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101 Physiotherapy Tips & Insights to Help You Conquer Pain & Reclaim Function

Diagnosing Pain, Injury & Dysfunction

#1. Instant Pain Does Not Mean Instant Dysfunction

The onset of most non-traumatic pain and injury is often the last straw, not the beginning of something new. This can sound counterintuitive considering we often go from having no pain to having pain in an instant. However, our tissue is far too robust to fail so easily. Instead, think of your dysfunction as the moment you finally breached your tissue's ability to cope with poor loading, poor positioning, and/or poor mechanics. The key to preventing its return, therefore, becomes about trying to uncover these hidden handbrakes.


#2. Hidden Restriction Is the Underlying Cause of a Lot of Dysfunction

From what I see clinically, restricted tissue - characterized by things like joint stiffness, or muscle tightness, is easily one of the most common underlying causes of pain, injury, and dysfunction. It's just hard to see if you're not looking for it. Pain is clearly an important symptom to respect, but local or associated stiffness often defines why something becomes painful in the first place. You just have to be willing to look for it.


#3. Pain Is Your Brain's Interpretation of Threat

Pain is not the tissue-specific consequence we often think it is. It's actually an expression of your brain and nervous system's perception of threat. With this in mind, your pain experience is therefore at the mercy of how heightened your nervous system might be prior to the onset of pain. If heavily stressed or constantly in a 'threatened" state your pain experience is likely to be greater than someone less challenged. This idea also helps explain chronic pain. Clinically, those with chronic pain usually have a chronically heightened nervous that must be respected before any long-term musculoskeletal changes can occur. Down-regulating a heightened nervous system is crucial to managing pain.

Related: Here's what I've come to understand about the cause of Fibromyalgia and effective treatment options.


#4. Muscle Weakness Is Not Always a Lack of Strength

Not all muscle "weakness" may indicate a lack of physical strength. In a strong percentage of cases, the apparent lack of strength may actually be an "inhibition" from spinal dysfunction. Local spinal dysfunction may act like a 'kinked' hose and negate the normal flow of neural activity to the muscle. This can result in less available output. To see this in real-time, test your strength, free up the relevant spinal segments and then retest your strength again. If previously deactivated, expect to see an immediate improvement in available strength.



#5. Diagnostic Scans Need Context

The result of any musculoskeletal scan needs context. It's always helpful to see how your tissue looks, but a scan can't tell you whether it's actually the source of your symptoms - despite how imperfect it may look. An arthritic knee, disc bulge, or chronic rotator cuff tear is obvious enough, but we can't confirm any link to actual pain without a thorough physical and biomechanical assessment. Interestingly, many imperfections picked up by a scan aren't painful. Even if they are, a patient's mechanics will often dictate why it's become sore. So, when this is addressed, we may prompt a resolution in symptoms without the appearance of a scan changing.


#6. Muscle Tightness Happens For a Reason

Muscles don't become tight on their own. It's often a response to your brain and nervous system looking for protection or support for something else. Essentially, the body draws function from relevant muscles to prioritize a situation deemed more important. With this in mind, stretching might ultimately prove ineffective over time if we aren't also addressing the underlying cause of that muscle tightness.


#7. Joint Stiffness Reduces Proprioception

As mentioned before, joint stiffness lays the foundation for a lot of our aches, pains, and injuries. Interestingly, it also reduces proprioception, or our ability to know where our joints are in space. If you were to close your eyes and bend your elbow, your joint-position sensors help realize you've bent the elbow. However, if your elbow is stiff, that biofeedback is dampened. With this in mind, it's important to keep those joints loose to remove another layer from the injury prediction model.



Upper Body

#8. Shoulder Internal Rotation is Crucial

A lack of shoulder internal rotation - characterized by the ability to put your hand behind your back, has a huge say in the onset of shoulder dysfunction. Missing this range forces the shoulder and shoulder blade to move differently, putting a number of structures at risk of pain and injury. Clinically, slouchy postures directly compromise the structures related to internal rotation.


#9. Upper Back Stiffness Is Just as Important

Another common feature of poor shoulder function and pain is upper back restriction. This often gets missed as it's rarely symptomatic. Take a tennis ball or lacrosse ball, lie down and gently let it press into your upper back. The stiff first rib in particular, which sits at the very top of your upper back, is lethal for shoulder dysfunction. Again, you can't slouch forever without potential consequences.


#10. Tennis Elbow and Golfer's Elbow Are Neck-Related

Interestingly, Tennis Elbow and Golfer's Elbow have strong clinical links to lower neck dysfunction. The base of the neck houses the beginnings of the Radial and Ulnar nerves, which pass through and supply the lateral and medial elbow respectively. It also has related Dermatomes and Myotomes, which are neural connections left over from fetal development. Dysfunction around these direct and indirect connections can set the elbow up to fail over time, and need attention if wanting long-term relief from elbow pain.

Related: Read more about how the neck may be the underlying cause of Tennis Elbow.


#11. Repetitive Strain Injuries Are Also Neck-Related

Similarly, poor neck function is also heavily linked to many repetitive strain injuries (RSI) of the hand, wrist, and fingers. As with the elbow, the base of the neck communicates with these areas and can set them up to fail if subtly compromised over time. Again, the neck itself may not overtly hurt in any way, but it's highly likely to be stiff and dysfunctional. Mobilize your neck and upper back up with a lacrosse ball or tennis ball and think closely about your daily neck habits to address this potential underlying cause.


#12. Chest Muscle Tightness Is Back-Related

Tight chest muscles are a symptom of upper back stiffness. Slouchy postures force the upper back and ribcage to stiffen over time in a response to poor loading. The Pec Major and Pec Minor muscles become involved via their connection to the front of the ribcage. This is important because traditional pec stretches don't address this underlying stiffness which is why we often have to keep doing them.

Related: Here's a more in-depth look at why chest muscle tightness is back-related.



Neck and Back

#13. Many Headaches Are Neck-Related

A large number of everyday headaches are neck-related. Obviously there can be some more sinister causes for some, but for many, they tend to be a referred from irritated and overloaded tissue at the very top of the neck. To figure it out, use a massage ball to gently hunt for relevant stiffness in the joints of your upper neck and re-assess your daily neck postural habits. Neck-related headaches usually relate to lots of time spent looking down. This can be anything from looking down to read, using a phone, cooking, cleaning, using a laptop or computer, and even reclining back to watch TV.

Related: Learn more about neck-related headaches and how to treat them.


#14. Many Subtle Head and Facial Symptoms Are Neck-Related

Furthermore, a stiff and overloaded upper neck can express itself as sinus pain, jaw pain, light-headedness, dizziness, toothaches, and ringing in your ears among many other facial and head symptoms. If something about your head or face feels a little less than perfect, gently press a ball into the top of your neck/base of your skull and see if it's connected. If it feels stiff or your symptoms change you have potentially found the hidden source of your complaint. As always it's important to have a low threshold to go and get yourself checked in case something more sinister is at play.


#15. Trigger Points Are a Sign of a Deeper Issue

Upper back trigger points or 'knots' are often a sign of two things: overloaded underlying joints and poor posture. Poor posture can overload the tissue of the upper back and ask our nervous system to use muscle spasm for support. We spend a lot of time trying to release these trigger points with constant pressure, but without addressing both underlying issues we can't truly get rid of them.



#16. Stiff Hips Can Cause Low Back Pain

Hip stiffness and tightness heavily contribute to the onset and persistence of low back pain. The less hip range we have, the more we have to use our back when sitting, bending, leaning, and generally moving throughout the world. Feed more slack to your lower back by freeing up those hips.


#17. A Band of Low Back Pain Is Referred From Somewhere Else

One of the most common presentations of low back pain - a band of pain across one or both sides of the lower back, may actually be referred from the base of the ribcage. Interestingly, the base of the ribcage has nerves that can refer to the lower back and top of the hips. We spend so much time looking specifically at the lower back despite there not being a structure that presents itself in this way. To confirm, free up the base of your ribcage with a lacrosse ball or foam roller and re-assess your symptoms. With any luck, you may even reproduce and settle them, confirming the hidden source of your pain.


#18. Quickly Assess How Stiff Your Back Is By Bending Backward

To get a sense of how stiff your back is, bend backward. If it feels anything other than smooth and supple there's likely to be some spinal joint stiffness there somewhere. Any stiffness, jamming, tightness, and of course pain, suggests the way you load your spine is less-than-perfect. Use a lacrosse ball, tennis ball, or foam roller to gently press into these areas and free them up until bending back feels smooth again.


#19. Unfortunately, Your Posture Counts

It may be hard to prove via research, but the single biggest factor I find clinically that links most back, neck, and shoulder pain together is sub-optimal posture and positioning. Clinically, the dysfunctional area almost always lines up with a direct hinge created when looking down or slouching. The key is to figure out when and where these shapes take place so we can ultimately solve them. Make no mistake, poor posture will never guarantee pain, but it's very, very difficult to succumb to these issues if you practice good shapes.



Lower Body

#20. Ankle Stiffness Creates Most Foot, Ankle, and Lower Leg Issues

The underlying cause of many feet, ankle, and calf issues is ankle stiffness. Not to be confused with muscle tightness, this deep capsular stiffness forces the entire leg to find a workaround. As a result, almost every structure is loaded differently. Plantar Fasciitis, Shin Splints, Achilles Tendon Dysfunction, ankle impingement, Navicular and 5th Metatarsal stress fractures, Bunions, Calf tears, recurrent ankle sprains, and more, can all be traced back in some way to poor loading and ankle stiffness. Try the banded ankle stretch (tip #60) for a quick way to loosen stiff ankles.

Related: Here's everything you need to know about the cause of Achilles Tendonitis (Tendinopathy) and how to approach treatment.


#21. Stiff Ankles Are Linked With ACL Injuries

Following on from this, stiff ankles also have a huge say in an overwhelming number of ACL injuries. Approximately three-quarters of all ACL injuries are non-contact. And this speaks to a common problem with sports injuries. We often blame bad luck and activity when in actual fact its a sudden exposure of poor mechanics. With ACLs, there's a strong clinical link to stiff ankles, and unless we free up these ankles, we will continue to be at an unnecessarily high risk of re-injury post-op.

Related: The Complete Guide to Understanding the Cause and Treatment of ACL Injuries.


#22. Patella Tendonitis Is Linked to Mid-Low Back Dysfunction

Clinically, Patella Tendonitis (Tendinopathy) may have strong ties to a dysfunctional mid-low back. We traditionally see Patella Tendonitis, or 'Jumper's Knee', as overuse or an overload of the patella tendon. However, dysfunction around the base of the ribcage seems to create an increased resting tension through the patella tendon, setting it up to fail. This helps explain why many suffer from 'overuse' on just the one side.

Related: Here's what I've come to understand about Patella Tendonitis and its link to back dysfunction.


#23. Tightness at the Back of the Knee Isn't Hamstring Tightness

Tightness at the back of the knee when stretching is more likely an increase in Sciatic nerve tension than Hamstring muscle tightness. This increase in tension is not nerve tightness, but a reduction in available 'slack' due to a restriction at the lower back. So take a moment to free up your lower back and do a neural floss exercise instead.


#24. Hamstring Dysfunction Is a Sign of Low Back Dysfunction

Clinically, almost all Hamstring injuries are back-related. More specifically, they're a direct consequence of poor low back function. Consistently placing the lower back in poor positions and shapes forces the body to recruit the Hamstrings to help provide stability and support, to the detriment of their normal function. If you suffer from frequent hamstring injuries or tightness, make sure to work hard on better low back postures, reactivating your trunk muscles and eliminating any hidden low back stiffness.

Related: Here's why the majority of hamstring injuries are back-related.


#25. The Back Is Also to Blame for Quadricep Injuries

Much like the Hamstrings, our Quadriceps are also at the mercy of poor spinal function. In this case, dysfunction at the top of the lumbar spine and base of the ribcage can compromise Quadriceps function and set it up for injury. Clinically, there seems an increase in Femoral nerve tension and a tightening of the Quads to help support the lower back. Again, if you have consistent Quadriceps complaints, make sure to address any spinal dysfunction and prioritize better postural habits.


#26. Groin Pain Often Relates to Hip and Back Dysfunction

Groin pain is usually caused by underlying hip and/or low back dysfunction. It's notoriously persistent not necessarily because it's the norm, but because we often fail to address these hidden features. Like many soft-tissue injuries, the tissue fails when it's forced to cope with poor loading over time. So, enhance your groin-specific rehab by mobilizing your hips and mid-low back as well.



#27. Genuine Leg-Length Discrepancies Are Rare

Despite how it seems, it's rare to have one leg shorter genuinely shorter than the other. It can happen as a result of Arthritis or a nasty accident, however, the majority are just a consequence of pelvic asymmetry. More specifically, one side sits higher giving the appearance of a shorter leg. Common causes include sitting on your wallet or phone and sitting with both heels tucked up under one hip.


#28. Leg Cramps Are an Expression of Low Back Dysfunction

Clinically, leg cramps are a symptom of an overloaded lower back. Traditional causes like dehydration, nutrition and deconditioning are important, but potentially too broad to specifically explain why certain muscle groups cramp, especially if one-sided. From my experience, cramping is actually a sudden increase in the baseline muscular tone caused by segmental spinal dysfunction. Free up your spine with something like a foam roller to address these symptoms.


#29. Flat Feet Are Not a Foot Problem, They're a Leg Problem

Collapsing arches, or 'flat fleet', have more to do with poor overall leg mechanics than the arch itself. To get a sense of this, stand with your feet straight and rotate your knees out without moving your feet. You should feel your glutes activate and those arches lift. If you let your knees de-rotate again, your arches will collapse. Restoring the integrity of your arch does require some general foot strength and mobility work, however, unless you spend time working on improving the function of your leg, those arches will keep wanting to collapse.


Enhance Rehabilitation & Recovery

#30. Stop Using Ice to Treat Acute Injury

Despite ice being a staple of acute injury management for almost 50 years now, it's time to reconsider its place. Pain, inflammation, and swelling, the things we often try to suppress with ice, are normal physiological processes that must happen for our tissue to heal. Instead of trying to stop them, we should focus on ways to help expedite these processes. Interestingly, Dr. Gabe Mirkin, creator of the R.I.C.E protocol, now recommends against the use of ice to treat an acute injury. It's time to focus more on techniques that respect our physiology, not oppose it.

Related: Here's why you shouldn't ice an acute injury.


#31. More Swelling Often Means a Lack of Movement.

Swelling is neither good nor bad. It's just the accumulation of waste at the end of the inflammatory cycle. Increased swelling does not mean too much is being produced, it's an indication that not enough is being evacuated. And considering the body's swelling removal system, the Lymphatic system, is passively fueled by movement, any increase in swelling effectively means we aren't respectfully moving the area enough. Avoid ice and opt for respectful, pain-free movement, and movement-based techniques instead.


#32. Rest Is Not the Answer Post-Injury

Rest is not the key to optimizing your post-injury recovery. The more appropriate term is 'relative rest'. Not enough movement may cause more pain, swelling, and muscle atrophy. Too much may cause pain and increased tissue damage. Therefore, like most things in life, it's about balance. We want to find an appropriate level of movement that sits just below your comfortable tolerance to help optimize the healing process.


#33. The Marc Pro Can Expedite Rehab and Recovery

To dramatically reduce rehab and recovery time, use a machine like the Marc Pro. The Marc Pro is a muscle stimulation machine that allows the body to complete an active recovery during the more passive moments. By applying the pads post-injury or activity we can continuously engage the lymphatic system and revolutionize our ability to turn things around quickly.

Related: Here are 14 ways the Marc Pro can revolutionize your health and fitness.


#34 Familiarize Yourself With Voodoo Floss

Voodoo Floss is a highly useful tool to de-congest and mobilize restricted tissue. Clinically, it's great for optimizing rehab and recovery. Popularized by Kelly Starrett of The Ready State (formerly Mobility WOD), it involves tightly wrapping an area with strong elastic for a few minutes at most. We pair this with movement to "floss" tissue and flush out congestion. Due to its strong compression, we definitely need to apply common sense in terms of when, where and for how long it's used, but it's a brilliant technique nonetheless.


#35. A Crutch Goes on the Opposite Side

If you need a crutch, make sure to use it on the opposite side. The purpose of a crutch is to help you move, and move normally in the face of dysfunction. When used on the opposite side, a crutch will unload the dysfunctional area and reduce limping. If used on the same side, it will increase a limp (I'm looking at you House M.D) and potentially reinforce bad habits that'll need to be addressed later.


#36. Deep Breathing May Help With Concussion Recovery

Deep breathing may hold the key to expediting concussion recovery and post-concussive ailments. The short and long-term ramifications of concussion can be nasty and are still being studied. Clinically, deep breathing may help clear up concussive symptoms by down-regulating a heightened and acutely threatened nervous system while helping to re-balance acidic and inflamed physiology through hyperoxygenation.


#37. Timing of Post-Workout Protein Isn't Vital

Protein consumption immediately post-workout is not as vital as we once thought. Dr. Brad Schoenfeld, a world leader in all things muscle hypertrophy and strength, suggests protein intake is less about the initial 20-30 minute 'window'. Instead, it has more to do with your protein intake throughout the day. Dr. Schoenfeld suggests most protein meals allow for a 4-5 hour window, so if you had a good feed 2 hours pre-workout you'd have another 2-3 hours to top up again. He also suggests as much as 40g of protein is needed as opposed to the traditional 20g. This is important to consider if looking to build muscle post-injury or enhance performance.

Related: 13 ways to optimize your post-workout recovery


#38. Cortisone Injections Are a Short-Term Solution

Like many medically-based treatments, we should only consider cortisone injections a (potentially great) short-term symptomatic treatment. If cortisone helps, use this break from pain to work on bettering your mechanics and address the original underlying cause. You don't deserve to rely on these injections forever, especially considering they can lead to their own issues.


#39. 'Prehab' Helps With Post-Operative Rehabilitation

Pre-operative rehabilitation or 'prehab' is crucial if wanting to expedite your post-operative recovery time. Anything you can do to improve your mechanics, strength, mobility, and overall tissue health prior to surgery will dramatically reduce the time it takes to reclaim them again later on. It's more advantageous to try and settle any post-operative pain, swelling, and inflammation if you minimized how much of it was already layered in beforehand.



Reclaim Normal Function & Enhance Performance

#40. Learn to Brace Your Spine Effectively

Learning to activate your deep trunk muscles or 'core' will increase spinal stability, function, and performance. In order to do so, take a comfortable breath in, and as you breathe out gently draw your belly in and up toward your spine. You should be able to maintain a comfortable tension independent of your breathing and activity demands.


#41. Learn to Generate Rotational Stability at Your Shoulders and Hips

Similarly, when performing any upper or lower body movement make sure to externally rotate your shoulders and hips respectively. This creates peak joint stability by winding up the joint capsule and engaging relevant stabilizing muscles. Doing so allows for improved strength, function, and performance over time. For the upper body, this looks like breaking a bar in half, or elbows in. With the lower half, this is expressed as rotating your knees out.


#42. A Strong Core Doesn't Mean It Activates Well

The concept of a strong core is different from one that activates well. By learning to create a well-braced spine (above) you can make sure your well-sculpted trunk performs, at the right time. This can be seen quite clearly when sitting in a poor posture. You can have a brutally strong trunk but use none of it when slouching in poor, passive shapes, opening the door for spinal dysfunction.


#43. Re-Learn to Breathe With Your Diaphragm.

Constant sitting and stress can train us to breathe with our chest and not our diaphragm. This 'stress-breathing' pattern is far less efficient and can keep our nervous system unnecessarily heightened. Take the time to check in with your breathing during the day and make sure the base of your ribcage and stomach expands as you breathe in and falls on exhale.


#44. Re-Learn Nasal Breathing

Similarly, many of us now breathe predominately through our mouths and not our noses. Interestingly, the nose forms part of the respiratory system with its ability to clean and filter air. Alternatively, the mouth is part of the digestive system. In terms of breathing, the mouth is used as a secondary system when the body requires large amounts of oxygen ie, towards the end of a long run, running up a hill, etc. The catch is it comes at a much higher metabolic cost and is far less efficient. Nasal breathing is associated with the Parasympathetic nervous system, the body's anti-stress programming responsible for down-regulation and recovery. With this in mind, try breathing more through your nose to better manage stress and become more efficient.


#45. Learn to Box Breathe for Stress Relief

If looking to specifically down-regulate your nervous system and better control stress, master Box Breathing. The body associates certain breathing patterns with particular physiological states. And when highly stressed, we tend to adopt a faster, more shallow, chest-breathing pattern. Box Breathing is simple and effective because it forces you to take deep, slow, diaphragmatic breaths, which the body associates with rest and relaxation. To Box Breathe, breathe in through your nose for five seconds and then pause at the top for another five. Exhale for five and then pause at the bottom for five more seconds to finish. The number of seconds will increase or decrease as you feel comfortable and all it takes is a few cycles to feel your body noticeably shift down a gear or two.


#46. Re-Orientate Your Pelvis by Squeezing Your Bottom

If you'd like to know whether your pelvis is orientated correctly, stand up and squeeze your bottom. If it tilts back, this means your pelvis may sit forward too much and too often. This forward position increases the load on your lower back and can negatively affect your pelvic floor function. Work on restoring this position and practice activating your core to hold it in place.


#47. Run Barefoot for a Lesson in Optimal Mechanics

To get a sense of how efficient and mechanically sound your running technique is, run barefoot. It's hard to run poorly barefoot, so if you notice a dramatic difference to your regular running pattern you may have just exposed a hidden handbrake. If like many, you value how fast you run, correcting these deficiencies can open up greater athletic potential beyond just training harder and longer.


#48. Reduce Oxygen Debt by Deep Breathing Prior to Exercise

Deep breathe for a few minutes prior to the start of exercise to minimize oxygen "debt". Oxygen debt refers to the initial stages of activity where the amount of oxygen needed is greater than the body can provide. This is important as it's hard to start performing at your peak before the body catches up. We try to counteract this with a thorough warm-up, but try deep breathing to hyper-oxygenate your body and increase the oxygen available for use from the get-go.


#49. Fatigue From Exercise May Not Just Be Fitness-Related

Fatigue from exercise is not just an exploration of the outer reaches of your fitness. It's also an expression of your mechanics. The more efficient your movement, the less energy is needed and the more bang for your buck. By freeing up or strengthening areas of your body, you should be able to improve your 'fitness' beyond training harder.


#50. Ribcage Stiffness Limits Mechanical Ventilation.

Similarly, ribcage stiffness can limit efficient breathing and oxygen intake. If your body mechanics can influence how 'fit' you feel, so can factors that affect your breathing. It's hard to express yourself optimally if your lungs expand against a rusty ribcage. Loosen it up for a sneaky performance boost.


#51. Orthotics Should Only Be Used as a Short-Term Aid

Hands up if you've had a pair of Orthotics for years. Technically they should only be used as a short-term aid. Orthotics may help prevent your arches from collapsing, but they don't stop your arches from wanting to collapse. By all means, use them if they help improve your function and quality of life, just make sure you're also trying to correct the broader leg dysfunction that makes those arches collapse in the first place.


#52. For Better Balance, Reduce Ankle Stiffness

As discussed earlier, joint stiffness diminishes proprioception. And considering this joint-position sense is crucial for balance, we can improve balance by mobilizing ankle stiffness. Not only can it help improve your sense of balance, but better ankle flexibility also gives your body more movement options with which to maintain your balance.


#53. Make Your Day Movement-Rich

We all know structured exercise is important, but make sure the rest of your day is movement-rich. An hour in the gym is fantastic but spending the other 15 glued to a chair may unbalance the equation. The human body is designed to move so please consider adding as much non-exercise activity into your day as possible.


#54. Peeing Yourself During Exercise Is Not OK

Peeing yourself during exercise is not an admirable trait. It's not a sign of how hard you've worked but the point at which you can no longer maintain normal pelvic floor control. This may indicate poor pelvic function, the most likely of which is an unnecessary anterior pelvic tilt. As mentioned above, practice squeezing your glutes and creating external rotation forces at the hip to help re-align and re-awaken your pelvic floor musculature.



Exercise Tips

#55. Make Home Exercise More Convenient

The key to being consistent with home exercise is to make it easy on yourself. Taking 10-15 minutes out of an already busy day can be hard to maintain. Instead, do your exercises while doing something else. If you sit down and watch TV at night, use that time to stretch. Use equipment? Have it lying around in plain sight so it's easily accessible. Consider sprinkling these moments throughout your day to distribute the commitment.


#56. If There's No Change, There's No Change

Each exercise you do should always show actual, observable change. If there's no change, there's generally no change. It may sound silly, but don't continue with a stretch that doesn't make you feel immediately looser or progressively looser over time. Strength training or muscle building may take a little longer to shift, but you deserve to see progress over time. If not, make sure you have a conversation with your therapist or trainer to figure out a better way. Don't waste your valuable time and money stagnating.


#57. Hydrotherapy Is a Brilliant Exercise Alternative

For those with long-term or chronic pain, consider Hydrotherapy. The heat and added buoyancy of a Hydrotherapy pool helps to open up greater potential for exercise and rehabilitation for those who struggle with the demands of weight-bearing and balance on dry land.



#58. Passively Holding a Stretch Doesn't Work

We've come to realize that passively holding a stretch doesn't make you more flexible over time. Instead, use what's called Proprioceptive Neuromuscular Facilitation (PNF) or 'hold, relax' stretching. Find a good stretch and then actively tense the muscle and those around it for 5-10 seconds. This will engage your brain and nervous system and prompt the muscle to release.


#59. Use a Power Band to Mobilize Joint Stiffness

A power band is a must-use tool to quickly improve your mobility. Once again popularized by Kelly Starrett of the Ready State (formerly Mobility WOD), the power band allows us to mobilize tough-to-reach joint capsule stiffness - one of the biggest reasons we aren't as bendy as we should be. Unlike traditional stretching, a power band promotes immediate mobility gains, making it a great technique to use pre-activity for peak performance.

Related: Here's why a power band and PNF stretching are the most effective ways to improve mobility.


#60 De-Stiffen Those Ankles With the Banded Ankle Stretch

One of the most important stretches to master in today's world is the banded ankle stretch. We know how detrimental stiff ankles can be to leg function, so it pays to have a simple countermeasure. Use a power band to bias the deeper joint capsule for fantastic results.



#61. Combat the Effects of Sitting With the Couch Stretch

Do your hips, knees and back a favor and practice the couch stretch. Yet another valuable contribution by Kelly Starrett, this stretch has an amazing ability to mobilize the front of the hip and quadriceps. The couch stretch can be scaled from a more simple version with your knee in the back of a chair (couch), and made harder by doing it on the ground and/or with a power band. It can be brutal, but it's an absolute must-do stretch for those with low back, hip, and knee pain, or who just want to move and perform better.

Related: How to do the Couch Stretch.


#62. Mobilize a Stiff Back and Neck With a Lacrosse Ball

Something as simple as a lacrosse ball or tennis ball can be used to free up your neck and back. Lie on your back and gently let the ball press into the tissue right next to one side of your spine. Get a sense of how stiff and/or tender it may feel and then compare it to the other side. Prioritize the side that feels the stiffest and tightest, not just where the tenderness is. Spend a few minutes on each spot and continue hunting for stiffness. Upon standing you should feel immediately looser if you've hit the right spots.


#63. Mobilize Your Hips With the Banded Hip Capsule Stretches

An important series of exercises for good hip and low back health is the banded hip capsule stretches. When on all fours, gently shift your hips and shoulders across to the side you're stretching. The idea is to feel like your thigh bone is pressing out the back corner of your hip. This biases the deep hip capsule, a structure criminally underrated as a source of dysfunction and poor mechanics. You can also rotate your leg inwards and outwards to hit different aspects of the joint. It can also easily be done without a power band.


#64. Improve Shoulder Function With A Capsular Stretch

There are a number of good shoulder stretches, but not many effectively target deep capsular stiffness like you can with a power band. Capsular stiffness is particularly troublesome with a Frozen Shoulder and post-shoulder surgery. This deep stiffness can seriously limit the range of motion and overall function, so it's important to have a specific stretch to combat this. Similar to the hip capsule stretch above, the key is feeling like your arm is pressing out the back corner of your shoulder. You can rotate your arm in and out and have either your elbow or hand on the ground to vary the amount and type of pressure.


#65. You Can't Stretch the ITB

Despite the general perception, the Iliotibial Band (ITB) can't be stretched. This is because it doesn't actually get tight. The ITB is a tough connective tissue that acts as an insertion point for the Quadriceps, Hamstrings, and various hip muscles. We can, however, feed more slack to the ITB by mobilizing the muscles as they insert into it. Use a roller or lacrosse ball to do the job.


#66. Protect Your Back by Learning the 'Good Morning'

Many people with low back pain have unknowingly lost the ability to bend purely from the hips without bending their back. The hip hinge or "Good Morning" is a great way to re-learn the art of bending from the waist. Practice taking your bottom back while your trunk moves forward. Ideally, your hamstrings should lower you down and pull you back up. Nothing should be felt in the lower back and the goal is to get somewhere close to 90 degrees. Interestingly, this also forms the basis of a good deadlift - an essential movement to master for optimal hip and spine health.


#67. Practice the 'Gut Smash' for Better Sleep Quality

For better sleep quality, give the "Gut Smash" a try. The brainchild of Yoga Tune Up guru Jill Miller, the Gut Smash involves lying on your stomach with a softish, medium-sized ball gently pressing into your abdomen. This simple technique helps stimulate the Vagus nerve to down-regulate the nervous system. It may also help de-stiffen your back by taking off a subtle handbrake from the front.


#68. The Skin of the Heel Can Limit Ankle Flexibility

Many don't realize the skin of your heel can act as a handbrake to ankle mobility. When the compressive force of footwear is mixed with body heat, it can create a sliding surface restriction between the skin and underlying tissue. Any ankle stretches are incomplete unless you also try to restore the integrity of those sliding surfaces. Use a shearing motion with a lacrosse ball or foam roller to help get the tissue sliding again.




#69. Practice the Ideal Deep Squat Shape

The ideal squat shape for optimal leg function is a deep one. Start by standing with your feet straight and create an external rotation force at the hip (tip #41). As you squat down, your knees will travel out as far as possible without your feet moving. This often feels a little awkward at first as you may be fighting against hidden ankle and hip stiffness. The depth of your squat is dictated by your capacity to keep your feet straight, knees out, and back straight. Going beyond this point is fine, but if you're squatting for reps or with a heavy load you'll be doing so with compromised mechanics. In the meantime, work on addressing your ankle and hip stiffness, and the depth of your squat will improve.


#70. Try the Box Squat If You Have Knee Pain

If you struggle to squat because of knee pain, try the box squat variation. Place a chair or box behind you and slowly lower your bottom down to touch the seat before standing up again. This squat shape allows you to maintain a more vertical shin, reducing forward sheer at the knee. The box squat is particularly valuable after knee surgery.


#71. The Handstand Is Underrated for Shoulder Strength and Stability.

Although relatively unusual, the handstand is a fantastic way to build functional shoulder strength and robustness. Doing them up against a wall can help you concentrate on good form and endurance. If a handstand is too advanced, start with your hands on the ground and your feet on a chair. Aim to place your feet higher and higher until eventually vertical.



Debunking Myths

#72. Growing Pains Are Not Growing-Related

The way we perceive "Growing Pains" is slightly incorrect. Our tissue does not hurt because we grow, instead, growth exposes underlying poor mechanics. After all, growing is normal and symmetrical. Yet common issues like Sever's Disease and Osgood Schlatter's Disease often present on just one side. In short, let's uncover the hidden stiffness, tightness, poor loading, and/or poor posture and take back control.

Related: Here's a different perspective on the hidden cause of Osgood Schlatter Disease.


#73 You Can't 'Pull' a Back Muscle

Although a common phrase, it's rare to "pull", or tear, a back muscle. It's a great descriptive term for how many feel, but it's far more likely the muscle is compensating for an irritated joint underneath. Tearing a back muscle is reserved for truly horrific accidents, not getting up off the couch, coughing and sneezing, or subtly "moving the wrong way."


#74. The Spine Does Not 'Go Out'.

Despite how it feels, the back (and neck) do not easily dislocate, or "go out". The spine is a seriously robust piece of machinery, and it needs to be as the foundation for all human movement. It also protects the more delicate nervous system underneath. If a joint, disc or spinal segment did physically shift out of place, it would seriously compromise our nervous system with potentially horrible consequences. Instead, this feeling generally relates to stiff and irritated spinal joints. It's still a jammed up feeling but not because something physically moves out of place.


#75. Popping and Cracking Is Not a Sign of Arthritis

Clinically, tissue that clicks, crunches, grinds, pops, cracks, or generally makes noise is not a sign of arthritis. It's an expression of poor mechanicals. This isn't to say it's Arthritis-free, but that Arthritis is not the cause of these orchestral sounds. If we can improve the immediate function of the area with a lacrosse ball, foam roller or power band, we can expect an immediate improvement in any unwanted sound effects - regardless of Arthritis.

#76. Upper Trap Tightness Is Not From Holding Your Shoulders Up

If your upper traps feel tight it's not because you hold your shoulders up. It's because you let them drop too much. The upper trapezius muscle, which sits at the top of the shoulders, becomes tight in response to slouchy shoulder posture over time. With this in mind, we don't want to correct our shoulder posture by shifting back and down. Ultimately we want to shift our shoulders back and up a little, which is counterintuitive to many.


#77. Resistance Training Is Highly Appropriate for Children

Resistance training is highly beneficial for kids and does not negatively affect growth. Like everyone, there still needs to be a strong focus on proper form and technique, with an appropriate weight one that allows the child to experience fatigue. A well-coached resistance training program is a fantastic way to teach children robust movement habits and develop lean muscle mass, which is crucial for a long, active life.


#78. The "No Pain, No Gain" Motto Should Not Disrespect Actual Pain

We need to reinterpret Nike's "No Pain, No Gain" slogan. It's clearly a brilliant piece of marketing, but its meaning has morphed from a great motivational tool into something that devalues genuine pain. At no stage should we ignore pain and dysfunction, as it's a signal something is wrong. By all means, suffer through the "pain" of hard work, just be aware of the difference.


#79. Cracking Your Joints Does Not Lead to Arthritis

Cracking your joints may not lead to Arthritis in the future, but the reason why they need to crack in the first place might. The crack itself, called a cavitation, is just a release of pressure. However, that pressure builds up thanks to poor postures and poor loading. By addressing these poor shapes and mobilizing the area itself, we can take away the feeling of needing a good crack completely.


#80. Morning Pain and Soreness Does Not Mean You've "Slept Funny".

It's easy to wake up in the morning with neck or back soreness and feel like you've slept funny. However, it may surprise you to know that it's actually a consequence of the day before. It's a similar idea to next-day muscle soreness from a heavy workout, but the cause often isn't as obvious. Think back to the postures and positions you got in to and you'll eventually see what went wrong. Free up the symptomatic areas and improve your positioning to wake up without the funny business.


#81. Pain Is Not a Normal Part of The Aging Process

Despite how it feels for so many, aches and pains are not age-related. However, time may expose dysfunctional loading and poor mechanics if left unchecked. At no point is the human body designed to breakdown, in fact, it's supposed to get better the more we use it. The caveat is that many unnatural aspects of the modern world can take a toll over time. Your knee isn't designed to wear out, but it might if a stiff ankle forces you to load it differently for 30 years. Make no mistake, there are absolutely age-related changes to our tissue, but this relates to capacity and output rather than pain and dysfunction.

Related: Here's more about why your aches and pains are not a normal part of the aging process.



Combat Modern Living

#82. Make Sure You Know What Good Posture Feels Like

In today's world, it pays to know what a good sitting posture feels like. To find your best position, start by standing tall with your feet straight and pull your shoulders back. Squeeze your bottom to re-orientate your pelvis, draw your belly in (independent of your breathing) then sit down. Interestingly, nothing from the waist up should change.


#83. Optimize Your Posture in the Car

When thinking ergonomics, many just consider the work desk but don't forget about the car. Don't rely on your car's lumbar support, create your own with a rolled up towel. Have your seat relatively upright and close enough to the steering wheel so that your shoulders stay back. Similarly, adjust your rear-vision mirror accordingly. If you begin to slouch, you'll get a non-too subtle reminder.


#84. Sit Cross-Legged to Improve Low Back Stability and Hip Mobility.

If you sit for any length of time, cross your legs. Doing so helps maintain normal hip range and makes it easier to keep your back in a good position. If sitting cross-legged hurts your hips or knees, know this: it's a direct consequence of hip stiffness. Mobilize those hips for a much more pleasant experience.


#85. Use a Standing Desk Where Possible

This won't be news to many, but strongly consider a standing desk to reduce time spent sitting each day. There are significant functional, mechanical and physiological benefits to a standing desk when compared to sitting. Having said that, the idea is not to stand more, but to create the potential for more movement. Consider a standing desk the gateway to a more movement-rich environment.


#86. If You Can, Look Down From Your Hips Not Your Neck

If you have to stand and look down a lot, do so from your hips. This takes the load from a very small section of the neck, which can become dysfunctional over time, and spreads it across one the body's most robust areas. The movement itself looks like a condensed version of the hip hinge (tip #66) and is highly valuable for those who cook, clean, treat or generally remain on their feet at work.


#87. Squat to Your Full Depth Often

The western world doesn't value the deep squat nearly as much as we should. Our over-reliance on chairs robs us of the opportunity to express the depths of our full hip, knee, and ankle range of motion. As a consequence, it's easily lost. You may not currently have the capacity to squat to full physiological depth, but there's nothing stopping you from exploring the depth you do have. Make this one a priority!


#88. Clothes Can Be an Unnecessarily Stiff Exo-Skeleton

This always sounds silly, but tight and stiff clothing can negatively affect your function and range of motion. For example, skinny jeans look fantastic, but if the material doesn't allow your legs to bend fully, you're unnecessarily putting your lower back at risk. Similarly, a stiff jacket that isn't broad enough will force you into a slouchy shoulder posture and limit your ability to raise your arms above your head. Again, this is certainly a first-world problem, but it's a genuine issue for those who often wear restrictive clothing.


#89. Any Shoe With a Heel Is Likely to Stiffen Your Ankles

The size of your shoe's heel is the exact amount of ankle range you won't have access to while wearing it. And as the saying goes, if you don't use it, you lose it. Many understand this when looking at a traditional women's heel, but we often don't realize the majority of our sneakers, running shoes, work shoes, and dress shoes now have an unnecessary heel at the back. Clinically, heeled shoes are a covert contributing factor to so many of our lower limb complaints, so it pays to be aware long-term. Free up your ankle with the banded ankle stretch (tip #60) and aim to make your next pair of shoes a little flatter.

Related: What makes a good shoe. Why modern footwear is ruining our mechanics and setting us up for injury and dysfunction.


#90. Flip Flops Are Junk Food for Your Feet

Flip flops are not good for our foot and leg mechanics long-term. Like a heeled shoe, they can create ankle stiffness as we need to hold on to them with our first and second toes. This is highlighted by the fact it's hard to run, walk backward, or kick a ball while wearing them. If appropriate, consider switching to a self-securing sandal or just spend more quality time barefoot.


#91. Spend More Quality Time Barefoot

We spend so much time in shoes that our feet have become de-sensitized, stiff and weak. So much so, that many of us just don't feel comfortable walking around barefoot anymore. Social standards, etiquette, and asphalt make being completely barefoot difficult, however, we need to devote more time to it. Spend as much time as possible barefoot on different surfaces with different densities and textures to re-sensitize, mobilize and strengthen your connection to the ground.


#92. Prioritize Your Sleep.

This one's probably obvious, but we have to prioritize our sleep. Not just the amount of time we get, but it's quality as well. Considering we spend about one-third of our lives asleep, and every single human function is influenced by its quality, we need to take it more seriously. If you need a morning coffee to recover from all that supposedly restful sleep you just had, perhaps it's time to take a step back and reconsider what's going on.


#93. Reduce Blue-Light Exposure at Night

One simple, but hugely effective way to improve your sleep is to reduce exposure to blue-light once the sun goes down. Commonly emitted by smartphones, tablets, laptops, computers, and TVs, blue-light can suppress Melatonin, the chemical responsible for preparing our body for sleep. Blue-light itself is neither good nor bad, but our exposure to blue-light heavy sunlight naturally decreases once the sun sets. Opt for a blue-light filter on all technology to help maintain this natural status quo, or better yet, try to decrease the amount of technology used as you approach bedtime.

Related: Here's why blue-light has no place after dark.


#94. Care More About the Posture Underneath the Heavy School Bag

Heavy school bags rightfully need monitoring to decrease the risk of neck and back pain in kids. But we've missed the point a little. Clinically, the weight clearly matters, but it's the child's posture underneath that has the biggest influence on future pain and dysfunction. In a perfect world, a heavy school bag should only ever strengthen a child's neck, back, and shoulders if supported by good positioning. However, a heavy load applied to an already poor shape is a recipe for disaster if left unchecked. Having said this, there will always be a weight that exceeds a child's ability to maintain a good shape. But this threshold becomes more obvious if we value good posture in the first place.


#95. Run Towards the Extremes of Cold and Heat, Not Away

One of the downsides of being a modern human is our tendency to control the temperature around us. If it's slightly too cold we scramble to turn up the heat. If it's too hot, we turn on the cooling. As a consequence, this comfortable temperature range stops our body from needing to regulate this itself, effecting our vascular and immune system health. If you're too hot or too cold try deep breathing for a few minutes to acclimatize your body before reaching for the temperature control. Alternatively, try the simple task of adding or removing layers of clothing. This way your body will still need to do some of the work itself. Better still, why not enjoy a sauna or cold shower to really boost your body's ability to cope.



General Tips

#96. Stand and Walk With Your Feet Straight.

Thanks in part to our thirst for sitting, many now walk with their feet turned out. As the front of the hip stiffens, the leg is forced to rotate outwards in order to work around this restriction. This changes the way we load everything from our foot and arch all the way up to our hips and low back. To correct this we obviously need to mobilize the front of our hips (tip #61) but start by simply trying to keep your feet straight when standing and walking.


#97. A Good Massage Caters to How You Feel

The hallmark of a good massage isn't how hard it is. It's how well it caters to your nervous system. To decrease pain and muscle tightness, the body needs to feel safe. A massage that feels "too hard" probably is. If you don't speak up, you run the risk of threatening an already heightened nervous system and increasing the chances you'll feel sore the next day. Always aim for a massage that is comfortably tolerable, whatever that means for you.


#98. Make Sure You're Actually Absorbing the Water You're Drinking

If you try to do the right thing and drink plenty of water, make sure your body is actually absorbing it. The body requires electrolytes to assist in the process of osmosis and Dr. Stacey Sims of Osmo Nutrition suggests adding a pinch of good quality rock salt to your daily water bottle. By doing so, you shouldn't feel the need to run to the toilet all the time. You'll also come to realize that clearer urine doesn't necessarily mean 'better' hydrated.


#99. Look for Bias in Research

If you respect a piece of research evidence, take the time to consider whether its results are actually valuable. Unfortunately, many are too quick to take a conclusion as gospel without looking for bias and its ability to be generalized. For example, a really interesting study may be hard to generalize if the study was conducted by an organization with a vested interest. The results may also be hard to appreciate if not conducted on a broad range of participants. The bottom line is that research results are meaningless without context, so please make sure you have your wits about you and an open mind.

Related: Here's why I'm at odds with Evidence-Based Practice.


#100. Become Friends With a Cold Shower

A cold shower has so many physiological benefits if you can get past the mental hurdle of actually having one. They're brilliant for stress relief and down-regulating a heightened nervous system, strengthening your immune system and improving mental health. Start by having your regular warm shower and then slowly turn the temperature down at the end. You don't have to go fully cold in the beginning, just to the limits of your comfortable tolerance. Focus on breathing slowly and deeply and your tolerance will gradually improve.




#101. Take the Time to Practice the Wim Hof Method

If you have a moment, take the time to familiarize yourself with the Wim Hof Breathing Method. Wim and his technique have the genuine potential to change your perception of what's possible with the body. It may even change your life. Wim's technique utilizes deep breathing and cold exposure to create an environment where you can begin to dictate terms to your physiology. Its applications are almost endless but please do yourself a favor and explore what it can do for you. You won't be disappointed.

Related: 16 Incredible Benefits of the Wim Hof Method.


And there you have it, one hundred and one useful Physiotherapy tips!

As you can hopefully appreciate, there are some common themes throughout this article. Your posture unfortunately counts, everything does happen for a reason (although not always obvious), a healthy spine is crucial for good function and to decrease the risk of most common injuries and dysfunction. Ultimately, you really do deserve the chance to feel good all the time.

If you've found some gold here, please let me know in the comments below or reach out via the socials. I'd love to chat!


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