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Old Forum uneven gait?

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kris

Level 3 Valued Member
Chris, again, only a computerized  analysis can precisely find what' wrong in your gait, feet, legs and hips. And, it is the job of a Podaiatrist. Again, a precise posture analysis can show your imbalances, but first the Podaiatrist. Before thinking treatment, you must have a diagnosis.

Christine, Sports Medicines Australia member.

 
 

jgruginski

Level 3 Valued Member
I completely understand Brandon's point and while I think each person has to be cautious with advice given freely on the interwebz, one must also be able to think for themselves. One thing I like about Pavel's work is the understanding, sometimes explicit, that we are each responsible for ourselves alone. We motivate ourselves and we hurt ourselves, sometimes with our own stupidity. That could extend to reaching out for medical and movement advice in a digital forum.

We use the medium, with it's limitations painfully clear, to the best we can.  Anyone who says they can diagnose on the web, without at least video to guide them, is a charlatan and should be avoided. No argument here. But if a response of "it sounds like you have X going on" is considered a diagnosis, then we all need to put our big boy pants on and consider the medium. If it helps to whip out our credentials before we get into our replies, that's fine, but I think that's unnecessary as I trust smart people without credentials over some highly credentialed idiots I can get covered by insurance.  No disrespect to those with credentials, just that the proof of the pudding is in the eating.
 

dmaxashman

Level 3 Valued Member
joe  its not true to say we are responsible just for ourselves.  there are infinite relationships which disprove this idea... parent/children, friends, husband/wife, coach/athletes, architect/inhabitants of his building.  the idea that everyone is responsible just for themselves is so silly and i believe it comes from a good place motivation of strength and wanting to succeed but what's gonna happen if an architect has a faulty design and the building collapses crushing maiming and killing everyone inside, are people not gonna press charges cause they will say "oh when my kid went into that building he was responsible for himself"???
 

kris

Level 3 Valued Member
@ Daniel, I agree.

@ Joe, agree also in matter of diagnosis in line, the reason I always recommend further investigations with appropriate Healph Practitioner.

For credentials, whatever the field, I prefer to refer to somebody qualified and with credentials, I prefer to learn from a Master SFG if I can, and not with a SFGI, this is only my opinion
 

kris

Level 3 Valued Member
@ Joe, how do you know if somebody is NOT a charlatan ? Credentials are the first thing to read to talk to the right person, of course, after more parameters are importants.
 

kris

Level 3 Valued Member
Just realized that the end of my post is missing. Parameters importants to check in matter of credentials in Australia for Heatht practitioners is when the were graduate, it is commun to have a GP or any Doctors working on studies did 50 years ago or more. No ongoing education is needed...

Worse in " The Fitness Industry ", 90  % of " fitness trainers " are advertising with faulse graduations, and background.

So, yes, there is credentials and credentials.

 
 

postnspread

Level 2 Valued Member
The article referred to by Samuel was very interesting for a reason different from whatever intrinsic merit it might have. The views of the article's author are strikingly similar to what my brother, a neurosurgeon, has long maintained in spite of my occasional attempts to convince him otherwise! He also scoffs at the notion of "perfect" health and the tendency of some people to almost obsessively free of evn the smallest aches and pains.

Anyhow, therapies might work but for the wrong reasons or the best theoretically grounded procedure might not or what works once might not work a second time. We can only try stuff out without being too dogmatic as practitioners or patients and hope for the best.
 

stutkd

Level 1 Valued Member
Chris.

with regard to your problem has anyone who examined you explained any findings, i.e any factors underlying your back/gait issues?

The reason I ask is that not every physical ailment has a name attached to it and where there is one out can be an "umbrella" term for a variety of causes. For example the term frozen shoulder still gets used by some to explain sub acromial arthritis, yet this has also been used for bursitis, adhesive capsulitis etc. for some the term sciatica produces just as much frustration as it can refer to a variety of causes from arthritic spine at the appropriate level to tight piriformis muscle to adhesions in the calf and any combination of the above and more.

obviously  I don't know you but from working with others with chronic back pain and specifically referring to back pain it is very often a frustrating, draining, demoralising and for some an emotionally upsetting problem when it persists. As such it is easy to go searching from one strategy to another with little reasoning for doing such or allowing enough time for it to take effect.

I just wonder by one of your earlier responses if you have been given an actual diagnoses or even clear reasoning for what is causing your problem. Although I can't be specific in your case back problems are often multi-factoral not just relating to a single tight or weak muscle for instance. If you haven't been given clear reasoning by health practitioner find someone who can. Also, hands on treatment is great if it helps your problem but I would be surprised if this alone solved the issue for you. Therefore, I would fine someone who may treat, educate you and review your progress at appropriate intervals ready for the correct excerise/rehabilitative progression. In truth this may require collaboration with more than one discipline, preferably those happy to liaise with one another.

I know this sounds difficult but I suspect that the worst part is finding the right people for you.

I am sorry if this reads a bit patronising it certainly is not meant to be. I am just aware that in trying to find the answer to a problem amidst frustration it is difficult to see the wood for the trees.

Best of luck.
 

Brett Jones

StrongFirst Director of Education
Master Certified Instructor
Beast Tamer
OK - this will be  bit of a rant so hold on....

Pain is a medical issue not an exercise issue.

Yes roughly 85% of back pain is idiopathic (of unknown origin - likely a movement related issue) but there are times when it is cancer (small percentage but none the less), sometimes it is a abdominal aortic aneurysm (http://www.ncbi.nlm.nih.gov/pubmed/23594945/), and sometimes it is.........

Without a complete medical history, injury history, and evaluation it is impossible to know and internet advice is blind - period.

So for all of you giving advice on what to do about back pain - does your advice change if he is under treatment for a medical condition, if he has a history of a surgery or significant injury, if he is taking a statin medication that can cause muscular symptoms, if he has....??????  You simply don't know so it is blind at BEST to offer any advice.

I offer on-line training but only if we can skpe and I can see you move etc...

Dr.s, PT's, and medical professionals vs. the Exercise world

Personal trainers point fingers at PTs etc... because they lose clients for  a time and can come back still in pain etc...

And PTs and Dr.s point fingers at the exercise world for injuring people and creating business for them.

"Remember when you point a finger three of them are pointing back at you" (a little southern wisdom)

We are all part of the issue but we can all be part of the solution - appropriate referral within a "network" of trusted professionals is a MUST for an exercise professional - take time to develop this network.

If you choose to treat pain you choose to be held to that level of liability/responsibility.

I agree with Stuart in that it seems you haven't been given information that you can act on by the Dr. etc....

Chris - I have an SFMA PT in that area - shoot me an email (appliedstrength@gmail.com)
 

the hansenator

Level 6 Valued Member
Thank you to everyone for taking the time to reply and for sharing your advice. I really appreciate it.

Just for the record: I never was given a reason for my pain. Most of the people I've seen have kind of shrugged their shoulder and said they couldn't find any injury and do these stretches/exercises.

My history does include cancer with associated treatments, surgeries, and severed nerves resulting in a half paralyzed diaphragm and no upper-left ab muscles.

I did go to the doctor and she looked me over and took x-rays. She is aware of my history and she didn't find anything alarming from that context.

The good news is that it has improved in the last couple of days. Not gone but this morning was the best in quite some time. It appears that adjusting my position in such a way that the back muscles are more relaxed makes a difference.

I've been reading the Original Strength book and have been surprised to find how difficult some of the exercises are. I even feel good after practicing them.

Brett, I will be sending you an e-mail.

Thanks to everyone!
 

stutkd

Level 1 Valued Member
I think there is a danger here of thinking black and white, not considering the shades of grey which are  present.

Pain is a medical issue.

Not necessarily. As Dan John has been quoted as saying "squats hurt my knees. No, the way you squat  hurts your knees".

At the 2011 rkc certification in the uk I witnessed the correction of technique in squats presses and tgu with delegates who had knee and shoulder pain. To the best of my knowledge the instructor who did this was not a medic/pt etc. what he did do was correct what was a poor movement pattern through various explanations and drills. In one case the delegates shoulder pain was related to car accident previously. Dealing with the presenting movement problem (whether  attributed to the accident or some other pre existing problem) allowed that individual to be tested on the tgu on the final day without pain ( something they believed they would have had to sit out at the beginning of the course).

Prior to training as a physiotherapist I worked as a personal trainer in London.  Correcting poor exercise technique resulted on repeated occasions in reduced or resolved pain. This was either short term mechanical pain (with long term implications) and /inflammatory from repeated irritation (and likely muscle/postural imbalances, though this is assumption - it was around 17 years ago) Which carried over negatively to other daily activities.

I am sure there are personal trainers who empowered their clients to resolve pain from the significant weight loss following their interventions.

As a physiotherapist I have unfortunately seen some colleagues struggle to treat their patients, succeeding in part using therapies such as mobilisation, manipulation and/or electro therapy but causing subsequent regression with lack of attention to detail on (their prescribed excerise) technique and programming.

As Brett and Brendan rightly point out not all pain is musculoskeletal. I have been in the position to refer patients back to their GP following red flags. Scarily on one occasion a GP initially refused to do the appropriate blood tests stating that I was over reacting and demanded that I continue to see the patient. It was only after discussing my reasoning (not a pleasant conversation) and refusing further treatment until appropriate tests were completed that I was sadly vindicated. A cancer diagnosis from an initial presentation of hip pain.

Internet advice is blind without the complete history and evaluation.

I completely agree. However, we all must bear a responsibility either professional, ethical or moral regarding whether to give advice AND take it given the strengths and limitations of the medium used to convey it, the quality of the data given, the calibre of the person disseminating it, our own knowledge to understand and weigh up the pros and cons. It is a reason I believe speaking in lay mans terms to patients. Empower not blind with fancy clinical terms.

It is a frightening fact that statin medication is over prescribed (at least in the uk) as a primary preventative for heart attacks and strokes yet you would be lucky to find a Dr who knows the difference between Hdl/LDL and cholesterol particle analysis. The latter is not commonly used to assess prior to prescription of statins, Yet how many people blindly follow the dogma of certain health professionals. Do not assume the medical/healthcare sector has all the answers. They either don't have the depth of knowledge or (most likely the resources) for full evaluation. As one consultant told me when I was a student "medicine is often about finding out what the problem is not. This narrows the possibilities", it does not always define the causes.

If there is one indictment against my profession in the uk it is the often blinkered approach the profession takes to "outsiders". This is not I only limited to physiotherapy but the register of exercise professionals who said "Pavel who?" When I asked if my RKC would be recognised by them 18 months ago. I was given disparaging comments by some colleagues and concern expressed by my then superiors when I began plugging in kettlebell techniques to my practice with multiple sclerosis patients, yet it worked. Not only did they move better, some managed to walk again and yes pain improved.

I am not saying we can be all things to all people. I am not even saying the advice I would give today is the same I would give tomorrow. That is the nature of educational evolution. I would just say that advising in absolutes (generally as we'll as) on a medium such as this is not wise whether pain, medical or exercise related.

Likewise whilst we don't need to understand the mechanics of a car to drive, understanding them can improve the wear on the tyres the fuel consumption and for those interested improve on a future model of the car.

we all have something to offer. Whilst certain catagories exist to help those in need to understand the correct course of action or ideal resource to be advised they can in some instances inhibit those from achieving that precise purpose.

It is this that I believe this thread (and those like it here) is useful for, not doing a sub standard job (albeit from a good place) trying to diagnose someone in pain.

the dividing line is thin but there are plenty of grey shades either side of it.

I hope I haven' t offended anyone. I won't say on more on this.

 
 

stutkd

Level 1 Valued Member
chris

i just read your last post (got carried away writing my epic lol).

i am really glad you are feeling better i hope you continue to do so.

best wishes

Stu
 

Brett Jones

StrongFirst Director of Education
Master Certified Instructor
Beast Tamer
Stuart

We will not agree on this - exceptions to rules do not invalidate the rule and the rule in this case is the dividing line is clear and Pain = medical referral.

AND if you will reread Chris' last post about the cancer, surgeries, paralyzed half a diaphragm and no upper left ab muscles I think you will find my advice about the internet being blind and pain being a reason for medical referral well justified.

Chris,

I will be shooting you an email soon.
 

B.Hetzler

Level 3 Valued Member
"My history does include cancer with associated treatments, surgeries, and severed nerves resulting in a half paralyzed diaphragm and no upper-left ab muscles."
I will hold back on my rant, but like Brett pointed out - this miniscule fact is a GAMECHANGER.

Pain is 100% a medical issue. When you know the rules, you can break the rules. However, there are many that don't know the rules. Pain=referral 100% of the time. Blind medical advice (and anything on a forum is blind medical advice) is always wrong.

Well, guess I will call that a mini-rant.
 

stutkd

Level 1 Valued Member
Brett and Brandon.

I appreciate we will not agree fully on this but I think on some aspects we are singing off a similar sheet.

Medical referral for pain IS always needed but to say pain is 100% a medical issue is wrong. Other professions may have a role to play but only once the worst case scenario has been cleared. The personal example I gave was to illustrate both how medical advice is essential but not infallible hence the need to have a good network of people behind you. If anything Chris's past health declaration augments this.

The Internet is not the place for diagnosis I agree and made that point already. As such you will not find me making any such efforts here or anywhere without seeing the person in full where I can gain a full history, objective assessment including palpation which cannot be done via Skype. For pain not even this medium is appropriate .

However, I maintain this forum can be useful in advising people on such problems as have already been done in Chris's case regarding his supposed adjusted leg length discrepancy. From this appropriate referral can be sought or return to the original medic with pertinent questions. It is here I believe people such as Chris have to take the responsibility to accept that advice or not. I see too often patients bouncing between medical professionals with little guidance or explanation. If there is no problem seen in their speciality there is no problem. From this acute issues can become chronic.

Exceptions to the rule do not invalidate the rule but unfortunately not all medical professionals are aware of the role of their multidisciplinary  counterparts (effectively not knowing the rules themselves) hence effective onward referral does not take place. Again a point made regarding the discussion I mentioned above with the GP. a community such as this can provide that food for thought that may assist someone on his/her patient journey but cannot constitute medical advice or a replacement for.

Regards

Stu
 

B.Hetzler

Level 3 Valued Member
I will keep repeating this for those that might still be on the fence.  Pain is 100% a medical problem.  Pain is a signal from the brain that there is a problem - usually in the case of movement if there is not an acute injury or trauma the pain is a lagging indicator that something has been going on for a while, but the pain happens after the fact.  Now, the original problem that caused the pain may be truly movement based but once it gets to the point of pain, it is no longer a movement problem it is a medical problem.

I'm sure we won't agree, but that is a whole other issue.

 

 
 

jgruginski

Level 3 Valued Member
@daniel, I think the point of perspective is relevant to what you've said. If I were the asker of advice, I would consider myself responsible for the information I receive on an internet forum and what I choose to do with it. If I were the provider of information, I would consider myself responsible for the information I dispense and how it could be interpreted. so when I say we're responsible for ourselves, I don't absolve the person providing the information. I merely point out that the asker has a responsibility to themselves to consider the source and medium. Plenty of doctors give bad advice in person, so the medium is only part of the problem.

I struggle a little with the debate between Stuart and Brett because on one hand, I know that medical professionals are educated and compensated to accept what I call the "transfer of liability". What I mean is that a doctor, trainer or coach who refers someone to me is transferring the liability of the person's pain for me to make the call on what it is or could be and if treatment is warranted. Once I release that person to normal activity, I now accept responsibility for that person and their problem if I don't adequately address it. However, pain exists on a spectrum. Should a person who experiences pain during an FMS always get a medical referral? I'm asking because I'm not FMS trained and don't know if there is a protocol. If not, where does the line get drawn? (Please know that I am asking from a position of knowledge seeking and respectfully challenge the statement in the absolute). If someone experiences some form of pain during training, should they get it looked at? How is pain defined in this instance and do the qualifications of the person (e.g. FMS certified) matter?

I'd hate for online conversations to degrade into a string of caveats followed by a few simple observations which are then followed by a legal disclaimer. I think that would make these conversations pointless when they can be very helpful. Having said that, at no point should anyone try to dissuade someone from seeking medical attention. That goes beyond irresponsible and appears to be the point that I think all of this discussion has been aimed at. Maybe I missed that in all the posts, but I'm not seeing where that was done.
 

stutkd

Level 1 Valued Member
Just read both posts. Really interesting stuff.

Does that mean that someone in pain should not seek an FMS when in pain first because it is a medical issue or that as a matter of protocol they would be advised to go straight for medical opinion without a physical assessment following a subjective one? I ask this out of interest not challenging the FMS protocol (I hope to take the fMS sometime this year).

Whilst I agree on the basic physiology of pain it may  also not be a true signal of something being wrong, certainly in some chronic pain cases (at least by current understanding). Hence where other professionals may fit in.

My concern is that whilst doctors may be a source of referral to clear more sinister risks/causes, they are not the scource of useful info in dealing with the origins of that pain if movement related. Pain management via this route often leads to one of a hierarchy of treatments such as drugs, analgesic injections etc and ultimately surgery. These may be appropriate but as their pain management arsenal does not generally involve movement education pain often persists.

Is analgesic medication adequate to then engage in exercise (either rehabilitative or more intense recreational or sporting)? In the latter never, in the former only in severe cases when the pain is prohibitive to any rehabilitative movement.

I hope that this is not taken as disparaging of anyones opinion here particularly Brett and Brandon who have answered these posts the most. I actually have found it interesting so hope the difference of opinion has not been taken as offensive.

I would just like to add that for others reading this. If you are in pain invest the time (and where necessary the expense) in yourself and get checked out by your Doctor, but if they can't help ask to be referred to another discipline who may see things from a different perspective. I would hate to find someone took my opinion as a message to bypass a medical opinion and miss something serious which could have been diagnosed earlier. That is certainly not my message.

 
 

B.Hetzler

Level 3 Valued Member
On the FMS, if there is pain then yes it warrants a referral.  If someone is in pain, then the FMS is not the appropriate tool for them, the need the SFMA which is designed to weed out painful vs non-painful and functional vs dysfunctional.  Selecting the appropriate tool is the key.

I agree with you Stuart on the problem of some doctors and how pain is treated.  But, I still stand by my recommendation to find a qualifed medical practicioner (not necessarily a doctor).  Anytime someone complains about how a Dr, PT, ATC, DC, etc cares for them my automatic response is "who walked into who's office?"  The person seeking care voluntarily went to them.  It is the person seeking cares responsibility to do research to find the best medical professional for them. 

The SFMA is a game changer for people that suffer pain with or from activity.   And the beauty of the SFMA - only qualified healthcare practicioners can take the course.
 
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