Tuesday, 31 January 2017

Building Confidence in Ability

Back when I was in high-school, I took a class that involved a weekend practicum in the role of an outdoor camp counselor. There were a few typical rules asked of us in this position: Don't flash your cellphone or other technology around, don't swear in front of the kids, etc. One rule resonated as being particularly important to me, though.

"Girls, please no Lulu's or yoga pants. Boys, don't wear beaters. We want the kids attending camp to be motivated to do the things you're teaching them, not to aspire to look like you."

"You kids go canoeing while I stand here looking fabuloussssss!"

This was one of my earliest impressions that paved my philosophy as I became a professional with health and fitness. I heavily emphasize ability and performance over aesthetic regardless if I'm teaching a fitness class or rehabing a client. I find a much greater sense of achievement when my clients tell me they were able to run without pain that week than I do when they tell me they dropped a waist size.

Don't get me wrong. I'm not knocking the importance of developing healthy body image and allowing people to feel beautiful. I'm just not the best person for that job. As the "tiny" kid while I grew up, I quickly came to the terms with the fact that I'd never be the large, flashy muscle-dude in the magazines, but would always find solace in my ability to outrun my peers. For this reason, I find a particular speciality when it comes to training and coaching young people in their confidence in physical capability. Even more fulfillment comes when I'm able to guide someone to a physical achievement that they always assumed was out of their reach, such as introducing a previous non-athlete to success as a runner.

Pictured: A lot of runners who had never done a sport one year ago.

Training ability and function, I find, will leave an individual with a much more sustainable confidence and sense of identity than simply training towards a certain aesthetic. Especially when considering the toxic ideals instilled by modern media, training for an appearance involves a very different type of anxiety and mental coaching that I can't call myself experienced with. In fact, when asked on whether I still do personal training on the side with my rehab business, my answer is usually "no". With the exception of youth and sports-specific training (mostly speed and sprinting), I don't have a particular love for that kind of work these days. There are plenty enough workers who can focus on the aesthetic or coach someone in believing in their body image, but I'll use my time the way that I use it best.

Focus on what you can do rather than how you look while doing it.

Tuesday, 17 January 2017

Do More Techniques Make A Good Therapist?

"Do you do dry needling? Acupuncture? Active release? Graston?"

These are questions that I, as an Athletic Therapist, get quite often from potential clients. People are looking for the best-qualified clinicians to trust with their health. It seems like a given that the therapist with the most skills will be the best at treating their clients, and so advertising those additional certifications and continued-education courses are a sure-fire way to pick up on that.

Being an Athletic Therapist who is still relatively entry-level, though, these questions often frustrate me. To anyone in the public, or even to we therapists while we're still in school, yes, it seems like it'd be obvious that the more techniques, the better when it comes to treating. After beginning my career, though, I saw through the ploy.

Think of it like this. If a therapist was "better" at treating clients just based on knowing how to do the newest technique, then that would be like saying that the best personal trainers are automatically the ones with the most state-of-the-art equipment. Sure, those tools help, but the skills that set you apart from other professionals are knowing when, how, and why to use them.

I don't like to blow up my own ego or discredit anyone else, but this won't be an uncommon story across the board. I have a small set of entry-level treatment techniques: massage, joint glides, electrical stimulation, and a few more. However, I often get clients coming to see me after weeks - sometimes, months - of seeing another practitioner (whether it's another AT, physio, or chiropractor) who spent every treatment throwing fancy techniques at their client. Sometimes the treatments didn't work. Often, they did, but temporarily. After feeling like nothing was working in the long term, these clients will tend to try another clinician, and when I see them, sure, I don't have all those fancy skills, but I have my problem-solving skills.

After receiving a month of shockwave therapy on the shoulder, maybe the client really just needed more strengthening at the neck to reduce pain. Instead of endless active release on the low back, maybe conservative massage and core strengthening is going to be most-effective. Acupuncture to fix those nagging post-ankle sprain aches? Maybe start focusing on the mechanics at the hip instead.

I'm not trying to disprove the use of these higher certifications and treatment methods. By all means, they are meant to make a therapist's lives easier and be a part of an all-encompassing rehab plan. The thing to take away is that virtually any treatment method - whether it's the basic massage we learn in school or the dry needling we learn to do years later - all have the potential to accomplish the same goals. The trick is knowing where to use those techniques, why, and what to do afterward, and that comes down to the individual practitioner, regardless of what kind of continued-ed they've done.

Fancy tools are all and good, but by all means, they're far from the only thing to factor in when choosing a therapist.

Tuesday, 10 January 2017

Does Symmetry Matter?

I've had a few clients who see me regarding an injury or condition who have expressed a lot of worry over their muscular asymmetry.

Symmetry is a big concern in the fitness world; particularly in the circles of physique, fitness, and bodybuilding competitors who rely on the aesthetic of it for their performance.

However, when it comes to our health, fitness, and function, does symmetry really matter that much?

The answer is, frankly, nope.

You see, outside of the gym, our lifestyles don't really allow for the perfectly equal use of our limbs between left and right and the promotion of a symmetrical body-type. You have a dominant hand, a dominant leg, a preferred sleeping position. Without the focus of isolated exercise to specifically target the growth of individual muscles, it's unlikely you'll attain that perfect mirrored figure.

Does that translate to pathology, however? Probably not. Obviously, if there's a severe discrepancy such as a smaller quad due to a 6-month limp or one arm that's smaller after recovering from a fracture, those are more clinically significant. When it comes to a typical population group, though, smaller differences between left and right will usually be negligible.

Take the shoulders, for instance. I've heard many individuals remark on the fact that one of their shoulders - and thus, the entire arm - hangs quite a bit lower than the other other and worry about the implications of the "muscle imbalance" behind it. This is a perfectly normal occurrence though, with the dominant arm often - maybe even nearly always - hanging lower due to the more-constant reaching and lengthening of the musculature on that side.

And this isn't an isolated circumstance. Development of traps on one side, tone of spinal erectors, asymmetry of the abdominal muscles, and more. These discrepancies do not signal poor health; only habitual differences between sides. When flexing in the mirror, do not be alarmed by those subtle differences. You don't not need to be equally sized, toned, or flexible on both sides.

Don't get me wrong; I still will always note these asymmetries when examining a client who sees me in my clinic, as perhaps they are part of a larger problem that I haven't quite picked up on yet. However, it's important to keep those notes in the back pocket until needed, as it'd be useless to get hung up on every small change right off the bat. It's good to remember to not get hung up on how alike left and right look and to just focus more on each joint's ability to perform it's required functions overall.

In the words of Eric Cressey:

Tuesday, 3 January 2017

X-Ray and MRI Results: How Concerned You Should (Probably Not) Be

I'm going to draw off a few studies (Yay science!) as well as a couple personal clients that I've treated as an example here. Let's see if this sounds familiar:

You (or someone you know, a friend of a friend, an uncle's twice-removed cousin in Guam) have some x-rays or an MRI done. This person may or may not be currently experiencing pain. The results come back and BAM! "You have arthritis in your neck/two bulged discs/severe scoliosis," says your doctor. The doctor (or some other health professional) then reasons that these abnormalities are either the cause of your back pain or will soon be causing you severe pain in due time. These conditions are unlikely to ever get better and will probably get worse and worse with time. Too bad, tough luck; try again in your next life!

But hold on!

*Record screech*

Let's take a moment to consider exactly how much stock we should be putting into these imaging results.

I know, it's hard to argue with a picture that says that a condition is there. In fact, I'm not arguing that at all. If an x-ray says that you have degenerative arthritic changes in your neck or the radiograph shows a disc herniation in your low back, then those things are absolutely present!

What I am arguing, however, is how much those pictures actually matter.

I have one client who has been "plagued" by scoliosis that she found out was genetic and had been present for her entire life. She works out religiously and see's her chiropractor for adjustments, but was increasingly frustrated that she continued to be afflicted with back pain and fearful that she would eventually be crippled due to the condition worsening. Now, I'm not the world's greatest therapist by any means (I figure I have another 1-2 years before attaining that award). However, let's just say that after two treatments of assessing her "abnormal" anatomical formation and prescribing exercise to correct for some spinal instability, she has recently been without pain for the first time in years.

Even more recently, I had another client who had been shown the x-rays of degenerative arthritic changes in her neck. She attributed this "osteoarthritis" to her neural pain going down her arm. After examining her, I concluded that, indeed, she had nerve root impingement, but her localized neck pain and range of motion were not severe enough for me to think that those degenerative changes were the major factor. Rather, I can't help but believe her forward head and shoulder posture as well as her hypomobility in her neck segments to be the cause. But that's just me.

Actually, it's not just me. There have been numerous studies supporting the fact that individuals can, extremely commonly, have degenerative changes in their spines and be completely symptom-free. Take this one study that scanned subjects who experienced absolutely no pain, resulting in the conclusion that over half of them had disc bulges! And this isn't an isolated case of asymptomatic people having abnormal findings in their low backs. As for neck pain, how about this study showing that normal and abnormal changes in the cervical spine were found in equal amounts between patients who reported pain and those who reported none at all?

The lesson to take here is that while there are an endless number of reasons that the body may experience pain or dysfunctions that could be present, our bodies have a natural resiliency to them. Humans are adaptable to countless situations and environments, and thus, our bodies are extremely adept at working around physical irregularities, be they genetic or acquired. It is true that oftentimes we need therapeutic intervention in order to guide our mechanics back on the right track. At the end of the day, though, it's very seldom that you need to write yourself off as a lost cause, and we need to be cautious of practitioners who are going to try and capitalize on our fear of that photo. That x-ray photo doesn't have the final say when it comes to your quality of life, though, and clients should always seek second opinions if they feel that their so-called prognosis is unnecessarily bleak.

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