dannyg

Hello everybody! The British Journal of Sports Medicine has a nice open access article about Fascia. https://bjsm.bmj.com/content/early/2018/08/14/bjsports-2018-099308 If you can't access it, I have a PDF I can share. Hope you are all happy & healthy!

Both of these are excellent. I have been 'playing' with DNM for a little while now - it is very interesting.

Sorry to reply to an old post, but there was an interesting article in BJSM that made me think about your post: "The ECM also works as a molecular store, catching and releasing biologically active molecules to regulate tissue and organ function, growth and regeneration. Molecules stored in the ECM network can be cleaved to release biologically active cleavage products.5 Mechanical stress can induce the release and activation of ECM-stored molecules, inducing the cleavage prod- ucts of collagen XVIII and other basement membrane components." Where ECM is the extra-cellular matrix, which is a part of the fascia. I though this was relevant to the conversation, while it doesn't state the presence of any hormones that regulate mood or emotion - it does suggest that mechanical loading can release bioactive compounds that can have an impact on homeostasis, growth and/or repair. Which I thought was cool. Link here: https://bjsm.bmj.com/content/early/2018/08/14/bjsports-2018-099308

I worry you might be falling into a reductive trap. I can't really offer any clinical advice over the internet, but I can give you ideas so you might better look at your problem. The problem seems to be reduction in function. Muscle and joints work together - and I'd suggest rather than focussing on 'the bit behind your knee', focus on improving knee and hip function. I'd also suggest also improving gluteal strength and foot strength - if training the hamstring directly is too uncomfortable. Pain behind the knee can also be Popliteus though, not necessarily hamstring. Especially is straightening the leg is an issue! Ligament problems would more likely make your leg unstable not really restrict movement so much. Swelling could indicate something like a bakers cyst or effusion. Or perhaps bursitis or something similar. Perhaps have a read about popliteus function and see if it matches your symptoms.

Interestingly, this is something I have been doing to save time since I moved to Seoul. When I was doing Aerial work several years ago, a lot of our conditioning was leg lifts from almost max straddle, pike and lots of lifting from hanging/climbing. (Endless straddle climbs) I was trying to save time and do both ROM development and end range 'compression' work - and found that by using the 'compression' phase to draw me deeper, and then doing CR work (and repeating) not only drew me deeper into position than I expected, but also helped my hip strength. My lower back has just recovered from a 2 week period of injury - so I'll try it out again this weekend with added details. - In my notebook I call it agonist/antagonist stretching too! - In my head I call it 'Chuckle Stretching' as my verbal cueing for it is 'To me, to you' (Chuckle Brothers was a long running British TV show).

I apologise but I am not familiar with the condition - what does it manifest as? Usually a disc herniation causes little local pain, and plenty of referred pain. I urge you to read some of the posts about pain and pain science in the forum. It helps to view the spine as inherently 'strong', and that often pain is about sensitivity rather than tissue damage. In fact, worry about the spine can increase the pain experienced (even if there is no damage). One of the best things you can do is to remember that your spine is strong. And that tissue responds to loading, and that strengthening the spine is probably a good idea. How is your thoracic spine and hip mobility/health? I have lots of thoughts about this, but will refrain from writing too much!

Ah, this is something that I like discussing. I suppose many people (mainly therapists) are aiming towards 'useful' models rather than 'accurate' ones - which is sometimes frustrating. Hyaluronic Acid is the proposed 'lubrication' molecule I believe, but that doesn't necessarily change the structure of the fascia. Unless you mean 'in' as in 'within the layers'. haha. The argument I seem to bring up in situations like this is when we talk about 'stretching' fascia, or remodelling it - like it's special in some way. All tissue responds to load (or lack of load). I like the term 'bioplastic' to describe the 'plasticity' of all of our tissue. Fascia, like any of our tissue adapts to what it is made to do. When I think about tendons I am reminded that strong, thick tendons are the best for preventing injury and transferring force. Tendon hypertrophy occurs and is quite useful. The rate at which tendons change is significantly slower than bone or muscle. Now, in my opinion, fascia would remodel (slowly, over time) upon loading to be stronger, and thicker (more dense?). Loaded stretches provide a bigger stimuli and a greater adaptation. Allowing the self to perceive the stretch as less of a 'threat'. In an injury like a minor ankle sprain, there can be ligamentous creep which can affect joint congruency - creating a laxity in the joint. This seems to be permanent (as far as the research I've read). What I have noticed often happens in this situation is the muscular tissues take on a more 'protective' role. Often this manifests as peroneal (or fibularis) muscles, tibialis anterior and posterior getting rather tight and sore. What really seems to help is stability exercises to improve their function at this role. Basically I'm suggesting that the way our fascia might change (unless there is a trauma), that fascia responds to the load of stretching by being better at producing Hyaluronic Acid and getting thicker/denser. If there has been a trauma and permanent 'creep' has occurred, I believe this would unhelpfully affect the load distribution function of fascia. Requiring more muscular effort. I don't really have much to base this on however, as I'm sure that this only really occurs when we are 'loading' the stretches well. Please no-one mention the word 'tensegrity'. Rates of change of connective tissues happens in months and years. There's a cool study about nuclear bombs and achilles tendons and how there seems to be NO turnover in the core of the achilles tenon. https://www.ncbi.nlm.nih.gov/pubmed/23401563

This is a great post. I feel that you implicitly understand how that if you are consciously using conceptual model that has 'debunked' it is unethical. There's a great post on the 'Exploring Pain Science' Facebook group that talk about ethics. The post mentions Myers being fully aware of the research on Fascia, yet still 'selling' his product without mentioning it. What we do might not change, why we think we do it might. I have to bite my tongue regularly when talking about massage and treatment, I often refer to what I'm doing as 'Neuromodulation' and give a little explanation about what is happening. It's not as good business practice as telling someone they are 'mis-aligned' and getting them to come back for weekly adjustments, but I feel it is more ethical.

From page 2 of the book: Definitely start with with painful yarns, it has some great stories and metaphors to help understand pain. BUt it depends on your ability to decipher 'Scientific Jargon' if you want to go for EPS or one of the others. Personally I think Explain Pain is more useful than the protectometer book. Here's some of the blog, if you want to have a read - and expose yourself to some of the research - https://noijam.com/2017/12/21/hot-damn-our-top-jams-2017-edition/

So, when I was a student I read the original 'Explain Pain' by David Butler and Lorimer Moseley - and while it was interesting as far as using it to explain some concepts and research to patients - I didn't enjoy it that much. (If anyone is suffering chronic pain I do Highly recommend 'Painful yarns' by Lorimer Moseley which is a funny and educational read. I steal stories from it all the time to put across the useful concepts, rather than the research) Anyway - although this book was expensive, I bought it anyway: Explain Pain Supercharged: The Clinicians Handbook. It is FULL of wonderful gems and concepts that support everything we talk about here. If any of you in Australia can get hold of a copy (it ships from Australia) I really recommend it. It's excellent. I can write up a full review when I have finished it, if anyone is interested. The reason I'm posting now is because early on in the book it has a lovely statement that has been buzzing around my head: "The way our body feels to us relates closely to what we are able to make it do" Which immediately made me think of @Kit_L Lorimer Moseley's writing is great anyway though - as he is the first person I heard using the term 'bioplasticity'. Which I have shamelessly stolen, and use all the time. Hope you are all having a wonderful year so far.

Interesting perspective. I prefer to view things like sensations through the eye of the nervous system. The nervous system is the only way we can feel things - and sometimes it can get sensitive (for various reasons). So when dealing with 'injuries' I commonly like to think about the difference between injured and hurt. I frequently experience 'hurts', but all are very short lived. Most recently: Crazy medial epicondyle pain (bilaterally) from doing work with Rolling Thunder, COC Grippers, heavy wrist curls, and levering work (pronation, supination, Ulnar & Radial Deviation) - 2 days in a row at a high intensity after a 6 month grip strength absence. Only lasted a day - but was hilariously tender to palpate. An injury is a real clinical issue. Often with obvious signs of tissue damage and trauma. Being hurt is very common for me (and many other people who train) - it's a discomfort, a weird muscle pain that lasts 3 days, a temporary ache in a strange place. Sometimes for a known reason - sometimes for an unknown reason. I feel that minor pain and things are probably nociceptors getting protectively sensitive - I doubt there's much in the way of 'damage' occurring. Pain does not always mean damage. Pain is a neurological event, that could be considered a warning signal. Perhaps the receptors and the pathways are sensitive - protectively - rather than in response. So my nervous system is experiencing something that is triggering a nociceptive response that my central nervous system interprets as pain. But that doesn't mean any damage has occurred. (In fact, in much of the problems in treating chronic pain are educating people that often there is no tissue damage occurring - but a highly sensitive nervous system that has adapted to be more and more sensitive) To my knowledge fascia doesn't store hormones - but always interested in things I might have to learn. I'd love to hear more about hormones and fascia - if you have more information. Hopefully that all makes sense - it's late here.

Breathing is highly contextual. Don't overthink it. Feel it. The breath serves different functions depending on what you need. Chris Duffin has a 20ish minute lecture online called 'Breathing is NOT bracing' where he talks about the functions of breathing and the transition from breathing to what you do under high load (bracing). Depending on the size and speed of the breath and activities - the levels of tension will vary. My suggestion it to practice something like Crocodile Breathing (https://www.functionalmovement.com/Exercises/823/crocodile_breathing_with_ankle_weights) for a little while to get a good sense of awareness and 'feel'. But all this depends on if you're talking about your breathing during everything you do or doing specific movements and stretches.

My understanding would be that yes - all 5 exercises to be done 2x a week. It doesn't look like a like a lot of volume to me, to be honest. It just looks like a good leg conditioning workout. Many people I know start with normal deck squats, but move on to single leg deck squats once they get strong enough. Edit: @Kit_L for clarification please, if I am wrong.

Sorry for not posting earlier. I'm not 100% on this, but I often have patients follow Caesarian sections or natural childbirth. Usual waiting time for resuming abdominal exercises or strenuous exercise following surgery is around 6 weeks. Depending on the person. However, most doctors suggest doing gentle cardio and light work after 2-3 weeks. My suggestion would be about cultivating awareness of her body, so she doesn't push herself too hard. But standing work, ankle movements, shoulder work, head and neck work should be fine. Awareness is the key, focussing on the feeling - rather than the end position. Hope that helps!

Some bits I copied from the earlier post. Sounds like 'Subacromial shoulder impingement' or something similar. The AC joint IS the front of the shoulder. It is the shoulder complex's only connection to the rest of the skeleton. Working on developing serratus anterior to protract the shoulder-blades and 'pushing with your Armpits' (which is one of Craig's Videos) might help. (https://physical-alchemy.uscreen.io/programs/lifting-with-the-armpits) The problem is made worse by tension through the upper fibres of trapezius and Levator Scaupulae which can hold the shoulder in an elevated position. Also working through pec minor (stretching and soft tissue release) will help being able to open the front of the shoulder properly, allowing the scapula to move more freely. But generally pec major stretches should be helpful too. While I agree with Kit here - in my experience the position of the shoulders and tightness in pec minor drawing the shoulders forward (and squeezing the scapulae close to the ribs, superiorly) is what often prevents this position. Do something like this: https://www.youtube.com/watch?v=mghh0eR7Uz4 BEFORE attempting the stretch kit linked to. If it still hurts work on developing scapula protraction rather than pushups for a little while. Basically, if pec minor is tight - your scapula can't move freely and it's really easy to do something to the front of your shoulder. If you want a picture of the Anatomy: Reduce Tension/ROM via stretching/manual release in: (Depending on how uncomfortable something feels) Pec Minor, Pec Major, Levator Scapulae, Supraspinatus, Infraspinatus, Teres Minor, Strengthen: Serratus Anterior Learn: Correct from in upper body exercises and better control of scapula haha. I hope I've helped a bit. Feel free to ask questions or want more details (or more simple advice). But this is advice on an online forum - I would advise you to see a professional (physio, osteo etc) about the shoulder if there simple things don't seem to help. PS. I am actually still not sure where the location of the pain IS exactly, but the actions you described can fit a subacrimial impignementy symdromey thingy issue very well. (The reason I call it that is because the more we know about the shoulder, the more we know that clinical uncertainty is bigger than we expected. We are not machines, why what see and feel often doesn't reflect what is going on in our bodies accurately).