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An Individualized Approach to Pain & Dysfunction

Fear mongering is can be found in all areas of fitness and health. With such a low barrier of entry to become a “qualified professional” (do you have a few hundred bucks and a weekend to spare?) it becomes easier to be a problem finder than a problem solver. I’ve worked with professional problem finders. They are great salesmen

because they convince you how much you need the service they are selling and what will happen to you if you don’t let them “fix” you. The result? A lot of people walk around feeling broken because some salesman or blog post convinced them they are on their way to back surgery or joint replacement.

Important note: There are also a lot of truly great coaches and healthcare professionals out there. Some of them may inform you of very real issues that need urgent attention. I do not wish to instill distrust. Rather, to inspire some deeper thought.

A while back I took a class on movement and posture. A big part of that class was its lab component. In the labs we would get in small groups and do various types of postural analysis for all parts of the body. While it was interesting to add so many assessment tools to my toolbox, it actually brought a much greater lesson.

One week we were measuring pelvic tilt by marking the ASIS and PSIS then measuring angle of tilt with digital software. It is an imperfect measurement, but it can provide insight into the amount of anterior pelvic tilt a person may have. Large anterior pelvic tilt correlates to more lumbar lordosis (arch in your lower back), which is what gives it its ties to back pain. This test was stirring up a lot of excitement in one of my lab partners. He kept talking about how he has such an extreme anterior pelvic tilt and therefore, lumbar curve. He had been working very hard to strengthen and stretch the appropriate muscles around the hips to correct this

When it came time to perform the measurement the results where a huge eye-opener for him. For context, a “normal” range is loosely defined to be 4-7 degrees in men and 7-10 degrees in women. I measured my partner at 2 degrees of anterior pelvic tilt. In a mission to “fix” his anterior pelvic tilt he worked himself into the opposite extreme. I actually couldn’t even see any tilt visually. He pelvic looked perfectly horizontal and his lower back looked perfectly flat, lacking its normal curve.

This is what happens all too often. A “problem” is found, all our energy redirects towards fixing it, and a new problem arises from over-correction or neglection of other important factors. The solution is found in context. We can find context in individual consideration and movement assessments.

Individual Consideration

Individual consideration is easy but often neglected. It’s as simple as asking questions of yourself or your client about how a particular deficiency effects their life. For example, you’re experiencing back pain that limits you from doing your job or playing with your children. If we determine that an unstable foot-ankle complex is causing dysfunction up the chain to your hip, and the dysfunctional hip is a likely cause for your back pain, you better believe we are going to work on correcting dysfunction in your foot (… and hip… and back… and still train the rest of the body, if that needs saying.).

As an alternate example, if you have the exact same foot/ankle “issue” but your hips and back are healthy, you don’t feel pain, and your lifestyle isn’t impacted then we aren’t going to make your foot the goal. Chasing a fictional functional perfection probably isn’t as important as, say, losing weight. Before I get coaches jumping down my throat, remember that a good training program for any goal is going to result in a stronger foot and a stronger everything else even if it’s just a by-product. So, let’s not get consumed with fake problems and keep the goal the goal.

“The man who chases two rabbits, catches neither.” Confucius

Movement Assessments

Movement, on the other hand, takes a skillful coach to assess. This is an important aspect because posture is dynamic. Analyzing how we stand in place is a very small piece of the puzzle. To get a true look at posture you have to look at the biomechanics of various movement patterns. The main ones being squat, hinge, lunge, push, pull, twist, flex/extend, and gait (walking/running).

It’s not enough to be able to hold good posture when sitting or standing if you are unable to get in good positions in any of the above movement patterns. These are the movement patterns we spend most of our time in, and we will spend much more time doing those movements than being static in one position.