ENDURE: June 26, 2015 "Yeah, They Must Workout" - The Enduring Power Center

Let's say you want to sit into or stand up from a chair....or climb stairs....or jump...or run....or even walk for that matter.....if so, you'd better have hips that can do the job....they're the body's workhorse - and sometimes they take a beating.  

            

The hip used to be a joint that didn't get much attention.  It's highly stable, supports us well during movement and in the last 20-30 years has become an easy target for replacement if it wears out. Seems simple enough.  Recently however, it's becoming a hot topic not only because it provides a window into the health of the entire system (e.g. hip fractures are often considered a sign of frailty and poor health) -- but also because when they're not moving well, they can be a source of other problems up and down the "chain".

For example, if the hip isn't providing the proper movement, force is transferred to the knee and it tends to get painful or more quickly worn.  The same is true for the back.  If the hip doesn't move like it should, the lower back will take up the slack.  Force which should have been distributed across the hip translates to the knee and a greater degree of twisting at the back is noticed.  This is very apparent with certain golfers and baseball hitters who swing with their front foot "toed in" more than usual. Toeing the foot in essentially locks the hip and prevents further rotation at the "ball in socket" style joint.  When it runs out of room, the segment above (lower back) and the segment below (knee) take extra force.

In the workplace this same risk exists.  If you ever see someone loading or unloading materials from one surface to another (like a pallet to the back of a truck for example), the same series of motions are also present.  As the person rotates across their hip (i.e. twist R with R foot toed in or visa versa) significantly more stress is placed on the knee and back.  It's not uncommon for us to suggest a person "toe out" slightly as a tactic to lower their risk of pain and injury. 

This of course is not all.  There are many other things we do that can place stress on the moving parts including:

• Sitting for long periods - compresses the hips and increases stiffness
• Sitting too low (knees higher than hips) - puts us in a more extreme range of motion.
• Allowing our "glute" muscles to get weak - this is our forward-movement power center, even those who exercise diligently tend to avoid squats and lunges when they can.
• Stretching with improper technique. Although it is more and more common to see people warming up in the workplace, it's not uncommon for their technique to slip a little....although any movement is a step in the right direction - it's important to get the most from the time invested by using proper form.
• Working in a deep squat without adequate range of motion -- this can stress the joint surface.
• Forgetting that balance and stability is a "hip thing" - similar to the rotator cuff of the shoulder, the hip has a series of "stabilizer" muscles designed to keep us upright and functioning well.

Whether it's a pinch in the hip or groin, discomfort that runs from the "cheek" to the leg or stiffness when you change positions or stand and move....almost always the hip is involved.  Here's the simple "at-home" test:

Sitting in a chair place an ankle on the opposite knee (as if to "cross your legs in a figure 4 position").  Now look at the position of your knee in relationship to your hip.  Are they in line with each other?  Are they close?  If not and the knee is quite a bit higher than the hip, and cannot comfortably achieve the "inline" position, your hip is not moving as well as it should. Not everyone's will....but most should....especially if there is a significant difference between sides.

Not sure?  Let us know how we can help.

Have a great weekend,

Mike E.

RECOVER: June 19, 2015 - End of the Chain & Critical to our Function

After several weeks, we've come to the end of the line.  Well, the end of one line.  We started at the crossroads, where the lower body and the upper body meet and then traced our way up and out....through the shoulder, across the elbow and into the forearm.  Last week we squeezed through the wrist and now....we arrive at the hand.

The hand is critical to our ability to function.  It plays a role in just about everything we do and, as some argue, is what makes us unique as humans.  Our ability to manipulate objects and tools with precise timing and force allows us to do things that literally nothing else on earth can do.  Watch any skillful musician and their speed and dexterity is obvious.  Watch any craftsman or hobbyist who masterfully uses tools to create/repair and you can appreciate the many nerve-connections between the brain and the hand as you watch ideas become reality....the original 3D printer.

However, not unlike any of the areas of the body, when a balance between use and recovery isn't maintained, things can go wrong.  The problem is, when things go wrong in the hand, it can have a major impact on our day to day lives.

So what typically goes wrong? Well, the good news is, the hand is pretty resilient.....it was built for a ton of use.....but it's not without limits.  Therefore, it's important to understand that the trade-off for dexterity and the finely tuned sensation we have in the hand is a lack of padding -- there just isn't much muscle bulk -- this means bones, ligaments, tendons, nerves and vessels are all very close to the surface and is one of the reasons the use of gloves can never be understated.  Lacerations, fractures and other acute injuries to the hand are ALWAYS a risk.

Beyond trauma however, we most commonly see signs of wear and tear.  Individuals who overuse the hands often develop thickening and stiffness of certain tissues.  As hands become muscular, a normal adaptation to hard work, they tend to lose dexterity, motion and sometimes even sensation.  One of the most common imbalances we see on a daily basis is a lack of finger extension and subsequent stiffness in the joints of the hand. This lack of motion often is accompanied by reduced circulation and sometimes results in discomfort....and is largely preventable.

QUICK TEST

Here's a simple self test to illustrate the point.  Flatten your hand on a tabletop by pulling your thumb into the "I swear" position (as if you were "placing your hand on the bible" and taking an oath).  Your fingers should be in line with your hand and the entire surface should be on the table.  

The good news is - most everyone can achieve this.  The not as good news is - that's not the test.

Now, without allowing your fingers to bend (and not using the opposite hand to help), try pulling your fingers up off the surface without lifting your hand....so only the fingers come off.  This is called active finger extension as shown on the third set of pics HERE and is something everyone should be able to do.  Over the years we've evaluated many movement patterns including finger movement and there are many many folks who have lost this motion.  Sometimes the loss in motion is accompanied by other signs/symptoms, sometimes it's not. After evaluation, we often recommend simple "tendon gliding exercises" to help restore motion - as simple as they are, they are surprisingly effective when used appropriately.

Of course, decreased movement is not the only thing we see in the hand....sometimes too much motion can be an issue (unstable or repetitive micro-trauma to joints) and overuse of the thumb with over-reliance on mobile devices is a growing threat (google "iPad Hand").

The best news is, like most areas of movement impairment or imbalance, with some effort, hand motion can return, stiffness in the joints or soft-tissues can often be resolved and movement impairment today doesn't have to be limiting forever.

Let us know if we can lend a helping....um....if we can help.

Have a great weekend,

Mike E.

MOVE: June 12, 2015 - You've Reached the Bottleneck

I hate traffic.  Well, maybe hate is a strong word....I really really dislike traffic....especially the kind that seems to come out of nowhere.  Maybe it's sun glare in the morning, or perhaps the aggressive folks jockeying for position when a lane closure is ahead (potholes!), or maybe it's volume at a toll plaza - no matter, there just always seems to be that little bit of dread in knowing the person behind you is at "ramming speed" and you're not sure they see the brake lights.....and that was just yesterday's commute.

In a sense, this is what happens at the wrist.  A bunch of different tissues (tendons, bones, ligaments, nerves, arteries, veins, etc) all with differing size, structure and function trying to get through a bottleneck....and like any bottleneck, if the flow gets altered too much, it can ruin your day.

Take for example the "simple act" of opening and closing your hand to grasp something. It's something we do thousands of times per day and something that typically doesn't require much thought or effort.  If we have an occupation that requires us to manipulate something in our hands (hand tools for example), we may not only have to do it often but may have to apply force at the same time.  Like any form of exercise, the more we use the tissues (tendons that flex the fingers), the thicker and stronger they get.  Occupationally this is a good thing - it makes the job of gripping more efficient.  Anatomically however, it's a bit more tricky.  If these tissues become too thick, they begin taking up space in the bottleneck and soft/sensitive tissues (nerve, blood vessel) can get compressed or pushed-aside, which alters how we move and might leave us in some discomfort.

Or, consider the bone structure.  We have 8 wrist (carpal) bones and another 5 where the hand begins (metacarpal).  That's 13 different bones all jammed into a very small space.  No different than any area where bones come together to form joints, adequate space between the surfaces (to avoid rubbing and grinding) is a must for proper movement. It's a pretty delicate balance.  Now think about how difficult it might be to maintain that space with all of the challenges we throw at it. Grasp something and the bones compress.  Pull something and they are under tension.  

The golfer who swings a little deep and hits the club against the hard ground can experience serious compression at those surfaces and often pain.  The fitness enthusiast who has begun incorporating the ever-en-vogue "burpee" into his/her routine -- can absorb significant force if they are not using proper form through the hips and core a good thing that can go bad. Or, whether on the job or at home and no matter what the task, the person who positions the hand in a non-neutral wrist alignment, the more uneven (and potentially harmful) the force of the task.  The list could go on and on.

The key to remember at the wrist is - like all parts of the body - it was built to MOVE.  If that movement gets restricted, it can have a significant impact on quality of life. Another recent study  for example showed that grip strength is an incredibly strong health and longevity predictor....in this case, better than systolic blood pressure....so keeping that wrist moving well is important.

Here are three very simple tests you can do to get some information about the condition of the bottleneck:

1. Place your palms together in a "prayer" position and try to raise your elbows up in line with your wrists.  How far can you go?  Are you close near 90 degrees without pain or restriction?  Any discomfort in the hand?

2. Reverse the position so the backs of your hands are together and try to lower your elbows.  Does your wrist allow more than 90 degrees of pain-free motion?

3. Make a light fist with your thumb tucked into your palm (under your fingers). Gently tip your hand toward the pinkie (5th finger) side.  Does it move freely? Do you have to alter your movement because of discomfort?

Although there is no "failing" on these tests, and shouldn't make you worried if they don't go as planned, they can be simple early warning signs that should be addressed.  The earlier....the easier...a few simple tendon and nerve glides can go a very long way.

The wrist is an intricate....but not necessarily delicate part of the body. If we are to keep the structures strong and functioning well, like any narrow passageway, maintaining an organized flow is critical.  Let us know if you need help.

Have a great weekend,

Mike E.

CONNECT: June 5, 2015 - The Most Powerful Hinge I Can Think Of

Most of us take the lowly elbow for granted.  It's not as complex as the shoulder, not as cranky as the back and not nearly as intricate as the hand or foot.  In fact, it's really a pretty boring joint....until it doesn't MOVE like it should....then you really really appreciate this "simple hinge".  Want to eat something? It's tough to FUEL the body without bringing your hand to your mouth.  Want to read a book or send a text? Very difficult without the elbow.  Need to re-position the pillow so you can be comfortable while you RECOVER? Try it without bending or straightening your arm.  The list is long.  So, as I continue to explore some of the common aches and pains we see, here's a bit of a different take on one of the most underrated joints in the body.

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Over the last few days and as part of my new duties in the American Physical Therapy Association of NJ, I attended a conference in Washington DC with some of my colleagues from around the country to discuss health issues that face our clients and profession. We dove in and debated fiercely how we can best help our clients ENDURE the health risks they face and ultimately take back health....and although this was my first time attending this type of meeting (and so I was a bit skeptical we would actually accomplish anything with this many differing points of view), it didn't take long to realize we could...and in this case "many elbows would lighten the load".

It dawned on me that supporting and affirming each other's ideas, CONNECTs us with people on a deeper level and ultimately builds us up -- something known to positively influence health. As these simple acts improve our ability to work with others and create a positive atmosphere we are rewarded with a relaxation-response, the opposite of being "stressed" something we all can benefit from. Although I suppose we don't officially need functioning elbows to clap (makes me think of seals), it's a lot easier to provide this positive feedback with them.

Every time we outstretch an arm to introduce ourselves or formalize a commitment by "shaking hands", we CONNECT with the other person and let them know we care. Much like the elbow, this too is an incredibly underrated health action. We are social creatures, hard wired to feel strength and safe in a community.  When we "shake on it" we tell the other individual we are "with them", that we consider them, at some level, part of our community which has a major impact on our health.....and it's just not the same without the lowly elbow. 

And....after a series of exhausting "dawn to dusk" days....I can't wait to get home, put my things down and re-CONNECT with my family. Although I suppose we could figure out a work-around (some cultures touch noses), I can't imagine not getting a bear hug from my kids....like a handshake with a turbo boost....a pretty big role for elbows in there.

Not unlike any meeting or work group that has a big goal or challenge it faces, we certainly did not solve all of the problems related to health. We definitely didn't agree on everything and not everyone walked away satisfied with the outcome; but regardless of the meeting, setting or community, when you've got a great end-goal, people who care and many pairs of functioning elbows, anyone can play a role in improving the health of our community....we can CONNECT.

Sometimes it's the little things....

Have a great weekend,

Mike E.