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2017 Hits : Vol. 1 : Clinical - Movement Meditations

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Movement Meditations

  • "We get resourcefulness from having many resources. Not from having one very smart one." -Marvin Minsky

Meditation can scare people.  I think it’s because most people don’t really know what it is.  They think it’s a medium that turns people into monks.  Or they think it’s simply the act of having no thoughts.  These two ideas couldn’t be further from the truth (no pun intended).  In broad terms, meditation is the practice of quieting the mind and improving awareness.In the realm of movement and physical therapy, meditation can have powerful effects to reduce sympathetic drive, decrease tension, decrease stress, enhanced immune function, and improve interoceptive awareness.  In the realm of health and quality of life, meditation can lead to improved working memory, less emotional reactivity, decrease biases, increased focus, relationship satisfaction, enhanced self-insight, and improved brain function (among other things).I usually advise patients to start with a simple 5 minute breathing meditation.  But thanks to Seth Oberst, I now have another resource.  Seth has created a series of movement-based meditations.  Right now he has 4 meditations - grounding the feet, visual relaxation, trusting the legs, and weightless shoulders.  I think they’re all valuable, but I find it useful to have specific mindful practices for certain patients.  It provides an entry point to meditation and mindfulness that directly correlates with the reason they’re in the clinic.  For example, I’ll prescribe the vision meditation for my chronic neck pain patient that is anxious, stressed out, stuck in high-threshold patterns with limited ROM, and can’t stop the ruminations (see #1 & #2 here if you’re still skeptical about vision and the cervical spine).  https://www.youtube.com/watch?v=XBmrwL9J41gAs with all interventions we should always experiment on ourselves before we prescribe something to a patient.So give these meditations a shot.  I think you’ll be surprised at the outcome for both yourself and your patients.And again, I want to thank Seth Oberst for his generosity in sharing this work.

2017 Hits : Vol. 1 : Clinical - Shock Absorption

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Shock Absorption & Eccentric Control

1) Being able to attenuate force efficiently is extremely important.  A loss in variability or efficiency in shock absorption can cause the forces to be absorbed in a maladaptive manner.  #ConservationOfEnergy2) Uncontrolled motion is always a problem.  Especially at end-range.  “Groups differed in ankle biomechanics, but not non-weight-bearing ROM or strength. During stair ascent, the IAT (insertional  Achilles tendinopathy) group used greater end-range dorsiflexion (P = .03), less plantar flexion (P = .02), and lower peak ankle plantar flexor power (P = .01) than the control group”3) Maybe better shock absorption is another reason why eccentric isometrics work so well?4) Sometimes we know why someone has pain when they run without even looking at them.  These are the patients we put on the treadmill and before we can even look it sounds like the Jurassic Park T-Rex scene.  They sound like they’re trying to put their foot through the treadmill as if it owed them money.  In other words, they’re not accepting force very gracefully.  Their ground reaction force is not being attenuated efficiently.  Their shock absorption sucks.  One easy fix for this is to decrease the force.  How do you do that?  Think about it temporally.  Spread the force over more area (i.e. more steps).  Increase the cadence.  It’s like running on all 4’s, except not.  Maybe if there’s less force per step, the patient will have the capacity to efficiently absorb the force.  https://www.youtube.com/watch?v=1koa2xAxCAw5) “Patellar tendon straps decrease pre-landing quadriceps activation in males with patellar tendinopathy”  Maybe this is one of the reasons why these straps work anecdotally?  But the force will have to be attenuated somewhere.  Maybe the body figures it out?  Maybe it’s forced to choose a better pattern?  Just hope that they have variability in their movement.6) Eccentric shock absorption is usually much more difficult than the concentric propulsion.  Which may be why many people tend to skip training it or will compensate around it.7) There are an infinite number of ways to compensate. Especially when fatigued.  Maybe one of them is to avoid the energy expense of shock absorption?  ITBS runners might be avoiding the global lower extremity pronation to avoid “wasting” energy on shock absorption.  “Regardless, In the runners with ITBS, fatigue was associated with a mean peak hip adduction angle that was 3° smaller than in the uninjured runners, which translated to an 18.5% difference between the groups”.8) Another study finding pain and injury lead to greater impact and poor shock absorption “Compared with the uninjured group, the CAI group had significantly higher impact peak forces and active peak forces, faster loading rate, and a short­er time to reach active peak force.”9) Concussed athletes lost their ability to shock absorb proximally, “when the authors compared change in stiffness from preseason to postseason they found that the concussed athletes exhibited decreased stiffness at the leg and knee, and increased hip stiffness compared with the non-concussed athletes”10) Maybe our body will only allow us to output as much power as we can absorb?  Like jumping, our body won’t let you jump any higher than what it can handle on the landing.  It’s simple self-preservation.Image result for running vertical ground reaction forces(source)

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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2017 Hits : Vol. 1 : Clinical Spine

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Spine

  • "Usually, the best exercise is the one that creates the largest effect with the minimal risks" -Stuart McGill

Cervical

1. It’s more than a chin-tuck and lift.  “Elder women with cervicogenic headache had significantly reduced rCSAs of the rectus capitis posterior major and multifidus muscles compared to controls (p < 0.05). Larger amounts of fat infiltrates were also observed in the rectus capitis posterior major and minor and splenius capitis muscles in the cervicogenic headache group (p < 0.05). There were no changes in the size and fat infiltrate in the cervical flexor muscles (p > 0.05).”2. This is a solid collection of exercises from the Prehab Guys for cervicogenic patients.  I really like the cueing in the quadruped deep neck flexor exercise.3. The neck influences the rest of the spine.  "Head posture was found to significantly influence low back muscle endurance within subjects (p < .001), with extension yielding the highest endurance scores (boys = 186.6 ± 66.2 s; girls = 192.1 ± 59 s), followed by a neutral posture (boys = 171.3 ± 56.5 s; girls = 181.7 ± 57.3 s), and flexion (boys = 146.2 ± 63.8 s; girls = 159.8 ± 49.3 s)."

Thoracic

4. I had a patient who complained of bilateral hand numbness when she was washing her hair.  The MD diagnosed her with bilateral carpal tunnel syndrome.  She got better with treatment directed at her thoracic spine, shoulders, and neurodynamics.  Moral of the story: the patient will give you the answer in the history and if something is bilateral you should probably look proximal.

Lumbar

5. The veins leaving the vertebral bodies are the only veins in the body that lack valves. They may act as hydraulic shock dampeners. Which is another reason why a healthy cardiovascular system is such an important variable in low back patients.6. I see this all the time in the clinic.   The hip and the back are always related.  A recent study on LBP patients gives us research ammo for our empirical evidence, “On physical examination, 81 (80%) had reduced hip flexion; 76 (75%) had reduced hip internal rotation; and 25 (25%) had 1, 32 (32%) had 2, and 23 (23%) had 3 positive provocative hip tests.”  7. If you have a patient that is flexion intolerant, but can’t tolerate the traditional prone press-up, try this quadruped transition (learned from Erson).  I find it much less compressive.8. A picture is worth a thousand words.  Or a postural assessment is worth a prediction regarding health and falls.  “Forward-stooped or knee-flexion deformity relates to lower quality of life.  Limited extension in the lumbar spine is a significant predictor of falling.”9. Guy-wires.  It doesn't matter how you perceive it, if you don't have any guy wires, that tent isn't going to work very well.10. LBP and muscle characteristics.  It may not be what you would think... “Older adults with LBP had a greater average multifidus muscle-to-fat index (0.51 versus 0.49) and smaller average erector spinae relative muscle CSA (8.56 cm2 versus 9.26 cm2) when compared to control participants without LBP. No interactions between LBP status and average muscle characteristics were found for the psoas or quadratus lumborum (P>.05).”11. Just because it's complex doesn't mean we still can't take care of the simple things while we try to solve the bigger problem. ‪Muscular endurance (back extension) may be protective against back pain‬.  And the balance of muscle endurance (flexion, extension, lateral) also seems to be important (here, here, here, here, here, here).  #GetThemExercising #Safely12. “squats elicited more lumbar erector activity than deadlifts...deadlifts elicit more thoracic erector activity than squats” -Bret Contreras13. As Stuart McGill has pointed out, when the lumbar spine is in neutral the pars lumborum produce a protective posterior shear force (it becomes compressive when the spine is in flexion).  And the pars thoracis  (below) has the largest extensor moment arm with the minimum of compressive force to the spine.14. Here’s an exercise to work on spine extension endurance.  Focus on segmental extension of the thoracic spine (see #13 above).https://www.youtube.com/watch?v=5sWeuyLq3Ok15. We’re currently in a time where lumbar flexion is in vogue and lumbar extension is a sign of the devil.  I’m definitely guilty of jumping on this bandwagon.  I even wrote an article 4 years ago on how we need to do a better job of controlling our anterior core to avoid excessive extension.  These concepts are still valid, but have we let the pendulum swing too far to the other side?  Are we losing our ability to extend?  Are we ignoring back endurance and strength because we’re too worried about extension?  Being weak and fatigued is never a good plan of care.  Maybe instead of swinging back and forth with the trends we should embrace it all and focus on better identifying what the patient in front of us needs.16. It can be as simple as a picture...biomechanics matter.  Know the loads that you're placing on your patient.*yes, it all matters.  strength, mobility, endurance, beliefs, values, expectations, motor patterns, history, distal influences, proximal influences, breathing, novel input, pain science, education, humor, repeated movements, ergonomics, load capacity, activities, lifestyle, sleep, stress, diet, social interactions, culture, environment, etc.  i think we need to stop identifying so deeply with certain approaches.  maybe then we could stop arguing with one another and focus on getting patients better.

 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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2017 Hits : Volume 1 : 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.

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

Miscellaneous Clinical - variability, exercising too much, breathe to remember, cupping, ear muscles

The Spine - extension, endurance, and the baby that got thrown away with the bathwater

Upper Extremity - scaption, cardiovascular RTC, scratch a nerve

Lower Extremity - hips are shoulders, frontal plane, the hallux

Shock Absorption - force attenuation, eccentric control, global pronation, Jurassic Park

Movement Meditations - Seth Oberst's guided meditations to help improve the way we move

Wim Hof & Cryotherapy - a novel technique for improving health

The Knowbodies Interview - asheville beers, dropping the ego, guitarist analogy

General Healthcare

General Healthcare Stuff - income inequality, millennial colon cancer, opioids, lsd, ken jeon

Psychology, Neuroscience, & Pain

Psychology, Neuroscience, Mental Health, Mind Training - empathy for our future, catch them when they're good, JKZ on the iphone and more, music and opioids, sandpiles

Physiology Influencing Psychology - how our bodies influence our minds

Pain - Lehman's workbook, better biasing, exercise, predictive coding

Training / Strength & Conditioning

Training / Strength & Conditioning - exercise and weight loss, contradicting people from exercise, seated press and the downdog exercise, 3 training errors, exercise and the brain

Exercises & Movements - quadruped stuff, physioball anterior core, hamstring progression, get up variations, and the bowler

Social & Communication

Social & Communication - social circle and health, telling the truth to save relationships, facts and biases, motivation, non-complementary behavior, hierarchy of vulnerability

Diet

Diet - addicted to food, mushrooms, diet and mental health, Robert Lustig's processed food article, the case against sugar

Time-Restricted Eating / Intermittent Fasting - read this one if you care about your health or the health of others

Other Good Stuff

Other Good Stuff - minimalism, values, singularity/AI, Katherine Switzer, common sense, Crisis of Confidence

Ephemerality - something we should all learn to enjoy

Gratitude is Healthy

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, 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: Other Good Stuff

This Edition's Table of Contents

 1) I heard this quote from Tim Ferris’s weekly update.  Something I definitely need to embrace.  ““Reading, after a certain age, diverts the mind too much from its creative pursuits. Any man who reads too much and uses his own brain too little falls into lazy habits of thinking.” – Albert Einstein2) James Cameron was right. The trees are connected through an underground web. They do talk to each other. Here's a great TED talk explaining this complex system. 3) “Lack of sleep can negatively affect memory, emotional processing and attentional capacities. For example, sleep deprivation has been shown to disrupt functional connectivity in hippocampal circuits (important for memory), and between the amygdala (important for emotion regulation) and executive control regions (involved in processes such as attention, planning, reasoning and cognitive flexibility).“4) Turn your phone screen black and white to break the addiction.  “Emotions and attention are tied to color perception, so what if everyone removed the color from their phones? “5) Keep earning your title.  A great read from Derek Sivers.  This is why I’m skeptical of taking advice from “clinicians” that don’t have a current practice.6) Sleep more to make more money.  “A one-hour increase in location-average weekly sleep increases wages by 1.3% in the short run and by 5% in the long run.”7) Get out of the city and into a green area.  Even if it’s just for 5 minutes.  “This study indicates that five minutes of viewing urban green space can support recovery from stress as shown in enhanced parasympathetic activity. These findings strengthen and deepen the growing evidence-base for health benefits of green space in the living environment”8) “Evil settles into everyday life when people are unable or unwilling to recognize it. It makes its home among us when we are keen to minimize it or describe it as something else.”9) “Markers for vagal activity were significantly greater after the walk in nature compared to the built walk. Lunch time walks in nature-based environments may provide a greater restorative effect as shown by vagal activity than equivalent built walks. Nature walks may improve essential recovery during night-time sleep, potentially enhancing physiological health.”10) “Exercise coupled with a regimen of methamphetamine could help addicts get clean, according to a pre-clinical study published today in The FASEB Journal. The reason lies in the mechanism through which exercise and methamphetamine affect circadian rhythms, the roughly 24-hour cycles that drive all organisms.”11) Maybe we should make kids meditate in detention?
 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: Diet

This Edition's Table of Contents

1) Want to learn more?  Consume more cinnamon.2) Authority Nutrition dispels 14 diet myths.  Good read.3) Sleep to eat less.  “We found that sleep loss increased the dietary intake of preschoolers on both the day of and the day after restricted sleep,”4) Eat slower.  Eating fast is associated with increase in weight.5) A new way to look at stress eating.  “A common probiotic sold in supplements and yogurt can decrease stress-related behavior and anxiety”6) Feeling hungry is subjective.  “From a review of more than 460 studies, researchers from the University of Sheffield in the United Kingdom found little evidence of a link between how hungry we feel and the amount of calories we consume.”7) “Three low-carb meals within 24 hours lowers post-meal insulin resistance by more than 30 percent, but high-carb meals sustain insulin resistance”8) “Low-calorie sweetener use is independently associated with heavier relative weight, a larger waist, and a higher prevalence and incidence of abdominal obesity suggesting that low-calorie sweetener use may not be an effective means of weight control.”9) The gut bacteria microbiome is pretty important for overall health.  Here’s an article that describes it’s effect on sleep and mood.10) Here’s a great, concise article on the health problems associated with sugary drinks.11) Is it your food that’s causing chronic systemic inflammation?  “The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, acellular flours, sugars, and processed foods produce an inflammatory microbiota via the upper gastrointestinal tract, with fat able to effect a "double hit" by increasing systemic absorption of lipopolysaccharide.” #microbiome12) Poop health.  Because digestive health is an indicator of overall health.  And because it's funny to say.
 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: Social & Communication

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1) Repetition = Persuasion.  One of the benefits of a checklist assessment type of examination is that it is repeatable and consistent.  This not only makes it clinically effective, but it makes it repeatable and consistent.  So instead of chasing a different pain path every time the patient comes in, you repeat the assessment, repeat the clinical reasoning, and repeat the treatment approach.  Instead of confirming their hypochondriac wonders by chasing pain, persuade them with repetition and consistency.  So stay consistent and keep repeating yourself (more than just words).  Repetition = Persuasion.2) Create the “curiosity gap”.  “Our results suggest that using interventions based on curiosity gaps has the potential to increase participation in desired behaviors for which people often lack motivation,” 3) Friendship is an important aspect of health, “It appears that both in and out of stressful situations, the daily presence of bond partners actually regulates the system that manages the body’s hormones, reducing an individual’s overall stress. While active support of a bond partner reduces glucocorticoid levels the most, their mere presence also leads to less stress.”4) “The words you attach to your experience, become your experience” -Tony Robbins5) “Find a meaningful analogy to spur on the behavior needed for change.” -Matt Dancigers6) “The best way to get people to take action is to touch their emotions and give them a cause worth fighting for.”7)  Sometimes being optimistically positive leads to stagnation.  Sometimes people need to hear the truth.  “In a recent study by Nabi and Prestin (2016) in which “fear” and “hope” were investigated as motivating factors in health care decisions, an interesting finding turned up. If fear is used as an argument for engaging in a particular behavior, and the lack of action is associated with dire consequences, people are as likely to commit to taking action as those who receive a message of hope where choosing to act is associated with positive consequences for an individual.”8) Use stories to make points.  Not arguments or lectures.9) Here’s a great article on reducing anxiety before big speeches, “We can calm our nerves by observing, accepting, and reframing it as part of a natural process.”10) I had an older patient come in with neck pain that was so bad she went to the ER the week before.  No neurological signs or symptoms.  Just restricted high-threshold movement patterns.  I educated her on pain, anatomy, and the way the body works.  I gave her the simplest exercises (pain free AROM and diaphragm breathing).  I told her to do them often and that “lotion was motion”.  I gave her confidence that it would get better.  She came back the next week, turned her head to both sides with pain-free full range of motion, looked at me, smiled, and said, “lotion is motion”.11) Matt Danciger explains why the rhyme in the above scenario works so well - “As we know from Recall Bias, if things are easier to remember and recall, they seem more prevalent, and perhaps more true in your world view.”12) Another one I recently heard, “you have to feel it to heal it”.13) Herzberg Motivation Theory 
 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: Training / Strength & Conditioning

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  • get comfortable being uncomfortable

Articles

1) Strength is joint-angle specific2) Eric Cressey gives some tips on tall athletes and reminds how adding a reach into exercises, like the lateral lunge, can help promote the transverse plane.3) Exercise Motivation - what matters most is that they enjoy it 4) More volume + closer to failure = improved hypertrophy || less volume + further from failure = improved performance5) Movement can be meditative.  Don’t understand how?  Read this one by Jennifer Pilotti.6) One of the main benefits of exercise is on the hormonal level.  “A group led by a University of Florida Health researcher has learned more about how the hormone irisin helps convert calorie-storing white fat cells into brown fat cells that burn energy. Irisin, which surges when the heart and other muscles are exerted, also inhibits the formation of fatty tissue, according to the researchers.”  In layman’s terms, “Exercise releases a hormone that helps the body shed fat and keeps it from forming.”7) “Longer distances between the rear and front legs make the split squat more hip-dominant”-Chris Beardsley8) “faster athletes display greater horizontal braking forces and a tendency toward smaller vertical impact forces”9) Some nice details on the “reaching” push-up cue from Mike Robertson10) Dean Somerset shares his thoughts on lat strengthening - “Just as Bret Contreras’s work as shown that the hip thrust isolates the glutes better than squats and deadlifts, one of the best ways to isolate the lats is through single-joint extension exercises. The go-to exercises in this category are stiff-arm pull-overs, stiff-arm pull-downs and – to a lesser extent, due to their inherent difficulty – front levers.”11) Training triple flexion with anterior core activation is always a good idea12) You should really exercise outdoors at any chance you get.13) 50 Jump Rope Exercises (via Robertson)14) 5 Training Strategies for Hypermobile People: ask them where they feel it, give them extra sensory input, use cues to develop and maintain tension, use pause, eccentric, and tempo work, stop before they feel the stretch

Exercise, Movement, & Techniques

15) Zach Long put together a great collaboration of TRX exercises from various different movement rehab professionals.  I feel honored to be on this list with such great other clinicians.16) It's like a reverse hollowed body hold17) Snatch lunge18) Christine Ruffolo teaches us how to use gravity to improve movement.  Some great examples in this post.19) This is a clever glute stretch20) Lateral hop kettlebell swing21) A great yoga based core flow22) Maybe I need to get more aggressive with my PNF techniques? Here's a great quick video with various shoulder PNF techniques. 23) Awesome pigeon/9090 exercise24) Founder Training from Eric Goodman is interesting.  It’s like yoga with an emphasis on extensor tone and posterior chain tensioning.  25) 2 common movement impairments are poor scapula motor control and a lack of hallux mobility.  This exercise fixes both of these impairments.26) Chris Johnson shares an advanced hamstring exercise with a novel way to use a rowing machine. 27) Some pilates based spinal articulation exercises.  I really like the kneeling cat stretch with the trapez.28) I like this suspension trainer single arm row/rotation 29) Load can be for more than stress. It can also be used for proprioception. 30) Some great TGU flow work from Scott Fournier31) This is some crazy kettlebell flows32) I really like this half kneeling elevated bottom range lunge exercise from Shante33) My current favorite anterior chain mobility drill. Or as Shante Coffield calls it, vertical bretzel.

Exercise of the Month

https://www.youtube.com/watch?v=JEK8VQxO2hUVertical Quadruped Isometric.  Or Opposite Arm/Leg Hover.  Or as Paul Chek calls it, Horsestance.Regardless the name, I've found this exercise to be extremely valuable.Since there is such little movement, it allows the observer to better assess the control.  Sometimes with the traditional bird-dog there is so much movement that the compensations occur quicker than one can notice.  Sometimes people go to places they shouldn't be going (full "hip extension/shoulder flexion").In this variation, the end point occurs instantly after the initial movement.  So there are no end range compensations or reactive high-threshold strategies.  Plus, from a rehab point of view, this little motion makes it less threatening and very accessible for the sedentary and injured population.I was told that Chek wants people to be able to perform 10x10sec holds on each side.  Give this protocol a try.  You'll quickly find asymmetries and endurance issues.A key point is that unlike other variations of the bird-dog that emphasize a narrow base of support, a wider base in this exercise will actually make it more difficult.I've been experimenting with crawling exercises with this wider base of support.  It provides a much different outcome.

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: Brene Brown, Vulnerability, Shame, Empathy, & Compassion

  • “Shame cannot survive being spoken...and met with empathy” -Brene Brown

I recently listened to Brene Brown’s The Power of Vulnerability.  I was hesitant at first.  It seemed like a self-help book about the latest pop-psychology trend.  Plus, I had watched the TED talk and thought it was suffice for the subject.However, I quickly learned that my prejudgements couldn’t have been more wrong.  By the time I finished the book I had a new perspective on vulnerability, learned things about myself I didn’t want to know, and developed new skills to cultivate compassion and empathy for others.One of the greatest aspects of her teachings is the practical anecdotes she uses to back up her research findings.  She doesn’t cite her research in a dry, abstracted manner.  She provides personal, real life examples that bring the qualitative analysis to life.  These stories not only help to reiterate her points, but they provide a path to follow in your own life.Overall I think Brene Brown’s work offers a valuable perspective for everyone.  More specifically, I think it is a must listen for those treating people who are suffering and in pain.  The obvious reason being that it will help to improve your compassion and empathy towards the person you are trying to help.  The less obvious reason being that it will improve your compassion and empathy towards yourself.  Sometimes the flashlight needs to point inward.  Much like how a psychologist must be analyzed to make sure they are aware of their own projections and biases, I think practitioners need to be aware of their own vulnerabilities before trying to help others.Here are some of her definitions in case you’re wondering what the hell I’m talking about...Dr. Brown definitions:

Shame is ”the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.”

“Shame is a focus on self, guilt is a focus on behavior. Shame is, "I am bad." Guilt is, "I did something bad."

Vulnerability is “uncertainty, risk and emotional exposure”.  It “sounds like truth and feels like courage. Truth and courage aren't always comfortable, but they're never weakness.”

Empathy is feeling with people (great 2 minute video with Brene Brown)

“It’s rare than an empathic response starts with ‘at least’”

“Rarely can a response make something better.  What makes something better is a connection.”

Other articles, videos, thoughts and collections on the subject:

1) When discussing vulnerability, it is imperative to be able to see the other person’s facial expressions and make eye contact.  There’s nothing more healing than being able to communicate vulnerability and receive a genuine facial gesture of empathy.  Because you don’t need to have an answer for them.  You just need to show them that they’re heard and understood.  Maybe this is why there are so many mental health and shame issues in today’s social media world?2) Here’s a massive collection of empathy related material.3) Use the ladder of inference to rethink thinking and develop compassion4) Here’s a nice article summarizing some of Brown’s work

“I talk about shame as these gremlins that fuel two primary messages: “You’re not good enough,” and “Who do you think you are?” These shame gremlins are right there when you are thinking of doing something that makes you feel vulnerable, whether it’s putting a new idea out there, negotiating a raise, or speaking out against something that is unfair. Shame is the thing that says, “Hey, keep quiet. You’re not smart/good/informed enough. No one will like you if you say that.””

5) “All men are brothers and love is mankind’s most potent weapon for personal and social transformation” -Martin Luther King Jr (read this book)6) Love really is the answer.  Oxytocin levels are related to empathy.7) More prosocial (empathy, agreeableness, trust, perspective taking, helping, etc.) behavior through experiencing the beauty of nature.  “Beautiful nature promotes greater prosociality for those who perceive natural beauty.”  #GetOutside8) Empathy is a great predictor of clinical outcomes9) Self-awareness is a prerequisite to empathy10) It’s not about being right or changing beliefs.  It’s about listening to their story and understanding.11) “Compassion recognizes the suffering of another as a reflection of our own pain. Compassion is shared suffering.” -Jack Kornfield12) Daniel Goleman’s 3 Kinds of Empathy

Cognitive Empathy - “simply knowing how the other person feels and what they might be thinking. Sometimes called perspective-taking, this kind of empathy can help in, say, a negotiation or in motivating people”

Emotional Empathy - “when you feel physically along with the other person, as though their emotions were contagious.”

Compassionate Empathy - “With this kind of empathy we not only understand a person’s predicament and feel with them, but are spontaneously moved to help, if needed.”

13) Rule #1 = people need to feel validated14) “Treat everyone you meet like God in drag” -Ram Dass15) Read Theresa Wiseman’s article on empathy:

3 Components of Empathy

1. Affective (sensitivity)

2. Cognitive (observation and mental processing)

3. Communicative (helper’s response)

“Rogers (1957) states that bemg understood is the most basic human need, and it is only by being understood and accepted that individuals are able to change and grow”

“Communication of understanding seems vital if empathy is to be felt”

5 Defining Attributes of Empathy

1. Ability to listen

2. Seeing the world as others see it

3. Non-judgemental

4. Understanding another’s feelings

5. Communicate the understanding

For Empathy to Occur

1. Interaction involving the communication of a feeling

2. Listening on both sides, one to the feelings and thoughts of the ‘empathee’ and the other to empathy being conveyed

“The consequences of an empathic interaction is that 'empathees' have a basic need to be understood satisfied, they feel valued and more ready to understand themselves and change”

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