The TRIFORCE

When describing our treatment approach to patients, I often cite what I call, Three Dimensional Care:

Three Dimensional Care consists of three areas:

1. The Intervention.
2. The Behavior.
3. The Environment.

With each patient we address these three aspects to provide a comprehensive, multi-dimensional solution to a health issue that, in the vast majority of cases, is a multi-faceted problem.

The Intervention.
This is why people go to the doctor, or to any other service industry -- to GET SOMETHING. It could be a medicine, or a diagnostic test. In other health care fields -- chiropractic, massage therapy, PT -- it could be a stretch, and exercise, a joint/tissue mobilization (e.g. massage or adjustment).

This is what people (and insurance) is willing to pay for -- the something. It's perceivable and often tangible, and frequently provides results.

Unfortunately, those results are frequently temporary.

Why? Because these next two are frequently neglected:

The Behavior.
The the vast majority of pathologies, our own behavior -- either knowingly or unwittingly -- either causes or exacerbates the situation.

How we use our bodies -- in motion and at rest -- is ultimately the most important factor in our well-being. More often than not, an issue -- e.g. PAIN -- requires either a temporary or permanent change in how we treat our bodies.

The healthcare professional MUST address this, and help the patient determine if he/she is using their body -- sitting, standing, walking, lifting, reaching, lying, squatting, twisting -- in such a way that is preventing recovery.

The Environment.
Nearly as important as The Behavior is The Enviroment. What about a person's surroundings is causing, exacerbating or hindering recovery from PAIN? For an office worker with neck, back, or arm pain, it may be office ergonomics -- or how one's work station is set-up.

Take, for example, this case:

An office worker who commutes 30 minutes each day to work is involved in a rear-end condition. Prior to the accident, they "never had back pain"*; however, after the accident -- despite "clear" diagnostic testing (x-rays, MRI), they continue to have chronic and debilitating pain -- worst in the morning, gradually improving in the AM, then worsening again by work's end and bed time.

(*"Well, it's been sore on and off...for twenty years...")

They've tried pharmaceuticals (NSAIDs to prescription narcotics), physical therapy, chiropractic, massage, acupuncture -- with varying results -- but always TEMPORARY.

Must be something siniser, right? Maybe NOT.

More likely is this person is only receiving one-dimensional care -- the Intervention, only.

Upon further examination:

- The worker sits with a flexed posture for a significant portion of his/her day -- in the car, at work, then at home "relaxing" in the easy chair or on the computer (BEHAVIOR).

- The person's work station requires frequent twisting -- from computer to file cabinet -- that, after further discussion -- gradually exacerbates back pain as the day goes on (ENVIRONMENT).

After addressing BEHAVIOR and ENVIRONMENT, the person -- coupled with effective and individualized INTERVENTION (e.g. manual therapy to lumbar spine, self-stretching, core stabilization) improves significantly over 2-3 weeks until their once-chronic back pain is abolished.

A True Story

This exchange actually occured in my office a few weeks ago.

[Joe walks into office, en route to the locker room -- undoubtedly to change after running before work]

Medical Assistant: "Joe, do you know a good stretch for your upper back?" [points to area between shoulder blades] "It's been bothering me for a few weeks..."
Joe: "Sure, try this." [proceeds to demonstrate trapezius/rhomboid stretch] (INTERVENTION)

Joe: "You know, most upper back and shoulder blade pain come from the neck. Make sure to watch your posture while working; a forward head posture can stress the neck and cause that soreness." (BEHAVIOR)
Med Assistant: "It's really sore in the morning..."

Joe: "Your neck can also get stressed out at night time -- do you ever read or watch TV in bed?"
Med Assistant [reluctantly]: "Yes..."

Joe: "Do you look like THIS?" [lays on the floor - literally - and demonstrates posture]
Med Assistant [more reluctantly]: "Yes..."

Joe: "It's likely you're straining your neck in that position. I recommend you read on your side -- or lie flat and hold the book over your head instead! Or read in a chair, before going to bed" (ENVIRONMENT)

In this example, the Medical Assistant's "upper back pain" (read: NECK PAIN) subsided in a few days with Three Dimensional Care. Equipped only with an INTERVENTION (e.g. a stretch, or massage), she likely would've received only temporarily relief.

*****

The next time you visit your healthcare professional, look for Three Dimensional Care. It applies to all health issues.

For example: HIGH BLOOD PRESSURE.

1. "Here's a blood pressure medication." (INTERVENTION).

But what about:

2. "Add a 20 minute walk to your day -- even a brisk walk at lunch can lower blood pressure levels." (BEHAVIOR)
3. "Have you considered replacing the salt shaker on your table with a low-sodium seasoning?" (ENVIRONMENT)

Because, without Three Dimensional Care, your relief from any health issue may be only temporary, or require chronic usage of the intervention -- medications, massage, chiropractic adjustment, or pain drugs.

Springing Forward

Happy Spring, everyone!

With the new season comes new opportunities! Lots of exciting things happening at EPT in 2010. Stay tuned for updates on upcoming collaborations, with these guys and these gals!

Cheers,
-J

A Solution

Thanks to all for a lively debate on the topic of mechanics in long distance running.

To summarize the 4 Fundamental Problems listed in the previous post:

#1 - No One Teaches Us How to Run
#2 - Fast Kids Become Sprinters, Slow Kids Are Distance Runners
#3 - The Complete Disregard for the Dynamic Nature of Running Strides
#4 - The Over-Emphasis on Physiological Distance Training versus Biomechanics

These distill down to one big issue: we're passing the buck on running mechanics, and missing out on making significant improvements in athletic performance.

Based on that premise, as promised, below are some proposed "solutions":

#1 - Recognition of Stride Mechanics as a Relevant Aspect of Performance

You cannot fix a problem if you do not recognize it, or at least consider it within the realm of possibility. Many coaches out there -- elite coaches -- fail to consider or recognize the contribution of individual mechanics in performance.

Clearly, mechanics is not the only factor in performance, nor is it the "end-all" solution to running greatness. However, recognize that mechanics should hold equal if not higher priority than all other aspects of training -- because the success of all other running-based training relies upon optimal mechanics.

To reiterate:

• Decreased maximum efficiency --> the body absorbs more energy than it transmits --> more tissue stress --> slower recovery --> lower training volume tolerance, or INJURY -- SLOWER PERFORMANCE
  

Stride mechanics should, in the very least, be given equal regard to physiology, training theory, sport psych, and nutrition.

#2 - Belief that Stride Mechanics Can Be Improved Through Coaching

Too many runners and coaches believe that either (A) stride mechanics cannot be changed, or (B) that to do so is a death wish.

Neither is true. I read several comments saying, "So-And-So has weird mechanics and they're GOOD, so why change?"

That's like saying, "Billy's doing easy mileage and hills for training and he's FAST, so why change?" Yet coaches constantly tinker with training methodology -- mileage, workouts, timing, cross-training -- with the intent that optimization facilitates improvement.

This should also be the case with stride mechanics.

Negative, "distaster" examples from a change in training program are just as common (if not more so) than a change in mechanics. And both arise due to:

• lack of knowledge by the coach on what the athlete truly needs, and/or
• poor implementation on the part of the coach and/or athlete

The answer to flawed mechanics is not, "Let's not mess with it, 'cuz it could get worse". The answer is education.

#3- Recognition that "Doing Drills" Alone Will Not Change Mechanics

I've seen countless kids that rule at "A-steps" and "B-skips" with perfectly awful strides. Why? Because the (well-intended) principles of the drills are not consciously and repetitively practiced in stride.

To change form, you have to run differently -- not just do a skip before or after. If the stride does not feel differently to an athlete, it isn't changing.

#4 - Acceptance of Fundamental Norms of Optimal Stride Mechanics

The BASIC norms proposed below, like physiological training systems (aerobic, anaerobic alactic, anaerobic) and subsystems, are based on research conducted in biomechanical labs, or on observational study.

The most detailed, coherent and easy-to-implement resource on running biomechanics I have found is called Explosive Running, written by Michael Yessis, Phd, a biomechanist/Professor Emeritus at Cal State Fullerton. It is primarily from his text where I choose to obtain these norms.

This is not an all-inclusive list. Listed below address but a FEW of the common mechanical errors observed clinically:

Inadequate hip flexion during flight phase

The #1 problem I see -- both clinically and as a coach/runner -- is inadequate hip flexion during swing or flight phase of running. They're simply not getting their leg high or far enough forward.

PROBLEMS ASSOCIATED: inadequate hip flexion can result in a myriad of problems. Instead of their body energy going FORWARD, it is going DOWN, resulting in:

• Shorter strides
• "Shuffling gait"
• Slower running speeds
• Heel striking
  

INJURIES: anterior shin splints, knee pain, ITB syndrome, stress fractures (foot, tib-fib, femur), back/SIJ pain

NORM: 35-45 degrees of hip flexion (as measured from vertical) sustained through swing phase*

(*depending on pace; the faster pace, the more flexion)

Inadequate knee extension during flight phase/early stance phase

The second most common is inadequate leg extension, or "flicking foward" of the tibia on the [FIXED] femur.

PROBLEMS ASSOCIATED: Like insufficient hip flexion, not enough knee extension causes a short stride. But, different from the hip, not enough knee extension results in a bouncy or "squat" stride and overall poor efficiency, as the leg is not acting as a stable lever for power transfer between the runner --> ground --> runner.

• Short striding
• Slower speeds
• Poor frontal plane control of hips/knees (knees going in and out)
• "Bouncy stride"
  

INJURIES: heel/arch pain, medial shin spints, patellofemoral pain ("runner's knee"), ITB syndrome, back pain

NORM: 5-10 degrees of knee flexion at initial contact ("nearly straight"/"slightly bent")

Poor pelvic position or instability

Translation: the pelvis has to be in the neutral position, and neither tilted too far forward or back, or demonstrating excessive side-to-side motion (as seen from in front or back).

PROBLEMS ASSOCIATED:

Excessive forward or backward tilt:

• lack of full hip range of motion, resulting in short striding
• poor transfer of ground reaction forces (runner --> ground --> runner) from trunk <--> legs.
  

Excessive side-side motion:

• decreased stance time (=shorter strides)
• less stable/efficient stance leg for propulsion, poor GRF transfer
  

INJURIES: chronic hip flexor strains, posterior thigh pain ("hamstring" or "glut" pain), foot/shin/knee pain due to poor dynamic knee control, SEVERE BACK/SI Joint pain

NORM: Pelvis should be in slight forward tilt and stable in both sagital and frontal planes.

*****

This is just a brief example of the some stride norms. What, exactly, they should be are up for [scholarly] debate, no differently than what %VO2Max constitutes optimal 3K pace versus 5K pace vs the marathon.

The devil is in the details and, as with all coaching, there is both science and art to their adoption and implementation with runners.

But you cannot adopt and implement what you do not recognize, know, or value. Which brings me to #4:

#5 - Improve Coaches Education w/Greater Emphasis on Mechanics

I've been a runner for nearly 20 years. I've been a coach for eight. I hold certifications in coaching from the National Federation of High Schools, USA Level I, and USA Level II. I have a Doctorate in Physical Therapy.

Both USATF Levels I and II cover stride mechanics, as does PT curricula, but, no different than water-cooler discussion, to be GOOD at addressing mechanics requires emphasis and balance in the big-picture.

We, as coaches and runners, need to raise stride mechanics to the same level of discussion, debate, and study as we do physiology, training theory, and sport psych/team dynamics.

We also need to value and legitimize the USATF-sanctioned curriculum by promoting Coaches Education. High schools, universities, and professionals should support this standard of education by encouraging these ed programs and hiring coaches with these certifications.

#6 - Utilize Readily-Available Technology

Several years ago, a complicated set-up was required for a formal biomechanical assessment, including a treadmill, visual markers, an expensive high-speed video camera, and often specialized computer software for analysis.

Today, this technology is so ubiquitous most of us don't realize we already have it.

Digital (still and video) cameras and even mid-grade cellphones can now be used for "video analysis". Here's how:

Step 1: Get out camera or phone
Step 2: Turn on
Step 3: Hit "record"
Step 4: Have someone run by (and the tricky part:), HOLD STEADY.
Step 5: Watch it.

It's that simple, and often a tool I use clinically. Digital cameras and phones are EVERYWHERE -- nearly every kid has one. Use it as a way to evaluate form with nearly immediate feedback.

Greater technological orders of magnitude can be used but, like everything, is best reserved for the serious runner with resources. The most ideal: set up a camera, hook it up to TV, which sits in front of a treadmill. Run and "watch yourself"! This is by far the best method to change form -- real-time feedback.

Whatever you choose, recognize this emergent tool for stride optimization.

#7 - Recognize Important Occasions to Re-Examine Biomechanics

There are specific occasions where it is most important to look at a runner's mechanics:

Repetitive Injury - If a runner, engaging in consistent training, continues to experience the same pain in the same spot, or continues to suffer the same lost-time injury, there is a biomechanical flaw. Too often the buck is passed to, "Oh, she can't handle the training!"/"He breaks down when he runs 70 miles per week". False. His/her mechanics are not allowing that level of training. Rather than give up to "fate", look at mechanics.

A Plateau in Performance - How often do we see runners who do the same training, the same group, the same coach, the same environment -- only to run SLOWER a year later? Often enough to consider the possibility that his/her mechanics have changed.

Burn-Out - When mechanics are poor, they typically cause injury. But sometimes they don't. Instead, they slowly wear us down. Inability to handle the same amount of volume/intensity may signal biomechanical inefficiency -- just enough to hamper recovery but not enough to injure.

ALL THE TIME - No matter how you're running, runners should routinely consider mechanics and ask and receive frequent feedback. "How's my form looking today?" is a simple question, but is not asked of coaches and teammates nearly enough.

It's not enough to "just do drills" and go run. Mechanics require a consistent level of attention, just like any other area of performance.

*****

This list is not a "magic bullet" for world record performance, nor do I claim it to be. Instead, the goal is to raise our awareness, education and expertise with stride mechanics as a vital tool for optimal athletic performance.

Distance runners pride ourselves on success through determination, and overcoming (if not complimenting) natural ability with hard work and a drive toward excellence. There is no reason why we cannot take that same desire and apply it to, arguably, a runner's only "skill" -- putting one foot in front of the other, really fast!

Best of luck in that pursuit. :)

The Cart, The Horse, and a Racing Spoiler on a Ford Festiva: What is WRONG with American Distance Running

It's 2010. A new year, and renewed excitement for fast times: indoor, outdoor, and over hill and dale.

And runners across the country flood message boards with hits and posts oozing excitement about the latest trends: the new training, the new gear -- "Free" (but not the least bit cheap) shoes, supersocks, beltless trench coats, ad nauseum -- the brilliant new coaching minds, and the fresh new talent. All of which buoys our hopes that, indeed, this year will finally be the year for The Breakthrough for US distance running. Or, at least, my running.

But, it probably won't.

Sorry.

There are Four Fundamental Problems with US Distance Running. And until they're recognized, we will never reach our potential. And you will never reach your potential -- no matter the Team, the Coach, the Workouts, or the Gear.

#1 - No One Teaches Us How to Run

How silly. Everyone knows how to run, right? It's just like walking but (presumably) faster, and more tiring.

Wrong. There's a right way, and limitless flawed ones.

Distance running is the only "real" sport where kids are simply not being taught the fundamental mechanics for success.

Take basketball: if a little kid shows up for the first day of practice, chucking the ball, "granny-style" to the hoop, that's a major problem, right?

Here's what the youth basketball coach might do:

"Hey Johnny, let me show you the CORRECT WAY to shoot a basketball!"

He would then demo those correct mechanics and might even use a clever acronym for the kiddies to remember (who else remembers "BEEF" from kid ball?).

Atta boy, coach. But what does the high school, and even college and "professional" running coach say?

"That's OK, Johnny! Just chuck that granny shot up there A FEW BILLION TIMES, and you'll eventually get really efficient at it!"

He/she might even add a few coaching pearls about dedication and perseverance, or a vital importance of weekly session of 50,000 granny shots being the key to "ideal mechanics".

This is unacceptable, and a major reason why the talent in this country fails to develop: the lack of biomechanical emphasis by coaches and runners at every level -- even at the highest professional levels.

Oh sure, there's "steps" and "skips" and "drills" galore for sprinters and distance runners, alike, but find me one coach who knows WHY those are importance -- and their direct application to stride mechanics -- and I'll find a hundred runners who haven't the slightest idea what they do.

#2 - The Fast Kids Become Sprinters, the Slow Kids Are Distance Runners

In the US, when you're considered "fast" as a kid -- in other words, when you possess ideal stride mechanics -- our youth sport system funnels you directly to the sprint coach, post-haste. The slow kids -- with form characteristics ranging from "distance" (in other words -- inadequate hip flexion/knee extension during max velocity running) to "clunky" are diverted to the mile, two mile, or whatever distance is longest. Where, of course, they lack coherent instruction on mechanics.

Thus, the vast majority of our track and field talent pool goes toward sprints, while the remains are swept over to distance.

#3 - The Complete Disregard for the Dynamic Nature of Running Strides

Across the board in all "skill sports" -- basketball, baseball, golf, bowling (and the field events!) -- sports that require rhythmic, multi-directional biomechanical motions -- heavy attention is paid to the complex and painfully frustrating dynamic nature of FORM.

Basketball and baseball players often cite "hot" and "cold" streaks relating to shots, swings, and pitches -- and they'll spend hours refining them. Golfers' swings are broken down in slow-motion with telestrators on TV, pointing out strengths and weaknesses. And field event coaches -- from the hammer ring to the high jump pit -- surround and bombard their athletes with step-by-step feedback and cues for approach and execution mechanics.

What are the runners and distance coaches doing? Fretting about splits and paces, spikes v flats v trainers, "VO2Max" v "Special Endurance II" v "Extensive-Intensive".

All the while wondering why -- after having done the same workouts with the same teammates in the same shoes on the same track -- they're slower and feel worse than a year ago. How is this possible?

Must be the iron levels. Are they eating enough protein? Too much?

No one is asking about their mechanics.

Even keeping all else equal -- coach, training, environment, and gear -- strides change. And, like the golf swing and the jump shot, can change fundamentally (and tragically) by the day, or moment.

This lack of awareness of dynamic nature of an individuals' stride is -- in my professional opinion as runner, coach, and healthcare practitioner -- the single greatest cause of poor performance, lack of career development/progression, and injury, burnout, and, ultimately "retirement".

#4 - The Over-Emphasis on Physiological Distance Training versus Biomechanics

This is a culmination of numbers 1-3. The physiological training aspects of distance running -- base mileage vs sprints vs intervals vs fartleks vs recovery vs altitude vs sea level vs core strength vs weights vs plyometrics -- absolutely dominates coaching theory, as well as internet banter.

A simple word search of the ubiquitous LetsRun message board found the following search results:

TRAINING: 141,000 results
WORKOUT: 35,166
INTERVAL: 6,576

STRIDE: 6,101
MECHANICS: 1,838

That's nearly a 100:1 ratio of training-related v mechanics-related discussions on arguably the most popular distance-running message board.

This is representative of how runners and coaches at all levels prioritize the sport. Attend your state's annual coaches clinics, and I will bet my next paycheck the bulk of discussions will be on training theory, zippy mental tricks or, my favorite -- "My Team Did Really Well This Year, So I'm Gonna Tell You Why We're Good".

To have training theory -- at its current level of hyper-analysis and obsession -- dominate over basic running biomechanics is, by definition, putting the cart before the horse.

*****

I have resided in Track Town USA long enough -- and interacted with enough elite track and field athletes and coaches -- to have become sufficiently jaded with this flawed approach to US Distance Running.

For youth and collegiate runners, it's disappointing to see such glaringly misplaced priorities: obsessing about this training theory versus that, or debating the merits of weights versus plyometrics, static versus dynamic stretching, etc.

Well-known Coach Brad Hudson put it well on his own website, stating (in paraphrase) that distance runners need not obsess about the latest gimmick; they simply need to run more. And while I agree with that philosophy, I'll take it a step further:

Distance runners need to run more with optimal stride mechanics.

For post-collegiate and professional runners, the incredible sacrifices they make to achieve their goals -- all the while ignoring fundamental flaws of stride mechanics -- is simply tragic.

These are people leaving loves ones behind, delaying families and careers, living in near-poverty (often without healthcare, even at the highest levels). Yet they continue to train with often glaring biomechanical faults.

That some of these athletes train and perform at such elite levels with such basic (and changeable) flaws in mechanics is both amazing and, frankly, embarrassing.

Think a Division I or Professional basketball player dribbling a ball with two hands, or underhand shooting free-throws. I put these examples on par with some of the more fundamental (and, shockingly, "accepted") biomechanical flaws, including:

• Trendelenburg hip gait
• Extreme lumbar lordosis ("gut out")
• Inadequate hip flexion/knee extension ("The Distance Stride")
  

It's embarrassing, not only for the athlete, but for the coach who allows these habits to persist all the while hyper-emphasizing other "esoteric things" such as peak base mileage or 5 repeats instead of 4.

*****

Why is this a problem? Improper biomechanics result in:

• Decreased maximum speed --> SLOWER PERFORMANCE
• Decreased maximum efficiency --> the body absorbs more energy than it transmits --> more tissue stress --> slower recovery --> lower training volume tolerance, or INJURY -- SLOWER PERFORMANCE
  

I heard one elite runner lament about how injury-prone she is, even though she "works way harder than her teammates at stretching, icing, and nutrition".

Perhaps it is because they are more biomechanically efficient. Pouring in quart after quart of oil every day does not fix the leaky engine.

*****

In summary, to train so incredibly hard and sacrifice so much -- all the while sporting a significant biomechanical deficit -- is akin to this:

A SPOILER might be vitally important to achieving your top-end speed, but...might you wanna turn that Festiva into a Ferrari first?

*****

The solution? Recognition of biomechanics as the most important aspect of distance running. If it's important to analyze and perfect the 13-stride approach in high jump, might the 26,000-step approach to the marathon finish warrant similar scrutiny?

*****

NEXT POST: The Solution, with specifics. It's not that difficult. If high school quarterbacks can memorize a playbook, a kid can learn how to put one foot in front of the other.

And so can the coach.

The Fridge and the Fuse Box

Happy New Year. A New Year's resolution -- more posts!

*****

There is a notion -- particularly in sports medicine -- that the only possible injury sources are muscle, tendon, or bone:

"Hey, Doc! My leg hurts!"
"You probably just pulled a muscle. Go see a PT."

[3 weeks later]

"Hey, PT! I've been strengthening my leg, but it still hurts!"
"You probably have tendonitis. Let's massage and ultrasound it."

[3 weeks later]

"........STILL HURTS!"
"Gosh, I guess we better get an MRI or bone-scan. Maybe your leg is broken."

This "Muscle-Tendon-Bone" (MTB) paradigm is reliable for acute injury -- the football player with a thigh bruise, or the soccer player with the sprained ankle -- but its utility for non-traumatic, gradual onset chronic condition is very poor. Because, by definition, muscle, tendon, and bone are three of the fastest healing tissues in the body. And as such, given enough time (usually no more than six weeks), they will heal on their own.

Therefore, those have issues -- pain, weakness, or poor control -- usually have a fourth tissue involved:

THE NERVE.

In the fall of 2001, the Journal of Orthopedic Sports Physical Therapy had two issues devoted entirely to neurological issues in sports injury and rehabilitation. Indeed, Editor Richard Di Fabio's introduction, entitled "Athletes Have Nerves!", shares this blogger's exasperation with "conventional MTB treatment":

"....Clinicians [must] look over the horizon and discover relevant scientific findings in disciplines that might initially seem irrelevant. We have only recently discovered that athletes have nerves. Now, the core of rehabilitation following knee injury has been forever changed by the literature in neurophysiology, neuromotor control, and motor learning."

His tongue-in-cheek declaration of this"recent discovery" of an alternative to MTB is refreshing, if not frustrating: because, here we are, 9 years later, and few in the sports medicine community even consider "Nerve" in their evaluation and intervention of pathologies of all kinds.

*****

When I first see a patient, I always do two things:

(1) Watch how they move
(2) Ask them about their spine

The former relates to motor control: How do you control your body? Is it normal or "weird"? Pathology can arise and thrive simply by abnormal control. The latter relates to the "power supply" -- the spinal cord and nerves -- and how well it is "flowing" to the affected body part.

In the very least I get confused looks (at worst, disgruntled no-shows) from patients when I address The Nerve.

"Why is he looking at my BACK when my KNEE hurts?"

Patient understanding has improved since I've begun using this Allegory:

Your refrigerator is broken: you open it up, its contents are lukewarm, the motor isn't running. Things are beginning to ripen. What to do? You call the repairman, who may look at the compressor, or the fan, or the refridgerant. He finds some flaws, repairs and replaces them.

Problem solved, right?

You restock the fridge with food. And at first it seems fine -- the inside gets pretty cool, but soon enough, it stops running again. You call the repairmen back, or maybe you seek out another repairman, who tries something else.

This goes on and on. What to do?

You could go to a third repairman, who might recommend a full overhaul. Or perhaps a trip to the store for a brand new fridge: both expensive and frustrating choices.

Or you could CHECK THE FUSEBOX.

The fusebox -- the modulation of power to the refridgerator -- controls all. An overloaded fuse will repeatedly blow and, no matter what you do to the fridge: no fuse, no power.

The same applies to physical pathology. You must examine the power supply -- The Nerves. Because, no matter what you do to the fridge, no matter how fancy the fan or compressor...you ain't "plugged in", you ain't wrastlin'!

As such, no matter how hard you work toward tissue healing, strengthening, stretching -- if you don't have ideal neurological exchange, your condition may not fully resolve.

The Faulty Power Supply: Four Potential Problems

A faulty power supply -- typically the spine, but infrequently peripheral nerves -- can cause for main problems:

(1) Pain

In acute cervical or lumbar strains, the spine can be the primary pain producer: directly through pain referral (more generalized limb symptoms) or radiculopathy (following a precise nerve pattern). In more chronic cases, the spine can amplifiy (e.g. "turn up the volume") on true orthopedic (MTB) pathology.

(2) Weird Sensations

These include parasthesias such as burning, tingling, numbness, or any other "weird" sensations unlike typical injury pain.

(3) Muscle Weakness

(4) Abnormal Motor Control

If I find neurological findings, what I then tell patients is, "We're gonna treat your (insert extremity condition HERE), but if we also don't address The Nerve, then it's like fixing the fridge, loading it full of food, only to have it spoil and have to start all over because we keep blowing the fuse."

After that explanation, the patient is much more amenable to this multi-dimensional approach to care. And, far more often than not, they get better and stay that way.

For interesting case examples highlighting The Fridge and the Fuse Box, stay tuned...