If I Only Knew…

If I Only Knew…
“If I only knew…” -A common statement from our patients.

A typical day can be filled with stress, distractions and obligations. It is easy to get overwhelmed with… well, life.  Sometimes you just have to “keep it simple.”

As an outpatient physical therapist for the last 10 years, the most common condition I treat is the spine. It is hard to say which aspect more so, the low back or the neck- as usually they go hand-in-hand. Through extensive training in graduate school and critical continuing education, such as the McKenzie philosophy, every spinal evaluation is individualized to a person’s specific needs and goals. However, there are common presentations/characteristics that are may be demonstrated.

We are trained to observe movement patterns and mechanics, so our evaluation starts as soon as we see the individual walk into the clinic. Besides a million other components we are looking for, most individuals that have back or any lower leg (hip/knee/ankle) pain, stand unevenly. The limb they are shifting the weight off of, is typically the one involved. Now that may sound obvious in some respects, but most individuals are doing it subconsciously. By not standing evenly, there are multiple factors occurring to the body’s movement efficiency.

As you could imagine there are several scientific explanations for these presentations, but the most important is pain. Pain inhibits the tissue from recruiting at the rate it is intended, and sometimes not even engaging at all.  In this example of standing, the involved leg is weak from having pain, so the body copes by ‘hanging on ligaments’ versus using the muscles of your core and glutes to hold you upright.  Over time, living in that inefficient position creates an issue in the ‘length-tension’ relationship of the muscles.  The muscles on slack are in poor positions with respect to the physics of the involved joints, and therefore our nervous system will not be signaled to facilitate them.

In other words, here is how we fix it! Ideally, seeking an assessment from a physical therapist will identify your individual needs and start you on a plan to success.  For starters, posture is first!  Yep! It could be that simple! Remember you have to try to develop habits to keep that posture.  A basic prompt is to “picture a string being pulled from the top of your head to get your whole body feeling upright.”  “Finding your heels” is another helpful concept to slightly shift your center of gravity and feel your glutes “turn on.”  Most people may require even more cues to facilitate the injured tissue, and “trying to squeeze your cheeks together” seems to be effective.  Besides a new patient’s “corrective” homework, the main objective they have at that first session is to learn how to perform their everyday life- standing, walking, sitting, working, etc.- while being aware if they’re activating the right muscle and identifying what proper posture feels like.

It might sound like a lot, but when you are healthy, your brain is naturally using these muscles to stabilize the entire spine.  And if the core, or your “powerhouse”, is not being used properly, then your limbs are getting unnecessary forces through them, which could lead to a bursitis, tendinopathies, patellofemoral pain syndrome, ankle sprains, etc.  Overall, alignment precedes strength. So hold yourself back from trying to do the most interesting hip exercise on Instagram to work on your back/lower leg issue, and just start by standing evenly!

In recent weeks, I have become more aware of a common statement from my patients as they have been achieving their goals: “If I had only known that something so basic as learning to stand evenly and squeezing my butt would get me feeling better and back to my activities so quickly, I would have been able to stop my issue before it got this far!”   Of course, this is a foundational element, but without it you may be unsuccessful in your recovery.  It is amazing how quickly your body can re-establish your mechanics when given the chance.

So do not be discouraged!

I have a challenge for you… See how many times you catch yourself standing on one leg more that the other, sit in a chair/couch turning your hips one way, or stand/walking with your foot/feet turned out.  Can you save yourself from having an injury and enjoy the upcoming holiday season doing the things you love and enjoy?


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