The last few months in clinic have brought in some, if I can borrow the new Netflix title, "Stranger Things." I have had at least 4 people have extremely hard falls that actually fixed chronic pain. This was musculoskeletal pain that had been present for over 2 years. One gentlemen had disc pain and was recommend surgery from his orthopedist.
Hard fall on a hip that took all the pain away and stated felt stronger then ever. Another hard fall directly on a knee that shoved the hip up. Again, took all pain away in the hip. (knee was sore for a few weeks ) Lower back pain that went away after a hard fall down stairs onto the butt. (I've actually had this happen 3x now in the last 7 years) One had some serious disc pain for about a 6 month period and was in PT. They all stated they had shot of pain, layed on the ground wondering if they broke something, slowly got up and realized the pain wasn't there. All felt stronger after the incident immediately.
From a chiropractic stand point I don't believe there was an "out of alignment" joint. To have that kind of need for that force would suggest a joint that was very misaligned to the point of limping or horrid movement. One hip I can verify moved extremely well. (I understand my bias on this and while I could be wrong I'm trying to think of other possibilities.)
For the sake of argument, if it was misaligned, I at this point in my thinking/career, wouldn't feel ethically comfortable putting the amount of force they experienced into 60+ year old hips. Nor do I think I could actually generate that type of force.
So what happened?
I don't really know. If a joint moves like a joint, doesn't have abnormal tension in any of the prescribed motions what's left? Proprioception of the joint and strength of the muscle is the only things I can come up with. While I am a big believer in strengthening muscles/movements. I haven't found that to be that effective with people that have had chronic pain that the joint moves well. So for me, that eliminated this option. That leaves proprioception of the joint. How well the individual can find and use the joint. This comes back to old school "muscle testing."
I've blogged before about how I don't think we are muscle testing but testing proprioceptive awareness of that movement in that position. Movement variability even states that every successive test you are most likely not even testing the same fibers and that their is a ton of bias on the practitioners part. But, my personal bias still thinks we should be able to lock a joint in in all planes of motion without much effort. (not clutching the table, holding your breath, squeezing your jaw)
This question of what happened with these patients lead me to think about performance and if this could be done at a lower level. (not having to take a huge fall to make a change.) After much debate, I decided to take Douglass Heels Be Activated course. I went with an open but skeptic brain. I probably asked 5-6 people that had taken the course before their thoughts and opinions. Really looking for a reason not to go. All spoke highly. What made up my mind was the number of strength coaches implementing it into their programming and all stating that the soft tissue injuries have come down.
I've found for me, the most useful tools in therapy from high class strength and conditioning coaches. The elite use it first and it trickles down.
It was held at the Spot Athletics in Columbus, OH. (side note...kudos Columbus, you guys have solid 3rd wave coffee scene.) The owner JL Holdsworth a super respected guy in the strength coaching industry. The teachers for the weekend were Cal Dietz and Chris Korfist. Cal is the Strength coach for the University of Minnesota and has been using it with his athletes for over 3 years. Chris is track coach and been doing it for over 6 years and has worked with Douglass for the full 6 years. So it was great to learn from guys using it daily with real athletes. It was equally awesome to be in a room with some pretty respected strength coaches from all over the country.
Without going into the details, it's getting muscles to fire stronger. When JL spoke of the term "wake up" drills it clicked for me. By the way JL, if your reading this I'm stealing that phrase! If you believe in corrective exercises for your patients or athletes, then you can't argue with a wake up drill if it gets the muscle to fire stronger, or have better awareness, or have better proprioception in that area. (terminology can vary)
Wake up drills make sense to me. Can you fire the muscle/movement without a compensation pattern. It's in the compensation pattern that many injuries can possibly be explained. In my way of thinking it can be easily implemented into a warm up routine. Just like many injuries can be mitigated with a great warm up, something most athletes fail at, perhaps this will be a way to increase the benefit of the warm up.
Perhaps the falls were just a jolt into the nervous system that globally stimulated the sympathetic nervous system and then a huge parasympathetic release when they realized they were ok. Perhaps the falls literally "woke up" the muscles around the area. A figurative defibrillator to the muscle/movement.