Manual therapy and skepticism

This was shared via Diane Jacobs’ Facebook page and I thought it contained some great insights so I wanted to keep a copy of it for myself by sharing it here:

Re: Manual therapy: What I’m skeptical about:

1. any treatment system that has been based on one’s supposed ability to be able to directly affect structural (mesodermally derived) tissue (which is 98% of the body)

2. that I can accurately feel (with my hands) or differentiate (let alone have any direct effect upon) such tissue

3. That any effect treatment has on somebody is a direct result of anything I managed to “do” “directly” “to” somebody else’s “tissues”

Re: Manual therapy: What I am NOT skeptical about:

1. that there is an awake, alive nervous system in there watching and feeling every move I make, with neurons that come all the way out to the surface

2. that neurons are physically organized into nerves, even though I cannot perceive how through my hands

3. that the nerves of every human organism that comes to see me are unique, with anatomical variation

4. that they are nonetheless codependent with and attached to the vascular system through 72 kilometers/45 miles of folded up complexity

5. that mechanical deformation of the physical aspect of nerves can and does exist, is detrimental in that it can become uncomfortable, painful even, and is more often a function of behaviour, not of form

6. that nerves emerge from the depths to the surface through openings in (stiffer) body wall containers

7. that the skin organ is rubbery and should feel mobile and homogeneous

8. that heterogeneity perceived through relatively superficial palpation is generally an indicator of something not quite right with autonomic output behaviour

8. that I can make temporary distortions in the thick skin organ and can move limbs about

9. that although I cannot accurately palpate the nouns of the body, I can notice the verbs – i.e., changes that occur, such as softening, expansion, and increased homogeneity

10. that softening, increased homogeneity etc. is usually coupled with less tenderness (hyperalgesia) and easier movement by the person living inside that nervous system

11. that it is certainly not I who have instigated these changes, that rather they come about because two nervous systems, one which comes to see me because it needs some physical outside referencing, and mine, together, have formed a temporary partnership, in which the first one is the creative, self-corrective force, and mine has been mere catalyst.” – Diane Jacobs

Jeromie

You are not your scan

In my previous post, I alluded to a forum called SomaSimple where pain science is discussed and ideas on treatment models and modalities are challenged. Two folks who are not regularly contributing on the forums, but who are sharing good work on social media are Adam Meakins and Gregory Lehman.

The questions they ask and content they provide have helped shaped my thoughts on both personal training and massage therapy. We are not like a car that needs regular tune-ups and aligning, just like we are not like a computer with software or hardware hang-ups. Greg’s view of the human body is the one that I connect with very strongly: we are a robust ecosystem. I don’t like to think of the human body as fragile, and the ecosystem comparison alludes to the fact that the experience of our interaction with our environment is multifactorial. One thing that can show how multifactorial our experiences are have been shared by Adam and Greg and I’ve found them quite compelling.

When it comes to scans, such as MRIs, they can provide us with a sense of the environment of certain regions of our ecosystem. The regions I wanted to share in this post are the cervical spine, lumbar spine, and knee. Most of this information I found via Adam’s Twitter feed, which is linked above and in the caption of the graphs.

In the cervical spine, a study titled, “Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects” demonstrated that people without any symptoms (asymptomatic) of cervical spine problems, over 87% were likely to find a disc bulge.

Because of this study, Adam tweeted another two studies: one on the lumbar spine and one on the knee joint showing similar findings:

Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations

Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study)

The number of subjects varied in these last two, and 29% of the subjects in the knee pain study had experienced pain in the month prior, but nonetheless, the findings are important. This goes to show how you are not your scan. Pain is much more about your ecosystem’s interaction with its environment.

As you age, and as you can tell by the studies above, it is very likely you’ll have an “abnormality” if you were to ever have imaging done. “Abnormalities” and pain do not coexist, because if they did, the people in these studies would be experiencing pain of some kind. This is where Greg offers a great resource: Pain Fundamentals: A Pain Science Education Workbook For Patients and Therapists.

When it comes to pain, there’s a few things I’ve come to learn and advice I wanted to offer: 1. Pain is normal and not to be feared, and tissue “abnormalities” do not mean you’ll end up in pain. 2. You should be as active as possible, as long as it doesn’t make the pain worse. 3. You should incorporate novel inputs that help reduce the pain experience (moving in ways that are new to your ecosystem); these inputs should be gradually progressed over time. 4. Manual therapy/massage therapy can help turn the volume down; if the pain returns within a few hours, it probably wasn’t the right approach.

This doesn’t mean that scans aren’t helpful and that you can always avoid big interventions, like surgery, but it does mean that if you utilize physical therapy, massage therapy, exercise, or other interventions to help with your pain, you can help keep your ecosystem running nice and robust. And for fun, here’s a study comparing knee meniscus surgery with a sham surgery. The results? “…the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.” If you can teach the body to reduce a perceived threat, positive things happen.

Jeromie

A different lens

I wrote this on a forum called SomaSimple where ideas are challenged regularly and the discussions are regularly about the topic of pain. Since the BPS model includes psychological factors, the overlap seemed to fit well with some of my experience as a trainer. Here’s what I wrote:

“I don’t work in a clinic, I work in a gym. As a personal trainer, it isn’t uncommon for us to have clients who have some kind of ache or pain; if not at first, there’s likely a point where they’ll run into that experience during training. This was one of the main reason I enrolled into a massage program and eventually found DNM and this forum.

In my training career, my clientele has predominantly been female between the ages of 25 & 60. Most clients come to the gym for weight loss (specifically fat loss, but that’s a separate rant) and some of the measures that are taken to work toward better aesthetics are quite extreme (such as using a feeding tube “diet” to lose weight for a wedding).

The extreme measures that can be taken are usually drawn out of something quite emotional. I had one client cry after telling me she was sexually abused and used weight gain to make herself unattractive to her abuser. You can only imagine the road that kind of trauma will take people down when it comes to healthy lifestyle choices.

Much of what training is about is behavior change. Then Jason Silvernail recently posted this great comment on his FB by Bronnie Lennox Thompson. If you can’t read it due to privacy settings, this part of the comment particularly stood out to me:

Quote:
“…, then I get on with helping them do behavioural experiments anyway, because behaviour change WORKS, while cognition/information doesn’t always do the trick.”

I wanted to share what I thought might be some behavioral comparisons or overlap in what the therapist might see in clinic (PT) vs. what I see in the gym with clients (GC):

PT: “I don’t want to bend forward because I’m afraid I’ll do more (perceived) damage.”
GC: We can get a similar statement above, but I commonly hear, “I don’t want to lift weights because I am afraid I’ll get big and bulky.”

PT: Client might cease movement for fear of pain or further (perceived) damage.
GC: Client will cease food intake for fear of weight gain.

PT: Client may try extreme therapy protocols to help relieve the pain.
GC: Client may try extreme dieting or training protocols to help lose weight.

PT: Client may over-analyze diagnoses and split hairs on the little things, like “I hurt because I was sitting too long with bad posture.”
GC: Client will split hairs and over-analyze the little things, like “I didn’t lose weight this week because of that one candy bar I had on Tuesday.”

PT: Client may jump from therapist to therapist or modality to modality.
GC: Client may jump from trainer to trainer or protocol to protocol.

PT: Client may have issues with body awareness (smudging).
GC: Client may have body image issues (perceive themselves as bigger than they are).

This wasn't a part of the original SS post, but we all have those clients who are strong and beautiful, with unrealistic expectations. Image source Tumblr.

This wasn’t a part of the original SS post, but thought it fit well with the emotions behind diet and fitness behaviors I’ve experienced. Image source Tumblr.

If you think I am going a little too far out on a limb, let me know, these were just some random thoughts that were rushing through my head the other day and I wanted to get them out. Also, I’m not picking on women, I know men who have similar body image issues, I just have more experience training women. My thought process is that with the neuromatrix model, the emotions that people experience can be another form of pain that people bring the table, and emotions are a big driver in health and fitness choices and behaviors, making this information just as important for trainers, as well.

Thanks for reading.”

Jeromie

The Lunge

For those who are new to my musings, I started working in a new facility basically right after my wedding. It’s been an interesting 6 months, but I really appreciate that one of my co-workers, Nick, is a talented and experienced trainer. I feel like I’ve learned more from him over the last 3 months or so than I have from many of the courses I’ve taken (words from my wife during dinner conversation). One of the things I recently brought up to him was his opinion on the lunge.

It was this article by Tony Gentilcore that sparked my curiosity. I read the article when it was first posted well over a year ago, which drove me to pay more attention to the lumbar spine during lunges, and Nick agreed, but he brought up another good point. With lunges, the focus is usually on being tall, shin vertical, and taking a relatively big step for a good stretch on the hip flexor of the back leg. The point he wanted to make? The only way to get up out of this position is by pushing off the back leg.

Lunge copy

As you can see by the arrow, related to the post from Tony, there’s some lumbar extension, there’s a big stretch on the hip flexor of the back leg, and the shin is vertical.

This vertical shin position is something I look for in a box squat, and it’s a difficult task to do because of how much emphasis it places on loading the hips. Now take one of your legs out of the equation (the back leg) and try to stand up with a vertical shin – this is basically what is being asked for with a lunge. You have no choice but to push off with the back leg. If you try to slow down your lunge and really focus on loading the front leg, you will have to shift your weight forward some. Which brought up another great point: eccentrically loading the glute on the front leg. When Nick brought this up, I immediately dropped down into a 1/2 kneeling position and slowly shifted my weight forward until I felt a big pull on the tissue in my gluteal region. Once I felt the difference for myself I knew I needed to make that adjustment.

Here’s what I do now:

1. Take a step back (or forward if you’re walking) only big enough to push off as little as you can with the back leg.

2. Make sure to have a little forward lean in your torso so you’re not getting too much lumbar extension.

3. Make sure your weight is shifted forward enough so you feel a nice eccentrically loaded glute, but can also keep your foot flat and not come up onto your toes. You still want a tripod foot position while minimizing shear forces on the knee joint.

It's much easier to load the front leg when I shift forward a tad.

It’s much easier to load the front leg, and I get better glute involvement, when I shift forward a tad. I probably didn’t need to lean forward in my torso this much, either.

For all of the form perfectionists and one-size-fits-all folks, I realize that everyone’s position will probably look a bit different. It will depend on what you as a trainer or trainee hope to accomplish with the movement and if something hurts. And if you or your clients even enjoy the movement at all. This is just something I’ve been playing with and it’s something that a couple of trainers that I respect made really good points with, so I tried it, liked it, and started implementing it.

Give them a shot and let me know how you felt with the adjustment, if it was harder because maybe you were pushing off with your back leg a lot more than you thought, and if you were sore in your glutes in a whole different way.

Jeromie

Quick post: Musings on pain and activity

Pain fascinates me because you can experience pain without having any tissue damage. I’ve been coming across information lately that has me thinking about pain and physical activity.

There are nearly 45 miles (72 km) of nerves running through the body, yet the nervous system only accounts for about 2% of the body. The nervous system is accompanied with a blood supply because of its requirements for about 20% of the available glucose and O2.

I came across and appreciate this picture that I saw via social media and I thought it was really interesting to see the veinous system (both arteries and veins) mixed into the bundles of nerve fibers.

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I found the original source of the picture here.

To add to that, there’s a capillary every 5 cell widths. No wonder sitting is considered the new smoking.

With this in the back of my mind, I see how physical activity can be really helpful in managing pain conditions (especially chronic pain).

“Motion is lotion.”

The more I read about pain, the more I realize it’s not something to fear. Pain is a normal part of living. It’s a signal that’s trying to tell you, “something is wrong, or something might go wrong, so something needs to change.” It’s your body’s alarm system.

Physical activity can help “turn the volume down”, or speed up the recovery process for tissue that is actually injured, so it’s important to move. Move everyday. If you move with intensity, give yourself a break from that kind of activity, but don’t stop moving. Give yourself challenges. Move differently all the time. Play. Just try to utilize the ranges-of-motion that your body feels safe with (that don’t “sound the alarm”), while trying to address movement discomfort with a knowledgable healthcare provider. You’ll feed the nerves, you’ll keep the blood flowing, and you’ll keep your brain happy.

Your body will thank you in the long run.

Jeromie

Memento Mori

Scrolling through social media the other day, I came across a blog post titled: Memento Mori: Art to Help You Meditate on Death and Become a Better Man.

From the post:

Memento mori. Remember that you will die. [emphasis mine]

Us moderns don’t like to think too much about death. It’s a bit too depressing and morbid for our think-positive sensibilities. Our culture is devoted to perpetuating the lie that you can stay young forever and your life will go on and on.

But for men living in antiquity all the way up until the beginning of the 20th century, rather than being a downer, death was seen as a motivator to live a good, meaningful, and virtuous life. To help men remember death, artists created paintings, sculptures, and mosaics depicting skulls, skeletons, and other symbols of death.”

I found a photo very similar to the one below using Google images and now I have it as my background picture on my cell phone.

 

Memento Mori
Image source: click here.

Remember that you will die. I appreciate the use of death as a motivator to live a good and meaningful life. I remember seeing a blog post about the top 5 regrets people had at their deathbed. You can find a link to the post (I don’t think it’s the original) by clicking here. Each regret people had seems like something that would be less of a regret if death was used as a motivator for a meaningful life. #1, for example, is wishing for the courage to live a life true to one’s self, instead of a life others expected of them. There isn’t much that’s more meaningful than a life true to yourself.

With the thought “remember that you will die” being thrown around in my head, I started to write some things down and here are those musings thrown together in one place for the rest of the world to read.

What are some things you’ve decided to not do because of fear?
What have you not spoken up about or stood-up for?
Have you ever held yourself back from anything? If so, what’s held you back (if not fear)?

Now I want you to think about having only 6 months to live: would you still hold yourself back from any of the things that popped into your head after reading the previous questions? What about having only weeks to live? Days? Minutes?

When death becomes a nearing reality, it can be used as a great motivation to do the things you desire. But that’s something most of us assume will happen many years from now. As I sit in a Starbucks lobby writing this, I could drive home later and end up in a fatal car wreck. I could go to sleep tonight and not wake up for reasons unknown. Life is full of “what ifs” and my own life is rather predictable with each day, but that doesn’t make me invincible. It doesn’t make anyone invincible.

Just because you’ll die doesn’t mean you shouldn’t live.

We will all pass one day; what will you be known for by your family and friends? What kind of risks will you have taken? What things will you have spoken up about? Be honest with people. Never give up on your hopes and dreams. Most importantly, don’t hold yourself back.

There are people in my life, myself included at times, who make choices out of fear that may lead them to having those same 5 regrets on their deathbed. They may be big life choices, such as a change in careers, or less significant choices, such as not driving to the next town because of a fear of driving on the freeway.

I’ve not given my all to friendships – I am terrible at staying in touch and could spend much more time than I do with friends and family. I’ve not given my all to employment opportunities – I’ve not gone the extra mile and have failed to follow through on certain things which have disappointed employers or employment opportunities. Most importantly, as this is a movement- and massage-oriented blog, I’ve not given my all to my well-being, and I know many people who likely follow my work or stumble upon my work who feel the same way. You’re not alone. You’re never alone, as much as you may tell yourself those things, and this is your reminder.

This is your reminder to dig deep inside yourself. To stay consistent. To understand that knowing you’ll die is all the more reason to live for yourself, which is a much different feeling than living with yourself. To know that you need to make decisions about your health that are for you and nobody else. To not let fear get in the way of your goals to be a healthy, happy human. Trust your instincts and knock down the walls of doubt. Memento mori.

Jeromie

What sorts of thoughts does this post provoke for you? Let me know in the comments.

SMRT Reads – Functional Anatomy Seminars

I’ve written 5 posts this year and it’s nearly August. For that, I apologize, but my focus has been on working to save for a wedding. Work has slowed down, so I figured I’d throw something together with a few of the posts that I’ve read and have been keeping in my inbox.

Since taking my FR® course, I figured I’d post a few of the articles that highlight the knowledge that has driven me to respect and appreciate Dr. Spina’s systems. And I am taking the Functional Range Conditioning™ course hosted in my home state coming up in January.

Function of Anatomy: the SPINE

This quote sums up the brilliant way Dr. Spina thinks: “At the level of the spine, there is very little relative tissue motion that occurs between each spinal segment (motion segment). The creation of gross spinal movement occurs via the summation of small segmental movements across larger spinal sections. Production of such movement is the job of the more superficial muscle groups that cross several articular segments. For example, when forward flexing the lower spine, movement production is achieved by activation of the larger, stronger, superficial muscles, and the gross movement should be distributed across several lower lumbar motion segments (as well as a significant contribution from the hip articulations). In contrast, when a significant amount of movement is achieved at a single segment, tissue damage often results. We commonly refer to this phenomenon as ‘spinal segmental buckling.’ Because of this, it is more accurate to think of the spine as a single, stiff unit that ‘bends’ rather than as a collection of individual articulations that move independently.”

Muscle…

And his thoughts on muscle: “If you consider ‘a’ muscle to be a single unit that produces one specific function you are grossly underestimating the complexity of its structure.

A muscle is more than ‘a’ muscle as all of the units that make up the structure (myocytes) can themselves be considered ‘muscles’ in their own right, each producing the exact function independently as does the whole. Namely, they draw tension into the connective tissue elements which surround them. From this perspective, each individual sarcomere can also rightfully be thought of as an independent ‘muscle’ whose protein components interact on the molecular level to tension their endomysial encasements. Thus ‘a muscle’ is more accurately thought of as a general name given to a group several thousand functioning structures. Each of these structures produce slightly differing angles of pull and thus create differing angles of tension affecting movement production.”

The secret to health…

This is a post written as a letter to a client: “The fact of the matter is that a general overview of all of the scientific evidence that has ever been published on human health strategies leads to one common conclusion: Being a healthy human requires ongoing effort and dedication.”

“Functional” Exercise??? What do you mean? …

This post is a favorite because it addresses how anything can be “functional” given the context and reason for choosing the exercise: “Two of the most common questions that I am asked on a regular basis (likely due to the names of the seminars I teach) are “what is functional anatomy,” and “what is functional movement.” On the surface these seem like reasonable questions that should have relatively easy answers. For example when considering the first question one might simply say that functional anatomy describes the “function of anatomy.” Or I suppose you could also say that it outlines the “anatomy used as one functions.”

What if you were asked as a follow-up question “what is the most important part of human anatomy?” This question seems more difficult because there really is no single answer. In fact, to answer the question one would need to demand more information as it would depend entirely on the specific function that the ‘anatomy’ was performing at a particular time.

Similarly the question “what is the most important function?” poses a similar problem. The most important function is the one that is needed at a particular time.

How about the second question? What is functional movement? The answer would be that functional movement is movement that achieves a certain function. What then is/are the most functional movements? Again, to answer this question we would require further information as the ‘functionality’ of a movement depends entirely on the goal that it sets out to achieve….”

Be sure to read the entire post, as I just posted snippets from each one. I look forward to what FRC™ can teach me and how I can apply the methodology to get even better results than I am now.

Jeromie