Two weeks ago, I had the pleasure of travelling to the beautiful city of Vancouver to meet and learn from Diane Jacobs. Diane is a physiotherapist whose tireless investigation of neuroscience and pain has been generously shared online for several years. I first bumped into her in cyberspace several years ago and have followed the development of her thinking and practice on SomaSimple ever since. I think it is safe to say that few have done more studying and reflecting than Diane in order to build a scientific foundation under manual therapy for pain.
So why is a scientific foundation so important? For far too long, physiotherapists have settled for "whatever works" in treating pain. Understandably, whatever works is often acceptable for someone who is seeking relief from their suffering. But we can do better. Our understanding of the brain and the rest of the nervous system is growing every day and it is information desperately needed to update our professional body on knowledge. Medicine and therapy, in attempts to emerge from empircism and tradition, have taken up the mantle of Evidence-Based Medicine. While helpful in many ways, this editorial highlights the futility of lobbing outcomes studies at one another like grenades. Rothstein points to the importance of theory to guide our thinking and practice.
I have questioned outdated models of human function on this blog before. Critiquing theory does not necessarily mean I think these models offer nothing of use. Reading outcome studies that show questionable theories are effective in practice does not convince me that the theory is correct. Although much remains to be figured out, there are some concepts that do not meet the criteria of plausibility and do not warrant further consideration. Some explanations offered are little more than perceptual fantasy. If these are not informed with what science tells us, they become nothing more than belief systems and cults of personality.
Throughout her long career, Diane has both studied and subsequently deconstructed many such systems of treatment. She has worked hard to understand - in the light of neuroscience - what she feels under her hands and the changes induced in people's bodies. She understands the role of therapist as catalyst to help a person's nervous system do the necessary work of down-regulating persistent pain and she performs her task with the light hands of an experienced guide that knows the landscape well. All of this and she is still seeking better maps. Here's why it matters: science - the effort to discover and the method of perpetual inquiry - is our best hope of deepening our understanding. It requires informed theory and good research. It requires clinicians to bring it to the care of their patients.
Wednesday, October 29, 2008
Sunday, September 28, 2008
Pain is Like Thirst
A client asked me the other day why she recently began having pain in her legs again after several months of being painfree. In spite of my efforts at education, pain remained for her a signal that something was "broken" and being painfree meant it had been fixed. Now, apparently, something had gone wrong and she wondered why the "fix" had not held. After all, nothing had really happened that would have caused this injury. So why the pain?
As uncomfortable as it may be, it is important to realize that pain is a normal biological experience. It is one way our nervous system communicates information about the outside world or our inner happenings. It often begins as a low rumble and, when ignored, builds to a deafening roar. Even if not ignored, responses are frequently unhelpful and generally end up making the problem worse. We need to learn the language that is being spoken.
When my four year old son says he's "starving" or that he's "dying of thirst" I know (even if he does not) that he's demonstrating his flair for the dramatic and that there's actually no threat of him becoming too hungry or in desperate need of a glass of water. We are very fortunate to have our basic needs met with relative ease and rarely become distressed by these normal biological signals. But let's look at how these "sensations" work and what this has to do with pain.
Our brains constantly monitor what is happening in our internal and external environments. For instance, when blood volume decreases beyond a certain point, the brain detects this change and recognizes a need state. In order to drive the system back toward balance, thirst is produced as an output of the brain to motivate us to drink. In this sense, pain is very similar to thirst. When the brain receives increased inputs from certain nerve fibers, it may produce pain as a means of producing a particular response. The helpful response depends on the context of the signalling and the required behavioral change. In most cases, we're looking for a movement.
And so, I asked my client if she ever became thirsty after working out in her garden in the hot sun. She replied affirmatively and I asked if that meant there was something wrong with her or if her body was simply reacting as it should given the circumstances. Again, she agreed that thirst was normal, even helpful, in this context. Likewise with pain. If you are not giving your body the movement it requires when it requires it, pain is the natural result and the right kind of motion will help you resolve it.
As uncomfortable as it may be, it is important to realize that pain is a normal biological experience. It is one way our nervous system communicates information about the outside world or our inner happenings. It often begins as a low rumble and, when ignored, builds to a deafening roar. Even if not ignored, responses are frequently unhelpful and generally end up making the problem worse. We need to learn the language that is being spoken.
When my four year old son says he's "starving" or that he's "dying of thirst" I know (even if he does not) that he's demonstrating his flair for the dramatic and that there's actually no threat of him becoming too hungry or in desperate need of a glass of water. We are very fortunate to have our basic needs met with relative ease and rarely become distressed by these normal biological signals. But let's look at how these "sensations" work and what this has to do with pain.
Our brains constantly monitor what is happening in our internal and external environments. For instance, when blood volume decreases beyond a certain point, the brain detects this change and recognizes a need state. In order to drive the system back toward balance, thirst is produced as an output of the brain to motivate us to drink. In this sense, pain is very similar to thirst. When the brain receives increased inputs from certain nerve fibers, it may produce pain as a means of producing a particular response. The helpful response depends on the context of the signalling and the required behavioral change. In most cases, we're looking for a movement.
And so, I asked my client if she ever became thirsty after working out in her garden in the hot sun. She replied affirmatively and I asked if that meant there was something wrong with her or if her body was simply reacting as it should given the circumstances. Again, she agreed that thirst was normal, even helpful, in this context. Likewise with pain. If you are not giving your body the movement it requires when it requires it, pain is the natural result and the right kind of motion will help you resolve it.
Friday, August 29, 2008
A Theory of Practice
"In theory there is no difference between theory and practice. In practice there is."
Yogi Berra
People frequently ask me why I practice differently from other therapists they have experienced. Most seem appreciative of the approach. Others struggle to go where they think I want them to go. Expecting someone to tell them everything that is wrong with them and set about fixing it, they are taken aback when I begin with acceptance and follow their lead toward correction. The truth is, they know more about finding their way out of pain than I do. I just need to help them find that path. I decided long ago that since I rarely met anyone's expectations of therapy that I would have to try instead to exceed them. That is easier said than done.
In this thread on SomaSimple, a fellow moderator had this to say about our profession:
"Perhaps as a profession, we've been following the wrong directions so long that we've had to convince ourselves that where we ended up is where we wanted to go. I imagine it would be hard to convince someone that all the hard work used to get somewhere may have been wasted (or at least not used efficiently)."
I think he is exactly right. When one finds oneself somewhere they don't really want to be, they should change course. So, I guess my simplest answer to the question of why my practice is different is that I have corrected course many times.
A few years ago James Willis, MD, gave an address on the importance of science in medicine that I think everyone should read. In The Sea Monster and the Whirlpool, he discusses the difficulty and imperative of steering a course between pseudoscience (see my last post) and scientific fundamentalism. In physiotherapy these days, these two extremes are exemplified by the enthusiasm for alternative methods and the excitement about clinical prediction rules for manipulation. This is not all bad, of course, and one must carefully separate the wheat from the chaff. The main imperative for many, however, seems protection of traditional methods of practice. This makes no sense when the science is leading us in a different direction.
I spend every day encountering patients in pain, trying to figure out how to help them find greater comfort and how to function better in their every day lives. Thankfully, there has been a tremendous amount of work in neuroscience that has revolutionized our understanding of pain. It has charted a course for my profession that we simply must follow if we hope to help those in need of our care. It is time for new theories. And from new theories, new practice.
That is why I practice differently.
Yogi Berra
People frequently ask me why I practice differently from other therapists they have experienced. Most seem appreciative of the approach. Others struggle to go where they think I want them to go. Expecting someone to tell them everything that is wrong with them and set about fixing it, they are taken aback when I begin with acceptance and follow their lead toward correction. The truth is, they know more about finding their way out of pain than I do. I just need to help them find that path. I decided long ago that since I rarely met anyone's expectations of therapy that I would have to try instead to exceed them. That is easier said than done.
In this thread on SomaSimple, a fellow moderator had this to say about our profession:
"Perhaps as a profession, we've been following the wrong directions so long that we've had to convince ourselves that where we ended up is where we wanted to go. I imagine it would be hard to convince someone that all the hard work used to get somewhere may have been wasted (or at least not used efficiently)."
I think he is exactly right. When one finds oneself somewhere they don't really want to be, they should change course. So, I guess my simplest answer to the question of why my practice is different is that I have corrected course many times.
A few years ago James Willis, MD, gave an address on the importance of science in medicine that I think everyone should read. In The Sea Monster and the Whirlpool, he discusses the difficulty and imperative of steering a course between pseudoscience (see my last post) and scientific fundamentalism. In physiotherapy these days, these two extremes are exemplified by the enthusiasm for alternative methods and the excitement about clinical prediction rules for manipulation. This is not all bad, of course, and one must carefully separate the wheat from the chaff. The main imperative for many, however, seems protection of traditional methods of practice. This makes no sense when the science is leading us in a different direction.
I spend every day encountering patients in pain, trying to figure out how to help them find greater comfort and how to function better in their every day lives. Thankfully, there has been a tremendous amount of work in neuroscience that has revolutionized our understanding of pain. It has charted a course for my profession that we simply must follow if we hope to help those in need of our care. It is time for new theories. And from new theories, new practice.
That is why I practice differently.
Thursday, July 24, 2008
Where's My Qi Gone???
The ancient art of Qi Gong has become all the rage in Halifax. It comes complete with extraordinary claims and even a modicum of evidence. I want to be very clear that I think it is a wonderful form of movement therapy and can benefit many. Its focus on movement and breathing addresses two of the fundamental issues so important for people experiencing persistent pain. And it is here that the ancient art intersects with modern science.
There is a growing body of research literature that demonstrates the efficacy of acupuncture and other related modalities - at least in some circumstances. However, one must be careful not to leap to an acceptance of the theories behind these methods. Traditional approaches claim that energy or qi (chi) flows along channels called meridians and that blockages can cause illness or dysfunction of various sorts. In spite of claims to effectiveness, there is no support for this theoretical model. Meridians have never been identified by scientific method and far more plausible mechanisms, such as endorphin release and neuromodulation, are offered by neurophysiological investigations. One need not depend on outdated theory and magical thinking to understand empirical observations.
Dr. Harriet Hall helps shed light on such matters in discussing what she calls Tooth Fairy Science:
"You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists."
For instance, Qi Gong or acupuncture or many other similar treatments may produce measurable outcomes (even good ones), but that does not establish the existence of some vital energy that can be manipulated by a practitioner claiming to have special powers. No one has bothered to establish whether qi and meridians even exist.
Here is the protocol for treatment outlined in a pilot study for Qi Gong for people with fibromyalgia (THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 12, Number 9, 2006, pp. 851–856)
"EQT treatment by this specific healer consisted of administering acupressure, qi emission, qi balancing, and magnetic cupping on each individual. The following is a briefdescription of the main steps in the specific EQT of this healer, and the presumed functions of these various steps in the treatment process:
(a) The fully clothed patient lies down on her back on the examination table; the healer lightly touches the abdominal area to sense the blockage of qi flow in the major organs, allegedly moving the qi around, and driving the stagnant qi out via the bottom of the patient’s feet.
(b) The healer examines the key acupoints (not necessarily the tender points) to sense the extent of the blockages at each point and in the internal organs. He uses his palm(s) movements to generate the flow of qi in each blocked area, driving the stagnant qi out through the patient’s feet (Yongchuan acupoint).
(c) The patient turns around facing down on the examination bed and raises the back of her shirt;
(d) The healer examines major organs from the patient’s back with his palm to locate any deficiency in function and qi balance.
(e) The healer moves his own qi to the organs and verifies that the organ is functioning normally with balanced energy. He drives the stagnant qi out, and supplies healthy qi energy to the major organs.
(f) After the qi adjustment, small magnetic cupping is often used to directly take the excessive stagnant qi out from a specific organ (through acupoints)."
I'm leaving it to you readers to spot the Tooth Fairy here. Let me know if you see her. I'll be back with more later.
There is a growing body of research literature that demonstrates the efficacy of acupuncture and other related modalities - at least in some circumstances. However, one must be careful not to leap to an acceptance of the theories behind these methods. Traditional approaches claim that energy or qi (chi) flows along channels called meridians and that blockages can cause illness or dysfunction of various sorts. In spite of claims to effectiveness, there is no support for this theoretical model. Meridians have never been identified by scientific method and far more plausible mechanisms, such as endorphin release and neuromodulation, are offered by neurophysiological investigations. One need not depend on outdated theory and magical thinking to understand empirical observations.
Dr. Harriet Hall helps shed light on such matters in discussing what she calls Tooth Fairy Science:
"You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists."
For instance, Qi Gong or acupuncture or many other similar treatments may produce measurable outcomes (even good ones), but that does not establish the existence of some vital energy that can be manipulated by a practitioner claiming to have special powers. No one has bothered to establish whether qi and meridians even exist.
Here is the protocol for treatment outlined in a pilot study for Qi Gong for people with fibromyalgia (THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 12, Number 9, 2006, pp. 851–856)
"EQT treatment by this specific healer consisted of administering acupressure, qi emission, qi balancing, and magnetic cupping on each individual. The following is a briefdescription of the main steps in the specific EQT of this healer, and the presumed functions of these various steps in the treatment process:
(a) The fully clothed patient lies down on her back on the examination table; the healer lightly touches the abdominal area to sense the blockage of qi flow in the major organs, allegedly moving the qi around, and driving the stagnant qi out via the bottom of the patient’s feet.
(b) The healer examines the key acupoints (not necessarily the tender points) to sense the extent of the blockages at each point and in the internal organs. He uses his palm(s) movements to generate the flow of qi in each blocked area, driving the stagnant qi out through the patient’s feet (Yongchuan acupoint).
(c) The patient turns around facing down on the examination bed and raises the back of her shirt;
(d) The healer examines major organs from the patient’s back with his palm to locate any deficiency in function and qi balance.
(e) The healer moves his own qi to the organs and verifies that the organ is functioning normally with balanced energy. He drives the stagnant qi out, and supplies healthy qi energy to the major organs.
(f) After the qi adjustment, small magnetic cupping is often used to directly take the excessive stagnant qi out from a specific organ (through acupoints)."
I'm leaving it to you readers to spot the Tooth Fairy here. Let me know if you see her. I'll be back with more later.
Saturday, June 28, 2008
Sparked
John Ratey's new book Spark combines a look a two of my greatest interests - exercise and brain science. Ratey promises to "supercharge your mental circuits to brain stress, sharpen your thinking, lift your mood, boost your memory, and much more." How could anyone resist? He presents a compelling case for the positive effects of aerobic exercise on brain chemistry. While I agree with much of what he writes, there are some complicated issues that he does not address. I have written Dr. Ratey about these questions, but have yet to receive his reply. To state my position most clearly, I think he would do well to distinguish more explicitly between exercise and recreational activity. Find more on that in previous posts on Good Medicine.
Basically it comes down to this issue at the heart of his book: Ratey states that "the paradox is our that our wonderful ability to adapt and grow doesn't happen without stress - we can't have the good without the bad." He also offers that everybody's threshold for stress is different and admits that "there is no specific point at which scientists can say stress shifts from building up to tearing down." These are extremely important points and I think they are glossed over too quickly and easily in the final analysis of his recommendations. I agree that people need to move more than they do and that enjoyable activity has tremendous psychological and social benefits driven, at least in part, by the chemical changes in one's brain. However, causing the body to adapt requires hard work balanced with adequate recovery. Ratey gives lip service to resistance training and recovery, but neither is given the attention it deserves and requires. If everyone is unique, then generic admonitions to be more active certainly will not do. Again, like any medicine, exercise must be prescribed in a manner that suits a particular individual and accomodates the desired response. He states the importance of individuality in the book, but the rest of his writing contradicts it.
Here, in my opinion, is the biggest mistake in the book: "The process of getting fit is all about building up your aerobic base." This statement simply is not true. Sure, it is important to get your blood pumping but think about where that blood is going. Ratey, importantly, adds the brain to the list of tissues that benefit from exercise; however, he mostly overlooks the muscles. In personal correspondence, he did acknowledge the importance of resistance training for brain changes and he gives it a brief nod for preventing osteoporosis in the book. He recognizes that "even if you do all the aerobic training in the world, your muscles and bones will still atrophy with age." But he seems to fail to see the implications of this. First, it is the primary reason why people become frail and lose functional ability, including performing all that activity he is so fond of. Second, there is growing evidence, though Ratey seems not to have read this research, of the connection between healthy muscles (ie. ones that are not wasting away) and healthy brains.
Good news: a little activity can do wonders for your brain. Spark could be a great motivator for someone requiring a little extra motivation to get moving and stay strong. Beware, however, the generic recommendations. Injury and pain are real problems that often significantly limit activity tolerance and negatively impact quality of life. In other words, don't just do it; do it right!
You can also listen to Dr. Ratey at Brain Science Podcasts, one of my favorite sites on the net. Check it out.
Basically it comes down to this issue at the heart of his book: Ratey states that "the paradox is our that our wonderful ability to adapt and grow doesn't happen without stress - we can't have the good without the bad." He also offers that everybody's threshold for stress is different and admits that "there is no specific point at which scientists can say stress shifts from building up to tearing down." These are extremely important points and I think they are glossed over too quickly and easily in the final analysis of his recommendations. I agree that people need to move more than they do and that enjoyable activity has tremendous psychological and social benefits driven, at least in part, by the chemical changes in one's brain. However, causing the body to adapt requires hard work balanced with adequate recovery. Ratey gives lip service to resistance training and recovery, but neither is given the attention it deserves and requires. If everyone is unique, then generic admonitions to be more active certainly will not do. Again, like any medicine, exercise must be prescribed in a manner that suits a particular individual and accomodates the desired response. He states the importance of individuality in the book, but the rest of his writing contradicts it.
Here, in my opinion, is the biggest mistake in the book: "The process of getting fit is all about building up your aerobic base." This statement simply is not true. Sure, it is important to get your blood pumping but think about where that blood is going. Ratey, importantly, adds the brain to the list of tissues that benefit from exercise; however, he mostly overlooks the muscles. In personal correspondence, he did acknowledge the importance of resistance training for brain changes and he gives it a brief nod for preventing osteoporosis in the book. He recognizes that "even if you do all the aerobic training in the world, your muscles and bones will still atrophy with age." But he seems to fail to see the implications of this. First, it is the primary reason why people become frail and lose functional ability, including performing all that activity he is so fond of. Second, there is growing evidence, though Ratey seems not to have read this research, of the connection between healthy muscles (ie. ones that are not wasting away) and healthy brains.
Good news: a little activity can do wonders for your brain. Spark could be a great motivator for someone requiring a little extra motivation to get moving and stay strong. Beware, however, the generic recommendations. Injury and pain are real problems that often significantly limit activity tolerance and negatively impact quality of life. In other words, don't just do it; do it right!
You can also listen to Dr. Ratey at Brain Science Podcasts, one of my favorite sites on the net. Check it out.
Wednesday, May 28, 2008
One too many dandelions...
I thought of this when a patient of mine wondered aloud about how many of us on our death beds would wish we had spent more time killing weeds. This was while she was being treated for back pain after spending the weekend making her yard look beautiful. Isn't it amazing how often our culture chooses beauty over comfort?
Then again, maybe I'm just rationalizing the state of my lawn and hoping my neighbors forgive my obvious lack of passion for green carpet.
I’d Kill More Dandelions
Nick Matheson, Age 35
If I had my life to live over,
I'd try to make fewer errors next time.
I would stress out. I would stiffen up.
I would be more sober than I have on this trip.
I would be more orderly. I would be neater.
I would take fewer chances, I would stay home more.
I would climb fewer mountains, swim fewer rivers, and watch fewer sunsets.
I would burn less gasoline. I would eat less ice cream and more broccoli.
I would have fewer actual troubles and more imaginary ones.
You see, I am one of those people who throws caution to the wind and hopes it won’t blow back in my face.
Oh, I have had my moments when I thought I had it all figured out.
Everything seemed just right.
Risk appeared to have its reward
and truth was more certain than reality.
But if I had to do it again, I would forget now and live every day in the far off future, ready for any eventuality.
You see, I got kicked out of Boy Scouts and have never been prepared.
If I had to do it over again, I would stay home and do more yard work.
I'd watch more TV and read fewer books.
I’d spend less time worrying about my kids and more time worrying about the neighbors.
If I had my life to live over, I would start weeding earlier in the spring and keep mowing way later in the fall.
I would make sure the grass was greener on my side of the fence.
I would never miss a day of work. I would make more money and live in a bigger house. I would be fully insured.
I would avoid merry-go-rounds, but would run on treadmills.
I'd kill more dandelions.
Wednesday, April 30, 2008
Pain Without Pain
So back to the Pain List - Ten Steps to Understanding Manual and Movement Therapies for Pain.
"2. Nociception (warning signals from body tissues) is neither necessary nor sufficient to produce pain. In other words, pain can occur in the absence of tissue damage."
Perhaps even more surprising is that tissue damage, even when severe, may not result in pain. A few weeks ago I had the privilege of attending a seminar with Lorimer Moseley, one of the leading researchers in pain science and physiotherapy. His book Painful Yarns contains many great stories about the pain experience. In one, he recants the experience of a man who had the great misfortune of having a hammer go through his neck. Arriving in the Emergency Room, the man showed no sign of being in pain and even joked about the situation. Joked, that is, until he banged his knee on a table and doubled over in pain.
Moseley concludes that in order to experience pain, one's brain must
(a) conclude that tissue is in danger, and
(b) conclude that one should do something about it.
Mr. Hammerhead Shark, as he is named in the story, had concluded that he was safe and he took action to resolve the problem. Pain, therefore, was not necessary in spite of significant warning signals from the tissues.
On the other side of the coin, pain can, and frequently does, occur in the absence of tissue damage. Mr. Hammerhead experienced more pain with a bang to his knee that resulted in no damage. In many instances, pain occurs without any signalling from the tissues at all. We'll examine how in upcoming posts.
"2. Nociception (warning signals from body tissues) is neither necessary nor sufficient to produce pain. In other words, pain can occur in the absence of tissue damage."
Perhaps even more surprising is that tissue damage, even when severe, may not result in pain. A few weeks ago I had the privilege of attending a seminar with Lorimer Moseley, one of the leading researchers in pain science and physiotherapy. His book Painful Yarns contains many great stories about the pain experience. In one, he recants the experience of a man who had the great misfortune of having a hammer go through his neck. Arriving in the Emergency Room, the man showed no sign of being in pain and even joked about the situation. Joked, that is, until he banged his knee on a table and doubled over in pain.
Moseley concludes that in order to experience pain, one's brain must
(a) conclude that tissue is in danger, and
(b) conclude that one should do something about it.
Mr. Hammerhead Shark, as he is named in the story, had concluded that he was safe and he took action to resolve the problem. Pain, therefore, was not necessary in spite of significant warning signals from the tissues.
On the other side of the coin, pain can, and frequently does, occur in the absence of tissue damage. Mr. Hammerhead experienced more pain with a bang to his knee that resulted in no damage. In many instances, pain occurs without any signalling from the tissues at all. We'll examine how in upcoming posts.
Friday, March 21, 2008
Sicko
I finally watched Michael Moore's documentary Sicko last night. Although it would be wise to recognize the one-sided nature of Moore's depiction of the health care crisis in America, it is hard to argue with him on many of the issues raised in this film. Unless, of course, you were the beneficiary of greased palms from those seemingly interested in anything but your health.
For me and my wife Lori, the issue certainly hit home. After weathering a severe health care storm in our own family, we cannot imagine the added burden of dealing with a bureaucratic nightmare hellbent on protecting precious profits. We are extremely fortunate that our health care system and the support of family, friends, and even strangers, enabled us to focus solely on getting our daughter well. Without that support system a completely unforeseen illness would have left us bankrupt in more ways than one.
Our journey through Maryn's illness brought us into contact with many families experiencing similar trauma. The stories that reached us from the U.S. left us very grateful our daughter's life was not left hanging by a thread while we waited for insurance approval. I'm pretty sure her treatment didn't come cheap. Which, of course, raises another issue...
As Canadians, we greatly value universal health care. We also recognize, however, that it is huge economic burden and one that is showing no signs of abating. There are no simple answers to resolving this issue, but we all should consider how to preserve those things worth fighting for.
For me and my wife Lori, the issue certainly hit home. After weathering a severe health care storm in our own family, we cannot imagine the added burden of dealing with a bureaucratic nightmare hellbent on protecting precious profits. We are extremely fortunate that our health care system and the support of family, friends, and even strangers, enabled us to focus solely on getting our daughter well. Without that support system a completely unforeseen illness would have left us bankrupt in more ways than one.
Our journey through Maryn's illness brought us into contact with many families experiencing similar trauma. The stories that reached us from the U.S. left us very grateful our daughter's life was not left hanging by a thread while we waited for insurance approval. I'm pretty sure her treatment didn't come cheap. Which, of course, raises another issue...
As Canadians, we greatly value universal health care. We also recognize, however, that it is huge economic burden and one that is showing no signs of abating. There are no simple answers to resolving this issue, but we all should consider how to preserve those things worth fighting for.
Saturday, March 15, 2008
The Pain Experience
Wow. Keeping up with a blog is much harder thean I could have ever imagined. It's becoming a painful experience itself. Time to revisit the overview of pain science and clinical application I wrote about a few weeks ago.
Today, we'll review number 1 of the Ten Steps to Understanding Manual and Movement Therapies for Pain. Much credit for this summary belongs to Luke Rickards, an Australian osteopath and researcher, and many of the other moderators at SomaSimple, a site dedicated to the application of scientific principles to the treatment of pain.
"1. Pain is a category of complex experiences, not a single sensation produced by a single stimulus."
Most people think of pain as a sensation - sensory input coming from a particular body part signalling that something is wrong. We are "hard-wired" to respond to danger signals in order to protect ourselves. That is why we have a pain system. However, pain is much more than sensory input being transmitted along a single pathway. Modern pain science describes pain more as an output generated by the brain, rather than an input from the body. It is always a bit hard to wrap your mind around something that seems to contradict your immediate experience. Then again, that is what science is for, right?
I think pain is most accurately understood as an experience, an experience comprised of sensation, but also the way one interprets and responds to that sensory information. It is easy to fall into the trap of linear or even circular thinking here, but understanding the importance of processing and behavior is essential to moving beyond pain. Understanding pain accurately helps reduce sensitivity and facilitates adaptive motor responses.
In Pain: The Science of Suffering, Patick Wall, asked the question: "What are the appropriate motor responses to the arrival of pain and injury signals?" In other words, "what movement do I need to do to feel better?" To me, this is, or ought to be, the central question of physiotherapy. Contrary to those who insist we treat biomechanics or function not pain, patients generally seek our care because they hurt and want to feel better. Understanding pain is the central issue for both therapist and patient. As we explore its meaning, we will begin to see how the right kind of movement can set us free.
Today, we'll review number 1 of the Ten Steps to Understanding Manual and Movement Therapies for Pain. Much credit for this summary belongs to Luke Rickards, an Australian osteopath and researcher, and many of the other moderators at SomaSimple, a site dedicated to the application of scientific principles to the treatment of pain.
"1. Pain is a category of complex experiences, not a single sensation produced by a single stimulus."
Most people think of pain as a sensation - sensory input coming from a particular body part signalling that something is wrong. We are "hard-wired" to respond to danger signals in order to protect ourselves. That is why we have a pain system. However, pain is much more than sensory input being transmitted along a single pathway. Modern pain science describes pain more as an output generated by the brain, rather than an input from the body. It is always a bit hard to wrap your mind around something that seems to contradict your immediate experience. Then again, that is what science is for, right?
I think pain is most accurately understood as an experience, an experience comprised of sensation, but also the way one interprets and responds to that sensory information. It is easy to fall into the trap of linear or even circular thinking here, but understanding the importance of processing and behavior is essential to moving beyond pain. Understanding pain accurately helps reduce sensitivity and facilitates adaptive motor responses.
In Pain: The Science of Suffering, Patick Wall, asked the question: "What are the appropriate motor responses to the arrival of pain and injury signals?" In other words, "what movement do I need to do to feel better?" To me, this is, or ought to be, the central question of physiotherapy. Contrary to those who insist we treat biomechanics or function not pain, patients generally seek our care because they hurt and want to feel better. Understanding pain is the central issue for both therapist and patient. As we explore its meaning, we will begin to see how the right kind of movement can set us free.
Thursday, March 6, 2008
How Do You Figure
"She looks that way because she was a dancer and did all kinds of ballet exercises."
Or maybe she was a good dancer because of her body type and what she did for exercise really did very little to change that. A long, lean body tends to be useful when performing, but if you're short and stalky, all the pilates, pole dancing, and gyrokinesis in the world is not going to change that. Sure, exercise is a means of altering your appearance, but not all appearances are reality.
In his article, Appearance Based Considerations found here, Dr. Doug McGuff states that "probably the most profound truth we can acknowledge about exercise is the fact that what we most desire from an exercise program is to improve our physical appearance." He goes on to say that "in contemporary society we have become obsessed with the aspects of beauty based on rarity and relatively unconcerned with those aspects based on health... The problem with the rarity aspect of beauty is that it is totally out of our control. Despite the implications that 'you too can look like this', these people have been bestowed a genetic gift that is very useful to them but can never be given to you. The fact that we fail to understand this truth is the driving force behind women's (and men's) fashion magazines, almost the entire exercise industry, food supplement industry, sporting goods industry and on and on."
Now, before you get discouraged, understand that there is lots you can do to improve both your health and appearance. There are three things that control your body shape - your skeleton, your muscles, and your body fat. Aside from improving bone density, exercise will not change the shape of your skeleton. It is a given, dictated by your genes. Although genetics also influences the amount of muscle you can develop, the way you distribute fat, and the order and rate at which fat can be lost, these tissues are more responsive to exercise and proper nutrition and determine your overall body shape. You may not look like a model, but you can become your personal best. Muscles can become stronger or weaker and fat can be gained or lost. You decide. Just don't be fooled.
Or maybe she was a good dancer because of her body type and what she did for exercise really did very little to change that. A long, lean body tends to be useful when performing, but if you're short and stalky, all the pilates, pole dancing, and gyrokinesis in the world is not going to change that. Sure, exercise is a means of altering your appearance, but not all appearances are reality.
In his article, Appearance Based Considerations found here, Dr. Doug McGuff states that "probably the most profound truth we can acknowledge about exercise is the fact that what we most desire from an exercise program is to improve our physical appearance." He goes on to say that "in contemporary society we have become obsessed with the aspects of beauty based on rarity and relatively unconcerned with those aspects based on health... The problem with the rarity aspect of beauty is that it is totally out of our control. Despite the implications that 'you too can look like this', these people have been bestowed a genetic gift that is very useful to them but can never be given to you. The fact that we fail to understand this truth is the driving force behind women's (and men's) fashion magazines, almost the entire exercise industry, food supplement industry, sporting goods industry and on and on."
Now, before you get discouraged, understand that there is lots you can do to improve both your health and appearance. There are three things that control your body shape - your skeleton, your muscles, and your body fat. Aside from improving bone density, exercise will not change the shape of your skeleton. It is a given, dictated by your genes. Although genetics also influences the amount of muscle you can develop, the way you distribute fat, and the order and rate at which fat can be lost, these tissues are more responsive to exercise and proper nutrition and determine your overall body shape. You may not look like a model, but you can become your personal best. Muscles can become stronger or weaker and fat can be gained or lost. You decide. Just don't be fooled.
Someone just asked me why I was displaying my religious beliefs on this blog. They had seen the link to The Year of Living Biblically and assumed I was proseletyzing on behalf of literal Biblical interpretation. In case you were worried, you can relax. I don't exactly make a great spokesman for such things, even if I were a proponent. AJ Jacobs, however, has written a very funny and enlightening book that demonstrates some of the absurdities of anachronistic hangovers that continue to "inform" our culture. The sheer number of extreme beliefs and believers he connects with on his journey are enough to give one deep pause about why everyone's so confused and conflict reigns supreme.
Tuesday, February 19, 2008
Having It All
My last poll investigated the meaning of Work-Life Balance. Over 60% voted for all of the above. It seems we want to have it all. No big surprise there. What does continue to amaze me is how in an era of incredible technology no one has any time. Why are we all so damn busy?
Timothy Ferris, author of The Four-Hour Work Week, has an interesting answer. His life seems like living in a different dimension to me, but I must say I find his ideas intriguing. He says to forget about balance and start working on separation of work from the rest of your life. He says, "Be productive instead of busy, and recognize that life is full of special relationships and activities that need to be protected from one another."
It would seem we can't have it all. At least not all at the same time.
Regular readers will also note his clarity on the issue of exercise and recreation.
Timothy Ferris, author of The Four-Hour Work Week, has an interesting answer. His life seems like living in a different dimension to me, but I must say I find his ideas intriguing. He says to forget about balance and start working on separation of work from the rest of your life. He says, "Be productive instead of busy, and recognize that life is full of special relationships and activities that need to be protected from one another."
It would seem we can't have it all. At least not all at the same time.
Regular readers will also note his clarity on the issue of exercise and recreation.
Sunday, February 10, 2008
How Thinking Makes It So
A few weeks ago, I wrote about the discovery of neuroplasticity, the ability of the brain to change in response to experience. I stated that this is the hope and purpose of all rehabilitation. Without changing the brain, nothing much happens in the way of learning and the body is not going to change much either. Even with strength training, the initial phase of improvement is almost all neurological. Some studies have even shown that you can strengthen your muscles just by thinking about exercise!
This understanding is very exciting indeed, but there is a downside. Alvaro Pascual-Leone, a neurophysiologist at Harvard university, explains that neuroplasticity can also lead to rigidity and repetition in the brain. Remember those ruts I wrote about? I'm sure we've all experienced difficulty changing a bad habit or destructive way of thinking. Pascual-Leone explains that the plastic brain is like a snowy hill in winter. "Aspects of that hill - the slope, the rocks, the consistency of the snow - are, like our genes, a given. When we slide down on a sled, we can steer it and wil end up at the bottom of the hill by following a path determined both by how we steer and the characteristics of the hill...But what will definitely happen the second time you take the slope down is that you will more likely than not find yourself somewhere or another that is related to the path you took the first time. It won't be exactly that path, but it will be closer to that one than any other. And if you spend your entire afternoon sledding down, walking up, sledding down, at the end you will have some paths that have been used a lot, some that have been used very little...and there will be tracks that you have created, and it is very difficult now to get out of those tracks. And those tracks are not geneticaly determined anymore." (The Brain That Changes Itself, Doidge, p.209).
I think that is a great metaphor for the middle of a Canadian winter! More later on what those tracks mean and how to choose a new path.
"If you want to succeed you should strike out on new paths, rather than travel the worn paths of accepted success." J.D. Rockefeller
This understanding is very exciting indeed, but there is a downside. Alvaro Pascual-Leone, a neurophysiologist at Harvard university, explains that neuroplasticity can also lead to rigidity and repetition in the brain. Remember those ruts I wrote about? I'm sure we've all experienced difficulty changing a bad habit or destructive way of thinking. Pascual-Leone explains that the plastic brain is like a snowy hill in winter. "Aspects of that hill - the slope, the rocks, the consistency of the snow - are, like our genes, a given. When we slide down on a sled, we can steer it and wil end up at the bottom of the hill by following a path determined both by how we steer and the characteristics of the hill...But what will definitely happen the second time you take the slope down is that you will more likely than not find yourself somewhere or another that is related to the path you took the first time. It won't be exactly that path, but it will be closer to that one than any other. And if you spend your entire afternoon sledding down, walking up, sledding down, at the end you will have some paths that have been used a lot, some that have been used very little...and there will be tracks that you have created, and it is very difficult now to get out of those tracks. And those tracks are not geneticaly determined anymore." (The Brain That Changes Itself, Doidge, p.209).
I think that is a great metaphor for the middle of a Canadian winter! More later on what those tracks mean and how to choose a new path.
"If you want to succeed you should strike out on new paths, rather than travel the worn paths of accepted success." J.D. Rockefeller
Thursday, January 24, 2008
Again...
Three times in the last 24 hours I have heard how people "gave up on physio" after struggling for months to overcome various forms of pain. I cannot tell you how frustrating this is for me. The number of people suffering from chronic pain continues to grow at an alarming rate in spite of (maybe even as a result of) the wide array of practitioners offering an even wider array of fixes. In case you have not already noticed, very few of them will tell the same story. The result? Complete and utter confusion. And, of course, persistent pain.
I certainly make no claims to quick fixes for this problem and have no special magic up my sleeve. What I do have is a serious commitment to learning everything I can about pain and passing that understanding along to those I aim to help. I honestly believe that a therapist helps more with their understanding of the condition they are treating than any special technique or treatment approach. It all starts in the brain!
For the last several years, I have delved into the challenge of pain with a brilliant and dedicated group of therapists from all over the world. The internet is truly a wonderful thing and this network has transformed my understanding and clinical practice. The Moderators of SomaSimple, of which I am one, recently developed our current consensus on pain. "Nothing Simple - Ten Steps to Understanding Manual and Movement Therapies for Pain" is a terrific application of neuroscience. Some points may seem a bit complex, but I will unpack the details here and will certainly entertain any questions you may have. I welcome your comments and you can also reach me by e-mail at nmatheson@121wellness.ca. My aim? To stop having people give up on physio and start getting the help they need.
I certainly make no claims to quick fixes for this problem and have no special magic up my sleeve. What I do have is a serious commitment to learning everything I can about pain and passing that understanding along to those I aim to help. I honestly believe that a therapist helps more with their understanding of the condition they are treating than any special technique or treatment approach. It all starts in the brain!
For the last several years, I have delved into the challenge of pain with a brilliant and dedicated group of therapists from all over the world. The internet is truly a wonderful thing and this network has transformed my understanding and clinical practice. The Moderators of SomaSimple, of which I am one, recently developed our current consensus on pain. "Nothing Simple - Ten Steps to Understanding Manual and Movement Therapies for Pain" is a terrific application of neuroscience. Some points may seem a bit complex, but I will unpack the details here and will certainly entertain any questions you may have. I welcome your comments and you can also reach me by e-mail at nmatheson@121wellness.ca. My aim? To stop having people give up on physio and start getting the help they need.
Too Many Experts
One way the analogy of prescription in my last post breaks down is how infrequently doctors prescribe exercise. In fact, beyond the common admonition to "lose some weight" and "start walking", medical advice in this area is seriously lacking. They sometimes seem over-anxious to fault exercise for just about any strain or pain a person might be feeling - often when the connection to exercise is very remote. Lifting weights seems particularly suspect in spite of the growing body of evidence that supports its safety and utility, even for many with special concerns or conditions. There are many reasons for this distrust, but few of them are rational. I certainly don't fault them for lack of expertise. They have enough to keep up with and I accept responsibility for this subject myself. I think it is a shame though when people miss out on the very thing that could improve their quality of life because they entrust their health to someone who misunderstands physical medicine.
My purpose is to begin examining the reasons for this lack of understanding and to continue delivering excellence in clinical exercise to those who face barriers to participation. I want to deconstruct the myths and misinformation that obfuscate the essential role that exercise must play in one's quest for better health.
My purpose is to begin examining the reasons for this lack of understanding and to continue delivering excellence in clinical exercise to those who face barriers to participation. I want to deconstruct the myths and misinformation that obfuscate the essential role that exercise must play in one's quest for better health.
Monday, January 21, 2008
Minimum Dose
I want to revisit the Wolfe article referenced in the Good Medicine post. I think the following line, when discussing motivation, is of particular significance:
"...it is important to identify the minimal exercise regimen to achieve desired results, including maximizing the interactive effects between nutritional intake and exercise on protein synthesis."[emphasis mine]
The notion of physical medicine is important here as well. When doctors prescribe medication, they do not try to determine the maximum amount your body can stand. They do not think that if a little bit is good for you than more must be better. They attempt, based on research, clinical reasoning, and trial-and-error, to determine the minimum dosage to produce the desired therapeutic effect. So how does this apply to exercise?
The first thing I do is try to help people identify the effect they desire from exercise. Most people have some vague sense that exercise is good for them and is something they should do for a variety of different reasons. In reality, exercise is a stressor that produces benefits indirectly. In other words, exercise breaks your body down in order to produce a positive adaptive change. This means that if it is not performed within safe parameters the natural result will be pain or injury - either now or later. Yes...exercise can have side effects and all that healthy activity can be hazardous to your health. Ever wonder why sports medicine is a thriving industry?
"...it is important to identify the minimal exercise regimen to achieve desired results, including maximizing the interactive effects between nutritional intake and exercise on protein synthesis."[emphasis mine]
The notion of physical medicine is important here as well. When doctors prescribe medication, they do not try to determine the maximum amount your body can stand. They do not think that if a little bit is good for you than more must be better. They attempt, based on research, clinical reasoning, and trial-and-error, to determine the minimum dosage to produce the desired therapeutic effect. So how does this apply to exercise?
The first thing I do is try to help people identify the effect they desire from exercise. Most people have some vague sense that exercise is good for them and is something they should do for a variety of different reasons. In reality, exercise is a stressor that produces benefits indirectly. In other words, exercise breaks your body down in order to produce a positive adaptive change. This means that if it is not performed within safe parameters the natural result will be pain or injury - either now or later. Yes...exercise can have side effects and all that healthy activity can be hazardous to your health. Ever wonder why sports medicine is a thriving industry?
Monday, January 14, 2008
One Too Many Priorities
So it's not the most scientific poll ever, but it's nice to have your input. Turns out the biggest issue on your minds is Work-Life Balance. 38% of you want to achieve that ever elusive equilibrium this year. I'm afraid I would be lying BIG time if I claimed any expertise in this area. I just took this quiz to prove to myself that I am a dismal failure at walking the tightrope between work and home. In my defense, I have just survived two and a half years of business start-up and that seems to be enough to rattle anyone's cage. I'm told those first few years are the hardest and I think I sometimes glimpse a light at the end of the tunnel, but I'm pretty sure that doesn't qualify as balance. The best I can say is that we'll work on this one together.
Check out Life Balance: Wellness That Works for a more comprehensive treatment of this subject. I also highly recommend Jason Roth & Associates for anyone juggling or struggling with life's demands. And if you need cheering up, just listen here. Sappy, I know, but the guy can sing.
Check out Life Balance: Wellness That Works for a more comprehensive treatment of this subject. I also highly recommend Jason Roth & Associates for anyone juggling or struggling with life's demands. And if you need cheering up, just listen here. Sappy, I know, but the guy can sing.
Wednesday, January 9, 2008
Good Medicine
In an excellent article, The underappreciated role of muscle in health and disease, Robert Wolfe has this to say:
In other words, exercise is physcial medicine. Like any medicine, it must be dosed appropriately. You need the right amount and the right type to produce the desired result. As the above quote makes plainly clear, the desired result is to build muscle. Muscle is the only system in your body that you can directly exercise. Other changes, such as increased bone density or improved cardiovascular efficiency occur secondarily to work performed by the muscles. If you are going to bother with exercise, you should ensure that your work produces some kind of positive adaptive change in your muscular system. You should get stronger. And the best way to do that is to strength train.
"There is little debate regarding the beneficial effects of exercise on muscle, whether it be to maintain or attempt to restore muscle mass and function. The most practical issue from a public health standpoint is motivation. In that light, it is important to identify the minimal exercise regimen to achieve desired results, including maximizing the interactive effects between nutritional intake and exercise on protein synthesis. Furthermore, the desired result should be identified in terms of outcomes on muscle mass, strength, and metabolic function, as opposed to traditional measures of exercise training, such as the maximal oxygen consumption, which have little direct relation to health outcomes."
In other words, exercise is physcial medicine. Like any medicine, it must be dosed appropriately. You need the right amount and the right type to produce the desired result. As the above quote makes plainly clear, the desired result is to build muscle. Muscle is the only system in your body that you can directly exercise. Other changes, such as increased bone density or improved cardiovascular efficiency occur secondarily to work performed by the muscles. If you are going to bother with exercise, you should ensure that your work produces some kind of positive adaptive change in your muscular system. You should get stronger. And the best way to do that is to strength train.
Your Choice
So much to write, so little time. I'm reading one too many books right now. I'll save my technology rant for another day and, for now, spare you the details of me tearing my hair out as we implement a new computer system in our clinic. All evidence to the contrary, I somehow remain convinced that computers will make life easier and better.
I've covered a fair amount of mental ground in my last few posts and want to bring things into sharper focus. I am arranging a series of interviews on wellness with experts from several different walks of life. Stay tuned...it should be interesting. And at least you'll get more than my incessant ramblings when you tune in here.
My mission is to share with as many people as I can the lessons I have learned about wellness. My experience has shown me that health is not something that is completely within my control, but that it is definitely something worth fighting for. I am committed to exploring and facilitating the possibilities of healthy aging for all those I can reach. I want to unlock the power of prevention with simple strategies that can make a profound difference in the quality of one's life. I want to help strengthen your health. The smarter conversation begins now.
Millions of people across North America have just made New Year's Resolutions to make this the year they finally lose weight, get more fit, defeat pain, attain happiness. Unfortunatley, most will fall prey to the myths and misinformation so prevalent in the fitness industry. In a few short weeks, the empty promises will be revealed and many will quit in frustration and discouragement. Others will be sidelined by injury or pain - side effects of performing exercise improperly. Over the next few days, I will share with you some of the best available evidence to help you get on the right path. It is all about direction. Choose yours wisely.
I've covered a fair amount of mental ground in my last few posts and want to bring things into sharper focus. I am arranging a series of interviews on wellness with experts from several different walks of life. Stay tuned...it should be interesting. And at least you'll get more than my incessant ramblings when you tune in here.
My mission is to share with as many people as I can the lessons I have learned about wellness. My experience has shown me that health is not something that is completely within my control, but that it is definitely something worth fighting for. I am committed to exploring and facilitating the possibilities of healthy aging for all those I can reach. I want to unlock the power of prevention with simple strategies that can make a profound difference in the quality of one's life. I want to help strengthen your health. The smarter conversation begins now.
Millions of people across North America have just made New Year's Resolutions to make this the year they finally lose weight, get more fit, defeat pain, attain happiness. Unfortunatley, most will fall prey to the myths and misinformation so prevalent in the fitness industry. In a few short weeks, the empty promises will be revealed and many will quit in frustration and discouragement. Others will be sidelined by injury or pain - side effects of performing exercise improperly. Over the next few days, I will share with you some of the best available evidence to help you get on the right path. It is all about direction. Choose yours wisely.
Wednesday, January 2, 2008
Starting Small
"Revolutions always start small and among the weirdos." Robert Scoble
I've had one too many holidays. I actually survived 5 whole days with no work...didn't even bring my laptop home, which is amazing for me. I'm sure my kids appreciated it, but I think I may need to spend more time with my computer because they seem to be rapidly outpacing me in the technology department. When is it time for the parent to become the student rather than the teacher?
The holidays afforded me some time to get caught up on some reading and to feed my latest obsession. Some people (mostly my wife) think it's strange that I want to read books about my work all the time, but I can (and do) relate almost everything to therapy. It's something I seem to have learned from one of my mentors. He recently directed me to a book that is one of the most important I have ever read and I recommend everyone with a brain pick one up. Norman Doidge, M.D., has written an astounding book about the most exciting development in neuroscience in the last 20 years. Your brain is plastic! Sounds anti-climactic I know, but the implications are profound. It is further reinforcement for me about the ability of someone to rewire their nervous system - at any age - and transform the mind and the body. It is the hope and purpose of all rehabilitation.
Funny thing is, it has taken weirdos to bring about this transformation. And, at least as it pertains to therapy, much need for change remains. There is a revolution in pain science that has been occuring for years, but few in my profession seem to notice...or care. Revolution means there is no more business as usual. The world is changing. Keep up! Join the weirdos.
Sometimes this change seems to be occuring at a dizzying pace. As I said above, my children, whose incredibly plastic brains absorb almost anything with enviable ease, move about the world eagerly welcoming new experiences. They are not trapped in the ruts of mental habit or physical posturing that afflict some of us as we age. People often lament that symptoms must mean they're getting older. In reality, they are becoming less plastic, reinforcing entrenched habits of being. But research shows us that incredible changes - for the better - can occur even in the brains of the elderly or disabled. We can learn new things. We can do things differently. Begin it! Welcome to 2008!
“Whatever you can do or dream you can, begin it. Boldness has genius, power and magic in it.” Goethe
I've had one too many holidays. I actually survived 5 whole days with no work...didn't even bring my laptop home, which is amazing for me. I'm sure my kids appreciated it, but I think I may need to spend more time with my computer because they seem to be rapidly outpacing me in the technology department. When is it time for the parent to become the student rather than the teacher?
The holidays afforded me some time to get caught up on some reading and to feed my latest obsession. Some people (mostly my wife) think it's strange that I want to read books about my work all the time, but I can (and do) relate almost everything to therapy. It's something I seem to have learned from one of my mentors. He recently directed me to a book that is one of the most important I have ever read and I recommend everyone with a brain pick one up. Norman Doidge, M.D., has written an astounding book about the most exciting development in neuroscience in the last 20 years. Your brain is plastic! Sounds anti-climactic I know, but the implications are profound. It is further reinforcement for me about the ability of someone to rewire their nervous system - at any age - and transform the mind and the body. It is the hope and purpose of all rehabilitation.
Funny thing is, it has taken weirdos to bring about this transformation. And, at least as it pertains to therapy, much need for change remains. There is a revolution in pain science that has been occuring for years, but few in my profession seem to notice...or care. Revolution means there is no more business as usual. The world is changing. Keep up! Join the weirdos.
Sometimes this change seems to be occuring at a dizzying pace. As I said above, my children, whose incredibly plastic brains absorb almost anything with enviable ease, move about the world eagerly welcoming new experiences. They are not trapped in the ruts of mental habit or physical posturing that afflict some of us as we age. People often lament that symptoms must mean they're getting older. In reality, they are becoming less plastic, reinforcing entrenched habits of being. But research shows us that incredible changes - for the better - can occur even in the brains of the elderly or disabled. We can learn new things. We can do things differently. Begin it! Welcome to 2008!
“Whatever you can do or dream you can, begin it. Boldness has genius, power and magic in it.” Goethe
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