Athletic Therapy, Chronic Pain, health, nutrition, Weight Loss, Wellness

Lessons Learned – Experience Shadowing a Rural Physician By: Logan Brennan

April 7, 2019April 8, 2019 Katmah

Part I – Life of a Rural Physician

Introduction

This past week I had the incredible opportunity to shadow Dr. Reid Hosford and Dr. Megan Cook at the Pincher Creek Hospital in Southern Alberta. Dr. Hosford is a General Practitioner Anesthesiologist (GPA) and Dr. Megan Cook is a Resident Family Physician working with Dr. Hosford. I was introduced to Dr. Hosford through a family friend who suggested I contact him to better understand the life of a rural family physician and to help me determine and understand if this is my ultimate career goal in life. After observing two clinical shifts, one surgery, one colonoscopy and an overnight emergency room shift, I have a significantly greater understanding of the life of a rural physician and a greater appreciation for the entire health care system. As a practicing Athletic Therapist and Community Outreach Coordinator for Integrative Movement I walked away with many Lessons Learned which I hope to share with our followers as well as apply to my current practice and future endeavours.

Demands and Life of a Rural GPA

There is no doubt physicians have a career which demands an exceptional quantity of time and commitment. As most of you know, physicians generally work long hours, are on call both weekends and nights, have massive patient loads and function in multiple roles and capacities depending on the needs of the organization and community (clinical, emergency, in patients etc).

Dr. Hosford demonstrates the importance of achieving a healthy work life harmony. I chose the term work life harmony because I believe Jeff Bezos explained it best. “Having a work life balance is a debilitating phrase which implies a strict trade off.” The term work life balance creates competing interest rather than emphasizing the interrelatedness of your occupation and life. In order to achieve work life harmony you must recognize this as a continuum rather than a balancing act. Dr. Hosford demonstrates these skills well by maintaining an active lifestyle and prioritizing his young family amidst just recently beginning his career as a practicing physician.

Teamwork and Breadth of Knowledge

Rural physicians epitomize being a career generalist. The demands and problems which a rural physician faces are diverse to say the least. From ingrown toe nails and strep throat, to drug overdoses and surgeries, rural physicians truly have an incredible breadth of knowledge and skills. Because of this variability in practice, the entire healthcare team must work seamlessly and expect exceptional teamwork from all members.

During shadowing, I was continually impressed with the level of communication, respect and accountability which every member of the team demonstrated. From administrators, surgeons, nurses, students, homecare workers and physiotherapists, every member demonstrated professionalism and was appreciative and understanding of each member’s role to achieve the collective team goal. My take away from this experience is that with the right leaders and the right mindset, teams can accomplish and solve exceptionally variable and complex problems.

Responsibility

Although I have always recognized the societal responsibility of physicians, after shadowing Dr. Hosford I acquired an even greater appreciation for the responsibility they bear. Rural physicians are not only Doctors. They are life savers, community leaders, policy makers, counsellors and above all genuine and caring human beings. From delivering babies and completing one-year old check-ups, to treating patients with terminal cancer and writing death certificates, rural physicals interact with the community at every level. These individuals bear massive responsibility for the health, welfare and future of the communities in which they practice and call home.

Part II – Applications to Athletic Therapy and Professional Take Away.

Critical Need to Proactively Address Diabetes and Hypertension

One of the greatest lessons learned from my experience is that our society and specifically our profession as Athletic Therapists needs to address the critical need to proactively prevent and treat individuals at risk for Prediabetes, Type II Diabetes and Hypertension.

Over the course of my shadowing shifts it was shocking to see how many patients required medication to control hypertension and regulate blood glucose levels. Now to clarify, I am not saying every patient can control their situation by other means (ie exercise, nutrition, meditation etc.) however I do believe many individuals, who if provided with appropriate resources and confidence, could take control of their health and overcome these conditions in the early phases through simple lifestyle adaptations.

In Manitoba alone, 50% of those with prediabetes will be diagnosed with Type II Diabetes by the end of 2019. Secondly, Hypertension is proven to be directly correlated with sedentary behavior. Rather than prescribing a patient basic blood pressure medications or diabetes medications which can become a crutch and create a mindset of hopelessness, we as Athletic Therapists can drastically change a patient’s outlook on these conditions and give them responsibility and control of their personal health.

Furthermore, these two conditions are direct risk factors for Cardiovascular Disease (CVD) and therefore Doctors are very quick to treat these conditions with medication. By treating these conditions immediately, they reduce the risk of CVD which is ultimately the greatest health concern facing Canadians. I believe prescribing medication for conditions which are directly correlated to lifestyle is a short term and largely ineffective means to providing meaningful lifelong changes. Furthermore, this is not the Doctors responsibility but rather our responsibility as Athletic Therapists to build relationships with Physicians and healthcare officials so that appropriate referrals and protocols exist to make long term and sustainable changes to our approach on healthcare.

Smoking and Alcohol

Although both of these are the subject of constant discussion, I believe I need to give my two cents on these issues and communicate why they are important for Physicians and ATs. After spending approximately 36 hours with patients in both a clinical and emergency environment, it is shocking to me how many people still choose to drink and smoke excessively. As a society we all recognize the dangers of these activities and yet as a society we also accept and even encourage them. To everyone reading this, I challenge you to have the difficult conversation of addressing smoking and alcohol use with your loved ones, co-workers and your friends. As Jordan Peterson put it, your success as an individual, family, organization, team, or society is based on the number of constructive uncomfortable conversations you are willing to have. Have that uncomfortable conversation sooner rather than later.

Reliance on Healthcare and Hospitals

As briefly touched on above, our society’s reliance on healthcare is sobering. I am not going to sugar cote this or downplay it. The extent to which our society relies on the healthcare system to save, fix and help them on a moment’s notice is alarming. Because of technology and health care advances, the system has done an exceptional job looking after people. Yet, it has done a disservice to every individual who now believes they do not have control of their own health and that they require a doctor and or medication to stay healthy. As an Athletic Therapist I truly believe we need to emphasize the importance of patients taking accountability for their health by providing them the guidance, confidence and the basic support to do so.

Future Role of Athletic Therapists

The values, principles and scope of practice of Athletic Therapy will provide the essential framework for our profession to adapt, grow and progress to become a valuable contributor in the Canadian Health Care System. The most important component of success will be adaptation. Each one of us must learn and act on improving our recognition with other healthcare providers and prove value. Without creating and demonstrating value we will continue to be overlooked and undervalued in the health care field that can desperately use our support and expertise. There is significant opportunity for us to make a major impact in providing treatment and value to those with orthopaedic and lifestyle implicated conditions. We must strive to provide value and expect nothing short of excellence in our respective field. If we are able to do this there is no doubt in my mind that the relationship between Physicians and Athletic Therapists will not only prosper but will address and make an impact on many of the significant and current health care issues facing Canadians today.

Have a wonderful week everyone!

Let er buck,

Logan Brennan

Athletic Therapy, Biomechanics, Chronic Pain, Conditioning, Equestrian, Free Workouts, Motor Learning, strength training, Weight Loss, Wellness

At your age…

November 15, 2017 Katmah

Here’s a fun tidbit I hear OFTEN second hand from clients after their friends/family/peers find out what their training and therapy plans consist of…

“At your age, should you really be lifting weights?”

“Isn’t weight training dangerous for your joints? Does that really help you feel better?”

“Aren’t you worried about getting injured again?”

“I heard that weight training is bad for you- doesn’t it cause arthritis”

First off.. I’m honestly not sure where people are finding that last bit of information from, at this point in our history. Secondly I’m also endlessly grateful that I’ve stopped frequently hearing that weight training will make women bulky- at last that myth has been put out of it’s misery. Third off- weight training is highly effective for arthritis rehabilitation and management- WHEN IT IS DONE CORRECTLY. The only time it’s going to cause arthritis is if you don’t do it in good form. This is why having the guidance of a trained professional is imperative when starting any new program. At the very least get a movement assessment and see where you need to work!

Would I tell someone of ANY age to just go and start lifting weights (no matter how much)? NOPE.

Do I prescribe and coach programs for ALL ages (yes, all the way up to 90-somethings- seriously) that involve various amounts of loaded movements, functional movements, dynamic movements, and stability training? You bet I do!

Here’s the neat things about the body.. it works on an adaptation based system. Which means- invariably- to IMPROVE our systems we have to STRESS our systems.

Here’s the feedback I get from my dedicated clients:

“I don’t wake up at 3am anymore with back pain”

“I sleep through the night and don’t wake up stiff in the mornings anymore”

“I don’t get tired during the day”

“My joints aren’t bugging me as much since I started training”

“I’m making healthier choices elsewhere in my life since starting this training routine.”

“I FEEL GOOD”

When we apply GOOD, healthy stress to our system- things change for the better. We also develop a higher tolerance for negative stressors, which means we function just overall more kick ass.

It no longer new information that the mind and the body are one coordinating unit.

Exercise, movement- of any kind- is the BEST and most EFFECTIVE medicine. The stats support it. Check these out.

According to the Conference Board of Canada, if we were to decrease the number of inactive Canadians by even 10%, we’d see a 30% reduction in all-cause mortality and major savings in health care. It is in fact estimated that more than $2.4 billion, or 3.7 per cent of all healthcare costs, were attributed to the direct cost of treating illness and disease due to physical inactivity1. The financial impact of poor health amounts to a loss of more than $4.3 billion to the Canadian economy, and the negative repercussions of inactivity cost the healthcare system $89 billion per year in Canada2. According to several studies, properly structured and supported exercise program, designed and delivered by a kinesiologist can, among other benefits:

Reduce the risk of high blood pressure and heart disease by 40%;

Reduce the incidence of type 2 diabetes by 50% and be twice as effective as standard insulin in treating the condition;

Help the function of muscles for people affected by Parkinson’s disease and Multiple Sclerosis;

Decrease depression as effectively as pharmacological or behavioural therapy;5

Reduce the risk of stroke by 27%;

Reduce the risk of colon cancer by 60%;

Reduce mortality and risk of recurrent cancer by 50%;

(Based on year 2009. Jansen et al., 2012 2 Based on year 2013. 3 Cardiorespiratory fitness is an independent predictor of hypertension incidence among initially normotensive healthy women.
Barlow CE et al. Am J Epidemiol 2006; 163:142-50. 4 Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. DPP Research Group. New England Journal of Medicine 2002; 346:393-403. 5 Exercise treatment for depression: efficacy and dose response.
Dunn A et al. American Journal of Preventive Medicine 2005. 6 Physical activity and colon cancer: confounding or interaction? Medicine & Science in Sports & Exercise:
June 2002 – Volume 34 – Issue 6 – pp 913-919)

Weight training- when done intelligently for each individual- is just as effective as other types of exercise in improving health. It has it’s own set of extra benefits and of course risk factors. Just like that Tylenol you like to pop for your back pain.

There is no one way to utilize the benefits of movement. Some people to pick things up and put them down.. others like to yoga.. some like to do step classes, and others just like to go for regular walks and stretch. IT’S ALL GOOD.

The biggest emphasis I am trying to make is that adding weight to your routine when you’re doing it correctly for YOUR SYSTEM (this is where the help of a trained professional often comes in), you’re looking at more resilience throughout your body and mind.

Don’t knock it til you try it 😉

(With the correct prescription and educated advice, of course!)

Athletic Therapy, Biomechanics, Chronic Pain, Conditioning, Equestrian, Motor Learning, Posture, Weight Loss, Wellness

If it ain’t broke.. The right way to move

November 5, 2017November 5, 2017 Katmah

Is there a correct way to move?

This is a question that has plagued therapists, trainers, and clients since the age of time.

Actually.. probably not that long.

The evolution of health and movement is one to be admired- in that, we’ve gone from quadruped beings, to walking, running, bipedal masterpieces, to what we are now.

We’re at an interesting point in movement science. We’ve somewhat regressed in our movement ability. While yes, we are still bipedal, upright beings- we no longer spend much of our time moving around in a variety of ways.

Now we move from point a-b-c-d in condensed timeframes, spending majority of our time between 3 positions (or variations of..): standing, seated, and laying down.

The author of Sapiens, Yuval Noah Harari, points out that the Agricultural and Industrial Revolutions not only may have ended our movement ability, but also may have birthed the beginnings of the various chronic illnesses and pain that affects us today.

Modern Day practitioners have been preaching alignment for decades already, and certainly our posture and ability to move has a huge impact on our overall wellbeing.. but is there such a thing as the “perfect” posture or alignment? Is there one optimal way to move?

The truth is yes, but also.. no.

There is certainly a most efficient way to move- in that, we will put minimal stressors on our structure and expend the least amount of energy to create that movement. There is a general textbook answer to this optimal alignment.

As an aside- it’s common to hear practitioners saying that one of your legs is longer then the other, or your pelvis is out of alignment.. when often the truth is some asymmetries are NORMAL to a certain degree.

We all have one shoulder that will be slightly depressed based on our hand dominance. We all have slight differences in how our rib cage sits, because of our anatomy (the left side has less lung in it to account for the heart- causing a shift between left and right), and where the rib cage goes the hips follow. Our body works in a chain like system- one link compensates for the next.. and while many compensations cause other problems, not all asymmetries are bad or abnormal. This will also change based on the mental health and perception an individual holds on pain, stress, and their systemic health. The debates on these fuel many research articles and books already. Stay tuned for more discussion on those topics and how movement relates to them.

When it really comes down to it, our movement is as unique as we are- and what is the best way to move for one person may not always mirror the best way to move for another person. We’re designed to be adaptable beings, and our postures should be just as adaptable.

Wait.. haven’t you been preaching posture and biomechanics your whole career?

Yes.. and while there may be differences across our spectrum of movement- majority of us inherit similar postural dysfunctions.. it’s very rare to find someone who moves well, even though there is no set checklist for what exactly moving well means.

Moving poorly in relation to your body can create a vicious cycle of degeneration, causing pain, causing less movement, causing more negative health outcomes. You can get enough movement, but if you don’t move well- you can actually do harm to your body which results in less movement.

For that reason *usually the first step with clients is to assess and correct how they move. From there we build a foundation of efficient movement, and build their movement habits on top of that foundation.

While I can’t say there is one right way to move, I can say that it is very rare to find someone with obviously inefficient movement without some sort of history of pain. The thing about pain is that it may not even present as physical pain.. it may be present in the form of gastrointestinal issues, or undue mental states. Our structure represents our internal framework too- and that can be a chicken or the egg scenario.

Many movement based practitioners will offer within their consult with you a movement screen. If you’re looking for an assist with your health, this is one of the things you should look to your professional to do. Cookie-cutter exercise programs, apps, and group fitness classes are convenient and cost effective- but the grain of salt there is if you get injured or develop pain because you’re movement wasn’t properly screened before starting a program- they cost you more in the long term.

We routinely see clients at their wits end come into our care. They’ve tried everything and nothing works- they are even hesitant to try anything else. They can’t move enough because of pain, or- they’ve never been taught healthy habits around their lifestyle (including movement and nutritional practices). This is what plagues our healthcare system today, and the message I keep putting out there to clients and peers is that none of this is a difficult fix- it just requires a shift from expecting a quick, cheap fix, to some quality time spent investing in our own health and getting educated guidance.

If you have questions about your movement today- send us an email and we’d be happy to help. Consults are always free.

Athletic Therapy, Chronic Pain, Wellness

5 Reasons Why Integrative Movement is Different

October 31, 2017 Katmah

1. Accessibility

We pride ourselves in providing a simple, affordable solution to health and lifestyle services. We also offer services out of four satellite locations covering South Winnipeg, the Pembina Valley, Charleswood, and Selkirk region. All our locations are partnerships with other likeminded health facilities. From full functioning gyms to yoga studios – we do the groundwork to develop a health focused community feel wherever we go.

2. Investment

How many of us have bought into a health program, rehab, or gym membership only to under utilize it and later feel like we’ve just wasted the money? Our job is to support you in whatever your health goals require. Whether it’s developing healthy habits in the gym or at home, recovering from an injury, or pushing yourself to a new level of health and fitness, we work hard to provide highly skilled and knowledgable support. As a bonus, new members at our Selkirk and Charleswood locations automatically get 6 weeks of coaching alongside their memberships. No longer will you be stuck not knowing what to do with your gym membership! Your health is an investment, and we believe that navigating those investments is best with accessible, individualized support.

3. Individuality

It’s all about YOU- At IM we are different then your average rehabilitation facility or personal training sales pitch. We take the time to figure out what makes you tick. From consult to regular sessions, you can expect to spend 45min-1hr with us in either dedicated one on one therapy, consult, or training sessions or in a small group of likeminded individuals working at a common goal. Keeping things personal allows us to make sure you’re getting all the resources YOU need to reach your full health potential.

4. Diverse Experience

We are a team of Kinesiologists and Athletic Therapists with years of education and a growing experience base. Each of us enters our practice with our own personalities, history, and interests. For that reason, we pride ourselves in working as a team to meet our clients where they are at- and when appropriate work as a team with other professionals you deem valuable to your healthcare team.

5. We get it.

Life happens. Injuries are tough. Pain messes with our heads. Taking the steps towards lifestyle change seems impossible some days. We have been there, and we understand. Even on the days where you think it’s never going to change, the pain will never leave, or you’ll never get your old energy back.. we’ve got you. We won’t give up even when you don’t know where you stand. As the therapists and coaches we are, we hold out hope even when all hope seems lost. We’re all in the same boat, us humans, and we approach your care on your side every single day.

Want to learn more about how we can fit seamlessly into your journey towards optimal movement and health? Book your FREE consult here or drop by any of our locations to learn more. Looking forward to meeting you!

Athletic Therapy, Chronic Pain, Wellness

5 Reasons Why Integrative Movement is Different

October 31, 2017October 31, 2017 Katmah

1. Accessibility

2. Investment

3. Individuality

4. Diverse Experience

5. We get it.

Want to learn more about how we can fit seamlessly into your journey towards optimal movement and health? Book your FREE consult here or drop by any of our locations to learn more. Looking forward to meeting you!

Athletic Therapy, Biomechanics, Chronic Pain, Conditioning, Equestrian, Motor Learning, Posture, Self-Development, Wellness

What’s Up at IM- Winter Update

February 25, 2017February 25, 2017 Katmah

Hey everyone!

As usual I’m falling behind on my posting. I just wanted to pop in and give a quick update on Integrative Movement and Katmah Training, as things are happening!

As many of you know, Integrative settled into it’s very own location in the South End of Winnipeg this fall. While we still travel for some clients, we cut down our mobile services to only a few days a week. This hasn’t stopped us, however, as we still travel to Portage and MacGregor, and St. Agathe for clientele. Kathlyn also works out of Carman at Empower Fitness a few days a week. Accessibility for all our clients is a must!

In January Integrative was happy to welcome Lisa to the team as another Athletic Therapist. She is at the studio 3-4 days a week and is taking on new patients! She offers both therapy and training services!

Katmah has been on the go as well, recently having done a workshop for riders on the topic of Mind Body in coordination with the Manitoba Horse Council, and Scott Erickson Performance Consulting. It was a great afternoon, focused on equestrian sport psychology- dealing with adversity, preparing for competition, and common issues faced in our sport’s culture around mental preparation. Katmah followed with a discussion on what the equestrian requires from their body and movement, and of course there was exercises involved! Kat will next be speaking at Pine Ridge on April 23 in a full day clinic. This clinic includes both a lecture and riding sessions and is still open to auditors and a few riding spots are waiting to be booked!

Most recently Kathlyn was honored with making the top 25 shortlist for Athena Leadership’s Leaders of Tomorrow scholarship for her work and goals in healthcare. It was an exciting and enlightening evening networking with some of Winnipeg’s leading women business owners!

Through the fall and winter, Integrative Movement has been working to provide rural communities with access to movement education, exercise instruction and therapy. Integrative Movement was titled as such because we believe in making movement a part of everyday life, and that movement is integral in an integrated approach to health care and prevention medicine. We’ve also been working on building bridges with local senior’s centres to offer exercise instruction for their well being.

So what’s coming next?

IM is proud to be returning to Murdoch McKay Clansmen as the medical supervision for the 2017 season.

IM will also be returning to the MHJA circuit as medical coverage, and will be offering Athletic Therapy Services on competition weekends.

Weekly classes are being offered on Tuesday evenings at 5:45pm in Winnipeg, as well as 10:30am on Thursday mornings. These classes are all about fitness and mobility- and are open to all ages and fitness levels. As pre-season kicks into gear, IM is offering a discount on training services and therapy services (unless you have insurance coverage 😉 for the next few months. Contact us to find out more about this if you’re an MHJA, or MHC member.

We are also hoping to reach out to physicians in the city and rural communities to talk about movement, athletic therapy, and kinesiology. So if you think you’re GP would be interested- please let us know!

That’s about all the news for now- stay tuned to our social media for exercise ideas, handy tips about your health, and other updates!

Facebook: Integrative Movement

Instagram: @integrative_movement

Booking site: http://integrativemovement.janeapp.com

Athletic Therapy, Biomechanics, Equestrian, Motor Learning, Posture

Fixing the Lower Leg Slide

December 21, 2015December 21, 2015 Katmah

Do you find that your lower leg is a constant issue? Keeping that leg a mixture of functional, strong and supportive as well as not letting it get stiff, slip back or forward can be tough if you don’t have the right tools. I see plenty of riders who thing their lower leg is perfect, only to look at a photo of them over a fence, or during a ride and find it’s slipped behind them, or watch a video of them posting and see that it is wiggling up and down with their seat in an attempt encourage their horse forward.

It’s not an uncommon issue, but it does take some outside thinking to fix.As I discussed in a previous article, problems with the lower leg can come from weak hip stabilizers. The leg, although made up of many parts, acts to some extent as a whole when it comes to our position. If our hips aren’t stabilizing correctly, it’s going to be pretty hard to keep the leg functional underneath us. Symptoms of weak hip stabilizers can include low back pain, poor balance, knee pain, calf pain and ankle pain as well as an inability to keep the leg strong or underneath you during a ride. Below is a diagram of where the gluteus medius sits, one of the major players in pelvic stabilization. Other big players are the core musculature, and quadratus lumborum which sits in the low back attaching from the pelvis to the ribs.

Another piece to this problem is the foot’s position in the stirrup. An often overlooked factor, if the foot isn’t balanced and centred the alignment all the way up to the hips will be off.. which will interfere with how the hips function, and therefore the rest of the leg and even torso.

The foot in the stirrup should be similar to how we stand. When we stand, there are three points on the foot that should be the main points of contact. The ball of the foot, the base of the pinky toe, and the heel. If you stand with more weight to the outer or inner edges, or more to front or back of your foot- you have some work to to. An easy way to test this is to stand on one foot and see how you shift your weight in the foot. Feeling for those three points of contact equally is the first step.

In the stirrup we only have two points of contact with the foot- the ball and the pinky toe’s base. Next time your in the saddle, note if your foot is equally balanced or if it is shifted more to one edge. If it is shifted, practice focusing on getting the balance equal between both feet and see how that effects your lower leg’s ability to work.

The position of the foot plays a minor roll to the hip’s stability when it comes to the lower leg. The hip itself and our ability to balance and stabilize the body is the biggest part. The muscles that help with this are often over looked in training programs, and subsequently forgotten about by our brain, and not used as they should be. It sometimes takes an outside eye, and assistance retraining how to move before it all clicks into place.. but here are a few of my favourite exercises that combine balancing the foot and the hip to better the lower leg.

Side Plank/Bridge:

– Start from your knees moving from the hips, as shown in the video. Once you feel strong holding from the knees.. you can progress to a full side plank position.. having the feet wide is often more comfortable then stacking the feet. Try both out and see which is best for you!

These exercises should not cause pain anywhere, and you should be checking for proper alignment and core activation the entire time! There is many progressions to both those exercises, but master the basics first and then move up. Remember, perfect practice makes perfect!

The next is the Flamingo or Single Leg Deadlift. Basically anything single leg is going to be awesome for you, as it really targets our balance (obvi) but also gets us using the foot correctly (if we focus on it) and works the hip stabilizers. This one in particular is my all time favourite for the hips, and everthing lower body.

Make sure the body stays in one straight line, as in the second picture.. the shoulders must stay active as well as to not let the posture fail. Move continuously on one leg in and out of the posture, feeling the standing leg work- especially in the hips. Make sure the leg in the air is active too- push the heel down and back as if you were standing in your stirrup on that side.. this will help keep the hips even. Doing 10 on each side, x3 is excellent! I often have my riders work on this exercise off the horse, and then feel for the same activity once their are on the horse as well (visualizing the leg being this active really helps kick the musculature into action). Here’s a video of a similar exercise. The technique remains the same between the two. Maintain a strong posture, keep hips level and toward the ground, use the core to help balance, and keep everything active!

flamingo-move

Lastly, reverse lunges to a step up..

ball-step-up

Here we start with the reverse lunge. Stepping backwards and bending, then swinging the back leg up as we stand to step up to a small box or bench (or bale) to stand straight, bringing the other leg up to the high knee position as shown. Master your reverse lunge first by just doing a few week of step backs and lunging.. this is often a big enough challenge balance wise. Watch the hips don’t sway, and your maintaining equal contact between the three points of your front foot. From here progress to the reverse lunge plus a high knee afterwards (no step-up yet). After you feel confident at that movement, add the step up. Be warned, it takes a lot of concentration!!

Try those out by adding them on their own into your day, or adding them to your regular work out. Looking for some guidance in your exercise and health? My membership options may be just what your looking for. Check out my membership page for more.. at offers as low as $10 for your first month.. what are you waiting for? Really?

As always, if you have questions about your riding or these exercises specifically.. shoot me and email at katmahtraining@gmail.com!

Conditioning, Equestrian

No Stirrups November: Some Thoughts and Strategies

November 3, 2015November 2, 2018 Katmah

Don’t get me wrong… I’m 100% for feeling the burn and making those riding muscles work without the aid of those things we put our feet in. NSN1 I just have a few things I need to get out about the entire month dedicated to riding without stirrups.

As any rider who came up through a lesson program likely has experienced, No Stirrup November is a time where either someone suggests politely to you to ride withouts stirrups as much as you can, or (more often) someone literally steals your stirrups and you spend a month without them, hacking, in lessons, jumping.. you name it, you’re stirrupless.

In my professional opinion, I believe riding with no stirrups has a great place within the realms of developing position, strength, and function in the tack. Hunter/Jumper/Event riders, we’ve all found ourselves in the middle of a line approaching a huge oxer or in the middle of a combo just having conveniently lost our stirrups at some point, amiright? Having some background in being able to keep your leg and your balance without weight bearing is hugely beneficial.

We know the pros to this. Increased balance, strength, and confidence. These are great pros! But if NSN is done wrong, you may not get the full benefit and actually end up affecting balance, strength, AND confidence.

Yes, there are safety cons to NSN. Falling, muscle soreness/strains, higher chance of injury.. etc. However, that’s not exactly what I want to focus on today.

Too often what I see happen with NSN is an immediate jump into absolutely no stirrups (as in the cases where stirrups mysteriously disappear from saddles and aren’t returned for 4weeks). While, yes this is a sure way to commit… it’s also a sure way to develop bad habits, compensations, and put yourself at risk for newly developed poor equitation come December. Think of it this way.. if someone took away your desk chair and you had no way of modifying the desk height or finding another seating device, so you had to still get down low enough to work at the desk.. Let’s say you’re ambition and you try to maintain a seated position (now squat) position (because we all sit in that nice posture, right?!)… you probably wouldn’t last long, and soon you’d start trying other weird things just to keep functioning. You’d probably start out by hunching or crouching, then maybe try to kneel and crane your neck, then maybe standing in a lopsided posture looking down…

Now think about the last time you rode without stirrups. Were you fluid and efficient with your movements? Or did you immediately lock up your hips, clamp with your legs and knees, and stiffen your arms and the rest of your body in an attempt to maintain your “normal” eq? This is before muscles even got tired!

If the above didn’t happen immediately.. it likely happened as soon as you got fatigued. Which is very normal. My issue with this? Now you’re training bad habits, and strengthening in your position in the wrong ways. Yes, the more the month goes on, of course the stronger you’re going to get. But if you build that strength on top of incorrect equitation.. it’s not really benefitting you. Also, your horse won’t appreciate you bouncing around all stiff and clampy for the first few weeks either. Think of their back and yours!

All this being said.. I’m still in favour of no stirrup training. If it’s done appropriately. Here’s my recommendations for NSN.

Week 1 (3-4x/wk):

Regular warm-up with stirrups
1-5 min of no-stirrup work (or as long as you can until you find you begin to lose good equitation and posture.. this could be only 1-2min to start!). All gaits. Trot is obviously going to be the most difficult gait, with walk and canter being a little easier to maintain.
10-15 min regular riding. Do any jumping or more intense work within this time.
1-5 min of no-stirrup work. Focus here on things like sitting trot and transitions to build that core stability. Make sure you’re still letting the hips move, and keeping the legs in an appropriate position and of course maintaining a correct posture!
Cool down. Or continue with a regular ride with stirrups.
Repeat this every second ride (if you ride every day) or 3-4x/week with days in between.

Week 2 (3-4x/wk):

Reg. warm-up with stirrups.
10-15min regular riding with stirrups.
3 min trot work with out stirrups, posting and sitting, 2 min canter work and transitions from trot to canter no stirrups.
2 min break
3 min trot work with out stirrups, posting and sitting.
1 min break
1 min trot work with out stirrups, OR transitional work (walk to trot, trot to canter, canter to sitting trot, sitting trot to canter, canter to posting, posting to walk.. etc).
1 min break
3-5 min with stirrups holding two-point at trot. Focus placed on leg position and hip elasticity!
Cool-down.

Week 3 (3-4x/week):

Reg. warm-up with stirrups
10 min reg. ride with stirrups.
2 min with stirrups holding two-point at trot. Focus placed on leg position and hip elasticity. Trust me you’ll feel the burn in your legs!
Jump-work with no stirrups (if you jump), or lateral work or advanced work with no stirrups. Do this only until you feel your position slipping… Take breaks as necessary. If jumping, start at a level you’re comfortable with (obviously). Ideas here could be:
- small gymnastic exercises or grids or small course work.
1-2 min break.
5 min regular hacking or jump work with stirrups.
5 min hacking with no stirrups, all gaits.
Cool-down.

Week 4 (3-4x/wk):

Reg. Warm-up with stirrups, including 3-4min two point position work at trot.
5-10 min no stirrups, all gaits.
5 min regular hacking with stirrups.
Any jump work or advanced skills with NO stirrups. If you’ve been working on jumps, work towards a full course at a comfortable height for you within this week!
1-2min break.
5-10min no stirrups, all gaits.
Cool-down.

Some general rules of thumb for this progression:

The times are a suggestion. If you feel you can do more or can only do less before your position and posture get poor, by all means modify!
The point is to challenge yourself, but not to the point of training a bad position. Be aware!
The two-point position holds will challenge your position in a similar way to not having stirrups. I recommend throwing these in at the beginning and end of every ride you do for 2-5 minutes. Challenge yourself to control your horse with your legs, while keeping good position, and maintaining balance. Use your saddle or horse’s neck for balance IF NEEDED ONLY. This will work legs, core, and overall postural stability.
Perform the above progressions every second ride, or 3-4x/week. On days off from no stirrup work, add in the two-point holds and ride as usual otherwise.

NSN is often viewed as a month to go hard or go home. While I’m all for challenging riders to improve their fitness in the saddle.. it has to be done appropriately and smart. If it’s not then that’s where we end up with injuries, chronic pain, and perpetually fixing bad habits!

If you’re interested in a consult and a more personalized program for your NSN… contact me at katmahtraining@gmail.com

Happy Riding!

Athletic Therapy, Biomechanics, Chronic Pain, Equestrian, Motor Learning, Posture

Hinging and Locking: Finding true stability in the upper body

September 22, 2015 Katmah

The human body is a fascinating thing. When one thing doesn’t work the way it should, something else will adapt to make movement as efficient as possible. The body will also always do it’s best to balance itself, in whatever way it can, which is also accomplished quite often by something doing what another thing should be.

Let’s talk today about the elbows and the mid-upper back.

One of those things should hinge and flow, while the other should stay stable through movement in the tack. One is compared to an elastic band, while the other could be related to the mast and supports on a ship (I don’t know the technical terminology…). One is a hinge point for two dynamic resistors (hand and core), and the other is the stable base point from which all control stems from.

Our elbows are pretty much a direct contact to our horse’s mouth (via the hands). Intuitively this means they should avoid being stiff and instead be fluid (even through resistance) and allow the hands to do their work on the reins. This is another reason why we are coached for thumbs up,or in an “A” position, and coached out of flat hands. Not only is the forearm better positioned with thumbs on top, it is a much more biomechanically efficient position for the muscles that control the wrist and fingers to work from. The ideal position is just a touch past the centre line with the thumb coming into very slight pronation. This also creates an optimal grip position for the ring finger on the reins. Why is this important? The hands and CORE should create active resistance through a ride, NOT the elbows. A firm grip and a steady, strong position is a better solution then a locked arm and a compensated torso position.

Hand position is an important first step to establishing elbow fluidity. There are two reasons I find that the elbow locks up on riders and you see them riding with stiff arms.. sometimes even to the point of the arm being almost straight.

Postural dysfunction/poor motor control in the upper body. This what we’re going to focus on in this article. What do I always come back to? Body awareness and core activity are a athlete’s best friend- especially for riding athletes. Let’s say the shoulder girdle is unstable. The muscles in the upper back aren’t doing their job and the shoulders are rolling forward. Combined with this, the athlete in question doesn’t have a clue how to stabilize their core through movement and doesn’t have great posture. This is demonstrated by a collapsed forward position, a slouch in the upper back, and in movement, a hinging in the mid-back. Something has to be stiff and stable.. so the elbows (and sometimes the hips) take over.

Fear or nervousness. It’s human nature to stiffen up when we are nervous or afraid. Whether a rider is a novice, or is returning from injury or a bad fall.. underlying fear is completely understandable and I’m sure any rider can admit to being there at least once in their career. Unfortunately, the stiffness developed in the early stages can stick around long-term if it becomes a habit. So coaches, if you notice a returning rider with stiff elbows.. do them a favour and start assisting them in breaking the habit before it forms. The great thing about the musculoskeletal system is that it is under our control, so even if we have fear or an underlying emotional issue causing symptoms such as stiffness… we can learn to control them separately. We’ll discuss this in another post.

These two facts apply to all riders, right across the board. Dressage, hunter/jumper, western dressage, rodeo, western disciplines, and even recreational riders. If you’re stiff in your elbows, likely another piece of your posture puzzle is out of place.

We’ve talked about the upper back and shoulders before, so for anatomy and correctional exercises here I’ll refer you back to this post. Also, if you need a reminder on how to properly activate the core and a few exercises for that.. check out this previous post.

What I haven’t discussed is the hinging effect in the mid back. The exact location is different for everyone, but it is commonly where the thoracic spine and the lumbar spine meet (T-L junction)… right around here:

It’s easiest to see this in the sitting trot. Look for any movement through the mid-back that seems excessive. Many riders, due to not understanding how to use their core appropriately resort to what I like to call “jello-spine”, clench their glutes (locking the hips), round their shoulders and lock their elbows. This creates a false sense of stability, but really it is a very unstable position. I also see this in jumping athletes, both in flat work and in over fences during a release. Arching and hinging in the back makes them feel like their sitting up tall and strong, and while they are sitting up tall, they are taking away efficient stability in the core because of the hinge and opening themselves up to wear and tear injuries in the upper body. This hinging habit is commonly formed early in a rider’s career. “Shoulders back” is a commonly used cue for riders, but coaches need to be aware that athletes like to cheat (whether they know it or not) by hinging the back instead of moving just the scapula (shoulder blades). Missing the correction of this early on enables the habit to be formed. That’s when you meet someone like me down the line when you have chronic pain in your back and shoulders!

Why do we care? Hinging in the spine causes undue stress on the vertebrae/discs/tissues which will cause pain over-time. Postural dysfunctions as a result of that hinging (poor shoulder posture/motor control, head poked forwards, locked elbows during movement) can cause pain, muscular tension, headaches, and stiffness that will translate into our horse’s health and movement. Check out this study done a few years ago that relates a rider’s posture back to the horse’s health.

So, now we know whether we’re locking our elbows or not, and why that’s not a good thing.. How do we fix it?

The first approach I use with my clients is building their awareness of the stiffness. Working at a gait their comfortable in, or even off the horse completely, we first improve their position overall. Then, I like to relate the elbows to the hip. They should be equally fluid. The posting trot is the easiest to demonstrate this in. If the hips are moving appropriate, pushing up and forwards and then down and backwards, the elbows should coordinate to open as the hips open and close as you sit back down. Same pace, same elasticity. Some clients have been so reluctant to let those elbows go that I put them on a lunge line and practice “jello-arms” while holding an activated core. Here the rider is instructed to let the arms hang loose while maintaining the rest of the position correctly. This encourages them to relax, let the arms specifically loosen, and build awareness of how tense they get otherwise.

In the video below, we see the rider in the top frame (before instruction) bouncing and very stiff in the tack. This rider does have a history of fear in the tack and has developed an overall stiffness to compensate. You’ll also notice that her horse is on edge with his head high and back hollowed. The bottom frame is after instruction (keep in mind this was all within a 45min session, so changes are small). You’ll likely notice less bounce in her seat. This was after teaching core activation and encouraging hip movement. Her hands and elbows are better, but not great yet.. but you can already notice her horse beginning to relax with the small changes to her seat.

Awareness is always the first step. Then rebuilding posture, then improving fluidity. I’ll will discuss the relationship between emotions and false stability (stiffness) in the body in another post, as it is also an important piece in the posture puzzle. Having somebody there to help you build your awareness of hinging and stiffness in the upper body is a great first step. Then trying the Wall Slides and Retraction exercises, along with the core exercises is this post and this post are the first steps in postural correction and improving fluidity in the tack!

Contact me at katmahtraining@gmail.com if you have questions about your position and how to take the next steps in bettering your performance for you and your horse!

Athletic Therapy, Biomechanics, Equestrian, Motor Learning

The Heels Down Conundrum

August 7, 2015August 17, 2015 Katmah

From the day we start riding we were told to get our heels down as far as we can. Keeping the heels down and the toes up is a common thing to want to instil into a new rider, mainly for safety reasons. Us riders spend most of our time functioning off of the ball of our foot in the stirrup. Though it’s common to see even the most advanced riders jamming their heels down and keeping them that way. The forced rigidity in keeping the heels down this way is not necessarily a benefit to us in the tack (or in the rest of life).

Lets start with a brief anatomy lesson.

ankle

There is a whole bunch of stuff in the foot and ankle, but the joint we want to focus on today is the “talocrural joint” which is the joint that moves the foot/ankle into “dorsiflexion” (heels down) and “plantarflexion (pressing a gas pedal). The muscles that do dorsiflexion include the muscles at the front of the leg, the main one being tibialis anterior, while the big meaty calf muscles at the back (gastrocnemius and soleus) do plantarflexion. The talus bone fits into the Mortise (shown well on the picture on the left), a dome like joint that allows for a rolling/gliding when the ankle moves into dorsi and plantarflexion. There are ligaments surrounding this and tendons running above and around this joint as well.

Got all that? Good.

heels down1 When the heel is forced downwards and locked there rigidly the tibialis anterior muscle (and it’s helpers) are contracting while the gastroc and soleus muscles in the back are stretched. Not only is this overkill for both muscle groups, when you add in any amount of force travelling through that lower leg and into the ankle (gravity plus your weight plus the force created by your movement and your horse’s movement) we get a not so happy combination for that ankle. Rigidity in any joint creates resistance for force through the tissues. If there is a resistance it means the force won’t travel very efficiently and the joints starting in the ankle, all the way up to the knee and hip will take on more strain then they might otherwise.

Now if we take the example of the rider above who is riding without stirrups, but still forcing those heels down as if her life depended on it we encounter another issue of rigidity in the leg. While she is dead focused on that perfect position and heels locked down.. she is locking in that dorsiflexed position which means she has her tibialis working to it’s full potential and the calf on stretch. Holding that position with no support from the stirrup takes away some helpful physics, and I’d bet that as a result her knee is also quite stiff and her hips aren’t moving very well either.

So while there won’t be much rebound force from the stirrup travelling upwards due to stiffness in the joints.. the muscle tension alone will restrict movement at the ankle, knee, and hip.. and when those guys don’t move well something else has to.. and that’s where we run into compensation pain.

So.. we know we need our heel down for safety and function… but now I’m saying don’t try and get them down?

Yes. After the initial learning phase where none of us can tell if our heels down or not (hence the constantly being told to get those heels down).. we need to learn how to relax that ankle too.

When the ankle is fluid all the force travelling down the body and up from the stirrup will be absorbed into the tissues and repurposed to aid in movement. Let’s imagine trotting. As the horse’s feet meet the ground force travels up from the ground, through them, and into you via the stirrup. Here you want to have a nice neutral heel position and let gravity pull your heel down as the tissues take the force. The heel will then naturally move back up to the neutral position as the weight and force move on.. until the next step. If the ankle is rigid in this same example, the force has nowhere to go and gets trapped in the first joint it encounters.. sending stiffness up the rest of the leg and making for a rougher ride.

This same example can be visualized when landing from a jump, or cantering…

Fluidity is a big thing for certain joints. The ankle, knees, hips, and elbows all need to have a certain degree of relaxed functionality to allow for force absorption and repurposing. With this in mind, then all those joints can move very efficiently and allow for the core, upper back, and hands to be stable.. Check out this video of some slow motion dressage. There are some great examples of the rider letting his ankle be fluid with the movement.

If you’re having trouble visualizing this, remember that as riders we have to mirror our horse’s movements.. and not interfere with them. If you look at a horse’s ankle as they move.. you’ll see a significant amount of flexion towards the ground as they impact, and a spring back as they move on. This is exactly what we want for our own ankles. Without this everything get’s much bouncier.

While the best way to develop this fluidity is practice in the saddle and getting a feel for it.. “Walking the dog” as shown in this picture is good for feeling out your ankle mobility (and stretching your hamstrings and calves while you’re at it!). To do this, get into a downward dog position and alternate bending your knee and relaxing your legs. Then, next time you’re riding a trot or canter.. focus a bit on your ankles. You may find that as you develop the ability to be conscious of your subtalar joint your sitting trot gets much easier to sit!

As always, if there are any questions or you’d like to submit a video for me to analyze of your riding.. shoot me an email at katmahtraining@gmail.com