Piriformis Syndrome

There is a sneaky little muscle in your bum that often makes your back , or legs hurt.
It’s sneaky as, whether or not you have a booty or a skinny ass,  its a muscle that hides underneath the big ( or skinny?) obvious bits.
It creates a lot of mischief. So Voila, the piriformis is the muscle to blame. Its this muscle that I’ll often try and find and “trigger point” if I see you acting  or moving in one of many ways. If you are going to have back pain,  you might as well understand the anatomy
So this is where it lives.
piriformis location
When I’ve found it, here is where I’ll try and press
Piriformis points
I’ll often press or rub each point with my thumb about 10 times. Often I’ll try and teach you how to find these points with a Lacross or massage ball.
Obviously, there are other muscles in this area that I’ll identify and treat, but this is often the cause of a lot of back pain
Well, thats why Ive probably shoved my thumb in your bum!
If you have back pain, do get in contact and I’ll see what I can do to help.
I do a lot of work with the Backaholic programme at Crossfit London in E2 , and I help people cure there back pain. Strangely Im just a massage therapist, but as I teach people to olympic lift,  clamber over objects and do lots of cool  gymnastic stuff, Ive been forced to deal with the bad backs my clients bring to their sessions

The big warning.
Some back pain is really serious: check your RED FLAGS by clicking here 

Sit on your Ischial Tuberosities

When sitting, you can sit on your  Coccyx, or your Ischial Tuberosities. After all, it’s your ass!
sit on you ischial tuberosities
BUT…..sitting on your coccyx  ( right picture above: Boo. Bad) is the same as bending over badly and slumping (bad): the abdomen protrudes (bad) , the chest sinks ( bad), and breathing is inhibited. (cannot be good) It also indicates  fatigue (yawn) , and lack of support (Boo). In this position you can  try and make the client  (or yourself) sit up, but it will only last a short time before slumping back (sob) into your Backaholic patterns
Sitting on your Ischial Tuberosities ( a good place to sit, on the left above) , causes a more upright position (good), which elongates the spine (good)  and reduces excessive curvature (good; high five) .  Maintaining  this natural spine is easier as it is seen as a natural position (good. Fist bump). Each minute of wrong sitting can be compared to doing  the wrong exercise. if you sit poorly for 8 hours a day, thats a lot of bad exercise.  you are not a runner or a body builder or a crossfitter, you are a “bad back maker”
Of course, you should never sit  for that long, but if you must sit, sit on your Ischial Tuberosities!!
To get into correct “sit”, once you have sat down, lean to one side (imagine you are  trying to break wind!)  and gently lift your “lifted” buttock up with your hand,  scoop it back then sit down, then do the other side.
This said, you still  have  to fight your slumping habit. You must learn to sit tall and relaxed, but with an appropriate amount of abdominal tone. Say No to being a Backaholic!!

10
Feb, 2015

Help your back find its way: tape it up!

If you struggle to maintain  a neutral spine when deadlifting or squatting, or sitting for that matter, a “bit of gaffer tape” either side of your lumbar spine can give some very useful feedback. Set your neutral back, and get someone to stick tape either side of your spine ( the boney bit in the middle): when you stoop it pulls, and reminds you to maintain a better back position (  but don’t tape into a hyper- lordotic position!!)
backtape1
Obvious point, but make sure you are not allergic to the tape you are going to use! This can really help you save your back and cut down your  pack pain. Essentially it tells the body where your back is. Often back pain sufferer’s have no idea what their back is doing.

30
Jan, 2015

Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis: my justification for the side plank

Should  a client with Scoliosis perform the side Plank? I think so, as a strong side plank, when  matched with a strong plank and a good “brace” means the torso is “nice and locked down” ( highly scientific stuff)
The paper, “Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis” came to my attention as it was reported In the Wall street Journal. I chased the actual study down to  an obscure Journal
Global advances in Health and Medicine.
So, it  got some people to perform the side plank
“Results: The mean self-reported practice of the side plank was 1.5 minutes per day, 6.1 days per week, for a mean follow-up period of 6.8 months. Among all patients, a significant improvement in the Cobb angle of the primary scoliotic curve of 32.0% was found. Among 19 compliant patients, the mean improvement rose to 40.9%. Improvements did not differ significantly among adolescent idiopathic and degenerative subtypes (49.6% and 38.4%, respectively).
Conclusions: Asymmetrically strengthening the convex side of the primary curve with daily practice of the side plank pose held for as long as possible for an average of 6.8 months significantly reduced the angle of primary scoliotic curves. These results warrant further testing”
My own take on this  is that  no harm resulted from this experiment, and it makes sense to test  strengthening both sides. The core  and torso needs to be braced: lets do it all! I should say the self reporting , does not make this the best evidence ever, but , interesting . The side plank is used by Stuart McGill in the treatment of back pain. It seems safe, if monitored, to use and test.
We will see how my client responds

will this help clients with scoliosis?
will this help clients with scoliosis?

27
Jan, 2015

Be careful of your deadlift form: why sport science reports can mislead you

Much of the development of human movement comes from coaches comparing techinques. Better coaches hang out with other coaches, go on their courses, read their blogs, learn, analyse, video, and humbly put stuff up for criticism.  Many sport science papers purport to do the same thing. However, the only value of  a report of an experiment is, if you can reproduce the experiment yourself.
Do you remember those basic physics and chemistry experiments we did at school? We followed the exact doses, mixed , shook, heated and retreated to a safe distance. The instructions told us, how much, in what container , in what proportion. to what temperature.
This often isn’t the case in sport science journals. Sport scientists  casually say they are testing the efficacy of , say,  the deadlift and squat but often fail to explain what they mean. This frequently means back specialists often prescribe or ban  movements where there is no correct understanding about what the movement is and how to perform it. I often see clients who have been banned from performing movements they do well and perfectly, and being set drills and movements, which, clearly, the  instructor had not the faintest idea of the correct form or the correct mechanics .
The picture here is from a leading book on back issues and is supposed to be the correct form of the deadlift. It is, unfortunately not brilliant, (probably for all the best reasons), but, if you  deadlifted in this way, you would , eventually, overload your back ( as always, poor form needs to be mixed with  repetition and  escalating load weight  to be truly nasty).
This is not an attack on sport scientists ( I do that elsewhere). After all,  all research is useful , it is a plea to look for the instructions or method in the report you are reading. Can you reproduce what they did? If not, treat the information with caution.
We will post later the correct way to deadlift.

Turn the pain into science

So, you have tweaked you back again!  Now your whole day consist’s of finding positions of comfort and seeing what moves hurt.
Don’t think of this as suffering,  Think of this an an experiment. Of course you are the only participant so no drug company can use your results, ( without re validating them) but, its interesting science nevertheless.
if you have been reading this blog you will have had several bracing strategies discussed. You probably ignored them or just skim read them.
Now its time to experiment. Does bracing your abs stop the pain: is sucking you abs in or pushing them out pain relieving. If so, how much in and how much out. Is it mild engagement or hard engagement ? Experiment with the anti shrug. Does pulling your shoulders down help?
Now, if possible get up and walk, swing your arms.
Move.
Does that help?
Do you find that if you lie down or lean against something it helps, but its a bit of a pig to get moving again?
What back movements hurt or help: does moving into flexion hurt, or extension? Can you find a neutral spine? does it help.
Now pay attention to your bum. Does one cheek hurt more than the other. Does it feel dull?   Is one leg sore compared with the other
What movements create pain. if theses are limb movements can you reduce the pain by  bracing your abs more, because, if you can, you could well have discovered, that for example, every time you move your leg, you actually move your back too! Thats a lot of work for your poor back.
Observe, experiment, record.Learn.
Unless your doctor has diagnosed “cancer of the back”, the chances are that the  LBP you suffer from is what 98% of others suffer from. You can fix it!
As always if you cannot find a  position of ease  check out  RED FLAGS , so see your doctor who may want to screen you for other possibilities. but if you simply have LBP, start to sort the issues.

So I screwed my back again

I always like re -injuring my back, as it really helps me cut through the academic and medical bullshit.
Its very common for us to over sympathise with  and “forgive” back pain sufferers .
We should not.
Every single bit of “normal”  back pain  is self inflicted. (m not talking about the weird obscure stuff that effects  a teeny proportion of back sufferers). Im talking about our old friend , the non specific back pain stuff that is now costing the NHS loads of money.
Anyway , today  I pulled my back in gymnastics. Obviously i could go on a campaign: one that bans gymnastics, and  stops gymnasts from holding high office. Gymnasts should be rounded up and shot. Certainly banned from schools,
You will find lots of campaigns like this: Ban Crossfit, ban strength training, Olympic weightlifting . If you come across someone  trying to ban something, look at their personal involvement and see if their conclusion is reasonable. Being knocked down by a car, does not justify a ban on cars: iI may justify a lower speed limit, more education for pedestrians etc.
So, I screwed my back doing gymnastics? Well, actually yes and no. Here is the whole story.
1) over the last month, my focus has slipped. I found myself more and more in my slumping place, slumping. I have done no “good core” enhancing exercise. My hip and shoulder flexibility regimes have wobbled.
2) On wednesday I booked  myself quite a tough day: 3 hours driving ( I rarely drive) and 8 hours standing about ( i was an extra in film set)
3) On thursday, apart from one gymnastic training session ( 1 hour) i slopped around the flat. I slumped and hunched.
4) On thursday night, i had a terrible night: I got up late on Friday, and  after skipping breakfast I went to gymnastics. I did my normal 1 hour session 10  to 11), but as warm up and  planned to start my coached session straight after. I had felt my 1st back twinge at 10.50, but continued  after a quick rest.  At 11.10m, my  coached session began and at 11.20 a slightly wrong back flick, brought the pain flashing up. While I could still move. I stopped.
So here was the story. Id stopped all my recommended exercises and began slumping. In short, i wasn’t building up my back balance as Stuart McGill tells us to do, and I was “spending” back capacity like water. That said, I had still got through my basic “back buck spending” sport. and then, at the end of a terrible week, i thought i should push my luck by adding an extra hour.
I’m a pratt and  I deserve every scrap of pain!!