On: Fitness

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A colleague had started going to the gym “to get fitter”. While admirable and absolutely to be celebrated, I did wonder how they would know when they had achieved that goal.

After some reflection, and a walk, I developed the thought that fitness can be broken down into 2 main components. A duration / distance one, and a strength / durability one.

Duration / distance is comparatively simple. Can the person go further, for longer, or faster. These are goals that can be defined, measured and checked. Walk for a mile, walk for an hour, finish a 5k event, run a marathon, cycle for 3 hours, push the wheelchair to the shops.

The other component is harder to measure. Yes, strength can be measured by increasing the amount you can move against resistance and for how long. But that doesn’t tend to serve an end purpose. I would posit that the role of strength for the vast majority of people, athletes included, is to help them carry out a defined task with more capacity, to be more durable and to recover faster. In Crossfit this may be to complete the prescribed workout faster, or with less fatigue. For others, it may be to be able to carry a child, lift down a suitcase or spend longer with their family before tiring. And for all, it should help reduce the risk of injury.

By redefining our initial goal of fitness, we can review the strength component in this capacity and then prescribe the correct stimulus to get the desired response.

Instead of saying you want to get fitter, define a goal, and a measurable, meaningful outcome. Then tune the exercise to that.

Flow and glide

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To move smoothly, all your tissues need to flow and glide. If they cannot, or do not, then the body will attempt to compromise. And eventually, it can fail. This leads to restriction, pain and immobility. Which can of course create a viscious circle of reduced ability.

What can cause changes in the glide? Joints we all sort of understand. Pain, swelling, inflammation and instability will lead to changes around that joint. But the soft tissues can also experiene those, leading to a conceptual stickiness, where tissues simply don’t want to move over each other smoothly. Some stickiness can be temporary, some can be more permanent (scarring), but stickiness within the system can lead to drag on the tensegrity, reducing the adaption capabilities. This is why you can see limitations in the shoulder and find the solution in the ankle, why mobility exercises that improve tissue range of motion can reduce pain globally, and why it is sometimes so hard to achieve complete resolution in a presentation. You haven’t dealt with the underlying lesion.

The thing is, trying to get your head around this is only the first element of treatment. and it can be particularly difficult, to detach from the description and go looking, or listening, to where another problem lies.

Treat close, check the chain, look at the centre, improve the chain, repeat.

On: The power of words

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Words have power. This has been known for a very, very long time.

The words we say to each other, the words we say to ourselves and the words we use to describe the world around us.

By reframing the words we use, we can change the way we view the universe. Even the language we speak with changes the way we interact with the world around us.

The internal monologue we have can change our entire day, or even path of life. So does everyone elses. And of course, these things can be deep and challenging to deal with, so are far beyond the remit of such pages here.

With that in mind, the following are suggestions that can allow us to catch ourselves in simple situations that may then offer benfit to the way we approach certain circumstances.

For example. You injure a knee on a run, which limits your mobility while it heals. If you start telling yourself that you cannot do things because of your knee, then you are creating limitations within your mindset. However, simply by saying that in spite of the knee you can do activities that maintain your fitness, you will optimise recovery, improve your mindset and view the current difficulty in a better light. That is not to say that it is not a difficulty, but the perspective shift of the barrier changes its height.

Or. Change “I can’t” to “how can I?” Shift the view of the problem.

Within a medical setting, we often get patients expressing suffering. Suffering is subjective, valid and to be believed. However, as a professional, you can help reframe the situation by the use of your language patterns to check in with what they are experiencing. From suffering to experiencing does not and should not invalidate their personal reality, but may help explore what it means at that point.

Again, within a medical or caring setting, empowerment is important. If we help someone, we can often disempower them and either create passisivity or an unbalanced dynamic. So instead of helping, consider or ask how you can support them. If they have limited abilities for any reason, then this can help set the correct tone for them to communicate their needs, rather than having your “help” thrust upon them.

If you have repetitive and perhaps tedious tasks to help those around us, from small children and work colleagues to aging relatives, and find yourself saying that you’ve got to, reframe it to get to. I’ve got to take the kids to football – I get to watch them learn new skills. I’ve got to see my grandfather this afternoon – I get to spend time with my grandfather. And so forth.

And sometimes, if you don’t know what to say, say nothing. Supportive silence is much underrated and certainly underused. Slow down, check in with yourself and say nothing.

In spite – because of

Can’t – how can

Suffering – experiencing

Got to – get to

Silence.

Onwards.

On: Rituals and routines

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It seems like every influencer has their own special ritual and routine that helps them optimise their productivity, create more wealth and still manage to find time for their side hustle / thruple / vanlife trip around the pacific north west. And you can learn the secret if you listen to their podcast / buy their e-book / subscribe to their youtube channel.

And if thats true then I’m pleased for them, they’ve achieved some sense of balance and awareness in their lives.

For the rest of us, those who don’t speak fluent Aspiranto (the common language of the Antisocial media personality), some of the ideas can still offer us a benefit, especially if we draw our attention to them.

First though, definitions.

A routine is a sequence of actions that are repeated regularly, often without much thought. They can be simple, like brushing your teeth before bed, or more complex, like going to the gym regularly. As well as saving time and energy, they can also provide us with a sense of structure and predictability.

Rituals are also a series of repeated actions, but they are typically more intentional and meaningful than routines. Rituals can be religious, spiritual, or secular. Often performed less frequently, they can be performed to mark important life events, to connect with others, or simply to find peace and calm.

However, it is important to note that the distinction between routines and rituals is not always clear-cut. For example, a morning routine of yoga and meditation could be considered both a routine and a ritual, depending on the individual’s intention.

And herein lie the key differences: Intention, Attention, Focus.

To turn a routine into a ritual, we have to be fully present in the process. We have to understand the why , not just the what, and allow that awareness to be part of the process. And, we can often use symbols and anchors to help us trigger those patterns more effectively.

If, for example, you were brought up in the Western Christian Catholic tradition, then the smells and the bells would automatically allow you to access the full script for the ritual taking place, whereas it could seem confusing and overwhelming if you had never experienced it before.

These symbols and anchors can all be used to create a sense of belonging in those who have been initiated, and may create a barrier to those who are outside.

So, to improve an aspect of our lives, we can create a routine to support it. Want to drink more water, put in place a structure that encourages this with the use of triggers and anchor points. Feel that a 5 minute mobility routine would offer some benefit to your overall health? Make it simple to carry out. Look at what is currently stopping you and remove those barriers.

And, to make the mobility a meditation, or to use the water break as a gratitude practice (both of which are backed by real science to offer benefit), then choose your focus in the moment to be on your breath, on the process, on reflection, rather than carrying out the motions.

On: Testing and Imaging

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Just because you can, doesn’t mean you should.

As a clinician, there are a huge range of tests and investigations available. Blood tests, scans, investigations, the list of what you can order goes on and on.

Some of them are quite invasive and unpleasant for the patient to go through. Others can expose them to small doses of radation. And all of them have a cost.

How do you choose which to use? The first step is to listen to the person and understand their clinical history. From that, and in conjuction with an appropriate and consented examination, one develops differential diagnoses. And only then, do we start to consider tests to confirm or exclude the diagnosis.

And of course, we have to consider, or at least should take into account, what we will do with the result of the test.

Blood tests can give an idea of the current status of many organs, but if you are complaining of UTI symptoms, i don’t need bloods, I just want a non invasive dip and will treat according to that. However, if I believe that you are anaemic and want to understand why, then a blood test may help, and guide the treatment. And if I believe there is something complex, where it shouldn’t be, then I will want to image it, whilst referring you to the most appropriate speciality.

This is especially true for complex and expensive imaging routines, such as MRI or CT. If you have simple musculoskeletal back pain, and no indication for surgery, then an MRI is not going to change matters. If your clinical history indicates a complex presentation that may require intervention then an MRI or CT is an effective next step. For context, a CT is Computed Tomography, essentially a three dimentional thin slice x-ray model, which is good for seeing hard structures. MRI is Magnetic Resonance Imaging, and best suited to soft tissues and organs.

However, far too many professionals request tests as a holding pattern, so that they feel they are doing something, and are reassuring both the patient and themselves that they are being proactive. This is not a judgement on clinical practice, simply an observed trap that we all fall in to and should be aware of.

So, as a patient, or patient advocate, take the time to check with the person what the test is for and why they think it will help. This will give them the opportunity to educate you, explain their thinking and hopefully answer any questions you may have.

From knowledge comes understanding. From understanding comes courage.

On: Galen

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The history of medicine is littered with men, and women, who even today, have an impact on the way we treat and are treated when we are ill.

One of these, and one of my favourite, was Galen. A Greek physician who practiced in the 1st Century CE Roman Empire, he studied extensively before moving to Rome and eventually becoming physician to the Emperors, and Gladiators. This gave him significant insight into many areas, and although we now know that many of his thoughts on illess and physiology are incorrect, a great deal of his work is still relevant.

Two of his tenets, which I believe still stand, and we still use are:

The body is a complex interconnect system, which has the capacity to heal itself. This is very similar to the osteopathic principles.

Use physical therapies first, then drugs, then surgery.

This last principle is still undervalued by both patient and practitioner, as it is not an easy fix, and given today’s current phamacopea, it is too easy to reach into the cabinet and take a pill rather than look for an underlying cause.

I would advocate to choose to be different. Seek the cause, make a change and overall health will improve.

How we move affects how we think

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There is a connection between how we move, how we breathe and how we think. This connection is well known and recognised in many traditions, and even by a running shoe manufacturer, but most of us ignore the cues that are there, if we were to tune into our bodies a little more.

I was discussing this recently with a professional singing and breathwork coach, and having worked with people with varying levels of paralysis, it is possible to see the way thought is entrained to the breath cycle.

As the coach showed me, we begin each thought with a breath and generally reach the end of the thought before the end of the breath. However, if we are unable to hold a deep breath for long enough, our thoughts can get chopped off by the need for air.

Thus we may begin the thought again, creating a frustrating cycle of thought and breath. But by allowing ourselves the space to breath and think, to move and breath, and to move and think, by acknowledging that this cycle takes place then we can help it all to work more effectively.

And, through seeking professional support, to optimise our breathing, to find balance in the respiratory system as well as the rest of the body, then we can improve even more.

The big secret the fitness industry doesn’t want you to know.

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They’re lying to you. They have been for years and maybe even they’re lying to themselves.

They’re selling you all these messages and machines and plans and regimes. And they’re not going to work, leaving you disappointed and looking for the next big secret. The next short cut.

So, what is the secret they don’t want you to know?

Exercise won’t make you lose weight. Diet won’t get you fitter.

All the booty classes and HIIT training and smoothies and shakes don’t work alone.

Maybe if you’re running 5-6 hours plus a week then yes. You may lose some weight. You are going to create a significant enough caloric deficit to see a difference. But not much and not for a sustained period. If you don’t back it up with a solid refuelling and recovery strategy.

You’ve got to do both, in the correct proportions.

Look at a visually super fit person, that influencer, gym bunny. Not only are they exercising frequently, they’re looking after their nutrition. They’re not completing the circuit class and immediately down the coffee shop for a syrupy latte. The inside is reflected on the outside.

Exercise is for fitness, nutrition is for weight management. The combination leads to improved health. Which is reflected in your physique.

You don’t need their latest method or protocol or supplement. It’s been said before but you don’t like it because it’s hard and slow and repetitive and dull.

  • Eat to sustain activity, refuel and recover.
  • Eat occasionally for pleasure.
  • Exercise to improve muscle mass
  • Exercise to improve cardiovascular health
  • Exercise to maintain balance and skill
  • Exercise because it’s fun
  • Do it regularly and seek healthcare advice when something seems wrong for a while.

Simple is not the same as easy. But consistency and iteration works.

Resilience and capacity

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In the end you have to have something that I give to give the disease as a price of recovery.

Not sure where I heard that but it makes sense.

The more fitness, the more muscle you have to give a serious illness, the more likely you are to come out the other side.

Professor Oliver (geriatrics) noted that he could guess someone’s probability of a safe discharge from the quality of their handshake. Firm, strong, reassuring. Weak, flaccid, concerning. A handshake conveys vitality, determination, strength, even psychological state.

Put the work in now so your future self can live to fight another day.

On: timing shift

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From the beginning of May 23, we will be open on Thursdays rather than the previous Fridays.

Roles are changing at other organisations, leading to a change in clinical hours.

We will be available from 1000 – 1700 on Thursdays.