Acute pain (tissue discomfort) versus Chronic pain (long lasting irritation)

What is pain?

Pain or discomfort derives from a physical injury, an emotional trauma, or distressing memories.

The chief function of pain is to direct your energies and attention to these states of irritation by inducing deep-seated anxiety to ensure that you know that your body is under threat. Very much like when you touch a burning stove. The shock and fear induce you to retract the hand in micro-seconds knowing that this danger could cause traumatic damage.

What does the nervous system do?

We now know through detailed brain imagery that acute pain (initial pain) travels up the spinal cord via the central nervous system from the site of the tissue damage and into the insula and anterior cingulate cortex which are activated when the tissue nociceptors or pain receptors are stimulated by pressure, swelling, or heat. Your brain and spinal cord constantly receive signals from your muscle spindles and the periphery of the skin to sense the world around us. This system controls your flexibility (or inflexibility) strength, control, and balance.

The spinal cord is like a messenger sending and receiving messages and making decisions in the form of reflexes letting the brain know how badly injured the tissues are. The brain gives the decision as to what to do and how to repair it. Every sensation however feathery light or intensely sharp is experienced through your emotional brain called the limbic brain or our third brain.


How does acute pain become Chronic pain?

If you have pain that heals and repairs quickly, we refer to this as acute pain. If the pain lingers especially for longer than 3 months, we call this chronic pain. New research suggests that the brain became used to the irritation and the nervous system is wired to overprotect and guard movements and the fear factor persists. Chronic pain according to brain scans tends to travel from the brain through the spinal cord down into the body even when there is no obvious tissue damage. The scans show that the emotional brain (limbic brain) lights up to a far greater extent and is far more involved with the experience of chronic pain.

It is suggested that we should be rethinking and reframing our techniques to treat chronic pain. A more integrative, holistic approach that includes physical therapy, meditation, and hypnotherapy and helping the client remove the anxiety and fear by adding acceptance and gratitude, and commitment which is part of cognitive therapeutic modalities. The most successful of which is called; “pain re-processing therapy”.

In a new book by Dr. Haider Warraich called “The Song of our scars; the untold story of pain”, he amusingly but succinctly describes present-day pain management by primary healthcare practitioners like chefs who don’t taste their own food. They dish out pain medication like opioids and ibuprofen without really understanding the real causes and effects and feelings of their patients. Treating chronic pain in the same way as you treat acute pain is a big mistake and has led to the opioid crisis around the world. Suffering begets more suffering.

Pain is worsened by psychological factors such as a lack of self-worth and depression. Dr. Warraich had chronic back pain himself and was afraid to do any exercise as he was told he would break his spine. In the end, it made his body weaker and his pain perception more tangible. He clearly states that the nervous system looks at chronic pain as an emotion we feel in our bodies.


The brain and pain

Every single body is different and there is no one size that fits all. We as physical therapy practitioners have a huge responsibility to hone our skills carefully in order to try to understand the triggers that our clients are experiencing from a longstanding memory of being hurt or traumatized as a child. With each experience that feels emotionally or physically unsafe, the brain learns to go into a protective mode more quickly and its warning system may become increasingly more sensitive. Health scares during childhood can have a big impact on how protective the nervous system becomes. Injuries or incorrect diagnoses can lead to a more intense experience of pain due to increased amygdala activity. Even the death of a loved one Changes in financial standing or a traumatic event can create this onset of “pain catastrophizing.”

A friend of mine had a high-pressure water hose thrust into his ear. He took Asprin to relieve the pain. Months later he would take Asprin and within seconds of taking it the pain would disappear. He then knew that his pain was psychological, and the pain memory was “Catastophising” the nervous system. Once he realized that and stopped the aspirin the pain went away in days, and never returned.

We know that our nervous system will go into overdrive when these triggers are not managed and therein lies the issue with over-stimulation that we refer to as being chronic pain. Since one in five people are affected by Chronic pain this affects 1.5 billion people around the world. This is a major new step in the treatments and understanding of pain management.


Chris Watts- Master mobility trainer

CEO Motion Dynamics

+852 28823397

Sit Less Move More – By Chris Watts


If you believe in the mind/muscle connection, then the more soft-tissue flexibility you possess the more easily and effortlessly it is to move and the more relaxed you will become as a result of unwinding the tense and entangled resistance that occurs in muscles and fascia. Restrictive movements in the soft tissue can often be from overuse and old injuries that never healed well.

Agility is the ability to move freely with less friction within the muscle fibers. Flexibility training often transcends the physical so that you adapt more easily to cope with life’s variable issues. Withstanding stress without excessive effort is the objective.

Body flexibility creates a more positive psychological and more open and expansive mindset.

Anyone can learn to improve their ability to move better.
Movement improvement is the ultimate challenge as we get older, the purpose of which is to attain a better life purpose and draw-back time. Posture improvement allows us to optimize our golf swing, tennis serve, or running stride. It just gets easier to perform any activities at higher levels. You will incur less soft tissue stress as a result of being more pliable and mobile.

Your active end of the range for each of the 360 joints will improve and you move with less effort.

Flexibility training is joint-specific so you can be perfectly mobile on one side of the body and totally hypermobile on the other. It’s like putting high octane fuel back into your car, you move faster, stronger, and with greater efficiency.

Once you begin the road to optimal flexibility you will learn that you can age gracefully and stay active much longer optimizing the way you look, feel and move.

Flexibility training is as much about how you think and perceive life and how you deal with the daily challenges. Flexibility also allows you to go out and try new sports and activities and learn new skills, it gets you out of your comfort zone and ultimately sets you up for a more extraordinary life. As the American slogan goes:” This is the first day of the rest of your life.” So, let’s start to make it better right now.

Flexibility training done well is actually easy and it requires a skill set to get you on the right track. The 2-second Active Isolated Stretching system of dynamic movements focusing on the contracting muscle on one side of the limb to release and relax the target muscles on the opposite side is the safest and most sure-fired approach to achieving quick and long-lasting results. In fitness training the first thing you start to lose is cardio-vascular efficiency, the second is strength and the last is flexibility.
Once this is attained the body will accept the new norm and adapt.

In lifestyle fitness, the first real goal is to boost energy levels. Energy output is my personal goal in all the fitness programs I do. As you get older you really want to focus on more metabolic improvements like some HIIT and some specific cardiovascular workouts with as much variety as you can possibly work with.
Speed variation is one of my big training philosophies, in general as we approach older age we tend to slow down. I am the opposite as I want people to train their neuromuscular and fascial systems to move quicker and with more agility too. Physicality is all about purpose to want to do more and go further and have lots of fun doing it too.

To do this you need to create a more efficient neuromuscular pathway or as we say in our lingo “feed” into the soft tissue removing adhesions and restrictions and allowing the oxygen-rich, alkaline fluids to travel the path of the least resistance. Performance training for your favorite sport is all about creating a more physically efficient you.

Upregulating Oxygen more efficiently and more directly into the 30 trillion cells where energy levels are determined and ultimately converted into action potential is the key thinking when performing at a higher level.


Sitting here right now writing this article I am acutely aware that I must not sit for any longer than 40 to 45 minutes as I am drying out my intervertebral, cartilaginous disks that act as a cushion for my joints. I am also compressing them as I sit. When we sit, we place 6-8 times more force on our lower lumbar disks than when we stand.

The disk is the only part of our anatomy that has no independent blood supply. It is filled with water and hyaluronic acid as well as a thick collagen matrix. Protecting one’s disks is one of the most important aspects of physical awareness that we can share with our clients as it will prevent so much hardship in the latter years when the disks begin to start their natural degeneration process. Protect your disks as a priority. This is why we spend so much time correcting poor postural patterns as the disks do not like tilts torques and rotations throughout the pelvic girdle. It grinds down the disks and weakens them to eventually lose their integrity and start to bulge and herniate.

Research also tells us that sedentary workers have a 112% increase in onset of Diabetes, Heart and cardiovascular diseases rise by 147% and back pain goes up by over 200%.
This so-called “Sitting disease” is one of the greatest problems of our modern age. Low energy output, little or no physical expenditure, low metabolic activity, less muscle mass, and poor vascularization.

The Goal: Sit less move more.

  • Motion Dynamics invites you to discover the “Friction Free” movement.
  • Book a complimentary 30-minute “Stretch and Align” session by appointment only.
  • Call 28823397 to make an appointment or email us at:


There are many ways humans communicate with each other. The way you walk, speak, run sit or stand speaks volumes about who you are and how you feel in your environment. Let’s look closer at the way we sit.

There is the right way, the wrong way and your way to sit. Yes, we all have very different builds.

A slovenly posture whilst sitting could imply that you are bored, couldn’t care less, are tired and de-energized. You would rather be at home than at work, no enthusiasm.

Slouched, sloppy and inactive are words that come to mind when thinking of our sitting habits.

How do we learn to sit more upright and gradually learn to unsaddle ourselves?

Sitting posture tips:

Use what I call a 50-minute chair. One that is not ergonomically designed and allows you the opportunity to get up every 50 minutes. Can be a simple stool that you sit on.

When seated you should always have your knees below your hips to encourage a natural Curve in the lower back. Use a wedge cushion under the buttock to create that lift.

Computer screen should be around 28 inches in front of your eyes. Your eyes are lined up
with the top of the screen so that you are looking slightly downwards.

Never cross your legs when seated as this throws the hips and pelvis out of alignment.
Your feet should always be planted on the floor or a footplate. When the foot is off the floor you lose the neural connection to your spine. The spinal muscles turn off!

Be fidgety and move around as much as you can when seated.

Stretch your spine by bending your spine forwards when seated to look between the legs.
Hold stretch for 2 seconds and repeat 8-10 times.

Rotate the spine left and right once every hour to open up the joints of the spine and warm up the spinal muscles.
Every 50 minutes get up and get a glass of water to re-hydrate and to switch on those extensor muscles.

Enquire about standing desks or what is called sit/stand desks. You burn an extra 200 calories a day when standing rather than sitting. Also, it helps to rev-up the metabolic system that will allow you to activate the enzyme lipase. Our natural fat burners.

Posture is a body language that we all can read innately. Does that mean we should be

conscious of how we sit, stand and move?

In my observations posture is the reason why we gravitate towards each other and why we are continuously reading each other’s non-verbal body language. You are either attracted or repulsed by how someone carries themselves. It happens at the deepest intuitive levels. HR and AI (Artificial Intelligence) are looking at posture to reveal attitude, energy levels and willingness to comply.

Can we improve our postural habits?

Something strange happens to our bodies when we get past the heady age of 40.
Our muscles start to lose tone and shape and we begin to gain more adipose (fat) tissue. An indication that our metabolic system is changing, slowing down as we are not as active as we once were.

Over consumption and lack of fiber in our diets mean we are not eliminating toxins and we are accumulating unnecessary extra weight which makes us move more sluggishly, creating extra compression on our joints.
For example, the knee takes 5 times more load than any other joint in our body. A 10-pound extra weight translates to 50 pounds of extra load on our knees! Our nervous system is our main command and control for movement. It sends back via the central nervous system a feedback in microseconds of the pressure and the sensations surrounding the joints and soft tissue. We are starting to wear and tear at much earlier ages that we should.
Many anthropologists and anatomists are saying that humans are so well designed that we should be expected to live for 120 years or more. It is what we do to our bodies along the way that wears and tears the cartilage and the soft tissue.

Sitting is a form of compression. You place 8 times your bodyweight up your joints in the lumbar spine when you sit than stand. Your lower back is being compacted by the full force of gravity and the forces of your own bodyweight as well as the way you sit. If you are not sitting evenly on the 2 sitz bones in the lower pelvis you will likely be overloading the disks on the heavier side and more importantly de-hydrating the soft tissue surrounding the disks in between the joints. When they begin to desiccate or dry out you have lost shock- absorption and you have lost disk integrity. You are in fact weakening your spine. 90 percent of all the people we see at Motion Dynamics who work sedentary jobs in offices have fundamentally weak lower backs. In fact, weak spinal muscles that support them all the way to the top of the neck. Those multi-layers of muscles have atrophied and lost the reflexes to create the necessary upright support.

The key for any postural correction work is to get the mechanical alignment right. An even distribution of your own body weight between the left and right side. Then we need to stabilize the weakened postural muscles. Eventually we can add weight and load and start the process of really strengthening our bodies. As we get older, we need to do more strength work not less. We need to remind those reflexes that upright is efficient, we move with greater ease and with less resistance. More energy rather than less is our goal.

Sit less, stand and move more.

Chris Watts is CEO and Founder of Motion Dynamics Ltd.
Tel: +852 28823397

Active Assisted Isolated Stretching Treatment of a race car driver patient with persistent back and neck pain


The purpose of this Case Study is to demonstrate and discuss the effectiveness of Active Assisted Isolated Stretching treatment as applied by caregivers at Motion Dynamics on a patient with persistent mild to severe back and neck pain.

Clinical history:

The patient is a 40-year-old male with a sedentary working lifestyle. He is also an amateur racing car driver. He suffered from chronic lower back pain, neck irritation, lack of shoulder flexion from adhesive shoulder capsules and poor finger grip strength.

This condition proved especially challenging for the patient given his specific activity. His limited range of motion in the neck can caused stiffness and irritation as well as discomfort. His driving was hampered, especially at high speeds.

This kind of persistent comfort can also be dangerous for more conventional driving. It is difficult to drive a car safely if an individual cannot turn their neck far enough to check their ‘blind spot’.

The patient had previously tried conventional physiotherapy for his back and neck pain, including massage, heat treatments and electro therapy, but these had proved ineffective.

As a first step, the patient did a full postural screening and a range of motion testing on all the major joints to see where his movement restrictions were, and to identify musculoskeletal compensation that could have been contributing to his lower back pain.

This postural assessment was performed standing (weight bearing) and lying down (non-weight bearing) to check for tilts, torque and rotation throughout the body structure.

[Photo: Chris Watts stretching and aligning Jonathon Hui]

The observational findings were as follows: Subject’s entire right hip was depressed by 1.5 inches and his left hip was up-slipped by 1 inch. His lower left lumbar quadrant was hypertonic, especially the quadratus lumborum muscle. It was also very sore to the touch.

His left hip was twisted and torqued to the right side creating irritation in his sacroiliac joint on his left side. The sacrum was also torsioned to the right with some muscular and ligamental strain on L4 and L5.

The head was tilted to the right side, compressing the right side neck flexors and shoulder elevators. There was some referred pain through the brachial plexus nerve bundle translating through into the tips of the fingers.

Treatment: Active Assisted Isolated Stretching and Strengthening (AIS) is a uniquely effective exercise system developed by Aaron Mattes. Motion Dynamics uses AIS and expands on the application of the method together with other physical therapy methods. AIS is a specific program of flexibility exercises, based on sound physiological principles. AIS, which is carried out actively or assisted by a practitioner/therapist or by the subject’s own efforts (often assisted by a rope or band), is designed to specifically increase range of movement of muscles, fascia and connective tissue. During AIS, movement is carefully monitored in order to prevent activation of the stretch reflex.

The patient underwent 5 months of treatment in an attempt to transform and rehabituate his alignment. This required deconstructing his existing poor postural patterns and then reconstructing the balance and alignment.

This consisted of 40 treatment sessions, with each session lasting about 90 mins. The patient underwent these sessions twice a week.

At the start of treatment, the patient’s shoulders had only 140 degrees of shoulder flexion with a very hard end feel, suggesting a very adhesive joint capsule on both sides.

His sideways elevation was restricted by a non-gliding acromio-clavicular joint that prevented the fluid motion when the arm was raised to only 120 degrees of range.

The shoulders were also protracted forwards by a very tight pectoralis minor and weak and tight serratus anterior muscle.

The head was also forwardly protracted by 2-3 inches creating strain on the posterior extensors of the neck.

The neck could only laterally tilt less than 25 degrees to the left side due to the right side constriction of scalene and upper trapezius shortening.

Cervical rotation was only 45 to 50 degrees on each side showing strong restrictions in range at C1 and C2

[Photo: Chris Watts chatting with Phil Whelan]


The application of the Active Assisted Isolated Stretching method used multiple sets of active and dynamic repetitive movements to slowly bring his soft tissue flexibility and joint mobility to a functional range.

These movements consisted of:

Cervical rotation with flexion at end of range In this movement, the patient tucked in the chin and rotated the neck to the right side 80 to 90 degrees, then flexed the neck by bringing the chin down towards the shoulder. He aimed to turn far enough that his chin was almost in line with your shoulder. The patient then repeats the exercise on the other side.

This specifically worked on the insertion of the upper trapezius muscle on the left side of the neck at the site of the acromium on the shoulder blade.

The patient reached a range of motion of the neck in rotation between 80 and 90 degrees. His lateral cervical flexion or side bending reached around 45 to 55 degrees.

Cervical flexion and extension This exercise has the patient touch his chin to his chest from a tucked chin position. Over the course of treatment, he reached an acceptable athletic range of motion for neck flexion of 40 to 60 degrees. Neck extension involved the patient tilting his head back. He attained a normal range of motion that allowed him to look straight up at the ceiling. The patient reached a range of motion from the neutral neck position of 45 to 70 degrees.

Cervical oblique hyperflexion and oblique hyperextension For the lateral cervical flexion exercise, the patient bent his neck to the side so that his ear was leaning towards his shoulder while looking straight ahead. He then brought his left ear toward his left shoulder, then rotated his neck 45 degrees to the right side and then drew the left ear towards the left chest. This exercise targeted the upper trapezius and levator scapular muscles. He would then perform the same exercise to the opposite side.

Having reached a normal range of motion in lateral cervical flexion, the patient was able to move halfway between straight ahead and his shoulder, which is a 45 degree angle. Shoulder forward elevation

For this exercise, the patient kept his shoulder blades set in a downward rotated position, raising his arm straight up with his thumb pointing upwards, lifting his arm through a full range of 180 degrees of forward elevation.

He then performed the same movement with the palm facing forward, followed by the arm fully internally rotated with the thumb pointing forward.

Sideways shoulder elevation For this exercise, the patient set the scapular in a downward depressed position and then abducted the shoulder with the thumb pointing upwards until the arm reached just behind the ear.

He then repeated this action with the fully internally rotated so that his thumb was pointing upwards and then abducted the shoulder until the arm touched the ear.

For these movements, the patient endeavoured not to elevate the shoulder, nor allow shoulder impingement at the acromioclavicular joint.

Shoulder internal and external rotation in multiple positions of horizontal flexion and adduction The patient held his shoulder positioned with the arm abducted to 85 degrees, horizontally adducted 5 degrees and the elbow positioned at 95 degrees of flexion. Over the course of treatments, his internal rotation range of motion with a fixed glenohumeral joint reached 80 – 90 degrees.


The patient also changed the position of the humerus by horizontally adducting the humerus by 5 degrees to release the posterior shoulder capsule. For external or backward shoulder rotation, the patient worked towards developing a range of motion between 45 and 65 degrees.


Each set of the movements described above consisted of 10 to 15 repetitions to slowly and gradually unlock the patient’s shoulder joint capsule and fascial adhesions.

The patient was taught how to stabilize and eventually strengthen the neck and shoulders to maintain all the structural work undertaken to realign and reposition the shoulder and hip joints.

He accomplished this by a process of light stability training, using his own bodyweight as well as the natural weight of gravity. We worked in all planes of motion and through full functional ranges to build stability at the origins and insertions of the entire neck structure.

Over the course of this treatment, the patient became acutely aware of where his centre of mass was located and how to gauge a neutral pelvic base.

During the initial phase of treatment, the patient showed radical improvement, and there was a slow upward curve of benefits through the rest of the period.



As a result of the Active Assisted Isolated Stretching Treatment, the patient no longer experiences any pain or irritation in his back or neck.

Prior to beginning treatment, the patient neck movement was limited to 25 degrees of lateral neck flexion and less than 10 degrees of extension at C1 and C2. Neck flexion was less than 20 degrees. degree tilt in any direction. After treatment, he had a full range of neck movement in all directions.

Prior to his beginning treatment, the patient experienced persistent back and neck pain that he described as being between an 6 to 8 on a scale of 1 to 10. After treatment, his level of constant discomfort was reduced to Zero. He was experiencing a lower back compression that was referring pain into his mid gluteal region. His neck pain had also significantly reduced when driving and also post driving when dehydration can typically cause muscle spasms in the areas of common weakness. Most importantly, the patent was experiencing improved energy output during the day and also during the race event too. The physiological effects from improving posture and mobility were profound.


After receiving the treatment described above, he was able to participate in a 24 hour car race. For this event, the patient was driving over 10 hours during a 24 hour period. Throughout, he experienced no significant pain or discomfort in his lower back.



The conclusions obtained from the application of the relevant aspects of Motion Dynamics therapy are especially effective and successful in addressing the immediate symptomatic issues experienced by the patient, and also exponentially raised his level of mobility and comfort in his neck and back. The reduction of constant pain and discomfort has a direct effect in improving his sports performance.


[1] Chris Watts is the founder of Motion DynamicsTM in Hong Kong. He holds certifications from National Certification Board for Therapeutic Massage & Bodywork; Active Release Technique; Master Trainer of Active Isolated Stretching (AIS): The Mattes Method; Myofascial Release Therapy – John Barnes Technique; Neuromuscular Therapy – Paul St. John Method; and Positional Release – Kerry D’Ambrogio Method. He has studied with Aaron Mattes, who is the creator of AIS, and Paul St. John, founder of Neuromuscular Therapy. Watts has been in private practice for over 25 years and is the author of “The Beauty of Posture” (2014). Email:

Active Assisted Isolated Stretching Treatment of a patient with chronic back during pregnancy


The purpose of this Case Study is to demonstrate and discuss the effectiveness of Active Assisted Isolated stretching treatment on a patient with back pain caused by pregnancy.

Clinical history:

The client was a 38-year-old woman who experienced chronic back pain during and after her first pregnancy. The discomfort was most severe first thing in the morning. Initially, this pain was highly debilitating. The client described it as feeling as though it moved in multiple “arcs”, vertically and horizontally, across her lumbar spine. On rising, she would engage in movements that warmed the lumbar joints, and the pain would quickly diminish. The symptoms of her back pain started during the 2nd trimester of her first pregnancy. She would wake up with an inflamed and sore back at the L4 and L5 region of her lumbar spine.

The client had been diagnosed with disk herniation with a right-side bulge and disk narrowing in L4 and 5. This diagnosis was made by her orthopedic doctor after she underwent a physical examination and performed a range of motion tests. At the request of the patient, no x-rays or MRI scans were performed at that time, due to concerns regarding the potential damage to the fetus from radiation.

The pain was localized to the segments mentioned above but did on occasion refer down the right side of her body. The client is generally very fit, engaging in Pilates classes and stability resistance training 2 times a week. She otherwise led an active life, caring for and playing with her first child on a daily basis. She also has a very positive demeanor and is very determined to stay fit and pain-free.

The back pain described above began during her first pregnancy and persisted right through to the end of that pregnancy. She still experienced back pain after giving birth to her first child, but it was much more tolerable than during the pregnancy. However, she continued to wake up with soreness and irritation in her back. Her first child is now two-and-a-half years old. It was when she became pregnant for the second time that her back pain returned with increased severity.

She came to Motion Dynamics for alignment training (postural re-balancing) on the 2nd month of her 2ndpregnancy.


On performing the initial postural assessment, it was noticeable that the misalignments were all around her hip/lumbo/pelvic structures where there was significant anterior pelvic tilting on both ilia with ensuing lower back lordosis.

The pelvis was tilted 25 degrees forward on the right side and 15 degrees on the left side, with a distinctive right dominant hip shift translating the extra weight to her right hip. The right gluteus medius and minimus were weak and hypertonic with poor range of motion in abduction (25 degrees).

The right-side rectus femoris at the AIIS origin was very sensitive to the touch as were the right-side hip flexors indicating weakness and hypertonicity to those important postural and phasic muscles groups. There was a distinctive shift or translation of her body weight to the right side with a very noticeable head tilt to the right side and shortening of her right sterno cleido mastoid muscles.


The entire spinal erectors were weak and unsupportive, and the client was incurring a lot of neck pain especially in the suboccipital region. The levator scapular on the right-side insertion point on the superior angle of the scapular had trigger points and was very sensitive to touch, as was the transverse process of C2 on the right side.


We mapped out a flexibility protocol plan for the coming weeks of her pregnancy to re-balance the client’s musculo-skeletal system. With optimal alignment and good functioning joint mechanics, we were able to have her move well and freely without restrictions and irritation. Then we addressed the muscle imbalances, especially in the lower back and gluteal muscles. These were all very weak and neurologically deficient.

We started the first trimester deconstructing some of her faulty structure and movement patterns, building a strong but balanced foundation using Active Isolated Stretching techniques to unwind the right-side muscle shortening.

I used the principle of 3 sets of AIS stretching on the right side to one on the left to help retrain the neuromuscular patterns of movement. The tightest tissues were in the Iliopsoas muscle group. She only had 5 degrees of hip extension on the right side.

Once we gained the full 20-25 degrees of extension and reactivated the gluteal and hamstrings on both sides, she was able to stand much more upright since her pelvis had shifted back to its neutral position.

Her postural muscles were very slack and weak, and much work was done to stabilize the spinal extensors using Active Assisted trunk hyperextension stability exercises and Assisted oblique trunk hyperextension for the latissimus dorsa, intervertebrales and quadratus lumborum muscles.

The client initially found these very challenging. At the start of treatment, she was only able to perform 4 repetitions of each exercise. Eventually, we were able to build these muscles so that she could perform up to 3 sets of 10 repetitions.

The client could only perform these exercises in the first trimester due to the fact they were performed in a prone position off the table. During the second trimester, all back-stability work was performed on a mat using the isometric tabletop exercises that target the deep multifidus muscles.

At the start of her 2nd trimester, she was only able to perform a 60-second hold on each side. When we finished the 2nd trimester she was doing 3 minutes holds on each side.

Most of the pain that she experienced when we first saw her had diminished by the end of the 2nd trimester.

The 3rd trimester saw the client grow rapidly around the trunk and at one point she was carrying 38 pounds more weight. Her calves were cramping at night and she was retaining fluids around her ankle.

We used Active Isolated Stretching for her lower body, having her lie in a side position with a wedged pillow under her abdomen to provide support whilst working on her calves, hamstrings hip flexors and quadriceps, as well as her gluteus maximus.


The client gained pain relief from the Active Assisted Stretching to the point where she rarely experienced calf cramping. Her lumbar spine was aching and uncomfortable, but she had no sharp pains from the excessive forward pelvic tilting.

We used an elastic belt to help support the extra-abdominal load and I used manual therapy soft tissue release more specifically Neuromuscular (NMT) techniques to relax the lower back and make sure the lumbar vertebrae were gliding well.

I kept up the AIS flexibility and stability training right up to the final session even using AIS for the adductors to open up the pelvic floor which was fully functional in terms of range and stability. The maximal range in abduction is 90 degrees with an internally rotated hip. She was at this end range by the final session.


We found that the client really enjoyed knowing the tiniest detail of each area of progress that we were able to make. She developed a strong kinesthetic and somatic sense along the journey. Her understanding of her own positioning and center of mass was key to the client being able to subconsciously make the necessary long-term changes to help de-pressurize the joint and soft tissue structures.

The mother had a natural birth and delivered on March 26th 2019. The baby was 7lbs and 6 ounces. The birth was comfortable and, after the month of confinement that is tradition for Chinese mothers, I was able to see her at the beginning of May. She is now having a period of abdominal bandaging to firm the abdominal muscles and I will start to see her again for post-natal stability training. The focus will be on the pelvic floor and the pelvic and lumbar extensors.