Mitch Starkman of The Movement Centre with Part 4 of The Squat Series. Got Butt wink? Here are some solutions.

Improve Hip Flexion and Your Butt Wink | The Squat Series | Ep 4A

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Dr. Aaron Swanson demonstrating great variations on the classic open book exercise.

Open Book Progressions

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Most of the biology of pelvic pain does not exist in the pelvis. The same is true for any pain — back pain, knee pain, neck pain etc. Much like the screen turning blank in the cinema, the problem itself is not the screen but instead the projector or the power source. In other words, to think about pain requires us to go well beyond the place where it is experienced.
Pain is of course lived and whilst it must have a location, the relationship between pain and injury is unreliable. With a huge number of factors influencing the chances of feeling pain in any given circumstance, there is a requirement for a perception of threat that is salient and exceeds other predictions in terms of a hierarchy. Once felt, pain compels action much like thirst and hunger. Again, like thirst and hunger, context and meaning we give to the sensations influence that very experience, which clarifies to a greater extent the difference between on-going (chronic) pain and that of labour.
To feel pain we need a concept of the body, which itself is constructed elsewhere as the sensory information flowing from the body systems is predicted to mean something based upon what is already known and has been experienced, we need a nervous system, an immune system, a sensorimotor system, a sense of self and consciousness to name but a few. Where in the pelvis do these reside?
This is not to ignore where we may feel pain as this is an ‘access’ to the pain experience that should be used in terms of movement and touch. However, it is the person who is in pain and not the body part. My pelvis is not in pain, I am. My pelvis does not go and seek help, I do. My pelvis does not ease its pain, I do. So when ‘treating’ a person, we must go beyond the place where the pain is felt to be successful. And it is vital that the person is considered a whole; there is no separation of mind-body. The notion of physiological, body, psychological division etc. etc., just does not fit with the lived experience; I think, and I do so with my whole person — embodied cognition.
Locally one will usually find evidence of protection and guarding, which themselves manifest as the tightness, spasm, painful responses to touch and movement. This is all manifest of an overall state of protection, co-ordinated largely unconsciously accompanied by a range of behaviours and thinking that quickly become habitual — they are certainly learned from priors, our reference point. This is simply why delving gently into the story is important, as we can identify vulnerabilities to persisting pain such as previous experiences of pain, functional pain syndromes, stressful episodes in life; all those things that put us on alert when the range of cues and triggers gradually expand so now I am vigilant and responding to all sorts of normal situations with fear.
The start point is always developing the person’s working knowledge of their pain, which also validates their story. So many people still report that they feel that they have not been believed, which I find incredible. How can someone work in healthCARE and not believe what a person says? Baffling. Once the working knowledge is being utilised and is generating a new backstory, new reference points emerge. We create opportunities for good experiences over and over, moment to moment, day after day, in line with their desired outcome, the healthy ‘me’ that is envisioned from word go. This strong foundation that opens choices once more then permits exploration of normal and desired activities supported by sensorimotor training and other nourishing movements, alongside techniques in focus, relisience and motivation. Realising and actualising change in a desired direction must be acknowledged as the person lives this change knowing that they can.
Pain can and does change when you understand it, know where you want to go and how to get there, quickly getting back to wise, healthy action when distracted (i.e./ flare ups, mood variance, loss of focus etc). The biology of the pain is one aspect, hidden in the dark within us, and the lived experience is another. The two are drawn together to give meaning and to develop an understanding of the thinking and action that sculpt a new perception of self and pain, resuming the sense of who I am, as only known and lived by that person.

Mitch Starkman's Squat Series Part 3 goes over the thoracic spine, how to deal with upper back stiffness and why it relates to the squat.

The Thoracic Spine and Upper Back Stiffness

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Coconut oil is incredibly popular, and for good reason.
It offers many health benefits, has a delicate taste and is widely available.
It’s also an extremely versatile oil with a number of uses you may not be aware of.
Here are 31 clever uses for coconut oil.

1. Protection From Sun

Coconut oil may protect your skin from the sun’s ultraviolet (UV) rays, which can cause wrinkling, brown spots and raise your risk of skin cancer.
In fact, one study found that it blocks about 20% of the sun’s UV rays (1).
However, keep in mind that it doesn’t provide the same amount of protection as conventional sunscreen, which blocks about 90% of UV rays.
Another study estimated that coconut oil has a sun protection factor (SPF) of 7, which is still lower than the minimum recommended in some countries (2).

2. Increase Your Metabolism

Coconut oil contains medium-chain triglycerides (MCTs). These are fatty acids that are quickly absorbed and can increase the amount of calories you burn (3).
Controlled studies have shown that MCTs can significantly boost your metabolic rate, at least temporarily (45).
One study found that, on average, 15–30 grams of MCTs increased calorie expenditure by around 120 calories over a 24-hour period (6).

3. Cook Safely at High Temperatures

Bowl of Coconut Oil
Coconut oil has a very high saturated fat content. In fact, about 87% of its fat is saturated (7).
This feature makes it one of the best fats for high-heat cooking, including frying.
Saturated fats retain their structure when heated to high temperatures, unlike the polyunsaturated fatty acids found in vegetable oils.
Oils such as corn and safflower are converted into toxic compounds when heated. These may have harmful effects on health (8).
There is no reason to fear the saturated fats in coconut oil. New studies show that they have no link to heart disease risk.

4. Improve Your Dental Health

Coconut oil can be a powerful weapon against bacteria, including Streptococcus mutans. This is the bacteria in the mouth that causes dental plaque, tooth decay and gum disease.
In one study, swishing with coconut oil for 10 minutes (known as oil pulling) reduced these bacteria as effectively as rinsing with an antiseptic mouthwash (9).
In another study, swishing daily with coconut oil significantly reduced inflammation and plaque in teenagers with gingivitis (inflamed gums) (10).

5. Relieve Skin Irritation and Eczema

Research shows that coconut oil improves dermatitis and other skin disorders at least as well as mineral oil and other conventional moisturizers (111213).
In a study of children with eczema, 47% of those treated with coconut oil had major improvements (13).

6. Improve Brain Function

A Jar of Coconut Oil and a Teaspoon
The MCTs in coconut oil are broken down by the liver and turned into ketones, which can act as an alternative energy source for the brain (14).
Several studies have found MCTs to have impressive benefits for brain disorders, including epilepsy and Alzheimer’s (151617).
Some researchers recommend using coconut oil as a source of MCTs to increase the production of ketones (14).

7. Make Healthy Mayonnaise

Commercial mayonnaise often contains soybean oil, added sugar and other unhealthy ingredients.
However, it’s easy to make your own mayo with much healthier ingredients, including coconut oil or olive oil.
Recipe number two on this list uses coconut oil as one of the fats for a healthy homemade mayonnaise.

8. Moisturize Your Skin

Coconut oil makes a wonderful moisturizer for your legs, arms and elbows.
You can use it on your face as well, although this isn’t recommended for those with very oily skin.
It can also help repair cracked heels. Simply apply a thin coat to your heels at bedtime, put on socks and continue on a nightly basis until your heels are smooth.
Coconuts, Soap and Cream on a Wooden Table

9. Fight Infections

Virgin coconut oil has strong antibacterial properties that can help treat infections.
One study found that it helped stop the growth of the intestinal bacteria Clostridium difficile, commonly known as “C. diff,” which causes severe diarrhea (18).
It also appears to fight several other bacteria and yeasts — an effect generally attributed to lauric acid, the main fatty acid in coconut oil (19).

10. Increase Your HDL Cholesterol

Coconut oil has been shown to raise cholesterol levels in some people.
However, its strongest and most consistent effect is an increase in HDL cholesterol, which is known as the “good” cholesterol (202122).
One study of women with abdominal obesity found that HDL increased in a group consuming coconut oil (22).
In contrast, women consuming soybean oil had a decrease in HDL cholesterol (22).

11. Provide Relief from Insect Bites and Stings

Coconut oil’s anti-inflammatory properties can help relieve the pain or itch caused by insect bites or stings. It may also reduce swelling and decrease risk of infection.
To try this, gently rub a small amount onto the bite and cover with a bandage.

12. Make Sugar-Free Dark Chocolate

Coconut and Dark Chocolate Slab
Homemade dark chocolate is a delicious way to get coconut oil’s health benefits.
Just remember to store it in the refrigerator or freezer, since coconut oil melts at 76°F (24°C).
Here’s a delicious recipe for sugar-free dark chocolate candy bars made with coconut oil.

13. Reduce Belly Fat

Coconut oil may help reduce belly fat, also known as visceral fat, which is linked to increased health risks such as heart disease and type 2 diabetes (212223).
In one study, obese men lost 1 inch (2.54 cm) from their waist fat by adding 2 tablespoons (1 oz or 30 ml) of coconut oil to their diet (21).
Another study looked at women on calorie-restricted diets. Those who took 2 tablespoons of coconut oil per day had a decrease in waist size, while the soybean oil group actually had a slight increase (22).

14. Protect Your Hair from Damage

Coconut oil can help keep your hair healthy.
One study compared the effects of coconut oil, mineral oil and sunflower oil on hair.
Only coconut oil significantly reduced protein loss from hair when applied before or after shampooing. This result occurred with damaged as well as healthy hair.
The researchers concluded that the unique structure of lauric acid, the main fatty acid in coconut oil, can penetrate the hair shaft in a way that most other fats can’t (24).

15. Massage Your Newborn

Half a Coconut and a Spoon with Coconut Oil
Massaging newborns with oil has been shown to promote normal weight gain and growth.
One study suggests that coconut oil may be the best type of oil to use for this purpose.
Premature babies who were massaged with coconut oil for 30 days gained significantly more weight than those massaged with mineral oil for the same time period (25).

16. Decrease Hunger and Food Intake

The medium-chain triglycerides in coconut oil may help reduce hunger, leading to a spontaneous decrease in calorie intake (32627).
In a small study, men who followed a high-MCT diet took in fewer calories and lost more weight than men who ate diets with low or medium MCT content (27).

17. Improve Wound Healing

One study found that rats whose wounds were treated with coconut oil had a reduction in inflammatory markers and increased production of collagen, a major component of skin. As a result, their wounds healed much faster (28).
To speed healing of minor cuts or scrapes, apply a little bit of coconut oil directly to the wound and cover it with a bandage.

18. Boost Bone Health

Animal research suggests that the the antioxidants in virgin coconut oil may protect bone health by neutralizing free radicals, which can damage bone cells (2930).
A 6-week study of rats showed that the group receiving 8% of their calories from coconut oil had significantly more bone volume and improved bone structure (30).

19. Make a Nontoxic Insect Repellent

Jar of Coconut Oil With a White Lid
Some essential oils may be a natural way to keep bugs away and avoiding bites and stings.
However, rather than applying these oils directly to your skin, they need to be combined with a carrier oil.
In one study, combining Thai essential oils with coconut oil provided over 98% protection from the bites of certain mosquitoes (31).

20. Combat Candida

Candida albicans is the fungus responsible for yeast infections, which commonly occur in warm, moist areas of the body such as the mouth or vagina.
Test-tube studies suggest that coconut oil may help fight candida infections (3233).
Researchers found coconut oil to be as effective as fluconazole, the antifungal medication typically prescribed for candida infections (33).

21. Remove Stains

Coconut oil can be used to get rid of stains, including spills on carpets and furniture.
Combine one part coconut oil with one part baking soda and mix into a paste. Apply to the stain, wait 5 minutes and wipe away.

22. Reduce Inflammation

Two Coconuts and Coconut Oil in a Jar Without a Lid
Several animal studies show that eating coconut oil provides strong anti-inflammatory effects (343536).
Human studies suggest eating coconut oil may reduce markers of oxidative stress and inflammation, especially when compared to highly unsaturated oils (3738).

23. Natural Deodorant

Sweat itself has no smell. However, the bacteria living on your skin can produce undesirable odors.
Coconut oil’s strong antibacterial properties make it a great natural deodorant that contains no chemicals.
Here is an easy recipe for an effective natural deodorant made with coconut oil and other natural ingredients.

24. Quick Energy Source

Coconut oil contains fats called medium-chain triglycerides, which are digested differently than the long-chain triglycerides found in most foods.
These fats go directly from the gut to the liver, where they can be used as a quick source of energy that won’t raise blood sugar levels (3).

25. Heal Ragged Cuticles

Coconut oil can be used to improve your cuticles, including hangnails.
Simply apply a small amount of coconut oil to your cuticles and massage for a few moments. Do this several times a week for the best results.

26. Relieve Symptoms of Arthritis

Coconut Oil
Arthritis is characterized by pain and immobility of the joints due to inflammation.
Animal research suggests that antioxidants called polyphenols found in coconut oil may be able to relieve some symptoms of arthritis.
A study of arthritic rats found that treatment with polyphenols from coconut oil reduced swelling and several inflammatory markers (39).

27. Make Your Wood Furniture Shine

Coconut oil may help keep your furniture looking shiny and well-cared-for.
In addition to bringing out the beauty in natural wood, it seems to act as a dust repellent. It also has a pleasant, delicate aroma, unlike many commercial furniture polishes that contain strong fragrances.

28. Remove Eye Makeup

Coconut oil is a gentle and effective eye makeup remover. Apply with a cotton pad and wipe gently until all traces of makeup are gone.

29. Improve Liver Health

Animal research has found that the saturated fats in coconut oil can help protect the liver from damage due to alcohol or toxin exposure (4041).
In one study, mice treated with coconut oil after exposure to a toxic compound had a decrease in inflammatory liver markers and increased activity of beneficial liver enzymes (41).

30. Soothe Chapped Lips

Coconut oil makes an ideal natural lip balm.
It glides on smoothly, leaves your lips moist for hours and even provides some protection from the sun.
Here’s an easy recipe for making your own lip balm with coconut oil.

31. Make Homemade Salad Dressing

Commercial salad dressings are often loaded with sugar and preservatives.
Here’s a great recipe for a coconut oil salad dressing that tastes wonderful and is made with nourishing ingredients.

Take Home Message

Coconut oil has several health benefits, but it also has many other clever and practical uses that you may not have considered before.
Make sure to always have plenty of coconut oil on hand. You never know when you might need it.

Mitch Starkman is back with episode 2 in the Squat Series, this time looking at mobility loss in the shoulders and what to do about it.

Fix Tight Shoulders In The Squat

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There are things that we know are good for us: sleep, water and space. Of course then we need quality sleep, water and space. I’m interested in space, and not the kind that is out there, but rather the space we choose to place ourselves day to day and how this impacts upon us consciously and subconsciously. In particular I am keen to understand how we associate with certain environments and in fact how our brains predict the meaning of a given environment and the experiences that emerge.
Here are a couple of classic examples that I hear about:
1. RSI — repetitive strain injury: I am using this term for ease, although I have issue with it, but that’s for another time. I refer to pain and other symptoms that people attribute to repeated use such as typing, clicking a mouse and texting. In the vast majority of people I see with this burdensome condition, we can evoke their symptoms by just thinking about certain environments! Their desk at work for example. When we close our eyes and think about a place, we are in essence there and it feels like it. When a place or space becomes associated with a threat value because of a link that has been established, then it makes sense to feel a warning when we think about it. However, when this persists, this becomes an increasing problem due to the behavioural aspects — altered movement, restricted use and guarding, all of which perpetuate the threat value and hence the on-going pain. Thankfully, this cycle can be broken with the right understanding and training.
* This is not unique to RSI, but any pain problem is contextual and becomes associated with certain places, positions, movements, activities etc etc. A significant part of overcoming persistent pain is by creating new habits.
2. A place in nature: a pleasant image comes to mind, unified with feelings of comfort in the body to make it an overall calming and soothing experience. This is why visualisation is so effective as we can choose to shift into our resource state whenever we need: when anxious, stressed or in pain for example. This is a technique that I blend with others to create the necessary calm we need to refresh and renew, particularly if we are suffering pain or tiredness.

Placing ourselves in an environment has enormous effects upon us as we become part of that very environment. In fact, what you experience as that environment you are creating using at least your brain, your mind and your body, and importantly how they unify. Using a film analogy, you are the film maker, the script writer, the star and the audience all rolled into one. Wow! How do we explain that? Using the very same unified processes to explain themselves! So, in becoming part of threat environment, the importance of choosing the right space is vital. Each day we should absorb ourselves in a nourishing place such as a park, by a river, in a forest or at least in a space where there is plenty of exactly that, space! And if you can’t do this on a particular day, then you can use imagery and visualisation and feel the resulting great feelings.
On a moment to moment basis, where we spend a lot of time, perhaps home and office, these spaces need to be nourishing and promote the feelings we want to feel — e.g./ at work to concentrate, focus, think, write, communicate; at home to feel comfortable, warm, safe etc. This may take some thought and some re-organising but it will be worth it — see here, a professional organiser: Cory Cook. Remember that the environment you choose to put yourself in impacts upon you enormously: the way you feel, the way you think, the way you interact. Something similar could be said for the people you spend time with.
So, when you are at work, at home, choosing a new job or accommodation, think carefully about the environment in which you will be living moment to moment experiences, because they will be shaped somewhat by that very environment. Get out into a big open space and move around in it, see it, smell it, feel it, using all your senses. And if you can’t, then take a deep breath, slowly let it go, do it again, close your eyes and take yourself to a space where you will feel great.
Pain Coach Programme for persistent pain | t. 07518 445493

Thanks to Dr. Aaron Swanson's youtube for this great demo on some classic thoracic rotation exercises.

Gaelyn Rogers demonstrates a great rotational yogaflow

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Physio Answers is proud to bring you The Squat Series, by physiotherapist, Mitch Starkman of The Movement Centre. Check out Part 1 below!

The Squat: How to and About the Series

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It is estimated that approximately 100,000 ACL reconstruction surgeries are performed annually.  Undoubtedly, you probably know someone who has had this procedure done or even had it done on yourself.  The public perception seems to be that if you undergo ACL reconstruction surgery, it’s a temporary setback and you will be able to return to playing your sport in about 6 months.  The research done on returning to prior level of play after ACL reconstruction tells a much different story though.
Let’s take a look at some of the numbers from some research studies (I included links to the abstracts of each article):
  • The authors of this study wanted to determine how many of their patients who had ACL surgery returned to their previous levels of sports.  While 81.2% reported normal or nearly normal knees, only 62.2% returned to their previous level of sports.  That means 38.8% did not return to their previous level of sports.
  • This study did a systematic review of the research out there and found that 82% of patients had returned to some level of sports participation and 63% had returned to their preinjury level of participation
  • Here is some data on football players who had ACL reconstruction:  of 147 patients (high school and collegiate) who identified football as their primary or secondary sport,  63% for high school and 69% for collegiate players returned to play after ACL reconstruction.  However, only 43% of the players were able to return to play at the same level as prior to their surgery (based on player perception) and 30% of players said they were unable to return to play at all after ACL reconstruction.

  • And some data on NBA players who had ACL reconstruction: over a 10 year period, 78% returned to play and 22% did not return to NBA competition.
  • This study did a review of patients who had a transphyseal ACL reconstruction (a type of ACL reconstruction performed in young patients with open growth plates).  38% had another operation performed, 28% tore the ACL in their other knee, and only 41% returned to and maintained their preinjury level of play.
  • This study looked at division I athletes at a single institution from 2003-2008 and found that athletes who had undergone ACL reconstruction were 19.6 times more likely to sustain a knee injury.
To summarize many of the studies out there and put it into real-life terms, think of it this way – if 3 people on your team have ACL reconstruction surgery, 1 of them is likely not going to play again.  That’s a rather scary thought!

Now, let’s say you have ACL reconstructive surgery, put in the consistent, hard work and actually make it back to playing your sport…you’re still not out of the woods yet.
  • This study found that repeat ACL injury occurred in 12% of patients – 6% occurred in the ACL graft (surgical knee) and 6% in the contralateral (non-operated) knee.  They also found that the risk of sustaining a rupture of the ACL graft was greatest in the first 12 months after surgery.
  • This study found that 9.6% of patients had suffered a subsequent ACL injury (5.3% to surgical knee and 4.3% to contralateral knee); and the risk of subsequent ACL injury to either knee was 17% for patients who were less than 18 years old, 7% for patients 18-25 years old and 4% for patients over 25 years old.
  • This systematic review analyzed 6 high-level research studies and found that the overall rate of subsequent ACL injury was 11.8%.  The rate of ACL graft rupture ranged from 1.8-10.4% and the rate of injuring the ACL in your other knee ranged from 8.2-16%.
Essentially, 1 out of 10 people who have ACL reconstruction surgery will suffer another ACL injury.

not so fast
You made it back to your prior playing level and didn’t suffer any more knee injuries, now you can finally breathe a sigh of relief…not so fast.
  • I won’t bore you with any more numbers from studies, rather I’ll just tell you that the risk of developing osteoarthritis in your knee after ACL reconstruction surgery increases significantly – roughly half of patients have arthritis with associated pain/impairments 20 years after surgery.
Returning to prior level of activity is one of the primary reasons for undergoing ACL reconstruction and the research shows that a significant number of patients never achieve this and even for those that do, there is a percentage of patients who suffer another ACL injury.  The reasons for these issues are still not fully understood and are definitely multi-factorial.  All aspects of the ACL reconstruction process/rehab are being looked at – from the surgical side of things (different surgical techniques, more anatomical placements/grafts, etc.), to the rehabilitation process (are physical therapists not rehabbing patients well enough, are they not addressing the reason for the ACL injury in the first place, are they not assessing patients properly before allowing them to return to play, etc.), to the patient side of things (do they not emphasize PT enough, did their insurance cut them off early, are they non-compliant, psychological factors, etc.).
If you undergo ACL reconstruction surgery or know someone who does, make sure you/they understand the significance of the injury and that it will take the proper team of clinicians (surgeon, physical therapist, etc.) and consistent, hard work for about 9-12 months (and essentially a lifetime of attention) to give you the best chance of success.