Tuesday 1 May 2018

Random Thoughts April 2018 - Is Any Exercise Good Or Bad, How I Go About Challenging Patient Beliefs … Before I Actually Challenge Them, The “Bottom Up” Prioritization Pyramid – How I Wear Multiple Hats, And Are Trainers Bad At Coaching Or Just Uneducated

Are burpees (or any exercise) good or bad?

A lot of good discussion lately on burpees and whether exercises are good or bad.

My simple thoughts are it depends on ...

1) The medical/injury history of the individual

Someone who has flexion-aggravated back pain would be best served to temporarily stay away from burpees. Someone who has knee pain that worsens with repeated knee extensions may be best to take a break from the leg extension machine.

2) The baseline fitness level

Does the individual have the ability to perform the exercise "correctly?" Yes there is a wide range of correct form with many exercises but I'm not a fan of having someone squat with their knees moving in & out like a baby giraffe's legs and their back looking like its gonna collapse at any second.

By contrast to 1 & 2 people who are healthy & capable of doing these exercises properly are probably OK as long as they
- progress their volume appropriately
- provide appropriate rest & deloads
- don't max out all the f*cking time
- manage sleep, nutrition, hydration and psychosocial factors

3) The goals of the individual

The McGill and Weingroff biomechanically influenced guy in me uses the goals to determine the acceptable risk/benefit ratio of an exercise.

If you satisfy 1 & 2 - and enjoy doing burpees and/or competing in CrossFit or bootcamp or whatever that's fine - do em. If not there may be other options to give you a good workout with low impact.

If you're like me who enjoys powerlifting than heavy (by my standards https://static.xx.fbcdn.net/images/emoji.php/v9/f4c/1/16/1f642.png:) ) squats & deads are a part of the sport. If you're training for general health/fitness there may be better options.

So the answer isn't as black & white as people think and requires some good reasoning behind it to make smart training decisions that will maximize results & minimize injury risk.

How I go about challenging patient beliefs … before I actually challenge them

On challenging patient beliefs...

It's tricky. I don't necessarily start by trying to confront patients or change their beliefs right from the get go as I found it gets more push back than anything else.

What I do do is

1) Just simply be a good person, listen to and validate the patients' story. Nothing replaces this.

2) Try to educate patients about all the different factors that can contribute to pain. I find when some patients hear about the false +ves on their imaging they feel invalidated and feel like we're brushing them off. This is a better strategy to listen to and acknowledge the patients concern but also still honour the complexity of pain.

3) I try to empower them by
- showing them what they can do and
- giving them a plan to manage pain and get back to what they want to do

4) Educate patients that hurt doesn't always mean harm and in certain situations (ie chronic pain, post surgery) where painful exercise/movement may be unavoidable - educate them on what level of pain & pain response is acceptable and what is going on.

5) Don't scare the shit out of them with nocebo-ic language

To me that steers the ship and gets it sailing in the right direction. Then later on, after the trust is built, we can start to work on changing beliefs.

Some people may disagree with some of my points, that's fair enough, but that's how I go about belief changes & empowering patients.

The “Bottom Up” Prioritization Pyramid – How I Wear Multiple Hats

Over the last week in the clinic I’ve been asked a lot how I manage being a physiotherapist, educating through my UW curriculum work & website, training for powerlifting, and also being there for my family without burning out.

It took me a lot of trial & error but I basically figured out what I call the “Bottom Up” Prioritization Pyramid which was influenced a lot by Stan Efferding, Will Kuenzel and Nicholas Licameli.

Let’s start with the foundation. The foundation enables you to fulfill your priorities, maintain morale & not burn out. For me that includes
-          7+ hours of sleep a night
-          Adequate high quality food in the right amounts
-          Adequate down time and contact with friends

This doesn’t mean be lazy as f*ck – it means build in proper recovery (both physically & psychologically) to enable you to do the hard work. You can only work or train as hard as what you can recover from. The size of the foundation enables you to determine how high you can go and how much time you can put into your other priorities. I don’t know of too many people (yes there are some) that function highly on 4-5 hours of sleep a night.

I design the rest of the pyramid from a bottom-up perspective. The #1 priority, whatever that is to you, is at the bottom as it has the most size (and time given to it) and is most influenced by the foundation. Priority #2 goes next and so on & so forth.

To give a visual example of what this looked like during my storm stayed week in Fergus.

Family time and contact was fairly minimal as I was storm-stayed and couldn’t see anyone. The lifting (which was modified due to the CPU Coaching Certification) was condensed & done earlier in the week. Hence my priority (on top of a 40 hour week of treating patients) was working on professional content for both my website and in my UW curriculum work.

The priorities change for me based on what I have on the go in my life and what time of the year it is. If I’m getting ready for a meet or losing bodyfat lifting is a bigger priority. If it’s a long weekend with family that becomes #1 priority. This enables me to manage multiple big priorities in life while keeping me from burning out.

If you’re someone who wears multiple hats I hope this helps you.

Are personal trainers bad at coaching exercises or just uneducated?

Quick rant for you trainers & strength coaches out there.

I'm tired of seeing posts like "if your client can't do X exercise or doesn't get X exercise than you are bad trainer/coach/person" all over the interwebz.

Maybe the problem is that the trainer wasn't properly educated in the first place.

Back in 2012 when I first started in cardiac rehab, aside from learning from Stu McGill, I was never trained on how to properly coach or teach exercises. And in physio school we didn't cover much exercise other than TVA/glutes/rotator cuff/scapular muscles. Even some of the big trainer certifications fall short in that regard.

When I help out at the UW KINNection event I see the way I was back in 2012 - underconfident, way too wordy with coaching, stumbling & fumbling, and unsure of what to do if an exercise was too hard for a client or if the client didn't get it.

Over the last 5-6 years my ability to coach/regress/progress/modify exercises has improved a lot thanks to learning from, networking, and working with top level trainers, strength coaches, and exercise-based therapists.

So keep in mind not every health or fitness has discovered these resources or has access to them when making comments online. Instead of berating someone's ability - take the time to show them some of what you're learned and pay it forward. It's likely that you didn't know this stuff before trainers, strength coaches or therapists showed you these tricks and tidbits either in person or through video.

Rant over.

1 comment:

  1. Hip flexors, in the human anatomy, refer to a cluster of skeletal muscles that help to pull the knee forward, by flexing the femur or the thighbone onto the lumbo-pelvic complex. Together called iliopsoas, or the muscles of the inner hip, they consist of Psoas major, Psoas minor and Iliacus muscle. The hip flexor group of muscles, located in the abdomen and the thigh, are active when you stand up from a sitting position, or when you dance, climb stairs, run, play soccer or even when you do resistance training. Allowing the up and down movements of your legs and at the same time working to balance your spine’s stability, they represent the strongest muscles in your body.


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