The Relationship is the Intervention

With all the advances in technology and AI, we are becoming more and more dependent on our devices.

But there’s one thing that AI can’t replace, the human experience.

It would be epistemologically arrogant to think it could.

The Intervention We Can’t See Or Touch

My brother is a counselor at a high school in Chicago. Our professions have a lot in common.

We were discussing some of the complexities of working with people.

We were talking about how sometimes the specific intervention doesn’t matter. In my field it means it doesn’t matter what specific exercises or manual techniques.

He said he went to a course one time where the instructor said something very powerful:

  • “The relationship is the intervention”

It resonated with me as much as it did him when he heard it.

The human relationship is a powerful thing. Friendship, love, empathy, and family are all priceless.

This is why it’s important to keep an equal and open working relationship with patients. It shouldn’t be a dictatorship or a sales pitch.

In PT they often refer to this in the literature as therapeutic alliance.

But really, it’s just being a good friend to your patients.

CHINGFORD STUDY: OSTEOARTHRITIS AND METABOLIC FACTORS

This was first posted on The A&G Project Blog


In 1995 a paradigm shifting study on osteoarthritis was published.They found:
  • “hypertension, hypercholesterolemia, and blood glucose are associated with both unilateral and bilateral knee OA independent of obesity, and support the concept that OA has an important systemic and metabolic component in its etiology”

This shows that osteoarthritis is not just a wear and tear pathology. Systemic and metabolic factors have a huge influence.The take home clinically...lifestyle factors in OA patients need to be addressed for the best outcomes.

Only You Can Prevent Forest Fires (Chronic Pain & Self-Management)

this article originally appears on The A&G Project
 ( image source )

Chronic pain is an epidemic.Not only is this a problem for the individuals who suffer from pain, but also for our society.The economic costs of inefficient care and failed short-term treatment plans have led to an inefficient healthcare system.  Worse, these short-term passive pharmaceutical solutions have destroyed the lives and communities of many.As a society we need to look at chronic pain through a different lens.  One that incorporates the complexity of the situation and the realistic length of care.To accomplish this, our focus needs to change.  Instead of the clinician providing a short term solution and patient receiving a passive fix, healthcare should focus on clinician led education and active patient self-management.Clinical experience and current research show that outcomes are directly correlated with patient self-efficacy and compliance.  With the perspective of the clinician as a teacher or guide, the patient is encouraged to adopt the active role in their recovery and lifestyle that will lead to better outcomes.  This is not only much more effective, but also more efficient.In a powerful article, Holman and Lorig suggest a 3 fold change in our healthcare system:"The prevalence of chronic disease and the scope of its consequences have created a dramatically new situation in health care. Patients, health professionals, and the health service must now play new roles:

1. The patient—who must be responsible for daily management, behavior changes, emotional adjustments, and accurate reporting of disease trends and tempos—becomes the principal caregiver. Expressed in economic terms, health is the product of health care, and the patient, as a principal caregiver, is a producer of health. As in any production system, a producer must be knowledgeable about the product and skilled in the production process.

2. The health professionals, in addition to being professional advisers and partners in the design and conduct of medical management, become teachers in developing the patient’s management skills. In the present system, physicians, nurses, and public health workers are not trained for this role.

3. The health service becomes the organizer and financial supporter of the new roles for the patient and health professionals, focusing on assuring continuity and integration of care."

SUMMARY

The path to changing our healthcare system and our nation's health is already available.  We just need both the medical practitioners and the patients to get on board.

Medical practitioners need to stop looking for short-term solutions and acknowledge the complexity of an individual's health.

Patients need to stop looking for passive solutions and become an active leader in managing their health.

At The A&G Project in Asheville, we use this philosophy with all our patients.  It's the Jerry MaGuire philosophy.  Less volume of patients.  More individualized care.  And a focus on giving you the tools to manage your health so that you can achieve the best quality of life possible.

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Remi & 7 Things We Learned in One Week of Parenting

 Remi Hendrix Rogers Swanson
On March 3rd, 2018 we welcomed our first child into the world.  Remi Hendrix Rogers Swanson was born at 11:06pm in Asheville, NC.As many parents say, words can’t describe this experience.  The amount of love and joy of having a baby are so overwhelming that the mere act of trying to put it into words diminishes its significance.It’s been 1 week since he was born.  It feels as if we’ve been time traveling.  Looking back, there’s a few things we’ve learned in the first week.

7 Things We Learned in One Week

1) MY WIFE IS SUPER HUMAN

When it comes to birth, most people discuss the baby and parenting.  One thing I wasn’t prepared for was the intensity and the thrill of the birthing process.  While there are many digressions I could go into, I think the most amazing aspect was watching my wife, Gaelyn, act like a superhero.I’ve always thought the most of Gaelyn.  She’s an incredible person, extremely strong, and has never shied away from adversity.  But after watching what she did during the weekend Remi was born, I have a new role model myself.She never wavered, didn’t resist, embraced the intense struggle, and went above and beyond the insane requests her body and Remi were making.  Hell, she even made a few jokes in-between the intense contractions. Her rockstar performance made me feel honored to be her husband. I’ve never been so proud in my life.Watching birth also solidified the notion that women are the stronger gender.   We’re lucky they keep us around.

2) SWADDLE FOR YOUR LIFE

Everything is new when they hand you the new little life and send you home.  The feeding, cleaning, diaper changing, and soothing. It’s all new.But the one thing that is important to quickly master, especially when it’s 3am on that 3nd night and you’re trying to get some sleep, is swaddling.My friends have told me that we’ll try a ton of different swaddling techniques.  My pediatrician said finding the right swaddle is the process of matching it to a personality.  They were spot on. We tried every different swaddle technique within 3 days.But what helped the most was my brother and sister-in-law showing us this swaddling technique.  It moved us to 3-4 hour sleep intervals immediately. I owe them drinks for life.

3) BABY FLUIDS EVERYWHERE

I didn’t know that when I visited my friends who had a newborn that there was a 90% chance I was sitting on dried urine or spit-up.Newborns apparently just sleep, wake up, and spew fluids out of every orifice possible.  I didn’t know I could get desensitized so quickly.

3) BABY FLUIDS EVERYWHERE

I didn’t know that when I visited my friends who had a newborn that there was a 90% chance I was sitting on dried urine or spit-up.Newborns apparently just sleep, wake up, and spew fluids out of every orifice possible.  I didn’t know I could get desensitized so quickly.

4) LOSING THE ARM WRESTLE

I remember from the pediatric course in grad school that newborns are very reflex driven.But what I didn’t know is that these reflexes would challenge my manhood.Trying to pull Remi’s hand away from his face to help Gaelyn with breastfeeding or attempting to swaddle his arm down by his side ends up being a battle.  My frustration builds as I wonder, “how the hell can a 4 day old be this strong?”.Maybe I need to workout more.

5) DON’T GOOGLE ANYTHING

The internet is already a dangerous place for acquiring information.  But with babies it’s a damn war zone. It’s riddled with layman blogs and discussion forums.  Two of the worst sources of information for new parents.Maybe it’s the monetary goals?  Maybe it’s the prevalence? Maybe it’s a dunning-kruger effect?  Maybe it’s that all first-time parents are overly concerned and there’s a high demand for any type of information?Regardless of the reason, if you type a baby question on google you’ll either get offered something to buy or read a horror story with the worst case scenarios.We’ve tried to surround ourselves with a good team of experts (doulas, pediatrician, midwife) so that we can get trusted information from true experts.  If we do google something, we try to stay in peer-reviewed journals (pubmedgoogle scholar).  We also have a few books on the coffee table for reference (Moms on Call & What to Expect)

6) SELF-CARE: PATIENCE AND SELF-COMPASSION

It’s a new learning experience for everyone.  We have no idea what we’re doing. Remi has no idea what he’s doing.  So it’s definitely not a time for judgment or perfectionism.We’ve been trying to stay calm and forgive ourselves for the fumbled diaper changes, awkward transfers, and failed soothing techniques.  Sometimes we handle these situations with humor and grace, other times not so much.

7) THE JOY AND THE LOVE

For some reason, people love to tell you horror stories when you’re expecting.  Or they say negative things like “just wait...”, “you’ll never sleep again...”, “hope you’re enjoying yourself now...”.I never really understood this weird phenomenon.  But it turns out it’s as much bullshit as I thought it was.Sure there’s some frustration and mild discomfort.  But this adversity pales in comparison to the level of love and joy we have because of Remi.  Our hearts are so full that it makes everything else seem insignificant. Nothing can prepare you for this feeling.

THANK YOUS

We’d like to thank the wonderful people at Mission Hospital.  From start to finish we were treated extremely well with the best care possible.  The nurses were incredible in every way. I’ve never experienced so much compassion, empathy, and professionalism from a healthcare team.  This is the gold standard of healthcare in my opinion.We’d like to thank our doula, Rachel Ansari, from Mothership in Asheville.  Her guidance and education helped ease our stress and led us in the right direction.We’d like to thank our midwife, Lauren Fountain, who helped give us a safe and meaningful birth.  Without her things could have gone much differently. She went out of her way to make sure we were having the birth we wanted in the best possible way.  We were lucky to have her on-call.We’d also like to thank our families and friends.  Whose support and guidance have made this transition much easier.

Your Body State is Your Mental State

this post was originally published on agmovementproject.com


The mind-body connection is nothing new.In fact, controlling the mind to control the body is common practice.There’s sports psychology for improved performance, meditation to relieve stress, and placebos to decrease pain.Even in our everyday life it’s easy to see this mind-to-body perspective.When we’re sad we frown or cry.  When we’re angry or stressed our blood pressure goes up.  When we see something funny we laugh.But what if it’s reversed?  What if our feelings are actually a result of our body states instead of our emotional states?What if we’re sad because we’re physically tired?  What if we’re angry and stressed because we have too much tension in our body?  What if we laugh because we’re physically excited?In other words, we should consider that we might be transferring our physiology to our psychology.

THE FLIP SIDE

It’s more difficult to understand the reverse process of this mind-body connection (the body-to-mind connection).Maybe because it’s uncommon to discuss the process of how our body affects our mind (sometimes referred to as embodied cognition).It might be weird if we conversed in terms of our physiology instead of our psychology.A Valentine’s Day card declaring our current sympathetic arousal state wouldn’t exactly charm our partner.And yelling “I didn’t sleep much last night and I have a lot of tension in my body since I’m running late for work!” at the car that just pulled out in front of us wouldn’t have the same catharsis.

So maybe we don’t need to go as far as explicitly bringing our physiology up in social situations.

But since our body influences our mind, maybe we should try to listen to it more often.If we can become more aware of our inner state, we might have more success in managing our thoughts and emotions.  We might even improve our relationships and the quality of our lives.

Post-traumatic stress disorder or physiological stress from water deprivation?  There's a reason why no one has road rage after leaving a yoga class...  (source)

 

CONTROL OUR BODY, CONTROL OUR MINDS

This isn’t the just latest trend in pop-psychology.  It been around for millenniums.  It is supported with a strong theoretical background, an abundance of research, and profound pragmatic effect.  For instance...Consider the following everyday scenarios where our bodies control our minds:

• We feel more anxious when we haven’t exercised

• Our significant others get emotional late at night when they’re physically tired (or when we’re tired)

• We dislike going to work after a sleep deprived night

• Our sister-in-law gets agitated when she’s hungry

• We’re much less ambitious when we’re sick or hungover

Still skeptical?Here are just a few examples from the literature:

Facial expressions can affect our mood

• We’re more generous when we hold a warm drink

Skipping makes us happy

• We’re more likely to be attracted to people on a high bridge

• A wonder woman posture makes us feel more powerful

And then there’s one area of the body to mind effect that has been studied and practiced thoroughly by many different disciplines - breathing.

(source)(source)

HOW YOU BREATHE IS HOW YOU FEEL

One of the more consistent areas of research on how your body affects your mind has been with respiration.A research review is beyond the scope of this article.  If you want to learn more seek out the references listed below.However, I do want to point out one study that we can start using immediately.This study had people breathe with a specific pattern and then had them fill out a 22-item questionnaire on their physical sensations and emotions.  They were told it was a study on breathing and cardiovascular characteristics to avoid any biases.Breathing Directions:

"Breathe and exhale slowly and deeply through the nose; your breathing is very regular and your ribcage relaxed." (Joy)

"Breathe and exhale quickly through the nose; slightly deeper than regular breathing amplitude. Your breathing is slightly irregular with some tremors and your ribcage is very tense." (Anger)

“Breathe and exhale quickly from the top of your ribcage; with a normal amplitude. Your breathing is slightly irregular with some tremors and your ribcage very tense.” (Fear)

“Breathe and exhale through the nose with a normal amplitude and pace. Your ribcage is slightly tense, and there are some sighs in your expiration.”  (Sadness)

The results consistently showed a correlation between breathing patterns and emotions.In other words, it could be theorized that emotions can be elicited by manipulating the breath (results below).

So next time you want to change your emotions, start by changing your breath.*more thoracic breathing was found with fear than any other emotion

A BIGGER PICTURE

This body-to-mind concept is useful beyond breathing and emotions.Changing our physical body can influence the way we think, the way we feel, how we perceive our environment, and how we interact with others.  In other words, it can alter our reality.For a greater impact, consider the following 3 step process to change our body to change our mind.

  1. Understand how our physiology (our body state) may be affecting our psychology (our emotional state)
  2. Be aware and modulate the physiology we can control (use postures, movements, facial expressions, breathing, attention)
  3. Develop habits that foster a better physiology (adequate sleep, healthy diet, exercise, etc.)

SUMMARY

Unfortunately, as the pendulum swings it can cause many to forget where the momentum came from.The body-to-mind peripheral theory of emotion used to be very popular.  The body used to be considered as important as the brain, if not more.  You may have even heard the ancient term, “your body is your temple”.However, times have hanged.We’re now in an age where the brain supposedly “runs the show”.  Psychotherapy, complex cognitive theories, and neuroscience are very popular.  And for good reason.  Advancements in these fields have provided tremendous value in many clinical sciences.But this isn’t a zero-sum game.  Both concepts can add value.  It is a dynamic system after all.Our physiology matters.  Our bodies matter.  It’s not just a “peripheral thing”.  It's a part of us.  And it can have a great impact on not only ourselves, but our perception of the world around us.Whether it’s as easy as altering our breath for a quick emotional change or as in-depth as altering our lifestyle for a more profound effect, being aware of how our body influences our mind can change our world.[subscribe2]


REFERENCES & DEPTH

Philippot P, Chapelle G, Blairy S. (2002) "Respiratory Feedback in the Generation of Emotion." Cognition and Emotion.Misattribution of arousalArousal transference“Grasping air with the lungs goes hand-in-hand with grasping at life” -Alan WattsArtificial Intelligence needs a body if it wants to surpass humansAlan Watts - The Way of Zenembodied cognitionZen and the Art of Motorcycle MaintenanceAntonio DamasioStephen PorgesBody Keeps ScoreAmy CuddyWilliam JamesVagus Nerve Stimulation“Notice this…”"what do you feel?"

The 3 Most Powerful Words

this article was originally posted on the A&G Project

"When nothing is certain anything is possible"

-Many Hale


When asking important questions, one of the best answers we can get is…”I don’t know”Why is this so powerful?It’s like opening a door to a new pathway.The pain of thinking you know...when you really don't.  He would have been much better off answering "I don't know if that's a glass door" (source)(image source)Now of course we don’t want to hear this answer to certain simple questions.We don’t want the local to tell us “I don’t know” when we’re lost and asking for directions.  We don’t want our financial advisor to say “I don’t know” when we ask him if our investments are doing well.  We don’t want our physical therapist to say “I don’t know” when you ask him why breathing is important.
There’s definitely a time and a place for the “I know” answer.But maybe for some questions we should look for the “I don’t know” answer.

I Don't Know.jpg
What is the best meal for me in Asheville?  What should I do for a living?  How much money is enough to make me happy?  Why does ice cream taste so good?There’s no single solution to those questions.  But there might be a discussion, or a collaboration, that can help lead to a meaningful answer.“I don’t know” leads to a path.“I know” points in a direction.Directions can be useful, but only if we already know where we’re trying to go.  If we don’t know where we need to be, then how can someone else “know” for us when we ask them?You might miss some good stuff if you only focus on the directions to the destination...
To find where we need to be, we should find someone that has the compassion and wisdom to answer with “I don’t know”.It may not be as comforting as getting a short term answer, but the process will likely be much more effective in the long run.So the next time you find yourself asking a question (or answering one), stop and acknowledge the uncertainty instead of grasping for an answer.  Get more comfortable with not knowing.In the end, you might not only find a better question, but a better answer as well.

Dig Deeper

“A subsystem cannot know the system that is meta to it” -Ram DassWe'll see...[subscribe2]

2017 Hits : Vol. 1 : Ephemerality

click here for this edition's table of contents


Ephemerality

  • Ephemeral - lasting a very short time; short-lived; transitory;

1) “There are many forms of ephemeral art, from sculpture to performance, but the term is usually used to describe a work of art that only occurs once, like a happening, and cannot be embodied in any lasting object to be shown in a museum or gallery.”2) “Because different people may value the passage of time differently, "the concept of ephemerality is a relative one".[3]3) One of the things I like most about hiking is the ephemerality of it.  Depending on the time of day, the weather, the season, the animals, and the people, it’s different every time.  It is constantly altered by time and perspective.  And on a bigger scale, with the soaring trees, wrapping vines, flowing rivers, and tectonic shifts, the natural world could be considered the greatest ephemeral “art”.4) 21 Examples of Land Art5) Ephemerality is a practice in accepting impermanence.6) Andy Goldsworthy is incredible.  He is “is a sculptor and photographer whose site-specific artworks directly engage with the environment, incorporating natural specimens and found objects into semi-permanent sculptures, which are then extensively documented in photographs”  He doesn’t use any tools or glue.  It’s a transient act of pure quality.

“The energy and space around a material are as important as the energy and space within. The weather--rain, sun, snow, hail, mist, calm--is that external space made visible. When I touch a rock, I am touching and working the space around it. It is not independent of its surroundings, and the way it sits tells how it came to be there."

goldsworthy-sycamore.jpg(Sycamore leaves edging the roots of a sycamore tree, Hampshire, 1 November 2013 Andy Goldsworthy : image source)7) Wheatfield - A Confrontation by Agnes Denes8) The practice of physical therapy is ephemeral.  There is a constant flux in the plethora of variables within practitioner and the patient, as well the interaction between them.  It’s being able to realize this dynamic system and listen to the transient states for the right phase shift that can create a positive ephemeral state.  Blindly clinging to a permanent variable by either the practitioner ("this exercise or manual technique always works") or the patient ("I am not someone who gets injured and needs to work on myself") can create a negative ephemeral state.  9) 8 types of Ephemeral Art10) Our body is ephemeral.  It’s not going to stay the same forever (or even a few hours).  It’s going to constantly change.  Our physical and mental actions have both immediate and long term effects on our collective physiology.11) I think the ephemerality of our body and mental states is how some can practice the same thing over and over and still find enjoyment each time.  Because even if you perform the same yoga poses everyday, it’s never the same.  Attention and awareness of the subtle, ephemeral, differences in our individual-environment-task relationship is what helps bring one into a flow state.  This transient goal of the mastery of our internal focus is much more rewarding than living in the future trying to attain some external physical goal.12) Chris Jordan’s art isn’t necessarily ephemeral.  But the reason behind it may be.  He uses visual representations to bring awareness and change to our current cultural issues.  In other words, Jordan uses his art as a visual doorway to the “slow motion apocalypse”.  

For example, “Whale” is made with 50,000 plastic bags, the same number of of floating plastic per square mile in the ocean.  

Or “Caps Seurat”, which depicts 400,000 plastic bottle caps, equal the the average number of plastic bottles consumed in the US every minute.  

His art is hopefully ephemeral in the sense that these issues will be resolved in the future and they will become a mere piece of history.  Most of all, his work also reminds us that small acts matter and can make a difference.

13) Food is ephemeral.  Both in the short term of preparing and eating it, as well as the long term of satiation and effects on your health.  However, what you eat will drastically alter those timelines.  What kind of ephemeral state do you want your body to be in now? Tomorrow? In 30 years?14) Check out the ephemeral rock balancing of Kokei Mikunihttps://www.youtube.com/watch?v=46I5V51yH5815) Ephemerality is one of my favorite things about music.  Both as a fan and as a guitar player.  Sure, there’s enjoyment from recording a song and the creative process of making a permanent track.  And hitting play to hear a song just the way you remembered it can feel good.  But I find much more pleasure in the jamming.  It’s when all the variables come together, just right, to create a moment that can only be felt while immersed within it.  This is why people follow bands like the Grateful Dead around.  This is why playing with other musicians is so much better than recording on the computer.  It’s for the ephemeral moments where the music is alive.16) “Janet Echelman reshapes urban airspace with monumental, fluidly moving sculpture that responds to environmental forces including wind, water, and sunlight”.  How is our own environment changing our perspective?17) Giovanni Anselmo demonstrates an ephemeral art piece in “Untitled (Sculpture That Eats)”.  What energy would we have to keep replenishing to hold the granit together?  What will we be letting go of when it finally runs out?18) Check out Christo and Jeanne-Claude.  It’s not photoshopped.19) To be aware of your ephemeral state, you have to be in the moment.  After this, you can work to shift the ephemeral state into a flow state.  It's an intention of the mastery of the now.  It’s a timeless meditative process.(image source)20) Felix Gonzalez-Torres uses ephemeral art to help us feel the impermanence of our relationships and to raise awareness for human rights (gay rights).  

In “Untitled: Portrait of Ross in L.A.” he creates an artwork meditating on the 1980s AIDs crisis/prejudice and the heartbreaking loss of losing a loved one.  This piece “comprised of 175 pounds of candy, corresponding to Ross’s ideal body weight. Viewers are encouraged to take a piece of candy, and the diminishing amount parallels Ross’s weight loss and suffering prior to his death. Gonzalez-Torres stipulated that the pile should be continuously replenished, thus metaphorically granting perpetual life.”  

In “Untitled: Perfect Lovers” he makes us think about the different time scales in which we all exist and the inevitability of death.  We each have our individual ephemerality, even our loved ones, thus making all relationships inherently ephemeral.  The Dallas Museum writes, “Two clocks are placed side by side; one will inevitably stop before the other. The date of this work corresponds to the time during which Félix González-Torres’s partner, Ross Laycock, was ill, and it embodies the tension that comes from two people living side-by-side as life moves forward to its ultimate destination. González-Torres once commented: “Time is something that scares me . . . or used to. This piece I made with the two clocks was the scariest thing I have ever done. I wanted to face it. I wanted those two clocks right in front of me, ticking.”

21) Brian Eno created his own dynamic system-type of music generating app that creates an ephemeral musical piece each time you listen to it.  Fascinating.  22) Dance more.  It's ephemeral.23) Ephemerality is something we should all practice more.  Sometimes we try to cling to more materalistic permanent things.  Houses, furniture, clothes, cars, electronic devices, social media, achievements, professional titles, plans, etc.  Rarely do any of these things bring us lasting happiness, or even contentment.  If we embrace ephemerality we may start to learn that joy and fulfillment is realized in the moment.  Whether it’s art, music, food, movement, or mindfulness, we should all try to cultivate a healthy ephemeral practice.

  • “Only the ephemeral is of lasting value.” -Eugene Ionesco

*special thanks to Ryan Swanson for the great conversation on ephemerality and for directing me towards many of the artists mentioned above



The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.If you enjoyed it and found it helpful, please share it with your peers. And if you are feeling generous, please make a donation to help me run this website. Any amount you can afford is greatly appreciated.

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