Practical Science on Movement and Pain

Interview with Tony Ingram from Bboy Science

I am very pleased to be have just completed a very fun and interesting interview with Tony Ingram, author of the Bboy Science blog. Tony is a physical therapist and writes one one of my favorite blogs about movement health.

And he is a kick ass dancer:

Not bad for a white science nerd from Canada! Here’s the interview, where we talk about dancing, movement IQ, the “neuro” revolution in physical therapy, and whether posture matters.

Background

Tony IngramHi Tony, thanks for agreeing to do the interview. Why don’t you tell us a little about your educational background and how you got interested in movement science and blogging.

Hey Todd, thanks for interviewing me! I’m honoured to be on your blog, one that I’ve followed for quite some time!

From an educational standpoint, I have a B.Sc. in Behavioural Neuroscience (notice the u in behavioural – queens English, since I’m Canadian), then went on to do an M.Sc. in Physiotherapy (professional degree), and I’ve been working as a PT ever since. Currently, I am completing an M.Sc. Kinesiology (thesis degree) because I am interested in a career in research, because I’m a science and movement geek. Considering how much I study movement, I’m actually ashamed that I can’t move better than I do!

Originally, I started www.bboyscience.com to give dancers advice on exercise and injuries, but it’s become much more than that now. Turns out I had more to say than I thought. I quickly realized that I could connect with like-minded people, have a positive influence on my field, and generally advance my career in numerous ways. Blogging is simply incredible this way, which I guess is why it’s so popular!

Dancing

How did you get interested in dancing?

I became interested in the body and how it works in high school when I started weight lifting. I’ll admit, I began motivated by vanity – bigger muscles (I’m an “ectomorph”, and I still am).

Ectomorph. I hear you. But who needs big biceps she you can spin on your head right? 

Haha, exactly. I care not for big muscles – I am more interested in what I can make these muscles do!

That’s why I got into ping pong.

I always wanted to learn how to dance (bboying, specifically), but I grew up in a small town in Canada and there was no one to learn from. I ended up simply weight lifting and doing handstands in my basement.

I then went to university and started my neuroscience degree. I started taking martial arts because bodybuilding simply wasn’t for me, and I desperately wanted to learn skilled movement. Finally, I met some bboys through the martial arts classes, and the rest is history. I quickly became a “dancer”, which is now part of my identity and will never change.

I find it interesting that you started dancing pretty late in the game. It seems like some of the physical qualities it takes to be dancer, particularly hip flexibility, would take years to develop. How did you get that? Did you just have it already or did you need to improve it a lot? What methods did you use? 

I was pretty flexible before I started I think. I consulted old phys ed books and muscle magazines while I was in high school, which really wasn’t so bad for basics like “how to stretch your hamstrings” – the practical fundamentals are the same today, despite the scientific explanations having changed so much. I’m naturally a bit flexible, but I’ve had to work hard for the amount I have today… and I do stretch regularly – even *gasp* static stretching!

One thing I was NOT naturally gifted with was coordination. I was an awkward lanky white guy. That’s what I had to work for.

That is surprising considering your current state of awesomeness. Do you feel more coordinated off the dance floor now that you have done a lot of dancing? In other words, has dancing increased your overall movement IQ? Or has it increased your “GPP”, or useable functional strength or fitness in other areas? 

Absolutely there is carry-over. I’ve definitely increased my coordination and “movement IQ.” For one thing, I learn other forms of dance and choreography much easier. For instance, I had to learn some ‘commercial hip-hop’ choreography for a co-ed piece I did at a burlesque show (yup) last week. I also notice any physical activity or sport comes easier now.

As for strength, the transfer is more relative (bodyweight) strength, namely control. But this transfer is very general, and only helps with the basics of anything else I try. Not that it isn’t a big deal – I believe I’ve developed a great foundation for any physical activity I ever wish to try. That’s what I’ve noticed.

One thing I find interesting about watching bboys is the way you guys can balance on one arm. What did you do to develop the upper body and core strength for the hand balances, other than just practicing the moves? Do you do some form of resistance training? And dude, how much can you bench? 

Well, I did weight lift when I was younger, but I was never really strong. The most I ever benched was when I was 18, and that was a 1RM of 220 – (I think)… I obviously need to bulk up bro!

Seriously, it’s all technique. Trying the move and falling on your ass repeatedly until you “get it.” I often record my practice and watch myself to pick out mistakes. How you feel is never an accurate representation of how you look.

I really don’t see what I do as indicating I have a strong core or a lot of upper body strength. For example, balancing on one hand is a highly practiced, highly specific skill. There are little tricks that help you learn these things… I’m planning on making videos soon. After balance skill, shoulder strength is the next limiting factor, but never the core (not to me, anyway). And just so you know, I dumbbell shoulder press about 50 lbs each arm for 10 reps, which is by no means impressive in the fitness world. And my core isn’t that impressive either – I can’t hold a plank much longer than the next guy at the gym. Although I think I have developed a fair amount of power and coordination over the years.

All of this has made me a strong believer in the specificity principle, and incredibly dubious about the necessity of having a big squat and deadlift to be a great athlete – I really don’t care how many CSCS certified trainers I piss off saying that. Whatever.

I’m getting a little pissed myself. I’ll point you to a few T-Nation articles and just leave it at that. Tell us about the hardest thing you ever learned to do as a dancer and how you achieved it. 

Wow… that’s a difficult question to answer. I’ll give two examples: in terms of physical / technical difficulty, the hardest move I’ve learned is ‘continuous flares’ which I do at 1:17 of my ‘practice’ video. But the most difficult movement (notice the distinction between move and movement) would be learning to truly freestyle, losing yourself in the music and letting it dictate your movement rather than pre-planned moves.

Once you achieve this, you are really dancing, and it’s an amazing experience. When you know how to really connect with the music, and let go with a group of like-minded people in a circle (we call it a cypher) there is nothing more tribal, more “flow”-like than that. It’s an experience of movement that transcends any other reason to train that I can think of. I plan to write a lot more about this in the future.

Anyway… that’s as closest to “spiritual” as you’ll ever see this skeptical realist get!

That sounds awesome. What are some of the most common injuries that bboys face? Which ones have you faced and how did you overcome them?  

Bboys often complain of wrist and knee trouble. Then hips and necks. Personally, I have chronic neck pain which I certainly attribute partly to spinning on my head (hey, I can’t lie) and I’ve had numerous sprains and strains, some more severe than others. The longest I’ve had to take off from dancing was two months, thankfully, so I’ve been lucky. I plan to make a post on my site listing all the injuries I’ve had, because when I talk about how pain works, I often get a sense from people that they are thinking “easy for you to say, you’re not the one in pain!” – I’d like to assure people, that is not the case!

Physical therapy practice

Good luck with that neck pain. Speaking of which, tell us a little about your PT practice. When did you start, what kind of clients do you see, what are you up to now and what do you hope to do in the future? 

Sure. Right now I am working in ‘ambulatory care’ at the General Hospital in my city. I’ve been here since January. It’s mostly orthopaedic issues, injuries, post ortho surgery rehabilitation, and chronic “musculoskeletal” pain (which as you know, can be quite a lot of things). Being interested in pain science, I like it here. Although I will admit – despite how interesting I find the science, working with people with complicated, chronic pain is incredible difficult! But it can be very rewarding as well.

For the last couple of years I worked at a rehabilitation hospital, where I worked in both inpatient and outpatient neurological rehabilitation (stroke, trauma, head injury, spinal cord injury, MS, Parkinson’s, ALS… the list goes on). It was a wonderful experience. Working in that setting has given me such incredible insight, essentially materializing my previous education into something more “real.”

Prior to the neuro rehab, I worked in a private PT clinic since I graduated. It was very similar to where I am now, but clients were younger, less chronic, and I got to work with more athletes. It was also a great experience, and I do plan to return to the “private practice” world soon, but right now I am diversifying my experience. Plus, working in the hospital certainly has benefits, and I’m finding it more conducive to my current Masters degree in Kinesiology.

You are a guy who really likes critical thinking, sticking to the evidence, a science based skeptical approach. As you know, many common practices in PT are contradicted by science and evidence. What are some of the biggest myths out there that you see in PT treatment? 

Oh my goodness… daily, I have to hold back my opinions to avoid conflict… hahaha. I’d have to say the least evidence based area of PT, in my opinion, is unfortunately the area of practice that the public is the most aware of – private practice musculoskeletal PT. This is where the “tight” is stretched, and the “weak” is strengthened – which is a paradigm I see overused daily (but it’s occasionally true, let’s not throw the baby out with the bathwater). People are still doing a lot of “core” exercises and finding “imbalances” and prescribing “correctives.” These are the things that bother me the most (check out my Outdated Pain Theories series to see why). I should probably stop now before I make too many enemies… lol

However, there is a lot of improvement with the shift towards evidence based practice in our profession. I notice that younger PTs are often more skeptical, and many experienced PTs are surprisingly open-minded and willing to change their practice in light of new evidence, which I respect tremendously.

Furthermore, other practice areas are virtually pseudoscience-free (from what I can tell), such as almost all inpatient PT, cardiorespiratory PT, and neurological rehab PT. I haven’t much experience in ‘cardio’ PT other than covering some weekends at the hospital, but what I see is brilliant stuff and the evidence base is impressive, and the patients benefit tremendously.

That all said, I don’t think I necessarily “stick” to the evidence all the time. For one thing, there isn’t enough of it, and some of it is of poor quality. However, I am a strong believer in at least basing the rationale for treatment in the evidence that does exist. For instance, if it appears eccentric exercise is effective for achilles tendinopathy, and I have a patient that appears to have shoulder tendinopathy (for arguments sake) but there are no studies on that specifically, I still think it’s within reason to try eccentric exercise on that shoulder. That’s where clinical reasoning comes into play.

Does posture matter?

You have stated in some of your articles that posture and biomechanics are overrated as causes of chronic pain. (and I agree!) But is there still room for these approaches in PT? If not, then what replaces them? 

Absolutely. I may even edit my articles to make them more clear. Here’s the thing: most of the pain I see now is chronic, so I have to be very aware of that literature, and that’s what I write about the most. However, depending on the setting, most pain is “acute” – athletics for instance. Furthermore, I’d say that even in most of my chronic pain patients, the pain is nociceptive in origin (not “central” or “neuropathic” – whatever people think they mean by that).

Yes, sometimes posture matters, and so does a lot of biomechanics. Where postures relevance is overblown is in chronic pain (as a cause, or target for intervention). But can poor posture cause acute pain? Hell yes, in fact, I just changed position in my chair because I started feeling my back.

I am a firm believer in the relevance of biomechanics in injury prevention (like avoiding knee valgus during sports performance). I worry that in our vehement quest to educate people on the role of the nervous system / brain in pain, we may be missing the boat on some important issues.

You write a lot about pain science and a more “neuro” perspective on PT, as taught by guys like Moseley and Butler. Many PTs meet with some cognitive dissonance when learning this material, because it may conflict with their understanding of why their treatment approaches work. Jason Silvernail has referred to the problems of incorporating a more “neuro” approach into the PT clinic as “crossing the chasm.” Do you agree that there is a chasm? Did you cross it? How? 

I agree that there is a chasm, and it’s mostly due to cognitive dissonance, I think. Fortunately, however, I don’t believe I had to cross it. I went to PT school with a neuroscience degree, and knew a little about pain (especially phantom pain and Ramachandran’s research) and a lot about how complex the brain is. I was skeptical right from the start, which made things a little difficult until I found some like-minded class-mates and PT’s within the city, who then directed me towards the somasimple forum. I was lucky enough to read Explain Pain while still a student. Perhaps now that is my bias: “pain is in the brain” – and to be honest, I am trying to think twice about it. I could be completely wrong about everything! But if there is one thing I love, it’s learning. So I don’t mind being uncertain – it just means there’s always more to learn, and it’s okay to be wrong.

Very well said. Thanks for the interview Tony!

If you want to know more about Tony, check him out at his blog.

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8 Responses to Interview with Tony Ingram from Bboy Science

  1. Geo says:

    “All of this has made me a strong believer in the specificity principle, and incredibly dubious about the necessity of having a big squat and deadlift to be a great athlete – I really don’t care how many CSCS certified trainers I piss off saying that. Whatever.”

    Amen. I have held this belief for a while now. I am on the extreme end and believe that “strength” is a meaningless term, or at best a very vague term.

    If anything can be called “pure strength” it’s the amount of tension that individual muscles can produce. Think bicep curls, for example. How do we measure that? Surely it’s not simply the weight of the dumbbell since it can be lifted at different speeds. Which speed of movement is the “correct” one? Should we measure the peak tension that can be produced or the average tension produced? And if it’s the average tension then over what time period? Three seconds or three minutes? Oh and by the way, at what joint angle should we measure the tension?

    So now we start coming up with terms like explosive strength, speed-strength, strength-endurance, etc. But why stop there? Let’s continue to get more specific until we eventually deconstruct them to specific movements like “a jab” or a “3 second full-range pullup.” (When I first read “Supertraining” I thought it was a work of genius that I needed to study non-stop to truly understand. But now I see it as just a summary of a field that is confused by its own imprecise terminology.)

    You have a certain amount and composition of muscle fiber in various muscles. You produce tension in the various muscles to articulate one or more joints which results in movement (or counterbalancing of external forces to prevent movement). Depending on individual physiological factors (limb lengths, muscle insertion points, muscle fiber composition, etc), the movement will have an ever-changing amount of force (mass x acceleration).

    For example, let’s look at punching. To simplify the physics we can view the fist as a single point. As the fighter throws the punch, the fist accelerates. If the punch lands, the contact with the opponent produces an opposite force that decelerates the fist. If it misses and then the fighter’s connective tissues (shoulder, elbow, etc) are forced to decelerate the punch.
    So where is the “strength” in all this? Well it’s in the coordinated action of the hips, torso, and pretty much the whole body. So “strength” is always specific to a particular movement. It’s really skill. Squatting and deadlifting are skills as well.

    So I don’t know what the hell “strength” is. But I do know that the more muscle fibers you have the more of them you can put to use to produce specific movements with a better “force profile.”
    Here is in my opinion what all of the science and lingo of strength and condition boils down to. Pushing your muscles to exhaustion will cause hypertrophy, but only as much as your genetics will allow. Most folks will max out their potential at around 6-12 months and will spend the rest of their lifting career maintaining those initial gains. IMO once a week full body is enough for most athletes and regular folks alike.

    Focus your energies on training the specific movements relevant to your sport / activity of choice.

    And there are much safer and equally effective alternatives to squats and deadlifts, despite all of the T-Nation contributors. Squatting and deadlifting is only for competitive powerlifters or those who find those movements fun to perform and don’t mind the risks.

  2. Jan Hetherington says:

    Thx Todd – another great blog piece.

    Aiee – so much information, so much to ‘understand’ – & then ‘re-understand’ (& then again) – and then add one’s personal take & then it’s time for a nap.

    And upon awakening, one can PANDICULATE – that ‘oh so natural’ contract & lengthen that every animal does — & we ‘used’ to, before we ‘forgot’ (or perhaps it’s because we have alarm clocks which have us leaping out of bed BEFORE we have had a chance to do this luxurious ‘contract & stretch’. There are a few articles about this- a research paper was published in 2011 — http://www.ncbi.nlm.nih.gov/pubmed/21665102

    An activity which perhaps could be explored much more??? Contract & active-release – but so much more “functional”.

    I’m curious as to whether you guys discussed the somatic field – Feldenkrais etc. Self-awareness …… et al.

    Also — the idea of alignment/biomechanics ….. Tony said that he didn’t think that it was crucially important for pain etc ….. but I might actually beg to differ — as I have found in the last few months that paying MUCH more attention to my standing alignment (weight more back over heels instead of front of feet/pelvis forward) & more diligent bending forward at my hips (NOT lower/mid back) and the standing up via my hamstrings (not using back muscle so much) has made a HUGE difference in my lack of ‘creaks’ first thing in the morning (yes, I am no longer 25) — AND my back feels much ‘safer’ and more secure, my ankles, knees, hips feel more ‘congruent’, so that bending down & up actually feels much more ‘fun’ now ……. moving from impossible, to possible, to easy, to elegant – & to FUN!!!

    oh, and just this week, I endure a slightly changed computer/sitting orientation, such that after a day or so I found that getting up from a bent knees position was most interesting in my right knee (I never have knee issues, normally). I put this down to a lower chair where hips & knees were more bent. After modifying my seat & paying detailed attention to using skeletal alignment/sense of balance & comfort upon getting up from crouched, I was able to bypass the knee tweak …

    Jan

    • Todd Hargrove says:

      Thanks Jan,

      Thanks for the comments. We didn’t really discuss Feldenkrais. But Tony is a neuro guy so maybe next time!

  3. chris Busby says:

    Hi Todd.thanks for continued interviews which all help create a picture for me.
    I let you know how helpful im finding your mp3s on body movement aka Feldenkrais and
    I use them daily,they are really helping to improve many areas of my life.
    i have a question regarding what is your advice to this 63 year old regarding any supplemental muscular work.having done weight training in moderation intermittently over the years but aware of lower back and shoulder and neck issues I’m unsure of how to supplement your programme with some other
    work that taxes the muscles to prevent to fast a loss of strength as i age.maybe you could write one :)
    thankyou once again
    Chris

    • Todd Hargrove says:

      Hi Chris,

      Thanks for the feedback on the lessons, I’m glad you are enjoying them. I haven’t written much about how to do a resistance training program but I think it is very beneficial. Of course everyone has different needs and therefore there is no one program that fits all. The best advice I could give is to find a good personal trainer who can design a program for you to meet your individual needs and goals. Best of luck.

  4. Matt says:

    Interesting interview. This is the first “neuro guy” I’ve read say something like this (maybe I’m not reading closely enough other times?):

    “Furthermore, I’d say that even in most of my chronic pain patients, the pain is nociceptive in origin (not “central” or “neuropathic” – whatever people think they mean by that).

    Yes, sometimes posture matters, and so does a lot of biomechanics. Where postures relevance is overblown is in chronic pain (as a cause, or target for intervention). But can poor posture cause acute pain? Hell yes, in fact, I just changed position in my chair because I started feeling my back.”

    The big question for me is how do you differentiate between something that is “chronic” and now central/neuropathic or something that just nociceptive but happens to have been going on for a long time? For an overblown graphic example, if I stick a small knife in my arm, I get “acute” pain. If I leave it there for a year (and don’t die of infection for the sake of this illustration) and allow it be moved about in my daily life, constantly irritating the wound and giving my brain nociceptive signals, does it simply get labeled “chronic” because it’s been over the 6-9 month threshold? In this case, I suspect we’d say this is an acute case of pain that’s just reaggravated constantly. But what of poor biomechanics?

    If you develop musculoskeletal pain from poor biomechanics that gets reaggravated on a daily basis for a year and attempts to correct it fail, is one to assume then that the pain is in fact “chronic” and then central/neuropathic or that the strategies employed are simply not up to the task or a combination?

    • Todd Hargrove says:

      Matt,

      Those are great questions and I think definitely the right questions to be asking. I don’t think anyone has any great answers and different experts will disagree. Here are some semi-random thoughts in response.

      I think at least some people think that central sensitization is only maintained through a chronic noci driver.

      Lorimer Moseley has a helpful chart that tries to identify the primary inputs that are causing pain. See the bottom of this post:

      http://www.bettermovement.org/2012/review-of-moseleyhodges-conference-part-four/

      And Peter O’Sullivan is developing some sort of therapy where he tries to group his clients into people who need posture or biomechanics help and others who need more psychosocial help.

      http://www.youtube.com/watch?feature=player_embedded&v=ySJ5O2NnnuE

      I think all therapists start to get an intuitive sense of when biomechanics will matter, even if they don’t have a clear idea of the objective indicators.

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