Fall Hits 2016: Psychology, Neuroscience, & Pain

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• “Nothing is either good nor bad but thinking makes it so.” -Shakespeare

Psychology, Mental Health, Mind Training

1) Buy a djembe and drum up some good vibes.. “When viewed holistically, communal drumming creates a physical and emotional experience of belonging that addresses one of the core psychological components of depression: feelings of isolation, alienation, invisibility and worthlessness.”2) “What people are paying attention to doesn't just reveal who they are... it makes them who they are in that moment”' -Robert Cialdini3) Your narrative identity is important.  Is your life a contamination story?  Or a redemption story?4) Dropping forms. “Well, consistency is good, right? Only to the degree that we want to be who we have been.”5) A different kind of medication - “A single dose of psilocybin, the active ingredient of magic mushrooms, can lift the anxiety and depression experienced by people with advanced cancer for six months or even longer, two new studies show.”6) Sleep and the circadian cycle continues to show its importance in research.  This latest research shows how disrupting the circadian cycle can lead to “helplessness, behavioral despair, and anxiety-like behavior”7) Looking at trees decreases your stress more than looking at buildings #GetOutside 8) Want to soothe your cognitive dissonance (both conscious and unconscious)?  Put on some music.  “Thus, because we constantly grapple with cognitive dissonances, we created music, in part, to help us tolerate – and overcome – them.”9) It’s a dynamic system.  It’s all connected.  “increased levels of inflammatory cytokines are associated with increased rates of depression and psychosis, and that treatment to reduce cytokine levels can reduce symptoms of depression”10) Marvin Minsky on why our brain doesn’t separate emotion and thinking.  It’s all emotional states.  And emotional states bias thinking.  “The word beautiful means I’m in a state where I can’t see all the flaws in it.”11) A crime-plagued McDonald’s in Dallas started playing classical music.  Their crime rates dropped dramatically.  Environment matters.12) The body-mind connection is real.  Here’s a classic study to support it “In study 1, participants who briefly held a cup of hot (versus iced) coffee judged a target person as having a “warmer” personality (generous, caring); in study 2, participants holding a hot (versus cold) therapeutic pad were more likely to choose a gift for a friend instead of for themselves.”13) We need physical contact for our well-being.  “The answer is that interpersonal touch is a crucial form of social glue.”14) People are apart of your enviornment too.  “Partners of people with depression are more likely to suffer from chronic pain, research has found.”15) “Most of the bad feelings you have are caused by irrational beliefs.  Next time you’re feeling negative emotions, don’t focus on the event that you think “caused” them. Ask yourself what belief you hold about that event. And then ask yourself if it’s rational”16) Intermittent fasting continues to gain momentum...skip breakfast to decrease depression. 17) 3 Things That Successful Cultures Share: 1) Good People 2) Dedication to Improvement 3) Social Facilitation

“uses social facilitation to foster an environment of continuous improvement and accountability to the team”

18) Writing your story is good for your mental health - “Professor James Pennebaker has shown that just 20 minutes of writing your story for 4 days has the power to dramatically improve your life. It helps people overcome anxiety, tragedy and heartache. Those who wrote about their problems felt happier, slept better, and even got better grades.”

Neuroscience

19) Cortical representation is interesting. These researchers are asking better questions: “That we found no relationship between S1 representation and the duration of CRPS signs and symptoms is intriguing and raises some novel possibilities: is the difference in S1 representation between hemispheres pre-morbid and does it reflect a vulnerability to CRPS onset? Or might the difference between hemispheres arise early on in the disease, for instance soon after injury or during immobilisation?”20) Now we can tell our significant others that it’s for an altered state of consciousness -“rhythmic sexual stimulation - if intense enough and if it lasts long enough - can boost neural oscillations at correlating frequencies, a process called "neural entrainment."

Pain

21) This is some good shit.  “Swearing can add emotion and colour to a description, salience to a statement or be used as a means of acceptance – the willingness to break a cultural taboo in front of others creates an atmosphere of informality and a sense of community. Swearing can also act as a cathartic means to cope with pain.”22) Reorganize your pain neurotag:

1) Explore/Find safe movement

2) Go for a walk outside #justamemory

23) “Age, anxiety, catastrophizing and insomnia associated with MSK pain severity” -Derek Griffin24) “Optimism decreased the negative influence of pain catastrophizing on shoulder function, but not pain intensity.” #BePositive25) This is one of the better pain articles I’ve read in awhile - “It is important to clarify here that although we talk about the mind, thinking and emotions in relation to pain, the actual experience of pain emerges in the person and is felt in the body or the space in which the body should reside (for many biological reasons). The notion that pain is in the brain or in the head is nonsense. And, we are more than a brain.”26) This is a great article on Dr. Sarno with plenty of links regarding pain science and the biopsychosocial influence.

 “Furthermore, Dr. Sarno also began to see associations between emotional distress, early life adversity, and certain personality profiles (notably perfectionism and the need to please) and the onset of back pain and other so-called functional syndromes, such as headaches and irritable bowel syndrome. And most importantly, he found that when a patient is diagnosed with having a psychosomatic illness and given a clear understanding of that process, many people have dramatic resolutions of their symptoms, even if they were of a long-standing nature.”...”Over time, a few other physicians and therapists began using Dr. Sarno’s methods and they had equally impressive results. Research studies came out showing that most people with chronic back pain do not have a clearly defined medical explanation and that MRIs are abnormal in the majority of adults who do not have back pain. Studies of surgery for back pain have not shown better results than non-surgical interventions. Injections for back pain have not been shown to be better than placebo injections. Studies of brainimaging show that physical pain and emotional pain are equivalent and that emotionally laden regions of the brain (rather than somatosensory areas) are activated in chronic back pain. And emerging research shows that psychological interventions that target emotionsare showing significant results.”

27) How do you adapt to millions of years of harsh and painful conditions?  Evolve the ability to dim sensory perception to modulate pain.  “Evolutionary tweaks to the amino acids in their pain receptors make naked mole rats extremely insensitive to pain after they are born.”28) Sure, diagnoses and biomechanical talk can cause fear. But it can also cause ease, understanding, and social belonging. “These results are indicative of social exclusion of patients with pain for which there is no clear medical explanation.”  And remember that loneliness is linked to increased pain...29) +2000 patient study shows that expectations dictate outcomes30) I like using the LANSS questionnaire.  I have my patients with signs and symptoms of central sensitization fill it out.  It helps them understand that what they’re feeling is normal.  It helps them feel that others have these symptoms too.  See #2831) “Insomnia and short sleep duration are risk factors for developing chronic pain” -Mary O’Keefe32) People always like videoshttps://www.youtube.com/watch?v=NvrhBF4RHlo

Opioids

33) Regarding Opioid Induced Hyperalgesia, “Your biology fights back and says, ‘I’m blindfolded to pain by all these chemicals. I need to be able to sense pain again.” -Martin Angst34) But let’s not throw the baby out with the bathwater…”There is no question that in many cases opioids have been used inappropriately (prescribed too much or too little, given at too high or too low of a dose) for many individuals suffering with pain. But, it is also a very effective drug for many people in pain. Opioids help reduce acute nociception and can potentially reduce the risk of developing chronic pain for those in the more acute phase. They can also be an effective part of a comprehensive chronic pain treatment for some. My hope is that those of us in the physical therapy profession educate ourselves properly and understand how to talk to our patients about the use of opioids, because they will ask us.”-Korzy Zimmer35) It's an epidemic 36) Ask your patients if they take any pain medication.  Educate them on how to use medicine after surgeries and injuries.  Be a responsible provider.

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

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Fall Hits 2016: General Healthcare

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 1) Environment matters. Want to know more about your patient's environment? Look at their significant other. "Doctors tend to treat people as individuals, guided by the need to ensure patient confidentiality. But knowing about one partner's health can provide key clues about the other's. For instance, signs of muscle weakening or kidney trouble in one may indicate similar problems for the other."2) Another reason why you need to work on your aerobic fitness “new research suggests that fitness, not physical activity alone, plays a protective role in guarding the body against risk factors for heart disease and other conditions.”  3) I think it was Joe LaVacca that said something like, “if left unresolved, your knee pain will become heart disease”.  This study shows he’s right.  “Not only are people older than 40 years who report a history of knee or ankle injury more likely than their uninjured counterparts to have osteoarthritis (OA), they are also more likely to have a cardio­vascular or respiratory disease, the researchers found.”4) Opioid Induced Hyperalgesia (OIA) - “At high doses, opioid painkillers actually seem to amplify pain by changing signaling in the central nervous system, making the body generally more sensitive to painful stimuli.”5) “A study by researchers at UCLA’s Semel Institute for Neuroscience and Human Behavior has found that a healthy diet, regular physical activity and a normal body mass index can reduce the incidence of protein build-ups that are associated with the onset of Alzheimer’s disease.”6) The continuing decline of American health - “the life expectancy for 65-year-olds is now six months shorter than in last year’s actuarial study”7) Mesothelioma is a life-threatening, terminally ill disease caused by exposure to asbestos and those who suffer from this disease could possibly use the dedication, commitment, and resources that this website site provides.8) Lose weight to save our future.  “In addition to immediate implications for pregnancy complications, increasing evidence implicates maternal obesity as a major determinant of offspring health during childhood and later adult life. “9) Longevity and healthy lifestyle is more than just diet and exercise.  It’s stress management, social support, and helping others. 

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

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Late Summer Hits 2016: Other Good Stuff

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• "You can get help from teachters, but you are going to have to learn a lot by yourself, sitting alone in a room." -Dr. Seus

1. “Choosing a partner is choosing a set of problems.” -Eric Barker with a great post on relationships2. Plato’s Allegory of the Cave. 3. How to Make Good Decisions

“Spend less time trying to amass all the information and more time better defining the problem so you can find the right information.”

“For simple decisions without many factors involved (What soda should I buy?) be rational.  For very complex or weighty decisions (Am I in love?) trust your gut.”

“A new study from researchers at Rice University, George Mason University and Boston College suggests you should trust your gut — but only if you’re an expert”

“A good decision now is better than a perfect decision in two days”

Take the “outside perspective”

4. Louie CK’s 10 Rules for Success5. This is fascinating.   Fire ants and their dynamic system6. Try something new for 30 days: you can do anything for 30 days, it slows the perception of time down, small changes are sustainable, it makes you a more versatile person, it’s good for your brain, 7. “The best shape for a fire is one that’s as tall as it is wide.”

Sleep

8. Improve Your Sleep

-Get more bright light during the day

-Reduce Blue Light at Night (screens)

-No caffeine 8 hours before bedtime

-Reduce irregular naps

-Wake up and go to bed at the same

-Use melatonin (or other supplements)

-Avoid alcohol

-Make your bedroom perfect for sleep (cold, dark, white noise, etc.)

-Don’t eat late at night

-Relax before bed (use pre-sleep routine, read, hobby, bath, meditation, etc.)

-Invest in a good mattress, pillow, covers - it’s worth it

-Exercise regularly, but not before bed

-Don’t drink any liquid before bedtime

-Rule out a sleep disorder from a trained professional (google doesn’t count)

9. “22 hours without sleeping has been shown to cause cognitive and reactive impairment comparable to being legally drunk”10. Go to sleep and wake up at the same time, for your low back’s health - “These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.”11. “A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects.”

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

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Late Summer Hits 2016: Diet

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• "The sensation of comfort can be maintained only in relation to the sensation of discomfort" -Alan Watts

1. “iron carries oxygen and is the backbone of nearly every neurotransmitter inside your skull” -Ben House2. A very thorough and well researched review of dietary fat from Vox.    3. Why we’re fat:

we’re eating out more, portion sizes have increased, we drink a lot of sugar, healthier foods cost more, our vegetables are mainly potatoes, too many of our meals are like dessert, we’re bombarded with ads for unhealthy foods

4. Rehydration Index - here's the bar chart. Interesting stuff.  5. “Study: higher intakes of berries → ↓rate of cognitive decline in older adults”6. Fat infiltration into weak dysfunctional muscles is a common physiological change. Should we start to consider diet’s role in this as well? “Diabetes creates a high glucose environment that not only results in peripheral neuropathy, but also causes adipose stem cells to differentiate into adipose cells, which migrate into muscle tissue, according to several studies”7. “research shows taking MCT oil before drinking alcohol can help protect the liver against membrane oxidation”8. “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. Over time, excess blood glucose can result in increased body fat, weight gain and a higher risk for diabetes.”9. “Now, for the first time, Cornell University researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.”10. This is terrible news “The study, published in the scientific journal Addiction, concludes that there is more than simply a link or statistical association between alcohol and cancer that could be explained by something else. There is now enough credible evidence to say conclusively that drinking is a direct cause of the disease, according to Jennie Connor, of the preventive and social medicine department at Otago University in New Zealand.”11. Authority Nutrition shares 20 science backed ways to lose belly fat:

eat soluble fiber, avoid foods that contain trans fats, don’t drink too much alcohol, eat a high-protein diet, reduce your stress levels, avoid sugary foods, do aerobic exercise, cut back on carbs (especially refined carbs), replace cooking fats with coconut oil, do resistance training (build strength), avoid sugar sweetened beverages, get plenty of sleep (at least 7 hours a night), track your food intake and exercise, eat fatty fish every week, stop drinking fruit juice, add apple cider vinegar to your diet, eat probiotic foods, try intermittent fasting, drink green tea, change your lifestyle

12. 14 ways to lower your insulin levels. Great read for some solid diet advice. 13. “Breakfast: bacon, eggs, & coffee >>> cereal, toast, & fruit juice (P<0.05)” -Bill Lagakos14. Interesting food pyramids from other countries15. “Vitamin D2 was found to be ineffective at impacting muscle strength in both studies wherein it was administered. In contrast, vitamin D3 was shown to have a positive impact on muscle strength”16. Want a better life? Try living one. Eating healthy leads to improved health in other areas, such as mental health. “The researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and veg a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment”. It's all connected. #Variables 17. Checking your bone health may be the same as checking your gut health - “The human microbiome has been shown to influence a number of chronic conditions associated with impaired bone mass and bone quality, including obesity, diabetes, and inflammatory bowel disease.”

Sugar

18. Eating a healthy diet can be complex (nutrient timing, vegetables, types of carbs/fats, protien intake, processed foods, microbiome, etc.).  But it can also be simple - EAT LESS SUGAR.  If we want to improve our nation’s health and stop the obesity epidemic we need to convince our society to stop eating so much sugar.  It is by far the single worst ingredient in one’s diet.19. “When the low-fat guidelines first came out, food manufacturers removed the fat from foods but added a whole bunch of sugar instead.”20. “People are getting a lot of sugar from conventional foods, without even realizing it. Many of these processed, high-sugar foods are endorsed by health organizations like the Australian Heart Foundation.”21. “Overall, sugary soft drinks (and fruit juices) are probably the unhealthiest and most fattening aspects of the modern diet, by far.”22. Dr. Lustig lays down the law on Sugar23. “The sugar industry paid scientists in the 1960s to play down the link between sugar and heart disease and promote saturated fat as the culprit instead, newly released historical documents show.”24. We need to start calling breakfast what it really is...dessert. 25. Here’s a layman's infographic on sugar26. 18 Foods/Drinks that are high in sugar:

low-fat yogurt, bbq sauce, ketchup, fruit juice, spaghetti sauce, sports drinks, chocolate milk, granola, flavored coffees, iced tea, protein bars, vitamin water, pre-made soups, cereal bars, canned fruit, canned bake beans, bottled smoothies, breakfast cereal

27. “Obese children who cut sugar from their diets saw improvements in markers of heart disease after just nine days, a study in Atherosclerosis found.”28. 8 ways food companies hide the sugar content of foods:

calling sugar by a different name, using many different types of sugar, adding sugar to foods you’d least expect it, using healthy sugars instead of sucrose, combining added sugars with natural sugars, adding health claims to products, having a high number of servings per pack, making sweet versions of a low-sugar brand

29.  Addiction is an unhealthy behavior...regardless of what substance it isCocaine = Addictive + Harmful = IllegalSugar = Addictive + Harmful = Legal(source)https://www.youtube.com/watch?v=31IDxvpI-L0

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

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Late Summer Hits 2016: Social & Communication

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• “If you want to be interesting, you have to be interested.”

1) “The authors examined whether facial expressions of emotion would predict changes in heart function… Those participants who exhibited ischemia showed significantly more anger expressions and nonenjoyment smiles than nonischemics.”-Eric Barker with 4 ways to improve your body language2) Proxemics and personal interactions - very interesting3) Want to give a better speech? Practice in front of your dog “Addressing a friendly and nonjudgmental canine can lower blood pressure, decrease stress and elevate mood — perfect for practicing your speech or team presentation.”4) The 3 Most Powerful Words5) “researchers at the University of Virginia School of Medicine have determined that the immune system directly affects – and even controls – creatures’ social behavior, such as their desire to interact with others….The relationship between people and pathogens, the researchers suggest, could have directly affected the development of our social behavior, allowing us to engage in the social interactions necessary for the survival of the species while developing ways for our immune systems to protect us from the diseases that accompany those interactions.”6) “Google sought out to make the most efficient teams by studying their employees. Named 'Project Aristotle' the research found Psychological Safety to be the most important factor in a successful team. That is an ability to take risk without fear of judgement from peers.” (source)7) “MIT found that the outcome of negotiations could be predicted by body language alone 87% of the time.”  Read this great article by Eric Barker with 5 tips to improve your read on people8) “A study from researchers at the University of Michigan found that couples in which both parties drink reported slightly better marriages than couples where one person drinks and the other does not.”9) “That’s why, as productivity writer Seth Godin points out, evidence isn’t the only thing you need to change the minds of those around you. You also need empathy so you can see where they’re coming from, and persistence to keep the conversation going even when it feels like you should just give up.”10) “The Danes’ highly developed sense of empathy is one of the main reasons that Denmark is consistently voted one of the happiest countries in the world (this year it is once again number one). Empathy plays a key role in improving our social connections, which is a major factor in our overall happiness.  What many don’t realize is that empathy is a learned skill that many of us miss out on in America. In fact, some studies show empathy levels have dropped up to 40 percent in the U.S. in the last 30 years, while narcissism is on the steady rise.”11) Quick Book Review - Made to Stick by Chip & Dan Heath

Seth Oberst recommended this book to me.  It’s right up there with Dale Carnegie’s classic, How to make friends and influence people.  Made to Stick offers great strategies to simply...make what you say stick.  

As a PT I found this very applicable in regards to patient communication.  One of the biggest struggles for me as a PT is changing patient's beliefs and teaching important complex concepts.  This book left me with some great strategies to improve this ability.  

Below is a chart I made about the book.  Unlike the book, I selfishly made it about the concepts I enjoyed from the book, rather than making it simple for everyone.  Sorry.

 

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

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Late Summer Hits 2016: Training / Strength & Conditioning

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• “Once you understand the feeling and purpose of a position, change one thing..... then change one more.” -Christine Ruffolo

1. The squat is not the same as a deadlift.  The tibia should go forward (if you have ankle dorsiflexion).  Mike Robertson even cues knees first at times for this reason.2. Mike Robertson’s 5 least favorite training cues3. How to prevent choking: practice under pressure, self-disctraction, don’t dilly-dally, express your emotions before you start. For a better understanding check out my Coaching & Cueing series.4. When done correctly, the push-up is an incredibly difficult exercise that works the whole body.  If you’re only feeling your arms or chest, you should read this article from GMB.5. Some nice training pearls from Eric Cressey - single leg training is important, but if you want maximal strength you need double leg training (squats, deadlift), teach people that the deadlift pattern is a push not a pull. 6. Eric Barker teaches us how to become motivated to exercise

Don’t focus on the beginning, think about how good you’ll feel progressing towards your goals

Make a plan and write it down, and plan for obstacles ("if-then" implementation intentions)

Make it a game

Use music

7. A difficult, but important concept to intrinsically understand - going backwards can be just as satisfying as going forward.  Christine Ruffolo expands on this concept in this great post - “Making something novel isn’t the same as revealing something novel.  I don’t think anything can be invented that wasn’t here already.  The perspective and introspective journey is what’s different.  It’s what you can claim as your own and be proud of.  The passage from question to answer to another question is where confidence grows, because the dialogue is all internal.”8. “Coaches: I don't care how well you coach pros. They're already good. Show me what you can teach someone with a family and a job.” -GMBFitness9. This will cause some controversy as it doesn't match up with many accepted beliefs on strength - “New research is challenging traditional workout wisdom, suggesting that lifting lighter weights many times is as efficient as lifting heavy weights for fewer repetitions.”10. Good cue - “foam roll one inch per second”11. 5 solid fitness industry advice from Eric Cressey12. The key to reducing muscle cramps is in the mouth-to-mind-to-muscle connection?13. Dean Somerset goes over the layering approach, also known as chunking, for teaching complex movements.14. Mike Robertson has a great article that reviews some of the basic conditioning concepts championed by Joel Jameson.  

“Lactic training and aerobic training work against each other. Quite simply, the better you get at lactic training, the less aerobic you become.  Lactic training is not sport-specific. While a basketball player will tap into the lactic system from time-to-time, it’s not the most prevalent energy system used. Instead, basketball tends to be a blend of alactic (explosive work) paired with aerobic (lower-intensity) demands.”

15. Velocity Based Training - “would have your athletes perform sets of dynamic effort squats at 0.8 m/s instead of at 55 percent”16. Eric Cressey reminds us how important relative stiffness is, tells us to work the serratus to improve hyperextended elbows, and job advice - become a hip surgeon.17. Mike Robertson shares a nice post on Alternating Function - “tri-planar in nature and connects the upper and lower extremities.  I like to think of alternating function in two ways:

The ability to separate or perform opposing patterns between the same side hip and shoulder. Example: Internally rotating the right hip while externally rotating the right shoulder.

The ability to coordinate movement patterns between opposite hip and shoulder.Example: Externally rotating the right shoulder and left hip, while internally rotating the left shoulder and right hip.”

18. Cue thorax rotation from the sternum19. “The researchers concluded that these results indicate that “force vector” is a key factor determining the extent to which exercises transfer to sports performance. The front squat has a vertical force vector, and transfers well to athletic activities with a vertical force vector, like the vertical jump. In contrast, the hip thrust has a horizontal force vector, and transfers well to as athletic activities with a horizontal force vector, such as sprint running. This places “force vector” among other important factors that affect exercise transfer to sprinting, like velocity, and muscle group emphasis.”20. Use the full ROM for hypertrophy - “elbow flexion exercise with full ROM seems to induce greater muscle damage than partial ROM exercises, even though higher absolute load was achieved with partial ROM.”21. “The researchers concluded that training with heavy, mixed or light loads produces similar gains in muscular size, but only training with heavy loads produces meaningful gains in strength and RFD.”22. Miguel Aragoncillo’s Bag of Tricks: Half Kneeling using an external band to help someone create internal reference points for a wedge23. GMB has a nice review of periodization. I really like the graph in this post (below).

Exercise, Movement, & Techniques

24. I really like this side plank correction from Lori of PRI. 25. Stealing from yoga is always a good idea.  Here is a YogaFlow with the intention of improving thoracic rotation.27. This is a little aggressive for most of my clientele, but a nice way to add a valgus knee moment RNT. #TrainInjuryPositions 28. 15 ways to improve your vestibular system (and why you need to).29. I like this cue for wall lift offs30. Lateral lunge, rotation, and high plank flow. 31. This may be the best vestibular exercise (you won’t regret watching this one). 32. Extended Clamshell from Christine Ruffolo is a great exercise you can use tomorrow.  Plus, she reminds us to work on the ability to dissociate hip ER from hip abduction.33. One of the best rotational core exercises I've seen. Combines agility, footwork, and proximal stability. 34. Craig Liebenson is on Instagram and it's awesome.35. 3 closed chain lower trap exercises from Dan Pope36. I like these closed chain horizontal overhead wall push variations (rhythmic stabilization)37. This is a great SLDL corrective from Ruffolo38. Here's a ton of open book variations.  Fit the right one to the right client.39. Mike Robertson teaches the crossover step up.  A nice way to add more planes of motion into the step up.40. Deficit lunges are a nice bridge between traditional lunges and pistol squats. 41. Christine Ruffolo shows you how to go from no hip IR to lots of hip IR, plus this nice tip “Drive the calves down against the ground for your abs to reflexively hold you up.  You should feel the oblique of the lead leg light up as you force rotation.”42. Downdog

Push-up to Downdog

Downdog, high plank, elbow plank

Downdog Flow

Downcatcameldog

Downdog, crab, sideplank

Seated 90-90

Andreo Spina started a wildfire when he re-created the seated 90-90 position within his FRC system.  With his system’s principles and open minded practitioners, this position has boomed and become an ideal canvas to explore movement and create mobility.43. Double IR from Christine Ruffolo44. Joe LaVacca displays the seated 90/90 ER/IR Hover45. Craig Liebenson adds a med ball toss to the 90/90 position46. PRI has an exercise in this position (intentions are different than the FRC system). This can do wonders to improve R rotation (among other things). 47. For my patient population, the vertical trunk 90-90 IR hip mobilization is a little too much.  Most of them don’t have that type of hip abduction/IR mobility.  They’ll compensate with too much spinal torque.  So I’ve found this variation more accessible for the novice or impaired movers.  Think acetabulum and lower lumber spine.48. Liebenson reminds us how load can change movement patterns49. Ryan Faer shows how you can mobilize the upper extremity too with this seated 90-90 posterior sling mobility50. Master FRCer, Dewey Nielson, shares some of his 90-90 variations51. You could call this a biceps femoris mobilization, or maybe a posterolateral chain mobilization, or maybe a sciatic nerve mobilization.  Or maybe you should just consider it a movement exploration...52. Sometimes I like to finish my 90-90 work with this alternating roll.53. 90-90 Hip Abduction from Kate Galliet54. Seated 90-90 Hip IR to Hip Flexion from Dean Somerset55. Christine Ruffolo shows us that you don’t always have to be seated...supine wall, half-kneeling/standing transition, 3-D chair, extended hip, lever change

Exercise of the Month

This is a great "thoracic mobility" exercise.  It helps to expand the posterior thorax tissues, improves anterior opposition, and achieves a more neutral position (PRI).You can use this to destory flat thoracic spines, decrease paraspinal muscle tone, improve hip positioning, increase scapula protraction, balance breathing, increase ankle dorsiflexion, and/or accelerate recovery.I like to elevate the heels in most of my patients (and myself sometimes) since they don't have the best mobility.  It also allows them to keep a low-threshold movement pattern and prevents the high-tension patterns that a counter-weight may induce.https://www.youtube.com/watch?v=f0E0HnG6vkE

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

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Late Summer Hits 2016: Psychology, Neuroscience, & Pain

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• "Perception and perspective are often the fundamental difference that control human behavior and the quality of our lives" -Tony Robbins

Psychology, Mental Health, Mind Training

1. “In the midst of the widespread support and criticism of psychoanalysis there has been significant progress in its use as a valid approach to treatment. If for no other reason than to gain an important historical perspective on mental health treatment Freud’s psychoanalytical theory is worthy of study.”2. Fake it till you make it.  “People using self-talk, for example telling yourself “I can do better next time” – performed better than the control group in every portion of the task.”3. Curiosity - the bias killer.  “Neither intelligence nor education can stop you from forming prejudiced opinions – but an inquisitive attitude may help you make wiser judgements.”  Maybe we should focus on the questions and creating the curiosity/knowledge gap?4. A study confirming why the practice of letting things go and being in the here and now can help improve mental health and well being.  “A 2016 study published in Clinical Psychological Science utilized transdiagnostic theory to reveal that rumination, the act of obsessing on negative experiences, is correlated with a host of psychological conditions.”6. Great review of stress and its variables from the King’s College London - ““It should be noted that active coping strategies, humor, hardiness, and extraversion can promote resilience through fostering feelings of mastery, commitment, and competence as well as the ability to help others through bonding. Importantly, the propensity of resilient individuals to express positive emotions, in relation to negative events, enables them to control their anxiety and fears.”7. “Panic attacks occur when we treat our difficult feelings as the enemy, doing everything we can to deny them until they fairly scream for our attention. Hayes isn’t suggesting you can solve your issues just by admitting them, but that by “holding” them you treat anxieties as signals of things that are bothering you, the same way physical pain tells you to remove your hand from a hot burner. And by looking at your anxieties, you let out enough of the hidden pressure they generate to keep them from overwhelming you.”8. Environment matters. “children who grew up in poverty are more likely to develop depression rather than those who grew up in wealthier environments9. 2 Common Beliefs Linked to Anxiety:

1) The worst is likely to happen

2) I can’t handle it

Change these beliefs and you may be able to decrease the levels of anxiety

10. A walk to remember

“The results of the study showed the happier the students ‘walked’, the fewer negative words they recalled. Another interesting point is that these findings were not influenced by the participants’ emotional state”

”For instance, in the future, if changes in walking style are found to influence cognitive processes in a sample of people with depression; walking as an exercise may be prescribed not only in terms of its intensity, but also in terms of its style. Meaning that, a happier walking pattern may be used to facilitate a positive change in what people with depression remember. Potentially, breaking a negative cognitive-affective cycle.”

11. Your body is your emotional container12. Pokemon Go helps with depression - “We already know that exercise helps greatly with depression (along with virtually every other mental health problem), but being motivated to exercise when you’re depressed is a challenge. That’s why an engaging game like Pokémon Go can be helpful.”13. Also, studies show exercising outside is better for people with depression.14. “It was discovered that outdoor activity appears to have a significantly improved effect on certain symptoms of depression when compared to the indoor alternative.”15. Very interesting Buddhist philosophy / newly researched concept. “Researchers have examined how the heart and brain communicate with each other and how that affects our consciousness and the way in which we perceive our world. For example, when a person is feeling really positive emotions like gratitude, love, or appreciation, the heart beats out a certain message. Because the heart beats out the largest electromagnetic field produced in the body, researchers are able to gather significant data from it.”16. Social comparison and social media can be poison for one’s mental health.  “A new equation, showing how our happiness depends not only on what happens to us but also how this compares to other people, has been developed by UCL researchers”17. Feeling stressed?  Try being creative.  “Stress-related hormone cortisol lowers significantly after just 45 minutes of art creation”18. Inflammation & Depression - “The new test measures two inflammation biomarkers in the blood shown in previous studies to be linked to a poor response to antidepressants.”19. A quick and easy infographic on how successful people deal with stress.  

Neuroscience

20. Want time to slow down? Try some new experiences - “Our brain encodes new experiences, but not familiar ones, into memory, and our retrospective judgment of time is based on how many new memories we create over a certain period. In other words, the more new memories we build on a weekend getaway, the longer that trip will seem in hindsight.”21. The importance of environment has gained more attention recently. Here, James Clear, discusses why it may be more important than motivation. 22. And here's a study showing music (environment) can make beer taste better. 23. “Neural representations and the cortical body matrix: implications for sports medicine and future directions”  For those that don’t have access to the full article, read this one to understand more on body cortical representation.24. A great summary of the latest research on the mind-body-stress connection.

“Another surprising result was that motor areas in the cerebral cortex, involved in the planning and performance of movement, provide a substantial input to the adrenal medulla. One of these areas is a portion of the primary motor cortex that is concerned with the control of axial body movement and posture. This input to the adrenal medulla may explain why core body exercises are so helpful in modulating responses to stress. Calming practices such as Pilates, yoga, tai chi and even dancing in a small space all require proper skeletal alignment, coordination and flexibility.”

25. Want to improve your brain power? Try leaning another language. 26. 5 psychological habits that inhibit your intelligence: brooding/ruminating, unresolved guilt, ineffective complaining, overanalyzing rejection, worrying27. More in the realm of Cognitive Biases: Motivated Reasoning - an emotion-biased decision-making phenomenon that describes the role of motivation in cognitive processes such as decision-making and attitude change in a number of paradigms, such as cognitive dissonance reduction, beliefs, evaluation of evidence.  This is why you want the Scout Mindset.  For more see 51-54 here.28. “The ability to understand and empathize with others’ pain is grounded in cognitive neural processes rather than sensory ones, according to the results of a new study led by University of Colorado Boulder researchers.”29. Quick Book Review - Predictably Irrational with Dan Ariely

Overall a good book with some great take home messages.  There were some new concepts for me: how to create a menu, decoys, anchoring with novel experiences, power of zero, and social vs. marketing norms.  There was also a review of some other common ones: expectations and priming.  But like Daniel Kahnman’s Thinking Fast, Slow, it becomes extremely redundant and the emphasis on the studies methods are exhausting to listen to.  What is it about these behavioral economists that makes them so dry, boring, and redundant?

I still put Mindless Eating and Power of Habit at the top of my list for education on human behavior

Pain

30. Dehydration leads to increased pain sensitivity. 31. Researches found a link between the placebo effect and the immune system. Maybe this is one of the major mechanisms leading to positive outcomes. 32. Pain science experts have contributed a great amount to our field.  However, it’s not ALL in your head (see the last edition on smell).  “researchers at Drexel University College of Medicine are aiming to identify new molecular mechanisms involved in pain. Their latest study, published this month in Epigenetics & Chromatin, shows how one protein — acting as a master controller — can regulate the expression of a large number of genes that modulate pain.”33. “There is evidence of motor cortex disinhibition in chronic pain populations, suggestive of a disruption in GABA-mediated intracortical inhibition”

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  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]

Late Summer Hits 2016: General Healthcare

Click here for this edition's Table of Contents

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• "The sign of a good doctor should be how many patients he can get OFF medications, not how many he puts on."

1. NYTimes writes a story about surgery being no more, if not less, effective than exercise. Yet still being popular. Interesting that they didn't interview a physical therapist in this article. You think that might be apart of the problem?  #GetPT1st2. Addiction is a serious problem in our country.  Know where to get more information - Addiction Resource & ASAM3. The slow catastrophe of antibiotics - “At least 23,000 people die as a direct result of antibiotic-resistant infections, and many more die from other conditions that were complicated by an antibiotic-resistant infection, the agency says.”4. The environment may be playing a bigger role than we thought, “the findings at least raise the possibility that exposure to environmental toxins before birth might change babies’ physiology in ways that affect their interest in exercise throughout their lives”5. If not for you, for your kids.  “A mouse study I wrote about recently suggested, encouragingly, that if a mother exercises during pregnancy, she might increase her offspring’s subsequent interest in working out.”6. Get outside - “People who visit parks for 30 minutes or more each week are much less likely to have high blood pressure or poor mental health than those who don’t, according to new research by Australian and UK environmental scientists.” #Nature #Goulet7. Smoke some pot?  “Salk Institute scientists have found preliminary evidence that tetrahydrocannabinol (THC) and other compounds found in marijuana can promote the cellular removal of amyloid beta, a toxic protein associated with Alzheimer’s disease.”8. “One’s biological age is a far better indicator of their health than their age in years.”9. Buy a water filter. “Millions of Americans may be drinking water with unsafe levels of industrial chemicals, according to a study published Tuesday in the journal Environmental Science & Technology Letters. These chemicals, known as polyfluoroalkyl and perfluoroalkyl substances or PFASs, have been linked to high cholesterol, obesity, hormone suppression -- and even cancer.”10. The end of antibacterial soap. It's a "what doesn't kill you makes you stronger" thing. And in this manner, we've been making some harmful bacteria much stronger.  "Lastly, and most importantly, triclosan and chemicals like it are rarely present in high enough concentrations in consumer products to kill all the bacteria on your skin. At these low concentrations, they instead exert selective pressure on bacteria, allowing them to quickly evolve adaptations—like one cellular mechanism that sucks in triclosan and pumps it right back out, almost like a gag reflex. Add up these adaptations and you get bacterial resistance, which gets passed down genetically, and eventually you get…our future superbug overlords. “You can contribute to sublethal exposure ,” says Aiello, “and then you’ve got a pretty dangerous situation on your hands in terms of changing antibiotic resistance.”11. “Health advocates have long pointed out this seeming contradiction. While the federal government recommends that people fill half their plates with fruits and vegetables to help prevent obesity, only a small fraction of its subsidies actually support the production of fresh produce. The vast majority of agricultural subsidies go instead to commodity crops that are processed into many of the foods that are linked to the obesity crisis.”12. Hiking is the organic food of exercise13. Greed works both ways, not just the insurance companies - “One of the state’s wealthiest healthcare operators [Philip Esformes] was arrested Friday at his Miami Beach waterfront estate on charges of orchestrating the nation’s biggest Medicare fraud scheme — $1 billion.”14. Revolution is not a singular act.  It’s millions of acts towards a common cause.  Here’s an example of an individual taking action to revolutionize our nation’s health.

Christine Ruffolo is a Physical Education teacher changing lives through movement.  As an educator, Christine takes pride and responsibility in improving our nation’s health through movement empowerment.  If all physical educators followed her path, we would see a lot less health problems for our future generations.  

Here’s her Jerry Maguire memo

Here’s an example of some of her teachings

Late Summer Hits 2016: Clinical

Click here for this edition's Table of Contents

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• "Muscles drive the motions, motions drive the joints, joint position drives the CNS." -Charlie Weingroff

1. “If we aren’t physically fit, maybe our environments are perceived as more threatening than they really are so we become more rigid and tense in an effort to protect us from too much movement that could be dangerous. It’s a perceived mismatch between us (our self-image) and our environmental demands. The bigger the gap between what we need to do and what we think we need to do, the more tension and threat we will perceive.” -Seth Oberst and Ben House with an article on autonomics2. “Hypertrophy of the masseter muscle often causes tension type headache.  This review concluded that conservative treatment such as counselling, exercises, occlusal splints, massage and manual therapy are the best way to treat TMDs. ”3. Unless you’re getting paid to play, what’s the rush? “Athletes who wait at least 9 months after an anterior cruciate ligament reconstruction and/or regain quadriceps strength compared with the uninjured limb may be at lower risk for reinjury than those who fail to meet these criteria.”4. It’s changing the expectations, educating on the long term recovery, and teaching tissue remodeling principles - “Metabolic activity evident six months after an Achilles tendon rupture”5. If you’ve been reading this blog you know the importance of isometric contractions to reduce pain.  Here’s another study supporting this empirical finding.  One thing I have found clinically is that it’s important to re-assure the patient that the discomfort they feel from the isometric contraction is okay and is safe.  Sometimes there’s a delay in the pain reduction.6. This doesn’t really fit what I see clinically.  “Subjects with LBP displayed less lower lumbar extension than control subjects during prone extension. These differences should be considered when evaluating and prescribing prone extension”  Maybe the take-home point is that people with LBP have poor motor control and a loss of segmental spinal dissociation that leads to decreased extension?  Maybe it’s high-threshold strategies or guarding against a perceived threat?  Or maybe like the study says, it’s just less motion and poor movement.  Regardless, quadruped cat-camel seems like a safer way to assess this rather than forcing end-range in a painful patient. 7. Christine Ruffolo goes over ankle plantarflexion from an isolated joint ability (CARs) to a full functional use.  Worth the read.  I really like the idea of using an unloaded knee flexion to add some degrees of freedom to the system.8. Eye motion drives neck motion and vice versa.  “This study suggests that people with nonspecific neck pain have an increased COR (cervico-occular reflex)”9. “It looks like high daily activity levels (60-75min) DOES counteract high levels of daily sitting (8 hrs).” -Noah Harrison10. Breathing is pretty important.  Here’s my dissection of it (1 & 2).  Here’s Seth Oberst’s lesson. Here’s Noah Harrison’s monster article on it.11. Sustained Isometrics: go below 30% or above 70% for increased activation. “MMG amplitude (motor unit activation) had a cubic relationship (p=0.001, R2 = 0.94) that increased from 10-30% of the time to exhaustion, then decrease from 40-70% of the time to exhaustion, and then markedly increased from 70% to task failure.”12. It doesn’t always have to be rocket science or novel…”Thus, conservative rehabilitation focusing on rotator cuff and posterior deltoid strengthening may reduce instability recurrence and pain and increase function in PGI (posterior glenoid instability).”13. “For individuals with chronic ankle instability (CAI), the somatosensory feedback necessary for postural adjustments, walking, and running may be hampered by a decrease in soleus spinal reflex excitability, according to a new study in the Journal of Athletic Training.”14. Shoe shape matters. “This study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot.” You wouldn't want your shoulder patient to wear a shirt that pushed their humerus forward...15. This is such a great concept from Michael Mullin - Perceptive MMT. 16. “We all know that a good history can yield some superb differential diagnosis choices. This can only happen in environmentally appropriate silence.  We already know what we know.  Therefore we can keep quiet about it.  We don't know what the patient knows... so we must listen” - -Matt Dancigers17. Functional Hallux Limitus - less than 1/3 of unloaded hallux dorsiflexion18. Cross-over effect of foam rolling - the opposite leg that wasn't foam roller showed improved ROM. #Neurological #DynamicSystem19. Here’s an interview I did on FreePT about my philosophy on patient care, diagnosis, treatments, and other stuff related to physical therapy.20. Michael Mullin shares his advice on sitting position - finding neutral to allow the rib cage to move. Great internal cues in this one. 21. Todd Hargrove with an excellent review of Bosch’s S&C book:

“the intention-action model, which hypothesizes that movements are primarily organized according to their intention, as opposed to the required combinations of joint movements and muscle activations.”

“Repetition and practice is necessary to get better, but if it leads to monotony and reduces motivation, learning will suffer. Variation in training increases motivation and avoids monotony. If the load in strength training is kept low, more variation as possible. Periodization probably works not because of the exact order in which work is done, but in the simple fact that it increases variability and thus motivation.”

22. Do you know where the Fabella is on the human body?23. I love biomechanics.  Here’s another solid one from Chris Beardsey - why are we stronger at some joint angles?

“Bigger muscles have longer moment arm lengths (Vigotsky et al. 2015)”

“some studies have reported that muscle stiffness (as measured by passive resistive torque and not during active contractions) decreases after eccentric training (Mahieu et al. 2008; Kay et al. 2016)”

“the research that has reported differences divides roughly into those studies that have reported greater neural drive at short muscle lengths, and those that have found greater neural drive at long muscle lengths. In reality, both may occur, with a peak at either end and a trough at the optimum length (Altenburg et al. 2009).”

24. Charlie Weingroff’s Lowest System Load and why swinging a kettlebell may be a safer choice than deadlocking a barbell - “What is clear is manipulating the A in F=MA can lead to significantly increased Force with signficantly less Mass.  This is a higher return on training investment.”. 25. “We tend to assume that people’s movement behaviors are driven by internal states of the mind, or the fitness of the body, or personal preferences, or discipline, or intentions. All these factors certainly matter, but in some cases, the environment is the most powerful determinant.” - Todd Hargrove with a nice short post on bike riding and how the environment effects us26. Red Flags?  Pancoast Tumor?27. Seth Oberst shares a great post on how it’s important to have options, because when we don’t, we can perceive it as a threat - “Anxiety and physical tension are often the manifestations of being in a reactive state that is deprived of choice.”  He offers a potential solution - being able to reverse your movements (not letting yourself go beyond the point of no return).28. Sian with a nice post on the TFL. I like the closed chain pure hip ER exercise.29. Doug Kechijian reviews SFMA, PRI, & FRC from a clinician's perspective. If you haven't heard of any of these approaches I highly recommend checking this series out. 30. Erson shares a Positional Inhibition technique for the rhomboids31. “Reducing the Time Between Concussion and Exercise Restores Motor Impairment, Short-t Memory,and Alt Gene Expression”32. I loved this article integrating the pelvic floor training with ortho patients: “Getting back body diaphragm expansion while holding a side plank will change your patient’s world.  Start with sideplanks from an elevated surface, then advance to the floor, then finally add a balloon.”  This is some great coaching for the rotational lunge.33. Good advice from Seth Oberst - “feeling is understanding”34. Eric Cressey goes over why shoulders respond better than the lower extremity (ZOA and patterning). Sometimes the best intervention is the correction of the failed assessment. 35. I always learn more everytime I look at anatomy.  Here’s some picture of the lateral knee I’ve been meditating on recently (1, 2, 3, 4, 5)36. “30.4% of subjects (285) had severe central stenosis but only 17.5% (50) had symptoms” #painiscomplex #TreatTheManNotTheScan 37. A hilarious title and a nice review of disc herniations from Sian.

“The probability of a spontaneous regression was:

96% for disc sequestrations.

70% for disc extrusions.

41% for focal protrusions.

13% for disc bulges.”

38. It’d be nice to have the full article - Underlying mechanisms of neuro-fascial body interactions39. Maybe the hamstring is an important muscle?  “Hamstring strength asymmetry 3 yrs after H-graft ACLR associated with altered knee mechanics during gait, jogging.”40. “Finding the position in which a move is most difficult emphasizes any gaps you may have overlooked.” -Ruffolo with a great post on hamstrings and knee mechanics. I love her integrative perspective on hamstring function (relation to dorsiflexion, use for pulling into hip flexion, ect.). 41. It's often not tight hamstrings. It's often neurodynamics. Try this one next time someone is asking for a “hamstring stretch”. 42. Mechanotransduction is probably the most important concept for movement professionals to understand - "Cells only have two 'senses' to interact with their environment," Wang said. "They cannot see or hear, but they can 'feel' mechanical forces and 'taste' chemical signals. Many studies have detailed chemical-signaling pathways, but it's important to understand how the mechanical forces affect the cell as well. Mechanical signaling is as important as chemical signaling, and this study shows it's a direct pathway."43. Mechanotransduction will always be a primary principle of health and movement(image source)

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 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]