Air Quality and Pain

If you're reading this from anywhere on the West Coast, you're likely aware of the smoke conditions we're experiencing due to the record-breaking forest fires. The amount of smoke and toxins in the air had BC pegged as having some of the worst air quality in the world!

Obviously, there have been the obvious health concerns of this occurrence, mostly in regards to asthmatics, COPD, and even cancer in the long term. However, is there a link between air quality and musculoskeletal pain as well?

I had a client this week who I've been treating for shoulder pain involving nerve entrapment between the shoulder and neck. After weeks of improvement, she came in on Monday frustrated over a severe relapse in her symptoms. The relapse began on Wednesday of last week with no apparent trigger.

I thought for a minute. In Victoria, I remembered Wednesday as being one of the peak days for smoke in the air.

So I doublechecked her intake form for health conditions. There it was: asthma! Upon questioning, we were able to come to the realization of how irritating the smoke has been for her, resulting in persistent coughing and tightness throughout her chest. Thus, reaggravation of the nearby structures regarding her injury and the return of her pain! With that in mind, we were able to treat appropriate and reassure my client that this relapse was temporary with no true set-backs; only speed-bumps.

This being said, this is a good lesson in how things such as air quality and smoke can be a cause for pain, even when it's not completely obvious. If we look at COPD patients, we can easily find a prevalence of upper back pain. I wasn't able to find statistics, but from here, it's not a difficult leap when considering similar effects that might plague individuals who live in areas that experience smog or industrial workers with regular exposure to toxic fumes.

Could there be links between air quality and pain that aren't purely mechanical as well, though? There isn't a ton of research on this subject, but we do have findings of air pollution having neuroinflammatory effects that, while are mostly looked at in relation to central nervous system disease, is likely transferable to neuropathic (chronic) pain as well. More specifically, airborne chemicals also are linked to neuropathy in painters and the exacerbation of neurogenic pain in smokers.

This information shouldn't be taken as something to scare you, but hopefully it makes everyone think and be cautious. Whether it's your outdoor environment, your job, or another type of exposure, protect yourself and save yourself some pain! Hopefully this forest fire issue will resolve soon, cigarette smokers can clue in and change their habits, and for those in highly-polluted areas...I don't know, vote?

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The Secret In Simplicity

We’ve all witnessed the unfortunate reality of therapists who don’t look toward progressing an individual’s rehab program enough for it to be effective. You the know stories I’m talking about; the person who’s done clamshells for their hips or the one performing forward band flexions for the shoulders for the past eight months and for some reason still isn’t feeling better.

Has anyone not been given these?

On the flipside, I’m also privy to those practitioners who are overcomplicating what they prescribe to clients to the point that they’re either unable to perform their exercise effectively or just left totally confused and unclear as to what the goals of the plan are.

There are big hypes around new and fancy fitness and exercise methodologies, (such as DNS or Ido Portal’s training, for those of you in the know) and they are absolutely fantastic philosophies! I won’t argue against the scientific basis and benefits of any of these schools of thought and I’m eager to continue to study and learn from them more.

BUT, should a new client have all of that content thrown at them in the first few appointments?

I'll let your imagination run wild here.

I was listening to the Adam Meakins’ NAF Physio podcast and heard a great quote when they were discussing tendon health and exercise simplicity. “When treating an organism, let the organism organize.”

What this refers to is that the human body is an extremely sophisticated system. It works within itself incredibly well to perform its functions and adjust to its environment. Note that I never call the body a machine. It neither has a single manual on how to fix it, but neither does it need every single gear and function specifically programmed by us to work properly. Often, as soon as we make one or two adjustments to the faults that it’s experiencing, the body is intelligent enough to do the reprogramming and reorganizing on its own.

Going back to the quote, why it resonated is because it correctly suggests that the body has the potential to recover on its own accord with very simple changes or exercises. What’s more, simplicity translates to a better understanding for the client on how everything works, allowing them a better feeling of control for better treatment success.

So, absolutely, I will begin by showing a person a simple chamshell or forward shoulder flexion exercise to get them started, and sometimes that has actually been enough to get them feeling better! In the event that those simple measures are unsuccessful, then that’s our cue to compound and layer on top of the plan with more complexity. But, by having those simple changes first, we’re building a foundation for both the conditioning and the knowledge in order to most-effectively progress the plan.

You don’t teach a person to multiply without first showing them how to add. Remember the K.I.S.S. principal: Keep it simple, stupid!

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See Ya Later, Functional Training! Let's Go Applicability!

While the hype seems to have decreased a little bit, at least in my tiny corner of the world, the term "functional training" is still thrown around as a hot-word. It seems like every fitness instructor and trainer is now specialized in it. (Is it still special when everyone is doing it?)

I've had my rant about how out-of-context the term "functional" has become in the past few years. If an individual is a long-distance road runner, do they need to be doing instability BOSU squats? Does a basketball player need to do handstand push ups? Does grandma require the ability to do 10 minutes of burpees?

This will help my golf swing!

As I went on about before, functional movement has been misconstrued, lately, as meaning any compound movement up to and including the most complex circus acrobatics you can think of. But if we're talking function, shouldn't we be thinking less about how many muscle groups we can hit in one exercise and more about the function that the training is intended for?

Enter: Applicable Exercise!

When clients discuss the thought of switching to more functional training, I jump in and suggest "applicable training" as an alternative. I can immediately see the gears and bells all lighting up in their heads. No longer are they imagining unnecessarily complicated balance exercises on unstable surfaces or handstands for shoulder stability. Instead, they now picture themselves doing exercise more closely replicating their desired activities, such as the sport they like to play, the hikes they like to go on, or the gardening that they love to do at home. Whatever the activity, there are specific movements, joint directions, and energy systems that accompany them that need to be considered.

This switch of focus bodes well not only for training in the gym, but also for rehab. As previously discussed, making rehab homework more specific to a person's lifestyle and activity is not only more enjoyable for the client, but will be much more successful!

For you in either the health or the fitness worlds, I challenge you to try and substitute "functional" for "applicable" when it comes up in conversation or at work. It's very interesting, the change in thought-process that this simple switch can trigger.

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Exercise And Why You Aren't Lazy

I found a great article regarding how laziness does not exist, and it applies beautifully to rehab and exercise.

"But I don't wannaaaa...."

Clients often come to their follow-up appointments with tails tucked after not doing their exercises. (And I'm speaking on doing them at all. The people who feel bad for only doing them every second day need to chin-up.)

A lot of therapists will put their hands on their hips and immediately scold their clients, citing their predicted inability to get better if they don't exercise and pushing them to just do it. But we know, but now, that this is an ineffective method, don't we?

I think I just heard Nike call their lawyers.

The psychologist who researched and wrote the above article boiled "laziness" down to two causes. One was anxiety regarding the task and a perception that the person's attempts would not be "good enough". (Fear of failure.) The other was confusion or lack of clarity on the first steps of the process.

Understanding this now, can you see why a stern "just do it" is the last thing you want to tell someone with either of these struggles? Instead, I find it to be a crucial exercise in empathy in order to help clients past their hurdles.

If a client can't foresee a positive outcome and doesn't believe that they can get better, regardless of their homeplan, then it takes a great deal of coaching in order to teach them how to perceive control over their condition. They need to know, deep down, that recovery is possible; not simply go through the motions of an appointment.

And as for the lack of clarity, any half-decent therapist should have the ability to educate and break down the pieces for their clients as needed.

Everyone has their own background. We prefer to see things as simple and black and white, but have you put yourself in someone else's shoes lately?

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