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OA Action Steps: Action #1

Dear Friends,

How are you today? This week has been so full of wonderful work and busyness, and I am finding that I need so much more rest to recover at the end of the day.

This week, we will dive into one of my absolute favorite topics, using beautiful biomechanics and assessment to align your body's skills with your fitness.

We explored last week how OA is a degenerative and cyclical disease process, similar to Type II diabetes, and requires a multifactorial approach to treat. During these next few weeks, we will explore steps you can take to positively influence your arthritic cycles (slowing them down, even hopping off the cycle at points).

Lifestyle changes, education, strength and biomechanics training as well as specific manual therapy treatment should all be part of a well-rounded care approach.

It is not enough to just take advil, put on a brace (though these are both helpful steps!) and live your life (ahem, Trina!).

We need some tools in our toolbox. I love a good game plan, and we definitely need one here. This is a marathon.

OA Action #1: Improve Your Strength, Flexibility and Biomechanics

An Ounce of Prevention is Worth a Pound of Cure

When you look at the image below, this is the first point (and most exciting to me) in the cycle to intervene!

Work preventatively to make sure your biomechanics are good in the movements you do the most (especially if you are a runner/ tennis player- both plyometric activities); modify your training to reduce forces until you are strong enough to control shearing forces. Work to reduce body weight (if that is your challenge).

Another way of looking at this, is the fantastic check book analogy from my mentor, Tim McGonigle at Folsom PT. (To read more on Tim’s Checkbook Practice click here). Is the checking account of your body, large enough to cash the checks you are writing with the movements you are doing? Or are you writing bigger checks than you can cash?

Most of us started an auto pay program back in our 20s, and have just been signed up for decades, even though our checking accounts have changed as we've aged.

For example, I used to volunteer at a running assessment program where we would see tons of runners- from novice to professional- many with various pain and injury. When we would check the runners gait and strength, their functional movements such as squats and lunges, 100% of the time, their mechanics were of. It could be that in the runner's squat form, their knee is diving and arcing all around- unable to track well. When this happens, the femur sloshes and slides on top of the tibia-scraping cartilage and relying on ligaments in the absence of muscular support. The poor patella gets squashed under over active quads. The inability of a runner to track their squat movement well is demonstrates to us movement geeks that the individual not having the pre-requisite strength to squat- let alone run.

So this person is doing something they are not strong enough for, but adding 2-3 times their body weight, up and down hills, sometimes for hours. Just breathe on that for a second.

Many many of us athletes are simultaneously under supporting our bodies, while also overtaxing them. We are taking a low balance account, and writing a $10,000 check.

Why not stop running, strengthen safely, and then return to running progressively when you are ready?

Another example I see in the clinic occurs when clients are attempting to walk without enough hip flexibility. The progressive development of hip stiffness (from all of our beloved and cozy chairs) can lead to an inability to stand upright. This can creep up on us through years and years, and we may not experience these limitations for a long time.

Having enough hip flexibility to stand upright is a crucial ingredient for successful walking.

If you are walking without this necessary ingredient, you are writing checks that are larger than your body can cash at this time.

I am biased, but I believe strongly that, just as we all get checked by a dentist semi-annually, we should have quarterly check-ins with a PT to monitor our strength, mobility and biomechanics of our beloved activities.

If you cannot afford to see a provider to assess your movement, record yourself moving and watch. Is your spine neutral? What is the alignment like at your knees?

Most of your know I had the uncomfortable practice of doing this when I started recording myself, and could see just how unstable my neck position was in certain movements. This process allows you to come to terms with what is in the present.

Just as important as the assessment of movement, is embodying this idea that you may not yet be strong enough or mobile enough (at this point in time!) for the movement you desire to perform. The practice of witnessing this gap requires reflection, and actually courage. My yoga teacher Djuna Devereaux calls it "being honest with yourself" which I love. It requires moving away from habit into the realm of reflection and reality.

Though this can be sobering, please remember that you can always change your mobility and strength, every day, until the day you die.

Changing and improving your biomechanics and matching your strength and mobility with your fitness practices is a practice of a lifetime and constantly unfolding. It is the first step in preserving your articular cartilage, because without it, we experience excessive forces and poor nutrient exchange, which starts the cycle of cartilage cell death (the second stop in our cycle). We will explore cell death and how to work with the sequelae next week.

Until then, happy moving!


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