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Dry Needling as Treatment for Hallux Valgus – A Case Report

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Common Anatomical Related Pain

• Pins and Needles, Numbness, Tingling Sensations

  

  Before we start discussing the matter, it is important to know that if you feel the above, or the likeness of it, to be on the safe side, might be better to consult your physician. While it can be caused due to various reasons, if you experience these sensations for big portions of the day and nothing changes, consult your physician, same goes for head sensations, physician right away.

  In the meanwhile, let’s point out some key things you would want to pay attention to. First, when did you start feeling this sensation? Was it after performing a certain activity, or did it just appear out of no where? Where exactly do you feel it? Are there any movements that reduce or worsen the feeling? Maybe it’s the same sensation regardless of what you do?These can narrow the causes and help treat your case.

  The importance of when can help determine if the sensation is caused by trauma, overuse or overload. In case of a trauma, it could be disc related, depending on the forces involved and the location of the hit. Same goes for overload, a massive amount of force without needed preparation can also cause disc related sensations. In case of overuse I would not rule out the discs, but, in my experience, it is more likely to be musculoskeletal related. According to each case a better assessment can be carried out, all three can be both disc and musculoskeletal related, but it is important to build a correct profile for the sensation and know the details.

  Where do you feel the sensation would narrow the locations that may have been effected. Both blood and nerves are going from the middle of the body in an outwards directions towards the fingers and toes. If we’d look at the arm, it is important to know if you feel it throughout the whole arm, the palm, which fingers or which specific area, because all those can direct to different places and rule out different injuries. There is a big difference between a sensation going on throughout the whole arm, or just through some of the fingers. Same goes for the legs, each part of the leg can point in a different directions. Specificity with the sensation would go a long way for the case.

  Is it a static pain? If you feel the same sensation if you lay down, sit, stand, walk or do any type of activity, go to your physician. If you notice that doing a certain activity or movement triggers the sensations you feel, while other activities or movements reduce said sensations, it is important to remember which does what, as it provides a specific cause and can be used to find the root of the issue. These type of sensations are very common and are treatable, they are a symptom of a musculoskeletal issue and are nothing to worry about.

  Should you sensations be musculoskeletal related, a therapist that works within the injury field would be able to locate and treat the cause. The root could be a specific tissue, or it could be a chain reaction of different tissues working with and against each other to compensate and balance the skeletal structure. According to the severity of the situation, the number of treatments needed may vary, and can take longer than first expected.

  Should you have a disc issue, it is important to remember it is not the end of things, the disc would heal in the end, and the symptoms should still be treated, a different method could be used, depending on the cause. You can read more about Herniated and Bulging Discs on the article I wrote.under the section Do and Don’t.

  If you found any fault or error through the article please make sure to let me know.  Remember in any case of these sensations, consult a physician, just to be sure. Feel free to contact me for questions. The information above is not a replacement to a physician’s diagnosis, and it is only for reference and knowledge. Stay Safe!

• Neck

  

  I’m guessing you expect to see, as in the other articles relating to pain, the different causes of neck pain. But due to the complex structure of the neck, I would go over different types of pain that can be caused due to a neck issue, but are not necessarily felt through the neck itself. Another important note before diving into the base structure, through the article, there would be a reference and a short discussion over the skull and jaw, as the skull is part of the neck, and the jaw is part of the skull.

  The neck is a relatively small area, but consists of many important parts of the body, including blood vessels (that bring blood to and from the brain), our vocal box, the beginning of our breathing and digestive systems, and is the origin of our Spinal Cord.

  Although not all of these system are important to this article, and other systems might not be included to begin with, it is important to understand the complexity of the neck before diving into what can be caused due to it.

  Bone wise, the neck is built of 7 vertebrae, called the Cervical Spine (AKA C Spine), starting from the base of our skull with C1 and C2 (AKA Atlas and Axis), and builds down to the connection with the torso on the Thoracic Spine (AKA T Spine) with the C7 – T1 joint. However, the C Spine is not the only element of the neck when looking at the bone structure, the base of the skull (Occipital Bone) and the lower jaw (Mandible Bone) are both integral parts of the neck and can also cause some severe issues that would project on the neck and from it. Through the bottom of the neck we’d find the 1st Rib, connecting to T1, and the Clavicle bone as barriers from the neck and the torso.

  Let’s Examine Some Base Illness Symptoms

  Dizziness / Headache / Migraine / Nausea / Vertigo 

  How many times have you found yourself waking up, opening your eyes and feeling a bit dizzy? Maybe it was after looking at a screen or a book, changing the head’s position triggered slight dizziness that either passed or required you to move your neck a bit to return to stability? And what about finishing a call with a slight headache? Well, I’m guessing the description might sound familiar to some of you, while others might relate to the symptoms but not the trigger scenario. Any of the cases described can occur out of the blue and be resolved just as fast, or some stick for a prolonged period.

  The above may be caused by pressure over the Occipital Nerves (Greater Occipital Nerve [GON], Lesser Occipital Nerve [LON] and Third Occipital Nerve [TON]), which may require some release to the muscles located around the area of the nerves. The Occipital Bone is the base of your head, where the skull and the C1 connect. Mild cases can be self handled with some movement and stretches to release the area, while Moderate cases might require a certified therapist involved,however Severe cases should be referred to a MD, for further medical assistance.

  Migraines, headaches and vertigo specifically are more common to occur from the jaw, as we might be grinding our teeth, or we eat while working, which places our body in a very questionable posture while chewing, and that could lead to the Masseter pressuring the Facial Nerves that passes through it causing a headache sensation or migraine like feeling.

  Shortage of breath – Trigger

  While it can be an asthma case, or a reaction to season changes, if you experience any symptoms mentioned through the article, keep the neck a suspect and see if it relates to your latest state of coughing hard. As mentioned, the 1st rib is the lowest border of the neck, at least in this specific article, other sources may claim otherwise, and the 1st rib, as the name might hint, is the pioneer rib in the whole structure of the Rib Cage that holds the lungs and helps us breath. Looking at the breathing process through the upper ribs, main muscles that are used for maximized breathing are the Sternocleidomastoid (SCM) and the Scalene muscle group.

  The SCM originates from the neck, it is engaged in heavy breathing, and is mostly used to move the head around, it can rotate, flex and bend the neck (depending if both sides are working or if it’s a single side motion). It originates from the Mastoid process of the Temporal Bone, and is with proximity to the Occipital Bone. Any change to that muscle, either tightness or inflammation can trigger the surrounding muscles and effect the Occipital Nerves.

  On the other hand, we have the Scalene Muscles, consisting of Scalenus Anterior, Scalenus Posterior and Scalenus Medius. This group of muscles are used to lift the 1st and 2nd ribs during the breathing process, but are also used to bend and rotate the neck. As with the SCM, should those muscles be irritated they can affect the nerves near by and have radiating sensations to the upper limbs. Those are discussed in the following session.

  Herniated/Bulging Disc? Not So Fast

  Tingling / Numbness / Radiation Sensation To The Arms & Hands

  In my experience, those are pretty common among the general population, as most of us are sitting hours at hand using a PC/Laptop/Smart Phone etc. with poor ergonomic settings which places a lot of pressure on the muscles holding the neck and the head. I won’t lie to you, my setup is not always the best, and I pay the price with neck pains or numbness of my arm. 

  Why is it happening though? The C Spine is responsible for the nerves reaching and nerving our shoulder, arm and hand (both sides), the nerves originate from C5 to T1 and any muscle that might be tight or inflamed could effect the nerves passing through near it, and affect the nerve supply of the target organ, which would cause the symptoms described.

  I encountered cases in which the symptom is triggered during a specific motion or exercise. A quick solution for such case is to move the head either sideways, up or down  (case dependent) and perform the movement with a repositioned head.

  It’s not a permanent correction, and it won’t solve the issue, but it enables the person to finish what they were doing with less to no pain and it reveals to me, as a therapist, the target muscle I should be working on to release or, as a trainer, the muscle I need to strengthen to that person to prevent it from future occurrences. You can check an example for neck pain with shoulder related exercise through an Instagram Post I’ve uploaded. 

  Now don’t get me wrong around the subject, those symptoms may also appear due to medical related reasons that require MD’s examination, or could be related to a more proximate muscle to the symptomatic area, but it is important to have the neck considered a suspect as well. A tight back or chest can cause the same symptoms, and of course, the title of this section, a herniated or bulging disc.

  If you found any fault or error through the article please make sure to let me know. Remember these are only general cases and there are many more which do not appear in this article, feel free to ask me for guidance. This is not a replacement to an MD’s diagnosis, and it is only for reference and knowledge. Stay Safe!

• Fascia

  What is the fascia exactly? Is it a protective layer? Part of the movement mechanism? Maybe it’s just a wrapper layer to keep everything intact..?

  

  Whichever answer you’ve picked, you were correct, Fascia is all of the above, it’s a protective layer that covers up our whole body, including our internal organs, muscles, bones, and so on. Fascia is built of layers, each layer reacting to the layer above and below allowing smooth motion, maintaining Newton’s law of action and reaction. It’s like a web of collagen fibers that wrap around the organ to keep it intact and placed. It allows the muscles to work along side other muscles by protecting them from colliding with one another and allowing smooth motion contributed by the layer structure described above. Due to it’s web like structure, it allows movements in a variety of directions, according to the muscular requirements. Fascia can be found from our head, to our toes, it’s everywhere in the body and it has a very strong influence of our ability to move without pain. 

  Let’s Talk Some Anatomy

  The Fascia is a layered structure of connective fibers that goes one on top of the other to create a rigid but mobile structure. If we’re to put Fascia in a metaphor, it’s like a big traffic junction were road going north and south are on the 1st level, above you’d have roads leading east and west, on the 3rd level you’d have the roads taking you northeast, and southwest, while on the 4th and last level you’d have the last roads taking you northwest and southeast. That sort of junction, allows traffic to go in all directions without the requirement to stop the traffic on any other lane.

  Fascial fiber direction is set according to the muscle fibers connecting to it, and would determine the movement structure for the organ. In order to maintain this type of motion, Fascia, like a Synovial Joint, requires lubrication. While a Synovial Joint uses Synovial Fluid, Fascia uses a Hyaluronic Acid to allow the movements between layers and fibers.

  It is important to note that the Fascia is like a sheath covering the whole body and connects all our organs and body parts together. In recent years, Fascia’s role in our bodies begin to unfold and take new attributes. While not only allowing movement, Fascia is also used as part of the nervous system to have better transmissions sent through the body. A recent study relating to post-COVID syndrome has found that ” Fascia  focused  therapeutic  interventions  are  shown  to  reduce  pain  and  support  a  re-establishment of function while providing safe, effective and appropriate non-invasive therapy”.

  What Does Any Of It Has To Do With Pain?

  Well, a poorly functioning Fascia would cause poor functionality in the body. Should a Fascia be damaged in anyway, the overall structure can be negatively affected and that can cause mobility restrictions amongst other things.Taking into consideration that we’ve mentioned Fascia can be found anywhere, the pain inflicted at a certain area does not necessarily mean that area is the location of the injured tissue.

  To supply a more understandable example, if you take the shirt you are currently wearing, and twist a part of it on the back, you’d see the shirt tightens on your front, and changing it’s shape on the back. The change you’ve just applied was only to the back of the shirt, however, since it’s one piece of fabric that wraps around you, the change was felt on the front as much as it was felt on the back. Fascia functions in likeness to that very same idea, should there be an issue on the any part of the body’s Fascia, it could effect the whole muscular system. The pain could be felt on a group of muscle in proximity to the Fascial root cause, but it could also be felt on a different area that related in some way to the root cause.

  So how can a Fascia start to poorly function? There are a few causes, the first cause, is an trauma injury that resulted with lose of the Fascia’s mobility, and has made it less elastic. Another cause, would be lack of lubrication, if for any reason the Fascia is lacking the Hyaluronic Acid between the layers it would not be as mobile as it should. On the other end of that same spectrum, having to much of Hyaluronic Acid held within, would swollen the area and restrict movement as well.

  What Can You Do?

  If we look from a sports angle, a warmup for the area using easier weights or movement patterns would engage with the acid release in the Fascia and help with the elasticity of the Fascia. Foam rolling or using a ball at a specified area that may cause some issues, can supply relief as it warms up the area and engages circulation along with neuromuscular and Fascial responses, helping the tissue become more functional.

  Looking through a therapist’s point of view, treating Fascia is considered a very gentle therapeutic technique. Should a Fascia function as expected, the patient would hardly feel anything, and might think you are wasting time, but should a Fascia be irritated, the therapist would feel pops in his hand while engaging the technique, and the patient may feel severe pain, burning sensations, or would describe a very unpleasant feeling. 

  The image of this article, is a demonstration of the technique I’m referring to at the paragraph above. You would grab the skin on the area you suspect might have a malfunctioning Fascia, with both your finger and thumb, make share you are not pinching the patient,  pull it slightly up, and roll the skin around the area of the muscle. You can go with the muscle direction, or cross it’s fiber direction, for as was mentioned, Fascia is built with layers and varies in directions. Repeat the motion until you stop feeling the little pops between your fingers, the patient would also report that they are at ease and it is no longer hurting them. Attached an Instagram post with a short video as an example of how to engage.

  From my experience as a manual therapist, treating the Fascia along side muscles and joint mobilization can give a tremendous effect,and can make the session much more efficient.

  If you have specific questions or want to dig deeper into a topic, feel free to contact me, if you’ve found an error through the article, let me know as well so it would be corrected shortly. Stay Safe!

• Wrist Pain

  

  Wrist pain or issues with reaching a full range of motion can be resulted with a variety of causes.

  To understand better the causes for the pain or mobilization issue, let’s first have a look on the structure of the wrist bone wise, tissue wise and also, nerve wise. Our wrist is built of 13 bones, 8 Carpal Bones form the base of the wrist itself and connect the arm and hand, moving to the arm we’ve got the Radius and Ulna connecting the Carpal Bones and going to the hand we’ve got 5 Metacarpal Bones that begin the structure of our hand. Tissue wise, we’ve got going through the wrist both the Wrist Extensors (8 muscles) and Wrist Flexors (6 muscles), which sum up to a total of 14 muscles going through the joint. If we inspect the Nerve System, the wrist has 3 major nerves that passes through, the Median, Ulnar and Radial nerves.

  As you would have already guessed, wrist pain can be caused by either muscle ache or nerve pressure along with dislocated or fractured bone as “easy” causes, and it can also be resulted as a combination of elements from all the structural components of the delicate joint.

  We’d start from simple cases and move on to more complex pain causes, taken from my experience as a manual therapist and a trainer. I would not dive deep into the names and precise locations of each bone and muscle but would address the overall groups as Carpal bones, Metacarpal Bones, Wrist Extensors, Wrist Flexors, and so on depending on the group, if I’d have a first reference, I would explain a bit of the structure, but would not dig in too much, should you have specific questions, feel free to contact me privately.

  Musclar Causes

  The most simple cause of pain, is pain caused by tight, short and sore wrist Extensors and / or Flexors. Personally, I come across Flexor caused pain more, and that is because most of us usually hold things and tighten our fist, which is a Flexors function, so while we carry groceries, lift weights or even hold our cup to drink, we use them, we usually start to feel the pain while leaning on the wrist, which supplies a pretty good stretch for the Flexors as both the fingers and the hand are entering an extended position.

  However, don’t be fooled that the Flexors cause the pain alone, our body is always striving to achieve homeostasis state, which for the wrist means that the bones would keep their neutral natural positioning. If the Flexors are tight and are pulling both the hand and the fingers towards them, forcing a fist and flexion of the wrist, the Extensors would pull back to fix the wrist and fingers back to neutral point. This type of action can cause early fatigue and sore feeling of the forearm, as the Extensors are working hard to undo the Flexors pull due to shortness or tightness. This pull on both ends of the wrist can cause a dysfunction with the wrist’s mobility and reduce the range of motion while causing pain and weakness on daily tasks.  

  Important to note that the chain of events can begin with the Extensors as well and result with the same feeling, every case should be examined individually.

  Why is this the most simple cause of pain? Well, the correction is easy, you could either stretch the area to relief muscle pull and lengthen issue causing muscle, or go to a manual therapist to treat the muscles and tissues to a more eased state.

  Bone Causes

  Personally, as a teen I’ve had a slight Ulnar Dislocation, it was hardly noticeable, since it was first thought to be an inflammation and was treated the same, but when the treatment did not work and the pain remained I had it looked by several doctors and physiotherapists until one saw that at a pushup position my Ulna seems to go higher than it should. 8 months of daily pain due to a slight movement of the bone structure.

  I guess you wonder why I’ve started with that short personal story, well, I think it’s a great example of how even the tiniest of movements in the bone structure can cause a lot of pain, and it was a great intro for bone causes.

  As mentioned at the beginning, the wrist is built of 13 bones, and as shown in the personal story, you don’t need more than a single bone to be slightly away for the whole structure to “collapse”. 

  If you’ve had a force trauma to your hand, can be a slip that was prevented with your hand contacting a flat surface or a fast ball that was stopped with your hand before hitting or scoring a goal, the ways of receiving the trauma vary and are not always in our mind when we start to feel the pain. Do yourselves a favour,  and check the structure to prevent worsening in your condition.

  The Bone causes are  second on my list, because even though they might require a bit more care while treating and a certified professional, they are still easier to track than Nerve Causes.

  

  Nerve Causes

  Last but not least, the Nerve Causes. In the image to the left you may find the 3 nerves mentioned in the beginning of this article high lighted through the arm, forearm and hand. Those nerves originate at the neck and go all the way through to our fingers.

  So why did I list these as a hardest cause? Well, due to their length and many muscles surrounding them, the slightest tension applied on either of them can result with pain or issues with range of motion or strength control of the wrist.

  A trauma to the neck can result later on with wrist pain, a strong shoulder or arms exercise can be a cause of wrist pain, poor positioning of the arm while performing daily chores can result with wrist pain, and so on.

  A trauma to the neck can result later on with wrist pain, a strong shoulder or arms exercise can be a cause of wrist pain, poor positioning of the arm while performing daily chores can result with wrist pain, and so on.

  I’ve heard of cases where Carpal Tunnel Syndrome was poorly diagnosed due to pressure originating from the neck muscles that are in proximity to the nerves and have applied pressure that skipped the shoulder, arm and forearm and reached straight to the wrist. 

  A Nerve caused pain can be tricky and handled with care, it is important to bare in mind that the result may take time, as the pressure point resulting with the nerve malfunction can be found through various places and is dependent of daily movements done, along with the original trauma cause, followed by the body’s compensation to ease motions and tasks while using a different set of muscles to achieve the same goal.

  I hope this has clarified some of the causes for your pain, all the described information above is relaying on my experience and knowledge. Refer to a certified professional should you start to experience pain. If you have specific questions or want to dig deeper into a topic, feel free to contact me, if you’ve found an error through the article, let me know as well so it would be corrected shortly.

• Elbow Pain

  

  While the elbow’s main movements are flexion and extension, the muscles around it work as stabilizers during side bending. For instance, if you lift an item to the side of your body, your elbow would be facing away while pressure applied would push the elbow into side bending, creating a sheering force on the joint.

  Another movement that is sometimes overlooked when inspecting the shoulder is rotation. While the palm would be the end result of that movement (Supination and Pronation), the initiation of the movement begins at the base of the bones, located in the elbow. 

  To sum it up, before going into muscles, we have 3 bones that are located in the elbow, we have the distal part of the Humerus, and the proximal or bases of the Ulna and Radius, The Ulna and Humerus interlock to create the extension of the elbow, while the Radius and Ulna create movement in the wrist. You can read more about Wrist Pain here.

  Our journey into muscular causes would begin with muscles coming from the shoulder, progressing into more localized muscles and we’d finish with a group of muscles reaching the wrist. Let’s dive in, shall we?

  Biceps Brachii

  The Biceps Brachii was introduced when discussing the shoulder flexors, it is a big muscle stretching from the shoulder with two heads, and going through beneath the elbow to connect to the Radius. When discussing the elbow, the Biceps Brachii is involved with flexion and supination.

  When fully contracted, the Biceps Brachii will create both shoulder and elbow flexion, and will bring the palm to a supine position. If you wish to stretch the Biceps Brachii, set your arm to full extension of the elbow and shoulder, and place your palm in a prone position. This may reduce the pain you feel and allow you to continue your day with more ease.

  Triceps Brachii

  The Triceps (no need to refer to it as Brachii, as there is only one Triceps in the body), like the Biceps Brachii, begins at the shoulder, crosses the elbow and connects to the Ulna on the Olecranon. Opposite from the Biceps Brachii, the Triceps would extend both elbow and shoulder.

  The Triceps, as it’s name suggests, consists of 3 heads, if one of these heads is a bit sorer than the rest it would apply a pull in it’s direction, a pull that may cause discomfort while extending the elbow, as the Olecranon would not insert properly into it’s the Olecranon Fossa (docking point) of the Humerus. 

  Brachialis & Brachioradialis

  Both are assistants of the Biceps Brachii when flexing the elbow. The Brachialis begins on the Humerus and connects to the Ulna, while the Brachioradialis begins on the Humerus but connects to the Radius.

  Brachialis is a simpler muscle, the connection to the Ulna is pretty close to the elbow, making it one of the localized muscles in charge of flexion only. However, the Brachioradialis connects to the Radius close to the wrist, and can be used to both supinate or pronate the palm, depending on the angle of the elbow/wrist.

  Depending on the discomfort felt and the working angles, these muscles should be considered as well in some cases.

  Pronator Teres

  This muscle has part on all 3 of the bones of the elbow, it begins on both the Humerus and Ulna and connects to the radius. While it is not a big muscles, it’s location can cause discomfort in the elbow while moving the wrist into pronation.

  Wrist Related Muscles

  Looking at the movement of some of these muscles, there isn’t always a relation to the elbow, and most movements take place in the wrist. However, due to them starting on the Humerus, dysfunction with these muscles can be felt in the elbow. In this list you may find Flexor Carpi Radialis,  Palmaris Longus, Flexor Carpi Ulnaris, Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis & Extensor Carpi Ulnaris.

  For this group, it is important to understand when exactly you feel the pain, as if you feel the pain while moving your wrist, those are the prime “suspects”, depending on the exact move of your wrist and the angle of the elbow.

  Important Note! While it is mostly muscles that may cause pain and discomfort in the elbow, pain can also occur due to structural misplacement of the bones, it could be nervous related issues that might begin from our neck or it could be a whole other issue that should be examined.

  I hope you have found the information in this article to be informative. These are just options and potential causes for pain, there could be other causes, and a proper examination is required. If you have any questions, please feel free to let me know. Stay Safe!

• Foot & Ankle Pain

  

  Before we go for a dive, I would like to point out two important notes, first of all, I’ve chose to look at the foot and the ankle combined due to the mutual muscles they share, and the pain factors that are tangled with one another.

  Second, the foot and and ankle are the base of our body and one of the more complex systems in it. It withholds many joints, ligaments, muscles and tendons, and it is engaged in most of our daily movements. Baring this fact in mind, it is easier to understand that the tiniest of change in either the location or the structure of that system would create a chain reaction of “dislocated” joints and muscles, in order for the body to bring itself back to an almost neutralized position. Why ‘almost’ you wonder? Well, it can’t be neutral if the base is not set properly, and maintaining this position takes a lot of effort.

  Throughout this article, we would go over some of the common injuries relating to the foot and ankle, which would follow by an anatomical examination of the structure supplying another point of view for the injury and offering a solution.

  Sprained Ankle  

   One of the more common injuries people might experience in their life time is an ankle sprain. Can be caused due to high velocity trauma while misplacing a leg, or through slipping a slippery road and having a sharp movement within the ankle. While it is not easily ‘achieved’, having a Sprained Ankle once, raises the risk for having another one in the future.

  Let’s go over the structure of the ankle, built out of 2 joints and 4 bones, the Tibia and Fibula support the Talus bone and together they create the true ankle joint that allows the ankle to form a planter and dorsal flexion, underneath that joint you would find the Subtalar joint which consists of the Calcaneus and the lower part of the Talus. To better understand the locations of all the bones, if you look at your ankle you’d see two parts of your bones pointing to and from the body, those are called Malleoli (singular = Malleolus), one pointing toward the other ankle is part of the Tibia, and the other one is  part of the Fibula. The Calcaneus is your heel bone, and the Talus is the bone residing between the inner and outer Malleoli and above the Calcaneus. 

  Bare in mind, just like placing a few branches together would not hold the same position for a long period, bones alone, would not create a steady structure. Along side those bones you can find ligaments connecting the bones together in all direction. These ligaments will allow the joints the movement they require, set the limit of the motion, and ‘glue’ the ankle along so that the joints would remain in a neutral non-harmful position.

  A Sprained Ankle can either mean a ligament has a tear in it, or is completely teared in 2, depending on the damage done to the ligament. Sprained Ankles are graded by a certified MD to asses the damage and build up a future plan, since I’m not a certified to do the grading, I would not dig into the matter to avoid confusion. Symptoms for this injury would include swelling, bruising and tenderness while touching the area.

  Now, since I bring things from my perspective as both a trainer and a senior massage therapist, I’m letting you know I’ve encountered another case that may be caused the same way a Sprained Ankle is caused, but does not fit the symptoms, for it’s lacking one or two of them. Sometimes when you misplace your step, before the ligaments can receive the damage, the body engages in a strong muscle pull to place the step as it should have been placed and correct the ankle, now this pull of the muscle can cause soreness and initiate a chain reaction that would mimic a pain that can be caused due to lower grade sprain but is non related to the ligaments, and does not have the symptoms, there are quite a few muscles going through the ankle to allow it’s motion and stability, and depending on the motion that caused the pain, the correct muscle can be figured, that in itself is an article and testing required, so I would not examine relating muscles for the Sprained Ankle, but you can ask a certified therapist dealing with those conditions for his/her opinion of the matter.

  One other thing, that I’ve personally experienced and encountered with some of my clients, after the pain is gone, and no special treatment was taken, just rest and wait for the pain to leave, there may be some lack in the range of motion of the ankle when comparing left to right, that usually indicates muscle trauma and not necessarily structural change of the joints, so don’t panic that you’ve lost your motion for good, it may be solvable.

  Heel Spurs

  As was mentioned in the previous section regarding the Sprained Ankle, the heel is a bone called Calcaneus. The heel connects with the rest of the foot through a thick fascia named Plantar Fascia, which originates at the Calcaneus, and goes all the way to each of our toes.

  Just like any other organ in our body, bones can either grow and change shape to match a situation or an ongoing state, or they can degenerate and lose their form from lack of use and tension. When inspecting heel spurs, we can see the first example, due to excessive tension of the Plantar Fascia, there is a constant ‘pull’ on the Calcaneus bone, as a reaction, the body would grow a bone spur from the insertion of the fascia to shorten the length it over goes, and try to reduce the tension and pull on the bone. This process takes some time, and does not always relate with pain, but people may describe their heel as if they have a needle, pin or a knife stuck underneath their heel.

  It is important to note, undergoing a surgical procedure for this case is not necessarily the  only solution, usually it would be a waste of your time and money, and stretching or going to a physical therapy treatment may help in reducing the pain or making it disappear for good. If you payed attention, a heel spur does not relate to pain on most occasions. Relieving the tension from the fascia, would reduce the ‘pull’ on the bone, relax the muscles involved in the stabilization of the foot and reduce the pain.

  Now, after understanding the bases of this pathological condition, it’s time to look at another condition that are often referred to as a Heel Spurs but is actually non related and is actually an inflammation caused due to overuse or over tension of the fascia. This condition is Plantar Fasciitis. 

  Why would Plantar Fasciitis be confused with a Heel Spur? Well, one of the symptoms, is a stabbing feeling near the heel when starting a walk after a period of rest, can be either laying down, standing or sitting. This feeling is a confusing symptom, the pin and knife description of the spur mentioned earlier suits as well. In my experience, the best solution for Plantar Fasciitis is to understand the original cause for the tension on the Plantar Fascia, and perform stretches to reduce the tension and enable the fascia a healing period. The most common reasons, I’ve seen, are:

    Continuous tension on the Achilles Tendon, causing the foot to ‘engage’ into a plantar flexion without actually having the muscle perform the motion, which would create a chain reaction of the rest of the muscles to put the foot back into a neutral position, causing them to perform a dorsi flexion of the foot at all times, raising the tension within the foot, causing the Plantar Fascia to overload.

   Inspecting the other direction for that matter, we’d look over the Tibialis Anterior muscle which helps in stabilizing the foot and allowing it to lock on certain motions. As with the Achilles Tendon, constant pull from the muscle, would create a counter chain reaction to neutralize the position of the foot.

   Also relating to the front chain, we would be able to find the Tibialis Posterior muscle, which has an important role in preserving the arch of our foot, could trigger a chain reaction as well as the Tibialis Anterior muscle.

  Understanding the main muscle pulling on the foot, would help better understand the cause, and would supply stretches and strengthening exercises to ease the pain of the Plantar Fasciitis and prevent it from re-occurring in the future.

  Achilles Tendinitis 

  The Achilles tendon is the connection between the calf muscles (Gastrocnemius and Soleus) to the heel, and is the lever used to create a planter flexion. This tendon is the strongest tendon in the body, and can withstand a big amount of force applied on it, however, as any tissue in our body, it has it’s limits and an overuse can cause inflammation or a tear.

  This section would discuss an inflammatory condition, the Achilles Tendonitis. Like any other tendonitis, this condition occurs from excessive use of the tendon, without proper stretching or resting periods. The pain would usually be felt at the back of the leg, just above the heel, it would be more sensitive in the morning or after a long rest, and would ease with movements.

  Now, the Achilles Tendonitis is not a very complex condition, and would usually require rest and stretching to heal. So why is it included in this article? That’s right, because of the reason I would handle as a manual therapist, the muscles connecting to the tendon, the Gastrocnemius and the Soleus, prior to an inflammation, those muscles might be shortened, or sore, in which state they can mimic the tendonitis pain and symptoms, but on a more upscale anatomical view, when those muscles pull, they create a planter flexion motion of the foot, which would require the body to use strength and activate different muscles to pull the foot back into neutral position.

  Pain might not be felt at the back of the leg, where the muscles are pulling but at the front of the leg where the body is using extra strength to pull the foot back. This state of push pull in the body would irritate the tendon and would lead to an overuse and as a result an inflammation. An opposite view of the chart described would suggest that the Achilles Tendonitis could infect be triggered due to a pulling muscle at the front part of the leg, that would create a chain reaction of Achilles pull through the Gastrocnemius and the Soleus.

  In cases of which the pain is not a result of tendonitis, a manual therapy to either the Soleus or the Gastrocnemius could ease the pain. Note in the example given that if the pain persists after treatment, it could be a result of a bigger chain of operating muscles, so try a different method of pain reduction in the therapy.

  To sum it up, our feet and ankles are a complex part of the body. Always pay attention to when the pain starts, which action was done when it first begun, remembering those details would help in understanding the condition you are in.  Also, an important notice, the name of the condition supplied after inspection, is not always as terrifying as it may sound, sometimes the pain is a result of muscle ache that mimic the ache of the condition given. Stay Safe. 

  The described above, are suggestions for muscles that I think should be examined as well, there are other conditions not discussed in this article, and other chains that can be examined for the conditions discussed. Should you have any questions, feel free to ask 

• Knee Pain

  

  While knee pain can be a result of many causes, this article focuses on muscular related pain, and not menisci or ligament related damage. 

  Knee Pain is a common and scary type of pain with 5% of primary care visits revolving around it (Duong et al., 2023).  The fear of knee pain usually evolves from horror stories going around and the thought the knee is ‘gone’ and will restrict daily life with the potential for a whole replacement. 

  There are many possible reasons for pain in the knees, with the most common being patellofemoral pain, knee osteoarthritis, and meniscal tears (Duong et al., 2023). But those does not mean muscles do not play a role in pain (D’Ambrosi et al., 2022, Beutler and Fields, 2025).

  A quick structural review of the knee: the knee consists of 2 joints. Patellofemoral, and Tibiofemoral. The Patellofemoral joint is create from the Femur (thigh bone) and the Patella (kneecap), while the Tibiofemoral joint consists of the Femur and Tibia (shin bone). The Patella is a sesamoid bone, meaning she is enclosed inside the tendon of the Quadriceps. While not officially part of the knee joints, you may find the Fibula resting besides the Tibia. The Fibula is important for the ankle structure, however, it does provide insertion points for muscles crossing the knee joint, and it is important to know of its location. Our first clue at muscle involvement with knee pain, is the Patella. Since the bone resides inside a tendon, any change to the muscle will affect the location of the bone, which could potentially cause pain.

  Muscles and Causes for Knee Pain

  

  Quadriceps

  Quadriceps (Quads) are the most common group of muscle that can cause knee pain. The Quads are made of 4 different muscle heads (hence the name Quad = 4, ceps = headed). The Quads insert to the same tendon, which hold the Patella. A change in muscle elasticity or force in any of the 4 heads will directly effect the Patella position and may cause pain with knee movements. A simple way for a therapist to check for tension is a technique called Patella Tracking.

  If you recall from the Lower Back Pain (LBP) article, the Rectus Femoris is the connecting link between the Quads and our back, and pain to the back can start from the knee and vise versa.

  Hamstrings

  The Hamstrings are a group of muscles, just like the Quads, and they perform the opposite movement to the Quads. They are located at the back of your thigh and insert on the lower border of your knee. When looking into knee pain, a tightening of the Hamstrings will pull the lower portion of the knee backwards into flexion. This constant pull will cause the whole musculature structure to adjust activation patterns and positions within the joint through the motion and could cause pain.

  Just like the Quads, the Hamstrings are also part of the causes for LBP, and any pain on either one, can be caused due to an issue on the other.

  

  

  Gastrocnemius 

  The Gastrocnemius (Gastro) are part of both the ankle and the knee. They assist the Hamstrings with flexing the knee, however, their insertion to the joint is to the upper border, and so any tightness in them may cause instability to the structure of the knee and lead to pain.

  Gastro related pain can populate through the Foot and Ankle and affect the knee, and vise versa. 

  Adductors

  Even though the knee’s main function is flexion and extension, there could also be a slight side bend either externally or internally.

  The Adductors are a group of muscles consisting of  5 muscles. Those muscles originate from the pelvic bone, and grab a hold of the knee from both the upper and lower borders. As their name suggests, their action is adduction of the leg, and since their pull is through the knee they can populate different types of pain, depending on the injury you had. This group can often be confused with MCL or LCL injuries due to their location.

  

  

  Iliotibial Band [Tract in some sources] (ITB)

  The ITB is controlled by 2 different and opposing muscles originating at the hip. The ITB inserts into the knee on the external part of it, and any movement done with it can affect the knee.

  Unlike the muscles discussed so far, reducing the pull of the ITB is not done directly on it, but from the muscles controlling it. Massaging the ITB can be very painful, and is not efficient. In order to reduce the pull on the ITB, you need to address both the Gluteus Maximus and the Tensor Fascia Latae (TFL) which control the ITB.

  To Sum It Up

  While knee pain is commonly related to structural issues, it is important to remember muscles are playing a crucial role in it. Getting a proper examination will lead to an educated diagnosis, and correct treatment to help you get back on track. A qualified manual therapist (orthopaedic therapist, osteopath, physiotherapist, etc.) will be able to provide a correct assessment of your pain, and treat you accordingly.

  Left you with some questions? Feel free to contact me regarding the matter.

  Content Last Reviewed & Updated on February 2026 –   All statistics, references, and therapy recommendations have been reviewed to ensure current best practices.  

  References

  Beutler, A. and Fields, K.B. (2025). UpToDate. [online] Available at: https://www.uptodate.com/contents/approach-to-the-adult-with-knee-pain-likely-of-musculoskeletal-origin.

  D’Ambrosi, R., Meena, A., Raj, A., Ursino, N. and Hewett, T.E. (2022). Anterior Knee Pain: State of the Art. Sports Medicine – Open, 8(1). doi:https://doi.org/10.1186/s40798-022-00488-x.

  Duong, V., Oo, W.M., Ding, C., Culvenor, A.G. and Hunter, D.J. (2023). Evaluation and Treatment of Knee Pain: A Review. JAMA, [online] 330(16), pp.1568–1580. doi:https://doi.org/10.1001/jama.2023.19675.

  Images taken from Sobotta – Atlas of Human Anatomy, 11th English Edition, Vol. 2

• Lower Back Pain

  

  When considering how to make this specific article we’ve ran into some conflict whether we should focus on movements, as was done when explaining the Shoulder Pain or should we focus on the muscles involved and supply examples for the pain they may reflect.

  We’ve decided in the end to take the second option, should you have a specific question, using the movement method, please feel free to contact us and we’d do our best to supply with a satisfying answer.

  First things first, lower back pain can be caused due to several reason, from spinal condition (i.e. Retrolisthesis, Anterolisthesis, Spina Bifida, etc.)  through bulging discs and nerve compressions  (Kabeer et al., 2023)  and finally with our topic for today, muscles  (Seyedhoseinpoor et al., 2022,  Matheve, Hodges and Lieven Danneels, 2023).

  Make no mistake, lower back pain (LBP), can be caused from either the upper or lower body. It does not have to originate from the lumbar area (the lower segments of the spine), even though it is felt there.

  Anatomically, the lower back is the area between the 12th rib and the Iliac Crest. It contains the Lumbar spine [L1 to L5 vertebrae  (plural for vertebra)]. It may differ through different books you check, but for this article, that is the area we will focus on when presenting with pain.

  When a client complains about LBP, the assessment should consist of range of motion testing, the questions of where is the pain felt exactly; when is the pain felt; and what was the trigger for the pain along with specific tests that might be required. According to the findings, further assessment may take place above the pelvic area or below it, in order to pin point the cause and treat it. It is crucial to remember, the location of the pain might not be the cause of it.

  For the sake of the article, we’re going to use the Iliac crest as the border line between the upper and lower muscle groups that can cause LBP.

  Superior to Iliac crest

  Erector Spinae

  Consisting of 3 muscles: Iliocostalis, Longissimus and Spinalis, the Erector Spinae are usually the first to be examined when presenting with LBP.

  

  While following the spine the whole way up to the neck, in our experience, most of the pain they cause is found in the lumbar region.

  Releasing the tension from the erectors could be done either by stretching (which would include bending the spine forward),  going through some massage work with a qualified practitioner, or training within the limits of pain under the guidance of a qualified trainer who understands your condition and can draw the line so you won’t injure yourself further.

  Quadratus Lumborum (QL)

  The QL originate from the Iliac crest and grabs a hold on both the lower rib, and the Lumbar Spine. The region the QL is covering is where LBP is usually described. 

  The QL is the deepest back muscle and is part of the core muscle in charge of posture control. It can work either unilateral (one side is contracting) or bilateral (both sides contracting). When contracting unilateral the QL would help with side bending of the spine, whereas when contracting bilateral the QL would assist with the extension of the spine.

  

  Releasing the tension from the QL can be done through stretching, in which the client would be asked to side bend away from where they feel the pain, and lean forward creating a two dimensional movement in the spine allowing the muscle to stretch.

  As with all the muscles we are going to cover, manual therapy with a qualified practitioner is a great way of addressing this muscle.

  

  Psoas Major

  Sharing an insertion point with Iliacus (see below), Psoas Major originates from the Lumbar Spine and is the only muscle in the body that attaches to the discs.

  Should the Psoas Major be contracted, it would either pool the hip towards the abdomen, or pull the spine towards the hip, shortening the muscle length and causing an anterior tilt of the spine.

  Due to it being involved with flexion of the hip, over extending it would supply us with the needed stretch to help relieve the pain. However to make it a sufficient stretch, you might want to suck your stomach in, forcing the pelvic to tilt backwards.

  Another way of addressing the pain is receiving manual therapy, however, be warned, it might not be the most comfortable sensation as it is a deep muscle with access only through the belly.

  Inferior To Iliac Crest

  Iliacus

  Sharing insertion point with Psoas Major, it originates on the Iliac Fossa. Shortening of Iliacus would cause the hip to be drown towards the abdomen or create an anterior pelvic tilt which will cause discomfort.

  A release to this muscle is tied with the release of Psoas Major,

  

  Gluteus Maximus

  Stretching across the Ilium and the Sacrum, the Gluteus Maximus has a strong hold and effect on the lower spine, when contracted it pulls the pelvis into a posterior tilt, which would reposition the spine and remove the natural arch from it. Due to the unnatural new position of the spine, you may feel discomfort in the area.

  Releasing the Gluteus can be done by stretching, which would involve placing the heel of the shortened side as close as possible to the contralateral ASIS (the boney area you can feel below you abdomen on the hips) and getting the knee as far away from the body as possible.

  This stretch can be done both facing up and facing down, along with standing and using an elevated platform the place the leg. The stretch changes according to your physical abilities.

  

  Tensor Facia Latae (TFL)

  Small, yet trouble making. The TFL originates from the Iliac Crest, and inserts into the Iliotibial Band (ITB). Due to it’s insertion, the TFL is in constant clash with the Gluteus Maximus, as both effect the ITB, each towards it’s own side. Any issue in the Gluteus Maximus may cause tension in the TFL and vise versa.

  Overall, the TFL would not be triggered alone, and would have a few muscles affected by it, Lumbar pain is one of it’s symptoms but not the worst of them.

  Stretching the TFL may prove difficult, and the best suggestion we can give you is go for a manual therapist to have a look and treat it for you. A very common way that people use is the rollers on the ITB, according to Pepper et al. 2021, stretching and foam rolling does not alter the stiffness of either ITB or TFL.

  Rectus Femoris (Long head of the Quadriceps)

  The long head of the Quadriceps, the only one of the group to connect to the pelvis and have an influence on the hip.

  Excessive use of the Quadriceps can lead to a constant pull originating from the Rectus Femoris on the pelvic resulting with the same effects of the Psoas Major and Iliacus when inspecting the pelvic tilt.

  However, unlike the the two, to stretch the Rectus Femoris better, other then over extending the hip, you should add a flexion of the knee, for the Quadriceps muscle is the sole extensor of the knee, which would require a flexion if willing to stretch it or parts of it.

  

  Hamstrings

  The Hamstrings are a group of 3 muscles (Biceps Femoris, Semitendinosus and Semimembranosus) originating from the Ischial Tuberosity and going over the knee.

  Their pull is similar to the pull of the Gluteus Maximus when inspecting the position of the pelvic bone, both would pull the pelvic backwards (into a posterior pelvic tilt position) which would result in the straightening of the spine.

  Common stretch for the Hamstrings would be to extend the knee and flex the hip as much as possible, either when lying on the back, or when standing. In both cases you would like to try and reach the toes of the leg your are stretching while maintaining as straight as possible back.

  

  The described above, are the main muscles we think should be looked at, there could be other less commonly known cases that would require further study and understanding, but in general those might be the cause for your pain. In all cases it is best advised to go to a qualified therapist for proper examination and referral if needed. For any issue you may have, let us know through the contact page area. Stay Safe!

  Content Last Reviewed & Updated September 2025 –  All statistics, references, and therapy recommendations have been reviewed to ensure current best practices. 

  References

  Pepper TM, Brismée JM, Sizer PS Jr, Kapila J, Seeber GH, Huggins CA, Hooper TL. The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness: A Randomized Controlled Trial. Int J Sports Phys Ther. 2021 

  Kabeer, A.S., Osmani, H., Patel, J.J., Robinson, P. and Ahmed, N. (2023). The adult with low back pain: causes, diagnosis, imaging features and management. British journal of hospital medicine, 84(10), pp.1–9. doi:https://doi.org/10.12968/hmed.2023.0063.

  Matheve, T., Hodges, P.W. and Lieven Danneels (2023). The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. Journal of Clinical Medicine, 12(17), pp.5510–5510. doi:https://doi.org/10.3390/jcm12175510.

  Seyedhoseinpoor, T., Taghipour, M., Dadgoo, M., Sanjari, M.A., Takamjani, I.E., Kazemnejad, A., Khoshamooz, Y. and Hides, J. (2022). Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. The Spine Journal: Official Journal of the North American Spine Society, [online] 22(4), pp.660–676. doi:https://doi.org/10.1016/j.spinee.2021.10.018.

  Images taken from Sobotta – Atlas of Human Anatomy, 11th English Edition, Vol. 2

• Shoulder Pain

  Before we dig into the operating muscles of the shoulder and begin to “dissect” it, it is crucial to understand that the shoulder is built out of 2 joints that form the shoulder as we know it.

  The first joint is the Glenohumeral (GH) Joint. This joint is a ball and socket type that connects our arm (Humerus Bone) to the torso through the Glenoid Cavity of the Scapula.

  

  The second joint is the  Acromioclavicular (AC) Joint. This joint is the connection point of our Clavicle and the Scapula through the Acromion process. An extension of this joint is the is the Sternoclavicular (SC) joint, while it is not part of the shoulder joints when looking on the anatomical build of the joint, it is inseparable from the shoulder, as any dysfunction in it would immediately affect the AC joint due to the shared bone of the clavicle.  

  Now, after we’ve cleared that the shoulder is actually a complex joints structure, we can understand that pain can be caused due to dysfunction on either the joints, as it would affect the rest of them as well.

  

  The shoulder can perform movement in all the movements planes. The movements include flexion and extension of the shoulder on the Sagittal plane, abduction and adduction on both the horizontal and the frontal planes, internal rotation and external rotation along with elevation and depression of the shoulder. These are the movements we are going to discuss and check what could cause pain in any of them.

  Each motion can be done through several muscles, but it is also important to note that each muscle might be able to perform several motions. We will examine the optional muscles that could be causing the pain along with the movement they create.

  This article contains muscular related pain. A proper examination may rule out muscle related pain, and you will be referred to get a scan to check the structures of the shoulder. This article was created to give some idea of what is going on in the joint when you feel pain, but should not be a replacement for an appointment with a certified therapist or your GP.

  If the following information leaves you with an unanswered question, that is completely understandable, feel free to send us a message describing your situation so we could discuss it specifically.

  Shoulder Flexion

  

  As mentioned above, every muscle can perform more than one movement, and every movement consists of more than one muscle. There are three main optional muscles that may interfere with flexion of the shoulder: Biceps Brachii, Pectoralis Major, and Anterior Deltoid.

  While the Biceps Brachii is most commonly known for flexion of the elbow, it is important to note that both proximal insertions of the muscle are found on the Scapula. Due to their location, they are also taking part with the flexion of the shoulder.

  Pectoralis Major, is also a big cause of discomfort. It’s a vast muscle that is involved in different movements in the shoulder. The Pectoralis Major originates from the Clavicle, Sternum and ribs, and attaches on the Humerus. It will pop with other movements too.

  The last one of the three, is the Deltoid, specifically the anterior portion of it (hence the name Anterior Deltoid). The Deltoid divides into 3 main groups, of which we will discuss later on, and in accordance to the group’s location, so does the function they supply. The Anterior Deltoid is involved with shoulder flexion, and so is taken into consideration while checking the pain arising from the motion.

  Shoulder Extension

  Again, we will be looking at three main muscles: Long Head of Triceps, Latissimus Dorsi and Posterior Deltoid.

  Unlike the Biceps Brachii, the Triceps consists of three heads, but only one of which crosses the shoulder and takes part of the movement. This head is called the Long Head of Triceps, and is the only part to take part of shoulder extension. 

  

  Next We’d have the Latissimus Dorsi. Often looked upon as the opposite muscle to the Pectoralis Major, the Latissimus Dorsi is vast, originating from the Thoracolumbar fascia and inserts into the Humerus.

  As with flexion, the last of the three is the Deltoid, however, this time we are looking at the Posterior Deltoid.

  Shoulder Abduction

  

  While it is a swift motion all the way through, it is divided into three muscles that are doing it: Supraspinatus for the first ~30 degrees, Middle Deltoid for 30 ~ 90, and Trapezius for the rest. 

  The first to start the motion is Supraspinatus, while it is part of the notorious Rotator Cuff muscles, it also plays an important role in abducting the shoulder, and bringing the Humerus into working range for the Deltoid to take from. 

  Once Deltoid takes over, it is the middle portion of it, and so the tests would be to the Middle Deltoid.

  Once the Deltoid fully contract, the Trapezius will take over the rest of the motion, by rotating the Scapula upwards and bringing the whole arm above the head.

  Shoulder Adduction

  The major muscles in this case would be 2 muscles we have already examined: Pectoralis Major and Latissimus Dorsi.

  Depending on the angle in which the shoulder is being adducted, one of them will be the prime mover. If the shoulder is being adducted to the front of the body, we will examine Pectoralis Major. However, if the shoulder is being adducted to the back the Latissimus Dorsi will be examined.

  Shoulder Horizontal Abduction

  Again, a muscle we have already looked at, for the horizontal abduction, the examination would focus on Posterior Deltoid. While there are other muscles that may be involved in the motion, they would require a more thorough examination of the movement itself.

  Shoulder Horizontal Adduction

  We have two prime muscles taking part of this movement, Anterior Deltoid and Pectoralis Major. This is where all the past motions we’ve discussed will come to play, as we will be able to differentiate which of them might be the cause of the pain. 

  Internal & External Shoulder Rotation

  

  I’ve decided to combine those motions along as they are caused by the same group of muscles, the Rotator Cuff (Supraspinatus, Infraspinatus, Subscapularis and Teres Minor). External rotation is created by Supraspinatus, Infraspinatus and Teres Minor (refer to the image of Supraspinatus. Infraspinatus is right below it and Teres Minor pops below and a bit to the left). Which leaves Subscapularis to perform internal rotation.

  While the above are the main muscles responsible for shoulder rotation, they are not the only ones.

  nternal Rotation is also performed by Pectoralis Major, while the External Rotation also relies on Latissimus Dorsi.

  Please Note that while pain can occur due to the performing muscle being tight, it is highly likely that the pain is caused from a resting muscle not allowing the motion to occur fluently, and every case should be examined as a stand alone case by a qualified practitioner.

  The described above, are the main muscles that could be causing discomfort and pain. There could be more cases that would require further examination and tests. If you feel any issue with your shoulder, please go see a qualified therapist or your GP. For any questions you have, or if you wish to book an appointment with me, follow the links. Stay Safe!

  Content Last Reviewed & Updated on September 2025 –   All statistics, references, and therapy recommendations have been reviewed to ensure current best practices. 

  References

  Images taken from Sobotta – Atlas of Human Anatomy, 11th English Edition, Vol. 1 & 2

• Introduction To Pain Relations

  

  Those of you who know me, would agree that I always attempt to make connections, even when those are not visible or “making sense”. A client can arrive with chronic neck pain that has not been solved with any therapist before, and I would start looking at his legs, arms and lifestyle in order to determine the cause of said pain and not just treat the symptom.

  Further to that, as can be seen in the other articles regarding pain, I have stated before that the pain felt, is almost never the cause of the pain, and lower back pain (LBP) would be addressed mostly through the legs, shoulder through the arm, chest, back and neck and so on and so forth. In this article, I would provide evidence of those connections and interrelations using the literature.

  I am true believer of the osteopathic approach, which concludes two basic ideas to be based on: the body is one organism where structure and function are intertwined; The body is well able to fight disease supplied with the right environment (Tyreman, 2013). 

  It has been shown that there is a direct relation between ligamentous injury and reoccurring injury. It has been suggested that a ligamentous injury will be followed by reduced proprioception (body’s ability to determine placement in an environment), leading to decrease in the neuromuscular control, resulting with functional instability which will cause a repetitive injury leading back to ligamentous injury (Lephart and Henry, 1996). The cycle described is not joint specific and can occur within any joint that has experienced an injury. 

  A research measuring the forces passing through the ankle and the knee while performing a run and while landing from a jump, has shown that during a run the forces transmitted to the knee are equivalent to 1.6 – 3 time the body’s weight, while the same forces in a jump can reach up to 6 times the weight, depending on the type of landing measured (Dufek and Bates, 1991). This is important information we’d circle back to in a moment, but sheds light that from a functional point of view, it is crucial to have appropriate joint stability in order to have proper force transition within the joint. 

  A few studies that investigated the ankle and knee joints compared stability and proprioception of the joints after injury with those of healthy joints. While comparing the joint stability of an uninjured ankle with the joint stability of a post sprained ankle, it was shown that the ability to hold a single leg stance on the injured joint has decreased. On the same note, while checking injured knees, either from wear and tear due to old age or Anterior Cruciate Ligament (ACL) rupture, the ability to sense the positioning and movement, through a passive examination of the knee, has decreased (Lephart et al. 1998).

  From those papers, we can conclude that an injury to the ankle would result in problems with the transmission of forces throughout the body, due to the reduced proprioception of the joint, leading to a potential injury to any area of the body and not just the ankle. Furthermore, taking into consideration the body’s need for homeostasis, a dysfunction in any joint may require a different joint to compensate the instability causing it to operate outside of its functional range of motion, which can lead to an injury. 

  A few studies on the matter have found direct relation between the hip position or muscle strength in different regions. A review of those studies demonstrates some of the more common characteristics. For instance, Gluteus Medius was found to be more active during sudden ankle inversion motion, with no direct connection to whether or not that ankle is hypermobile. This supports the theory that the body would recruit different joints to compensate for a dysfunction. Another example from the review shows that subtalar joint (ankle) pronation, which is also theorized to be connected with ACL injuries, can affect the hip abductors strength and cause imbalance between the adductors and abductors (Reiman et al. 2009).

  When inspecting the spine, a direct relation to the hip can be made due to the anatomical structure of the joint. The inferior (lower) part of the spine, vertebra L5, is mounted on the Sacrum which creates a joint with the hip. Any change to the structure or function of the hip would affect the Sacrum and therefore affect L5. Reviewing some of the literature on the relation between LBP and hip dysfunctions can shed some light on mechanics leading to LBP. Spine movement has a direct correlation with our walking pattern. Subjects with degeneration of the hip joint have more movements in their spine and pelvis when having their gait inspected (Mellin, 1988).

  Having excessive movements in a joint while performing daily routines can lead to an overuse of that joint. An overused joint may result with a performance dysfunction, and while said dysfunction may not cause direct injury or raise a need to stop a given activity due to an injury, an overused joint may cause an inflammation of the tendons around it (Siewe et al., 2011). Having that in mind, inspecting the anatomy along with the body’s need for balance through compensation discussed previously, we can infer that a dysfunction due to overuse in the lower regions of the spine can effect the upper regions either by compensation overuse of the segments or by a lower tendon inflammation affecting the muscle and reaching the higher regions of the spine, including but not limited to, the cervical spine (C – spine) also knows as the neck. Looking into the literature available on the C – spine in relation to shoulder pathologies, a C – spine degeneration may put an individual at risk of getting a rotator cuff tear. Looking at that junction from the other way, a shoulder injury can effect C – spine alignment (Katsuura et al. 2019).

  To sum up all of the above, an injury in the foot, whether you feel it or not, may start a chain reaction leading up to your neck, as the placement on the ground would be a bit different, so that you avoid possible pain, and that would change the whole structure of the body along with force transmission, which, as was shown before, can vary according to the activity you partake. I know this information is a lot to take in, but I am sure that with this bottom line in mind, you may ask your therapist (GP, Physio, Massage, etc.) to try a more holistic approach to your pain instead of treating the same area every time when you present the same symptoms.

  If you have found any error in the article let me know so I could address it. If you have any questions regarding the article or want to consult me regarding yourself, please feel free to reach out for me and let me know. This was made to high light the connections present in the body between different regions when looking at pain symptoms. Consult a professional before changing anything in your routine to maximize your benefit. Stay Safe!

  References:

  Dufek, J. and Bates, B. (1991). Biomechanical Factors Associated with Injury During Landing in Jump Sports. Sports Medicine

  Katsuura, Y., Bruce, J., Taylor, S., Gullota, L. and Kim, H. (2019). Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review. Global Spine Journal

  Lephart, S. and Henry, T. (1996). The Physiological Basis for Open and Closed Kinetic Chain Rehabilitation for the Upper Extremity. Journal of Sport Rehabilitation

  Lephart, S., Pincivero, D. and Rozzi, S. (1998). Proprioception of the Ankle and Knee. Sports Medicine

  Mellin, G. (1988). Correlations of Hip Mobility with Degree of Back Pain and Lumbar Spinal Mobility in Chronic Low-Back Pain Patients. Spine

  Reiman, M., Bolgla, L. and Lorenz, D. (2009). Hip Function’s Influence on Knee Dysfunction: A Proximal Link to a Distal Problem. Journal of Sport Rehabilitation

  Siewe, J., Rudat, J., Röllinghoff, M., Schlegel, U., Eysel, P. and Michael, J. (2011). Injuries and Overuse Syndromes in Powerlifting. International Journal of Sports Medicine

  Tyreman, S. (2013). Re-evaluating ‘osteopathic principles’. International Journal of Osteopathic Medicine

Common Topics

• Lymphatic Drainage

  

  Before diving into the term, we feel it is important to discuss and present the Lymphatic System, and its role and structure in the body. The lymphatic system is part of the body’s immune system, dealing with pathologies and inflammatory processes (Randolph et al., 2017,  Schwager and Detmar, 2019). In simple terms, the lymphatic system contains within it cells who help fight off infections, while also help with liquid distribution across the body to help reduce inflammatory oedema. The system is slow flowing, with an estimate flow that is 100 – 500 times slower than blood flow  (Swartz, 2001).

  The structure of the system is important to understand the process of Lymphatic Drainage, which is what brought you here: Lymph is formed in the lymphatic capillaries, moves on to the collecting vessels, which go through at least one lymph nodes before moving on to the lymph trunks, which drain to the ducts and joins the blood stream (Swartz, 2001). The system is set to move in one direction, from the extremity of the body back into the center and towards the heart.

  Issues with the system begin when a blockage occurs along the route.

  This blockages can occur from a number of reasons which include:

  • restricted blood flow,
  • illness, injury,
  • overexposure to chemicals (i.e. drugs, environmental or work chemicals),
  • lack of exercise,
  • food allergies, tight clothing and stress (Vairo et al., 2009).

  Why was this important to map out? We believe that if you understand the system, you understand what is being done, and what treatment you require. We are going to lay out a few techniques that can be used to achieve Lymphatic Drainage, explain their mechanism of work, and what to expect from them.

  All we ask, is that you bare in mind the lymphatic system is “passive”. As there is no single organ pushing it through the stations, which is why the flow is slow, and the possible causes for blockages to occur.

  Manual Lymphatic Drainage (MLD)

   According to Vairo et al. (2009), there are 4 principles for the theory of this technique: 1. Increasing lymph circulation to stimulate the lymphatic system; 2. Speed up the process of waste removal from the body; 3. Help with fluid flow and there by reduce swelling; 4. Reduce stress in the body and allow the switch between sympathetic (fight/flight/freeze) to parasympathetic (rest/digest) nervous system.

  According to the MLD Ireland website, the treatment is light touch therapy, that follows the neck, trunk and the affected limb in that order. So when getting it done, pain should not be part of it, and neither should extreme pressure.

  Research about the effects of MLD compared to other modalities is varying in results and lacking in variety. A paper by Yıldırım Bulut and Çinar Özdemir (2025) compared MLD with connective tissue massage for headaches, and while both helped achieve a better quality of life, the connective tissue group had better results with pain and disability reduction. Looking into older publications, a paper by Happe et al. (2016) found the MLD was more effective than traditional massage for migraines treatment, and Ekici et al. (2009) concluded that MLD is superior to connective tissue massage for fibromyalgia patients. There is lack of comparison studies between MLD and other modalities for the same conditions, and so it is hard to give an educated conclusion about its effectiveness. Our advise to you is to try and see how you feel about it. MLD might be exactly what you need, but there could be other, better alternatives.

  Physical Activity

  As mentioned earlier, restricted blood flow and lack of exercise can cause blockages in the lymphatic system. That means that adding exercise to your daily routine and improving your blood flow will help reduce the chances for blockages in the system. While also creating a renewed flow which in term can help break down existing blockages.

  Besides the benefits to your lymphatic system, you will also enjoy a variety of positive effects: better memory, enhanced processing speed, less depression, decreased risk of cognitive decline, attentiveness, weight control, reduce diabetes affects, change in cholesterol composition, blood pressure reduction, cardiovascular improvement, improved bone density and many more! (Pujari, 2024, Liang et al., 2021, Vasundhara Singh Hooda et al., 2024, Ribeiro, Andrade and Nunes, 2021). We think, this is by far the best course of action for all pathologies. Lymphatic Drainage is no different, while receiving treatment is great, exercising must be incorporated.

  

  Taping

  Kinesiology taping is a controversial discussion. While some believe it is not a useful modality, but failing to provide sources, science have found many benefits to it, including assistance with lymphatic drainage. The taping application for lymphatic drainage is unique, the tape is not applied as one singular piece, but rather made into smaller stripes that follow a parallel route. This application helps create an area with varying height levels, lifting the skin slightly allowing for an increased space between the skin and the inner tissues, which promotes better flow of blood and lymph (Taradaj et al., 2014).

  In a study performed by Selcuk Yilmaz and Ayhan (2022), they compared MLD with taping and and low-level laser therapy (which will not be covered in this post), on patients with stage 2 lymphoedema relating to breast cancer. They have found that the taping was superior to the MLD in its effect on the lymphoedema. MLD was helpful, but the taping was better.

  Looking at knee replacements Guney-Deniz et al. (2022) compared MLD with taping, and concluded that they are both effective ways to treat oedema after surgery, with no difference between them. Still in the domain of knee replacements, Sobiech et al. (2022) found similar results, providing another layer of proof of the effectiveness of taping for lymphatic drainage. 

  Medical Acupuncture (MA)

  MA can be applied for a variety of conditions, including lymphatic drainage. Keeping in mind that blockages in the lymphatic system can occur from restricted blood flow and injuries, treating those will in turn help reduce the current inflammation and assist with the lymphatic drainage.

  As you may know, and if you don’t, let this be a reminder, we are an expert clinic specializing in Medical Acupuncture among other therapies. Using different methods of MA to provide you with best outcomes, according to your needs, is what we do best. From the science perspective, and specifically looking at lymphatic drainage, a meta-analysis by  Zhang et al. (2019) have shown great results of MA with reducing breast cancer related lymphoedema.

  Massage Therapy

  While not exactly MLD, massage can also help with lymphatic drainage thanks to its blood flow enhancing properties (Mori et al., 2004), as mentioned, one of the causes is restricted blood flow. Massage can also help with injury recovery, and as we mentioned, injury can cause lymphatic blockage.

  Another important aspect of massage is the relaxation process that is usually accompanied with it (Harris and Richards, 2010).

  Reducing stress will also assist with lymphatic drainage, as stress is one of the potential causes for blockage. 

  Bottom Line

  Lymphatic Drainage can be achieved in many ways, and can be caused due to various reasons. Going to a Manual Lymphatic Drainage treatment is one way of doing it, but certainly not the only way. It is trendy, but don’t let the trend blind you from all the potential options you have.

  As we have shown, exercise, taping, medical acupuncture and massage therapy are great options for a lymphatic drainage, and those can provide extra benefits to your body. 

  At the end of the day, you choose what is working for you, and what you want to do and try. We only hope to have shown you that there are a few options available to achieve Lymphatic Drainage.

  Not sure which option might suit you best? To find answers book your Free Consultation call today, and we will discuss with you what would be the best option for you!

  Content Last Reviewed & Updated on September 2025 –   All statistics, references, and therapy recommendations have been reviewed to ensure current best practices.  

  References

  References

  Ekici, G., Bakar, Y., Akbayrak, T. and Yuksel, I. (2009). Comparison of Manual Lymph Drainage Therapy and Connective Tissue Massage in Women With Fibromyalgia: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 32(2), pp.127–133. doi:https://doi.org/10.1016/j.jmpt.2008.12.001.

  Guney-Deniz, H., Kinikli, G.I., Aykar, S., Sevinc, C., Caglar, O., Atilla, B. and Yuksel, I. (2022). Manual lymphatic drainage and Kinesio taping applications reduce early-stage lower extremity edema and pain following total knee arthroplasty. Physiotherapy Theory and Practice, 39(8), pp.1–9. doi:https://doi.org/10.1080/09593985.2022.2044422.

  Happe, S., Peikert, A., Siegert, R. and Evers, S. (2016). The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 37(10), pp.1627–1632. doi:https://doi.org/10.1007/s10072-016-2645-3.

  Harris, M. and Richards, K.C. (2010). The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing, 19(7-8), pp.917–926. doi:https://doi.org/10.1111/j.1365-2702.2009.03165.x.

  Liang, M., Pan, Y., Zhong, T., Zeng, Y. and Cheng, A. S.K. (2021). Effects of aerobic, resistance, and combined exercise on metabolic syndrome parameters and cardiovascular risk factors: a systematic review and network meta-analysis. Reviews in Cardiovascular Medicine, 22(4), p.1523. doi:https://doi.org/10.31083/j.rcm2204156.

  Mori, H., Ohsawa, H., Tanaka, T.H., Taniwaki, E., Leisman, G. and Nishijo, K. (2004). Effect of massage on blood flow and muscle fatigue following isometric lumbar exercise. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 10(5), pp.CR173-178.

  Pujari, V. (2024). Moving to Improve Mental Health – The Role of Exercise in Cognitive Function: A Narrative Review. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 1), p.S26. doi:https://doi.org/10.4103/jpbs.jpbs_614_23.

  Randolph, G.J., Ivanov, S., Zinselmeyer, B.H. and Scallan, J.P. (2017). The Lymphatic System: Integral Roles in Immunity. Annual Review of Immunology, 35(1), pp.31–52. doi:https://doi.org/10.1146/annurev-immunol-041015-055354.

  Ribeiro, M.M., Andrade, A. and Nunes, I. (2021). Physical Exercise in pregnancy: benefits, Risks and Prescription. Journal of Perinatal Medicine, 50(1), pp.4–17. doi:https://doi.org/10.1515/jpm-2021-0315.

  Schwager, S. and Detmar, M. (2019). Inflammation and Lymphatic Function. Frontiers in Immunology, 10(308). doi:https://doi.org/10.3389/fimmu.2019.00308.

  Selcuk Yilmaz, S. and Ayhan, F.F. (2022). The Randomized Controlled Study of Low-Level Laser Therapy, Kinesio-Taping and Manual Lymphatic Drainage in Patients With Stage II Breast Cancer-Related Lymphedema. European Journal of Breast Health, 19(1), pp.34–44. doi:https://doi.org/10.4274/ejbh.galenos.2022.2022-6-4.

  Sobiech, M., Czępińska, A., Zieliński, G., Zawadka, M. and Gawda, P. (2022). Does Application of Lymphatic Drainage with Kinesiology Taping Have Any Effect on the Extent of Edema and Range of Motion in Early Postoperative Recovery following Primary Endoprosthetics of the Knee Joint? Journal of Clinical Medicine, 11(12), p.3456. doi:https://doi.org/10.3390/jcm11123456.

  Swartz, M. (2001). The physiology of the lymphatic system. Advanced Drug Delivery Reviews, 50(1-2), pp.3–20. doi:https://doi.org/10.1016/s0169-409x(01)00150-8.

  Taradaj, J., Halski, T., Zduńczyk, M., Rajfur, J., Pasternok, M., Chmielewska, D., Piecha, M., Kwaśna, K. and Skrzypulec-Plinta, V. (2014). Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report. Przegla̜d Menopauzalny = Menopause Review, 13(1), pp.73–77. doi:https://doi.org/10.5114/pm.2014.41082.

  Vairo, G.L., Miller, S.J., Rier, N.M.C.I. and Uckley, W.B.I. (2009). Systematic Review of Efficacy for Manual Lymphatic Drainage Techniques in Sports Medicine and Rehabilitation: An Evidence-Based Practice Approach. Journal of Manual & Manipulative Therapy, 17(3), pp.80E89E. doi:https://doi.org/10.1179/jmt.2009.17.3.80e.

  Vasundhara Singh Hooda, Muley, P., Pranjali Parikshit Muley, Ashish Anjankar and Gulshan Bandre (2024). Effect of Exercise on Depression, Anxiety and Mood: A Narrative Review. Journal of Clinical and Diagnostic Research, 18(1). doi:https://doi.org/10.7860/jcdr/2024/65557.18929.

  Yıldırım Bulut, B. and Çinar Özdemir, Ö. (2025). Comparison of the efficacy of connective tissue massage and manual lymphatic drainage in patients with migraine: a randomized controlled trial. Journal of Oral & Facial Pain and Headache. doi:https://doi.org/10.22514/jofph.2025.054.

  Zhang, X., Wang, X., Zhang, B., Yang, S. and Liu, D. (2019). Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Acupuncture in Medicine, 37(1). doi:https://doi.org/10.1136/acupmed-2018-011668.

• Conclusion

  

  Be honest with yourself, have you ever considered training just that one specific muscle group you wish to grow better? If you’re honest answer is no, I personally congratulate you! As this article is going to cover the cons of training just the one group out of the whole body. If your honest answer was yes, maybe this article will change your perspective when planning your goals.

  It’s not everyday that I come across a question regarding specific body part training, but unfortunately, it’s not that rare as well. Usually the male clients would would work their upper body, and skip lower body sessions whereas for the female clients it’s the opposite. It’s not wrong wanting to target a specific muscle group, you have your goal, and that’s great! But, and that’s a pretty big but, it’s not recommended to train only the muscle group that would support your goal.

  If you’ve been following the articles section of the site and browsed some of the pain related articles, you probably remember some of the muscle related pain chains, where a single muscle can cause pain in a whole different area of the body. That is the first reason why you should not train just one muscle group. Without getting into specific muscles, as the examples vary from client to client, we’d use force explanations. If you train only a specific muscle group, every contraction of that group, over time, would generate more force, and as a result would require the surrounding muscles to generate more force in order to keep the skeleton aligned. Due to the fact that those surrounding muscles are not engaged as part of the training program, there would come a time where no more force could be generated from them, at which point the risk for an injury to occur is high. And an injured individual cannot participate in weight training, so the whole goal is missed.

  In case the injury prevention does not change your mind, let’s dive into some of the less discussed topic of the body. The endocrine system, AKA hormones. Yes, hormones! Different studies conducted on the matter show that there is a relation between hormonal response and the amount of muscle tissue engaged. For instance Endocrine Responses To Resistance Exercise discusses the different variable that may effect endocrine responses to different weight training programs, examining specific hormone responses.

  While the study found that the endocrine response may be related to the intensity, volume and amount of muscle tissue involved. Different study checked the relation between hormonal response and muscle strength when training a single arm, or a single arm and the legs. The results from that study, both on the endocrine and strength build up favours the arm legs group.

  Bottom line for this paragraph, if you train the whole body, involving more muscle groups and therefor engaging more muscle tissue and raising the intensity of the session. You are more likely to progress more towards your goal faster.

  Conclusion

  You would benefit more from training your whole body rather than just focusing on that specific area you wish to change. Training your whole body would not interrupt your goal, it would most likely accelerate the process.

  Engaging bigger muscle groups would trigger your endocrine system, and as a result help with your recovery and progress. Training the whole body would keep the balance between different muscle groups and would reduce the chances of an injury. Which would allow you to continue training towards your goal more efficiently.

  Always make sure to consult a professional when planning your training program. Do not   consult uncertified individuals regarding matters concerning your  health. If you have any questions or found an error in this article, let me know. Stay Safe!

• Is My Weight Right For Me?

  

  Looking at our weight has been the most common way to define health and wellbeing of an individual for so long. But our body contains so much more than the weight we see on the scale. Ever heard of BMI? What about BMR? Body Fat Percentage? Lean Body Mass? Pretty sure you have, but if you feel like you might be missing on something, and want to understand those phrases better, tag along, we’ll break down some of the ingredients in just a bit.

  However, before we drill through the phrases, I would like to share with you my experience with all the weight and height shenanigans. It’s pretty often I hear the phrases “I need to loose wait to suit the criteria”, “My height is so and so, what is the ideal weight for me?” and other of the same type. There is no right answer for those questions !

  The weight of your body is just a number on a scale, it’s all the sub-weight materials that create the answer if you should change your life style, not your weight.

  Weight is the summation of different anatomic parts of the body, and has a direct effect on some of them. Now that we’ve cleared that of the way, we may begin our journey through some of the main aspects of body weight ingredients.

  Body Mass Index (BMI)

  Maybe the most common of them all, usually comes on the form of “I weigh ‘X’ and my height is ‘Y’, should I gain/loose weight?”.

  So what exactly is BMI? Metric speaking, it’s your weight in kilograms divided by you height squared in meters. The normal BMI score range is between 18.6 and 25, and according to BMI anyone under 18.6 is underweight and over 25 is overweight, with varying levels of obesity along the way, depending on the exact score.

  Let me tell you this, I really do not like this method of measuring the body. Should someone be underweight, that should raise a flag, and further tests should be done, including blood tests, before they should be recommended to gain weight, it is very possible that they are perfectly healthy and do not fit into that formula. On the other end of the chart, I am considered overweight and unhealthy according to the chart, my score (while writing this article) is 27.8, almost 3 points above the health max score, so I am considered unhealthy.

  To conclude BMI, it is very common but reflects the body very poorly, I do not use this score with my clients.

  Body Fat Percentage (BF%)

  Fat has got a very bad reputation in recent years, it is an unjust reputation if you ask me. Each and everyone of us has fat, and it’s not a bad thing. Fat is a base material in the human anatomy and is used through different processes and mechanism in the body. We need fat, but having too much or too little of it, can be a serious health hazard.

  So what is a normal amount of fat? There is no one true answer to fit all! depending on your gender, and your age, your BF% can vary. In general, males would have less body fat compared to females, and youngsters would have less body fat compared to older ages.

  There are many tables regarding fat percentage, some are more accurate than others, some use labels that are hurtful and not scientific, but overall, most are showing the same data. If you are not sure if your fat percentage suits your body and age, you can consult a professional from the field, and ask them to show you the table they were using to determine your condition.

  The lower BF% we have, the more Lean Body Mass (our next subject) our body has, meaning our weight is mostly muscle and not fat. The ideal condition is having more muscle mass than fat, your body weight, for that matter, has no relevance.

  Lean Body Mass (LBM)

  Muscles. No right and wrong here, no chart of recommendations, the goal is simply to have enough. What is enough? Well, that depends on your overall goal,

  enough can be the right amount to keep your body moving and performing daily activities without reaching early fatigue, while maintaining good BF%.

  Bone Mass

  Let’s break a myth to begin with, there is no such thing as heavy bones. On average, for women bone mass should be about 2.4 Kg, and for men about 3.3 Kg. As with BF%, bone mass is gender related, however, unlike BF%, it is also dependent on body weight. The more you weigh, the bigger bone mass you should have. 

  Why is it important to keep track on your bone mass? It could indicate an issue or a bone related disease. Let’s say you are a man, who weighs around 80 Kg, and have a bone mass of 3.1 Kg, or if you are a woman 70 Kg with a bone mass of 2.35 Kg, this is a red flag. Low bone mass might indicate osteopenia or osteoporosis, or it could also be an error with the measuring machine, non the less, I would refer away to do a bone density test to make sure there is nothing to worry about. A low bone mass could result with an unwanted injury, and set back the whole process.

  Bone mass is health related, and can cause a lot of issues if overlooked. Make sure to have it checked regularly along with the rest of the characteristics. 

  Water Percentage

  As most of you had probably learned in biology class during middle school or elementary school, most of our body consists from water. Water are a crucial ingredient in our body, many physiological processes depend on our body water. While the range differs between men and women, I like to remind people that about 60% of our body is water, so both males and females should have that, or close to it.

  Getting some real numbers, for females, the range for water percentage should be around 45 – 60% while males should be 50 – 65%. There is no specific recommendation for people to drink, there is the 2 litter recommendation, but if you are staying within a hot environment you should probably drink more. If you stay in a cold environment and hardly loose any liquids, you might not require those amounts.

  Stay hydrated is not just a motto, it would actually help you feel better and allow your body to operate on the max. 

  Basal Metabolic Rate (BMR)

  This is basically, the amount of calories you burn each day in order to perform basic functions such as breathing, thinking, digesting, maintaining your muscles working, etc. There are 3 main formulas to calculate the BMR for each body, 2 are pretty general and do not require too much data on the person, and one that is a bit more specific and uses also the BF%.

  We’ll start with the original formula of Harris Benedict, for men: 88.362 + (13.397 × weight in kg) + (4.799 × height in cm) – (5.677 × age in years), and for women: 447.593 + (9.247 × weight in kg) + (3.098 × height in cm) – (4.330 × age in years). As can be shown, for the same sex, same age, same height and same weight, the BMR would be the same, even though one individual would have slightly more muscles than the other, which would require more calories for the BMR.

  Using Benedict’s formula, Mifflin St Jeor revised it and created a slightly more accurate formula. For men: (10 × weight in kg) + (6.25 × height in cm) – (5 × age in years) + 5  and for women: (10 × weight in kg) + (6.25 × height in cm) – (5 × age in years) – 161. Still no use of the LBM, which would bring the same results for the case described above.

  A more accurate formula, in my opinion, belongs to Katch-McArdle. This formula takes into consideration the BF% which in reverse would bring the LBM, the formula as is follows: 370 + 21.6 * ( 1 – BF%) * (weight in kg). Choose which ever formula you think suits you, note that the result should be changed should you live a more active life, and know the calorie intake you require for your goal. 

  Of course there are many aspects that should be taken into consideration, aspects that do not belong to this article, such as blood pressure, heart rate, blood tests etc. Those should be tested every once in a while as they can reflect issues that are non related to the external body view.

  To conclude, your body weight is a result of more than one variable, the weight it self does not reflect merely enough data on your health, and therefor should be inspected closely and broken down into the variables that build it up.

  Always bare in mind the example of two individuals with the same height and weight, one has less BF% while the other has more BF%, they are not in the same health state, and probably do not share the same fitness shape level. Do not look at your body as numbers for weight and height, you’d only confuse yourself with will to loose weight instead of loosing fat, or gaining more LBM. The digits on the scale do not represent your health state, you have to dig deeper than that to see the real picture.

  Stop trying to fit into BMI tables, as I’ve mentioned before, I’m not fitting into one. My current state (year 2020) is almost 3 marks above the top bar for a normal BMI, and I’m aiming to gain even more weight in the coming future. I can assure you, I’m healthy, even though I weigh more than some table says I should.

  Always make sure to consult a professional when planning body related changes. Nutrition must be discussed with a certified nutritionist and exercise must be discussed with a certified physical fitness instructor. Do not take someone’s advise because it has worked for them, and do not consult uncertified individuals regarding matter concerning your health. if you have any question or found an error in this article, let me know. Stay Safe!

• Rest Days

  

  Doesn’t matter what kind of exercise you are engaging with, you should always put up some resting days. While some may claim that rest will include doing absolutely nothing, stay along with me as I would like to bring up another resting method that might suit you better.

  Let’s begin with the “Doing Nothing” method. If you are at the beginning of your journey, indeed, a rest day would include mostly nothing, you are not to engage with your training program for at least a day or three during the week. Rest days may differ between workout plans, as each plan has a different set of requirements.

  For instance, a basic gym plan would involve a full body workout, in such a program, the body needs to receive rest in between each session, meaning that the maximum amount of engagement should be every other day. If you are doing a full body workout and you are doing it daily, you do not supply your body with sufficient rest, and instead of increasing your performance you will start noticing a decrease in performance and an early fatigue. People are always afraid of not training enough, but they should be more afraid of not resting enough, because that’s where injuries occur.

  Another common gym program (don’t worry, I will give some non gym related example during the end) is the A B program, in which you engage with half of the body through A and the other half through B. I would strongly advise to use this program with a rest day between B to A. Meaning you perform A, B and you rest before going A again, if you are just starting your way with such a program. The more you progress with this type of program and gain more experience you can, if you’d like, ‘lose’ a rest day and rest after 2 A B rounds in a row.

  Moving on to the other resting method, using the A B Program module. A very experienced trainee, with a carefully built schedule might have the ability to train daily, no rests included. I’m all for it, but the body does needs a rest, so how are we to get such rest with no day off? 

  Well, every few weeks, you should engage with a de-load period. How do we do that? There are a few de-load methods out there, I found that the one that works best for me, gym-wise, is taking the weight out of the equation. I do not change the reps I perform or the sets I do, I just decrease the weight I train with. The body still performs the motion, we still have muscle activation, but we do not reach our limit, which allows the body to recover even though it’s not actually resting.

   For those of you who have read about me, among other things, I’m also a Long Distance Running Trainer. In my programs for long distance running I use a de-load method (see? Told you not only gym examples) that reduces the volume of the run. Some may claim that reducing speed from the run is a great method as well. Personally, I disagree, in order for you to maintain the same distance on a slower pace, you would actually find yourself working harder in order to maintain that pace. However if you reduce the pace and the distance, it’s mainly a matter of distance changing, meaning a volume change. 

  This de-load period can last one week, but can be extended for a longer period if there is a need for such an extension to improve recovery. If you are not sure about the de-load planning time, I strongly advise you to consult a professional to help you with that. The idea of de-loading is simple, keep doing, but engage with less, and so it can be applied on every activity from lifting weights to doing stretches through dancing and performing aerobic exercises.

  To sum it all up, rest is a crucial part of any workout plan, and should be taken into consideration. There are different types of resting methods, and you should find that which suits your lifestyle most. Do not over look it, find the method that you feel best about.

  If you have any questions for me, or found an error in the text, don’t hesitate to let me know. You can subscribe to the blog if you want to stay updated with new articles I upload every once in a while. Always consult with a professional if you feel unsure of a method you’ve learned. Stay Safe!

• Your Dream Body – Shortcut Revealed

  

  If you have clicked this link because you thought I’d have a grand secret on how to achieve your dream body in just a few weeks, do not exit the article, and keep an open mind. If getting the dream body was just a few workouts away, everyone would have it, but not everyone is training. People keep working hard to achieve or maintain their results. There is no magic path for your dream body.

  Results require hard work and dedication, any shortcut that is being offered to you is either illegal, or dangerous.

  I would not be getting too much into the illegal section of things, but there are drugs that are used to improve results, I do not know enough about those, and so I will not dive into that area. 

  Now let’s talk dangerous, I have seen many different challenges around promising a certain result within a very short period of time. These challenges can be alright, for trained athletes, it can supply the needed change and final push required for them, or just give them a fresh change for a while.

  But let’s face it, most of the people that would interact with these challenges are not trained, and are most likely at the beginning of their journey, their bodies would not react as well to those challenges and they are very likely to get injured either from overdoing at once, or not performing the exercise as it should be.

  These challenges and shortcuts can also  have a negative effect when inspecting the mental aspect of the participant. Why? The participants were told they’d have a perfect belly in 3 weeks, or the perfect butt in 2 weeks, or any other body part within a short amount of time. However, when the challenge is over, and the result is not as expected, the participant’s disappointment can drive them into abandoning the journey they have began for a better and healthier lifestyle, and drive them back into their old habits. 

  From my experience, you can’t achieve your goal in a matter of a few weeks. The body takes time to adjust to the changes in the routine. All those shortcuts and challenges are excellent click baits, and they give a lot of reputation to whomever released them, but they do not hold the test of time, and so those are replaced by new challenges and shortcuts every now and then.

  I know these challenges and shortcuts are fun to participate in, they are short but give you a feeling of accomplishment as you are exhausted after just a few minutes. But according to my experience, you can achieve a perfect workout that does not require you to reach your limits every time, and no, you do not have to feel dead by the end of it. If you are following a well built program, that is considerate of your current state of health and is built to chase your goal, you will not feel like you can’t move after every workout, but you will progress at a pace that suits you and is built for your progress.

  Another issue I find in almost all the challenges and shortcuts, is the lack of resting days. You are not supposed to work the same muscle group every day. The body needs the rest to “fix” the damage done to the muscle during the workout. If you do not supply the body the rest it requires, you will damage your muscle tissue on the long run,

  and would experience a decrease in performance that can be followed by an injury. Should you engage a full body workout, the best practice for you would be to train every other day, so it’s a training day, rest day, training day and so on. After a while of training, and if you have the time required during the week, a split program can be used, so you work different muscle groups every day.

  If you’ve reached this far in my article, do not give up on training, understand that results takes time. You need to work for them, and pursue them with dedication and consistency. Yes, there might be some days you feel invincible and others that you would feel off, That’s alright, it’s part of the process, and with everyday that goes by we learn to adapt to our current state so that we’d achieve the best we can out of every session. Results can take a few weeks, but they can also take a few months or maybe years, depending on the end result and starting state. If you are just beginning your journey, feel free to go over the Getting Started Workout Routine article, as it is my way of giving you the best start I could think of.

  I would always suggest consulting a professional around you to make sure you are training correctly (trainer) and that your diet suits you (nutritionist). If you feel that something is off, take a moment and start to question ‘why do I feel what I feel?’. It might be wrong technique that can be easily inspected and changed, it might be a non suitable diet, and it might require a Doctor’s appointment. If you want to, feel free to reach out for me through here, and I’d give my best to help you understand what might be off. Stay Safe!

• Six Pack Abs

  

  Before you go any further, be warned, it’s very likely you won’t like what I have to say, and might consider it wrong. So I’m not going to argue whether you should continue doing crunches after this article or not, I’m leaving this choice entirely to you. I will, however, share my thought on doing crunches and other Six Pack Abs exercises.

  I’ve heard many times that people do their crunches and other abdominal exercises to burn their belly fat. As far as I know, there are no known methods to burn fat from a specific part of our body, so that excuse for performing crunches in order to burn belly fat is invalid in my eyes. I’ve also heard that some are sure that they are on the right track of burning fat due to perform those exercises because they feel a burning sensation while performing those, and so it means that they are burning belly fat. Unfortunately, that burning sensation is a normal physiological outcome for working hard on a specific area and is non related to fat burn.

  I feel that burn while doing Squats, Deadlifts, Over Head Presses, Sprinting and/or any other exercise reaching my limit, but that does not mean I burn more fat. The burning sensation can be caused due different reasons, one of which is the heat that the muscle produces while contracting and engaging the movement that is performed. Overall, if you check different charts, doing crunches is not necessarily more beneficial for you, calorie wise, if compared to other movements, it burns a low amount of calories, and might not be the extra push you wish to include in your session.

  Most crunches I’ve seen, were not performed properly – legs were engaging as well, sometimes the spine entered movements with high velocity, that for the long term could cause pain, the shoulder blades were misplaced, and the list continues with different, more specific, variations of the above.

  Yes, you should work your Abdominals, they are part of the body, and engage in many different ways, throughout almost every motion we perform. No, you should not engage in common conventional training methods in order to reach them.

  I do not remember the last time I did any conventional work for my Abdominals, you will not see me crunch, or suggesting someone to engage in a crunch, because when I check Pros and Cons, the benefit is not worth the risk.

  I work my Abdominals through compound movement exercises. They are engaged to help maintain our spine’s posture from over extending when we lift weights for most of our upper body activities. Should you decide to work, single sided, or do an uneven lift, they would prevent your body from rotating or side bending and keep you spine where it should be. I highly recommend engaging those types of movements every once in a while, you can read more about those methods through the article Symmetrical Vs. Asymmetrical.

  Another way I recommend to work and engage the abdominal group, is by doing static work, Planks, Side Planks, Static Rotations, Single Leg Stands, holding unbalanced positions with your body, etc. Note not to over exceed with Plank time, as it can cause issues as well, but if done correctly, for either short periods or with non-spine related movements, it can do wonders, and can really work on all the layers of the Abdominal group on a more functional level (Functional Training should you like to read some more on the matter).

  Six Pack Abs are achieved with a balanced diet, tailored for you, and not with how many crunches you can or can’t do. If you check any other muscle in the human anatomy, for you to see the muscle’s outline and fibers, you must reach a low enough fat percentage amount, or you’d just have the strength and not a defined form.

  Take for example Strongmen and Body Builders, you can see every fiber of every muscle on a professional Body Builder, unlike the muscle and body posture of a Strongmen, which is lacking the muscle definitions. Yes, both Body Builders and Strongmen have strong muscles, but Strongmen do not seem as fit as Body Builders. Why? Because Strongmen have a pretty high amount of fat percentage compared to Body Builders.

  Find the way that suits you best, and meets your goals, take into consideration that you might be doing something wrong when trying to achieve your six pack abs. Highly recommend you to schedule a session with a certified nutritionist. Hope you found my ideas enlightening and would change the way you pursue your goal. You can always reach out for me through here should you have any questions or requests.

• Getting Started Workout Routine

  First things first, this is a training program that might not suit you (due to your mobility or health history)., it’s not the only way to get started and it might differ from what you’ve heard so far from your friends or other professionals around you. This program will include the base exercises I believe every trainee should begin with, it is based on the article Functional Training written some time ago, and on my personal experience and priorities regarding movement and body preparations for future training.

  No matter what your goal is, or how far you want to go, at this stage we will focus on building movement patterns and basic strength, so that we have a strong and reliable core base to begin with. The program presented here would help with building that base, which can later be used to build a more complicated movement that could get us closer to your goal. Everything starts at the beginning. Training is a process, there are no shortcuts., and if you’ve heard of any, research them before using them, as they might not be legal or healthy to use.

  NOTE IF INJURED do not undertake this program without consulting a professional first (Or contact me if you are not sure). To see real results you should also consult a nutritionist. A nutritionist can develop a program specific to you that would include advice on calorie deficit and surplus etc. according to your goals, and would get you closer achieving your goals in a healthy manner.

  Squat

  First exercise for us to get started with, is a squat. Squatting is a great way for us to build our leg strength along with our core strength and upper body stability. While performing a squat, I would like to make sure that we maintain a straight back posture, having our shoulder blades together throughout the whole motion.

  Our pelvis leads the way, we are imagining a chair that is behind us, and we reach it when initiating the motion. Our knees should be taken into consideration, I do not want your knees to collapse inwards or have a rotation outwards while performing the motion, maintain a straight line throughout the motion.

  What if that is too hard? Let’s regress a bit, instead of imagining a chair, let us actually bring a chair and sit on it, maintaining the same highlights of the squat, but having a little rest while we sit. As time goes and it becomes easier for you, we can change the sit, with touch and go, the aim is to feel the chair while we go down, and as soon as it is felt we go up to standing. After mastering the movement, we can proceed to a regular Squat.

  What if that is too easy? In case the Squats are not enough for you, and you can perform over 15 without breaking a sweat, we can do one of 2 things, we can either progress to performing a Goblet Squat, holding any type of weight in front of our chest while maintaining a neutral shoulder positioning, shoulder blades kept tight, and perform the Squat with that extra weight. Should you lack weights to work with, we can hold the “sitting” position mid air while Squatting for a period of 3-5 seconds and back to standing position.

  Here’s a video showing all the movements, starting Squat, the regression option of Sit & Stand, and the progression options of Goblet Squat and Pause Squat:

  Pushup

  This is a very common exercise, you can see it everywhere, and is sometimes being overlooked or treated poorly. Yes, you read correctly, an exercise can be treated poorly, it can be performed in a variety of ways, and hand stances, which, by the way, are mostly correct. Sometimes we see a pushup being performed incorrectly.  Body posture is very important, as is wrist positioning and elbow movement.  If you are not strong enough yet, it is okay to do a half rep pushup. You can build up to a push up and reach full motion once you have mastered the half rep correctly, with good form and body position.

  While inspecting a pushup, I would look at the wrist positioning compared to the body, some people place their palms under the shoulder, or under the neck, align your wrist with the chest, right below the shoulder. A pushup is similar to performing a Bench Press or Chest Press at the gym, when inspecting the shoulder movement pattern. Keep your pelvis aligned with the body, not above or below it. Use your core to to do so while ensuring correct movement. 

  What should I do if it is too hard? We have two ways of engaging the Pushup if we wish to regress the difficulty level. First would be to place your knees on the ground and reduce the body weight that is being used. Secondly, we can place our hands on a higher platform, note that while doing so, the chest needs to align in between the wrists while going downwards, a common mistake I see when looking at this type of Pushup is bringing the head down towards the platform instead of the chest.

  What should I do if it is too easy? We can progress in two ways, first would be to remain low for a couple of seconds, like with the Squats, and pause our movement close to the floor for 3-5 seconds. The second approach would be to place our legs on a higher platform, make sure to bring the chest towards the ground and not the head to maintain a correct motion.

  Here’s a video showing all the movements, starting Pushup, the regression options of Knee Pushup and Incline Pushup, and the progression options of Pause Pushup and Decline Pushup:

  Band Resistance Row

  If you do not own a Tera Band, invest in one. If you don’t have one starting off, it’s not an issue, I would demonstrate the motion while using a towel as well. The row exercise is our pulling motion and will work both our target muscle (our back – Latissimus Dorsi) and the stability of the spine.

  Legs stance can be either a Squatting position – legs are next to each other, or a Lunging position – one leg back and one leg to the front. Personally would prefer the Squatting stance as it is better for stability, but I might consider using the Lunging stance in some cases. Put the band on a hook, a door knob or have someone else hold it for you, about pelvis line, hold the band with both your hands and pull your arms to the side of your hip bones, keeping your elbows tight and close to the body, and do not drive yourself towards the band or the anchor point.

  Too hard for me! The easiest way to regress would be to walk towards the anchor and release some tension for the band, however, should you find the movement puzzling, you can enter prone position (facing down) on a mattress, grab a towel and place your hand above the head on the ground, and pull the towel with both hands towards your chest, keeping your elbows pulled behind, chest stretched, or just engage the motion with no towel to practice the motion.

  Too easy for me! Easiest approach to get a harder practice would be to walk away from the anchor to increase band tension, or grab both ends of the band with one hand and have some asymmetrical workout (you can read more on Symmetrical and Asymmetrical training through here). You can also combine the two to have harder on both ends. Should you not have a band, you can try and engage Bent Over Rows using a bag or a weight, however, please proceed with care, as it requires other technique related elements, maintain a straight back posture, keep your pelvic back, bend your knees and pull your weight towards your hip bones.

  Here’s a video showing all the movements, starting with Band Resistance Row along with easing or hardening controlled with distance from anchor, the regression options of Prone Towel Row and Prone Row Motion, and the progression options of Single Hand Band Resistance Row and Bent Over Row:

  Shoulder Press

  Many variations for this exercise, from the Military Press or Over Head Press using Barbells and Dumbbells or even Tera Bands and Pilates Balls, you can also find extended variations such as the Arnold Press. But prior to all these and advancing with weight, first you need to have full control with the Shoulder Press, you can either use Tera Bands (hope you took my advice and bought one or two), or you can use water bottles and Dumbbells.

  Starting position for the movement would be when my hands, holding my resistance are aligned with my ears, shoulders are relaxed and chest is stretched out, from there I would push through and create an Isosceles triangle above my head to have both the weight (should I be using those) or hand (if using bands) meet. Throughout the whole way I would keep my shoulders relaxed, and have a controlled motion all the way.

  Easing or making the exercise hard, should be done with the resistance you are engaging, you can change the resistance or use a single hand.

  Here’s a video showing all the movements, starting with Shoulder Press, I used water bottles  for the examples, and how to perform a Single Hand Shoulder Press:

  Plank

  To wrap up this program, we will be engaging the Plank. Elbows are placed under the shoulder, using out forearms as anchors on the ground, pelvic and shoulder align and create a parallel line with the surface we’re Planking on, legs are straight back and we hold the position. Really important that you breath while doing a Plank, as we would not want to have extra tension build up in your body, as soon as you are exiting the posture described, you should stop for that set, rest and perform again. A Plank should not be engaged in for too long, so I would recommend build up to a minute keeping your body static.

  1 second is way too much for me… If you can’t hold the posture, don’t panic, place your kneed under your pelvic, and straighten the arms, keep a staright back and lift one of your hand above the ground for a few seconds, afterwards, place it back and lift the other hand instead for the same amount of time. Place your hand back and move on to lift one knee from the ground and replace it with the other knee. Go around switching anchors as much as you can while maintaining a straight posture.

  60 seconds? That’s it? If you find Planking easy, I would ask you to engage a motion of back and forth with your entire body, starting with your toes and pushing through to your shoulders, this should be done slowly and controlled, as soon as you go to fast, the exercise looses it’s intention.

  Here’s a video showing all sorts of Planks described, starting with regular Plank, the regression option of Limb Raise from Bird-Dog Stance, and the progression option of Moving Plank:

  There are many types of starting programs, the fact that they may differ from this program does not mean they are wrong. All exercises performed can be changed to align with your experience and need, and to help you with achieving your goal. I would personally recommend starting with 15×3 (reps X set) for the first 2 months before starting to change and progress, as I would want your body to learn how to perform this as best as it can. If you feel that 15 is too easy, and you’re already trying the hard version, feel free to add weight, as long as the technique stays the same. The recommended amount is doing once every other day tops! You have to give your body rest, and working out with this program every day won’t give extra benefit, it would probably cause discomfort over time. Feel free to contact me through here for further questions.

Do & Don't

• Carpal Tunnel Syndrome

  

  Carpal Tunnel Syndrome (CTS), is one of the most commonly misdiagnosed conditions of the hand. As a therapist I can say that almost any client walking through the doors to my clinic with a pain in their hand, that has been seen by their GP, has been diagnosed with CTS. According to a literature review by  Genova et al., 2020, CTS cases in the UK stand on roughly 9% – 16%, where as in the US the general population reports 5% of actual CTS. If the number states that 16% is the highest reported occurrence rate, I ask how is it that roughly 90% of cases (if not more) presented in the clinic are diagnosed with CTS?

  The answer to that question, unfortunately, is overdiagnosis with no relevant test. If you describe some of the symptoms to your GP, you have “doomed” your fate to a CTS diagnosis, even though, you are most likely to have a range of other conditions that could create some of the symptoms of CTS.

  To put things in perspective, a false diagnosis of CTS, would lead to a false treatment plan, and more times than none, an unnecessary surgery to resolve the misdiagnosed injury.

  To put things in perspective, a false diagnosis of CTS, would lead to a false treatment plan, and more times than none, an unnecessary surgery to resolve the misdiagnosed injury.

  

  Phalen’s Test is a bit like a reverse prayer, you place your hands together and try to get at least 90 degree flexion with your wrists. A positive test would be if you feel any tingling, burning, pricking or prickling, skin-crawling, itching, “pins and needles” or numbness on, or just underneath, your skin in either your thumb, index finger, middle finger or a combination (Brüske et al., 2002). The most you should hold this position is a minute, if by that time nothing has occurred, that is a negative test. According to the same research, this test is only 85% accurate, which is why, if you do this alone and not in a clinic setting, please be sure to follow up on the Prayer test.

  Prayer test, as the name suggests, is putting your hands in a praying position, and extending your wrists as much as you can. This position would apply tension to your Carpal Tunnel, and if positive would produce similar symptoms to Phalen’s Test described above. As with Phalen’s this should not be held for longer then 60 seconds.

  If both these tests are positive for you, you are very likely to have CTS, and should definitely continue reading on, to see what you should and shouldn’t do. If only one of these tests was positive, you might have CTS, but should get it checked more thoroughly, by either a therapist that has experience with CTS testing, or a physician that will look at you, and not just diagnose you according to your symptoms.

  

  Do

  1. Think back, has anything changed for you just before the pain appeared? Could have been a tool change (if you work with tools), office change (keyboard/mouse moved or completely changed), started a new exercise etc. Once you find what could be a potential cause, either change again if possible, or consult a professional on what you are doing wrong with the equipment so you can start over with less pain.

  2. You can use a tennis ball / massage ball (or any other similar type ball you may have) and roll around both inside and outside of your elbow on the forearm. This will reduce the tension your muscles are creating, the same tension that is pushing on your nerve and causing you the CTS.

  3. Sink your hands in lukewarm water with Epsom Salts for 10 – 20 minutes. In the warm water, the Epsom Salts will break into Magnesium and Sulfate ions, which are easily absorbed through the skin, and will promote muscle relaxation, reduce inflammation and stress levels  (Abdelaziz et al., 2020, Joicy et al., 2021).

  4. Immerse your hands in icy waters. If you are a bit more like me, and prefer the cold over warmth, this option might suit you better when compared to the Epsom salts option. Be advised, it is not a very nice sensation, and building up to 10 minutes of immersion might take a few tries. One of the many effects of cold immersion is the narrowing followed by thickening of the blood vessels (Espeland, de Weerd and Mercer, 2022), creating a “forge fan” effect of bringing new blood to the area after clearing it completely. The immersion will also reduce inflammatory processes (Dzintare and Krišāns, 2020).

  Don’t

  1. Work in painful postures. It will only make things worse.

  2. Lose hope, there are many ways to treat CTS that do not involve surgical interference.

  As always, I am here for any questions you may have, so please reach out if something was unclear. It is always advisable to go to a professional for specific and proper treatment. That being said, this post is aimed to supply you with tools for self assessment and treatment on a first aid basis. Stay Safe!

  References

  Abdelaziz, S.H., Abdo Elmetwaly, O.I. and Maged, L.A. (2020). Effect of Using Warm Shower and Warm Water Footbath with and Without Adding Epsom Salt on Fatigue Level in Systemic Lupus Patients. | Indian Journal of Public Health Research & Development | EBSCOhost.

  Brüske, J., Bednarski, M., Grzelec, H. and Zyluk, A. (2002). The usefulness of the Phalen test and the Hoffmann-Tinel sign in the diagnosis of carpal tunnel syndrome. Acta Orthopaedica Belgica, 68(2), pp.141–145.

  Dzintare, M. and Krišāns, A. (2020). THE EFFECT OF COLD-WATER BATHS ON RECOVERY AFTER ANAEROBIC EXERCISE IN 20-30-YEAR-OLD TRAINED MEN. LASE JOURNAL OF SPORT SCIENCE is a Scientific Journal published two times per year in Sport Science LASE Journal for sport scientists and sport experts/specialists, p.47. 

  Espeland, D., de Weerd, L. and Mercer, J.B. (2022). Health effects of voluntary exposure to cold water – a continuing subject of debate. International Journal of Circumpolar Health, 81(1). doi:https://doi.org/10.1080/22423982.2022.2111789.

  Genova, A., Dix, O., Saefan, A., Thakur, M. and Hassan, A. (2020). Carpal tunnel syndrome: A review of literature. Cureus, 12(3). doi:https://doi.org/10.7759/cureus.7333.

  Joicy, M.S., Shetty, G.B., Sujatha, K.J. and Shetty, P., (2021). Effect of Neutral Immersion Bath with Epsom Salt on Hypertensive Individuals. Indian Journal of Integrative Medicine, 1(3), pp.75-79. 

  Widodo, S.A., Rochman, F., Haryadi, R.D. and K, P.M. (2020). The Diagnostic Accuracy of Phalen Test and Prayer Test in Carpal Tunnel Syndrome. | Indian Journal of Forensic Medicine & Toxicology | EBSCOhost.

• Fibromyalgia

  Like all my other articles, this article is based on both clinical research and evidence along with my experience as a manual therapist and a personal trainer . 

  

  So what is Fibromyalgia (FM)? FM is a chronic condition typically characterized by widespread pain, issues sleeping, having a non restorative sleep, fatigue, cognitive dysfunction, and other somatic symptoms which can vary from one patient to another, all symptoms negatively effect physical and emotional function and reduce the quality of life. FM is more common among women rather than men (3.4% compared to 0.5% – according to a study at 2011).

  Like any other condition, FM can be treated using medications, however, since those are not my area of expertise I’ve not included those in this article, and would strongly advice you to consult your Doctor regarding medications, should you decide those are the best option for you as a patient or a clinician treating a patient with FM.

  So let’s get started with the exercise aspect of this article, there are many types of exercise that can be used, from aerobic, to resistance training, through aquatics and stretches. Each one of those types of exercise has so many sub-types and examples or methods, so finding the correct way might be challenging, but the variety of options means it’s possible.

  As with any new client starting their way with exercise, there should be a well built and calculated procedure to make sure that it’s not too hard for them so they would not drop out as soon as we start, and when it comes to FM patients, we also want to make sure that we do not trigger the symptoms and send them home in a worse condition than the one they had before.

  

  Exercise Comparisson Table as shown in the article Exercise Therapy for Fibromyalgia (2011)

  The table attached shows the effects of different types of exercise on FM symptoms, as can be seen, there is no bad practice, any exercise is going to start a change, but some exercises are shown to effect some symptoms better than others, so let’s take a first look at

  Aerobics

  Walking, running, cycling, stair climbing and so on, all these can be great if the physical condition allows it. As the saying goes, better safe than sorry, it’s recommended to start of easy and build progress up. If the FM patient is not physically active, a short walk to start the process would be enough, always track the feeling, as a short walk for some is around the neighborhood,

  and for others might be to the car and back. A more physically active patient might prefer running, or cycling, as long as they are capable to do it, it’s fine. There are no rules for distance or pace, but there must be some sort of screening done prior to the activity so that the intensity would not exceed the ability of the client and trigger FM symptoms.

  Strength

  Body weight, band resistance, external weight training. Name it as you’d like, as long as we have muscle strengthening, it is great. Why is it so beneficial? Stronger muscles means a patient with FM would require less muscle activation over time in order to perform the same activity. Less muscle activation required would mean a more efficient movement,

  and a more efficient movement, drops the risk of experiencing FM symptoms. However, and it is very important, just like with any strength training method, if you over reach and use too much resistance, the patient would experience musculoskeletal pain, with a FM patient, this pain is far more extreme and can be a huge step back with the process.

  Aquatics

  While there is no straight forward evidence that aquatic exercise is more beneficial than land exercise, at least not any evidence I was able to find, some studies show better results with more severe cases of FM when inspecting aquatic exercise. One of the prime reasons, I think would make the aquatic exercise better for severe cases is the weight reduction, standing for instance would be easier in water when compare to standing on the ground, so the muscles and joints would have less to carry.

  Another reason I believe would make aquatics better is the supporting effect of the water, every movement is being supported, so the whole structure of the joints engaging can focus mainly on the motion and less on stabilizing it. I’ve noticed from my experience that helping a joint maintain a certain position is more than enough in order to reduce movement pain, and so the water can have a very large impact doing a similar effect.

  I hope we can agree, that if any of these cause a reduction with FM symptoms, a correct and well thought combination of them might show better results. So how should we decide which of these do we want to engage in? It’s not actually ours to decide, it’s patient dependent. Let’s be clear, when you feel tired most of the times, your body is aching, and you hardly sleep, you might not wish to engage in every activity. Understandable.

  Find something that the FM patient likes more than other things, this way you help with creating some passion and excitement, instead of immediate rejection. It is more than OK to tell your patient if they need to go and do the process with a different professional colleague if the patient prefers cycling and you are not certified for that, or if your patient would prefer aquatics but you are a master of land exercise. Client well-being should always come first, and you would be much more appreciated by them if you refer them to the relevant professional so they would feel better over time. 

  Before moving on to manual therapy, I would like to remind you the importance of the mind when training. Most FM patients are afraid of performing any type of activity, they would prefer to remain with little to no movement at all, maintaining a pain threshold they are familiar with, rather than engaging with an unknown activity that might cause them pain.

  Is there a promised way to relieve them of the pain? No. Can we try different methods in order to reduce their pain? Absolutely YES! A successful program would help with building confidence in FM patients, the confidence to move and be active in their daily life without the fear of flaring FM symptoms.

  Manual Therapy

  As a manual therapist, I have came along FM, and I know that some therapists are not willing to treat FM clients. It can be quite the challenge, and there are no hard evidence for success rate with our profession, I’ve even come across some papers advising FM patients not to go to a manual therapy session. So in this section I would be relying on my experience. Yes, it is a bit tricky to treat a patient that is experiencing a lot of pain from the slightest of touch, but it does not mean you can’t do it. Every joint in the body is a meeting place of quite a few muscles, every muscle in the joint has an effect on the other muscles within that same joint. If you can’t work a specific muscle, due to extreme pain levels, either go to a different muscle within that area that might have an effect on the painful area, or go above an below to create a similar effect. It’s not as efficient as going head on to the issued area, but even some effectiveness in FM cases might be day changing for the client, sometimes going from a 100 down to 85 on pain scale is all the client needs for a good night sleep.

  Do I think a client would have the most benefit ONLY from manual therapy? Absolutely not. Movement is the best cure for most things I’ve encountered, manual therapy is a tool to be used in order to make sure that movements remain engaged. I often combine both strength/aerobic training with manual therapy to keep my clients going with as little pain as possible, and I can tell you, with my FM cases, I could see the difference much clearer than any other case I’ve had. From not being able to perform due to excruciating pain, to performing almost pain free, and over time experiencing less pain with any activity, especially not during exercise sessions. Manual Therapy could be the tiebreaker from not being able to train regularly, to train regularly with anticipation for the next time there is an exercise session.

  There are many ways to address FM, any patient would benefit more from a different approach, always bare in mind the end result, having FM symptoms reduced so that FM patient would have as normal life as possible. If you can’t help your client, make sure to investigate where are your abilities reaching their limit and refer them to another professional associate that can complete your limit and help out. The information in this article may be lacking, if you’ve found an error with the content or think I’ve missed an important aspect, please be sure to let me know, I wish to make it the best possible. Also if you’ve found a type-o be sure to tell me. Available for any question you might have, Stay Safe!

• Sprained Ankle

  

  One of the more common injuries I’ve came across. We all know someone who had twisted their ankle and were suspected for spraining it. If you have not read my Common Anatomical Related Pain article – Foot & Ankle Pain, I suggest you go ahead and check it out, you might find it useful when coming across ankle related cases. 

  It is important to note, and clarify from the very beginning, if you have sprained your ankle once, it is more likely you’d sprain it again, and the more it has been sprained, the less stable it would be, which would lead to a higher risk of spraining it one more time. But, and it is a very important but, strengthening and working on ankle stability can reduce these risks tremendously. It’s not going to be a bulletproof ankle, but it can be built strong enough to stabilize.

  The do list would go from easy to some more extreme exercises, an acute pain might require treatment before going on to the exercise part, depending on the stage and the Doctor’s analysis, a cast might be needed for a short while, or for lower severity some manual therapy to reduce the tension and muscle spasm that might have occurred due to the injury.

  Do

  Strengthen the area isometrically. Apply external force to the joint while maintaining a steady and motionless ankle. Build up the force as slowly as possible, reaching a point you either can’t hold the ankle steady or you feel pain. This should not involve pain.

  Find out the range of motion that may have been affected by the injury by moving the foot around, compare both feet to see the difference in range. Once you’ve figured the issued range, start mobilizing it with some non resistance movement exercises, and dynamic stretches of the area to increase and engage with the missing range.

  Engage with some mild resistance training for the ankle muscles, you can use external force such as a resistance band or yoga ball wall press to perform controlled ankle movements and strengthen the muscles to allow stabilization of the joints throughout motions.

  Perform a single leg stand on the injured side, if needed have some support at first to unload your weight (can use a safety rail, a bar, a Deuserband to help with the body weight, inside a pool etc.). You can perform some gentle arms movement to change the center of gravity and have the ankle co-op with the change of the body positioning.

  Stand on an unstable surface, could be a Bosu, balance cushion, or anything that is safe to use and is unstable to stand on. This is a more advanced exercise I would recommend engaging the last, after the injured ankle can carry all the body weight on it’s own to avoid worsening of the condition.

  Don’t

  Engage with pain. Big no on this one. Pain may suggest the tissue can’t hold it yet, and it might worsen the injury.

  Refrain from overdoing, you might try to over achieve progress by going a few steps at a time. It is important to go step by step. Warming up the place can ease the progression on the same session (from isometric movement to standing for example) but it might cause some issues. Progress is tricky, depending on the severity, you might consider taking baby steps with the progression.

  Do not be ashamed to take some time off. No, I do not mean sitting at home doing nothing, but do not try to reach full performance after the resting period, provided by your physician, is over. Try to resume your activities as soon as you’re able to, but go easy at first.

  Always have a professional around you when progressing and engaging with an injury. Make sure to warm up before any activity that might involve ankle risk for injury. Keep strengthening your ankle even after the injury and rehabilitation stage are over, as mentioned at the beginning, it can always occur and has a higher potential of reoccurring after the first time.

  If you have have any questions regarding this article, or maybe some corrections, please contact me through here. Always pay attention to your body, noticing a sign can reduce the chance of an injury occurring, if you feel that something is not exactly right, consult a professional to help you figure the root of the issue you feeling and help you get back on track as soon as possible. Stay Safe!

• Herniated\Bulging Disk

  

  I’m sure you’ve met someone with herniated or bulging disks. I usually hear about people disks when asking them to perform leg exercises such as Squat or Deadlift, and the answer I get is something like “I can’t I have a herniated/bulging disk, I should not get involved in such activity”. Let’s get something clear, if we are to go get a screening for bulging or herniated disks, we are likely to receive a positive result.

  Yes, we might have a herniated or bulging disk as we speak, but, no, there is no need to stress about it, as it is asymptomatic and does not require special attention. For the following article, I would refer to herniated disks more, as those are more likely to cause symptoms than bulging disks, but if you have a bulging disk, these article is great for you as well.

  As with other articles I write, the data that is going to be shown below is based on research I did, and on my experience with my clients, should you find anything that you know to be wrong, don’t hesitate to reach out and let me know so I can research and correct the error.

  Now, let’s talk about herniated disks, what exactly is a herniated disk? Our spine disks contain a liquid in their center allowing them to maintain the spine’s structure along with enabling it’s movements, a two vertebrae structure is called a segment, when the segment is creating a certain motion, the liquid in the disk changes to support that motion. When this liquid bursts out of the disk, that is a herniated disk. Diagnosis of such a disk would always give out the segment in which the individual experiences the herniated disk, for instance,

  L4 has two disks along, the disk between L3 to L4, and the disk between L4 to L5, which is why the precise location (L4-L5 or L3-L4) segment is required. Depending on the location of the disk, different symptoms may occur, numbness and tingling sensations to either one of our limbs, muscle weakness, and/or limb pain. Why are these symptoms occurring? The liquid that burst out of the disk can apply pressure on the Spinal Cord, and that can cause either one of the symptoms of the herniated disk, according to symptoms, a doctor may suspect the location of the issued disk segment and address you to a screening for that area.

  Now back to our topic, what should we do, or not do with a herniated disk?

  Do

  Strengthen the body, involve compound movements, build a strong support for your body.

  Maintain an active lifestyle, it would reduce the pain and allow you to move freely while performing daily tasks.

  Should the herniated disk be part of the Lumbar (lower) Spine, engage in strengthening the legs, it would improve the way your spine receives weight changes and impacts and would help improve your daily life.

  Should the herniated disk be part of the Cervical (neck) Spine, engage in moving the area and opening the range of motion of the segments, it would stabilize the muscles around the spine and ease the movement of the neck.

  Don’t

  Know your limits, overreaching the goal can have a negative impact, use a progressive program tailored for you and your goals.

  Reach pain, try to minimize the pain as much as possible, if that means working a limited range of motion in any exercise do it, it would improve over time until you can perform it fully. 

  For Lumbar Spine herniated disk, I would suggest not to engage in rotations at first, build isometric strength for rotations before engaging into a full rotation.

  Most importantly, don’t give up, as mentioned in the “Do” section, an active lifestyle is the way to go.

  Acute pain from herniated disk must be treated and referred to a doctor. Having symptoms does not necessarily mean having a herniated disk, it could be a muscle reaction as well, you can find my Common Anatomical Related Pain articles regarding the matter. Should you have further questions, please feel free to contact me. Stay Safe!

• Osteoarthritis

  

  Osteoarthritis [OA],  also known as degenerative joint disease, can occur at any joint of the body. It is the most common joint disease, and can cause pain, loss of function, disability and financial burden  (Coaccioli et al., 2022).

  OA occurs when the cartilage between bones starts to disappear, which would cause our joint to lose some of its range of motion (ROM). OA is diagnosed using scans and imaging, as the joint condition can then be assessed  (Corti and Rigon, 2003).

  The main symptoms for OA are pain, stiffness of the joint, and swelling. A quick overview of the symptoms would conclude that pain is felt due to the loss of cartilage which causes the joint to move with less ease affecting structures within the joint. The stiffness, is created either due to osteophytes (bone growths) that block the ROM in the joint, or the pain restricting the ROM over time. Since the body would try to fix the joint, an inflammatory process would start at the joint causing swelling.

  Before starting physical treatment through training, it is important to understand the specific joint affected by OA, for example, if we look at the shoulder, is it the Acromioclavicular joint of the Glenohumeral joint. And another aspect we would need to check is the ROM that is troublesome.

  After we’ve understood the exact joint that is affected by OA, we need to investigate that joint from an Anatomical-Muscular view, examine the muscles relating to the joint, and once those are memorized, connect them to the issued ROM (which we’ve inspected before as part of step two) to understand how to work through the range.

  Don’t

  Since pain can be somewhat alarming, let us begin with things you should not do, and the first thing is to be afraid. Pain is indeed unpleasant and it is one of the body’s mechanisms to avoid damage, but bare in mind that the client is suffering from daily pain and they know how much they can handle or whether or not that pain is right for them or exceeding their normal range. If you are not familiar with pain training, either consult someone who is, or refer the client to another professional. The client’s health is first priority, and there is no shame in admitting you are not qualified to work with them.

  Another aspect that is occurring with OA training, is the cracking / clicking / creaking noises that the joint may produce. As long as those are not painful, they are a part of the pathology, and may reduce over time with training and therapy. So DON’T be afraid of those.

  Do

  Make sure you understand the condition as best as you can.

  Prior to every exercise perform the motion with no resistance to inspect problematic areas of the ROM.

  Should you find alarming areas at the ‘dry run’ of the exercise, consider warming up some more, or skipping those areas when using high resistance.

  Build up the motion, start from basics. Build a good movement pattern with the client! If they control the basics, and are gradually introduced to training, they will benefit greatly from the exercise.

  A well prescribed exercise routine can help conservatively manage OA and offer relief (Hunter and Eckstein, 2009).

  We can help with OA symptoms with training. Every case is unique and requires different considerations for the program to work. If you have any questions, or wish to consult us, reach out to us, and we’d do our best to supply you with the most relevant data we can. Stay Safe!

  Reference

  Coaccioli, S., Sarzi-Puttini, P., Zis, P., Rinonapoli, G. and Varrassi, G. (2022). Osteoarthritis: New insight on its pathophysiology. Journal of Clinical Medicine, 11(20), p.6013. doi:https://doi.org/10.3390/jcm11206013.

  Corti, M.C. and Rigon, C. (2003). Epidemiology of osteoarthritis: Prevalence, risk factors and functional impact. Aging Clinical and Experimental Research, 15(5), pp.359–363. doi:https://doi.org/10.1007/bf03327356.

  Hunter, D.J. and Eckstein, F. (2009). Exercise and osteoarthritis. Journal of Anatomy, 214(2), pp.197–207. doi:https://doi.org/10.1111/j.1469-7580.2008.01013.x.

• Parkinson’s Disease

  

  Parkinson’s Disease is a neurodegenerative movement
  disease, and affects between 2 – 3% of population above the age of 65, making it one of the more common neurodegenerative movement disorders (Poewe et al., 2017,Balestrino and Schapira, 2019). It is important to clarify two main points, before going through the do and don’t sections:

  Firstly, you can’t stop Parkinson’s. You can reduce the speed in which the disease spreads and it’s affect, but you can’t stop it once the wagon has started to roll.

  Secondly, the notes you are about to read are based on our experience with the disease from our clients along with the literature about it. Remember that not all people are the same, and while it may be true from the literature or our experience, it does not apply to all.

  Now, let’s go over some information regarding Parkinson’s:

  1.  it’s considered to be a Neuropathology disease, as it affects the nervous system.
  2. It’s symptoms consist of  tremors throughout the body, stiffness of limbs and back, slowness of movements, and reduction in stability and coordination. (Balestrino and Schapira, 2019)

  3. There are pills that can be prescribed, but we’re most definitely not M.D.s so we will not be discussing those, check with your doctor for more details. 
  4. Recent research shows that a way to slow Parkinson’s is through movement (Earhart and Falvo, 2013, Mak et al., 2017, Ahlskog, 2011). Logically thinking of it, Parkinson’s have a negative effect on movements, so treating it can be done by moving the body and having the brain grab a hold of the organs and not the other way around.

  Do

  •  Since we’ve discussed Parkinson’s effect on stability, one of the things you would want to do, is work on that, either by lifting a leg up and balance yourself on a single leg (make sure to have a safety bar near you), or by standing on uneven surfaces (pillows, towels, blankets, Bosu, etc.) There are many ways to work your balance, however always make sure it is done safely.

  • It has also been shown, that raising the heart rate and incorporating aerobic exercise to the training routine has a positive effect on the patient, and so riding a stationary bike, or rowing on a rowing machine are great exercises to include in the training routine (Benevides et al., 2024) .

  • Challenge more than one muscle group at a given time. Aiming to perform complex exercises, containing more than one or two joints, would help with coordination. Don’t be afraid to try some more complex exercises once you get a hold of the basics, practice makes perfect.

  • Core involving movements would improve the overall body stability and help build a strong base for future activity, don’t look for close range machine motions, search for open range exercises to involve as many core muscle as possible (Zemková and Zapletalová, 2022) .

  • Stiffness of muscles can really have an effect on the training routine, you might want to consider manually moving the operating parts of the body prior to actually doing the activity, and add a stretch at the end of each exercise to maintain as much range of motion as you can. Great methods for a bigger range of motion on spot are PNF and MET. Do not perform those unsupervised or without knowledge of use, as they might cause harm.

  • In addition to the above, seeing a manual therapist occasionally can also reduce muscle stiffness and promote better performance during exercise routines. 

  • According to Ellis et al. (2013) low outcome expectations, fear of falling and lack of time to exercise are the leading reasons why people suffering from Parkinson’s Disease do not take part of any exercise routine, make sure to explain the process and reassure them that it is beneficial and safe to train, while planning the routine to fit their daily schedule.

  Don’t

  To the best of our knowledge, Parkinson’s does not have restrictions when engaging training. If the program is progressing gradually, covering the basics and building on top of those, it is a safe to use and incorporate exercise routine.

  Always make sure to train in a safe environment that can support your needs, and corresponds with part 7 of the Do’s. 

  If you have a question, feel free to reach out. Make sure to work along side a professional, either as a consultant that can check the progress or as a guide to monitor and inspect the progress and help you through. Stay Safe!

  Content Last Reviewed & Updated on September 2025 –  All statistics, references, and therapy recommendations have been reviewed to ensure current best practices. 

  References

  Ahlskog, J.E. (2011). Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology, 77(3), pp.288–294. doi:https://doi.org/10.1212/wnl.0b013e318225ab66.

  Balestrino, R. and Schapira, A.H.V. (2019). Parkinson disease. European Journal of Neurology, 27(1), pp.27–42. doi:https://doi.org/10.1111/ene.14108.

  Benevides, R., Mawston, G., Taylor, D. and Lord, S. (2024). Targeting exercise intensity and aerobic training to improve outcomes in Parkinson’s disease. Sport Sciences for Health, 20. doi:https://doi.org/10.1007/s11332-024-01165-0. 

  Earhart, G.M. and Falvo, M.J. (2013). Parkinson disease and exercise. Comprehensive Physiology, 3(2), pp.833–848. doi:https://doi.org/10.1002/cphy.c100047.

  Ellis, T., Boudreau, J.K., DeAngelis, T.R., Brown, L.E., Cavanaugh, J.T., Earhart, G.M., Ford, M.P., Foreman, K.B. and Dibble, L.E. (2013). Barriers to Exercise in People With Parkinson Disease. Physical Therapy, 93(5), pp.628–636. doi:https://doi.org/10.2522/ptj.20120279.

  Mak, M.K., Wong-Yu, I.S., Shen, X. and Chung, C.L. (2017). Long-term effects of exercise and physical therapy in people with Parkinson disease. Nature Reviews Neurology, 13(11), pp.689–703. doi:https://doi.org/10.1038/nrneurol.2017.128.

  Poewe, W., Seppi, K., Tanner, C.M., Halliday, G.M., Brundin, P., Volkmann, J., Schrag, A.-E. and Lang, A.E. (2017). Parkinson Disease. Nature Reviews Disease Primers, 3(3), p.17013. doi:https://doi.org/10.1038/nrdp.2017.13.

   Zemková, E. and Zapletalová, L. (2022). The Role of Neuromuscular Control of Postural and Core Stability in Functional Movement and Athlete Performance. Frontiers in physiology, [online] 13, p.796097. doi:https://doi.org/10.3389/fphys.2022.796097.

Training Methods to Help Reduce Pain

• External Joint Support

  

  Let’s start with a statement, and it is very important to have that cleared before we proceed, I am not against the use of assistive gear for joints, as long as such gear is needed. Now that we have established that crucial statement, we are free to proceed a bit further into the rabbit’s hole and look at some research and my experience on the subject.

  I’ve had clients coming to me, with Knee support, Elbow support, Wrist support, Belts and so on. My  first question to my client, coming with any type of external joint support, is why? Usually, the answer would be that they were recommended to use it by a GP, in order to help them reduce pain they experience in the joint.

  Other times it is because they believe it is better for them, and they saw so many people using it. Needless to say, the later is not a good reason, and I would kindly ask them not to use it. However, in the first scenario, my follow-up question will be what was the exact recommendation? While some are advised to use the gear all day long, since the moment they wake up to the moment they go to sleep, others are advised to use it only when practicing certain movements that cause them pain and put them in a risk of injury. Both are good answers, but I would still try to reduce the need to use any kind of equipment for both. 

  When using external joint support, we are taking away the work from our muscles and joints, as a post injury for acute pain, it might be the perfect solution. However, when the use of that support is becoming a habit, and is not longer required for the acute pain, that’s where I would mostly intervene. When people come to train, and they use those external support mechanisms,

  they are becoming dependent on them, their muscles and joints are getting used to having that support along, and they do not get the required stimulation for them to become stronger and more stable, in which case we might see muscle hypotrophy (note, not hypertrophy). Should a client be using a single side support for a prolonged period, chances of noticing differences between left and right are increasing.

  When checking the literature, a research published in 2011 found a correlation between use of external support and reoccurring injury of Powerlifters. The study consisted of 245 professional powerlifters, and checked the effects of different criteria on their injury rate. Among the parameters looked at, we can find use of supporting devices. The study reported that athletes using supportive devices reported significantly more injuries when looking at the Lower Back, Elbow and Wrist. (Siewe et al., 2011).

  So back to the question of WHY? If the ultimate goal is to reduce or remove pain, the correct approach would be to teach the body how to control and use the injured joint. In order to do so we must stimulate the joint and surrounding muscles to take charge instead of letting them rely external support. Yes, it’s a process, and yes, it might take time, but that is the best way to deal with chronic pain and gain joint independent that could last long. .

  If you are experiencing pain while working or engaging in daily activities, that’s alright, you can use the support for those tasks, but when you engage in training with the intention of strengthening the area and resolving the pain, do not use support as it would slow your progress. Work within your limits. Again, because I do not think it is being said enough, use external support when needed! Do not make it a habit

  While I am not a fan of the use of any external help, as I am a firm believer the body is a magnificent machine that could do wonders, if you wish to use a bit of help for your extreme sets, be my guest. As long as there is no dependency created, and you are able to train and perform tasks without external assistance, it’s alright with me. However, once you become dependent, that is an indication you have used it too much, and it is time to lower the load and build your body back to being non-dependent on any form of external support.

  To sum it up, using External Joint Support isn’t all bad, if used wisely and when needed. Pain is a great indication for our limits, and we should learn to work within our limits. If you feel like something is not right for you, consult a professional, but don’t do anything that might be causing you damage in the future. Hope I got you thinking. Feel free to contact me if you have any question. Stay Safe!

  References:

  Siewe, J., Rudat, J., Röllinghoff, M., Schlegel, U., Eysel, P. and Michael, J. (2011). Injuries and Overuse Syndromes in Powerlifting. International Journal of Sports Medicine

• Running

  

  It’s one of the base actions the human body is capable of doing, yet also a very feared factor due to high injury rate.

  Different sources give different statistics, but according to Sports Medicine Australia (SMA) up to 70% of runners get injured over a period of 12 months.

  Should that alarm you? Well, I’d have to both agree and disagree on the matter. Yes running may cause injuries, but there’s a saying, the best way to avoid injury is to do nothing, if you avoid the risk, you can’t injure yourself, so we’re covered on the front. However, I would have to disagree, as some of the injuries people describe (knee pain, ankle ache, back pain etc.) are usually, in my experience, just poor training and preparations for the run, and so, I would try to discuss as much base as I can for preparing for a run, set some pointers and try to reduce the risk factor of an injury occurring.

  So, you’ve passed the warning, and have decided to start running, long distance, short distance, at first it’s all the same for me, the first few steps and the base are similar. Running, both short and long distance, requires the body to be able to stabilize itself either under great pressure for a short period of time or under moderate pressure for a prolonged period.

  Therefore, our first subject of the article:

   Stability

  Stability is a main key for a successful runner, while most people may think it is a matter of either the knees, ankles, or the pelvic, it a combination of all of them with some extras of the feet and spine.

  A base analyze of a stride motion while running is simple, the feet collides with the ground with a certain force, the force is sent all the way up to the skull while passing through the ankle, knee, hip, pelvic, and spine. Have one junction poorly functioning and the whole system is affected. Say for example, the running surface had a little bump, so the collision with the ground wasn’t as expected, the ankle got a little angle, the force now needs to continue it’s route to the skull, if you’ve done enough stability training, your body would adapt upon impact, and the force would continue it’s way to the top as expected, however, poor ankle stability could cause sprain as the force would stop at that junction and not keep onspreading through to the rest of the body.

  On a different point of view, say your ankle is slightly misplaced while running, the impact from the foot landing on the ground would transfer force to the knee which would need to compensate for the ankle, in order to have the force keep it’s route to the hip, but since the force came slightly off from the knee as the compensation may not have been perfect, the hip would require a compensation of it’s own going up to the spine and so on, all those tiny adaptations over a long period of moderate force, or short period of max force passing through (long distance compared to short distance) would cause muscle early fatigue if not properly trained for, which would lead to aches and injury.

  All runners should have their stability well based, they can achieve those from Single Leg Standing, hoping on a single leg, performing single leg exercised such as Squats, Deadlifts,

  Hip Thrusts, stabilizing on a Bosu or a Balance Cushion and after perfecting the stability start to perform leg strengthening exercises to help with the muscles coordination and mechanism.

  The next aspect of running I would like to go over is:

   Mobility

  This aspect will be addressed and looked at from two angles, the first one would be the joint mobility while running, and the second will be the joint mobility after running. 

  I hope you would agree with me that running uphill, downhill or on a flat surface, requires different strides, which means a different angle requirement of the joints participating. I do not expect the body to make those transitions on it’s own, without any injury factor being taken to consideration, unless, the body has engaged those movements within a controlled environment prior to the run itself.

  Yes, I know those exercises look weird to the outside world, but their importance cancels the looks, there is a variety of exercises that I like to use, starting with quick steps with a minor hip motion, following a relatively big motion of the hip while slowing down both step pace and distance taken with a stride. Another type of exercise I use, would be a rotation of the upper spine in contrast to the lower spine to over exaggerate the tiny motion that is created while our hands are moving in synchronization with our opposite leg during the run. To have both stability and mobility addressed I would sometimes use high altitude or long distance leaps to have the joint participate in a specified pattern of mobility while  adjusting to the rest of the structure upon impact with the surface.

  Now, for the second aspect of mobility, it would be post exercise stretching. While running we perform the same motion a countless amount of times, or use a lot of force to perform the motion for a few strides, that kind of muscle use would trigger a range of motion shortage to ease the motion of the body while performing the run, so post stretching is a very important activity to be added post run,

  to get the joint back from the percentage it locked on during the run to it’s max range. The stretch should be held for a few seconds, usually, you’d feel a bit of pressure from the muscle that is being stretched, but that pressure would reduce in a matter of seconds while the muscle regains it’s range and flexibility. Don’t over do a stretch, not the range, feel your body and work along, over stretching can cause an injury as well.

   Gear

  Last but not least, your running gear, now I’m not suggesting buying a certain brand, and run as if you represent it,or buy the most expensive gear you can find. Far from it, I mean it’s important to have shoes that fit your running style, or have soles that fit your feet. Over time,

  it is crucial to have a good support for your feet, after all we’ve had the discussion throughout the whole article about every stride, in which you have your foot land on the ground with a certain impact, either soft and lasting or short and massive, it is still an impact, and the way it makes through the joints is a game changer.

  You can read more regarding the different types of shoes and support they provide through this Instagram Post, make sure to examine your running style, and have the best support you can possibly get for your feet, either shoe or sole, DO NOT COMBINE those, as they would create a negative effect.

  To sum it all up, when I’ve only started to instruct runners, I’ve been working with both trained athletes that have already finished their first Marathon, and new runners that are trying to build up towards their first few kilometers. I was surprised to see that both stability and mobility for both experienced runners and new runners was about the same,

  but wasn’t surprised to hear of past injuries from the experienced runners. As a resolution, and part of a working method, I’ve planted some stability and mobility exercises for the the runners during their sessions, and unless I was lied to, injury rate with those who practiced their exercises on a weekly base, dropped tremendously.

  A little bonus, a research published recently (January 2020) named “Training for a First-Time Marathon Reverses Age-Related Aortic Stiffening” the conclusion was the following: “Training for and completing a marathon even at relatively low exercise intensity reduces central blood pressure and aortic stiffness—equivalent to a ∼4-year reduction in vascular age. Greater rejuvenation was observed in older, slower individuals”.

  To conclude this article, I recommend you to start running, it has many benefits, but be sure to build it up correctly, along side a professional instructor or advisor, and listen to your body.

  If you have questions, as always, you can contact me with anything you wish, if you’ve found any error with the article let me know through the same channel. Good luck with running! Stay Safe!

• Symmetrical vs. Asymmetrical

  

  As human beings, our body isn’t at full balance, one side will always be stronger while the other side may be better coordinated with the brain. We are a well designed machine that works in harmony, but this design has a few flaws to it, and while we strive to be the best version of ourselves, sometimes we may struggle with anatomic obstacles.

  We come across those side strength differences almost everyday without thinking about it, for example, when you go grocery shopping, you’d probably use your stronger hand to hold the groceries, or if you require both your hands at work, you’d have an uneven load on both hands to perform the task as easily as possible for your body.

  Now don’t get me wrong, it’s alright to have a stronger side, but we should always try to keep both sides as even as possible. So let’s bounce from grocery shopping to training, can be at a gym, studio or even outdoor, how many of you are focusing on one side while performing a certain motion and than do the same for the other side? Most people are doing Bilateral (both sides active) exercises during their workouts, and do not try Unilateral (one side active) or uneven Bilateral exercises, where one side is loaded with X kg. while the other is loaded with Y.

  If you are less interested in how you may encounter the slight strength differences, you may scroll down to some examples of exercises we all do with the Unilateral or Uneven Bilateral version for them.

  Now, for those who are interested, if you look at other trainees, you may have noticed the bar not going straight up while some people perform a Bench Press, or one arm is done with the motion while the other is struggling to do so with dumbbell exercises, maybe a slight rotation of the back to ease the lift for a certain side, all those, and other examples alike, are signs of lack of symmetry between left and right muscles of the same joint.

  Again, so you do not think you have an issue with the body, those examples are natural to have, and do not mean you have a problem, but might require a closer examination of the motion or muscle fatigue to ensure you won’t injure yourself. Breaking down the exercise, to it’s simplest form, every exercise is a group of joints performing a certain movement using various muscles,  every motion is created using a few muscles, and every muscle can create a few motions. Having that said, if a muscle or a joint, can’t perform their part of the motion, the body will use other muscles and joints to compensate the movement and finish the exercise, certain compensations are harmless, but the other compensations can lead to future injury.

  So how do I determine good from bad compensation? If the range of motion, or the motion itself differs on both sides, it’s an issued compensation, on the other hand, if the range of motion and motion are the same on both sides, and the only difference is the velocity of the motion, the compensation is fine, for the body is using a weaker muscle to end to motion, rather than a different joint to ease the motion.

  So, now that the overall data is laid out, let’s discuss what can be done with a few quick examples of Asymmetric exercise compared to Symmetric exercise:

  SQUAT

  While performing a squat, a certain knee can go either external or internal to where it should be located, the pelvic might be uneven, the angle in the knee joint and leg’s gap from the middle can be different. Those are signs of unbalance that I would address using Asymmetric Squat:

  Unilateral: Single Leg Squat, Pistol Squat, Box Climb. Those are great for knee, ankle and pelvic stabilization.

  Bilateral: Squat with an uneven bar load, Squat -> Single Leg Stand. Great for pelvic balance and stability along with core activation.

  PRESS

  If while pressing the bar or dumbbells you encounter one side that is pushing harder and finishes the motion quicker than the other, you might want to consider moving to Asymmetric work for a while, or just add it to your routine.

  Unilateral: Press with a single dumbbell, starting with the weaker side to set the repetitions limit, and do the same with the stronger side afterwards.

  Bilateral: Press the bar with extra load on the ‘weaker’ side, or with different weight dumbbells setting the ‘weak’ side with the heavier load. Another method would be to add a rubber resistance as an extra pull on the issued side. 

  ROW

  An uneven lift would be dealt best with a Unilateral method: a Single Hand Dumbbell Bentover Row, or a Supported Dumbbell Row using a bench or a higher platform for support, should do the trick as they allow you to concentrate on the motion and strengthen up the issued parts separately.

  In general, I would advise everyone to engage an Asymmetrical workout every once in a while, can be either Unilateral or Bilateral, the impact on the body while engaging this type of routine is great, and can help reduce pain or injury probability. 

  If you have questions, as always, you can contact me with anything you wish, do not try those for the first time without any supervision, wrong use of any Asymmetric technique can cause injury. Stay Safe!

• Functional Training

  

  Functional training is one of the more commonly used phrases to get people to join a certain session. Most “functional” sessions, at least those I’ve been shown, and those I’ve seen around me, would include compound movements and a high heart rate that would mostly increase our calorie burn and take our body to it’s limit.

  Now don’t get me wrong, I’m not against those types of sessions, but I would not give them the title ‘functional’, I would use HIIT or Tabatha, or maybe just circuit training.

  What is functional? To answer that, I would look at the term given from Dictionary.com for a function: “the kind of action or activity proper to a person, thing, or institution; the purpose for which something is designed or exists; role.” Using this definition of a function, I would define functional training as a set of movements with the purpose to ease the trainees day to day life activities. Say you are a carrier, you would not necessarily need to jump rope as much as you may need to learn to lift heavy weights and move around with proper form. At the other end of the scale, say you are a kindergarten teacher, you do not need to lift heavy weights and move around, but focus more on leaning down with proper form and moving around in an environment that is fit for little children without hurting yourself. Both of those people can benefit from doing both types of exercises, but it’s not functional for their day to day activity.

  Don’t be mistaken, we all share the same movements in the end, and we all can benefit from doing the same exercise, but we would require a different load and amount of reps to benefit the best. Looking back at the examples above, a carrier would benefit from a heavy Deadlift more than the kindergarten teacher, who would benefit more from a lighter Deadlift with more reps, the carrier might need to lift a washing machine, whereas the teacher would need an infant or a child who weighs a lot less, the carrier would need to do it once or twice, whereas the teacher have the potential of lifting a child more than 10 times to calm them down.

  With this example of a Deadlift, I would proceed to the basic movements we all use on a daily basis, but with different load and use rate:

  Walk 

  It may sound obvious, and maybe that is a reason it is considered a basic activity, walking is a functional exercise, we walk from different places, we carry stuff around, so it is important to involve walking as part of your routine,

  and strengthen the legs to support a correct walking posture to avoid inflicting damage. Running is also part of this section, but it is more advanced and is not a must do for all the people, at least in my opinion.

  Squat [Sit & Stand]

  If you’d look around, at a family reunion or even on the street, you may see elderly people using their hand to both sit down (would usually be placed on the surface on which they are about to sit on) and stand up, instead of using their legs.

  This use is unnecessary and can cause pain in the arm joints to begin with, but lack of strength in the legs could also cause them to fall down hard if the hand slips and that is a sure method to be injured. We spend quite some time sitting and standing, while entering the car, sitting at work, relaxing in front of the TV, etc. So while we’re at it, don’t drop to the chair, squat towards it and later on from it.

  Lunge [Stair Climb]

  As part of our walk, or on our way to sit at work, we might need to climb some stairs, lunges would mimic that motion for as. Lunges would also mimic kneeling, should you require that motion throughout the day. Doing a lunge is a great exercise to strengthen your legs and work your balance, it can reduce future falls that are caused due to weak leg muscles and low stability.

  Hinge [Deadlift]

  How many times have you heard of someone leaning to grab something from the ground, and losing their ability to get back up afterwards? Maybe I’ve heard more cases like these because I’m a trainer or because I’m a massage therapist, but even before I was any of those, I’ve heard people around me complain about it.

  The hinge in this case is referred to the pelvic bone hinging the back forwards and the legs backwards to create a leaning motion. A Deadlift is a great form of hinging for it makes the body maintain a proper form while lifting the weight straight of the ground, as we so often do.

  Push [Press]

  The simplest example I have in mind for pushing, is that high shelf we have at the kitchen or at our closet with boxes on it that we use often, but not to often, which is they’re there. Getting those boxes on the shelf or from it is a pushing motion,

  either positive push when putting the box on the shelf or a negative push when we take the box from it (Concentric and Eccentric motions if we are to look at the professional term). We do a lot of pushing activities but during our daily routine, but I’ve decided to use the shelf example for simplicity.

  Pull

  Taking our laundry from the washing machine, opening closets, picking up a bag, moving a chair back so we could sit, and the list goes on… All of these are pulling motions which we do on a daily base. Some might not require too much strength, but they all require a great technique if we wish to avoid an injury.

  If we would examine the chair movement to allow us to sit on the table, the chair might be heavier than we can imagine, and a wrong pull can cause some unpleasant pain, or if we pull on a door that is either heavy or is air pressured due to a working AC or a ventilation system, the outcome can be the same.

  Rotate

  One of the last motions we learn as babies, and one of the first we “forget” as we get older, is the rotation. Spine rotations are important and crucial for our body to have, starting with a static rotation, such as when opening a car door using just a single hand, and going on the turning in bed while we sleep, the muscles should operate correctly. Combining controlled rotations within your workout routine is not the only way to work of that motion, a more functional way to work on it would be to engage into uneven pulls or pushes, that way you work on a few elements of the basic movements structure.

  To sum it up, we all use the same motion elements, but we use them under different circumstances and for various reasons, if you want to have a functional session every now and then, you must first understand the movements you require, from those mark the movements you do the least while training, and build a routine combining them together into a beneficial training session. If you are lacking the knowledge, consult a professional to help you figure the motions and build a program accordingly.

  And one last thing to bare in mind, should have a different set of exercises they need to engage to have the proper functional session, that session does not necessarily have to contain compound motions only, it could also use a single joint motion, and it does not have to reach a high heart rate for strength exercises. You can always contact me should you have questions about what you’ve read. Stay Safe!

• Proprioceptive Neuromuscular Facilitation

  

  PNF, short for  Proprioceptive Neuromuscular Facilitation, is a stretching technique that help engage a larger range of motion (ROM) in just a few moments  (Hindle et al., 2012). This technique is great for pain reduction should a certain movement or ROM cause pain. While there is an ongoing debate, whether PNF is different than Muscle Energy Technique (MET), from our studies of both modalities, the instruction are very similar, one is more popular with physiotherapists while the other with osteopathy. For the purpose of this article, they are the same modality.

  Before we would dig further into PNF/MET understanding and physiological effect on the body, it is important to note: Should you be unfamiliar with the method, do not try and engage it on your own, it can cause damage to your muscle tissue should it be done poorly. Find a professional that is familiar with the method when using it or trying it for the first time.

  Engaging the PNF effect

  So we’ve recognized a motion restriction, either on ourselves or on our trainee, how do we use the PNF Technique?

  Overall, there are three common ways to engage the technique. We will focus on one of those three that we’ve found to work best, bare in mind, however, all the three are rather similar to one another.

  Isometric Contraction (AKA Hold-Relax-Contract) 

  After finding the target muscle group, engage into a stretching position, and stop just before pain or discomfort are being felt. It is important to perform PNF with as little pain as possible to avoid injury. In some people, this painless position is not even considered a stretch, and that is perfectly fine, the benefit they will feel will be much more impactful. Once finding this position, simply ask your client to perform a contraction with the desired muscle group with about 10% of their force while you resist that contraction and maintain position of the body part. Hold that contraction for 5 to 10 seconds, release while maintaining position, and once fully relaxed move further with the stretch. Repeat those 3 – 5 times, and end with a light stretch  (Franke et al., 2015).

  In the image above, you can see a PNF to add ROM to shoulder flexion. The pain free end ROM has been engaged. Force has been applied on the shoulder through shoulder extension while exhaling, meeting the resistance of the suspension trainers. After about 8 seconds, inhalation and relaxation occurred, during exhalation another step away from the anchor has been taken, forcing the arms into further shoulder flexion, stopping just before pain / discomfort occurs. Process will be repeated again, until a sufficient ROM has been engaged allowing to train better with lower risk of injury.

  How Does it work?

  On the anatomical view, our muscles have 2 organs to prevent or allow motion through different ranges of motion. If you engage a motion that is too fast, or too strong, the body’s reaction would be to block the motion from occurring in order to prevent that motion from inflicting injury, the organ used in such case is the Muscle Spindle.

  PNF, however, is accessing the opposite organ in the muscle, the Golgi Tendon Organ (GTO), unlike the Muscle Spindle, GTO instructs the body to release the tension from the muscle to allow a bigger ROM, during the contraction of the muscle, the GTO “recognizes” there is an attempt to access a certain ROM that would not inflict any injury, and sends signals to relax the muscle and enable the ROM that was not accessible before  (Hindle et al., 2012).

  Muscle Spindle and GTO are the reasons you should be concentrated on the stretch, and make sure it is not used through painful or discomfortable ROMs, should you attempt to engage PNF while under discomfort, instead of triggering the GTO and allowing bigger ROM, you might be triggering the Muscle Spindle and causing the exact opposite.

  Still have questions? Have some things you wish to clarify? Feel free to contact us about those.

   Content Last Reviewed & Updated on February 2026 –   All statistics, references, and therapy recommendations have been reviewed to ensure current best practices.  

  Refrences

  Franke, H., Fryer, G., Ostelo, R.W. and Kamper, S.J. (2015). Muscle energy technique for non-specific low-back pain. Cochrane Database of Systematic Reviews. doi:https://doi.org/10.1002/14651858.cd009852.pub2.

  Hindle, K., Whitcomb, T., Briggs, W. and Hong, J. (2012). Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. Journal of Human Kinetics, 31(1), pp.105–113. doi:https://doi.org/10.2478/v10078-012-0011-y.