You know when you were growing up and your mom or dad told you not to crack your knuckles because they would grow uncontrollably (not true) or not to stare into the sun because it would damage your eyes (likely true)? There are many things like eating your vegetables and taking your vitamins that we get told to do at an early age that has no discernable immediate impact but we are told to do it anyways. Fast forward 10 years and it seems like all the things we were told to do then are now terrible for us….hello low fat diets.
One of the items however that has actually been pretty consistent in growth and development is the 'W' sit for kids. This is of particular interest to me not only as a chiropractor but also as a father of one extremely flexible (and small) 4-year-old son whose favourite position is the 'W' sit. For those who don’t know what this is, sit on the ground in a kneeling position with your feet tucked under your bum. Then slide your feet out so that your bum can sink to the floor. Sounds awful right? And most adults can’t even come close to sitting like this because we simply do not have the muscle flexibility to do so.
I was first exposed to the idea that this was potentially harmful many years ago in pediatrics class in chiropractic school and then again several years later during a Dynamic Neuromuscular Stabilization course. Since that time, I have watched my son (who is made of rubber) naturally adopt this position and it has been a battle to undo.
Lots of young kids have the ability to do this and they love it because it allows them to sit up tall and be stable in the trunk while playing with toys. There are some problems with this position however and realistically it should be avoided.
The main long-term problem with this position from a structural view is that it causes tremendous internal rotation of the hip joint; which if allowed to continue can cause structural damage to the head of the femur and the acetabulum. Down the road, it can cause significant pain and be a culprit for an early hip replacement. It also can also contribute to tightness of the external hip and hip adductor muscle groups, since they are in a continuous shortened position with the 'W' sit. Lastly, because they are sitting in a relatively supported position, the kids do not have to actively use many of their “core” stabilizing and rotating muscles to accomplish their playing which can be detrimental to their overall motor development with tasks such as reaching across midline.
Teaching your kids to not rely on this position is easier said than done. For a lot of them (including my son), it is their default playing position and can be hard to correct. Kids who use this position love it and realistically it is probably the best position for them to do what they want; which is play. The alternatives such as criss-cross apple sauce, or sitting on your feet simply are not as comfortable for them and not as ideal for reaching for toys. This is a battle you as the know it all parent, however should be consistent with and encourage in a positive manner by showing alternatives instead of just saying “don’t sit like that”. My son still will often default to this position, however when reminded of it he will go through all the alternative postures for me. So it is not like he is unaware of the better strategies, he just doesn’t always listen to me. Apparently 4 year olds have an issue with that.
This week’s column of ‘Back to Basics’ is presented by Chris Collins, MSc. CSCS, who is the owner of Okanagan Peak Performance Inc. and along with Dr. Greg Dumanoir (a previous contributor to this column) are hosts of the Okanagan Strength and Conditioning Conference which is happening in Kelowna on July 25-26, 2014.
Local Strength & Conditioning Conference Draws Variety of Practitioners
Next weekend Kelowna is going to be invaded by a number of people coming here for a common purpose. And no, I'm not talking about those coming to town for the sports and concerts happening at City Park. The group I'm referring to is coming for the annual Okanagan Strength & Conditioning Conference.
In only its 3rd edition, this event has quickly grown to become one of the biggest conferences of its kind in Canada and attracts participants and presenters from all over the continent. The speakers list reads like a who’s who of performance, nutrition and rehabilitation.
This two-day event features seven speakers presenting on topics ranging from long term athlete development, managing training stress, nutrition for power, strength training, recovery methods and more. The format will see each presenter give a lecture and a hands-on presentation to allow attendees to learn the theory as well as put the new skills into practice.
As the name would suggest the conference was initially marketed primarily to strength & conditioning coaches. But with the growth of the event the demographic of the event has grown to include a variety of other practitioners. Attendees now include personal trainers, group fitness instructors, massage therapists, physiotherapists and chiropractors such as Dr. Marc Nimchuk, the regular author of this column.
Widening the scope of the audience has helped grow the attendance 400% in three years but has also has had the benefit of offering new perspectives, questions and discussions with each presentation. Imagine a strength coach, a physiotherapist and a chiropractor all working with the same athlete. Each brings a unique background and perspective when considering the treatment and development of an athlete. These unique perspectives help bridge the gap between science and application allowing the athlete to realize better results in less time.
Besides the education and continuing education credits so in need by health practitioners, attendees will also receive a performance training shirt, most meals, a licensed evening banquet, prizes and giveaways.
If you have a coach, trainer, physiotherapist, chiropractor or massage therapist who professes to have interest in performance, nutrition or rehabilitation they should be attending this event, which won't happen anywhere else in Canada. To register go to strengthconference.com. It's what everyone not downtown July 25-26 will be doing.
Following an aggressive game of water polo at a nameless all-inclusive resort in Mexico this past winter I have been troubled by a nagging shoulder injury. It has not taken me away from work or play to this point, but has affected my quality of sleep and I have to be careful with certain movements.
Like everyone else with injuries, I have self-diagnosed myself, albeit probably with a little more accuracy than the non-medical trained individual. There are a myriad of different shoulder injuries that can occur including dislocations, separations (sprains), rotator cuff injuries, impingements, and adhesive capsulitis (frozen shoulder).
As with many people, I have waited it out for a few weeks with my shoulder before getting it specifically looked at. I knew it was sore, but figured it would just get better. Well age, severity of injury or overuse has not allowed that to happen. After paying a little more attention to it I ran myself through a series of orthopaedic tests to narrow down what was happening. I am experiencing what is know as impingement syndrome where the tendon of one of the rotator cuff muscles is being irritated as it passes through an anatomical space. This makes reaching overhead and out to the side painful and has also affected my strength in the arm.
I have been getting it treated with Active Release Technique, massage and also acupuncture from fellow Castanet columnist Ryan Samuels. All of these have been helpful but the one thing that will keep this from becoming a chronic; debilitating injury is to build strength. The easy route is to let someone try and take care of an injury for you, but no matter the injury, you are going to have to strengthen the area to get back to 100%. This is the hard work and often there can be hills and valleys associated.
Here is a link to an article that has 5 simple (not easy) shoulder exercises that can be done for shoulder injuries. These exercises can be done with simply tubing or band. They are not designed to be a cure all by any means and if you are experiencing sharp shoulder pain associated with them, please have yourself assessed properly.
THEY DO NOT SLIP! They bulge, they herniate, they sequester or extrude, they degenerate, but they most definitely do not slip no matter how many times people tell me they have a disc out. Patients telling me this is not their fault of course, because at some point either a friend, family member or a misguided yoga website (here) have told them this condition exists; it does not. Patients often attribute low back pain with referral to the back of the leg to a disc problem and this is often known as sciatica.
Anatomy of a disk
Intervertebral discs are found in between each unfused vertebrae in the spine with the notable exception of the space between your atlas and axis. The first thing is to realize that your discs are not like poker chips. They are not rigid, solid and immovable. Discs would be more accurately thought of as a really stale jelly donut. The main role of the discs is for shock absorption in the spine, to help dissipate axial forces and to form a fibrocartilagenous joint with its adjacent vertebrae. The individual joints allow a small amount of movement between each vertebra and all these joints combined allow for much greater range of motion.
They have two main distinct anatomical parts. The outside covering of the disc is known as the annulus and the inside portion (or the jelly of the donut) is the nucleus pulposus. The annulus is the tough shell of the disc, which is sort of like rubber. It is somewhat pliable and is thin layers of fibrocartilage that provides the stability and structure to the disc. The annulus itself can degenerate, be damaged and be a pain generator in the back all by itself without anything like a bulge or herniation. This can be acute or what is known as degenerative disc disease. A bulging disc is when the annulus is pushing outward beyond its normal anatomy but the annulus itself has not ruptured. The pulposus is the jelly of the donut and while it is much firmer than jelly its main purpose is to help with the shock absorption functions of the disc and when well hydrated helps to provide the height (or normal disc space) to the disc. When a disc gets damaged and you get a herniation or sequestration, it is the pulposus that gets pushed through the annulus.
MRI’s and CT Scans
It is important to keep in mind that while these conditions can certainly be painful, they are not always and that many, many people are out there going about their normal everyday activities with these conditions with no symptoms at all. With findings like these that would be viewable through an MRI or CT-scan, they have to be clinically relevant to what the patient is experiencing. For more on MRI and their limitations with disc injuries, you can view one of my previous columns here. Another informative column is here regarding how these findings on advanced imaging does not necessarily mean a surgical intervention is warranted and that disc herniations can and do resolve with conservative treatment.
Read more Back to Basics articles
- Roll to better golf Apr 3
- What is your passion? Mar 20
- Why rolling over is important Mar 6
- Chiropractic & sciatica symptoms Jan 23
- Is Paleo right for you? Jan 9
- Supplements for pain management Nov 28
- Core exercises you are better off without Nov 14
- Why your back hurts Oct 31
- Choosing a personal trainer Oct 17
- The problem with "making good time" Oct 3
- The ankle-foot complex Sep 5
- Common questions in my office Aug 22
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