You evolved to run…

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It has been said many times before, especially here, that you evolved to run. The combination of an independent respiratory system (via diaphragmatic control), the ability to lose heat via sweat, the nuchal ligament in the neck, large gluteals and an achilles tendon all indicate that we run. There are also evolutionary theories that indicate our brains developed to allow us to predict the behaviours of animals we were hunting.

Running also has a fantastic effect on the skeleton, triggering hormones in the long bones that help control appetite (Lipocalin-2), driving osteogenesis (the continued creation of new bone) and preventing degeneration. It even helps neurogenesis, the creation of new brain cells and nerve pathways, by flushing fresh blood through at a much higher rate for longer, as well as suppressing excessive glucose storage by forcing muscles to use it as fuel.

Many people, including respected orthopaedic surgeons, believe that running is not healthy for the joints, and that it will leave to early degeneration. There is some validity to this concern, but with a certain number of caveats. If you have not run for a significant period of time, or are overweight, then you may experience joint pain when you start. Similarly, if you are not biomechanically efficient, then you find it harder work than you expect. Not only that, if you look at indigenous runners, they don’t do it in the same way we consider standard, rather running and walking, depending on the terrain.

However, a number of studies (https://doi.org/10.1002/art.24840, https://link.springer.com/article/10.1007/s00167-013-2686-6) as well as others, show that there is no detrimental impact on the joints, with some evidence that it actually helps strengthen the tissues.

What is the practical upshot of this? If you can, start running. Carefully, steadily and allowing a great deal of time. The upside far outweighs the downs. If you can’t, cycle or walk.

If you want to start running, do so slowly. Follow the NHS couch to 5k program. Given that any weight over your theoretical optimal (BMI of 23 – 27 depending on muscle mass) is increased load on the joints, limit your long runs to reduce the chance of injury while you work on the weight. And, as you approach a maintainable weight, you will experience the benefits far more than the lows.

If you can’t run, do something that mimics the cardiovascular and skeletal load. Lift weights, row, walk at a rate that leaves you sweaty, it all helps.

Beyond 3 basic skills

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Previously, the 3 basic movement skills were raised.

These were:

  1. Getting off the floor from lying on your front
  2. Getting off the floor from lying on your back
  3. Walking at least a mile carrying a load

These use the primal movement patterns and the vast majority of us have been able to do them since the age of 2.

We can therefore advance these and actually start to develop them as a physical practice to improve our health, with very little other equipment.

If you have not exercised for a while, or have pre-existing medical conditions, please do consult your GP or practice nurse for a health check before starting any program.

As a test day, start by going for a brisk walk, sufficient to get you slightly breathless after 10 minutes, then aim for a mile, or 20 minutes. Once in a safe place and once you are warm, get on the ground. First, from your front, get up. Then from your back.

If that was challenging, or you struggled to get up, your first month would be simply practicing until you can do 10 from both front and back.

Once you can do that, you can add some more load.

With nothing more than a couple of bin liners, a reel of strong tape, an old rucksack and a bag of builder’s ballast (sand / gravel mix), you can create all you need for a very effective workout.

Fill a bin liner with a few kilos of the ballast. Tape it into a strong, short sausage shape and place this in another bag for safety. Create a few of these, of differing weights.

Once you have the weights, put sufficient in your rucksack to equal 5-10 kilos then do a 30 minute walk at a brisk pace.

Once back, adjust the load in the rucksack to about 2-5kg and perform 10 front get ups with the bag on. The, taking a sausage across your shoulder, perform 5 with it on the right before doing 5 on the left. As you get stronger, increase both the load in the rucksack for the walk and the getup challenge.

You should find that that provides a decent workout and can act as a gateway to more training techniques.

5 daily habits, 3 basic skills

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There are 5 habits we do every day, and that most of us take for granted. They are the basic skills needed to function well in everyday life, well before the more complex elements of household management and navigation in a modern society come in to play.

Yet when we are unable or unwilling to perform them, it’s time to ask for help from those around us, as they are the foundation stones on which all other skills rest. These are the things that our primary carers would have taught us to do by the time we were ready to leave home and almost all of us will have done today.

  1. Get up and make your bed
  2. Perform a personal hygiene routine and dress appropriately
  3. Prepare and eat a nutritious hot meal
  4. Movement and physical maintenance
  5. Interact socially and do something creative and productive

These can be viewed as a stack, and performing one allows the next to take place more efficiently. The inclusion of creation and productivity in the list, is in my mind, crucial, as it allows us to express an important element of our personality, and its presence or absence is an indicator in our mental, as well as physical health.

The habit most people will tend to misunderstand and misinterpret is that of movement and physical maintenance. Here, there are 3 basic skills that we should be able to perform unless we have a diagnosed impairment. And, as above, the inability to do these indicates that we need to check in with an appropriate professional for support and to allow us to regain them, or plan to mitigate the risk of losing that element of independence. 

  1. Get off the floor from lying on your front
  2. Get off the floor from lying on your back
  3. Walk a mile with a moderately heavy load

These use all the primal movements (push / pull / flex / twist / squat / lunge / walk), as well as the fundamental human expression of gait.

Physical maintenance is the skill of daily self care, being able to mobilise and strengthen the body, with stretching, joint position awareness, breathing exercises and strength training. If starting this practice, after a period of relative immobility, then it is recommended that you start gently, focusing on the ankles, hips and shoulder girdle, with breathing as a guide.

Basic Measurements

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There are basic markers we can measure and improve to gauge overall health.

In a hospital or medical environment, we will measure Heart Rate, Respiration Rate, Temperature, Peripheral Oxygen Saturation (SpO2), Blood Pressure and AVPU (the patients level of alertness).

More invasively, we will then take an ECG and VBG / ABG (Venous Blood Gas / Arterial Blood Gas). These allow us to have a good  impression of the current state of your heart and a gross impression of your metabolic processes (glucose, haemoglobin, lactate etc).

With these measures and a good history, we will have a good idea of just how unwell you are and where to start looking for the underlying problem.

If you are unfortunate enough to need admission, part of the nursing process will involve measuring your height and weight. This allows us to calculate the correct drug dose and other supportive measures.

We are also able to calculate your body mass index. This is a commonly used scale, taken from your weight in kilos, divided your height in metres squared. It allows us to quickly see whether you are underweight, average, overweight or obese.

Outside a hospital environment, some of the above measures are often really useful for tracking your personal health, in conjunction with your general practitioner. A low pulse, low blood pressure and stable BMI are all indicators of positive health.

Some people argue that in more athletic individuals, BMI is not a good marker and it may not be very useful in very muscular people. However, it does still indicate how much overall load is being placed on the body, including the heart and the joints.

It can also be argued that, as a healthy adult, until you are able to squat 70-100% of your own body weight, bench press 50-70% of it (dependent on gender), deadlift 120% of your bodyweight, get up from lying on the floor 10 times and walk quickly for at least an hour, with a body fat percentage of between 20 and 25% then you can probably do with losing some fat and improving your global fitness. These are, of course, arbitrary markers for a fully able bodied adult and you may wish to define your own within your own physical boundaries.

Another easy to track health marker is waist to hip ratio. This has been written about before here and is the circumference of your waist, just above the navel, divided by the circumference around your hips. For men, this should be less than 0.9 and for women, less that 0.8. If it were too high then it is indicative of intra abdominal fat, which is known to be unhealthy.

Therefore, I would propose the following as good targets for anyone without underlying known health condition.

A blood pressure of 120-130 / 70

A resting pulse of 50-70bpm

BMI below 25 unless measurably muscular

Waist to Hip ratios appropriate for gender

The above markers for fitness, once warmed up.

If you think that you have a physical restriction holding you back from what you would like to achieve and would like us to support you in improving your health, call and book in for a no obligation chat.

As always, this is not to be taken as legal medical advice and if you have any health concerns, see your registered doctor who will be able to help.

 

I might be wrong….

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I probably am.

There’s a somewhat silly quote in medicine that 50% of what they teach at medical school is incorrect. The problem is we don’t know which bits.

The same probably stands for most other areas. It’s only by constant reflection, learning and communication can we start to edit out the blatantly incorrect and work on the rest.

I know that I’ve evolved in my own practices, both as an athlete and practitioner. The advice I have given to patients has changed over time as well, as I’ve worked on my skills. My training has changed as I find new sources, techniques and experts. That which worked, stayed. That which proved risky or without a solid evidence base went.

The basics remain the basics though. The human machine evolved to move frequently, eat a broad diet and occasionally do bouts of intense physical activity proportional to age and health.

Stress Innoculation

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Without stress, we wouldn’t be here. Stress is an evolutionary force that has shaped us.

These days, we tend to use stress as a bad thing, often saying “I’m so stressed at work” or “This situation is stressing me out”. Which, other than being an appalling abuse of the English language, is a misunderstanding of the role of stress in our lives.

That sort of external, uncontrolled stress is bad for us. It generates negative changes in the body, leading to an increased risk of obesity, heart disease, and diabetes, as well as a host of other related health dysfunctions.

Some of this is unavoidable. We cannot always choose our line manager, the person ahead of us in the ticket queue or the unthinking person who has parked across 2 bays when you are already running late.

But we can choose to temper our responses to it and we can train to mitigate the effects.

The body does not differentiate between stressful stimuli. It only knows the basic responses available, so by putting ourselves in stressful situations in controlled conditions and then learning to adapt to them, the body learns an increased resilience to all forms of stress.

Controlled stress can be intense workouts, cold showers, intermittent fasting, learning new or challenging skills. Essentially anything that allows you to develop and grow.

And as you grow in one area, it will cross over to all the others as well.

The longevity project – building better people

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A professor in gerontology recently told me his theory of ageing. As it is inevitable, he said there are 2 ways to age, a slow decline towards increasing immobility and the end or a steady state followed by rapid decline and a quick finish. He was very clear that he would much prefer the latter.

In my experience, we generally die of a main organ failure, which has knock on effects on the whole system. For example heart failure leading to breathing and kidney problems, lung problems leading to heart failure, kidney failure leading to blood pressure and organ problems. And so forth.

The other huge life change that older people suffer from is dementia, in all its varied horror. Although there is some genetic predisposition, there is thought among many researchers that lifestyle factors also play a significant role.

We therefore need to promote longevity. Not the sort desired by the stranger elements of Silicon Valley, but practical things that we can all do to optimise our epigenetic expression (how our lives effects our genes) and maximise our lifespans, whilst accepting that an endpoint will be there.

What so we know from the get go?

  1. Don’t smoke
  2. Limit alcohol
  3. Limit refined sugar
  4. Mange your weight for a healthy BMI
  5. Optimise muscle mass
  6. Stay flexible
  7. Maintain bone mass
  8. Eat a broad balanced diet of mostly vegetables and protein, with some carbohydrates
  9. Avoid diabetes. Reverse it if possible, manage it very carefully if not
  10. Take part in your GP health screening program when offered
  11. Make plans – a will, a digital plan, talk to your loved ones about organ donation
  12. Reduce your planetary impact burden – travel mindfully, reduce clutter, minimise debt
  13. Make your peace with yourself. There is a diffuse but definite link between life satisfaction and longevity
  14. Keep learning, creating, exploring

This may seem like an inordinately long list, but it is simplified into three main categories

  1. Eat sensibly
  2. Move frequently, lift heavy things
  3. Be mindful

 

Breathing mechanics and change

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When we consider respiration, most of us will think of it as breathing in and out. Those with a science education will then look at the passive gaseous exchange taking place across the membranes within the alveoli and the processes taking place deep in the cells. A medic will be able to look the physiology, the gases themselves and the state of the arterial blood and have a good run at diagnosing many medical conditions. If you are unfortunately hospitalised, 2 of the prime observations we make will be your respiration rate and your oxygen saturation in your blood.

In the end, this means very little but has a huge consequence on our lives. If we cannot breath well, we cannot live well.

Whenever we are challenged or threatened, our breathing will change. If we are shocked or surprised, we will instinctively hold our breath. Fine for a few seconds, less useful when we need a balanced oxygen / carbon dioxide ratio for thought and efficient brain function. So if you are permanently on edge, it may be that you spend most of your time holding your breath, leading the brain to chronically adjust the carbon dioxide / oxygen ratios (measured at the aorta). This breath holding pattern may also lead the brain to consider all things a threat, be that sport, academic or practical.  And, if our respiratory mechanics are dysfunctional, for any number of reasons, then we will not be as efficient as we can or should be, which can also lead to this challenged patterning at a neuromuscular level.

From a practitioners perspective, we need to consider not just the anatomical structures directly involved in respiration, but those tethered and related to it. As an osteopath, respiration is probably the most important system I am able to directly influence. More so than circulation (apologies to A.T Still). The rule of artery is important, but if there is poor gas balance and compromised respiration, then all other systems will be adapting to compensate, assuming blood flow is present at rest.

To me, the respiratory system starts with the nose and the sinuses in the head. It includes the standard elements of trachea, bronchi, lungs and diaphragm, but also needs to include the thoracic and lumbar spine, the ribs and even the hip flexors and all surrounding musculature.

If I can create sufficient change within in any of these elements, then I can create a positive shift in state. If I can change state, I can positively influence the health of the whole body.

Breath better, move better, be better.

The basics of positive mental health

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Firstly, if you reached this via a random search on the internet and are feeling stuck, buried under unmanageable pressure, in a corner or suicidal, breathe.

If that is you now, if you have a plan, if you’re looking for ways to end your life, if it’s so dark that the relief of knowing how is a comfort, stop. Please. Call a mate, phone Samaritans, if you think you’re going to OD or have, get yourself to A&E.

If you need to self harm to relieve the pain, to give you something to focus on, try ice cubes. Squeeze them in your hand and feel the burning cold. Put down the sharp blade and open a window.

When we, as professionals, talk to people who’ve cut or attempted suicide after we’ve stabilised them, they almost all regret it. Most attempts are a cry for help, to get attention, to put down the enormous burden, to ask someone to take over, just for a while, to deal with the crap life has handed you.

If this is you, I’m sorry. I have no idea what demons you’re fighting but I do know that so many have been there before you and there is a solution, somehow. But the never ending darkness is not it. There are charities who are there to support you, pathways in place to show you that, however dark it is now, there is a way forward.

Please note that this is not about mental illness. This is not about PD, psychosis, mania or depression. These are the kind that leaves you debilitated and requiring professional assistance. For those who have such things, it is important that the rest of us do not stigmatise them, help support them in any way and be conscious that we are all a few steps and some genes away from their situation.

For the rest of us, who live every day with our own mental health, it is thankfully starting to become more commonly talked about in recent years. The typical English attitude of stiff upper lip and crack on is slowly becoming more less expected, but the underlying causes of poor mental health is less commonly discussed.

Positive mental health is much more of a holistic approach, a way of recognising that body and mind are inextricably linked, that we can influence those around us and by intercepting negative trends, and that we may be able to prevent or minimise darker times.

The sketch above shows the basic pyramid of mental health.

Positive health choices are obvious in retrospect. Avoiding drugs that effect mental state (alcohol, cannabis, tobacco, illicit chemicals), taking regular exercise, maintaining a healthy weight, getting sufficient rest.

Regular life patterns play a more subtle role. We all have a circadian clock, a biological rhythm that governs eating, sleeping, and even more complex processes. But we also have a human need for regularity. For work, for seeing friends, for doing things we enjoy. If we neglect this, or it is removed from us, we soon notice its absence.

Positive relationships make more sense. We have all had relationships that drag us down, that make us feel less than we like to be. These can be personal, romantic or work, but their effect is pernicious and corrosive.

We can tolerate shifts in any one of the points for a period of time, for example poor health choices by eating too much, drinking too much or not resting enough, but if we also have a few unsupportive or negative relationships and no regular life pattern then we are in a slippery slope to poor mental health.

Mental health is a gift to be nurtured, shared and to be grateful for.

3 simple rules

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As humans, we like rules. They reduce cognitive load, and give us something to fall back on when making decisions. For me, I have developed 3 to reflect on and work with.

The first is from Kurt Vonnegut, who, in God Bless you, Mr Rosewood, wrote:

“Hello babies. Welcome to Earth. It’s hot in the summer and cold in the winter. It’s round and wet and crowded. On the outside, babies, you’ve got a hundred years here. There’s only one rule that I know of, babies-“God damn it, you’ve got to be kind”

The second comes from Col. Chris Hatfield, astronaut and all round good Canadian.

“In any new situation, whether it involves an elevator or a rocket ship, you will almost certainly be viewed in one of three ways. As a minus one: actively harmful, someone who creates problems. Or as a zero: your impact is neutral and doesn’t tip the balance one way or the other. Or you’ll be seen as a plus one: someone who actively adds value. Everyone wants to be a plus one, of course. But proclaiming your plus-oneness at the outset almost guarantees you’ll be perceived as a minus one, regardless of the skills you bring to the table or how you actually perform.

I’ve translated that to be “Be useful”

If the most useful thing you can do it sweep the floor, do it. Don’t think the job is beneath you, but don’t end up being the one who always does it. Look at the team around you and see what they need doing.

The third came from a delightful polymath I had the pleasure of meeting. A physicist, screenwriter and doctor, he had one tip for surviving without burning out in a career. He said:

“Within in each of us, no matter how old, there remains an 8 year old child. Insatiably curious, always wanting to learn, to grow. Always find something to be curious about, to keep that inner person happy and delighted”

With those three guides to reflect on, I often feel I have a decent path forwards.

  • Be kind
  • Be useful
  • Be curious