Home Stretch

Case study - 4 medical specialists cannot help dancer with severe knee pain

2008-08-09T12:11:00.000-07:00

Listen to Allie tell her story:

[Permission graciously granted without monetary benefit to Stretch to Win by the people in this story to post this blog entry & these videos about a personal medical condition].

A 12 year old female pre-professional ballet dancer by the name of Allie came in to see me last week. She was referred to me by the director Lisa of the Plum Performing Arts Center in Scottsdale because her student hasn't danced for 3 months due to severe left knee pain.

Allie came in with complaints of pain on the front-inside (it's called 'antero-medial') part of her left knee but her diagnosis was a Baker's cyst which occurs in the back of the knee.

In adults, Baker's cysts usually arise from almost any form of knee arthritis and cartilage (particularly the meniscus) tear. Baker's cysts in children do not point to underlying joint disease. Baker's cysts arise on the inside calf (between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles & posterior to the medial femoral condyle).

Allie told me that about 8 months ago she had lost her balance while in her pointe shoes & fell onto the front of her left knee. She kept dancing that day (typical dancer) but the knee got increasingly worse over time until 3 months ago she had to stop dancing. X-rays & MRI revealed only a small popliteal (Baker's) cyst.

Allie's mom told me that they have been to 2 medical doctors & 2 physical therapists over the last 3 months & there was no change in her pain (7/10 at rest---8/10 walking---9/10 squatting---10/10 pain dancing). She had been on anti-inflammatories with no effect. They were both very frustrated & the mom felt that the medical system left them without any hope that her daughter would be able to return to dance anytime soon, if at all.

After taking her history & physical exam, it became clear to me that she probably had a biomechanical dysfunction in the joint beneath her kneecap. When I asked the mom if any of the previous medical specialists or therapists mentioned the words "patellofemoral joint syndrome" she said no, which encouraged me to pursue this line of reasoning (& differential diagnosis) even further.

When I tested the strength of her quads manually, she had 8/10 reproduced pain with quad weakness (tested at 3/5), so I shifted her kneecap with my hand & firmly held it in place while again testing her quad strength. This time it was pain-free & strong (tested at 5/5). Next I used the Kinesiotaping method to shift her kneecap into a better position & taped it into place.

When she stood up & walked her pain was 1/10 & a squat tested at 1.5/10. I added another strip of tape on a specific angle - she then tested at zero pain in walking & .5/10 pain squatting. Allie had a big smile on her face & her mom said "Is that all it took? I can't believe it! Why couldn't the others figure this out??" I replied "I don't know but I consider this a basic & fundamental part of evaluating a knee".

It annoys & angers me that this simple diagnosis & treatment was missed by 2 medical doctors & 2 physical therapists & caused so much wasted time & unnecessary pain on the part of the patient who is supposed to matter the most. I think a big part of the problem is that with "managed care" doctors & therapists are way overbooked & don't spend the necessary time to ask the right questions & take the time to look at the whole patient.

Next week she starts a dance specific Pilates rehab program to progress her to dance class in another 2 weeks.

* * *

Here is her home program:
- self myofascial release (self-massage) of trigger points on the outside hip & leg connective tissue (for anatomy geeks: glute min/med, IT band, lateral hamstring/quad).
- stretch above mentioned muscles
- inner quad (vastus medialis obliqus) strengthening
- self tape kneecap

* * *

Listen to Mom tell the story:

STW Institute graduate helps client make the Olympics & big leagues!

2008-08-01T09:03:00.000-07:00

Paul Turner is a kinesiologist & provider of Fascial Stretch Therapy in Vancouver, BC, Canada and graduated from our Institute as a Certified Flexibility Therapist - Level I. With his permission, I present to you his short story about how dreams come true for those that stay focused & no one stays more focused through the ups & downs of life than Olympic athletes. Enjoy:

Three Peaks kinesiology client Scott Richmond was named to Canada's Olympic team last week and his good luck has continued as he has been called up to the big leagues this week with the Toronto Blue Jays. check out the active roster at this link: Toronto Blue Jays.

During the off season Scott worked with me (Paul) 2-3 times a week helping him maintain and improve his flexibility in his throwing arm and throughout his back. We at Three Peaks Kinesiology are extremely excited and proud for him getting his well deserved recognition, and a chance to show that he can throw the heat in the big leagues and for Canada.

Good luck Scott with Toronto and in Beijing.

We are behind you all the way. See you in the off season.

--------------------------------------------------------

If you want Paul to help you achieve your goals, here is his contact information:

Paul K Turner BHkin, RK,CEP, CFT-1

Three Peaks Kinesiology INC.

Peak Recovery, Peak Performance, Peak Fitness

Reach Your Peak http://3pk.blogspot.com/ check out our blog for great health info.

Located @ Total Fitness Langley.

202 20165 91A st

o: 778-298-3pks F: 604-648-9552

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If you want to find a provider of Fascial Stretch Therapy who graduated from our Institute in your area, go to our Locator at this link: http://www.stretchtowin.com/therapist-locator.

Stretch to Win at Cardinal's Camp

2008-07-31T18:09:00.000-07:00

Written yesterday:

I am writing this from Flagstaff, AZ where we came today to work with our clients from the Arizona Cardinal football team (Ann is downstairs working on Anquan "Q" Boldin right now). Ten players were waiting for us to help them with jacked up hips, backs, knees and ankles from turf that "was messed up". Hard, dry, cracked and uneven, the players said that it was an accident waiting to happen.

Fortunately we also had our naturopathic physician, Dr. Brian Popiel, with us to administer electrolytes & vitamins by IV to help them recover much quicker. Ann and I notice that their connective tissue feels much more responsive to the stretching as well. Tomorrow, Jimmy Yuan, chiropractor extraordinaire will be joining us to complete the "dream team" of rehabilitation for the sprains, strains and dehydration that is endemic to the football training camp experience.

The players told us that they couldn't live without the electrolyte water that we get for them and also reported that the Neuro1 product is really helping them focus while the Sleep1 is helping them sleep and recover.

We're here till Sunday, so I'll try to report back again on what's going on with the Cardinals... .

In the meantime, check out the video of Matt Leinert & teammates in practice below.

A question about assisted fascial stretching

2008-06-29T09:34:00.000-07:00

Question excerpt from one of my Stretch to Win Institute students:

Dear Chris and Ann,

I have an unusual situation with a client arise, I thought you might have some advice....

When doing the "sack of potatoes" stretch with this gentleman last week there was a loud crack during the stretch phase of the work. It sounded just like scar tissue... at the time he had pain in the lateral aspect of the joint. It lasted for three days, getting progressively better each day (again, just like scar tissue). All special tests for the knee clear ligaments, tendons, and meniscii. There are no ROM limitations. In addition, he tolerates all weight bearing exercise, including change of direction and heavy squats without difficulty.

However, when I bind the fascia for the sack of potatoes stretch and also for the gluteus maximus position, he experiences pain in the medial/anterior aspect of the tibia (no where near any ligamentous or muscular attachments and beneath the meniscus). There are no other subjective complaints except in those two positions (he is even able to perform a glut stretch in sitting and supine without symptoms, full range). Again, there are no significant objective findings.

There are restrictions in the gluteus maximus and the hip, so ideally I would be able to work with this fascial train. I'm not sure how to proceed and also have no idea exactly what happened. Do you have any advice or have experienced a similar situation???

Answer:

I discussed your case with Ann and we both have not had this experience nor have we ever heard of any others experiencing what you describe.

While seeing a video of you performing the moves would also be helpful, we'll just work with your descriptions and offer you my thoughts:

Since you say that all tests and FWB functional movements screens are clear then all that remains is either a trigger point referral or a cruciate ligament trigger point vs scar tissue lesion.

a) there is possibility that your client is experiencing what Travell calls a "shortening activation" which basically means that the antagonist to the muscle being stretched reacts by contracting. In the case of the positions you mentioned, it's plausible that the adductors may by reacting this way to the glutes and other lateral structures under increasing tension. Solution: search & deactivate TPs in antagonists.

b) in the sack the anterior cruciate is under the most tension, since there also occurs some tibial IR therefore if there is any defect or scar tissue in the ACL, the stretch may stimulate this & cause pain in the antero-medial aspect. Solution: if you believe the cruciates to be hypomobile from a scar or whatever then it is probably safe to explain to the client what you are doing and get a verbal OK to proceed. If not, then use the upper hand wrapping around the outside of the thigh, fingers coming underneath to control & direct traction and even rotation, thus greatly reducing or even eliminating any traction with rotation to the knee joint. If no pain with this modified move then you will have no more pain in the knee using this technique (but it suggests that there is a lesion in the knee that needs separate treatment). This effect may also occur in the glute stretch because of the long lever force pushing the knee into a slight anterior draw position with a slightly internal rotated knee (no problem for a normal knee but stressful to other knees). Another solution: try varying the leverage angle & while simultaneously reducing the IR.

Let us know how it works out or if you need more direction.

Dear Chris,
Thanks again for taking the time to respond... I found a major trigger point at the Gracilis origin and after releasing it was able to perform both the sack and glut max stretch! I'm very excited 1) to have learned something new and 2) to be able to assist this gentleman with his martial arts work.

You are making a difference! :-)

Laura

Stretch to Win client qualifies for Olympic Trials

2008-06-11T22:45:00.000-07:00

Bryan Gilmore, former wide receiver of the S.F. 49ers (now a free agent) said to Ann Frederick 6 weeks ago "I'm bringing in a friend of mine that I'm training. He'd like to make the Olympic team and I believe he can do it."

After Bryan paid for Michael Lawrence's first visit, Ann said "It's on the house from now until he makes the team. I've always loved supporting at least one athlete each Olympics". The last Olympian Ann worked with extensively was Sanya Richards who won the gold in the 4 x 400 and later became the fastest individual runner in the world in the 4oo meter event.

Michael Lawrence is like Forrest Gump in the sense that he doesn't have much of a background training for the games but knew that he could run and should soon find a coach if he was to fine tune his technique. Bryan Gilmore ran track in high school and believed that his friend was a natural.

Well the short story is, Michael found a running coach in Phoenix and then he found Ann who has been his flexibility coach for the past 6 weeks. This past weekend , all the hard work paid off big when Michael ran the 200 meters in 20.4 seconds qualifying him for the Olympic trials and a chance to make team Beijing.

After he qualified, Michael said "Ann not only got my body right, she got my head right too!" We wish him the best in his quest to make the mens Olympic track team for 2008!!

FAQs from readers

2008-05-12T14:04:00.000-07:00

Question:

I am an ACE-certified fitness instructor and on the mailing list for the Human Kinetics catalogue, which features Ann and Chris' book, Stretch to Win.

I have been on a quest to become more flexible for a number of years, and the book sounds good, but before spending the money on yet another book that may not make much difference to my flexibility level, I thought I would write and ask what this program can offer someone with my goals.

As an aspiring classical dancer who started dancing later than childhood, I did not develop the extreme flexibility that comes with beginning regular stretching at the age of 8 or 9. I need a split in at least the front and back directions, and very open hipflexors in front, which are quite tight. With my access to the fitness and dance professions, I have consulted at least 4 different practitioners over the past year for help with flexibility, and I have improved somewhat, but not to the level I need to become a fluid dancer.

I have seen accomplished athletes struggle for basic flexibility, and I'm wondering if your book addresses people like this. I am way beyond the basic level--yet still have not attained the flexibility level a dancer needs to be effective in classical technique. Can this program offer a quantum leap in flexibility (with dedicated practice, of course)?

Many thanks for your attention to my inquiry.

Answer:

My wife & I were professional dancers & like you, my focus was on classical ballet training. I started late (17) yet still managed to get accepted intoJoffrey Ballet when they were one of the top companies in the USA. The reason why I tell you this is for you to know that it is still possible to make quantum leaps but you need to have a certain amount of natural or genetic ability in strength, flexibility, balance and musicality to endure the rigors of classical dance.

What makes the flexibility training program in my book different is that I take you through a Personal Flexibility Assessment (PFA) & teach you how to do the same for yourself so that you may gauge your progress. Then you proceed to focus on the areas that are restricting your flexibility after you have identified them through yourPFA.

The first part of the program is based on self myofascial release (sMFR) which is much more than just rolling on a foam roll. Stretching, which is the second part, comes after sMFR but instead of the static stretches that many dancers do before class (which is wrong) I teach you about the Stretch Wave™ which are undulating movements that areperiodized.

The Stretch Wave™ is done a little faster before dance class (or sports) in order to increase blood circulation & body temperature, as well as to move in all possible directions, for a comprehensive warm-up. After class, rehearsals or performance (or after training or a sport participation) the Stretch Wave™ is done slower to take advantage of the high body core temperature & restore elasticity of the fascia before it tightens again when you cool down and go to bed.

After you try this program, I'd be happy to help you adjust the program even more to suit your particular needs. Happy stretching!!

Stretch for Sex

2008-05-03T10:36:00.000-07:00

After using Fascial Stretch Therapy™ (also called FST™) on thousands of patients & clients to eliminate pain or to improve function & performance, several of them have commented that their sex lives have improved as well.

That makes sense because loss of mobility & flexibility from injury, surgery, accumulation of scar tissue or lack of having a good anti-aging strategy will lead to tighter muscles & stiffer joints. This scenario will not only affect daily functional activities but can also dampen or even eliminate one of the great joys and de-stressors of life, namely sex.

To see Ann & Chris Frederick on local major network TV check out the story & video at this link: Exercise for "love muscles". (Link should work for a few more weeks).

If you want to download the free video "Stretch for Sex" core flexibility program & also get the stretch program on a sheet then go to this link: download FREE program now.

Happy stretching!

Ann Frederick remembers Pat Tillman

2008-04-19T16:43:00.000-07:00

Just several hours ago, Ann & I got back from volunteering our services at Pat’s Run, a 4.2 mile run/walk around ASU that celebrates the life of Pat Tillman, who sacrificed his life while serving for his country in Afghanistan. Fees from participants in the event benefit The Pat Tillman Foundation which seeks to carry forward Pat's legacy by inspiring and supporting young people striving to promote positive change in themselves and the world around them.

The cool thing is that my wife Ann was Tillman’s flexibility coach while a graduate assistant in Intercollegiate Athletics at ASU. The football season was ’95-’96 when ASU went to the Rose Bowl against Ohio State & Bruce Snyder, who at the time won Coach of the Year, was in charge. “Till’s goal was for me to get him to do the splits” Ann said. “He was 8" off the ground & for some strange reason, that’s always the benchmark for flexibility in male athletes”.

Ann also remarked, “The thing about Till was that he had this incredible zest for life & he approached everything head-on. What was remarkable was that he had the talent to play football but it did not define him which is why he could step away from it & serve in the armed forces. He’s the only athlete I know who had a degree in business & was a straight ‘A’ student.”

Ann and I had an amazing experience loosening up about 60 participants’ muscles before the event & melting away the tightness & soreness right after the run/walk. The smiles & comments of gratitude touched our hearts & made us both commit to volunteering our services at this event every year from now on.

Principle 1: Synchronize your breath with your movement

2008-02-26T17:06:00.000-08:00

We said in the previous post that we would go through our 10 Principles
for stretching success with you, so here goes.

We have discovered over the years that instead of counting how long to
hold a stretch, athletes can stretch better by synchronizing their
breathing with their movement. Counting puts an arbitrary time
constraint on the stretch that competes with the actual release of the
restricted tissues.

Our experience has shown repeatedly that if the athletes instead
focus on how they are breathing during a stretch, they get an
optimal response from the stretch as well as an increased
awareness of their bodies. They realize that their muscles and
tissues have their own biological time clock for responding to a
stretch that does not follow some prescribed formula or arbitrary
time limit.

Rather, it follows the state of the tissues and what they require at
that moment. In this way, the breath actually assists the stretching
movements by easing rather than forcing the athlete into increasing
ranges of motion. By focusing on breathing, an athlete is also better
able to gauge and adjust how much mental or physical tension he or
she brings to the stretch.

FAQs from our readers

From Victor K: "I have been reading the Stretch to Win book and of the
Ten Principles of Stretching, I do not understand the principle on traction.
I do not know how traction is being perform. I hope that you can help me
in this."

Victor, first of all thank you for getting our book! Over the next 10
posts, we will be reviewing the 10 Principles, including the one about
traction in more detail but for now please let me know if this answers
your question:

Since you are asking about how traction is being performed I will
assume you know the why, what and where about it. How traction is
being performed is a technique question & obviously we do not go into
detail on this in the book & is beyond the scope of this blog to describe it
for assisted stretching. But since traction is such a major component of
our technique & is clearly lacking in all the other assisted techniques as
well as most self-stretching programs, let me briefly explain how you
would traction yourself.

For other readers of this post, please go to p.124 & view the 4 photos of
the stretch. If you don't have the book, just imagine the typical half-
kneeling hip flexor stretch on the ground. The big difference between
the way we do this stretch is by adding self-traction. This means that
you start by inhaling with an erect torso, then as you exhale into the
stretch you maintain a constant lift in the torso until you reach the end
of the stretch, at which time you inhale as you return to the start
position.

In traditional stretching, there is no traction & instead there is
collapsing. Traction adds more complete stretch of the fascia & hip joint
capsule while collapsing compresses the joint.

The whole idea is to maintain space in your joints as you stretch because
as you age this space reduces & starts the downward spiral of joint
deterioration and osteoarthritis.

"Stretch to Win" the book: excerpts & discussion

2008-02-03T10:29:00.000-08:00

In the last post, we mentioned parameters of stretching like
intensity, duration & frequency. We recommend not establishing
these parameters until you first evaluate your flexibility, or
range of motion (ROM). Once the results from the evaluation are
in, you can design an individualized program to increase your
sport-specific flexibility. Instead of a generic stretching program,
you can have a refined flexibility training program that will be
much more responsive to your individual needs as they change
over time. The comprehensive evaluation will also help you
establish a baseline of flexibility that you can refer back to
periodically when you reevaluate your progress. This way, you
are sure to meet your ROM and sport performance goals. The
program of stretching may be set up in special intervals or
periodized over the course of a year to complement your other
sport training.

Before we go into specific parameters or evaluation, we think it's a
good idea to list & explain the 10 Principles that the Stretch to Win®
System is based on:

1. Synchronize your breathing with your movement.

2. Tune your nervous system to current conditions.

3. Follow a logical anatomical order.

4. Make gains in your range of motion without pain.

5. Stretch the fascia, not just the muscle.

6. Use multiple planes of movement.

7. Target the entire joint.

8. Use traction for maximal lengthening.

9. Facilitate body reflexes for optimal results.

10. Adjust your stretching to your present goals.

In the next post we will explain what we mean in each principle.

Stretch to Win: Flexibility for improving athletic ability and sports performance

2008-01-15T21:14:00.000-08:00

Whether they are training for football, golf, a 10K running race, or any sport in the Olympics, most athletes recognize the performance benefits of a progressive strength and conditioning program. However, stretching programs are often less popular, for a variety of reasons. Research on stretching has produced mixed reviews. The physical changes resulting from a stretching program may not be as outwardly apparent as the muscle-mass development that takes place in just eight weeks of strength training in a healthy adult. Therefore, stretching is not perceived as the most productive use of time for an athlete, as is evident in many training programs designed for high-school, college, and even professional athletes.

When athletes stretch at all, they usually do so ineffectively, performing the same old-school stretching exercises that several generations of athletes and coaches have used. These programs often consist of holding the familiar positions to stretch the groin, hamstrings, hip flexors, and low back at the same intensity and for the same duration, day in and day out, regardless of the sport or the particular activities that the athlete will be engaging in that day. Or, even worse, a program may entail many repetitions of quick, jerky stretches (often with the aid of a band or rope) that are supposed to warm up the muscles right before practice or competition. In both cases, the athletes are likely to be worse off than they would have been if they had not stretched at all.

So, is a stretching program just as important as a strength and conditioning program for optimal athletic performance? Yes, if the stretches are performed correctly. This is not just a matter of finding an accurate position to stretch in; it is also a matter of using appropriate training parameters to get the most benefit from the stretch. It means properly warming up the body and developing each specific type of stretch and its intensity, duration, and frequency.

In my next post, I will continue this discussion using evaluations to design individualized programs for sport specific flexibility, which is covered in great detail in my recently published book Stretch to Win by Ann and Chris Frederick. You can see sport specific programs in my new DVD called Flexibility for Sports Performance. Check out both at www.StretchToWin.com.

You may also listen to our podcast at the link above and listen to our virtual book tour. You will hear from real professional athletes about how this particular work has helped them perform better.

While we work on getting videos of stretch programs going for you, check how out the flexibility on a gent called "Rubber Boy" on this video:

Topics for 2008

2008-01-15T15:10:00.000-08:00

For those of you who have been here before, we are starting our blog with a brand new, clean slate! For new visitors, read on...

Stretching and flexibility training is one of the least researched and least understood topics in the broad field of strength and conditioning & is not much better represented in sports medicine, physical therapy or rehabilitation medicine.

As a result of this lack of awareness of the proper parameters to use when stretching, we have specialized in this field and are becoming more well known as pioneers in effective technique development.

Until we publish current research, we can only relate anecdotal evidence but client testimonials can be very compelling when nothing else but our brand of assistive stretching has worked for them.

Nevertheless, we cannot rest on our laurels and so we continue taking courses, realizing that we can always learn and improve and we try to stay up on research in connective tissue biomechanics.

In fact, we attended the First Congress on Fascial Research last fall at Harvard Medical School and will be sharing knowledge with you about recent findings that lend a lot of support to both how we think about the body and how we approach stretching, specifically assistive stretching, that is uniquely effective because it targets the fascia.

Features>>>

this blog is about a totally NEW take on stretching (this is NOT traditional by any means!)
easy, quick & effective stretches to increase your flexibility
practical programs built on a foundation of solid research
Stretch to Win programs for athletes of all ages
Stretch for Life programs for fitness and anti-aging
cutting edge research information & links
authored by a certified flexibility specialist & licensed physical therapist

Benefits>>>

get more flexible quickly & more effectively
your flexibility will last longer
it won't hurt!!
you will move and feel better than you have in years
learn more about how to maintain flexibility to prevent degeneration of your muscles & joints

Enjoy the rest & feel free to comment.