Because we’re not dead yet (Turner et al 2015)
You cannot remain in stasis. Even that requires the expenditure of energy, so with no input you will slip into slow decay.
Therefore, choose wisely. Put your shoes on. Expend energy in a positive direction. Get better at something. Move more, eat fewer junk snacks, spend less time scrolling mindlessly, spend more time reading and learning.
Make that choice every day. It’ll be worth it.
They presented with a long history of shoulder and back pain, with occasional headaches, particularly in the evening. No other significant complaints, simply a tight and painful upper back, and shoulders, with a stiff neck.
After taking a thorough history and checking pertinent red flags, I carried out a suitable examination, looking at how they used their body, how it wanted to respond passively and actively.
And the thing was, other than the presenting complaint, there wasn’t much to be found. An anteriorised head posture and slightly kyphotic thoracic spine, but nothing much more than you might expect for a modern lifestyle. They exercised frequently, were not obese and tried to optimise their working posture when at a desk.
I treated what I found, and we addressed a few issues, but I was unhappy with their progress, as the complaint didn’t feel like it was resolving along the curve I expected.
Then it clicked. Whenever I went through to reception to collect them, they were playing with their phone. Head slumped forwards on the chest, looking down at the tiny screen and typing or scrolling away.
The problem is, modern expectations are that we are constantly connected, with rewards and punishments meted out by both the device and other people if we do not respond to its electronic siren call. I am as guilty as the next person, at instinctively checking and wasting hours.
It was this small, but frequent behaviour that was causing, in this case, the shoulder pain. Looking down was loading the back of their neck, the shoulders were coming in to support the arms holding close and everything matched when I mimicked them.
However, other than taking the phone away from them, there wasn’t a direct intervention I could do, so instead we discussed possible mitigation strategies, to reduce the automatic reaction, shorten the time spent interacting and change the posture, things that have been shown to work.
Following the rules of three, I suggested:
The point was simply to create a brain pause that allowed for a moment more reflection before the action, rather than create a wholesale change that would more likely fail.
Having created this awareness and put in some simple measures, we were both very happy to see that the treatment was then far more effective and the presenting issues resolved.
After they had left, I reflected in how the simple actions we do can have profound impacts and that, as practitioners of every discipline, we need to continue to look at the whole person, not just the complaint.
When thinking about training planning, whether for personal development or competition, there are a number of variables we all need to consider, whether as the trainer or trainee.
Underlying it all and before we can even start planning, we need to work out where the following are:
Both for the immediate goal and the longer term structure. Once these have been identified, and there can be only one or two main intention points, then the next step can be assessed.
Here, we need to look at which phase of training we are in. If we are a beginner, or have been training for only a short period of time, then we are still in base development, where we are learning the mechanics and improving work capacity. As we improve, we can start working on the individual elements of our chosen discipline. These can include:
These lead to a development of work capacity. Or, the ability to do something faster, more accurately and for longer and more efficiently.
When looking at each days training plan, it goes through 4 phases, the length of which dependent on the above goals and the physiological status.
We first start to move, to explore the body’s capacity for work that day, consider recovery from the last training session or injury. We then start to groove in the movements that we will be training that day. Once warm and ready, we can finally get the load moving, whether that is under a barbell, a HIT phase or a bike ride. Once we have completed the scheduled work, we finally cruise down, checking in again to note how we went, and to feedback for the next session.
The final, often overlooked and probably as important element of training is the recovery and nutrition. However, we tend to look at the work rather than the recovery, believing that more is better, which for most people, it tends to be, given the rest of their lifestyles, but with that, the nutrition element still has to be considered, and for most people, should be one of their two main attention points. Nutrition is a huge, complex and troublesome area, can be generally be summed up succinctly as:
“Eat meat and vegetables, nuts and seeds, some fruit, little starch and no sugar. Keep intake to levels that will support exercise but not body fat”
Greg Glassman
Now, forget everything, go and play.
Previously, the 3 basic movement skills were raised.
These were:
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.
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.
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.
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.
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.
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.
If a patient is presenting with shoulder pain, once you have screened for red flags and visceral referral, we can focus on the mechanical presentations.
Although we get taught hundreds of techniques for assessing shoulder range and function, in general a gross assessment of all planes will give you sufficient information to begin treatment.
However, one area we tend to ignore or forget is the connections to the rest of the torso.
We need to look at fascial chains connecting the anterior shoulder to the chest and abdominal structures and especially the role of the lattismus chain in the stabilisation of both the lumbar spine and the shoulder.
Referring back to our core principles, we can see that if the pelvis and lumbar spine are dysfunctional then the lat chain and hence the shoulder may be recruited to improve stability.
Therefore, whenever we see a shoulder issue, it falls on us to check further away which may lead to a more significant improvement than just working locally.
There is no easy way to lose weight.
Anyone saying otherwise is trying to sell a system.
It is a challenge between reducing energy intake, maintaining muscle and bone mass, ensuring hormonal levels are stable and slowly allowing fat mass to decrease.
This is pretty much the only way for fat to shift and stay off.
The commercial weight loss clubs are brilliant for support and basic nutritional advice but there is little evidence that the points or programmes offer any other benefit over self management in a well educated and motivated individual.
However you do it, getting your weight down to a healthy point, with a BMI below 25 is probably the single most important thing you can do to improve your health, other than not smoking.
Rubbish.
It’s another day, 24 hours after you probably ate and drank to excess.
It’s one more rotation of the planet, on a calendar defined by an Italian pope several hundred years ago.
And it’s the chance, just like any other day, to start again, get disciplined, and change one thing.
I’ve written several times on finding the one or two things that have the most significant impact. In this case, think about what you can cut out. What, if you take it away, could have the most impact?
If you smoke or drink frequently, cutting it out not only improves health but improves your purse.
If you’re thinking of joining a gym, start by cutting out the worst rubbish from your diet instead and walking more.
Instead of turning on the tv, work through some basic mobility.
Don’t look at Facebook for the tenth time today, read a real book.
Make a small change, with consistency and reap huge benefits.
The Camford Clinic 
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