Grateful For Pain

I'm a big fan of analogies when it comes to explaining things in the clinic.

Today, my 8am patient expressed disappointment that her thus far linearly progressing improvement had been derailed.  For the first time since commencing therapy following a fracture of her humerus (long arm bone), she experienced an increase in pain and assumed something was wrong.  From the outset, this patient had openly expressed her apprehension and fear of pain.  I had to work to build her trust, and today we had a good discussion about pain.

Pain is a GOOD thing.  Without its perception, staying alive and healthy becomes infinitely more challenging.  Imagine how difficult it would be to keep from harming yourself if you could never feel a hot stove with your hand or a rusty nail in your foot?  For the sake of simplicity, I will avoid bogging you down with the details of the neurophysiology of pain perception.  Rather, I'll use the following analogy.

If your body were a car, imagine pain playing the role of both the steering wheel and the brakes.  If your car were cruising down the road at 65 miles per hour and all of a sudden it began to veer out of your lane, you'd use the steering wheel to adjust and compensate.  If you were driving in the dark and a deer ran out into the road, you'd instinctively hit the brakes to avoid a collision.  Pain can both steer as well as limit or stop your movement.

A common concern that many people have is the fear of "doing more damage" if they continue to perform such-and-such behavior.  I think most folks can tolerate a certain degree of pain, as long as they are assured that nothing "serious" is wrong, and that it is only temporary.  The simplest advice I can offer my patients is to use pain as a guide when it comes to movement.  Don't be afraid to move.  Rather, explore movement in the affected area.  If that's too intolerable, then try moving the surrounding joints in a pain-free manner.  Never barrel ahead with a "no pain, no gain" mentality.  Rather, tease the edge of your pain tolerance with gentle repetitions until you edge that barrier back towards normal functional limits.  This is likely what occurred with my patient this morning.  Her body is diligently healing itself at a normal pace.  Perhaps her progress lead to some over exuberance, and she pushed herself too far.  Not to worry.  We simply dialed it back and used her pain to steer her back into a safe lane.  

If your drifting car didn't have a steering wheel, then you would be liable to end up going off the road.  If your car wasn't equipped with functioning brakes, then you might hit that deer head on.  Disaster in both cases.  Thankfully, functioning cars are equipped with these vital features.  If not, the only safe bet would be to never remove the car from the garage.  The resultant disuse will cause all of its other moving parts to begin a slow, steady decline.  Eventually, your car would never be able to go anywhere.

Don't be like that car sitting idly in the garage.  We were born to move.  Rather than fear pain, embrace it for its protective role and be grateful for it.  Recognize its power to keep you alive and regulate your movement as your body heals itself.  When it's finally gone, get back to moving well.

IMPORTANT FOOTNOTE ON PAIN:

Not all pain is the same.  Should you ever find that pain WAKES you up at night, or that you have pain that is unremitting and unresponsive to positional or activity changes, go seek medical attention.  You must rule out that anything serious and systemic is going on in this case.  In addition, please don't misread the above to suggest that anyone should SEEK pain.  Pain alters motor control (meaning it will cause movement compensations).  We don't want to move for too long with poor movement, because our brains will record these aberrant patterns.  The quicker we can rid our bodies of pain, the faster we can get back to restoring healthy movement.

Where Have You Gone, Mrs. Robinson (and Mr. Philips)?

Things seemed much simpler in the 70's and 80's.  There were no 7-point harness car seats.  We just slammed around the back of the wood paneled station wagon like air hockey pucks.  Gluten and GMO food wasn't in the vocabulary.  Kids played an hour or two of organized sports on the weekends, and then played with their friends and families the rest of the weekend.  Not anymore.

My kids are too young to have hit the sports insanity full force.  As much as I'm excited to watch and coach my kids on the sports field, whichever one that may be, I have some trepidation about the current sports landscape out there.  Kids are specializing in sports at such a young age, with camps and select teams that seemingly suck up every free moment of their lives, not to mention their parents'.  It's a highly competitive environment, with big money stakes by way of collegiate scholarships in the offing.  While I'm all for esteem-building competition and team camaraderie, I wonder if the pendulum has swung too far?

I just read an article in Sports Illustrated about Roy Hibbert, the 7'2" center for the Indiana Pacers.  He's in the midst of a breakout season, and his team is seriously challenging Lebron James' Heat for Eastern supremacy in the NBA.  One thing that I found interesting in the article was the fact that while a freshman at Georgetown University, Hibbert was unable to execute a single push-up or stand up from a chair without using his hands.  Here was a Division 1 college athlete who was too weak to move his own (albeit massive) body via fundamental movements.  Unfortunately, the article did not mention one thing about his current workout routine.  I happen to know that Hibbert spent the summer preparing for the season by working with Mike Robertson at IFAST (Indianapolis Fitness and Sports Training), a trainer whom I follow online.  It would have been nice for readers to recognize the relationship between strength and fitness and athletic success.

Back to the '70's.  Mr. Philips and Mrs. Robinson were my grade school gym teachers at Stratford Avenue School.  In hindsight, they really knew what they were doing.  I remember bear and crab walking across the length of the gym floor.  I recall climbing ropes and cargo nets to the height of the gym ceiling.  I remember playing hockey, softball, football and soccer.  I remember the annual "Olympics" which involved a myriad of events, from tire jumping, to softball tossing, to sprinting, to tug-of-war.  I remember early morning gymnastics.  We did it all.  And it was fun!  Sure, I didn't always love bearing walking back and forth.  But by having us do these exercises, Mr. Philips and Mrs. Robinson provided the building blocks to create successful future athletes.

I wonder if today's gym teachers are following in their footsteps?  I wonder if today's youth coaches are too focused on sport-specific drills rather than the fundamentals of foundational strength and movement?  I suppose I will find out over the next several years as my kids grow into the sports scene.  But I sure hope that the adults in charge of the sports programs don't foster the college version of Roy Hibbert in the pursuit of creating the next Lebron James.  I hope that coaches, gym teachers, and parents recognize that the basics always matter, and that keeping it simple will ultimately yield more healthy and successful athletes.

Next time your child scores the winning goal, touchdown or basket, give them the praise they earned.  But don't forget to check if they are still able to handle the basics.  Can the do a push-up?  Can they squat down and stand back up with ease?  Can they crawl a distance with their knees off the floor?  Can they stand up from a chair without using their hands?  Amid all the pressures of today's youth sports landscape, don't neglect the basics.

Resolutions With a "Why?"......Part II

I do not know everything about rehabilitation.  Not even close.  But I know enough to know what I don't know.  Sometimes I wonder about others.

Today, within an hour's time, I heard the following from two patients:

Scenario 1:

When I encouraged a 30-something year old man to strength train, he responded with:

"My martial arts instructor told me that I shouldn't lift weights with my arms, because having strong arms will take away from the strength of my legs."

Scenario 2:

While evaluating a three-month pregnant woman presenting with back pain, she said the following:

"My nurse practitioner told me that I shouldn't bend forward because I could break the baby's neck."

My female patient at least did her due diligence and Googled whether or not bending forward can harm her fetus.  Not surprisingly, she did not find anything to validate her healthcare professional's statement.

Reiterating my theme from a prior post, don't be afraid to ask, "Why?" when you are given advice about your (or your baby's) well being.  I'll admit that there is an overwhelming wealth of information on the internet, and finding trustworthy sources can be daunting.  However, I would recommend starting with a simple self-test.  Ask yourself, "Does this seem to make sense?"  Unless the answer is an unequivocal "yes" , then go find a second and third opinion.  Don't take every statement made by ''experts" at face value.  At a minimum, you might be depriving yourself of something.  At worst, you may be doing yourself harm.

Get informed.  Nobody cares more about your health and well being than you.

Don't Be "Creepy"

The below image was included in an article I was reading this morning about Superbowl ticket prices:

It's a pretty ordinary looking work scene.  However, the thing that jumped off the page at me is the poor posture assumed by the two figures in the foreground of the shot.  Look familiar to you?  Do you think that you spend most of your waking hours in a similar position, only to follow it up with a commute staring at even smaller ipad and cell phone screens?  If so, here's a simple piece of advice for you.

Try standing up every 20 minutes or so if you have a sedentary job.  The reason for this suggested time interval is because of a phenomenon called ligamentous creep.  After about 20 minutes, ligaments (connective tissue that provides passive support to your skeleton) begin to elongate and stretch out.  By simply standing up a few times an hour, you will help "reset" those ligaments.  Of course, there are many exercises that can help strengthen the dynamic (muscles/tendons) supports of your body, but this is about as basic as it comes in terms of interventions.

Many patients tell me that they simply forget to move during the workday because they are so engrossed in their work.  Here are a few simple tips:

-Drink plenty of water.  In addition to being just plain good for you, it will force you to go to the restroom frequently.
-Set your smart phone alarm as a reminder.
-Move your copier/printer away from your desk so that you are forced to get up.
-Stand up every time you receive or make a phone call.
-Use post-it notes on the corner of your monitor to remind you to get up.
-This is a more expensive solution, but many of my patients who work at Google have invested in adjustable sit to stand desks, so that they can spent part of their day working in standing.

If you spend most of your day in this flexed forward posture, commit yourself to getting extended.  You will minimize ligamentous creep and its potential uncomfortable consequences.