1. Assessment
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CASE STUDIES
ANTONIO B
Antonio came to Wise Moves after years of debilitating migraines and severe low back and neck pain that encroached on nearly every aspect of his life. The inescapable pain in his neck and tingling and numbness in his right arm lead to a surgical fusion of his C4/5 vertebra. Even after the surgery he took pain killers regularly and would have to miss days of work at a time due to a migraine.
Antonio’s case was complex and involved his history, his relationship to stress, his lifestyle and his breathing habits. He had played Rugby for many years at school and had been twisted and cranked in every direction, kneed in the face and tackled at least one time too many. He runs a busy production company with 65+ employees and has a family. His work involves days at a time of shooting where he is often directing and producing for 16 hour blocks. Migraines would usually follow such a shoot.
Antonio had tried the medical approach to these health challenges. He’d had surgery on his neck and tried pharmacological interventions, neither of which worked. Chronic pain has very different mechanisms than acute pain and needs to be treated very differently. With acute pain, a sprained ankle for example, the site of injury is where the problem lies and treatment here will usually be effective. With chronic pain the central nervous system, immune system and just about every other system in the body can be involved and numbing or even removing the site of pain completely ( as in the example of what must be the most frustrating pain of all, phantom limb pain, where a painful limb will be amputated and still feel as though its always in pain). Antonio is another example of this where despite having a surgical fusion the C4/5 disc was still causing Antonio’s neck to hurt.
Antonio’s pain was elusive and very closely related to his level of stress. The body handles stressful situations by activating the sympathetic nervous system (SNS), also known as the fight or flight system, and the release of our primary stress hormone Cortisol. Cortisol and the SNS have the job of keeping us safe and getting us out of immediate danger at the cost of growth and repair. Constant low level stress means that important healing and repair is being depressed and over time things begin to break down. Area’s of pain and inflammation are particularly sensitive to cortisol and in chronic pain stress can trigger the pain experience. Learning to manage stress will have a positive effect on pain. Another problem with this kind of stress is that it changes breathing mechanics. When we’re in danger we tend to breath short shallow breaths that utilise 3 little pairs of muscles that attach the ribs to the neck known as the Scalenes. When the scalenes are chronically tight from being over worked they begin to compress the joints in your neck and strangle the nerves that leave the neck and travel to and from the arms.
Antonio’s treatment involved corrective exercise to correct posture and stabilise his painful joints, a nutrition program that helped him reduce inflammation and gave him the raw materials to repair damaged tissue and coaching around his triggers for stress, looking at the drivers that put him into the fight or flight state. This included learning to breath diaphragmatically and to have the presence of mind to check in with his breathing particularly at times of high stress.
A large part of Antonio’s healing was learning about his own triggers and learning his unique nutritional needs. He is now free of pain as long as he manages his stress and he has tools to relieve any pain when it does arise. He is not longer a victim to his body as he understands the messages it gives him early on in the piece
MATEO
Mateo is an incredibly passionate 17 year old junior tennis player. He’s played tennis since he was 3 and is the #1 junior player in NSW and #4 in Australia. For 3 years until seeing us he was plagued with a recurrent forearm injury that meant pulling out of tournaments and many missed training sessions.
Of all the specialists Mateo had seen no one had looked beyond his arm. After physiotherapy, massage and even surgery hadn’t helped Mateo came to Wise Moves.
The assessment process used by Wise Moves looks at the body as a whole system and allows us to get to the root cause of a problem and see patterns that are often missed by the traditional approaches. The first thing that became obvious during Mateo’s assessment was that he lacked the mobility in his feet and hips needed to lunge and pivot, commonly used movements on the court.
When we looked closely at core function, Mateo didn’t have sufficient strength to stabilise his back and pelvis during the demands of a game of tennis, particularly while fatigued.
Racket sports like tennis and squash require rotational force to be generated from the ground by pivoting on the ball of the rear foot. A small quick rotation of the foot on the court is transferred through the trunk and magnified by the leverage of the arm. It’s this leverage that turns the energy from the foot into the whip like motion you see when a player like Federer strikes a ball. In Mateo’s case, he didn’t have the mobility in his feet needed to pivot optimally, and his lack of core strength meant that the power he did generate wasn’t resulting in the power needed at the level of tennis that he plays. To make up for this lack Mateo was using his wrist to generate power, in effect flicking the ball. This action, done again and again during every training session and every game meant his forearm was being overworked and developing tendonopathy, pain and inflammation.
The second clue important for Mateo’s recovery was that he had actually done better in tournaments after missing weeks of training with his injury and recovery from surgery than when he was in full training even when he wasn't injured. This clue indicated overtraining and the need to address factors like nutrition, hydration, sleep and training volume. This is incredibly common amongst athletes, especially when thy have school and school sport on top of the training for their event. There is an optimal level of output that the body can recover from. Beyond this, the nervous system, muscles, joints and ligamentous structures will build fatigue, becoming more and more depleted as time goes on until something breaks. Recovery will be dependant on factors such as sleep quality and quantity, time spent relaxing, hydration, nutritional status and mindset.
Mateo’s program focused on gaining mobility through his feet and hips to allow him to pivot effectively and to get lower to the court for low shots and core stability to transfer force from the court up to the racket. Mateo’s parents were with him every step of the way and quickly saw the benefit of a nutrient dense, home cooked, whole food diet.
Mateo is a great example of how a holistic approach that sees the body as a whole system is needed to have it functioning at its best. He no longer suffers from his forearm pain and is in Mallorca, Spain training with the world best up and coming tennis stars at the Rafa Nadal Academy. We’re looking forward to see you at the Ozzie open in the next few years Mateo!
