I was driving home from work a couple weeks ago, taking the backroads and avoiding the freeway. Taking 5 minutes longer than the road more traveled, my back route is rural, or at times foresty. It winds through scattered homes nestled among the evergreen forest or lining the shorelines of placid lakes, then coasts past bucolic pasture land replete with a variety of barnyard animals.
This road is narrow and has no sidewalks—street lights and traffic lights are non-existent. After leaving work, crossing the railroad tracks and leaving suburbia in my rearview, there is a stretch of road where there is a bare 2 foot grassy bumper between the white fog line and a deep, cattail choked ditch.
Cruising with traffic and puttering along at about 45 mph, I saw a person on foot up ahead. Cars are passing this figure by at alarmingly slim margins, but the ton of hurdling metal seemed to elicit no reaction from this seemingly fearless pedestrian. As I got closer, I could make out that it is a young woman, head down and eyes glued on the mesmerizing images of her phone.
Apparently, she had supreme confidence in each and every driver that passed, as she didn’t even as much as glance up. Aha! Not brave then, oblivious. Furthermore, instead of seeking the relative safety of the grassy margin, she walked on the edge of the pavement, right on the white line (maybe she didn’t want to get her shoes muddy?).
Instead of being alert to possible danger, instead of looking up and being aware of what was coming toward her, she was lost in some virtual reality. Instead of contemplating the consequences of keeping her shoes clean, instead of walking near the ditch, she sticks her head in the sand and walks the knifes’ edge of pavement. An interesting life choice, to be sure.
And so, dangers can come from the outside and one should be on the lookout for them. Treacherous traffic situations, your daughters’ new boyfriend with a knife-through-the-skull tattoo on his neck, the lightning storm approaching your golf course.
But, dangers can also arise from within us. And this applies specifically to repetitive stress injuries of various types:
- Plantar fasciitis, ankle impingement and Achilles tendonosis.
- Patellar subluxations and tracking dysfunction.
- Trochanteric pain syndrome and degenerative lumbar conditions.
- Cervical degenerative conditions, shoulder girdle myofascial syndromes and glenohumeral impingement syndromes.
These are examples of wear and tear injuries. They arise in response to the way we use our bodies—the way we overuse, misuse, disuse and abuse various tissues. These kinds of dangers can’t be blamed on outside circumstance, so solutions to these dangers can’t be sought exclusively externally.
While injections, surgeries, massage, joint mobs, *insert favorite modality/technique* can be helpful in treating the stressed tissues, they do nothing to affect a positive change in the underlying dysfunctional movement and postural patterns that led to the tissue stress in the first place:
- Pronating my foot is hurting my foot/ankle, and ibuprofen won’t change it.
- Valgusing my knee is putting my patella at risk, and cortisone won’t change it.
- Lateralizing my pelvis in gait and standing hurt my hip and low back, and double knee to chest won’t change it.
- Thoracic extensor laziness stresses my neck and protracts my scapula, and massage won’t change it.
Behaviors of Self-Harm
These are examples of habitual behaviors, internalized behaviors set by a habit driven nervous system, that lead to internal dangers. The true solutions to these types of conditions needs to be sought internally. Sadly, modern humans are not very proficient at self-examination. The desire for instant gratification, the sensory overload of the electronics revolution, the flickering attention spans and the constant hype and search for excitement are defining features of modern life.
Our time is consumed by, and our attention is riveted by, an ever-changing kaleidoscope of thoughts and emotions, hopes and fears, relationships and social status, politics and religion, sports and celebrity gossip. People mostly attend to events and sensations that are external to ourselves, leaving little room for proprioceptive self-awareness.
Until, that is, something happens to change the equation. And this something usually comes in the form of pain. As a movement teacher, this is our moment. This is our opportunity to preach the benefits of musculoskeletal introspection and to urge the adoption of musculoskeletal optimization. And we should strike while the iron is hot, as these repetitive stress injuries tend to recur or persist—episodic or chronic pain ensues and perpetuates.
Point it Out & Propose a Solution
The first thing to do when identifying the likely ‘movement mistake’ leading to degeneration or repetitive stress injury is to point this out to your student. And what we point to is not primarily visual (this is what you look like), but proprioceptive (this is what it feels like):
- How is your weight distributed between inside/outside of your heel, and between first and fifth MT heads?
- Where is your knee in relation to your foot? Is it inside or outside?
- Where is your hip in relation to your foot when standing or walking? Is it aligned over your foot or is it collapsing outward?
- What is the shape of your thorax? Where are your scapula in relation to vertical?
The second thing to do, after identifying and pointing out the offending movement or postural pattern to your charge, is to propose a solution and set up the conditions where your ward can compare and contrast the old/dysfunctional to the new/improved:
- This is what it feels like when your foot in centered, is a tripod foot.
- This is what it feels like when your knee is directly over your foot.
- Notice the sensation of contraction in the muscles you need to use to prevent collapse onto your hip while standing or walking.
- This is what it feels like to engage your thoracic extensors and posterior intercostals, but to simultaneously relax or differentiate your shoulder girdle retractors.
Internal sensation is the key to identifying the underlying conditions that create repetitive stress injuries. Internal sensation is the key to training the movement/postural optimization that ameliorates these repetitive stresses. Our folks need to know what ‘the bad thing’ feels like, then contrast it with what our proposed ‘good thing’ feels like, then decide (with internal criteria of comfort, ease, balance and, most of all preference) which one they like best.