Many of us are familiar with the massage therapy term “trigger point.” But, outside of those who work with patients and deliver trigger point therapy on a regular basis, how many of us know how trigger points form? And what can be done to relieve these painful annoyances?  
 
How do they develop?
Trigger points develop as a result of muscular injuries, strains, and trauma. When muscle fibers, fascia, ligaments, or tendons become weakened, overstretched, or inflamed, tiny tears in the associated soft tissue can occur. As the tissue heals it contracts, becoming twisted and knotted. These knotted fibers restrict the fresh blood supply needed by the muscle cells. In addition, there is often a shortening of the muscle fiber to protect itself from further injury.
 
Additionally, structural imbalances, improper body mechanics, poor nutrition and mental or emotional stress are all factors. In effect, the muscle learns to avoid pain and guards against it by limiting its movement. This results in a loss of range of motion of the joint and the probability that the muscle and associated structures will develop trigger points. ¹
 
Skeletal muscle, the largest single organ of the human body, accounts for 40 percent or more of body weight. As reported, there are 200 paired muscles, a total of 400 muscles, any one of which can develop myofascial trigger points.¹
 
How do you locate them?
Trigger points are found within a hard, rope-like or knotted band of muscle. You will know when you have found one as it will be very sensitive to the touch. By sensing this tenderness, you are given an opportunity to become aware of it and to consider its cause. Muscles involved in past surgeries tend to have painful trigger points as do muscles located around the joints. Some points, particularly those between the shoulder blades, will be instinctively located, while others may require a bit of detective work on your part. Gentle stretching of your muscles on a regular basis will provide you with the clues you need to help yourself. ¹
 
Most muscles and trigger points are paired. A point on the right side of your body has a corresponding point on the left side. Normally the most tender of these parallel points or muscles will be on the same side that’s painful. Pressure applied to this side will usually give the most relief. For best results, however, pay equal attention to points on both sides of your body.¹
 
How do they affect the body?
Trigger points can affect movement by keeping muscles short and stiff, which reduces range of motion. They can maintain spasms in other muscles. They prevent muscles from relaxing, causing them to tire quickly, recover slowly from exertion, and contract excessively when they work. They can also keep muscles out of balance to the extent that they partially disarticulate joints, causing them to catch or pop when you move. ²
 
Movement requires some muscles to contract and others to lengthen. Trigger points can make a muscle reluctant to do either. Stretching or contracting irritates trigger points and increases pain, making you less and less inclined to move. Trigger point massage works extremely well for myofascial pain. Done correctly, it usually shows clear results within a week, often in just a day or two. ²
 
How do you perform trigger point massage?
Of course, one of the best ways to tackle nasty trigger points is to make an appointment with your massage therapist. But there are also many self-therapy tools on the market to help overcome the pain of trigger points. The following trigger point massage tools can help alleviate and prevent discomfort throughout the body.
 
 


Franklin Method^® Products
Mind-body guru Eric Franklin is famous for having created his Franklin Method, a movement therapy approach that uses exercises and imagery to help improve how the body functions. He has created several massage and trigger point products that are helpful in releasing tension in various parts of the body.




The Franklin Fascia Massager™ Oval is a small tool that is great for treating the hands, neck, and feet, but can be used to release tension and smooth out connective tissue anywhere on the body. The Franklin Fascia Massager Oval has points that provide a more intense massage and wake up the body’s sensory receptors.

 



The Franklin Fascia Ball is designed for rolling out fascia and providing trigger point therapy for comfort. It’s a great choice for hamstrings, glutes, IT bands, and more. The Franklin Fascia Ball is water-filled for a comfortable density and features a smooth surface.  






This pair of red Franklin exercise balls is perfect for massage of constricted fascia. The balls have a smooth surface and a 3” diameter that allows for precise trigger point relief on the shoulders, neck, and hips. The Franklin Mini Smooth Ball™ Set offers the ability to adjust firmness with inflation, a nice feature to personalize the level of comfort.

 


Breaking it down
The products above are just a small sampling of the many trigger point massage tools available. Find what works best for you and stick with it. Regardless of which massage device you try, applying consistent use and an adequate, “just right” pressure will help you conquer those feisty trigger points.
 
 
1) Hennessey, D (2006). Thera Cane Owner’s Manual. Denver, CO: Thera Cane Co.
2) Davies, C (2004). The Trigger Point Therapy Workbook: Your self-treatment guide for pain relief. Oakland, CA: New Harbinger Publications.

As a company that sells foam rollers as one of its primary products, we get asked the question quite often: “What’s the science behind a foam roller?” Or, as some put it, “Really…how can there be technology in a piece of foam?”

The Rollga^® Dynasty, OPTP’s newest addition to its extensive lineup of foam rollers, offers answers to some of these questions. Shaped to fit the body, the Rollga has a unique contour design that allows for targeted, invigorating massage for tension relief and muscle recovery.

One of the biggest challenges with growing older is that we begin to lose our overall body awareness. This unfortunate (and unstoppable) fact is one of the reasons why there is a direct correlation between falling injuries and age.

Let’s try a simple test. Reach both arms straight over your head and point your index fingers toward one another. Now, without looking up, try to touch the tips of your index fingers together directly overhead. Can’t quite get it? It’s okay, most people can’t do it on their first try, but they can get close.

How do you know where your arms, hands, and fingers are, even when you can’t see them? Body awareness. In this case, the sensory receptors (also known as proprioceptors) in your skin, muscles, and joint capsules were communicating with your brain to tell you where your limbs were, even though you couldn’t see them.

This crucial sense is necessary for many of the basic activities and tasks that each of us performs on a daily basis. And while our body awareness is slowly diminishing as we age, all hope is not lost.

That’s because there’s a second contributor to our body awareness ability — and this one’s actually under our control.   

Move It or Lose It
Lack of movement throughout your life is just as bad as, if not worse than, the physical aging process on your body’s internal balance and health systems. Living a life without exercise or physical activity can, simply put, speed up the aging process.



Look at the chart above. Notice how from birth (the big red dot) as we age, our body awareness abilities are actually increasing (think going from crawling to walking to running as a child). This happens all the way until the age of around 16-18, when we are done growing through puberty and enter adulthood. Then, things start to go downhill, first slowly and then faster as we age.
 
But here’s the good news. Notice the people who follow the path on the red line. They have exercised their entire lives, ate well, and have generally taken good care of themselves. Those on the yellow line decided to ignore exercise and eat poorly. The result? Even though these two groups of people are the same age, one of them is living a fulfilling life while the other has limited functionality.  
 
We can choose to exercise, or we can choose to surrender our body’s mobility.  
 
Movement is Medicine
So we know that movement keeps your body awareness systems activated, your muscles strong, and your mind sound. It can also keep you free from disease, disability, and ailments, and allows you to do what you love. It truly is a medicine.

But what types of movement should we be doing? Are there certain exercises that are better than others when it comes to turning back the hands of time in regard to our balance and body awareness?

The ActivMotion Bar^® was a training tool developed to address these exact needs. ActivMotion Bars are hollow and partially filled with ball bearings that shift during movement. This shifting weight allows you to feel and hear your imbalances as you try to keep the bar stable, training your senses and body awareness.



The 4.5lb ActivMotion Bar, the shortest and lightest weight of all ActivMotion Bars, is the easiest to control but still provides a great workout that builds balance, core strength and stability, and body awareness. It’s an ideal tool for active aging exercise and for anyone looking to focus on their proprioception abilities.

Most importantly, the shifting weight more closely imitates the tasks we are faced with in our daily lives. Its dynamic, constant state of motion means that we are always trying to maintain stability; unlike the static, repetitive movements performed with traditional exercise equipment. The ActivMotion Bar is more representative of real life activities such as gardening, tennis, and playing with children, and helps us prepare our body for doing what we love.

The video below features four exercises performed with the ActivMotion Bar. The moves are specifically focused on the development of proprioception and body awareness. Each can be adapted in different ways to allow for varying degrees of challenge.   



Age is But a Number
While there’s probably no such thing as a fountain of youth, that doesn’t mean we can’t do our best to fight Father Time. As they say, age is merely a number. Stay young by staying active; focus on your proprioception abilities with exercises that challenge your body awareness, core strength, and balance. It’s never too late to start, and your future self will thank you.     


About the Author
Derek Mikulski, BS, CSCS, CPT, is the creator of the ActivMotion Bar. He holds degrees in exercise physiology and health promotion, and also has fitness certifications from NASM, NSCA and NPTI. He launched ActivMotion in 2013, aspiring to build a stronger world through innovation grounded in sound fitness and training theory.

Whether you run to reduce stress, beat the clock, or attain a leaner figure, it’s a lifestyle that’s hard to give up…even in the face of injury.

Over one-third of runners sustain at least one soft tissue injury over the course of a year.^1,2 The following three types of injuries are some of the most common, and ones that you’ll likely experience at some point if you haven’t already. But don’t fear, we’ve identified therapy products for each condition to help expedite the recovery process.

Iliotibial Band Syndrome (ITBS)
ITBS is an overuse injury that presents itself in up to 12 percent of runners each year, and it is the most common cause of lateral knee pain in running athletes.⁴ Significant risk factors include downhill running and an abrupt increase in running distance, pace, or frequency.

One of the best ways to tackle Iliotibial Band Syndrome is through myofascial release with a foam roller. Foam roller therapy is an essential aide for several running injuries, including ITBS.³ If you’re new to foam rolling, it can be a bit overwhelming as foam rollers come in all shapes, sizes, and densities. This page provides a brief introduction to foam rollers to help you get started.

Once you’ve found your roller, take advantage of the many educational resources out there that will help you use it. Foam Roller Techniques by Michael Fredericson, MD features color illustrations and clear, step-by-step instructions to effectively massage and stretch a runner’s most important muscle groups, including the IT Band. Check out the video below and see how to massage the IT Band and other sensitive areas with your roller.



Shin Splints & Ankle Sprains
About 10-20 percent of all runners experience a bout of medial tibial stress syndrome (MTSS), or shin splints, at some point during their career.⁸ For inflammatory conditions like shin splints or ankle sprains, ice, rest, and orthotic shoe inserts are commonly prescribed.

Kinesiology taping, however, offers additional options for pain modulation and return to function. Unlike conventional tapes, SpiderTech^® kinesiology tape has the same weight, thickness, and elasticity as human skin, allowing it to work naturally with the body’s own sensory system to reduce pain and provide natural stability. It’s available in more than a dozen pre-cut applications, including designs for the ankle as well as a foot arch and calf combo.  

Another way to address shin splints, ankle sprains, and calf strains is with the OPTP Slant^TM. This pair of lightweight foam wedges allows for simple stretching exercises. Their 18-degree incline is ideal for stretching the hamstrings and calves to help with tight fascia and strengthening of the tissues in this region.

Plantar Fasciitis
Plantar fasciitis is the third most frequent injury among runners.⁵ It is characterized by inflammation in the long tendon at the bottom of the foot, which stretches from the heel to the toes. Although the etiology of this condition is controversial, several risk factors, including high body weight and reduced ankle dorsiflexion, have been associated with increased incidence rates.⁶ Research suggests that conducting tissue-specific plantar fascia stretching several times a day helps alleviate and prevent pain due to chronic plantar fasciitis.⁷

With a cradle design that encompasses the foot, the Stretch-EZ™ is a unique stretching aide that assists with plantar fasciitis, as well as calf, thigh, hip and low back strains and injuries. By inserting the foot into the cradle and pulling back, it produces superior dorsiflexion of the toes that stretches the plantar fascia. Since the Stretch-EZ features multiple strap loops, it allows you to safely and easily control each stretch.

A lot of runners are told to use a tennis ball or lacrosse ball for their plantar fasciitis. While this can be a viable option, there are plenty of products out there designed specifically for massage of the foot. These Half Balls are the ideal texture and firmness for that purpose. The flat bottom ensures they won’t roll away during use, making it easier to target specific areas for a better massage and stretch of the plantar fascia.

Back Up and Running
Perhaps you’ll be one of the fortunate ones who’s able to steer clear of these running injuries. But if not, you now have some basic knowledge to guide you on the path to recovery. Hopefully, with consistent use of the right therapy tools and a mental approach grounded in patience, you’ll be back out on the pavement and trails before you know it.

* For your safety, always consult with your healthcare professional before starting any type of exercise or stretching program, especially if you have any health concerns. Products mentioned in this article are intended to provide therapeutic relief but do not guarantee cure of condition.


References
1 Buist I, Bredeweg SW, Lemmink K, et al. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study.
Am J Sports Med. 2010; 38(2):273-280.
2 Rauh MJ, Koepsell TD, Rivara FP, et al. Epidemiology of musculoskeletal injuries among high school cross-country runners. Am J Epidemiol. 2006; 163(2):151–159.
3 Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006; 16(3):261-268.
4 Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Med. 2005; 35(5):451-459.
5 Ribeiro AP, Trombini-Souza FT, Tessutti VD, et al. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clinical Biomechanics.
2011; 26:194-199.
6 Riddle DL, Pulisic M, Pidcoe P, et al. Risk factors for plantar fasciitis: a matched case-control study. Journal of Bone & Joint Surgery. 2003; 85A (5):872-877.
7 DiGiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia–specific stretching improves outcomes in patients with chronic plantar fasciitis: a prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2008; 88:1775–81.
8 Hubbard TJ, Carpenter EM, & Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exercise. 2009; 41(3): 490-496.

Whenever I make the statement “every patient has a brain,” I hear the same joke: you haven’t met my patient. Of course, they’re kidding, but there’s a dangerous assumption in their joke. What’s more concerning is that many clinicians have seemingly forgotten that every patient has a brain. There are three major issues that warrant discussion.

Tissues and Pain
First, let’s discuss the assumption that pain comes from tissues. The Cartesian model that correlates tissue issues (nociception) to pain is over 350 years old, and it’s still doctrine in medicine and various therapies. The model is false. You can have tissue injury and no pain. You can have pain and no tissue injury. For too long, practitioners and patients have sought answers to their pain by exploring the various tissues, including joints, muscles, ligaments and more. Pain is a leading reason that people seek care, and when they do seek help for pain, they are presented with a tissue-based model to explain their pain.

Think about it: A patient comes to you seeking help for pain, and you teach the patient anatomy! No wonder pain rates in the US have doubled in the last 15 years alone. Never before have we performed as much surgery or prescribed as much medicine for pain in the history of mankind, and pain rates are ever-increasing. A large portion of the blame should be leveled at these outdated models. It’s time practitioners wake up and realize people in pain are interested in…pain! This leads us directly to the second issue.

Pain Neuroscience Education
There is also an assumption that patients are not smart enough to learn the latest neuroscience of pain. Shame on us for thinking that. Research has shown patients are, in fact, able to understand the biological processes of pain. Pain neuroscience education (PNE) takes complex neurobiological and neurophysiological processes and explains pain to patients via metaphors, examples, and pictures. We have been teaching people about pain for years, in various countries, to different age groups, in different languages, to various ethnicities, etc. The end result? They all get it. The best part is they experience less pain and disability; move and function better despite no hands-on interventions; catastrophize less; are less afraid and are able and willing to move further into pain during exercise and functional tasks.

Healthcare education has simply become a display of knowledge. “Let me tell you how much I know about….” The language we use is completely foreign to patients. Even more worrisome, the current medical vocabulary contains various terms and languages that actually increase fear and anxiety. Ever been guilty of using terms like “torn,” “ripped,” “instability,” “bleeding,” “rupture” and so forth?

Top-down Approach: Brain First
The third issue needs special attention. Manual therapy, electrical modalities, exercises and so forth have been around for decades and form the mainstay of many therapies. These approaches are still based on the Cartesian model: intervene on tissue level and pain will get better. How is that working out for us? One in four Americans has persistent pain. The key issue is right in front of you, every day. It’s attached to your patient. Every patient has a brain! Current therapies focus so heavily on a bottom-up approach they forget this simple fact. The sad reality is that the cognitive approaches, such as pain neuroscience education and altering a patient’s beliefs, may be far superior in their outcomes compared to traditional bottom-up treatment models.

Pain is 100 percent produced by the brain based on the perception of threat. What a patient thinks and believes contributes to their pain experience considerably. Altering what a patient thinks or believes can alter the patient’s pain experience, hence the “top-down” approach. It is suggested that this approach could be far superior to the typical bottom-up approach. For example, patients who receive sham surgery for compression fractures, but believe the tissue issues are fixed during the surgery, perform just as well as patients who actually have the compression fracture surgically corrected. For patients with chronic pain, functional MRI scans show reduction of brain activity after pain neuroscience education, results that are far superior to any narcotics currently used on the market. Spinal movements and neurodynamic test improves significantly in patients after receiving PNE and no hands-on therapy.

To date, a dozen high-quality randomized controlled trials and two systematic reviews have shown that when people in pain are taught more about their pain, their pain decreases, function improves, catastrophization reduces and they’re more interested in movement and exercise. Now, imagine you do both: a bottom-up and top-down approach. All clinicians talk to their patients. Sure, you could chat about last night’s game or the local weather report, but why not use any/all clinical time to teach patients about pain? You could teach them while doing the movement-based approaches of manual therapy, exercise and more.

It’s Time to Start Treating the Brain
Pain neuroscience education provides clinicians with step-by-step, validated, evidence-based approaches to treat patients with chronic pain. We have the research data to prove we don’t just merely “manage” these patients’ pain, but can actually help them recover and experience less pain and disability. The best part is that our current research (various papers accepted for publication or under review) has shown that PNE is helpful for patients in the acute and sub-acute phase. In these scenarios, patients not only experience less pain and disability, but pain neuroscience education may in fact preempt the development of chronic pain. Chronic or acute, we know where all pain is produced. It’s time we start treating the brain, as well as the body.

About the Author
Physical therapist, neuroscience researcher and author Adriaan Louw has been teaching throughout the US and internationally since 1996. Adriaan has authored and co-authored numerous articles, books and book chapters related to spinal disorders and pain science.


References
1. Gifford LS. Pain, the tissues and the nervous system. Physiotherapy. 1998;84:27-33.
2. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation. Dec 2011;92(12):2041-2056.
3. Louw A, Butler DS, Diener I, Puentedura EJ. Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. May 2013;92(5):446-452.
4. Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport. Aug 2012;13(3):123-133.
5. Moseley GL, Hodges PW, Nicholas MK. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain. 2004;20:324-330.
6. Moseley GL. Reconceptualising pain according to modern pain sciences. Physical Therapy Reviews. 2007;12:169-178.

The Bar and its Activating Functional Mobility book provide a host of effective exercises for physical therapy patients

When I first picked up an ActivMotion Bar®, I was instantly intrigued. So many ideas came into my head, I spent a few hours testing it out and I was instantly hooked. I brought it to work the next day and started integrating the Bar into the exercise programs of many of my patients – those dealing with balance issues, those with trouble correcting scapular dyskinesia, post-ACL reconstruction patients learning to use full knee extension and maintain their stability in standing, and patients learning to stabilize their entire bodies by connecting their scapula, trunk, and pelvis with dynamic movements.
 
Incredible Sensory Feedback
I use a wide variety of techniques and tools to facilitate and correct functional movement patterns, and I was surprised how the Bar not only fit into each patient’s exercise program but how much better it was than other tools. ActivMotion Bars provide the feedback that our patients need to be aware of and self-correct dysfunctional movement patterns. As we all know, self-awareness plus quality feedback provide the best environment for learning. The sensory feedback provided by the Bar is almost more accurate than we as PTs can be with our own eyes and movement assessment skills. It is more sensitive and more tactile, as a slight hike of the shoulder or a dip of the hip into Trendelenburg can cause the rolling steel weights to shift and let the user know that they’ve lost their stable position. In addition, it gives them feedback when they’re doing the exercise correctly, as they can feel the weights become stable, but not static, inside the Bar. I enjoyed seeing my patients respond quicker, become more motivated, and enjoy their exercise programs more when using the Bar. I soon saw many of my patients carrying the Bar around the clinic and asking to use it even for exercises that had not previously involved the Bar.
 
Creating a Comprehensive Program
When I was approached by ActivMotion and OPTP to come up with a manual for how to apply the Bar to the field of outpatient physical therapy, I felt challenged in creating something that would accurately represent the Bar and all of its capabilities. How do I build a systematic functional exercise program for something that is so dynamic? We collaborated, and eventually came up with a system of three different ways to use the Bar; the first two using the Bar for facilitation and the third using the Bar for eccentric resistance. I brainstormed daily in the clinic and compiled a list of exercises, then categorized them in to the three cardinal planes of motion (sagittal, frontal, and transverse) to provide a comprehensive program of corrective functional movements. The result is Activating Functional Mobility: A Guide to Rehabilitation Training with the ActivMotion Bar. Breaking Down the Exercises
The exercises are divided into sections that each address a common area of instability: Scapular instability, trunk instability, and hip/pelvic instability. Having to hold and stabilize the Bar actually makes every exercise a scapular stability exercise. We commonly refer to the “core” as simply trunk and lower body stability, but it is important to include the scapula as it is the proximal attachment of the upper extremities to the trunk. As there is no inherent joint space or ligamentous stability in the scapulothoracic joint – only muscle attachments – nearly all stability here relies on muscular control. Within each section (scapular, trunk, and hip/pelvic) there are 9 different exercises: three levels of exercises in each of the cardinal planes of motion. From here we can start our patients with a beginner level exercise in any of the planes of motion and progress them from using the Bar to provide tactile feedback to assist with stabilization, to using the Bar for dynamic resistance and eccentric loading of the joint stabilizers.
 
Beginning Level Exercises: Introducing Balance & Proprioception
The beauty of the ActivMotion Bar lies in its versatility. The beginner level of exercises in each section of stability involves using the Bar pressed against the body to physically create a closed-chain connection between the body and the Bar. The tactile feedback of the Bar’s connection to the body as well as the tactile and auditory sensations of the rolling steel weights shifting as the patient strives to find equilibrium help to stimulate the patient’s proprioceptive systems and facilitate a correction of that movement through increased self-awareness. The beginner level of exercises involve keeping the Bar parallel to the floor and are more isolated movements focused on gaining static stability through tactile sensation. A hook-lying bridge while pressing the Bar into the hips is an example of a beginner level sagittal plane exercise. Using the Bar to anchor the upper extremities to the trunk and facilitating symmetry in the hips and pelvis is great for correcting common deviations of lumbar extension, asymmetrical hip extension, and muscle imbalances between sides.



Intermediate Level Exercises: Increasing the Core Stability Challenge
The intermediate level of exercises in each section of stability involves moving the Bar with the body, while also maintaining a parallel position of the Bar to create balance. Exercises in this section require more stability than the beginner section as the patient now has to work to control their body and the Bar together in more active, dynamic movement patterns. The intermediate level progression of the hook-lying bridge is the side plank hip swing, in which the patient maintains a stable forearm side plank with the Bar balanced on the top leg and flexes and extends the top hip. Maintaining a balanced position of the body while moving the top leg and Bar together dynamically improves hip and pelvic stability in individuals with gait deviations. The patient can hear and feel the weights in the Bar shifting if they don’t maintain neutral hip abduction, and they are simultaneously working on trunk and scapular stability to keep their balance.


Advanced Level Exercises: Dynamic Moves, Full Range of Motion
The advanced level of exercises in each section of stability involves tipping, tilting, or swinging the ActivMotion Bar to create dynamic resistance throughout the full range of motion and provide eccentric core muscle activation at the end ranges of the movement pattern. Patients can feel and hear the active resistance shift within the Bar, and use this as feedback to create a rhythm and sequence the movement correctly. As patients tip, tilt, and swing the Bar, the resistance shifts to the end of the Bar and creates an eccentric force resulting in even greater contraction of the major core muscles as they work to control the increased weight. In Activating Functional Mobility, the advanced level sagittal plane hip/pelvic stability exercise is the static lunge with overhead sidebend. The sagittal plane muscles are working to maintain a stable position of the lower extremities, while the trunk and scapular muscles activate dynamically to tip and tilt the Bar and create a sense of dynamic instability for the lower extremities. This exercise could also be considered an advanced frontal plane stability exercise for the trunk and scapular stabilizers.


An Excellent Method of Corrective Exercise
In nearly every exercise performed with the ActivMotion Bar, users are truly required to stabilize their entire body, making the Bar a very effective and efficient tool for facilitating functional movement patterns in corrective exercise. Capturing the benefit of these traits, Activating Functional Mobility contains an overview on the science behind facilitating stability and proprioception in the human body. It also contains information regarding the unique aspects of the ActivMotion Bar, and instruction on cueing fundamentals to assist you in helping your patients use the Bar to its fullest potential.

Low back pain. Millions of Americans have had it or will have it at some point. It’s estimated that it affects nearly 80% of us at one point in our lives (Adriaan Louw, Everyone Has Back Pain, 2015). And then there’s the expense. Billions of dollars go toward medications and surgeries to combat the common condition, though these costly solutions may be temporary or ineffective.

So how do back pain sufferers, or those who might be forced to deal with the formidable beast somewhere down the road, rise to the challenge? Here are three simple and affordable (compared to the alternatives) actions we can take to help prevent or alleviate pain.

1.    Increase Movement
Sitting has actually been called the new smoking. While this may be a bit of a stretch, it goes to show that many experts agree on the dangers of prolonged sitting. The fact is, we’ve become a sitting society (sit in the car on the way to work, sit at work for eight hours, sit in the car on the way home, sit on the couch), and our spines — not designed for this — are feeling the effects.

Due to this stagnant behavior, we tend to suffer from a lack of blood flow and oxygen to the discs of the spine. As physical therapist and research specialist Adriaan Louw says, “Motion is lotion.” When we don’t move enough, we don’t hydrate the discs, leading to more stiffness and less flexibility (think Tin Man from Wizard of Oz).

So what’s the best way to increase movement? Most experts recommend 30-40 minutes of moderate exercise four days per week. But even those of us who are achieving that outside of work might still struggle with back problems if we spend numerous hours plastered to an office chair. To be aware of how long you’ve been sitting at work, set a reminder on your phone, watch, or computer that tells you to get up and move. Take periodic breaks to get water or just get up and walk around.

A great way to increase movement and provide the back with therapeutic exercise is to use a foam roller. Foam rollers provide rejuvenating massage and tension release, helping to hydrate fascia (the body’s connective tissue). These foam roller videos demonstrate how to foam roll to relieve lower back pain.

Can’t foam roll at work? Incorporate some basic stretching into your day as your job allows. Occupational therapist Angela Kneale provides some ideas on how to do this without even leaving your desk in her exercise book, Desk Pilates. Another excellent way to reduce sitting time is to use a raise-lower workstation that allows you to stand while at your computer; many companies are now implementing them.


2.    Improve Posture
Sure, we’ve all heard this one before. But the way we carry ourselves while walking, lifting heavy objects, sitting and sleeping has a direct impact on our spine. And as we know from point #1, many people spend a good portion of the day sitting, so proper posture and alignment is crucial.

The spine’s natural ‘S-shaped’ curve provides the key. Many people tend to slouch forward while at a desk or computer, eliminating their natural curve and proper alignment. It’s so easy to do, it usually happens without realizing it.


To counteract slouching, try a posture awareness device that keeps the head from moving too far forward. The OPTP Posture Supporter™ can be worn discreetly underneath clothes to help reduce poor postural habits. It promotes awareness of spinal posture and assists in retraction of the shoulders.


Another product that helps promote proper sitting position is a lumbar roll. Placed behind your lower back (lumbar region of the spine) on a chair or vehicle seat, it encourages good alignment while providing a comfortable support. One the most popular pain relief products of all time is the Original McKenzie^® Lumbar Roll™, a foam cushion that has helped thousands achieve freedom from low back pain. Its simple design is the brainchild of the late Robin McKenzie, a world-renowned therapist who was also responsible for the famous McKenzie Method^® of self-treatment.


3.    Get Stronger
Our muscles can also be a culprit. Because the lower back is not an area of the body that is often worked in most exercise programs, the muscles in this region can become underutilized and weak. It’s important to include forms of exercise that directly address the low back, hips, pelvis, and abdominals, helping to make these core muscles stronger. Stronger back muscles will not only alleviate pain, but also help prevent injury, especially in the case of lifting heavy objects.

Training core muscles can be done in many ways. Simple, classic moves such as sit-ups, squats and planks can be easily performed using just your own body weight. Practices that endorse controlled, focused movement such as Pilates and yoga are also excellent for enhancing core strength. Consider signing up for a class with a local instructor or practicing basic moves at home. Many exercises can be done without the aid of equipment, though these core strength and stability products make excellent props for use during Pilates and general fitness routines. As always, make sure to consult with your physician before starting any exercise program.

When Joseph Pilates first administered his exercise regimen in early 1900s Germany, it was practiced mainly by soldiers returning from war. Much has changed since those beginning days, but the method continues to be admired by many all over the world. More and more people today are discovering the benefits of Pilates, an exercise discipline that inspires focused, controlled movements.   

Advances in Pilates equipment have provided us with fresh new exercises, as well as creative challenges for existing ones. While the following three props might not have been part of Joseph Pilates’ original vision, they might be just what you need to spark motivation and take your workout to the next level.

1.    ActivMotion Bar^®
What is it?
The ActivMotion Bar is a unique piece of fitness equipment that was developed by personal trainer and strength and conditioning specialist Derek Mikulski. At first glance, it may seem just like any other weighted bar you’d find in the gym. But once you pick it up, you quickly realize that’s not the case. Weighted ball bearings inside the bar shift back and forth, creating instability as well as a very intriguing sound. The shifting weight challenges and activates your core muscles during exercise, with some studies revealing as much as a 173% increase in core engagement over traditional fitness tools.

What makes it amazing?
Unlike other props you may have used during Pilates workouts, the ActivMotion Bar is constantly moving, providing continuous feedback regarding your positioning, areas of weakness, and imbalances. Being that it requires more strength and stability to operate, the bar forces you to become aware of your body and engage muscles you may not otherwise use in order maintain controlled balance.

How do you use it?
The ActivMotion Bar can be used during either mat or reformer workouts. Half roll-down variations where you either attempt to keep the bar stable or tilt it from side to side are just one of many moves that work nicely with this unique tool’s design. The bars come in several weight and length variations, though the 4.5lb ActivMotion Bar is ideal for Pilates. A book by Derek Mikulski, Activating Functional Mobility, explains in more detail how to use the bar and demonstrates exercises for Pilates, therapy, and golf.

2.    Stretch Out Strap™
What is it?
The Stretch Out Strap is a woven strap with multiple loops designed to help you get a good stretch, promoting flexibility and range of motion for major muscle groups. While the strap was originally intended as more of a pre and post-workout tool (warmup before athletic event or stretching afterward for aiding in injury prevention), Pilates and yoga enthusiasts have found that it’s perfect for use during an exercise routine as well.   

What makes it amazing?
The simplicity of the Stretch Out Strap’s design makes it incredibly easy to use, and the multiple loops ensure that people of all different sizes can make it work for them. The multiple loops also allow for a wide variety of exercises, bringing a new twist on familiar movements. For those who might not be quite as flexible, the loops enable them to perform movements more comfortably and effectively; movements that may have been more difficult or otherwise not possible. Another benefit: The small, lightweight strap is easily folded up and placed in a bag for taking to the studio.      

How do you use it?
Traditional Pilates movements integrate nicely with the Stretch Out Strap. The strap assists in exercises that lengthen and strengthen the body, helping build greater control and awareness of movement. The classic spine roll is an example of a move that is enhanced with the strap. By placing your hands in the strap loops at holding them taut above your head while performing spine rolls, you make this move more challenging and obtain additional core strengthening benefits. Moves such as this, along with many others, can be found in Angela Kneale’s exercise book, Stretch Out Strap Pilates Essentials.



3.    SMARTROLLER^®
What is it?
The two-sided design of the SMARTOLLER foam roller is unlike other foam rollers on the market. With both a flatter side and a rounder side, it provides the ability to easily make any exercise less challenging or more challenging. Like traditional full-length rollers it measures 36” in length, allowing you to fully lie on it to perform a wide range of exercises. The unique two-in-one roller is the creation of physical therapist and certified Pilates instructor Stacy Barrows.   

What makes it amazing?
The SMARTROLLER offers the same benefits of tension release, self-massage and increased flexibility that traditional foam rollers do, but its dual-sided design takes things one step further. Used with the flatter side down it is ideal for balance movements, while placing the rounder side down provides a more challenging, dynamic workout. In addition to Pilates moves, the SMARTROLLER can also be integrated into training principles of the Feldenkrais Method^®, a sensorimotor learning approach that promotes higher states of body awareness.

How do you use it?
Since the SMARTROLLER offers both a traditional rounder side as well as a flatter side, you can choose your level of challenge. For those who are less experienced, exercises can be performed with the flatter side down for increased stability. A simple flip to the rounder side down results in more of a core stability challenge. Exercises such as the abdominal curl-up (pictured with the spine resting comfortably along the flat side) are excellent for core strengthening. This is just one of many possibilities demonstrated in Barrows’ SMARTROLLER Guide to Optimal Movement, an exercise manual designed for diverse ages and abilities.


Keep Evolving
Pilates, both its exercises and equipment, continues to evolve. As we learn more about health science, the practice will only further be enhanced by a deeper understanding of the body and new tools designed to promote strong, efficient movement. By adding products like the ones mentioned above to your routine, you, too will be able to evolve; mixing things up and adapting to your needs as you progress. 

Sure, the word on the street is out that foam rollers are great for self-massage, myofascial release, reducing muscle soreness, and increasing flexibility. But how many times have you thought about using a foam roller during exercise, as opposed to preparation for it or recovery from it afterward?

Magical Versatility
The foam roller can actually be used to perform a wide variety of exercise movements. Who knew? Turns out that a lot of folks in the Pilates and yoga scene did. In these disciplines, the roller is often used to create an instability that challenges the core, promoting strength and balance. Other movements use the roller in ways that increase flexibility and range of motion, such as stretching exercises. Like many fitness products, foam rollers hold possibilities for movement that are nearly endless, limited only by the imagination. But if you’re not feeling terribly creative, don’t worry…we have three great exercises demonstrated below, just waiting for you to try.    

Exercise #1: Toe Taps
This classic Pilates mat exercise is a great way to integrate the core and lower body. Adding the foam roller provides an extra balance and stability challenge, providing even further core engagement. When done slowly with precision, you can really feel the deep core muscles being worked.

How to Perform:

• Lie vertically along the length of the roller as pictured
• Rest your hands along the ground for stabilization
• Keeping both feet together, pull your knees toward your chest as shown
• Slowly, with focused control, lower one leg at a time until you tap your toes on the floor
• Return to starting position, then continue to alternate lowering each leg

Exercise #2: Push-Up Combo

Push-ups have been long regarded as one of the best exercises you can do for building upper body strength. This spin on the classic takes it to the next level. A great training and conditioning or general fitness exercise, it adds a “pike” component to challenge your core as well as your upper body.

How to Perform:

• Begin with your hands placed on the roller in push-up position, feet close together
• Perform a standard push-up
• Roll the roller in toward you and perform a pike
• Roll the roller back out away from you, extending into the top position of a push-up
• Slowly lower yourself back down into starting position, then repeat 

Exercise #3: Abdominal Crunch
The basic crunch is not an extremely difficult move. But performing crunches while balanced lengthwise along the roller makes for a much different experience. The instability of the roller requires more balance, making it an effective move that promotes a broader range of core activation.

How to Perform:

• Lie vertically along the length of the roller as pictured
• Place your hands behind your head
• Slowly curl upward using your abdominal muscles
• Don’t go too far forward; keep tension on the abs and avoid straining the neck

Looking for more?
Ask your fitness instructor if he/she is aware of more ways to use the foam roller in your exercise routines. Pilates instructor and integrative health coach Angela Kneale also has some great exercises for the foam roller in her books PRO-ROLLER Pilates Essentials and PRO-ROLLER Pilates Challenge. And don’t forget the plethora of foam roller exercise videos out there that can help you put that roller to good use. With so many ways to use the foam roller, you’re sure to enjoy all the creative challenges that it offers.
 

You might have heard about goop, Gwyneth Paltrow’s ambitious project that encompasses all things trending in the healthy lifestyle space. From content to products, the goop website and its various forms of outreach embrace topics such as clean-eating recipes, fashion, mindfulness, travel, and fitness. Here’s more about goop and their upcoming wellness summit scheduled for June 10, 2017 in Los Angeles, California.

The Scoop on goop
Actress Gwyneth Paltrow started goop as a weekly newsletter in 2008. According to the goop website (goop.com), she wanted “A place to organize her unbiased travel recommendations, health-centric recipes, and shopping discoveries for friends, and she also wanted to get her own questions—about health, fitness, and the psyche—answered.” The endeavor grew and has now become, as the website says, “A fully formed lifestyle site, offering a tight curation of products and content.”
 
 
Going All-In on Wellness
In goop Health, goop’s upcoming wellness summit, is being held on June 10 in Los Angeles. The event will share an array of healthy living content in the form of guest speakers and breakout sessions. Although just one day, the in-depth event promises to be packed with valuable information in the form of “…panels, keynotes, and restorative interactive sessions from the health-defining doctors and experts we rely on at goop.” Attendees will also get exclusive access to a market set to include beauty products, food companies, wellness products, and more. As the site says, “In goop Health brings our most requested and shared wellness content to life.”
 
 
Foam Rolling: Art & Science
The event will feature a number of wellness sessions led by health professionals. Topics include Crystal Therapy, Mani Time, I.V. Drip, Aura Photography, Flower Remedy Station, Sound Bath, and The Foam Rolling Physique. The Foam Rolling Physique session will be led by fascia and alignment expert Lauren Roxburgh, dubbed “the body whisperer” by goop. According to the website, Lauren will take participants “Through a revitalizing roller routine designed to flush toxins from the lymphatic system, reduce pain, and diminish cellulite — while lengthening and toning the body.”
 
While it might sound like a foreign concept, it’s one that Lauren Roxburgh has perfected. The certified Structural Integration practitioner and celebrity trainer released her first exercise book just a little over a year ago; Taller, Slimmer, Younger: 21 Days to a Foam Roller Physique. All of the book’s movements utilize the foam roller, and are part of a system based on the Rolfing “10 Series” combined with elements of Pilates. The program guides the reader through a series of foam rolling techniques for a balanced, aligned and more youthful body, as well as a calmer state of being — all in just 15 minutes a day over the course of 21 days.
 
Lauren, who was named by Shape Magazine as one of their "50 Hottest Trainers in America," developed her signature technique as a way to help busy clients with body transforming, muscular sculpting, stress releasing, and fascial remodeling. Her quest for the ideal foam roller eventually led her to OPTP, where she collaborated to develop the LoRox Aligned Roller™. The unique foam roller features raised, circular bumps that aid in lymphatic drainage and decreasing inflammation. Not only will the LoRox Aligned Roller be used in Lauren’s session at the event, but attendees will receive complimentary goodie bags that include a portable version; the LoRox Aligned Travel Roller™.


The Who’s Who of Health
Anyone attending In goop Health will have an amazing opportunity to see and hear from some of the biggest names in the industry. Wellness experts and celebrities that will be in attendance include:

• Tracy Anderson, fitness trainer
• Dr. Robin Berman, psychiatrist
• Tory Burch, CEO & designer, Tory Burch LLC
• Cameron Diaz, actress, author, advocate
• Dr. Steven Gundry, surgeon & author of the Plant Paradox
• Dr. Alejandro Junger, founder, The Clean Program
• Jenni Konner, writer & Lenny Letter cofounder
• Elise Loehnen, Head of Content, goop
• Seamus Mullen, chef, restaurateur, author
• Dr. Amy Myers, functional medicine practitioner
• Gwyneth Paltrow, CEO & founder, goop
• Esther Perel, psychotherapist
• Nicole Richie, entrepreneur, philanthropist, actress
• Dr. Habib Sadeghi, integrative practitioner & Be Hive of Healing cofounder
• Dr. Sherry Sami, integrative orthodontist & Be Hive of Healing cofounder
• Dr. Oscar Serrallach, family practitioner
• Dr. Phil Stutz & Barry Michels, psychotherapists & authors 

 

The International Spine & Pain Institute (ISPI) Clinical Conference will once again be held at the Hilton in Bloomington, MN. This year’s conference will be held June 9-11, and the theme will be Neuroplasticity: Reshaping the Treatment of Pain.

The conference will focus on reshaping pain from a neuroplasticity perspective. Increasing understandings of the functional and structural changes of the brain in people struggling with pain provide exciting opportunities to help with their suffering, and the presentations at this event will focus on these opportunities. The conference will feature both keynote presentations as well as breakout sessions on targeted topics.

This year’s scheduled special topics and lab sessions include:

• Neuroplasticity and the treatment of pain
• Graded motor imagery
• Neuroplasticity for shoulders
• Motor control
• Dystonia and sensory processing disorders
• Neuroplasticity and dry needling
• CRPS, CLBP and neuroplasticity
• Mirror therapy
• Virtual reality
• Peripheral neuropathy
• Phantom limb

Physical therapists, physical therapy assistants, and many other healthcare providers who address patients with chronic pain will benefit from the knowledge shared at the event. The ISPI Clinical Conference provides a chance to hear from many international and nationally recognized speakers, including the following:

• Paul Hodges PT, PhD, MedDr, DSc, BPhty(Hons), FACP
• Siobhan Schabrun PT, PhD, BPhy(Hons)
• Nancy Byl PT, PhD, FAPTA
• Hunter Hoffman PhD
• Steve Schmidt PT, M.Phys, OCS, FAAOMPT
• Kory Zimney PT, DPT, CSMT, TPS
• Louie Puentedura PT, DPT, PhD, OCS, FAAOMPT, CSMT, TPS
• Adriaan Louw PT, PhD, CSMT, TPS
• Paul Mintken PT, DPT, OCS, FAAOMPT
• Edo Zylstra PT, DPT, OCS
• Kevin Farrell PT, PhD, OCS, FAAOMPT
• Debra Rico PT, DPT, CSMT
• Colleen Louw PT, MEd, CSMT
• Rebecca Vogsland DPT, OCS, CMTPT, CSMT, TPS
• Lindsay Marth MA, OTR/L, TPS 

As title sponsor of the event, OPTP will be providing therapy products and educational resources for viewing and sale, including exclusive neuroscience education products by guest speaker Adriaan Louw.

Anyone interested in attending the event can view complete information and register online at the ISPI website.