You click bait jerk. I know. But hear me out. Apologies for the length of the post. It was meant to be a microblog but it morphed into pre-course reading for those taking Reconciling Biomechanics with Pain Science. I know many people hate the term non-specific low back pain.  The assumption being that if you know the anatomical source of pain you can give tailored treatment to your patients.  But not only do I think that doesn’t matter much in the spine (there are exceptions and I wrote about that here) but it also doesn’t matter much at other joints.  Let’s talk about the kne ..read more

Clinical experts often hold strong opinions about the interventions they champion.  They have no doubt helped a lot of people and have also been involved in research that supports their opinions. I want to listen to these people and learn from them. But, they have blind spot that they don’t recognize.  They will often hold negative opinions about some interventions that they are against and I think this is an area where we should listen to them less. For example, I am an advocate of heavy resistance training for a number of conditions.  In years past I was strongly against str ..read more

Why this blog: This is a bit of thought experiment. Bear with me. I hate running Not sure why I do it. I do prefer talking about though ASSUMPTIONS ABOUT PAIN, INJURY AND RUN TRAINING Tissue injury/failure is considered to be a cause of running related injuries and pain. It is assumed that building tissue strength will decrease our injury risk. Hence, we say things like injuries occur when Load exceeds Capacity. Yes, there are issues with the term Capacity but that’s another blog Some research suggests that Bone and Connective Tissue (tendons, fascia, ligaments, cartilage) do respond posi ..read more

Let’s jump into a few areas where joint stiffness, tissue stiffness and joint mobility might matter. Please don’t consider this exhaustive. 1. When it matters to you Easy-peasy eh? If you are concerned about the feelings of stiffness and think it is contributing to your pain then its something we need to discuss. We need to figure out if it is really contributing to your pain or function or if your feelings of stiffness are just “victims” from whatever else is driving your pain. The thought here is that sometimes we might be trying to “fix something” (perceived tightness) that actually isn’t ..read more

Traditional physiotherapy has often looked to find “deficits” in someones function and then suggested those deficits are what is causing pain.  Deficits are typically any type of physical functions or attributes that deviate from averages.  Typical examples being altered postures when you are standing that deviate from neutral (e.g your head might be forward, your pelvis might be tilted more anteriorly than average, some muscle is weak or range of motion is less than average). A very common and fully unsupported explanation for all sorts of pain problems would be the lower crossed ..read more

This is going to be a three part blog.  The first two parts will explore the reasoning why stiffness/tightness is often irrelevant for pain.  The last blog will discuss times where stiffness and mobility might be relevant for pain and injury. Part 1: Why you can stop worrying about stiffness Muscle and joint tightness can be viewed as two things: 1.  Actual or perceived joint and muscle stiffness.  Stiffness is a mechanical concept that describes how much force it takes to move a joint or structure.  Stiffer materials or joints require more force to lengthen or move ..read more

Audience: Therapists and bored patients of mine I don’t think good rehabilitation has changed dramatically in the past 20 years. I keep hearing people say that if they are doing the same thing 5-10 years from now they have somehow failed as therapists. Poppycock. We’ve known the fundamentals for many years but where we improve as clinicians is how and when we apply them. See this Twitter thread for more details Reconciling Biomechanics with Pain Science has three main areas: 1. Critical thinking development to improve clinical decision making 2. Deep dives into research to support, refute and ..read more

Confused? My apologies. Ten years ago I wrote a blog post (here) saying that foam rolling can’t stretch (i.e permanently deform or lengthen) your ITB. I stand by it. Its not some dough that you can kneed into some new shape and you sure aren’t “breaking up adhesions. BUT, you can transiently “stretch” your ITB. This means that when you put tension through your ITB part of it will undergo strain. This means it lengthens will force is applied to it. The same thing happens to a tendon when you contract a muscle or move towards end ROM. Tensile force (tension) is applied to the tendon and it under ..read more

I’ve had some amount of varying persistent pain for more than 25 years.  In general, I’m pretty sensitive but I’ve learned to cope and do the things I love with varying amounts of modifications through the years.  Like many people with persistent pain I have other sensitivities.  The big one, as my family will attest to, is my misophonia.  I hate the sound of people chewing, breathing, slurping, sighing…ughhhhh.  I’ve excused myself from countless dinner tables through the years.  When I lecture, if someone whips out a carrot I’m heading to the other side of the ..read more

Below you will see a picture from a 2007 handout I would give for talks about running injuries and stretching.  I had been anti-stretching for at least a decade.  At least, I was anti-people telling others they needed to stretch to prevent injuries. I’ve also written about it here, here and here.  It never made sense to me (it still doesn’t) so I enjoyed saying that the research at the time didn’t support stretching as an injury prevention method (again, it still doesn’t in runners) From a 2005-2008 Injury Management Handout But, where I was wrong was calling it a myth.  A ..read more