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

this article originally appears on The A&G Project

---

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.

[subscribe2]

2017 Hits : Vol. 1 : Clinical Lower Extremity

Click here for this edition's table of contents

Lower Extremity

Hip

1) The glutes are internal rotators too…2) Some great clinical insight on chronic hip flexor strains from Dave Tilly.  I love the idea of treating the hip like the shoulder in regards to PNF rhythmic stabilization and wall ball circles.3) The hip and the back are always related.  “The authors concluded that dynamic pelvic orientation significantly influences the functional orientation of the acetabulum. This study also found that people with impingement have reduced trunk control bilaterally, supporting the need to include trunk rehabilitation in treatment. This has implications for therapists rehabilitating patients with symptomatic FAI as not only should the trunk be a strong focus of rehabilitation but pelvic positioning during exercise and ADLS can have an impact on the positioning of the hip and range of movement.”4) Erson uses the SL Bridge to fire the posterior chain, improve anterior hip ROM, and increase rotary stability.

Knee

5) This study was done on athletes. I wonder if it would be different for a sedentary population with co-morbidities. “Postoperative bracing after ACLR has not beneficial effect on clinical outcomes and the complication rate. Patients who wore the rigid brace had limited flexion early on.”6) Sometimes there’s a big difference between anatomy and function.  “With respect to range of motion, pain, clinical, and radiological outcomes, no clinically relevant differences were found between total knee arthroplasty with retention or sacrifice of the posterior cruciate ligament.”7) Mark Comerford once said his clinical mantra was, “I love a level pelvis”.  Here’s some quick research to back it up, “Increased hip adduction during stance phase of Trendelenburg gait contributes to excessive knee joint loading.”(source)

Ankle/Foot

8) “Those ankles with more swelling had the most anteriorly positioned fibulae. The fibulae in sub-acutely sprained ankles appear to be positioned more anteriorly compared to the contralateral ankles. This positional fault may be maintained acutely by swelling.” (via Michael Mullin)9) Are they pronating because they don’t have ankle rocker or because they don’t have forefoot and midfoot stability?  “When the foot is unstable, things often switch; the once mobile ankle rocker shifts towards stability attempts.”10) Tendinopathies aren’t just about load.  They’re also about circulation.  And what dictates circulation?  One of the variables is movement patterns.  “the more the eversion excursion observed, the lower the increase in blood flow”11) Strengthen the feet to improve balance “In the foot-focused training group, increased toe flexor strength was associated with significant improvements in perceived general foot health (based on the Foot Health Status Questionnaire) and single-leg balance time.”12) The glute max and the abductor hallucis both “supinate” the lower extremity.  “The group that performed both gluteus maximus and abductor hallucis strengthening exercises showed smaller values in the height of navicular drop than the group that performed only abductor hallucis strengthening exercises. The muscle activity of the gluteus maximus and the vastus medialis increased during heel-strike in the group that added gluteus maximus exercises, and the muscle activity of the abductor hallucis significantly increased in both groups.”(source)13) “The simulations revealed that strong preparatory co-activation of the ankle evertors and invertors prior to ground contact prevented ankle inversion from exceeding injury thresholds by rapidly generating eversion moments after initial contact. Conversely, stretch reflexes were too slow to generate eversion moments before the simulations reached the threshold for inversion injury. These results suggest that training interventions to protect the ankle should focus on stiffening the ankle with muscle co-activation prior to landing.”  Good advice, but I wonder how to do this in the clinic without compromising the ability to absorb shock.

---

---

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.

[subscribe2]

2017 Hits : Vol. 1 : Clinical Upper Extremity

Click here for this edition’s Table of Contents

Upper Extremity

Shoulder

1) Too many people advance too quickly with pull up progressions.  Too few spend enough time mastering the hang.  Dan Pope writes a nice concise post with 3 basic hang exercises for the shoulders.  And he backs it up with some solid biomechanical logic.2) Eric Cressey gives a nice 3 minute breakdown of proper cueing for the scaption exercise.  I think a tactile cue for posterior tilting the scapula is one of the best rehab interventions out there.  3) Heart disease and rotator cuff symptoms are linked in a new study. Maybe it has to do with circulation? Or maybe the rotator cuff symptoms are just the output of a lifestyle dysfunction?4) Erson shares a nice example of a motor control shoulder dysfunction.  Before you jump to conclusions, assess their movement impairment with different patterns (i.e. posture changes, sequencing, distal positioning, centration, etc.).5) When all else fails...try sticking a needle in their trigger points.  In this study, they found dry needling the teres minor and infraspinatus resolved a patient’s shoulder symptom.  “This case report described the examination and use of dry needling in a case where the diagnosis was unclear. Clinicians may consider trigger point referral when examining patients with reports of abnormal sensation, especially when a more common cause cannot be identified.”(source)

Elbow

6) Proximal stability...again, “In closing, the study demonstrated that the group of players with a torn UCL showed a great decrease in strength on the throwing and non-throwing arm in both ER and IR when compared to the healthy control group”7) This elbow scratch collapse test for ulnar neuropathy is interesting.  It’s like NKT, but with nerves.  Reminds me of the importance of using MMT as an assessment of the system after interventions.  “The scratch collapse test had significantly higher sensitivity than Tinel's test and the flexion/nerve compression test for carpal tunnel and cubital tunnel syndromes. Accuracy for this test was 82% for carpal tunnel syndrome and 89% for cubital tunnel syndrome. This novel test provides a useful addition to existing clinical maneuvers in the diagnosis of these common nerve compression syndromes.”

---

---

 --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.

[subscribe2]

2017 Hits : Vol. 1 : Clinical

Table of Contents

Miscellaneous

• “The patient’s nervous system can sense both a lack of practitioner confidence, as well as a lack of control.” -Dr. Andrei Spina (via Shante)

1. “Evidence has shown that performance and variability have an inverse curve relation (too little variability, performance suffers and with too much variability, performance also suffers). Current evidence shows that an optimum balance of variability seems to be the key to maximize performance of an individual and achieving this balance is key in recovery.” -Adriaan Louw2. Assessing gait is a skill we should always continue to develop.  Even on the blink level it provides useful information.  “Walk speed = "vital sign". Connects to fall risk, dependency, & hospital. Community design & PA programs matter”3. This might explain why marathon runners often stumble into our clinic a month before their race.  “Overtrained athletes have abnormal inflammatory and anabolic responses to exercise, indicating that their body is not responding to exercise the way that it should.”4. The Well provides some concise practitioner-based tools for better examinations (low back, neck, obesity, poverty, preconceptions,  etc.).5. As a clinician I sometimes underestimate the ability of my hands to assess and cue movement.  Feeling it may be best for both the practitioner and the patient.6. Some thoughts on cupping from Marc Wahl: consider that it may alter their kinesthetic awareness, are we making their movements harder or easier by reducing fascial tension (pull up vs push up), we need to do our own research7. You should follow Andrew Rothschild on twitter.8. Tell your addicted endurance athletes to take a break!  “Following high-intensity endurance exercise, recovery may require 48-72 hours for cortisol and testosterone to return back to resting levels.”9. Noah Harrison with another monster article.  This time on Cultivation and Kinesthetic Intelligence, “kinesthetic intelligence is not the appearance of an athletic body, but the ability for the body to be athletic and capable”10. Don't just rely on neurodynamic testing, “the small fibers (A delta) of the peripheral nerve innervate the epineurium. One of the features of neurodynamic testing is mechanosensitivty, theorized to come from these fibers. If they are compromised, a pain response may not be possible. Therefore, it may be possible that a negative ULTT in the presence of other factors indicating nerve entrapment may indicate a positive for small fiber compromise.”11. I didn’t know there was evidence supporting the use of herbal medicine (devil’s claw, white widdow, capiscum) for low back pain.12. Exercise is medicine.  “The results revealed that a 20-minute session of moderate exercise can have anti-inflammatory effects.”13. "When a muscle is strained, the first thing to do is look for a weak or underactive synergistic." -Shirley Sahrmann14. The answer to our handedness lies in our ancestors teeth.  

“In an earlier study, researchers noted striations on the front side of teeth belonging to European Neanderthals. They hypothesised that these marks were made when material was held in one hand and gripped between the front teeth and worked by the other hand with a stone tool, with the stone tool occasionally striking these teeth.”

15. No one has ever had a decrease in their quality of life or function because they didn’t get enough manual therapy.  #exercise #movement #lifestyle16. It's not all in the brain. It's not all in the body either. We're not psychologists. We're not mechanics. #BeAPhysicalTherapist17. Have you heard of this thing called breathing?  

“In this study, we collected intracranial EEG data from rare patients with medically intractable epilepsy, and found evidence for respiratory entrainment of local field potential activity in human piriform cortex, amygdala, and hippocampus. These effects diminished when breathing was diverted to the mouth, highlighting the importance of nasal airflow for generating respiratory oscillations. Finally, behavioral data in healthy subjects suggest that breathing phase systematically influences cognitive tasks related to amygdala and hippocampal functions.”

18. You remember more during the inhale.  

"our body's innate response to fear with faster breathing could have a positive impact on brain function and result in faster response times to dangerous stimuli in the environment."  Another potential insight of the research is on the basic mechanisms of meditation or focused breathing. "When you inhale, you are in a sense synchronizing brain oscillations across the limbic network"

19. NOI shares 3 questions to improve clinical reasoning skills

1. Based on a careful examination, what likely processes are suggested?2. What changes need to occur to those processes to safely bring about positive change?3. How do the patient and I bring about those changes?

20. Mike Reinhold put together a great compilation of what movement professionals are doing differently this year.  Here’s some snippets:

Greg Robinson - adding more work capacity and play to the youth population

Dean Somerset - doing more group training

Erson - more isometrics and blood flow restriction training

Erwin Valencia - adding spirituality and zen to his practice

Peter Dupuis - “fitness tourism” - exploring other places

Ken Crenshaw - cultivating leadership

Dave Tilly - focusing more on advanced rehab and energy systems

Dan Lorenz - increasing his network, stop wasting time arguing on social media

Mike Boyle - delegating responsibility, developing his staff, and napping

Wil Fleming - focusing less on the gurus and the popular social media people, finding the true experts that actually practice

Patrick Ward - integrating math and statistics to assess results better

Charlie Weingroff - trying to understand motivation, reverse engineering successful individuals, “continuing to find common targets of physiology and neurology that link the methods that are typically classified as training and/or rehabilitation”

21. I found the ear muscle study fascinating (video below).  It shows how different sensory inputs can have an effect on our bodies without us even being aware of it.https://www.youtube.com/watch?v=rFxu7NEoKC8

---

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.

Fall Hits 2016: Clinical

Click here for this edition's Table of Contents

---

1) Everyone is different (joint, osseous structures, myofascial structures, developmental history, etc.).  So it’s easy to understand why “there are no systematic advantages of one foot strike pattern over another when it comes to running economy”.  #DynamicSystem2) "Proximal joints act as motors and distal joints as adjustable dampers & springs" -Derek Griffin3) Are we overlooking the blood flow component of tendinopathies?  “Tendon blood flow tends to decrease with age and compression, which often results from increased mechanical load. This decreased vascularization, at least theoretically, can contribute to the probability of tissue damage as tissue compliance and flexibility will be compromised (LER). Oxygen consumption of ligaments and tendons is 7.5% lower than skeletal muscle, which may contribute to longer healing times (2,3).”4) The Gait Guy’s breakdown of a case study is always worth the time.  In this one they find the driver in the spine.  In this one they breakdown the biomechanics of 4 different runners.5) What do we use to regulate ourselves?  Thought or awareness?  Seth teaches us how using thought can lead to chronic pain.  “But we can’t think our way out of a physical “problem”. The autobiographical self (story we tell ourselves) and the embodied self (our experience in the present moment) are separate neural networks.“6) Michael Mullin teaches us how to use farmer’s walks within the PRI approach. Off set load with more weight on the left or perform a slow pause when in left stance. 7) I put kinesiotape on a knee replacement’s scar.  Just a simple vertical piece along the scar.  The temperature and swelling of the knee joint decreased dramatically (upon assessment 2 days later).  Many professionals talk about the importance of managing scar tissue.  But I never thought about it’s effects on swelling and temperature.8) Charlie Weingroff shares some of his latest thoughts on rehab and training. 9) Leon Chaitow goes over the possible positional release mechanisms - “At its simplest, positional release techniques as used in manual therapy settings, involve the unloading of tissues, placing them into less-stressed, “ease” positions. In such a comfort state, a number of beneficial changes may emerge including reduced pain perception and reduced inflammation, greater local muscular strength, reduced fascial stiffness, reduced pain-medication use and number of days of hospitalization, as well as enhanced peripheral circulation, post-surgically.”10) One of the better PT business articles I've read in awhile from Ben Fung. “If only 8% of the general healthcare consumer population ends up seeing a Physical Therapist for musculoskeletal concerns, we are missing out on 92% of the population who very much NEED OUR HELP! This is a terribly and massively underserved need in our society; we are doing a disservice to ourselves and our customers by not upping our advocacy game.”11) A well designed study and a good study are not always synonymous.  Researcher vs. Clinician.  Theory vs. applicability.  Scientific respect vs. real life patient outcomes.  Confirming hypothesis vs. solving clinical questions.12) People shouldn’t be allowed to do research without at least 5 years of clinical work.  13) “N=1 for your patient, N-100 for your research” -Matt Dancigers14) “Like sleep deprivation, chronic poor sleep quality impairs postural control in healthy adults.” -Jordana Bieze Foster15) Maybe it’s because they’ve lost balance?  They need a wider base of support?  Maybe the coronal plane isn’t as robust as the sagittal or transverse?  Maybe it’s a disuse thing?  "older adults prioritized medial to lateral control over forward progression during adaptive walking challenges."16) “Exercise is characterized as a test of physical limits, of grit and suffering and never succumbing to defeat.  It is a competitive chore for you to conquer and get over with.  Play is cooperative.  It is a coexistence with task and environment” -Christine Ruffolo17) Movement and anxiety are linked “Researchers have discovered that the response to anxiety in teenagers may include not only the parts of the brain which deal with emotions (the limbic system), as has been long understood, but also movement control centres in the brain, which may be associated with movement inhibition when stressed (“freezing”).”18) Get to the joints through the muscles. “Hilton's law, espoused by John Hilton in a series of medical lectures given in 1860–1862, is the observation that in the study of anatomy, the nerve supplying the muscles extending directly across and acting at a given joint also innervate the joint.”19) 2016 Exercise and Pregnancy Recommendations20) Ultrasound is effective as a diagnostic tool for stress fractures. “TUS (5 cm2 probe, 1 MHz) was conducted at the site of pain with continuous ultrasound at highest intensity (2 W/cm2) and the most symptomatic point was spotted for 30 seconds (probe was moved at 1 cm/s)”21) It took me almost a year, but I finally finished Daniel Lieberman's Evolution of the Human Head.  It’s not a book you read.  It’s a book you study.  It took me on many different tangents and pointed me to places I didn’t even know existed.  I had to put the book down and study from other sources before I could progress through.  It may not offer interventions, but it definitely takes you several layers deeper.  #FunctionalIntegration #Tinkering22) Mechanotransduction, again.  Although I wonder if these researches have ever heard of something called exercise and physical therapy.23) “Stretching any part of your body increases flexibility in other parts (more than just a cross-over effect from one limb to another)”-Chris Beardsley24) Charlie Weingroff writes a nice article on the differences between rehab and training and how they should be used simultaneously. “When we engage in intelligent training in the joints that can sustain it, we create hormonal effects that that can help the tissue in the shoulder heal more quickly and reduce pain.”25) Seth Oberst teaches a short class on mindful movement “But moving in real-time frees us. We aren’t anticipating pain or tension, or remembering pain and tension the last time we moved.”26) “Do clinicians spend too much time trying to change stressors rather than working to develop coping skills? #stress #resilience #coping” -Derek Griffin (nice info graphic)27) Tell your patients to go for a walk outside.  Meta-analysis shows walking is an effective intervention for chronic pain.

Cervical & Cranium

28) “Extra ocular muscles are 300x stronger than mechanically necessary to move an eye in a socket. #thingsthatmakeyougohmm” -Alex de la Paz, DPT

29) Five of the 6 muscles that move the eye attach to the sphenoid bone

23) I like reactive and antalgic postures. They help with diagnosis. And are a fun way to predict diagnosed when watching injuries happen on TV (I can't be the only sick PT that enjoys this, right?). Examples of antalgic postures are an AC joint dislocation unloading their affected side by holding it up. Or a fresh ACL trying to posteriorly glide their tibia. Here Sian sharing some antalgic postures for cervical radiculopathy.  What are your favorites?

24) I did not know there were this many different types of headaches.  

“To breakdown the neural and vascular mechanism of migraine we can say that a migraine headache depends on:

1.The Activation of the trigeminovascular pathway by pain signals that originate in peripheral intracranial nociceptors, and

2.Dysfunction of CNS structures involved in the modulation of neuronal excitability and pain“

25) “Chronic neck-shoulder pain: Heavy strength training improves strength and rate of force development” -Lars L. Andersen

26) Solid summary of cervicogenic dizziness by Sian

27)  It's always nice to have studies that back up what we see in the clinic.  Neck patients are respiratory patients.  “Patients with chronic neck pain have reduced vital capacity, expiratory reserve volume, FVC, and minute volume.”

28) Proximal > Distal.  “Neck muscle fatigue alters upper extremity proprioception”

29) Unfurrow your brows to stop the headaches.  “Research from the journal of Plastic Reconstructive Surgery in 2007 specifically points to the corrugator supercilii as a chief culprit of headaches and "complete resection" of this muscle is necessary for "effective decompression of the supraorbital nerve and supratrochlear nerve branches in the surgical treatment of migraine headaches."

Thorax & Upper Extremity

30) Homo naledi had an upward rotated and laterally positioned scapula.  Suggesting the upper extremity was used for locomotion as opposed to throwing and manipulating objects.

31) Christine Ruffolo dissects wrist motion through her movement exploration practice - “Wrist movement is directly affected by forearm rotation”

32) Clinical pearl from Eric Schoenberg, “Prone external rotation with no support results in increased use of deltoid to support the arm against gravity”

33) I like this upper thoracic MWM

34) Hand Grip Strength from Noah Harrison (massive article)

Predictor of mortality

Directly correlated with respiratory muscle strength

Associated with overall body strength

Dominate the homunculus

“Hands are extensions of our eyes”

Integrated with shoulder stability muscles

4 Areas that increase irradiation: feet, jaw, respiration, hand

4 Forms of gripping: pinch, open, closed, hook

3 Ways to work on it: farmers carries, bottoms-up KB, hanging based movements

35) Forward shoulders. Is it a tight pec minor? Postural adaptation? Or maybe your body’s way of making up for the lack of center of gravity shift that a normal thoracic kyphosis would cause? #PRI #GaelynRogersBeerThoughts

Lumbo-Pelvic

36) “Back muscles of healthy individuals had a type 1 percentage ranging from 54%-74,3% and type 2 from 16,4%-30,2%. In the thoracic muscles, there is a higher percentage of type 1 fibres.”

37) The best way to treat extension based low back pain is to perform the SFMA break out and address the impairments and patterns. For those who don't use that system, try this great shotgun approach from Dan Pope.

38) 5 easy extension based low back screens

39) The drama continues…”Stabilization exercises are better than general exercises for people with chronic non-specific low back pain.”  My thoughts...don’t get caught up in the professional drama.  Don’t be that guy.  Do what gets YOU positive outcomes in the clinic.  If your chronic back pain patients aren’t getting better, then YOU need to get better.  And that might mean finding a different approach.  n=1 goes for not only the patient, but for each clinician, and each clinical relationship.

40) Sacral autonomic neurons are sympathetic, not parasympathetic.  “the parasympathetic nervous system receives input from cranial nerves exclusively and the sympathetic nervous system from spinal nerves, thoracic to sacral inclusively” (via Michael Mullin)

Hip

41) “Use step under uninvolved limb to address compensatory weight shift during bilateral exercises.” -Terry Grindstaff

42) The Gait Guys teach us why external tibial torsion can limit hip extension “When the hip is in an externally rotated position it is easier to extend; the femur head moves anteriorly, the femoral joint capsule becomes tighter and stability is created”

43) If you want to be active, move well, and prevent injuries, then you should strengthen the hips. It's associated with ankle sprains and shoulder dysfunction.

43) “The superior portion of the gluteus maximus had significantly greater relative EMG activity than the inferior portion of the gluteus maximus during exercises that incorporated elements of hip abduction and/or external rotation”

44) It's not always about mobility and stretching the hip flexors.  “Hip flexor muscle strength was found to be decreased in patients with labral pathology compared to control subjects”

45) Jennifer Pilotti writes a nice article on closed chain hip flexor strengthening

46) “A recent study investigated the use of the single leg hamstring bridge (SLHB) as a clinical test in predicting hamstring injuries in football players. The single leg hamstring bridge tests the hamstring muscles in a functional position similar to terminal swing and assesses endurance parameters rather than peak torque. This study demonstrated a significant deficit in preseason SLHB scores on the right leg of players that subsequently sustained a right-sided hamstring injury.”

Knee

47) “Patients who sustained an anterior cruciate ligament (ACL) rupture were more likely to develop secondary meniscal injury and arthritis when compared to a matched cohort. Specifically, those that were treated nonoperatively or with delayed surgery may be more likely to develop secondary meniscal injury, develop arthritis, and be in need of a total knee replacement when compared with those patients treated with early surgery.”

48) I usually focus on 3 things immediately after knee surgery: 1) edema management 2) knee extension ROM 3) quad development

49) Interesting study on the forward lunge.  “Trunk and shank position have a significant influence on patellofemoral joint loading of both limbs during the forward lunge, with the trail limb generally experiencing greater total joint stress. Restricting forward translation of the lead limb shank reduces patellofemoral joint stress at the expense of increased stress in the trail limb.”

50) It’s as easy as strengthening hips.  New meta-analysis shows “significant hip strength deficits exist in people with knee osteoarthritis.”  These exercises are an easy way to improve hip strength in the osteoarthritis population.

51) Injuries are complex.  The neurocognitive continuum is something we see all the time in the clinic.  A new study measured this and correlated it with injury.  “Athletes with low neurocognitive scores are more likely than their higher-scoring counterparts to demonstrate landing mechanics associated with anterior cruciate injury (ACL) risk” #Variables #DynamicSystem

52) Glute Med and ACLs - “There were significant group by phase interactions for the GMed during both SEBT and the SDT. GMed activation was lower for the ACLR group during the return phase of the posteromedial direction of the SEBT compared to the control group (P = .03). During the SDT, GMed activation was higher for the ACLR group during the ascending phase than descending phase (P<.001), while the control group showed no difference between phases (P = .707).”  I like doing these inner-range holds with my ACLR patients early in their rehab (I manually position them instead of having them set up on a table or wall).

53) “A professional athlete who fails to meet functional criteria for return-to-sport or who has a low hamstring:quadriceps ratio is at greater risk for an anterior cruciate ligament graft rupture.”

Foot/Ankle

54) You can tell a lot just by looking at feet. “Post hoc pairwise comparisons showed a significant difference between flexible versus stiff AHF (arch height flexibility): those with flexible AHF exhibited reduced CPEI (greater hyperpronation) while those with stiff AHF showed elevated PP. Results suggest that, in addition to AHI, the arch flexibility may affect dynamic foot function.”

55) Tell your patients with peripheral neuropathy to wear stiffer shoes. It's the next best thing to being barefoot. #IncreasedSensoryFeedback

56) “the findings suggest that foot overpronation may affect Achilles tendon blood flow, particularly at mid-tendon, thus enhancing the possibility for injury”

57) “The findings of this study are interesting because it shows that physically active individuals with CAI are “pre-activating” muscles differently than healthy controls to try to protect the previously injured joint in preparation for landing.  However, it remains unclear if participants with CAI had these activation patterns prior to developing CAI or if the activation patterns developed as a result of the injury and subsequent CAI.”

58) Training complex movements to fatigue is never a good idea.  “A fatigue running protocol caused increases in forefoot push-off time in all participants, but caused increases in different foot regions based on arch height.”

59) There are 3 planes of motion to compensate in.  Don’t assume.  It’s not always pronation for an absent heel rocker.  “Frequently a premature heel rise can force knee flexion but in this case the rise just kept going vertical and forcing them into the use of the gastrocsoleus group and thus forcing a lift of the entire body.”

60) A weak toe grip is associated with hallux valgus

61) Are you standing up?  Look to your left behind you.  Do you have enough cervical and thoracic rotation mobility?  Do you have enough left hip internal rotation?  Do you have the motor control of your rotational slings to drive the rotation?  Do you have enough right foot pronation?  Or are you going to have compensate with excessive left supination and sprain your ankle?  Biomechanics matter.

62) “Ankle plantar flexor and toe flexor muscle performance was impaired in individuals with plantar heel pain”  This is a good starter toe flexor exercise (the hallux flexion variation)

63) Less ankle dorsiflexion during a squat increases valgus moment, decreases quad activation, and increased soleus activity (among other things not measured in this study).  Here are 4 great ways to increase ankle dorsiflexion mobility (MWM, neurodynamics, histological stretch, pattern specific)

Some Kathy Dooley Anatomy Lessons

64) Kathy Dooley is one of the best anatomy teachers out there:

“TFL wants to be an accessory quadricep so badly, that this muscle embryonically migrated from the gluteal region to the anterior thigh. This makes the TFL a wonderful connection between the quadriceps and gluteus maximus during the propulsion phase of gait.”

A lack of hip IR is usually not a flexibility issue, it’s usually a lumbar stability or pathoanatomy problem.  “the hip’s internal rotators, like TFL, gluteus medius, and gluteus minimus, which receive their major spinal innervation from L5. (Think: L5 on the side of the hip). “

Use the grip to test if the scalenes are locked long “When testing grip, the test will likely improve upon coronally stretching the OPPOSITE side, which shortens the stretched-out side in this plane. This takes the stretch tension off the compressed neurovascular bundle, resulting in better circulation and nerve conduction.”

Trouble swallowing?  “When many people stress, especially when the stressor is huge and out of nowhere, they alter breathing.  The gasp is a sharp inhalation, creating concentric tightness around the diaphragm.   This tightness constricts the esophageal hiatus of the diaphragm, which permits passage of the esophaus and vagus nerves in and out of the thorax to the abdomen...But if vagal tone is already low, the typical indigestion the person may feel now is accompanied with a lump in the throat. This is because the vagus nerve also innervates the laryngopharynx (lower throat) and larynx (voice box).”

The cervical lumbar connector - Longissimus Capitis.  “The LCap is covered on its posterior surface with the posterior layer of thoracolumbar fascia (TLF). This connection from skull to lumbar spine helps the cervical spinal musculature fire when the lumbar spine fires...This explains why you use your neck as a secondary set of core muscles, often deemed the extrinsic core.”Kathy Dooley is one of the best anatomy teachers out there:

Breathing

54) So breathing is pretty important.  “We have proposed that a sigh serves as a psychophysiological resetter, restoring homeostasis both physiologically and psychologically when a homeostatic balance has been compromised,”

55) Sometimes people really struggle restoring normal breathing patterns.  Sometimes people get frustrated and make no progress with internal cues.  Sometimes people need an easier place to start.  Since we’re all very visual and very addicted to our phones, these gifs may be an ideal entry point.  Big thanks to Nathan Pyle for providing a wonderful visual cue to help people coordinate their breathing patterns.  And thanks to my friend, Peter Hwang, for sending them my way.

---

 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.

 [subscribe2]

Fall Hits 2016: Table of Contents

This is a collection of information to help improve health and movement.  It includes articles, videos, and quotes that I have found helpful in studying the human species.  Due to the complexity of this subject matter, I have tried to include a variety of variables that can influence the dynamic system.In an attempt to avoid information overload, I’ve separated the information into different categories.  I will post each category separately to make it easier to scroll through.  The links below will be added over the next month as they are posted.Feel free to follow me on social media to keep up to date on the latest postings.

Twitter

 Instagram

 Facebook

 YouTube

 AG Project Blog

Making this information accessible for everyone takes a great deal of effort and time.  If you have the resources, please consider a donation.  Your support to maintain this website is greatly appreciated.

Table of Contents

Clinical

Blood flow, self-regulation, studies, headaches and furrowing, hip flexor strength, forward lunge trunk angle, running fatigued, Kathy Dooley anatomy, best breathing gifs of all time

General Healthcare

How knee pain will end your life (another reason why PT is important), decline of american health, and why you should worry about your significant other's health

Psychology, Neuroscience, & Pain

What kind of narrative are you living?,  emotion states are all there is, bad feelings=irrational beliefs, pain is in the body too, Dr. Sarno, why we need diagnoses, and opiods

Brene Brown, Vulnerability, Shame, Empathy, & Compassion

Work on yourself to work on others

Training / Strength & Conditioning

volume effect, split squat lunge torso angle and feet distance, vertical quadruped

Social & Communication

Motivation and stuff

Diet

Microbiome and stuff

Other Good Stuff

Trees, titles, and rhinos

---

Subscribe below for the latest updates

We don’t share your email address.  It's just for updates on when the good stuff comes out. [subscribe2]

May-June Hits 2016 : Tom Myers, Self-Image, Pain & Noses, Instagram, Diet & Tendons

The Hits

This is a collection of some of my favorite articles from the past month.  I bolded and underlined the numbers of the articles that I found most remarkable.  Of course, this is just my bias.  I think all the articles here have value.  I realize that some readers may be looking for something more brief.Unfortunately, I am currently busy with a couple other projects and do not have the resources to produce a collection of “Hits” every month.  However, I’ll continue to do my best to get it out as frequently as I can.For a more real-time update of movement and health information follow me on social media:

Instagram - exercise pictures, movement flows, and Rigby

Facebook - movement and health articles (geared towards the public to improve education)

Twitter - weird abstract comments, out of context stuff, quotes, and good stuff from things I’m reading

If you enjoy this collection and find it valuable, please share it with other professionals.  If you have the resources available, please make a donation to help me run this site and continue to put information out there to help movement professionals grow.

Also, I want to encourage any readers to share their favorite articles, books, or podcasts of the month in the comments below.  I know there’s a ton of great stuff out there that isn’t on my radar.  It will introduce me and other readers to new perspectives.

Clinical

• "You can recognize a deep truth by the feature that it's opposite is also a deep truth" - Frank Wilczek

1) “The human body is one of the most complex organizations of matter in the known universe. To understand it, we must build models, use metaphors, and deal in abstractions. This necessarily involves ignoring certain details, creating simplified pictures, and relying on metaphors that have the potential to mislead. But we have no choice! Models and metaphors are indispensable thinking tools to understanding the body. Each model is a different perspective from which to see the world, with its own unique insights and blindspots.” -Todd Hargrove2) Michael Mullin shares his highlights and thoughts from a great article on the diaphragm.3) Solid article from Chris Beardsley - "Eccentric training produces specific gains in eccentric strength, partly by increasing the strength of the passive elements in a muscle, which makes them stiffer. This gives muscles a greater capacity to decelerate, and absorb energy. This superior ability to absorb energy is probably why eccentric training then leads to a reduction in the risk of getting a muscle strain injury."4) “If existing interventions don’t adequately address the way patients use somatosensory versus visual information, that could explain why patients with CAI often continue to experience episodes of ankle sprain or giving way despite having gone through a full balance training protocol.”5) A nice #GetPT1st video6) Louis CK on his “shitty ankle” and the language of MDs these days...7) Most patients come to us because a habit or behavior has accumulated past a threshold which the body (or mind) can handle. As Gray Cook says, “it took a habit to make that pattern, and it's going to take a habit to break that pattern.” Just be sure to remind your patients that habits take an average of 66 days to acquire. 8) 5 Eval Questions from Shante Coffield

1 what do you think caused your symptoms?

2 what do you think is going on?

3 what do you think should be done?

4 what can i do for you?

5 what do you want out of PT?

9) Great minds think alike - Adriaan Louw’s Questions

1 What is wrong with me?

2 How long will it take?

3 What can I (the patient) do for it?

4 What can you (the healthcare provider) do for it?

10) “If the lat (and teres major) are limited they will force the shoulder into more internal rotation at end range shoulder flexion.” -Dan Pope11) Michael Mullin reviews PRI vision

-“Vision writes spatial equations for our muscles to solve” – Myron Weinstein, OD

-”Visual processing occurs in every area of the brain and integrates with information from all the other senses. It can “override” information from other senses and “overpower” other skill areas.”

-”The eyes, as appendages, need to move independent of the head and neck so they are not over-utilized for stabilization.”

12) Rethinking Heel Lifts for Achilles Tendinopathies

“walking in standard running shoes with a typical cushioned heel appeared to increase loads on the Achilles tendon compared with barefoot walking”

It’s not just one variable (heel lift) - “An important aspect of the QUT study was that the shoes were associated with changes in several spatiotemporal gait parameters, including lower cadence (five fewer steps/min), greater stride and step length (5% each), and longer step duration (12%), even though both conditions involved walking at identical speeds.”

““There are very individual responses to shoes and heel lifts, and some people respond totally the opposite of what you expect,” Silbernagel said”

Pathology matters - “If there’s insertional injury, I won’t have patients exercise barefoot,” she said. “In those cases, I want to start them in various degrees of plantar flexion to minimize the pain. You get compression on the tendon, over the bursa, and onto the bone, when you go into more dorsiflexion. If you put in a heel lift to unload that, you get a great effect. Someone with midportion tendinopathy, but no insertional pain, can often start exercising barefoot, though never on the stairs.”

“Loading is always critical—tensile loading; heavy, slow resistance training; and then training the tendon to do the energy storage loading that’s by far the best thing for your mid-Achilles and insertional Achilles. The difference between those is that with insertional Achilles, you must keep people in a heel lift until symptoms start to resolve. For the peritendon, it’s about reducing movement, so heel lifts can help there for a different reason, because you stop the friction between the tendon and the underlying tissue. The treatment can be similar but for completely different reasons.”

Running Technique matters - “If you’re a heel striker I can allow you to run longer than if you’re a forefoot striker, which puts more load on the tendon”

It’s all about the soleus - “In any event longer than about fifteen hundred meters, the soleus is the most important force producer, at about eight times body weight,”

In the end, the clinician's voice is the loudest - “We had a lot of discussions with clinicians who pointed out that heel lifts should lower forces, so then we took the same shoes and added a twelve-millimeter heel lift,” he continued. “In that study [the 2016 paper noted above], there were no changes in gait parameters, so we concluded that heel raises themselves do slightly reduce Achilles loading.”

13) Clinton Lee summarizes the FRC course with some great Spinaisms.14) “New Muscle” - Tensor Vastus Intermedius15) “So play is some kind of pleasurable combination between repetition and variation (or maybe work and insanity).” -Todd Hargrove with a great article on play #RepetitionWithoutRepetition #Tinkering 16) There should be no more than a 10% difference between active range and passive range.  If there patient can perform more than 10% of their active range then they have a stability problem.  Or in scientific terms - active insufficiency.  17) Make them run uphills - “More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here...If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip. “ -Gait Guys18) 9 Modern Concepts of Treating Tendinopathies19) Eric Cressey on Lat Strains and 7 Reasons they happen:

1 Lower Traps Relative Weakness

2 Rotator Cuff Relative Weakness

3 Dominant Lat Lifting

4 Lack of Manual Therapy

5 Poor Anterior Core Control

6 Turning All Row Movements Into Lat Dominant Movements

7 Loss of Shoulder Flexion

See the exercise of the month in this post for more

20) Clay Holton is sharing what he’s learning with a Weekly Highlights series.  Sign up for another perspective on movement and physical therapy.  My advice to Clay, use a numbered list for future references, add a useful quote or summary from each article (for the TL;DR), expand yourself beyond research, and don’t let anyone else dictate what you read/write.  This blog has been the greatest catalyst for my professional growth.

• “I write because I don’t know what to think until I read what I say” -Harrey O’Connor

21) Trouble cueing scapula position? Try cueing the collarbone.22) “APTA is committed to the triple aim of health care. The association’s proposed coding reforms are just one way—but an important one—of achieving it.”23) Transverse Plane is an important one - “Although the orthosis did not have an effect on most of the joint kinematics of the forefoot, medial longitudinal arch, and first ray, it did have a significant and consistent effect on transverse movement at the forefoot.”24) Christine Ruffolo with a solid article on awareness training

“Problems are beautiful puzzles to be solved, and the thoughtfulness in which we approach them dictates whether or not they are perceived as suffering.”

“No specific end-point means you are free to roam and appreciate what is going on right now.”

“As you attempt to navigate what you should and shouldn’t do to get the ‘best’ results, remember that your perception of results is biased by comparison.  Your journey and your needs start with your body. It offers you real-time evaluation, instant feedback, and the ability to create the most perfect obstacle to continually satisfy the yearn to learn.  Acknowledge its expertise and listen to it.”

25) Interesting dry needling approach - “As people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are treating. For example, you may facilitate or needle the L2-L4 paraspinals (ie: femoral nerve distribution) along with the quads, or perhaps the C5-C6 PPD’s along with the shoulder muscles for the deltiods or rotator cuff for arm swing. We do this to get more temporal and spatial summation at a spinal cord level, to hopefully get better clinical results.”26) Summary of a new paper on proximal hamstring tendinopathies - reviews the latest concepts27) It’s refreshing to read something so open-minded, positive, and forgiving when it comes to movement science.  Here’s a solid post from Michael Mullin on the mindset behind exercise and why LeBron performs physioball back extensions - ”With a firm foundation of the requisite mechanics in place of respiratory balance, positional control and understanding of tri-planar movement, there are very few bad exercises out there…. just some that are better than others for the individual’s needs.”28) “Notice how much the cervical spine moves without the neck moving at all” -Noah Harrisonhttps://www.youtube.com/watch?v=GCluRCd2YuM&feature=youtu.be

Exercises & Techniques

• "The first step to seeing positive change in others is to expect it" -David Rock

29) 5 Ways to improve the prone press up: use only arms and chest, straighten the elbows all the way, tilt your head back at the end, let your hips sag, add a relaxing exhale and diaphragm breathing - “repeated end range loading may also help convince a vigilant nervous system that full mobility is safe as well as ability to load”30) I have always struggled the most with the elbow-hand transition of the TGU.  This great article by Bret Jones has helped a ton.

“Begin this transition by rotating the arm and forearm away from the body and even beginning to point the fingers behind you. Once you are rotated as far as you can while keeping the forearm on the ground, then press down through the heel of the hand, continuing to point your fingers behind you and rotating the arm so the triceps squeeze against the lat and the arm/hand is pushing down into the ground bringing the body to the tall sit position. This externally rotated position of squeezing the triceps against the lat and pressing down into the ground will produce a shoulder position that is ready to lift the body for either the low sweep or high bridge.”

31) I’m not the biggest fan of doing endurance strength tests in patients with neck pain, but I really do like the motor control with the laser pointer that happens 6 minutes into this video.  Nice cheap way to make the motor control device as well.32) Closed chain tibial internal rotation is relative femur external rotation.  So if they’re missing tibial internal rotation it may be a culprit of the dynamic valgus pattern.33) I like the foam roller hip flexor control exercises - scissor and bicycle34) Genius ankle dorsiflexion external cue from Jeff Cubos - scotch tape. 35) Sian and Jill go over some great pilates based core exercises.  Solid stuff here that you can use tomorrow with your patients.36) Manual therapy breathing cue: breathe in space, breathe out length37) Solid stuff.  5 Non-Painful Ways to Use a Foam Roller38) Upper Thoracic Mobilization39) Nice easy clinical test for forefoot flexibility - The Gib Test40) Jarod Hall shares an interesting neurodynamic exercise using the cervical spine to improve multi-segmental flexion.41) Random Cue for Posterior Pelvic Tilt - if coaching proximal isn't working, go to the legs. Sliding the knees forward posterior pelvic tilts. Sliding the knees backwards anterior pelvic tilts. (*not in every position*)42) Great article from Jackson Taylor showing the continuum of dead bug progressions.  Some great variations in this article.43) L-Shaped / Half Handstand - one of my favorite overhead shoulder stability.  This makes my lower traps feel like they’re about to explode.44) The answer to tennis elbow often lies proximally45) 7 Ways to Improve Ankle Dorsiflexion45) A nice shotgun approach to foot mobility46) Great post from Erson on manual modern therapy concepts

Threat free end range is now defined as:

No pain during the full range actively

Being able to tolerate passive overpressure at end range

Tom Myers

47) Very interesting Q & A with Tom Myers

2 Ways Body Reacts Stress: Biochemical and Tension Patterns

“With those, the brain keeps sending out the same messages to the same muscles, and so you take on a specific postural pattern. And after a while, your mind has fit into that pattern, your muscles have fit into that pattern, your fascia has fit into that pattern, your distribution of energy has fit into that pattern, and that may in itself cause illness or lack of ability to move.”

“the pattern in your muscles is going to determine what the pattern in the fascia is”

“If you change your mind or you change your nervous system or even if you change your movement patterns, you’re working against this very slow moving, steady tissue of the fascia. But if you change that fascia, then it’s easier to change the nervous system and the circulatory system on top of that. “

“Now that pattern is in the nervous system, that pattern is in the muscular system, that pattern is in the chemistry, that pattern is in the fascia. But once the pattern is lodged in the fascia, you have to address it at the level of fascia for it to release.”

48) Reading the above article reminded me of how much I enjoyed reading Anatomy Trains several years ago.  I looked around online and read some articles to refresh my memory.  I really do love Tom Myers work, philosophy, and writing.

Great article in response to criticism

10 Tips for Fascial Fitness

“The collagen fibrils in fascia are completely replaced every six months”

“There are 10 times more sensory fibers in your fascia than your muscles”

Muller & Schleip

Perspectives, Sensory Input, and Self-Image

• “Inquiry is like a flashlight in the darkness of belief.” -Seth Oberst

49) Seth Oberst has a great article series on Spatial Perception and Self-Ownership (Part I, Part II, Part III)

“the spatial representation of our own body sets the vantage point with which we perceive the environment”

“there are no isolated sensory experiences as we test our senses against each other and integrate them via higher order multi-modal neurons.”

“there appear to be two primary reference frames thru which we perceive the world: the egocentric (self-based) and allocentric (object-based)”

Myofascial tension as a substitute for another sensory input: “It seems to me that if one can't feel the ground or perceive peripheral vision, for example, they will produce tension and hold themselves in certain postures in an effort to create a reference frame.”

“the way you sense and feel influences your view of yourself. And how we move is a product of how we see ourselves within our environment. Feeling is understanding.”

“Try to determine how far objects are from other objects (a great way to practice switching reference frames). Try doing it without vision as we are so visually dominant. Picture and feel where you are in relation to the boundaries of the room or space.”

“Pay attention to peripheral vision and stop looking at your feet - "feel yourself moving thru the environment instead of the environment moving around you"

Balance - lower threat, go to the ground; cue intrinsically to feel the feet

50) “Maintaining a belief about something that has not been reality-tested affects our neurophysiology in a very tangible way — it modifies our behavior to perpetuate the conviction.” -Seth Oberst 51) Well-built environments are important for well-being

“The built environment can restrict or promote spatial cognition, which can influence one’s self-hood,” the researchers explain. “Our spatial coordinates and our ‘selves’ are intertwined.”

“According to the researchers, we understand our environment differently depending on our experience of it. For example, learning your way through a space using a map gives a different understanding than through learning your own route. In a mapped environment, the tendency is to think of objects in relation to one another, whereas finding your own way might lead to thinking about the space in terms of its relation to you.”

“The researchers say social perspectives also change spatial perspectives.”

52) Consider that the feeling of asymmetry or out of place structures may be rooted in the mind's representation of the body (for a more detailed explanation of this concept click here).53) Overweight individuals perceive distances as further than normal weight individuals - "it follows that obesity isn’t just unhealthy, it also creates a perceptual obstacle that limits physical activity (because it seems even more strenuous than it really is), which in turn contributes to staying obese." | "“You’re not seeing the world as it is, you’re seeing the world in terms of your ability to act.”"

General Healthcare Stuff

54) Our medical system is the 3rd leading cause of death in the US55) “Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year.”56) 13 Ways to Extend Your Lifespan: avoid overeating, eat some nuts, use turmeric, eat plenty of plant foods, exercise and be physically active, don’t smoke, keep alcohol intake to a moderate level, prioritize happiness, avoid chronic stress and anxiety, nurture your social circle, increase your conscientiousness, drink coffee and/or tea, develop a good sleeping routine57) Our nation’s deteriorating health is a serious issue (see April Hits for more information).  Here’s a great short article summarizing it and their advice: “Health care professionals can model healthful behaviors and dedicate time during routine office visits to discuss diet. In addition, citizens can vote in 2 ways: with the ballot, for politicians who place priority on food policies in the public interest; and also with the fork. With every food purchase, the food industry can be incentivized to market healthful food instead of commodity-based industrial products.”58) “Childhood obesity rates have more than tripled since 1980.”59) “Since the end of the Civil War until the late 20th century, lifespan increased rapidly in the United States, a tremendous public health triumph brought about by a more dependable food supply, improved sanitation, and advances in medical care. In 1850, life expectancy among whites was an estimated 38 years for men and 40 years for women. These numbers nearly doubled by 1980, to 71 years for men and 78 years for women. With the start of the obesity epidemic in the late 1970s, this trend began to slow, leading some to predict that life expectancy would decline in the United States by the mid-21st century”

Pain, Psychology, Neuroscience

• “People who learn to control inner experience will be able to determine the quality of their lives, which is as close as any one of us can come to being happy” -Mihaly Csíkszentmihályi

60) Thank you for putting this together, Erson.  Here are 5 great pain explanations/metaphors to help your patients understand pain better.

Pain as a sunburn

Pain as an over-reactive protector

Pain is like the wind

Pain as a home alarm system

Your Brain as a Police Station

61) A quick and easy read on pain. Goes over 9 fundamental concepts of modern pain science. This is a great resource for PTs and patients. 62) "Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears" #PainScience63) “Pain is like the wind.  It can only be viewed by its interface with the environment.”64) This is outstanding - Matt Dancigers’ patient education binder.65) This is too dense for me to read, but some pain lovers might enjoy this - National Pain Strategy66) Random Advice - keep in mind, just because there is a plausible top-down explanation doesn’t meant the bottom-up one is invalid.  #DynamicSystem #Variables #BabyAndBathwater67) Self-Compassion > Self-Esteem68) “social comparison seems sufficiently destructive to our sense of well-being that it is worthwhile to remind ourselves to do it less” -Eric Barker on alleviating FOMO69) 6 Ways Krav Magav develops mental skills

1-Visualization

2-Goal setting

3-Positive self-talk (and changing of internal monologue)

4-Combat mindset (courage, determination, perseverance, controlled aggression)

5-Focusing

6-Relaxation

70) Great article on cultivating the ability to focus on what you can control - TAIWA (thoughts, attitudes, imagination, words, actions).  

-I love the weather analogy - “There’s no such thing as bad weather, just bad gear. You can’t control the weather, but you can control the clothes and gear you use to deal with it.”

-”Fear arises when we imagine bad outcomes for ourselves, or others. Controlling our imagination allows us to manage our psychological and physiological response to the unknowns in our lives. Rather than fill our minds with images of fear and anxiety, we can choose images that support and empower us.”

71) “A new reports whole body hyperthermia improved symptoms of major depression for as long as six weeks following a single treatment...We think that using heat to stimulate the skin activates serotonin-producing cells in the mid-brain, which then produce a change in how the brain functions” #DynamicSystem72) This is a great article for medical and healthcare professionals to learn more about mindfulness practice.

"One might think of the historical Buddha as, among other things, a born scientist and physician who had nothing in the way of instrumentation other than his own mind and body and experience, yet managed to use these native resources to great effect to delve into the nature of suffering and the human condition. What emerged from this arduous and single-minded contemplative investigation was a series of profound insights, a comprehensive view of human nature, and a formal “medicine” for treating its fundamental “dis-ease,” typically characterized as the three “poisons”: greed, hatred (aversion), and ignorance/delusion (unawareness)."

73) 10 Things for Emotional Resilience:

1 “Foster optimism: Don’t be in denial. See the world clearly but believe in your abilities.

2 Face your fears: Hiding from fear makes it worse. Face it and you overcome it.

3 Have a moral compass: A strong feeling of right and wrong tells us we must when we feel we can’t.

4 Practice spirituality: Be a part of a group that has strong beliefs.

5 Give and receive social support: Tapping on the wall of your cell can keep you going.

6 Imitate resilient role models: Or have people you know you do not want to be.

7 Physical fitness: Exercise adapts your body to stress.

8 Be a lifelong learner: Keep your brain sharp and it will give you solutions when you need them most.

9 Have a number of ways to cope: Be like Navy SEALs and Special Forces operators — and laugh.

10 Have meaning in your life: Don’t just do a job; have a calling and a purpose.”

74) “Paying attention to the mental and physical signs and experiences that occur during stressful situations gives you an opportunity to practice composure.”75) This is extremely interesting.  What is unconscious and conscious?  What’s the difference?  How do they interact? “The whole process, from stimulus to conscious perception, can last up to 400 milliseconds, which is a considerable delay from a physiological point of view.”76) “The different environmental needs of varying personality types may be increasingly relevant because studies show that Americans have shifted towards higher levels of neuroticism in recent decades, Newman says.”76) Breath-centered meditation can improve attention in heavy media multitaskers. #mindfulness77) “New research shows that two types of psychological strategies — cognitive restructuring and defusion — can help people cope with negative thoughts.”

Cognitive Restructuring stems from a form of therapy called cognitive-behavior therapy. The technique is based on the idea that changing how someone thinks about something will change how they feel and behave relating to that thing. Using this technique involves thinking about the negative thought itself and evaluating it to see if the thought is realistic or not.

Defusion is based on acceptance and commitment therapy. The idea behind this technique is to learn to view thoughts as nothing more than ideas. There is no need to address them as they don’t mean nearly as much as people commonly think that they do. A common thing people using defusion do is constantly repeating a word until it loses some of its meaning. This way, they may spot some of their beliefs concerning that idea.

78) Fascinating perspective on mental disorders, cues, and “objects of capture”.79) Interesting Motivation - Losing Cash Motivates Better Than Rewards When Losing Weight #LossAversion80) Social media use and depression are correlated - “In a study of 1,787 adults between 19 and 32, new study finds a significant relationship between depression and social media usage. Specifically, the more social media someone uses the more likely it is that they suffer from depression even after controlling for relevant covariates.”  It also prevents us from sleeping.  Need more evidence?  Here’s 25 more reasons why cellphone/internet addiction is a problem.81)  Want to make everything better?  It’s easy, just celebrating more.  Great article with something we should all take to heart.

“If you make sure to always end happy times or tough challenges with a little celebration, you already have half of what it takes to make great memories.

If you have a head full of happy memories, it’s hard not to feel like you have an amazing life.

And an amazing life is something worth celebrating. So go celebrate.”

82) 6 Ways to Build Habits

1 Keystone Habit - “The power of a keystone habit draws from its ability to change your self image. Basically, anything can become a keystone habit if it has this power to make you see yourself in a different way.” -Charles Duhigg

2 Minimal Viable Effort - “The key to new good habits is to do the minimum and be consistent.”

3 Make a Plan - “Thinking about the details makes you more likely to follow through. And another small thing that makes a big difference is just writing down your plan.”

4 Reward Yourself - tie a “want” to a “should”

5 Use Reminders  and Checklists

6 Hand out with people whose habits you want - “Across many different kinds of behavior: voting, cooperation, smoking, weight loss and weight gain, happiness, cooperative behavior, public health behaviors, we and others have been able to show that people are very meaningfully affected by the behaviors of other people to whom they’re connected.”

Pain is all in your...nose?

83) I have this weird theory that people with a more sensitive sense of smell tend to be more sensitive in general.  In the clinic I’ve had many patients that have asked to move tables because of a certain scent or noticing someone else’s perfume that I didn’t even recognize.  These also tend to be the patients that are prone to hyper-reactivity to exercises and tend to have more pain (both short term and chronic).  While I don’t have any evidence towards this theory, other than clinical, here are some other things sense of smell can determine:

A defective sense of smell appears to be a good predictor of dying within five years, a new study has found.

Studies also show it predicts cognitive decline, neurodegenerative diseases, and neuroimmune diseases

Autistic children had indifferent reactions to different smells

Sense of smell predicts social networks

84) Upon doing more research, I did find that there is a correlation between pain/nociception and olfaction at the ion channel level (sodium-channel gene SCN9A, Nav1.7)

“...expression of Nav1.7 channels is not confined to nociceptive neurons. They are also expressed on olfactory neurons...”

“we verified that there is a robust link between nociceptive and olfactory acuities at Nav1.7 ion channel level and that this link works in both directions, rather than in the already known negative direction of sensory function loss”

“A number of (inflammatory) mediators, such as prostaglandin, adenosine, and serotonin, affect the electrophysiological properties of voltage-gated sodium channels. These mediators increase the magnitude of the current, lead to activation of the channel at more hyperpolarized potentials, and enhance the rates of channel activation and inactivation. As a consequence, inflammation can sensitize nociceptive neurons. In an experimental model of inflammatory pain in which an irritant was injected into the hind paw in rats, Nav1.7 protein expression was upregulated within DRG neurons that project their axons to the inflamed area, a change that should increase excitability of these cells. Collectively, these data suggest that Nav1.7 contributes, at least in part, to pain associated with inflammation.”

“Nav1.7 channel that is critical for human pain perception could also be essential for odor perception”

85) Recent study - “The smell of pain: intersection of nociception and olfaction.” (special thanks to Lauren Alix)

“brain areas processing pain and olfaction largely overlap”

“Olfaction functioned as a warning system against an imminent threat associated with a challenge by male mammals.“

“preferred odor modulates the neural pathways that mediate the learning of pain”

“In particular, citrus fragrances, to which mood enhancing properties are attributed, provided evidence in a number of studies for effects of olfactory stimulation on human mental performance, mood and, ultimately, on pain“

“Exposure to unpleasant odors elicited greater pain intensity ratings and stronger nociceptive withdrawal reflexes, whereas pleasant odors evoked opposite responses in humans [6; 57]. Pleasant odors induced positive mood, decreased pain unpleasantness and pain-related activity within the anterior cingulate, medial thalamus, and the primary and secondary somatosensory cortex.“

“Nav1.7 sodium channels, which are expressed on nociceptive nerve endings but also on olfactory neurons”

“the frequent gain-of-function human TRPA1 variant rs11988795A was associated with enhanced perception of odor- ous stimulants, which in a subgroup of healthy volunteers was accompanied by increased sensitivity to thermal nociceptive stimuli”

“Nevertheless, cannabinoids and in particular, THC were able to modulate both, nociception and olfaction in humans...THC reduced the processing of nociceptive information by impeding the cerebral connectivity between somatosensory and limbic areas “

Conclusion: “Different lines of evidence support the proposal that nociception and olfaction share various characteristics at several levels. This includes co-expression of pain genes in olfactory brain structures, mutual roles of ion channels or G-protein coupled receptors in the transmission and processing of pain and olfaction, and shared brain areas involved in the central processing of both nociceptive and olfactory information”

86) How come when someone isn’t able to feel pain we can call it a genetic mutation?  But when someone seems to be more sensitive to pain we tend to say it’s all in their brain?  We don’t explain people with channelopathy-associated insensitivity to pain by saying that their brain is able to process the input in a non-threatening way because they understand pain science.  So why should we only look at the brain when it comes to pain?  Is this fair?  Or even logical?  Are we going to far with the clinical application of pain science?

Exercise of the Month

The latissimus dorsi extends the spine, extends the hip, extends and IRs the shoulder, and extends the elbow (through fascial attachments).  This exercise does the opposite.Plus, it adds a strong active component.  Struggling to round your back, push through your elbows, flex your hands back, and rotate them out creates a ton of great neuro "stuff" to make the changes last.I find the serratus anterior/external oblique sling to be very important when working with lat dysfunction.  This exercise activates that sling with the lat in a compromised position.It has become my go-to exercise for shoulder flexion mobility.https://www.youtube.com/watch?v=sQtFuR4XLBM

Training

• Movement should be an inward inquiry as much as it is an external achievement of a task

87) Nice article on the importance of matching golf technique with the individual’s physical abilities.88) Owning hip extension is paramount for athletes.  It seems easy enough to accomplish, but most people overlook the details. Here are 3 detailed ways to improve hip extension. 89) I was very lucky to have my first official Kettlebell lesson from Phil Scarito.  Here is his great post on how to spread the tension to the contralateral leg to improve one-armed pushed-ups - “One thing I see frequently during the OAP is the student putting most of their focus and energy on the working arm—the arm that is on the ground. This makes the movement harder by shifting the student’s weight to that arm, essentially making them feel heavier.”90) 12 Kettlebell variations91) Dean Karnazes can run forever...because he has no lactate threshold…

“However, genetics alone does not tell the full story. Karnazes believes that his lactate clearance abilities could also be down to low body fat, low sweat rate, a highly alkaline diet and low exposure to environmental toxins. Genetics can give you the propensity for a natural advantage but you express your genes differently depending on your environment and your lifestyle.”

92) Some nice frogger/monkey variations from GMB93) Having trouble cueing someone out of a bad push-up technique?  Cue them to lead with their hips.94) Mike Robertson goes over the 5 basics of any training program: mobility, speed, power, strength, conditioning95) I think being able to do a pistol squat on each leg is a greater feat than being able to lift a huge amount of weight for a partial range.  Karen Smith gives you some tips on how to do it.  96) Great training article on embracing individuality by paying attention to: limb lengths, bony structures, injury history, body mass/fat, competition goals.97) I’ll shamelessly plug my article from the same choir - embracing complexity98) Great stuff - Zack Long shares a great collection of hanging band techniques for overhead shoulder stability.99) I’m a big fan of the pelvis and the pelvic tilt.  Christine Ruffolo is too and explains why in this post - Pelvic Control Precedes Core Control.100) This is GOLD from Eric Cressey:

“If someone is very set in their beliefs (e.g., I won't change my diet), you need to change the surroundings to impact their behaviors (e.g., get junk food out of the house). Make it harder for them to eat like crap.

If someone is set in their behaviors (e.g., lifting with brutal technique), you have to change their beliefs (e.g., teach them what good technique actually is). Make it harder for them to "accept" lifting like crap.”

Plus 9 other great pieces of advice for the fitness business

101) “Most athletes attempt to stay vertical by creating extension throughout their system, where they can use joint compression (and/or impingement) to stabilize.” -Mike Robertson on his top 5 coaching cues #PRI102) I like the plank towel crawls103) Patrick Ward goes over FRC with a strength coach periodization model. 104) “The researchers concluded that there is no difference in the training volume performed when using either self-selected or fixed (2-minute) rest periods. This suggests that trainees with >6 months of resistance training experience can use a self-selected rest period duration, which reduces complexity, and may also reduce the total training session duration, making it more time-efficient.”105) TGU Side Plank Flip is very difficult when performed slowly106) Want to learn how to do a handstand or how to do one better?  Check out this article from GMB.107) I like the creativity of these Landmine Exercises - 1 & 2.  Although the guy in #1 definitely needs to lower the weight and focus on quality.  108) I love the idea of single arm hangs with body rotation from Ruffolo109) Improving athletic performance - “These findings suggest that exercises using the push phase of the Olympic lifts could be valuable for developing athletic performance....The researchers concluded that the jump squat was more effective than the push press for developing jumping, sprinting and agility in high-level young soccer players.”

Move with Instagram

110) Never get bored with your fitness. Awesome Instagram pages for exercise ideas, flows, and movement play.  When I’m having a mental programming block I’ll check out one of these pages for ideas.

OnnitAcadamy - Mixed Training

Christine Ruffolo - great movement

KultFitness - Best.KB.Corrections.Ever.

GMB Fitness & Ryan Hurst - Bodyweight Masters

Marcus Martinez - Creative Kettlebells

Karen Smith - kettlebells and strength

JanetheClapp - YogaFlows

ResiliantPT - Strength & Performance

GFunctional - movement, strength, advanced correctives

Kathy - I can't do any of this, but it's beautiful movement

AwakenGymnastics - nothing that I can do, but good stuff for gymnasts

Alan Ng - a great mix of rehab and strengthening exercise

Dewey Nelson - stuff that 90% of the population can't do

Jill Harris - Pilates.

Aaron Swanson - shameless self-promotion, a mix of stuff, and a good looking dog

Shante Cofield - the instagram master who taught me the way

Research

• Absence of evidence isn't always evidence of absence

111) Want to reduce your stress hormones?  Go to a live music concert.112) Resolution of Lumbar Disk Herniation without Surgery113) If someone is in pain, they will muscle guard during a special test.  So not only are you likely inflicting more pain, but you’re probably getting a lot of false positives.  #FindProblemsNotADiagnosis114) "running barefoot leads to better cognitive performance than running with shoes"115) “The data from this study support the idea that the differences between individuals with chronic ankle instability versus those that who cope after an ankle sprain may have more to do with changes in the sensorimotor system than ankle laxity.”116) "In all analyses, higher stress was associated with worse recovery. Stress, whether assessed as life event stress or perceived stress, moderated the recovery trajectories of muscular function and somatic sensations in a 96-hour period after strenuous resistance exercise. Therefore, under conditions of inordinate stress, individuals may need to be more mindful about observing an appropriate length of recovery."  117) “treadmill running resulted in greater Achilles tendon loading compared with overground running”118) In rehab and general movement training, increasing variability is a good thing. "Far from being a source of error, evidence supports the presence of an optimal state of variability for healthy and functional movement."119) “The results of this investigation indicate that using higher external resistance is a more effective means of increasing motor unit activity than increasing the number of repetitions performed with lighter weights even when the end point is muscular failure. Accordingly, previous recommendations for the use of heavier loads during resistance training programs to stimulate the maximal development of strength and hypertrophy are further supported.” (via Tim)120) “Load & speed influence motor/movement behavior. Low load & slow speed is not motor specific to high speed sport.”-Tim reminds us to be specific in our assessments and interventions121) The long term effects of cortisone - “Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year”122) All sensory input matters.  Music matters.  “The results show that some music has an activating influence, increasing velocity and motivation, while other music has a relaxing influence, decreasing velocity and motivation.”123) The future is here “Using specially designed insoles to deliver stochastic resonance to the plantar surface of the feet has the potential to significantly improve static balance, dynamic balance, and gait mechanics in healthy, young individuals as well as elderly people and others with somatosensory deficits.”124) Fat as an endocrine organ - “the enlarged adipocytes of obese individuals recruit macrophages and promote inflammation and the release of a range of factors that predispose toward insulin resistance”125) Go Hiking

“researchers found that performance on problem solving tasks improved by 50% for those who took part in this tech-free hiking excursion”

“They found those who walked for 90 minutes in a natural environment reported lower levels of rumination and they also had reduced neural activity in the subgenual prefrontal cortex, an area of the brain related to mental illness”

“It has also been proven that people who exercise outside are more likely to keep at it and stick to their programs, making hiking an excellent choice for those wishing to become more active on a regular basis.”

126) “Researchers from the David Geffen School of Medicine at UCLA found that cardiovascular disease patients who have high muscle mass and low fat mass have a lower mortality risk than those with other body compositions. The findings also suggest that regardless of a person's level of fat mass, a higher level of muscle mass helps reduce the risk of death.”127) Another reason why you don’t want high-threshold strategies with your rehab clients - “The results of this study suggest that unlike isolated voluntary training, co-contraction training of the trunk muscles does not restore the motor control of the deep abdominal muscles in people with LBP after a single session of training.”128) The CAI (chronic ankle instability) group had a smaller degree of left hemi-diaphragm contractility compared to the control group”.  How is this not on PRI’s front page?129) “The knee torques that positively correlated with increased tibial slope angle in this investigation are associated with heightened risk of ACL injury. Therefore, the present data indicated that a higher posterior tibial slope is correlated to increased knee loads that are associated with heightened risk of ACL injury.”130) “The current results suggest that, for acute and subacute [cervical radiculopathy], treating joint and muscle stiffness without a focus on increasing the size of the IVF is as effective as a program that specifically focuses on increasing the size of the IVF of the affected nerve root.”131) “When groups were asked to jointly build creative Lego models, their speech, movements and heart rates became increasingly coordinated...The study shows that behavioral coordination is crucial for teamwork. The more groups develop routines and effective ways to take turns in speaking and acting, the more their heart rates become in sync.”132) “Performance on the vertical drop jump landing task was not found to be associated with anterior cruciate ligament injury risk in a group of female handball and soccer athletes. “

Social & Communication

• "The human tongue is a beast that few can master." -Robert Greene

133) “Small changes in the social lives of older people are early red flags showing that their thought processes and brain functioning could be on the decline.”134) Acetaminophen (tylenol & painkillers) decrease empathy.  Decreased empathy can impair relationships and lead to less social outreach.  Decreased social relationships can lead to loneliness.  Loneliness can lead to increased pain.  Increased pain can lead to consumption of painkillers / acetaminophen.  The consumption of painkillers/acetaminophen decreases one’s ability to feel empathy.  Decreased empathy…135) “Even as adults, friendships play an important role in our lives. By bringing laughter and camaraderie, their mere presence can buffer stress as well as the effects of negative experiences. Furthermore, they can help alleviate despair or emotional turmoil. New research published in Scientific reports suggests a better pain threshold may be another benefit of having friends. “136) Be more persuasive, repeat your main points. Research shows repetition biases judgement (helps people change their minds). 137) 4 Themes of Patient-Therapist Interaction

(1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication)

(2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients)

(3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account)

(4) organizational and environmental factors (ie, time and flexibility with care and appointments).

138) “Small changes in the social lives of older people are early red flags showing that their thought processes and brain functioning could be on the decline."139) A very well written article on the "road trip effect" - the how and the why of road trips improving friendship.

-Increased Exposure

-Working Toward Common Goal

-Getting to Know One Another (mutual disclosure)

-Discovering Points of Similarity

-Having Shared Experience

140) Be More Persuasive (it’s really just great communication advice)

-Don’t be direct: Direct usually comes off as rude, no matter your intentions. Be nice and slow it down.

-Don’t try to get them to say “yes”: Pushing for a “yes” makes people defensive. Try to get a “no.”

-Do an “accusation audit”: Acknowledge all the negative things they think about you to defuse them.

-Let them feel in control: People want autonomy. Ask questions and let them feel like they’re in charge.

-The two magic words they need to say: Summarize their position to trigger a “That’s right.”

-Listen for levers: They might only need the orange peel. Listen, listen, listen.

-Keep asking “How am I supposed to do that?”: Let them solve your problems for you.

141) The Power of Words

"In the western mind, there are two notions of compassion," he explains. "One is, I'm going to be a good Samaritan and help this guy. But that is the compassion of the weak. The compassion of the strong is in waking people up to their blindness. For that, you need to be a warrior. I am tough and sweet. I show you your bullshit, but I'm also infinitely patient with you."

“Our best comes out when we have honest discussions. Our worst comes out when we behave like robots or professionals.”

“Since all action is based in conversation, the shock has to come through language.”

“When trust improves, the mood improves. Everyone feels more confident.”

“We don't realize how much we create reality through language," Flores says. "If we say that life is hard, it will be hard. If, on the other hand, we make commitments to our colleagues to improve our productivity, we also improve our mood, and as a result, clarity and happiness will increase. People talk about changing their thinking, but they have no idea what that is, let alone how to do it. The key is to stop producing interpretations that have no power."”

142) Quick Book Review

I’m listening to the 48 Laws of Power on audiobook.  It’s an interesting book, but I think it’s depressing me a little bit.  I find it sad that people have to play these power games to make money and gain control.  It’s even more sad when you know people are doing this in front of you and you have to sit back and watch them play out their “game”.  I understand that awareness of this power game is necessary and may be useful.  However, I think we should strive to live an honest, compassionate, altruistic life.  Not a scheming life that wants fame, money, and power.

Diet

• "Our preoccupation with goals, results, and the quickfix has separated us from our own experiences." -George Leonard

143) Great research based article from VOX on how exercise isn’t enough to lose weight.  144) Diet and Cancer - “A new study finds that consuming sugary beverages, processed foods and other energy-dense carbohydrate-containing foods markedly increased the risk of prostate cancer, choosing healthy carbs like legumes, fruits and whole grains was associated with a substantial reduction in the risk for breast, prostate and colorectal cancers.”145) 29 healthy snacks146) You’re getting fat if you’re reading this at night - “Northwestern scientists found bright light exposure increased insulin resistance compared to dim light exposure in both the morning and the evening. In the evening, bright light also caused higher peak glucose (blood sugar) levels.”147) “Variations in human diets across a plausible range of intakes have been shown to have no effect on blood pH. Consistent with this lack of a mechanistic basis, long-term studies of alkalinising diets have shown no effect on the age-related change in bone fragility. Consequently, advocating the consumption of alkalinising foods or supplements and/or removing animal protein from the human diet is not justified by the evidence accumulated over the last several decades.”148) 7 Reasons Why We Love Alcohol149) “Eating a meal of seafood or other foods containing omega-3 fatty acids at least once a week may protect against age-related memory loss and thinking problems in older people, according to a team of researchers at Rush University Medical Center and Wageningen University in the Netherlands.”150) “Never make a decision when you are hungry. The hormone ghrelin – that is released before meals and known to increase appetite – has a negative effect on both decision making and impulse control.”151) 12 Best Foods to Eat in the Morning152) For the tea enthusiast out there - “Results showed a link between peppermint tea and enhanced mood and cognition. Those who drank peppermint tea also exhibited improved long-term memory, working memory, and alertness. On the other hand, volunteers given chamomile tea experienced a calming sedative effect, which the team noted also seemed to slow their memory recall and attention speed”153) Diet and Fibromyalgia154) “Within the human digestive system lives a massive ecosystem of bacteria, known as gut flora or the gut microbiota, and recent research suggests that these microbes can manipulate your brain into eating unhealthy things and even into feeling stressed and depressed.”155) "The results of our study suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and açai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation.”156) 18 Science Based Ways to Reduce Hunger and Appetite: eat more protein, opt for fiber rich foods, pick solids over liquids, drink coffee, fill up on water, eat mindfully, indulge in dark chocolate, eat some ginger, spice up your meals (capsaicin), eat on smaller plates, use a bigger fork, exercise, lose belly fat, get enough sleep, reduce your stress, eat omega-3 fats, opt for protein rich snacks, visualize eating the food you crave157) 15 Ways to Reduce Blood Sugar Levels: exercise regularly, control your carb intake, increase your fiber intake, drink more water, portion control, choose foods with a low glycemic index, control stress levels, monitor your blood sugar, get enough quality sleep, eat foods rich in chromium and magnesium, try apple cider vinegar, experiment with cinnamon extract, try berberine, eat fenugreek seeds, lose some weight.

Diet & Tendons

158) “Chronic hyperglycemia and central obesity are independent risk factors for degenerative tendon disease and the underlying mechanisms involve an accelerated accumulation of advanced glycation end-products (AGE’s), collagen cross-linking, oxidative damage, and aberrant remodeling of the extracellular matrix. Consuming a diet that results in consistently optimal blood glucose levels and improvements in body composition may improve tendon health in the general population. Lifestyle interventions for preventing and treating tendinopathies should be considered given that evidence based treatment options are limited.”159) “A diet that is low in highly refined carbohydrates and simple sugars, relative to the modern western diet, can reduce AGE accumulation, collagen cross links, inflammation levels, maintain ECM homeostasis, and improve body composition. These effects will likely provide significant benefits for long-term tendon health.”160) Another Great Article

“The main point here is that the quantity of highly processed carbohydrate and sugar in a standard Western Diet is not just harmful to your cardiovascular and endocrine systems, but likely to your connective tissues as well. “

161) “several studies show that, in obese subjects, tendons frequently undergo to degeneration, which can progress to a symptomatic stage, with pain and functional impairment”

Other Good Stuff

• "And those who were dancing were thought to be insane by those who could not hear the music" -Friedrich Nietzsche

162) Get out there and dance more: “Studies show that dancing at parties and in groups encourages social bonding, whether it is a traditional stomp, a tango or even the hokeypokey. Many researchers have argued that people experience a blurring of the self into their groups thanks to the synchronization that occurs while dancing. Yet it is also possible that the exertion inherent to dancing releases hormones—like any other form of physical exercise—and these molecules are behind the bonding effect. A new study suggests both views may be correct.”163) “Researchers are learning that as we age in relationships, we change biologically to become more like our partners than we were in the beginning.”164) “We have become attracted to distracted. Constantly checking for updates and new information. Obsessively checking for the latest word from this expert or that.  Strangely this constant activity feels like progress. The truth is we’re busy, but we’re not focused. Nothing much is getting done.”165) "Yes, it’s that simple. If girls & women around the world were given an education (a full education!), then poverty would not be so persistent."166) Trees sleep at night too.  “Genes that code for a 24-hour circadian rhythm exist ‘in most every cell, in most every organism on Earth,’”167) “Using digital platforms such as tablets and laptops for reading may make you more inclined to focus on concrete details rather than interpreting information more abstractly”168) 8 Ways to Change Habits: Pick one at a time, Reduce the variability of the habit, Change your environment, Don’t stress, Replace habits, If-Then planning, Expect setbacks169) Use your body to learn quicker - “Physical movements seem to be particularly suitable fodder for making non-declarative memories, and so by both speaking and gesturing, we may encourage our brains to make two independent memories of an event, boosting our chances of remembering the event later.”170) I’m always skeptical of people that say they read 5 books a month.  There’s no such thing as speed reading -  “Reading is about language comprehension, not visual ability.”  For more on this myth, check out #72.171) 5 Benefits of Acupuncture You Didn’t Know About172) “Three bricklayers are asked, “What are you doing?” The first says, “I am laying bricks.” The second says, “I am building a church.” The third says, “I am building the house of God.” The first bricklayer has a job. The second has a career. The third has a calling.” -Article from Eric Barker on developing Grit173) What are we doing?  Where is the empathy and compassion?  The altruism?  The humanity?  “The world's 62 richest people now own as much wealth as the 3.6 billion people who make up the poorest half of the global population”

Bottom Line

If you enjoyed this list please share it with others to help the world move better.  If the general population knew the benefits they could get from working with quality physical therapists, chiropractors, athletic trainers, strength coaches, or personal trainers then we would ALL have a lot more business.For a more real-time update of movement and health information follow me on social media:

Instagram - exercise pictures, movement flows, and Rigby

Facebook - movement and health articles (geared towards the public to improve education)

Twitter - weird abstract comments, out of context stuff, quotes, and good stuff from things I’m reading

[subscribe2]

April Hits 2016 : Epistemological Arrogance, State of Healthcare, Cognitive Bias, Arm Ergometer, Insulin/Glycemic Index, Nutrient Timing, Reform the World

The Hits

This is just a collection of some of my favorite articles from the past month.  I bolded the numbers of the articles that I found most remarkable.  Of course, this is just my bias.  I think all the articles here have value.  I just realize that some readers may be looking for something more brief.Also, I want to encourage any reader to share their favorite articles, books, or podcasts of the month in the comments below.  There’s only so much information that I can go through in a month.  I know there’s a ton of great stuff out there that isn’t on my radar.  It will not only help introduce me to new perspectives, but it will provide other readers this opportunity as well.

Epistemological Arrogance

1) “Epistemic Arrogance: measure the difference between what someone actually knows and how much he thinks he knows.  An excess will imply arrogance, a deficit in humility.  An epistemocrat is someone of epistemic humility, who holds his own knowledge in greatest suspicion.” -Nassim Nicholas Taleb 2) Complex does not mean complicated - “Complicated systems are usually built from design, and include cars, computers and buildings. Complex systems were not built but evolved, and include living things, ecologies and economic systems.”  Great piece by Todd Hargrove3) Sometimes in the buffet style of information digestion that is the internet, there will be “gurus” out there who will claim “all health problems can be fixed with these “3 things you’re not doing”.  Or worse, they'll take a "if your not doing ___ you're missing the boat" approach.  Those of us in clinical practice know it’s not this simple.  The problem is that ranting about a simple, secret solution to a complex problem gives people either false hope or it makes them feel bad as a clinician that they don’t know about the “secret answer”.  And I don't think anyone in healthcare should be making clinicians feel bad or teaching through narcissistic ways.My intention with this article is simply to put something out as a clinician that says it’s not simple.  There are no easy answers when it comes to treating the human species.  Each patient will be complex.  It’s a very intricate system with many parts.  It doesn't work out all the time.  Some people don't get better.  Sometimes they need a different approach or control parameter.

Clinical

• "To understand is to perceive patterns" -Isaiah Berlin

4) It’s an honor to have one of my articles re-published on FunctionalMovement.com (FMS).5) I’ve always thought people tend to get carried away with rolling patterns.  Especially when it comes to injuries distal from the core or people with ROM limitations.  You can’t roll your way out of a forefoot varus.  Emily Splichal apparently thinks the same way.  Here’s her article on the importance of the foot.6) “The most common orthopedic surgery in America had it’s final epitaph written this month with a level-1 study showing that surgery for meniscus locking is no better than placebo.”7) Erson shares 5 methods for improving your manual skills “you get more bang for your buck the more skin you contact - effecting greater portions of the homunculus”8) “All movements are assessments. Not being able to do something gives you a lot more insight into what your weaknesses and vulnerabilities are.  This is where joint disassociation has it’s greatest benefit — increasing your awareness to which joints are lacking.  Mindfulness, then, leads to control.  If you can control something it gives any movement utilizing that joint more confidence.” -Christine Ruffolo9) Some great thoracic mobility and stability exercises from Zach Long.  I haven't seen most of these.  All of them are solid.  I really like the idea of side lying resisted open book. 10) I like the nervous system “wringing” (lumbar trunk rotation with contralateral cervical rotation).11) 5 Things to Look at with Shoulder Post-Ops: why, t-spine, cervical sb, shoulder extension, and lat/teresmaj12) “Perhaps its the ability to adapt to varied force distributions and striking patterns that makes you most resilient to injury. In a study published in 2015 in the Scandinavian Journal of Medicine & Science in Sport, authors Malisoux et al found that runners who rotated between different pairs of running shoes were 39% less likely to get injured versus those who ran in predominantly the same pair of shoes over 22 weeks. It's possible that rotating between different shoes, and thus different strike patterns, minimizes the repetitive strain at each specific tissue structure and allows for more effective recovery and overall decrease in injury risk.” -Laurey13) This might be one of the best explanations of mechanoreceptors and manipulation I’ve ever heard - stimulating type 2 joint mechanoreceptors causes pre-synaptic inhibition of pain14) I’ve clinically seen a couple back injuries from lifters “burning out” their quads before deadlift or squat sessions.  #UprightAgainstGravity 15) You should do single leg seated calf raises for patients with achilles tendinopathies.16) “The ability to inhibit unnecessary or excessive muscular tension is a true marker of self-regulation.” -Seth Oberst with a great article on how to improve your movement/self-regulation via play, slowing down, and detachment. 17) Brian Tiu with a shoulder course review.  Interesting perspective of rotator cuff being the cause of scapula instability.18) The Gait Guys continue to teach the valuable lesson of torsions - “Because of the degree of external tibial torsion (14 to 21° considered normal), activity modification is imperative. A foot leveling orthotic with a modified UCB, also inverting the orthotic is helpful to bring her foot somewhat more to the midline (the orthotic pushes the knee further outside the sagittal plane and the patient internally rotate the need to compensate, thus giving a better alignment).” Here’s another great one with a video explanation.19) Great Stuff From Peter Malliaris on Tendinopathies

“This doesn’t mean switching to midfoot strike is the only factor to consider – optimising leg stiffness, and training the muscle-tendon unit to maximise effectiveness of stretch-shorten cycle are also important, among other factors.”

"The authors own studies and others suggest that that less stiff tendons, particularly Achilles (Kubo et al. 2015 – in 5000m runners, Stafilidis et al. 2007 – in sprinters) may be advantageous for performance."

"The muscle can work minimally to provide maximum efficiency or in a manner to generate optimal velocity for maximum power at ideal muscle lengths for maximal force generation’. Shorter/stiffer tendons with longer fascicles facilitates the latter (ie maximal force generation), like for example around the hip, as apposed to the longer/less stiff Achilles tendon that strains to allow the short calf fascicles to operate efficiently in an optimal range (see figure below – parts of the hamstrings have long fascicle lengths (FL) relative to muscle length (ML), whereas planterflexors have short FL relative to ML."

20) I never thought about doing shoulder IR/ER from the knee.  Makes it very easy for patients.21) Grip strength is important - “grip strength is a dependable predictor of overall health and wellness” #GetStrong #GoodForShoulders22) Question: Jon Herting wants to know if anyone is using grip strength as a measurement for physical readiness? Great question and could be an easy assessment for all to implement. 23) “Clubfoot is usually not congenital”24) Seth Oberst reminds us that as one progresses motor skills the degrees of freedom and available low-threshold patterns should increase, not decrease.  Someone with high-threshold, locked-out patterns is someone who has not reached the true autonomous stage of learning.  “Allow the nervous system to have a choice, mediated thru awareness, in making a more efficient movement output.”  See #71 for a research example of this fault.25) Shoe tongue problems, lack of hip IR and ab/adductory twists - Gait Guys go over the mechanics of a common shoe problem.26) “Gait appears most robust to weakness of hip and knee extensors, which can tolerate weakness well and without a substantial increase in muscle stress. In contrast, gait is most sensitive to weakness of plantarflexors, hip abductors, and hip flexors.” - van der Krogt (via Gait Guys)27) Inside the Mind of Charlie Weingroff

From Greg Rose:

Restricted in 1 plane = TED

Restricted in all planes = JMD or Neuro-Locked

“It seems like the best way to coach is to let the learner tell you how to help them or let them coach themselves.”

“The real problem is our health care folks don’t look widely enough.”

“The body follows the eyes, not the neck.”

“The best constructs are inclusive and systematic and philosophical, and don’t simply tell you what to do.”

“Fascia answers a lot of the why and how to errors and successes in movement. The brain can’t control everything all the time, especially when movement is governed by the M1 reflex.”

“If you put a bunch of pieces of Swiss Cheese on top of each other, meaning you use multiple markers on a regular basis, the holes seem to get covered up.”

28) I’m not sure I understand the rationale for some of this, but there are some good points in this review of Greg Lehman’s course.29) Quick Book Review

Why Zebras Don’t Get Ulcers - Robert Sapolsky

I thought it was just going to be another version of the Polyvagal Theory.  Instead, I was pleasantly surprised.  Sapolsky is a great writer, makes you laugh, and provides logical reasoning behind his detailed evidence.  He gives a detailed physiological argument for why stress is bad (glucocorticoids are the devil) and provides some profound solutions in the final chapter.

30) Great article on Anteromedial Ankle Impingement Syndrome - "The manipulation illustrated in Fig. 2A is particularly important in managing this condition because recent three-dimensional research confirms the medial cuneiform can dorsiflex as much as 10 degrees on the navicular. By maximizing the range of dorsiflexion available from the midfoot, the navicular / cuneiform joints may absorb motion that might otherwise be absorbed by the talotibial joint."31) Jill Cook is one of the best when it comes to treating tendinopathies.  Here in this post she gives you 10 things you should avoid doing.

Rest Completely, Have Passive Treatment, Have Injection Therapy, Ignoring Pain, Stretching Your Tendon, Massage Your Tendon, Be Worried About Imaging, Be Worried About A Rupture, Take Short Cuts in Rehab (it will take at least 3 months), Not Having An Understanding of Load Management (think speed too)

Important Healthcare Information

• "The more income inequality there is in a society, the worse the health and mortality rates" -Robert Sapolsky

The decline of American health…32) “Kapadia and his colleagues found that from 1995 to 2014, the average age of [heart attack] patients dropped from 64 to 60, and the prevalence of obesity increased from 31 percent to 40 percent.Also, the proportion of heart attack patients with diabetes rose from 24 percent to 31 percent. High blood pressure was reported in nearly four out of five cases, up from 55 percent. And COPD, usually the result of smoking, increased from 5 percent to 12 percent.”33) Number of adults with diabetes reaches 422 million worldwide, with fastest increases in low and middle income countries34) Here’s a thorough article on one of the factors of our poor health - Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease35) Decreasing sedentary time is equal to increasing moderate-high intensity exercise time.  #DontHaveToBeAnAthlete #Move36) “Dunstan et al. found that for each 1-h increase of TV viewing per day, there was a 26% increase in the prevalence of metabolic syndrome”Discuss or share this with your peers, friends, family, and patients.  Awareness is the first step in change.

The Life of a Physical Therapist Summed Up in One Gif

 

Pain, Neuroscience, & Psychology

• "A diagnosis of psychogenic anything...is usually a diagnosis of exclusion" -Robert Sapolsky

37) “Systematic reviews concluded that the evidence for Explaining Pain in decreasing pain, increasing physical performance, decreasing perceived disability, and decreasing catastrophization was compelling...Critically, the state of the evidence does not suggest EP alone as a viable intervention to induce long-lasting improvements in pain and disability. However, EP is clinically intended to be combined with multimodal approaches.”38) This ISPI Newsletter has some very useful pain stories to help educate and persuade your patients.  I love the New Zealand guy with the rod in his head.39) Uncertainty can cause more stress than inevitable pain. #Expectations #Control40) Great story about Steve Kerr and his chronic pain and headaches.  Makes me wonder if he saw a PT before surgery.  Makes me wonder if he's seen a pain science specialist.  Makes me wonder about the cerebrospinal fluid.  Makes me wonder about his neurodynamics and myodural bridge.  Makes me wonder about his cranium.  Makes me wonder if maybe there's something else missing that we don't know about yet.41) Mindfulness practice reduces pain.  “Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain”42) “The aim of Pain Neuroscience Education (PNE) is to teach patients more about the pain they’re experiencing from a biological AND physiological perspective, embracing a biopsychosocial approach.”43) "Research looking at the link between listening music and pain tolerance suggests that it is not only effective in relieving acute and chronic pain but can also help patients manage anxiety and depression.  According to one study from 2012, two daily sessions of music listening helped a sample of chronic pain patients relieve symptoms related to conditions such fibromyalgia, inflammatory disease, or neurological conditions as well as the anxiety and depression linked to chronic pain."44) The rest of the healthcare world is starting to catch up to physical therapy. "The nation's top federal health agency urged doctors to avoid prescribing powerful opiate painkillers for patients with chronic pain, saying the risks from such drugs far outweigh the benefits for most people." #GetPT1st #PainScience45) It’s not that there are bad people, it’s that there are prefrontal cortexes.  “Human brain mapping study suggests you might be hard-wired for altruism”46) Elevation leads to happiness.47) Interesting study on how the brain uses objects to help focus visual attention.  “Perception experts have long known that we see much less of the world than we think we do. A person creates a mental model of their surroundings by stitching together scraps of visual information gleaned while shifting attention from place to place. Counterintuitively, the very process that creates the illusion of a complete picture relies on filtering out most of what’s out there.”48) “Rather, the findings provide support for the embodied social-communication model, suggesting that chemosignals act as a medium through which people can be "emotionally synchronized" outside of conscious awareness.”49) Another perspective on the importance of expectations.  ““What we’re showing is that attention is not enough to ensure accurate memory,” said Wyble. “You need some kind of expectation that attributing certain features to the object is important.”  This indicates that much of what a person can remember is based on their expectation of the information they will need to recall.”50) We should all take some LSD - “Dr Carhart-Harris explained: "Normally our brain consists of independent networks that perform separate specialised functions, such as vision, movement and hearing -- as well as more complex things like attention. However, under LSD the separateness of these networks breaks down and instead you see a more integrated or unified brain...Our results suggest that this effect underlies the profound altered state of consciousness that people often describe during an LSD experience. It is also related to what people sometimes call 'ego-dissolution', which means the normal sense of self is broken down and replaced by a sense of reconnection with themselves, others and the natural world. This experience is sometimes framed in a religious or spiritual way -- and seems to be associated with improvements in well-being after the drug's effects have subsided."

Cognitive Bias

51) “a failure to acknowledge cognitive bias is a failure to acknowledge the limits of human intuition”52) Here’s a great infographic describing 20 cognitive biases53) “It seems that researchers are less likely to scrutinise results that “align” with their theories, but when we’re faced with results that appear out of the ordinary, intuition tells us to take another look. Some will even re-analyse the data to find plausible explanations for the unexpected result.”  BodyInMind has had a great series of articles on cognitive biases.54) For more on cognitive biases, check out Daniel Kahneman's book

Training

55) Diagonal Side-Sit Unilateral Press from Perry Nickelston56) Dan Pope teaches you how to do some handstand push-ups.57) “High intensity interval training may not be healthy for untrained individual. Study finds it cuts mitochondria production in half. “58) Eric Cressey gives many reasons why it’s important to train after surgeries/injuries.  I agree with all these points.  Great read.59) If you force people to lift based on what you want it to look like rather than what it feels like, then you are going to have a bad time.  Dean Somerset agrees and writes a post on spinal angles and deadlift variations.  #RespectTheVariables #Individuals60) Random Advice - If it’s extremely uncomfortable in the set-up, it’s going to be painful and potentially damaging during the lift.  Be a coach - plan, prep, modify, regress, use alternate exercises.61) 5 Core Exercises from Mike Robertson - I like the dying bug with reach and kettlebell62) Mike Robertson gives 27 random tips on training the core - “While we’re on the topic of PRI influence, just check out how much real estate the internal obliques and transverse abdominus on the pelvis. I’d say they’re kind of important if we want to control our pelvis, lower back and hips!”63) Eric Cressey shares 5 core exercises for 5 different planes of motion.64) Solid research on split training vs. whole body training.  Conclusion = not that big of a difference, WBT has more benefits for lean-mass.  I enjoyed the graph showing the dramatic difference in cortisol in the two groups (WBT had significantly lower).  And then there’s this gem - “Although there are some indications that full body training may be better than a split routine for even some well-trained individuals (Schoenfeld et al. 2015), total training volume seems to make more difference than training structure.”65) Dean Somerset couples proper spinal mechanics in a plank position on a physioball and adds in a banded pull-down motion to groove the proper spinal mechanic position for pull-ups.66) “I've been fortunate to visit a lot of different strength and conditioning facilities in the private, collegiate, and professional sector. Without fail, the most successful facilities are the ones with an awesome culture.” -Eric Cressey

Exercise of the Month

https://www.youtube.com/watch?v=5g1ln-kBw-AEverything is better with a kettlebell.This exercise helps to level the pelvis, stabilize the trunk in the frontal plane, improve shoulder stability, and can help to reduce a trendelenburg gait pattern.You'll get a completely different muscle activation pattern depending on which side you put the kettlebell on.Keep in mind you may need to raise the kettlebell to avoid too much lateral flexion in some patients.It's pretty much this thought process, but it removes the ankle - so most people lose their compensation strategy.

Research

• "If you want to know if an elephant has a stomach ache don't ask the veterinarian.  Ask the cage cleaner."

67) I have no idea what these insoles look like, but on a fundamental level this shows the importance of the sole of the foot in all human movement.  “Sensory enhancing insoles improve athletic performance during a hexagonal agility task”68) “These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.” #Mindfulness 69) The Hip Thrust is good in many ways - “The barbell hip thrust activates the gluteus maximus and biceps femoris to a greater degree than the back squat when using estimated 10RM loads.”  Here’s why you should use it in the clinic.70) “The results suggest that patients with chronic neck pain have gait disturbances. This supports the notion that assessment of gait should be addressed in patients with persistent neck pain.”71) If you stiffen your body...your body will stiffen.  “Abdominal Bracing resulted in significantly reduced knee and hip flexion and increased peak vGRF during landing. No differences in lumbar multifidus EMG or lumbar spine kinematics were observed.”  Drop landing is not a simple tasks = external cues preferred.  #Principles #HighThresholdError 72) I first learned about it in undergrad psychology class with the pencil and cartoon study.  Then Amy Cuddy’s TED talk reminded me about it and brought it to gross postures.  Now this quick 60-second research review brings it to gait.  Sensory input can change your brain.  Change your gait, change your state.  73) An attempt at feed-forward protection?  ”Increased Gmin motion during swing-phase and earlier Gmin and superficial Gmed motion in individuals with hip pain suggest an overall increase of muscle activity.”74) “This study suggests that postural cueing to increase lumbar lordosis during trunk stabilization exercises may better promote multifidus activation than traditional stabilization exercises alone.”75) “Following a first-time lateral ankle sprain, a patient who was unable to complete the single-leg drop landing and drop vertical jump at 2 weeks post injury was more likely to be classified as having chronic ankle instability.”  Do people really have their patients perform a single-leg drop landing 2 weeks after the initial injury?76) “Cognitive flexibility, heart rate variability, and resilience predict fine-grained regulation of arousal during prolonged threat.” (via Jennifer Pilotti)77) It’s a dynamic system.  It’s all connected.  This is well known for those that study the human species, but may offer other traditional or old school practitioners a new perspective - “treatment for depression resulted in a decreased level of cardiovascular risk”  #TheWholeIsGreaterThanTheSumOfItsParts78) Get a dog!  "Dr. Andrea Beetz and colleagues at Rostock University, in a comprehensive survey of research on the relationship between exposure to animals and immune function, found strong evidence that owning dogs or other pets: Reduces levels of stress hormones such as cortisol that depress immune function Increases circulating levels of oxytocin, which promotes a sense of well being and had been linked to improved immune response Increases parasympathetic function (relaxation response), which has also been linked to elevated immune function (parasympathetic neurons directly innervate, and stimulate components of the immune system such as spleen and bone marrow)"79) “Experimental measurements of humans showed that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12 per cent more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63 per cent without it. Walking with opposite-to-normal arm phasing required minimal shoulder effort but magnified the ground reaction moment, causing metabolic rate to increase by 26 per cent.“ #ArmSwingMatters

Bring Back the 10 Minute Arm Ergometer Warm-Up!

80) Endurance Exercise as an “Endogenous” Neuro-enhancement Strategy to Facilitate Motor Learning

“Physical exercise facilitates long-term potentiation (LTP)-like plasticity in M1 (Singh et al., 2014b) and increases the level of learning-related neurotrophins (Rojas Vega et al., 2006). These and other mechanisms of physical exercise are discussed to potentially modulate motor learning (Fabel et al., 2009; McHughen et al., 2010; Cantarero et al., 2013).”

“In humans, neurophysiological studies showed that motor learning (i) requires LTP-like plasticity in M1 (Cantarero et al., 2013), (ii) increases the size of the movement representation of trained limbs in M1 (Pascual-Leone et al., 2005) and (iii) enhances motor corticospinal excitability (Muellbacher et al., 2002), although the relationship between cortico-spinal excitability and motor learning is complex (Tunovic et al., 2014).”

“Taken together, these studies provide evidence that exercise at low, moderate or even high intensities rapidly reduces intracortical inhibition and that this effect is not limited to the exercised limbs. This may be beneficial for online motor learning.”

“acute exercise induces facilitative effects on early neuroplasticity (within the first hour after exercise)”

“endurance exercise does likely not lead to neuronal adaptations (except of neurogenesis in the hippocampus) but exercise-induced vascular changes might contribute to subsequent learning-related neuroplasticity”

“Besides the changes in neurochemicals, exercise influences the energy supply of the brain. For example, recent investigations highlighted that lactate, elevated in response to exercise-induced anaerobiosis in the muscle cells (Robergs et al., 2004), is increasingly used as energy source for the brain and becomes the preferred fuel if arterial lactate values exceed the lactate values in the brain (Dalsgaard et al., 2004; Kemppainen et al., 2005; Boumezbeur et al., 2010).”

“An intriguing finding of Skriver’s study is the significant correlation of lactate with better skill retention at all measurement points”

Don’t over fatigue on the warm up : “To sum up, evidence indicates that acute exercise improves motor skill learning but further research is required to disentangle the effector-specificity of this improvement. Based on the existing evidence, a negative effect on motor skill performance and learning might be expected if warm-up exercise is potentially fatiguing and involves at the same time the main effectors that are important for the execution of the skill to be practiced in succession.”

“As mentioned in the previous section, Roig et al. (2012) showed that acute high-intensity exercise immediately after skill acquisition facilitates long-term motor memory.”

Post-skill practice: “exercise contributed to the emergence of an off-line performance gain in the retention test session despite of task interference”

“At the molecular level, skeletal muscles can act as endocrine organs capable of secreting molecules relevant for neuroplasticity”

Skill acquisition use before.  Skill retention use after.

Other Good Stuff

• “The sun doesn't discriminate; the sun shines on all equally. We don't get the light and warmth because we deserve it; we get it because we are. It's the same with the heart's compassion.” - Cheri Huber

81) "Tool use meant we didn't need as big teeth and jaws as earlier hominins. This may then have increased evolutionary pressure to spend less energy developing teeth, making our teeth smaller."82) Seth Oberst told me to listen to this podcast with Josh Waitzkin. Tons of great stuff - flow, growth mindset, mindfulness, thematic learning/interconnectedness. I like the idea of interval training as a back door for teaching mindfulness to the skeptics. For example, put someone on a bike for intervals. Use high intervals to spike their heart rate (140-170), then on the low interval have them focus on their breathing for “recovery”. Show them how it helps lower their heart rate for the sale transaction.83) Magic?  Higher levels of consciousness?  Different epistemology?  A Hoax?  You decide - 6 people with superpowers that science can’t explain.84) “There are many kinds of toxic coworkers, but two that can do the most damage are those who won’t listen to others (egomaniacs) and those who suck the energy from a team (naysayers).”  Learn how to deal with these guys in this post.85) 3 Mistakes Parents Make With Technology That Hurt Their Kids #PreventAddiction

1.Not Setting Limits on Technology

2.Not Having Enough Family Activities without Technology

3.Parents are also Tech Addicts  

86) “A programme to teach young children the basics of philosophical thinking in UK schools has been shown to help them progress in maths and reading.”87) “We potentially can affect our epigenetics by living a healthy lifestyle and providing our body with the necessary building blocks for these epigenetic flags.”88) Interesting article on anxiety.  “Problems in a Delayed Return Environment can rarely be solved right now in the present moment...Our brains didn’t evolve in a Delayed Return Environment, but that’s where we find ourselves today. My hope is that by measuring the things that are important to you and shifting your worry to daily practices that pay off in the long-run, you can reduce some of the uncertainty and chronic stress that is inherent in modern society.”89) From 4 Rituals to Become an Expert by Eric Barker -

“What sets expert performers apart from everyone else is the quality and quantity of their mental representations. Through years of practice, they develop highly complex and sophisticated representations of the various situations they are likely to encounter in their fields… These representations allow them to make faster, more accurate decisions and respond more quickly and effectively in a given situation. This, more than anything else, explains the difference in performance between novices and experts.”

“Dan Coyle says you only want to be succeeding in 50-80% of your attempts. Less than that and you’ll get frustrated. More than that and you’re not pushing yourself.”

“Get outside your comfort zone but do it in a focused way, with clear goals, a plan for reaching those goals, and a way to monitor your progress.”

90) "Cato didn’t have Caesar’s military skill, or Cicero’s eloquence, or Pompey’s boyish good looks. But he had something even more formidable: a determination to hold himself, and those around him, to an insanely high standard. He asked to be measured by a standard higher than winning and losing in Roman politics, and that’s why he still matters long after ancient Rome went to ruins." #Stoicism

Social

91) Great article summarizing the importance of social ties on overall health and well-being.92) "A much more important barometer of long term health and well-being is the strength of your relationships with family, friends and spouses."93) Why are we becoming more narcissistic?  What is causing it?  How has our society changed to let this happen?  This article answers many of these questions.94) “The latest scientific research shows that making eye contact and interpreting eye movements is paramount to forming strong social bonds.”95) Relationships are a significant indicator of health and happiness

1) Relationships = health: Three times as powerful as exercise.

2) Online relationships don’t count: Don’t substitute Facebook for face-to-face. Use tech to arrange relationships, not replace them.

3) Be part of a community: Be a Sardinian and be engaged with groups of like-minded people who care.

4) Work relationships matter: Take breaks with your friends and give’em a hug.

96) Want better relationships? Study on social anxiety says don’t hide your personal weaknesses.

Diet

97) Great article with 3 easy, concise protocols for intermittent fasting.98) I’m obsessed with coffee.  So I love articles that talk about how good caffeine is for performance.99) Not only are flavored coffee lovers philistines, but they’re also ingesting propylene glycol (used as an airplane de-icing compound).100) "The Learning Gardens provide essential education around food. The industrial food system has encouraged less education because the less you know, the more likely you’re going to eat their food. It’s not even food. We need to come up with a term for it. It’s calories, but it’s not food."101) “Scientists have shown that diet-induced obesity and diabetes can be epigenetically inherited by the offspring via both the oocytes and the sperm.”102) "Children whose parents consume a high-fat diet are more likely to develop obesity and diabetes, according to research published in Nature Genetics" #EpigeneticInheritance103) A great way to educate the public - The ANDI Score

“ANDI stands for "Aggregate Nutrient Density Index," a scoring system that rates foods on a scale from 1 to 1000 based on nutrient content. ANDI scores are calculated by evaluating an extensive range of micronutrients, including vitamins, minerals, phytochemicals and antioxidant capacities.”

104) “Overweight and obese adults who are losing weight with a high-protein diet are more likely to sleep better, according to new research from Purdue University.” #BaconBeforeBed105) DRINK MORE BEER!

“Scientists have been working on harnessing the anti-inflammatory and anticancer properties of beer hops....”

“Along with their purpose of balancing flavors, hops have been known to contain antibacterial and anti-fungal properties”

“Recently, studies have also found that hops may fight dementia: They contain antioxidants that prevent oxidative stress and cognitive decline.”

“One 2014 study argued that a flavonoid supplement found in hops could boost cognitive function. Not to mention all the health benefits that have been associated with drinking beer in general — including a reduced risk of heart attack in women and lowered risk of kidney stones.”

“In the latest study, the researchers note that there are two compounds in hops that are promising from a medical standpoint: humulones, which are alpha acids with anti-inflammatory and anticancer features; and lupulones, beta acids that may also have some healthy properties”

Insulin, Glycemic & Insulin Index

There are many differences between NYC and the South (pizza, BBQ, accents, pace of life, interactions, etc.), but one of the startling differences in in weight.  The South is much more overweight and obese.  This is difficult to be around as a healthcare professional, let alone when it’s your family and friends that are struggling with weight control.  So I’ve started to dig a little deeper into diet and nutrition.  I still am trying to refer many people to Dieticians, but I figured a baseline knowledge of the mechanisms would help.  One of the foundations of diet, nutrition, and weight loss is insulin.  Here’s a few sources that I’ve found.  

106) Insulin Index

107) Glycemic Index & Load

108) Insulin Resistance

109) The amount of sugar our country consumes is a MAJOR problem

110) “Administration of exogenous insulin increases fat mass.   Reducing insulin, by a variety of means, burns fat and spares lean mass.”

111) “Fat blunts the insulin response to meals; even if the additional calories aren’t accounted for.  In the Collier study, 50 grams of carbs (200 kcal) induced more insulin than 50 grams carbs + 50 grams fat (650 kcal).”

112) “There is strong and consistent evidence that a single exercise session can acutely reduce triglycerides and increase high-density lipoprotein (HDL) cholesterol (HDL-C), reduce blood pressure, and improve insulin sensitivity and glucose homeostasis.”

113) “Exercise blunts insulin secretion; meal timing matters...Exercising after the meal nearly cut the insulin spike in half.”

114) “Postprandial walking may be more effective at lowering the glycemic impact of the evening meal in individuals with type 2 diabetes compared with pre-meal or no exercise and may be an effective means to blunt postprandial glycemic excursions.”

Nutrient Timing

115) “The researchers say their findings may explain why people who sleep and eat out of phase with their body clocks are more likely to become overweight and obese and develop chronic diseases, such as diabetes and metabolic syndrome.”

116) “New proposed model, incorporating the circadian regulation of metabolism in adipose tissue:

AM: high muscle insulin sensitivity, low adipose insulin sensitivity; carbs now are OK, and exercise is better (but not necessary, unless goal is muscle growth)…?

PM: insulin sensitivity low in muscle, high in adipose insulin; carb-loading nowrequires exercise to increase muscle insulin sensitivity and offset the high adipose insulin sensitivity by improving nutrient partitioning.”

117) “Exercise blunts insulin secretion; meal timing matters...Exercising after the meal nearly cut the insulin spike in half.”

118) “How the “energy in” is handled is critically important.  With regard to an energy excess, dessert before bedtime is stored as fat but the same amount of calories from protein before exercise are invested into muscle.”

119) “Any protein is better than no protein (C & H, 2006), and protein immediately after is superior to 2 hours later (Esmark, 2001; Tipton, 2001).  I am proposing that protein prior to exercise is superior to protein after after.”

120) “eat more when the tissue-specific circadian regulation of insulin sensitivity is high in muscle and low in adipose = earlier in the day”

121) “These data suggest that the daily addition of a breakfast, particularly one rich in protein, might be an important dietary strategy to reduce food cravings and potentially modulate the underlying substrates that control food hedonics/reward in overweight/obese young people.”

122) “For elite athletes, nutrient timing may provide an important competitive advantage.  However, the current research doesn’t support the importance of nutrient timing for most people who are simply trying to lose weight, gain muscle or improve health.  Instead, focus your efforts on consistency, daily calorie intake, food quality and sustainability.”

It’s important to keep in mind that the obesity epidemic is a complex process that involves psychology, education, society, the microbiome, and health habits.  It’s not as easy as calories in vs. calories out.  It’s not as easy as telling people to stop eating so much.  Instead, we need to have empathy and try to help in whatever ways we can.

Reform the World

I’m reading Robert Pirsig’s Zen and the Art of Motorcycle Maintenance.  It’s a very powerful and useful book in many ways.  Here’s a quote I think everyone should read, especially in the crazy political landscape of our country at this time.

• “I think that if we are going to reform the world, and make it a better place to live in, the way to do it is not with talk about relationships of a political nature, which are inevitably dualistic, full of subjects and objects and their relationship to one another; or with programs full of things for other people to do.  I think that kind of approach starts it at the end and presumes the end is the beginning.  Programs of a political nature are important end products of social quality that can be effective only if the underlying structure of social values is right.  The social values are right only if the individual values are right.  The place to improve the world is first in one’s own heart and head and hands, and then work outward from there.”

--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.

 [subscribe2]