Corrective Exercise Ankle Rocking with Stability Ball

February 24th, 2020

Limited dorsi flexion isn’t always a “tightness” issue. Sometimes the ability for the talus to pass through the mortise of the true ankle joint can be compromised. As the joint approaches the individual’s current limit of dorsi flexion, often the nervous system will up-regulate increased tone of the surrounding musculature, which can approximate the joint surfaces and further restrict the gliding route the talus needs to take. This can often be experienced as a “pinching” or “bunching” sensation in the front of the ankle.

Using the principle of rhythmical motion and passive self-assistance, improved joint motion can be achieved. Anybody can do this for themselves with a stability ball. An excellent option to send your clients home with!

Pain and the Guessing Game

December 23rd, 2019

As your 2019 wraps up, I’ve got a valuable message for you that will pay dividends for years to come, but it may be most relevant to you right now, as you welcome the holidays in full force.

There’s a great video that has made its way around social media about what occurred when 5 wolves were reintroduced to Yosemite. There are several versions of the video, but essentially the message is how introducing these wolves even changed the flow of the rivers and streams through the park. Watch on YouTube here if you’d like to see this video.

Now we would all be hard pressed to draw a direct line from a wolf to impacting the way millions of gallons of water flow. But what it does illustrate is the profound output that emerges from multiple inputs, especially with a biological ecosystem OR a biological human=YOU!

In the case of the changes to Yellowstone, it was the interaction of all the sub systems initiated by the introduction of a predator that had been eliminated from the ecosystem. Overgrazing was controlled, smaller animals for birds of prey returned, etc. and nature took over.

As humans, when we experience physical pain-especially chronic pain-there are always multiple contributing factors that are related to the bio-psycho-social paradigm around pain. You are more than a bulging disc, osteo arthritis, spinal stenosis or anything else you’ve been diagnosed with.

Which is why it is often so difficult to determine why you are having a “bad day”. But we search for answers and as humans, desperately strive to find a connection or relationship with something so that we can make sense of it. But how come we don’t do the same with “good days”? We welcome them but we don’t drive ourselves crazy trying to determine what led to that good day.

Let me help you. Lots of things lead to both good and bad days. And there are often patterns that we don’t look for or recognize. And it is almost never just one thing, unless the pain was felt immediately (within seconds or minutes) of a physically taxing or traumatic event.

The greatest gifts you can give yourself during challenging times of experiencing pain are these (in no particular order):

 Corrective or restorative exercise (ideally your Function First program)
 5-10 minutes of deep, diaphragmatic breathing in a restful position
 Non proactive aerobic exercise that elevates your heart rate for a sustained 20+ minutes
 Quality sleep
 Avoiding over processed and/or gut irritating foods
 Plenty of water
 Occupy your mind with social interaction or deep, meaningful work or projects

Happy Holidays from all of us at Function First!

Corrective Exercise Floor Glides with Leg Extension

November 14th, 2019

In this video we are bringing you a very influential exercise that does a surprisingly effective job at lower back stabilization as it challenges the mobility of the shoulders and efficiency of the the thoracic spine in extension.
As you are probably acutely aware, when working with corrective exercises and the client in pain, it is more than just the exercise, it is a thorough understanding of:

“For Whom?”

“For What?

And “When”

Insight into the biomechanics, psychological mindset of the client and social setting/implications of the movement all come into play and are critical to the client’s success.

Corrective Exercise A-P Cat and Dog Rewind

October 4th, 2019

In one of our past newsletters where we talked about myofascial mobility with rhythm, timing and amplitude, we revisited the Anterior Posterior Cat and Dog as one of the examples of applying those principles.

In this exercise, we take the A-P Cat and Dog and progress it into a surprisingly challenging core exercise. We call it the A-P Cat and Dog Rewind.

You’ll see as the clients center of mass moves forward with the change and limits of base of support, the core has to switch on in a very novel way.

The beauty of this is that the response is reflexive with no feedforward response necessary by the client or patient.

This helps us move beyond the bracing and “keep your core tight” cues that are not part of our long term goals and authentic movement.

Try it, feel it and let us know what you think.

Mobility Matters: Flexibility vs. Mobility

September 29th, 2019

via Gfycat
The terms flexibility and mobility are often used interchangeably. Although from the same “family” they are two different things. The fundamental difference is that flexibility relates to the ability of a muscle to lengthen. Mobility refers to the ability of the muscles to lengthen with control.

For example, if you can lay on your back on table and someone can push your straight leg back toward you with your knee straight so that your hip is flexed past 90 degrees, that would be your hamstring flexibility.

Then if you stood up from the table and tried to kick your leg to the same range, it is doubtful you get more than 60-80% of the range you had on the table.

That’s the difference between mobility and flexibility in its most simplified way.

Is one better than the other?

Both are important and we use both with our clientele at various times in their journey and for different objectives. But ultimately, mobility is more transferable to activities of life, work and sport. This is because mobility is a much more integrated “hardware” and “software” process. Hardware referring to the soft tissue and software referring to the nervous system.

Conversely, someone pushing on your leg (or you pulling with a strap or belt) is more of a hardware process and less of a software process then the more movement-based mobility approach.

At the end of the day, flexibility is a means to an end and not the end itself. The results of stretching can feel good and help with the compliance of our tissue.

Improvements in our range of motion (ROM) from flexibility practices can be acute (immediate but short term) and chronic (sustained improvements).

Some of the most up to date research on flexibility has shown that the most effective strategy for acute changes in ROM is self-myofascial release followed by either static or dynamic stretching. This would include foam rolling, lacrosse or tennis balls, massage sticks and other implements.

The following guide can help compare and contrast the techniques you use to feel like you have more range of motion and feel “looser”.

Self-Myofascial Release

What it is: The use of foam rollers, lacrosse or tennis balls, massage sticks and other implements in soft tissue areas of the body to produce a form of self-massage.

What it does:
Effects both the mechanical properties of the soft tissue (skin, fascia, muscles, tendons, nerves, blood vessels) and the nervous system. It reduces the resting tone of the effected muscles, leading to healthier, more compliant soft tissue.

What it doesn’t do:
Lengthen muscles or fascia

Senior woman using a foam roller for self myofascial release


Static Stretching

What it does:
Increases range of motion at a joint by lengthening the elastic component of the muscle, causing some changes in the visco-elastic properties of the muscles. Some improvements in stretching are actually attributed to the individual’s increased tolerance to the discomfort of stretching.

What it doesn’t do:
1. No clear evidence that is reduces the risk of injury prior to activity
2. May decrease force production when done prior to explosive and/or maximal effort (such as jumping, maximal lifting, etc.).

Dynamic/Active Stretching

What it does:
Increases heat and fluid exchange to the tissue. This helps with elasticity to the soft tissue. Stimulates the nervous system and thereby prepares the body for activity.

What it doesn’t do:
Provide huge gains in range of motion

Some of the most up to date research on flexibility has shown that the most effective strategy for acute changes in ROM is self-myofascial release followed by either static or dynamic stretching. The research include using foam rollers, lacrosse or tennis balls, massage sticks and other implements.

Corrective Exercise Wall Glute Bridge

August 8th, 2019

This version of the glute bridge is a great corrective exercise for teaching the body the sequencing and synchronization from the ankle to the lumbar spine that is associated with triple flexion and squatting.

It will certainly challenge dorsi flexion in a pseudo closed chain environment as the knee moves over the toes. There is feedback from the wall and load placed into the wall, but no vertical forces acting on the joint.

The body gets comfortable with relative lumbar flexion in an unload position because it has to go through that motion to get the buttocks of the floor. The beauty is both the novelty and very limited load placed on the spine. So even those with lower back pain will find this a helpful exercise as it reduces the threat.

Additionally, it helps create some separation and distraction of the tissue at the thoraco-lumbar junction. The upper part of the body is fixed on the floor as the lower part moves away, creating the distraction.

Put it to good use and tell us how you did!

How Accurate Are Your MRI Findings?

July 15th, 2019

We all want the best, most accurate information we can get regarding our health. And when the doctors and therapists are not getting the results everybody wants, they will typically order imaging studies to gather more information and an “accurate” look at what is going on.

Many in the general public consider the MRI as the gold standard or best possible diagnostic available. What we must realize, however is that an MRI (magnetic resonance imaging) is an image or picture. And as such, its interpretation relies on the individual reading the image. This is generally a radiologist but may also be another medical doctor that is treating you.

The technology behind an MRI is quite amazing and is not in question. What is of concern is the accuracy of the conclusions reached and therefore the ensuing treatment plan, costs and expected outcome(s)that follow.
lumbar mri
A 2017 study in The Spine Journal, wanted to look at just how accurate and consistent MRI findings would be across 10 different MRI centers. A 63-year-old women with a history of lower back pain and nerve pain down her leg received 10 MRI’s at 10 different locations over the course of 3 weeks.

What they found were very large differences in what was reported as the findings on the MRI in both false positives and false negatives (see chart from study below). Using disc herniation for example, 47.5% had a false negative or miss rate. Meaning the herniated disc was there but missed by the radiologist.

For those of us that work with a population determined to overcome their pain, the MRI is a double-edged sword. Because, as you may know from some of my past posts, the findings on an MRI do not have a one-to-one correlation with pain. There are people who have MRI’s that looked like they have been hit by a bus and have no pain. And there are people who have no clear findings on an MRI and may have significant pain. The bio-psycho-social factors that contribute to the pain experience are numerous.

What Can We Do?

Most importantly be informed and question everything. Even if you are sure the MRI findings are accurate, they don’t equate to surgery. In the absence of any medical emergency (significant muscle weakness, bowel or bladder problems), conservative treatment has shown to be as good as surgery and in several studies having even better outcomes.

At Function First, we are not doctors or physical therapists. We are exercise and movement professionals who understand the pain experience and how important it is to provide exercises that remove mechanical stress from the body and restore movement confidence through a very systematic process of program design and coaching.

When you seek help from a practitioner, you always want to be the head coach. And appreciate that passive treatments (hands on therapy, modalities) and medications may be necessary to progress you to the next step. But a comprehensive exercise program is ultimately what translates to the real-life functions you seek to participate in and enjoy.
mri variability study

Corrective Exercise-Half Frog

July 11th, 2019

This simple exercise can be quite challenging for those with a history of lower back pain, as well as the deconditioned client. The ability to disassociate the hip motion from the movement of the lower back and pelvis can be very helpful in removing stress from the lower back.

This “Level B” exercise from the PFMS is both a corrective and assessment opportunity. You will be able to see, and the client will be able to feel any control and/or range of motion differences between the two sides.

The Half Frog is also an exercise, that as a Level B allows for more intrinsic focus of attention for motor learning purposes. The client is able to concentrate on what muscles are engaging and the sensory feedback of those contractions.

Corrective Exercise-Prone Single Arm Lifts

June 14th, 2019

This corrective exercise for the shoulder and thoracic spine is significantly more challenging then it appears. A great exercise to cue the thoracic spine and scapula to better “set” their anchor points for more controlled and stable motion of the shoulder.

Three different lift angles suggested to vary the position of the gleno-humeral joint and rotation of the scapula.

How does a client achieve success with Function First?

May 20th, 2019

In this part of the interview, Anthony shares several client success stories and what the transpires during the process. Exercise is the vehicle, but there are plenty of other elements that must be in alignment as well.