tag:blogger.com,1999:blog-89456122534828734332024-03-27T00:28:32.753-07:00Evidence Based Rehab and TrainingEric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.comBlogger60125tag:blogger.com,1999:blog-8945612253482873433.post-44094635090464812382020-05-11T03:23:00.002-07:002020-05-11T03:23:32.443-07:00How I've Adapted The McKenzie Method Over The Years <br />
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If someone were to ask me
“what are the biggest influences on your therapy philosophy” they would be (in
no particular order)<o:p></o:p></div>
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</span></span></span><!--[endif]-->Stuart McGill<o:p></o:p></div>
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</span></span></span><!--[endif]-->The biopsychosocial approach popularized by
Lorimer Moseley, David Butler & Peter O’Sullivan<o:p></o:p></div>
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</span></span></span><!--[endif]-->SFMA <o:p></o:p></div>
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</span></span></span><!--[endif]-->Tim Gabbett<o:p></o:p></div>
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</span></span></span><!--[endif]-->Good ol’ strength & conditioning (S&C)<o:p></o:p></div>
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</span></span></span><!--[endif]-->And Robin McKenzie and the McKenzie Method (MDT)
<o:p></o:p></div>
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During one of my clinical
placements I worked with several strict McKenzie therapists – including Richard
Rosedale who teaches many of the courses. Through the placement, and through
all of my jobs, I’ve been quite happy with the results I’ve gotten from MDT –
however I’d be lying if I said I didn’t need to adjust things along the way. 2
years ago I wrote an <a href="http://ericbowman03.blogspot.com/2018/02/an-evidence-experience-based-critique.html">article</a>
critiquing MDT which would become my 2<sup>nd</sup> most viewed article. The
focus of this article is to showcase how I’ve adapted the method, and my
principles, to better suit the needs of my clientele.<o:p></o:p></div>
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Disclaimer: I am writing this assuming that you have a
base knowledge of MDT. If you’re not reasonably familiar with the method I
recommend you take the time to do a course and/or read the books in order to
have a basic understanding of MDT. It’s more than just “chin tucks” or “sloppy
pushups” and should be understood for what it is, not the bastardized version.<o:p></o:p></div>
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With that out of the way – here are the modifications
I’ve used <o:p></o:p></div>
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1) Test non-painful directions first<o:p></o:p></div>
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The MDT therapists that I worked with in school taught me
to test the most painful and/or most restricted movement directions first to
see if a directional preference could be found that would improve symptomatic
or functional baselines. <o:p></o:p></div>
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However – I found that about 50% of patients would
benefit whereas the other 50% would be flared up … even more so for chronic
cases.<o:p></o:p></div>
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I got more bang for the buck testing non-painful
directions (where applicable) first. Then, if that didn’t produce any effect
and didn’t flare up symptoms, I would then proceed to look at other directions
of movement or positioning. I found by getting as much out of non-painful
movement as possible that patients adhered to exercises better and got better
results. <o:p></o:p></div>
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2) (For more irritable clients) Only test 1-3 “symptom
modifiers” per session<o:p></o:p></div>
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<o:p> </o:p>This is a tip that I learned on my own and was echoed by
Greg Lehman when I took his course in December 2019. Two of the downsides of
symptom modification methods (i.e. McGill, MDT, SSMP) is that you can easily
flare irritable patients up with a lot of failed symptom modification tests
plus a lack of success with them can make the patient less confident in
themselves and the therapist – not what you’re looking for from a client
retention perspective.</div>
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<o:p></o:p></div>
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As such – I recommend testing no more than 2 or 3 symptom
modifiers, whether that’s different positions and/or repeated movements in a
direction, in a session. If it ain’t working it ain’t working. Don’t beat them
up physically or psychologically. <o:p></o:p></div>
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3) (For more irritable clients with spinal pain) Test positions
first – then work your way up<o:p></o:p></div>
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Even though MDT is predominantly associated with neck
& low back pain (even though it can be applied to all joints) I never got
what I wanted out of it with respect to spinal pain – particularly with neck
pain.<o:p></o:p></div>
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Many people I see with spinal pain in my current job are
more chronic & globally sensitized cases that have constant pain that’s
aggravated by every position & movement. Many of the chronic, insidious
onset neck pain cases tend to follow suit. <o:p></o:p></div>
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For these more irritable cases I usually just test static
positions first (i.e. lying/sitting in a more flexed or extended position) to
see if that provides some symptomatic relief or functional improvement – and
then go from there. I’ve found many do find a position that finds relief but
don’t necessarily tolerate repeated spinal movements in any direction.<o:p></o:p></div>
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4) Use it within a comprehensive approach <o:p></o:p></div>
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My second big knock against MDT, other than the ability
to potentially flare patients up, is that it could be more comprehensive. What
does this mean? Breaking it down by area I like to also look at<o:p></o:p></div>
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</span></span></span><!--[endif]-->Psychosocial factors & beliefs: which MDT
does and was way ahead of its time on<o:p></o:p></div>
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</span></span></span><!--[endif]-->Endurance, strength & control of the
affected area & other joints <o:p></o:p></div>
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</span></span></span><!--[endif]-->Workload management: this is where Tim Gabbett’s
stuff comes in<o:p></o:p></div>
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</span></span></span><!--[endif]-->General lifestyle factors like sleep &
bodyweight management <o:p></o:p></div>
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Repeated knee flexions may temporarily improve a person’s
pain or their ability to do stairs – but if they’re running way more than they
have in the past & flaring up their symptoms with it than you may not get
far. Your client with discogenic back pain and a directional preference to
lumbar extension may not make much progress if their hips & ankles are so
stiff that they have to flex their spine excessively anytime they bend over. <o:p></o:p></div>
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If you have a directional preference that’s great – but
if any of these other factors are heavily contributing to an individual’s
sensitivity then they need to be addressed to allow for optimal recovery. <o:p></o:p></div>
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5) Know when to bail<o:p></o:p></div>
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Sometimes clients don’t have a directional preference to
repeated movements or positions and/or it just flares them up everywhere.
Sometimes those aren’t right for everyone and then patients have to be shifted
to, and treated appropriately, within the “other” categories (refer to the
books and courses for more detail on those).<o:p></o:p></div>
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MDT can be a useful part of a comprehensive therapy
program – but it does need to be adapted to the individual. I hope this article
provides some insight into how I adapt the method. As always – thanks for
reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-47587315093662828322020-01-29T03:21:00.002-08:002020-01-29T03:21:24.520-08:00My Experience With A Learning Disability, Anxiety And Depression Part 2: Understanding Mental Health For The Rehab & Fitness Professional<br />
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Two years ago, in honour of Bell Let’s Talk Day, I <a href="http://ericbowman03.blogspot.com/2018/01/my-journey-with-learning-disability.html">wrote</a>
about the battles I’ve had with a learning disability, anxiety and depression.
It was one of my most viewed articles and got shared by many big names and
organizations in the rehab & fitness industry. A lot of people messaged me
and opened up about their own battles.</div>
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<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>After
all that, I misguidedly thought I was <a href="https://www.youtube.com/watch?v=qYzY25b_uek">in the clear</a>. But two
phases in my life, over the past year and a half, had flared up some old issues
(although nowhere near to the same extent as they were a few years ago). The
first was being too busy and having too much on my plate – which went away when
I decided to cut back on a bunch of projects & prioritize my physical
health and time with others. It got to a point where I realized that more success
didn’t mean more happiness. The second, which I’ll describe in more detail here,
in honour of Bell Let’s Talk Day, is learning how to manage the stresses of
working with a primarily “persistent-pain” population. <o:p></o:p></div>
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In my current job at least 90% of the people I deal with
are people with persistent pain and/or post-concussive symptoms secondary to
workplace injuries. The vast majority of these people have been to therapy
elsewhere and made no (or very little) symptomatic or functional progress. It’s
well established in the literature that work-related injuries, all things being
equal, have <a href="https://www.ncbi.nlm.nih.gov/books/NBK470372/">worse</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015720/">outcomes</a> than
non-work related injuries. The reasons and hypotheses why are another story for
another time – but needless to say I don’t work with the traditional “private
practice” population. <o:p></o:p></div>
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The staff I work with, and the management I work under,
are wonderful. That said – working with a complex population can wear on you
from time to time. Admittedly I hesitated about posting this piece, but after
hearing other stories of practitioners struggling with their own confidence
& mental health – it needed to be shared. <o:p></o:p></div>
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At the end of the day – we are able to help the vast
majority of my clients function and feel better than they did when therapy
started … and I’ve had many people tell me that I’ve been able to do more for
them and help them get much further along than previous providers did.<o:p></o:p></div>
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Side note: I don’t want to sound arrogant or get on a
high horse – but the rehab education system needs to really educate providers
more on proper care for people with persistent pain. This is something that, in
my experience, gets neglected in a lot of schools which leads to problems.
While I see a lot of people who have been mis-managed by previous community
providers, heck I wouldn’t have known what to do with this demographic had I
not done a ton of independent reading/coursework + gotten a lot of advice from
coworkers.<o:p></o:p></div>
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Back on track – while I think I did “ok” there were times
where I felt like I couldn’t get any patients better or accomplish anything if
my life depended on it. And to be honest – I came damn near quitting on more
than one occasion. The sad thing is I know I’m not the only who felt this way. <o:p></o:p></div>
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Towards that end I realized I needed to get some more
help. Here are some of the strategies I’ve used to help with managing people
with persistent pain…..<o:p></o:p></div>
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1) Understand that you’re not probably gonna be Superman.
<o:p></o:p></div>
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If you’ve read any of my old articles (and if you have,
thank you) you’re probably someone who values your work very highly and wants
to go beyond the traditional “physio” status. You take a lot of provide in your
work and you want to be great. That’s the mindset I had and still have. We want
spectacular outcomes that are well above that and our colleagues … and our self
pressure, combined with that of social media, makes us feel bad (and sometimes
demoralized) when we don’t get there. <o:p></o:p></div>
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In the process of dealing with my own stuff I had to think
“why did I think this way.” Part of it was the pressure of being surrounded by
amazing people both in my job and in my network, and the bigger part was the
desire to “pay it back” and make my successes worth the time others put into
me. I know other professionals who feel a great deal of pressure to perform. <o:p></o:p></div>
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The problem with a strictly “outcome based” measure of
success is that there are so many factors that go into a patient’s recovery, or
lack thereof. Below is a table which barely just scratches the surface…<o:p></o:p></div>
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<b>Injury-related factors<o:p></o:p></b></div>
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<b>Patient factors<o:p></o:p></b></div>
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</span></span></span><!--[endif]-->Context of injury (i.e. traumatic vs
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</span></span></span><!--[endif]-->Management of injuries in acute, sub-acute and
chronic phases <o:p></o:p></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 233.75pt;" valign="top" width="312">
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</span></span></span><!--[endif]-->Prior fitness levels<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Medical comorbidities (i.e. diabetes, smoking)<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Previous injuries<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Personality & motivation levels<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Beliefs<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Preferences<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Lifestyle (i.e. diet, sleep, relationships) <o:p></o:p></div>
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<b>Workplace factors<o:p></o:p></b></div>
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<b>Psychosocial factors <o:p></o:p></b></div>
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<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
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</span></span></span><!--[endif]-->Whether or not <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Work
is enjoyable<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l3 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Work
is considered safe <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Demands of work<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Positivity or negativity of interactions with
coworkers (both prior to and subsequent to the injury) <o:p></o:p></div>
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<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 233.75pt;" valign="top" width="312">
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</span></span></span><!--[endif]-->Prior psychiatric history<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Psychosocial factors arising from injury (i.e.
PTSD)<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Pain behaviours and beliefs, <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Poor or excessive social support<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Cultural beliefs about pain and activity and
work<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Family lifestyle <o:p></o:p></div>
</td>
</tr>
</tbody></table>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
With all those factors going on – it makes you realize
how complicated it is. When I look at many of the patients that I’ve struggled
with – the main reasons are (starting with the most common) psychosocial,
workplace related, medical comorbidities, and poor pacing strategies. And these
all interrelate and don’t exist in a vacuum. For instance poor pacing may be
related to psychosocial barriers. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
These can also be tough things to change. To steal one of
the quotes from Difficult Conversations “it’s not my responsibility to make
things better; it’s my responsibility to do my best.” One of the best things I
ever did in my career was let go of the desire to be “superman.” <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
2) Learn to manage the difficult conversations <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s1600/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s320/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing">
The biggest thing I struggled with in this job, which was
probably in part due to having Asperger’s which already makes communication
difficult, is learning to have difficult conversations with clients pertaining
to</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Communicating realistic outcomes/prognoses<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Setting realistic goals<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->And trying to motivate/navigate cases who <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Don’t
want to do therapy or aren’t buying in <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Are
using therapy as a means of secondary gain <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Are
fearful of going into any kind of pain or causing more damage<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Don’t
want to go to work … or are afraid of going to work<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l2 level2 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Get
in “boom or bust” cycles where they overdo it, flare themselves up, rest, feel
better, overdo it and repeat…<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
It’s tough as communication isn’t something we’re taught
much in university – so you either have it or you don’t. I’ve found the
following books to be helpful<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Motivational Interviewing In Healthcare<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Difficult Conversations<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Crucial Conversations<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Also having good psychologists/psychotherapists and
occupational therapists is a must for this population. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
3) Take time to remember what does go well <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxRob5e-0gIOhL5OQNMxN0YOelCNjfbi4j4_o4sIdl7NcruDnq0dcyFOuUliTRfofW4NO-t8x8uogwNmPmKKYAlh91eTJRrucvQYa3p3i_WYwiGHrEwGddEP0tGxC-P_3MFFNyrXJ0UXyg/s1600/with+mike+stewart.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxRob5e-0gIOhL5OQNMxN0YOelCNjfbi4j4_o4sIdl7NcruDnq0dcyFOuUliTRfofW4NO-t8x8uogwNmPmKKYAlh91eTJRrucvQYa3p3i_WYwiGHrEwGddEP0tGxC-P_3MFFNyrXJ0UXyg/s320/with+mike+stewart.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing">
<o:p> </o:p>When I was at Know Pain I asked Mike Stewart “how do you deal
with this stuff.” He said that one of the strategies he uses is to look at 3
things that go well each day in the clinic. I’ve adopted that practice – and it
has certainly helped put things perspective … especially when you have those
moments where it seems like no one is getting better.</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
4) Understand that you will make mistakes and that
professionals are also complex <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
With high performance demands and sometimes challenging
clients it can be easy to beat yourself up over past mistakes/failures. Hell –
I still struggle with this. With all the new information that comes out each
year on exercise, patient communication, pain science, and the like I’ve found
myself second-guessing cases all the time and thinking “damn I wish I knew this
for the client I saw 2 years ago.” <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
At the end of the day – I remind myself that I did the
best I could with the knowledge, experience, and confidence level that I could
to manage the situation that I was in. And if I made a mistake (hell I don’t
know if anyone is 100% perfect working in complex healthcare situations) I look
back to see what caused it – and come up with a plan to handle the situation
differently. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
One of the things I learned from Difficult Conversations
is that we are complex human beings and that our wishes, desires are all
complex as we balance multiple things in our lives and our careers. It also
takes acceptance that you will make mistakes. By learning and accepting this,
it helped me greatly diminish that “all or nothing” thinking that can be bad
for both people with Asperger’s and Type A personalities. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
5) Learn to be present<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Sometimes it can get easy to caught up in a lot of drama,
worrying about the next patient or worrying about the next meeting. I’ve found
simple things like mindfulness strategies (deep breathing, focusing on your
feet and the environment around you) plus having a to-do-list to offload stuff
that needs to be done later – help a lot with keeping me focused on the
situation I’m in and not worrying about 20 things.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
6) Don’t be afraid to ask for help<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In the Fall of 2019 I reached out to my old
psychotherapist and got set up with him. It was one of the best decisions I’ve
ever made and has helped to give me useful strategies and keep me accountable
through this process. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
7) Remember to do the simple stuff like getting good
sleep, nutrition, exercise, and time with friends/family. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
This isn’t, and shouldn’t be, considered a “end-all be
all” or fix for managing the stresses of working with a persistent pain
population. It’s a tough clinical job … and is not for everyone. Heck – I’m by
no means a master at all of these and find myself needing to reset. But – I
hope you find these tricks helpful.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Have you found any strategies helpful? If so comment
below or message me at <a href="mailto:bigericbowman@gmail.com">bigericbowman@gmail.com</a>.
As always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-74377933211299112092019-11-18T03:17:00.001-08:002019-11-18T03:17:19.647-08:00Top 3 Things I Would Have Done Differently Over The Past 10 Years <br />
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<span style="mso-tab-count: 1;"><br /></span></div>
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<span style="mso-tab-count: 1;"> </span>This
September marked 10 years since the start of my entry into the rehab and
fitness fields as a student in the Kinesiology program at the University of
Waterloo. Over the past decade I’ve been blessed to graduate from 2
universities (and contribute to the curriculums of both universities &
teach at one of them), get my PT license & strength coach certification,
write for numerous websites & contribute to books, and meet a lot of great
people along the way. <o:p></o:p></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>One
would look at it and say “you’ve had a successful career.” While I’m proud of
my successes at a young age, especially despite some of the challenges I’ve
had, I’d be lying if I said there weren’t some things I would have done
differently. <o:p></o:p></div>
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
When I look back 10 years to
when I started my rehab/fitness journey and think of what went well & what
didn't ... there are 3 things that stand out to me as "things I would have
done differently."<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Side note: A common <a href="https://www.theguardian.com/lifeandstyle/2012/feb/01/top-five-regrets-of-the-dying">regret</a>
identified by many is not spending enough time with others. I do agree with
this partially – but I also believe that (to quote <a href="https://www.youtube.com/watch?v=cSsnZo2Ssek&t=905s">Stan Efferding</a>)
“you can be good at anything but you can’t be good at everything.” If you’re
trying to achieve a high level of success in an endeavour; be it athletics,
school, career, family, relationships; that endeavour(s) will take a greater
time & effort commitment than other parts of your life. While I wish I
could have spent more time with friends, particularly as a University of
Waterloo student, the mature part of me realizes that I may have not gotten to
where I am today.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
With that in mind here are the 3 things I wish I would
have done differently over the past 10 years - <br style="mso-special-character: line-break;" />
<!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" />
<!--[endif]--><o:p></o:p></div>
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1) (The big one) Done a better job of prioritizing my
mental health. <o:p></o:p></div>
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<br /></div>
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This is easily my biggest regret. I’ve wrote about this
in previous <a href="http://ericbowman03.blogspot.com/2018/01/my-journey-with-learning-disability.html">articles</a>
so I’m not going to beat this point up too much – and I want to write a piece
on how I try to manage stresses of working with a predominantly persistent pain
population.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
I 100% believe that having less anxiety & depression
would have likely made me more productive, healthier and likely even more
successful than I was both in school and in my licensing exams. Seeing
counsellors and psychotherapists was the best thing I’ve done in the last 5
years. It helped me feel & perform better … and I wouldn’t be where I am at
today without it. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
2) Spent more time learning about psychology &
communication<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
This is more geared towards physio school and my first
2-3 years as a practicing physiotherapist. <o:p></o:p></div>
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So much education is focused on the sexy stuff like
exercises, modalities and manual therapy techniques - particularly the latter
two. But not enough time is spent on how to communicate with people (both in
terms of teaching exercises/concepts and behaviour change), how to build
rapport/alliance with people, and how to handle difficult conversations
(particularly in healthcare). <o:p></o:p></div>
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<br /></div>
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I joke around that exercise prescription is the
straightforward & easy part for most cases (athletes, people with chronic
diseases are more complicated). Aspects like<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Motivating people for health behaviour change<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Coaching exercises<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Teaching people about pain and pacing<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Managing maladaptive beliefs and behaviours <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Handling difficult conversations (i.e. dealing
with difficult clients, goal setting/managing unrealistic expectations) <o:p></o:p></div>
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…are the hard parts and are often the limiting factors of
the clients that I struggle with in my current job where 90% of my clientele
have persistent pain and/or post concussive syndrome. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I wish I would have spent more time learning about those
things - and I impress that on the students that I educate.<o:p></o:p></div>
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<br /></div>
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Resources that I recommend are…<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span>For coaching exercises: anything by Nick
Winkelman – a lot of his stuff can be found at ResearchGate or even just
through Google <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->For behaviour change <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->The
book Motivational Interviewing in Healthcare<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->BJSM
has a good <a href="https://learning.bmj.com/learning/module-intro/motivational-interviewing.html?moduleId=10051582">free
course</a> on motivational interviewing<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->For pain science education<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Know
Pain by Mike Stewart (a phenomenal course for communication in general)<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Explain
Pain <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->For handling difficult conversations <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Difficult
Conversations: How To Discuss What Matters Most<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Crucial
Conversations: Tips For Talking When Stakes Are High <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Courier New"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Covalent
Careers and Ignite Physio also have great resources on their sites</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUlZlRhxxZf7TqJYnD-fx8oVZffG5upZ6YLDJCfEbJkGV9j5OX-JIUWNxg3twBHsfq42mklevlkGLRmMr3jp74uIpZ3NfcAxYPQrfAa4kucE1KOTb-TRlA2KUH1Gn2n5lPG08a2hFIiIXR/s1600/with+mike+stewart.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUlZlRhxxZf7TqJYnD-fx8oVZffG5upZ6YLDJCfEbJkGV9j5OX-JIUWNxg3twBHsfq42mklevlkGLRmMr3jp74uIpZ3NfcAxYPQrfAa4kucE1KOTb-TRlA2KUH1Gn2n5lPG08a2hFIiIXR/s320/with+mike+stewart.jpg" width="320" /></a></div>
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<i><br /></i></div>
<div class="MsoNoSpacing" style="text-align: center;">
<i>With Mike Stewart at his Know Pain course earlier this year</i></div>
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<br /></div>
<div class="MsoNoSpacing">
3) Hired a damn coach<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
In high school I tried training myself. My workouts
consisted of half ROM bench presses, cheat curls, situps, leg extensions &
endless running. While they helped me lose a lot of weight and improve my
running & calisthenics performance – they weren’t what I needed to maximize
my athleticism either for rugby (which I was training for at the time) or
powerlifting. Plus whenever my deadlift got up to 225 I hurt my back and had to
restart again. Until taking Stu McGill’s class in 2012 I never really learned
how to strength train properly. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Using a 3x5 “Starting Strength” like style of training I
made good progress for 8 months and then got hurt with patellofemoral pain and
took too long to bust out of the “novice/early intermediate” training phase.
Bear in mind this was when we didn’t know much about good PFPS rehab and the
pain science information was just in the “infancy” stage of mainstream
physiotherapy knowledge. It was also when the strength & conditioning scene
really shifted from being influenced by Westside Barbell/multi-ply powerlifting
to having programs geared towards raw lifting and general preparation for
athletics. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I would have saved a lot of headaches and made a lot more
progress earlier on had I have hired a good strength & conditioning coach,
even to just sporadically audit my programming, - rather than waste time
figuring it out myself. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
That said, making years of mistakes did give me a lot of
perspective and education which I've been able to apply to others. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Programming resources I recommend for therapists/trainers
are<o:p></o:p></div>
<div class="MsoNoSpacing">
- The Ultimate Back: Enhancing Performance DVD and
Ultimate Back Fitness & Performance by Stu McGill<o:p></o:p></div>
<div class="MsoNoSpacing">
- The 5/3/1 book series by Jim Wendler<o:p></o:p></div>
<div class="MsoNoSpacing">
- Mash Files by Mash Elite Performance<o:p></o:p></div>
<div class="MsoNoSpacing">
- Advances in Functional Training 2.0 by Mike Boyle <o:p></o:p></div>
<div class="MsoNoSpacing">
- 10/20/Life by Brian Carroll – hell even the warm up
section is worth the price of the book<o:p></o:p></div>
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- Starting Strength by Mark Rippetoe<o:p></o:p></div>
<div class="MsoNoSpacing">
- The Juggernaut Method by Chad Wesley Smith<o:p></o:p></div>
<div class="MsoNoSpacing">
- The Vertical Diet and Peak Performance 3.0 by Stan
Efferding <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
No one is perfect – and I’ve learned a lot from my
mistakes that I’ve been able to apply to other professionals and students that
I’ve educated. I hope this helps because that’s my article and as always – thanks
for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-7726450120475735332019-07-08T03:11:00.005-07:002019-07-08T03:12:19.022-07:00Barbells And Bone Health II: Osteoporosis <div class="MsoNoSpacing" style="text-indent: 36.0pt;">
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVsN41iIl-9rd8NycyAau17yBWwbv9Tcjb10hU5cuSWpxMQCu9BLcojUYwPj-z-ernmum9Qx1gKZX1GA5OfqwVadXX_yyD87cZ5CxVVSG0o6dmg_liUjrNadksEsrfk6SIbtVEpIoc1ilp/s1600/star_wars_meme_yoda.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="390" data-original-width="640" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVsN41iIl-9rd8NycyAau17yBWwbv9Tcjb10hU5cuSWpxMQCu9BLcojUYwPj-z-ernmum9Qx1gKZX1GA5OfqwVadXX_yyD87cZ5CxVVSG0o6dmg_liUjrNadksEsrfk6SIbtVEpIoc1ilp/s320/star_wars_meme_yoda.jpg" width="320" /></a></div>
<div style="text-align: center;">
Meme courtesy of Owned.com</div>
<br />
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
Before we begin – no this
isn’t Star Wars where the installments are recorded out of order. The original
Barbells and Bone Health article focusing on weight training for younger adults
is here <a href="https://rebel-performance.com/barbells-bone-health-review-literature-says-building-strong-bones/">https://rebel-performance.com/barbells-bone-health-review-literature-says-building-strong-bones/</a>
<o:p></o:p></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span><a href="http://www.osteoporosis.ca/">Osteoporosis</a> is a condition that affects
1 in 4 women and 1 out of every 6-7 men. Osteoporosis is characterized by
decreased bone mineral density causing an increased likelihood of fracture. 20%
of men and 37% of women will die after fracturing their hip and many who suffer
a fracture are likely to refracture. For people who have osteoporosis a
fracture can cause a downward spiral of avoiding activity, becoming
deconditioned, and then becoming more susceptible to a future fracture.<o:p></o:p></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>Fortunately,
a well designed exercise program can help to offset the losses in bone density
that occur with age and may even allow people to slightly increase their bone
density. The purpose of this article is to show you which exercises can help people
with osteoporosis based on the research.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Disclaimer: As I’ve said before on the website the
information here is tailored for health & fitness professionals and is not
intended so much for the layperson. If you are someone with osteoporosis or
significant risk factors I encourage you to work with health professionals
(e.g. doctors, physical therapists, kinesiologists) whom have formal education
in prescribing exercise for people with osteoporosis. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Disclaimer 2: A lot of lay people I talk to get
osteoporosis and osteoarthritis confused as they sound similar but are two
different conditions. Please read here to understand the differences between
the two conditions <span style="mso-spacerun: yes;"> </span><a href="http://www.osteoporosis.ca/osteoporosis-and-you/osteoporosis-and-osteoarthritis/">http://www.osteoporosis.ca/osteoporosis-and-you/osteoporosis-and-osteoarthritis/</a>
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
WHAT IS THE BEST EXERCISE TO HELP MY BONES? <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The best exercises to help with bone density are weight
training exercises and impact exercise. When a bone is loaded with more force
than it’s used to, assuming it’s not so high as to cause a fracture, this <a href="https://journals.sagepub.com/doi/abs/10.1177/0022034510363963?journalCode=jdrb">starts</a>
a signalling process in the bone that causes bone building cells (osteoblasts)
to lay down bone that adapts and remodels over time to get stronger. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
The general <a href="https://www.bgs.org.uk/sites/default/files/content/attachment/2019-02-20/FINAL%20Consensus%20Statement_Strong%20Steady%20and%20Straight_DEC18.pdf">guidelines</a>
for weight training for people with osteoporosis are as follows<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Frequency: at least 2 times/week<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Intensity/Time: 1-3 sets of 8-12 repetitions of
each exercise<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Type: 1 exercise per body part <o:p></o:p></div>
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Obviously I can’t give specifics without considering the
individual, their health conditions, their general work capacity, and their
goals but I hope this gives you something to start with. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheixDti4AoY80-CgD6JZkfWCovHP_wYWLrOqpjnYtIje4YUo5ZKDrut5JTp3y-qyiiED8Gpql6cmzvO3-AssMVtUU7WjGOs5K-gX9DQk4dcsilcVVGJFTEFhDZAqTH8hhxDQCejTKHGhwA/s1600/111-power-man-squatting-with-heavy-weights.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheixDti4AoY80-CgD6JZkfWCovHP_wYWLrOqpjnYtIje4YUo5ZKDrut5JTp3y-qyiiED8Gpql6cmzvO3-AssMVtUU7WjGOs5K-gX9DQk4dcsilcVVGJFTEFhDZAqTH8hhxDQCejTKHGhwA/s320/111-power-man-squatting-with-heavy-weights.jpg" width="320" /></a></div>
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<o:p> </o:p>Daily balance exercise of up to 15-20 minutes per day is
also recommended but obviously can be rather unfeasible due to time
constraints. Balance needs to be challenged in order for it to be effective and
balance exercises must be maintained as balance can decrease quickly.</div>
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<o:p></o:p></div>
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Side note: I’ve found that balance exercises are
sometimes the most challenging type of exercise to get people to do as some are
very fearful of falling & will sometimes get more anxious during the
exercise which decreases their balance & self-efficacy … and so on. With
clients I find combining balance with strengthening or balance in daily
activities works better than structured balance exercise. I also find, with
these people, that you need to progress the exercises very slowly and also
start wayyyyyyyy below their threshold – even if it looks like the exercises
are fairly easy for them just to gain their trust. <o:p></o:p></div>
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The recommendations for impact exercise are…<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->For people with osteoporosis but without
fractures: at least 50 moderate impacts a session (i.e. jogging, low level
jumping, and hopping) are recommended and should be interspersed with walking
activities. This may need to be modified for people with spinal or lower extremity
pathology.<o:p></o:p></div>
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</span></span></span><!--[endif]-->For people with vertebral or low trauma
fractures brisk walking is recommended assuming that the individual is not at
risk of falls <o:p></o:p></div>
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Again – this needs to be adjusted based on the
individual. Some can tolerate this (or more) and some caan’t. <o:p></o:p></div>
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WHAT ABOUT POSTURAL EXERCISES? <o:p></o:p></div>
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The bulk of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/11710670">research</a> on postural
corrective exercises (e.g. strengthening weak muscles and stretching tight
muscles) doesn’t seem to be very effective in changing people’s posture,
contrary to popular belief, but a small <a href="https://www.sciencedirect.com/science/article/abs/pii/S002561961261372X">body</a>
of weaker evidence suggests that these exercises may be effective for very
slightly reducing kyphosis in postmenopausal women. <o:p></o:p></div>
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Postural exercises should focus on the scapular muscles
and the spinal erectors to improve endurance. <o:p></o:p></div>
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WHAT ABOUT YOGA AND SPINAL FLEXION EXERCISE? <o:p></o:p></div>
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For people at lower risk of fracture yoga doesn’t pose
too many issues but for people with moderate to high risk of fracture yoga
poses involving spinal flexion and/or twisting (particularly under high load,
repetitively, and/or to end range) should be avoided. Biomechanics research has
shown us that osteoporotic vertebrae are <a href="https://www.ncbi.nlm.nih.gov/pubmed/25460926">more likely</a> to fracture
under flexion and rotation loads. By the same token I would advise staying away
from traditional core exercises such as situps, twists and leg raises as they
involve similar motions. <o:p></o:p></div>
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Some lower risk people who have built up the tolerance,
flexibility, coordination, and muscle tone may be able to do these in low
volumes but many people would increase their likelihood of fracturing. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_wvfSFr5HlGct-Gh7O9WQOgMzvSMNE9K4ATR41ryZSTLlPvUsfSko4dYDy7QoYADYXXdnqgORn3_hzIVmBM7YBj736mCSJ6TavxBAwz_ZE81BlAczXQch6xztagwEh5BbS1qXqYNPk-Qn/s1600/219-toe-touch-yoga-stretch.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1349" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_wvfSFr5HlGct-Gh7O9WQOgMzvSMNE9K4ATR41ryZSTLlPvUsfSko4dYDy7QoYADYXXdnqgORn3_hzIVmBM7YBj736mCSJ6TavxBAwz_ZE81BlAczXQch6xztagwEh5BbS1qXqYNPk-Qn/s320/219-toe-touch-yoga-stretch.jpg" width="269" /></a></div>
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<o:p> </o:p>Some reading this article may say “oh well they can
adapt.” But the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112023/">research</a>
as a whole (aside from outlier studies) shows that osteoporotic bones may
slightly increase bone density, may maintain bone density, or may lose bone
density at a slower rate than before. The adaptive capability of these bones is
very limited.</div>
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<o:p></o:p></div>
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WHAT ABOUT WALKING? <o:p></o:p></div>
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Walking and other forms of cardiovascular exercise such
as cycling and swimming fail to produce significant increases in bone density in
most people as those exercises don’t provide enough of a loading stimulus to
stimulate bone growth. While these exercises have other physical and
psychosocial benefits just walking, cycling or swimming won’t do much for
improving bone density. <o:p></o:p></div>
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However, as stated above, brisk walking may
(theoretically) provide an impact stimulus for people who have suffered
osteoporotic fractures and may not tolerate other high impact activities. <o:p></o:p></div>
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WHAT ABOUT CALCIUM AND VITAMIN D?<o:p></o:p></div>
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Even though I’m not a doctor or a dietician I do get asked
a lot about the effects of Calcium and Vitamin D on osteoporosis. A recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820727/">review</a><span style="color: red;"> </span>has shown that calcium & vitamin D
supplementation doesn’t reduce fracture risk in community dwelling older adults
when compared to placebo. It may be helpful with increasing bone density but it
doesn’t make as big of a dent on fracture risk as many think<span style="color: red;">. </span><o:p></o:p></div>
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I can’t safely give specific recommendations for
supplementation as I don’t know your blood profile, bone density, allergies, health
conditions or what medications you’re taking. At the risk of overstepping my
boundaries if you (or your clients) are interested in supplementation I
strongly encourage you to talk to a registered dietician regarding it. <o:p></o:p></div>
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Osteoporosis is a condition that will continue to affect
the health care system as the baby boomers age but proper exercise can help
offset the natural decline in bone density with age and can also greatly
improve quality of life.<o:p></o:p></div>
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As always thanks for reading <o:p></o:p></div>
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<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com6tag:blogger.com,1999:blog-8945612253482873433.post-69651360794735810752019-05-27T03:04:00.003-07:002019-05-27T03:04:52.503-07:00Product Review - The Ultimate Landmine Program by Meghan Callaway<br />
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Ever since 2016 I’ve been a fan of fellow Canadian
Strength Coach <a href="http://www.meghancallawayfitness.com/">Meghan Callaway</a>
for her knowledge; attention to detail with exercise coaching; and authentic,
no-nonsense approach to strength training nutrition as well as her authentic
personality. If you follow her on social media you know she’s capable of some
amazing feats of strength & coordination in some crazy exercises – some of
which I’ve tried myself.<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>When
she asked me to review her upcoming product - The Ultimate Landmine Program I
couldn’t wait to read it and review it.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYmwL6K5aX5YrnX5Zxa1kdJzFV306hGr_4qDOwBdLPV2NlWlNc1Ybxhm03XzHk4yo2E0XAGQjL97gE_ot7YAMgy2HqjURSb347mwkOO_bVOCYVD1ULUWhjtHtcgWlBV8Icay91HE5P1Mc3/s1600/landmine+program+meg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="464" data-original-width="640" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYmwL6K5aX5YrnX5Zxa1kdJzFV306hGr_4qDOwBdLPV2NlWlNc1Ybxhm03XzHk4yo2E0XAGQjL97gE_ot7YAMgy2HqjURSb347mwkOO_bVOCYVD1ULUWhjtHtcgWlBV8Icay91HE5P1Mc3/s320/landmine+program+meg.jpg" width="320" /></a></div>
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<o:p> </o:p>Side note: As with my <a href="http://ericbowman03.blogspot.com/2017/10/product-review-ultimate-pullup-program.html">review</a>
of her pullup program I am not an affiliate of Meghan and do not get any money
for her products. I choose not to be an affiliate with anyone so that I can
review products in an objective, unbiased fashion.</div>
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<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>If
you’re reading this you might be wondering “what the heck is a landmine?” A
landmine is a cylindrical strength training apparatus on a platform that is
bolted to the floor. You can place one end of a barbell in the cylindrical
portion of the apparatus – allowing you to press, pull, squat and lift the bar
at various angles that are impossible to do with traditional “straight bar”
movements. If you don’t have a landmine apparatus you can stick one end of the
barbell in the corner of a gym or the corner of a squat rack as Meg describes. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>As
you might have guessed – the program is all made up of landmine exercises.
However – there is a supplement to the book which covers non-landmine exercises
which can be added into the program.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>The
program consists of two progressive phases – each made up of three workouts a
week that incorporate landmine variations of compound movements (i.e. squats,
deadlifts, presses, rows) along with advanced core stability exercises. In
Phase 2 the exercises are made more difficult by adding band resistance and/or adding
extra components & movements to the exercises.<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>As
with the pullup program – Meghan is the most anal (I say that as a complement)
person I’ve known (in-person or online) with regards to coaching proper exercise
technique & ensuring proper form. In each exercise she also emphasizes
total body tension and proper scapular control.<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>When
I reviewed the pullup program in 2017 my only hesitation was that I felt some
of the exercises may not be appropriate for certain injuries (i.e. elbow,
shoulder) or certain medical conditions (i.e. congenital laxity). By contrast I
feel a lot more comfortable recommending this program to a general population.
That said, an exercise that is appropriate for one may not be for another – and
Meg would be the first to agree with it. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>The
program also incorporates a lot of novel, less well known exercise variations.
I must confess, coming from a powerlifting background that is highly specific
and incorporates a narrow range of exercises, my training got stale – and I am
looking forward to incorporating some of these exercises in my powerlifting
training.<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>The
only critique I have is that there are common coaching cues that are repeated a
lot through the book – which is what Meghan intended in order to reinforce
proper form – but it does lengthen the book & the read. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>All
in all I enjoyed Meg’s Landmine program and wish her all the best with her
success. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-24130671659509301302019-04-15T03:09:00.002-07:002019-04-15T03:09:16.308-07:00When Do We Need Specific Exercises In Rehab? <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5H2OIsRd4dwDJDwBXtvpUfoKk0Luht4UJ3YYF8zG5y2bzu0giG5eT1F3ar2pbl0B9kujFv_DTiBPWZTiWOSOI1MJOXZQu06jObSJiEcb96aC2nI0JCRTznUd60ncTCKyzv-Gx28DaJz9R/s1600/Fitness-man-doing-plank-exercise-workout.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5H2OIsRd4dwDJDwBXtvpUfoKk0Luht4UJ3YYF8zG5y2bzu0giG5eT1F3ar2pbl0B9kujFv_DTiBPWZTiWOSOI1MJOXZQu06jObSJiEcb96aC2nI0JCRTznUd60ncTCKyzv-Gx28DaJz9R/s320/Fitness-man-doing-plank-exercise-workout.jpg" width="320" /></a></div>
<br />
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If you’ve followed the physical therapy literature over
the last 5-10 years you’ll notice that more and more, the literature is
challenging the longheld belief that you need to do X,Y and Z exercises to get
out of pain. The ideas of “you need to activate your TVA” or “you need to get
your scapula set first” are slowly (sometimes very slowly) becoming a thing of
the past. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>With
research like this it begs the question – do we need specific exercises in
rehab? That is the topic of today’s article.<o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">When are specific
exercises needed?<o:p></o:p></i></div>
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Specific exercises are for specific adaptations in
specific tissues and can also be influenced by your clients’ tolerances.
Breaking this down by section …. <o:p></o:p></div>
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1) Specific adaptations<o:p></o:p></div>
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If your goal is to build the muscle & tendon strength
necessary to withstand sprinting – doing 10 minutes of jump rope probably isn’t
going to help. If your goal is to develop neuromuscular control of your knee to
prevent a repeat ACL injury – doing bicep curls isn’t the best choice.<o:p></o:p></div>
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Some clients, particularly elderly and/or those with
persistent pain, can be so weak and deconditioned that simple tasks like
getting out of a chair can be very difficult. As much as I am all for people
doing activities that they want – when you don’t have the baseline strength or
mobility to do IADLS … that’s a big problem that needs to be addressed. <o:p></o:p></div>
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If your goal is to develop specific adaptations – be it
strength, hypertrophy, power, endurance, mobility, and/or neuromuscular control
– the exercise needs to be tailored towards that. Plain & simple. <o:p></o:p></div>
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Whether or not those adaptations are relevant to getting
out of pain is up for debate as research has shown that improvements in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326132/">strength</a>, <a href="https://www.researchgate.net/publication/307887469_Stabilization_exercise_compared_to_general_exercises_or_manual_therapy_for_the_management_of_low_back_pain_A_systematic_review_and_meta-analysis">muscle
timing</a>, <a href="https://www.researchgate.net/publication/293042296_A_Critical_and_Theoretical_Perspective_on_Scapular_Stabilization_What_Does_It_Really_Mean_and_Are_We_On_the_Right_Track">kinematics</a>
etc don’t always correlate with changes in clinical symptoms. I look at in
terms of what the client needs from an activity demands perspective versus
where they’re at. <o:p></o:p></div>
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2) Specific tissues<o:p></o:p></div>
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Over the course of the decade we’ve worked to move away
from structural diagnoses – which is a much needed move for the better. <o:p></o:p></div>
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That said – some injuries, such as tendinopathies and
muscle strains, do require more specific exercise to allow the area to heal,
adapt & recover. Arm curls don’t do much for a hamstring strain nor does
your biceps tendinopathy benefit much from calf stretches. Can general
exercises help? <a href="https://www.ncbi.nlm.nih.gov/pubmed/28850347">Most
definitely</a> – but to rehabilitate the specific tissue you need specific
loading.<o:p></o:p></div>
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It’s important to note that even within the category of
“specific” exercises you have a large range of options to work with that can
range from strengthening, mobility and neuromuscular exercise all the way to
practicing the desired activity with some modifications as needed (i.e.
“sprinting” with reduced speed). Again these are all based on the individual.<o:p></o:p></div>
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3) Based on your client’s specific tolerances <o:p></o:p></div>
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Sometimes, in more nociceptive presentations, people may
not tolerate specific movements or postures and may tolerate others very well.
In those cases, emphasizing exercises in well tolerated directions &
postures is a wise decision – at least during the early stages of rehab. This
is where approaches like the McGill method make a lot of sense as they take
away what hurts and emphasize painfree movement & exercise. <o:p></o:p></div>
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How long painful movements are avoided, if at all, is a
controversial topic that depends on numerous individual factors. <o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">When are specific
exercises not needed?<o:p></o:p></i></div>
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For more general pain relief where there are no major
structural tissue concerns, and where there are no major physical deficits that
need to be addressed, you can incorporate more general exercises and some more
valued, leisurely activities such as walking, gardening, skiing, handyman work,
whatever you like. <o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">Best of both worlds
<o:p></o:p></i></div>
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And to be honest – an ideal rehab program for most (not
all) people incorporates valued activities that people enjoy & want/need to
get back to as well as specific exercises to address specific physical
deficits. <o:p></o:p></div>
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So there you have it – a very simple explanation of where
specific and general exercises & activities fit within the scope of rehab.
As always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-47997269014331944802019-03-03T09:29:00.002-08:002019-03-03T09:53:16.393-08:00Pain Science Education: What It Is And What It Isn't <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s1600/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s320/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" width="320" /></a></div>
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Over the course of this weekend two main themes filled my
social media feed. The first were videos of the amazing feats of strength from
the various events at the Arnold Sports Festival (side note: props to two-time
Arnold Strongman Classic champ Hafthor Bjornsson as well as to powerlifting
world record breakers Blaine Sumner and Stefi Cohen for their successes). The
other was this <a href="https://www.sciencedirect.com/science/article/pii/S1526590018307478?fbclid=IwAR35XikWdC-b_Lgq80eQu1iDr9GSJjfsDl2I6Qc0IiA7cEoSdPtMs87N9lE">study</a>
that provided a systematic review & meta-analysis on pain science education
(PNE). The article showed that…<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 38.25pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->PNE did not significantly reduce pain or
disability<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 38.25pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->But PNE did reduce catastrophizing and
kinesiophobia<o:p></o:p></div>
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It created a lot of controversy and debate amongst
therapists from different backgrounds & ideologies as well as a need for
clarification as to what PNE is and isn’t – the topic of this article. <o:p></o:p></div>
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<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">What PNE isn’t<o:p></o:p></b></div>
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PNE is not <o:p></o:p></div>
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<br /></div>
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1) A cure or magic bullet<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
As we’ve discussed above pain science education doesn’t
create significant improvements in pain. This review showed a reduction in pain
of 3.2/100 – less than half a point on a 0-10 pain scale.<o:p></o:p></div>
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<br /></div>
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2) A standalone intervention<o:p></o:p></div>
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<br /></div>
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Some studies have shown better effectiveness of PNE mixed
with exercise versus <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/29138049/?fbclid=IwAR0NP0ys75pori3xC2dWAgn4cSaOMO7NFw2FamkV4gH1s4B9tfC0-gKgIBQ">one</a>
or the <a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-14-21">other</a>
alone. Granted this is still being studied and is still up for <a href="https://www.sciencedirect.com/science/article/abs/pii/S1356689X10000391">debate</a>.
<o:p></o:p></div>
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3) An intervention that will produce the same results in
everyone<o:p></o:p></div>
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Some <a href="https://www.mskscienceandpractice.com/article/S1356-689X(16)30269-7/fulltext">qualitative</a>
<a href="https://www.ncbi.nlm.nih.gov/pubmed/26511524">studies</a> have shown that
PNE can create great reductions in fear and improvements with activity in some
people but can be useless or even counterproductive with others. <o:p></o:p></div>
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Side note: studies like these, plus my own experiences,
are why I disagree with (well meaning but misguided) practioners who think that
everyone needs PNE. As with everything else the intervention needs to be
tailored to the individual.<o:p></o:p></div>
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4) The only part of biopsychosocial rehabilitation<o:p></o:p></div>
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As Jarod Hall and Sandy Hilton say “pain science should be the air you
breathe” – not something you just do to people. There are many components of
biopsychosocial rehab (and proper rehab in general) including<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo2; text-indent: -18.0pt;">
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</span></span></span><!--[endif]-->Simply being a good person who’s attentive,
caring and is a good listener<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Acknowledging that there are numerous
contributors to the pain experience, working to address these different areas and
referring out for help when needed<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Educating people on how to get back to a
lifestyle that is meaningful for them through pacing <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Also educating people on healthy lifestyle
habits <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Experiential learning & graded exposure to
activities: to me this is a great way for people to experience that hurt doesn’t
equal harm and that they can likely do more than what they’re capable of<o:p></o:p></div>
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</span></span></span><!--[endif]-->Getting people more physically active<o:p></o:p></div>
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</span></span></span><!--[endif]-->Using positive language & self-management
skills to empower the patient and build their self-efficacy<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">What PNE is<o:p></o:p></b></div>
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<br /></div>
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PNE is <o:p></o:p></div>
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<br /></div>
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1) A means to explaining the science of pain and the
contributing factors behind a person’s pain<o:p></o:p></div>
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<div class="MsoNoSpacing">
2) A means to (hopefully) decrease some of the anxiety,
fear and negative beliefs surrounding pain and a means to get people more
physically active & working towards the lives they want to live.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I hope this article sheds some light for you (and others)
on what PNE truly is & isn’t and where it fits in the grand scheme of
things. As always – thanks for reading. <o:p></o:p></div>
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<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-5776492664250719142019-02-12T13:06:00.001-08:002019-02-12T13:06:22.185-08:00Is Strength Training The Newest Fad In Sports Injury Prevention?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkNhYcALO9HGU_eMWTDlrhuXh-JS77hCWHPPEgg6rgfCXMAwjBH3eJJpvb_yFKRTz_nmyiBy7UP70bov0vNKQw3NfMkGB-wdFpztCV9fcOlz7GRBuZ9-L441IHC0kLPZ403IKd1JQuWZYa/s1600/111-power-man-squatting-with-heavy-weights.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkNhYcALO9HGU_eMWTDlrhuXh-JS77hCWHPPEgg6rgfCXMAwjBH3eJJpvb_yFKRTz_nmyiBy7UP70bov0vNKQw3NfMkGB-wdFpztCV9fcOlz7GRBuZ9-L441IHC0kLPZ403IKd1JQuWZYa/s320/111-power-man-squatting-with-heavy-weights.jpg" width="320" /></a></div>
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<div align="center" class="MsoNoSpacing" style="text-align: center;">
Image courtesy
Focus Fitness <o:p></o:p></div>
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Earlier this year I watched a <span class="MsoHyperlink"><a href="https://www.youtube.com/watch?v=-FoZbPIB22c">video</a></span>
on Canadian trainer Omar Isuf’s YouTube channel where he interviewed DPT and
20x world record breaking (as of the time I’m writing this) powerlifter Stefi
Cohen. As a physiotherapist who competes in powerlifting Stefi is definitely
someone whom I greatly idolize for her insane athletic accomplishments as well
as the success she’s had getting her DPT and starting a fantastic performance
gym & company with her fiancée Hayden. <o:p></o:p></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>In
the video Omar asked Stefi about her thoughts on strength training as a means
of preventing sports injuries and Stefi discussed that it may be or may not be
a fad. She also brought up the fact that we seem to shift from fad to fad with
common trends (over the last 2 decades) in sports injury reduction including
(but not limited to) bracing, transverse abdominnis exercises, movement
screening & functional movement, workload ratio and other topics. So it
raises the question – is strength training a fad in sports injury prevention? <o:p></o:p></div>
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<div class="MsoNoSpacing">
First the term “injury prevention” is a misnomer and
should be changed to sports injury reduction as we can never truly prevent
injuries. There are some injuries; particularly contact injuries; that you
can’t prevent no matter what – short of completely removing yourself or your
athletes from the sport. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Now that that’s out of the way let’s look at the evidence
….<o:p></o:p></div>
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A 2018 systematic review and meta-analysis in the British
Journal of Sports Medicine (free access link <span class="MsoHyperlink"><a href="https://bjsm.bmj.com/content/52/24/1557">here</a></span>) showed that a
10% increase in strength training volume reduced sports injury risk by 4%. It’s
a heterogenous paper with many different sports & many different protocols
… but it gives us something to work with. <o:p></o:p></div>
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But with this evidence comes a few caveats, one more
opinion based and one more evidence based <o:p></o:p></div>
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<div class="MsoNoSpacing">
#1: Past a certain level of strength; which is sport
& athlete specific; increasing strength comes with a point of diminishing
returns. The stronger you get the harder it is to get stronger; from an eating,
sleeping, rehab, and recovery perspective; plus there is (in my anecdotal
opinion) a higher risk of injury as you push the envelope of maximal strength. For
most athletes (excluding powerlifters, Olympic lifters & strongmen); past a
certain level of strength; more time could be spent improving other components
of athletic performance such as speed training, conditioning, and most
importantly skill work over trying to get your athletes stronger.<o:p></o:p></div>
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#2: Sports injuries are multifactorial and can be
influenced by <span class="MsoHyperlink"><a href="https://bjsm.bmj.com/content/50/5/273">training workload</a></span> (and
fluctuations in workload), <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/25028798">sleep</a></span>, <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27406221">psychosocial
factors</a></span>, <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/">nutrition</a></span>,
genetics, <span class="MsoHyperlink"><a href="https://bjsm.bmj.com/content/40/9/767">previous injury</a></span>, <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28199800">movement
skill</a></span>, anatomy & anthropometrics, and other factors. As such we
have to take a multi-faceted approach to sports injury reduction rather than
simply relying on a single cure-all. I plan to elaborate on these topics on
more detail in future articles for both my site and for <a href="https://www.mashelite.com/">Mash Elite Performance</a>. <o:p></o:p></div>
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I hope this brief article provides some food for thought
on a complex and popular topic. As always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-7930250903647589922019-02-12T12:59:00.001-08:002019-02-12T12:59:34.344-08:00What Role Do Physiotherapists Play In Managing Psychosocial Factors?<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s1600/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvRKkKYY4EazrkW9K6zXnbo7Xg1mY4KCNmyvEkfe8RcctwUZAtXI78VXfuBbMcaZ7AOj3Q_l5FQryWuy-qgG3Oqn1ItUAINWCYCHnlSdJE8-hOx7Y0gzJMIEA9eDw6bWotIvUYMCiYo41S/s320/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" width="320" /></a></div>
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Over the course of the decade
we’ve seen a shift in physiotherapy practice guidelines from a focus solely on
tissue and biomechanics to looking at biological, psychological and social
factors as part of the individuals’ pain and disease experiences. While many
are slow to adopt these new guidelines the shift is encouraging. <o:p></o:p></div>
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
The increasing focus on
psychosocial factors begs the question; especially for those of us who aren’t
trained psychologists, psychotherapists, or psychiatrists; “where does the line
get drawn and what’s our role in managing psychosocial factors in our patients?”<o:p></o:p></div>
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<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">Getting something
important out of the way first<o:p></o:p></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Regardless of whether you’re a medical or rehab
professional working with diseased and/or pained populations, or a strength
coach working with high performance athletes, psychology feeds into everything
you do whether it’s motivating a client for behaviour change or helping an
athlete achieve peak performance. What we do does not operate in vacuums and
almost always has both physiological and psychological effects.<o:p></o:p></div>
<div class="MsoNoSpacing">
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<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">Where our
boundaries lie in managing psychosocial factors<o:p></o:p></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
This is going to be controversial, but I partially disagree
with the opinion of some people that I’ve seen (no names mentioned) post in
threads on social media that state that we should be directly managing
psychosocial factors in our patients and that our scope of practice should be
expanded. <o:p></o:p></div>
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<div class="MsoNoSpacing">
The reason is … as physiotherapists we are responsible
for a ton of information and skills when it comes to assessing, diagnosing and
treating musculoskeletal, cardiopulmonary, neurological and systemic conditions.
I’m of the belief that you can be good at anything but you can’t be good at
everything (to quote Stan Efferding). I don’t know of anyone who’s great at
nutrition, strength sports, orthopedic physical therapy, pediatrics and the
like all at the same time. Doing 8-10 years of post-undergraduate schooling;
along with tons of post graduate courses & continuing education; to excel
at both physical therapy and psychology is both expensive, unhealthy and
impractical in my opinion. That’s where you network with other professionals
and refer out as needed.<o:p></o:p></div>
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<div class="MsoNoSpacing">
I think we would overstep our boundaries if we <o:p></o:p></div>
<div class="MsoNoSpacing">
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<div class="MsoNoSpacing">
1) Diagnose mental health conditions: Just as we can’t
diagnose cancer or infections or heart issues as physios (at least in Canada)
we shouldn’t try to diagnose PTSD, OCD or other mental health conditions. We
just need to recognize the symptoms and refer out.<o:p></o:p></div>
<div class="MsoNoSpacing">
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<div class="MsoNoSpacing">
2) Try to treat psychosocial factors that aren’t related
to pain, injury, movement, or activity: We aren’t trained to grief counsel a
mother who’s lost her kid and we aren’t trained to treat the PTSD of someone
who has been sexually assaulted. That ain’t our skillset and just as we get
POed when a trainer tries to be a therapist we shouldn’t try to be a
psychiatrist if it’s something outside of our ballpark.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Where can we help
with managing psychosocial factors?<o:p></o:p></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
We can help our patients with psychosocial factors by<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
1) Finding ways to help get them active: Exercise can
help for chronic pain and for mental health conditions<o:p></o:p></div>
<div class="MsoNoSpacing">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNx6u11Je0MyDlQWZRTRCZmbZLTFaYI26ZwFSqXSzfpYnc7NvPm55SwFiyWHIZk1Y1iBhbITs-gWz3l0zV114wvnazvpkb8uXll_JzrCGigd_I1ojRUQUhNR7IwCuHMUgT2lJBVM2a2VsH/s1600/19-woman-walking-in-the-park.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1500" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNx6u11Je0MyDlQWZRTRCZmbZLTFaYI26ZwFSqXSzfpYnc7NvPm55SwFiyWHIZk1Y1iBhbITs-gWz3l0zV114wvnazvpkb8uXll_JzrCGigd_I1ojRUQUhNR7IwCuHMUgT2lJBVM2a2VsH/s320/19-woman-walking-in-the-park.jpg" width="320" /></a></div>
<div class="MsoNoSpacing" style="text-align: center;">
Image courtesy Focus Fitness</div>
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<div class="MsoNoSpacing">
2) Educating our patients on the importance of sleep
hygiene: Given how poor sleep can be a contributor to (and result of) pain and
mental health issues we’d be remised if we didn’t discuss this (and ways to
improve it) with our clients.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
3) Quite simply being a good person to be with: I open
any (non WSIB specialty) assessment with “tell me your story.” This allows
patients to say what they need to say and helps them get whatever they need to
get off their chest – which can be therapeutic in and of itself. There’s a lot
to be said; especially in chronic cases where a client may have been mistreated
by employers, coworkers, family members and/or friends; for being the first
“good guy” they talk to and by being attentive & caring.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
4) Helping to decrease anxieties and unhelpful beliefs
regarding pain, injury, and activity: Educating patients on the many factors
involved in pain & hurt versus harm; as well as gradually increasing your
client’s tolerance to both feared & desired activities (barring any medical
or orthopedic contraindications); can be helpful in improving the function
& well being of your clients. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
5) And obviously referring out as needed<o:p></o:p></div>
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<br /></div>
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So, in a nutshell, that’s where the role of
physiotherapists is in managing the psychosocial factors of patients. Not
everyone’s gonna agree with me but that’s my opinion and as always – thanks for
reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-48605625971245652122019-01-07T03:35:00.001-08:002019-01-07T03:35:38.500-08:00Case Study: How I Rehabbed My Own Knees<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjReAgF1Yx1zCDLuRJ5y20L7IilqB85BJ2qcj9wbIOqRJVkm3G5_PUBEPQGfQlDtK2UTD7e8QLXgwxtG9YleZZQgH5uwqE-1ekiFg1nKK0Y5fqDBLEeNxxkJWo8iAYwiN8SIEztEW0doxg/s1600/121-woman-doing-leg-press-exercise.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="996" data-original-width="1500" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjReAgF1Yx1zCDLuRJ5y20L7IilqB85BJ2qcj9wbIOqRJVkm3G5_PUBEPQGfQlDtK2UTD7e8QLXgwxtG9YleZZQgH5uwqE-1ekiFg1nKK0Y5fqDBLEeNxxkJWo8iAYwiN8SIEztEW0doxg/s320/121-woman-doing-leg-press-exercise.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
In today’s article I take you
through a case study. Because of rules set by our regulatory body, The College
of Physiotherapists of Ontario, I cannot give specific confidential details of
any patients I have formally treated. However, I can and will share my own
story of how I rehabilitated my own knees. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>Before
we get started – from January 10<sup>th</sup> to the 13<sup>th</sup> I will be
taking part in Travis Mash’s “Feats Of Strength” online meet (<span class="MsoHyperlink"><a href="https://www.mashelite.com/onlinemeet/?fbclid=IwAR1geO_g4EcegAcfj9LvojvWAryZZywXY5LtVIZTwk7NdcdbcD0qTcmahm0">link
here to register</a></span>) to help raise money for his weightlifting team and
to get back into the mindset of competing after a year long hiatus. Check out
the link to compete or at least make a donation to Coach Travis Mash’s
non-profit weightlifting team. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I developed patellofemoral pain a few years back during
my days as a runner which carried over into the beginning of my powerlifting career.
Unfortunately, this was compounded by getting some bad advice from other
professionals (which I’ll elaborate on). In this piece I share my story of how
I, as a powerlifter and physical therapist, returned to painfree squatting and
running. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Disclaimer: I’m a N=1. Pain can be influenced by <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770065/">numerous factors</a></span>
so as such this is strictly anecdotal. Also this is not intended to be specific
medical advice for anyone else. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
My rehab plan came down to the following components which
form my philosophy.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
1) Minimize what worsens symptoms<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
2) Find well tolerated movement & move … a lot<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
3) Address maladaptive beliefs, psychosocial factors, and
general health factors<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
4) Eventually build up tolerance to the desired activity<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Going through these step by step<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
1) Minimize what worsens symptoms<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The McGill and McKenzie influenced therapist in me looks
at what movements, postures, and loads exacerbate symptoms … and what are
tolerated. For me running and deep squatting past a certain weight were what
caused problems. As such I removed the running (which partly came due to my
injury and partly due to me beginning powerlifting) and set all squatting
weights below a weight & depth threshold that caused pain <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In certain rehab situations, which I’ll write about in
another article, sometimes painful exercises are supported in the literature.
That said, I’m not a fan of pain during high skill strength, speed and power
activities (in most situations) due to the negative effects of pain on motor
control. Also, while some <span class="MsoHyperlink"><span style="mso-color-alt: windowtext;"><a href="https://l.facebook.com/l.php?u=https%3A%2F%2Fbmcmusculoskeletdisord.biomedcentral.com%2Farticles%2F10.1186%2Fs12891-017-1539-8%2F&h=ATPo9WDwdmkhJc-_c4I_v_g6HVsbx7eIXztRuHAy1Lm5r2amyk6yQ49U5SnP-xf6nNLtsQmZM_9-Ibp7iAjJL_fbqH1CjK4fIFeDf3pUfr41xuB5Rs0EE2ag0kkKVTiD8iJVG20Mof2GE_01iXTm7q8Jug9LyJdrS3uKZDXm1tytg5CbbRE5uPW1bChdosR9cpwduWC2VFz6LtEgm6NSBb1puW2OTuCTNRrg_SuMIcyp2RO9isWLI4ne0gak_XCEFI95fGcBjdVWLA_LQ1vZlpP3rfWzveviQ6OpOA"><span style="mso-color-alt: windowtext;">research</span></a> </span></span>supports
painful exercises in PFPS I’ve found it not to work to my liking for me or my
patients.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Which brings me to <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
2) Find well tolerated movement & move a lot<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
When I work with physically active clients I do my best
to find painfree exercises that they can do in their own exercise routines to
help with maintaining (and if possible improving) mobility & fitness and to
help with not making the rehab process seem boring.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
For me – I could tolerate hip dominant exercises such as
good mornings, swings, deadlift variations, GHRs and leg curls. Low impact conditioning
options such as the rower, sled pushes/pulls and the recumbent bike were the
main tools I used to help with cardiovascular fitness and GPP. I also regularly
performed the McGill Big 3 and weighted carries.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8uxhWyPDF1oV4eRmszAJl1h22A-Zo_o5hOgBNSrBzL0RzfLGvARWlJ1hEXs3J47QJizibwfryCCFLvfK5VyIB2ftTXqqp_nQq7bLxRo676XZHgjalC2pth-s09HjjiPIidYVJ-fJNlvLP/s1600/Eric+doing+curlup+2016.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="958" data-original-width="960" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8uxhWyPDF1oV4eRmszAJl1h22A-Zo_o5hOgBNSrBzL0RzfLGvARWlJ1hEXs3J47QJizibwfryCCFLvfK5VyIB2ftTXqqp_nQq7bLxRo676XZHgjalC2pth-s09HjjiPIidYVJ-fJNlvLP/s320/Eric+doing+curlup+2016.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing">
Quad/knee dominant training was more difficult as most
every exercise that involved a lot of deep knee flexion initially bothered my
knees. The way I beat this was through three steps.</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
First was through doing 20-rep sets of leg presses (with
a neutral spine), leg extensions, and walking lunges. I got this idea after
watching one of Stan Efferding’s <span class="MsoHyperlink"><a href="https://www.youtube.com/watch?v=ch-4-xet6iU">videos</a></span> &
reading his Vertical Diet package. The leg presses & lunges were initially
done with a more vertical shin angle and then were progressed to deeper levels
of knee flexion as my tolerance improved. My best explanations for how these
worked can be attributed to a combination of <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Simply lighter weight & load being used<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->The novelty of the stimulus: if you’re used to
doing sets of 1-5 in your training like a powerlifter doing sets of 20 rep leg
presses with a 90-120 second rest between sets definitely provides a new
stimulus. As a side note it can provide a good training stimulus if you’re just
looking for something different. <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Increased blood flow & post-exercise
analgesia from the higher reps & volume used <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->And the other components of any treatment that
can affect recovery such as patient expectations, natural recovery etc etc <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Second was through very high volume warmups. I got this
idea from Matt Wenning and other proponents of conjugate training but had
gotten away from it recently. In my high volume warmups for leg days I would do<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Recumbent bike for 5 minutes<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->The McGill Big 3<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->2 (and later 3) sets of 20 of leg curls and leg
presses using a weight that was just heavy enough to give me a “pump” at the
end of the sets</div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
While this style of warmup added a good 8-10 minutes to
my training session, and took a few weeks of adjustment from a recovery
perspective, the results were well worth it. I got my heart rate up & got a
good leg pump, snuck in some extra volume to help with hypertrophy & work
capacity, and my knees were a lot less stiff when I began to warm up for squats
with the empty bar. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Third was through building up squat tolerance (more on
that below).<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
3) Address maladaptive beliefs, psychosocial factors
& general health factors <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
At the time I initially developed patellofemoral pain we
didn’t have the same understanding of pain science that we do now. As such I
believed that all pain was due to tissue damage and I felt like “oh I have
cartilage damage I’m just going to wear my knees out.” As such I initially,
permanently avoided everything that hurted. While my knees became painfree with
99% of tasks the fitness wasn’t where I wanted it to be & I still couldn’t
tolerate deep squatting. Once I realized the adaptive capability of my body and
used a graded exposure approach to build my squat tolerance … while training
what I could do to build my fitness … things took off. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
In terms of psychosocial factors I had some stress and
depression as I battled to get to and through physiotherapy school & the
board exams. I have elaborated on these <span class="MsoHyperlink"><a href="https://ericbowman03.blogspot.ca/2018/01/my-journey-with-learning-disability.html">in
a separate article</a></span> but that’s as open as I want to be about this
topic for the time being.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In terms of general health – due to the above factors
(and getting sick) I ended up gaining a bunch of excess body weight. Reducing
body weight through initially a IIFYM diet and later through Stan’s Vertical
Diet helped a lot with sleep, knee health, and overall well being.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
4) Building up tolerance to the desired activity<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
While I was grateful for the positive effect of all these
painfree exercises – I realized that at some point I need to build myself back
into squatting if I wanted to do full powerlifting meets again. I was nervous
and realized that I protected myself a lot when descending in the squat as I
was anticipating the pain + guarding. My squat descent was initially so slow it
looked like I was in a multi-ply squat suit and had the tightest pair of briefs
& knee wraps imaginable on.<o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgozIdJq6Kxt8VFzqfOTZ6EaTrXnhqGkZizMFABz6nfXXLeT3DF63wJqlCo37gJEvpF2G00iywokDOpzHCGFt54DphvAchbiUCr563yl68X4nFtWVzWKt6YMlOh5_oZz-OmbzUIBISL-yhl/s1600/111-power-man-squatting-with-heavy-weights.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgozIdJq6Kxt8VFzqfOTZ6EaTrXnhqGkZizMFABz6nfXXLeT3DF63wJqlCo37gJEvpF2G00iywokDOpzHCGFt54DphvAchbiUCr563yl68X4nFtWVzWKt6YMlOh5_oZz-OmbzUIBISL-yhl/s320/111-power-man-squatting-with-heavy-weights.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing">
Towards that end I realized that I, psychologically,
needed to get out of my own head and get back to my usual “dive bomb” style of
squatting – which I did initially beginning with body weight squats. Once I hit
this stage – getting psychologically confident with squatting plus doing the 20
rep sets of quad dominant exercises got my knees painfree.</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Then I realized it was time to add load. I squatted twice
a week – once with knee sleeves & a belt and the other without equipment
after deadlifting. I stuck to <span class="MsoHyperlink"><a href="https://www.elitefts.com/education/training/sports-performance/prilepins-chart/">Prilepin’s
Chart</a></span> to get in volume while emphasizing proper technique. Over time
I got to the stage where I could work up to a 3RM squat without pain. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
As of now my strength is still not where I want it to be
but it is building up fast.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Again, I’m just a N=1 but I hope this helps provide some
insight into what I did to rehab my knees. If you have any questions DM me or message
me at <span class="MsoHyperlink"><a href="mailto:ericccbowman90@gmail.com">ericccbowman90@gmail.com</a></span>.
And as always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com3tag:blogger.com,1999:blog-8945612253482873433.post-82033353596095731602018-12-03T03:02:00.002-08:002018-12-03T05:52:18.922-08:00My 2018 In Review: Top Things I Learned + My Top 5 Most Viewed Articles Of 2018<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCJ2LFQQAg1WPK9XiihYc63CM_zct5E0lahS09vuJJPmpHLSy5qWtuTgowg7EPxOPkNB6uNoVR9Izn9HEx41TgSF6GBTmVkwUEcWKk-TQYLEAroc9ixPMOS6o6faTMaBF01JcPr1EZe48u/s1600/Eric+2018+in+review.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCJ2LFQQAg1WPK9XiihYc63CM_zct5E0lahS09vuJJPmpHLSy5qWtuTgowg7EPxOPkNB6uNoVR9Izn9HEx41TgSF6GBTmVkwUEcWKk-TQYLEAroc9ixPMOS6o6faTMaBF01JcPr1EZe48u/s320/Eric+2018+in+review.jpg" width="320" /></a></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="text-indent: 36pt;">2018, especially its Fall, was an
exciting time for me. I’m grateful for all the people who I’ve met and talked
to over the past year through working at Altum Health, SWIS, taking the Canadian
Powerlifting Union Coaching Certification, guest lecturing at UW and becoming a
writer for </span><span class="MsoHyperlink" style="text-indent: 36pt;"><a href="https://www.mashelite.com/">Mash
Elite Performance</a></span><span style="text-indent: 36pt;">. Thank you all.</span></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
Through all the excitements and
highlights of 2018 I’ve learned quite a few things, some of which the hard way,
that I’d like to share in the final article of 2018.<o:p></o:p></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal">
Side note: This does not include anything that I learned at
SWIS 2018 as that would basically involve regurgitating another article that I
have written <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/11/my-experience-at-swis-2018-and-top.html">here</a></span>.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
1) You may not always get all of your patients’ psychosocial
factors on Day 1<o:p></o:p><br />
<br /></div>
<div class="MsoNoSpacing">
In my career I’ve worked hard to gain a complete
understanding of my patients’ psychosocial factors through <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27351690">subjective
history</a></span>, questionnairres such as the <span class="MsoHyperlink"><a href="https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/212908/Orebro_musculoskeletal_pain_questionnaire_Final.pdf">Orebro
Questionnaire</a></span> and just good interviewing skills. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I’ve had a few experiences this past year with patients
where patients didn’t open up about various psychosocial issues, stressors or
traumatic events until a few weeks (or even a few months) into therapy. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When you think about it – it seems like common sense. You
wouldn’t tell a random dude on the street your most personal secrets on the
first day … so as such I (and you) need to not assume that we’ve detected all
of a patients’ psychosocial factors on Day 1. <o:p></o:p></div>
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<br /></div>
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This shows the importance of <o:p></o:p></div>
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</span></span></span><!--[endif]-->Taking your time<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Listening to the patient’s story<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
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</span></span></span><!--[endif]-->Validating their story<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->And just being an overall good person to build
that rapport with your patients <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
2) Core exercises & core stiffness may not be a bad
thing (at least for a short time period) in certain people with LBP<o:p></o:p></div>
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<br /></div>
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With some of the research that’s came out showing that
core exercises are equal to (or maybe slightly better than) general exercise
for LBP – many practitioners wonder why we even bother with them. <o:p></o:p></div>
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<br /></div>
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However in some LBP cases, to paraphrase a quote from Greg
Lehman, people may be aggravated by specific movements/postures/or loads in a
more “nociceptive” manner. These are the cases most people refer to when using
terms like “flexion intolerant,” “extension intolerant,” and others. While we
know back pain can’t be attributed to just mechanical factors – sometimes a
person’s movement or posture can make a big difference on their individual
symptom presentation.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
In these populations I do believe there is a place for
McGill-esque core exercises, if anything else, to teach them the control
required to move in a way that doesn’t aggravate the problem. This is where approaches like McGill and McKenzie make a ton of sense – you move and exercise
in a way that doesn’t exacerbate the symptoms long term. <o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8uxhWyPDF1oV4eRmszAJl1h22A-Zo_o5hOgBNSrBzL0RzfLGvARWlJ1hEXs3J47QJizibwfryCCFLvfK5VyIB2ftTXqqp_nQq7bLxRo676XZHgjalC2pth-s09HjjiPIidYVJ-fJNlvLP/s1600/Eric+doing+curlup+2016.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="958" data-original-width="960" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8uxhWyPDF1oV4eRmszAJl1h22A-Zo_o5hOgBNSrBzL0RzfLGvARWlJ1hEXs3J47QJizibwfryCCFLvfK5VyIB2ftTXqqp_nQq7bLxRo676XZHgjalC2pth-s09HjjiPIidYVJ-fJNlvLP/s320/Eric+doing+curlup+2016.jpg" width="320" /></a></div>
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<o:p> </o:p>That said</div>
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<o:p></o:p></div>
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</span></span></span><!--[endif]-->You don’t want to have people avoid movements
forever and/or walk like Tin Man from The Wizard Of Oz <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
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</span></span></span><!--[endif]-->For some people other factors (i.e. stress, poor
sleep, fear of movement) may be bigger drivers of your clients’ sensitivity. In
those situations I care less about “core stiffening” and more about managing
these other issues. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
3) You’re never gonna please everyone<o:p></o:p></div>
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<br /></div>
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Having worked at a couple different clinics, and having
talked to many different clinic owners, I’ve learned that … you’re never gonna
please everyone whether its patients or other physios.<o:p></o:p></div>
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<br /></div>
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Some want more manual therapy … some want less. Some want
more exercise … some want less. Some want more education … others want less
talking more doing. Some want more modalities … some want less. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
At the end of the day you can’t please everyone. That
said – it is important to ask patients (and clinic owners if you’re searching
for a job) what their expectations are. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Therapy shouldn’t be a dictatorship but there has to be
some give and take on both ends. <o:p></o:p><br />
<br /></div>
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While I’m not a huge modality guy – if doing 5 minutes of
ultrasound gets a patient to do everything I need them to do – I’ll take that
tradeoff. That said if a patient doesn’t want to follow any of my
recommendations outside of the clinic and just wants me to “fix” them – then we
have problems and have some work to do. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I’m also more OK now with just letting the occasional
patient go rather than feeling like I have to excessively bend over backwards
to please everyone when I know it’s not in their best interest.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
4) Don’t be intimidated by fibromyalgia & chronic
pain diagnoses <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
This came partly through my last job at Impact
Physiotherapy & Performance but was more solidified through my current job
at Altum Health in Cambridge, Ontario, Canada. Approximately 80% or more of my
caseload is people with persistent pain. <o:p></o:p></div>
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<br /></div>
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I, like most physios at some point, got intimidated by
these more complex and more irritable cases & was more cautious with them.
While you have to be careful to not flare them up – quite often many people,
even those with chronic pain, are capable of more than we realize and a process
of starting super slow and building up gradually can (in my experience) provide
great benefits for fitness, mobility & health.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
That said, as I said above, there are some patients that
will be flared up regardless of how gentle you proceed with things. Again these
people likely need more help in other areas (i.e. psychosocial factors, sleep
management) to help with decreasing pain. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
5) How great vacations are … when you actually take them<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
2018 was the first year out of physio school where I took
all of my vacation days. Some of these were spent with family & friends and
some were spent travelling across Ontario. As much as I enjoy working hard it’s
great to take some restorative time and to catch up with friends – something
that gets neglected in the pursuit of selfish goals.<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6oYzPykefRbDeDHRKcGZSTgNhXWIa-NMtJzfm-GEllRpZD9YS_gMmr1vUn8YwFoIxb5h4HG4ql-7mDm7y7Y815AbiMcKDIYduy5ZZGfD5xqgQTLWrG6F4trn3sGnbVaXzZ0oIS7QTXi1_/s1600/20180623_155850.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6oYzPykefRbDeDHRKcGZSTgNhXWIa-NMtJzfm-GEllRpZD9YS_gMmr1vUn8YwFoIxb5h4HG4ql-7mDm7y7Y815AbiMcKDIYduy5ZZGfD5xqgQTLWrG6F4trn3sGnbVaXzZ0oIS7QTXi1_/s320/20180623_155850.jpg" width="320" /></a></div>
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<br /></div>
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<o:p> </o:p>6) Sometimes you just gotta say “no” and set boundaries</div>
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<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Having a lot of great professional opportunities can be
both a blessing and a curse. It’s a blessing in the sense that people value
your work & your opinion – plus some of these come with financial benefit.
But it can also be a curse as it’s very easy to get overloaded &
overburdened. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Over the course of this year I’ve had to, for the sake of
my own mental sanity & energy levels, say no to some big opportunities with
some big names in the field. As someone who wants to help as many people as
possible – that hurt. But it was something I had to do to take care of myself
first. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Below is a list of my five most viewed articles of 2018
on this site…. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
5 – <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/01/barriers-to-exercise-in-people-with.html">Barriers
To Exercise In People With Chronic Health Conditions</a></span> <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
4 – <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/05/how-i-assess-treat-people-with-low-back.html">How
I Assess & Treat People With Low Back Pain: Parts 1</a></span> <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/05/how-i-assess-and-treat-people-with-low.html">and
2</a></span> <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
3 – <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/01/my-journey-with-learning-disability.html">My
Journey With A Learning Disability, Anxiety and Depression: Finding Strength
& Confidence</a></span> – I wrote this article in honour of
#bellletstalkday and had no idea how well it would be received. Thank you. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
2 – <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/03/the-mcgill-method-common-misconceptions.html">The
McGill Method: Common Misconceptions</a></span> – Co-authored with Dr. Stuart
McGill <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
1 – <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2018/02/an-evidence-experience-based-critique.html">An
Evidence & Experience Based Critique Of The McKenzie Method (MDT)</a></span>
<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I wish you all a Merry Christmas and a fun, safe and
happy holiday season with friends & family. Thanks for reading and I will
see you in 2019!!!</div>
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<o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-53303341654838152022018-11-07T14:30:00.003-08:002018-11-07T14:38:06.555-08:00Do I Need A Strength & Conditioning Certification As A Physiotherapist And If So Which One Should I Take?<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1Z6gHes1GzjHNxTq8ou5kYhEpkwA-g62P9l4EXaCZu7LI-KAfWbASm1qbW5rF9Pdi9s_Z3lxIdqJH3fOOKI25yXEbjd2f6jYasQidXvsnm4pzSBZi99V9ztdX3QF5P2ah2EtYp4kDi6-k/s1600/scotty+dani.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="721" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1Z6gHes1GzjHNxTq8ou5kYhEpkwA-g62P9l4EXaCZu7LI-KAfWbASm1qbW5rF9Pdi9s_Z3lxIdqJH3fOOKI25yXEbjd2f6jYasQidXvsnm4pzSBZi99V9ztdX3QF5P2ah2EtYp4kDi6-k/s320/scotty+dani.jpg" width="320" /></a></div>
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Over the last couple weeks I’ve gotten several messages
in my Messenger inbox and I’ve also seen several social media posts discussing
whether or not physiotherapists should get involved in strength training
clients and discussing which certifications to get. The past decade has seen a
huge increase in “hybrid” physiotherapists & strength coaches and while
it’s great to see people that can take clients from in pain to high performance
it begs the question – do all physiotherapists need S&C certifications and
if so what route to take?</div>
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<o:p></o:p></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>The
answer is, to quote my friend and mentor Stuart McGill, “it depends.” It
depends on…<o:p></o:p></div>
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<br /></div>
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1) The demographic you want to work with<o:p></o:p></div>
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<br /></div>
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This is the biggest decision-maker. If you work in
pediatrics – good luck getting them into strength training. If you work in ICU,
or acute care in general, spending a lot of money on a strength &
conditioning certification probably won’t offer the same return on investment
as courses & education more tailored to that setting. Same goes for pelvic
health physiotherapy. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When it comes to neuro rehab it’s a grayer area as it
depends on how well functioning your clients are. If many of your clients have
at least Grade 3/5 muscle strength than hell yes it’s worthwhile to know this
stuff. If many of your clients tend to be more flaccid and lack that strength
than learning more neuro-rehab specific techniques is likely a better use of
your time & effort. As Stan Efferding said “you can be good at anything but
you can’t be good at everything.” <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
If you work in orthopedics in a more general population
setting I don’t believe a S&C certification is essential although it can be
helpful if you have athletes and/or lifting junkies come through the door on
occasion. That said I do believe a basic knowledge of exercise prescription is essential for all physios in any setting.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
The biggest populations where having a personal training
or strength coaching certification can be helpful are <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
- When working with chronic disease populations such as
osteoarthritis, osteoporosis, cancer, diabetes, heart disease and/or lung
disease due to the number of safety precautions and rules that you have to be
aware of. <o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgfZpsA33cLYsJOioO4x-Fuin6_NOCQdt3X4PRcUDTLuQ1bIwjnjRZpWmSD0_yDqtyuYyDkoTNRWIF_mDhqmUQXaV5PTnDKdOsH7OQR10KfQbvCtppFs6Cvhh5ios6CPQUiBY7k8BxaJyt/s1600/kinnection+2018.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgfZpsA33cLYsJOioO4x-Fuin6_NOCQdt3X4PRcUDTLuQ1bIwjnjRZpWmSD0_yDqtyuYyDkoTNRWIF_mDhqmUQXaV5PTnDKdOsH7OQR10KfQbvCtppFs6Cvhh5ios6CPQUiBY7k8BxaJyt/s320/kinnection+2018.jpg" width="320" /></a></div>
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<i>At UW KINNection 2018 where many Kinesiology students get their first experience making exercise programs for people with chronic diseases.</i></div>
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<br /></div>
<div class="MsoNoSpacing">
- The big one … if you work in a clinic with athletes
and/or people who love weight training. This is self-explanatory as you need to,
to do your job effectively, have the knowledge to transition those clients from
pain & potentially very remedial levels of exercise to being able to do
high performance movements such as lifting, sprinting, jumping, and potentially
throwing based on their activities. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
This may seem like common sense but, as strength coach
Trevor Cottrell said, a lot of physios don’t know strength training and
athletics & spend more time strengthening their clients’ glute med than
they do physically preparing them to withstand the demands of athletic +
strength training endeavours. It’s as big of an injustice to underload and underprepare
someone and put them through “rehab purgatory” just prior to returning them to
sport as it is to overload them. <o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjun8hO56Efw9N4CyHxQOtOnP7yOMvcjCmRmLu2n3h_4igIvfDRVX-IheEdnmoezZo4XsnwY2Muob5cJRpqZolKakFiIRynHPEGZQS9LnkFRYxqYto_VYKZaRNAIH53kcmrES-5tk6FAgdA/s1600/o+lifting+course.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="502" data-original-width="960" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjun8hO56Efw9N4CyHxQOtOnP7yOMvcjCmRmLu2n3h_4igIvfDRVX-IheEdnmoezZo4XsnwY2Muob5cJRpqZolKakFiIRynHPEGZQS9LnkFRYxqYto_VYKZaRNAIH53kcmrES-5tk6FAgdA/s320/o+lifting+course.jpg" width="320" /></a></div>
<div class="MsoNoSpacing" style="text-align: center;">
<i>Under Trevor Cottrell's coaching earlier this year at the Intro To Olympic Lifting course at The Vault Barbell Club</i></div>
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<div class="MsoNoSpacing">
2) If you need it for a job <o:p></o:p></div>
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<br /></div>
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Some clinics, particularly sport rehab clinics or clinics
in a gym, will require you or recommend you have a strength coaching or
personal training certification. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
So now to the second part of the article … which
certification should I take?<span style="color: red;"> </span><o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Option #1: I work with elderly and/or diseased
populations<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
In that case the best certifications are the CSEP (in Canada)
or ACSM (in the US) Exercise Physiologist certifications. I do believe you
should spend a fair amount of time working with those populations, under the
direction of someone highly qualified, before working with that population on
your own as there is great potential to help people but also great potential
for harm if things are done incorrectly.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
The GLAD (GoodLife with osteoArthritis in Denmark)
courses done worldwide are fantastic for understanding lower body exercise
prescription, not just for osteoarthritis, but in general. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
BoneFit, done by Osteoporosis Canada in Canada, is quite
useful as well. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Option #2: I work with athletes and/or weight training
clients<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
CSCS is the most popular one that people go with. That
said there are a couple holes that CSCS, in my opinion, leaves uncovered which
are<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Understanding how to coach, program and progress
speed movements (I.e. sprinting & jumping): I recommend Joe DeFranco, Lee
Taft, and Nick Winkelman’s work as resources for speed training as this is
essential for returning team sport athletes to sport after certain injuries
(i.e. ACL tear, hamstring strain)<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Understanding how to coach and modify the
powerlifts for clients: I did the Canadian Powerlifting Union Coaching
Certification this year and found it insanely valuable. It was probably the
best training related certification I’ve done specifically on the powerlifts. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgghKBR1ruKzSUxxqj3KP3gdC5UWyti-6THnS6tlhsuJw8QJeGw_UitpvAM9RJ476M66nHAo4brNFAz8UcfmKGSJSxplBoM_n-_oQOb_qh4Y06CC62gPnDif6_ibeMnhH6ltRnYFazKf8bZ/s1600/coaching+certification.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgghKBR1ruKzSUxxqj3KP3gdC5UWyti-6THnS6tlhsuJw8QJeGw_UitpvAM9RJ476M66nHAo4brNFAz8UcfmKGSJSxplBoM_n-_oQOb_qh4Y06CC62gPnDif6_ibeMnhH6ltRnYFazKf8bZ/s320/coaching+certification.jpg" width="320" /></a></div>
<div class="MsoNoSpacing" style="text-align: center;">
<i>At the CPU Coaching Certification earlier this year at The Vault Barbell Club</i></div>
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<br /></div>
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As with Option 2 – you still need to, in my opinion,
spend time working with these populations under the supervision of a qualified
coach before working with these populations on your own. That’s why, despite my
certification, I don’t call myself a powerlifting coach.<o:p></o:p></div>
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<br /></div>
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Bonus: Who are good people to learn from? <o:p></o:p></div>
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<br /></div>
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People that I recommend other physios learn from in
regards to strength training are <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Physiotherapists: Scotty Butcher, Charlie Weingroff, Stefi Cohen, John Rusin, Dani
LaMartina (Overcash), Christina Prevett (Nowak), Michael Mash, Zach Long … and
myself.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Strength Coaches: Nick Winkelman, Brian Carroll, Chris
Duffin, Travis Mash, Meghan Callaway, Mike Boyle, Eric Cressey, Mike Robertson.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
I hope this article provided some useful advice and
guidance and I hope you will share it with other physiotherapists &
physiotherapy students who may have the same question. As always – thanks for
reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com178tag:blogger.com,1999:blog-8945612253482873433.post-45013559574943122362018-11-05T03:45:00.006-08:002018-11-05T03:47:41.189-08:00My Experience At SWIS 2018 And The Top Things I Learned<br />
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On October 26<sup>th</sup> I
travelled down the 401 to Mississauga for SWIS (Society of Weight-Training
Injury Specialists) 2018. The weekend was the highlight of my year and exceeded
all expectations. Hell – I’m still coming down from the energy high of the
symposium a week later. So bear with me while I try to explain my experiences
from the weekend. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>In a
previous Facebook post SWIS organizer Ken Kinakin encouraged people to come to
SWIS in person rather than just buy the video package. Don’t get me wrong, the
presentations were great, but the interpersonal interaction with many great
rehab & fitness professionals from around the world was even greater. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>I
came to SWIS with a list of people in my head that I wanted to meet (and get my
picture taken with). I thought to myself “I’ll probably be lucky to get a few
seconds here & there with them” but I ended up running into all of them
fairly frequently in the hallway, restaurant, bar and lobby. I met Ken &
Sheri Whetham, caught up with Stan Efferding, met Dani LaMartina (Overcash) and
met Scotty Butcher within the span of just over an hour. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>Some
of the highlights (god there were so many) from these interactions included <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Hanging
out with fellow PTs, lifters, and strength training junkies – EliteFTS writer
& 2<sup>nd</sup> ranked powerlifter in the world in her weight class Dani
LaMartina and University of Saskatchewan professor & Strength Rebels
founder Scotty Butcher.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Getting
into a conversation (and picture) with Stan Efferding, Brian Carroll, and Stu
McGill – easily 3 of the biggest influences on my training.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Ducking
out after the Rehab Panel’s presentation on Saturday afternoon & being
invited for a whiskey by Jim Wendler. If you’d have told me I’d have spent the
evening of my 28<sup>th</sup> birthday talking about everything under the sun
with Wendler I wouldn’t have believed you.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->A
good hour or so of chit chat with Dani and John Rusin – two of the most
influential PTs in the world of strength training today. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Spending
a good chunk of Sunday afternoon with my good friend & mentor Stuart
McGill, Brian & Ria Carroll, Dani LaMartina, and Paul Oneid. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">6)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->And
meeting Bill Kazmaier (whom I’ve watched on TV since being a little kid) and
Eddy Coan – that’s pretty self-explanatory <o:p></o:p></div>
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The presentations that I went to (and the top point I
learned from each) were…</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Stan Efferding - The Vertical Diet: Meal prepping and
organized diets like Weight Watchers & Jenny Craig are actually more
effective for weight loss than advice provided by a dietician or doctor. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Bill Kazmaier & Ed Coan - Powerlifting Workshop: Both
lifters emphasized how they trained in a “powerbuilding” style in the
off-season further away from meets using more general movements and a focus on
volume. This is a contrast to the popular high-volume, high specificity, and
high-frequency style of training used by many drugfree lifters yet it seems (so
far, anecdotally) that the former style of<span style="mso-spacerun: yes;">
</span>training is more conducive to longevity.<o:p></o:p></div>
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<br /></div>
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Chris Duffin & Brandon Senn – Back Training For The
Strength Athlete: Their presentation was not so much on stereotypical back
muscle training (i.e. chins, rows, face pulls, shrugs) as it was on training
the back to withstand high training volumes of axially loading exercises.
Brandon emphasized that you can progress training volume very slowly – a couple
reps or a set at a time over a period of weeks to months to allow for progress
while minimizing injury risk. This is in line with Tim Gabbett’s work on
acute/chronic workload ratios & injury risk in athletes.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Bill Kazmaier, Ed Coan, Jim Wendler, Matt Wenning, Ken
Whetham, Brian Carroll, J.L. Holdsworth – Powerlifting Panel: The biggest point
they emphasized to me was putting the ego in park, not rushing things, and
progressing slowly. This is a tough thing to do as we are a delayed
gratification society … and admittedly it was a tough thing to do for me as I
had i) achieved a lot of professional success at a young age and ii) always
felt like I needed to be a better lifter for fear that I would be seen as a
“fraud” by the strength training community.<o:p></o:p><br />
<br /></div>
<div class="MsoNoSpacing">
Brian Carroll & Stu McGill – Gift Of Injury: Now
being a student of Stu’s and having worked off of Brian’s training philosophy
for 3 years I am quite familiar with their work already. The biggest thing I’ve
learned from them over the years, and told them, was their focus on purposeful
repetitions and maximal full body tightness & intensity. This is the kind
of technique that you can only execute for a rep or 2 ‘cause it’s so
exhausting.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
J.L. Holdsworth – Grip Strength Training: J.L. broke down
grip strength training to a level that I had never thought of before. To me
grip training was always doing lots of deadlifts, carries, shrugs, chins and
rows with challenging weights. J.L. described 7 different types of grip
strength and the ways to train each of them. He also discussed how, contrary to
popular belief, long duration holds (i.e. farmer’s walks) may be
counterproductive for grip strength training and would build more endurance
than strength. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Rehab Panel: How funny and outrageous Dr. Eric Serrano
is. No but seriously the top thing I learned from this presentation was the
value of scapular upward rotation & protraction work for athletes who train
the bench press in a competitive manner (i.e. lats tight, scapulae retracted
& depressed). The problem is – people think that chins or rows are
antagonistic to bench press but they really (assuming you bench for strength)
involve the same scapular movements. The presenters described a neat variation
of the scap pushup that involved more scapular upward rotation and t-spine movement
to, in theory, involve the serratus anterior more and train those movement
qualities that get neglected in bench pressing powerlifters. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Jim Wendler – High School Strength Training: Wendler’s
known worldwide for his ability to simplify strength training through his 5/3/1
books and this was no different. The two top things that Wendler discussed were
the concepts of letting young athletes become leaders and the idea of giving
them a high GPP base through running, jumping jacks, bodyweight movements and
the like. I wish I would have done this kind of training earlier in my lifting
career. <o:p></o:p></div>
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<br /></div>
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John Rusin - Performance Recovery Systems: In Rusin’s
recovery system he discussed a difference between foam rolling for warming up
to work out (i.e. hard, short, fast) and the idea of foam rolling for recovery
(i.e. slow paced, over broad muscle groups, relaxed). Admittedly I did treat
foam rolling as a “fuck it – let’s get this over with” kind of project but now
I will focus more on foam rolling in the latter manner to get the maximum
benefit.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh65QHXQzKAUwepUmQ_Cghy7psTn5uHaImUZYRQDl9HHVn_j35l5YM78UPSeiIiuGCIpCCLWEnvehhYxvMmkF68ylvXVMFRzE8He2ocAQByhyphenhyphenlnUSPEa1Bb4otYbnZJgVbe8N1rlrqomkwD/s1600/stu+stan+brian+hallway.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh65QHXQzKAUwepUmQ_Cghy7psTn5uHaImUZYRQDl9HHVn_j35l5YM78UPSeiIiuGCIpCCLWEnvehhYxvMmkF68ylvXVMFRzE8He2ocAQByhyphenhyphenlnUSPEa1Bb4otYbnZJgVbe8N1rlrqomkwD/s320/stu+stan+brian+hallway.jpg" width="320" /></a></div>
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<div class="MsoNoSpacing">
<o:p> </o:p>I ended up helping Stu & Brian with some stuff Sunday
afternoon and as such didn’t get to the last couple presentations. I have a
good 15 hours (or more) of video to watch from presentations I didn’t even
attend.</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
My only regret from the weekend was not getting to know
more about the less “famous” (if that’s the right word) presenters. I wanted to
meet the heavy hitters like Kaz, Coan, Carroll, Wenning, Rusin, Wendler etc.
and as such didn’t investigate the backgrounds of many of the other presenters.
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
As an example - at the dinner table on Saturday I was
surrounded by Wendler on one side and by medical doctor & 2 time European
Union powerlifting champ Dr. Fionnula McHale on the other side. Fionnula was
visited by many people, almost to the point where we couldn’t talk much. She
struck me as a very beautiful, outgoing, physically fit woman who I had; to my
own chagrin; assumed was a bodybuilder or figure competitor. I had no idea;
until Kaz told me the next morning; that she had overcame a lot of mental
demons to present here and that she was such a successful athlete, doctor &
person. I had no idea how amazing of a person I had sitting behind me. I use
this as an example, and as advice to future attendees to do your homework and
read more into the stories & credentials of all the presenters … not just
the #1 attractions. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Another piece of advice I have from SWIS, and in contrast
to above was something I did right, is to take the time to meet local fitness
& rehab professionals closer to your area. When you have people coming from
as far as Singapore & Hong Kong it’s easy to neglect connections with the
people near you. Take the time to do so.<o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH4X_hVMeGIUMXgESPJhmZ-eVBpnt0LLvmWgfekcUoRgIIyzQcK5aS6jtD67ipZa1nAlccaVdHn7AaQxklsxA5uZ59mbjcCvQ2MVd6gijqUPWH9J9hjREqnLbih_B_p9ePVAtjNoHB00vI/s1600/with+ken.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgH4X_hVMeGIUMXgESPJhmZ-eVBpnt0LLvmWgfekcUoRgIIyzQcK5aS6jtD67ipZa1nAlccaVdHn7AaQxklsxA5uZ59mbjcCvQ2MVd6gijqUPWH9J9hjREqnLbih_B_p9ePVAtjNoHB00vI/s320/with+ken.jpg" width="320" /></a></div>
<div class="MsoNoSpacing" style="text-align: center;">
<i>With the man behind the magic - Ken Kinakin</i></div>
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<br /></div>
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Well – this article is nearing 1500 words and as such
it’s time to wrap it up. Thank you Ken Kinakin, and all the amazing people mentioned
above, for an amazing weekend. I look forward to the next SWIS symposium. As
always – thanks for reading.</div>
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<o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-87512969987379396502018-10-24T15:37:00.002-07:002018-10-24T15:40:43.171-07:00The Future Of Evidence Based Rehab And Training <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgryCK10v9zqJV9weeOxQRyrS8R2SIefFKlk_8ud5rCOXgBZCeyCOobydNysyDbboGWgzWDTpMeHCrwqjFgCN1VVLdt6HfAMudmdetLat7_gObuMmfeOtjulVj3TpENxelakrUB1hYQ4zn_/s1600/20180623_155850.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgryCK10v9zqJV9weeOxQRyrS8R2SIefFKlk_8ud5rCOXgBZCeyCOobydNysyDbboGWgzWDTpMeHCrwqjFgCN1VVLdt6HfAMudmdetLat7_gObuMmfeOtjulVj3TpENxelakrUB1hYQ4zn_/s320/20180623_155850.jpg" width="320" /></a></div>
<br />
Hello all. First of all I want to say thank you for all your support over 2017 and 2018. It's been an amazing and fun ride & you have no idea how grateful I am for everything.<br />
Secondly - I know I've been MIA lately as I've recently switched jobs and moved to a new city. Needless to say it's been an exciting fall. In addition to the delays involved with starting a new job and moving ... I have also been working on a revamp to the style and content of my site.<br />
<br />
Content focus –<br />
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<o:p></o:p></div>
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As I have switched jobs from Impact Physiotherapy and
Performance to UHN Altum Health Cambridge my clinical focus has changed. I deal
more with complex injuries to the shoulder, lower extremity, and entire spinal
column as well as with concussions. </div>
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Sports-related therapy is a very small focus of
what I do now so it will get a smaller emphasis on the website. My “rehab to performance” based material will still be more prevalent on <a href="https://www.mashelite.com/">Mash Elite Performance</a>.</div>
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<o:p></o:p></div>
My involvement
with geriatrics and chronic diseases, aside from OA and
osteoporosis/osteopenia, is pretty much nil.<br />
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<o:p></o:p></div>
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Concussion therapy is very difficult to describe via a
500-1000 word article and is probably best left to the experts who teach concussion
therapy courses such as the Shift, R2P and my old physio school instructor Shannon
McGuire. <o:p></o:p></div>
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<o:p> </o:p> </div>
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Now you may be wondering “what does that leave for my
site.” Well my content will focus on<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Persistent Pain: exercise strategies and general
concepts around persistent pain <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Communication based themes such as explaining
various concepts (i.e. pain science education, exercise coaching) and
subjective interviewing<o:p></o:p></div>
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</span></span></span><!--[endif]-->Tips for schooling and early practice (now that
I’m through that phase of my career)<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Specifics (i.e. risk factors, special tests) on
specific conditions such as <o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Shoulders:
rotator cuff strains & tendinopathies, shoulder dislocations<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Knees:
ACL/MCL tears, patellar dislocations, meniscus tears, OA<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l0 level2 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "courier new"; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Spinal:
WAD, Osteoporosis, I’ve already got a series on low back pain <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->As well as some exercise tips & tricks that
I use. I’m hoping to get more tech savvy and put more video content out. <o:p></o:p></div>
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Frequency – <o:p></o:p></div>
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As I posted on FB recently a goal of mine is to cut-back
a bit on writing, curriculum work, and even lifting time to give me more time
for both my patients and myself. As such I am not holding myself to a set frequency
of articles. You may see one every few months or a few in a month depending on
my creative juices and what comes through. <o:p></o:p></div>
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If you have any comments, suggestions or anything you'd like covered send me a DM or message me via my email bigericbowman@gmail.com. As always - thanks for reading. </div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-28978518832613934162018-10-01T04:18:00.000-07:002018-10-01T04:18:00.023-07:00If You Want To Stay Fit And Painfree Don't Ever Do This Exercise!!!!<br />
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As a physiotherapist who also works and lives in the
fitness industry I’ve seen many people who have hurt themselves performing
various exercises or activities. Over time – a few common exercises stand out
in my head as problematic for many of the people I work with. In this article I
tell you what exercises you must absolutely avoid to stay fit and painfree.<o:p></o:p></div>
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…..Alright, but seriously, now that the clickbait is out
of the way it’s time to get to the true purpose of this article. A <span class="MsoHyperlink"><a href="https://www.rd.com/health/fitness/exercises-to-modify-over-50/">recent</a></span>
couple of stories have been making rounds over the past few weeks as they
recommend modifying or eliminating specific exercises for people over 50. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9GJw6Y_eL_punMbC6qvpFanjq2z5KkslYAGJBimWXG_f5xEQobYYLDxr7L46lqUU8owwTzjhcCSv76ip9EMYiwYzaQlNXcz_pLHLqe9q_2JC80W6NREWJCLCL5Dy8VYh2sGSsYEdwqzh8/s1600/42470039_10160982755515375_4964857988016766976_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="720" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9GJw6Y_eL_punMbC6qvpFanjq2z5KkslYAGJBimWXG_f5xEQobYYLDxr7L46lqUU8owwTzjhcCSv76ip9EMYiwYzaQlNXcz_pLHLqe9q_2JC80W6NREWJCLCL5Dy8VYh2sGSsYEdwqzh8/s320/42470039_10160982755515375_4964857988016766976_n.jpg" width="240" /></a></div>
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<span style="mso-tab-count: 1;"> </span>Although
my involvement with the middle aged & elderly has decreased as a result of
my recent change of jobs I still spend a fair amount of time with those
populations through my current job and through my involvement with the
University of Waterloo. While the above pieces are a bit overboard and can
border on fear-mongering – it’s important to understand that some exercises may
not be good fits for certain people. Instead of saying an exercise is bad or
good a better way to do things is to look at an exercise through the questions
I pose below<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Question 1: What
is the goal of the individual?<o:p></o:p></b></div>
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This will vary based on the setting you work with (rehab
vs fitness) and the specific population you work with. The goals determine the
acceptable risk/reward ratio of the exercise.<o:p></o:p></div>
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For instance – a heavy deadlift with chains on each end
of the bar may be an appropriate exercise for someone competing in strength
sports but can be overkill for someone who’s interested in other goals such as
pain relief, fat loss, hypertrophy or improved athleticism. Another exercise
that has less joint load may be a better choice for them. <o:p></o:p></div>
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Running is a big example of this as it does have a higher
injury rate compared to other activities, <span class="MsoHyperlink"><a href="https://www.strengthandconditioningresearch.com/2014/07/08/injury-strength-sports/">even
strength sports</a></span>. If you enjoy running; are healthy; and manage
training load, recovery, nutrition, sleep, psychosocial factors etc well it’s
probably a fine activity for you. But if you’re 100 lbs overweight and have a
variety of medical & orthopedic issues there are better options to improve
your fitness.<o:p></o:p></div>
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<o:p><br /></o:p></div>
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Basically, to make a long story short, does the exercise
fit within the goals of the individual and work towards those goals.</div>
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<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Question 2: Can
the exercise be done properly?<o:p></o:p></b></div>
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Research and anecdotes have shown that there are lots of
different ways to perform an exercise properly. But there does, in my opinion,
need to be standards for technique when it comes to higher load movements such
as the powerlifts & the Olympic lifts. I’m not gonna lose sleep if someone
forgets to “grip the floor” with their toes in a front squat but if they’re
excessively falling forward and their legs look like that of a baby giraffe
then it may not be an appropriate choice for them. <o:p></o:p></div>
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Side note: before saying an exercise can’t be done
properly and making your client do a million corrective exercises – try showing
them what you’re looking for in terms of technique, coaching & cueing them,
and also experimenting with different grips & stances & bar positions.
If they still can’t do it properly despite all that then, in an SFMAish sort of
fashion, break things down to look at mobility and control of individual joints
to see what is lacking and modify training as deemed appropriate by giving your
client exercises that can be done properly. <o:p></o:p></div>
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Bottom line: if an exercise, despite proper coaching and
cueing, can’t be done to an acceptable standard find another option to achieve
the goal.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Question 3: Does
the exercise aggravate any medical issues?<o:p></o:p></b></div>
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In general, for fitness training, exercise should be
painfree. If an exercise causes issues modifications should be given to make
training painfree.<o:p></o:p></div>
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Some exercises just don’t sit well with certain people.
Tricep extensions/skullcrushers/JM presses etc; regardless of technique, order
in the workout, rotation of exercises, or volume progression; just irritate my
elbows so as such I stick to pushdowns and tricep dominant pressing movements
(i.e. dips, close grip bench press). <o:p></o:p></div>
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The only exception I make in training, as I <span class="MsoHyperlink"><a href="https://www.mashelite.com/bowman-207/">talked about</a></span>
with Travis Mash, is when an athlete is peaking for a major competition that
means a lot to them. In that case “the juice may be worth the squeeze” to quote
Brian Carroll. <o:p></o:p></div>
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In rehab, for the most part, exercises should be painfree
where possible – but I also believe some people (i.e. chronic pain,
post-surgical, central sensitization) may not be able to do anything painfree. Exercising
patients into pain is a complex and difficult topic which I plan to write about
in more detail in a future article. <span style="mso-spacerun: yes;"> </span>I
would say if you’re not someone who’s well versed (from a research knowledge,
professional training & licensing, and experience perspective) in exercise
for those populations you need to refer out to someone who is. If you need help
contact me via Facebook. <o:p></o:p></div>
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If an exercise doesn’t have an appropriate risk/benefit
ratio based on the goals of the person don’t force it if it’s painful.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Question 4: Is the
exercise being programmed & progressed appropriately? <o:p></o:p></b></div>
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Sometimes an exercise is good but can be programmed
inappropriately. Take for instance people that go from squatting 1x/week to
doing a “Squat Everyday.” Neither of those are bad programs but there needs to
be a proper progression that allows for recovery & building work capacity.
In a <span class="MsoHyperlink"><a href="http://ericbowman03.blogspot.com/2017/08/the-most-important-concept-ive-learned_21.html">previous
article</a></span> I discussed Tim Gabbett’s research provided some general
ideas on progressing activity volume that I find useful for competitive
athletes, weekend warriors, and even people with persistent pain.<o:p></o:p></div>
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I hope this article provides some useful algorithms for
you to determine whether or not an exercise is good for you or your clients. As
always – thanks for reading.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-47406362486553192922018-08-25T09:36:00.003-07:002018-08-25T09:36:24.919-07:00Strength And Conditioning For The Regular Person - How Much Is Enough? How Much Is Too Much?<br />
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Earlier
this summer my friend and fellow PT and strength training junkie Scotty Butcher
tagged me in a brilliant <span class="MsoHyperlink"><a href="https://www.youtube.com/watch?v=YHTjqYJZ7IE&feature=youtu.be">presentation</a></span>
for Ignite Physio where he discussed the value of strength training post
rehabilitation to transition from PPLOF (piss poor level of function) to OLOF
(optimal level of function).</div>
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<o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>As
someone who’s a physio, strength coach and powerlifter and has seen, worked
with, and/or learned from people who have squatted over a grand to people who
can barely out of their own chair it got me thinking. For the regular person
who’s not a competitive athlete and just wants to look good, feel good, and be
healthy … how much strength is enough? How much cardiovascular fitness is
enough? At what point does trying to improve those areas become detrimental to
health and cross-over into high performance athletics? That is the topic of
today’s article.<o:p></o:p></div>
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<div class="MsoNoSpacing">
Disclaimer: Since many studies on strength use grip
strength as a primary measure (which is linked to mortality) I will discuss
this topic from a philosophical and opinion based perspective than with
specific data as most people, outside of a physio clinic or performance centre,
can’t measure their grip strength on a whim. Same goes for cardiovascular
fitness.<o:p></o:p></div>
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I’m going to look at this topic from two perspectives<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Perspective #1: We
should just let people do the activities they want and live their life that way<o:p></o:p></b></div>
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There’s a lot to be said for this especially given the
rates of obesity and inactivity in the developed world. A common saying is “the
best form of activity is the one you’ll do and stick to.” <o:p></o:p></div>
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From a compliance perspective – yes it’s important that
people enjoy the activities that they are doing. Not everyone enjoys running or
slugging weights around as much as you do. It is what it is. As much as people
like to knock CrossFit – it’s helped excite a bunch of people to get physically
active.<o:p></o:p></div>
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My only concerns with this perspective are two fold<o:p></o:p></div>
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Concern 1 – In some regions, especially here in Canada
where it seems to be either cold and snowy or stinking hot all year, many
activities that people enjoy (i.e. certain sports, walking, gardening) just
don’t get done. What good is an activity if you’re not doing it most of the
year?<o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNx6u11Je0MyDlQWZRTRCZmbZLTFaYI26ZwFSqXSzfpYnc7NvPm55SwFiyWHIZk1Y1iBhbITs-gWz3l0zV114wvnazvpkb8uXll_JzrCGigd_I1ojRUQUhNR7IwCuHMUgT2lJBVM2a2VsH/s1600/19-woman-walking-in-the-park.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1500" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNx6u11Je0MyDlQWZRTRCZmbZLTFaYI26ZwFSqXSzfpYnc7NvPm55SwFiyWHIZk1Y1iBhbITs-gWz3l0zV114wvnazvpkb8uXll_JzrCGigd_I1ojRUQUhNR7IwCuHMUgT2lJBVM2a2VsH/s320/19-woman-walking-in-the-park.jpg" width="320" /></a></div>
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<o:p> </o:p>Concern 2 – Are these activities enough to build both
strength, cardiovascular fitness, lean body mass, and bone density to a point
that</div>
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<o:p></o:p></div>
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</span></span></span><!--[endif]-->People can take part in more strenuous
activities without any major issues<o:p></o:p></div>
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</span></span></span><!--[endif]-->These attributes are built enough and maintained
enough to the point where they won’t sink to a harmful level with age and<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-indent: -18.0pt;">
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</span></span></span><!--[endif]-->Supply a reserve of ability for after the
activity is done <o:p></o:p></div>
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Explaining these points in more detail, and again using
Canadian examples, look at the person who just walks and does things around the
house … and then has a heartattack during the first major snowfall of the
winter while shovelling snow. Those activities that the person took part in did
not prepare them enough for the demands of a more physically demanding (yet
essential) task nor did it give them a reserve of ability for afterwards as it
was a beyond “max effort” task. <o:p></o:p></div>
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In addition – some research have questioned where low
intensity activities <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/21616030">such as walking</a></span>
can provide enough of a stimulus to maintain health, especially through the
aging process. <o:p></o:p></div>
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As such, while it’s important that people pick activities
they enjoy, there needs to be enough of a stimulus to promote health and to
enable more strenuous essential activities to be done while still maintaining a
reserve of physical functioning afterwards.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Perspective #2: We
should turn all our physical therapy or personal training clients into
powerlifters, endurance athletes or functional fitness freaks<o:p></o:p></b></div>
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As my friend Nick Tumminello said (paraphrased) we do
tend to train our clients based on our specific biases – whether it’s cardio,
bodybuilding, powerlifting, kettlebells, crossfit or the like.<o:p></o:p></div>
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While all of these activities, when programmed properly,
can have great benefits on physical function my concerns are twofold.<o:p></o:p></div>
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First of all … these activities carry a higher health
risk than just training for general health. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ODCusQHeR45E2OEmVF3Yn3QuA9kTEGXVYDxgMYuqlqP4sEkucR-20ZI2No_3ni7usn_89TIyA6kbCepKxmeVET0GKH8a94qFXV_2iw9ThNG04BiueeTbrt9Jskl5stnSevLVhiSnrTQI/s1600/20170513_130202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7ODCusQHeR45E2OEmVF3Yn3QuA9kTEGXVYDxgMYuqlqP4sEkucR-20ZI2No_3ni7usn_89TIyA6kbCepKxmeVET0GKH8a94qFXV_2iw9ThNG04BiueeTbrt9Jskl5stnSevLVhiSnrTQI/s320/20170513_130202.jpg" width="240" /></a></div>
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<o:p> </o:p>My friend Stan Efferding <span class="MsoHyperlink"><a href="https://www.youtube.com/watch?v=yxHZrF4AFRg&t=615s">has said</a></span>
“if you want to be healthy don’t compete.” While strength sports such as
bodybuilding, powerlifting, strongman, and crossfit do have an injury rate
comparable to (or slightly less than) those of <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/27328853">non-contact sports</a></span>
an injury rate ranging from 1 every 10 years to over 1 per year is a lot for
someone who’s not pursuing highly competitive athletics. In addition there are
the other health risks involved from carrying
too much bodyweight; which includes too much fat and too much muscle;
which include OA, insulin sensitivity, high blood pressure, and sleep apnea.</div>
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<o:p></o:p></div>
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Endurance sports, while widely considered to be healthier
than strength sports, <span class="MsoHyperlink"><a href="https://www.strengthandconditioningresearch.com/2014/07/08/injury-strength-sports/">actually</a></span>
have a much higher rate of injury. In a recent <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28504066">paper</a></span> recreational
runners are less likely to develop knee OA than the sedentary population –
however competitive runners are more likely to develop knee OA. In addition –
the relationship between cardiovascular fitness and health is not 100% linear.
High performance endurance athletes can have higher mortality and adaptations
of the heart that <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491465/">can predispose
them</a></span> to further issues.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXH5Vfx3PqAXXNFIFtH5fu9VmcQZj7taSVxDrgMfyJ6gA01zFJq7D24cJhAUbar4wUz_G0X3KpMr920frLEVBbaQoZAEaen2vbyb47GHBaw8e_xWs2UD7Nm-jIceZLa-UUXDXm4K3p_7ru/s1600/2+61-fit-woman-stretching-legs.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1125" data-original-width="1500" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXH5Vfx3PqAXXNFIFtH5fu9VmcQZj7taSVxDrgMfyJ6gA01zFJq7D24cJhAUbar4wUz_G0X3KpMr920frLEVBbaQoZAEaen2vbyb47GHBaw8e_xWs2UD7Nm-jIceZLa-UUXDXm4K3p_7ru/s320/2+61-fit-woman-stretching-legs.jpg" width="320" /></a></div>
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<o:p> </o:p>Secondly … training like a high-level athlete can become
very burdensome from a time, effort and money perspective. Many high-level
athletes train, eat, sleep and recover like it’s their job. Eating 6 meals a
day, being in bed by 10 every night, and training 8-10+ hours a week doesn’t
seem like the lifestyle most people want to live when their goal is just to be
healthy.</div>
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<o:p></o:p></div>
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<br /></div>
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As such – training like a competitive athlete isn’t the
answer either.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Well what is the
answer?<o:p></o:p></b></div>
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It’s tough to give specifics without understanding a
person’s goals, general health, and demands of their life. <o:p></o:p></div>
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A good general guideline for what I consider to be
“sufficient” strength and cardiovascular fitness is for people to ….<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Be
able to do physically demanding activities such as factory and farm work, help
move furniture, and be able to play some sports with coworkers/kids … without
these tasks being a “max effort” or causing such fatigue or muscle soreness
that they can’t be performed consistently. <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Have
appropriate levels of bone density and lean body mass <o:p></o:p></div>
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<br /></div>
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…all throughout the lifespan. Some may argue with me –
but that’s my standard.<o:p></o:p></div>
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<div class="MsoNoSpacing">
For most people who are healthy and already eat &
train well – 2-3 days a week of some well designed strength training & a
bit of HIIT training – as well as some leisure walks or bike rides a week
should have the desired effect without being burdensome or counterproductive to
health.<o:p></o:p></div>
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<o:p><br /></o:p></div>
<div class="MsoNoSpacing">
I hope this article provided some useful food for thought
on making the distinction between optimal health and optimal athletic
performance. As always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com2tag:blogger.com,1999:blog-8945612253482873433.post-90459936922714356162018-07-28T08:39:00.003-07:002018-07-28T08:39:32.968-07:00The Biggest Step I Had To Take To Be A Rehab & Fitness Educator<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjUeda7vy3GFGHZOeGI6H5FJkF0PjUzc7Q8_LtfSBGcwCLzSU5-u-gKJN-4sG1jSHEfvx1PlVTUXKx0Pb3Hc4VzMv4o9_OsPbA9SbqbYp-1Ajyd_1STZLX5kqqQkzf07d9ux3Mijcx0tx/s1600/inside+BMH.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyjUeda7vy3GFGHZOeGI6H5FJkF0PjUzc7Q8_LtfSBGcwCLzSU5-u-gKJN-4sG1jSHEfvx1PlVTUXKx0Pb3Hc4VzMv4o9_OsPbA9SbqbYp-1Ajyd_1STZLX5kqqQkzf07d9ux3Mijcx0tx/s320/inside+BMH.jpg" width="320" /></a></div>
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<span style="mso-fareast-language: EN-CA;"><br /></span></div>
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First of all – I
want to say thank you to everyone who has supported my site over its first year
of existence. I really appreciate all the feedback, likes, shares and other
benefits you have given me. Thank you.</div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;"><o:p><br /></o:p></span></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">I sometimes get
asked how I’ve gotten into the role that I have – writing for two sites, having
contributed to two books and having contributed to multiple university courses.
Also, given the amount of outdated & questionable material out there in
health & fitness, I’m sometimes asked how I stay sane and keep a level,
positive attitude. This article, which I feel is an appropriate “1 year
anniversary” article, delves into that…. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">Back in 2013, as
I was preparing for physio school application interviews, Stu McGill was
gracious enough to take some time out of his insane schedule to let me work
with him. When I asked him about some of the schools he told me that some of
them do teach a lot of outdated materials.<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;"><br />
Alo and behold - during my first term of PT school I was getting taught, what I
knew was outdated, information and was angry, bitter, frustrated, and depressed
about it. Sometimes I felt like I took my anger out on my fellow classmates
which, along with my lack of taking care of my physical and mental health, sits
as my biggest regret from PT school. This is why I’ve always appreciated when
someone sends me a message or posts a comment complimenting me for having a
positive, balanced attitude as I wasn’t always that way and have tried to work
in that direction. Due to these issues I almost quit PT school more than once
along the way and have known many people who have struggled through similar
journies.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">Side note: so
many people comment on my successes but they don’t see the hardships, failures,
or low points along the way. Such is true with a lot of people’s stories on
social media. <o:p></o:p></span></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;"><br />
Those frustrations, to be honest, were the biggest spark for me to want to make
change in the educational system for both rehab & fitness professionals. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">In 2014, during
a casual phone call, my old professor and great friend Lora Giangregorio asked
me if I would help her design a course on exercise for people with chronic
health conditions for the University of Waterloo KInesiology program - to which
I said hell yes. I’ve been involved with UW ever since.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">In 2014/15 I got
asked by Brian Carroll, James Cerbie, and Alexander Cortes to write for PowerRack
Strength, Rebel Performance, and EliteFTS respectively. For a 24 year old,
still in grad school, the opportunity to write for those high level sites was
nothing short of amazing.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">Fast forward a
couple years – I got asked to be part of a review panel for Western University,
contributed to two books, started my own website, and am currently a writer for
<a href="https://www.mashelite.com/">Mash Elite Performance</a>. <o:p></o:p></span></div>
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<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">Even though I’ve
had the opportunity to reach people from Alaska to Australia … I felt something
was missing in my work and my attitude up until a few months ago. The event
that tipped that off was the passing of my former physio school instructor Deb
Lucy. Deb was one of the main masterminds behind the way the Western University
physiotherapy program runs today. She always had a lot of energy and cared a
lot about her students. When you’re in the same classes Monday-Friday with the
same 50 or so people for months on end … you become a family.<o:p></o:p></span></div>
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<span style="mso-fareast-language: EN-CA;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsT-HxwMRhd5kz3H-16oyolf1NjjYcg1w977mWqNxXPcII7b1rc3-t1pHi95W_OFSMOVgbF47GA4aARetENkOpxAdgM2nCqQu34nQwU7VFqz1Pzl44rPMvCfHdy3PrFc4bIXyT5OzB4PDY/s1600/elborn+rainy+day.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsT-HxwMRhd5kz3H-16oyolf1NjjYcg1w977mWqNxXPcII7b1rc3-t1pHi95W_OFSMOVgbF47GA4aARetENkOpxAdgM2nCqQu34nQwU7VFqz1Pzl44rPMvCfHdy3PrFc4bIXyT5OzB4PDY/s320/elborn+rainy+day.jpg" width="320" /></a></div>
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<span style="mso-fareast-language: EN-CA;"><br /></span></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;"><o:p> </o:p></span>That made me
realize – it was time for me to let go of the anger and bitterness that I
harboured towards the education system. It wasn’t helping me and, if anything,
it was bringing me down and negatively affecting my relationships with
colleagues.</div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-fareast-language: EN-CA;">I’m not saying
that every piece of material out there in rehab or fitness is peachy or
perfect. Far from it. What I do believe though is </span>this - "If you
change the way you look at things, the things you look at change" to
quote Wayne Dyerr.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
When I first learned about pain science & the
biopsychosocial model in 2014, near the end of first year physio school, it
really shook me and made me question a lot of things I thought I knew. It
created some cognitive dissonance and it took me a while to rewire my thought
pattern. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
That, and the desire to be diplomatic in order to get my
knowledge across, are the two main reasons I try to be patient with other
professionals who I educate & deal with. I operate under the premise that
most professionals mean well and want to help patients – and that belief change
is tough especially when you’ve emotionally invested yourself into your methods
& the results you get with your clients. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
As such – my attitude has shifted. We still have a long
way to go and a lot of work to do in improving rehab & fitness education
for professionals & students. But I look at the positives – we have a lot
of great rehab & fitness professionals who care a lot and want to learn and
get better and we have great opportunities and educational methods through
schooling, courses, and social media to get the information out there. We can’t
change the world – but we can make a little part of the world, a little bit
better.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Thank you for your support for the past year, and as
always, thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0tag:blogger.com,1999:blog-8945612253482873433.post-15872002852789789842018-07-22T11:45:00.001-07:002018-07-22T11:52:42.769-07:00What I'm Doing Differently In My Third Year Out Of Physiotherapy School - Part 1<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjZGWhpVpUn7G0OQYHWx34NWN3EP1xCZTqgsdyV6OODvAB7njLUOx7196YNU4XUV0Sze28QskfDI8Xv3eNcfWo-fce_bBoTLE1SBXdxtaXoYba4KSW7J35fCK77v4AH1nu5Y6Ht9mAPizr/s1600/elborn+rainy+day.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjZGWhpVpUn7G0OQYHWx34NWN3EP1xCZTqgsdyV6OODvAB7njLUOx7196YNU4XUV0Sze28QskfDI8Xv3eNcfWo-fce_bBoTLE1SBXdxtaXoYba4KSW7J35fCK77v4AH1nu5Y6Ht9mAPizr/s320/elborn+rainy+day.jpg" width="320" /></a></div>
<br />
<div class="MsoNoSpacing" style="text-align: center;">
<i>On a rainy summer day by Elborn College - the building where I spent the bulk of my two years in physiotherapy school.</i></div>
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August
28, 2018 marks the 3<sup>rd</sup> anniversary of my last day of physiotherapy
school. This time last year I wrote a <span class="MsoHyperlink"><span style="font-family: "calibri" , sans-serif; font-size: 11.0pt; line-height: 107%;"><a href="https://ericbowman03.blogspot.ca/2017/09/what-im-doing-differently-in-my-2nd.html">series</a></span></span> where I discussed several changes I’ve made in my own practice. In this article
I will share some of the things I’ve been doing differently since that time
period.<o:p></o:p></div>
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1) Doing more neck strengthening instead of stretching<o:p></o:p></div>
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The traditional, stereotypical PT approach to neck pain
rehab consists of a lot of stretching, soft tissue work, and needling of the
upper traps, levator scapulae, scalenes and/or SCM muscles. For whatever
reason, and maybe it’s just me, this approach never worked well for me or my
clients with neck pain and just left a lot of people feeling sore.<o:p></o:p></div>
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By contrast – I’ve gotten much more out of isometric neck
exercises (sets of 7-10 second holds within a tolerable level of force) and
dynamic shoulder strengthening exercises such as front/side/rear raises, rows,
shrugs and shoulder presses (based on the patient’s activity tolerance and
physical capabilities). This approach is (in my opinion) better tolerated by my
clients. <o:p></o:p></div>
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Side note: this isn’t to say I don’t do any stretching or
soft tissue work in people with neck pain as I do see an anecdotal benefit in
certain populations (ie radiculopathies) but many people I work with tend to <span style="mso-spacerun: yes;"> </span>not enjoy being stretched and are limited more
by pain before their neck movements even encounter resistance.<o:p></o:p></div>
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<o:p><i> Image courtesy Focus Fitness</i></o:p></div>
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2) Doing less more often in people with persistent pain<o:p></o:p></div>
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Working with persistent pain can be a challenge in terms
of exercise prescription as it may be entirely possible that every
movement/activity hurts and they can be easy to flare up. It leaves us in a bit
of a conundrum as we want to be able to improve/maintain our clients mobility
& fitness but we also don’t want to flare them up.<o:p></o:p></div>
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A solution I found came from a <span class="MsoHyperlink"><a href="http://chewshealth.co.uk/tpmpsession41/">podcast</a></span> I listened to
with Greg Lehman last year where he suggested “doing less more often” with
people with fibromyalgia and other chronic pain conditions. For example – I
would prescribe a set of 3-10 of 1-2 exercises (depending on the client’s
goals, limitations, level of irritability, and whether they are having a “good”
or “bad” day) to be done repeatedly through the day. <o:p></o:p></div>
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I found this approach helped my clients immensely with
maintaining (or even improving) mobility & fitness while minimizing the
chances of flaring up.<o:p></o:p></div>
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3) Referring out (or at least backing off) if I’m not the
right person to treat someone’s pain<o:p></o:p></div>
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This may seem like common sense physio. If someone has <o:p></o:p></div>
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</span></span></span><!--[endif]-->Red Flags: ie tumor, infection, cauda equina
syndrome and/or<o:p></o:p></div>
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</span></span></span><!--[endif]-->Major orthopedic issues requiring surgery: ie
fracture; dislocation; progressive neurological deficit; ligament/meniscus tear
creating locking, instability, and/or giving out;<o:p></o:p></div>
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…. Then you need to refer out<o:p></o:p></div>
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I’m not talking about those in particular. I’m talking
about cases where, quite frankly, physio just may not be the most valuable use
of a client’s time and resources even in the absence of the above issues.<o:p></o:p></div>
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I’ve seen a fair amount of clients this past year with
significant levels of pain and disability that were linked to significant
psychosocial factors such as job stresses or even deaths/family illnesses. These
clients would even tell me that as their stressors went up, so did their pain. After
a couple of these cases I realized that, while physio can still have a benefit
for maintaining/improving mobility & physical function, that the drivers of
their pain were likely beyond my skillset and required counselling or
psychotherapy to deal with these issues. <o:p></o:p></div>
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Over the past year I’ve also had patients referred to me
for conditions that were clearly medical in nature – such as polymyalgia
rheumatica. Again, while we can help with mobility in function, most of the
treatment for conditions like PMR is medical in nature. <o:p></o:p></div>
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I’ve ranted before about how I don’t like personal
trainers & strength coaches trying to be half-assed PTs but at the same
time I don’t believe a rehab professional should try to be a half-ass
psychiatrist or doctor. That’s where we need to realize our limitations and
refer out to other professionals. <o:p></o:p></div>
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Side note: this isn’t to say that I completely stopped
treating them – but we both came to a consensus that other resources were
needed. <o:p></o:p></div>
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4) Bubble diagrams for pain science<o:p></o:p></div>
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Quite often I find patients want to know “what causes
this?” That’s a great gateway to get into some pain science education. But
instead of bombarding people with a bunch of neuroscience – I take the time to
do a bubble diagram (similar to Peter O’Sullivan) to show all the different
factors that can be involved with a patient’s pain including (where
applicable)…<o:p></o:p></div>
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</span></span></span><!--[endif]-->Tissue changes<o:p></o:p></div>
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</span></span></span><!--[endif]-->Too much (or too little) activity<o:p></o:p></div>
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</span></span></span><!--[endif]-->General health factors (i.e. body weight,
smoking, poor sleep)<o:p></o:p></div>
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This is a great way to get some practical, applicable
information about pain out to the patient without bombarding them with info. <o:p></o:p></div>
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5) Giving patients exercise set/rep ranges</div>
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This follows in from Point #3 – I like the idea of giving
patients set/rep ranges for exercises so they can adjust if they’re having a good
day or bad day. I find this useful for people with persistent pain (or any
fluctuating pain) and/or for “borderline” cases where you’re not 100% confident
about how far you can push them.<o:p></o:p></div>
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That’s the end of Part 1 of this article. Tune back in a
few weeks where I discuss four more changes I’ve made.<o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-9612325546813979182018-06-25T10:42:00.002-07:002018-06-25T10:42:14.009-07:00Enough Is Enough - Finding Common Ground In Manual Therapy <br />
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(Yes I did have one with swearing in it but decided to replace it)</div>
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Anyone who knows me knows that I’m not a big fan of participating
in online debates. While they can be useful if performed respectively (for
instance one between Alan Aragon and Paul Carter from a few years back) – quite
often they tend to turn into heated arguments where both sides have hard headed,
dogmatic views and have to be right.</div>
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This is no more apparent in
rehab than in the controversial, hotly debated topic of manual therapy. Some
think that manual therapy is the “end all be all” of orthopedics whereas others
claim its useless and creates dependency. Once again these debates have sparked
up again and have prompted me to come out of my shell and say “enough is enough.”
The purpose of this article is to find some common ground between the two ends
of the spectrum. <o:p></o:p></div>
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Side note: as with some of my other articles this is not
going to be a lit review just for the sake of keeping it easy to read. <o:p></o:p></div>
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Side note two: you can read the preceeding editorials by
my lovely, former instructor & <a href="https://www.orthodiv.org/why-physiotherapy/physiotherapists-are-not-corn/">colleague
Laura Ritchie</a>; by <a href="http://www.greglehman.ca/blog/2018/6/22/orthopaedic-physiotherapy-training-in-canada-reflections-on-manual-therapy-and-the-orthopaedic-division">Greg
Lehman</a>; and by <a href="https://thesports.physio/2018/06/23/more-manual-therapy-bickering/">Adam
Meakins</a> by clicking the hyperlinks in their names. <o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">Is manual therapy a
high skill technique? No.<o:p></o:p></i></div>
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As I’ve written about in my article “Simplifying The
Manual Therapy Process” – many believe (and teach) the idea that manual therapy
is a high skill technique that requires thousands of hours (and dollars) in
training. Hell – in physio school we sometimes covered the same technique five
times. It gets to the point where new therapists aren’t confident at all in
their manual therapy skills in comparison to their bosses, mentors or
instructors.<o:p></o:p></div>
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As I said in last year’s article<o:p></o:p></div>
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</span></span></span><!--[endif]--><a href="https://www.tandfonline.com/doi/abs/10.1179/106698102792209585">Motion</a>
& <a href="https://www.ncbi.nlm.nih.gov/pubmed/2715742">positional</a> palpation
techniques are not reliable<o:p></o:p></div>
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</span></span></span><!--[endif]-->You can’t isolate manual therapy <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102240/">to one joint</a><o:p></o:p></div>
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</span></span></span><!--[endif]-->Different techniques have shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700500/">the same
effectiveness</a> for the same condition<o:p></o:p></div>
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</span></span></span><!--[endif]-->Manual therapy’s mechanisms are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19027342">neurological</a> in nature <o:p></o:p></div>
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Is there “no skill” required to do manual therapy? No.
You have to provide enough force & contact to make it feel worthwhile and
you have to emphasize the principles that I will discuss near the end of this
article. <o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">Is manual therapy
the most effective treatment for musculoskeletal issues? No.<o:p></o:p></i></div>
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This area is more up for debate as studies have shown
manual therapy has results ranging from placebo to even better than certain
types of exercise. You can pick any PubMed study to support your stance so I’m
not going to spend a lot of time on this other than to show that, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480856/">looking at the evidence
as a whole</a>, manual therapy falls behind exercise & psychosocial
therapies in the “hierarchy” of effective treatments. <o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">Does that mean we
should be 100% hands off? Hell no.<o:p></o:p></i></div>
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Some may argue with this but I do believe manual therapy
has its place in certain situations such as <o:p></o:p></div>
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1) Highly irritable patients<o:p></o:p></div>
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This time of year (late spring/early summer) is when I
quite often see patients in irritable situations – quite often due to doing too
much too soon with gardening, sports, backyard/cottage parties, or other
activities. Sometimes patients just do too much; or have an accident; and are pretty
sore, inflamed, and sensitized to the point where they can’t tolerate much of
any exercise. And at the end of the day there’s only so much education you can hit
someone with & expect them to retain. That’s where manual therapy comes in.<o:p></o:p></div>
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Some would argue “I’d rather have a patient’s appointment
cut short than do passive treatment” but if you’re in a clinic where everyone
gets 20-30 minute appointment times, and you only give them 5-10 minutes of
exercise & education, good luck hanging onto them.<o:p></o:p></div>
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2) Patients with medical contraindications to exercise<o:p></o:p></div>
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Occasionally, in orthopedic practice, you will get
patients who have contraindications to exercise due to recent surgery … or
cardiovascular or other medical conditions. Again manual therapy, and even
(gasp) modalities, can have a time & place in these situations. <o:p></o:p></div>
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3) Highly deconditioned patients <o:p></o:p></div>
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Similar theme as above – we’ve all had those patients
that do a few minutes on a recumbent bike or do a couple sets of a very
remedial exercise … and are “toast.” <o:p></o:p></div>
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4) Building therapeutic alliance<o:p></o:p></div>
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I only do this occasionally – but I’d rather do a few
minutes of manual therapy (or any passive therapy that isn’t contraindicated)
to get a hard headed patient on my side & get them doing what I want – then
see them go to another therapist who may provide them with a lot of negative
language. <o:p></o:p></div>
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<o:p> </o:p><i>Where do we go from
here?</i></div>
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As someone who’s been formerly involved with the
physiotherapy education system we need a paradigm shift. Instead of emphasizing
pseudobiomechanical faults (that often can’t be reliably assessed and/or don’t
correlate with pain), nocebo-ic language, and passive therapies we need a shift
towards<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Teaching professionals to be more effective
communicators & build therapeutic alliances with their patients <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Getting patients to believe in & trust in
their bodies and their adaptability<o:p></o:p></div>
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</span></span></span><!--[endif]-->Teaching manual therapy in a way that is in line
with the evidence<o:p></o:p></div>
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</span></span></span><!--[endif]-->Educating patients that pain is more than just
tissue damage<o:p></o:p></div>
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</span></span></span><!--[endif]-->Emphasizing an interactor vs an operator model
(to quote Jason Silvernail)<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Shifting from emphasizing predominantly passive
therapies in practice (and having them on this high pedestal) to using them as
an adjunct combined with exercise/movement therapies & education <o:p></o:p></div>
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</span></span></span><!--[endif]-->Putting patients in the drivers seat to improve
their quality of life <o:p></o:p></div>
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</span></span></span><!--[endif]-->And teaching therapists to be competent and confident
in all of these areas <o:p></o:p></div>
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This takes a lot of work in the physiotherapy (and rehab)
education system, in knowledge transition, and in practice. This is a big
challenge for us to take up – but is a must for us to improve the quality of
patient care.<o:p></o:p></div>
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I hope this helps find some common ground because that’s
my article – and as always thanks for reading. <o:p></o:p></div>
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<br /></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-58325089298057671392018-06-25T08:51:00.002-07:002018-06-25T08:51:36.132-07:00How Louie Simmons Influenced My Approach To Training & Rehab (for Mash Elite Performance)Over the last few weeks I have begun to put out content for strength coach & world champion powerlifter Travis Mash. I plan to keep the rehab-based content on this site and put my strength training content on his site (although I will have links to everything here).<br />
<br />
In my first article I discuss how Louie Simmons, the coach & owner of Westside Barbell, has influenced my approach to training & rehabilitation.<br />
<br />
You can check it out at the link below<br />
<br />
https://www.mashelite.com/how-louie-simmons-influenced-my-approach-to-training-and-rehab-by-eric-bowman/Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-18187514243126679272018-06-11T04:13:00.001-07:002018-06-11T04:13:16.409-07:00Advice I Would Give A New Physiotherapist Or Physiotherapy Student<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiMgmjxZR2HSbb6Sie7GojUlHXHv6dpnhIvAC7mX3NU1Wv0LGuLDwIi53VpQmjNW-0WCT53V9LaaMsgYyZzigjRmRrZIbdmQ2JOSTE2Y4DXcTTiyeYOW1Jzds9Ner48FgpADF2-2L1LurT/s1600/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiMgmjxZR2HSbb6Sie7GojUlHXHv6dpnhIvAC7mX3NU1Wv0LGuLDwIi53VpQmjNW-0WCT53V9LaaMsgYyZzigjRmRrZIbdmQ2JOSTE2Y4DXcTTiyeYOW1Jzds9Ner48FgpADF2-2L1LurT/s320/twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" width="320" /></a></div>
<br />
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Before
we get started I am going to be writing for Travis Mash’s <a href="https://www.mashelite.com/">website</a> in addition to continuing to post
content here. My content for Travis’s website will be more strength training
focused whereas this site will be more rehab focused.</div>
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<o:p></o:p></div>
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One of my favourite podcasts
is Karen Litzy’s Healthy, Wealthy, Smart <a href="http://podcast.healthywealthysmart.com/">podcast</a>. At the end of each
episode she asks her guests “what would you tell your younger self” (or
something of a similar nature). It made me think – <span style="mso-spacerun: yes;"> </span>almost three years out of PT school – what
would I tell my younger self. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>With
that in mind, in no particular order, here are some things that I wish I would
have known in PT school and when I started….<o:p></o:p></div>
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<br /></div>
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1) You probably know enough in your exercise & manual
therapy knowledge to help a lot of your patients no problem. So be confident
when assessing them and interacting with them.<o:p></o:p></div>
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<br /></div>
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Which brings me to….<o:p></o:p></div>
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<br /></div>
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2) There are a lot of things you should learn that aren’t
taught in school so take the time to do continuing education and take the time
to critically reflect on your practice & what needs to be improved.<o:p></o:p></div>
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<br /></div>
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3) Learn a system of rehabilitation such as Maitland,
McKenzie, Mulligan, McGill (why do these all start with M?). You don’t need to
be a strict Maitland, McKenzie etc therapist but I believe in the importance of
having a base system to work with and to consolidate the info you know. I see
too many therapists that are overwhelmed with information, have a hard time
consolidating it, and end up throwing crap against the wall to see what sticks.
<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn1wsjdUDrOiifov69a6lHolMxX4B7zjyFFS1Nz-wtAVXtVt5cpydZrMGTSyeP5YtW7_SjO0ttLRm5t-snACmr5WapzYTY2Lbgn0BV25grWADDQR3cK3sZXxf6XBa5SkoEr4fI4ILxHMbb/s1600/With+Dr.+McGill+Bomber+End+Of+Term+Winter+2013.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjn1wsjdUDrOiifov69a6lHolMxX4B7zjyFFS1Nz-wtAVXtVt5cpydZrMGTSyeP5YtW7_SjO0ttLRm5t-snACmr5WapzYTY2Lbgn0BV25grWADDQR3cK3sZXxf6XBa5SkoEr4fI4ILxHMbb/s320/With+Dr.+McGill+Bomber+End+Of+Term+Winter+2013.jpg" width="320" /></a></div>
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<o:p> </o:p>4) Understand that you’re never going to be able to cure
everyone. Sometimes patients won’t do their exercises or sometimes can’t modify
exacerbating activities. Sometimes the patient needs surgery or medical
management. Sometimes there are other health issues or psychosocial factors.
Sometimes it’s a chronic issue that may not get that much better. Sometimes
it’s not the right match of patient & therapist and sometimes, no matter
how evidence-based it is, it’s just not the right input to reduce threat.</div>
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<o:p></o:p></div>
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5) In physio school they teach that every exercise should
be painfree. I believe you should do the best you can to make exercises
painfree but in some situations (e.g. chronic pain, post-surgical) that may not
always be possible. In those cases you need to educate patients that hurt
doesn’t always equal and to do exercises in a way that may slightly increase
symptoms but achieves their goals and doesn’t worsen them in the long term<o:p></o:p></div>
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Which brings me to….<o:p></o:p></div>
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6) One trick I learned from listening to Greg Lehman is
to do “less more often” when working with people with signs of a central
sensitization/more widespread pain. I anecdotally find 1-2 low dose exercises
done frequently through the day more advantageous than the traditional 3x10 or
3x15 for helping these clients achieve their goals without as high of a risk of
flareup.<o:p></o:p></div>
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7) Following on the heels on #5 – pain science education
is great <span class="MsoHyperlink"><a href="http://www.sciencedirect.com/science/article/pii/S1356689X15001915">but
it does need to be tailored to the individual</a></span> in terms of <o:p></o:p></div>
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- Whether you do it or not and<o:p></o:p></div>
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- How much information you provide<o:p></o:p></div>
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Some will want to know all the details and some patients
will be put off by it. A fellow therapist said it best – ask the patient if
they want to learn more about pain. If not, no harm no foul. <o:p></o:p></div>
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8) One mistake that I made was subconsciously being in a
hurry with my assessments. It’s tough to do this after being put through
rigorous, time crunched exams but its important to really slow down your assessment
in order to build better rapport with your patients. You may very well be the
first one person in the healthcare system that’s actually listened to them. <o:p></o:p></div>
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Also – many objective physiotherapy assessments lack
reliability, validity, sensitivity and/or specificity. Towards that end you can
really hack down your objective assessment to what’s essential. <o:p></o:p></div>
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9) Take the time to learn how to progress, regress, coach
and modify exercises. I learned most of what I know about exercise coaching,
cueing, progressions & regressions from strength & conditioning
coaches. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfg8aH2QwUSKKA_xvhtUW3gLFpZuSnlhxbeeM5bzjesZrg6Gt9eSOLsHTzUR8dDVp-4J0JpH5LZ5o4CCpKs0o9fEO1X8_nL3QFGdWdQHG79Haz8s6EPLoy_ViJqqFNddWB2tLlyUuyL5tK/s1600/111-power-man-squatting-with-heavy-weights.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1000" data-original-width="1500" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfg8aH2QwUSKKA_xvhtUW3gLFpZuSnlhxbeeM5bzjesZrg6Gt9eSOLsHTzUR8dDVp-4J0JpH5LZ5o4CCpKs0o9fEO1X8_nL3QFGdWdQHG79Haz8s6EPLoy_ViJqqFNddWB2tLlyUuyL5tK/s320/111-power-man-squatting-with-heavy-weights.jpg" width="320" /></a></div>
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<o:p> </o:p>10) When it comes to managing athletic/training injuries
I believe workload management is the most important thing. <span class="MsoHyperlink"><a href="http://bjsm.bmj.com/content/50/5/273">Tim Gabbett’s
research</a></span> has shown that the “sweet spot” for increasing workload
lies at about 10-25% at a time. I tend to stick to the “10% rule” of increasing
workload in a week as a start and then go from there.</div>
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<o:p></o:p></div>
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11) Understand that a patient’s recovery (or lack
thereof) from pain or disease can be influenced by a multitude of factors
including non-specific effects (I hate the word placebo), natural recovery, and
other factors in addition to the treatments provided. <o:p></o:p></div>
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The last two points will be familiar if you’ve read my
work….<o:p></o:p></div>
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<br /></div>
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12) Probably the most important point: use positive words
with your coaching, cueing & communication. If you tell your client they
got 20 things wrong with them, need you to fix them, and will hurt themselves
with everything than that may set them up for chronic issues. <o:p></o:p></div>
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Sometimes yes – if you have a client that’s repeatedly
doing activities that worsen the issue (despite advice to modify those activities)
than you may have to come down heavy – but that should be a last resort. Read
on the <span class="MsoHyperlink"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213146/">magnitude of the
nocebo effect</a></span> and the impact of clinician words. <o:p></o:p></div>
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13) If you’re reading this site you probably value
continuing education and improving yourself (and others) as a therapist. My big
advice – take it slow and don’t rush it. I poured myself into long weeks during
and after school with writing, curriculum work, and other side ventures … and
burned myself out more than once. Understand that you’re only as good as what
you can recover from. Know that line and stick with it. <o:p></o:p></div>
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If you’re a new therapist or a student I hope this
provides you with some useful tips. As always – thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com2tag:blogger.com,1999:blog-8945612253482873433.post-16402370606048690132018-05-28T04:09:00.001-07:002018-05-28T04:10:06.274-07:00How I Assess And Treat People With Low Back Pain Part 2: Treatment<br />
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In <a href="http://ericbowman03.blogspot.ca/2018/05/how-i-assess-treat-people-with-low-back.html">Part
1</a> of this series I discussed how I assess people with Low Back Pain (LBP).
In this article I get down to the treatment side of things. I want to thank
everyone who took the time to read the article & provide such useful
feedback. Hence this article is out later than desired as I wanted to reformat
it & do it right. <o:p></o:p></div>
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Disclaimers: As I said in Part 1 this is not intended to
be medical advice. Plus I don’t expect that everyone’s going to agree with
every single point that I make – that’s fine. Also this is going to be a long
article and is very context and assessment dependent. It’s not a recipe. <o:p></o:p></div>
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My approach comes down to 4 basic tenets<o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">1) Minimize what
exacerbates the issue<o:p></o:p></b></div>
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<br /></div>
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I didn’t say “take away” or “remove” as for some people,
such as patients with chronic pain and central sensitization, that may not be
realistically doable. But I still believe in modifying and reducing (and if
possible eliminating) what exacerbates the issue. These can be <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Specific movements, postures, loads, behaviours,
activities (or volumes of activities) or repeated movements OR<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->General health factors such as poor sleep,
stress, depression, or being overweight<o:p></o:p></div>
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Going step by step through these…<o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">Movement/Posture</i><b style="mso-bidi-font-weight: normal;">:</b> My movement recommendations depend a
lot on the mechanism. <o:p></o:p></div>
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If someone is aggravated by very specific directions or
postures (i.e. what some would consider flexion intolerant or extension
intolerant) than yes I get people to move in a way that’s not provocative (or
is at least less provocative). This may involve using a neutral spine/hip hinge
technique (I teach a modified sumo lift technique for people with sciatica and
for tall people), emphasis on using the gluteal muscles more (they are never
turned off short of a neurological injury) and bracing … or conversely relaxing
the core musculature and breathing deeply as some patients are very tense &
guarded and need to relax. <o:p></o:p></div>
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<o:p> </o:p>For posture – oddly enough (and there’s a bit of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2605454/">research</a> and
anecdotal support on this) that some people tend to sit or stand in the same
posture that provokes their symptoms and some are very rigid &
overprotective!!! For these people I will have them adjust their lordotic curve
to find a position that’s comfortable for them. I’m more of a fan of teaching
people how to find movements & postures that are comfortable for them rather
than trying to find an ideal.</div>
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<o:p></o:p></div>
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One of the reasons why I look at movements and repeated
movements is to give people ways to do their day to day tasks that (hopefully)
don’t aggravate their symptoms. While I’m not a fan of telling people to avoid
movements forever it doesn’t make sense to force people through movements that
can aggravate and worsen their symptoms with repetition. Sometimes you need to
take a break from the exacerbating issues to facilitate recovery. How long
movements are avoided is a contentious topic that depends on a variety of
different factors. <o:p></o:p></div>
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For people who have more of a central sensitization (CS)
pattern it may be that everything (including hip hinging) hurts to some degree.
In these populations I’m not as concerned about movement technique as I am
about other variables (more on that below) but I will still teach some
biomechanical principles (i.e. keeping loads to the body, avoiding excessive
muscle tensing or bracing) to make things easier in theory.<o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">General health</i>:
In terms of other risk factors and contributors to LBP<o:p></o:p></div>
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</span></span></span><!--[endif]-->Sleep: I educate patients on simple sleep
hygiene (which I will write about in another article) and on the importance of
sleep. Past that if there are other issues I will refer to sleep specialists
especially if I have bigger clientele who may have sleep apnea or people who
may have major psychosocial issues.<o:p></o:p></div>
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</span></span></span><!--[endif]-->Stress, Anxiety, Depression and other
psychosocial factors: I’m gonna get some heat for saying this but I don’t
believe; unless it’s related to movement, injury, pain or activity; that
physios should be trying to treat psychosocial factors other than educating
patients about their importance, giving them some exercise to do (which can
help with psychosocial factors) and again referring out.<o:p></o:p></div>
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</span></span></span><!--[endif]-->Body weight management: Same principles apply –
educate the patient about the importance of it, get them moving, and if need be
refer out to other health professionals who can help fill in the blanks with
diet and hormone management.<o:p></o:p></div>
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The 2<sup>nd</sup> key principle of my approach to back
pain is that<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">2) Well tolerated
movement & exercise are good<o:p></o:p></b></div>
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A lot of research has shown that general exercise and
“core stability” exercises <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293521/">are equally
effective</a> for LBP management. While I don’t disagree with the research I’ve
found (anecdotally) that some people with LBP may not tolerate certain
exercises well – be it core training, walking, cycling, general strength
training, or directional exercises. <o:p></o:p></div>
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For home exercises my first go to are generally repeated
movement/McKenzie style assessments based on the directional preference of the
person I’m working with. If a client I’m working with doesn’t have a
directional preference my home exercises are generally <o:p></o:p></div>
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</span></span></span><!--[endif]-->For more nociceptive/neuropathic cases: usually
exercises that address “painless dysfunctions” (I hate the term but that’s what
people understand) that may limit an individual’s ability to move in
non-painful (or less painful) patterns such a lack of hip, ankle or shoulder
mobility and/or a lack of hip/core strength or endurance <o:p></o:p></div>
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</span></span></span><!--[endif]-->For people with more of a CS presentation: some
people I work with who have CS are insanely deconditioned and have some MAJOR
mobility or strength limitations. In those situations I give people 1-2 low
dose exercises (ie sets of 2-5 2-4x/day working into a bit of pain but not
blowing through it) to either address these limitations or maintain the
mobility that’s already there<o:p></o:p></div>
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In the clinic I am also a fan of core, glute, and general
cardiovascular exercise for most people with LBP who tolerate them. Some may
criticize me – but given the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24169445">poor adherence of patients</a>
to home exercise programs I’d rather see them do a few exercises in the clinic
rather than f*cking around with a TENS machine or ultrasound. For people who
tend to have more of a CS presentation I spend more time talking and a lot less
time with exercise & manual therapy. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">3) Address
negative beliefs about movement, the body, pain and activity<o:p></o:p></b></div>
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As I said above I’m not a fan of physios trying to be
psychiatrists. Just as you wouldn’t want a personal trainer trying to treat a
client’s broken arm … I don’t believe a physio should be trying to treat a
client’s PTSD from combat or trying to grief counsel a mother who’s lost her
kid. <o:p></o:p></div>
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But anything related to movement, activity, pain, injury
or the body is within our ballpark IMO. <o:p></o:p></div>
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Therapists such as Peter O’Sullivan have written about
the importance of beliefs as they relate to LBP. While pain science education
is important sometimes patient education has to take different paths based <a href="https://www.sciencedirect.com/science/article/pii/S1356689X15001915">on
the individual</a>. <o:p></o:p></div>
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In my experience some people respond quite well to pain
science education and others have a hard time changing their view of pain.
Behaviour change and belief change is a long, time consuming process for some
people and some may never change their beliefs. We as a society have become so
engrained in the idea that pain is always due to “issues in the tissues” that
some patients may never change their beliefs. We as therapists have to accept
that we can’t change everyone.<o:p></o:p></div>
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In more “non-specific” cases I point out how a patient’s
pain is due to changes in their nervous system and body that make them more
sensitive and more likely to experience pain. This allows me to put a “feeler”
out there to determine if the patient is interested in more pain science
education. If they are – great. If not, no harm no foul. <span style="mso-spacerun: yes;"> </span>If they want to learn more than I will draw a
bubble diagram outlining all the factors contributing to the situation and will
go into more detail about pain science in coming appointments. <o:p></o:p></div>
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In patients where there is a legit tissue injury, or in
cases where a patient is dead-set that their MRI findings are the cause of the
problem, I point out how a lot of back injuries <a href="https://www.ncbi.nlm.nih.gov/pubmed/28072796">can heal</a> given proper
management. <o:p></o:p></div>
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A big component of my work is positive coaching and
cueing. Some health and fitness professionals freak patients out by pointing
out numerous dysfunctions that either can’t be reliably assessed and/or don’t
correlate well with pain. I don’t coach certain people to do certain movements
or exercises by saying “do this or your back will explode.” I coach movement
and positional strategies in a way that empowers patients to move in ways that
are comfortable for them. Sometimes showing people ways to move and exercise
that are comfortable for them alleviates a lot of the anxiety and enables
people to trust in their bodies a lot more. <o:p></o:p></div>
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I also believe that getting people to do things they
never thought they could do (within reason of course) and progressively working
them towards the activities they want to do also helps build confidence &
change beliefs.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">4) Build people
back to the activities that they want to do<o:p></o:p></b></div>
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This is where we tackle the first elephant in the room …
spinal flexion <o:p></o:p></div>
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<o:p> </o:p>Yes – most of my patients that I see on Day 1 (arguably
over 97%) don’t tolerate much spinal flexion. As such I try to minimize that in
the early stages. However, while I’m still reluctant to have people flex 100
million times a day or to do it under heavy load, I do believe we should be
able to move our spines as needed.</div>
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<o:p></o:p></div>
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When patients are getting closer to full recovery I start
to ease them back into spinal movements through low-load exercises such as cat
camels & prayer stretches and progress them to being able to move fully in
standing. There are however situations where I will stick to the “minimize
spinal movement” approach such as….<o:p></o:p></div>
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</span></span></span><!--[endif]-->People with a recurrent flexion or extension or
motion intolerant low back pain that is more nociceptive and/or neuropathic in
nature<o:p></o:p></div>
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</span></span></span><!--[endif]-->People with moderate to severe osteoporosis who
are at <a href="https://www.ncbi.nlm.nih.gov/pubmed/25460926">higher risk of
fracture</a><o:p></o:p></div>
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</span></span></span><!--[endif]-->Athletes who require a great degree of spinal
stiffness in their sports such as powerlifters<o:p></o:p></div>
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In these three populations I often encourage people to
hip hinge as much as possible. I don’t say “don’t bend your back or your spine
will blow out” but I do believe that hip hinging is a better option to achieve
their goals. <o:p></o:p></div>
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If a certain exercise or activity is a goal of the
individual (e.g. returning to walking) than the activity itself (or some close
derivative) is part of the exercise program and is progressed based on the
individual’s activity tolerance in increments of 5-20% per week based on how
the patient responds. As Tim Gabbett has said (yes his research is in athletes
but I believe it applies here too) people respond <a href="https://www.researchgate.net/publication/320519829_Pain_and_fatigue_in_sport_are_they_so_different">differently</a>
<a href="http://bjsm.bmj.com/content/early/2016/01/12/bjsports-2015-095788">to
different</a> increases in activity and as such you have to be flexible to
adjust the rate of progression to your clients tolerance. <o:p></o:p></div>
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For people with nociceptive or neuropathic pain I prefer having
people do activities in shorter bursts, stopping just before their pain would
increase, and repeating those bursts through the day. I find anecdotally that
many of my patients who use this technique for walking or activities experience
a huge increase in their pain free walking tolerance within a couple weeks. <o:p></o:p></div>
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For people who have more CS with walking (or any
activity) I just advise that it’s OK to work into a little bit of pain, not to
blow aggressively blow through pain, and work with them to slowly increase the
amount that’s done.<o:p></o:p></div>
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<o:p> </o:p><i>What about the
other elephant in the room – manual therapy?</i></div>
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I’ll confess that I use manual therapy less than most
therapists do. If it’s a patient that’s had chronic back pain for years and has
already sought out a bunch of passive treatment modalities than manual therapy
isn’t going to be the first thing that I’ll do with them. In addition I find
manual therapy, no matter how gently its done, just makes some people really
sore. <o:p></o:p></div>
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By the same token if I have a case that’s so irritable
that they can barely tolerate any activity, someone who’s overdone it, or
someone who is limited in ability to exercise due to deconditioning or medical
comorbidities, than manual therapy (or even modalities) can play a role but in
my opinion it’s not as important for overall treatment as many therapists
think. <o:p></o:p></div>
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When doing manual therapy for the back (or for other
joints) I try to direct it towards painless limitations (I hate the word
dysfunctions) first and then afterwards painful areas. Since manual therapy’s
effects are non-specific, if I can reduce pain and improve function in another
of the body that kills 2 birds with 1 stone. <o:p></o:p></div>
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So that is basically how I go about treating people
with LBP. As always, thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com5tag:blogger.com,1999:blog-8945612253482873433.post-54639520912454218152018-05-07T04:10:00.001-07:002018-05-07T04:10:23.641-07:00How I Assess & Treat People With Low Back Pain Part 1: Assessment<br />
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I get asked all the time,
especially when people find out I’m a physiotherapist, “what can I do for my
back pain” or “what exercises can I do for my back?” These are understandable
questions as Low Back Pain (LBP) is the leading cause of disability worldwide
costing the health care system millions of dollars in assessment, diagnosis and
treatment.<o:p></o:p></div>
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When it comes to LBP assessment
and treatment we are in a bit of a difficult spot as the vast majority (80-90%
of LBP) cases are not attributable to a specific diagnosis such as a disc
pressing on a nerve root, a fracture, or a lumbar muscle strain. As such most
LBP cases get lumped into the “non-specific LBP” category. While attempts have
been made to subgroup LBP patients the validity of most subgroups have been
called into question over the last several years. <o:p></o:p></div>
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In terms of treatment the same
conundrum exists as many treatment approaches are equally effective for LBP, no
form of exercise seems to be better than the other, and the validity of
clinical prediction rules has also came under scrutiny over recent years.<o:p></o:p></div>
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
This leaves us in a bit of a
tough situation – what do we do for people with LBP? Well in my article I will
address how I personally assess & manage someone with LBP in the clinic…. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Disclaimer 1: This is for professionals and is not
intended to be medical advice. If you have any symptoms such as fevers, chills,
night sweats, unremitting night pain, unexplained weight loss, sickness or
unwellness, tingling/numbness in the groin, changes in bowel/bladder function
and/or a loss of sexual function you may have symptoms suggestive of a serious
medical pathology and may need to seek medical attention as soon as possible.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Disclaimer 2: The topic of individualized management in
LBP is a controversial one so I accept full well that people (you the reader
included) may or may not agree on all the points here but I do hope you will
give it a read.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Side note: at the time I was working on this article I
happened on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633330/">this
paper</a> which is very very similar to my approach (aside from a few
subtleties) <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
FIRST THINGS FIRST – RULE OUT RED FLAGS AND SERIOUS
TISSUE PATHOLOGY<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The most important reason as to why someone in pain
should see a doctor and/or a physical therapist is to make sure, if anything
else, that there are no major health concerns that need to be medically
managed. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27797737">research 1-2% of LBP cases</a>
are attributable to a serious pathology such as fracture, cancer, infection,
inflammatory condition, or cauda equina syndrome among others. I will not go
over the symptoms suggestive of these conditions but I suggest updating
yourself on these regularly if you are a professional. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
AVOID UNNECESSARY IMAGING<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
<a href="https://www.ncbi.nlm.nih.gov/pubmed/27797737">Imaging
is indicated for</a> LBP patients if they have symptoms suggestive of a red
flag or serious tissue pathology and/or if they have a significant neurological
deficit (i.e. dermatomal loss of sensation and/or myotomal weakness) that isn’t
improving with conservative management. This applies to a small percentage of
people with LBP.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Unfortunately medical imaging is overused, particularly
in the US. Now I understand that its easy for doctors to feel pressured to send
patients for imaging, but a lot of research suggests that people with LBP who
don’t have an indication for imaging are actually worse off getting an X-ray or
MRI.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Also – its important to keep in mind that <a href="http://bjsm.bmj.com/content/early/2017/08/10/bjsports-2017-097725">80% of
people with LBP</a> have 1+ symptoms suggestive of a red flag condition yet
only 1-2% have them. As such its important to have good clinical reasoning to
order special tests. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
But won’t the X-ray or MRI show me what’s wrong?<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The problem is numerous studies have shown that lots of
PAINFREE people have degenerated discs, arthritis, and disc lesions among other
things. See the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/">chart
below</a> for examples. <o:p></o:p><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkw6LPVYxLqUY3gqHcpuKDdoqH_Ln7vwpQ54tetrwm8qS8e7cqHuPXWnrLKXSqJOmNSPuXCh6bD_XxKSgutZlzJCEYX6LDegQgIv1Y98qJyG9LFuG1PC-NSAt3pG5bEUQLjNU0ag0iCVtN/s1600/1+asymptomatic+imaging+findings.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="294" data-original-width="600" height="156" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkw6LPVYxLqUY3gqHcpuKDdoqH_Ln7vwpQ54tetrwm8qS8e7cqHuPXWnrLKXSqJOmNSPuXCh6bD_XxKSgutZlzJCEYX6LDegQgIv1Y98qJyG9LFuG1PC-NSAt3pG5bEUQLjNU0ag0iCVtN/s320/1+asymptomatic+imaging+findings.png" width="320" /></a></div>
<br /></div>
<div class="MsoNoSpacing">
Patients often freak out about what their MRI findings
say while they may be incidental.</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
WHAT DO I LOOK FOR IN SOMEONE WITH LBP? <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
I look at pain from a biopsychosocial perspective.
Breaking it down<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Bio – general health factors (e.g. fitness,
comorbidities); aggravating/relieving movements, postures, and loads; sleep;<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Side note: a lot of research claims that biomechanical
factors don’t correlate with LBP which isn’t necessarily wrong but I do believe
biomechanics shouldn’t be ignored. Sometimes people do have pain with specific
movements/postures which may be due to overuse of those movements/postures,
guarding, kinesiophobia, or other factors. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Psychosocial – factors that can be related to movement,
injury and pain such as fear avoidance, catastrophizing, kinesiophobia, other
maladaptive beliefs and passive coping; as well as psychosocial factors such as
stress, anxiety, work situation, and depression <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
I also look at what the patient is working towards (in
terms of occupational and/or sporting demands) as well as their goals. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Prior to assessment I’ll have each patient fill out the
Orebro Questionnaire – a questionnaire designed to detect psychosocial factors
& factors that can place someone at an increased likelihood of chronic
pain. I’m not as interested in the overall score as I am in the score of individual
items. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
SUBJECTIVE ASSESSMENT<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Peter O’Sullivan taught me to open my assessment with “tell
me your story.” I say that, shut up, and let the patient say what they have to
say. I find this gives me probably 65-70% of the useful information I need and
it gives the patient a chance to get whatever they need to get out there &
off their back. Sometimes just talking can be therapeutic.<o:p></o:p><br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlSuE28f9WxK06oSa6YeMp0vXxtbS26bEt1W2hB6evKJEXuaW66JU3NKpI5luIjo2bJ1EL17nKANZnYYOGk9hAh8o-fKgL3js58aTgBFbiOHgl1H88xgnkJuKcV_Cp0PVvVPja8uiF2bdH/s1600/1+twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlSuE28f9WxK06oSa6YeMp0vXxtbS26bEt1W2hB6evKJEXuaW66JU3NKpI5luIjo2bJ1EL17nKANZnYYOGk9hAh8o-fKgL3js58aTgBFbiOHgl1H88xgnkJuKcV_Cp0PVvVPja8uiF2bdH/s320/1+twenty20comp_90ea51d3-55b5-4862-95a6-16ab163548e9.jpg" width="320" /></a></div>
<br /></div>
<div class="MsoNoSpacing">
Examples of specific questions (aside from ones to rule
out red flags) that I’ll ask are</div>
<div class="MsoNoSpacing">
<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Any recent life changes in your family, work,
hobbies, or financial life? You don’t have to tell me the specifics if you
don’t want to.<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Have you had any X-rays or MRIs recently?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Have you gotten any advice from your doctors,
friends/family members, or the internet on what is going on and how to address
it?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->What do you think is going on?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->How have you been doing in managing this? <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Any stress, anxiety or depression?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Any issues with sleep before or after this
started? <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->How has this impacted your life?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Where do you see yourself in 6 months?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->What would you like to do that you aren’t
already doing? <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Have you had to stop or modify any activities?<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->What do you think would happen to you if you did
<insert activity here>? <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Some may disagree with me, but aside from workers comp
cases, I don’t ask a lot of questions specifically about pain except for <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Whether it’s constant or intermittent<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Type<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Aggravating/relieving factors<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
I find the 0-10 pain scale highly subjective plus I don’t
like the idea of feeding into a patient who may be ultra pain focused &
causing them to ruminate about it even more. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Two papers I recommend for people wanting to learn more
about a good biopsychosocial subjective history are the papers “<a href="https://t.co/HJQ1SDRWMz">Listening Is Therapy</a>” and Peter O’Sullivan’s
recent “<a href="https://t.co/ocOnVj7TMS">Cognitive Functional Therapy</a>”
paper. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
OBJECTIVE ASSESSMENT<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
My objective assessment is basically a hybrid of the
McKenzie (MDT) assessment as well as the assessment Stu McGill describes in his
books Low Back Disorders, Back Mechanic and Gift Of Injury. These assessments
guide my exercise, movement & postural recommendations towards what is more
tolerable and (temporarily) away from what’s not tolerated in the early going.
For the sake of not giving away their work (and keeping this article from
getting ridiculously long) I recommend you buy and read those books.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
In addition to these I also do a simple neurological
assessment (ie dermatomes, myotomes, reflexes & cord signs). As I’ve
written about before <a href="http://www.tandfonline.com/doi/abs/10.1179/106698102792209585">motion
palpation</a> & <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807681/">positional palpation</a>
are unreliable so I just quite frankly don’t bother with them. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
I also, in a SFMA-ish style, will look at gross function
of the surrounding joints (ie hips, shoulders, ankles) to see if a deficit in
one of those areas may be causing a client to have to “overdo” painful
movements due to a lack of mobility, strength, or motor control at a distal
joint. An example of this could be someone who has pain with lumbar flexion but
has to flex the lumbar spine everytime they bend over due to a lack of hip mobility.
<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
This isn’t so much of a subgrouping approach but it enables
me to pick and choose what is important to the individual’s treatment plan. I’ve
had patients with no psychosocial factors and patients with a ton of
psychosocial factors involved. <o:p></o:p></div>
<div class="MsoNoSpacing">
<br />
<br /></div>
<div class="MsoNoSpacing">
I hope this helps give you an idea of how I assess people with LBP. In Part 2 of this series I get down to the treatment side
of things. As always - thanks for reading.<o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com5tag:blogger.com,1999:blog-8945612253482873433.post-18690626212086424522018-05-01T05:40:00.002-07:002018-05-01T05:40:26.511-07:00Random 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<br />
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">Are burpees (or
any exercise) good or bad? <o:p></o:p></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
A lot of good discussion lately on burpees and whether
exercises are good or bad.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
My simple thoughts are it depends on ...<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
1) The medical/injury history of the individual<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
2) The baseline fitness level<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
By contrast to 1 & 2 people who are healthy &
capable of doing these exercises properly are probably OK as long as they<br />
- progress their volume appropriately<br />
- provide appropriate rest & deloads<br />
- don't max out all the f*cking time<br />
- manage sleep, nutrition, hydration and psychosocial factors<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
3) The goals of the individual<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
The McGill and Weingroff biomechanically influenced guy
in me uses the goals to determine the acceptable risk/benefit ratio of an
exercise.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
If you're like me who enjoys powerlifting than heavy (by
my standards <span style="mso-no-proof: yes;"><!--[if gte vml 1]><v:shapetype
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alt="https://static.xx.fbcdn.net/images/emoji.php/v9/f4c/1/16/1f642.png"
style='width:12pt;height:12pt;visibility:visible;mso-wrap-style:square'>
<v:imagedata src="file:///C:/Users/Owner/AppData/Local/Temp/msohtmlclip1/01/clip_image001.png"
o:title="1f642"/>
</v:shape><![endif]--><!--[if !vml]--><img alt="https://static.xx.fbcdn.net/images/emoji.php/v9/f4c/1/16/1f642.png" height="16" src="file:///C:/Users/Owner/AppData/Local/Temp/msohtmlclip1/01/clip_image001.png" v:shapes="Picture_x0020_1" width="16" /><!--[endif]--></span><span class="7oe">:)</span> )
squats & deads are a part of the sport. If you're training for general
health/fitness there may be better options.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">How I go about
challenging patient beliefs … before I actually challenge them <o:p></o:p></b></div>
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<br /></div>
<div class="MsoNoSpacing">
On challenging patient beliefs...<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
What I do do is<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
1) Just simply be a good person, listen to and validate
the patients' story. Nothing replaces this.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
3) I try to empower them by<br />
- showing them what they can do and<br />
- giving them a plan to manage pain and get back to what they want to do<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
5) Don't scare the shit out of them with nocebo-ic
language<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
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Some people may disagree with some of my points, that's
fair enough, but that's how I go about belief changes & empowering patients.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">The “Bottom Up” Prioritization
Pyramid – How I Wear Multiple Hats<o:p></o:p></b></div>
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<br /></div>
<div class="MsoNoSpacing">
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. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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, <a href="https://www.powerrackstrength.com/priority-of-exchange/">Will Kuenzel</a>
and <a href="http://tonygentilcore.com/2018/04/everything-moderation-makes-mediocre-everything/">Nicholas
Licameli</a>. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Let’s start with the foundation. The foundation enables
you to fulfill your priorities, maintain morale & not burn out. For me that
includes<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->7+ hours of sleep a night<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Adequate high quality food in the right amounts<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Adequate down time and contact with friends <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.
<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
To give a visual example of what this looked like during
my storm stayed week in Fergus. <o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp-sI22-sFLsRKeqemGylmqV9980wumR7Z3FMRjbibfJYvlogfn5tqV5gNCOOqTDlQlKwRl88ARqef2Ra3722LG2LN6yshuO7KMLN9ZUtl4uo-bxbWAw4DfGZ1EaDVxK3bisKSEVPVMdOo/s1600/priority+pyramid+example.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="412" data-original-width="584" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgp-sI22-sFLsRKeqemGylmqV9980wumR7Z3FMRjbibfJYvlogfn5tqV5gNCOOqTDlQlKwRl88ARqef2Ra3722LG2LN6yshuO7KMLN9ZUtl4uo-bxbWAw4DfGZ1EaDVxK3bisKSEVPVMdOo/s320/priority+pyramid+example.png" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing">
<br /></div>
<br />
<br />
<div class="MsoNoSpacing">
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. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
If you’re someone who wears multiple hats I hope this
helps you. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
<b style="mso-bidi-font-weight: normal;">Are personal trainers
bad at coaching exercises or just uneducated? <o:p></o:p></b></div>
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<br /></div>
<div class="MsoNoSpacing">
Quick rant for you trainers & strength coaches out
there.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing">
Maybe the problem is that the trainer wasn't properly
educated in the first place.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
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.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Rant over.<o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com1tag:blogger.com,1999:blog-8945612253482873433.post-21838056684986532082018-04-16T14:44:00.001-07:002018-05-21T04:28:24.301-07:00The Most Underrated Tool In Your Rehab & Fitness Arsenal – The Short, Frequent, Daily WalkUpdated May 21, 2018<br />
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHGY4twDGggW5eImR7uVJPZSHTBu1S9qXAYbgEGb-miMpZGVeY7EdiK7bIMGtyyJdRt6XliK9HuToFRl_d6-A_gK79h286HJtKUnasZaM4prpcko1cQkexvtBzgg39_27xlg6OCTGKAoAM/s1600/19-woman-walking-in-the-park.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1500" height="218" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHGY4twDGggW5eImR7uVJPZSHTBu1S9qXAYbgEGb-miMpZGVeY7EdiK7bIMGtyyJdRt6XliK9HuToFRl_d6-A_gK79h286HJtKUnasZaM4prpcko1cQkexvtBzgg39_27xlg6OCTGKAoAM/s320/19-woman-walking-in-the-park.jpg" width="320" /></a></div>
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<br /></div>
<div class="MsoNoSpacing" style="text-align: center;">
Photo courtesy Focus Fitness</div>
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<br /></div>
<div class="MsoNoSpacing">
<span style="mso-tab-count: 1;"> </span>Before
we get started I just want to say thank you and props to Jacob Lucs, Jordan
Foley and Mark Giffin for an amazing weekend at the Canadian Powerlifting Union
Coaching Workshop & Seminar at The Vault Barbell Club in Guelph two
weekends ago. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing" style="text-indent: 36.0pt;">
In May of last year I got to
meet former pro-bodybuilder & world record powerlifter Stan “the Rhino”
Efferding. In addition to numerous other knowledge bombs in lifting &
business – one of the big concepts he drew my attention to, through his presentation
& videos, was the concept of the “10 minute walk.” In this article I
discuss the concept of the 10 minute walk & the science behind. I also take
the concept a step further to discuss how short, frequent, daily walks can be
applied for various diseased, pained and healthy populations. <o:p></o:p></div>
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<br /></div>
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<i style="mso-bidi-font-style: normal;">The 10 minute walk
… and how it originated<o:p></o:p></i></div>
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<br /></div>
<div class="MsoNoSpacing">
The concept of the 10 minute walk started with <a href="https://www.ncbi.nlm.nih.gov/pubmed/27747394">research</a> that was done
in Australia on people with Type 2 Diabetes. Research showed that a 10 minute
walk after each meal (3 times/day) was more effective than a single 30 minute
daily walk for improving insulin sensitivity & glucose levels. An <a href="https://www.ncbi.nlm.nih.gov/pubmed/22776874">earlier study</a> also showed
that a 10 minute walk<span style="mso-spacerun: yes;"> </span>times a day
improved blood pressure more than single daily 30 minute walk. And an informal
experiment that came out <a href="https://www.independent.co.uk/life-style/health-and-families/step-counting-10000-per-day-good-health-fitness-weight-loss-control-a8186851.html">this
year</a> showed that doing 3-10 minute walks a day at a brisk pace resulted in
more moderate to vigorous physical activity than doing the traditional 10,000
steps a day. <o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
At this event, and in Stan’s <a href="https://www.youtube.com/watch?v=xyrmMjxHzPE">later videos</a>, he’s
discussed how he’s used these 10 minute walks with his clients (including
Hafthor Bjornsson and Brian Shaw) in combination with either a calorie deficit
or surplus for weight loss or muscle gain goals, respectively. Stan <a href="https://www.youtube.com/watch?v=BeOc7TRo9Os&t=5250s">recommends</a>
doing these walks 2-4 times a day after a meal. <o:p></o:p></div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDLeQQshou_vxhOAFfR_WnP1udNcK2rQCwXSzO2g0hwypKSXCfJxIoR8Eqft8QRFlssdG5_84pojfVpaRyYk1RWjbDgWh8ktrv3yQstW7a6b4y-kAYydso8xHQ3vlVUrr6FpXTy89N0RLS/s1600/20170513_130202.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDLeQQshou_vxhOAFfR_WnP1udNcK2rQCwXSzO2g0hwypKSXCfJxIoR8Eqft8QRFlssdG5_84pojfVpaRyYk1RWjbDgWh8ktrv3yQstW7a6b4y-kAYydso8xHQ3vlVUrr6FpXTy89N0RLS/s320/20170513_130202.jpg" width="240" /></a></div>
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<o:p> </o:p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/18562968">benefits</a>
of walking have <a href="https://www.ncbi.nlm.nih.gov/pubmed/9181668">been</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098122/">well</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920578/">studied</a> and
include</div>
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<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Improved cardiovascular & metabolic health<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Improved sleep<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Improved mental health<o:p></o:p></div>
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<br /></div>
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Short, frequent walks also have many benefits compared to
single walks such as <o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Ease of fitting into a busy schedule<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Less monotony<o:p></o:p></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->More frequent activity & shorter sitting
durations<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
Side note: sitting is not the new smoking like many would
have you believe but, for most people, less sitting & more movement is
overall better for health.<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
So as you can see 10 minute walks are definitely a great
idea if you can do them but….<o:p></o:p></div>
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<br /></div>
<div class="MsoNoSpacing">
<i style="mso-bidi-font-style: normal;">I work with
clinical populations. They’ll never be able to tolerate three 10 minute walks
daily!!<o:p></o:p></i></div>
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<br /></div>
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Some populations – be it due to deconditioning or pain
may not be able to do these sessions. This doesn’t mean however that they can’t
reap the benefits of short, frequent daily walks – just that the sessions have
to be modified.<o:p></o:p></div>
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<br /></div>
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Some clinical populations that may not be ideal for these
are <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-fareast-font-family: Calibri; mso-hansi-font-family: Calibri;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->People who are contradicted for exercise due to
cardiovascular or metabolic reasons. I recommend you look up the ACSM &
CSEP guidelines for a full list of these contraindications.<o:p></o:p></div>
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</span></span></span><!--[endif]-->People with weight bearing restrictions or
limitations post fracture, dislocation, or surgery<o:p></o:p></div>
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</span></span></span><!--[endif]-->People who have balance issues and are at high
falls risk <o:p></o:p></div>
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Two populations that I use short, frequently, daily walks
with a lot are <o:p></o:p></div>
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1) People with respiratory diseases<o:p></o:p></div>
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2) People with low back pain and/or lower limb pain<o:p></o:p></div>
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3) I also use these with people in cardiac rehab … but a
discussion of cardiac rehab is outside of the scope of a quick 500-1000 word
blog.<o:p></o:p></div>
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Getting back to those populations I mentioned earlier<o:p></o:p></div>
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1) People with respiratory diseases – I’m a big fan of
interval training for people with COPD, asthma, and other conditions as its
less monotonous and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23728873">allows
for more recovery & less shortness of breath</a>. In these populations I’ll
have clients walk for anywhere from between 15-60s at a 4-8/10 RPE (sometimes
less than that), rest for 45-120s, and repeat for 8-30 minute long sessions. As
with people with musculoskeletal pain, I like to increase the number of
intervals before decreasing rest periods.<o:p></o:p></div>
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2) People with low back or lower limb musculoskeletal
pain (i.e. OA) <o:p></o:p></div>
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Some research has shown interestingly enough that walking
can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293521/">be just as
effective</a> as core stability training for people with back pain. The trick
is to have it dosed in a way that doesn’t increase long term symptoms. <o:p></o:p></div>
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For walking duration – I like to have these people stop
just before their pain would increase. The frequency of walks is inversely
proportional to the duration of walking that is tolerated. If someone has pain
after 20 steps of walking I will have them walk for 15 step intervals as
frequently as every couple hours through the day. If someone’s pain increases
after 30 minutes of walking I may only have them walk twice daily for 20
minutes at a time. This technique was taught to me by professor Stuart McGill in
his books Back Mechanic & Gift of Injury with Brian Carroll. <o:p></o:p><br />
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Sometimes; for people who are morbidly obese and are
limited due to mobility limitations, balance issues, or musculoskeletal pain; I
prefer replacing the walks with stationary bike rides – a tactic <a href="https://www.youtube.com/watch?v=pPnGvp_Yg8w">Stan</a> has used with some
of his larger clients. <o:p></o:p></div>
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I hope this article shows why short, frequent walks are
an underrated tool in the fitness arsenal as well as how to apply them to
clinical populations that you may work with. As always - thanks for reading. <o:p></o:p></div>
<br />Eric Bowmanhttp://www.blogger.com/profile/06345318541180226892noreply@blogger.com0