There is nothing special about the 10,000 step rule. Like the 10,000 hour rule, the threshold is influenced by the group of people you evaluate and the references you choose (how you define expert practice and the comparison groups, for example). The number of steps needed to see a substantial improvement is fewer than 10,000 and the curve starts to flatten too (in general, more is better for >60 years old).
There was a progressive decrease in risk of mortality among adults aged 60 years and older with an increasing number of steps per day until 6000–8000 steps per day and among adults younger than 60 years until 8000–10 000 steps per day. Furthermore, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0.67) and a peak of 60 min (0.67).
The higher peak stepping rate may represent higher levels of fitness, accounting for the reduction in mortality.
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Athletic performance comes down to your ability to master multi-planar movements.
Sports occur in all planes of motion: sagittal (forward/reverse), transverse (rotational/twisting), and frontal (lateral/side-to-side). Hence: multi-planar.
Positional Demands of Sports
Sports demand a lot from athletes especially when it comes to different speeds, different angles, and different positions.
Single Leg Training: My Top 5 ⠀ There’s a been a great ongoing discussion in our field of unilateral (single leg) lower body training versus bilateral (double leg) lower body training.
🎯 Core & Grip Strength ⤵️ ⠀ 🧱 Building core and grip strength can come in many forms and through many outlets. Using the hanging position from a pull-up bar serves as a useful way to build both at once. The hanging position challenges core strength through the abdominal muscles and grip strength through the forearm muscles, in addition to latissimus dorsi ("lat") muscle flexibility and shoulder joint mobility.
EIH has been widely studied in both pain free individuals and persons with persistent pain showing both short term effects initially after one exercise session, with other evidence suggesting longer term higher pain thresholds after consistent activity.
🧱 Strength development in the core and trunk muscles is a vital component within a well-rounded strength and conditioning program. A physioball can be a valuable tool to use when attempting to develop a strong core.
Strength training and loaded exercises have been known to improve resilience and tolerance to the many tissues in our body. When an exercise becomes painful, an individual’s intuitions might say to avoid the exercise because it is dangerous.
5 Ways to Modify an Exercise Around Pain by Cameron Faller
Most likely, that is not the case and there are several ways someone can modify the same exercise around pain.
👉Reduce the Weight - Simply dropping the weight lessens the load tolerance on the painful tissues and will allow you to continue performing the same exercise gradually building the weight back up.
👉Reduce the Repetitions - Performing less repetitions also lessens the load for a temporary time when you can either increase the weight or begin to gradually increase the repetitions as your body recovers.
👉Modify Range of Motion - This may be a temporary solution to still allow you to perform the same exercise without fluctuating the weight or repetitions.
👉Modify Posture/Position - Simple postural changes may be able to disperse the stress away from painful tissues. This is considered movement exploration where people may be able to make one simple change such as pointing toes out, screwing the feet in the ground, putting your shoulders in front of a barbell, etc. This may make all the difference between a structurally strong movement pattern and a painful one.
👉Perform a Preparatory Stretch/Movement - When performing more dynamic movements, simply breaking the movement down into one of its parts to prepare the body for may result in a more pain free exercise.
When recovering from an injury, pain does not need to be completely avoided but there are several ways that may lessen those symptoms to allow the body to recover better. There is no such thing as No Pain; No Gain but before ditching an important dynamic loaded exercise, make sure you go through these variations to optimize your recovery.
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Despite high quality evidence supporting exercise as a first line treatment for the management of osteoarthritis (OA) symptoms, typical management continues to prioritize short term strategies such as injections, medications, and/or surgery.
In 2018 Arundale, Bizzini, Giordano et al published a CPG reviewing the current injury prevention programs for ACL and knee ligament injuries. The results were extremely positive and state that “there is strong evidence for the benefits of exercise-based knee injury prevention programs, including reduction in risk for all knee injuries and for ACL injuries specifically, with little risk of adverse events and minimal cost” (Arundale, Bizzini, Giordano et al., 2018, p. A7).
Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com . Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Jason Shane at Shane Physiotherapy.
Keeping it Eclectic...
We know that performing eccentric hamstring exercises such as the Nordic Hamstring Exercise can be beneficial in hamstring strain rehabilitation and injury risk reduction. The problem is, you don't always have a partner willing to hold your legs down while performing the Nordic Hamstring Exercise.
About Scot from http://scotmorrison.com/about-me-3/Scot Morrison is a board certified physical therapist and strength coach who started his undergrad career as an engineering major. He quickly realized that he was spending all his free time researching human performance and moved on to Exercise Science while also training clients at the university fitness center. After graduating with honors in 2008 Scot began working for a hospital based medical fitness center in south Florida where he was involved in the development and implementation of a variety of programs with a focus on childhood obesity, Parkinson’s, Cardiac rehab, and corporate health. During this time he also resumed his schooling and graduated with honors from the University of St. Augustine as a Doctor of Physical Therapy. As part of his DPT Scot completed advanced manual therapy training which he has continued since graduation with a focus on the approaches of the Maitlaind-Australian and McKenzie groups. Scot is a Titleist Certified golf fitness coach and a NSCA Certified Strength and Conditioning Specialist. He is very active in his professional bodies and is an occasional co-host of the popular podcast PT Inquest.
Scot currently works as the head of medical services for the MLS Professional Referee Organization. He also treats local athletes at Black Diamond Physical Therapy and runs a concierge private practice.
PERSONAL PHILOSOPHY
I believe that every patient is unique. I believe that a system based on sound principles will trump a collection of methods. I am not quite sure that all we can change matters or that what matters can always be changed. I think perturbing the system, as long as adaptation is positive, is a good thing.
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How body anthropometrics and bar placement affects barbell squat technique
How to choose the optimal squat variation based on mobility demands and injury history
How to coach the barbell deadlift utilizing simple cues to maximize body mechanics
How to properly prescribe the deadlift and its variations in clinical practice based on patient presentation
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Hope to see you there!
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Keeping it Eclectic...
I'm a Physiotherapist that teaches Pilates and loves to practice Yoga. I have not taken the formal 200 hour yoga training programs but have been practicing for 4 years. This is not a long time in fact to learn about movement but it has shown me that overtime we all change and merge towards new trends. What I have currently experienced is the shift away from high-intensity workouts (which some yoga studios were trending towards) and the emphasis on foundations of movement and student-education.
I wanted to take a moment to reflect on how Yoga practice has changed my teaching style. Each class I take teaches me about my body and how language translates into movement in the body. This blog explores some of the key aspects of my teaching that have changed over time and beliefs I aim to share with my students.
OUR BODIES CHANGE DAILY AND THEREFORE PRACTICE WILL ALWAYS FEEL DIFFERENT.
Every time I practice my body tells me a different story. There are so many variables at play impacting how we feel; sleep, hydration, fatigue, and physical health. As a student it is empowering to understand how alive we are and how change is continuous. Sometimes it feels like we are moving forwards and other times backwards but the point is we are moving. As a teacher I try to remind my students of this continual change. In biological terms (from my recent biology studies) we call this phenomenon 'maintaining dysequilibrium'. It explains the theory that the environment around us is always changing and for us to stay balanced, we always need to adapt to that change, from our hydration levels to cell pH and ATP stores. We are always finding the balance in a never-balanced world. So go with it and accept that it will always be different and that is ok.
BREATHING IS THE KEY TO MOVING BETTER.
Breath. The key to life itself. Without breath we cease to exist.
Breathing through movement is one of the cornerstone signs that you are in control of your body. If you can't breathe, you can't move, that is my philosophy. Simple and easy to consistently follow.
PLANKING & PUSH UPS ARE ACCOMPANIED WITH SERRATUS ANTERIOR.
Get to the top of the plank and return there after doing a push up. Too often I see people trying to draw their shoulder blades together in a plank position and this takes you out of normal thoracic kyphosis and can make your head drop as well. If you want to get better at planking, push ups and your chaturanga, you need to hold the top of the plank well and push yourself away from the floor. Engaging serratus anterior is a great way to improve your core control, allow for easy breathing through movement and develop upper body strength. It keeps you out of your wrists and elbows and works the muscles in your trunk more.
EACH MUSCLE HAS A ROTATIONAL COMPONENT & COMBINING MOVEMENT WITH ROTATION GIVES YOU MORE KNOWLEDGE ABOUT HOW YOU MOVE.
When you are learning about exercise and rehabilitation it is easy (and often more simple) to learn about exercises that target specific muscles. Bridges are for hamstrings and glutes. Squats for quads. Calf raises are for calves etc... What yoga has enforced for me is that muscles are not uni-planar and life is not uni-directional. Combining rotation into poses like a lunge or a side balance teaches me about how well my body takes on variability of movement and adapts to control different planes of movement. If you are finding exercises too simple or if progress is stalling, maybe its time to bring in rotational control?
HAVING STRONGER HAMSTRINGS IS BETTER THAN LONGER HAMSTRINGS.
As you might see from these photos flexibility is not my forte. I always feel like I could benefit from stretching my calves and hamstrings but that doesn't mean everyone I teach needs the same. I do however feel that hamstring strength and control is a goal most people can work towards. Due to their attachment on the pelvis and inherit control over hip, knee and pelvic position, the hamstrings are a key player in trunk and lumbopelvic movement.
SHOES OFF IS THE WAY TO GO.
This one might seem simple but believe me, many people still practice Pilates or Yoga with shoes on. The foot is the vital in providing stability on the surface we stand on and providing proprioceptive feedback about our positioning in space. So, unless it is specifically needed for a condition, shoes are off and foot articulation and control is brought back into the routine. One of the hardest poses I know for balance and control is tree pose with arms above head (growing your branches), looking up (disturbing visual input and cervical afferent input) and then closing the eyes.
SLOW AND STEADY.
Often it is too easy to move to the end of the pose without going through the sticky middle. For example take a simple spinal roll down or forward flexion. The focus is articulation of the spine but it is easy to just fold from the hips and rush down without gaining any articulation. Slow it down, take one movement with each section of the breathe and challenge yourself to go through the entire range of the pose with intention and concentration. Yoga is hard, physically and mentally. It takes so much focus to train movement patterns well, but, it has taught me so much about my body, areas I can continually improve on and areas that are my strengths.
WE NEED TO CONTINUE TO PRACTICE TO MAKE CHANGE MORE PERMANENT.
There is an old saying "practice makes perfect" which I've come to appreciate and understand more. But, its not about being perfect. I actually don't believe there is a perfect. I know that everyone is different and uniquely made so striving for one ideal body shape or function seems unachievable. I do think that we have to practice frequently to make change and habit become more permanent. I know this from experience and how my body feels when I take breaks from practice. I also believe that each day is going to be different and is a new opportunity to learn, grown and change. So instead of practice makes perfect, I know think, practice makes change more permanent.
And lastly, for me Yoga is a place where I can be myself, wear what ever crazy leggings I want and just enjoy the practice of personal progress and discovery. You can practice Yoga anyway and it will always teach you something. The hardest part is turning up and being present.
Sian
This blog has been shared from Sian's Pilates Blog. Sian Smale is an Australian-trained and APA-titled Musculoskeletal Physiotherapist. Sian has been writing a Physiotherapy evidence-based blog for the past 3 years called Rayner & Smale. Sian is based out of San Francisco and continues to write and teach Clinical Pilates while working towards her Californian Physical Therapy license.
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Keeping it Eclectic...
The longer I practice and the more I learn through reading
the research about various interventions, I look at sometreatments thatare being delivered and say,
REALLY!?! But that gets me wondering: “What treatment does my patient REALLY
need?” I’m not asking what treatments have been shown in study to get people
better or what treatments that I’ve used before and I’ve noticed they got
better. I’m asking a deeper question, what treatment do they really, really
need. I mean the type of treatment that if I did not provide it, the patient
most likely would not get better and suffer more because I withheld the
intervention.
I’m curious to see what the comments section will bring as
we debate a question like this. It’s a question without evidence to definitively
say one way or the other which treatment is really needed all the time. (We
probably never will. When treating a patient, we are treating a n=1 and trying
to answer that patient’s questions. It’s not the same as answering a research
question)
How can a study say it doesn’t work, when I’ve done it on patients and they tell me it works? Or flip it, in those cases where a study says it works, but it didn’t when you tried it with a patient.
While there is some research in some areas they may be
pointing us more one direction than another. I frequently come across various
research articles on interventions (IASTM, PRT, Manual Therapy and Exercise,
TDN) that I wonder what
conclusion the therapist reading it come to after reading it? Does it work on
not work? How can a study say it doesn’t work, when I’ve done it on patients
and they tell me it works? Or flip it, in those cases where a study says it
works, but it didn’t when you tried it with a patient. It gets confusing when
one study says something works as good as something else (stabilization exercises as
good as manual therapy) and then another seems to say that they are
different (manual
therapy better than spinal stabilization). Of course with understanding the
evidence, the devil is in the details (what questions are the researchers
seeking, how good was the study, what are the biases, could the data be
interpreted differently from what the authors came up with). To be an evidence
based practitioner we need to have a critical eye when we read and apply
research to our clinical practice and ask more questions. It is vital to the
growth of our profession and the health of our patients and society.
I’m not suggesting some form of nihilistic view that nothing
works and everything is the same so don’t do anything or the “I know my
patients get better so I don’t need to read the research” attitude. I’m just
challenging us to think and reflect on our treatments, if it was REALLY needed
for my person in pain. Could I cut out a few things and still get the same
result (this saves everyone time and money)? Should I spend more time on some
things and less on others (this may expedite and enhance results)? Do I think
through what the patient might want to do or believe they should do? Do I
consider what they will be motivated to do? How about if they have the
resources, skill, and knowledge to do what I’m asking them?
In regards to certainty with treatment interventions, I
think we can be certain there is not ONE treatment that will work with everyone
(even though there are plenty of advertisements telling us there is). I like to
put treatment interventions into three categories. First, there are some
treatments that research has shown that are better for most people with certain
conditions. Second, there are some interventions that from a research
perspective get similar results as others in general. Third, there are the
interventions that seem to be centered mostly around placebo effects when
patients get better when we provide them. We need to provide more of the first,
used shared decision making with patients with the second, and work to
eliminate the third.
via Dr. Kory Zimney, DPT
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Keeping it Eclectic...
Combined Treatment for the Low Back and Pelvic Floor
What happens when a patient comes in with back pain from repeated forward bending but they also have a pelvic floor issue? This is more common than we realize since so many women think leaking is normal and fail to even admit to it when asked. I often have to ask more than once.
So, what then?
After you diagnose and treat the back, you need to prevent it from happening again and to do this you have to be able to generate and sustain intra-abdominal pressure to keep a spine healthy. That’s low back treatment 101 (thank you, McGill). But, what if intra-abdominal pressure makes their pelvic floor worse? What if the pelvic floor treatment that worked for them was decreasing all intra-abdominal pressure? How do we mix that with creating spinal stability to make the entire system happy?
First we need to understand that not all pressure is bad, we just need to teach the pelvic floor how to handle it and find some middle ground between pelvic floor PT and the ortho world before we confuse all our patients with all or nothing thinking. So, let’s take a closer look at a progression with a patient that has mild urinary incontinence with pressure (coughing or sneezing) and a suspected herniated disc. This is an incredibly common scenario because postpartum moms are picking up heavy car seats and bending awkwardly over changing tables and cribs and they tend to be the highest subset with pelvic floor issues. It’s a great combo of postpartum ligament laxity and poor postural movement habits.
Here is a step by step breakdown of treatment:
#1. Get her diaphragm working. This will naturally help turn on the pelvic floor as well as provide a dynamic stabilization system to the spine. Not just deep belly breathing, but make sure you are getting a 360 expansion of her diaphragm. This will provide some spinal traction as well.
#2. Make sure her pelvic floor is coordinating with her diaphragm. This step might take a a bit of work and ability to feel. (Pelvic floor PT that uses biofeedback is incredibly helpful for this.) I will also have the patient palpate themselves if they can’t “mentally feel” in the comfort of their own home. Usually, they can physically feel if they take a large enough breath. Deep squatting also helps with mental feeling. Just make sure you instruct the patient to direct the pressure from a breath down but not bare down on their pelvic floor during the inhale.
Inhale: diaphragm goes down, pelvic floor relaxes
Exhale: diaphragm goes up, pelvic floor contracts
Deep Squat Exercise for 360 Diaphragm Expansion:
#3. Now it’s time to teach her to brace - even if she has to hold her breath a little in the beginning. Yep, I said it, create intra-abdominal pressure. BUT, you must make sure that the pelvic floor is coordinating. If not, you will make a pelvic floor issue worse! If a patient is having a hard time figuring out how to brace, just have them cough and hold it. Then move on conscious control from there. Now, if the pelvic floor is coordinating, this isn’t an issue, a cough (forced exhale) should cause a recoil up of the pelvic floor, effectively managing pressure in the trunk to stabilize the spine.
#4. Teach her to brace, breathe and move. This is hard one but absolutely possible through great exercises like McGill’s Bird Dog and Side Planks. You may need to start with a classic deadbug before advancing to these. Getting back body diaphragm expansion while holding a side plank will change your patient’s world.
Start with sideplanks from an elevated surface, then advance to the floor, then finally add a balloon.
Advanced sideplanks:
Make sure her diaphragm is coordinating with her pelvic floor. Absolutely no breath holding during this. Learning to manage spinal stability while breathing is the goal!
#5. Teach a hip hinge. This is a must but extremely hard to teach unless you have some core stability first. If a patient can’t stabilize their spine, then eccentric glute loading is virtually impossible. She will need this hip hinge for picking up that child a zillion times per day!
Learn how to hip hinge:
#6. Build a great squat with tons of eccentric glute loading. I also love to throw in the diaphragm for this one as well as the pelvic floor. The goal is to get all the parts moving and coordinating so it becomes second nature. Plus, great glutes = a safe back and a great pelvic floor!
Squat with pelvic floor timing:
#7. Both the low back and pelvic floor need hip rotation. If her hips don’t rotate properly, then her low back has to do more rotation. Not what we want from a back pain patient, especially one with a forward flexion injury. The pelvic floor also plays off the loading of the hips. So, building a dynamic reactive pelvic floor means you need hip rotation.
Start with a basic lunge, then work up to this rotation.
This exercise brings together core stability through transverse plane loading and hip rotation. Most patients will automatically feel their pelvic floor fire. The pelvic floor can’t help it; there is just too much stimulation from the deep core, deep hip rotators and adductors to resist firing in this exercise, which makes it such a great exercise for the pelvic floor.
Lunge with Rotation:
#8. Assess overall alignment. Does the patient have a forward head? Do they stand with their knees locked? Posture is huge for both the treatment of the low back and pelvic floor. These are pieces of the puzzle that need to be addressed.
#9. Don’t forget about the top of the lumbar spine. Do they have thoracic spine stiffness? Same as with the hips, if the thoracic spine is not rotating and extending properly then the lumbar spine will take a beating. Not to mention the increased risk in pelvic floor issues from poor posture. Gaining 360 diaphragm expansion will really help with this.
#10. Last but not least, don’t forget about the feet. They are the foundation for the entire body. Weak arches + tight posterior chain = compensation up the chain. Make sure she can engage her arches and has plenty of ankle dorsiflexion. If you want to get fancy, be sure to check for talus movement as well.
This is a long list, but a comprehensive one. You probably won’t get repeat business from this patient because you will fix them so well, but you can guarantee they will tell everyone they know what an awesome PT you are!
Want to learn more? Check out Sarah's 3hr CEU class on the Pelvic Floor [HERE]. This class takes a closer look at how the kinetic chain affects the pelvic floor. Take away effective new exercises to implement immediately into your program.
Sarah Ellis Duvall, PT, DPT, CPT
Sarah is a PT with passion. She has owned an out of pocket pay practice for a decade and enjoys treating both ortho and women’s health issues. Her passion lies in bringing together the big picture and treating the body as a whole. She is also a mom and adventure sports athlete.
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
All written and filmed content on this blog and its channels is meant as instructional and informational. The author and guest authors of this blog are not responsible for any harm or injury that may result.
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