Shattering The Glass On Exercise Promotion

"It's easy to fit exercise into every single day."

"Just take 20 minutes to get up and move!"

"Time is only an excuse to not exercise."

How often do we see statements like this plastering our media? According to fitness and health professionals out there, exercise is the easiest, simplest thing to insert into your day or week, and no one has an excuse to skip it.

In theory, this makes sense. We all definitely spend 20 minutes or more doing unimportant work during our days. Replacing it with a 20 minute walk should be no problem.

The problem that I have with promotional messages such as this is that they ALL come from professionals who work and spend their entire days in health-promoting environments. Personal trainers who work at gyms, therapists who do exercise with clients all day, doctors who maintain health initiatives for their entire staff; the list goes on.

Let me make this clear. We professionals say that exercise is easy to work into a day because, for us, it IS easy! We work in settings that contain exercise equipment. We spend all day positively enforcing the idea of movement. Our job is to focus on health!

But for the individual who works an office job on the 20th floor of a building in the downtown core with little surrounding greenspace; the member of a staff that is, overall, not active or interested in health promotion; the person who works a second or third job on the side to support their kids, this message has little hold.

If you're not part of that environment, yourself, can you just imagine so for a second? Access to exercise is one thing - and one that many people still do not have to a great extent. Motivation is another. When you spend your days surrounded by people and work that do everything but promote exercise, what is the inclination to partake. (Aside from gorgeous Instagram trainers who make you feel guilty for skipping something soooo easy in your day.)

Now, I'm not saying that the public is a lost cause to convince to exercise, and I'm not guilt-free of trying to make broad, general statements on ways to incorporate exercise into the day. However, as a mindful practitioner, I realize that access and motivation for exercise is a highly-individualized thing, and generalized tips will not go far. It boils down working with each client, one-on-one, to develop methods and ways to increase a client's participation.

And don't feel bad because that guy on Facebook says it should be easy.

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How Getting Past Pain Relapses Is Like Quitting Smoking

We made it to February!

How are those New Year's resolutions coming....?

Mmmhmmm!

Stepping aside from New Year's-specific goals (as you already know my opinion on them), let's discuss the realistic situation of regression.

Across the board, regressions and relapses occur in every type of behaviour or lifestyle change, whether it's recovery from pain, smoking, or weight loss. While the ideal is that we persevere through the road block or speed bump and continue on through the recovery process, often, hitting a point where pain returns, a cigarette is lit, or a few pounds are gained back are enough to shatter motivation and derail progress altogether.

One research group categorized pain relapse responses into four possibilities, some less ideal than others.

1) An unpleasant mystery that leaves negative feelings towards oneself and the situation.
2) A fact of life that should just be ignored.
3) A reminder to keep within physical limitations in order to avoid a future relapse.
4) An indication to change your behaviour to avoid another relapse.

You can probably assume that the first option is the least constructive, likely resulting in an ever-increasing level of negativity regarding the pain and loss of motivation to pursue further recovery.

The second option, ignoring the pain, is dangerous, as it may result in the individual becoming too content with their pain to the point of identifying with it.

The third possibility is good to a point. During a more acute phase of healing, learning to stay within limitations is vital, and sometimes the reminder is necessary. However, avoiding behaviours for too long can end up in a person simply using avoidance as a long-term coping mechanism.

Lastly, the fourth option is the most ideal in the long term. Understanding triggers or becoming aware of an increased need for self-work for your health is the most productive response to have if reexperiencing pain. However, sometimes coaching (whether it be self-coaching or help from a therapist) is necessary to reevaluate a relapse in order to maintain a positive foreseen outcome on the situation.

As it turns out, you can closely relate behaviour change relapses between health behaviours fairly well across the board! For instance, these tips of quitting smoking are amazingly applicable to this very process!

1) Focus on the next 24 hours:
Manage the acute phase of the relapse. Modify the environment so that further aggravation doesn't occur. Understand that this was an acute occurrence only and that you shouldn't become down on yourself and treat all the work up until this point as a failure.

2) Talk to someone:
Seek advice or support as needed. Seek your therapist or even consult a doctor if it puts your mind at ease that this wasn't a complete reset to square-one.

3) Analyze what happened:
Did you decide to get too aggressive with the weight you were squatting? Did you take a week off of your rehab exercises in too-early of a stage? Try and ask yourself exactly what may have caused this relapse to happen so that you can use that knowledge for future recovery.

4) Build a new plan:
This one is built straight into the basic rehab process. We're always modifying and changing pain-management and prevention strategies as needed, and having this relapse happen is a bit of a blessing in disguise, as it can help you and your therapist to further progress your long-term plan.

I try my best to ensure that my clients are ready for the possibility of their pain returning at some point, whether it's simply next week or a sudden reoccurrence in five years. Yes, it may happen. No, it is not the many steps back that you may think it is. And yes, there are steps that you can take to get right back on the train and continue to always get better.

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Life Doesn't Mirror Gym Movements (And Doesn't Have To)

No, I'm not telling you that the gym is bad and that you should stop going. There are many fantastic reasons why the gym is awesome.

However, there's a certain phenomenon among many of my clients that I'm noticing. Fear of movement.

The best example is the rounded-spine position. On one hand, many individuals who experience back pain are told by doctors, therapists, and more to absolutely avoid bending down and rounding their backs; that doing so will result in more pain. Having this fear of that movement instilled, however, does little to remove their pain, as these positions are, to say the least, inevitable. As a result, the nervous system, essentially, becomes primed and ready to guard against those movements, causing pain in those ranges and positions when pain wouldn't normally be a necessary response in that case. 

We call this kinesiophobia, the fear of movement due to pain which actually works to prolong pain and disability.

Here's the surprising thing. Active and healthy individuals experience this too! I've also seen this in very disciplined gym-goers who, for all intents and purposes, have nothing mechanical going on to suggest that they should be in pain. However, due to the immense emphasis on "good form" that active and athletic individuals may be bombarded with, I've been witness to the exact same avoidance-triggered pain. These are clients who are under the impression that it's necessary to square-up and keep a neutral spine curve every time that they so much as bend down to tie their shoes. And again, this belief that any other type of position is harmful is so strong that, just the same, they experience guarding and pain. Even so-called functional training isn't devoid of instilling these messages.

The takeaway from this is that the body has very natural movement patterns that it likes to use that don't necessarily reflect the strict and controlled form of the gym. Absolutely, if you're at the squat rack, moving in a single-plane only, and are loaded up with multiple plates per side, then you should definitely be observing "proper form". However, whether you're an active or inactive individual with or without formal training, the body is built for free and fluid movement. Don't let anyone, including Instagram personalities, magazines, or even doctors to tell you that dropping form as you live your life is a dangerous thing.

Credit: Greg Lehman

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Is Running Bad For Your Joints?

You'll be hearing me celebrate the return of running season for the next little while. Running is a fantastic exercise and sport, and I'm more than happy when I see both experienced and brand new runners partaking. However, is running a healthy activity?

It has generally been the common consensus that running is bad for your joints, whether it be for your knees, your hips, or back. Thus, it's often the reason (or excuse) for many people to not partake in any running. It makes sense; too much impact on the joints could totally cause some arthritic development or degeneration in the spine. As we understand it, this is basically the definition of how osteoarthritis onsets, right?

The research journal search was actually extremely easy here. As I was able to find out, between both old and new studies, long-term studies, and cross-analyses, running was almost always found to be unrelated to any development of osteoarthritis in the knee, hip, and spine. At the worst, some studies suggested it to be merely inconclusive.

In fact, one brand new piece of research even found that, as far as intervertebral discs go, running actually promoted more strength and better disc health as opposed to contributing to degeneration!

So what's going on? What actually causes arthritis? Well, recent skeletal examinations are now suggesting that osteoarthritis development has more to do with a lack of physical activity rather than too much of any particular type. This was strengthened by the fact that degenerative joints correlate highly with the morbid obesity seen in many modern-day skeletons.

Furthermore, there may even be mechanisms that actually protect runners from degenerative changes from their spot. While the overall impact and force going through the joints is higher during a running gait, there may be some evidence suggesting that the decreased contact time with the ground actually works to counteract any damaging effects.

All this being said, no, running is not the joint-destroying, pain-inducing activity that many out there believe it is, and there's even the possibility of being a runner if you already do have arthritis. Keep in mind, running, like ANY other activity, can cause injury, whether it be from an accident, poor conditioning, or training error, so don't forget the importance of proper training.

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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

Post: Fascia: Not Your Enemy

"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

Post: When Does Training Become (And Stop Being) Functional?

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

Post: The K-Tape Review

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

Post: Mobility: Fad or Fallout?

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

Post: Textbook Posture - It's A Myth

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

Post: Muscle "Knots" (Are Not All Trigger Points)

Also: Is Self-Release Your Trigger Points Helpful?

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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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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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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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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Random Thought On Exercise Adherence

As an Athletic Therapist, I'm obviously always concerned with how to keep my clients adherent to their exercise plans in order to accelerate their recovery. It's not always easy, especially when that client's motivation was low enough that they barely made it to my office in the first place.

It's funny, though, some of the methods we employ to try and keep ourselves motivated. One common thing I've noticed that people attempt to do to keep themselves true to healthy habits is bargaining the use of passive habits in order to achieve them. Allow me to explain..

Once in a while, I see a client who floats the idea of adhering to their rehab plan by doing their exercises during "down-time" to make it easy, such as while watching television. Unfortunately, not a single client who has said this has been able to maintain their routine. Where is the disconnect here?

I'm too snuggly-wuggly comfy to exercise right now!

Well, it could simply be the fact that using those passive activities is only going to motivate our psychology toward more passive habits, rather than the other way around. When it comes to exercise in general, our brain is going to activate these exercise-related habits when it experiences related stimuli that normally goes along with them. (ie: When the "switch is flipped" when you walk into a gym or get up early for your run.) Since your brain is going to have trouble associating passive activities, such as television, with activity, the chances of developing those habits are slimmer.

As well, this is speculation, but perhaps trying to bargain passive methods in order to stay healthy is a sign of poor self-efficacy. Maybe someone who attempts to use these tricks, in reality, has poor confidence in the first place that they will adhere. And as we know, self-efficacy is vital when it comes to lifestyle changes and without that sense of control, success rates are low.

In short, the clients of mine that are the most successful are the ones who are intrinsically motivated enough to set aside time to, well, get'er'done!

Does this mean that a person is a lost cause if they're not one of these go-getters who's ready to go guns-out and balls-to-the-wall with their recovery, however? OF COURSE NOT!

This article was written based on topics collaborated on with of Sasha Tanoushka, owner of Verus Systems Therapy. Sasha is a member of the BC AMFT and AAMFT  ( American Association of Marriage n Family Therapists  ). She's completing her MA in Marriage And Family Therapy through Northcentral University. She's worked extensively with families and individuals over the years in both community sports, martial arts, kids' clubs and ladies' community groups.

She has a particular interest on neuropathy and works with several therapeutic modalities but has a particular leaning towards Satir, Bowen and Gestalt.

Follow her on Facebook!

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