Victory Friday | Issue 123
Orthopedic Insights: Men's (Fascial) Health • Squat Symmetry Strategies • Sneaky Sticky Aortas (in Hip & Back Pain)!
“What you create is an honest reflection of who you are.” ~ Naval Ravikant
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Welcome to a stiff and sticky Victory Friday! That’s the theme: what to do with stiff, asymmetrical squats, subversively sticky sources of common men’s health ailments, and how sneaky-stiff aortas can cause — and perpetuate — stubborn low back, hip and nerve pains! Dive in (but stay loose)!
What I’m Into: Men’s (Fascial) Health. We tend to blame a lot of age-related health problems on “irreversible degeneration” or a certain unavoidable decline of body systems, organs, and physical function.
But what if many of these issues are driven by a gradual buildup of fascial tension? And what if, with the right movements and (mechanical) treatments, we may be able to not only prevent or even reverse them, with no drugs or major surgery needed?
Here are my thoughts on three common men’s health issues, through the lens of fascial restriction:
Diastasis recti. This condition — essentially a central herniation of the abdomen through the linea alba fascia — is often thought to be due to weakness and inactivity.
Conventional wisdom: Older men become more inactive, get weaker, and gain fat. That combination supposedly causes the central abdominal herniation.
My theory: It results from a fascial mobility imbalance, where one (or several) aspects of the abdominal pressure system are too stiff to move well… so only the central abdomen moves, creating the herniation.
(This is another example of an Inert Stiffness Dysfunction1.)
This is similar to pregnancy-related diastasis recti in women: it’s not simply “weakness” of the central core, but rather a lack of slide-and-glide mobility of the rectus abdominis over the obliques and transversus abdominis.
Increased urinary frequency. It is common as men age to experience increased urine frequency, particularly more nighttime waking and urination episodes (nocturia).
Conventional wisdom: Prostate enlargement is the cause.
My theory: Increased fascial tension around the lower abdomen, bladder, and pelvic floor reduces bladder volume and may cause hyperactivity of the bladder’s stretch reflex.
While prostate enlargement likely plays the primary role in many cases—by physically crowding the bladder—progressive fascial tension around the bladder is a more plausible contributor in others.
Erectile dysfunction. This is a major one. Some data suggest that the percentage of men with significant erectile dysfunction (ED) roughly matches their age in decades: ~40% of 40-year-olds, ~50% of 50-year-olds, and so on.
Conventional wisdom: Like diastasis recti, ED is attributed to inactivity, weight gain, weakness, and vascular inflammation.
My theory: A healthy male erection—both onset and maintenance—requires a well-functioning local nervous and vascular system. Fascial tension in the pelvic floor and genitalia can (just as it does elsewhere in the body) compromise the “flow and firing” of nerves and blood vessels, thereby impairing erectile onset, intensity, and duration.
To reiterate:
Healthy male erection requires a well-functioning local nervous and vascular system.
Fascial tension in the pelvic floor and genitalia can compromise the flow and firing of nerves and blood vessels, thus impairing erectile onset, intensity, and duration.
Yes, many older men are weak, under-active, overweight, and inflamed. But what is more plausible?
That weakness, inactivity, obesity, and inflammation are so severe and widespread that a simple majority of men develop ED after age 50?
Or:
That most of us are indeed under-active, carry a lot of residual tension (including from old traumas), likely under-hydrate, and are therefore really stiff?
Once again, it begs the question: how much is a given dysfunction driven by chemical or mechanical factors? Once again, I contend that many issues we attribute to chemical/inflammatory processes — or simply to inevitable aging — are actually caused mechanical (tissue) restrictions.
And this tension, if adequately addressed, can at least prevent — and in many cases help reverse — these common and significant men’s (and women’s) health issues.
Stay tuned for a more in-depth discussion of potential fascial-mechanical solutions. For now, here is what I currently recommend to my older male clients:
Diastasis recti:
• Visceral mobilization with the “belly” ball (with special attention to the periphery of the pelvis and ribcage)
• Diaphragm mobilization (with a foam roller)
Hyperactive bladder / increased urinary frequency:
• Visceral mobilization with the “belly” and lacrosse balls (emphasis on the lower/anterior abdomen)
• Pelvic floor self-massage with a tennis ball
Erectile dysfunction:
• Pelvic floor self-massage with a tennis ball (with prolonged pressure on all “four corners” of the pelvic floor, with special attention to the “anterior pelvic floor”²)
Cool Exercises I Like. Squat Symmetry Strategies. If you see or feel an asymmetry of movement and alignment in a deep squat, don't:
• ignore it
• try to simply fix by “shifting more”
If you find you our a client consistently shifting to one side — with an inability to correct with cueing — it’s likely there is a movement dysfunction.
Krista Fazio, DPT (@dr.kfazio) recognizes this, and shared this terrific correction sequence utilizing:
• banded joint mobilization
• hip capsule (and sacroiliac joint) mobilization through active loading
• neuromuscular (“brain-retraining”) exercise with banded resistance:
For increased efficacy, prior to the banded distraction, I would add:
• posterior hip foam roll or ball massage
• posterior and lateral pelvic rim massage (with lacrosse ball)
Once again, more folks — including Dr. Fazio — are recognizing the importance of mobilizing and actively loading the posterior(-inferior) capsule of the hip (the PILC).
Give it a go!
Victory Friday. Sneaky Sticky Aortas (in Hip & Back Pain)! They say weird stuff comes in threes. I had a fascinating three-pack this week:
Three dysfunctional aortas. Three cases of aorta mobilization being the key to alignment, mobility and pain improvements in three stubborn cases this week!
The cases:
A 50+ year-old woman with chronic right hip and pelvic pain. In addition to stiffness and pain in the right hip and posterior pelvis, she presents with a stubborn right torsion/rotation of her pelvis2.
A 50+ year-old woman with chronic, stubborn neurogenic anterior left pelvic, hip, thigh and knee pain. She is nearly two years post-hip replacement, but complains of pain, tension, and neuralgia over her left thigh and knee, limiting activity.
A 40+ year-old man with chronic back and hip pain, with a painful, stubborn lateral (trunk and pelvis) shift.
In all three cases:
• comprehensive (if not exhaustive) Systems & Dimensions treatment3 failed. Treatment to the whole body was useful in decreasing pain, but failed to sustainably correct the alignment and range of motion restrictions.
• there is a trauma and/or hard-impact history.
Serendipitously they all re-appeared on my schedule this week. And after scratching my head, I recalled one of my most memorable Victories of my career: my guy with the restricted aorta, where mobilizing it was the key to restoring his ability to exercise symptom-free4.
In his case, his aorta had become severely restricted; enough so that, when he tried, the demands of exercise attempted to dilate the aorta. But it was so restricted by fascial tension that it could not; instead, he experienced a sympathetic response: pain, nausea and lightheadedness.
Recalling the concept of aortic mobility — and feeling multiple “listenings” to the central-left abdomen on my three clients this week — I assessed for, and found stiff aortas!
I thus treated the restricted aortas, which included:
• induction (“bringing together” and compressing the aorta with tight surrounding structures)5
• sustained medial glide pressure (left side, toward midline) along the outer vessel wall, coupled with motion from adjacent body segments: hip flexion, extension and rotation; lower trunk (and leg) rotation.
(What I didn’t do: conventional soft tissue mobilization strategies such as direct pressure, cross-friction, or any other aggressive strategies that compressed or sheared it6).
Each client experienced interesting sensations mid-treatment:
50 yo hip: “I can feel it in my [posterior pelvis and] hip!”
50 yo neurogenic hip/knee: “It’s tugging on my hip and knee” [replicating nerve tension]
40 yo low back: “I can feel it going down my back and leg”
Immediately post-treatment: lower quarter (spinal, pelvic, leg) mobility and alignment in all three clients.
Take-Aways. Blood Vessels Need to Move! (Especially the Big Ones). This was another reminder of the impact that tension around both nerves and vasculature can cause not only pain but sustained — and profoundly stubborn — orthopedic mobility and alignment deficits.
I like to say, “The Brain only cares about itself and its nerves.” But what’s most important for the brain and nerves? It’s blood supply.
As such, significant restrictions around the blood vessels may contort the orthopedic (and, secondarily peripheral nervous) systems in order to prevent vascular compromise.
While these are very early results, I have already seen the profound effect that aorta restriction — and its mobilization — can have in orthopedic function. Fingers crossed for sustained relief for this fascinating trio!
Issue 123 is a wrap!
Help people move, function and feel better: please share this publication!
Thanks for reading, and have a great weekend,
Issue 9. Inert Stiffness Dysfunction. An Inert Stiffness Dysfunction (ISD) is an asymptomatic, painless restriction in one area (usually fascial/muscular) that silently steals mobility and creates distant pain or dysfunction through connected tissues. The ISD site itself stays asymptomatic until directly treated. Examples: stiff quads causing knee pain, silent plantar foot restrictions driving calf issues, or dense contralateral neck fascia triggering unilateral neck/head pain.
Issue 10: More Torsions! Torsions are paired rotations that occur in structures like the pelvis, ribcage, or cranium that cause that structure to be functionally rotated in one direction (ex: in a right pelvic torsion, the left pelvis rotates anteriorly and internally while the right side moves posteriorly and externally). Torsions, often linked to fascial changes from trauma, can lead to compensatory (ipsi- or contralateral) torsions elsewhere in the body, causing issues like functional leg length differences, leg or spine pain, and even internal problems such as digestive or pelvic floor dysfunction. Torsions are a major driver of lower body strain as well as spinal pain.
For further information, is the best resource I’ve ever seen on torsions.
Issue 41: Systems & Dimensions. Full and sustained pain relief and recovery of function often requires a comprehensive treatment approach of multiple Systems (body areas: spine, pelvis, abdomen, pelvis, hip, knee, etc) and Dimensions (types of tissue: muscle, tendon, bone/joint, fascia, nerves, blood vessels, etc).
Issue 30: “Aor-ncha Glad I Got That Moving?” A young, healthy mid-20s male, limited for over a decade by exertional abdominal pain, nausea, and lightheadedness following an inguinal hernia repair and abdominal trauma, achieved full symptom resolution only after the mobilization of a restricted abdominal aorta. Initial treatments cleared lower abdominal restrictions and eliminated early-onset pain, but persistent autonomic-like symptoms during exercise resolved only after mobilizing the restricted abdominal aorta in its upper left region. The client has since returned to unrestricted activity—including intense cycling, weightlifting, yoga, and elk hunting—with no recurrence more than a year later, highlighting the value of vascular mobilization techniques.
regarded as the most low-intensity, least aggressive visceral mobilization strategy: taking two or more tissues that are “stuck together” and bringing them even closer, with prolonged (but otherwise light) pressure. Various forces then result in an “unwinding”, whereby those tissues can more more independently.
Also note: the precautions for aortic work are similar to the potential indications of aortic aneurism: heart disease and hypertension, inflammation, and smoking. Not only did all three clients fail to show any signs of aortic ompromise, outside of a mobility deficit, they are all extremely fit and healthy, in the top 5% for their respective age groups.