Style and substance

Panjabi divided the motor control system for the spine into three distinct subsystems -  passive, active and neural. I like applying this idea to the whole body, partly because I find it an interesting way to distinguish different strategies for movement and posture, based on preferential use of one subsystem over the others.

The passive subsystem

The passive musculoskeletal subsystem includes bones, ligaments, joint capsules, connective tissue, discs, and the passive mechanical properties of the muscles and fascia. This subsystem creates tension and stability through passive restraints to movement. The stretchy elements (muscle, fascia and tendons) can store and then return elastic energy, and the bones can act as levers and transfer force from place to place. So all of the work done by this system is “for free” because it does not require any expenditure of metabolic energy.

The active subsystem

The active musculoskeletal subsystem consists of muscles. The work of this subsystem is energetically expensive – muscles require energy to contract.

The neural subsystem

The neural subsystem consists of the various motion sensors located throughout the body, and the nervous system, which reads signals from the body and the sends signals to fire motor units. Nervous system activity requires energy. Although the brain accounts for only 2% of the bodies’ weight, it consumes up to 20% of the body’s energy.

You can think of someone’s movement style as being preferentially oriented toward the passive or active system. (Everyone uses the neural system, just more or less intelligently.)

The passive strategy

If someone has long, skinny, flexible limbs, and elastic muscles and tendons, they will probably learn to rely to a large extent on their passive system. They don’t have much muscle to generate power, but their structure is well suited to do lots of work. Flexibility allows them to easily reach end ranges of motion that store elastic energy and provide free stability. The long levers generate power after summating motion at many joints. These body types start moving slowly through lazy graceful arcs, but finish movements at great speed like the cracking of a whip. Think of the long, flowing whip like movements of a lanky tennis player like Gael Monfis, a golfer like Phil Mickelson, a fighter like Jon Jones, or quarterback like Tom Brady. The impression is effortless lazy power.

This style of movement can be pathological when it gets too lazy or sloppy, and places excess stress on the ligaments and other connective tissues that make up the passive system. Imagine the posture of a slouching bored teenager – one hip kicked out to the side, hyperextended knees, collapsed chest and forward head position. In this position they are basically hanging off their ligaments. This is energetically efficient because it requires less muscular work, but it places excess stress on the physical health of the passive subsystem.

A great deal of “poor form” that we see in the gym or in sports is a result of excessive use of the passive system, possibly due to deconditioning and reluctance to use the active system. This makes movement look sloppy, floppy, or poorly aligned. Movements are controlled too much by passive restraints created by an end range of motion, as opposed to active muscular restraints which keeps the joints better centrated. Some classic examples would be valgus knees in a squat position, or a rounded lower back in a dead lift. In each case, the passive elements are doing too much stability work as the muscular system relaxes. This strategy is energetically efficient in the short term, but creates excess stress on the passive structures, and fails to create the joint centration and alignment that is required for optimum coordination, balance and power.

The active strategy

Now let’s look at the movement style of someone with a stockier, stiffer, more muscular build. They will probably learn to preferentially rely on the active system. They have plenty of muscle for generating power, but they lack the range of motion and long levers that create large, flowing whip like motions. Instead, their movements look short, compact, controlled, punchy, and piston-like. The movements start fast and end fast, unlike the slow build up of the passive athlete. Balance and change of direction is easier because their joints spend more time near a neutral position. Think of the punching of Mike Tyson, the pitching of Roger Clemens, the racquet work of Andre Agassi, or the water bug changes of direction by Lionel Messi. These athletes don’t look lazy and effortless, they look like frighteningly dynamic.

The active strategy can be pathological if taken to extremes. This might happen if the athlete fails to relax antagonists, or to pause long enough to elastically load the joints before firing them. Movements will then appear stiff, musclebound and awkward, like they are fighting against themselves or driving with the parking brake on. This style is very metabolically expensive and energetically inefficient.

Conclusion

I usually end a blog post by asking what practical takeaways we can derive from whatever analysis I just performed. In this case, I’m not sure there are any! I just think this is an interesting topic.

Actually, here’s a few possible ideas. Different bodies will gravitate towards different styles of movement, which have their relative strengths and weaknesses. If you’re going to imitate another athlete’s style at something – say their golf swing or tennis stroke or throwing style – make sure they have a similar body type to yours.

Further, these concepts might help you to find a weak link in your movement strategy. Personally, I am a classic “passive” type – long skinny limbs that tend toward floppiness. So it is not surprising that I really benefit from strength training. Others with a more “active” style might need an opposite strategy – more focus on mobility and relaxation. And of course, everyone can learn to use their neural system more intelligently. There’s always room for improvement there.

Any thoughts? Share in the comments.

UPDATE: I just came across this article by Sam Sturgis at Mike Reinold’s site about the effects of rhythmic stabilization on ROM and throwing velocity in college pitchers. It seems the effects of the intervention depended on the “style” of the pitcher. Very on point!

There is very limited evidence about what benefit, if any, foam rolling confers. But there are at least a few studies showing that it leads to short term increases in range of motion that are not accompanied by strength loss. (This is interesting because stretching interventions tend to show increased range of motion that are associated with a loss of strength and power.)

The purpose of this article is not to question whether foam rolling is effective for anything. I’m willing to assume that it is effective in some way for some people. It is hard for me to believe that so many intelligent trainers such as Mike Boyle would be singing its praises unless it was good for something. So I’ll give it the benefit of the doubt for purposes of this article.

The question that I want to answer in this post is the following: if foam rolling does work to reduce pain or improve mobility, what is the mechanism? I do not find the common explanations very convincing. But there is one (less commonly heard) explanation which I really like. Here’s my critical analysis of the different theories for why foam rolling works, including my favorite one.

1. Does foam rolling “improve tissue quality”? 

This is one you will hear quite frequently, usually without any specifics as to which “qualities” are at issue. I think some people imagine that foam rolling can somehow smooth out bumps or incongruities in their tissues like a rolling pin over pizza dough. Of course, this explanation is usually intended for lay people and not scientists, so perhaps we can cut some slack about the lack of specifics. Perhaps the qualities to be improved involve the presence of fascial adhesions or trigger points. I’ll address those claims specifically below.

2. Does foam rolling lengthen or “melt” fascia? 

For some reason people just tend to assume that foam rolling works by changing the fascia. I honestly have no idea why. A foam roller puts pressure on all the other tissues in the body, and they all communicate with the CNS, which controls how we move and feel. Isn’t the CNS the most obvious place to look for changes after foam rolling?

No, it always has to be the fascia!

But fascia is tough stuff. Sure it has some interesting adaptive properties, but at the end of the day its purpose is to form a solid structure for the body. Is it really plausible that we can significantly change our structure just by leaning on a foam roller a little bit? We must be made of stronger stuff than that. If fascia started to break down, or elongate, or “melt” every time it felt a little sustained pressure, we would be pretty fragile creatures. Every time we sat on a rock our posterior chain would lengthen. So for me the idea that foam rolling lengthens or melts some important structural stuff in our body does not pass the common sense test.

And, more importantly, the research does not support this idea either. There are a few research studies (here and here) which try to determine the degree of pressure necessary to cause permanent deformation in mature human connective tissue. The upshot is that if you want permanent change, you better be prepared (as Paul Ingraham notes) to “get medieval.” Steam roller maybe, foam roller, no. It’s not going to happen in any of the places where the roller is most commonly applied, which are usually the strongest parts of the body – the ITB band, lumbar fascia, plantar fascia, etc.

 3. Does foam rolling break up fascial adhesions?  

Maybe a foam roller can’t lengthen the IT band, which is stronger than steel, but could it break up some little fascial adhesions that prevent sliding between different muscle groups? One of the studies I referenced above show that manual pressure might be enough to deform nasal fascia. Now I don’t see many people foam rolling their nose, but maybe there are tiny little adhesions between large muscles groups that are as weak and deformable as nasal fascia.

Again this seems highly speculative to me. How do we know where these adhesions are, or what angle will help break them? A foam roller is a blunt non specific instrument that delivers force in a diffuse manner into the tissue. Smash! Part of the job of fascia is to diffuse force, so it would be hard to target a specific point here. Also, the angle of pressure is always straight in. The foam roller would have limited ability to provide the kind of precise oblique force that might be able to slide one layer of tissue with respect to the other.

Another problem I have with the idea that foam rolling breaks up fascial adhesions is that the effects are often temporary. People do some foam rolling, they feel better for a while, and then tomorrow or even later that same day, they feel the need to roll the same area again. If the mechanism of effect is breaking fascial adhesions, then why do we need to repeat the process? Did the fascia knit itself back together again? The temporary nature of the results strongly suggests a nervous system mediated mechanism for efficacy, not a structural one.

3.  Does foam rolling get rid of trigger points?

Many foam rolling proponents explain that proper procedure involves finding a “trigger point” and staying on that point for a while. Is foam rolling a way to treat trigger points?

It should be noted that the term trigger point means different things to different people. For some it just means a sore spot, but for others it refers to a specific pathology. The technical definition involves several elements such as a hyperirritable nodule within a palpably taut band that elicits a twitching response to snapping palpation. Trigger points are thought to be caused by some sort of metabolic crisis in the muscle cells which causes chemical irritation in the local area and for some unknown reason refer pain to other areas when pressed.

Trigger points are controversial to say the least. There is substantial debate as to whether they even exist. Whether they can be reliably identified is another debate. And whether they can be effectively treated is another. There are many recommended treatments – stretching, post-isometric relaxation, sticking needles into them, pressing on them, etc. I definitely don’t have the time or anything approaching the knowledge to address all these debates.

But given all these uncertainties, I’m disinclined to believe that foam rolling works by getting rid of a trigger point. There are just too many unanswered questions here. The experts in trigger point therapy will tell you that not every sore spot is a trigger point, that not all trigger points are clinically relevant, and that their identification and treatment takes practice and expertise. So I don’t think shotgun fascia smashing with a foam roller is a plausible trigger point treatment (assuming they exist and can be treated with pressure.)

4. Does foam rolling work by proprioceptive stimulation?

I often hear claims that foam rolling works by proprioceptive enhancement – stimulating mechanoreceptors in the muscles and/or fascia, such as golgi tendon organs, or muscle spindle fibers, or ruffinis, or pacinis, or Pacinos or DeNiros. This could have some beneficial effect of encouraging relaxation of muscular or fascial tone, or causing the brain to reorganize its sensory or movement maps in the local area.

I think this is a very plausible explanation and definitely on the right track. But I doubt it is the main mechanism which explains why people like to foam roll. If stimulating these mechanoreceptors explains the claimed benefits of foam rolling, then why wouldn’t you just stretch and move around, and get probably even more stimulation to these organs, but within the context of functional movements? Can the foam roller, which doesn’t really provide that much movement or stretch to the target muscle or fascia, provide more proprioceptive stimulation then functional movements like the squat, lunge or reach? I think not.

Perhaps what foam rolling has to offer over movement is novel proprioceptive stimulation. I think novelty is great and of huge potential benefit. It helps get the brain’s attention, which is what you need to do if you want the brain to change. But here’s something else that you need to do. You need to provide the brain with information that is relevant to something that the brain cares about. The brain cares about how to move your body through functional patterns such as squats, lunges and hip hinges. How is the information derived from foam rolling relevant to these tasks? The brain is not interested in information just because it’s novel. The information must also help it solve movement problems. Why would the nervous system be interested in how it feels to have a lacrosse ball jammed into your butt?

5. Does foam rolling work by diffuse noxious inhibitory control?

This is my favorite explanation. And this is probably the mechanism with which readers will have the least familiarity. Here’s a description of what it is, how it works, and why I think it’s the major reason for the potential efficacy of foam rolling (and many other forms of manual therapy).

Diffuse noxious inhibitory control (DNIC) is one of several varieties of “descending modulation”, by which the brain adjusts the “volume” on nociception (danger signals which originate in the body). DNIC means that the brain inhibits nociceptive signals from traveling up the spinal cord to the brain.

DNIC is reliably triggered by a sustained nociceptive input, such as immersing your hand in cold water. The inhibition is diffuse – it suppresses nociception not just from the local area, but distant areas as well. In other words, if your leg hurts, and you stick your hand in icewater for a while, the resulting DNIC will cause both the hand and the leg to hurt less. This dynamic of fighting pain in one area by creating it in another likely explains the success of many therapies, and is sometimes called counterirritation. The effect is temporary of course.

How powerful is the effect of DNIC? Very powerful. When a soldier loses a limb in battle, he will often feel no pain so long as the emergency persists, and DNIC is a major reason. David Butler refers to DNIC as the “drug cabinet in the brain.” Here’s a video where he explains this idea in a little more detail, including the fact that some of the drugs in the brain are stronger than morphine.

Pain expert Lorimer Moseley views descending modulation and DNIC as a way for the brain to “second-guess” the periphery about the threat posed by a particular stimulus. For example, if the periphery is communicating information suggesting there is a large amount of mechanical threat in a particular area, the brain, which has access to a wealth of additional information about what is actually going on in the periphery, may decide that the problem is not so serious, and therefore inhibit the transmission of nociceptive signals to the brain.

There is significant research showing that many chronic pain conditions such as fibromyalgia, irritable bowel syndrome, and TMJ are characterized by relative failure of the DNIC mechanism.

The effectiveness of DNIC in suppressing pain is highly dependent on the expectation that the counterirritant will have an analgesic affect. In this interesting study, researchers immersed the hands of participants in cold water, shocked them with an electric blast to the sural nerve, and then measured the level of nociceptive activity in the spine, as well as the self-reported pain level. Importantly, the participants were divided into two groups. The first group, called the “analgesia group”, was told that the cold water immersion would reduce the amount of pain they felt from the shock. The other group, called the “hyperalgesia group” was told the opposite – that the cold water immersion would make the pain in the leg worse.

The analgesia group experienced 77% less pain, and less spinal cord nociceptive activity than the hyperalgesia group, who experienced almost no reductions in pain or spinal cord nociceptive activity. In other words, expectation of relief was a huge factor in determining whether whether DNIC worked.

Now let’s put this all together. DNIC is a powerful but temporary way to reduce pain in one area by creating pain in another. It depends on a decision by the brain to ignore danger signals from the body. Expectation of benefit from the irritating stimulus plays a strong role.

There are several aspects of foam rolling that are very consistent with the hypothesis that its main benefit is achieved by creating DNIC. Rule number one in foam rolling is to find a sore spot and stay on it for some time. You need to create some pain. Of course, the pain is often a “good pain”, which is exactly the type of feeling that would correlate with the brain’s conclusion that the irritation is somehow beneficial – which is what gets DNIC going.

Foam rolling often creates pain relief, not just in the area of pressure, but in other areas as well. People also tend to feel more freedom of motion, which could easily be explained by suppression of nociceptive activity, which tends to create muscle guarding, stiffness, and compensatory patterns of movement.

Further, the results of foam rolling are often temporary and need to be repeated (and often repeated harder the next time- are people becoming addicted to the drug cabinet in the brain?) This suggests a CNS mediated mechanism.

So here is the story I tell about foam rolling. You put a foam roller into your butt and create some significant nociceptive signalling. The brain receives it and says something like: “OK, the butt is telling me that there is some danger down there right now. But I happen to know that this is a therapeutic situation because my trainer said so. So, let’s send some drugs down the spinal cord to block all this talk about danger. And, we’ll make this feel like a “good” pain, not an injury.” The drugs reduce pain and thereby improve movement temporarily.

Make sense?

Practical implications 

Now some people will read this and say “well who cares about how it works, all I care about is that it works.” And in some sense that is fine, but this lack of curiosity ignores the potential improvements one might make to a therapeutic regime by understanding the real mechanism of effect.

If foam rolling really works by nothing other than DNIC, then perhaps it would be easier to get the same effect by just pinching yourself or putting your hand in ice water. Or maybe this would mess with expectations, which we know are important to get the effect.

Here’s another interesting question that arises from the consideration that foam rolling may work purely on the basis of DNIC. If the results are only temporary, can there be any progressive benefit? I think the answer is: it depends. Pain relief and improved movement open a window of opportunity that one might climb through. If you are feeling better only for an hour, this provides enough time to train movements that would not normally be accessible, learn new skills, develop new capacities, and reduce the perceived threat associated with certain movements. This could have permanent benefit. But of course if you just sit on the couch, the benefits would probably be temporary.

Here’s another question I have in regard to foam rolling. If the major reason it works is release of the drug cabinet in the brain, then can one become addicted? I have no real evidence of this, but I swear I’ve seen a disturbing pattern. Someone gets relief from a foam roller, and then graduates to the lacrosse ball, and then to the wooden ball, until they are bruising themselves with steel in an effort to get that fix! Avoiding this type of situation is one reason it’s a good idea to know why something works.

Conclusion

Well there’s a lot more to be said here, but I am out of time, and if you have already read this far you are a champion!

I’m sure some of my readers will point out that I missed one or two great explanations for why foam rolling works. If I did, then please post in the comments and I’ll try to address it in a further post.

One way or the other, let me know what you think in the comments. And pass this around!

I certainly have opinions about the strengths and weaknesses of these different systems to achieve different goals, and their appropriateness for different individuals.

But for many clients I don’t go through all that analysis, but instead just ask them what type of exercise they are most likely to show up for on a regular basis, day in and day out, over the long term, based on what fits into their schedule, what they can afford, what won’t get them hurt, and most importantly, what they enjoy doing. And then I might say that whichever workout you show up for on the most consistent basis is probably the healthiest one for you.

Those of us in the movement health industry can get very caught up in analyzing all of the differences between the different systems. Of course there are legitimate differences that need to be discussed and analyzed, and it is very fun to do so on Facebook and elsewhere. But as these debates filter down to the general population, they can overly complicate things, create paralysis by analysis, or unfairly demonize some form of exercise that is relatively healthy (and certainly healthier than sitting on the couch.) One way or the other, people need to establish a regular and sustainable pattern of physical activity. If someone can show up for a certain exercise program at some appropriate level of volume, intensity and regularity, then that program is probably better for them than some other program where attendance is compromised due to scheduling, injury, lack of interest or motivation, etc.

There is a great quote by Woody Allen to the effect that “80% of life is just showing up.” I think that often holds true for movement and exercise.

So which workout is best? The one you show up for.

Whenever I am someplace where there’s a lot of people, I tend to get into people watching mode. And as someone who is very interested in the way people move, my people watching mode involves watching people move. Now of course I get the chance to do this in many places, but one of the advantages of Disneyland (and the airports that get you there), is that you can watch families moving together. Which allows you to compare movement and posture patterns between members of the same family. So fun right?

Whenever I noticed someone with a particularly distinctive posture or gait, I immediately looked over to see if anyone else in the family had the same pattern. Some of the resemblances were so striking, that when I pointed them out to my wife she said: “Hmm.”

For example, I saw a 40 year old woman with very hunched shoulders and a forward head. Many therapists would look at this posture and assume it results from some bad (and changeable) habit of use. But when you see the exact same posture on her ten year old daughter, you have to wonder how much of it is due to genetics.

Nature or Nurture

Of course some people will say the daughter may be imitating her mother. Now I don’t have specific research to refute this explanation, but it does not strike me as very plausible. Babies learn the movement basics (rolling, creeping, crawling, deep squatting, standing) not by imitating their parents (who aren’t doing these things), but by trial and error. And once kids are in school, in general, they imitate their peers, not their parents. For example, even toddlers talk with the accent of their friends, not their family. I would guess kids try to move and posture themselves like their peers as well. This is particularly obvious in the teenage years, where social signaling through body language becomes very important. So when I see many family members moving the same way, I favor genetic explanations.

I actually did not need to go to Disneyland for this type of observation, because one branch of my wife’s family is a good example. If you go to a party with this side of the fam, you will notice that many of them like to stand with the pelvis translated forward and tucked under into posterior tilt. Do they all stand this way because they imitated each other, or is this posture simply an inviting way to stand when you have the structure that is dictated by their common genetics? Who knows, but again I favor the structural explanation, because the few family members without the distinctive family structure do not share the distinctive family posture. I better stop now before getting into trouble.

What do you think? Are posture or movement similarities between family members due to environmental or genetic influences? Do people imitate their peers movement wise? Anyone have any interesting family stories? Let me know in the comments.

Now the effects seen in the study were not so dramatic as to suggest that staring at your backside in the mirror all day would be a miracle cure for back pain. But it does raise an interesting question about the mechanism of the effect. Why should looking at your back make it hurt less? The discussion section of the paper provides an interesting analysis of the role of nonthreatening sensory feedback in reducing pain.

Seeing it helps for many things

The authors note that case studies have found that visual feedback can reduce pain in a number of conditions, including phantom limb pain, CRPS, brachial plexus avulsion and fibromyalgia. It is also known that viewing oneself causes a number of physiological responses, including changes in sensory experience, the perceived location of a body part, and increased excitability of motor pathways.

So why does visual feedback reduce pain? The authors offer several potential explanations.

Correcting sensory motor incongruence

The first explanation involves the concept of sensory motor incongruence (as you may have guessed from the title of this section). As I have discussed previously on this blog, there are numerous researchers who believe that pain related to movement may be caused by a discordance between a motor command and the related sensory feedback. The idea is that when the CNS issues a motor command, it makes predictions about the likely sensory feedback. When the prediction is off, the error is considered a threat which provokes pain.

In support of this idea, there is significant research showing that a wide range of painful conditions can be made better and worse by using reducing or increasing sensorimotor incongruence with visual data that is either informative or illusory.

There is also research showing that people with chronic low back pain have disruptions in the way their brains represent the back, including alterations in brain structure. They also have numerous perceptive deficiencies indicating poor mapping of the back, such as decreased lumbar tactile acuity, slow movement in the lumbar spine, difficulty in determining the outline of the back, and deficits in proprioception. These perceptual impairments can be improved by seeing the affected area. Based on this evidence, one might speculate that the pain reduction  seen in the study resulted from visual feedback correcting for poor mapping of the low back, thereby reducing the incongruence between the motor intention and the sensory feedback. (An idea not discussed in the paper is that the improved mapping of the low back helped correct motor errors, thereby reducing nociception.)

Non threatening input

An alternative theory explaining why visual data may reduce pain is that it acts as a non threatening input into the “neuromatrix” which reduces the threat associated with the movement. In other words, even as the brain is receiving nociceptive signals from the back indicating danger in the area, the eyes are watching the back and seeing it move normally without any visible damage. This may cause the brain to conclude that the back is not in as much danger as the nociceptive information might suggest, and that pain is less necessary as a protective mechanism.

Some research supports this theory. For example, looking at your hand when it is being irritated with a laser, or looking at your arm when it is being injected with a needle (but not at the needle!) will reduce pain. If you have CRPS and look at your affected hand with magnifying glasses it will hurt more, and with minimizing glasses it will hurt less. All this goes to show that the brain uses visual data to assess threat, and that when the visual data indicates no threat, there will be less pain.

The authors also discuss the interesting idea that we rarely see our backs, and therefore don’t often have the opportunity to get some visual reassurance that everything back there is basically OK. Isn’t it interesting that so many parts of the body that tend to be in chronic pain are places we can’t see?

Conclusion

Whether the mirror reduced pain by providing nonthreatening visual input, or by correcting mapping errors, I read this paper as saying it can’t hurt and might help to give your clients some information about what is going on in their body, provided that the information is basically good news. You certainly don’t need a mirror to do this. Manual contacts and novel movements can also give the brain a different perspective on the body.

In Feldenkrais classes I spend a lot of time asking my students to feel the contact their back makes with the floor: which parts touch the floor, which parts don’t, how high does the low back arch from the floor, and where does it return to the floor. I wonder if my students might sometimes get a little bored by this. Maybe I can tell them about this paper to convince them that the floor can be a mirror.

Thanks to Chris Johnson for pointing out this paper.

And he is a kick ass dancer:

Not bad for a white science nerd from Canada! Here’s the interview, where we talk about dancing, movement IQ, the “neuro” revolution in physical therapy, and whether posture matters.

Background

Hi Tony, thanks for agreeing to do the interview. Why don’t you tell us a little about your educational background and how you got interested in movement science and blogging.

Hey Todd, thanks for interviewing me! I’m honoured to be on your blog, one that I’ve followed for quite some time!

From an educational standpoint, I have a B.Sc. in Behavioural Neuroscience (notice the u in behavioural – queens English, since I’m Canadian), then went on to do an M.Sc. in Physiotherapy (professional degree), and I’ve been working as a PT ever since. Currently, I am completing an M.Sc. Kinesiology (thesis degree) because I am interested in a career in research, because I’m a science and movement geek. Considering how much I study movement, I’m actually ashamed that I can’t move better than I do!

Originally, I started www.bboyscience.com to give dancers advice on exercise and injuries, but it’s become much more than that now. Turns out I had more to say than I thought. I quickly realized that I could connect with like-minded people, have a positive influence on my field, and generally advance my career in numerous ways. Blogging is simply incredible this way, which I guess is why it’s so popular!

Dancing

How did you get interested in dancing?

I became interested in the body and how it works in high school when I started weight lifting. I’ll admit, I began motivated by vanity – bigger muscles (I’m an “ectomorph”, and I still am).

Ectomorph. I hear you. But who needs big biceps she you can spin on your head right? 

Haha, exactly. I care not for big muscles – I am more interested in what I can make these muscles do!

That’s why I got into ping pong.

I always wanted to learn how to dance (bboying, specifically), but I grew up in a small town in Canada and there was no one to learn from. I ended up simply weight lifting and doing handstands in my basement.

I then went to university and started my neuroscience degree. I started taking martial arts because bodybuilding simply wasn’t for me, and I desperately wanted to learn skilled movement. Finally, I met some bboys through the martial arts classes, and the rest is history. I quickly became a “dancer”, which is now part of my identity and will never change.

I find it interesting that you started dancing pretty late in the game. It seems like some of the physical qualities it takes to be dancer, particularly hip flexibility, would take years to develop. How did you get that? Did you just have it already or did you need to improve it a lot? What methods did you use? 

I was pretty flexible before I started I think. I consulted old phys ed books and muscle magazines while I was in high school, which really wasn’t so bad for basics like “how to stretch your hamstrings” – the practical fundamentals are the same today, despite the scientific explanations having changed so much. I’m naturally a bit flexible, but I’ve had to work hard for the amount I have today… and I do stretch regularly – even *gasp* static stretching!

One thing I was NOT naturally gifted with was coordination. I was an awkward lanky white guy. That’s what I had to work for.

That is surprising considering your current state of awesomeness. Do you feel more coordinated off the dance floor now that you have done a lot of dancing? In other words, has dancing increased your overall movement IQ? Or has it increased your “GPP”, or useable functional strength or fitness in other areas? 

Absolutely there is carry-over. I’ve definitely increased my coordination and “movement IQ.” For one thing, I learn other forms of dance and choreography much easier. For instance, I had to learn some ‘commercial hip-hop’ choreography for a co-ed piece I did at a burlesque show (yup) last week. I also notice any physical activity or sport comes easier now.

As for strength, the transfer is more relative (bodyweight) strength, namely control. But this transfer is very general, and only helps with the basics of anything else I try. Not that it isn’t a big deal – I believe I’ve developed a great foundation for any physical activity I ever wish to try. That’s what I’ve noticed.

One thing I find interesting about watching bboys is the way you guys can balance on one arm. What did you do to develop the upper body and core strength for the hand balances, other than just practicing the moves? Do you do some form of resistance training? And dude, how much can you bench? 

Well, I did weight lift when I was younger, but I was never really strong. The most I ever benched was when I was 18, and that was a 1RM of 220 – (I think)… I obviously need to bulk up bro!

Seriously, it’s all technique. Trying the move and falling on your ass repeatedly until you “get it.” I often record my practice and watch myself to pick out mistakes. How you feel is never an accurate representation of how you look.

I really don’t see what I do as indicating I have a strong core or a lot of upper body strength. For example, balancing on one hand is a highly practiced, highly specific skill. There are little tricks that help you learn these things… I’m planning on making videos soon. After balance skill, shoulder strength is the next limiting factor, but never the core (not to me, anyway). And just so you know, I dumbbell shoulder press about 50 lbs each arm for 10 reps, which is by no means impressive in the fitness world. And my core isn’t that impressive either – I can’t hold a plank much longer than the next guy at the gym. Although I think I have developed a fair amount of power and coordination over the years.

All of this has made me a strong believer in the specificity principle, and incredibly dubious about the necessity of having a big squat and deadlift to be a great athlete – I really don’t care how many CSCS certified trainers I piss off saying that. Whatever.

I’m getting a little pissed myself. I’ll point you to a few T-Nation articles and just leave it at that. Tell us about the hardest thing you ever learned to do as a dancer and how you achieved it. 

Wow… that’s a difficult question to answer. I’ll give two examples: in terms of physical / technical difficulty, the hardest move I’ve learned is ‘continuous flares’ which I do at 1:17 of my ‘practice’ video. But the most difficult movement (notice the distinction between move and movement) would be learning to truly freestyle, losing yourself in the music and letting it dictate your movement rather than pre-planned moves.

Once you achieve this, you are really dancing, and it’s an amazing experience. When you know how to really connect with the music, and let go with a group of like-minded people in a circle (we call it a cypher) there is nothing more tribal, more “flow”-like than that. It’s an experience of movement that transcends any other reason to train that I can think of. I plan to write a lot more about this in the future.

Anyway… that’s as closest to “spiritual” as you’ll ever see this skeptical realist get!

That sounds awesome. What are some of the most common injuries that bboys face? Which ones have you faced and how did you overcome them?  

Bboys often complain of wrist and knee trouble. Then hips and necks. Personally, I have chronic neck pain which I certainly attribute partly to spinning on my head (hey, I can’t lie) and I’ve had numerous sprains and strains, some more severe than others. The longest I’ve had to take off from dancing was two months, thankfully, so I’ve been lucky. I plan to make a post on my site listing all the injuries I’ve had, because when I talk about how pain works, I often get a sense from people that they are thinking “easy for you to say, you’re not the one in pain!” – I’d like to assure people, that is not the case!

Physical therapy practice

Good luck with that neck pain. Speaking of which, tell us a little about your PT practice. When did you start, what kind of clients do you see, what are you up to now and what do you hope to do in the future? 

Sure. Right now I am working in ‘ambulatory care’ at the General Hospital in my city. I’ve been here since January. It’s mostly orthopaedic issues, injuries, post ortho surgery rehabilitation, and chronic “musculoskeletal” pain (which as you know, can be quite a lot of things). Being interested in pain science, I like it here. Although I will admit – despite how interesting I find the science, working with people with complicated, chronic pain is incredible difficult! But it can be very rewarding as well.

For the last couple of years I worked at a rehabilitation hospital, where I worked in both inpatient and outpatient neurological rehabilitation (stroke, trauma, head injury, spinal cord injury, MS, Parkinson’s, ALS… the list goes on). It was a wonderful experience. Working in that setting has given me such incredible insight, essentially materializing my previous education into something more “real.”

Prior to the neuro rehab, I worked in a private PT clinic since I graduated. It was very similar to where I am now, but clients were younger, less chronic, and I got to work with more athletes. It was also a great experience, and I do plan to return to the “private practice” world soon, but right now I am diversifying my experience. Plus, working in the hospital certainly has benefits, and I’m finding it more conducive to my current Masters degree in Kinesiology.

You are a guy who really likes critical thinking, sticking to the evidence, a science based skeptical approach. As you know, many common practices in PT are contradicted by science and evidence. What are some of the biggest myths out there that you see in PT treatment? 

Oh my goodness… daily, I have to hold back my opinions to avoid conflict… hahaha. I’d have to say the least evidence based area of PT, in my opinion, is unfortunately the area of practice that the public is the most aware of – private practice musculoskeletal PT. This is where the “tight” is stretched, and the “weak” is strengthened – which is a paradigm I see overused daily (but it’s occasionally true, let’s not throw the baby out with the bathwater). People are still doing a lot of “core” exercises and finding “imbalances” and prescribing “correctives.” These are the things that bother me the most (check out my Outdated Pain Theories series to see why). I should probably stop now before I make too many enemies… lol

However, there is a lot of improvement with the shift towards evidence based practice in our profession. I notice that younger PTs are often more skeptical, and many experienced PTs are surprisingly open-minded and willing to change their practice in light of new evidence, which I respect tremendously.

Furthermore, other practice areas are virtually pseudoscience-free (from what I can tell), such as almost all inpatient PT, cardiorespiratory PT, and neurological rehab PT. I haven’t much experience in ‘cardio’ PT other than covering some weekends at the hospital, but what I see is brilliant stuff and the evidence base is impressive, and the patients benefit tremendously.

That all said, I don’t think I necessarily “stick” to the evidence all the time. For one thing, there isn’t enough of it, and some of it is of poor quality. However, I am a strong believer in at least basing the rationale for treatment in the evidence that does exist. For instance, if it appears eccentric exercise is effective for achilles tendinopathy, and I have a patient that appears to have shoulder tendinopathy (for arguments sake) but there are no studies on that specifically, I still think it’s within reason to try eccentric exercise on that shoulder. That’s where clinical reasoning comes into play.

Does posture matter?

You have stated in some of your articles that posture and biomechanics are overrated as causes of chronic pain. (and I agree!) But is there still room for these approaches in PT? If not, then what replaces them? 

Absolutely. I may even edit my articles to make them more clear. Here’s the thing: most of the pain I see now is chronic, so I have to be very aware of that literature, and that’s what I write about the most. However, depending on the setting, most pain is “acute” – athletics for instance. Furthermore, I’d say that even in most of my chronic pain patients, the pain is nociceptive in origin (not “central” or “neuropathic” – whatever people think they mean by that).

Yes, sometimes posture matters, and so does a lot of biomechanics. Where postures relevance is overblown is in chronic pain (as a cause, or target for intervention). But can poor posture cause acute pain? Hell yes, in fact, I just changed position in my chair because I started feeling my back.

I am a firm believer in the relevance of biomechanics in injury prevention (like avoiding knee valgus during sports performance). I worry that in our vehement quest to educate people on the role of the nervous system / brain in pain, we may be missing the boat on some important issues.

You write a lot about pain science and a more “neuro” perspective on PT, as taught by guys like Moseley and Butler. Many PTs meet with some cognitive dissonance when learning this material, because it may conflict with their understanding of why their treatment approaches work. Jason Silvernail has referred to the problems of incorporating a more “neuro” approach into the PT clinic as “crossing the chasm.” Do you agree that there is a chasm? Did you cross it? How? 

I agree that there is a chasm, and it’s mostly due to cognitive dissonance, I think. Fortunately, however, I don’t believe I had to cross it. I went to PT school with a neuroscience degree, and knew a little about pain (especially phantom pain and Ramachandran’s research) and a lot about how complex the brain is. I was skeptical right from the start, which made things a little difficult until I found some like-minded class-mates and PT’s within the city, who then directed me towards the somasimple forum. I was lucky enough to read Explain Pain while still a student. Perhaps now that is my bias: “pain is in the brain” – and to be honest, I am trying to think twice about it. I could be completely wrong about everything! But if there is one thing I love, it’s learning. So I don’t mind being uncertain – it just means there’s always more to learn, and it’s okay to be wrong.

Very well said. Thanks for the interview Tony!

If you want to know more about Tony, check him out at his blog.

How do you know where your pelvis is at? Does it rotate or tilt forward/back, left/right, up/down? A new study suggests that if your only method of finding out involves palpation of bony landmarks on the pelvis, you will likely have no clue.

In this study (full text available) the authors had the excellent idea of taking thirty five cadavers and then measuring all the bony landmarks in the pelvis to determine variations in pelvic shape between people, and between the left and right sides of the pelvis on the same person.

The information gained in the study suggests that it would be very difficult to determine the exact orientation of a client’s pelvis based solely on palpation of bony landmarks. Here’s some more detail.

Assessing anterior pelvic tilt

Many therapists believe that excessive anterior tilt of the pelvis is a significant cause of chronic pain because it increases lumbar lordosis and hip flexion. I have previously pointed out that despite the common sense appeal of this theory and its widespread acceptance, there is considerable evidence that calls it into question. Many studies have found little or no correlation between measures of anterior pelvic tilt and other similar measures (sacral angle, lumbar lordosis, thoracic kyphosis) and chronic pain. If anterior tilt was a significant cause of chronic pain, we would expect to see that people with more anterior tilt have more pain, but that is not what we consistently see.

But hey, I am open to the idea that determining the habitual position of the pelvis relative to the legs and low back might be a useful thing for a therapist to know when trying to improve a client’s movement. But the question remains, how do we do this?

Therapists commonly assess the degree of sagittal plane pelvic tilt by comparing the height of the PSIS to the ASIS in standing. The higher the PSIS relative to the ASIS, the greater degree of anterior pelvic tilt.

The problem with this method is that different people have different PSIS/ASIS angles as a result of the shape of their pelvis, not the position. In this study, even when the pelvises were in neutral*, the PSIS/ASIS angles were all over the place. The biggest difference between individuals was twenty three degrees, and the standard deviation was five degrees. This means that if you measure the standing PSIS/ASIS angle as a way to determine the degree of anterior pelvic tilt, you don’t know whether you are measuring the tilt of the pelvis or the shape of the pelvis.

Assessing pelvic asymmetry 

Manual therapists will often try to measure many other aspects of pelvic positioning. For example, they may assess whether the pelvis is rotated in the transverse plane or tilted in the frontal plane relative to the legs or low back. Even more complex, they may assess how one side of the pelvis is positioned relative to the other side (as a result of asymmetrical positions at the two SI joints.) Now things are getting difficult, and to succeed you better have a pretty good way of measuring pelvic position precisely. If your method relies on the implicit assumption that the right and left sides of the pelvis have the same shape (as most do), then it is likely not valid. The study shows that pelvic shape if often different from left to right.

For example, the study found that the PSIS/ASIS angle varied from left to right (up to eleven degrees), even when the pelvis was in neutral. The asymmetrical shape of the pelvis in this respect could make it appear that one side is rotated forward compared to the other.

The study also found significant differences from side to side in the height of the pelvis, as measured from the acetabulum to the iliac crest. This difference might make it appear that one leg is longer, or that the pelvis is tilted to one side in the frontal plane.

The study also found left/right differences in the angle of the iliac spine to the ASIS. I’m not sure what kind of palpation technique this difference might invalidate, but I’ll take it as just more evidence in support of my guess that no matter what bony landmark you choose to measure, you can expect to find some significant differences from left to right.

This shouldn’t be too surprising. We don’t need sophisticated measuring techniques to look at our hands and feet and see that the bones one side are not quite like the other. We should just assume that this low grade wonkiness is pervasive.

The lesson? Make sure your assessments don’t depend on an assumption that the bones are the same shape from side to side. They are probably not!

(*Note – In the study, the authors put the pelvis in “neutral” by aligning the left and right ASISes in the horizontal plane, and aligning the pubic symphysis and the ASISes in the vertical plane.) 

It’s an interesting question because almost any physical activity you can think of has costs as well as benefits. Of course, I usually answer that everyone is different so it depends on the individual and the sport and yada yada yada. But I also offer my Grand Unified Theory of Specialization, which, because it is Grand and Unified, applies to almost any activity, and goes something like this:

In general, as you progress in any sport or activity from novice to intermediate, you will probably benefit your overall movement health by improving some previously underdeveloped fitness quality, such as strength or aerobic fitness. You will also likely improve on your basic movement skill set by developing body control, or balance, or hand eye coordination. These fitness qualities and skills are likely to be transferrable to other domains. And, you will probably be performing at a low enough level of intensity and frequency to minimize injuries and excessive stress. So this is good.

However, as you progress from intermediate to expert, it becomes far more likely that this will negatively affect your movement health. The movement skills and fitness qualities you develop will become more and more specific and less useful in other domains. And, more importantly, these adaptations can only be bought at the great expense of putting the body under extreme levels of physical stress, which increases the risks of injury and overtraining. 

In short, the very general rule, to which there are obviously many exceptions, is that most sports and activities are good for you to the intermediate level, and bad for you after that. Here’s how this rule might play out in the context of different sports or activities.

Aesthetic movement disciplines

Gymnastics and dance (especially ballet) are excellent examples of activities that I think are quite healthy at moderate doses and then an absolute disaster at elite levels of performance. The good news is that they provide a great general education in body control. The highly successful Soviet sport development program considered gymnastics to be a key ingredient in general physical preparation (GPP) for athletes in any sport. My own experience in working with dancers or gymnasts is that they have a very good body sense that makes it relatively easy for them to modify their movement behaviors.

But the bad news is that at some level of accomplishment, these sports create massive stress on the body. This is particularly obvious in the case of ballet, where walking on the toes and turning the feet out wreak havoc with the lower hips and feet. I also think that excessive focus on the appearance of the body as it moves, as opposed to how it feels or what it does, can be an unhealthy way to form your self image.

Team sports

Soccer, baseball, basketball, hockey, etc. develop a wide range of fitness qualities such as strength, speed, endurance and power. At the same time, they teach many basic movement skills such as hand eye coordination, spatial awareness, agility, single leg balance, and fundamental movement patterns like kicking, throwing, swinging, and lunging. (By the way, when I dictated that last line into my Dragon Dictate program, it transcribed “swinging and lunging” as “swinging in London.” Oh behave!)

One of the drawbacks of team sports is that they can involve so much external focus on events outside the body (such as the ball, or the opponent, or the goal line) that you can miss out on the benefits of the internal focus that is present in gymnastics or the locomotive sports. And, as we all know from simply watching popular sports, these games take a huge physical toll when played at the highest level. Few people can remain elite competitors after the age of thirty, and even recreational athletes find competition tough after forty five.

Fitness sports 

Running, swimming, cycling, walking, cross country skiing and rowing all involve full-body basic primal movements in a cyclical, rhythmic, repetitive fashion. This type of exercise seems to uniquely beneficial in developing aerobic fitness, maintaining metabolic health, and creating the beneficial mental state of focused and meditative discipline.

Resistance training has been shown to have tremendous benefits for metabolic, structural and mental health, and it appears that as we age the importance of resistance training increases.

But whatever type of fitness quality you are trying to develop, elite accomplishment in that area will always come at the expense of other types of fitness or health. The more you lift, the less you can run and vice versa. Some top powerlifters can barely waddle a mile. Some top marathoners can barely do a push-up. They should both be admired for their amazing accomplishments, but not envied for their health. In some sense, your body really does not want you to be able to run a mile in under four minutes, or deadlift a thousand pounds. These abilities imply an allocation of limited health resources that is skewed so far in one particular direction as to be unhealthy.

Internal discplines

Certain martial arts and slow meditative movement practices such as tai chi, yoga, and Feldenkrais have huge potential benefits and I write about them on this blog quite a bit. They can reduce the threat value of movement, help with chronic pain, build new movement patterns, and develop a greater self awareness that extends beyond mere movement.

As much as I love this stuff I have to imagine that at some point the degree of internal focus in these disciplines can go too far. Surely it should be balanced by the occasional reference to the hard edges of the real world provided by an opponent or an objective measurement. This keeps us grounded in reality, and not off on some weird tangent of self indulgent internal exploration.

Conclusion 

There is nothing wrong with reaching for the highest level in whatever you do. It is very rewarding, and in fact I have devoted and continue to devote a lot of time and effort to reach my potential at one sport or another. But I don’t imagine this has made me healthier! Health is always about balance. Extreme performance or optimum health, pick one!

I was reminded of this quote after reading about a line of research which attempts to show exactly how meditation can help with chronic pain. The message seems to be that if you know how to focus your attention, you can focus on what you want – in this case, something besides your pain. Here’s some detail on this research, which is summarized in an awesome full text paper here. (courtesy of Diane Jacobs.)

Inputs, outputs and filtering

First some background. At any particular moment, our brains are bombarded by a massive amount of information from the sensory organs of the body – visual data, auditory data, information about body position, balance, and potential threats to tissues from mechanical, thermal or chemical stimuli. This information goes to the brain for processing, and often results in a subjective perception, such as sight, sound, kinesthetic sense or pain. So the sensory information can be considered an input to the brain and the sensation is an output of the brain. This is an important distinction.

Not all the inputs from the body actually result in a perceptive output. For example, just because your brain receives auditory information, this doesn’t mean you will hear a sound. A good deal of sensory information gets filtered out before becoming an actual sensation, because the information is deemed to be redundant, irrelevant or for whatever reason not worth turning into a perception. The result is that a good deal of the sense data gathered by our bodies never becomes part of the movie in our heads.

This is probably because if we subjectively perceived all the information that was available to us at one time, we would be completely overwhelmed. Like watching four movies at once, we wouldn’t get the message from any of them. So the brain picks and chooses what streams of information to turn into actual perceptions based on what it considers to be useful. This filtering process is sometimes called the cocktail party effect, based on the familiar experience of being able to tune in and out of different conversations at a party based on where your attention goes. Wouldn’t it be great to be able to focus on the good not the bad, the happy not the sad, the pleasure not the pain? Didn’t Bobby McFerrin write a song about that?

Meditation trains the filter

New research suggests that meditation trains the ability to optimally filter sensory information. Specifically, a series of studies described in detail here have shown:

• When attentional focus is shifted, alpha wave activity in the brain changes. Specifically, greater amplitude alpha waves means more filtering of information. For example, research shows that focusing attention on the left hand is associated with a drop of alpha wave amplitude in the brain map for the left hand.  
• Persons trained in an eight week mindfulness program display quicker and larger amplitude changes in alpha waves when shifting their attention from the foot to the hand.

So, to use the cocktail party analogy, meditation can help you improve your alpha wave function, which can make it easier for you to stop hearing the boring talker next to you and listen in on a more interesting conversation nearby.

The authors of this research state that skill in filtering is related to “metacognition”:

 … metacognition is an emergent property of mindfulness practice in ST-Mindfulness that is derived from training in subsidiary mechanistic processes including attention and emotion regulation. Drawing on this emergent metacognitive capacity, ST-Mindfulness practitioners learn to monitor their moment-by-moment experience so that they can “step back” from negative, distressing thoughts and feelings in order to view them as “mental events” rather than as unmediated reflections of reality.

Whoa. Sounds deep. And it sounds like the Feldenkrais quote about knowing what you are doing and doing what you want.

Mindfulness helps with … everything

But can shifting your attention from your hand to your foot really make you better at shifting your attention from negative thoughts or physical pains to happy thoughts and good vibrations? I have previously written about how the brain was originally  designed for movement, and therefore we shouldn’t be surprised that practicing movement has transfer to other mental domains. For example, practicing the skill of inhibiting unwanted movement through a “stop task” improves impulse control related to addictions. And here’s a quote from the authors describing some of the impressive research that has been developed showing that meditation has benefits far outside the realm of just getting better at sitting and watching your breath:

Based on multiple randomized clinical trials, there is good evidence for the efficacy of these ST-Mindfulness programs for preventing mood disorders in people at high risk of depression (Teasdale et al., 2000a,b;Ma and Teasdale, 2004; Segal et al., 2010; Fjorback et al., 2011; Piet and Hougaard, 2011), improving mood and quality of life in chronic pain conditions such as fibromyalgia (Grossman et al., 2007; Sephton et al., 2007; Schmidt et al., 2011) and low-back pain (Morone et al., 2008a,b), in chronic functional disorders such as IBS (Gaylord et al., 2011) and in challenging medical illnesses, including multiple sclerosis (Grossman et al., 2010) and cancer (Speca et al., 2000). ST-Mindfulness has also been shown to decrease stress in healthy people undergoing difficult life situations (Cohen-Katz et al., 2005), such as caring for a loved-one with Alzheimer’s disease (Epstein-Lubow et al., 2006).

…

…ST-Mindfulness is reported to reduce self-reported rumination (Ramel, 2004; Deyo et al., 2009), which is the negative repetitive, self-related internal cognitions that predominate in major depression (Nolen-Hoeksema, 2000). In chronic pain and functional disorders, ST-Mindfulness is reported to reduce patients’ tendency to catastrophize and engage in repetitive negative cognitions such as, the pain is “terrible and I feel it’s never going to get better” (Garland et al., 2012).

Is there a drug that can do all this? Meditation seems like powerful medicine indeed, perhaps second only to general exercise in its health benefits. I find it fascinating that this all purpose mental muscle can be developed by something as simple as focusing attention on bodily sensations.

So don’t just sit there!

Pay attention to just sitting there! You might get better at playing the mental movies you want to watch.

The talk was about the effects of perceived threat on physical performance.

The basic message was that if the central nervous system senses a threat in regard to a certain movement, it will take various protective measures, none of which are desirable from a performance perspective. For example, it might increase stiffness to reduce range of motion; limit muscle contraction to reduce force; limit endurance to prevent local tissue failure; change coordination patterns to protect injuries; or create pain to discourage the movement from happening at all.

The implication is that one great way to increase performance is to reduce perceived threat, because threat might make our movement weak, slow, stiff, uncoordinated and painful. Sounds like everything we try to get rid of when we go to the gym! But of course many people will create excess threat during their workout, which will tend to be counterproductive.

This was the first time I have ever done any public speaking about the topics I discuss on this blog, and, as you can see from the vid, this was a very informal gathering. But I was still a little nervous. I think my first words on video are: “OK, so what I am talking about here?” Ha! Luckily I remembered.

There are a few gaps in the tape, and you can’t hear the questions, some of which were quite good (including a few on foam rolling!) Other than that, I think it turned out pretty well and provides a good summary of one of the major themes of this blog.

Check it out and let me know what you think!

Thanks again to Rafe Kelly and Parkour Visions for letting me talk and taping it!