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.