Controlling Your Health – Part 2

 

In part 1, you learned about the four pillars of health and fitness.

1. Muscle and Joint (Musculoskeletal)

2. Cardiovascular and Pulmonary systems

3. Dietary Habits

4.Mental Well-being

You also became aware of self-efficiency and how it relates to your perception of health. By now, you should have a better understanding of your internal beliefs, perceptions, and how they relate.

In this article, you will be examining your external perceptions and understanding how they may be adversely impacting your health.

In this article you will be understanding you external perceptions and how they may be adversely impacting your health. In addition to discovering what can be done about it. Remember that the best indicator of how much control you have over your health is how much control you believe you believe you have.

The test used in this article is from Dr Frank Lawlis (Jeanne Achterberg and G.Frank Lawlis, The Health Attribution Test, Champain, III.: IPAT 1979). As a reminder this is a three part series covering the entire health attribution test. In part 1, we examined internal health perceptions, this time we are examining external health perceptions; and in part three we will be examining chance health perceptions.

 

External Health Perception.

External health perceptions are important to be aware of so that you become more empowered and accountable toward your health. Having the idea that you are going to be healed by your Doctor can lead to disappointment and the inability to create coping strategies.

Remember that accountability counts. A lack of self-accountability means that you are allowing yourself to become a victim. If you are overweight, you are accountable, if you have lower back pain, you are accountable, and so the list goes. If it’s something you have no control over then you are accountable for doing all you can to minimize future risks. By understanding you perception of dependence on others, you may stop relying on others to resolve your health predicament.

 

Identifying your External health perception.

For each of the following mark the most appropriate answer. Do this in private and be honest with yourself, knowing that you won’t be judged.

Score from 0-10: 0 being no confidence, and 10 being maximum confidence.

1.   My belief that my Doctor will heal me.
2.   My belief in medicines to heal my body and mind.
3.  My belief that if I follow all instructions given to me by my health care professional, I will be healed.
4.  My belief in the concept that if I have faith in my religious symbols of teaching,                        I will be healed by my spiritual power.
5. My belief in the healing power of my friends and family as crucial to healing my body    and mind.

Scoring Your External Health Perception

0-20: Low Confidence in others as healing agents.

21-30: Average Confidence in others as healing agents.

31-40: High Confidence in others as healing agents.

41-50: Very high confidence in others as healing agents.

Understanding your score.

If you have a high of average score you may be highly dependent on other people or influences to get you out of health troubles. You may believe that someone or something is the holy grail of health. This leads you to believe that your doctor has magic hands, your specialist has the magic technique, or your spiritual leader has the secret formula to prayer. In other words you are totally convinced they, the individuals and their methods, will work.

There is an upside to having a high score. You may be more likely to reach out for professional care, supported or trusted expertise. If this sounds like you, make sure you choose your health care professional wisely. As a health care professional, I can personally say that people presenting with higher score in this area are typically more compliant with rehab regimes. In other words you may be a doctors “perfect-patient.”

The downside is that you may lack healthy skepticism regarding the promises of a magic cure. No one is better at managing your health than you. Remaining inactive and passive toward your wellbeing creates a victim mentality, whereas being in control and accountable, helps you to take ownership. In the long run, maintaining such ownership increases your chances of success. Be responsible and take control now, without blaming others. I acknowledge that this may sometimes be difficult. If you have bad knees, or if you are overweight and under-active, then you need to address the contributing factors. If you believe that you are genetically predisposed to certain medical issues, then you have an even higher onus to live a lifestyle that minimizes your elevated risks. Cigarettes, alcohol, stress, your job, in-laws, none of them are to blame. Your own choices and actions are! Be accountable and active in influencing your wellbeing.

In regards to lower scores, the upside is an “I can do it myself” attitude. While foolish pride isn’t the answer, a rebellion against authority isn’t necessarily a bad thing. An example is the biomedical model for lumbar pain. Advanced imagery, surgery, bed rest, and narcotics aren’t necessarily the problem, let alone even beneficial! 

The downside of a low score is that you probably don’t trust anyone or believe that anything will work, in parallel, you may be overly skeptical toward the health care profession. Therefore, you may not seek treatment because you are not convinced it will help. You are “the glass is half empty” type. Unfortunately, that won’t solve health challenges.

In the next part of this series we will test your chance perception of health. If you are comfortable with it, leave your score and comments below.

Controlling your health. Part 1

Health and fitness is, without a doubt, one of the fastest growing fields in healthcare; and for good reason. The top six killers around the globe are heart disease, stroke, COPD, cancer, accidents and diabetes. What do most of these have in common? They are lifestyle based. Of course there will be medical elements to some of them but its hard to argue that a healthy lifestyle wouldn’t be beneficial.

I believe health and fitness is a state of balance between body and mind. This equilibrium in-duality  is accomplished by achieving wellness in four primary categories:

1. Muscles and joints

2. Cardiovascular system

3. Dietary habits

4.Mental health

When these four systems are healthy and happy, I believe you are in a balanced state of health and fitness. Doing so can be challenging, especially if you are lacking in self-efficacy. It will be our goal in this three-part series to get to grips with your own perception of health and self-belief. Your mindset creates, controls and influences your health, It is your beliefs, values and expectations. Ultimately, you will identify how you perceive health on three separate levels.

1.  Internal perception
2.  External perception
3.  Change perception

Once identified you will allow you to have an idea of your health expectations and beliefs. By knowing what you believe you can begin to halt destructive behaviors and begin to take action to improve your health. You are the ruler of your temple, no-body else manages your body but you.

 Internal health perception

In practice I have witnessed the difference between those who believe they can and those who don’t. The difference is huge in terms of recovery and relapse.We all know someone  that has overcome a great health crisis. Were they positive or pessimistic?

Pessimism, defined as stress resulting from hostility, resentment and despair, has been linked to a host of diseases. Men between the age of 40-55 who have high levels of hostility have a 42% higher risk of death, so relax guys because the stress is literally killing you.

Identify your internal health perception

For each of the following mark the most appropriate answer. Do this in private and be honest with yourself, knowing that you won’t be judged. Score them from 0-10. 0 being no confidence and 10 being maximum confidence.

1. My willingness to follow a good nutritional program in order to maximize my body’s healing abilities.
2. My willingness to exercise my body in order reach maximum recovery.
3. My belief in my ability to use focusing techniques to accomplish my goals in health.
4. My belief in my ability to calm my stress issues and use that energy to succeed in my physical healing.
5. My belief in my inner strength to heal my body.

Scoring your internal health perception

0-30 Low confidence in self direction

31-40 Average confidence in self direction

41-45 High confidence in self direction

45-50 Very high confidence in self direction

Understanding your score

Our perception of our health is so important to how we live, work and play. It’s within our beliefs and expectations by which we base our decisions concerning our well being. If we believe in a system there is a much better chance that it will work.

Take for example, chicken noodle soup for a common cold or flu. If you believe in it chances are it will help. Your internal health perception is how much you believe in yourself as the manager of your health and body. Your belief is important if you don’t believe in yourself you don’t have control. With that being said, there are cases and issues outside of such control. Hereditary disease or any uncontrollable events may also negatively impact your health. These are not your fault and there is no point in beating yourself up over it but instead focus on the future by what you can do now.

People who score low on this test need to understand that they are accountable. Now there is no reason to feel guilt but if you do feel guilt it is because you have violated one of your biggest standards. Now that you have acknowledged that move on!  Commit yourself to making sure the behavior doesn’t persist.Use the guilt as leverage to never violate your own standard even again.

If your scored high, congrats. Scoring high is for the most part a great thing It means that you take responsibility for your health The higher the score the more likely you are to:

1.Acknowledge your perceptions

2.Own your perceptions

3.Find solutions of your health issues.

4.Make the solutions happen

The down side to having a high score is that you may be overly self-sufficient. In this case, you may fail to seek advice or mentorship. You may fail to reach out to others that have a wealth of information. Again if the health concern you may have isn’t your fault (blindness, heart disease etc) don’t pressure yourself. Blaming yourself for issues outside your control is worthless. Focus on what you can do now to make a better future. Hold yourself accountable for your actions from here on.

In the next part of this series we will be looking at your external health perception. How you view others in regards to your health and wellbeing. If you feel comfortable leave your scores below; its alway nice to compare notes. There is nothing wrong with a low score as long as you own up to it and seek out advice or support.

In Health

Dr Anthony.

Acknowledgments.

Thank you to Doctor Frank Lawless for his health perception test.

Wellbeing App Released

“Would you tell me, please, which way I ought to go from here?”

“That depends a good deal on where you want to get to,” said the Cat.

“I don’t much care where-” said Alice “Then it doesn’t matter which way you go,” said the Cat.

“-so as long as I get somewhere,” Alice added as an explanation.

“Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.”

-Lewis Carroll, Alice’s adventures in wonderland

Imagine traveling without being able to recall where you have been. In order to know where we are going, we need to know where we are coming from and there is no difference when speaking about our wellbeing. For example, if you call me and ask, “how do to I get to Wellington,NZ?”, I will certainly reply, “where are you coming from?”.  We often have a goal but oddly enough we are blind to our progress (or lack thereof). For instance, ask yourself what your mood was yesterday. Now ask yourself how your mood was two weeks ago. I am certain you are slightly foggy on the last one. But what about your mood 3 months ago? 1 year ago? I imagine you truly don’t have a clue- unless it falls on a memorable day good or bad. Not having access to this information can be problematic when tracking progress and measuring outcome.

In practice I identified a problem with asking “on a scale of 1-10, what is your pain today?” The problem was not the question being asked but rather the frequency at which it was being asked. I do not see my patients daily nor do I want to see them daily, I want my patients to recover quickly and efficiently. But identifying progress can be difficult when it is sporadic and spread out over  several weeks. It’s simply better to know how the patient is coping daily.

Before the wellbeing apps creation I took on the tedious job of emailing clients an outcome based spreadsheet. The spreadsheet was simple and it allowed them to enter an 0-10 rating for pain, mood and sleep, everyday of the week. Once the spreadsheet was returned I would graph the data and use it to demonstrate progress to the patient. I found this very effective in unmasking ineffective treatments, demonstrating the harmless nature of flare ups and empowering self-care.

As my clinic grew this system became overly tedious. However what I found during early graphing was exciting. I found that once patients graphically visualized progress, it reinforced their attitude towards improvement. Often patients will forget where they came from (early pain episodes) but simply reminding them with the graph allows them to understand the progress made.

Because I was graphing data on pain, mood and sleep, patients were able to better understand the correlation. This can be simple to understand but also empowering to envisage. When my patients began to see the graphs and realise they were managing their pain, it was a lightbulb moment for them. They knew what was working and what wasn’t. That to me was empowering my patients. Moreover, it was done through powerful visual feed back.

Visual feedback is an invaluable tool. Whether it is EMG, biofeedback or wellbeing, seeing is believing. The primary goal and vision of wellbeing is this,

“empowering the users perspective in regards to health and wellbeing.”

It is a must for anyone wanting to know and see their progress. Wether it be pain, sleep, mood or your own unique category, you are now able to track it easily.

Finally to put the icing on the cake, you are able to overlay and compare graphs. Overlay strength with motivation or strength with impact on others. What ever you can dream up you can monitor. Wellbeing allows you to simply and easily track your progress on a consistent basis. After all how do you know were you are going if you don’t know where you have been?

Buy Here

Summary

1. Wellbeing allows for graphical mapping of your pain, mood, sleep, and motivation.
2. Input your own category to track (i.e. strength and eating behavior)
3. Wellbeing unmasks ineffective treatments and poor progress.
4. Touch screen monitoring. This is simply just cool.
5. Empowers the user to monitor outcomes daily, not at every doctors visit which could be at weeks apart.
6.  Email your graphs directly to your doctor, trainer, or therapist.
7. It costs less than a pizza and is better for your health.
8. Allows the patient understand that hurt doesn’t equal harm.

3 Major Myths Concerning Back Pain

1. The need for an accurate diagnosis
2. The need to rest until pain is gone
3. The pain will lead to chronic disability

The need for accurate diagnosis

The spine is a unique structure and is often subject to debate in various circles of study.  During your lifetime you have about a 70% chance of developing acute lumber pain.  I am sure if you have experienced significant pain in your back, you have had concerns regarding accurate diagnosis of where the pain is coming from.  In fact, many form their own lay mans version of a structural cause, such as the muscles, ligaments or disc.  What is interesting is that research shows that none of these can accurately be diagnosed as a source of pain.  What is even more important is that structural causes need not be identified in 85-90% of back pain patients for a successful outcome to result.  It should put you at ease knowing that serious medical disease resulting in pain is less than 2% of all back pain causes.  What’s more exciting is that the fact that these 2% maybe ruled out through a proper history and simple exam.  So what is causing the pain?

A better question is to ask “what is my pain trying to tell me?”  The perception that pain is a negative sensation is harmful; pain is simply trying to tell you that if you keep doing something (such as lifting improperly a certain way) the tissue may be harmed.  It doesn’t mean you have already harmed the tissue.  In the case of a simple back ache, pain doesn’t equal harm!  Therefore the pain is simply telling you to be more active or aware of your movements.

Need to rest until pain is gone.

The biomedical model has often prescribed bed rest for lower back pain (LBP); however multiple studies have shown bed rest to be more harmful than good.  In fact, 2-3 days bed rest is maximum for acute, simple back aches.  More over this should only be recommended when pain is severe.  Bed rest isn’t treatment for the pain; it is a consequence of the pain.  Even though uncomfortable, being astutely active is the best and most efficient form of treatment. For simple back pain when should you use bed rest?  If the pain is severe (9/10) then consider it, but only for a few days (remember rest isn’t always best).  Excessive bed rest may lead to chronic disability.

People experiencing back pain often become fearful that the pain will cause serious disability.  Such disability is highly unlikely; moreover, people who remain positive, active, and motivated are likely to recover quickly.  People who equate hurt to harm or exaggerate pain tend to become worse.  When a person experiencing back pain stops becoming active, the joints and muscles become inactive, this inactivity leads to de-conditioning and the de-conditioning results and more prolonged pain.  Do you see the downward spiral?  So how do we keep the pain from becoming chronic?

1. Remain active
2. Exercise regularly
3. Remember hurt doesn’t equal harm

If you are fearful, use a quota-based approach, gradually increase your activity in a step wise manner.  Limit activity by quota (set-reps) not pain.  Gradually encounter the things you fear and are safe and low load environment.  You can’t get over the fear of running by sitting on the ground, you get over it one step at a time!

Summary

1. Bed rest may have harmful effects on back pain.
2. The benefit of activity exceeds the risk the rest.  Swimming and walking are great for active recovery
3. Hurt doesn’t equal harm.
4. Flare-ups aren’t a failure they are expected.  Simple movements like a cat crawl or back bridge can immediately reduce symptoms.
5. Exercise is the best way to prevent future back pain; however, 25% of patients fail at sticking to a plan.  What can you do to stay motivated?

Acknowledgements.

Special thanks to Craig Liebenson for valuable insight

Proprioceptive warm-up

In a previous blog I briefly touched on reducing sensory information, in order to improve squatting mechanics. The purpose of this blog is to show a novel approach to modifying a warm-up to compound or Olympic lifts.

In all aspects of movement, such as strength and efficiency, lies the master control; otherwise known as neurological factors. The most notable factors being the sense of kinesthesis and proprioception. It’s important to consider that the joints, through these senses, talk to the brain in two general manners. First, they relay information regarding their individual position in space and time and secondly regarding their relative positions to one another. Moreover, when combined with other senses such as sight, sound and touch we are able to perform movements with incredible accuracy and skill (assuming all are operating efficiently).

In training, improving proprioception, is something that time is hardly devoted to. As a practitioner of manual medicine it is a fundamental piece in the perfection of optimal movement. Any practitioner using PNF techniques or sensory motor training understands and has most likely experienced the positive effects of improving the Proprioceptive system. The results are improved movement patterns, speed and timing of information.

The following is a simple system that I have personally found beneficial in improving proprioception and ultimately perfecting secondary movements and compound lifts. It is both time efficient and easy to monitor improvement. Moreover, this methodology may be used for any movement that may be in need of correction. Usually the person being trained is unaware of errors in movement and believes that the movement is being performed properly. Try using this system to allow the individual to ‘feel’ the errors described by the coach more appropriately.

Step One: Have the client cover their eyes with a soft blindfold or night mask (as used in sleeping).

Step two: Have the client get into the starting position of the lift, without weight or resistance. If the exercise being corrected uses a bar, replace it with a dowel rod or broom stick… Use appropriate touch and verbal cuing to correct any errors. Also, it is important to have them focus on what they are feeling from their feet to their head. They should be aware of both location and balance. Repeat this five to ten times or until satisfactory starting position is naturally achieved.

Step three: Remove the blindfold and allow the client to perform eight to ten reps of the movement in question. Light weights may be used at this time. (I.e. 20% IRM) Afterwards, place the blindfold back on and have the client repeat the movement for another eight to ten steps. As the client becomes proficient at the movement, guidance and correction will diminish. In addition, the movement will become perfected and stable. The client will become more aware of the movements natural feel with eyes open and closed.

In summary, this methodology is a wonderful way to clean up movements. It may be incorporated prior to the warm-up set of any lift or movement pattern. Be creative in how you use it but always be safe. It may be a valuable tool, not only for strength conditioning, but for rehabilitation as well.

Controversy: Imaging, is it helping your patient or wallet?

Controversy: Imaging, is it helping your patient or wallet?

When diagnosing the culprit of lower back pain, many clinicians rely on diagnostic imaging (i.e.: x-ray, MRI, CT). Lumbar pain is reassuringly benign, 85-90% of the time. Lumbar pain involving nerve compression comprises 10% of lumbar pain patients. Sinister or serious disease make up the remaining 2% of lumbar pain patients. The great news is that these ‘sinister’ conditions are ruled out by a proper history and exam. However, many clinicians still seem to be ordering imaging during the initial exam. The question often raised is

“structural pathology is often evident in images, so why wouldn’t we (the clinician) want to identify such abnormalities?”

While structural pathologies do have there place in medicine, they usually have little to do with lower back pain. In fact, most lumbar pain patients do not have a structural pathology that can be precisely identified as being a cause of their symptoms. McGuirk et-al found that 1.4% of lumbar pain patients had serious causes as a result of their lumbar pain, but they were suspected from the initial exam and history.

What about disc herniation?

Because the false positive rates are so high, in identifying a herniated disc, it makes imaging inappropriate as a screening procedure. Moreover, it can lead to labelling thus allowing the patient to assume a sick role or cause the doctor to prescribe unnecessary treatment. In a study performed by Bonenstein et-al, 67 asymptomatic individuals received MRI’s. The results were staggering, in that, 31% of them showed abnormality of the disc or spinal canal. Moreover, additional studies showed that these abnormalities didn’t predict a greater chance of future problems. Multiple studies have also shown that common “positive” findings are present in 28% to 50% of people with no pain at all! Disc herniations have a tendency to resolve in a natural process without surgery. But, what about the herniations that require surgery? The Danish guidelines show the following as being surgical indicators for herniated discs. 1: No improvement after 4-6 weeks 2: Progressive weakness in the leg 3: Leg symptom remains severe despite treatment and medication 4: There is a positive correlation between clinical findings and imaging reports. What about spinal degeneration (decay)? Again this is a term that instils fear into a patient. Disc degeneration is demonstrated with equal properties between those with and without pain. The prevalence of disc degeneration in people without pain and in their middle ages ranges from 46% to 93%! Therefore there is little correlation between radiological signs of degeneration and clinical symptoms.

When is imaging appropriate?

Most acute lumbar pain patients resolve quickly and with little intervention. In fact, It has been shown time and time again that reassurance, simple pain relief and staying active, is the best strategy for managing active lumbar pain. If there are red flags (sinister conditions) present, they should be picked up during the initial history and exam. Red flags of the serious disease are as follows: Mri of the back 1: Age younger than 20, older than 50 2: Trauma 3: History of cancer 4: Night pain (unremitting) 5: Fevers 6: Weight loss (unexplained)\ 7: IV drug use 8: Cortico steroid use 9: Recent infection 10: Cavda Eqvina 11: Generalised Systemic Disease (diabetes) 12: Saddle Anesthesia 13: Motor weakness of lower limbs 14: Sphincter Disturbance 15: Failure of 4 weeks conservative care Given these guidelines we are able to form a simple strategy. If there are no red flags, consider: 1: Reassuring the patient no serious disease is present 2: Relieve and reduce pain (simple analgesics, manipulation) 3: Reactivation (stay active, no bed rest) If there are red flags present consider the following: 1: Imaging 2: Lab work 3: Referral Informing your patient that you are able to rule out sinister conditions, even though an exact cause of their pain may not be identified, will register as very reassuring news. Craig Leibenson gives a wonderful analogy for simple back pain:

“liken the pain to a common cold or the pain experienced from gardening for the first time after a long winter”.

Conclusion

In a study by Kendrick, patients who received x-rays were likely to report a longer duration and greater severity of pain. Why reinforce a patient’s belief that they are unwell and cause them to limit their activities and in essence promote a more negative outlook? Yes patient satisfaction may be higher but the patient must be educated on why radiography is unable to improve therapy, decision making, or outcomes. If after 4-6 weeks there is no sign of improved function or red flags are identified from the patients history and exam, then consider (imaging or appropriate refferal). But always remember, a picture of a car doesn’t mean its running.

References. Leibenson C, Rehabilitiation of the spine. 2nd edition: 2007 Bonenstein DG, et-al. The value of MRI of the lumbar spine to predict lumbar pain in asymptomatic subjects. J Bone and Joint Surg 2001:83-A:1306-1311. Boden SD, abnormal MRI of the lumbar spine in people without back pain. N engl J med 1994;2:69. Kendrick D, Radiography of the lumber spine in primary care patients with lower back pain: Randomised controlled trial.  BMJ 2001; 322: 400-405. Jaruik JG, the longitudinal assessment of imaging and disability of the back study.  Spine 2001; 26:1158-1166.

16 simple rules to inner well being

Today I had passed onto me some well meaning axioms that were supposedly written by Buddha. I personally found them enlightening and thought I would share.

1. Take into account that great love and great achievements involve great risk
2. When you lose, don’t lose the lesson
3. Remember that not getting what you want is sometimes a wonderful stroke of luck
4. Learn the rules, so you know how to break them properly
5. Don’t let a little dispute ruin a great relationship
6. When you make a mistake take immediate steps to correct it
7. Spend some time alone everyday
8. Open your arms to change but don’t let  go of your values
9. Remember that silence sometimes is the best answer
10. Live a good and honorable life that way when you are older you can enjoy it a second time
11. A loving atmosphere in your home is the foundation for your life
12. In disagreements with love ones, only focus on the correct situation , don’t bring up the past
13. Share your knowledge, its a great way to achieve immortality
14. Be gentle with the earth
15. Once a year go somewhere you have never been before
16. Follow the 3 R’s

• Respect for self
• Respect for others
• Responsibility for all actions

In life we are merely passengers, so its best not to “back seat” drive. We are architects of our lives and great plans require great work. In many great projects there will be disappointment, discouragement and dissolution. These are nothing but tests and traps. True character is found in times of crisis. Focus on what lies ahead, stick to your true beliefs and values; and you will forge a noble reward. Remember that on the horizon of every dark  and cold winter, lies the promise of a sunny and warm summer.

Hip Stiffness or Congenital Defect

I realize to some this may be a little elementary,  but I was feeling a bit bored. All in all I think this is still important and relevant to consider.

When assessing hip mobility, it is important to consider all anatomical structures. In the realm of fitness, muscles are commonly assessed as being either stiff or short.

“Stiff muscles respond quickly to PNF stretching techniques whereas short muscles tend to respond better to low amplitude and longer time frames, in regards stretching.”

However, when assessing ROM such as medial and lateral rotation, it is important to not only consider the soft tissues but the actual skeletal architecture as well.When defining structural variations in the hip-joint, we may commonly see two categories.

1. Hip Antetorsion
2. Hip Retrotorsion

Hip Antetorsion is congenital and is defined by the angle of the head of the femur. As the name states, the head of the femur is rotated anteriorly. The by-product of this anterior rotation is

1. Increased Medial Hip Rotation
2. Decreased Lateral Hip Rotation

The best test to determine this insufficiency is Craig’s test. The hip may be considered anteverted when there is more than 15° of anterior rotation relative to the plane of the femoral condyle. Clinically, pain usually is reduced by flexing and medially rotating the hips.

Hip retroversion is a congenital process that is defined by a posteriorly rotated head of the femur. It is also more common in men than it is in women. In this condition, the opposite of hip anteversion is noted.

1. Medial Hip Rotation is limited
2. Lateral Hip Rotation is increased

If the hip is placed into medial rotation for a sustained period, pain will usually result.

Because of habits and anatomical differences, men usually do not experience pain during sitting and sleeping, whereas women will.

Again, the best test to determine is Craig’s test (aside from advanced imaging).

In summary, hip mobility may not always be due to short or stiff muscles (or a tight capsule). Anatomical changes must be considered when assessing a patient / clients ROM of the hip.

Hopefully you found this of use. Or at least a brush up on the basics.

Mastering Your Pain: Self Care

The word pain evokes a plethora of responses from human beings. However, pain is still in many senses elusive. Many different theories have been presented which attempt to describe, label and categorize pain.

Many current theories point to internal factors being the center of pain, processing and  perception. In other words, the nervous system transports and allows for perception of pain.Moreover, misdirected labeling and deceptive medical diagnosis often focus on external sources as an origin of pain.

The argument is that the patient might not have sufficient strength or endurance and as a result may be causing pain. Insufficient strength or endurance may cause improper movement patterns, which are causing tissue irritation, joint stiffness, deconditioning, and pain.

However, how do patients enter into this cycle? Is it a lack of fundamental movement? Perhaps, how about a lack of strength or endurance? perhaps, but what if it’s simply a lack of motivation? You see, I believe that most musculoskeletal pain (MSP) is a motivation problem first and a movement problem second. Of course, there are exceptions to this, but if you look hard enough at the patients’ history, you will find they deal with pain in one of four ways.

1. They avoid it
2. They deny it
3. They compete with it (boom / bust)
4. They accept and learn from it

Once a patient accepts that pain is their friend and not their enemy, they have taken the first step. Most patients will agree that they have been living life below their true standard or simply being lazy. Once they realize that pain is simply a indicator of something potentially underperforming, they can begin to understand why they need to change their approach. 80% is the why, the remaining 20% is the how.

Rename The Pain

Drop the intensity! What do you think of when you hear the word pain? Probably nothing good. But if we look at how we talk to children when they become injured, what do we hear or call the pain? A boo-boo or an ouchy! What if we did the same thing? If you are sitting right now and experiencing acute back pain, stand up and move around, and call your “pain” a boo-boo. It’s hilarious and immediately shifts your focus.

Own it.

Are you able to own and control your pain through thought process? Absolutely.

1. Identify it. Is the pain (boo-boo) truly there?
2. Realize it’s here to help, not harm.
3. Become very curious about your pain.
4. Be confident that you can handle and control it.

Remember, you can avoid it, deny it, go boom or bust, or you can accept and learn how to change it. Don’t live below your true standard. Be honest with yourself. Who are you? Are you a lazy, unmotivated, sedentary human? Of course not! Your habits may be sedentary or lazy, but inside, you know that’s not you nor is it what you intended. If its a lack of movement or lack of life, why are you or why would you harm yourself? Do yourself a favor and realize that you have the same potential that all human beings have. Strength gives birth to movement and movement defines life.

6 Steps to Motivation: Get rid of the pain for good.

1. Decide what you want to feel like and why you aren’t feeling that now.

Write it down, say it out loud, figure it out. Be honest and brutal. Are you sitting at work all day? Are you eating poorly? What do you do after work? Do you watch TV, sit, become and office worker at home? Once you have that figured out, focus on what you want and why.

2. Accountable leverage

Think of something which is part of your regular routine that is causing your pain. It could be anything from sitting too much,  standing to much, or simply not exercising. Whatever it is, connect it to the pain you have been experiencing. Connect even more pain to not changing it NOW. Now connect incredible amounts of pleasure and relief to the idea and action of changing NOW!

3. Interrupt your habits

Anytime you find yourself not behaving or slipping back into an old habit, immediately do something outrageous. This could as be silly as plugging your ears and

making a face. Or it could be as insane as jumping up and down, saying “An apple a day keeps the doctor away!” or “movement all day keeps my pain away!”

4.Own your alternative

What’s your alternative? The exercises your doctor gave you? Perhaps it’s simply getting up more often and taking short easy breaks. Whatever it is, do it and link pleasure to it. When you do perform your alternative, reward yourself. A reward may be smiling, calling a friend or playing a game you enjoy.

5. Make it subconsciously automatic

Habits are formed from repetition. The power that makes a habit breaks a habit. Get into the process of being in control of your habits, your movements, and your life. When you learn a new movement or better posture it will feel awkward. Give it time to become normal.

6. Re-test yourself

After a week or two weeks of honest change, re-think about your pain. Are you still in the same spot ? perhaps you are feeling better? Maybe you are even feeling energized and confident! If not, then go back through the process, be brutally honest with yourself and find out what went wrong.

Remember focus on the why not the how. There is no point in bashing yourself over inconsistency, just simply realize the problem and truly commit to changing it by using the steps above.

Patient Motivation-A minimalist approach.

Imagine a cluttered room, furniture everywhere, books that could fill a library, enough dishes to start a restaurant. T.V.s, Radios and other electronics scattered throughout the room, all of these need wires so plenty of them too. All this leaves little room to negotiate, limits behavior and over time causes more stress.

Now imagine the same apartment or house with only the bare essentials or even nothing at all. Its like a breath of fresh air or the ability to even breath at all. Hence the saying, “Minimize to Maximize”.

I have two approaches when riding the McGill slope to improvement. When looked at from a distance they seem quite simple and minimalistic, perhaps that’s why they work for me.

1. Stack and sway
2. Running the option

The Stack and Sway approach is simply selecting the most relevant exercise to address the patients most current needs. Sometimes this maybe just one stretch and one exercise.

Often I will change the word exercise to something else: an example, Movement Therapy or even Movement.

This at times takes great will power but its important to do the minimum required for the maximum amount of change. After the patient begins this simple routine, I begin to add more to the list one at a time. After 2-4 weeks the patient should be into the swing of their routine. Moreover they didn’t have the cramped list that is often handed to them. If there is no room for slip ups and expectations are high, there will be little room for the patient to maneuver. It also leads to higher levels of disappointment between Doctor and patient if (God forbid) there is a slip up.

Running the option requires some preparation on the Doctors part. Just as running the option in football, the client will be able to do the same. The preparation required is to take a list of commonly used rehab exercises and find a suitable option for each. When you prescribe the patient their movements you also give them their option. This places the patient in the driver’s seat. To make or create more control, add in two or three options. This has been a favorite in the past and was developed through personal discussions with a clinical psychologist.

Anyway that you can change the dynamic, empower the patient, and have fun in the process will be a winner in the patients eyes. Rehab doesn’t need to be boring nor does it need to be overly strict. It should be precise, effective, and simple.

SUMMARY

1. Sound yet Minimal efforts help create breathing space for both doctor and Patient.
2. If something isn’t working, it’s much easier to figure out what when your list is small and systematically built.
3. Remember the stigma and emotion attached to words. What do you think when you hear words such as: Pain treatment, Illness, decay, degeneration, exam and problem?

More over what does your Patient think?