The empty tool box

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At some point, the tool box is empty. There is nothing else you can offer. This is hard to acknowledge, both as a professional and a patient.

For a complementary practitioner, practicing honestly, this is the point where you have a conversation with the patient, and offer to refer on, either to a fellow professional or back to their medical practitioner.

For the hospital medic, they often carry out one more test, make a referral to another team or wait and see. This is almost always with the best intentions, but also because admitting you’ve reached the bottom of the toolbox is hard.

For the GP, at the front of patient care, it can be especially hard, since the patient has spent their life believing that medicine can fix whatever the problem is and finding out that there isn’t an easy pill, operation or test that can solve it all is challenging.

But sometimes it has to be admitted that the issue doesn’t have an answer, especially with some chronic conditions and mental health. Its at this point the person is vulnerable to quacks, charlatans and an alternative health tribe who offer an apparent quick fix in return for lots of money.

A lot of alternative treatments are wonderful, offer real benefits to people and can improve lives if used sympathetically and appropriately, but there are always grifters and con artists in every field.

Reiki may offer space, acupuncture can take a completely different view of a problem, an antidepressant can numb the emotions and help the patient get on with life, perhaps while waiting for the world to change around them, a painkiller can allow a return to activity that may help resolve the pain if well managed.

But sometimes, the toolbox is empty.

And then we have to get on with life anyway, rebuilding what we have into a structure that supports us now.

Find the tools that work for you, learn how to use them effectively, add to the box as often as possible and acknowledge that sometimes, the box is empty.

The many P’s of positive change

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Go to the gym , do mental health walks, eat more healthily, practice gratitude? We’ve all heard that advice and probably been given it by well meaning professionals. Who then wonder why we have poor compliance.

Unless you’ve also got remarkable self discipline, you are not likely to be able to do those without some considerable effort and there is a simple reason why not.

Because they’re boring, hard work and don’t offer immediate feedback.

Who wants to go for a walk if its raining. Who wants to go to the gym, get hot and tired and not see any results for weeks or months? Why eat that healthy balance of plants, proteins and starches that apparently will help improve longevity if its dull, bland and tedious.

When choosing an activity to do, or trying to make a change, it has to fulfil at least three of the following criteria:

Practical, physical, productive, progressive, pleasurable, profitable, purposeful.

Food, exercise, learning, they all need at least 3 from that list.

So rather than just going to the gym (physical), work out how to make it purposeful and progressive, so you get a little hit of reward from doing it. Don’t just lay up the plate of plants and nuts because you’ve seen an influencer doing it online, but make sure its actually pleasurable and purposeful as well.

Doom loop

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Dieting will not work long term.

You will not sustainably lose weight until you address the factors that made you fat in the first place. You may shed some timber for a specific event, or a short period, but it will not stay off and you are likely to get heavier if you don’t address the underlying factors.

Whats going on?

You are, in some way, a victim of the doom loop. You almost certainly weren’t born fat. You probably weren’t fat as a child, and then at some point you started to gain weight.

Lets start with a period of stress and inactivity. Perhaps exams, psychological issues, peer pressure and bullying at school, a family crisis, an illness leading to hospitalisation, or at least a time of recuperation. The inactivity is the important bit. This initial phase can be coupled with increased caloric intake for comfort eating / poor nutritional availability and so forth.

For most people, especially if there was a period of bed rest, some muscle mass is lost, or at least a significant reduction in exertion, as well as some fitness. This leads to a reduced caloric requirement as well as a shift in the endocrine (hormone) status. However, most people don’t account for this (and why would you, you’ve got other things on your mind), so gain a little bit of weight.

Not much, but just enough that, in combination with the loss of fitness, it adds up and the return to activity is hard work.

For most of us, the generally fit and healthy adults, especially if you’ve been reguarly active, we suck it up and get back on with it, the weight gain goes again and we break out of the issue.

However, far too many unconsiously remain inactive, or keep being kicked around the loop.

And, having seen the weight going up, the dress not fitting quite as well and generally not feeling quite so good about it all, we often attempt to correct course, either through exercise or through caloric restriction.

However. Both of these, and especially dieting is stressful. Cortisol increases, changing the way our body burns fuel, and for some of us, reducing the amount of energy the muscles use (probably an evolutionary throwback, since you are essentially inducing a famine state in the body by eating less so burning less is a good survival strategy). As we said ealier, you can lose weight short term but eventually the body will replenish the stores and it’ll all go back on again.

Now we’re into the doom loop. We are trapped in a cycle of stress / weight loss / weight gain / inactivity.

How to break out of it?

Don’t diet. Don’t even cut back on calories. To start with, don’t really go for it and hit the gym.

Your body needs to move regularly and have less stress to deal with.

And even if you can’t get rid of the external stress because the world is going crazy and the bills are stacking up and the dog next door like barking at the moon, then you can control the internal stress.

Drink less alcohol. Stop smoking. Go to bed for 8 to 10 hours. Turn off the social media firehose and stop scrolling netflix at 1am.

Then move. Just 5 minute movement snacks. You don’t even need to break a sweat, Non exercise related activity is how we should spend most of our lives.

On: Tendons and Ligaments

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Tendons tether muscle, ligaments link bone.

But both can be damaged, become weakened, or scarred.

So how can we, both as practitioners and people, prevent this, or at least minimise its impact?

Prevention is always better than a cure, and therefore ensuring the tendons (when reading tendons, assume ligaments as well, although there are differences in all sorts of subtle ways) remain strong is vital.

Note – If you are currently taking medications, especially certain antibiotics, check with the pharmacy regarding soft tissue effects. For example, Fluoroquinolone antibiotics have a rare side effect with regards to soft tissue, so if you are prescribed those, it may be sensible to reduce training load during and after the treatment.

Tendons can be trained, like any other tissue, and research indicates that they respond best to cycles of isometric tension, of approx 10 – 30 seconds, with 30 – 50 seconds rest. Initially, it doesn’t even matter what joint position you are in, as long as the tendon is under tension, and pain free. Over time, you can increase the load and the number of cycles you carry out, to ensure continued development.

There is also some evidence that longditudinal supplementation with collagen (preferably from biologically similar connective tissue) is beneficial, especially when consumed with vitamin C.

Once you have a stable, platform, you can work on repairing any scarring or weaknesses in the tissue by using long duration concentric / isometric / eccentric training movements, through the pain free range of motion. For example, a squat under light load, with all three phases taking 10 seconds, although this time is individual.

Finally, there is also some evidence that early, and safe return to loading after injury can help reduce the time to competition, since the stimulus causes the scar tissue to form beneficially, rather than scattered.

TLDR: tendons can be strengthed, healthy tendons can increase your overall performance, isometric exercises are beneficial to tendon health.

On: Obesity

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We all know what obesity looks like. Too many ‘spoons pie and pint nights, too many burgers, not enough gym time.

Except, we don’t.

It might be visually obvious if the T shirt barely covers the waistline, but how do you define it? If you use the BMI scale (weight in kilos divided by height in metres squared), then obesity is considered anything over a BMI of 30, overweight is over 25, healthy is 20-25 and so forth.

But then a lot of athletes, especially power althletes, are obese. Of course, the more mass you have to move around, the greater the load your body has to manage, both for joint health and cardiovascular load but this doesn’t take into consideration the positive effect of muscle mass, cardiovascular fitness, and any other number of markers for health. The only use for BMI in most aspects is to tell you what you already know, when its far too low or far too high. For reference, you probably don’t want to be below 20 (not enough muscle mass) and above 30 (increased risk of joint issues).

A preferred methodology, for a rapid ready reckoner, is height to waist ratio. This ignores mass, but can idicate central obesity, which has been shown to have a detrimental effect on internal organs and general health. This is simply calculated as a ratio of height to waist circumference (waist divided by height in m), and should be less than 0.5.

As for markers of fitness, define your own. Markers such as the amount you can lift, or how fast you can run, are spurious goal setting. And no matter what the companies might say, you can’t tell your fitness from blood tests. Those are for if you are sick. Otherwise the levels will constantly fluctuate and tell you very little.

Be able to run, if you have the physical capability. Then try to increase the distance you can cover. Lift heavy things safely, then do it again. Move regularly, as smoothly and freely as possible. Constantly develop your capacity.

Train as though your life depends on it.

It does.

On: failure

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If you try to do too much in one go, you’ll fail.

You’ll fail because change requires effort and energy to sustain and you only have so much of it to go around.

Getting up earlier requires going to be earlier. But you can’t do that if you have commitments that keep you busy.

Cleaning up your diet requires knowledge, planning, effort.

Going to the gym is bullshit. I love gyms, they’re generally my safe place, but they are not the panacea sold by fitness grifters. Gyms are a place of effort, learning, painful self reflection. Go when you are ready for the lesson and can take humility in your kitbag.

Meditation and mindfulness are not solutions, they’re tools. If you can’t accept the dancing monkeys in your head, you’re not going to want to spend any time with them.

And after all that negativity?

Get rid of something. Less is far easier to manage than more.

Stop drinking. Stop smoking. Stop scrolling. If you can’t, accept you might have an addition issue and ask for support.

Walk more, drive less.

Throw out something from your house. It’s almost certainly clutter and there’s a probability someone else could benefit.

Positive deeds are loops. One feeds another. Make space for positive things.

We can offer some of this support.

An exercise review. A safe space to work through basic coaching issues, treatment to give your body space in itself to heal. A motivating kick and gentle reminder that being human takes effort but is worth it.

But make space. Do less, just do less better.

Be kind, be curious.

On: You’re wrong about the gym

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A new gym opens, the marketing tells you that if you join, you can finally tone up, lose weight and get fitter.

Possibly.

But only if you know what you’re doing with the rest of your life.

Otherwise, its just a kind of fun place to hang out and move.

The gym should be a place of education (in ancient Greece, the gynasium was a place of practical learning, and its still grammar school in Germany). It should be a place where you find new boundaries, develop skills and work on yourself. It should be a structured, functional representation of the rest of life.

But. If you were to get a modern gym goer to take off their huge headphones, stop posing for IG reels and ask them why they’re there, it will more likely be that they want to get toned, or lose weight. Or both. If you managed to ask a teen boy, they’ll probably tell you they want to build muscle. The ironic thing being that a healthy teen is so awash with growth potential, almost any resistance training will create that effect. Less so a man over 30 but the potential is still there.

None of those will happen unless you have the rest of your life squared away. If you’re too stressed, if you’re not sleeping great, if you leave the gym and walk straight into Costa for a triple syrup latte with added cake, if you don’t get your protein intake dialed in, if you don’t allow yourself space to rest, then its going to be so much harder to achieve any of your desired outcomes.

Even if you have defined them well enough. But thats a subject for another day.

Go to the gym. take advice from a professional, not just an influencer. but get the rest of your life sorted as well.

Paused.

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Eventually everyone needs a break.

To sleep, to rest, to refuel, to focus.

Sometimes granting yourself the opportunity to have that creates guilt.

That if the rest of the world is still striving, how dare you stop for a moment.

This leads to burnout. The candle finally meets in the middle.

Chances are you saw it coming a while off but didn’t heed the warning light on the internal dash board.

Listen to that warning light before the engine shuts down and you’re forced to rest and wait for recovery.

The clinic is currently closed for a few months.

After 20 years in Alton, there is going to be a pause and recalibration while I figure out what’s next.

Thank you to all the people who have supported us in every way so far and hopefully the future will hold great things.

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.