The Importance of Unilateral Exercises

Most movements can be divided into two categories: unilateral or bilateral. Unilateral exercises are asymmetrical, in which one side of the body (e.g. one leg) is performing an action that the other side does not. Bilateral exercises are more symmetrical, in which both sides of the body are doing roughly the same thing. Both types of exercises are important and functional, but unilateral exercises will facilitate certain benefits that cannot be obtained from bilateral exercises alone. Some examples of unilateral exercises are: reverse lunge, single-leg bridge, single-arm overhead press, split squats, and single-leg deadlift. Examples of bilateral exercises include a squat, deadlift, barbell overhead press, push up, and bridge. In real life, we engage in both types of movements extremely often.

But, because life is rarely symmetrical, unilateral exercises tend to be more relevant to daily life.

Standing on one leg to pull your pants on. Reaching for the glass on the top shelf. Walking. Running.

Bilateral and unilateral exercises both serve a crucial role in functional fitness. While more force and power can be created with bilateral exercises, unilateral exercises require greater balance and stability. They can bring awareness to compensations and imbalances between sides of the body that can easily be overlooked during bilateral movements.(1)

For example, if one has weakness in the left leg characterized by a difficulty in distributing and generating forces, maintaining balance, or moving through a functional range of motion under load, a unilateral exercise will make this extremely clear. If one only ever did regular, bilateral squats, the right leg would continue to overwork, perpetuating a compensatory pattern that could contribute to issues down the road. While we should not expect that our two sides should be equal in their ability, it is helpful to be aware of our unique characteristics and engage in movements that will provide a stimulus for positive adaptations to occur. 

It is important to recognize that with most unilateral, “single leg” exercises, both of your legs continue to carry out an important job. Put simple, one is the mover, and one is the stabilizer. Contrary to what might be evident visually, it is the leg that is not moving that actually has the more difficult job. One leg is weight-bearing, and one leg is non weight-bearing (or bearing less weight than the other leg). The leg that is holding our weight is responsible for maintaining our balance and control of the movement, while the other leg is free to move through space. Consider walking. At each moment in time, one leg is holding your weight, foot on the ground, allowing you to move your other leg forward. By becoming more aware of where we are holding our weight, and which leg is free to move, we can refine our coordination, balance, and efficiency of movement. 

Mime Walking Example

Mime walking is a standing movement lesson that almost all Wellness Station clients learn early on. Many of us begin to have difficulty gliding our pelvis to shift our weight, which can be evident from a forward-flexed posture, short step length, and difficulty standing on one leg. This lesson helps to bring about greater elegance and ease to walking by teaching awareness of weight shifting from one leg to the other. The basic idea is to glide the pelvis to one side (e.g. right) so one leg holds your weight while the other leg lightens up, and then repeat on the other side. Once this concept is learned and felt in the body, countless variations and progressions can emerge that will translate into improved function and ease of walking.

Single Leg Stand to Reverse Lunge

To further progress mime walking, we can apply this motion into a single leg stand. We become aware that one leg is holding us up and controlling our movement and stability, while the other leg is free to move through space. Applying this into a single leg stand to reverse lunge flow is a dynamic way to improve balance, strength, and awareness of our differences from side to side. 

If lacking in steadiness and ease, gently hold on to a support surface with a hand (put your hands in the kitchen sink!), or don’t move the non weight-bearing leg through such a large range. 
If more challenge is desired, move in slow motion, increase the range of motion of the non weight-bearing leg, and/or hold a dumbbell.

Sit to Stands and Squats: Unilateral Bias

A basic squat or sit to stand movement can be changed to have a unilateral focus by holding more weight through one leg intentionally. Coming up onto the tip toes of one foot is a way to do this. 

If lacking in steadiness and ease, use a higher chair, and/or don’t come up as high onto the tip toes (keep more of the non weight-bearing foot grounded). Or, hold on to the kitchen sink as you do this motion. 

If more challenge is desired, use a lower chair or squat through a deeper range, move in slow motion especially on the way down, hold a dumbbell at the chest, or even practice hovering the tip toes off the ground. 

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Sources: 1 https://www.self.com/gallery/single-leg-exercises

Osteoarthritis: To Move or Not To Move?

Osteoarthritis (OA), which is also known as degenerative joint disease, involves a wearing down of the flexible cartilage tissue at the ends of the bones that form joints. It is the most common form of arthritis, and it is estimated that over 32.5 million US adults are affected by it!(1) Prevention strategies of arthritis before it occurs is the most effective way to make sure it will not become an issue in your life. These strategies may include improving movement patterns, staying active, keeping your muscles strong and joints flexible, having good nutrition while avoiding processed and pro-inflammatory foods, staying hydrated, maintaining a healthy weight, and ensuring adequate recovery from exercise with enough sleep and gentle movement.

Once a joint has become arthritic, what are some strategies to keep in mind to optimize functioning, improve joint health, and mitigate the impact that this condition could have on quality of life? 

There is plenty of misinformation out there regarding arthritic joints. Even the terms used to describe OA colloquially can impact the public’s perception in a negative way. Degenerative joint disease. Wear and tear arthritis. Bone on bone! These types of descriptions bring scary images to mind, and imply that movement and exercise is actually unhealthy for joints and can contribute to joints wearing out. Certain doctors may tell their patients with OA that they should not do certain things any more- bend, lift, squat, kneel, run.

Too often, adults with arthritic joints begin to fear movement, or the pain that they may associate with movement, and will begin to exhibit compensations in the way they move. They may begin to become more sedentary, limit participation in various activities, and develop a resentful relationship with the involved body part. These changes contribute to a snowball effect, in which case the changes in mindset and behavior lead to further decline in joint function and tissue weakness, which continues the arthritic process, thereby leading to further pain, fear, and avoidance of movement and activity.

On the other hand, some people may overdo vigorous activity, which can increase inflammation and contribute to additional strain on compromised joints. It can be difficult to find the balance between too much and not enough. Lower impact, moderate activity performed on a consistent basis tends to be the sweet spot in which those with arthritis can keep their joints mobile and strong without contributing to flare ups and potential joint injury. 

Movement is absolutely essential for all of us, and especially for those with OA. If the question is move or don’t move an arthritic joint, the answer is to move intelligently and often.

As arthritic joints tend to become hypersensitized to loading, we must load the joints efficiently without strain, and allow the muscles and other tissues around the joint to get stronger. Stronger, smarter muscles will provide shock absorption and support for the joints, which helps attenuate the forces from daily life, movement, and exercise (like having your own built-in knee brace!) Movement has been shown to limit pain and improve joint motion, as well as prevent the risk of a future injury or fall. (2)
Joints that become arthritic tend to be synovial joints, meaning the joints rely on synovial fluid (the lubricating WD-40 of our joints) to move smoothly. In order for the synovial fluid to stay healthy, slippery, and plentiful, we must move the joint! Movement of joints helps to improve synovial quality and distributes the fluid around the joint so we can move without friction. Additionally, movement helps to distribute blood flow (which contains nutrients and oxygen) around the joint tissues, and can help decrease excessive muscular tension which may be associated with a pain pattern. Exercise has even been shown to activate genes that can help to rebuild cartilage!2 Cartilage has a limited potential to rebuild, but it is possible, and the cartilage that we do have can be strengthened just like other tissues. 

If you have OA, it can be very difficult to get your joint moving and begin the process of regaining strength and mobility. When joints have been painful for a long time, central sensitization may have occurred, which involves central nervous system changes in our perception and response to pain. The pain perceiving pathways may now be embedded deep into our brain circuits, including the prefrontal limbic regions, which is associated with our emotional responses. (3) Combined with structural, tissue-level changes, it is no surprise that many with OA fear movement and require guidance from a physical therapist or other health practitioner to get moving again. Fortunately, physical activity has been shown to have a positive effect on central sensitization, as it can help modulate the pain response by decreasing excitability in the motor cortex as well as stimulating the release of endogenous opioids (endorphins and other substances that are our brain’s natural pain relievers). (3) 

At the Wellness Station, we will be able to guide you intelligently and compassionately towards building strength, improving function, and opening up your life to greater possibilities.

Here is one of my favorite, low-impact exercises for building strength and control in the lower body and core. This can be especially helpful for individuals with knee and/or hip arthritis, in which cases standing exercises like squatting may be inefficient and painful. Many people have done the “bridging” exercise. The Feldenkrais-inspired bridge is known as “spine like a chain”. It involves pressing through the feet to begin to lift one vertebrae at a time from the ground, and lowering down in reverse. This can help to strengthen the glutes and thigh muscles, mobilize the spine, and improve awareness of how we utilize the forces from the ground to move our bodies. Check out this video from Paul McAndrew to get a visual and verbal demonstration of the movement: Spine Like a Chain

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. https://oaaction.unc.edu/oa-module/oa-prevalence-and-burden/ 

2. https://lonepeakpt.com/blog/living-arthritis-move-more-or-move-less#:~:text=Moving%20is%20essential%20if%20you,helps%20your%20joints%20be%20healthier 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074793/ 

My Feldenkrais-Inspired Journey

Almost three years ago, my life changed for the positive when I was introduced to the Wellness Station and the methodology that influences our practice. I had barely heard of the Feldenkrais Method® at this point as a PT student, and certainly had no idea how to implement its principles into my own life or into therapeutic care. This was a pivotal moment in my life in which the end of my academic journey and the start of my career was just around the corner. I knew that I wanted to bring some new ideas into the therapeutic space, as my experience with traditional physical therapy left me searching for deeper meaning. Beginning to blend my learnings of the traditional therapy model with my study and practice of yoga was extremely helpful, but I knew I had much more to learn.

Following an auspicious introduction to the Wellness Station team, I began to open my mind and body to the greater possibilities that are achievable through a Feldenkrais approach. I began to receive mentorship, attended Feldenkrais movement classes, participated in my own body explorations at home, and improved my knowledge through reading various books on the topic. Through this journey, I have achieved personal growth and a refinement in motor skills, which are gifts that keep on giving.

Below I will reflect on some of the key takeaways of my journey that have helped me feel better in my body and motivated me to share these tools with the world. 

Keenly aware of more body parts and connections between

A key part of the Feldenkrais Method is to become more aware of our body in a non-judgmental way. With a background in anatomy as well as yoga, Feldenkrais helped to deepen my self awareness to a greater level of precision. Using the spine as an example, I used to be only generally aware of my spine, more as a series of “chunks”: my low back, mid/upper back, and my neck. Through slow, controlled movements with a keen attentiveness, I have been able to expand my sensorimotor skills to be aware of specific parts of my spine, and how to move and adjust my position to feel more comfortable in these various areas. Key lessons that helped to build this ability have been the pelvic clock, as well as piano keys and spine like a chain. This idea of each vertebrae being like a piano key can allow us to move with the precision of a skilled piano player- flowing up and down the scales with ease, rather than being limited to mashing many keys all at once. These practices allow us to feel “flow” and connections between various body areas, as the spine is our center, our core, the foundation for our head, and the bridge between our upper and lower body. 

Moved away from strain and over-efforting

Many of us have a tendency to put in too much effort, which can contribute to strain and tension. In fact, we all have inefficient movement patterns, which is just part of the human experience. These neuromuscular inefficiencies may present themselves during exercise, daily tasks, occupational duties, and more. For me, this tendency may have related in some part to perfectionism and competitiveness, as well as a reflection of the overall psyche of our society: do more, work hard, no pain no gain. Certainly it manifested into the way I exercised and practiced yoga to some extent. The Feldenkrais Method teaches us to do just enough, and no more. To become aware of unnecessary effort and tension, and find ways to move without our typical patterns of strain. By practicing movement in this way, I became aware of some of my habits that may have been less than helpful. Fitting myself into a tight yoga shape that didn’t feel good, but doing it because I felt like I should be able to. Overtraining because more is always better. Judging and being hard on myself when I felt like I wasn’t achieving something perfectly. My journey with Feldenkrais has not erased all of these habits, but it has done wonders to help me become more aware of them, and has allowed me to be able to make the conscious decision to be more kind to myself and my body. This has actually done wonders for my yoga and other fitness practices. By finding ways to unlock my emergency brake (unnecessary tension), work with my body instead of on my body, as well as a refined sense of awareness and biomechanics, I have been able to find new growth in terms of the physicality of my movement practices. Better ability to move into difficult shapes with ease, strengthen my body in three dimensions, walk and run with a sense of flow, all while respecting the limits of my body in the moment. 

Expansion of therapeutic toolset

One of the most important characteristics of an effective physical therapist is to walk the walk. These practices are part of my life not only for myself but also for my clients. Even though I am not currently a certified Feldenkrais practitioner, my experience with the method greatly influences my therapeutic style to provide clients with a unique approach to therapy. By practicing what I preach, I am able to share an integrative person-centered therapy that can be very helpful for those who are looking for an alternative option. While every person is very different, the tools obtained from mindful awareness practices can be applied to any person. We all have tissues, and our tissues all want attention!

At the Wellness Station, the therapist and client work together as “body detectives”, discovering neuromuscular inefficiencies that may be contributing to pain and movement challenges.

Based on these findings, lessons that are unique to each individual are taught with improved comfort, biomechanical efficiency, and fitness as the outcomes. To learn more about how Feldenkrais can be applied into physical therapy, read our Feldenkrais Method White Paper.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Movement Snacks

What is a movement snack, you ask? This catchy term (which I do not take credit for) describes taking brief movement breaks throughout the day. These breaks are especially important if we spend a long time sitting in the same position, such as during computer work, in the car, or on the couch. They can also be used as a way to warm the body up in the morning after sleep, or perhaps simply as something to do while waiting for the coffee to brew or the food to heat up.

Many people fall into all or nothing thinking when it comes to movement. Some less than helpful ideas out there are… “It has to be intense to be effective.” Or, “I went to the gym already today, so I checked that box.” Or, “I didn’t have time to do all my PT exercises, so I will wait to do them on a day when I have more time.” These mentalities are not so helpful, as they can contribute to moving less throughout the day, as well as equating movement to a chore that we should do as opposed to something joyful that we get to do. Rather than all or nothing, it can be helpful to shift to a mindset in which we reframe our daily movement practice into realistic, bite-size chunks, incorporating the mantra: “a little bit, very often.”

The brain and body respond well to repetition, so it is important to develop a routine that we are doing often in order to get the greatest benefits out of our practice. However, this does not mean that we have to spend a very long time all at once on our movement practices. A better strategy is to have “snacks” throughout the day in which we get our body moving in order to change positions, take strain and tension off our joints, get our blood flowing, and bring about positive changes to our mood and energy levels. Of course we want to also have “meals” regularly in which we are spending a longer period of time moving and exercising, but snacks throughout the day are an excellent way to stay moving in between these metaphorical meals, especially if we are busy.

The snacks you choose should ideally incorporate movement in more than one dimension, as well as include options for variations. Variety is the spice of life- you wouldn’t want to have the exact same snack every day! You might also choose snacks that are specifically targeted towards areas that you want to bring movement into based on what your day has been like. For example, number one below (back extension with thoracic pivot point) is an excellent way to mobilize the upper back, an area that can get stiff and stagnant after spending a long time hunched over a computer.

Here are some of our favorite movement snacks:

Back extension with thoracic pivot point-

Thigh to chest, tail wagging, circles-

Hip and shoulder extension-

Bridge gliding with figure 4 option-

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

The Power of Belief: Saying No to Nocebo

As the fields of cognitive science, psychology, and new biology continue to develop, the scientific community is beginning to understand more about just how powerful our beliefs are. The way we think affects our behaviors, our mood, our perceptions, and even the way we move and experience pain. Most of us have heard of the placebo effect- this is a beneficial effect that occurs after a particular stimulus that cannot be directly attributed to the stimulus, but rather to the belief that the stimulus had a positive effect. This occurs due to both expectancy and conditioning. We expect something to happen, perhaps because it has happened for us in the past, or because someone has planted the idea into our heads that something will happen. This expectation has a neurophysiological effect, which activates particular circuits in the brain that will actually contribute to the expected effect.

The specific neurophysiological mechanisms of how thoughts can impact our physiology are not fully understood, partially because our understanding of consciousness is still extremely limited. However, it is clear that our thinking can impact our body. If you have any doubt about how thoughts can impact our physiology, consider this thought experiment. Does imagining yourself biting into a lemon trigger any kind of physical reaction? Why might that be? 

While the placebo effect can certainly be used for good, we must be wary of its dark cousin, the nocebo effect. The opposite of a placebo, nocebo is a stimulus that creates negative expectations that result in negative health outcomes.1 This might be done intentionally, but more often it is an unintentional adverse effect commonly experienced through interactions with healthcare providers. Ever have an experience in receiving imaging (an X-ray, MRI, etc.), and the provider makes a comment such as … “Wow, no wonder you have pain! Your spine is a mess!” Or another favorite, “Geez, your knee is bone-on-bone! I’m surprised you can still walk! Time for a knee replacement…”. After hearing this information, the nocebo effect can occur, and one may actually begin to experience more pain. It can also impact behavior- perhaps by believing that one’s knee is bone on bone and walking should be difficult, one might stop walking as much, or may begin to compensate while walking. This can lead to actual tissue changes such as deconditioning, excessive tension in various muscles, and more. The negative belief that resulted from imaging and the subsequent conversation with the doctor ended up resulting in a greater experience of pain as well as impaired function. 

How can we use the power of belief to support our health and function? For starters, question negative beliefs, whether these are personal beliefs or from someone else. Anyone who receives imaging should be well informed that structural abnormalities found on imaging do not correlate with pain or function. While people with low back pain may have some abnormal findings on their MRIs, so do asymptomatic people.2 If 100 random people were taken off the streets and underwent imaging, there would be plenty of people with abnormal results with no pain, as well as people with crystal clear imaging who are in severe pain. If people attach too much value to their imaging results, they give up on their belief in themselves to get better. “I have stenosis and arthritis in the spine… physical therapy certainly can’t fix that!” Someone who maintains this belief is deciding that their situation is not in their control, and they are less likely to believe that they will get better. They will be less likely to participate in therapy, more likely to experience pain and dysfunction, and may seek more aggressive treatment options. 

In addition to questioning negative beliefs, create your own positive beliefs! Evidence shows that the use of positive affirmations can lead to improved performance, well-being, and more.3 The use of positive affirmations is a prime example of using the placebo effect to trigger positive health outcomes. By changing our beliefs about ourselves, we can change our behavior and function. This can be very helpful for those of us experiencing pain. A simple exercise could be creating several positive affirmations to repeat to yourself morning, afternoon, and night. The affirmations could be phrases that you don’t currently believe, but what you wish your life was more like. For example, consider the following positive affirmation: “I am strong. I am resilient. I am at peace with my body.” For someone experiencing chronic pain, it can be very difficult to experience peace with one’s body. However, having a sense of peace with oneself can have extremely beneficial effects, including downregulating tension in the body and decreasing the affective components of pain. As we continue to repeat these positive affirmations, they will gradually shift our mindset, beliefs, and experience of life. Ever try to force a smile while upset? Similar to the use of positive affirmations, simply smiling will bring about positive changes in mood, as our brain associates the mechanical act of smiling with happiness.

1. https://journals.lww.com/painrpts/fulltext/2017/03000/nocebo_and_pain__an_overview_of_the.2.aspx

   2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118107/ 
   

   3. https://www.mindtools.com/pages/article/affirmations.htm

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team