Greg Lehman talks about why pain science and biomechanics need to be reconciled. People think that pain science challenges everything in biomechanics, but it doesn’t. It challenges it a little. We can and should still use biomechanics. It’s still important but you have to add all the psycho social stuff to it as well. We talk about biomechanics research, how and why to use alignment, how the musculoskeletal systems is allowed to look weird, tendon research and why it’s OK to poke the bear (not hump it).
“The structure of the Musculoskeletal system is allowed to look weird. It’s allowed to deviate from the proposed ideals of everything upright and stacked and aligned. It can do that and be healthy and strong and pain free. It can have a massive scoliosis or kyphosis and be fine, and that challenges a lot of people. There’s this idea that when you go out of alignment you get into trouble and that’s just not well supported at all.”
Greg Lehman is a Physiotherapist and Chiropractor who treats Musculoskeletal disorders within a Biopsychosocial Model.
- Greg Lehman’s work with Dr. Stuart McGill was a huge deal for him. Stu was and is one of the most important biomechanics researchers out there. They agree on a lot and disagree on other things as Greg’s opinions have changed.
- One of Greg’s favorite studies early in his research career challenged the idea that you can activate the lower part of the rectus abdominis.
- Why do pain science and biomechanics need to be reconciled? Biomechanics is still important. It’s just that we get lost in the minutia.
- People often think oh you have a funny looking scapula, we have to get in the right position and improve its stability but that’s just not well supported. And you can almost say that about every joint.
- Damage and degeneration are poorly correlated with pain.
- Subtle changes as being a driver of pain or dysfunction irk me. It’s just not justified. Forget the research. It doesn’t even make sense. I’m confronted with people’s abilities all the time.
- Biomechanics of alignment is great for high load activities. Or it might be important when the teacher is correcting the poses you’re just feeling your body differently. So then it’s an interoception thing. And it changes your habits. And that’s worthwhile to start feeling your body in different ways but it’s not necessarily that you’ve moved into a better one, it’s just a different one.
- Spinal flexion – the crux of that argument is, how well does the disc adapt? That’s where we’re stuck. If discs wear away with repeated use then we’re in trouble then we should minimize flexion. If the discs are adaptable like other tissues. Then maybe repeated spinal flexion would be good – anabolic instead of catabolic. But we don’t have the studies.
- Poking the bear – we’re allowed to poke into discomfort. Because pain means that there’s pain. It doesn’t tell us that they’re damaged. It just tells us that their alarm is on. So we respect pain but just because it hurts doesn’t mean you have to stop.
- Tendinosis and tendinopathy…Load the tendon, ask it to adapt and don’t do too much. Make it a better tendon.
- Length tension curve – we have to train muscles to function at any length. Not only from the “ideal” neutral.
- Movement preparation trumps movement quality
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