Friday, September 5, 2014

"Living Long and Strong" Exercise and Aging Well.


I'm lecturing at Terra Bistro in Vail this Sunday at 12:00 pm on Exercise and Aging. "Living Long and Strong". Call 970-476-7960 to reserve a spot. It's $40 per person, but includes lunch at Terra Bistro (which is pretty awesome)!

Sunday, March 16, 2014

Foundational Movements to Improved Health and Performance

New Article in Vail Daily last week outlining some simple curing for the hard-style plank. Tightening up some of our basic exercises can enhance our workouts and make us more durable. Original article can be found here.






Living with Vitality column: Improving functional movements for performance and health


Exercise programs are typically designed around goals like recovering from an injury, getting stronger or losing weight. To achieve these fitness goals we need to move. But if we want to achieve these goals efficiently and without injury, we need to not just move, but move well.

Asymmetries in motion and limitations in movement can affect the effectiveness of our training, workouts and activities of daily life. Good movement should be the foundation of our exercise program. In many cases this base level is overlooked. Sometimes exercise progression is made without necessarily earning it – meaning we move to heavier weight or more complicated exercises without mastery of more basic movements. If we progress too quickly or do not address underlying deficiencies, we build strength, endurance or sport specific skill on top of poor foundation. This is a fragile balance and is not the way to produce the most durable athletes.

In our workout routines as well as in our daily lives, there are basic movements that can be improved to maximize results. A basic posture or “anti-movement like the plank and more dynamic movements such as pushing, pulling, squatting, lunging and hip hinging are foundational, movements that can usually be improved upon at the base level and then progressed or regressed as needed.

The ability to maintain good posture and generate appropriate core tension during a plank carries over to other exercises. While holding planks for long periods may be a great test, it is far from the best way to train them. The world record for holding the plank is three hours and seven minutes (seriously). For us mere mortals, maintaining a plank for a minute or two requires conserving some energy. We naturally try to make the exercise easier and do not engage as many muscles turning the plank into an inferior exercise, or at the very least prevent it from being a whole body exercise.

There are a few common faults in form we see with planks. Heads may drop, torsos may sag towards the ground or shoulders may ride high towards their ears or round forward. We can cue what is called a hard style plank which can correct these common faults and at the same time make it a more complete core exercise.

Cueing the hard style plank:
  1. While lying on your stomach on the floor, make a fist and drive your forearms into the ground.
  2. Bring your shoulder blades back and down engaging the lats
  3. Drive your heels away and squeeze the glutes.
  4. Contract your quads and gradually increase the contraction in the abdominal wall muscles pulling yourself into a plank position
  5. Ensure that your ears, shoulders, hips, knees and ankles make a straight line
  6. In this position draw your elbows and your toes together as if you are crinkling the carpet beneath you. 
  7.  This hard-style plank would be held 10 seconds or so, followed by 3-4 seconds rest to let the muscles recover, and then repeated for 1-2 minutes. The plank and other foundational movements can all be improved with some advanced cueing. 

Monday, October 28, 2013

Are You Still Stretching Your IT Band?

I have a new article out in the Vail Weekly Magazine. You can read the original here:

Given space constraints, I didn't include the references to the research I mentioned. Here are the links to the research discussed in the article:





Runners and cyclist know the iliotibial band or “IT band” (ITB) well. We tend to roll it, knead it and attempt to stretch it all the time. It is usually a love-hate relationship heavily biased towards hate. The problem is, recent research indicates much of this self-inflicted suffering doesn't do much to change the ITB.

The IT band is the thickened aspect of the fascia lata (connective tissue) that surrounds your entire thigh. This dense unyielding tissue allows transfer of forces between the hip and knee. It arises from the hip in three portions: From the gluteal muscles in the back, off the crest of the ilium (the hip bone) in the middle, and it envelops the tensor fascia lata muscle at the front. It inserts below the knee and helps stabilize the joint.
Iliotibial band syndrome is a painful condition that affects the lateral knee of athletes, especially runners and cyclists. It is also called iliotibial band friction syndrome because it is commonly thought the pain is a result of abnormal tracking, forward and backward, of the band against the femur. This notion has been challenged by recent research, which shows the IT band does not move forward and backward at all. The pain is actually from compression of the ITB into the outside of the femur, which irritates the pain-sensitive fatty tissue under the ITB’s attachment near the knee.
The compression at the knee worsens when tension increases at the hip and internal rotation occurs at the knee. While tension at the hip can be a result of tight glutes, it is more commonly weakness in hip stabilizers that allows the pelvis to dip slightly and the knee to collapse inwards as we bend the knee while on one leg.
Increasing strength can reduce these symptoms. One study showed runners who added hip abductor exercises could significantly improve muscle strength (51 percent) and resolved knee symptoms in 91 percent of the athletes tested. This is consistent with what we see in our office. While we do address the local inflammation, release adhesions between the ITB and quads, and stretch the hip musculature, we always assess the hip stabilizers for weakness. Prescribing muscle activation and strength exercises yields better results.
Over the years I have been guilty of prescribing rounds of painful ITB rolling. (Sorry guys). I still use rolling for other types of problems and still have patients roll the glutes and external rotators of the hip, just not specifically the ITB. The ITB often feels tight, so it seems natural to want to elongate it through stretching or rolling. However, this rarely works.
It has been said that the ITB has tensile strength of steel. A 2010 study used strain gauges implanted in cadaver ITBs to measure tension. Their analysis showed that even with maximal muscle contraction, the ITB was rigid, lengthening only 0.2 percent. Anatomical studies show the ITB is firmly attached to the entire length of the femur. It doesn't shorten. It doesn't lengthen.

There are many benefits to rolling and stretching in many areas of the body. While rolling and attempting to stretch the ITB probably doesn’t cause any irreparable harm to tissue, it really does feel lousy. Try rolling the quads instead of the ITB and find a good balance of hip mobility to gluteal strength and you’ll see better results with fewer tears. 

Monday, March 11, 2013

Breathing Patterns


I have a new article out in the Vail Daily this week on breathing patterns. For subjects like this, getting good information out and keeping it concise to fit in the column is particularly difficult.

Luckily I have this blog where I can use more images and video to expand on this ideas. Below is the enhanced article with video and additional images.

Vail Daily
Living With Vitality: Breathing
Issue: March 12, 2013

To say breathing is important is a bit of an understatement. It is not just paramount for survival, but important for a whole host of other reasons. Altered breathing patterns can result in decreased athletic performance, increased pain, muscle imbalances and loss of core strength.  

In normal efficient breathing, the ribs expand and the diaphragm contracts and lowers. Air is drawn into the lungs and the abdominal contents are pushed down and forward. The diaphragm is the most efficient breathing muscle and if not fully engaged, less air is brought into the lungs, respiration rate increases, blood pressure may increase and there is additional recruitment of the accessory breathing muscles.

Images courtesy of 3D4Medical.com

Images courtesy of 3D4Medical.com 



Since breathing is preferably a constant activity, overuse of accessory muscles in normal breathing can lead to overactive muscles and dysfunctional patterns.

A “weak core” is often blamed for decreased athletic performance and increased back pain. The inner core is like a corset of muscle and fascia that wraps around your torso closed at the top and the bottom by the diaphragm and pelvic floor. The strongest stimulus to enhance the activation of this inner core is the pressure created when diaphragm contracts.

When people diagrammatically breathe the belly is seen to rise. In contrast, chest or “apical” breathers tend to breath through their mouth versus their nose and their upper chest will be observed to rise instead of their lower ribs and belly. In these cases, the neck muscles can often be observed to aid in elevating the rib cage.

Stress response is probably the most common culprit for altered breathing patterns. When agitated in a flight or fight state, we are mentally and physically gearing up for increased demand or exercise. Heart and respiratory rates increase, muscles tense and accessory muscles of breathing are called into action. Luckily, this works the other way around and agitated states can be eased with breathing exercises. The benefits of mindful and diaphragmatic breathing have been known for centuries in many cultures. But this isn't alternative medicine, it is well-researched physiology.

There are other reasons for altered patterns. Many men and women consciously keep their abdominal muscles contracted to keep a flat belly, which makes belly breathing far more difficult. Significant inhibition of the diaphragm can also occur with pain after abdominal surgery. There is no better stimulus for re-programming movement patterns (and not ideal ones) than pain avoidance.

Many people may need specific coaching to help change their patterns, but there are some simple exercises that can helpful to restore normal patterns:

Lying on your back with knees bent, place one hand on your chest and one hand on your belly. Breathe in through your nose and out through your mouth. As you inhale, allow the hand on your belly to rise while keeping the hand on your chest still. Sitting with poor posture is not ideal for maximizing diaphragmatic breathing. Nevertheless, if you are reading this while sitting at your desk and think you might get some funny looks if you lay on the floor, go ahead, sit up straight and try this exercise right now. A few minutes of focused diaphragmatic breathing can yield noticeable change. Do enough cycles with your hands on chest and belly, until you have the pattern, and then continue for three minutes without your hands. More information and additional exercises can be found at www.markjpitcher.com.

Mark Pitcher is a chiropractor and exercise physiologist with Vail Integrative Medical Group located at the Vail Athletic Club. He specializes in rehabilitative medicine. For information visit www.vailhealth.com  or www.vailvitalitycenter.com



Monday, January 21, 2013

Fascia


The following article is published in the Vail Daily today. (You can read the original online version here) Fascia is not commonly talked about when we discuss recovery from injury and when it does get addressed, it is sometimes a little hard to wrap your head around. Due to space constraints in the Vail Daily column, I couldn't include any images which would have certainly been helpful. I've posted the article here with accompanying photos to give you a better idea about what fascia is all about.


A few months ago I gave a lecture to the Colorado Athletic Trainers Association on the importance of fascia. Fascia is one of the most common tissues in the body, has a rich innervation, and plays a major role in pain and dysfunction. However, it is still not something commonly talked about or adequately addressed when we discuss injury and rehabilitation.  

I thought I knew a lot about fascia. I treat people with muscle and fascial problems everyday, so I assumed it wouldn't be too difficult to put together a presentation. However, fascia has been getting a lot of attention through new research in the past few years, and I was a little humbled to find much of my understanding of fascia turned out to be outdated or incomplete.
superficial fascia under  the skin
Fascia is a connective tissue that is organized in a three-dimensional network that surrounds, supports, suspends, protects and divides the muscles, skeleton and organs of the body. There are three types of fascia in the body: visceral, superficial and deep. Visceral fascia creates compartments for the organs offering protection and lubrication. Superficial fascia is under the skin and creates scaffolding for nerves and blood vessels and allows the skin to move over the underlying tissue. It is elastic so when stretched, like in pregnancy, it can return to its original state over time. 

Unlike superficial facia, deep fascia is less elastic and more invested in the muscles and other tissues of the body. We typically think about muscles connecting bone to bone but they also connect with each other via fascial connections. The gluteus maximus, for example, is only 40% directly connected to bones. The rest is connected to other muscles or structures through fascia, which allows different muscle systems to work together and exert influence at a distance. This is how the glutes help stabilize the knee via the ilio-tibial band. If the ilio-tibial band gets stuck or develops adhesions to the thigh muscles, knee stability can be affected, even if the glutes are strong. Clinically, there are many situations where we need to look beyond simply just the site of pain.


One of the most intriguing aspects of fascia that was new to me was that the deep fascia is not an inert tissue connecting muscles, but one that is perceptive and reactive. Rich sensory innervation allows sensation of temperature, tension and of course, pain. Newly discovered smooth muscle cells in the fascia suggest it has the ability to pre-tense independently of the muscles. This may aid in its sensory role, but perhaps also enhance its ability to transmit forces. Thoraco-lumbar fascia, for example, is a thickened diamond-shaped area of the fascia connecting the lats to the glutes and lower body on the other side. When we sprint and swing our arms, tension through tightened fascia pulls on the opposite side of the lower body, improving sprint performance.
No muscle works in isolation. Fascia helps
link functional muscles systems together. 

Fascia is especially responsive to the stress applied to it. We know that use of manual therapies, like Graston and Active Release Technique, can affect adhesions and scar tissue, but recent research suggests that it can also produce more fibroblasts (the cells that create the building blocks of connective tissue) for remodeling and creating stronger, more functional tissue. (see slides below article) 

Bringing fascia back into the conversation about injury and rehabilitation and understanding fascial connections between muscles, the sensory properties of fascia and addressing the fascia to enhance repair and remodeling may allow for faster recovery and better, longer-lasting results.

To see more pictures of fascia and to learn more you can visit www.markjpitcher.com and click on the blog.

Mark Pitcher is a chiropractor, exercise physiologist with Vail Integrative Medical Group at Vail Vitality Center located at Vail Mountain Lodge and Spa. He specializes in rehabilitative medicine. For information visit www.vailvitalitycenter.com or follow Dr. Pitcher’s blog at www.markjpitcher.com



Comparison of a normal, injured untreated and an injured treated
MCL ligament using instrument assisted massage  


Increased fibroblast proliferation with instrument assisted  massage




Saturday, October 20, 2012

Flying out in a few mins


Dancers often offer an interesting challenge for the manual therapy practitioner. Although we think of them first as artists, make no mistake, they are also high level athletes. They are graceful, strong, limber and appear flawless in their movement. Like many elite athletes, they are also experts at developing compensatory movement patterns.

What struck me with dancers is that apart from a significant amount of feet trouble, they present with exactly the same kind of problems that our day to day patients present with. They are more limber in certain ways and stronger in other ways, but they excel is in their ability to perform despite any limitations, imbalances and weaknesses. While I am always impressed with the dancers performances I used to be perplexed when evaluating their movement afterwards.

Their bodies find ways to deliver the art, but may it sometimes requires a trade of quality of movement for quantity of movement. The strides, jumps, holds and flow of movement results in striking and beautiful dance. They can deliver an exceptional product. The body of the talented artist and athlete finds a way to make it happen. But for all the cleverness of the body in the moment, it lacks foresight. The long term effects of sacrificing quality for quantity often compromises durability, manifesting as unbalanced muscles, dysfunction of the joints and changes in the fascia. This is what we see not just in our dancers and athletes but in almost all the patients that walk through our doors.

Speaking of muscle imbalances, segmental dysfunction and changes in fascia, I am off to sit on a plane for about 24 hours. Catch you in Taipei.

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