It’s Not About The Pain

Being a good osteopath involves being good at communication.

Being good at communication involves being good at listening.

Being good at listening involves understanding, not only what was said, but what wasn’t said.

This is because:

People don’t seek your help because of their pain, they seek your help because of the pain their pain causes.

When We Start, We Don’t Know Where We Will End Up

When I was a teenager, I was lucky enough that my dad, for whatever reason, bought a copy of a book called Smart Sport, which is essentially a book of sports science for lay people.

I read that book multiple times, developing an interest in exercise physiology and sports performance.

Indirectly, that has lead me into my current profession, but that is not what this post is about.

Because of my interest in exercise physiology, I became interested in cycling, and if you were interested in cycling at the turn of the century, you were interested in Lance Armstrong. Say what you want about him, but the man made cycling exciting!

Part of his appeal was his back story, which he detailed in a book titled It’s Not About The Bike.

The book outlines Lance’s struggles in life, and with cancer, as well as his comeback from the brink of death. It peaks when Lance is on the recovery trail and is climbing a hill in Colorado, when he realises his life is meant to be a struggle.

Which brings me to pain.

Pain Is Good, And Bad

None of us is entitled to be pain free, all the time.

[Note: This actually wouldn’t be a good thing either, as people with congenital analgesia (genetically can’t feel pain) tend to have shorter lifespans than average.]

Most of us are lucky in that we only experience pain in a positive way. That is, short term pain that is protecting us from something obvious (or not so obvious); a broken bone, a strained muscle, too much exertion in too little time.

However, some people experience constant, chronic pain, which we could say is not positive at all, but rather negative.

This pain is still protective (all pain is), however it is also pathological.

It occurs when the nervous system has changed, both in structure and function and become hyper protective. This type of pain is negative, because in the vast majority of cases it doesn’t correlate well with any tissue damage needing protection, and becomes a big hurdle to living a full life.

What we (as a population) have to understand is, some pain cannot be resolved.

We just don’t know enough yet. And even if we did, perhaps some pain is not meant to be resolved?

So if you are suffering from chronic pain, you have to ask yourself:

If this pain never went away, can I still live a good life?

And to me, as an osteopath, the answer is always yes. Mind you, many people will actually experience their pain decreases as they learn how to manage it better, but more on that later.

If you have have chronic pain, and you cannot fathom a way to live a good life, then you need help.

You need a team of health professionals who understand pain, who can work with you on reshaping your expectations, improving your management and helping you get as much out of life as possible.

#TheStruggleIsReal

Back to Lance. This is what I think he was talking about: life is all about the struggle.

We all struggle.

Our struggles vary, but to the person struggling, as the internet says “the struggle is real”.

But this struggle defines us.

It is because we struggle that we become stronger people.

It is because we struggle that we rely on others, building relationships that add to the richness of life.

It is because we struggle that we can help others who share the same struggle.

Perhaps, if we can learn to find meaning in the struggle, the struggle isn’t so much of a struggle, but a journey. And like every journey, some have it harder than others. Some don’t even make it. It’s not fair, but it is life.

Knowledge Is Power

I have talked about pain over the last few years, using tens of thousands of words to try and help people understand what pain is, how it works and how to move, think and live in order to overcome pain and achieve optimal health.

But overcoming pain doesn’t always mean getting rid of pain.

It means overcoming the adversity that pain brings.

It means understanding the key points of pain science education, as my friend and colleague Alison Sim outlines:

  • Pain does not equal tissue damage
  • Focus on function, not pain
  • Use physiology to underpin management (i.e. manipulate physiology with exercise and pyschological techniques to reduce stress and anxiety)

Mostly, it means understanding that it’s not about the pain, it’s about living as well as possible given the circumstances.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

Your Body Is Not A Machine

Back of man with arms elevated exposing machine internals.

What a machine!

Food is fuel!

The heart is a pump.

The brain is a computer. Inputs. Outputs. Processing.

Analogies likening the body to a machine have been around for centuries, if not longer.

They exist in almost every culture.

They shape the way people think about their bodies.

They are wrong.

Your body is not a machine, and that is an extremely good thing.

Your body is a biological entity, which adapts over time to the stimuli it is exposed to.

Moreover, your body is part of you and you are part of your body – the separation is an illusion of the mind.

Let’s look at this a little more deeply.

Why Do We Use Machine Analogies?

In a word: simplicity (even I succumbed to computer based analogies in this post – my understanding is better now).

Even the most complex machines are computers are created by, and hence can be understood by humans.

When it comes to our body, our brain, our mind – we really don’t know that much.

We are learning at an astounding rate, but almost all research in human biology and psychology ends with the dreaded statement more research is needed.

So, to simplify things, we use analogies of machines. To the non-technical minded person, machines are complex, but we have an idea about them because of our interaction with them in daily life.

But, in the process of simplifying, we have made things too simplistic, and as a result, our explanations lead to incorrect ideas.

Incorrect Ideas Lead To Poor Health Behaviours

Many people are afraid of activity due to a fear that they will “wear out” their body.

You hear doctors described arthritis as “wear and tear” all the time.

This leads people to stop doing the very things that would improve their condition – exercise.

We see similar problems with the “hardware/software” analogies used (I have been guilty of this in the past).

When people are told their brain is like a computer, it is very limiting.

Computers cannot create.

Computers cannot feel.

Computers cannot express themselves.

At this point in time, computers can only do what they are programmed to do.

If we think our brain is like a computer, then it is becomes a tool for processing information, rather than the core of our experience.

Additionally, a computer can be reset. While we all love the idea of a clean slate (new diet on Monday, new year’s resolutions etc), in reality, everything we have experienced in our lives shapes us in ways seen and unseen, which affects what we do, think and feel going forward, which shapes us further, in a big, ever expanding circular fashion.

What Kind Of Analogies Should We Use Instead?

When it comes to adaptation, which is the hallmark of living organisms, I like to use examples from nature, like this tree from a Facebook post I made a couple of years ago.

I love how, despite the challenges of an unfamiliar, urban environment presented to this tree, it manages to adapt and thrive. This is true across all of biology. Species, both plant and animal, will do whatever they can to adapt to their environment in order to survive and reproduce.

From an evolutionary biology perspective, this is what our primary purpose of life is.

Now, as humans, we have higher aims – creation, expression, fulfilment, enlightment etc – but deep down, these biological imperatives are still there.

Instead of saying “the body is a car that needs servicing and alignment”, why not say the body is like a tree, it grows until maturity, then it endures good seasons and bad throughout its lifespan, but it adapts and survives?

Instead of saying “the heart is like a pump”, why not describe it as a river that keeps flowing to maintain it’s own health – sometimes it flows faster, sometimes it flows slower, but it still flows?

Instead of saying “what a machine”, why not say what an amazing person?

Why It’s So Important To Get This Right

Imagine if, instead of being told that her sore knee is because of wear and tear, a doctor tells her patient that her knee pain is because her nervous system is being protective of it. 

Imagine this doctor then tells her patient that to deal with the pain she needs to become more adaptable and resilient, and that she can do this by improving her flexibility, strength and endurance with exercise and activity.

Imagine if this doctor also told her patient that stress and fear makes her pain worse, and that she not only needs to become more physically adaptable and resilient, but more mentally as well, and that this is possible because even into older age, the brain and nervous system can learn and change for the better!

Conclusions

Medical and allied health practitioners need to lead the charge towards healthier attitudes towards bodies, pain, injury and ageing.

More needs to be done to build confidence in people’s health, especially in the face of pain and ageing – two big drivers of fear.

This can be achieved by stopping the use of machine based analogies and encouraging people to build strength and resilience in the face of pain, rather than retreat and avoid aggravation.

The evidence is clear: while short term rest in the case of tissue injury and post surgery is sometimes warranted, the sooner people resume activity, the better their outcomes.

We also know that expectations drive outcomes. This means more positive messages about recovery and less fear based mechanical analogies.

It’s time practice started reflecting the evidence, it’s been around for a while now.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

Why You Should Choose Conservative Health Care

,

You can’t cut out pain. – every *good* orthopaedic surgeon ever

Despite what we know about pain, many people are subjected to poor medical management for their pain on a daily basis.

From the recommendations of medications that don’t work for certain conditions (ahem, anti-inflammatory drugs and low back pain), to expensive courses of passive therapies that have extremely low effect sizes.

Not only do these treatments not work very well, they are is an enormous waste of everyone’s resources. To make matters worse, many of these management strategies are not benign, meaning they have the potential for negative side effects.

When it comes to poor medical management, over the counter medications and ineffective passive therapies are the (very small) tip of the iceberg. Many costly, and potentially dangerous drugs, invasive therapies like injections, nerve blocks and the “grand-daddy” of them all, surgery all carry high risk profiles and for very small benefit, especially over the long term.

It’s right about now that I should add some moderation to this post:

I’m not saying these treatments are completely worthless all the time. In fact, I have had many patients who have benefited from the right prescription or surgery over the years.

What I’m saying, is that these treatments often come with big costs and risks that are not fully disclosed when they are recommended (although nearly every surgeon does a better job at explaining the risks of their treatments to patients, many still overplay the benefits or don’t fully explain the alternatives).

With this in mind, the sleeping giant in the treatment of most painful problems, especially those involving the musculoskeletal system is good conservative health care.

I emphasise the good, because there is so much bad out there.

No, I’m not trying to be negative and put down other health professionals. I am simply stating, that based on my experiences with patients (and supported by research), many have not had adequate conservative care to begin with, which is how they’ve ended up with chronic conditions in the first place.

What Is Conservative Health Care?

Conservative health care is based around interventions designed to avoid radical medical therapeutic measures or operative procedures. 

They are typically lower in cost than more aggressive treatments, which a much safer risk profile.

The downside is that some conservative treatments don’t have a large effect size, and many work in general, not specific ways.

Some examples of conservative health care include:

  • Education, advice and reassurance
  • Lifestyle changes
  • Dietary changes, including supplementation
  • Exercise based interventions
  • Physical/manual therapy
  • Certain medications

When Should You Seek Out Conservative Health Care?

Conservative health care is not appropriate for all health problems.

Serious and life threatening conditions typically need more aggressive and/or invasive treatments. Examples of such conditions include major infections, cancer, organ diseases and major trauma (though there are many more).

When conservative health care is most optimal, is when a condition is chronic and stable, or progresses slowly, when the condition is self-limiting (i.e. it will resolve with time, and symptomatic management is all that is required) and when the condition is non-specific (it can’t be attributed to a single cause), like many low back pain presentations.

Usually, a general practitioner will be able to advise you when conservative options are suitable, so that’s often a good place to start.

Conservative Treatment For Pain

Pain is the number one reason people consult their GPs, however, a lot of pain is very poorly managed from the begining, leading to the progression towards chronic and more debilitating pain.

This is where I feel that conservative management can really shine.

Almost every chronic condition will improve to some degree from improving your health generally.

Additionally, many chronic pain presentations will benefit just as much, if not more in the long run, from good conservative management.

Unfortunately, many people miss out on receiving good conservative care when they need it most, leading to them needing/wanting more aggressive treatment options when their condition has progressed.

The Benefits of Conservative Health Care

Conservative health care has a number of benefits for all parties involved: patients, practitioners and 3rd party payers (insurance companies, governments etc).

One of the biggest benefits is economic.

Let’s take chronic low back pain as an example, because it is so prevalent, and so widely researched.

The cost of these conditions to the Australian economy in 2012 was more than $A55 billion. Back pain and osteoarthritis, the most common of musculoskeletal conditions, accounted for 52% and 41% of cost respectively.

When we look at the costs, most people intuitively think of the cost of treatment (consultations, investigations like imaging, medication etc), however, the bigger cost is the indriect cost, that is the cost to society and the individual of lost income, productivity and quality of life as a result of their condition.

While the direct costs of chronic conditions is around A$9 billion annually, the indirect costs are a staggering A$54 billion annually!

With such high costs, you’d think that prioritising excellent conservative care from the outset would be high on the agenda for all involved.

Unfortunately, many clinicians do not follow the clinical care guidelines which are developed by compiling the best evidence from researchers around the world. In fact, only 20% of low back pain patients received care inline with the guidelines.

These guidelines are designed to ensure the best possible management of each condition, yet with only one in five people getting treatment based around them, many are missing out and going on to develop chronic pain, which ends up costing them in time, money and quality of life.

Other benefits of conservative health care include:

  • Safety – by definition, most conservative health care is low risk.
  • Availability – there are typically many more health professionals able to deliver conservative health care than specialists who deliver more invasive treatments.
  • Sustainability – conservative approaches can typically be maintained over the long term, which can help manage chronic conditions.

What stops people getting good conservative treatment?

I believe that most of the time, most people are doing the best they can. As a result, the lack of implementation of clinical guidelines for conservative care is not down to any one factor, but here are a few:

  • Market forces – funding for public health services is always stretched, so GPs cannot spend adequate time educating patients. Private practice clinicians are often limited in the number of times they can see someone due to a patient’s ability to afford treatment.
  • Expectations – patients often want to be “fixed”, not understanding, or wanting to participate in more active management for their conditions.
  • Practitioner knowledge and skill – most health practitioners are skilled in diagnosis and treatment, not in facilitating behavioural change. This makes it hard to create long term, empowered change.

With this in mind, we can see the challenges that need to be overcome to offer the best available conservative care.

What is needed to improve conservative treatment?

  1. Government and insurance companies need to appreciate the long term cost savings conservative care offers, and fund it accordingly. If a surgery costs $20,000 spread across direct and indirect costs, and that surgery could have been prevented by 2 years of physical/exercise therapy, then even at $100 per session, twice per week, you are coming out at break even. However once you add in the rehabilitation costs of surgery, and the costs of the increased risk, the physical therapy option is actually cheaper.
  2. Patients need to take responsibility for their thoughts and actions. Yes, circumstances can affect everyone, which can make life harder and less fair for some, however, taking 100% responsibility for how you respond and act will mean that you are in the best frame of mind to improve your situation and your condition.
  3. Educational institutions need to adapt to the changing demands on healthcare and focus more on communication and behaviour change. Simply increasing the awareness of this important skill will lead to those interested healthcare practitioners pursuing further education.
  4. Health practitioners must accept that they can always improve, and seek out ways to develop their skills to better serve their patients. This includes seeking out appropriate continuing education, but it also means enhancing their networks and their ability to utilise these networks to benefit their patients.

The Big Two

Of all these factors, the two most important are economic and cultural forces.

Money is always an influence on how we make decisions, and many people simply don’t have the financial freedom required to pursue optimal conservative care, especially privately.

While there are always those who are living on the edge, and literally have no room in their household budgets for anything about the essentials of living (housing, food, transport and utilities), there are many more who claim that health care is too expensive. Yet these people walk around with the latest iPhone on a high monthly plan, or drink/smoke/gamble regularly. For these people, who may be on average incomes, it is simply a matter of choice and priorities*.

This is where culture becomes important.

Our culture in Australian is heavily influenced by commercial interests.

Unfortunately, there is a lot of money to be made in selling treatments for conditions that offer a simple solution to a person’s health problem.

Whilst they appeal to our emotions, simple solutions are usually inadequate for complex problems.

So when you propose a long term course of conservative care, which involves active participation by patients, it is often a tough sell.

It is made even tougher by the massive marketing budgets pharmaceutical companies and medical device companies have. They use these to influence our culture.  Every night on TV there are commercials for different types of pain medications. Ironically, if most people spent just 30 minutes less watching TV, and decided to go for a walk instead, they probably wouldn’t need them anywhere near as much.

A Different Perspective

If instead of thinking in terms of expense (cost and time/energy), you changed focus to investment, then immediately you have changed your perspective on health.

When you invest in a term deposit, at the end of the term you have more money than when you started.

Conservative health care, done properly, is an investment.

Yes, you are spending time, money and energy to change your health, which has an initial up front cost. But, by the end of the treatment program, you should have improved health, reduced pain, better function and an overall better quality of life.

Get more years out of your life, and get more life out of your years.

These improvements can be thought of as your return on investment. Like a term deposit, conservative treatment is mostly safe, offers fairly predictable outcomes and is overall, low risk.

Once you have restored your health, the idea is to maintain it (just like you would with wealth). Usually this means you need to continue your healthy habits which you established during treatment.

A final word on perspective; if you are in debt, you must pay back your debt before you can invest. The bigger your debt, the more work and time it takes to repay. The same school of thought applies to health. While things can change quickly, true healing from chronic conditions, or even severe acute conditions, takes time.

If that puts you off, think about it like this: time will pass, regardless of what you do or don’t do. If you do nothing, you will be in the same, if not worse situation in a year or ten.

Conclusions

Conservative care is extremely important from both a public health and individual perspective. Delivered optimally, it saves money, improves outcomes and reduces the need for interventions with higher side effect or risk profiles.

There are some barriers to delivering good conservative health care at the population level. On an individual level, the two most important variables can usually be overcome.

If you are a patient: when you are seeking out a health care provider, discuss long term strategies and look for providers who will incorporate an active management plan.

If you are a practitioner, you should look to improve your communication and behavioural change skills. Telling someone what to do isn’t good healthcare. Guiding them through the process of how to do it is.

 

Nick Efthimiou Osteopath

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

 

Notes

*For those who are truly struggling, most universities with allied health programs have student teaching clinics. These allow students to provide supervised care at reduced costs. In special circumstances, the fees can even be waived. Bottom line, no matter your circumstances, if you are really set on helping yourself, you can find a way.

References

(1) Medibank: Chronic pain costs economy more than $22bn a year

(2) Pain drain: the economic and social costs of chronic pain

(3) The burden of musculoskeletal conditions in Australia: a detailed analysis of the Australian Burden of Disease Study 2011

Factors Influencing Treatment Outcomes

Treatment outcomes are influenced by more than most people think.

To the average person who rings up a clinic, books and appointment and then shows up to get help with their painful problem, the expectation is that the treatment will do something, and hopefully make them feel better.

Often, people do get better, but not because of what they had done treatment wise.

If someone feels better, does this even matter? Is the outcome all that is relevant?

To me it does.

And it should to you as well.

Why?

Well, firstly, if you are paying for treatment and getting better despite what was done, not because of it, then you are wasting your money. I don’t know about you, but I work too hard to be wasting my money.

Secondly, if there is risk associated with a particular treatment, and an equally effective alternative is available that has less risk, well it’s obvious you would want the safer option.

Thirdly, if we know what influences treatment outcomes, we can strive to optimise all the variables.

So what are the factors influencing treatment outcomes?

Your Condition

If a practitioner wanted to look really good, they could focus on treating acute low back pain.

Simply seeing people for 12 weeks would give them approximately a 70-80% success rate (condition resolving), no matter what they did! (1) This is because for most people, acute low back pain is a self limiting condition that gets better with time. Experienced practitioners can probably predict your recovery more accurately (and there is research to support this). Essentially, they could just play the numbers and end up looking good. (2)

There are many similar conditions that do get better with time, and what research is showing us, is that often minimal management is just as good as lengthy treatment plans. (3, 4)

On the flip side, there are some conditions which we simply cannot treat, but rather have to settle for managing as well as we can. Many (but not all) chronic pain conditions fall into this category.

Time

Recall how I mentioned many conditions improve with time?

Well if you suffer from one of those, then you need to be patient. This is often lacking. I don’t know if impatience is more prevalent these days compared to decades past, but it definitely makes people do silly things.

Things like taking too much medication, seeking out controversial treatments and “doctor shopping” for stronger analgesics are all too common.

If a practitioner says the best course of action is to do nothing and wait, then they aren’t being lazy, and they are definitely not idiots (as is commonly mentioned to me in practice). What it means, is they are likely trying to save you from unnecessary interventions, which all have potential costs and risks.

Your Expectations

There is growing body of research showing that your expectations have a big influence on whether you get better.

This isn’t a case of new-age “believe in it and it will come true” stuff either.

Rather, if you expect a certain outcome, both consciously and unconsciously your behaviours and thoughts end up shaping that outcome.

This has to do with all sorts of things, but I like to credit the concept of priming for some of it. (5)

Priming is when you are shown words, pictures or similar with a certain theme, and then you are unconsciously influenced by them. Studies have used elderly words with students for example, and the students have changed posture and walked more slowly. When young words were used, they moved quicker and stood taller.

Because of this, managing expectations is one of the most important aspects of treating pain. If you are expecting to get better in 2 weeks, but you have a 2 month condition, you will need to adjust your expectations accordingly.

Likewise, if you expect you won’t get better because you are “old” and have lots of “wear and tear”, well chances are, you won’t.

Your Current Health Status

People who are healthier recover from injuries faster.

People who recover well from injuries are less likely to go on to develop chronic pain.

If you have co-morbid conditions you are likely to recover slower than someone your age with the same condition who is healthier.

Some things are in your control: what you eat, how much you move, whether you drink and smoke or take drugs.

Some things aren’t in your control: genetic predisposition, accidents, environmental factors.

All you can do is to try and maximise the positive things you can control, minimise the negative and worry as little as possible about the rest.

Your Socioeconomic Status

This isn’t talked about much, because in Australia (and many other cultures) it is generally taboo to talk about money.

If you are in a low income household, or unemployed (not by choice), then your both your current health status and your recovery from painful problems are negatively affected.

The eminent British epidemiologist Prof Sir Michael Marmot, the president of the World Medical Association and presenter of 2016’s ABC Boyer lectures, has shown that a person’s lifestyle and health choices (what medical types like to call your “risk factors”) simply cannot account for the differences seen in death and disease among people of different incomes. In his landmark Whitehall study, which examined British men working in different levels of the public service, those on the lowest grade of employment still had double the risk of dying from heart disease – even when accounting for all the factors we traditionally think of as causes. There was a clear gradient of risk between levels, with deaths decreasing as the public servants climbed the employment ladder. (6)

Being an osteopath, I’m not trying to solve all our political and social issues, but they must be considered when considering outcomes.

Practitioner Skill

This is a topic that interests me to no end. Two great questions linger in my mind:

  1. How much of somebody’s outcome is down to practitioner skill?
  2. What components of practitioner skill are the influential ones?

If you look at all the other factors, you can see pretty quickly that practitioners often take more credit than they deserve for achieving positive outcomes, then turn around and blame every other factor but themselves when they don’t.

I feel that the skill of a practitioner is not only having good diagnostic and treatment skills, but being able to have all these listed factors circulating in their minds simultaneously, while also giving people the voice, space and time they need to explain their story.

They then need to put all this information together into a plan of action that people can understand and apply, so that they actually achieve the desired outcomes.

I think that selecting a good practitioner can actually be the difference between developing chronic pain or not. There is evidence to suggest appropriate identification of risk factors, coupled with education and reassurance all reduce the likelihood pain progresses from acute to chronic.

So what makes a skilled practitioner?

I would say they all have highly developed the following attributes:

  • Clinical knowledge
  • Clinical reasoning
  • Clinical skills
    • Assessment and diagnostic skills
    • Treatment skills
    • Rehabilitation skills
  • Communication skills
  • Experience

Each of these areas is a massive topic, which means it takes time to develop them.

This doesn’t mean that more experienced = more skilled. Rather, it means you need to be continually learning and applying, so that your experience is congruent with the current scientific understanding.

All this complexity is why they call it practice. 

Conclusions

The purpose of this post was to illuminate the complex nature of treating pain and injury, and why things don’t always go to plan.

This is why it is important to have the right support. Family and friends are a good starting point, as they can provide social support and reassurance, but for anything more than a simple strain, often it is good to have medical management, to (hopefully) prevent the slide from acute to chronic.

Good education from the beginning, appropriate management (not over management, not under management) and a view to long term outcomes, not just symptom relief are all signs you are in the right hands.

It’s always funny to me that someone will happily drive half way across the city to go shopping, but when it comes to health professionals, many people choose convenience.

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

References

(1) Prognosis in patients with acute low back pain

(2) Predicting recovery in patients with acute low back pain

(3) Effect of early supervised physiotherapy on recovery from acute ankle sprain

(4) Comprehensive physiotherapy program or advice for whiplash

(5) Blink: Reading Guide – Chapter Two

(6) Our so-called ‘universal healthcare’: the well waste money and the poor get sicker

 

Movement Quality, Health and Fitness

When it comes to movement quality and fitness, nature had it right all along.

Developing movement quality before fitness is hard-wired into us.

We crawl before we walk.

We walk before we run.

First we develop the quality and control of movement. Then we start doing more of it, which develops our capacity of movement (fitness).

This is the pathway that humans have followed forever, until recently.

Now, around about the age of 5, we send children off to school, where they learn to sit still. We even give out stickers to the kids who do it best.

At this age, things aren’t too bad though. We have about 4 years of movement “training” under our belts compared to 1 year of sitting.

Fast forward to age 10, and that ratio is now 4:6, not great, but still not too bad.

Let’s accelerate to 18, when most kids, now young adults are graduating from high school.

They’ve now been sitting for the majority of their day for 14 of their 18 years.

Many would have played sports recreationally, and suffered injury as a result.

Can you see the problem?

And we are only looking at an 18 year old, who for all intents and purposes, is in the peak of youth, and physical potential.

What happens when we hit 40, 50 and beyond?

Fitness First, Then Injury?

You’d think getting fitter and healthier would be easy. Our bodies are designed to thrive after all.

The problem is, people start out with poor general health.

Think of the average person over 30. They are likely over stressed, possibly anxious or depressed. Body functions like their digestion, elimination and breathing are dysfunctional. Their physiology is impacted by poor sleep quality and quantity, and abnormal light exposure. And, they aren’t moving at all, with the average Australian clocking in at a measly 4000 steps per day. (1)

For the average person who decides to take action and make themselves healthier, it’s an uphill battle before they’ve started.

So when they start exercising with intense, and often short term programs, they are actually adding more stress on to an already stressed body. Combine this with a restrictive diet, and the situation becomes even worse.

It doesn’t take a genius to work out that this might be too much.

Get Healthy First

What should you do instead?

Before you jump head first into an intense exercise program, commit to walking*.

Sounds too easy?

That’s the point.

If you walk daily, you experience a myriad of health benefits that compound. This sets you up for more intense work in the future, if that’s your goal.

Walking is sustainable, so you can do it for the rest of your life (and you should).

You can walk outside, which is ideal, but if weather or safety doesn’t permit, you can walk on a treadmill.

The whole point of starting with walking, is that it is supposed to be mentally and physically achievable. Success breeds success.

All this walking will:

  • Reduce your stress levels
  • Improve your body composition
  • Improve your cardiovascular health
  • Allow you some “down time” in our constant “on” world

This in term will help you sleep better, so your mood improves as your brain and hormones start to balance out.

As a result, it becomes easier to improve your diet, because you aren’t fighting against a stressed out and fatigued brain that wants quick fixes of sugary, salty and fatty convenience foods.

The principles of a healthy diet are simple. Changing your diet is not, because it is about changing your habits.

For most, the best approach is to work with a dietitian or nutritionist. Because in most cases, it isn’t a lack of information that stops people making change. Everyone knows they should eat more vegetables, but most don’t eat enough.

If you can’t, or don’t want to, you can try and change yourself.

For the best chance of success, you want to change one thing at a time. This is why I recommend walking first. It establishes a healthy habit which can have a snowball effect.

With nutrition, change one meal at a time.

Check out the Australian dietary guidelines. Then, starting with breakfast, look to improve your diet one meal at a time. Once a breakfast becomes a healthy habit, move on to lunch and so on.

If you can start walking regularly, and get your diet in order, you are more than half way to a healthy lifestyle that minimises your risk of all kinds of diseases.

This also enhances your quality of life, which is often overlooked – it’s not just how long you live, but how well you live.

This process might take time. Months, even years for some. So it is important to learn how to relax, both physically and mentally.

You can’t keep putting stress upon stress and expect good results, let alone good health.

Learning how to relax physically and mentally allows your body to recover, which is when your body repairs and your health improves.

Everyone is different, but I find things like having a spa/steam, getting a massage, going for a walk and reading a book great ways to relax either alone, or with family/friends.

Again, the challenge here is more mental, the feeling of being in a “rush” to get fit.

It’s funny, because usually this rush is felt after years of doing nothing. Hence the appeal of “12 week programs”. A better approach would be a “12 month program”, but often this is felt as being too slow. The same people who feel 12 months is too long will undoubtedly be saying “wow, that year has just flown by” come December.

The simple act of getting healthier will improve your fitness, but trying to get fit when you aren’t healthy won’t improve your health, and can often harm it.

Then Move Well

Movement quality, like health, is often skipped over in the chase for capacity.

Like skipping the “get healthy” stage, skipping movement quality is a recipe for future injury.

The problem is, movement quality is hard to measure.

Doctors will be able to tell you whether you are healthy enough to exercise with intensity, they won’t be able to tell you if you are ready for a loaded squat or running.

There is no one way to move well, but there are common features on moving well. Think of watching a high level dancer. It likes smooth, controlled, almost effortless. They are moving well.

Moving well is a lifetime endeavour (are you sensing a theme?), but to start out, you can perform some simple tests to see what your starting point is like.

  • Can you touch your toes?
  • Can you reach over and under your shoulders and touch your fingertips, without straining?
  • Can you squat to below parallel without your heels rising or losing your balance?
  • Can you stand on one leg with your knee lifted above your hip for more than 10 seconds?
  • Can you perform a plank for 30 seconds? What about a push up? What about 5?

Most of these movements are simple, yet involve a lot of physical capability. If you can’t perform them, are you ready to be running for 30 minutes or performing “functional high intensity workouts”?

If you lack some fundamental movement quality, you don’t have to put your fitness on hold – remember, improving your health, in this case your movement quality, will improve your fitness.

Improving your movement quality doesn’t mean you don’t get to use load either. Load can often be corrective.

But it does mean identifying why you aren’t moving well.

If you have a mobility issue, simply adding load won’t resolve it. Likewise, if you aren’t moving well because of impaired sensory function, you will want to address that.

Moving well is a continual process, but after you have established a healthy base, you will likely want to build capacity.

Next, Develop Your Fitness

You need fitness too.

Especially later in life, when having low physical capacity becomes problematic.

The key though, is to build your fitness/capacity before you get older. The earlier you start, the better, but it’s never too late. Never.

How much fitness, or capacity do you need? Enough to do what you need to do, with a little left over.

This left-over is termed the physiological buffer zone (2).

It is basically your margin for error.

The bigger your buffer zone, the more you can do without breaking down, getting injured or ending up in pain.

A favourite study of mine showed that in US Marine recruits, those with low Functional Movement Screen (FMS, a simple screen to assess movement quality) scores and a low 3 mile run time had a much high probability of getting injured during physical training (3).

Both the run and the FMS were predictive, but the combination was much higher.

This suggests that moving well, or being fit alone is beneficial, but moving well *and* being fit has a compounding effect.

High Training Loads Protect Against Injury

Lots of recent research in sports science is showing that high training loads are protective of injury. (4)

This means, the more work you do, the more resilient you become.

However, how you get to those high training loads matters.

If there is a sudden jump in workload, that is a big risk factor for injury, so you have to build up slowly. If you look to fit people for inspiration, and try and model what they are doing, you are failing to take into account that it likely to them years to achieve their current level.

Monitoring your workload is important, so that you can know when to push and when to back off. A good personal trainer or exercise physiologist can help you, and will accelerate your progress.

Conclusions

This is a lifetime process.

If you do it correctly, focusing on health as your priority, then you set yourself up for a lifetime of benefits.

It’s definitely not easy.

You will have periods where you feel like it is all clicking.

You will have periods where it all seems so hard.

But, if you establish healthy habits, then you can continue with the behaviours that benefit you no matter what life throws at you.

 

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 


 

 

References

*If you are unable to walk due to disability, then a similar low intensity replacement is ideal, but for able bodied people, walking is the best option.

(1) Australian Daily Steps

(2) Movement Reserve: Enhancing the Physiological Buffer Zone

(3) FMS and Aerobic Fitness Predict Injury

(4) Monitoring Athlete Training Loads: Consensus Statement

(5) Andrew Read and Greg Dea seminar, September 2016: Advanced Program Design