Hip Flexors are More than Trouble Makers

Do you have low back pain that has been around far too long? Hip Flexors may be a contributing factor, so learn what they are and why they matter.

To put it simply, the hip flexors are a muscle group that works together to bend the hip, bringing the legs up towards your chest. If only it was that simple none of us would have low back pain, knee pain, pelvic floor issues, groin tightness, etc. The list can go on and on connecting the hip flexors to some pain or dysfunction. But the hip flexors are so much more than trouble makers, in fact, they are three very powerful muscles, the psoas and iliacus (often referred to as iliopsoas, pronounced like illy-oh-so-as) and rectus femoris (our main thigh muscle) We would be lost without them all work in concert to produce movement like kicking, walking, sprinting and dancing. These muscles are largely focused on bending the leg at the hip but the psoas muscle also helps to turn our hips outward like a ballet dancer (external rotation) and bend our trunk forward to pick up a box. The iliacus muscle also contributes to turn the hip out, but it is big helper in getting you up from laying on your back and swaying side to side like you are dancing at high school prom. Rectus Femoris has two purposes it bends the hip and straightens the knee (not shown in the image). The images below show how the muscles attach to the body.

Hip Flexors: psoas and iliacus

Tight hip flexors can put additional pressure on your spine that can contribute to lower back pain. They can also cause some exaggeration in the curve of your lower back which we often call sway back.

If the hip flexors are not working optimally, other muscle will try to jump in and do some of the work. The body is very good at coming up with compensation patterns to keep us moving. Other muscles that may start to do more work than they should include the glutes (butt muscles), the core (deep tummy & back muscles) and the pelvic floor (your pee stopping muscles). An imbalance in use of these muscles can result in some muscles overworking, while others are “underworking”. The result can be low back pain, strained posture, sacro-iliac ‘SI’ joint pain and pelvic floor issues.

The pelvic floor muscle group (muscles that make up the floor or bottom of our torso) plays an extremely important role with regards to support and stability of reproductive organs and other internal organs. Without the pelvic floor muscles all our organs would fall down because of gravity. Issues can occur if extra stress is placed on the pelvic floor muscles (sometimes related to shortness in the hip flexors). The pelvic floor muscles may start to “overwork” which may lead to an inability to “relax” this muscle group which can lead to potential pee leakage (incontinence) and/or low back or pelvic pain. On the other hand, the pelvic floor muscles may start to “underwork” as a result of mixed signals coming from other, overworking muscles. This can also lead to leakage, bowel incontinence and pelvic organ prolapse, where the organs start to fall down due to gravity and lack of support.

So, do you pee a little when you laugh, cough or sneeze? Do you have low back pain that seems to never really go away with trying many different treatments? Do you feel a ‘fullness’ in your pelvic floor that gets worse with long periods of standing? Well, a thorough assessment, stretching and strengthening routine with this added awareness of how some of the muscles in the lower body function would be a great place to start tackling some or any of these issues!

Rotator Cuff: What is it and do I have one?

This is not actually one thing it is a group of muscles often mis-named by terms like rotatory cuff, rotator cup, and just plain rotater or roter. So no surprise that this group of muscles is complicated and misunderstood.

You may have heard people talking about having “torn their rotator cuff” and how they have a ‘bum shoulder’ now because of it. What are they really talking about, is four muscles of the shoulder Supraspinatus, Infraspinatus, Teres minor, and Subscapularis that may not be working optimally together. We believe there is not really a ‘bum’ anything just something that has room for improvement. We aren’t expecting you to remember or even be able to pronounce those words, but know that the rotator cuff is a group of four muscles. We remember them as the SITS group to keep them straight. The four muscles work together to stabilize the shoulder joint because the joint is very shallow, like a golf ball (arm bone) on a tee (socket). Each muscle on their own is responsible for producing a specific movement of the arm.

Your Supraspinatus muscle runs from the top of your shoulder blade out to attach on to the top of your arm bone. Its main purpose is to start the motion of lifting your arm up at your side.

Your Infraspinatus muscle sits below the supraspinatus on the shoulder blade. This muscle covers most of your shoulder blade and is shaped like a fan. It is larger and attaches right next to the supraspinatus on the arm. It’s main movement is to rotate your arm to touch the back of your head.

Your Teres minor is the smallest muscle in the SITS group. It sits below the Infraspinatus muscle also attaching to arm bone with the two muscles above. Because it is so small it only helps Infraspinatus with its main functions.

Your Subscapularis is the only member of the rotator cuff group that sits on the front side of your shoulder blade, between the blade and the rib cage. This is the largest of the SITS muscles, and it fans over the whole front of your shoulder blade and attaches on the exact opposite side of the arm bone compared to the other three muscles. It’s main function is to internally rotate your arm to put it in the sleeve of your coat, scratch your back or squeeze your arm to your side.

Rotator Cuff Muscles of the Shoulder

Rotator cuff injuries are quite common, many people find out later in life that they have a tear from many years ago without ever knowing it. However, some result from falling and jarring your arm and shoulder or during some other incident that involved a lot of pressure or force being pushed/pulled through your shoulder (e.g. seatbelt during a motor vehicle collision). These impacts can result in anything from minor injuries like partial muscle tears to more severe injuries like full thickness muscle tears or even, in rare cases, the muscle being torn completely off from where it attaches to the bone. Even where the muscle has been completely torn off, surprisingly surgery is almost never the first option and often it’s not used at all. In all cases, appropriate exercises can help to re-train and strengthen the attached muscles back to full or near full function.

However, outside of the more traumatic injuries that can happen to your rotator cuff basic overuse/misuse injuries are much more common (e.g. tendinitis, bursitis or non-inflammatory injuries like Tendinopathies). Repetitive movements can often result in muscle and tendon irritation and you will often see athletes in sports like baseball, volleyball, and tennis having some problems with overuse injuries in their dominant shoulder. These injuries are most often not caused by inflammation meaning they are not an ‘itis’ like tendinitis instead they are a dysfunctional thickening of the tendon referred to as tendinopathy. With overuse/misuse injuries, the most effective treatment starts with the Physiotherapist diagnosing the areas for improvement in painful movements and muscle compensation patterns. The Physio will assess the extent of the injury and then create an appropriate treatment plan to stabilize, strengthen and return to activity.

Treatment for shoulders typically starts in the acute phase, days after the pain starts. In the acute phase treatments like massage therapy, acupuncture, soft tissue work, IMS (needling) and shoulder stabilizing exercises are often used. As the injury starts to improve, the treatment will shift into a more active approach where exercises are used to target the movement patterns that resulted in misuse in the first place.

Find a Physiotherapist and a Registered Massage Therapist, in your town, to help get you on the right track to getting back to the activities you love!

To Foam Roll or NOT to Foam Roll??

Is Foam Rolling going to be the NEW cupping of the 2018 Winter Olympics?

PyeongChang 2018 is on the brain, all over media and everywhere around us. This might remind you of the Summer Olympics of 2016 when Michael Phelps created quite a stir with his use of cupping for his shoulders and back. Athletes are always looking for an advantage on and off their playing field. They can’t always have their team of therapists around them and neither can you! So many people use foam rolling or trigger point balls to help with their pre and post training performance.

What is Foam Rolling? Foam rolling is the use of a stiff, smooth or nubbley foam/padded cylinder to ‘mush’ out soft tissue. It feels very uncomfortable… which makes us feel it might be needed. It definitely does not follow the fail safe adage “if it feels good do it” because it does not feel good, immediately. However, if you give it a try, even every other day for for a few weeks, you’ll notice it hurts less and you tolerate it better.

But does hurting less actually mean that you have caused a beneficial physiologic change? Like increasing range of motion, decreasing tightness and improving performance? You may hear people claim foam rolling reduces fascial (skin-like covering on muscles) restrictions, increases length of muscles, tendons, IT Band etc, improves strength output and the list goes on.

What does the peer-reviewed research say about foam rolling? We’re not sure if foam rolling does cause any of the above claimed physiological changes, but the latest research does tell us that foam rolling is effective in reducing pain perception after post workout soreness or delayed onset muscle soreness (DOMS) (Romero-Moraleda et al. 2017). Self-massage (assuming foam rolling falls into this category) has also been found to significantly improve stretch tolerance and flexibility when compared to a normal held stretch (Capobianco et al. 2018). Foam rolling even shows decreasing muscle sensitivity through muscle brain pathways, which may explain post-rolling improvements in range of motion and pressure tolerance (Young et al. 2018). However, like anything there is also a whole host of research that disagrees or finds that foam rolling has no significant positive effects.

So how do we decide whether it is right for us or not?  Some examples of situations where foam rolling may be appropriate are:

  1. Do you feel you have more tightness on one side compared to another, in the thigh for example?
  2. Do you have one-sided pain?
  3. Do you get really sore after a workout, in your calves for example, and want something to do after your workout to try and reduce this?

How do you foam roll? You may be among the crowd that looks at the foam roller and has no idea what to do with it, but would like to try without looking like a fool in the process. I have many patients say they have seen people using it in the gym and cast an awkward stare while trying to figure out what they are doing. They have even gone to Youtube for video instruction avoid looking silly. Check out ours below to learn how to roll the calf. Or you may be of the group that has figured out a few things that work for you, but would like to know some new tips and tricks. No matter what group you fall into, below are a few easy to follow instructions to get started.


  1. ROLL large meaty muscle bellies ​​examples: calves, thighs, glutes, hamstrings
  2. ROLL every other day, no more than 2-5 mins to start
  3. Stay below your shoulders and above belly button


  1. DO NOT Roll over bones close to the surface examples: shin bones, hip bone, knee cap, elbow, sitting bones
  2. DO NOT roll your LOW BACK
  3. DO NOT roll your tummy or chest

MAIN MESSAGE Try foam rolling every other day or after your workouts for 2-5 minutes for at least 2-3 weeks and notice if you feel better or not. If you don’t then don’t waste your time. If you do, then keep it up and maybe try new areas of the body to foam roll, like the lats or the middle back!

Check out our foam rolling video for how to progress from basic to more advanced calf rolling! As always, if you have any questions comment below or email at [email protected]

Pitch Out Injuries – FIFA 11+

The 2018 World Cup is upon us! If you are anything like the team at Lab Health, your competitive juices will be flowing. You’ll too want to hit the pitch with your friends and try and recreate the magic of your favorite players!

Since we are rehab professionals…. The World Cup causes us to think about the soccer injuries we see in clinic. Because of that, this is the perfect time to talk about injury prevention before hitting the field. After all, the best cure is prevention and exercise is the best prevention!

A quick background…

Some of the most common injuries in soccer involve knee ligaments (ACL, MCL etc.), ankle sprains, groin, hamstring and calf strains. These injuries can range from minor to severe and can potentially keep an athlete out of the game for an extended period of time. In fact, up to a quarter of a million Anterior Cruciate Ligament (ACL) injuries happen in Canada and the US each year (1) potentially leading to significant time away from soccer and increasing their risk of developing osteoarthritis later in life. Yikes!!

Fortunately, research shows that with consistent proper ‘neuromuscular training’ (I know, big words make us glaze over but this one is important so bare with me) can reduce many soccer related injuries. Luckily, there is a FANTASTIC resource for neuromuscular training and injury prevention specifically for soccer that is freely available with a quick Google search (or by clicking here for the PDF) called FIFA 11+.

What is FIFA 11+?

FIFA 11+ is a simple warm up program for soccer players aged 14 and up. It contains a well laid out series of neuromuscular exercises aimed at building proper strength and form to help decrease the number of soccer related injuries.

The program was developed by a team of experts and backed by research proving the program’s effectiveness. Studies have shown a 29% decrease in training injuries, 37% decrease in match injuries and up to 50% decrease in major injuries for those who stick to regular implementation of these exercises (2 or more times per week) (2).

Not only has FIFA 11+ been shown to significantly reduce the injuries in male and female players, consistent implementation has other benefits as it has been shown to improve muscle strength, coordination and performance (3,4).

How long does it take to complete and how often should I do it? Do I need fancy equipment?

All you’ll need to complete this warm-up is an open field or gym, a ball, a buddy, a few cones, and 20 minutes of your time! It’s recommended that you complete this warm up before every training session (or at least 2 times weekly) and a shorten version before every game.

Some of the exercises don’t look all that different from what I already do?

The program is designed to replace your current warm-up. Although the exercise are not anything new or groundbreaking, the real benefit is realized with commitment to consistently completing the warm-up with attention to proper form and control during the exercises. FIFA 11+ provides a step-by step guide with useful pictures demonstrating proper form that will help prevent potentially harmful joint movements. Check out the video below for an example of what we are talking about.

This is an example of good form while performing a FIFA 11+ jumping exercise. Notice how she is landing on the balls of her feet, hips and knees have sufficient bend and her knees stay in line with the middle of the feet. All of this allows for proper support and control at the knee and ankle joints.

Would this benefit me if I play other sports?

Yes! A recent study has shown the benefits of regular adherence to FIFA 11+ has decreased the number of injuries in elite male basketball players (5).


If you are a young soccer player or older recreational player, consider replacing your current warm-up with FIFA 11+. You will start to see the benefits with committing to twice weekly for 10-12 weeks! Start incorporating these exercises early, often and continue them throughout your playing days to reduce injury! If you would like some guidance on form, frequency and force of these exercises see a Physiotherapist or Kinesiologist familiar in neuromuscular retraining to help keep you playing your best and preventing injuries!


  1. Campbell, C. J., Carson, J. D., Diaconescu, E. D., Celebrini, R., Rizzardo, M. R., Godbout, V., … & Constantini, N. (2014). Canadian Academy of Sport and Exercise Medicine Position Statement: neuromuscular training programs can decrease anterior cruciate ligament injuries in youth soccer players. Clinical journal of sport medicine, 24(3), 263-267.
  2. FIFA 11+.
  3. Barengo, N. C., Meneses-Echávez, J. F., Ramírez-Vélez, R., Cohen, D. D., Tovar, G., & Bautista, J. E. C. (2014). The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. International journal of environmental research and public health, 11(11), 11986-12000.
  4. Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. Br J Sports Med 2015;49:577-579.
  5. Longo, U. G., Loppini, M., Berton, A., Marinozzi, A., Maffulli, N., & Denaro, V. (2012). The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. The American journal of sports medicine, 40(5), 996-1005.

Movement is Medicine: treating osteoarthritis with exercise

Osteoarthritis (OA) is most common in the knees and hips, followed by other joints like ankles and hands. For many people, the diagnosis of osteoarthritis in one of their joints feels like a life sentence of inactivity and inevitable slow descent into frailty. Often, the diagnosis comes after several months or even years of increased joint pain, and some kind of loss of function that results in a doctor requesting an X-ray. Once the joint is shown to be damaged, there is a common thread of “well, do what you can!” and “If it hurts, stop”. Anti-inflammatory medications and other pain medications may also be prescribed, which can have little or no impact on current or worsening pain. Unfortunately, these common coping strategies often result in a downward spiral of function due to decreased use of the joint, weakening muscles and joint instability; all of which results in increased pain during movement. This combination causes the person to use the joint less and less and.….. You see where this is going.

What Has Changed? Over the past decade, there has been a movement to change both the mindset and the treatment of osteoarthritis.  Scientists and therapists alike have become more aware of the mechanisms of joint maintenance and what we can do to conserve strength without risking any additional joint damage.  The current research shows that the connective tissues inside the joints  (i.e. meniscus, joint surface, etc.) are actually supported by movement and consistent loading and off-loading of the joint in low to moderate impact activities like walking and strength training serve to protect and maintain the joint’s integrity.  This change in mindset is in large part attributable to a group of researchers out of Denmark. Over the last 5 years they have enrolled more than 30,000 participants in their research called GLA:D. These participants joined supervised exercise and education groups all over Denmark that were  tailored to managing the symptoms of osteoarthritis of the knees and hips. Denmark is too far away for you to travel for OA management and that is why Bone and Joint Canada and The Arthritis Society have brought the training and certification program here to Canada and more recently, British Columbia to train Physiotherapists and Kinesiologists here at home. 

But Moving Hurts! Most of us are conditioned to see pain as potential damage and for that we reasonably choose to stop doing whatever hurts, because it feels like we are doing more harm than good. However, the pain that is associated with osteoarthritis is more often related to weakness, instability and poor movement patterns, not increased damage to the joint. 

So how can we get more active without intolerable pain? Since there is no known cure for OA, our best strategy is to manage the symptoms and improve function. As we said above, the best approach for treatment is NOT premature surgeries but treatment that includes specific exercises for strengthening, mobility and balance along with education.  The GLA:D program provided by a trained Physiotherapist and Kinesiologist are best suited to guide you through specific and appropriate exercises to help you manage your symptoms and improve function. Following 7-weeks of the GLA:D exercise and education program, participants reported more than 25% reduction in symptoms when measured right after the program and 1 year following the programs completion. So by participating in the program you are likely to have long-term lasting symptom reduction.  Participants also reported an overall increase in activity, reduction in pain intensity and use of pain killers and fewer lost days of work. 

Fortunately, the GLA:D program is now available in Canada and will soon be offered through Lab Health! The program is 7-weeks in length and includes two education sessions (the first one is free) and 6 weeks of twice weekly, one hour exercise sessions. CLICK HERE to sign up for the FREE GLA:D Program education session, no commitment required, just come and learn along with the rest of us!

Click to learn more about GLAD Canada or for more information on Osteoarthritis and it’s management CLICK HERE.  

References:https://labhealth.janeapp.com/ 1) http://gladcanada.ca/index.php/the-healthy-hip-and-knee-joint/

Treadmill Training Made Easier

Learn How to Use the Treadmill for Best Results

How to use the Treadmill… Well this may seem very simple and basic, and it is, but you have no idea how many people, including fitness professionals, don’t know what the buttons on the treadmill are for!

Sport specific training, like trail running or road racing, should resemble the training/race environment, as much as possible. What this means is, if you race on trails then train on trails, or if you race on the road then train on the road. But we all know this is not always easy or convenient depending on the weather, timing, your rehab needs, or if you have an injury and can’t yet tolerate the demands of the road/trail environment!

So, how do you make treadmill training resemble the training/race environment? If you are going to race on TRAILS:

  • Train in ‘Random’ or ‘Hill’ mode
    • This will engage the muscles more similarly to the ups and downs of actual trails

If you are going to race on the ROAD:

  • Train in ‘Random’ or ‘Quick Start’ with at least 1% incline
    • This will make you have to work a little harder than on 0% grade (no incline) which is never going to happen on the road

     PRO TIP!! Always put at least 1% incline on the treadmill for walking or running as it will simulate walking on land that much more. Why you ask? Because you naturally use your butt muscles to pushing you forward with each step on the land however on the treadmill the tread going round and round is what pushes you forward. So to get those glutes (butt muscles) firing more on the treadmill, you can set the incline to at least 1% so that you have to propel yourself forward.  We all know what our butt feels like after a good hill climb, so apply that same hill climbing (incline) principle on the treadmill to make it more similar to real life walking or running on land.

Speed Training: Are you that person that holds the speed button down to switch between faster and slower speeds to complete your speed interval training? Well, I was for the longest time but there is a way easier way to do it!!

      PRO TIP: Use the ‘Speed Interval’ Button

It will ask you for your ‘LOW’ (jog/recovery) speed and your ‘HIGH’ (sprint/challenge) speed and your incline (remember at least 1% for this, don’t pick 0% as Road or Trail running is never 0%) AVERAGE Speed Settings (don’t be fooled if the machine is in km/h then these numbers won’t work but most Treadmills display in mph (USA units)

  • Walk <4.0mph
  • Jog >4.0-6.0mph
  • Run >6.0-10mph
  • Sprint >10mph

The treadmill will start with your LOW/JOG speed but you can now switch between your JOG and your RUN speed with ONE click of a button. See the video below.

It will NOT switch between speeds automatically! You will have to push the FLASHING ‘Speed Interval’ button at your desired interval/frequency.

How do I know how long I should run at each speed? So this more comes down to the type of training outcome you are looking for.  Training Outcomes:

  1. HIIT (High Intensity Interval Training)
    1. Increase overall speed
    2. Increase Cardiovascular tolerance (endurance)
  2. FARTLEK: (Swedish for ‘speed play’; change at your will with no specific plan)

Tune in for a post on Interval Training, How to reach your PERSONAL BEST on your next run or race!