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.

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.

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?

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.

Good Medicine

In an excellent article, The underappreciated role of muscle in health and disease, Robert Wolfe has this to say:

"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.

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