Conservative Orthopedics and Wellness -COW

Conservative Orthopedics and Wellness -COW Formulating a network of healthcare professionals to provide education and guidelines for physical f

"Don't Get Old" is advice frequently received by healthcare professionals from their patients. These individuals have come to believe that age has now caught up with them and their body is breaking down at an alarming rate as each year passes. With the continued development of a new ache or pain comes the fear of making it worse and the hope that this problem will slowly fade away as mysteriously as it had arrived. The truth of the matter, and my response to these individuals, is that the pain they are experiencing is a result of moving their body in a similar fashion throughout their life with a preference to over utilize certain muscles while under utilizing others. No one walks around with the perfect balance of strength and flexibility throughout their body and we all develop weakness over time as our movements and positions fall into habitual patterns. Some areas of the body may be so well developed that they over power others. Resulting in the recruitment of the muscles that are the strongest to accomplish the daily climb up the stairs, the long distance run, or the moving of furniture. We do not become aware of these imbalances until they become so great that they have provoked our body's warning system, pain. The goal of this project is to bring together healthcare providers who have demonstrated the desire to set themselves apart from their peers through advanced post graduate education and superior patient outcomes. In doing so, creating a reliable source of quality orthopedic information for the spectrum of people who are looking to complete daily tasks along with those who desire to compete at high level, free of chronic injury and limitation. This website is designed to promote quality healthcare providers similar to the "Angies List" concept along with exercise and movement based interventions that are both safe and functional. This includes guidance in recreational fitness as well as competitive athletic strength and conditioning. We hope this site develops into a valuable resource to locate good clinicians when care is needed, and a resource for exercise recommendations that are effective in identifying common weaknesses and preventing recurrent problems.

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

Happy Holidays
12/25/2022

Happy Holidays

Continuing education timeMcKenzie Mechanical Diagnosis and Therapy  Advanced Cervical Thoracic and Upper Extremity refre...
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

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

https://news.stanford.edu/2021/02/23/four-causes-zoom-fatigue-solutions/

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.

03/22/2021

In the wide world of abdominal cylinder training, we have many options to achieve our desired training effect and results.  Along the spectrum of abdominal prompts and feedback tools we have here one of the cheapest ones, a weight.

When we're monitoring the different corners/areas of our abdominal cylinder, getting some feedback can be helpful, when we transition to positions where our arms are needed for different variations/challenges, sometimes a little sensor to make sure our abdominal wall is keeping up with the rest of us is required.  This high tech solution of making sure you're maintaining a wall in your abdomen by keeping a weight from sagging into your stomach is one of our better options.  Gravity is usually available, and most things have mass, so finding the ingredients for this one should be pretty easy.  Starting with a lighter object is usually better, only enough pressure to monitor the abdominal wall during exercise.

When working with a more detailed assessment of your abdominal wall, we can find some spots might have less activation than others.  This can be due to pain inhibition from the spine or pelvis, scar tissue pain, visceral/organ pain and other things requiring clinical assessment and treatment.  This comes more into play with DNS (Dynamic Neuromsucular Stabilization) and Schroth Scoliosis assessment.  Anyways, we can vary the placement of the weight to match the less active area of the abdomen, the little details can matter.

More on the qualitative side of things but can be the difference maker especially when working on overuse injury big picture retraining and balancing tension in the body.

Popliteus, connecting into things like the fibula and lateral meniscus, often ignored but can have a big effect on knee ...
03/16/2021

Popliteus, connecting into things like the fibula and lateral meniscus, often ignored but can have a big effect on knee tracking and arch control

from previous post

I like the popliteus, keeping it in consideration with lower extremity pain, especially posteriolateral and lateral knee pain, is crucial for effective treatment.

http://www.jospt.org/doi/pdf/10.2519/jospt.2005.35.3.165

I take particular interest in musculotendinous structures which tie into joints more than others, this would include the iliocapsularis and re**us femoris into the hip. One of the key visualizations in the jospt paper is the possible connection of the popliteus into the lateral meniscus, not on a large percentage, but more than zero, which is relevant when dealing with an outlier knee pain presentation.

From a kinetic chain perspective, in open chain it functions as a tibial internal rotator, which means with a fixed leg in closed chain it will function as a femoral external rotator. This opens the possibility for overload of the popliteus in weightbearing to control rotation of the lower extremity, when other external rotators such as the hip(too much to list) and foot arch complex, requiring assessment of the whole limb to sniff out an overload mechanism when those areas are dysfunctional but nonpainful, the coveted DNP of big picture treatment planning.

Topic for another post, but the PFL, or popliteofibular ligament is also intriguing, the fibula is more active than would be assumed and its link to ankle rocker at the other side of the tibia is a whole discussion in itself, we’ll save that for another day

A closer look at those lateral structures that keep you in line.. the posterolateral corner (PLC) is comprised of the popliteus tendon, the popliteofibular ligament, and the lateral collateral ligament (LCL, sometimes called the FCL 😉)

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