Osteopathy

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: 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: teaching the basics

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Following a conversation post training, I was pondering on knowing the basics. We so often absorb information and forget that, for many, the things we are talking about is brand new.

For example, the reasoning behind certain elements within a coaching program may be to access fast twitch or slow twitch fibres, depending on the desired outcome. For those who don’t do physiology, these are the different fibres within the muscles that have different properties and roles and require different inputs from a training plan.

Similarly, when we are providing therapeutic interventions of any form, the client almost certainly doesn’t have our background, or training, so you one may need to provide education under the radar to allow them fully informed consent. This also helps you by working through the elements of the treatment, which can further reinforce your technique and skill.

So, as a client of any practitioner, I encourage you to ask questions if you don’t understand something, so that the understanding can spread and grow.

On: Simple

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Simple is not the same as easy.

In fact, most of us complicate things, because simple is hard work.

If you look at the goals most of us want to achieve, they seem simple, yet we fail so often. Partly through our own weakness, partly through temptation, and mostly because the simple route is the hardest.

Want to get stronger, slimmer, richer, have better relationships? Good. Admirable goals. Now go work at them.

Stronger? Train, not just exercise. Sacrifice something important to get there.

Slimmer? Be careful what you wish for, lets change that to optimise your metabolic health. Now don’t have the take away and exercise regularly.

Richer? Spend less than you earn, clear up your debt burden and be creative with investing.

Better relationships? They take a lot of work, mostly on yourself.

All simple goals, all challenging and resource consuming.

And seek support. We can’t help with the financial or relationship goals, although being healthier and more resilient can have huge positive benefits in all aspects of your life, but we can support you with getting stronger, healthier and more resilient.

Contact us and see how we can help you upgrade.

What cost fitness?

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What cost fitness?

Occasionally, people complain about gym prices, the cost of personal trainers and kit.

Only occasionally though. Because if you understand the value, you wouldn’t complain about the cost. Other than kit. There’s always a new shiny toy to try, and past a certain point, none of which will really improve your performance.

If you’re stronger, you’re less likely to die early, unforeseen events excepting. If you’re fitter, you are more likely to survive a hospital admission (being admitted to hospital is really bad for your health). If you’re healthier, life seems easier, because you have a greater capacity for stress.

Now, fitness is different to wellness. Wellness is a never-ending feast of rubbish, where a huge number of people, both honest and exploitative play. You might benefit from a yoga and meditation session (both are demonstrably good for you), but you don’t need yoni steaming and jade eggs. And you certainly don’t need to spend 300 pounds on any of them.

Fitness is far more measurable and relatable.

At the most basic, you need nothing more than you already have to improve your fitness, other than knowledge.

However, if you know nothing, then the next step is to ask an expert, or at least a professional. This is where gyms, trainers and such come in.

Do not ask the internet, as you have no filter on what is good or bad. As an internet guru, I could tell you to do 5k every other day and 50 burpees for breakfast but if you’ve got a medical condition, or an injury, or the most exercise you take is picking up the remote when you turn off your laptop after working from home all day, then I may actually kill you. Unlikely, but possible.

Instead, find someone you can have a conversation with, who can answer pertinent questions and give you honest answers. You may need to pay for their time but hey, you wouldn’t ask your next door neighbour to help fit a kitchen unless they are already skilled in it.

If you can’t afford that route, then go to the library and read a book. Lots of fitness people have written books and at least they’re relatively validated. And the walk there is a good start.

So, to loop back to the start, pricing. A gym has significant running costs, a personal trainer is not working 40 hours a week and is self employed. In the end, it is a return on investment question “am I getting out what I am paying in?”

As an example, a local CrossFit box charges £75 per month for 3 sessions a week. But for that you are getting equipment, expertise, time, and a quality environment. A local council gym may charge £30 a month, but you won’t be getting the expertise and programming, so you’d better know what you’re doing on your own (hint- that 12 reps/3sets on each machine will rapidly lead to plateau and boredom).

How does this tie in to us? We are professionals. We treat injuries, and have over 20 years of working with people. We coach, and work with trainers who actually care and understand their jobs.

If you want to live longer, healthier and perhaps even happier, come talk to us.

The first step is the hardest, but the most rewarding.

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: 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.

You are what you do.

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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:

  • Switching on greyscale. This, interestingly, makes the device far less stimulating, but still allows you to work effectively. It also helps increase battery life on some devices.
  • Clean up the home screen and put apps that distract in a folder so you don’t see them first
  • Turn off notifications for social media applications

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.