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.

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.

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.

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.

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.