Phil Faris: Right. I know that in my personal history, I played basketball until age 65. In my 50s, I broke a couple of wrists, and it changed the way I had to shoot. I had to change my game. Then, I had back surgery, which changed my gait. What I found was my body adapted, allowing me to play basketball. It also had some repercussions. I started getting more injuries to the ankles and the knees; because I was using inefficient movement patterns to play basketball in an adaptive form. What I found was that my body’s going to adapt and it may get very, very good at doing something very, very bad for it. That can lead to other injuries. I’m a prime example of that. My desire to get back into playing forced me to adapt less than the best movement patterns, but I was playing. My ego got in the way. Do you run into that with your patients at all?
Denise: All the time. It’s normal, and that’s major. Our body, it is amazing how the body compensates when something isn’t working right. The body doesn’t want to show that it’s not working properly, so it will move things, it will shift joints. Then, the tendons will start to have to overwork, and then the muscles get irritated. There’s this whole process that happens just to keep us upright and doing what we love to do. That becomes a mind over matter thing. Then eventually, stuff starts to break down because the system can only handle compensation for so long.
The tendons start to talk back a little bit, saying, “I’m trying to work as hard as I can, but I’m not in the right position to do this. And now I’m angry about it.”
Then our pride gets in the way and says, “I can work through this.” This situation is when pain becomes an injury.
Next, you run to the doctor, and the doctor says, “Ah, just take some time off.” That’s not always an option. You want to keep playing. Of course, there are situations when you have surgery, and things are structurally changed. Then you just must retrain that new movement system to make sure that everything goes along with it.
Phil Faris:Â Can you give an example of patients you’ve worked with who recognized the movement pattern that caused injuries, and that they were able to correct?
Denise: I have this wonderful lady that I work with named Dee. She is an avid runner. She helps train half marathon groups through the local running store. She is an inspiration to everybody. She had a bad fall, and she tripped over the curb. It wasn’t like anything happened, but she tripped, and it scared her. After that, she started, even with her running, you could see she would just start shifting everything backward as a way of ‘Okay if I don’t go forward, I’m not going to fall. I’m just going to keep leaning backward.’ What ended up happening was she started getting hip pain, and shin splints, and plantar fasciitis, because now she’s standing or she’s running or doing a squat, she would shift all her weight backward. We call that a posterior weight shift.
When you start moving everything, it’s almost like you are falling forward. This is a key to running – being able to get your body weight forward. But if you end up asking the system to stop forward movement, then the system doesn’t know what to do, and it starts reacting slower. So, if she starts to trip or fall, instead of her being able to step out and quickly catch herself, she would then fall again; because now all her weight is shifted back and she can’t react and catch her weight.
Once we got her confident with, ‘Okay, it’s okay to fall,’ we had to practice reaction time. We had to practice quickly stepping out and catching yourself. We had to practice being able to quickly turn on a dime, and those kinds of things. Once she re-trained her neurological system that it was okay to get your weight forward and to start testing it to do that, she could get past that. It’s scary to ask yourself to try to fall. But in a safe environment, your brain needs to do that. Once we got her able to get her body weight forward again, she could start running better. Her running form changed, and she was happier because now she could run without the fear of falling. She could go play out in the yard with her grandkids because she wasn’t afraid of tripping and falling when they were playing ball.
The key to success was to start slowly, because it’s a scary thing to make your body start shifting weight and doing it quickly. Once she learned that, ‘Okay, I’m going to catch myself if I fall, I don’t have to be afraid and start leaning backward,’ then the system moves better because now the front of the body is being loaded equally to the back.
Phil Faris: That’s a great lesson. Let’s say I’m interested in learning more about injury prevention. What are some of the basic elements of your program and what can a patient expect once they get into your office?
Denise: We start with a video analysis because I don’t think most people know how they move. If you ask people how they move, they’ll tell you, ‘Well, I do this or I do that… especially runners. Then I’ll say, “Where does your foot land in relationship to your hips?” They’ll say things like, “Well, it lands right underneath me.” Then we film them, and we can see that they’re over-striding, that they’re landing way out in front of them on a locked knee and a locked ankle. I think what we perceive and what is happening are two very different things sometimes. We always start with video analysis. We can see what we’re dealing with. Then, we compare by looking at other people’s video, people that move more efficiently. What are they doing and how do we get you to that? I think when we start recognizing movement patterns, we can start trying to implement it in ourselves.
