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.

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

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.