Dan Walsh, chartered physiotherapist at Mid West Physiotherapy, grew up in New Jersey, USA. Unable to achieve his goal of becoming a super-hero, he decided there was other ways to help people in the field of medicine. He attended Thomas Jefferson University – College of Health Professions in Philadelphia, Pennsylvania where he graduated Summa Cum Laude, with a Masters and Bachelors of Science in Physical Therapy. He was licensed and practiced in New Jersey, before moving to Ireland in 2004. He is a member of the Irish Society of Chartered Physiotherapists. He is FMS and SFMA certified.
Dan’s introduction to running
I like to run. What could be easier as an exercise? Quite a few years ago I did what many people do and put on a pair of sneakers and started to run. I engaged in a stretching program to include my main muscle groups of my lower back and legs to prevent muscle tightness and injury.
However, even with the continuation of the stretching program, I started to experience pain in the lower back and buttock radiating into my leg. My pain seemed to improve with movement and activity, and worsened at night and during times of sitting.
What was I doing wrong? I assumed that studying the rehabilitation of injuries could help me prevent becoming injured. I was wrong. In one researcher’s view, apparently I was also working backwards. What I did notice at this time of self-exploration was that I was not alone; many others were experiencing similar difficulties.
Injuries caused by lower extremity mechanics
The turning point for me was at a course given by a University of Southern California researcher and physiotherapist. The subject was about lower extremity mechanics during activity and running, and their role in leg injuries. Research and assessment of the biomechanics and movement of the athletes had begun a few years prior to the course. Utilising dynamic (motion) MRI’s, slow motion videotaping, EMG, and a host of other measurement and testing devices, they began noticing some patterns emerging.
The athletes were often not properly activating their hip muscles (buttocks) during running. In some cases this led to a decrease in thigh kickback (hip extension). In other cases this led to an increase of the thigh turning in (hip internal rotation) with weight bearing. Athletes also showed an increase in hip flexor tightness (the muscles that lift your thigh as if to knee something), with a subsequent decrease in hip extensor muscle activation. This poor control of the hip has been shown to lead to a host of leg injuries from hamstring injuries, knee pain, ACL tears, calf strains, and hip injuries.
So, the world-class athletes in California – with all their talent and fitness combined with the technological advances in sports medicine – were experiencing non-contact injuries secondary to their poor mechanics, well then I didn’t feel so bad!
This was my beginning of attempting to understand and interpret how primitive movement patterns and gluteal muscle timing and strength could affect my physical health.
Primitive movement strategies
Primitive movement strategies are the ones used to describe the movements that most humans explore during growth and development. They include rolling, pushing up, and crawling. Initially, these motions were the first foundation in which we learned to move and stabilize ourselves. Children often explore these positions of mobility and stability on their way toward higher level activities such as kneeling, standing, and walking.
Western society has evolved over the last decades, but one fundamental principle that has undoubtedly occurred is that the movement strategies that we utilise today to run, lift, jump, and play are not the same as our predecessors on this earth. Our lifestyles no longer place the same physical demands on our bodies that were required in the past to survive and succeed on this planet, and which optimised our movement strategies and patterns. Our jobs and what we do at work has changed. Our leisure activities have changed. Our lifestyles and food habits have changed. All these factors and more have affected the way we move and the strategies we utilize to perform higher level activities such as running.
Therefore, it is no longer the case where one can just get out there and move. We must first establish if a person’s movement is fundamentally sound because it can no longer be assumed as a birthright for every human being. One could call it our ‘license’ to exercise and play. After scoring poorly on my functional testing, especially squatting, hurdle stepping, and inline lunging, my ‘license’ to run was revoked; I had failed the primitive movement pattern testing and was set up for injury. Unfortunately, I knew this already – I had been injured.
So how can we prevent these injuries?
The most helpful tools that I found were the Functional Movement Screen (FMS) and the Selective Functional Movement Assessment (SFMA). The FMS is being utilised by healthcare professionals and athletic trainers worldwide to aid in the prevention of time-loss related injuries in athletes at all levels of competition. The SFMA is a detailed assessment for healthcare professionals who want to implement a movement-based approach to identifying movement deficits and treating injuries. This screen and assessment are utilised by organisations such as professional sports teams and the Navy SEALS.
The FMS and SFMA were necessary to explain how I got to the injury stage. Similar injuries, can be created differently. For example, even though I presented with a similar signs and symptoms to many others, when put through functional movement testing, we all moved completely differently. Each had his or her respective strengths and weaknesses, but the common thread was that everyone scored below the threshold that increased the probability of suffering a time loss injury.
For me, it was therefore about developing a program that emphasised both hip and gluteal strength and the improvement of my primitive movement patterns. In theory, this in turn would improve my functional mobility and stability with higher level activities such as running.
Utilising these tools, I was able to identify some of my weaknesses and address them using a ‘neuro-developmental’ approach to my injuries. I was able to ‘clean up’ and improve the technique and motor strategy of my squat, lunge, straight leg raise, and push up. Correction of my movement patterns, combined with hip strength work, helped me to get back running pain-free for the last few years. It is an ongoing and lifelong process, like training for a marathon. I still present with some movement deficits, especially with squatting (similar to most Westerners) but at least now I have a guide to prevent and treat any injuries that plagued me during my first few years of running.
For further information or any resources that were used in the completion of this article please contact me at Mid West Physiotherapy.