The Hits
This is a collection of some of my favorite articles from the past month. I bolded and underlined the numbers of the articles that I found most remarkable. Of course, this is just my bias. I think all the articles here have value. I realize that some readers may be looking for something more brief.Unfortunately, I am currently busy with a couple other projects and do not have the resources to produce a collection of “Hits” every month. However, I’ll continue to do my best to get it out as frequently as I can.For a more real-time update of movement and health information follow me on social media:
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If you enjoy this collection and find it valuable, please share it with other professionals. If you have the resources available, please make a donation to help me run this site and continue to put information out there to help movement professionals grow.
Also, I want to encourage any readers to share their favorite articles, books, or podcasts of the month in the comments below. I know there’s a ton of great stuff out there that isn’t on my radar. It will introduce me and other readers to new perspectives.
Clinical
- "You can recognize a deep truth by the feature that it's opposite is also a deep truth" - Frank Wilczek
1) “The human body is one of the most complex organizations of matter in the known universe. To understand it, we must build models, use metaphors, and deal in abstractions. This necessarily involves ignoring certain details, creating simplified pictures, and relying on metaphors that have the potential to mislead. But we have no choice! Models and metaphors are indispensable thinking tools to understanding the body. Each model is a different perspective from which to see the world, with its own unique insights and blindspots.” -Todd Hargrove2) Michael Mullin shares his highlights and thoughts from a great article on the diaphragm.3) Solid article from Chris Beardsley - "Eccentric training produces specific gains in eccentric strength, partly by increasing the strength of the passive elements in a muscle, which makes them stiffer. This gives muscles a greater capacity to decelerate, and absorb energy. This superior ability to absorb energy is probably why eccentric training then leads to a reduction in the risk of getting a muscle strain injury."4) “If existing interventions don’t adequately address the way patients use somatosensory versus visual information, that could explain why patients with CAI often continue to experience episodes of ankle sprain or giving way despite having gone through a full balance training protocol.”5) A nice #GetPT1st video6) Louis CK on his “shitty ankle” and the language of MDs these days...7) Most patients come to us because a habit or behavior has accumulated past a threshold which the body (or mind) can handle. As Gray Cook says, “it took a habit to make that pattern, and it's going to take a habit to break that pattern.” Just be sure to remind your patients that habits take an average of 66 days to acquire. 8) 5 Eval Questions from Shante Coffield
1 what do you think caused your symptoms?
2 what do you think is going on?
3 what do you think should be done?
4 what can i do for you?
5 what do you want out of PT?
9) Great minds think alike - Adriaan Louw’s Questions
1 What is wrong with me?
2 How long will it take?
3 What can I (the patient) do for it?
4 What can you (the healthcare provider) do for it?
10) “If the lat (and teres major) are limited they will force the shoulder into more internal rotation at end range shoulder flexion.” -Dan Pope11) Michael Mullin reviews PRI vision
-“Vision writes spatial equations for our muscles to solve” – Myron Weinstein, OD
-”Visual processing occurs in every area of the brain and integrates with information from all the other senses. It can “override” information from other senses and “overpower” other skill areas.”
-”The eyes, as appendages, need to move independent of the head and neck so they are not over-utilized for stabilization.”
12) Rethinking Heel Lifts for Achilles Tendinopathies
“walking in standard running shoes with a typical cushioned heel appeared to increase loads on the Achilles tendon compared with barefoot walking”
It’s not just one variable (heel lift) - “An important aspect of the QUT study was that the shoes were associated with changes in several spatiotemporal gait parameters, including lower cadence (five fewer steps/min), greater stride and step length (5% each), and longer step duration (12%), even though both conditions involved walking at identical speeds.”
““There are very individual responses to shoes and heel lifts, and some people respond totally the opposite of what you expect,” Silbernagel said”
Pathology matters - “If there’s insertional injury, I won’t have patients exercise barefoot,” she said. “In those cases, I want to start them in various degrees of plantar flexion to minimize the pain. You get compression on the tendon, over the bursa, and onto the bone, when you go into more dorsiflexion. If you put in a heel lift to unload that, you get a great effect. Someone with midportion tendinopathy, but no insertional pain, can often start exercising barefoot, though never on the stairs.”
“Loading is always critical—tensile loading; heavy, slow resistance training; and then training the tendon to do the energy storage loading that’s by far the best thing for your mid-Achilles and insertional Achilles. The difference between those is that with insertional Achilles, you must keep people in a heel lift until symptoms start to resolve. For the peritendon, it’s about reducing movement, so heel lifts can help there for a different reason, because you stop the friction between the tendon and the underlying tissue. The treatment can be similar but for completely different reasons.”
Running Technique matters - “If you’re a heel striker I can allow you to run longer than if you’re a forefoot striker, which puts more load on the tendon”
It’s all about the soleus - “In any event longer than about fifteen hundred meters, the soleus is the most important force producer, at about eight times body weight,”
In the end, the clinician's voice is the loudest - “We had a lot of discussions with clinicians who pointed out that heel lifts should lower forces, so then we took the same shoes and added a twelve-millimeter heel lift,” he continued. “In that study [the 2016 paper noted above], there were no changes in gait parameters, so we concluded that heel raises themselves do slightly reduce Achilles loading.”
13) Clinton Lee summarizes the FRC course with some great Spinaisms.14) “New Muscle” - Tensor Vastus Intermedius15) “So play is some kind of pleasurable combination between repetition and variation (or maybe work and insanity).” -Todd Hargrove with a great article on play #RepetitionWithoutRepetition #Tinkering 16) There should be no more than a 10% difference between active range and passive range. If there patient can perform more than 10% of their active range then they have a stability problem. Or in scientific terms - active insufficiency. 17) Make them run uphills - “More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here...If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip. “ -Gait Guys18) 9 Modern Concepts of Treating Tendinopathies19) Eric Cressey on Lat Strains and 7 Reasons they happen:
1 Lower Traps Relative Weakness
2 Rotator Cuff Relative Weakness
3 Dominant Lat Lifting
4 Lack of Manual Therapy
5 Poor Anterior Core Control
6 Turning All Row Movements Into Lat Dominant Movements
7 Loss of Shoulder Flexion
See the exercise of the month in this post for more
20) Clay Holton is sharing what he’s learning with a Weekly Highlights series. Sign up for another perspective on movement and physical therapy. My advice to Clay, use a numbered list for future references, add a useful quote or summary from each article (for the TL;DR), expand yourself beyond research, and don’t let anyone else dictate what you read/write. This blog has been the greatest catalyst for my professional growth.
- “I write because I don’t know what to think until I read what I say” -Harrey O’Connor
21) Trouble cueing scapula position? Try cueing the collarbone.22) “APTA is committed to the triple aim of health care. The association’s proposed coding reforms are just one way—but an important one—of achieving it.”23) Transverse Plane is an important one - “Although the orthosis did not have an effect on most of the joint kinematics of the forefoot, medial longitudinal arch, and first ray, it did have a significant and consistent effect on transverse movement at the forefoot.”24) Christine Ruffolo with a solid article on awareness training
“Problems are beautiful puzzles to be solved, and the thoughtfulness in which we approach them dictates whether or not they are perceived as suffering.”
“No specific end-point means you are free to roam and appreciate what is going on right now.”
“As you attempt to navigate what you should and shouldn’t do to get the ‘best’ results, remember that your perception of results is biased by comparison. Your journey and your needs start with your body. It offers you real-time evaluation, instant feedback, and the ability to create the most perfect obstacle to continually satisfy the yearn to learn. Acknowledge its expertise and listen to it.”
25) Interesting dry needling approach - “As people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are treating. For example, you may facilitate or needle the L2-L4 paraspinals (ie: femoral nerve distribution) along with the quads, or perhaps the C5-C6 PPD’s along with the shoulder muscles for the deltiods or rotator cuff for arm swing. We do this to get more temporal and spatial summation at a spinal cord level, to hopefully get better clinical results.”26) Summary of a new paper on proximal hamstring tendinopathies - reviews the latest concepts27) It’s refreshing to read something so open-minded, positive, and forgiving when it comes to movement science. Here’s a solid post from Michael Mullin on the mindset behind exercise and why LeBron performs physioball back extensions - ”With a firm foundation of the requisite mechanics in place of respiratory balance, positional control and understanding of tri-planar movement, there are very few bad exercises out there…. just some that are better than others for the individual’s needs.”28) “Notice how much the cervical spine moves without the neck moving at all” -Noah Harrisonhttps://www.youtube.com/watch?v=GCluRCd2YuM&feature=youtu.be
Exercises & Techniques
- "The first step to seeing positive change in others is to expect it" -David Rock
29) 5 Ways to improve the prone press up: use only arms and chest, straighten the elbows all the way, tilt your head back at the end, let your hips sag, add a relaxing exhale and diaphragm breathing - “repeated end range loading may also help convince a vigilant nervous system that full mobility is safe as well as ability to load”30) I have always struggled the most with the elbow-hand transition of the TGU. This great article by Bret Jones has helped a ton.
“Begin this transition by rotating the arm and forearm away from the body and even beginning to point the fingers behind you. Once you are rotated as far as you can while keeping the forearm on the ground, then press down through the heel of the hand, continuing to point your fingers behind you and rotating the arm so the triceps squeeze against the lat and the arm/hand is pushing down into the ground bringing the body to the tall sit position. This externally rotated position of squeezing the triceps against the lat and pressing down into the ground will produce a shoulder position that is ready to lift the body for either the low sweep or high bridge.”
31) I’m not the biggest fan of doing endurance strength tests in patients with neck pain, but I really do like the motor control with the laser pointer that happens 6 minutes into this video. Nice cheap way to make the motor control device as well.32) Closed chain tibial internal rotation is relative femur external rotation. So if they’re missing tibial internal rotation it may be a culprit of the dynamic valgus pattern.33) I like the foam roller hip flexor control exercises - scissor and bicycle34) Genius ankle dorsiflexion external cue from Jeff Cubos - scotch tape. 35) Sian and Jill go over some great pilates based core exercises. Solid stuff here that you can use tomorrow with your patients.36) Manual therapy breathing cue: breathe in space, breathe out length37) Solid stuff. 5 Non-Painful Ways to Use a Foam Roller38) Upper Thoracic Mobilization39) Nice easy clinical test for forefoot flexibility - The Gib Test40) Jarod Hall shares an interesting neurodynamic exercise using the cervical spine to improve multi-segmental flexion.41) Random Cue for Posterior Pelvic Tilt - if coaching proximal isn't working, go to the legs. Sliding the knees forward posterior pelvic tilts. Sliding the knees backwards anterior pelvic tilts. (*not in every position*)42) Great article from Jackson Taylor showing the continuum of dead bug progressions. Some great variations in this article.43) L-Shaped / Half Handstand - one of my favorite overhead shoulder stability. This makes my lower traps feel like they’re about to explode.44) The answer to tennis elbow often lies proximally45) 7 Ways to Improve Ankle Dorsiflexion45) A nice shotgun approach to foot mobility46) Great post from Erson on manual modern therapy concepts
Threat free end range is now defined as:
No pain during the full range actively
Being able to tolerate passive overpressure at end range
Tom Myers
47) Very interesting Q & A with Tom Myers
2 Ways Body Reacts Stress: Biochemical and Tension Patterns
“With those, the brain keeps sending out the same messages to the same muscles, and so you take on a specific postural pattern. And after a while, your mind has fit into that pattern, your muscles have fit into that pattern, your fascia has fit into that pattern, your distribution of energy has fit into that pattern, and that may in itself cause illness or lack of ability to move.”
“the pattern in your muscles is going to determine what the pattern in the fascia is”
“If you change your mind or you change your nervous system or even if you change your movement patterns, you’re working against this very slow moving, steady tissue of the fascia. But if you change that fascia, then it’s easier to change the nervous system and the circulatory system on top of that. “
“Now that pattern is in the nervous system, that pattern is in the muscular system, that pattern is in the chemistry, that pattern is in the fascia. But once the pattern is lodged in the fascia, you have to address it at the level of fascia for it to release.”
48) Reading the above article reminded me of how much I enjoyed reading Anatomy Trains several years ago. I looked around online and read some articles to refresh my memory. I really do love Tom Myers work, philosophy, and writing.
Great article in response to criticism
“The collagen fibrils in fascia are completely replaced every six months”
“There are 10 times more sensory fibers in your fascia than your muscles”
Perspectives, Sensory Input, and Self-Image
- “Inquiry is like a flashlight in the darkness of belief.” -Seth Oberst
49) Seth Oberst has a great article series on Spatial Perception and Self-Ownership (Part I, Part II, Part III)
“the spatial representation of our own body sets the vantage point with which we perceive the environment”
“there are no isolated sensory experiences as we test our senses against each other and integrate them via higher order multi-modal neurons.”
“there appear to be two primary reference frames thru which we perceive the world: the egocentric (self-based) and allocentric (object-based)”
Myofascial tension as a substitute for another sensory input: “It seems to me that if one can't feel the ground or perceive peripheral vision, for example, they will produce tension and hold themselves in certain postures in an effort to create a reference frame.”
“the way you sense and feel influences your view of yourself. And how we move is a product of how we see ourselves within our environment. Feeling is understanding.”
“Try to determine how far objects are from other objects (a great way to practice switching reference frames). Try doing it without vision as we are so visually dominant. Picture and feel where you are in relation to the boundaries of the room or space.”
“Pay attention to peripheral vision and stop looking at your feet - "feel yourself moving thru the environment instead of the environment moving around you"
Balance - lower threat, go to the ground; cue intrinsically to feel the feet
50) “Maintaining a belief about something that has not been reality-tested affects our neurophysiology in a very tangible way — it modifies our behavior to perpetuate the conviction.” -Seth Oberst 51) Well-built environments are important for well-being
“The built environment can restrict or promote spatial cognition, which can influence one’s self-hood,” the researchers explain. “Our spatial coordinates and our ‘selves’ are intertwined.”
“According to the researchers, we understand our environment differently depending on our experience of it. For example, learning your way through a space using a map gives a different understanding than through learning your own route. In a mapped environment, the tendency is to think of objects in relation to one another, whereas finding your own way might lead to thinking about the space in terms of its relation to you.”
“The researchers say social perspectives also change spatial perspectives.”
52) Consider that the feeling of asymmetry or out of place structures may be rooted in the mind's representation of the body (for a more detailed explanation of this concept click here).53) Overweight individuals perceive distances as further than normal weight individuals - "it follows that obesity isn’t just unhealthy, it also creates a perceptual obstacle that limits physical activity (because it seems even more strenuous than it really is), which in turn contributes to staying obese." | "“You’re not seeing the world as it is, you’re seeing the world in terms of your ability to act.”"
General Healthcare Stuff
54) Our medical system is the 3rd leading cause of death in the US55) “Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year.”56) 13 Ways to Extend Your Lifespan: avoid overeating, eat some nuts, use turmeric, eat plenty of plant foods, exercise and be physically active, don’t smoke, keep alcohol intake to a moderate level, prioritize happiness, avoid chronic stress and anxiety, nurture your social circle, increase your conscientiousness, drink coffee and/or tea, develop a good sleeping routine57) Our nation’s deteriorating health is a serious issue (see April Hits for more information). Here’s a great short article summarizing it and their advice: “Health care professionals can model healthful behaviors and dedicate time during routine office visits to discuss diet. In addition, citizens can vote in 2 ways: with the ballot, for politicians who place priority on food policies in the public interest; and also with the fork. With every food purchase, the food industry can be incentivized to market healthful food instead of commodity-based industrial products.”58) “Childhood obesity rates have more than tripled since 1980.”59) “Since the end of the Civil War until the late 20th century, lifespan increased rapidly in the United States, a tremendous public health triumph brought about by a more dependable food supply, improved sanitation, and advances in medical care. In 1850, life expectancy among whites was an estimated 38 years for men and 40 years for women. These numbers nearly doubled by 1980, to 71 years for men and 78 years for women. With the start of the obesity epidemic in the late 1970s, this trend began to slow, leading some to predict that life expectancy would decline in the United States by the mid-21st century”
Pain, Psychology, Neuroscience
- “People who learn to control inner experience will be able to determine the quality of their lives, which is as close as any one of us can come to being happy” -Mihaly Csíkszentmihályi
60) Thank you for putting this together, Erson. Here are 5 great pain explanations/metaphors to help your patients understand pain better.
Pain as a sunburn
Pain as an over-reactive protector
Pain is like the wind
Pain as a home alarm system
Your Brain as a Police Station
61) A quick and easy read on pain. Goes over 9 fundamental concepts of modern pain science. This is a great resource for PTs and patients. 62) "Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears" #PainScience63) “Pain is like the wind. It can only be viewed by its interface with the environment.”64) This is outstanding - Matt Dancigers’ patient education binder.65) This is too dense for me to read, but some pain lovers might enjoy this - National Pain Strategy66) Random Advice - keep in mind, just because there is a plausible top-down explanation doesn’t meant the bottom-up one is invalid. #DynamicSystem #Variables #BabyAndBathwater67) Self-Compassion > Self-Esteem68) “social comparison seems sufficiently destructive to our sense of well-being that it is worthwhile to remind ourselves to do it less” -Eric Barker on alleviating FOMO69) 6 Ways Krav Magav develops mental skills
1-Visualization
2-Goal setting
3-Positive self-talk (and changing of internal monologue)
4-Combat mindset (courage, determination, perseverance, controlled aggression)
5-Focusing
6-Relaxation
70) Great article on cultivating the ability to focus on what you can control - TAIWA (thoughts, attitudes, imagination, words, actions).
-I love the weather analogy - “There’s no such thing as bad weather, just bad gear. You can’t control the weather, but you can control the clothes and gear you use to deal with it.”
-”Fear arises when we imagine bad outcomes for ourselves, or others. Controlling our imagination allows us to manage our psychological and physiological response to the unknowns in our lives. Rather than fill our minds with images of fear and anxiety, we can choose images that support and empower us.”
71) “A new reports whole body hyperthermia improved symptoms of major depression for as long as six weeks following a single treatment...We think that using heat to stimulate the skin activates serotonin-producing cells in the mid-brain, which then produce a change in how the brain functions” #DynamicSystem72) This is a great article for medical and healthcare professionals to learn more about mindfulness practice.
"One might think of the historical Buddha as, among other things, a born scientist and physician who had nothing in the way of instrumentation other than his own mind and body and experience, yet managed to use these native resources to great effect to delve into the nature of suffering and the human condition. What emerged from this arduous and single-minded contemplative investigation was a series of profound insights, a comprehensive view of human nature, and a formal “medicine” for treating its fundamental “dis-ease,” typically characterized as the three “poisons”: greed, hatred (aversion), and ignorance/delusion (unawareness)."
73) 10 Things for Emotional Resilience:
1 “Foster optimism: Don’t be in denial. See the world clearly but believe in your abilities.
2 Face your fears: Hiding from fear makes it worse. Face it and you overcome it.
3 Have a moral compass: A strong feeling of right and wrong tells us we must when we feel we can’t.
4 Practice spirituality: Be a part of a group that has strong beliefs.
5 Give and receive social support: Tapping on the wall of your cell can keep you going.
6 Imitate resilient role models: Or have people you know you do not want to be.
7 Physical fitness: Exercise adapts your body to stress.
8 Be a lifelong learner: Keep your brain sharp and it will give you solutions when you need them most.
9 Have a number of ways to cope: Be like Navy SEALs and Special Forces operators — and laugh.
10 Have meaning in your life: Don’t just do a job; have a calling and a purpose.”
74) “Paying attention to the mental and physical signs and experiences that occur during stressful situations gives you an opportunity to practice composure.”75) This is extremely interesting. What is unconscious and conscious? What’s the difference? How do they interact? “The whole process, from stimulus to conscious perception, can last up to 400 milliseconds, which is a considerable delay from a physiological point of view.”76) “The different environmental needs of varying personality types may be increasingly relevant because studies show that Americans have shifted towards higher levels of neuroticism in recent decades, Newman says.”76) Breath-centered meditation can improve attention in heavy media multitaskers. #mindfulness77) “New research shows that two types of psychological strategies — cognitive restructuring and defusion — can help people cope with negative thoughts.”
Cognitive Restructuring stems from a form of therapy called cognitive-behavior therapy. The technique is based on the idea that changing how someone thinks about something will change how they feel and behave relating to that thing. Using this technique involves thinking about the negative thought itself and evaluating it to see if the thought is realistic or not.
Defusion is based on acceptance and commitment therapy. The idea behind this technique is to learn to view thoughts as nothing more than ideas. There is no need to address them as they don’t mean nearly as much as people commonly think that they do. A common thing people using defusion do is constantly repeating a word until it loses some of its meaning. This way, they may spot some of their beliefs concerning that idea.
78) Fascinating perspective on mental disorders, cues, and “objects of capture”.79) Interesting Motivation - Losing Cash Motivates Better Than Rewards When Losing Weight #LossAversion80) Social media use and depression are correlated - “In a study of 1,787 adults between 19 and 32, new study finds a significant relationship between depression and social media usage. Specifically, the more social media someone uses the more likely it is that they suffer from depression even after controlling for relevant covariates.” It also prevents us from sleeping. Need more evidence? Here’s 25 more reasons why cellphone/internet addiction is a problem.81) Want to make everything better? It’s easy, just celebrating more. Great article with something we should all take to heart.
“If you make sure to always end happy times or tough challenges with a little celebration, you already have half of what it takes to make great memories.
If you have a head full of happy memories, it’s hard not to feel like you have an amazing life.
And an amazing life is something worth celebrating. So go celebrate.”
1 Keystone Habit - “The power of a keystone habit draws from its ability to change your self image. Basically, anything can become a keystone habit if it has this power to make you see yourself in a different way.” -Charles Duhigg
2 Minimal Viable Effort - “The key to new good habits is to do the minimum and be consistent.”
3 Make a Plan - “Thinking about the details makes you more likely to follow through. And another small thing that makes a big difference is just writing down your plan.”
4 Reward Yourself - tie a “want” to a “should”
5 Use Reminders and Checklists
6 Hand out with people whose habits you want - “Across many different kinds of behavior: voting, cooperation, smoking, weight loss and weight gain, happiness, cooperative behavior, public health behaviors, we and others have been able to show that people are very meaningfully affected by the behaviors of other people to whom they’re connected.”
Pain is all in your...nose?
83) I have this weird theory that people with a more sensitive sense of smell tend to be more sensitive in general. In the clinic I’ve had many patients that have asked to move tables because of a certain scent or noticing someone else’s perfume that I didn’t even recognize. These also tend to be the patients that are prone to hyper-reactivity to exercises and tend to have more pain (both short term and chronic). While I don’t have any evidence towards this theory, other than clinical, here are some other things sense of smell can determine:
A defective sense of smell appears to be a good predictor of dying within five years, a new study has found.
Studies also show it predicts cognitive decline, neurodegenerative diseases, and neuroimmune diseases
Autistic children had indifferent reactions to different smells
Sense of smell predicts social networks
84) Upon doing more research, I did find that there is a correlation between pain/nociception and olfaction at the ion channel level (sodium-channel gene SCN9A, Nav1.7)
“...expression of Nav1.7 channels is not confined to nociceptive neurons. They are also expressed on olfactory neurons...”
“we verified that there is a robust link between nociceptive and olfactory acuities at Nav1.7 ion channel level and that this link works in both directions, rather than in the already known negative direction of sensory function loss”
“A number of (inflammatory) mediators, such as prostaglandin, adenosine, and serotonin, affect the electrophysiological properties of voltage-gated sodium channels. These mediators increase the magnitude of the current, lead to activation of the channel at more hyperpolarized potentials, and enhance the rates of channel activation and inactivation. As a consequence, inflammation can sensitize nociceptive neurons. In an experimental model of inflammatory pain in which an irritant was injected into the hind paw in rats, Nav1.7 protein expression was upregulated within DRG neurons that project their axons to the inflamed area, a change that should increase excitability of these cells. Collectively, these data suggest that Nav1.7 contributes, at least in part, to pain associated with inflammation.”
“Nav1.7 channel that is critical for human pain perception could also be essential for odor perception”
85) Recent study - “The smell of pain: intersection of nociception and olfaction.” (special thanks to Lauren Alix)
“brain areas processing pain and olfaction largely overlap”
“Olfaction functioned as a warning system against an imminent threat associated with a challenge by male mammals.“
“preferred odor modulates the neural pathways that mediate the learning of pain”
“In particular, citrus fragrances, to which mood enhancing properties are attributed, provided evidence in a number of studies for effects of olfactory stimulation on human mental performance, mood and, ultimately, on pain“
“Exposure to unpleasant odors elicited greater pain intensity ratings and stronger nociceptive withdrawal reflexes, whereas pleasant odors evoked opposite responses in humans [6; 57]. Pleasant odors induced positive mood, decreased pain unpleasantness and pain-related activity within the anterior cingulate, medial thalamus, and the primary and secondary somatosensory cortex.“
“Nav1.7 sodium channels, which are expressed on nociceptive nerve endings but also on olfactory neurons”
“the frequent gain-of-function human TRPA1 variant rs11988795A was associated with enhanced perception of odor- ous stimulants, which in a subgroup of healthy volunteers was accompanied by increased sensitivity to thermal nociceptive stimuli”
“Nevertheless, cannabinoids and in particular, THC were able to modulate both, nociception and olfaction in humans...THC reduced the processing of nociceptive information by impeding the cerebral connectivity between somatosensory and limbic areas “
Conclusion: “Different lines of evidence support the proposal that nociception and olfaction share various characteristics at several levels. This includes co-expression of pain genes in olfactory brain structures, mutual roles of ion channels or G-protein coupled receptors in the transmission and processing of pain and olfaction, and shared brain areas involved in the central processing of both nociceptive and olfactory information”
86) How come when someone isn’t able to feel pain we can call it a genetic mutation? But when someone seems to be more sensitive to pain we tend to say it’s all in their brain? We don’t explain people with channelopathy-associated insensitivity to pain by saying that their brain is able to process the input in a non-threatening way because they understand pain science. So why should we only look at the brain when it comes to pain? Is this fair? Or even logical? Are we going to far with the clinical application of pain science?
Exercise of the Month
The latissimus dorsi extends the spine, extends the hip, extends and IRs the shoulder, and extends the elbow (through fascial attachments). This exercise does the opposite.Plus, it adds a strong active component. Struggling to round your back, push through your elbows, flex your hands back, and rotate them out creates a ton of great neuro "stuff" to make the changes last.I find the serratus anterior/external oblique sling to be very important when working with lat dysfunction. This exercise activates that sling with the lat in a compromised position.It has become my go-to exercise for shoulder flexion mobility.https://www.youtube.com/watch?v=sQtFuR4XLBM
Training
- Movement should be an inward inquiry as much as it is an external achievement of a task
87) Nice article on the importance of matching golf technique with the individual’s physical abilities.88) Owning hip extension is paramount for athletes. It seems easy enough to accomplish, but most people overlook the details. Here are 3 detailed ways to improve hip extension. 89) I was very lucky to have my first official Kettlebell lesson from Phil Scarito. Here is his great post on how to spread the tension to the contralateral leg to improve one-armed pushed-ups - “One thing I see frequently during the OAP is the student putting most of their focus and energy on the working arm—the arm that is on the ground. This makes the movement harder by shifting the student’s weight to that arm, essentially making them feel heavier.”90) 12 Kettlebell variations91) Dean Karnazes can run forever...because he has no lactate threshold…
“However, genetics alone does not tell the full story. Karnazes believes that his lactate clearance abilities could also be down to low body fat, low sweat rate, a highly alkaline diet and low exposure to environmental toxins. Genetics can give you the propensity for a natural advantage but you express your genes differently depending on your environment and your lifestyle.”
92) Some nice frogger/monkey variations from GMB93) Having trouble cueing someone out of a bad push-up technique? Cue them to lead with their hips.94) Mike Robertson goes over the 5 basics of any training program: mobility, speed, power, strength, conditioning95) I think being able to do a pistol squat on each leg is a greater feat than being able to lift a huge amount of weight for a partial range. Karen Smith gives you some tips on how to do it. 96) Great training article on embracing individuality by paying attention to: limb lengths, bony structures, injury history, body mass/fat, competition goals.97) I’ll shamelessly plug my article from the same choir - embracing complexity98) Great stuff - Zack Long shares a great collection of hanging band techniques for overhead shoulder stability.99) I’m a big fan of the pelvis and the pelvic tilt. Christine Ruffolo is too and explains why in this post - Pelvic Control Precedes Core Control.100) This is GOLD from Eric Cressey:
“If someone is very set in their beliefs (e.g., I won't change my diet), you need to change the surroundings to impact their behaviors (e.g., get junk food out of the house). Make it harder for them to eat like crap.
If someone is set in their behaviors (e.g., lifting with brutal technique), you have to change their beliefs (e.g., teach them what good technique actually is). Make it harder for them to "accept" lifting like crap.”
Plus 9 other great pieces of advice for the fitness business
101) “Most athletes attempt to stay vertical by creating extension throughout their system, where they can use joint compression (and/or impingement) to stabilize.” -Mike Robertson on his top 5 coaching cues #PRI102) I like the plank towel crawls103) Patrick Ward goes over FRC with a strength coach periodization model. 104) “The researchers concluded that there is no difference in the training volume performed when using either self-selected or fixed (2-minute) rest periods. This suggests that trainees with >6 months of resistance training experience can use a self-selected rest period duration, which reduces complexity, and may also reduce the total training session duration, making it more time-efficient.”105) TGU Side Plank Flip is very difficult when performed slowly106) Want to learn how to do a handstand or how to do one better? Check out this article from GMB.107) I like the creativity of these Landmine Exercises - 1 & 2. Although the guy in #1 definitely needs to lower the weight and focus on quality. 108) I love the idea of single arm hangs with body rotation from Ruffolo109) Improving athletic performance - “These findings suggest that exercises using the push phase of the Olympic lifts could be valuable for developing athletic performance....The researchers concluded that the jump squat was more effective than the push press for developing jumping, sprinting and agility in high-level young soccer players.”
Move with Instagram
110) Never get bored with your fitness. Awesome Instagram pages for exercise ideas, flows, and movement play. When I’m having a mental programming block I’ll check out one of these pages for ideas.
OnnitAcadamy - Mixed Training
Christine Ruffolo - great movement
KultFitness - Best.KB.Corrections.Ever.
GMB Fitness & Ryan Hurst - Bodyweight Masters
Marcus Martinez - Creative Kettlebells
Karen Smith - kettlebells and strength
JanetheClapp - YogaFlows
ResiliantPT - Strength & Performance
GFunctional - movement, strength, advanced correctives
Kathy - I can't do any of this, but it's beautiful movement
AwakenGymnastics - nothing that I can do, but good stuff for gymnasts
Alan Ng - a great mix of rehab and strengthening exercise
Dewey Nelson - stuff that 90% of the population can't do
Jill Harris - Pilates.
Aaron Swanson - shameless self-promotion, a mix of stuff, and a good looking dog
Shante Cofield - the instagram master who taught me the way
Research
- Absence of evidence isn't always evidence of absence
111) Want to reduce your stress hormones? Go to a live music concert.112) Resolution of Lumbar Disk Herniation without Surgery113) If someone is in pain, they will muscle guard during a special test. So not only are you likely inflicting more pain, but you’re probably getting a lot of false positives. #FindProblemsNotADiagnosis114) "running barefoot leads to better cognitive performance than running with shoes"115) “The data from this study support the idea that the differences between individuals with chronic ankle instability versus those that who cope after an ankle sprain may have more to do with changes in the sensorimotor system than ankle laxity.”116) "In all analyses, higher stress was associated with worse recovery. Stress, whether assessed as life event stress or perceived stress, moderated the recovery trajectories of muscular function and somatic sensations in a 96-hour period after strenuous resistance exercise. Therefore, under conditions of inordinate stress, individuals may need to be more mindful about observing an appropriate length of recovery." 117) “treadmill running resulted in greater Achilles tendon loading compared with overground running”118) In rehab and general movement training, increasing variability is a good thing. "Far from being a source of error, evidence supports the presence of an optimal state of variability for healthy and functional movement."119) “The results of this investigation indicate that using higher external resistance is a more effective means of increasing motor unit activity than increasing the number of repetitions performed with lighter weights even when the end point is muscular failure. Accordingly, previous recommendations for the use of heavier loads during resistance training programs to stimulate the maximal development of strength and hypertrophy are further supported.” (via Tim)120) “Load & speed influence motor/movement behavior. Low load & slow speed is not motor specific to high speed sport.”-Tim reminds us to be specific in our assessments and interventions121) The long term effects of cortisone - “Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year”122) All sensory input matters. Music matters. “The results show that some music has an activating influence, increasing velocity and motivation, while other music has a relaxing influence, decreasing velocity and motivation.”123) The future is here “Using specially designed insoles to deliver stochastic resonance to the plantar surface of the feet has the potential to significantly improve static balance, dynamic balance, and gait mechanics in healthy, young individuals as well as elderly people and others with somatosensory deficits.”124) Fat as an endocrine organ - “the enlarged adipocytes of obese individuals recruit macrophages and promote inflammation and the release of a range of factors that predispose toward insulin resistance”125) Go Hiking
“researchers found that performance on problem solving tasks improved by 50% for those who took part in this tech-free hiking excursion”
“They found those who walked for 90 minutes in a natural environment reported lower levels of rumination and they also had reduced neural activity in the subgenual prefrontal cortex, an area of the brain related to mental illness”
“It has also been proven that people who exercise outside are more likely to keep at it and stick to their programs, making hiking an excellent choice for those wishing to become more active on a regular basis.”
126) “Researchers from the David Geffen School of Medicine at UCLA found that cardiovascular disease patients who have high muscle mass and low fat mass have a lower mortality risk than those with other body compositions. The findings also suggest that regardless of a person's level of fat mass, a higher level of muscle mass helps reduce the risk of death.”127) Another reason why you don’t want high-threshold strategies with your rehab clients - “The results of this study suggest that unlike isolated voluntary training, co-contraction training of the trunk muscles does not restore the motor control of the deep abdominal muscles in people with LBP after a single session of training.”128) The CAI (chronic ankle instability) group had a smaller degree of left hemi-diaphragm contractility compared to the control group”. How is this not on PRI’s front page?129) “The knee torques that positively correlated with increased tibial slope angle in this investigation are associated with heightened risk of ACL injury. Therefore, the present data indicated that a higher posterior tibial slope is correlated to increased knee loads that are associated with heightened risk of ACL injury.”130) “The current results suggest that, for acute and subacute [cervical radiculopathy], treating joint and muscle stiffness without a focus on increasing the size of the IVF is as effective as a program that specifically focuses on increasing the size of the IVF of the affected nerve root.”131) “When groups were asked to jointly build creative Lego models, their speech, movements and heart rates became increasingly coordinated...The study shows that behavioral coordination is crucial for teamwork. The more groups develop routines and effective ways to take turns in speaking and acting, the more their heart rates become in sync.”132) “Performance on the vertical drop jump landing task was not found to be associated with anterior cruciate ligament injury risk in a group of female handball and soccer athletes. “
Social & Communication
- "The human tongue is a beast that few can master." -Robert Greene
133) “Small changes in the social lives of older people are early red flags showing that their thought processes and brain functioning could be on the decline.”134) Acetaminophen (tylenol & painkillers) decrease empathy. Decreased empathy can impair relationships and lead to less social outreach. Decreased social relationships can lead to loneliness. Loneliness can lead to increased pain. Increased pain can lead to consumption of painkillers / acetaminophen. The consumption of painkillers/acetaminophen decreases one’s ability to feel empathy. Decreased empathy…135) “Even as adults, friendships play an important role in our lives. By bringing laughter and camaraderie, their mere presence can buffer stress as well as the effects of negative experiences. Furthermore, they can help alleviate despair or emotional turmoil. New research published in Scientific reports suggests a better pain threshold may be another benefit of having friends. “136) Be more persuasive, repeat your main points. Research shows repetition biases judgement (helps people change their minds). 137) 4 Themes of Patient-Therapist Interaction
(1) physical therapist interpersonal and communication skills (ie, presence of skills such as listening, encouragement, confidence, being empathetic and friendly, and nonverbal communication)
(2) physical therapist practical skills (ie, physical therapist expertise and level of training, although the ability to provide good education was considered as important only by patients)
(3) individualized patient-centered care (ie, individualizing the treatment to the patient and taking patient's opinions into account)
(4) organizational and environmental factors (ie, time and flexibility with care and appointments).
138) “Small changes in the social lives of older people are early red flags showing that their thought processes and brain functioning could be on the decline."139) A very well written article on the "road trip effect" - the how and the why of road trips improving friendship.
-Increased Exposure
-Working Toward Common Goal
-Getting to Know One Another (mutual disclosure)
-Discovering Points of Similarity
-Having Shared Experience
140) Be More Persuasive (it’s really just great communication advice)
-Don’t be direct: Direct usually comes off as rude, no matter your intentions. Be nice and slow it down.
-Don’t try to get them to say “yes”: Pushing for a “yes” makes people defensive. Try to get a “no.”
-Do an “accusation audit”: Acknowledge all the negative things they think about you to defuse them.
-Let them feel in control: People want autonomy. Ask questions and let them feel like they’re in charge.
-The two magic words they need to say: Summarize their position to trigger a “That’s right.”
-Listen for levers: They might only need the orange peel. Listen, listen, listen.
-Keep asking “How am I supposed to do that?”: Let them solve your problems for you.
141) The Power of Words
"In the western mind, there are two notions of compassion," he explains. "One is, I'm going to be a good Samaritan and help this guy. But that is the compassion of the weak. The compassion of the strong is in waking people up to their blindness. For that, you need to be a warrior. I am tough and sweet. I show you your bullshit, but I'm also infinitely patient with you."
“Our best comes out when we have honest discussions. Our worst comes out when we behave like robots or professionals.”
“Since all action is based in conversation, the shock has to come through language.”
“When trust improves, the mood improves. Everyone feels more confident.”
“We don't realize how much we create reality through language," Flores says. "If we say that life is hard, it will be hard. If, on the other hand, we make commitments to our colleagues to improve our productivity, we also improve our mood, and as a result, clarity and happiness will increase. People talk about changing their thinking, but they have no idea what that is, let alone how to do it. The key is to stop producing interpretations that have no power."”
142) Quick Book Review
I’m listening to the 48 Laws of Power on audiobook. It’s an interesting book, but I think it’s depressing me a little bit. I find it sad that people have to play these power games to make money and gain control. It’s even more sad when you know people are doing this in front of you and you have to sit back and watch them play out their “game”. I understand that awareness of this power game is necessary and may be useful. However, I think we should strive to live an honest, compassionate, altruistic life. Not a scheming life that wants fame, money, and power.
Diet
- "Our preoccupation with goals, results, and the quickfix has separated us from our own experiences." -George Leonard
143) Great research based article from VOX on how exercise isn’t enough to lose weight. 144) Diet and Cancer - “A new study finds that consuming sugary beverages, processed foods and other energy-dense carbohydrate-containing foods markedly increased the risk of prostate cancer, choosing healthy carbs like legumes, fruits and whole grains was associated with a substantial reduction in the risk for breast, prostate and colorectal cancers.”145) 29 healthy snacks146) You’re getting fat if you’re reading this at night - “Northwestern scientists found bright light exposure increased insulin resistance compared to dim light exposure in both the morning and the evening. In the evening, bright light also caused higher peak glucose (blood sugar) levels.”147) “Variations in human diets across a plausible range of intakes have been shown to have no effect on blood pH. Consistent with this lack of a mechanistic basis, long-term studies of alkalinising diets have shown no effect on the age-related change in bone fragility. Consequently, advocating the consumption of alkalinising foods or supplements and/or removing animal protein from the human diet is not justified by the evidence accumulated over the last several decades.”148) 7 Reasons Why We Love Alcohol149) “Eating a meal of seafood or other foods containing omega-3 fatty acids at least once a week may protect against age-related memory loss and thinking problems in older people, according to a team of researchers at Rush University Medical Center and Wageningen University in the Netherlands.”150) “Never make a decision when you are hungry. The hormone ghrelin – that is released before meals and known to increase appetite – has a negative effect on both decision making and impulse control.”151) 12 Best Foods to Eat in the Morning152) For the tea enthusiast out there - “Results showed a link between peppermint tea and enhanced mood and cognition. Those who drank peppermint tea also exhibited improved long-term memory, working memory, and alertness. On the other hand, volunteers given chamomile tea experienced a calming sedative effect, which the team noted also seemed to slow their memory recall and attention speed”153) Diet and Fibromyalgia154) “Within the human digestive system lives a massive ecosystem of bacteria, known as gut flora or the gut microbiota, and recent research suggests that these microbes can manipulate your brain into eating unhealthy things and even into feeling stressed and depressed.”155) "The results of our study suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and açai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation.”156) 18 Science Based Ways to Reduce Hunger and Appetite: eat more protein, opt for fiber rich foods, pick solids over liquids, drink coffee, fill up on water, eat mindfully, indulge in dark chocolate, eat some ginger, spice up your meals (capsaicin), eat on smaller plates, use a bigger fork, exercise, lose belly fat, get enough sleep, reduce your stress, eat omega-3 fats, opt for protein rich snacks, visualize eating the food you crave157) 15 Ways to Reduce Blood Sugar Levels: exercise regularly, control your carb intake, increase your fiber intake, drink more water, portion control, choose foods with a low glycemic index, control stress levels, monitor your blood sugar, get enough quality sleep, eat foods rich in chromium and magnesium, try apple cider vinegar, experiment with cinnamon extract, try berberine, eat fenugreek seeds, lose some weight.
Diet & Tendons
158) “Chronic hyperglycemia and central obesity are independent risk factors for degenerative tendon disease and the underlying mechanisms involve an accelerated accumulation of advanced glycation end-products (AGE’s), collagen cross-linking, oxidative damage, and aberrant remodeling of the extracellular matrix. Consuming a diet that results in consistently optimal blood glucose levels and improvements in body composition may improve tendon health in the general population. Lifestyle interventions for preventing and treating tendinopathies should be considered given that evidence based treatment options are limited.”159) “A diet that is low in highly refined carbohydrates and simple sugars, relative to the modern western diet, can reduce AGE accumulation, collagen cross links, inflammation levels, maintain ECM homeostasis, and improve body composition. These effects will likely provide significant benefits for long-term tendon health.”160) Another Great Article
“The main point here is that the quantity of highly processed carbohydrate and sugar in a standard Western Diet is not just harmful to your cardiovascular and endocrine systems, but likely to your connective tissues as well. “
161) “several studies show that, in obese subjects, tendons frequently undergo to degeneration, which can progress to a symptomatic stage, with pain and functional impairment”
Other Good Stuff
- "And those who were dancing were thought to be insane by those who could not hear the music" -Friedrich Nietzsche
162) Get out there and dance more: “Studies show that dancing at parties and in groups encourages social bonding, whether it is a traditional stomp, a tango or even the hokeypokey. Many researchers have argued that people experience a blurring of the self into their groups thanks to the synchronization that occurs while dancing. Yet it is also possible that the exertion inherent to dancing releases hormones—like any other form of physical exercise—and these molecules are behind the bonding effect. A new study suggests both views may be correct.”163) “Researchers are learning that as we age in relationships, we change biologically to become more like our partners than we were in the beginning.”164) “We have become attracted to distracted. Constantly checking for updates and new information. Obsessively checking for the latest word from this expert or that. Strangely this constant activity feels like progress. The truth is we’re busy, but we’re not focused. Nothing much is getting done.”165) "Yes, it’s that simple. If girls & women around the world were given an education (a full education!), then poverty would not be so persistent."166) Trees sleep at night too. “Genes that code for a 24-hour circadian rhythm exist ‘in most every cell, in most every organism on Earth,’”167) “Using digital platforms such as tablets and laptops for reading may make you more inclined to focus on concrete details rather than interpreting information more abstractly”168) 8 Ways to Change Habits: Pick one at a time, Reduce the variability of the habit, Change your environment, Don’t stress, Replace habits, If-Then planning, Expect setbacks169) Use your body to learn quicker - “Physical movements seem to be particularly suitable fodder for making non-declarative memories, and so by both speaking and gesturing, we may encourage our brains to make two independent memories of an event, boosting our chances of remembering the event later.”170) I’m always skeptical of people that say they read 5 books a month. There’s no such thing as speed reading - “Reading is about language comprehension, not visual ability.” For more on this myth, check out #72.171) 5 Benefits of Acupuncture You Didn’t Know About172) “Three bricklayers are asked, “What are you doing?” The first says, “I am laying bricks.” The second says, “I am building a church.” The third says, “I am building the house of God.” The first bricklayer has a job. The second has a career. The third has a calling.” -Article from Eric Barker on developing Grit173) What are we doing? Where is the empathy and compassion? The altruism? The humanity? “The world's 62 richest people now own as much wealth as the 3.6 billion people who make up the poorest half of the global population”
Bottom Line
If you enjoyed this list please share it with others to help the world move better. If the general population knew the benefits they could get from working with quality physical therapists, chiropractors, athletic trainers, strength coaches, or personal trainers then we would ALL have a lot more business.For a more real-time update of movement and health information follow me on social media:
Instagram - exercise pictures, movement flows, and Rigby
Facebook - movement and health articles (geared towards the public to improve education)
Twitter - weird abstract comments, out of context stuff, quotes, and good stuff from things I’m reading
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