Hamstring Stretch Modification

As many of you know by my previous post, I went to a pretty phenomenal seminar the other weekend. During the portion of the seminar discussing the hamstrings, Dr. Spina mentioned how he didn’t like typical hamstring stretch and proceeded to discuss why, and I wanted to share that with you all. First, let’s look behind the knee and discuss what’s there superficially (closer to the surface). We have the hamstrings coming off of the ischial tuberosity as one tendon, which then starts to separate into the three hamstrings about a third of the way down. As you get closer toward your knee, the hamstrings sort of head in opposite directions so the semitendinosus can blend in with the pes anserine on the medial side, the semimembranosus will blend in with the knee capsule, and the biceps femoris will attach to the fibular head on the lateral side. If you look at this as a triangle of sorts, the gastroc will make up the bottom of that triangle. The middle of that triangle right above the knee line in the back is where you’ll find the popliteal fossa. Here’s a picture that basically shows what my word-vomit is trying to describe:

Fig8_popliteal_fossaOkay, it’s not so much a triangle as it is an arrowhead.

Do this for me real quick: with your knee bent at a 90 degree angle or so (if you’re in a chair, just scoot forward in your chair so the back of your leg is exposed near the knee). Take both of your hands and grab the hamstring tendons on either side of the triangle. The big tendon(s) you feel on the inside of your leg is the semi brothers (and gracilis), and the tendon on the outside of your leg is your biceps femoris. I demonstrate what I mean in this video:

 Sweet socks, I know.

Go right between those two tendons and sink a little deeper into the popliteal fossa until you can feel some dense connective tissue, but be careful, there’s some arteries and veins of importance in there. That dense, cord-like tissue you may be able to feel is your sciatic nerve (before it splits to become the peroneal and tibial nerve down the lower leg).

Ever wonder what that burning feeling is right behind your knee with a typical hamstring stretch? Yeah, that’s your sciatic nerve. As with any connective tissue in the body, your sciatic nerve can adapt over time (SAID principle), but does that mean you’re effectively stretching the hamstrings if you’re feeling your nerve getting irritated instead of the belly of the muscle pulling tight? I am reconsidering the effectiveness of a typical hamstring stretch based on what Dr. Spina presented. So what is a more effective stretch? Slightly unlocking the knees while keeping a lordotic curve in your lumbar spine as you bend forward. Then you want to drive your butt away from your knee while trying to keep your chest tall. This should allow you to actually feel the stretch in the belly of your hamstrings instead of behind your knee, which we have now determined is just an irritation of your sciatic nerve (but that doesn’t mean you’ll eliminate that burning feeling right behind your knee if you’re really tight).

Here’s Dr. Spina with a 2 minute video showing his version of the hamstring stretch, which I will probably start adopting as the version I use on myself and with my clients. Give it a shot and let me know how this slight adjustment helps the effectiveness of your stretch.

Jeromie

FAP/FR® Lower Limb Review – Being Humbled

frr-logo-png1

I’ve been a trainer for 4 years and a massage therapist for 6 months. In the pursuit of being great at what I do, I know that continuing my education and applying those principles to my practice to the best of my ability and understanding is an ongoing process.

As I’ve been seeking information from some of the well-read folks in both the strength & condition, as well as the rehab and bodywork world, I’ve been able to find some rather interesting/intensive courses that really push my knowledge. It has also allowed me to really evolve as a trainer/therapist.

The Functional Anatomic Palpation™/Functional Range Release® lower limb course this weekend was phenomenal. I think it speaks volume of the quality of the course when the room has at least 5 people you know who are great at their craft (I even own one of the attendees DVD). On top of that, the host of course, Dr. Andreo Spina (Dre), is very well read and his content and passion express that knowledge. I also appreciated that this course is about principles, and the application of the principles will always depend on your findings. There is no “Step 1, do this. Step 2, do that.” Much of the principles of tensegrity model were incorporated into the course, and the way all of the principles were explained made complete sense to me.

The seminar began with palpation. How do we know what we’re treating if we don’t know what we’re contacting? Dre utilized reference structures to start the palpation and we were able to move medially or laterally based on those reference structures to find other structures. For example, using the adductor longus as a reference, we could easily palpate gracilis and pectineus depending on how we guided our palpation. I have never been that specific with any of the lower limb muscles before. Ever. This is the kind of specificity I wish I had in massage school.

Why so specific? The idea is to objectively make treatment-based outcome measures – what tissue is affected by the soft tissue release procedures and what is actually happening to the tissues we are targeting with our technique application? Then he asked, Can our manual ‘inputs’ lead to actual changes in the tissue structure? If so, how can we maximize said changes? And is rehab more successful with specificity or will general strength and conditioning suffice?

The answers and main takeaway of the whole weekend can be summed up with two words: specificity & force. Your body’s tissue will adapt to specific forces, or lack thereof, by strengthening your tissues and the neural input of those tissues in the lines of force that you use most. Therefore, if you try to use your body (whether intentional or unintentional) in a line of force that your body is not adapted to, you’re more likely to injure yourself. With force, there’s internal force (neural: you driving the force) and external force (mechanical: something external driving the force, like my hands or a massage tool that isn’t just compressing fascia – there needs to be inter-layer sliding).

By utilizing our palpation skills, we then sought after tissue tension within mid-ranges of motion. It should be common sense that end-range is going to create tension in the connective tissue, but if there’s a similar tension while the tissue is in its mid-range, then that tissue is the target tissue for treatment. If the tissue doesn’t respond to external force (mechanical force), then the more neurally driven internal force is the other option. This made sense, as I’ve come across circumstances where I thought massage would help, but the tissue tension never changed. My hands can’t override your brain, so we were given strategies to try to influence the CNS to unload its signaling to the tissue (proper time and frequency are necessary, as well).

Once we went over palpation, we were introduced to the release technique. I found it very helpful in not only positioning, but also in saving my hands. I also appreciated the emphasis on connecting with the client. I highly, highly recommend every therapist attend at least one of his courses and see what you might learn and takeaway from Dre’s concepts. Trainers can attend his Functional Range Conditioning™ course, too, which is another awesome concept. We played with some of the FRC™ stuff briefly and I couldn’t do some of the movements because the joint capsule of my hips need work.

Some gems from the seminar:

1. Change comes from neural drive/cueing
2. Training or treating is just adding force
3. The spine doesn’t move independently on itself, it bends as a unit
4. There is no tissue or system that responds to single inputs
5. Lack of joint motion = a lack of communication to muscle attachments
6. All connective tissue (muscles, bones, fascia, etc.) are all just different expressions of the same material
7. With pain upon waking (night pain) think inflammation
8. We want to promote independent motion in a normal range
9. Closing angle pain = joint problems
10. The threshold of the tissues is the amount that you can control (CNS)
11. Increasing range-of-motion without training that ROM will lead to a return of symptoms
12. Internal rotation is the first to go with degeneration
13. The typical hamstring stretch is just a sciatic nerve stretch
14. The typical piriformis stretch is really a gluteal fascia stretch
15. The longer the muscle is when it is contracted, the more force through the tendon/connective tissue at the attachment site
16. Movement is neurologically complicated
17. It’s not about muscle – it’s about connective tissue
18. The movement of superficial fascia is important for afferent feedback
19. The knee isn’t a hinge joint – it also does internal and external rotation
20. Your body is continuously working on itself – move as much as you can
21. Palpation is an art – you flow
22. Touch induced analgesia is why you feel better after you’ve rubbed a boo-boo – it doesn’t last
23. The best thing you can do for inflammation is move

There was a lot more specificity to the application of the technique and to the course as a whole, but I will leave it at that because you really need to sign up and learn the principles behind Dr. Spina’s madness in person. It’s amazing how little you know when you go to these things and realize your approach has been so narrow. Functional Range Conditioning™ is coming out here (Newberg) in January, so be sure to check into it and sign up if you can!

I look forward to the spine and upper limb courses. Hopefully soon.

Jeromie

Am I doing this exercise right?

On May 12th, 2012, Jason (my boss for both the gym and EPLifeFit) wrote an article for Everyday Paleo called “Learning Proper Form at EPLifeFit.”

This is what we (which has evolved to mostly I) do just about every day on EPLF. Members submit a link to their unlisted YouTube video(s) on a private forum (that only they and myself can see) so we can critique the movements we prescribe for them.

Since I do this so regularly, I wanted to make a proposal: I want to say, publicly, that anyone who wants to have their movements critiqued by me may do so – all for free. All you have to do is send me a video of a front view and side view, where I can see the whole person (feet and head position included).

Send them via email to Jeromie@unorthodoxmassage.com

Stipulation: this isn’t intended to deter folks from signing up for EPLF, as it’s a great resource beyond the video critiques (which is extremely valuable itself), with loads of information on our forums, so I have to put a limit on the submissions to only being available over the next 30 days. That means that on April 19th, 2014, I won’t accept any more free submissions (but I will continue to work with you on any movements you have already submitted and still need to progress). The nice part about that is for only $20/month you can have unlimited access to me and my critiques on EPLifeFit.

Also, I’d like to be able to blog about them – without showing any faces or saying any names, I’d like to show the screen captures of what your movement looked like, my response and suggestions, and the critiques to follow to show progress.

If this sounds like something you might be interested in, again, my email is jeromie@unorthodoxmassage.com

Jeromie

p.s. I work 2 other jobs besides EPLF, plus my own massage business, so I may not be able to critique videos right away. Just as a heads up.

2013 in Review

Thought I’d jump on the bandwagon since…

This has been a year of ups and downs in my life. I started my 29th year of life in January, yet I felt as though I hadn’t accomplished as much as my peers who are still in their mid-20s. It felt a little disheartening, but the process of making a career out of my passion hadn’t fully revealed itself until I was about 27.

Let’s start with the ups.

The beginning of this year was the start of my second quarter in massage school. That’s the quarter where we started to practice on more than just our cohort during class hours. It was intimidating, but the experience was necessary – as it is with any profession. My third quarter went well, as I participated in the sports massage clinical rotation for 7 of the 11 weeks, leaving just a few weeks of on-campus clinical that was dedicated to staff only. My fourth quarter I rotated an off-campus clinical with an oncology clinical, and I also volunteered for a full day of massage at the beach volleyball tournament at Seaside.

For continuing education, I took a NeuroKinetic Therapy™ Level 1 seminar (on my birthday weekend), RockTape, one or two of the Kinetic Integrations’ courses, and Postural Restoration Institutions’ Pelvis Restoration course. After the course, a colleague of mine and I started an NKT™ study group. It’s been a great learning experience. I’ve also attended some get-togethers with a group of practitioners and trainers/coaches who like to hang out, have beers, and talk about the body/movement. I don’t say much, but I am surrounded by people who’re way smarter than me, so I take some simple advice I’d only recently heard (at the group, actually): I only have 1 mouth, but I have 2 ears.

For my personal life, I asked my partner, support, and friend to marry me back in May. We’ve been in the planning process and have a venue, photographer, florist, officiant, and outfits pretty much done. Most of it is just the deposit, but it’s nice having much of it planned and out of the way to focus on working to pay for the rest of the bill later. And the Ducks won the Alamo Bowl.

1390685_538203539581734_1972086430_nThis one. I love this one. My favorite engagement photo.

The end of the year took a slightly unexpected turn after graduating, becoming licensed, and starting Unorthodox Massage LLC. Unexpected because a) I never thought I’d have my own business, because I am not a “business person” and I don’t know if I ever will be, and b) because I had expectations that weren’t met. With my students loans kicking into repayment (because the majority of which had already surpassed the 6 month grace period) and a wedding to pay for, I needed to be working more. The reason I haven’t been blogging much is because of the end of the school year, start of a new business, and the search for another job (and getting one) has kept me quite busy. The week before Christmas was a 60-70 hour work week for me. With the gym, EPLifeFit, my massage business, and my new job doing massage/aide work in a rehab clinic, my 4 jobs keep me pretty busy. At some point, I’ll be venturing into the rehab realm full-time.

2014 should be a great year for me. I turn 30 in January, I am getting married in September, I am taking a continuing education course in March from Dr. Andreo Spina that will probably be my most favorite thus far, and I’m participating in a sports massage internship at Portland State University (my Alma mater) with one of my massage teachers. I am also looking into applying for an athletic training program, as I really like working with athletes and think I would provide value to any athletic team in the process of injury recovery for both exercise and soft tissue therapies.

The downs seem quite trivial now that I’ve shared the ups. The downs in life are always a learning experience and I’ve had my fair share. Sometimes you wish you could press rewind and do it all over again, but you can’t and there’s only moving forward and that is what I’ll continue to do. It’s what I’ve always done.

Some people I’d like to thank:
Erin and future father- and mother-in-law: thanks for the ongoing support and help you’ve given me in 2013. It means a lot.

My parents and siblings: I don’t see you as much as I wish I could, but thanks for being who you are, supporting me, and entertaining me on social media.

To the fitness pros who have changed the way I think about the body and how it operates, or who have shown me exercises and techniques that have helped me grow as a professional over this last year: THANK YOU. This includes:
Andreo Spina
Greg Lehman
Erson Religioso III
Perry Nickelston
David Weinstock
Thomas Wells
Dean Somerset
Tony Gentilcore
Lee Boyce
Patrick Ward
Phillip Snell
Guido Van Ryssegem
Jim Laird
Gray Cook
Zac Cupples
Bill Hartman
Dave Dellanave
Bret Contreras
Tony Ingram
Jonathan Fass
Paul Ingraham
& Charlie Weingroff

I look forward to what 2014 has in store for both my personal life and my education. Happy New Year everyone.

Jeromie

SMRT Reads – Improper Movement

It’s been a while since I’ve posted, but I’ve been busy with a lot of little happenings in my life. I graduated from school. I went deer hunting for the first time, but wasn’t successful. I took my state practical exam for my license. I have been at the gym more for a combination of covering other trainers’ classes, on ramps, and personal training. I’ve been preparing my future massage room at the gym. I’ve been doing some of the wedding stuff, like putting a deposit on our location, meeting with an officiant, and getting an engagement/save-the-date photo shoot organized with my fiance. And napping. That always feels glorious.

Even though I’ve been busy, I still try to catch up on the interesting postings that appear on my social media. I also have certain blogs email me updates, so I’ve had to catch up on those, too. During this process, I’ve had some things cross my mind. Some are rhetorical, but some are me being genuinely curious.

It seems that every person has some sort of asymmetry or imperfection when it comes to movement. This is sort of the premise with PRI – to optimize the body’s natural asymmetries. Therefore:

1. Is it okay to train in what some would consider “improper” patterns to strengthen that line of movement? Dr. Andrea uses the example of a rock climber in this interview he did that he posted the other day. The body positioning necessary to make a climb will require things like hip and knee extension with your femur internally rotated. But wouldn’t many consider that pattern “improper”? I guess context matters.

2. Is always training neutral joint positions good? Imagine if your body was never prepared to tolerate forces that were outside of “neutral”. Taking the words of Ido Portal at the end of this clip and asking in question form, is there such a thing as improper alignment or just improper preparation?

3. Is it always beneficial to go full range-of-motion? I think it was a post by John Meadows on Facebook that got me thinking about this, so I did some Google searching and found this article he wrote titled: Only doing full ROM is crazy! It was after attending a RockTape seminar that I started thinking about full ROM. The host of the seminar, Dr. Le Cara, stated that he wouldn’t have his ball players perform full ROM of squats because of their long lever angles. Again, context matters, and posterior chain strengthening would be high on my priority list with squats that weren’t full ROM.

4. Thinking about movement and range of motion, it would seem to me that not being able to demonstrate a certain range-of-motion would be worse than training an improper ROM. Let’s go back to the rock climber. Let’s say the rock climber trained internal rotation of the hip. Is that worse than a rock climber who always trained in hip external rotation and abduction who had limited hip internal rotation? It would seem that a rock climber who can’t perform full hip internal rotation will end up injuring themselves climbing a mountain. Take, for example, this photo that I found using Google search.

rock-climbing-020_1Both of hips are in internal rotation. If she presses up with her left foot to make keep ascending up the side of this rock, and she lacked the necessary internal rotation to be capable of that, don’t you think she would injure herself? If you always train external rotation and lose the capacity to internally rotate, that leads me to my next point.

5. If one extreme is “bad”, why is the other extreme “good”? Let’s say you’re tying to work on your hip mobility and you’re trying to be a Supple Leopard with the goal to externally rotate your hips like a boss a the bottom of your squat. What if you end up losing some hip internal rotation range-of-motion because of it? Is one extreme okay because the other is labeled as “bad”? What if we went back to point #2: is it really about proper alignment or is more about proper preparation?

I don’t want it to seem like it’s okay to start training “improperly”, but that with proper progression over time (like any training adaptation), you can strengthen a certain movement pattern to be better prepared for handling a certain load. In this video, Dr. Spina says that injuries occur when the load imparted exceeds the load absorbing capabilities of the body.

How prepared are you for any unknown load that may be imparted to your body?

Jeromie

Sports Massage: Another School of Thought

Taken from my class notes, here’s how sports massage is defined:

In the book Sports and Exercise Massage by Sandy Fritz, she describes sports massage in the following way: “Sports massage is targeted to support fitness, help reduce the demands the sport places on the body, increase the ability to perform the sport, and enhance and shorten recovery time” (p. 14).

Types of Sports Massage:

  • Pre-event
  • Inter-event
  • Post-event
  • Rehabilitation/medical
  • Promotional or event massage

We were told in the notes that: “specific techniques, such as deep or cross fiber friction work, should not be used. Massage techniques which are painful or require any recovery time are strictly contraindicated. This massage should be pain-free. —If massage is given directly before an event, it should be rhythmic, stimulating, superficial, fast-paced and last no more than 10-15 minutes. If an athlete is jittery, the pre-event massage may be modified slightly to provide some relaxation and centering. However, the above conditions still apply.” Inter-event is very much the same, with post-event being more relaxing to bring the athlete back to homeostasis and help with stress-recovery.

For my program, we need at least 10 hours of outreach, where we offer massage that is supervised by a clinic supervisor. On Saturday, August 10th, I chose to volunteer for a beach volleyball tournament in Seaside, Oregon doing sports massage. Not surprisingly, the big thing many of the athletes wanted was KT Tape.

Kerri_lowresLet’s see how much traffic my site gets with this picture

There were two other popular treatments I saw. The main popular treatment? Graston®. The other treatment I noticed was ART®. Graston® uses tools to provide soft tissue relief, while ART® uses a specific type of pin-and-stretch. Both can be quite intense/invasive as a manual therapy technique (*depending on the therapist*). If trigger point therapy or deep tissue massage isn’t recommended, why is it okay to offer instrument assisted therapy or a pin-and-stretch? Especially the instrument assisted soft tissue manipulation. If the therapist is too aggressive, wouldn’t it be presumed that the treatment will cause some inflammation and create a situation where the need for recovery would be necessary?

But here’s where the “contraindication” of this kind of pre- and inter-event therapies started to make me really confused. I read THIS POST by Erson Religioso III and he linked THIS STUDY. In Erson’s post, he describe this study to conclude: “The article by Chaudry, et al basically shows it takes extremely large forces (more than 100 lbs) to even produce 1% deformation. This is hardly the amount of deformation that would be required to see the rapid changes in ROM we often see when doing manual tissue work.”

If it takes more than 100lbs of force to deform tissues even 1%, where’s the contraindication to deep tissue/myofascial work before an event? The event itself is going to create inflammation, not to mention the influence of the athlete’s diet, sleep patterns (usually inconsistent due to travel), training (frequency, volume, intensity, etc.), and life stress (family and relationship stress, work stress if they aren’t professionals, etc.).

Many of the benefits of massage come from the effects on the central nervous system (the brain). In Zac Cupples review of Clinical Neurodynamics chapter 2, he shows how the nervous system can be influenced by body movements, but more importantly in chapter 3, he discusses the various ways neurogenic pain can be created by the abnormalities in the nervous system. The last one is inflammation.

“There are two inflammatory dysfunctions – neurogenic and reduced. Neurogenic inflammation involves substance P and calcitonin gene-related peptide (CGRP) release from C fibers in the dorsal root ganglion. These substances travel to the peripheral nerve’s distal terminals to affect vasodilation and inflammation. This inflammation occurs with increased efferent activity. The sympathetic nervous system can also play a role in inflammation. This act happens by releasing prostaglandins, adrenaline, and noradrenaline. These changes occur when there is excessive pressure on the nervous system.”

This makes me curious: is it the deep tissue/myofascial work that is dangerous or is it the pre-event stress, sympathetic dominance, sleep deprivation, or other stressor that is of worry? In that case, shouldn’t the application be athlete specific? If they like deep work, and it’s brief, why not (sports massage is usually 10-15 minutes, as stated above)? If they don’t like deep work, keep it more stimulation-based without discomfort. I experienced both of those types of athletes at the Seaside event. Some didn’t want deep pressure, while others liked it a bit heavier. If we’re not even deforming tissue 1%, is it wrong to try to make the athlete happy? I mean, their feeling of “accomplishing” something with the session is what appeases their nervous system, which I alluded to from the work of Greg Lehman in my Massage Myths SMRT Reads post back in January:

“Very simply manual therapy can modulate the nervous system’s production of pain. We have more than two decades of research showing that the means that manual therapy work is through changing nervous system function. This is not about joints being out-of-place, breaking down scar tissue or merely strengthening or stretching muscles. Immediate changes in the perception of pain, production of strength or change in range of motion can be seen. It’s not logical to assume that a 30 minute treatment session healed tissue, broke down scar tissue or suddenly made a muscle stronger. The only physiological component that can change this quick is our nervous system. Manual therapy affects the nervous system and can improve our function. All manual therapy techniques can be effective.”

Change the nervous system and you change what’s driving the car. If the driver is managing their stress well, they will perform well. If not, they will increase their risk of “crashing” (injury or burnout). I don’t see how a crash would occur from that 15 minute pre- or inter-event massage session that includes some deeper work.

Jeromie

Take Supplements? You Should Own This.

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If you pay attention to the social networks of popular fitness and nutrition outlets, you have probably already seen Examine‘s new supplement reference guide. It’s a fabulous resource and it’s filled with literally THOUSANDS of references.

The guys have done their research. And they’ve complied this research into one fantastic eBook (PDF) that they’re selling. All of your supplement needs are at your fingertips with this one. I was lucky enough to be offered an affiliate link, which means if you click on this link and purchase the reference guide, I will be given a small percentage for helping to market their product.

And I’m helping to market their product because I know it’s legit. Some of the best in the industry wouldn’t support it if it weren’t.
Elliott Hulse
Dean Somerset
Tony Gentilcore
Eric Cressey
Keith Norris
Skyler Tanner
Chris Highcock
Julia Ladewski
Paul Jaminet
Jonathan Goodman
Elsbeth Vaino

And the list could go on and on. I think the best part is the guys over at Examine recently wrote for website of the icon himself, Arnold Schwarzenegger. They’re the real deal, and so is their product, so be sure to check it out.

Jeromie