Why Am I So Much Stiffer in the Mornings?

 We all know what imbibing is and the swelling and increased tension we feel the next morning, when we have been partying all night long.  Well, your discs in your spine do this every night!  I like to say they have been "partying all night long" without you!

 If you need a more scientific explanation then check out this article on the  Nutrition of the disc

Essentially your discs get their nutrition by a process called imbibation.  They absorb fluid from surrounding tissues and then extract the nutrients out of it.  This is due to the osmotic pressure of proteoglycans.  We normally don't feel this increased pressure and stiffness in the disc, but if you have degenerative changes or an injury in the disc you generally feel stiffer and may experience more pain in the morning.


It takes about 4 hours of normal life (i.e. moving around) for the discs to return to normal height.  You can test this on yourself by bending forward as far as you can, as in touching your toes, first thing in the morning and then again 4 hours later.  You should see a considerable increase in flexibility because your discs aren't under so much tension.

                                                                                                                                                           

So maybe those dead lifts you a trying to PR or the leg press machine should be reserved for later on in the day when your discs aren't under so much tension.  Actually any activity that involves prolonged bending of the spine, like gardening or mopping the floor or even slouching in the chair would be better later in the day.







This also explains why  we are all taller in the mornings. In fact, you can be up to 2% shorter at the end of the day. Hope this helps explain some of that morning stiffness and increased pain a little.

However, if you are under the age of 40 and you have stiffness in the morning that doesn't ease after 30 minutes, or isn't eased by resting, seek additional medical advice.  This might be indicative of an inflammatory spinal condition.

You know what I am going to say.  "Everyone Deserves a Good Mechanical Evaluation and Treatment Plan!"  Visit grimmpt.com or call 504-228-0524 to schedule your assessment today.

Your Back MAY Be Out, BUT...

...Your sacro-iliac isn't out of whack, you are not too fat, your hips aren't misaligned, your SI is fine, your hamstrings aren't too tight, your arches haven't fallen, your core isn't weak, and your back isn't swollen...your piriformis doesn't have a syndrome, Your IT band isn't out of tune and your overly pronated feet are just fine like they are. You might have Scoliosis and Spondylolisthesis and your leg lengths might be different too, your stenosis and facets might be showing up abnormal as well.  Your structure may not be normal at all, but what is normal?

I always like to say if you took a MRI of my spine or pointed out  my asymmetries and imbalances I probably couldn't get out of bed!  Maybe these are simply what make me different than you.  These type of findings are what I like to term "noise" in my evaluations.  I am always thinking are these the pain producers or not?

"Once you start mentally leaning towards the idea of asymmetries as a major cause of pain, you start noticing and emphasizing only the cases that seem to confirm that expectation … and ignoring the ones that contradict it. "-  Paul Ingraham

I was reading Paul Ingraham's  article a few days ago and found it to be excellent!  I agree with pretty much everything he has to say.  Especially when he says

 "It is every health care professionals highest ethical responsibility not to mistake profitable recommendations for good health care. They are rarely the same thing." 

Does this sound like me or what?  If you have time I recommend that you read this.  It is great food for thought!  

As you know, I want to get to the root of your problem and teach you how to care for it yourself.  I love Graston and have advanced training in it.  I hardly ever use this because it doesn't get to the root of the problem, neither does electrical stimulation, foot orthoses, dry needling, or ART.  These seem to be all the rage in physical therapy and chiropractic care these days.  They are all targeted to treating soft tissue as if that is all that could possibly causing your symptoms.  If your symptoms are disc related, these modalities don't even come close to treating the cause.

I also have advanced training in spinal and joint manipulations but rarely do I need to use them when I practice MDT or the McKenzie Method.  This method is based on a progression of forces beginning with self generated forces.  In the majority of cases, this is all that is required in rapidly reducible conditions.  If I ever need to do a spinal manipulation I am assured that the force progressions have been thoroughly explored before this treatment option is reached.  You know I will think twice or three times before I every manipulate someone's spine.  I am really freaked out right now with spinal manipulation right now because of the recent death of a 30 year old father of two.  You can read more about that here.   I wonder what he was having his neck manipulated for.


So if you tell me you have your spine manipulated several times a year over the last umpteen years and it helped, then I always wonder if this really worked why are you still going after all of these years?

I guess what I am trying to say is, don't get hoodwinked into believing everything you hear from anybody in the healthcare business, including me.    Don't buy into it unless you have results.  Unless of course, you just want a massage, a spinal manipulation, dry needling, Graston or ART.  They all feel good to me too, just temporarily.  If you want to get to the root of your problem, to see if you have a rapidly reversible condition, and you want to learn how to take care of it yourself you know what I am going to say.  "Everyone Deserves a Good Mechanical Assessment and Treatment Plan!"  Visit grimmpt.com or call 504-228-0524 to set up your evaluation today.

One "Slick" Exercise for her Hip...A MDT Testimonial

The following is a testimonial from a friend of mine that I did not actually treat.  I invited her to be a demonstration patient for a McKenzie course here in New Orleans.  The course was entitled "The McKenzie Institute:  Part E:  Advanced Extremities.  The McKenzie Institute is the only one that I know of that actually brings up actual patients for demonstrations.  This is a huge component of why I found this method so fascinating.  They are actually willing to demonstrate their technique on patient's who have not been coached or have any idea of the method.  My husband also attended this course with me and we were both impressed with rapidly reversible joint conditions that we saw during the course. So without further adieu, here is her unedited testimonial.  (I did add a few pictures for interest.)


My pain was annoying.  It wasn’t life threatening or the result of a traumatic accident or degenerative disease; I hadn’t dealt with it for decades.  But it was pain, and it lingered, and it had a negative impact on basic daily activities, like sleeping on my side and moving from standing to sitting or vice versa.

Then, in 2012, Mark Miller (PT, Dip. MDT), for a solid hour or more, told me all the ways in which I was “deranged.”  My reaction?  If I ever see that man on the street, I’ll tackle him with an affectionate but borderline-illegal bear hug.  (That inappropriate impulse might actually support the “deranged” diagnosis in more than one context, now that I think about it.  But consider yourself on notice, Mr. Miller: forewarned is forearmed.) 

If you, too, are in pain, find someone trained in the McKenzie Method to tell you you’re deranged.  Because I’ve learned hard lessons, and you should learn from my mistakes.

Lesson #1: Stupid Human Gym Tricks Are Stupid

So a Stupid Human Gym Trick wrenched the hell out of my hip and quad.  Don’t ask; I won’t tell.  What I will tell is that for 15 months or more, every time I moved my hips or took steps or did anything with lower-body impact, I re-learned the lesson to eschew Stupid Human Gym Tricks (instead, and I can’t emphasize this enough, develop practical training goals, and follow a coherent training plan developed by someone who knows something about those goals and how to safely get you there).  And (spoiler alert) I’ll also tell how I developed my undying affection for Mr. Miller and how the McKenzie Method brought me relief I didn’t think I’d get without surgery. 

Lesson #2: The Googlez is Not a Trained Health-Care Professional

Immediately after my Stupid Human Gym Trick fail, I was simply happy I hadn’t broken my ankle.  But a few days later, I realized my thigh was sore, really really sore.  I hoped it would go away, so I backed off my workouts, Googled, talked to friends, took anti-inflammatories, stretched, foam rolled.  These were, at best, temporary Band-Aids.  Months went by (I let things linger longer than is probably advisable, which might be Lesson #2.A: When Standing Up, Sitting Down, and Lying On Your Side All Hurt, Take Action), and finally I sought out a health care professional trained in Active Release Therapy (ART).  I didn’t have much guidance or experience with injury, and ART seemed like a reasonable next step. 

Yes, it was confirmed: big nasty adhesions in my thigh were making my life hell.  Under the direction of a professional, there were x-rays, adjustments, massage therapy, heat, ice.  Also, ultrasound and Graston.  I was assigned do-at-home stretches, more foam rolling, directions for icing.  For months, my thigh was so deeply and thoroughly bruised from my therapeutic efforts that people would gape and demand, “What HAPPENED?”  Someone once said, “It’s painful to look at.” 

My quad pain improved but was still not gone.  More troubling was that as I got some relief in my thigh, I discovered hip mobility issues—I couldn’t squat below parallel.  When I asked about mobility, I got more aggressive versions of the stretches I was already doing.  When I asked if the pain would ever go completely away, I got vague answers: “You might always feel a tweak,” “There’s no way to know for sure,” “It may be worse if you’re fatigued.”  None of those answers seemed right to me (do people without major trauma, from things like car accidents and Action Movie Balcony Dives, actually walk around every day in pain?), but I showed up for every appointment, followed every instruction to the letter.

Eventually, my courses of treatment expired and my insurance (yay!  I have insurance!) refused to authorize more visits.  I tried more sessions paying out of pocket, but after months when I still had pain and mobility issues, when the relief seemed mostly temporary, and when the answers were still more non-committal than I preferred, I abandoned that ship. 

Lesson #3: If at First You Don’t Succeed. . . .

I had recently discovered powerlifting (yeah, I’m a gym rat in my 40s, but I was a slacker and an obese couch potato through my early 30s, so I’ve only begun to discover strength sports), and you can’t be a powerlifter unless you can squat, to depth, and with weights as heavy as you can manage.  I couldn’t get my hip crease even with the top of my leg, much less below the top of my leg for a legal squat.  It wasn’t that it hurt too bad to do it (although it did hurt, and it hurt even more without a weekly dose of massage); it was that I just . . . couldn’t.  And I wasn’t ready to go back to a life spent entirely on the couch.

My Gym Wife had seen a therapist about knee pain and had gotten great results.  I knew, and liked, the therapist personally.  I signed up.  This therapist gave me clear answers: yes, my pain should go away entirely.  Yes, I should be able to squat to below parallel.  More manipulation followed, repetitive strength-building exercises for my quad (“I think she’s a really capable therapist,” I told her assistant on my bajillionth rep of a cable exercise, “but her choreography is SUPER boring.”), more ultrasound, and valuable therapy for building a legal squat.  I still had hip and thigh pain, but at least I could get below parallel.

After a few more months of regular treatment and dutiful compliance, I saw improvement in both hip mobility and relief in quad pain that didn’t feel temporary.  And I could squat.  But I still had pain.  My therapist sent me to an orthopedist. 

Lesson #4: Needles Don’t Always Work

I could tell my therapist was frustrated.  I could also tell that she was working hard to figure out how to fix me.  She spent lots of hands-on time diagnosing and treating.  She listened.  She watched me move.  She gave me exercises that addressed my weaknesses.  When I did the math about how much time she spent with me compared to what my insurance company was paying. . . .  (Lesson #4.A: Insurance Is a Racket, But Just Try to Get By Without It).  Nevertheless, I appreciated her honesty and dutifully went to the orthopedist. 

I had x-rays in the office before I saw him.  He walked into the exam room, listened to me say that I had hip pain that didn’t allow me to move beyond a certain point without pain (he didn’t watch me move; he didn’t ask for much of a history), told me my x-rays were fine, told me my Chuck Taylors were the “worst possible kind of shoes” I could wear, told me to wear orthotic inserts inside heavily padded running shoes, gave me a cortisone injection in my hip, and told me to come back in two weeks if I still had pain.  Ten minutes later, he moved on to the next patient. 

Meanwhile, I left to buy orthotic inserts.  The pain never went away.  The cortisone shot made no difference.

Two weeks later, he told me to go back to the therapist.  And just to plan on not squatting.  Ever.

Lesson #5: Sometimes Needles Do Work

Don’t get me wrong: I don’t love squatting.  I’m not one of those weirdos who brags about my squat (how much, how often, how deep, how many nights I dream about squatting) and wears t-shirts emblazoned with sayings about how squatting will salve all wounds, change your life, achieve world peace, and cure ebola. 

I don’t even LIKE squatting.

Bench Press

Because any right-minded thinker knows bench press is the only lift that matters. 

But you have to have at least one legal (at or below parallel) squat in a powerlifting meet before you can move on to bench press and deadlift.  And beyond a powerlifting meet, you kind of have to be able to bend at the hips to do other things, like standing up and sitting down and . . . well, other activities that aren’t optional and that can’t be hygienically accomplished from a standing or lying position.  So not squatting wasn’t an acceptable answer.  I went back to the therapist. 

This was now a full year after the failed Stupid Human Gym Trick (don’t ask; I’m still not telling), months of various forms of treatment, and lots and lots of office visits and co-pays. 

My therapist was still puzzled and frustrated by my pain.  “Wanna try something really weird?” she asked.  How could I say no to an offer like that? 

Her colleague did dry needling.  You can Google it.  But the short version is that I let her colleague stick needles into my leg until my muscles twitched involuntarily, violently, and painfully.  Very painfully.  After some treatments, I could barely walk from my car to my front door.  If my pride had allowed it, I would’ve crawled up the three steps to my front door.  But after three or four weekly treatments, my quad pain was gone.  Absolutely gone.

The hip pain, however, remained.  My therapist called in another colleague, they watched me move.  They asked me questions.  She repeated my history and treatment to her colleague.  “Bursitis” was their answer.  Which (and I’m not a professional here, so don’t take my word for it) I’m pretty sure boils down to “pain because of something.”  I had a vague sense she might have thought it was a labral tear (which Google had told me months before was “bad”—again, not a professional here, and see Lesson #2).  She reluctantly told me there was nothing more she could do for me through therapy. 

I was stuck.

Did I mention that I whine?

Lesson #6: Sometimes Whining to the Right Person Works

So I whined.  A lot.  Everywhere.  At work, where MDs told me to just not squat.  To my friends, who love me despite my whining.  At the gym, where people told me to foam roll and stretch in even more aggressive ways.  I whined my way through 15-pound squats, and then 20-pound squats, and then 33-pound squats, which were to depth (and it took me months to get to 33), but were so painful that I couldn’t imagine ever putting actual weight on the barbell.  I stretched and whined.  Whined and rolled and stretched and whined. 

Enter Lynn Grimm, who is nice and patient and funny, but either got tired of hearing me whine, or really likes a challenge.

She called me one Saturday out of the blue.  “What are you doing today?  Wanna come be a guinea pig for an MDT training session?”  I’m taking some revisionist liberties here, because I’m sure she didn’t use the phrase “guinea pig,” and I wasn’t informed enough to have remembered “MDT.”

“I think it would be really good for you,” she said.  And that is verbatim.

Why not?  I had allowed (nay, paid) people to crack my joints, scrape my muscles, bruise my leg, douse me with ultrasound goo, and stick hollow needles into my leg and cortisone into my hip, so how bad could it be to be a teaching Exhibit A?  And what did I have to lose?  Plus, I’m pretty boring and asocial, so my Saturday was wide open.

Thirty minutes later, I was standing in front of a room full of physical therapists and orthopedists at a training seminar for the McKenzie Method led by Mark Miller.

“So you have hip pain,” he said.  And he asked me to move and describe the pain.  He asked me a bunch of questions about when the pain started, what I had done, when I noticed it.  He asked me what I had tried to do to alleviate it.  I ticked off the months and attempts.  By this time, it was about 15 months since the Stupid Human Gym Trick (I’m still not telling; it wasn’t that entertaining—just stupid), weeks at a time away from the gym, multiple different courses of treatment with several different kinds of health care professionals, unsatisfactory trips to an orthopedist, x-rays, adjustments, manipulations, exercises, stretches, needling, changes in shoes.  Pain, co-pays, frustration, disappointment.

“Did you have a cortisone shot?” he asked.

I was so caught up in the litany of failed efforts that by this point, I had even forgotten the cortisone shot.

“So what is it that you ultimately want?” he asked.

“To be out of pain, and to be able to squat,” it seemed so simple, but I felt stuck.  And I was probably close to tears.

“We’ve got to help her,” he said.  “She’s tried everything, and she’s been all around town,” [and NOW I felt so very . . . promiscuous] “trying to get help.”

“Sounds like she’s had some really bad advice,” someone said.  And I cringed.  Because the truth was that I had gotten some bad advice and had made some stupid decisions.  But I’d also gotten some really good care.  I interjected: “My last therapist was actually awesome: she and her colleagues got rid of all of my thigh pain and increased my mobility.  And she was honest enough to tell me that my hip pain should be completely gone, but that she couldn’t help me any more.  I’m more frustrated with the orthopedist because I feel like a hot potato, getting bounced around.”

“So what’s your next step?” Mark asked.

“I guess to be able to go back to the orthopedist and tell him that I’ve tried everything, and that it’s time for an MRI.”

Lesson #7: Knives Should Be the Last Resort (and You’re Probably Not There Yet)

Remember that it was a teaching seminar, so I got to hear this awful little detail: “As frustrated as you are with the orthopedist,” he turned to the seminar participants, “why doesn’t the orthopedist want to give her an MRI?”

“Because,” he continued, “he knows that [insert a shockingly high percentage here] of people in her demographic will have some kind of tear that will show up on an MRI.  And then he has no choice but surgery.  And then,” he turned to me, “you’ll have the expense and pain and recovery time of surgery.  But surgery might still not fix the pain.”

“Her demographic” might not have been his exact words, but I remember thinking that he had diplomatically called me “old” and maybe even “the worse for wear and tear.”  And the percentage probably wasn’t, like, 300% (again, I’m neither health-care professional nor biostatistician) but I seem to remember that it was upwards of 60%.  I am smart enough (and unlucky enough) to know that those odds weren’t in my favor.  None of this was looking good for me. 

And for the record, viewing surgery as a last resort wasn’t a new lesson I learned, but more like a shocking reinforcement of something I already embraced: I try to stay as far away from medical interventions as possible.  Like, for example, the time I told my husband as I was almost passing out on the kitchen floor that we could probably just superglue my finger instead of going to the emergency room for the gaping wound that the jagged black bean can lid had gashed into my finger.  Six stitches later, I realized the superglue idea was on stupid par with the Stupid Human Gym Trick that landed me in this hip pain mess to begin with.  And I’m still not telling.  But you get the point: if I was willing to superglue my blood-gushing finger but was now considering requesting hip surgery, I was at my wits’ end.

Mark Miller, PT, Dip. MDT

Lesson #8: I Owe Mark Miller an Apology in My Head

“So what would you say,” Mark asked me, “if I could give you one exercise to do for 48 hours that would reduce your pain by 80%?”

In my head, I said this: It sounds too good to be true.  It sounds almost slick.  Because I’ve been dealing with this for more than a year and now you expect me to believe you can fix this in 48 hours?  Because in college one summer, I got hoodwinked into selling $1000 waterless cookware door-to-door simply because the guy at the top of that pyramid scheme was pretty slick, so I know slick when I hear it.  And “one exercise, 48 hours” sounds pretty darned slick to me.

But I didn’t actually say any of that because I’m more polite than that on the outside.  Plus, I’d showered and driven to the seminar, and I have no social life so I really had nothing better to do with my time.  I’d also tried everything else I could think of to try.  What the hell?  “I’d say, ‘Let’s give it a try.’”

So he watched me move some more.  Asked me some more questions.  Talked about derangement.  Gave me an exercise.  Asked me if it helped with the pain.  It didn’t.  He asked me some more questions.  He gave me another exercise.  Asked me if it helped with the pain.  This one didn’t either.

I couldn’t tell whether this was amusing me that he had slickly promised one exercise but none of his exercises were working, or whether this was one more demoralizing, failed effort at trying to get rid of hip pain that was my own stupid fault.

Then he gave me another exercise.  It was simple—not pleasant, but not impossible, and it was less painful than climbing stairs and sitting down had become.  It required me to kneel on one knee and lean in a particular way as far as I could.  And it worked.  Immediately.  The pain was better by at least 50%.  I had at least another 3 or 4 inches of range in my pain-free movement.

One movement that helped her

Mark had me stop and talked to me (and the seminar participants) about derangement.  He talked about how ball-and-socket joints work, and how they react to injuries.  And he talked about derangement a little bit more.

He had me repeat the exercise.  A little bit less pain.  A little bigger pain-free range.  For the first time in more than a year, I was genuinely, but cautiously, optimistic.

I went home with instructions to repeat the exercise every few hours for the rest of the day, and to come back for the rest of the seminar the next morning.

On my drive back to the seminar, I apologized in my head for having dismissed “one exercise, 48 hours” as slick.

Lesson #9: Try It and See

I and my substantially less painful hip got to the seminar early and sat in the back of the room.  Someone else was at the front of the room.  Mark reminded the seminar participants of the person’s history and the prescribed exercise.

“How do you feel now?” he asked.

“60% better,” responded the person.

I watched at least three or four other people in front of me—people with elbow pain, heel pain, back pain.  All of them had been assigned one exercise.  All of them felt better.  OVERNIGHT.

I knew they weren’t shills or exaggerating, because I wasn’t a shill, and I wasn’t exaggerating. 

So when it was my turn, he watched me move, watched me do the exercise, talked a little bit more about derangement (I was beginning to think that now he was simply being gratuitous with the term, but as long as the hip pain was abating, he was welcome to shower me with whatever thinly veiled insults he chose.  And I’d thank him for it).

Squatting with Weight!!!

“Any questions?” he asked me.

“What about squatting with weight?” I ventured, hesitantly, because so far every doctor and therapist I’d seen had said, simply, not to squat.

“Try it and see,” and just like that, I had a reasonable answer to a reasonable question.  “If it still hurts, you may need more help,” and he told me to see Lynn, who also told me how to find other McKenzie-trained therapists.  No surgery, no shots, no invasive procedures, no lifestyle or shoe wardrobe changes (although, seriously, I could use some fashion advice, but that’s another topic).

It’s odd to say that I can’t remember when, exactly, the pain stopped entirely, but it was very shortly after the seminar.  Entirely gone.  One exercise that I did for a week, maybe two at the most.  It’s stayed gone for two years.  I’m still wearing Chuck Taylors.

Chuck Taylor's

  My one-rep-max squat has increased from 15 pounds to 225 pounds (which isn’t impressive by powerlifting standards, but it’s a huge improvement for me.  FYI: I still don’t like squatting.), and I’ve successfully competed in two powerlifting meets. 

But if this shoulder keeps bothering me, I’m going to go have Lynn tell me I’m deranged and work some McKenzie Method magic, because bench press is the only lift that matters.

And Mark Miller PT, Dip. MDT, better watch out the next time he’s in New Orleans, because I’m gonna bear hug him out of gratitude.  I’d squat him just for fun, but that would violate Lesson #1, and I’ve learned that lesson the hard way.



You know what I am going to say..."Everyone Deserves A Good Mechanical Assessment and Treatment Plan!"  Visit grimmpt.com or call 504-228-0524 to set up you evaluation today.  

My Bad! I thought you wanted to get better quickly...

It is difficult sometimes when you are able to diagnose a painful problem and teach someone how to abolish their symptoms in an incredibly short amount of time.  In fact, it is probably going to take some kind of major shift in our thinking to truly accept this.

I have had two patient's this week who were pain-free and independent with their home program in 5 visits which is awesome!  However, they didn't seem to like it, because their insurance company had approved several more visits and they felt they were entitled to use them.  "I have paid a lot of money for more insurance so I am going to use it!"  Doesn't that mean all of our premiums will go up?

I had another similar incident with a patient involved in a legal case.  The attorney was quite upset that his client got better so soon and demanded I continue to see him.  What?!?  Really?  

Since when did lawyers become healthcare providers?
What is it going to take to help people help themselves instead of lining attorney's and healthcare practitioners pockets needlessly?  

Just wondering.

Thanks for reading this.  I am a little frustrated with it all to say the least.  Would love to hear your opinion.

However, despite all of this I do believe that "Everyone deserves a good mechanical assessment and treatment plan!"  Call 504-228-0524 or visit grimmpt.com to set up your evaluation today.  

MDT and CrossFit go together like Rama Lama Ding Dong

Click here if the video does not load.

The McKenzie Method^® — Mechanical Diagnosis and Therapy^®    is a philosophy of active patient involvement and education that is trusted and used by practitioners and patients all over the world for back, neck and extremity problems.  This type of evaluation can uncover rapidly reversible conditions.  Once the syndrome is uncovered by the practitioner, the directional movement preference is found, then you are taught how to actually treat yourself!  

CrossFit is an inclusive fitness program utilizing "constantly varied, high-intensity, functional movement."    This leads to health and fitness.  If performed correctly this occurs in a relatively short amount of time.  

If we all knew how to treat ourselves, and how to stay physically and mentally fit, we would instantly solve the healthcare crisis that is occurring today!

That is why my office is located inside a CrossFit gym. Since both methodologies produce rapid results, I think they go together like Rama Lama Ding Dong!  

You know what I am going to say:  "Everyone deserves a good mechanical evaluation and treatment plan!"  Come learn how to treat yourself by scheduling an appointment today and check out the CrossFit box.  Visit grimmpt.com or call 504-228-0524.