Conservative Orthopedics and Wellness -COW

09/21/2025

Beautiful day in oakland to catch up on some visual aspects of DNS rehab with the always inspirational tower of ignorance in the background

09/01/2023

https://conservativeorthopedics.com/2023/08/shoulder-pain-very-effective-exercise-for-a-variety-of-patients-athletes/

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08/23/2023

https://conservativeorthopedics.com/2023/08/neck-isometrics-easy-and-effective/

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01/27/2023

https://conservativeorthopedics.com/2023/01/disc-related-low-back-pain-sciatica-what-should-you-do/

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12/25/2022

Happy Holidays

04/16/2021

Continuing education time

McKenzie Mechanical Diagnosis and Therapy  Advanced Cervical Thoracic and Upper Extremity refresher course, M&M version with Medcalf and Miller instructing, super pumped to learn from the masters

Fine tuning the diagnostic classification of whether an issue is a neck problem, arm problem, both or something else, without a full examination of neurological status, spinal mechanics and the whole upper body, things are going to be missed. If only seen as a muscle or a joint or a flexibility or strength issue, assumptions will generate errors.

Friendly reminder that McKenzie is a diagnostic system, not a set of exercises or protocol, frustrating to see how many patients have been told they were given mckenzie when it was just a few random stretches without an initial diagnosis or reassessment, we do a full comprehensive exam and start getting results with an open ear and attention to detail.

Never stop learning

04/08/2021

Continuing with our belated, boisterous and borderline blasphemous briefs on bird dog blunders series, we look at the elbow, not usually the center of attention with this exercise, but can have a big impact on where we feel it working.

This is of particular interest for bendy people, the ability to hyperextend the elbow gives a different option for loadbearing during a bird dog exercise, which can drastically change which muscle groups are working.

As we hold the bird dog or any other exercise which has our weight going through our hands into the ground, there are different muscle chains we can use to hold ourselves up, This can be directed by our hand pressure, elbow angle and shoulder/scapula position, whole body, its all connected yadda yadda, anyways today we are focusing on the elbow.

If we over straighten the elbow, we can shift the tension more into the front of the shoulder, anterior delt, long head of the bicep, upper shoulder blade muscles, etc along with the ligaments and stacked bony structure of the elbow. This can be an issue if those areas are painful or overworked, when we are still bracing through them, we're burning calories, but not having a real therapeutic effect.

If we keep the elbow neutral or slightly bent if required, we tend to activate more triceps, the long head inserts into the shoulder blade, and this ties into more the lower scapular muscles into the abdominal slings, connecting an arch from the hand on the table to the opposite knee. 

The key here is the load passing into the ground without a detour through the head and neck, our elbow and upper extremity position will determine the road we take, so needs to be observed and modified as needed. This can expose a lack of strength or endurance which needs to be built up, or its possible that we have the nuts and bolt but just aren't using that pathway preferentially.

Hope this helps, thanks for reading

Pete

                 

04/05/2021

For this month's mckenzie minute for moderately motivated musculoskeletal menders minute, we crossover some techniques to get into more of the creative side of mechanical testing.  

I like SOT blocks, they add some interesting forces into the therapeutic toolbox and are easy to teach a patient for self treatment.  

They can create a useful translation force of the pelvis relative to the rib cage depending on the depth of the blocks under the pelvis. Prone CAT 3 or 1 blocking causing a posterior translation or shear of the pelvis relative to the rib cage and CAT 2 supine blocking anteriorly translating the pelvis relative to the rib cage. This creates a shear force across the lower back which can be a good or bad thing depending on the mechanical response to range of motion and provocative testing.

We can put sagittal plane translation into our MDT assessment as a variable, we sideglide in frontal plane, so why not in sagittal also? Similar to traction vs compression with motions also, some patients need pulled apart while other need extra compression of sitting to get a full treatment effect.

Would be similar to the hands across the lower back with extension or leaning backward over a table to extend, extra pivot point and shear which can change the movement.  

Advantage of blocking would be the fine adjustment and ability to prolong the duration of the force, especially when it needs time for a small shift to take effect. Can utilize breathing to help relax further into the position while blocked, I've heard it described as a form of positional release from time to time. Can also be helpful with derotating certain patients for repeated extension prone, in scoliotic patients notably.

Hope that helps, little different today, but something to consider

03/29/2021

Continuing with our belated, boisterous and borderline blasphemous briefs on bird dog blunders series, we look at the stance width of our hands and knees.  Their position will determine if we draw more from the outer or inner arms and legs, this has an impact on which muscle links/fascial lines we utilize during the exercise.  This is important to consider what result we are looking for, if we are seeking abdominal challenge and are hanging on out outer arm and leg, not gonna get the results we need.  That said, not necessarily a right or wrong way to do it, narrow stance for outer extremity challenge and balance, wider stance for the abdominal arch connecting the hand and knee on the floor, all depends on what we want.  Sorry internet, no demonizing exercise positions today, just explaining the value of each modification in a specific situation.

Anyways, simple thing to monitor, can turn an exercise into a test, everything is potentially diagnostic when we switch our lenses

03/23/2021

Zoom fatigue, many contributing factors, personally have used an ancient 2nd laptop for just video to at least get 2 screens to bounce between

It’s not just Zoom. Popular video chat platforms have design flaws that exhaust the human mind and body. But there are easy ways to mitigate their effects.