Monday, October 31, 2011

Demonstration: Edgework for the Knee, Part 2 (Weight bearing)

Another of my video demonstrations produced by Will Stewart of 3D Optimal Performance.

Monday, October 24, 2011

Demonstration: Edgework for the Knee, Part 1

We put together another one. This one demonstrates some applications for knee pain. Enjoy!

Wednesday, September 21, 2011

The "3 Nails" of the Foot

This is a concept that I teach quite often as a way to monitor through the foot. I learned the technique in a tai chi for balance class. This is another production by Will Stewart of 3D Optimal Performance.

Monday, September 12, 2011

Demonstration: EdgeWork for the Foot and Ankle, progression to standing

This is part 2 of the series where I demonstrate the concept of EdgeWork as applied to the foot and ankle. Once again produced by Will Stewart of 3D Optimal Performance.



In case you missed it, here is part one.

Tuesday, September 6, 2011

Demonstration: EdgeWork for the Foot and Ankle

Special thanks to Will Stewart at 3-D Optimal Performance. Will produced this video and did a great job.

Thursday, August 18, 2011

Get In and Drive



I recently wrote about the balanced diet of movement and how important the movement repertoire can be. But I want to be clear that just having options isn’t enough. After all, just having a car and map doesn’t get you to the grocery store. You’ve got to get in and drive.

If a broad movement repertoire were all you needed then gymnasts, dancers and contortionists would all be pain free. But, alas, they hurt like the rest of us.

Let’s try an experiment . Place a cup upside down on the table in front of you. Now, turn it upright with one hand. Which way did you grab it? Did you grab it with your thumb pointing down or up? Most people will grab it with the thumb down so that they end up with the thumb up. You reached in a way so that you would end up in the most comfortable position versus starting out that way.

This is demonstrates the end state comfort effect.

subjects usually grabbed objects to be moved from one location to another in a way that afforded a comfortable final posture rather than a comfortable initial posture (the end-state comfort effect)

All things being equal, it appears that we tend to automatically move in ways to end up in a comfortable position.

An automatic mechanism for comfort has some interesting implications for therapy. Why is getting comfortable often so hard if it is supposed to happen automatically?

Now let’s try a thought experiment. Let’s say that your neck and shoulder were hurting and all you had to do to find relief was to stick your arm straight up in the air. Easy enough, right? Well, you are also sitting front row in a class. Not only that, but the class is filled with people that may hire you next week for a job you really want. Would you stick your arm straight up in the air to make your shoulder feel better? Or, would you be too worried about looking goofy?

Fear, expectation, and social taboo all could easily get in the way of letting this mechanism take place. This is the power of context. Competing desires can be derailing. Instead of getting comfortable we may act on the desire to not look silly. We may act on an expectation, like “sit up straight” or “don’t fidget.” In short, it is quite easy to get in our own way especially with a culture obsessed with appearance like ours.

An expanded repertoire might be enough when all that is holding you back is tendency, but otherwise I can’t think that it’s enough. Similarly, I’ve written that novelty is not enough. Both need a context or circumstance that is conducive to comfort.

Quote taken from:
Rosenbaum D.A., Van Heugten C.M., Caldwell G.E.
From cognition to biomechanics and back: The end-state comfort effect and the middle-is-faster effect
(1996) Acta Psychologica, 94 (1), pp. 59-85.

Friday, August 12, 2011

The Movement Diet



Ever heard of the Irish Potato Famine?

The Irish had found the perfect food. The potato was energy dense and plentiful and for reasons that are easy to understand, it became a staple. Eventually as much as 30% of the population took it beyond the status of staple and became totally dependent on the potato. And then it happened. Disease destroyed the potato crop. Without a viable substitute, widespread famine, starvation, and death resulted.

Pain with movement is often similar to this. Well, except for the starvation and death part.

We all have our staple movements that we use regularly. We tend to be confronted with similar scenarios from day to day and of course must always approach them with the same body and so, not surprisingly, we develop tendencies and habits. This option of autopilot usually serves us well since they free up attention for other things.

Sometimes, however, a level of entrenchment is reached in which the option of autopilot becomes the only choice. Now the habit has become a dependency. This is the dark side of habit because if that dependent movement happens to become a problem and we can’t access it anymore, we have no other options.

As the Irish made clear, dependency only works out if the crop is available. If we are dependent on a movement that becomes painful and we lose access to it, what will we do?

As an example, I routinely see people who perform literally every movement from a flexed position of the low back. If asked to move otherwise, they can’t. They’ve lost this ability because flexion has become so entrenched. This serves them fine until the day that the flexed position of the low back becomes painful. Now they’ve got a problem because they can’t find their way out of the uncomfortable position. They don’t know how to not be flexed. The potato famine has struck.

Luckily in the case of painful movement you won’t starve to death.

My advice is give yourself a varied movement diet so that you don’t become dependent on any particular movement or way of moving. This gives you options for finding the way to comfort.

This was the third in a three post series. The other two were:
The Ticking Time Bomb
When Pain Appears Everything Changes

When Pain Appears Everything Changes



In this previous post I argued that the Ticking Time Bomb theory of body mechanics is problematic. Now this is clearly blasphemy since “sound” body mechanics is seen as a pillar of my own profession of physical therapy. Am I ready to denounce my own profession as well as many others? No. Body mechanics clearly plays a role and many of us use movement every day to help people with pain. So what gives? Am I talking out of both sides of my mouth?

No. I’m saying that when pain appears, everything changes.

Body mechanics is not useful as a pain predictor but can be a useful solution to a problem that is already present.

Regardless of how we move we will all hurt from time to time (a robust foundation of research supports this statement) and the pain will correspond to certain movements. Perhaps it will hurt to bend forward and sit or maybe instead standing up straight and walking will be the nemesis.

Neuroscientist VS Ramachandran said that “pain is an opinion.” Painful movement means that our body is acting on the opinion that we are under threat and should therefore be protected. So, how can we change this opinion?

Movement patterns and postures are often tendencies or habits of moving. They develop over time and therefore give us a glimpse at someone’s typical movement diet. If we give them something new, something outside of their normal diet, we give them something to form a new opinion about. We are channeling their inner food critic!

If we are presented with this something new in a non-threatening context, a context of safety, a context of expansion, we are not likely to come to an opinion of pain.

Pain reduction occurring through body mechanics and postural change is, in my view, yet another example of the power of novelty. It has nothing to do with attaining some idea of perfection and likely little to do with strain reduction and everything to do with non-threatening change.

The Ticking Time Bomb



People worry that imperfect movements create patterns of strain that make them a ticking time bomb to be struck down with pain at any moment. But will they?

I have 3 questions:

1) Why don’t people with cerebral palsy hurt constantly at every joint?
*Cerebral palsy is a condition where movements are difficult to control and where movement and postural asymmetry are common

How do you explain why so many people display these imperfect and asymmetrical movement patterns but have no pain?

But maybe they are all just ticking time bombs whose time has not yet come. But if that’s true…

2) Why are so many of us walking around with herniated discs, meniscus tears, rotator cuff tears, and/or arthritis without knowing it?

Strain has resulted in actual tissue damage in these people and yet they don’t hurt. The research documenting all of these findings in people without pain is robust.

And lastly…

3) How’s that sit with phantom limb pain? More specifically, how’s that sit with congenital phantom limb pain?

Lorimer Moseley, pain researcher and blogger Body in Mind blog, posed this excellent question during a lecture I attended. These folks have no limb to move incorrectly and in the congenital cases, never have. Yet they hurt. How can faulty mechanics explain their pain?

Now you are asking (if not yelling), “Oh sure, Mr. Smarty Pants. Then why do I have countless stories of how I’ve cured pain by changing mechanics and posture? ”

Because when pain appears, everything changes. --> Please read this companion post.

I’m not saying that mechanics are not important or useful (as you’ll see in the other article). But, I do argue that we are not doing our patients, clients, nor ourselves any favors when we convince them that their body mechanics make them ticking time bombs. This is clearly not the case.


Friday, June 24, 2011

Taping for Knee Pain

Here is my latest youtube video. This demonstrates a couple of taping techniques I use for people with knee pain. Enjoy!

Thursday, June 16, 2011

Which Batman Character are You?


Loss of control is frustrating. It blurs boundaries and creates uncertainty. We all go to extensive measures to maintain our boundaries and have some sense of certainty (even if it is imagined). Regardless, we are often robbed of these precious possessions and are left groping for answers and as our story unfolds we assume a role. Two relevant roles that I tend to see in these situations are victim and hero in their various stages of victim-hood and heroism.

I am a huge fan of the new Dark Knight Batman movie franchise by Christopher Nolan starring Christian Bale. And since we’re talking heroes and villains we might as well talk Batman!

Victims, have control taken from them. They are subject to the whims of sinister plots and nefarious acts. They are the people of Gotham. John Q Citizen stands no chance against the likes of the Joker. Victims feel incapable of, and are even reluctant to, credit themselves for successes. Victims need a hero.

Batman is a hero. He has the tools to fight tyranny and restore justice in an evil world. Hero’s take responsibility for failure (and promptly work to reverse the failure) and receive the credit for successes.

Often my patients are looking for a hero and they would be more than happy to let me be that for them. But, I don’t want be your Batman. If your Batman is anyone but yourself, then you must wait for him to arrive and save you. And as much as I like my patient’s I don’t want them to be dependent on me although I do want them to be able to depend on me. Instead I’d like for them to learn the secret.

Here is a secret. You are Batman.

Don’t get me wrong, I’m not trying to say that you are on your own. Even Batman needs help. You may just need Alfred, and I’m cool with playing the role of Alfred.

Wednesday, June 15, 2011

Video: Taping for Elbow, Wrist, and Arm Pain

Here is a demonstration of a simple taping technique I use for people with elbow pain, wrist pain, or arm pain. Enjoy!

Tuesday, June 14, 2011

New Look and New Name

I’m happy to announce that the Moving Forward blog is now “Leaps and Bounds: Perspectives of a Physical Therapist.” I've also updated the layout.

Thanks for reading!

Wednesday, June 8, 2011

Story Teller vs. Contextual Architect

We are story tellers whenever we interact verbally or non-verbally with another, whether we want to be or not.

We are contextual architects when we attempt to have a specific impact on the stories people tell themselves.

Monday, June 6, 2011

Interaction 2

Whenever you are in someone’s presence, that person is telling themselves a story about you.

Whenever someone even thinks of you, they will project a story they perceive as coming from you.

It’s like seeing a movie. The movie makers had a story in mind to portray to you, to move you in certain ways. However, the story you actually tell yourself about the movie may be totally different. On many occasions I’ve seen the same “bloodletting” story used to make opposing points, as another example.

The story we’re told and the story we tell ourselves are two different things.

Interact with these things in mind.

Interaction

Whenever we touch someone, we are telling them a story with our hands.

Whenever we talk we are telling a story with our voice.

When we listen to someone, we are telling them a story with our body language.

When we enter a room that someone else occupies, we are telling them a story with our body language.

What stories are you telling?

Wednesday, May 18, 2011

No Pain, No Gain? Don’t be Such a Nietzsche!


As a physical therapist I’m in a privileged position to hear what people think when it comes to pain and getting better. Let me tell you, there are a lot of misconceptions out there and they run deep in our culture. Many misconceptions create problems of their own and are therefore worth addressing.

Here’s one: “No pain, no gain.” Do you need more pain to get rid of pain?
The “no pain, no gain” attitude has origins in the strength training realm (“push through the pain!”), the military (“pain is weakness leaving your body”), and even the philosophical (Friedrich Nietzsche’s “what doesn’t kill me makes me stronger”) and the religious (“the last will be first and first will be last”). I would submit, however, that these are themes of overcoming suffering when confronted with it. “No pain, no gain,” however, implies that gain cannot be achieved without suffering and pain should therefore be sought out.

Gains come from creativity and persistence which are often sparked when confronted with suffering, that’s true. But creativity and persistence may be sparked from any scenario. Seeing an apple drop from a tree was what sparked Isaac Newton to first describe gravity, for example. Ultimately, creativity and persistence come from the person and not from the suffering.

So, why is this myth so pervasive? Well, for one it’s a catchy phrase! It’s even outlasted “where’s the beef!” But, through its strength training relation, it’s also tied in with another common myth that says pain is caused by muscular weakness. If pain is from weakness then strength training should fix it. If strength training should fix it then you should push through pain, right? Well, if weakness causes pain and strength is the antidote then power lifters should all be pain free. But, they get pain just like the rest of us, I’m afraid.

The fact is that exercise is a proven method of pain relief for many conditions and when you exercise you do tend to get stronger. However, it’s not the strength that removes the pain. That’s a by-product. It appears that it is exercise’s gradual progression of movement that brings about the improvement. The organized progression of exercise is like built-in persistence, so it is often a successful way forward if applied creatively.

I don’t think this catch phrase will be going away anytime soon, unfortunately. So be creative and persistent when confronted with pain. But remember that you don’t need to seek out suffering to find them. You need only look where they originate….within you.

Saturday, May 7, 2011

Stacking the Deck: An example from this morning's run

This morning while out for a leisure 2 mile run an old runner's nemesis, knee pain, was there waiting for me. I was able to deal with it successfully by stacking the deck.

This week I've been talking about the concept of Stacking the Deck and I've even posted a couple of videos that demonstrate using it during Edgework. I thought this example may help to further demonstrate the concept.

In this case, despite warming up to "game speed" I noticed the discomfort pretty much straight away. Step onto the right foot, pain on the outer knee cap area. Worse on the downhill but also present on the uphill. Pretty standard anterior knee pain. Were I to seek a diagnosis based on my symptoms almost garauteed I'd have been diagnosed with either the vague (and appropriately so) "Anterior Knee Pain" or the more sinister sounding but more specific sounding "Patellofemoral syndrome" or "Chondromalacia Patella."

Also fairly standard, the pain improved a little ways into the run and worsened again towards the end. I ended on a 1/2 mile downhill section which was not the most convenient time for it to worsen.

This is when I stacked the deck and was able to finish my run virtually pain free.

What did I do? I ran harder. I increased my pace and I pushed off with the leg more vigorously.

I wasn't "pushing through pain" nor was I taking a "no pain, no gain" approach. The knee felt better immmediately, not worse.

I stacked the deck. Normally when I push in this fashion I'm either a) feeling good enough to push the edge or 2) trying to meet some training goal I've set and am in expansion mode. Either way, I usually do this when the scenario is favorable. Because of this my pre-conceived notion of running in this manner is not based on survival but expansion.

So, when my body was posed the question "how dangerous is this, really?" I put myself in a context that was not protective. I flipped the context from one of protection to one of expansion. The result was the favorable one that I was looking for.

How did I know this would work? I didn't. But I thought it might based on my understanding of pain. Also, I was willing to explore different ways of moving and did so creatively.

Does this make you think differently about why exercise and paricularly vigorous exercise can sometimes be helpful? What about when it's not?,

Friday, May 6, 2011

How Dangerous is This, Really?

Yesterday I talked about stacking the deck. Context is everything but so is timing. I suggest that a great time to stack the deck is when our body is asking the question “how dangerous is this, really?” (hat tip to Lorimer Moseley at www.bodyinmind.org)

This defines the edge of protective movement.

When we stack the deck so as to answer “It’s not so dangerous after all” the chances are increased that the level of protection will drop. We’re in friendly territory and the guard can be let down, if even just a little.

Thursday, May 5, 2011

Stacking the Deck


Novel movements give us a window of opportunity to create a new impression which can be quite useful when in pain.

But there is no guarantee that the new impression will be a favorable one. It could just as easily become yet another painful, protected, and therefore limited or limiting movement. In order to change things for the better we need to nudge things in that direction. One way to stack the deck in our favor is to couple the novel movement with something to which we already have a favorable impression.

It’s kind of like when the Indianapolis Colts sign a new player I of course assume that they are an upstanding citizen who is the epitome of toughness and fairness. But, if the same player were signed by the New England Patriots I would of course assume that they are prone to cheating and/or underwear modeling. I’m just saying.

Context is everything and can be used in our favor.

What ways of stacking the deck can you think of?

Monday, April 18, 2011

Vancouver, WA Getting Outdoors with Your Family

This is a bit different than my usual posts, but I built a resource site to help people in the Vancouver, WA community get out more with their kids.

vancouver-wa-outdoors-for-families

The idea is to have a place that all of the trails, events, parks, etc are all kept in one place and thus easy to find. I even put a weather link in.

I made it at a pretty cool site called Squidoo. All of the advertising on the page is built in by Squidoo. It generates royalties and I've submitted that any made by my pages are to be donated to charity.

Please let me know what you think.

Friday, April 15, 2011

Edgework applications: Low Back Pain

Friday, April 8, 2011

Novel Movements of the Hip and Pelvis

Thursday, April 7, 2011

Novel Movements of the Spine in Quadruped

Novel Movements of the Shoulder Girdle

Sunday, April 3, 2011

Novel Movements of the Foot and Ankle

Friday, April 1, 2011

Novel Movements for the Hand, Wrist, and Elbow

Check out my first youtube video. Watch out Spielberg!

Wednesday, March 9, 2011

Risk vs. Threat



Successfully getting off the ledge, to the edge, and then doing effective edgework depends on the absence of a looming threat, be it real or perceived. All three ideas I offered (1, 2, and 3) have in common one thing: they all aim at reducing threat.

But, don’t confuse threat and risk. Working at the edge is a risk. But then again, so is walking out your front door. A risk simply means a chance at failure. There’s a lot to be learned from failure and risk can be something that moves us forward if we handle it appropriately. Looming threats on the other hand elicit fear. And fear stops our forward movement and puts us into survival mode.

We need to clear the path to the edge of looming threats, real or percieved.

Monday, March 7, 2011

Or, You Could Always Use Maps

In my last post I talked about lifting the fog to get off of the ledge. I made two summarizing statements:

The fog of reason is the fog of working from bad information. The way out of this fog is critical rationalism.

The fog of faith is the fog of working from maladaptive beliefs. The way out of this fog is through evangelism.

These equate to “talking someone down from the ledge.” But there’s another option.

You could just give them a map.

I mean this both metaphorically and literally. If one has an accurate map one can navigate, even in the midst of dense fog. The thing about navigating by a map such as this is that you are at the mercy of the map maker.

Then there are brain maps. Our brain is a meticulous map maker. We make maps of where we are in relation to other things. We make maps of our own body and the movements available to us. We even make maps of the spaces that objects we hold occupy (even while driving a car!) Our brains, being obsessive cartographers that they are, constantly update our maps. This is both good and bad. It’s bad because we sometimes smudge maps that were previously well detailed and it’s good because we can redefine them relatively quickly. When on the ledge, we may be dealing with a set of smudged maps.

Our brain redefines its maps, at least in large part, through input. At least some forms of input, like various forms of manual therapy, are likely altering these brain maps and filling in the spaces. This is more like sonar, the vessel (brain) is pinging its surroundings to create a working map as it moves along. The brain is creating its own maps instead of being handed one.

So, for a person on the ledge, you could give them a map or you could help them build their own. I think you know which method I prefer.

For a great read on brain maps, I recommend the book
The Body has Mind of its Own
.

Sunday, March 6, 2011

Lifting the Fog

Yesterday, I spoke of the fog.

If one is in unfamiliar territory and blinded by fog it may feel as if the edge is an inch away in any or all directions. This does not feel like an edge. It feels like a ledge and it is crippling. People fall off of ledges unless they are rescued, after all. Either way, ledges rob one of feeling in control. It’s a helpless feeling.


Of course I’m using the fog metaphorically here. So, in reality, what makes up this fog? What is crippling about the fog is not the actual existence of a ledge, but instead the possibility of the existence and nearness of a ledge. The fog makes this possibility more anxiety provoking. It could be anywhere. It holds us down, makes action of any sort too risky. It thwarts coping.

So, how do we come to the thought of the possibility of a ledge? 2 ways, logic and belief. With logic, we reason that given one thing is true the logical conclusion is that other things will be true as well. As I tend toward the critical rational side, this realm is familiar and favorable for me. However, if that initial “truth” upon which our logic is based is errant, then all logical conclusions based upon it will be errant as well. When this is the case, there are logical ways to lift the fog. Providing evidence that makes the error clear, then progressively rebuilding the context through logical reasoning will make one aware that what has pinned them to the ledge is not present after all.

The fog of reason is the fog of working from bad information. The way out of this fog is critical rationalism.

Then there’s the tough one; belief. Belief is based on faith. No amount of reasoning will talk a person out of their faith because it has no authority in that realm. The saying holds true, “Don’t try to reason someone out of a position that they didn’t reason themselves into in the first place.” The problem is that it is not often clear when a person is working from belief or logic.

The fog of faith is the fog of working from maladaptive beliefs. The way out of this fog is through evangelism.

Evangelism occurs through cultural change, the mind of the majority, and its tools range from testimonial to social support to group think. It is therefore a slippery slope and to be treaded carefully and responsibly or not at all, in my opinion.

I’d love to hear thoughts on this.

Saturday, March 5, 2011

When the Edge Feels Like a Ledge

Yesterday I wrote of the body’s edge of protection. I need to spell out an exception. As I mentioned, edges are often blocked from view by fog. If one is in unfamiliar territory and blinded by fog it may feel as if the edge is an inch away in any or all directions. This doesn’t feel like an edge. It feels like a ledge and it is crippling. People fall off of ledges unless they are rescued, after all. Either way, ledges rob one of feeling in control. It’s a helpless feeling.

When at the ledge and blinded by fog, we have 3 choices, as I see it. 1) Use senses other than sight to better define what surrounds us, 2) cut through the fog, or 3) wait to be rescued.

The first 2 give us back a sense of control. The 3rd leaves us helpless and at the mercy (or apparent mercy) of others.

With pain, we can learn to feel our way toward edges until it becomes clear that we are not actually on a ledge. Or, we can lift the fog.

More on the fog in the next post.

Friday, March 4, 2011

The Edge

Edges are productive. When confronted with an edge one must alter the approach to continue. For this reason, at the edge is where creativity exists. At the edge is where most potential for change exists.

The body’s protective responses are an edge.

Sometimes it’s tough to know where an edge begins because some are a gradual transition. Some are hidden by fog. How will you notice an edge if you can’t see it?

Pain itself is not the only characteristic of the protective edge. There are many changes in behavior that may mark the beginning of the edge. Muscles may tighten. Breathing may change. Fear and uncertainty may take hold.

By getting to know the edge, learning to identify it, we can walk up to it with confidence.

The edge is where things happen. Be it good or bad, it happens at the edge. This is why so many choose to stay away from them. It’s quite possible that failure awaits. This uncertainty can be disabling, literally.

Don’t avoid the edge and don’t ignore the edge. Learn to identify it, then work at the edge.

Hat tip to Seth Godin. Until reading his description of “edgecraft” I had always called this movement concept “working at the boundary.” The edge captures this concept so much better.

Wednesday, March 2, 2011

Setting the Stage


Based on the interactions that I’ve had over the years with other physical therapists (and between my friends and colleagues, there’s been a lot) I’m comfortable making a general statement that therapists see the benefit in their patients having self-efficacy. I would agree that this is vital.

Is there’s a bigger passivity inducer than ultrasound? Do you suppose a laser treatment sets the stage for self-efficacy? Why do our clinics remain filled with modalities that foster the very attitude that we hope to alleviate?

Do our actions match our rhetoric?



Picture credit

Saturday, February 26, 2011

Mission



The common purpose across my roles as a therapist, writer, and business owner is to bring to reality the following scenarios:

People should be able to move comfortably when they are well.

When people are well they should not be made to feel or believe that they are not.

When people are not well, accommodations that bring about the most effective return to wellness should be the focus.



picture credit

Thursday, February 24, 2011

Practical Applications: Warming up and Restoration of Movement Variability


I’ve written about the real story of warming up, the real story behind stretching, and have introduced the concept of restoration of movement variability.

Now I’d like to submit some sensible foundation for how these methods are utilized. In this example the assumption is a person who has no current movement restrictions who wants to improve the ease and comfort of movement.

Step 1: Warming up

It makes sense that we’ll have a greater amount of movement available to us, a greater freedom of movement, if we first acclimate to movement. At this point, I’d like to discourage using stretching as a warm up routine. It is a poor method for acclimating to movement, which is the real benefit of warming up anyway. Instead, all of the body parts of interest are to be moved. To start, slow un-weighted movements are used and faster and more forceful movements gradually follow. There is no need to work all the way to an end range stretch. Working in the freely available range with a relatively high number of repetitions is the aim.
After warming up, it is likely that freedom of movement will have expanded even though no stretching has taken place.

Step 2: Restoring movement variability

At this point, directly after warming up, is the optimal time to refresh the movement variability repertoire. Slow, controlled movements into and out of positions that aren’t typically done with day to day movements are what I recommend. However, stretching and various other move and hold methods are applicable here as well. I’ll be submitting some specific movement ideas on this matter soon. But for now, as an example, someone who spends all day at the desk, sitting with head, shoulders, and hands forward and back rounded could introduce variety by standing up, extending the back and neck, reaching back with the hands and shoulders. The movements are done slow, and under control to the end of the available range. This is done repetitively and with focused awareness of what is being done and how it feels.

The thing about movement variability and our daily habitual movements is that our movement will tend to return if a habitual state if is continually reinforced by daily habitual movements. So, I typically suggest the movement variability movements be done throughout the day. Optimally, I would say 3-4 times throughout the day is a good place to start.

Should a warm up be done prior to each movement variability restoration throughout the day? If a person stays warm (acclimated to movement), say from an active job, then they may not need to. However, if they have a relatively sedentary job, they may. A bit of trial and error will be necessary here.

More specific applications and videos to follow soon. Stay tuned!

Do We Need to Stretch?

Stretching, the most common form of warming up, is not an effective way of lengthening muscle tissue. In order to add actual length to a muscle you’d have to stretch hourly, every day, for a looong time. Stretching may yet have value as a manner of increasing awareness of movement options. But, do we need to stretch?

There are many ways to increase your movement repertoire besides stretching. I call these methods of movement variability training. I think that much of the reported benefits of many popular movement methods, like pilates and yoga to name a couple, work at the level of movement variability.

Personally, I find showing people how to move into and out of positions that are unfamiliar to them (novel movements) with control and awareness is a great way to improve movement repertoires.

What’s unique about stretching? Sometimes it is done more effectively (by which I mean taken into further or different ranges of movement) when done passively. In general, it is my view that self efficacy should be encouraged whenever possible. So, stretching that requires the assistance of another is not optimal in this regard.

Sometimes we need help, though. And I’ve nothing against borrowing the hands of another to get moving when you’re stuck in a rut. After all, that’s part of what I do for people when necessary.

There are ways of stretching oneself that get around the self efficacy problem. Stretching also often feels “good” and I see nothing wrong with doing something for yourself that is pleasant, even if it is not necessary.

We may at times “need” to improve our movement repertoire and while stretching is one way to achieve this, it is not the only way. My opinion is that the “best” ways of improving movement repertoires are through methods that can be done successfully and safely without assistance once learned and are done without any wild belief systems attached to them. Stretching may fit the bill, and it may not depending on your situation.

Wednesday, February 23, 2011

Option Variety: The Real Story Behind Stretching

One very common method utilized for warming up is stretching. Stretching is commonly assumed to add length to muscles, improve range of motion, and therefore improve performance. However, research has made it clear that adding any lasting length to a muscle requires stretching every hour of every day for a loooong time. This is why people so commonly say “it doesn’t seem to matter how much I stretch, I’m always tight!”

So if stretching isn’t effective for adding muscle length, is there any value in it?

How well we cope with any situation depends on how well our options are suited to the task at hand. If all we use are round pegs, we’re only prepared to cope with round holes. We’re not prepared for square holes, and forget about star shaped ones! Essentially, what happens when we lose awareness of our habitual movements is that we try to navigate the world using nothing but round pegs.

Stretching takes us into positions that we don’t reach with our day to day movement habits and therefore can remind us of some of the variety available. Having a variety of option gives us more pegs to work with.

Keep in mind that stretching is not a great way to acclimate to movement, so be sure to warm up.

Monday, February 21, 2011

Something to strive for 2: Engagement

While we each bring different expertise to the table, we are all leaders, or should strive to be. I may not be qualified in your area of expertise and you may not be qualified in mine. This means that we each have a vital role in the collaboration.

You may come to me with an issue that lends itself to my expertise, like back pain. However, my expertise is of little value without your expertise regarding your goals, expectations, and circumstances. For us to collaborate, we need each other’s contributions.

We need engagement.

Sunday, February 20, 2011

Something to strive for

Manage yourself. Lead others.

I work in patient/therapist, client/consultant, and employer/employee relationships. I don’t want to manage a patient, client, or employee. I want to lead them.

At the same time I want to be led by them.

The truly great thing about any interaction is that each party brings something of their own to the table, the table is shared, and everyone then takes something away from the table.

Leaders create tables where effective sharing occurs.

Which tables you allow others to share with you and what you take away from them are responsibilities that you cannot share, however. That part is for you to manage.

Friday, February 18, 2011

Movement Enrichment 2: Variation. If all you have is a hammer, is everything a nail?

Are you a creature of habit? Of course you are. We all are. It’s how we’re built. Habits allow us to act without attention. And I don’t know about you, but I can use all the spare attention I can get.

But are you aware of your habits? I am aware that I habitually check my pocket for the keys before shutting the car door, even though this doesn’t require my attention. However, I may not be aware that each time I do this I also clear my throat.

I see people every day who have no awareness of their movement habits. They know that their back hurts every time they bend their spine forward, but they have no idea that they bend their spine forward to some degree with almost every movement they attempt. If you become aware of your habits, you can purposefully introduce some novelty. This is the value of variation. It is a great way to introduce novelty.

Variation from habit introduces novelty.

Novelty creates a window of opportunity for change.

Wednesday, February 16, 2011

More on Novel Movemements

Pain is an opinion.

Novel movements are those that your body has not yet made an opinion about.

Novel movement creates a window of opportunity for your body to come to a non-painful opinion about a movement.

If you get enough non-painful opinions accumulated, your body might change its overall opinion.

Do you stare at the sun? The real story behind warming up.

Did you ever notice how unpleasant it is to have a bright light in your eyes after they’ve acclimated to the dark? Or, how about when you take a hot shower immediately after playing in the snow and it feels like molten lava? Of course you have. This is a totally normal phenomenon that we’ve all experienced.

Vision and temperature sensation are both mediated by the nervous system which is very adaptive. It adjusts its sensitivity to attempt to match your current setting. A big change in the setting creates a bit of a shock to the system. Do you know what else is mediated by the nervous system? Movement.

When we become very active after having been relatively still it is the same shock to the nervous system as the bright light or the hot water.

If you don’t let your nervous system re-acclimate to the new setting gradually it can have consequences. The light can bring about a headache if you don’t look away to a dimmer area for a minute and the water can bring about a feeling of having been burnt that may last for several hours. If we don’t re-acclimate our movement we can be left with a sensation of stiffness, soreness, clumsiness, etc. This is the essence of “warming up” before activity.

I don’t know too many people that would stare into that bright light or punish themselves in the hot water without first “warming up.” So, why don’t we do it at work and play? Stop staring into the light!

Tuesday, February 15, 2011

Movement Enrichment

1. (noun) enrichment
act of making fuller or more meaningful or rewarding


People are demanding more enrichment in their lives. We’re seeing it addressed at the cutting edges of many sectors, like Google’s approach to employment and the rise of social networking’s role in marketing. There is a huge outcry and demand for Healthcare that is more enriching, and while I don’t pretend to have the answers to that, I do have an approach to the enrichment of movement.

Let’s break the definition down into 2 parts and make some sense of it as it applies to movement.

1) The act of making a movement fuller
2) The act of making movement more meaningful or rewarding

Fuller movement comes through reduced limitations. Reducing limitations is about removing barriers, whether they be our own physicality (like a lack of range of motion, strength, or conditioning), from our surroundings (as in the spaces with which we must move), or contextual (as in a fear of certain movements). In general, most good physical therapists (and other movement specialists) have successful approaches to removing these barriers.

Meaning and reward imply that it’s not just about where the movement takes you but also how you got there. I would argue that self-attribution, giving yourself credit for what you’ve accomplished, having a sense that you are in control of you own actions, self-efficacy, are vital markers of meaningful and rewarding movements. I would also argue that most clinics are not enriching movement in this regard. Think about the difference between these two people, “I sure am glad that therapist is there to fix me when I’m broken” and “I sure can get myself out of quite a mess once all the road blocks are out of the way.” While both situations are likely regarded as valuable, only the second has meaning and reward to that person.

People deserve all the credit for getting themselves out of a predicament, they deserve this level of enrichment. The movement specialist should be the producer, not the director.

To go even further, I’ll suggest that this level of enriched movement can be produced when we foster these attributes:

Creativity
Variation
Resilience
Playfulness
Spontaneity
Autonomy/Self Efficacy

I’ll be exploring these in more detail in this series of blog posts. Can you think of any other qualities that enriched or enriching movement might possess?

Friday, February 11, 2011

Novelty: A Window of Opportunity

Novelty is king when it comes to moving with less pain. There’s some pretty cool brain chemistry at play in this. Dopamine is released in the brain when we encounter something novel. It’s like a messenger to the rest of the brain saying “Hey everybody, wake up and pay attention. This is something new.”

Novelty is so useful because it is something you don’t yet have an impression of. In pain, you keep encountering movements that give the impression of danger and thus the response of protection. Novel movements give us a window of opportunity to create a new impression.

Thursday, February 10, 2011

The Fountain of Youth

Saw this quote in a toy store with my son last year in the San Juan Islands:

We don’t stop playing because we grow old. We grow old because we stop playing.

Wednesday, February 9, 2011

What can we learn from Pixar?

I recently posted about producers and the similarities with my work as a physical therapist. I said that I’m not a director and that people shouldn’t try to hand over their director’s chair to me. When I wrote this I know that some readers would think about the various movements and exercises that may be provided in physical therapy and how directed they can seem. So, let me further clarify.

I was recently watching some of the extras from Pixar’s Cars with my son. They were discussing the setting at Pixar’s headquarters and how the story went from an idea to a movie. Generally, things progress from a script and are brainstormed into story boards, which are brainstormed into scenes. Pixar looks to be an interesting place to work. Pixar was designed to foster creativity in its employees and a lot of play goes on. Other work places have similar practices with one famous example being Google. A great book on the subject is Daniel Pink’s Drive.

Patients usually bring me a script even if it is only a draft. They have an idea of where their story is presently (their current circumstance) and where they want it to go (their goals). They are not sure how to get from A to B, however. Therapy should be place where creativity is fostered and brainstorming takes place to help someone find a path from A to B. We come up with some story boards together, often in the form of some specific movements or types of movements, but it remains a place for creativity and brainstorming set by the boundaries of the script.

On the set there are rehearsals and actual takes which have been well thought out and prepared but remain a place for creativity. Mistakes are allowed because they often bring about a surprising outcome that ends up in the movie. Some sets even work with improvisation to foster this aspect of creativity. Some patients may need access to a set with someone’s help to be sure that when mistakes happen they are safe and foster improvement. Others may only need help in knowing how to build their own set from someone who has set building experience.

I want my clinic to be a place that foster’s creativity, where scripts are discussed and clarified so that story boards can be created and not dictated. I want my set to be a safe place to rehearse, when mistakes happen they happen safely and in a way that moves the work forward and not backward.

Monday, February 7, 2011

We Can't All be Clint Eastwood

I like movie analogies. After all, getting through pain, disability, and loss of function is a lot like a good Batman movie.

In this recent blogpost, Seth Godin said this of Sofia Coppola:

In describing the role her brother played in producing one of her movies, Sofia Coppola said, "he protected the film."

I hope the same could be said of my work as a physical therapist.

Sometimes we are not in a position to self produce, direct, and star in our own movie. Hey, we can't all be Clint Eastwood all of the time. Sometimes we get into predicaments with which we are not prepared to cope. After all, there's a lot that goes into making a good movie! You need a safe place to work. You need to know how to use all of the tools available to you. You need information. You need to walk through certain doors and stay away from others. A good producer can help with all of these aspects of making a movie because a good producer is also a Hollywood insider.

The director's chair is a place of privilege. Be wary of those who ask to sit in yours.