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I've been working with a man who has had a history of chronic back, pelvic, and knee pain. His back would develop a lateral shift every so often to the point where he couldn't stand up straight. The shift, his back, and knee pain have resolved and we are left with his hip pain which has been difficult to treat. Recently he was in so much pain, he was considering surgery.

We discovered his hip flexor and adductor (the muscles on the inner thigh) muscles on the painful hip side never seemed to relax. When he  consciously relaxed these muscles his pain would decrease. Now his hip pain is about 70% better but he still has trouble with a few things.

Today we worked on going upstairs which aggravated those muscles and caused him pain. We determined that his opposite ankle (which had a bad sprain about 40 years ago and was casted for three months) did not dorsiflex (bend forward) well enough while he was stepping up with the painful side. After getting the ankle to dorsiflex sooner, he could step up with his painful leg without pain or overactivity of the flexors and adductors.

We are constantly putting these pieces together for him to eliminate decades of pain. These are deeply ingrained movement habits that will take a while to correct but discovering them is half the battle. He has been a fascinating patient to see with layers of complexity we continually strip away. But it's working!

Would love to hear from any of you having trouble getting to the bottom of your or your clients' pain!

I just read a fascinating article, Metabolism Make-Over: Fact or Fiction?(Idea Fitness Journal, June 2011) by Dr. Len Kravitz, PhD, where he sifts through research about what affects our resting metabolic rate (RMR). RMR is the daily expenditure of energy we expend just by living. So the higher the RMR, the more calories you burn naturally.

The nuts and bolts  of his article come down to this: roughly 60% of our RMR is influenced by genetics, our activity levels, organ size, hormones etc. About 30% is due to effects of exercise, and 10% due to energy from food metabolism, digestion, etc.

He goes on to answer some important questions such as:

How much does RMR decrease from diet-ony interventions? RMR can be suppressed by up to 20% by dieting alone. Exercise will help offset this.

How is RMR affected by long term aerobic exercise? In the 16-month study he quoted subjects exercised 3-5 days/wk for 20-45min/session at moderate intensity. Females saw an average increase of 129 calories/day and males increased 174 calories per day.

How is RMR affected by long term participation in resistance exercise? Dr. Kravitz cited a 26-week study of sedentary 61-77 year old men and women. The study's protocol involved 2 sets of 10 repetitions with 2 minutes rest between sets for an exercise program involving arms, abs, and legs. They trained at 65%-80% of their 1-repetition maximum. Participants increased their RMR by an average of 7% or about 100 calories/day.

How do you calculate your RMR?

Males: RMR= 10 x (weight in Kg) + 6.25 x (height in cm) - 5 x (age in years) + 5.

Females:RMR= 10 x (weight in Kg) + 6.25 x (height in cm) - 5 x (age in years) - 161.

1 Kg = 1 lb divided by 2.205.

1 cm = 1in x 2.54

These formulas  have a margin of error of about 10% due to genetics and other factors.

Does eating more frequently elevate RMR? Yes. If you refer back to the percentages above, 10% of your RMR is derived from the energy expenditure of eating and digesting food.

If you have questions about these studies or your RMR, I highly recommend you read this succinct, reader-friendly article! I'd love to hear your comments.

Just saw a patient today with foot pain. I noticed the non-painful foot has prominent hammertoes. After further testing I discovered she had a retroverted femur (a femur that is twisted into external rotation). I asked her to change her gait pattern to accommodate her retroverted femur. When she did, her hammertoes diminished. After I pointed this out I asked her to resume her old walking pattern and we both saw the hammertoes rear up again.

I believe that, in order for her to walk with what she believed to be a proper gait pattern, she used excessive force to swing through the leg while advancing it. She used her foot and toe dorsiflexors to achieve this, contributing to her hammertoes. Once we corrected her gait to reflect her femoral rotation, less effort was required and the toes remained relaxed.

We also found that this unloaded the opposite painful foot, which was compensating for the increased stress to the non-painful side. This will be an interesting case to follow!

Was just at a kids running fundraiser where pre-school through second graders ran around an 1/8 mile track as many times as they could to raise money for their school. It was so much fun! I couldn't help but notice that every child ran with a forefoot strike pattern. This lends credibility to a new foot strike paradigm I'm using to help fix peoples' foot and ankle pain.