Friday, July 15, 2016

Loading and Unloading the Body

The more I work on patients and athletes the more I kind of view therapy as learning what to load and what to unload and how to manage it.  Load can be another view of stress.  When you stress a muscle or joint you are asking it to bear the burden, "to bear the load."  When you are unloading the muscle or joint or area, you are taking away stress from the muscle or joint.  I think most pain in a muscle or joint is that to much stress/load is being applied to the muscle or joint.

I think a lot of therapy and therapist are good at unloading a joint or muscle.  I think therapy as a whole has done a very bad job of loading tissue.  I think most therapists are afraid to properly load tissue.  Without loading the body, no progress can truly be made.  Even acute injuries, if you understand the injury mechanism can be loaded for faster recovery.

An example would be a hamstring tear that occurred on a Friday, the athlete may be able to do slow dribbles on a Saturday. A few things are happening.  First, the hamstring is still involved.  There is a neural competency that is making the muscle stay active, but at such a slow speed as to not aggravate the injury.  Second, we are increasing blood flow, paramount for healing.  Third, we are beginning the slow process of keeping the skill set of sprinting ingrained.  Finally, we are giving the athlete active part in the recovery process.  This isn't passive, only relying on the therapist.  I think this may be as important as all of it combined.  Passive treatment can lead to woe is me, victim mentality.  When the athlete stays involved from the onset, an injury can be just something to overcome.

This doesn't even going into all the different workouts that may be able to be done upper body.  Perhaps even riding a bike slowly could be done right off the bat.  

Chronic problems need even more direct approach.  Lower back pain isn't about just unloading the stress from the back or hip.  It's about finding what needs to loaded to ultimately unload the lower back from that stress.  A runner that comes in with knee pain after 5 miles, most likely needs to learn to load the hip better, not unload the painful area.

Years ago Gray Cook came up with the "Joint by Joint" approach.  Essentially, alternating joints have different components of mobility and stability.  Mobile big toe, stable mid foot, mobile ankle, stable knee, mobile hip, stable lumbar, mobile thoracic, stable cervical, mobile upper cervical, stable elbow, mobile wrist.  

I think there is a general "Load and Unload" approach.  I think most people will agree that the joint by joint approach is correct it doesn't mean the hip at times won't need to be more stable in certain individuals.  I think the load/unload approach is even more general.  Just what I see that is more common.  

Muscles to unload (destress)          Muscles to Load (Stress)
abductor hallucis                               extensor hallucis
medial soleus                                    lateral gastroc/ tibialis anterior
vastus laterals                                   rectus femoris (end range)  
psoas                                                 lower ab and external obliques
adductor magnus                              glute max
semimem/semitendinosis                 biceps femoris
TFL area                                           glute med/min
lumbar erectors                                 lumbar multifidi
thoracic erectors                               latissimus dorsi 
pec sternal                                         pec clavicular
anterior delt                                      posterior delt
levator scapula                                  upper trap/lower trap
rhomboid                                          serratus anterior/ mid trap
brachialis                                          biceps 
forearm flexors                                 forearm extensors (end range)
triceps lateral/medial                        triceps long head
SCM                                                 deep cervical flexors

This is probably very similar to what you will find on what is phasic and what is tonic.  But, it's just my way of viewing what are some common patterns that I see.

The key point to understand is to figure out ways to start loading the tissue and get better at loading it, not just address the unloading of tissue.   This approach can work for all forms of scenarios.  How much load or work can a patient assimilate in one treatment?  How much load or work can you athlete handle in a workout.  What is the deload strategy?

We can view exercise as a global load on the human body and something like a desk job as unloading the human body.  This has to be brought into balance or the human body will not remain healthy.  When astronauts go to space, special measures must be taken as their bodies immediately start losing bone and muscle mass as gravity (load) is no longer upon them.  How much can we load an older individual to keep their bone mass healthy?

I often ask the question, what stretches or exercises have you done that makes you feel better or worse.  You will be surprised how often the patient has the answers, but doesn't realize it.  "I feel horrible every time I stretch my hamstrings, but I love doing lunges." Again, their giving clues as to how their body likes to loaded.  As a therapist when you start looking at the issue your patients or athletes are dealing with, start looking for a way to load them to unload them.  In my opinion this will bring longer lasting results.

Wednesday, July 6, 2016

Reframing for Resiliency

Over the last several months I've been practicing the concept of reframing.  Some times I'm successful and sometimes I'm not.  Reframing is taking the situation you are dealing with and trying to look at it from a new perspective.  It doesn't change the situation.  It changes how you are going to react to it.

Create a different viewpoint.

My biggest downfall in terms of attitude is easily my viewpoint on time.  My time, or what I consider my time.  The concept that this thing or person gets this time, this task gets this amount of time and oh yea, this chunk of time is MINE.  Free to do with it whatever I want.

Life has a way of eating up that time occasionally.   Life chores, kids, owning a business, friends, family all have at moments eaten up "my time."  When it did, I would get angry, bitter, annoyed.  The gamut.  It was a weakness.

There is a quote by Henry Rollins that really got me thinking and looking at this more intently.

Time is not yours.  No one is actually promised time.  How many people have left this world to early thinking that they had more time?

Memento Mori may indeed be cliche.  But it is true.  We are all mortal.  No one is promised more time, another opportunity.  Time is a gift.  This is how I  reframed "my time" to build resiliency in myself.  I am better at what was a weakness.

I hate mowing the lawn.  It is a life chore to me.  It is not going away.  Once a week, I had to suck it up and just do it.  Again, it was something that I felt was robbing me of "my time."  How to reframe it?  It seems silly, but I threw on a weight vest and considered it aerobic work.  All of a sudden something I hated, became something I somewhat enjoyed.  Nothing changed but how I dealt with a life task, reframed.

Thanks to Stu Mcmillan, Sprint Coach at Altis, for his posts and conversation this past week about resiliency.  (Check out his instagram posts under @Fingermash, they are worth the follow)  He states that resiliency is a skill, like any other that can be trained.  It's his posts and conversation that got me thinking that reframing is a way to build a skill to to improve resiliency.

I think learning to reframe things is key.  Most people would consider resiliency to be getting up when you get knocked down.  For athletes, its bouncing back after an injury, a bad race, a unfair call.  Its reframing a disappointing performance.  It can also mean not letting a great performance deter you from the further work that needs to get done.

This past week at US Olympic trials I got to see great performances and disappointing ones.  I got to see Olympic dreams dashed because of someone elses error.  Imagine 4 years of work for a dream, gone because someone tripped you!

I have no idea if these athletes will show resiliency.  I do believe if these athletes will be successful, they must show resiliency through reframing.

The more often we practice reframing the easier and easier it will get, just like training a muscle.  The more you do it, the easier it will work.  The more it will get engrained in your psyche.

I write this in an airport waiting to catch my last flight home.  I was supposed to be home yesterday.  Storms, closed airports, crew switches and closed airports had different plans.  I'll eventually make it back to Grand Rapids, just not on the time I had planned.  I had to do some major reframing for me to not blow a gasket.  It sucked sure, but it gave me some time to read, write, listen to some podcast, and music.    Four things I enjoy.  Would I rather be home?  Yes, but that wasn't an option.

Don't begrudge the time you are in because it didn't work out, be grateful you have life time to deal with it.