Wednesday, 29 November 2017

Breaking Down the Buzzwords - 6 Blog Topics to Read

Buzzwords are every media-mogul's bread and butter. Need proof? Just look at how quickly everyone and their grandma eats up any news article with "Trump" in the headline.

Ok, enough about politics. I'm supposed to be writing about things that are healthy for you. (Ok, last one, I'm sorry!)

I came so close to posting a Trump meme as well, but I
stopped myself and went with a funny cat photo instead!
Your welcome.

Just like the nutrition and diet enterprises thrive off buzzwords such as "gluten", "cleanse", and "clean-eating", so does the healthcare and fitness realm have its own shortlist, at any given time, of words and phrases meant to strike a chord and turn the population into click-hungry internet trolls.

Pictured: A troll

Obviously, these trending topics make for easy game when it comes to looking for new blogging jumping points, so here's a collection of posts from the past couple years that break down each buzzword, both for better and for worse.

Fascia


"Myofascial release" is the new thing to do to get your body feeling great! Right? Well, it seems like many fitness enthusiasts are treating fascia like it's an evil entity that needs to be utterly destroyed. (Spoiler: It's not!)

Functional Training


Functional training is where "fitness is headed", by the sounds of it. Enough of isolated movements! Give me more squats on a BOSU! Let's stop and ask ourselves, though, where does "functional" begin and where does it end?

K-Tape


Ok, so maybe Kinesio tape isn't quite in the headlines the same way as it was for the couple years after London 2012. However, it still seemed worth it to revisit my own, quick, review on the application.

Mobility


The fitness industry seems to be preaching about proper joint mobility these days. Is there a benefit behind greater mobility? Is any amount too much? Is a conservative approach better? Lastly, what else, besides mobility, needs to be considered?

Posture


Forward heads and rounded shoulders are being demonized more and more in mainstream media. Is there really anything to be concerned about, though?

Trigger Points


Get that lacrosse ball and grind out those trigger points. Find that painful spot in your shoulder and press into it until it basically dies! Wait, is that right? Is every painful nodule a trigger point, or are our bodies more complicated than that?

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More Pain, More...Pain?

A lot of you reading this may subscribe to - and possibly live by - the "more pain, more gain" rule. The harder you workout and the more sore you get, the more strength and size you gain. The harder you run through the burn, the faster you become. Transferring this train of thought to the rehab realm: the harder you dig in there, the better you'll recover.

http://serre-humour.com/

Whether it's through traditional massage, Graston, cupping, active release, or some other form of modality, does a higher intensity of the treatment correspond to increased recovery? In other words, does a more painful session somehow equate to less pain once a client leaves? (Even if the client can "take it"?)

Well, let's consider the reasons why people may believe that "going harder" results in an increased benefit. For instance, when it comes to tight muscles, scar tissue, adhesions, and the like, the common believe is that these modalities are physically breaking down those restrictions. Unfortunately, as I've pointed out in the past, massage does not break down muscle or scar tissue. Rather, these treatments are providing a new sensation to the nervous system in order to allow the tissue to relax and release its tone in the region.



That being said, given that this effect is nervous system-driven, more or less pressure may sometimes be required. Pain tolerance, while not all in your head, can dictate how much of an effect you experience from treatment. With that in mind, however, it can mean that a highly-sensitive person can get the exact same result from a very light massage as a very highly pain-tolerant individual with a more aggressive session of active release.

With all of this being the case, I can't say that I'm very comfortable with trying to give anyone a "harder" session of soft-tissue work than they can take. Some discomfort is to be expected, of course, but if I'm causing excruciating pain, I don't see how that can result in the pain relief that I'm striving to achieve. In fact, the intensity of these treatments might actually work to increase pain-sensitivity, acting in the exact opposite direction of what the goal is!

Does this diminish the usefulness of therapists, however? Of course not. It's still my job to be able to gauge each individual's reaction to different sensations and deliver an effective treatment that remains within their tolerance. When it comes to modality application, just call me a Conservative.

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Tuesday, 21 November 2017

Stable Shoulders (At All Angles)

I've already spoken at length in the past of the importance of keeping your shoulder stabilizers healthy and methods of doing so. We're being neglectful if we think that simply working the delts, pecs, bi's and tri's are all that are needed. However, while you shouldn't simply isolate the large muscles, doing similar isolation of the smaller ones as well are typically not going to be enough to keep your shoulder optimally functional either.

A common training/maintenance error I see is, while many people are mindful when it comes to warming up and strengthening their stabilizers, there's a tendency to still remain in isolated ranges of motion. For instance, even if you're exercising your rotator cuff muscles on the daily, like so...


...is that properly teaching those muscles to be stable and functional in movements like this...


...or this?



Your shoulder doesn't remain in a lowered position with your elbow at your side, so why would you restrict your stability training to that one range? Individuals who need to recover from injury, train for performance, or even just maintain function for every day life need to be hitting their stability work from multiple angles from the shoulder being down at your side to being overhead.





The shoulder is a highly-mobile, multi-angle joint. If you have a range of motion available, make sure the musculature is conditioned to be supportive in each of those angles. You want to be able to keep using those things.



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Tuesday, 14 November 2017

Brain-Body Trust

Here's another scenario:

You're an avid weightlifter who hits the gym five times per week. You regularly do squats, deadlifts, and many others of those exercises that gym rats know and love.

Gains.
However, despite your ability to deadlift twice your bodyweight, one morning, you simply bend down to tie your shoe and you completely put out your back. You're in excruciating pain for the rest of the week which lingers to a lesser extent for the next month or so before you go and get it treated. All the while, you've been doing what you can at the gym but have been avoiding deadlifts and have been extra cautious when bending over to pick anything up on a daily basis in order to protect your back. Every time you try to bend down, you recreate that most-painful sensation and it needs to be avoided. Finally, you decide to go get treated. (Perhaps even by an Athletic Therapist!)

Promotionpromotionpromotion.
Treatment goes great. After one or two sessions, the constant pain is no longer a bother. You have your homework to condition and strengthen your core and protect your spine. You go on your way out of pain - except when it occurs the next time you go to deadlift again. Although your therapist told you that the tissue is all healed and the inflammation is gone, that bending motion, alone, still elicits tension and pain through your back as soon as you square up to lift heavy.

So here's the question: Even after receiving treatment and home exercises, after the tissue is healed and the inflammation is gone, once you've gotten strong enough that you core should be stabilizing your back without a problem, this one movement still causes you pain. Why could that be?

Pain science is a fascinating field and I'm not about to go into the neurobiology and in-depth psychology of pain today. However, I will quote the Pain Science Podcast that I listen to in this.

"Pain is a conditioned response," and "Pain is an output, not an input".

If you know of the Pavlov experiment, this is like how he was able to trigger salivation in dogs every time he rung a bell. Essentially, all physiological responses, pain included, can be conditioned to occur whether the stimulus is appropriate or not. This is related to when I talked about pain avoidance habits and how they can propagate pain rather than prevent them. After such a prolonged period of time of an individual telling their nervous system that bending down is going to cause pain, the nervous system is now trained and hyper-reactive, sending out pain signals every time that movement is performed even after healing has occurred.

Not kidding. This picture is how pain can work.
This is actually a common occurrence. Clients who should be out of pain are still experiencing it due to their nervous systems, basically, working against them. In a way, although there is not actually anything wrong with those tissues anymore, the brain no longer trusts that particular movement pattern and will have a sympathetic response every time that it's attempted.

Stupid nervous system!
This case I'm discussing is, in reality, actually one of the more simple ones. In severe chronic pain cases, those inappropriate pain triggers can extend to nearly every movement and even light touch to the body!

In any of these cases, careful rehab considerations to both the physical and psychological side of the recovery are required. It's the responsibility of the therapist to guide the client through those movements - or other stimuli - very carefully to progressively allow the nervous system to adapt and trust the pattern again. At the same time, coaching a client away from expecting pain is important, otherwise it may leave a barrier that the individual might never overcome. 

Pain is a funny thing and pain patients are kind of like the Murphy's Law of healthcare: Expecting the worst can cause the worst to happen. However, responsible therapists can recognize these barriers; no person should be trapped by their pain.

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Tuesday, 7 November 2017

The Advantage Of Active Rehab

In the wake of hiked ICBC rates due to an uncontrollable flood of payouts as well as an audit into unethical professional fees to do with claims, it has been a thought of mine recently that there is something not quite working with an insurance system that should be easily covering its costs due to the nature of what it is.

Now, there are many directions to point the blame. One of the articles above discusses how much autobody shops are milking the insurance company with hiked rates, and I'm sure there are therapy clinics who aren't much better in terms of ethics. There's the increase in legal fees as well, due to ICBC's fight against offering higher and fairer initial settlements. We won't even get into the political discussion of what role certain provincial parties may have played in creating this mess.


Whatever the reason, I'm mostly concerned with solutions to the problem. One way that I can see it - one that would save much in terms of time and money on the side of both the insurance companies, the legal teams, and the clients - is the shift towards more active approaches to injury rehab.

I don't often feel the need to talk about the importance of exercise for recovery since, to myself, it's a no-brainer. However, I remind myself that the world we live in isn't necessarily one that's focused on exercise and movement the same way that an Athletic Therapist is. But I digress...

It's easy to find evidence for my case. Studies are easily comparing the difference between active rehab (which includes movement and exercise prescription) to passive rehab (which is treatment-centered only) and consistently shows an improvement in client-condition and function when you get people moving.



The implications of this are easy to figure out. With more control of recovery being given to clients - by way of prescribed home exercises - the result is more-optimal recovery through means of fewer appointments and thus, less money! 

So while saving ICBC from paying a few less $70 appointments isn't quite comparable to the thousands of dollars that car shops might be milking, if the trend catches on, it can make a difference. And obviously, this doesn't solely apply for motor vehicle injury claims; individuals paying out of pocket for their recovery would of course appreciate paying a little less.

The advantage is clear. Exercise rehabilitation is the way to go!

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