Evidence Based Rehab and Training: December 2017

Before getting started I just want to extend my props to the people at The Vault Barbell Club and the staff of the Ontario Powerlifting Association for putting on a great meet at The Vault Barbell Open this past weekend. It was a pleasure to compete there and stick around to watch some of the other weight classes compete.

2017 was an interesting year on my part. I launched a website and guest wrote for other parties, launched my second cardiac (and first pulmonary) rehab program, dropped 24 lbs, got to be part of a review panel to review some of Western University’s Physiotherapy program courses and continued to help with the UW Kinesiology program (among other things).

All in all I consider this year to be quite successful but along the way I learned some very useful tidbits of information and I definitely had some things I’d like to have done differently. In no particular order here are the most important things I learned in 2017 as well as a list of my top 10 most viewed articles.

The most important things I’ve learned (in no particular order) in 2017 are…

1) How great a 10 minute walk after a meal is

I credit Stan “the Rhino” Efferding for teaching me about this trick.

Some research out of Australia in people with Type 2 Diabetes showed that taking a 10 minute walk after each meal was more effective in improving insulin sensitivity, digestion, and nutrient partioning than doing a 30 minute walk once a day.

Now, I must confess, I don’t do a 10 minute walk after every meal every day – but I get them in as often as possible and I find them helpful, not only for the above reasons, but also as a means of recovery from intense training and also just some relaxing, leisure activity in the midst of a busy day. While the above research wasn’t done in a healthy population, when you look at the benefits of the 10 minute walks you can’t go wrong.

2) The importance of having the right amount of force in manual therapy

As I’ve written about before – manual therapy is not the high skill treatment technique that many people like to think it is. You aren’t breaking up the ITB or releasing adhesions. As such you don’t need to kill someone with force.

That said, and this is more anecdotal than evidence-based, I do believe you need to put in enough force to get patients to buy in to the treatment. This is also patient-based. Some people who are used to heavy massages may need more force whereas people who are tense may need a “soft” manual therapy (to quote Charlie Weingroff). The art is finding the right level of force.

3) The importance of slowing down your assessment & treatment

I was thinking about this when I first Skyped with my lovely and awesome friend Joletta Belton - sometimes, even though we don’t intend to do so, we do tend to rush patients along subconsciously. In a busy clinic with tight booking schedules, it happens. I’m grateful to the people who pointed this out to me.

Towards that end I’ve really worked on hacking down (I hate to say minimalizing) my assessments & treatments to the most important things. As such I don’t feel as subconsciously rushed.

From an assessment perspective I highly value a good subjective (read these 2 papers for a lot of guidance on that). In the objective standpoint most special tests aren’t supported by the research and most assessments lack reliability and/or validity. Towards that end I still believe that a proper quadrant scan, active/passive/resisted/repeated movements, plus some functional tests will give you the vast majority of what you need to know to get started.

From a treatment standpoint many therapists use manual therapy to provide a “window of opportunity” to where active therapy done afterwards can be better. This year I’ve flipped my treatment order to where I do exercises & education first and use passive treatments to fill up any time in the session. Some may disagree with me but I do feel manual therapy has a place – especially when you are dealing with a patient who’s condition is highly irritable and/or has other medical conditions (e.g. recent MI, overall deconditioning) that prevent them from doing a ton of rehab exercise … and there’s only so much education you can hit someone with. That said manual therapy, in the grand scheme of evidence, should be a lower priority.

4) Pain Neuroscience Education (PNE) really needs to be tailored to the individual

Sometimes I harp a lot on how PNE is used. It’s supported in the literature and can be very helpful for decreasing fear, encouraging activity and improving outcomes both from a patient & provider perspective.

That said I hear of too many professionals either bombing patients with too much PNE at once and/or forcing it when the patient clearly isn’t interested. Research from the last couple years has shown that PNE can be received very differently by different people – some positively & some negatively. As such it needs to be relevant to the individual, done in small amounts (patients forget much of what they learn) and you should ask patients if they care to learn about it at all.

5) The importance of down time & prioritization

Props to Stan Efferding (and my buddy Will Kuenzel) for this as well.

Earlier this year I got super ran down on 2 occasions to the point where (especially on the latter) I got super burned out and didn’t really care for powerlifting or even physiotherapy that much. My burnout came from a combination of running hard with work, finding a place to live, personal & family stuff, various sidebar projects (including one big one that’s under wraps), helping with 2 universities, and launching my site.

Through meeting Stan Efferding earlier this year and talking with him he emphasized the concept of trying to do 1 thing great at a time – be it business, lifting or family. In hindsight that’s the approach I should have been taking – focusing on 1 or 2 things at a time as opposed to trying to do everything.