Greg Lehman
@GregLehman
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Physiotherapist, Clinical Educator & Strength &Conditioning Specialist. Movement Optimist and Old Man Tumbler
Toronto
Joined December 2010
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@djrothkopf
I’m a liberal but what the Clintons did to Lewinsky and how this affected women in general is horrible. So measuring the “evil” of an incident this ranks quite high.
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The reason I don’t slam manual therapy, TENS, Ultrasound or acupuncture about the research being poor quality is because the research supporting what I do (exercise, load/symptom modification, “pain education) is poor quality too.
Strong opinions can’t be held in this space
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Shoot. I just went for a run and can’t recall if I remembered to activate my Glutes before I left.
I hope I get away with it this time.
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What I love about this achilles tendinopathy study is:
1. Getting away from the idea you need to do a
lot of strength work before PLYOs
2. An achievable amount of exercise volume.
Other studies have 180 drops/day or 15 sets daily. This is real world stuff here 1/
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Where do ideas on spine health come from: a thread.
For no less than 15 years we've been hearing that the lumbar spine is built to resist motion. That movement in the lumbar spine should be minimized.
Let's look this ideas underpinning and promotion 1/
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Anyone recommend to their patients that they need a "Rehab Vacation"?
Stop doing specific exercises, stop doing meditation, stop trying to relax their core when they bend, stop tracking their activity etc?
Essentially, just stop trying to "fix" things?
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Why do people write “dynamic movement”. ? What other kind is there? I’m thirsty, going to have some wet water.
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Exercise prescription for rehab is simple.
Let’s stop making it complicated
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Embarrassing bullshit.
Chiropractic adjustments have been shown to boost the coordinated responses of the nervous system and immune system.
According to Ronald Pero, Ph.D
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Golf swing, throw, jump, pick stuff up, backflip, front flip, climb, punch, row, skate, run, live.
Moving your spine is not wrong. It’s what we do.
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I think it would be helpful for a lot of people in pain to know that there a numerous spots in the body that are normally tender in almost everyone if you press on them.
I wonder what percent of people know this.
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What the hell? Let's keep this paper a secret
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10 reasons to not worry about "core stability" when it comes to low back pain
@das_shield
@AdamMeakins
@PeteOSullivanPT
@kieranosull
@kjartanfersum
@DerekGriffin86
@PWMMarshall
@_Tyson_Beach
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This so interesting. Its a truism that heavy load (>70%) is needed for tendon adaptations and might be needed for rehab.
Yet with low load BFR we see tendon changes. So cool. Must read more.
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My public folder with access to my new paper on Symptom Modification, Recovery Strategies infographics and a bunch more papers on the disc and flexion
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Go ahead. You can skip it.
Running is tough on your body. The great thing about foam rolling is that you can do it any time of the day and your muscles and fascia will still benefit —just don’t skip it!
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Just told my 4 year old my shoulder was sore and asked if she could massage it. She said "let me see it. Oh OK. Maybe 'cuz your muscles are not strong and you need to lift that" Then she pointed at the dumbbell on the floor. She is a better therapist than me already
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More for
@PeteOSullivanPT
Spinal flexion seems inevitable when you lift from the floor. Yet, it is often said that spinal flexion will cause low back pain. This tweetorial will dive into these issues.
1/x
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Great. We have more research showing that people who lift with a cadaver spine are more likely to injure their dead tissue. Remember people, stay alive if you don't want to damage your dead back. Or have a deadback and don't feel it
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Not sure why we vilify spine flexion as a risk for low back pain because people have pain with a flexion movement. That’s like saying walking is bad when people have pain walking. We don’t have campaigns telling people not to walk
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Just asked my 10 year old daughter to delay doing her school work to come skateboarding with me. She turned me down saying she felt better getting it done now but maybe later.
Nerd
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Seems like the Soleus is the new Serratus Anterior of the lower body. People think we need special SA exercises but you just need to lift your arm. Same with Soleus - plantar flex under load and you’ve done it. Giddy up
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My running injury prevention guide from 2007! I stand by everything in here. Note the section on myths and the section on preventing injuries. Nothing has really changed and its amazing that we still see the need to keep busting these myths
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I think that for some people the message that their pain is coming from some tissue damage is more optimistic and actionable than telling them they have some over protective sensitivity neuro endocrine immune system.
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I can't say enough good things abut the PEAK Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis Training Program by
@HinmanRana
IT IS EXCELLENT! We should all do the FREE training.
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When did it become such an accepted truism that the “core” is meant to work isometrically this we should train it that way?
The core also produces movement.
Jump
Golf
Throw
Lift from the floor
Flip
Row
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My 9 year old just told me that my wife explained to her what an orgasm is.
How the hell would my wife know?
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Just a reminder that the underpinnings of the Lower Crossed Syndrome were disproven 30 years ago and nothing has changed about this in 3 decades
p.s. your Glutes are firing too
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If running requires “core endurance” then wouldn’t running be the best way to train it?
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Very restrictive thinking here. Mobility is often completely irrelevant and knowing when it’s relevant is more important than just blindly measuring and assuming a limitation is meaningful
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Whoa. I thought the term "faulty movement patterns" was a bit of a bad stretch but I've found my new favourite!
MISERABLE MALALIGNMENT
That's some solid evidenced based shade to throw :)
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I am now at the stage where my new patients have heard my podcasts, read my book and blogs and I just listen in our first session where they provide the diagnosis, explanations and the treatment plan 😊
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Good news!
@LouisHowe_SandC
and I just got a paper accepted on all things spine flexion, injury and lifting!
It’s a pretty thorough review so prepare for a few answers but a lot more questions.
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New Pain Guidebook is out (Recovery Strategies) at greglehman.ca for a free download
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How fucked up is it that if you get diagnosed with cancer in the USA you have to start a GoFundMe page? Doesn’t really sound like the land of the free.
And yes, I paid zero dollars for my wife’s pre-eclampsia and “hearts all fucked up” pregnancies here in Canada.
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Ha!
Just got asked to teach the training/physio staff at Cirque de Soleil but my offer to volunteer at my kid's cheerleading gym goes unanswered!
Gold!
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I think these exercises are great. But I think a better use of time is simple training the lower body with heavy strength training. The core is over rated for running.
#strengthfirstcorelast
To power through miles on the road, you need a strong core and solid cardio fitness.
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physio debates are like comparing Xmas trees. We focus on differences in approaches that are really just tree decorations. Instead of focusing on the tinsel we should recognize that the trunk, branches and needles are the same. We debate ornaments & ignore fundamentals
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I never understand the goal of these exercises. They are the equivalent of “Jack of all trades, master of none”. Nothing is worked hard enough to catalyze strength and nothing long enough for endurance.
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Currently doing another peer review for a journal. Yet, I don't have institutional research access to get the full text of the papers I need to read to review it properly. So using Sci-hub to do my volunteer work for a for-profit publishing company. That is messed up.
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I’m not sure any of these are true. And what the hell is Nutrition Flow :)
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Working within the biopsychosocial model means you have MORE options for treatment. Not everything must change and there are many roads to ROME. Find what's in their cup or build that cup up! The CFT group's new paper nails this perfectly!
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Latest blog. Lessons about pain from my 3 months of unrelenting stomach pain - and why non-specific lbp is an acceptable diagnosis
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Knee Valgus and ACL injuries.
A reflective thread on what we can say.
If you retweet what should be a comment I'm not responding :)
Keep it clean!
Let's go 1/x
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Parenting tip. When the school calls to tell you your 7 year old daughter got into a shoving match with some boy invading her space don’t ask who won.
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Whoa. Had WICKED low back pain Tuesday after wake boarding for 1st time. Couldn’t walk, stand up straight or handle any load from the back muscles. 10/10 at its worst.
Improved daily. Waterskied Friday and Ran yesterday. Still hurts but can live.
Humans are weird.
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Strength is easy.
1. Choose the movement you want to get stronger at
2. Do 2-4 sets of 5-15 reps (2 seconds up: 2 seconds down) where on your last rep you can only do 1-2 more
3. Do this 3x week
4. As it gets easier add more weight.
Easy Peasy
If strength is the target of ur rehab prog, I want to ask Twitter physios:
Do u think u have the knowledge & skills 2 coach it?
If yes, Did u have 2 learn outside of physio?
Do u have the equipment 2 support it?
Ru private or nhs?
Do u think the profession does it well?
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You should all bookmark this tweet when it comes to exercise prescription. It really can be this simple.
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The spine is an inherently stable and strong structure capable of handling 10-18,000 Newton of compression. Its pretty fantastic
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@RichSmithDPT
I'm terrified of what you will be told. You run facing forward and on your feet. This is a great start.
No one has any idea where you hurt based on how you run.
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I love papers that challenge the need to be highly specific in exercise prescription. These two suggest that knee flexion during calf raises is unnecessary if your target is the soleus.
Just do a calf raise - variations not needed
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is finally up and running. A program to help your patients with knee and hip OA. More on
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New Blog. Could have written it 10 years ago but finally got around to addressing the world wide epidemic of lazy butt syndrome
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Way more evidence that pain is associated with INCREASED Glute Activity.
We need to stop letting pet theories drive our narratives.
Tweetorial below 1/x
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Love these papers. Suggesting that simple exercise prescription is just as beneficial as more complicated and rules driven approaches
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I don't think
@AdamMeakins
was ever injured.
This is just another hoax perpetuated by the "big iron" industry.
Exactly 3 weeks today I injured my back deadlifting suffering a left femoral nerve radiculopathy, but I thought it was time to get back to the deadlifting today!
Many said it was too soon and that I was mad to try! Perhaps I should have listened to them??? 🤦♂️
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This is fantastic. And also what at least 70-80% of max lumbar spine flexion looks like. Our bodies can handle this!
345 lbs at 73 years old
The idea that older people shouldn't train heavy is BS.
If they're healthy and willing, go for it. Don't let fear hold you back from training a necessary quality.
Logical programming, cueing the right things, and taking care of recovery go a long way.
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I was asked to peer review a paper and said "Sure, in exchange for 6 months of full text institutional access so I can properly review it". How else can you review a paper without full text?
They weren't willing to honour that.
I had to decline their offer to volunteer
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new video on posture, pain and performance. Share how you see fit
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Look at those vertebrae move asymmetrically. Totally normal.
Realtime MRI vs traditional static MRI - seems you can learn different things from a dynamic scan? Here's my neck last week.
@KingsImaging
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Stretching is not recommended for tendinopathy. I think that recommendation is based purely on opinion.
Here is another paper finding no difference between loading and stretching.
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Told my athletic and workout loving daughter that my 4 month goal was to deadlift 300lbs or 2x my body weight. She disdainfully smirked, looked at my stomach and said "um, 2x your body weight?".
Fine, I have 4 months to lose 10lbs but its hard in this unsupportive environment
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If exercise is helpful for knee OA then all we need to follow are the current physical activity guidelines.
We don’t need special S&C or ever need to word “neuromuscular”
We just need opportunities for people to get active.
The difficulty is in the doing not the how-to
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Such a bloody judgmental tweet on so many levels. Hey you! You don’t run how I like so I’m going to denigrate you and tell you to stop doing the thing you love because of my shitty understanding of injury, mechanics and pain
@GregLehman
Totally not the point? Watch people jog. It’s literally speed limping. It hurts me to watch. Haven’t looked at your bio but I’m guessing you’re a runner. 😱
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Every time I see a foot mobilization, foam roller or ball massage to reduce the pain of plantar fasciopathy I always think “know what else reduces that pain?”
“Not doing that stuff”
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This stuff does not happen.
Your discs are not the winning bubble at the gum chewing convention.
Let’s pop this fear inducing nonsense.
#movementoptimist
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Running is Rehab
aka
THE DOING IS THE FIXING
Strength training or supplemental exercise has a role but we can often START with the goal task as the rehab activity. No one has to "earn the right to run"
In some ways we are Movement Homeopaths
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Greg Lehman Public Sharing Google Drive
Want to read a lot of papers related to spine flexion and injury.
Dig in
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I can modify a clamshell exercise to build strength, desensitize movements and enhance function. All tailored to a patients presentation and goals. It’s not the exercise that is the problem it’s how you use it.
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What makes no sense about “activation exercises” before a submaximal task (running) is that you are able to run before these drills. So what does “activation” actually activate? You are sufficiently activated if you were able to run.
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SLOUCHING - take advantage of that big old head get yourself strong bones.
#movementoptimist
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I'm interested in dialectic not debate on Twitter. If we disagree its not because I want to "prove you wrong and myself right".
I want to understand how you arrived at your idea and explain/stress test my interpretation and ultimately find out what we both don't know.
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The basics of Strength and Conditioning are easy.
"Advanced" knowledge of S&C is neither necessary nor superior for the common conditions you see.
Don't feel inferior when you see people adding unnecessary complexity to simple exercise prescription.
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I breathe through my face. Seems to work fine.
Too often proper breathing mechanics are overlooked and based on research many people have breathing problems.
To learn how to screen breathing check out our breathing course:
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you don't always have to avoid the things that hurt. Although it is an option. Some others here
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Shitballs. My 14 yo daughter just back squatted 1.3x her body weight. She just started training the squat a few weeks ago.
I’m now questioning her paternity.
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Frozen shoulder update!
Feeling amazing. Had a shot 4 weeks ago and I now have almost 90% full ROM. Golf doesn't hurt and more importantly I can give the finger vigorously to drivers who blow stop signs near my kids with impunity and no pain.
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Online Reconciling Biomechanics with Pain Science is debuting in 3 weeks. And because I like to see y'all in person you get to use the cost of the online course as a credit for future in-person courses (1 or 2 day).
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This not science. There is no evidence nor is the biological plausibility to support sitting like this. We have more evidence against this. This is an anecdote and spreading this information as "science" can be harmful and should be called out.
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Fudge. Just overheard more therapy advice. Kinesiotape works by lifting fascia, flushing out some of the inflammation and facilitating some muscle contractions. I can’t take it.
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Nope. No way. Might help with some pain but let’s just stay out of the injury prevention world
@runnersworld
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Tissue changes and pain: explaining their relevance
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My self mantra for running improvement.
1. Run more
2. Run more
3. Sometimes run faster
4. Run more
5. Strength train if I can’t run more
6. Run more.
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More Key Messages from Recovery Strategies. Will be putting these out in hi-res pictures and pdfs
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I’ve already completed my volunteer hours for peer review this year so have started charging.
Attached is my counter offer
@RodWhiteley
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It’s ironic. Inhibited VMOs, multifidi and serratus anterior theories have all be died out in clinical practice. Yet the muscle with the least research supporting the idea of its inhibition, Glute Max, still seems to have strong hold in the profession and popular culture.
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My bias for decades was to say OA was not “wear and tear”. I then took my own advice and tried to argue against myself. I now can’t honestly say that “wear and tear” is not part of the OA puzzle. It’s a shitty term for people but it’s not wholly inaccurate
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Shiny pain propaganda time. 2 infographics of pain, injury & recovery Key Messages. Goes along with Recovery Strategies book greglehman.ca
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another fascinating article about how the body is a liar :)
after stretch training there is NO change in stiffness yet the angle where they perceive the first stretch is greater! Why don't we "feel" that stiffness the same? Awesome work
@TonyBlazevich
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Got my vaccine today and immediately made out with 6 people on the bike ride home. My wife tells me that’s not how the vaccine works. She’s just jealous.
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The idea that runners need to do specific exercises before a run to "activate" their muscles seems to be extremely popular amongst elites and beginners.
I'm not sure there is anything this well adopted without a single shred of evidence and with such weak plausibility
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How about we stop calling normal movement "Faulty Movement Patterns".
If they are painful let's just call them sensitive.
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Ugh. Advanced physical therapy practice somehow became:
“You move funny. Let’s correct it or else your injury risk increases.”
Barf
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Police removed a mentally unwell woman from the train. told her she was disturbing others. I told the cops she wasn’t disturbing me. I mean no more than the well off person cackling on their phone at full volume. I guess it’s only a disturbance if the person is marginalized
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A new paper of mine in Symptom Modification. Looking to find similarities between different treatment approaches. Will probably please no one :)
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When searching Twitter you'll see a lot of assertions that the ITB can not be STRETCHED.
If you say this what do you mean by stretched?
There are two views:
1. Permanently lengthen the tissue as a response to strain
2. Have tissue undergo strain when loading it
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