Category Archives: wellness

Critical Decision Making and the Healing Process: Part 1

Image caption:  Crashpads and appropriate spotters are climbing critical decision making 101…double fail!

Critical decision making is one of the most important aspects, and oftentimes the key component, for the prevention and treatment of injuries.  Our bodies (and beings) have the amazing ability to heal themselves in most cases, aside from cases of severe trauma such as displaced fractures.  Its our job to create the environment to allow our bodies to do what they know how to do…heal.

There can be blockages to the healing process so we first have to figure out what those blockages are and then remove them.  This takes having a keen awareness of the things that are limiting the healing as well as those that are promoting it.   Listening to the signals that our bodies send, such as pain, depression, and anxiety, help us find the path that leads to healing.  This awareness ultimately gives us the power to make decisions that allow us to return to the life and activities that we wish for.  Pain and inflammation (discussed below) are important, albeit uncomfortable, parts of the healing process.

Understanding the healing process from a physiological perspective is a helpful start to show that healing is in fact a process, not an event.  For a more in depth description, check out the first chapter of Beyond Tape or the references below.1-11 Simply put, there are three main phases:

 Phases of the healing process
  1. Inflammation (roughly days 0-7):  When an injury occurs, the body sends an increased supply of blood to the area which bring in cells that remove dead or damaged tissue.   When those cells are finished, they call in a new group of cells to come in to lay down new tissue.  In addition to the cells, various chemical messengers are released, some of which signal danger (or pain) that prevent the person from continuing to touch the hot stove, for example.
  2. Proliferation (roughly days 7-21):  New tissue gets laid down.  Initially, the new tissue is disorganized, like a clump of cooked spaghetti.
  3. Remodeling/maturation (roughly day 21-weeks/months):  The disorganized tissue realigns in a more functional way so we can return to normal activities.  This realignment occurs from finding the balance of stressing the tissues (range of motion, stretching, strengthening, functional activities) enough to create healthy adaptation while not stressing them enough to cause more injury.

Now that we have the physiology out of the way, here are some other common themes that hold people back.  I think these topics are fascinating and shifted my personal mindset from seeing my own unhealthy decisions as “bonehead Mike decisions” to ways that I as a human being have a tendency to sabotage myself.   Having the awareness that we’re all subject to things like cognitive biases, allows us to think more critically about a decision before it takes us down a hard and unnecessary road.  Check out the lecture series “The Art of Critical Decision Making” with Michael Roberto from the Teaching Company and Daniel Kahneman’s book Thinking, Fast and Slow for a more in-depth discussion of these types of topics.

1. Sunk Cost Effect

The “sunk cost effect” is a term typically used in economics that applies to many other areas of life as well (we’ll use rock climbing as an example). It is “an irrational economic decision to invest more future resources after a prior investment has been made (costs are sunk) compared to a similar situation
without a prior investment”.12

For climbing, this is exemplified by making the decision to continue climbing when there is an injury present because of the desire to avoid wasting all the time, effort, and possibly money that has been spent training to reach a goal. This may involve working toward specific goals of boulder problems, red points, or summits. The climber finds herself in a situation where there are obstacles to those goals in the form of an injury, illness, or uncooperative weather. The rational decision would be to back off in order to return to climbing in a healthy
state. The irrational decision would be to ignore the obstacles and continue digging further into the hole. These irrational decisions are often easy to see in hindsight, but we are all capable of justifying unhealthy decisions when the sunk cost effect is present. Making the rational decision could mean the difference between returning
to climbing after a sprain or strain heals in a couple weeks versus doing serious damage that eventually puts the climber out for months or a year.

For mountain climbing, the difference could be aborting the mission in order to make another attempt on a later date versus continuing on and risking serious injury or death. The sunk cost effect was thought to be a major factor in the Mt. Everest tragedy in 1996 where 5 climbers died, including 2 experienced expedition leaders.13 Sticking to turn around times and acknowledging approaching ominous weather becomes more difficult the more prior investment has been made. Try to step back and see the bigger picture before ignoring the signs.

2. Good Pain Versus Bad Pain

Most of us were told some form of “no pain, no gain” over and over starting from a young age.  Is this a true statement?  As with most other things in life, it depends.  There is injurious pain (pain signifying injury or danger) and therapeutic pain (discomfort that leads to beneficial results).  Take a person who is training for a race and doing speed work at the track.  It’s hard and is becoming mentally painful to continue, but they know if they do a couple more sprints it will help their performance (therapeutic pain).  If that person broke their ankle, they hopefully wouldn’t continue to run because it will not help their performance (injurious pain).  That’s an extreme example, but you get the point.

This concept also comes up when talking about performing self body work at home.  I practice and teach people to perform myofascial release on themselves, which is sinking into an area that feels tight and tender and holding direct pressure on the area for 2-3 or more minutes of time to release restricted areas.  People often describe this a “good hurt”.  The idea is to work with your body rather than to beat it into submission.

This is a part of what is probably the most important message from this article…listen to the body, as well as to the environment, and to the signals they are sending. As they say, “if you listen to your body when it whispers, you won’t have to hear it scream”. Paige, Fiore, et al describe this perfectly: “Climbers should be encouraged to immediately stop climbing when they feel sharp pain. This is especially true of finger pain and if symptoms appear while “working” a move. This seems obvious, but successful climbers, like other successful athletes, have often conditioned themselves to ignore discomfort and to push through difficulties. Climbers must learn to differentiate between pushing oneself despite exhaustion and muscular fatigue and pushing oneself into a serious connective tissue injury.” 14

3. All or None Versus Modification

A crucial aspect of healing is determining aspects of our lives that either help the healing process or slow it down.  I think it helps to just start with concrete aspects without worrying about how you might modify those aspects.

For example, take a person who loves gardening, which is an activity that increases their pain.  People are often reluctant to even start this conversation, stating, “well I have to garden!” (or work or take care of my kids, etc.).  Starting from a place of either gardening or not gardening prevents us from considering the possibility of modification, or finding the balance between doing what we want but not in a way that causes further injury.  Once we have the aspect (gardening in this case), we can look at variables that might be modified. For example, length of time performing the task.  Instead of gardening for 4 hours straight, is it possible to try 1 hour blocks with a 30 minute rest break in between?  This not only might help the body heal, but it also allows a person to assess their progress over time (start with 1 hour for the first week, increase to 1.5 hours for the next if it feels ok, then 2 hours, etc.).

Some other examples of variables that can be modified might be the various activities (digging vs. watering vs. weeding vs. planting), time of day (does the pain tend to be worse first thing in the morning or in the evening?), the possibility of having someone else temporarily perform some of the more strenuous activities, body position (standing and bending over versus using a stool or bench).  The goal is to create the environment that allows your body to heal itself by making logical, rational decisions.  It helps to see these modifications as temporary, while you’re allowing your body to heal. I often suggest that if a person is having trouble deciding if they should perform a certain activity, pretend a loved one is telling them about this exact situation happening to that loved one.  What advice would you give them?

4. Real versus perceived threat 

I see lots of folks who haven’t tried a certain activity because they think it will hurt.  Oftentimes when we try the activity in the clinic, they find that its either not painful, or we’re able to modify it so they can start to ease into the activity.  Its a powerful feeling to realize that you may be capable of things you thought you were not and that there is at least the possibility you can return to your life.

There are many understandable reasons why we all avoid things that we think will hurt.  Sometimes people are told they shouldn’t do certain things (you should stop running, lifting, squatting, bending, etc.).  There can be important reasons for these suggestions (avoiding bending over or prolonged slouched positions with an acute spinal compression fracture, for example) but that’s not a long term plan.  In most cases, people should be able to return to their normal daily lives after an injury.

Problems that show up on imaging (Xrays, MRIs, etc.) can be disconcerting.  A lot of folks are under the impression that once damage is done (disc herniation, meniscus tear, arthritis, etc.) then it will be there forever.  In reality, these injuries heal the majority of the time15-27,   or may not actually be the cause of the pain.28-39  There are certainly times when your body may require some outside help (surgery, etc.), such as a herniated disc stopping the nerve signal to the area it controls which can cause significant and specific weakness, lack of sensation, or bowel/bladder problems.  Again though, most of the time the body can heal.

What you can do:  Gain greater and greater awareness into the meaning the signals your body sends.  See pain as a crucial tool to help you heal yourself.  Ease into activities in a controlled manner, initially avoiding forceful movements using momentum (starting a lawn mower, for example).  Consider how your body feels during the activity, immediately after, and the next day.   Assume you can heal, you may just not have figured out how yet.  People who believe they can heal make different decisions than those that don’t, which will be discussed further in Part 2.

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing (and non-climbing) injury related topics.  Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

References:

1Kannus P1, Parkkari J, Järvinen TL, Järvinen TA, Järvinen M. Basic science and clinical studies coincide: active treatment approach is needed after a sports injury. Scand J Med Sci Sports. 2003 Jun;13(3):150-4.
2Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J. BoneJoint Surg. 2005; 87:187Y202.
3James R1, Kesturu G, et al. Tendon: biology, biomechanics, repair, growth factors, and evolving treatment options. J Hand Surg Am. 2008 Jan;33(1):102-12.
4Hess GP, Cappiello WL, Poole RM, et al: Prevention and treatment of overuse tendon injuries. S p o r t s M e d 8 : 371–384, 1989.
5Järvinen TA1, Järvinen TL, et al. Muscle injuries: biology and treatment. Am J Sports Med. 2005 May;33(5):745-64.
6Bondesen BA1, Mills ST, et al. The COX-2 pathway is essential during early stages of skeletal muscle regeneration. Am J Physiol Cell Physiol. 2004 Aug;287(2):C475-83.
7Schleip R1, Müller DG. Training principles for fascial connective tissues: scientific foundation and suggested practical applications. J Bodyw Mov Ther. 2013 Jan;17(1):103-15.
8Lu H1, Huang D, et al. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. FASEB J. 2011 Jan;25(1):358-69.
9Arnold L1, Henry A, et al. Inflammatory monocytes recruited after skeletal muscle injury switch into antiinflammatory macrophages to support myogenesis. J Exp Med. 2007 May 14;204(5):1057-69.
10Smith C1, Kruger MJ, et al. The inflammatory response to skeletal muscle injury: illuminating complexities. Sports Med. 2008;38(11):947-69.
11Wren TA, Yerby SA, et al. Mechanical properties of the human achilles tendon. Clin Biomech (Bristol, Avon). 2001 Mar;16(3):245-51.
12Strough J1, Karns TE, Schlosnagle L. Decision-making heuristics and biases across the life span. Ann N Y Acad Sci. 2011 Oct;1235:57-74.
13Roberto, M. The Art of Critical Decision Making. The Teaching Company. 2009.
14Paige TE, Fiore DC, Houston JD. Injury in traditional and sport rock climbing. Wilderness and Environmental Medicine, 9,2-7 (1998).
15Benson RT1, Tavares SP, et al.  Conservatively treated massive prolapsed discs: a 7-year follow-up.  Ann R Coll Surg Engl. 2010 Mar;92(2):147-53.
16Saal JA1, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976). 1989 Apr;14(4):431-7.
17 Yukawa Y1, Kato F, et al. Serial magnetic resonance imaging follow-up study of lumbar disc herniation conservatively treated for average 30 months: relation between reduction of herniation and degeneration of disc. J Spinal Disord. 1996 Jun;9(3):251-6.
18Masui T1, Yukawa Y, et al. Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years. J Spinal Disord Tech. 2005 Apr;18(2):121-6.
19Matsubara Y1, Kato F, Mimatsu K, Kajino G, Nakamura S, Nitta H. Serial changes on MRI in lumbar disc herniations treated conservatively. Neuroradiology. 1995 Jul;37(5):378-83.
20Komori H, Okawa A, et al.  Contrast-enhanced magnetic resonance imaging in conservative management of lumbar disc herniation. Spine (Phila Pa 1976). 1998 Jan 1;23(1):67-73.
21Autio RA1, Karppinen J, et al.  Determinants of spontaneous resorption of intervertebral disc herniations.  Spine (Phila Pa 1976). 2006 May 15;31(11):1247-52.
22 Anakwenze OA1, Namdari S, et al. Athletic performance outcomes following lumbar discectomy in professional basketball players. Spine (Phila Pa 1976). 2010 Apr 1;35(7):825-8.
23Hsu WK1. Performance-based outcomes following lumbar discectomy in professional athletes in the National Football League. Spine (Phila Pa 1976). 2010 May 20;35(12):1247-51.
24Mochida K1, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine (Phila Pa 1976). 1998 May 1;23(9):990-5; discussion 996-7.
25Lee DY1, Park YJ2, et al. Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis. Arch Orthop Trauma Surg. 2018 Dec;138(12):1731-1739.
26Sihvonen R1, Paavola M2, et al.  Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial.  Ann Rheum Dis. 2018 Feb;77(2):188-195.
27Azam M1, Shenoy R2.  The Role of Arthroscopic Partial Meniscectomy in the Management of Degenerative Meniscus Tears: A Review of the Recent Literature.  Open Orthop J. 2016 Dec 30;10:797-804.
28Boden SD1, Davis DO, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Mar;72(3):403-8.
29Deyo RA. Magnetic resonance imaging of the lumbar spine. Terrific test or tar baby? N Engl J Med. 1994 Jul 14;331(2):115-6.
30Brinjikji W1, Luetmer PH2, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
31Bedson J1, Croft PR.. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008 Sep 2;9:116.
32Beattie KA1, Boulos P, et al. Abnormalities identified in the knees of asymptomatic volunteers using peripheral magnetic resonance imaging. Osteoarthritis Cartilage. 2005 Mar;13(3):181-6.
33Guermazi A1, Niu J, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 2012 Aug 29;345:e5339.
34Schwartzberg R1, Reuss BL, et al. High Prevalence of Superior Labral Tears Diagnosed by MRI in Middle-Aged Patients With Asymptomatic Shoulders. Orthop J Sports Med. 2016 Jan 5;4(1):2325967115623212.
35Kälin PS1, Crawford RJ, et al. Shoulder muscle volume and fat content in healthy adult volunteers: quantification with DIXON MRI to determine the influence of demographics and handedness. Skeletal Radiol. 2018 Oct;47(10):1393-1402.
36Nakashima H1, Yukawa Y, et al. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015 Mar 15;40(6):392-8.
37Register B1, Pennock AT, et al. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012 Dec;40(12):2720-4.
38Alyas F1, Turner M, Connell D. MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. Br J Sports Med. 2007 Nov;41(11):836-41; discussion 841.
39Videman T1, Battié MC, et al.  Associations between back pain history and lumbar MRI findings.  Spine (Phila Pa 1976). 2003 Mar 15;28(6):582-8.

 

 

 

 

 

 

Find Your Balance to Prevent Falls and Boost Confidence

About a third of people 65 years and older fall at least one time each year.1-3  Falls account for over half of all injury-related hospitalizations for the elderly.2

As a community, we can help  our friends and family members by assisting them with the exercises and helping them address any external factors noted below.  As individuals, we can boost motivation by exercising with a friend or taking a class.  Additionally, a common message that is conveyed to older folks is that they are frail and that inactivity and falls are an inevitable part of aging.6 As with many other things in life, its easy to take an aspect of truth and swing our pendulum in an extreme direction.  Its true that sarcopenia, the term given to the loss of muscle mass related to age, occurs.3,6  About two percent of muscle mass is lost per year after the age of 50.6 This loss in muscle mass is one of the main contributors to decreased function, such as rising from a chair, walking, making turns, and balance at rest and while performing activities.3,6,7  However, strength training has been shown to greatly mitigate this decline.5,6  Perhaps even more exciting is that exercises and educational programs have been shown to significantly improve balance and decrease the risk of falls as well as injuries caused by falls.1-13

Aside from the exercises mentioned below, Tai Chi2,14, Pilates21, and Yoga22 have been shown to improve balance and decrease the risk of falls.  If you live in the Bishop area, we’re blessed to have Tai Chi classes taught by Andy Selters and Deo Santos, Pilates at Bishop Yoga and Pilates Center and FlowMotion Pilates, and yoga at Bishop Yoga and Pilates Center, FlowMotion Pilates, Sabine Elia at Inyo Council for the Arts, and Sierra Shanti.

There are many exercise programs geared towards improving balance and decreasing fall risk.  They all tend to have the common themes of addressing strength, flexibility, and balance.  The general consensus recommends one hour sessions three times per week.  The bulk of the program below is taken from the Otego Exercise Program.  This program has been studied extensively and has been shown to decrease falls and the injuries caused by falls by over a third.5,10-12  In addition to the exercises, a discussion of the internal and external factors related to falls will be addressed first as many of these can be modified to greatly decrease a person’s risk of falling.1,4 

 

Internal Factors Affecting Balance:

  1. Vision – Make sure you have the correct prescription for eye wear.
  2. Vestibular system – This is the sensory system in your inner ear that communicates with your brain to tell it where your body is in space.  BPPV and Meniere’s Disease are examples of vestibular system disorders.
  3. Proprioception – These are the sensors in your joints that tell your body where it is in space.
  4. Strength – Weakness in the ankles, knees, hips, and low back/core region have been shown to affect balance and will be addressed below.5,8
  5. Flexibility – Decreased flexibility in the ankles, hips, and spine have been shown to affect flexibility and will be addressed below.5,8
  6. Dual tasking – Walking while adding another task, such as talking, turning your head to look at objects, or reacting to hearing or seeing something that is happening in your environment, is considered dual tasking.  This is a fascinating and overlooked topic that I did my grad school thesis on.  Older folks tend to have a decreased ability to dual task while walking which can increase the risk of falls.  One easy way of determining if you should be working on balance is if you stop walking when you begin talking.15-18
  7. Medical Conditions – Some examples are poor general health, diabetes, arthritis, osteoporosis, stroke, incontinence, medication use, and cognitive/mental health issues (memory, inattention, dementia, depression). Many of these issues can by improved greatly by exercise, nutrition, and lifestyle changes.
  8. Lifestyle Choices – Some examples are exercise, footwear, alcohol use, nutrition, hydration, and fear of falling.4

External Factors Affecting Balance:

  1. Throw rugs and cords or other obstacles
  2. Lack of nightlights for bathrooms/hallways
  3. Lack of handrails
  4. Objects that are out of reach
  5. Uneven ground
  6. Alcohol
  7. Decreased activity level
  8. Fear of falling
  9. Dehydration – The recommendation is about twelve eight ounce glasses of water per day for men and nine for women.19,20
  10. Lack of sleep – See my evidenced-based handout for sleep hygiene tips.
  11. Medication issues
    – Did your balance issues begin around the same time as a medication change?  Talk with your doctor.
    – Lightheadedness/dizziness with a change of position (lying to sitting or sitting to standing) can indicate a blood pressure issue.  Talk with your doctor.
  12. Pets – high energy dogs, for example

Exercises

I. General Guidelines – click on the underlined areas for video demonstrations

  1. A person should be evaluated by a healthcare practitioner familiar with balance disorders and training before performing the exercise program below.  All of the exercises can be modified to be made easier or more challenging and every person’s deficits will be somewhat different.  The best exercise program is one specifically tailored to the individual.  Safety is the most important aspect of any exercise program.
  2. Performing any of these exercises is better than none.  If the program is taking too much time or effort, have your physical therapist remove the exercises that are not as necessary for you.  It is much better to start off doing less than you are capable of and add to that program rather than starting with too much and hurting yourself or hating the program and throwing it in the garbage.
  3. Do not push through pain with any of the exercises, even if it feels like you are “not doing anything”.  Try to avoid having expectations about being able to perform a certain number of repetitions or move in a certain range.  Progress will come with consistent practice.
  4. Notify your physician if you experience dizziness, chest pain, or shortness of breath (ie., you are unable to speak because you are short of breath).
  5. Do not hold onto an object for support that may move (use your kitchen sink rather than a chair for example).
  6. Look ahead when walking on even surfaces or performing the exercises instead of looking down.
  7. Try to add walking into your daily activities as much as possible. For example, park farther away from the entrance when going to the store. Use the stairs when possible instead of an elevator.

II. Warm Up

  1. Walk for 20-30 minutes if time permits (stationary cycling is a good alternative if walking is too unsteady)
  2. Neck rotation – stand tall and turn your head to the side until you feel a stretch, repeat on the other side 5-10X each
  3. Chin tucks – stand tall and tuck your chin as if you are creating a double chin while imagining your spine stretching towards the ceiling, repeat 5-10X
  4. Trunk extension – place your hands on your low back and bend backwards until you feel a stretch, repeat 5-10X
  5. Trunk rotation – keeping your hips and pelvis stationary, rotate your trunk until you feel a stretch, repeat on the other side 5-10X each
  6. Seated ankle range of motion – bring your toes towards your nose, then push your toes down towards the floor, repeat 10X in each direction

III. Strengthening
use a kitchen counter for support for safety and to focus on your technique, as needed

  1. Seated knee extension – straighten your knee and pull your toes towards your nose, feel free to add ankle weights to make more challenging, repeat 10X for 2-3 sets
  2. Standing knee flexion – bend your knee by bringing your heel towards your buttocks, feel free to add ankle weights to make more challenging, repeat 10X for 2-3 sets
  3. Toe/heel raises (double or single leg) – raise up onto the balls of your feet, lower back down and raise up onto your heels, repeat 10X for 2-3 sets
  4. Hip abduction – stand tall and raise your leg out sideways away from your other leg, repeat 10X for 2-3 sets on each side
  5. Marching – stand tall and raise a knee towards your chest, repeat 10X for 2-3 sets on each side
  6. Squatting – keeping a neutral spine position with your chest pointing forwards and your eyes looking straight ahead, squat down until you feel pain or unstable and return to standing (you may want to use a chair to simulate standing up from a seated position and squatting back down until your buttocks barely touches the chair before returning to stand), repeat 10X for 2-3 sets
  7. Lunges (more advanced)
  8. Single leg quarter squats (more advanced)

IV. Static (not moving) Standing Balance
*use kitchen counter for support for safety as needed
*there are 4 progressively more challenging foot positions (1. feet as wide as your hips 2. feet together 3. tandem stance 4. single leg stance) and 4 progressively more challenging variables for each foot position (1. eyes open on an even surface 2. eyes closed on an even surface 3. eyes open on an uneven surface, such as a balance board, dyna disc, or pillow 4. eyes closed on an uneven surface)
*hold all positions for 30-60 seconds and repeat 2-3X

  1. Feet hip width with eyes open (close eyes or stand on an uneven surface to make more challenging)
    feet hip width
  2. Feet together with eyes open (close eyes or stand on an uneven surface to make more challenging)

    feet together
  3. Tandem stance (tightrope) with eyes open (close eyes or stand on an uneven surface to make more challenging) – both sides
    semi tandem stance (easier)

    tandem stance (harder)
  4. Single leg stance with eyes open (close eyes or stand on an uneven surface to make more challenging) – both sides

V. Dynamic (moving) Standing Balance
*
use a wall or counter (hallways can be helpful) for support for safety as needed
*perform each activity for 10 steps (or better yet, measure out 10-15 feet so the dual task of counting while you are walking is not added, at least initially) and repeat 5X

  1. Tandem walking (tightrope) – walk forwards placing one foot directly in front of the other as if walking on a tightrope
  2. Walking with head turns – turn your head side to side as if you are checking out the food on either side of you in the grocery store aisle
  3. Walking backwards
  4. Sideways walking
  5. Figure 8 walking – walk in a figure of 8 pattern
  6. Heel walking – walk on your heels
  7. Toe walking – walk on the balls of your feet
  8. Backwards tandem walking – walk backwards placing one foot directly in front of the other as if walking on a tightrope
  9. Stairs – use one or two rails for support until you feel comfortable walking with no support

VI. Stretching
*
hold stretches for 30 seconds and repeat 2-3X on each side daily

  1. Calf stretches (standing) – a stretch should be felt in the calf of the back leg
  2. Hip flexor stretches (standing) – a stretch should be felt in the front of the hip in the back leg
  3. Single knee to chest (lying on back) – a stretch may be felt in the knee, hip, or back

    single knee to chest
  4. Trunk rotation (lying on back)

    low trunk rotation
  5. Child’s pose (start on your hands and knees and sit back on your heels while bringing your head to the floor)
    Childs Pose

     

Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing (and non-climbing) injury related topics.  Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

References:

1Schwenk M, Jordan ED, et al. Effectiveness of foot and ankle exercise programs on reducing the risk of falling in older adults: a systematic review and meta-analysis of randomized controlled trials. J Am Podiatr Med Assoc. 2013 Nov-Dec;103(6):534-47.
2Sherrington C, Whitney JC, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Dec;56(12):2234-43.
3Hamed A, Bohm S, et al. Follow-up efficacy of physical exercise interventions on fall incidence and fall risk in healthy older adults: a systematic review and meta-analysis. Sports Med Open. 2018 Dec 13;4(1):56.
4Florida Injury Prevention Program for Seniors (FLIPS) – https://slideplayer.com/slide/8680174/
5McMahon SK, Wyman JF, et al. Combining Motivational and Physical Intervention Components to Promote Fall-Reducing Physical Activity Among Community-Dwelling Older Adults: A Feasibility Study. Am J Health Promot. 2016 Nov;30(8):638-644.
6Papa EV1, Dong X2, et al. Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clin Interv Aging. 2017 Jun 13;12:955-961.
7Gardner MM1, Buchner DM, et al. Practical implementation of an exercise-based falls prevention programme. Age Ageing. 2001 Jan;30(1):77-83.
8Emilio EJ1, Hita-Contreras F2, et al. The association of flexibility, balance, and lumbar strength with balance ability: risk of falls in older adults. J Sports Sci Med. 2014 May 1;13(2):349-57.
9El-Kashlan HK1, Shepard NT, et al. Evaluation of clinical measures of equilibrium. Laryngoscope. 1998 Mar;108(3):311-9.
10Shubert TE, Smith ML, Otago Exercise Program in the United States: Comparison of 2 Implementation Models. Phys Ther. 2017 Feb 1;97(2):187-197.
11Otego Exercise Program PDF – file:///C:/Users/Mike%20Gable/Documents/Originals/Articles/Balance/Not%20Read/Otago%20program%20PDF.pdf.
12Robertson MC1, Campbell AJ, et al. Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data. J Am Geriatr Soc. 2002 May;50(5):905-11.
13Sherrington C1, Fairhall NJ, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31.
14Taylor-Piliae RE1, Haskell WL, et al. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Altern Ther Health Med. 2006 Mar-Apr;12(2):50-8.
15Lajoie Y1, Teasdale N, et al. Attentional demands for static and dynamic equilibrium. Exp Brain Res. 1993;97(1):139-44.
16Wright DL1, Kemp TL. The dual-task methodology and assessing the attentional demands of ambulation with walking devices. Phys Ther. 1992 Apr;72(4):306-12; discussion 313-5.
17Chen HC1, Schultz AB, et al. Stepping over obstacles: dividing attention impairs performance of old more than young adults. J Gerontol A Biol Sci Med Sci. 1996 May;51(3):M116-22.
18Lundin-Olsson L, Nyberg L, et al. “Stops walking when talking” as a predictor of falls in elderly people. Lancet. 1997 Mar 1;349(9052):617.
19Sawka MN1, Cheuvront SN, Carter R 3rd. Human water needs. Nutr Rev. 2005 Jun;63(6 Pt 2):S30-9.
20http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10925
21Pata RW1, Lord K2, et al. The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodyw Mov Ther. 2014 Jul;18(3):361-7.
22Nick N1, Petramfar P2, et al. The Effect of Yoga on Balance and Fear of Falling in Older Adults. PM R. 2016 Feb;8(2):145-51.

Sleep And Healing

Having 2 and 4-year-old kids has me thinking a lot about sleep lately.  I’ve been interested in how sleep loss affects the healing process though for a long time since I became fascinated with chronic pain conditions early on in my career.  There’s research going back to before I was born linking sleep deprivation and what we know today as fribromyalgia.1,2  Since then, there has been an incredible amount of research linking sleep deprivation with a myriad of health issues.  At the end of this article, I break down each of the many aspects of health that are affected by sleep and some of the research that has been done on each topic.  Many of the references are mentioned in the fascinating book Why We Sleep by Matthew Walker while many are additional articles I found through my review of the current literature.  This post is a greatly expanded version of the information I wrote about in Beyond Tape.

The potential causes of sleep loss are vast but seem to be able to be broken down into 2 categories , behavioral and medical, which can be linked in many cases.  Medical causes including obstructive sleep apnea, hormone imbalances, medication-related, and psychological disorders, which should be ruled out first by a qualified health care professional.3,6,9  Behavioral causes can be changed by modifying a person’s behavior, such as avoiding screens before bedtime.  Oftentimes, the causes are more on the behavioral end, which is where treatments like cognitive behavioral training and sleep hygiene techniques come into play.  Cognitive behavioral training (CBT), when performed by an expert in this field, has been found to be the most effective (even more so than sleep medications in some studies).  Sleep hygiene tips, one aspect of CBT, have been shown to be helpful as well.4-11  Check out my evidenced-based handout for sleep hygiene tips if you or someone you know suffers from sleep problems.

As a physical therapist, I’m mostly fascinated with the effects of sleep on injuries and the healing process.  Growth hormone is produced during stage 3, a deeper stage which is considered slow-wave non REM sleep, of the sleep cycle.12-14  This hormone helps to facilitate the healing process.  It takes roughly 90 minutes to get into this stage of the sleep cycle.15  Inadequate sleep has been shown to decrease growth hormone production.  Sleep disturbance can also contribute to myofascial trigger point formation, another contributor to chronic pain.  Psychological stress is a major cause of sleep loss.  This is a double-whammy, as stress causes an increase in production of the hormone cortisol (as does sleep deprivation), which has a negative impact on healing.  Laughter, meditation, and yogic breathing each have been shown to decrease the negative effects of stress.13,14

Aside from the affects on the healing process, sleep loss is linked to all kinds of problems which are described in the summary below.  Some big ones that are being talked about in the research are the link with metabolic syndrome (increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of heart disease, stroke and diabetes), obesity and type 2 diabetes, both in adults and kids.16  This is thought to be due to the effects on hormones that play a major role in control of appetite and energy expenditure.  Hunger increases with poor sleep.  

Here is a summary of the health issues associated with poor sleep quality and quantity:

      • Cancer – Night shift work is associated with breast, prostate, and endometrial Cancers.17-19
      • Cognitive impairments – Cognitive functioning has been found to be impaired in all age groups, from children to the elderly, when restricting sleep by as little as 1 hour over 5 nights or 1 night of sleep deprivation.20-22
      • Alzheimer’s – Sleep fragmentation (repetitive short interruptions of sleep) and insomnia are found to be associated with Alzheimer’s and an increased rate of cognitive decline.23,24  Treating obstructive sleep apnea has been shown to improve cognitive function in Alzheimer’s patients.25
      • Cardiovascular disease and blood pressure – Poor sleep quality and insomnia are associated with increased blood pressure and vascular inflammation (C-reactive protein, a stable marker of inflammation that has been shown to be predictive of cardiovascular morbidity, has been shown to be elevated in subjects with total and partial sleep deprivation).26,27  People who get more sleep have been shown to have lower coronary artery (blood supply to the heart) calcification incidence.28  All these problems increase the risk of heart attacks and strokes.
      • Common cold and upper respiratory illness – Sleeping for less than 7 hours of sleep per night has been shown to be associated with an increased incidence of developing the common cold.29-31
      • Chronic pain and fibromyalgia – Sleep deprivation, especially of stage 3 in non REM sleep, has been shown to produce fibromyalgia-like symptoms of muscle tenderness and central sensitization.  This is where the nervous system becomes overly reactive, requiring less and less of a stimulus to create the sensation of pain and the pain is maintained even after the initial injury has healed.32-34  And as I mentioned above, stage 3 is when growth hormone is released which helps to facilitate the healing process.  Sleep hygiene education has been shown to decrease pain and fatigue in patients with fibromyalgia.35  Sleeping less than 6 hours has been associated with increased cortisol release and increased sympathetic nervous system activity, which contribute to central sensitization.36  Sleep disturbance is also thought to be a factor in the perpetuation of myofascial trigger points.37
      • Low back pain – Improvements in sleep quality are associated with improvements in low back pain and disability. 38 
      • Obesity – Sleep deprivation in both the short and long term is associated with increased obesity, body mass index, and weight gain in adults and children (including infants).  This is due to several factors including decreased glucose tolerance and carbohydrate metabolism, decreased insulin sensitivity, increased evening concentrations of cortisol, increased levels of ghrelin, decreased levels of leptin and increased hunger and appetite.  Ghrelin and leptin sound like Lord of the Rings’ characters, but they’re actually crucial hormones for regulating appetite.  Grehlin is an appetite stimulant and leptin an appetite suppressant.39-45  
      • Type 2 Diabetes – Sleep deprivation and poor sleep quality are associated with an increased prevalence of type 2 diabetes.  This is due to decreased carbohydrate metabolism and glucose tolerance, leading to insulin resistance and diabetes.46-49  
      • Sports injuries and performance – Decreased sleep is associated with a significantly increased prevalence of injury.  In one study, the likelihood of having an injury was 75% for 6 hours of sleep versus 18% for 9 hours in high school kids and 65% of kids were injured who slept less than 8 hours versus 31%  who slept longer than 8 hours.  This is thought to be due to the findings in other studies showing an association between sleep loss and impairment of psychomotor performance,  motor function, mood, and cognitive functions.50  Exciting research regarding performance shows that  basketball players who increased their sleep to at least 10 hours sprinted faster, shot more accurately, and noted improved physical and mental well-being.51  Decreased sleep is also associated with decreased performance, especially with “sports-specific skill execution and submaximal sustained exercise bouts”.  Increasing sleep showed an increase in “sports-specific skill execution and cognitive related tasks, such as reaction time and shooting accuracy”.52
      • Bone loss – Bone loss has been shown to occur after 3 weeks of sleep disruption, due to bone formation being decreased while bone resorption stays the same.53
      • Sleep medications – As a physical therapist, its beyond my scope of practice to give recommendations on medications.  That being said, sleep medications such as Restoril and Ambien have been shown to significantly reduce slow wave activity during non REM sleep.  Again, this is also called deep sleep and is the phase when growth hormone is released for healing of damaged tissues, glial cells in the brain are restored with sugar to provide energy for the brain, and synapses in the brain which are formed from learning and memory during wakefulness are regulated.54 Other factors that you may want to consider are that in some studies, sleep medications were no more effective than behavioral treatments55 and sleep medications have common, and often significant, side effects.54,56,57

It may seem strange for your physical therapist to be concerned about your sleep patterns, but I find (as does the research) that addressing all aspects of a person’s health leads to better and longer-lasting outcomes.  This is the purpose of my handouts for evidence-based sleep hygiene tips and evidence-based wellness topics.  Poor sleep quality and quantity is not just a normal part of the aging process and there are things you can do.  

Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.

1Moldofsky H, Scarisbrick P. Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med. 1976 Jan-Feb;38(1):35-44.
2Moldofsky H, Scarisbrick P, England R, Smythe H. Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med. 1975 Jul-Aug;37(4):341-51.
3Bloom HG1, Ahmed I, et al. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc. 2009 May;57(5):761-89.
4Sharma MP1, Andrade C. Behavioral interventions for insomnia: Theory and practice. Indian J Psychiatry. 2012 Oct;54(4):359-66.
5Orlandi AC1, Ventura C, et al. Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia. Rev Bras Reumatol. 2012 Oct;52(5):666-78.
6Zhou ES1, Gardiner P2, et al. Integrative Medicine for Insomnia. Med Clin North Am. 2017 Sep;101(5):865-879.
7Ye YY, Chen NK, et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open. 2016 Nov 30;6(11):e010707.
8Kozasa EH1, Hachul H, et al. Mind-body interventions for the treatment of insomnia: a review. Braz J Psychiatr. 2010 Dec;32(4):437-43.
9Maness DL1, Khan M1. Nonpharmacologic Management of Chronic Insomnia. Am Fam Physician. 2015 Dec 15;92(12):1058-64.
10Siebern AT1, Suh S, et al. Non-pharmacological treatment of insomnia. Neurotherapeutics. 2012 Oct;9(4):717-27.
11MacLeod S1, Musich S2, et al. Practical non-pharmacological intervention approaches for sleep problems among older adults. Geriatr Nurs. 2018 Sep – Oct;39(5):506-512.
12Cauter E, Leproult R, et al. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA. August 16, 2000 – Vol 284 No 7 pp. 861-868. 
13Robles TF1, Carroll JE.  Restorative biological processes and health. Soc Personal Psychol Compass. 2011 Aug;5(8):518-537. 
14Adam K, Oswald I.  Sleep Helps Healing. British Medical Journal. Volume 289, 24 November 1984. 
15Davidson J, Moldofsky H, et al.  Growth Hormone and Cortisol Secretion in Relation to Sleep and Wakefulness. J Psychiatr Neurosci, Vol. 16, No. 2, 1991. 
16Van Cauter E, Spiegel K, et al.  Metabolic consequences of sleep and sleep loss. Sleep Med. 2008 Sep;9 Suppl 1:S23-8.
17Pahwa M1, Labrèche F, et al.  Night shift work and breast cancer risk: what do the meta-analyses tell us? Scand J Work Environ Health. 2018 Jul 1;44(4):432-435.
18Viswanathan AN1, Hankinson SE, et al. Night shift work and the risk of endometrial cancer. Cancer Res. 2007 Nov 1;67(21):10618-22.
19Salamanca-Fernández E1, Rodríguez-Barranco M, et al.  Night-shift work and breast and prostate cancer risk: updating the evidence from epidemiological studies. An Sist Sanit Navar. 2018 Aug 29;41(2):211-226.
20Volkow ND1, Tomasi D, et al.  Hyperstimulation of striatal D2 receptors with sleep deprivation: Implications for cognitive impairment. Neuroimage. 2009 May 1;45(4):1232-40.
21Yaffe K1, Laffan AM, et al.  Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011 Aug 10;306(6):613-9.
22Sadeh A1, Gruber R, et al.  The effects of sleep restriction and extension on school-age children: what a difference an hour makes. Child Dev. 2003 Mar-Apr;74(2):444-55.
23Osorio RS, Pirraglia E, et al.  Greater risk of Alzheimer’s disease in older adults with insomnia. J Am Geriatr Soc. 2011 Mar;59(3):559-62.  
24Lim AS1, Kowgier M, et al.  Sleep Fragmentation and the Risk of Incident Alzheimer’s Disease and Cognitive Decline in Older Persons. Sleep. 2013 Jul 1;36(7):1027-1032.
25Ancoli-Israel S1, Palmer BW, et al.  Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study. J Am Geriatr Soc. 2008 Nov;56(11):2076-81.
26Aggarwal B1, Makarem N2, et al.  Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in Women: Findings From the American Heart Association Go Red for Women Strategically Focused Research Network. J Am Heart Assoc. 2018 Jun 9;7(12).  
27Meier-Ewert HK1, Ridker PM, et al.  Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004 Feb 18;43(4):678-83.
28King CR1, Knutson KL, et al.  Short sleep duration and incident coronary artery calcification. JAMA. 2008 Dec 24;300(24):2859-66.
29Prather AA1, Janicki-Deverts D2, et al.  Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015 Sep 1;38(9):1353-9.
30Cohen S1, Doyle WJ, et al.  Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7.
31Prather AA, Janicki-Deverts D, et al.  Sleep Habits and Susceptibility to Upper Respiratory Illness: the Moderating Role of Subjective Socioeconomic Status. Ann Behav Med. 2017 Feb;51(1):137-146.
32Moldofsky H, Scarisbrick P.  Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med. 1976 Jan-Feb;38(1):35-44.
33Moldofsky H, Scarisbrick P, et al.  Musculosketal symptoms and non-REM sleep disturbance in patients with “fibrositis syndrome” and healthy subjects. Psychosom Med. 1975 Jul-Aug;37(4):341-51.
34Simpson NS, Scott-Sutherland J, et al.  Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018 Jan;159(1):33-40.
35Orlandi AC1, Ventura C, et al.  Improvement in pain, fatigue, and subjective sleep quality through sleep hygiene tips in patients with fibromyalgia. Rev Bras Reumatol. 2012 Oct;52(5):666-78.
36Spiegel K1, Leproult R, et al.  Impact of sleep debt on metabolic and endocrine function. Lancet. 1999 Oct 23;354(9188):1435-9.
37Dommerholt J, Bron C, et al.  Myofascial Trigger points: an evidence-informed review. Journal of manual and manipulative therapy. Vol. 14 No. 4 (2006), 203 – 221.
38Kovacs FM, Seco J, et al.  The association between sleep quality, low back pain and disability: A prospective study in routine practice. Eur J Pain. 2018 Jan;22(1):114-126.
39Chen X1, Beydoun MA, Wang Y.  Is sleep duration associated with childhood obesity? A systematic review and meta-analysis. Obesity (Silver Spring). 2008 Feb;16(2):265-74.
40Van Cauter E, Spiegel K, et al.  Metabolic consequences of sleep and sleep loss. Sleep Med. 2008 Sep;9 Suppl 1:S23-8.
41Leproult R1, Van Cauter E.  Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev. 2010;17:11-21.
42http://teacher.sduhsd.net/mrall/ap%20bio/AP%20Bio%20classwork/sleep.pdf
43Spiegel K1, Tasali E, et al.  Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846-50.
44Taveras EM1, Rifas-Shiman SL, et al.  Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 2008 Apr;162(4):305-11.
45Kohatsu ND1, Tsai R, et al.  Sleep duration and body mass index in a rural population. Arch Intern Med. 2006 Sep 18;166(16):1701-5.
46Gottlieb DJ1, Punjabi NM, et al.  Association of sleep time with diabetes mellitus and impaired glucose tolerance.  
47Spiegel K1, Leproult R, et al.  Impact of sleep debt on metabolic and endocrine function. Lancet. 1999 Oct 23;354(9188):1435-9.
48Nilsson PM1, Rööst M, et al.  Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care. 2004 Oct;27(10):2464-9.
49Knutson KL1, Ryden AM, et al.  Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med. 2006 Sep 18;166(16):1768-74.
50Milewski MD, Skaggs DL, et al.  Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014 Mar;34(2):129-33.
51Mah CD, Mah KE, et al.  The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 2011;34:943–950.
52Bonnar D1, Bartel K1, et al.  Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Med. 2018 Mar;48(3):683-703.
53Swanson CM1,2, Shea SA, et al.  Bone Turnover Markers After Sleep Restriction and Circadian Disruption: A Mechanism for Sleep-Related Bone Loss in Humans. J Clin Endocrinol Metab. 2017 Oct 1;102(10):3722-3730.
54Arbon EL, Knurowska M, et al.  Randomised clinical trial of the effects of prolonged-release melatonin, temazepam and zolpidem on slow-wave activity during sleep in healthy people. J Psychopharmacol. 2015 Jul;29(7):764-76.
55Smith MT1, Perlis ML, et al.  Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry. 2002 Jan;159(1):5-11.
56MacFarlane J, Morin CM, et al.  Hypnotics in insomnia: the experience of zolpidem. Clin Ther. 2014 Nov 1;36(11):1676-701.
57Kripke DF1, Langer RD, et al.  Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012 Feb 27;2(1):e000850.

 

Evidenced-Based Wellness Recommendations

Healing is a multifaceted process.  When someone comes to me with back pain, for example, there are often other topics that come up.   “How does it feel to be injured?  How are you sleeping?  How does the injury affect your job, family, recreation?  How’s your diet and hydration?”  I’ve often wondered about the evidence behind some of the recommendations that are suggested from various experts or we see in articles or on the internet.  I’ve put together a handout, with citations included, for my patients about some common topics that come up in my clinic.  Below, I’ll briefly discuss my reasoning for adding each topic but here is the handout if you want to just skip to the business.

The Healing Process:  I think its crucial to have a basic understanding of what happens in our bodies when we have an injury.  This knowledge helps us understand that healing is a process, not an event.  It also helps us make decisions when trying to decide if and how a given intervention (exercise, manual therapy, surgery, medication, injections, anti-inflammatory modalities, etc.) will meet our goals both in the short and long term.

Sleep:  We spend roughly a third of our lives asleep.  Its easy to look at sleep as a waste of our waking lives and something we should try to fight (“Joe Shmoe is successful because he gets 4 hours of sleep a night”).  An overwhelming amount of research shows the incredible importance of sleep for all aspects of our lives.  A fascinating and in-depth read about this topic is Why We Sleep by  Matthew Walker (I hope Joe Shmoe checks this out).  Some people have been dealing with disrupted sleep for so long they think its normal or that nothing can be done.  Not so!  A psychotherapist with expertise in cognitive-behavioral therapy for insomnia can be of great help.  And here’s a list of evidence-based sleep hygiene tips.

Nutrition:  We’re learning more and more about how foods affect our beings and the healing process.  Recommendations change based off of new information and proper nutrition for each individual is often based on many factors that are unique to that person.  I frequently urge people to consult with an expert in nutrition.  Ask them questions about what you’ve heard or read about.  That’s what they’re there for.

Hydration:  Have you ever wondered if there’s evidence behind the recommendation to drink eight eight-ounce cups of water a day?  I have.  Turns out there’s not, but there has been research done regarding this topic.  I provide this information in the handout, and there are also lots of individualized caveats to consider.

Stress:  The fight or flight response is hugely important if you come face to face with a mountain lion while on a previously enjoyable jog in the mountains (that’s pretty extreme I know, but you get my point).  Many of us are living in a low-level fight or flight situation throughout each day, whether it be due to less-than-ideal relationships, work, or prior unresolved conflicts or traumatic events.  Hormones are released which are beneficial in short-term situations but wreak havoc on our bodies and lives when they’re constantly in our systems.

Volunteering:  I joined the Rotary Club (there are an infinite number of similar organizations who’s goal it is to serve their communities in meaningful ways) many years ago because I thought it would be a productive way to try to balance out the horrible things that we sometimes do to each other as human beings.  That’s why I continue to be a member.  The benefits I reaped (learning how to organize, speak publicly, work with people of differing views, gain the confidence to do things out of my comfort zone because I realize I’m a part of something bigger than myself, etc.) far outweigh my capacity to give back.  I was also pleased to see the solid evidence that volunteering benefits the helper in concrete physical ways as well.

Flexibility:  This topic got the ball rolling for me with the writing of Beyond Tape.  I was starting to see internet musings conveying the pointlessness of stretching and felt it would be beneficial for me to compile the actual evidence.  There are many benefits of stretching for both young and old.

Strength:   In my experience, many older folks are under the impression that strength training is a young person’s activity.  Not so!  This mindset tends to be a major player in the downward spiral that can, but doesn’t necessarily have to, happen as we age.  “If you don’t use it, you lose it” is for real.

Aerobic Activity:  It’s hard to make a lifestyle change and starting a walking, biking, or swimming program is nearly impossible without concrete goals.  We’re fortunate to have research that gives us solid guidelines to go by.  It’s important to see these guidelines as long term goals rather than something we should be doing right now.  I frequently suggest a person leave their front door, walk 5 minutes, and come back.  Add 5 minutes next week if it feels right to you.  Pat yourself on the back, you’ve made a start, and that’s the hardest part.

As always, let me know if you have questions or if you’d like to see additional topics added.  And please always feel free to let me know if I’ve missed anyone that you think should be on a list of practitioners I’ve provided (see the nutrition section of the handout).

Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here My primary motivations for Beyond Tape and any of the posts are to:       1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated       2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.