Medicine

On: Heat

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The UK and much of Europe is currently experiencing a heat wave (mid July 2022).

We are, by and large, not used to this although I fear that we may need to adapt, due to climate instability.

For those of us who enjoy activity, being active in the heat is a challenge and can be a medical risk for many.

Because not only do we have to take into consideration the temperature on a thermometer, but we also need to account for the humidity, since this has an impact on the body’s ability to lose heat. It is possible to run marathons in the desert more safely than a humid summers day.

Hydration status, electrolyte balance and other physiological conditions also have a role.

So how do we develop flight rules for exercise in the heat?

Firstly, know your body, and pay attention to it. Getting off the aircraft from a cool region and plunging straight into a desert marathon is asking for trouble. Allowing time to adapt and preferably having mimicked the conditions previously is a much smarter idea.

Secondly, understand your hydration and physiological status. Medically, you should expect a fluid balance of approximately 30ml per kilo per day. This does include the water in vegetables and fruit so is not just liquid water. You will also need to maintain a good electrolyte balance for yourself. If you are a ‘salty sweater’ (your t shirt develops white stains as the sweat evaporates or your lips taste salty) then you will need to replace more of both sodium and potassium in the correct proportions. Most sports electrolyte supplements cover this and advertising aside (we are not sponsored) Succeed caps, SIS electrolyte tabs and High Five electrolyte tabs have always done well during my endurance training career. Others are available and you don’t need the sugary sweetness of most sports drinks for anything under an hour anyway.

The other, under reported element to track during activity is heart rate. In general, if your heart rate is higher than you would expect for a specific workload, then you are possibly dehydrated and certainly accumulating heat stress, with your body finding it hard to stay cool enough. If it is dropping and you are struggling to elevate it to the target ranges then you may be suffering with cardiac fatigue. In either case, back off, drink, reflect and wait for it to settle before making the decision to go or no go. A personal rule is to take off 10 beats from my target heart in non acclimatised heat as a safety margin.

Summary:

  • Heat is a stressor
  • Acclimatise and adapt if possible
  • Hydrate using electrolytes if indicated
  • Monitor heart rate if possible and set yourself safety limits

Onwards and stay cool.

And of course, if you need more detailed input on optimising your training, resolving injuries and improving your health span, contact us.

Note: this article is a generic guide and not specific advice. If you have any health concerns or underlying conditions, seek support from your registered medical professional and care providers.

On: Gravity

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We exist in a gravitational field. You may not appreciate it for the most part but it has influenced your evolution for the past few billion years.

What we don’t tend to do it treat clients or patients in the appropriate gravitational plane. We barely even consider it.

And yet we wonder why we sometimes don’t have the success that we want when resolving issues.

We assess and examine while the patient stands or sits, then lie them down for our convenience.

Instead, why not examine and treat them in the plane that leads to dysfunction. This may lead to insights and interventions apparently disconnected from the presentation but linked and required.

Swimming problems? Standing exam is fine, but clarified in prone, sidelying or supine. Running issues? Listen to the body then treat sitting at the very least. Lower back pain? Get the patient to demonstrate relieving and exacerbating positions and listen, then apply your skill.

Want to create a relaxing outcome, then perhaps removing gravity is a good thing, unloading the heart and helping the lymphatic and venour drainage systems work effectively. But for more active therapies, it may be that following the gravitational field is a good idea.

Using gravity may well offer that differnce that can improve your practice.

Using gravity to change the relationship of the patient can pay dividends.

On: Keep paddling

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Or walking, running, swimming, cycling, dancing, lifting, playing.

Anything that gets you hot and out of breath, 3 to 4 times a week.

As more research is carried out into the causes and underlying mechanisms of post disease processes such as long covid and ME/CFS, a number of the researchers are following paths that lead to dysfunctions in patients mitochondria.

For those who for whom school biology was a while ago, mitochondria are generally considered the power plants of the cells, turning energy you consume into energy your cells can use.

Of course, it’s more complex than that and they tend to have a number of other roles, but essentially the research is showing that problems with these tiny batteries can lead to bigger problems elsewhere.

Whilst treatment modalities are still being developed, and for lots of sufferers recovery is going to be challenging, requiring multidisciplinary support, for the rest of us, we can reduce the risk to ourselves but optimising the efficiency of our mitochondria.

How? Use them.

It has been shown that endurance exercise stresses them in just the right way to make them stronger.

Finding that sweet spot depends on a number of factors including your genetic predisposition, your training history and the epigenetic environment (a catch all phrase for the nutritional, psychological and environmental pressures), but for the 80% rule, anything at low to moderate intensity for long periods of time will have a positive effect.

Prepare for an unknown future.

Get stronger, move further, fuel better.

Of course, if you have any more questions, musculoskeletal restrictions or want more technical input, contact us.

On: Self, Family, Community

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We are all linked, it is one of the joys and pains of humanity. We are nothing more than mammals that tell stories, and make tools, but far too many of us forget that and think we are above and disconnected from the rest of nature.

Reconnection with what supports and upholds us is vital for all of us, and all of us. No person is an island, or can exist for long as one. Neither should we. As the wheel turns, and peace becomes war, light, dark, the fragile nature of nature is revealed to those who recognise it.

What has this got to do with promoting optimal physical and mental health? Everything.

Unless we take time to listen and reconnect with our body’s requirements, we cannot develop. If we cannot develop, we cannot support ourselves. If we cannot support ourselves, we cannot support our families, our communities and the wider world.

For example, regular mobility work means less risk of injury, which leads to less time off work, or training. Improving your diet means better health and less need for medical support at some point in the future. And, if you are seen to be doing these by others, you might inspire them to try as well, another unintended benefit.

Looking further out, if we can help our family reconnect then we can have a positive influence on them as well.

And so on.

We must reconnect and re-engage with our selves, then our family, then the community, all the time holding onto the natural environment that supports us.

If you feel you need any help working though musculoskeletal issues that could be holding you back from being an asset, please contact us to see how we can work together. And then our skills can be used to help improve you, and the positive changes can roll on.

On: Dosing

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On: Dosing.

The dose is important. If you take too little of a medicine, it is ineffective. If you take too much it will kill you.

The same stands for training, or almost any action. Too little and you will experience no benefit, too much and you will burn out. Of course, this effect tends to be cumulative, and with training, too much may not be immediately obvious.

Which is why finding your baseline, and seeking professional input is vital, particularly when starting out or attempting a specific goal.

Once you’ve set a goal, seek an expert to tune it and succeed.

On: Advocacy

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I don’t have your best interests at heart. Why would I? I have my own stuff to deal with once our interaction is over. The criticism, fear of failure, and self doubt in my mind. Administration, other patients, personal and family concerns, my own health issues, background noise, the passing comment from a colleague that got stuck in my head and keeps rattling around, the alerts and distractions on the screen in front of me. That’s not even counting the 30 or 40 other interactions I will have today, another 8 patient appointments and the meetings related to those.

As a medical professional I try my best to push those aside, to silence them and focus on you. To give you the time and attention you need and deserve, to bring the years of training and experience to bear on your behalf. To know when to treat, when to advise and when to refer. And hopefully at the end of our consultation together, as we conclude our interaction, you will feel listened to, reassured and aware of the next steps.

But I don’t have the time to advocate for you, to have your long term best interests at heart and ensure a life plan is laid out before you. You simply get the time slices I can afford, amongst all the other pressures.

Thats your responsibility. It has to be. This is a 2 way relationship. Come to me for treatment, support, advice and reassurance. Then take control of the other elements yourself, to make sure everyone is working towards the overall goal of longevity and optimal health.

Be your own advocate.

On: technology, tests and treatment.

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Listen to the patients history, they will tell you the diagnosis.

Possibly not entirely, as patients sometimes miss detail or forget timelines.

However, subsequent to a thorough history and examination, all other tests should be used to confirm or deny your hypothesis, including imaging and blood tests.

The problem comes when we, as practitioners or medical professionals, get distracted by new technology or training. This means we look at what we can do, not what we should do.

Ethically, one should do the least for the most benefit. So just because I can order a blood test doesn’t mean I should, if it won’t change my subsequent decision tree. And just because I’ve bought a shiny machine, the information it produces won’t necessarily fundamentally alter the treatment plan.

As for treatment itself, the gold standard therapeutic ladder must always be applied. Physical intervention, then medication, then surgical intervention.

Knowing how to apply this, when to step up and down, the precise tool and most importantly when to stop, is what we spend years training for and why the patient needs to select their practitioner with care and recommendation.

Only then will they find the person that understands and diagnoses their presentation, educates and treats it effectively and most importantly demonstrates how to prevent its recurrence.

Whoever you, as a patient, go to, don’t be taken in by the technology and treatment modalities, look behind the curtain, look at outcomes and be driven by the outcome.

If you think we can help, please do call, we have over 20 years of experience, in both NHS and private practice, to help you work with your presentation.

On: Breathing

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We all do it, 16 times a minute, it’s been written about on here before. But how much attention do you pay to it, as a messenger of your current internal state?

Start by putting your hands on your abdomen, and sniffing. You should feel your diaphragm move. If you have difficulty initiating belly breathing, this is a great technique to find it.

Breathe 10 slow breaths, in through the nose, controlled and slow out through the mouth. Focus on your diaphragm moving smoothly.

If you use this to do a quick body scan, you may find all sorts of areas of tension and holding that you were otherwise oblivious to. You can then note these to work on later, when you have mobility and movement practice.

As you become more adept, you will also notice when your breathing shifts, a cue to your internal stress levels, and a hint that your body is shifting gears for some reason. If you can pause, reflect and assess, it may help you focus on a message your body has been trying to tell you.

If you really want a challenge, pause your normal training for a week, and just focus on breath and mobility work. You may notice a significant improvement in your training when you return, not just from the rest and recovery you have allowed yourself, but in the way you are able to access other underlying systems.

Of course, if you find any areas of restriction or concern, see your general medical practitioner and come to us for further support, education and intervention.

Breathe. Live. Move.

On: The basics

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As practitioners of any form, the more experienced we get, the more tempting it is to forget the basics, and yet, most problems can be resolved with techniques we learned when we were first studying.

Hopefully, we can apply them with more finesse, and refined judgement, but generally, the basics remain true.

  • Structure and function are reciprocal and related
  • We are the product of our environment
  • The body has the capacity to heal itself, given the correct inputs
  • The body wants to maintain a stable state
  • Movement is a hierarchy

If we, as practitioners, reflect and apply these to every patient we see, we can know whether to treat or refer, where to focus our attentions, and if the person is following the recovery path that we would expect, given what we know.

And then, we will have an outcome that, if not what the client expects, is more likely to be what they need at that point.

On: Rehabilitation / Prehabilitation

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The best way to recover from an injury is to not have an injury.

Other than the sort you simply cannot predict, the majority of injuries are caused by poor preparation or the inability to adapt dynamically to the situation.

Rehabilitation goes through three main stages.

  • Pain management
  • Ranging
  • Loading

First, control the pain. This is both passively and actively. Once the pain is a under control, it is a return of function, within that pain free zone. Optimise the range of motion, or activity that is available without causing excessive complaint. Finally, the loading phase, where we return to activity, initially graded and then competition.

This is, of course, a gross simplification of the tasks at hand, offers no insight into the variety of techniques considered, but is offered as a thought guide for the observer.

As stated at the beginning, the best rehab is prevention, through prehab. Prepare better, prevent problems.

Everybody has a weakness, a compromise point, or an area that appears to be less effective, so train those out to become more capable.

Seek professional input if you are prone to niggles, seek professional input for coaching if required and build steadily. Social media is not your coach, a search engine doesn’t replace a doctor.