing force’ required to make improvements can’t be done with the foam roller. And finally, the IT band is almost always being over stressed already, or over stretched if you will. You're better off staying away from the actual site of pain aside from maybe ice.
Foam rolling the muscles around the IT band in the quads, hamstrings, and calf will assist in improving the condition, but it’s an incomplete approach at best. This condition is not typically a knee issue. It’s a hip, foot, or core issue, so try this instead.
Roll the foot comfortably on a ball to ensure the joints of the foot are getting good movement, and make sure the big toe is sufficiently mobile. While weight bearing, you should be able to pull your big toe off the ground with ease to about 60 degrees of extension. You can also simply spend time out of your shoes on a natural surface which will “wake up” the tiny support muscles in the foot. Without a mobile foot, especially in the big toe, you will likely have less activation of the gluteal muscles which help stabilize the hip and therefore, has a huge effect on the knee.
For the hip, you need quality extension and internal rotation. Most people have very poor hip extension, and when they get into what appears to be hip extension (think of your back leg on push off), they arch in the low back creating a focused area of extension in the small of their back which will lead to joint and muscle pain of the lower spine/SI joints. Performing a good hip stretch followed by active hip range of motion will provide better joint motion over time. For a few good stretches for the hip YouTube the following phrases: “Bretzel 2.0” and “tactical frog”. For an example of active hip motion I’ve posted a video on ChiroStrength’s Instagram page.
Also, staying with the hip and core, you need to have good balance. Runners spend up to 95% of their race on one leg, however, most people don’t train any one legged exercises. A little more advanced, but fantastic exercise, is the single leg dead lift (with or without weight). This is a challenging exercise when a focus is put on maintaining a neutral spine and good hip extension on the up leg. And because we are bipedal creatures (walk on 2 legs), we must train more transverse plane core exercises instead of frontal plane exercises. That simply means, core exercises need to be focused on controlling or resisting rotational forces, (think Chops, Lifts, or Pallof Presses) instead of frontal plan exercises like planks, sit ups, or leg raises. A core that can properly handle the rotational force associated with throwing the right leg and left arm out in front of the body, for example, will be better able to support the lumbar spine, pelvis, and hips thereby saving the stress on the knees.
When these areas are ignored in a runner’s routine, you’ll commonly see them land on a knee that cave’s in, which stresses the IT band. Not because the knee is somehow functioning improperly, but the support system is failing. Runner’s knee is almost always a mix between stability and mobility problems, so if you want to foam roll the painful leg, follow it up with some quality stability routines or be prepared to deal with this issue for a long time.
Dr. Scott Dunaway is owner and Chiropractor at ChiroStrength Located in Clarksville TN. This facility combines corrective treatment with group classes in order to educate clients on how to maintain their bodies regardless of what their sport or hobbies are. Visit www.ChiroStrength.com or call 931-321-1414 to learn more.