So many time clients with spine issues tell me the following:

“I’ve had this in the past and my spine was out, so it had to be put back in place”.
Usually, they refer to a manual therapist or chiropractor that did that for them.

I believe this needs to be addressed since it’s simply not true and it can create problems which I’ll explain.

But first let me point out that the spine is a very strong and robust structure. It cannot simply be pushed into and out of alignment by quick thrust. If that would be the case, Rugby players and MMA fighters would be in serious trouble after nearly every match.
Also, in Australia, recently some students tried to take apart an SI joint. It took them more than an hour, 2 students, a hammer and lots of sweat to do it. There’s a small chance that if that’s the case, a microsecond and a quick thrust will provide any structural change.

As a matter of fact :

“No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal, this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.” 

Why is this misconception a problem?

Saying that a client’s spine “is out” creates two problems in my opinion:

  1. dependency on the practitioner or technique used to “correct” the problem.  It’s the practitioners duty to inform the client correctly and in my opinion, and provide information and/tools to empower the client to take manage or restore their own bodies’ function. We as health professionals can and should help this process but dependency on us should be avoided.
  2. False beliefs about a structural “dysfunction” of the spine. Saying something is “out of place” and “needs to be adjusted” creates the idea that there is something wrong with the spine. The next time a client deals with pain, a logical consequence would be to think “my spine is out again”, which will result in thinking that manipulation is needed to fix the problem.

Both of these issues can be avoided simply by not using these terms anymore. Spinal manipulations definitely have clinical value but we should aim to provide information that is accurate and beneficial to the clients beliefs, aside from just treating them.

The Epidemiology of low back pain. (Hoy D1Brooks PBlyth FBuchbinder R.)


During my session with Cheryl, she mentions right at the beginning that she might not be able to workout well.
She’s tired, her sleep quality hasn’t been good and she pulled a muscle in her during gardening work.
I make a note of it, smile at her and say “let’s just see what we can do”. During the workout session, she’s breaking records all over the place.
First, she did full sets with what her 1 rm was 4 weeks ago.
Then she completed double the work of an exercise she struggled with last week.
Last but not least, suddenly she realized that her back wasn’t hurting.

“Actually, I feel a lot better than when I came in”.

I don’t know if this will be the case at the start of the session, but clinical experience shows us that in most cases, it does.
It’s important because this realization creates a positive feedback loop which is the following:

  • I don’t feel good, might not perform well
  • Perform well, or better than expectation
  • Feel good about performance
  • Positive reference for next time when not feeling good
  • Better decision making

As opposed to a negative feedback loop like this:

  • I don’t feel good, might not perform well
  • Decide not to workout
  • Feel bad about not meeting expectations/ Lose progress
  • Lose motivation

Feedback loops


Mine, and Cheryl’s takeaway from this:

Especially when in the first 12 weeks of training, it’s important not to give in to expected outcomes that only give you short-term instant gratification. Make decisions based on planning, not on the emotion of the day.
Of course, if you find out that you’re actually hurting or not feeling good during the workout, you can still decide to rest. But at least at that moment you’ve made a decision based on actual feedback of your body and not a projected outcome of the brain.

I’ve been applying this mindset experiment over the last year -not just for fitness purposes- and it has given me great results. Hope it can do the same for you.




Okay, we can not put labels on people.

After all, we are all different and move differently. But the truth is that people mainly move in 3 directions, which are the following:

rug pijn hulp stap 1, bepaal welk type je bent

I will not make it too technical but the planes mean the following:

Sagittal (Blue): Move forward / backward, bend forward to pick up something
Frontal (Red): Sideways movements, such as when we raise our hands to wave to someone
Transverse (Green): Rotatory movements, such as when we reach to open a door.

The vast majority of our movements take place in the so-called Sagittal plane. Or often, actually to be more precise …

… the vast majority of our non-movements.

Een slechte houding plaatst 40% meer druk op de wervelkolom


Fact: A bad posture places 40% more pressure on the spinal column

When we move much in the same directions, the body adjusts to it. In practice, we see that this often results in 2 different archetypes: extension type and flexion type.

As you can see in the picture, there are a number of things that belong to these types.

Not everybody has all the features, but they often influence each-other . As a result, they are often seen together. The more features you have, the more you belong to this pattern.

Extension Type

The features or this type are:

-An enlarged arch in the lower back
-“Flaring out” the rib cage
-The pelvis tilts forward (“Water spills out on the front”)
-The knees are fully extended

Possible Issues:

Extension types often come with compression problems, or complaints related to pressure when joint surfaces are close to each other. -and thereby imposing excessive pressure on the connective tissue.

Flexion Type

The Flexion type has the following characteristics:

-The shoulders often “roll” forward
-The head is on the front and the neck is extended
-Upper back is rounded
-Lower back is flattened, or even rounded
– There is “no ass!”
– Knees are bent

Possible Issues:

The Flexion types are often the people with an office job. Working behind a desk easily pulls your body to this archetype . Mostly if you are not aware of your posture while sitting. This habit is then taken to the car and home where the “working posture” is continued to the “couch posture”.

This often passive posture can adversely affect the connective issue that hold the vertebra together. The inter-vertebral discs may also suffer greatly. Because there is little active support of the muscles, almost all of the strength ends up directly to the so-called “passive structures” such as the joints, ligaments and cartilage.

Herniated discs and instability problems are often seen complaints in this pattern.


Which back type do you have?

Which pattern is most like you? Once you know this, you can start balancing your posture through targeted exercises.

Under this article, please let me know what kind of type you are and what complaints you may experience!

I’ll be able to help you out from there on.



If I tell somebody “I think you may be a good candidate for Dry Needling, often their eyes open wide accompanied with a painful facial expression. The word “needling” doesn’t seem to trigger the best of responses even though “acupuncture” seems to have a more benign effect.

That’s a bit strange because by definition they’re the same thing:
Acu = Needle
Puncture = The act of piercing through 
As a Physiotherapist and Dry needling therapist, I’ve come to understand it’s mostly about understanding what’s going on during a dry needling treatment and what the differences/similarities are with acupuncture.
1. What is dry needling?
Dry needling is a so-called intramuscular- treatment performed by a specially trained physical therapist. This treatment method is often used for muscular complaints that have existed for a long time and is part of a total treatment. Examples can include chronic headaches, low back pain, RSI, neck problems, tennis elbow and other long-standing muscle problems . The physiotherapist uses thin acupuncture needles, which can help to quickly and easily fix “knots” in muscles.
2. Is it similar to acupuncture?
“There are similarities between acupuncture and dry needling.  For example, the same needles are used and the needle placement technique matches. However, there are also obvious differences.
The biggest difference is the approach. Chinese traditional Acupuncture is mainly used from an energetic concept. The idea is that the body has a wide map of “meridians”, which function as energy channels between different body charts. Blockages in these energy pathways can lead to problems and acupuncture needles are inserted to unblock the problematic areas.

A map of the meridians used in Traditional Chinese Medicine

Dry needling works from a physiological and bio-mechanical concept. There are many muscles that work together as a team through the body. Since all these muscles are connected, they strongly influence each-other. Sometimes some of the muscles in the team can hold “triggerpoints”, which are commonly known as “knots”. These points can cause pain, stiffness and dysfunction in the muscle and the joint it works for. But it can also affect the entire line it belongs to. With dry needling, the aim is to insert a thin acupuncture needle in the triggerpoint to release it from the muscle.

The Myofascial “arm line” muscle connection (From the book “Anatomy Trains”)

Another difference is that classical acupuncture often uses multiple needles, which remain in the body for some time. Dry needling uses one or a low amount of needles and they usually are in and out in a matter of seconds. 
3. When is dry needling applied?
“For long-term muscular complaints, dry needling is effective, especially if myofascial (muscle tissue and fascia = connective tissue) trigger points are present. These trigger points can be explained as a painful hardening or muscle node. Often these trigger points cause not only pressure pain , But also pain in other parts of the body.
The physical therapist is looking for these places because they can be the main cause of your complaints. In addition to pain, a triggerpoint can also provide movement limitation, stiffness and reduced activity of the particular muscle. Sometimes even reactions like sweating, dizziness, headache, blurred vision, tingling or cold hands can occur from an active Triggerpoint.

Low back muscles and their referred pain patterns

Most patients with muscle problems can be treated with DN, but in some cases dry needling is less suitable. Pregnancy is a reason not to treat, just as fear of needles. Acute injury due to an accident, for example a muscle tear, is also excluded from treatment.
4. How does it feel?
“In order to release trigger points, the physiotherapist will cause them to “twitch”, which will force the muscle to relax. The insertion of the needle will not or hardly be felt. The treatment of the muscle is often accompanied by a Sudden short tightening of the muscle. This “cramping” can be a bit painful but is usually short-lived,  and a positive effect of relief follows immediately after. The muscle may be more flexible, the mobility in the joint improves and pain decreases.
5. What is the effect of a treatment?
“After treatment, the treated muscles usually feel quite tired and heavy.” Strong muscle soreness” is a common phenomenon, which is quite normal and often disappears within a day. Sometimes, some general fatigue occurs after treatment. Regularly, patients experience a deep sleep on the night after treatment.
During a first treatment , the therapist usually only treats a small number of points. This way he/she can see how you react to the treatment before the intensity is built up.