Erik Dalton Bodywork Training Blog

Summary: Like many of our popular, but abnormal, athletic endeavors such as golf, tennis, bowling, etc., cyclists bring with them a complex biomechanical downside that is frequently hard to completely fix. The “arched back” model is typically the most problematic. In an effort to level the eyes, the rider must hyperextend occiput on atlas. The cervicothoracic junction is also forced to hyperextend (neck-on-shoulders) resulting in chronically locked intervertebral joints and rib jamming.

It is incredible the money and time many elite and “weekend-warrior” cyclists devote to retrofitting racing bikes to conform to their bodies rather than first restoring function to the most critical piece of racing equipment: the body of the rider.

When muscle imbalances, faulty movement patterns, and joint fixations distort the bony framework of the body, the cyclist is led on a never-ending journey searching for that perfect bike fit.

My personal mantra: “Fit the body to the bike, stupid!”

Bodyworkers and functional movement trainers whose practices cater to amateur and elite cyclists are highly aware of the clinical and performance advantages gained by restoring optimal mobility, flexibility, and stability to the muscle/joint complex. It makes sense to first get the kinks out before sending the client off for an expensive and sometimes useless bike retrofit. Without hands-on maintenance and functional fine-tuning, they often unknowingly reinforce dysfunctional movement patterns ingrained from long-forgotten micro- or macro-traumatic injuries.

Bewilderment and controversy over this chicken-or-egg (bike-or-body) thing is primarily due to lack of understanding of the Law of Cause and Effect. For instance, let us say a bike shop performs a retrofit and Bob, the cyclist, smilingly pedals away on his newly reconstructed bike feeling secure and pain-free – Life is good… or is it?

Unfortunately, if Bob is one of many “flexion-addicted” Americans with a sedentary job that keeps him glued to the computer terminal day-after-day, gravitational exposure will gradually drag his body into a big “C” curve. In time, Bobs brain relearns this aberrant posture as normal and on weekend expeditions his “hip-flexed” desk posture morphs into a similarly distorted riding posture.

To make matters worse, stubborn pain-spasm-pain cycles often appear as the hip stiffens and the imposed stress destabilizes sacroiliac and low back structures. In the presence of lumbar spine instability, the brain may decide to lock down the low back and ribcage with protective muscle guarding. Thoracic cage rigidity not only inhibits proper diaphragmatic breathing but also sends shock waves through the thoracolumbar and pectoral fascia and into the upper extremity joints where reverberations are met with strong resistance from habitually locked hands, elbows and arms. Meantime, compensations from adhesive hip capsules also travel down through the knees, ankles, and feet searching for a weak link in the lower kinetic chain.

Cyclists who go for a bike retrofit prior to receiving manual therapy to release fibrotic hip capsules and hip flexors, soon notice a loss of endurance and may develop soft tissue or joint sprains associated with lumbopelvic imbalance. Strangely, many flexion-addicted cyclists attempt to work through the injury despite sensing a noticeable reduction of speed, power, and efficiency. “No pain, no gain” is an unacceptable working model for those pursuing longevity in the cycling sport.

Does decreased hip angle mean less power?

One of the most common cycling positions used by “flexiholics” has the hip flexors locked short and the hams and glutes overstretched and weak. This imbalance pattern as described by Vladimir Janda in his lower crossed syndrome, forces the pelvic bowl to be drawn too far forward resuting in a decrease in hip angle.

Those who consistently ride with an anteriorly rotated pelvis and decreased hip angle are subject to capsular and ligamentous adhesions and a subsequent loss of economy and power. To accommodate the loss of hip extension, many recreational and competitive racers compensate by posteriorly tilting their pelvic bowl and rounding their backs into a hyperkyphotic posture just to advance hip angle and power. The famed cyclist Andy Pruitt believes that changing the seat height by a mere inch alters mechanics and motor control patterns of every joint in the lower extremity. By reducing seat height, excessive force is transferred to the patellofemoral joint, while raising the saddle too much strains the hamstrings, low back, and hands…

Erik Dalton, Ph.D., Certified Advanced Rolfer, founded the Freedom From Pain Institute and created Myoskeletal Alignment Techniques to share his passion for massage, Rolfing, and manipulative osteopathy. Visit the Erik Dalton website for information on workshops, conferences, and CE home study courses.

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http://erikdalton.com/media/published-articles/bike-body/

Summary: Many therapists don not realize the necessity of achieving and maintaining a sense of balance. In this article, Dr. Dalton expounds on techniques to achieve the fundamentals.

Many therapists wrestle with maintaining proper body mechanics, but some have discovered a simple exercise tool that dramatically enhances their therapeutic skills. I have found that training five to ten minutes a day on a rocker board drastically improves my balance, core stability, strength, and endurance. Since balance is the critical building block necessary for making movement possible, any exercise to improve balance will reveal itself in the quality of your touch.

Customers consciously or unconsciously sense if a therapist is centered and balanced. In the absence of dynamic body balance, therapist movements often are awkward and jerky, known as the “jiggling hands” syndrome. Conversely, a body worker with a firm and steady touch exudes confidence as body weight travels evenly through the hands, torso, pelvis, and into the legs and feet to form a stable working foundation. Many of these principals are demonstrated in my Myoskeletal Alignment home study courses.

How Do Balance Boards Work?

When the body notices a change of surface, it self-corrects to achieve appropriate positions for that particular movement. These rapid changes rely on proprioceptors embedded in muscles, ligaments and joints to detect speed and degree of stretch. The proprioceptors in the body are highly refined motion sensors, and balance boards help train these sensors. While the square rocker board allows for one plane of instability, the round wobble board provides multiple planes for the most difficult workout. Rocker and wobble boards are fun and safe, but be sure to purchase one with a tactile surface on top and nonskid surface below, such as those displayed in the photos.



Figure 2: Round Rocker Board

Technique Tips

• Always stay within your functional threshold of balance – hold on to a wall or doorway as needed.

• Strive to sustain balance in order to train the body to move efficiently.

• Pull your navel toward your back without flattening lumbar curve to activate dynamic core stabilizers.

• Contract your gluteus maximus muscles with more weight shifted to your heels and slowly rock back and forth to improve posture and restore proper hip-extensor firing order.

No matter your age or ability, daily use of a balance board boosts overall fitness, core strength, and therapeutic performance. By improving body and spatial awareness through dynamic balance board exercises, the therapist uses less energy, which promotes greater core stability, mobility, agility and touch.

Erik Dalton, Ph.D., Certified Advanced Rolfer, founded the Freedom From Pain Institute and created Myoskeletal Alignment Techniques to share his passion for massage, Rolfing, and manipulative osteopathy. Visit the Erik Dalton website for information on workshops, conferences, and CE home study courses.

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http://erikdalton.com/media/published-articles/bodywork-mechanics/

Iliotibial band (ITB) syndrome is typically regarded as an overuse injury common in runners and cyclists. Recently, this controversial condition has gained greater attention due to recent articles that include my “IT-Band Friction Fallacy?”, Mark Charrette’s “Lateral Knee Pain and Orthotic Support“, and Whitney Lowe’s “New Perspectives on ITB Friction Syndrome“. When it comes down to it, Myoskeletal bodywork practices are the only true solution to the puzzle.

Although many researchers and clinicians are convinced that the patho-anatomy of iliotibial band friction syndrome (ITBF) is simple and understood, the jury is still out on the exact cause(s) of this lateral knee pain condition. Ignortantly following conventional wisdom may often point good clinicians to the wrong therapeutic path. The following example clearly shows how “chasing the pain” led physicians into a linear treatment protocol resulting in months of unwarranted pain and unnecessary medical interventions.

Case Study

Recently a 44-year-old orthopedist, who for our purposes will be called Dr. Smith, was referred to me complaining of eight months of debilitating, self-diagnosed, IT-band friction pain. During his history intake, he admitted suffering sporadic foot, hip and low back soreness but dismissed these issues as “unrelated.” A self-described “weekend-warrior,” Dr. Smith’s knee pain increased with excessive running or cycling. Both he and his staff (a physical therapist and physiatrist) had carefully scrutinized the painful knee and arrived at a unanimous diagnosis of ITBF based on results from Ober’s Test (determines the tightness of the ITB), Renne’s test (specifies the area of pain during weight bearing) and Noble’s test (identifies the area of pain when the leg is flexed at a certain angle). To further strengthen their diagnosis, MRI studies showed a thickened iliotibial band over the lateral femoral epicondyle. The conclusion: diagnosis confirmed as ITBF – case closed.

Dr. Smith related that his group’s initial treatment goals focused on relieving the (supposed) inflammation with ice treatments and anti-inflammatory medications followed by a series of physical therapy sessions. Unfortunately, the “series” of physical therapy slowly evolved into months of heartbreaking disappointment. Standard treatment modalities (stretching, ultrasound, electrical stim, cross-fiber frictioning and trigger point work) brought little relief. Discouraged with the lack of progress, Dr. Smith and his physiatrist partner began a more aggressive approach with corticosteroid and proliferation injections. Although many of their ITBF patients responded well to this treatment protocol, Dr. Smith did not. Desperate to get back to his biking and running regime, Smith decided to undertake a surgical release of the ITB at the posterior 2 cm where it passes over the lateral epicondyle, but still no relief. So how did eight months of aggressive treatment lead to unproductive failure? My Myoskeletal alignment home study techniques will reveal the answer.

Conventional Wisdom

ITBF is generally thought to be a multi-factorial, non-traumatic, overuse condition in which the distal aspect of the iliotibial band rubs over the lateral femoral epicondyle during repetitive knee flexion and extension movements. This eventually leads to irritation of the iliotibial band, bursa and lateral synovial recess. In this popular theoretical model, the deep posterior ITB fibers are more vulnerable to back-and-forth rubbing on the knee’s epicondyle. Several studies have described a dynamic “impingement zone” at approximately 30 degrees of knee flexion where the ITB is subject to microfiber tearing and associated inflammation.

Therapists who abide by this “conventional wisdom” often search for the sore spots around the condyle and cross-fiber friction the affected tissue in an effort to break down weak-linked adhesions, enhance fibroblastic activity and encourage tissue remodeling. Follow-up treatments usually include elbow “fascia-mashing” and manual ITB stretching routines. All of these techniques can be effective if ITB fibers truly are damaged.

Erik Dalton, Ph.D., Certified Advanced Rolfer, founded the Freedom From Pain Institute and created Myoskeletal Alignment Techniques to share his passion for massage, Rolfing, and manipulative osteopathy. Click on the Erik Dalton website for information on workshops, conferences, and  CE home study courses.

Read More ~

http://erikdalton.com/media/published-articles/chasing-the-pain/