Move yourself free of pain: Part 2

Move yourself free of pain: Part 2

Now in part one of this blog we learnt that pain is a vital part of our survival but sometimes it can persist for longer than we need. So now I’d like to share with you some of the longer term changes that can occur as discovered by pain scientists (Hodges & Tucker, 2011). These adaptations give us a road-map on how to use exercise and movement to free ourselves from pain.

Pain leads to changes in the way we move

Think of a time when you may have hurt yourself and you were in pain. A very common occurrence is twisting your ankle. Sometimes this doesn’t create much tissue damage but it can have a very significant pain response. What you’ll notice is that you’ll limp, maybe just for a little while, as the pain changes the way we move so that we don’t load the affected area too much.

Our muscles around the area will “splint” to stiffen the area up and we’ll subconsciously take load off of the affected side. Now as I stated in part 1 of this blog, this is really useful during the first few months of tissue healing. But long term this can have other consequences. Some common examples are that if we were to injure a joint (let’s stay with the ankle). It can increase the load in joints further up the chain (such as the knee or hip). Alternately, let’s say that we injured our right ankle, if we don’t correct the way we are limping, we’ll place more weight through our left side making it work harder. This could then make the left leg more predisposed to injury.

Now many of these changes in how we move are subconscious. A lot of people don’t realise they are limping long after their initial injury. So sometimes we need to retrain our body to move freely and more evenly again. This is where specific corrective exercise can be useful.

Pain changes the way our muscles fire!

Not only does pain change the way we move, in doing so it also changes the way our muscles fire.

Some muscles will become facilitated

That is, they increase their tone to help protect and splint a particular area. Again while this might be useful for the first few months, these muscles tend to get tight and overworked in the long term.

They also become over-sensitised to pain to the point where even a gentle stretch, well below the threshold that would create tissue damage, creates a pain response. This is where it is important to get these muscles moving freely again, even if it is a little uncomfortable at first. In doing so we are retraining our protective response. Over time our brain no longer deems the use of these muscles as threatening and our pain will gradually decrease.

Some muscles will become inhibited

Now interestingly, while some muscles increase in tone others will “go to sleep”. These are quite often called inhibitions and the long term consequence of these muscles not firing properly can place undue stress on other tissues.

I don’t know whether anyone really knows why this occurs. Perhaps it is part of our short term protective response to prevent us from using a particular area and allow for healing. However we do know that in the brain the areas that fire a particular area become “smudged”. That is when we try to fire a particular muscle we might get a whole group of muscles firing (quite often the protective facilitated ones).

What we find is that we need to “wake up” these inhibited muscles which are quite often muscles that are important for the long term use of our past injured joints. And it is not until these muscles are firing properly again that our pain will subside.

Everyone’s protective pain response is individual

Finally, and most importantly, what we know is that our response to an injury and pain is unique and individual. How we move after an injury depends on what we were doing to cause the injury. How we splint and what muscles tighten up is very individual. And what muscles go to sleep and lose their capacity to fire can be different as well.

Interestingly, all of these people though may have the exact pain in the same location. So it is important that we don’t just focus on the area of pain. In fact, sometimes this can just feed our pain response as it make this area even more sensitive. We need to assess the way you move to see if you are still protecting an area long after it has fully healed. And we also need to identify what muscles are not firing appropriately and what muscles are still stiff and tight trying to protect.

Now this detective work is not always straightforward, particularly if like many of use you’ve accumulated multiple injuries over the years. But unraveling this tangled rope might be one of the best ways to do this and it is probably why good quality movement and exercise is shown to be one of the best ways to free yourself from pain.

References:

Hodges, PW & Tucker, K (2011). Moving differently in pain: A new theory to explain the adaptation to pain. Pain 152 S90-S98

Move yourself free of pain: Part 1

Move yourself free of pain: Part 1

Quite often when we injure or hurt ourselves we tend to go back into our shells and stop our usual activities to prevent pain. This can often mean limiting our movement and exercise, as doing so creates more pain. This is normal and something that shouldn’t be feared.

Pain is a protective response to keep us alive!

Let’s think back to our hunter and gatherer days when our main goals were to eat, sleep and procreate. Back then our survival was dependant on how successful we were in finding our food. This, of course, required a lot of movement. In fact, modern day hunters and gatherers such as the !Kung and Ache tribes average 15-20 km per day. (Cordain et al, 1998). That’s over 20,000 steps a day!

Now obviously if we were to injure ourselves this would severely limit our capacity to hunt and gather. So our in built pain response was designed to allow for tissue healing and conserve energy while our capacity to get food reduces. This protective response in our paleolithic environment was vital to keep us alive. Now pain science can get a bit heavy so I’ve tried to reduce some of the key points for us to understand:

1. Pain tags the brain with the circumstances that lead to creating it.

A toddler only needs to touch a hot stove once to remember that it is not safe to do so again! Back in the hunter and gathering days this might have included the location of dangerous terrain or the time and place of an aggressive animal. Research has shown that the pain response will improve our memory of these specific details.

2. Pain prevents us from moving the affected area for a short period of time.

This is incredibly useful as depending on the tissue that has been injured. It can take around 2 to 12 weeks for the area to heal. Pain can prevent us from loading the particular tissue too much and too soon and allow for recovery.

3. The protective pain response triggers metabolic responses in the body to conserve energy.

Inflammation and cortisol (part of the stress response) both have been shown to increase insulin resistance. This both triggers the body to increase your blood sugar levels for energy and also store your body fat. This is a perfect response for when you didn’t know if or when you would get your next meal. Unfortunately today food is at an abundance and many of us put on weight after an injury. So nowadays we don’t find this too useful!

Pain has short term benefits but can have longer term consequences

As I stated above our protective pain response is really useful for those first few months after the initial injury. However, for many of us pain can go on for much longer than that or we may not have actually had a trauma to create an injury. Long term pain is quite often diagnosed as non-specific pain as doctors can not find any tissue damage or pathology. Sometimes this pain might be the remnants of a past injury that has fully healed. But for some reason our protective pain response remains.

Going into the scientific reasons as to why this occurs is not something we can quickly delve into. However, in part 2 of this blog I’d like to share with you some of the longer term adaptations that occur to us. These adaptations will give us a roadmap as to how to best free ourselves from pain for good.

References:

Cordain, L., Gotshall, R.W., Boyd Eaton, S., & Boyd Eaton III, S. (1998). Physical activity, energy expenditure and fitness: An evolutionary perspective. International Journal of Sports Medicine, 19, 328-335.

From 0 to 1000km ‘Ride as One’ – Multiple Day bike event prep: Choosing the right team

From 0 to 1000km ‘Ride as One’ – Multiple Day bike event prep: Choosing the right team

ahp-team

Well, the last few weeks have seen me starting to clock up a few kms on the new steed, and I’m absolutely loving it. Having purchased the right bike, and being fit to it properly has made a huge difference to my enjoyment on it.

By the way, do you know what the right number of bikes is to own? Apparently it’s N+1, where N= the current number of bikes you have! On hearing this, my wife, Nina, corrected me by saying it’s actually D-1, where D= the number of bikes purchased leading to Divorce papers being filed…. Oops!

But I digress…!… What I’d like to chat to you about in this post is one of the foundations to successful performance in any field: having the right team around you!

SETTING UP THE RIGHT TEAM

As I alluded to in my last post,  my physical endeavours over the years have led to the accumulation of a few scars, and stiff joints – although luckily never a broken bone! Add to this the fact that I’ve just had my 42nd birthday, so my muscles and connective tissues are not quite as subtle as they used to be! Those of you that know me  will have heard me say that I don’t like it when people use age as their excuse, as after all “age is just an accumulation of behaviours” (there you go, I just quoted myself…). However, I would be going against all physiology textbooks if I didn’t grant the fact that we do lose some ‘pliability’ as we age! Throw in the mix the fact that neither of my parents were Olympic athletes or superheroes, so I have to make do with less than impressive sporting genetics. All this just means that I need all the help I can get to stay in good shape!

A large part of this help comes from a great team of Allied Health professionals, which in my case includes a chiropractor, a couple of physiotherapists (with different areas of expertise), a podiatrist, and the input from my trusted Exercise Physiology team at iNform! Oh, and once in a while, a psychotherapist helps ensure I don’t take my kid-like sporting loves across to other areas of my life! So as you can see, I’ve got all bases covered!!

But this is should not just be the case just  for someone of my age or older trying to tackle all that life has to offer, but also for the younger athlete wanting to maximise their performance. My experience in Strength and Conditioning, and a short stint in coaching runners showed me that a key to long term success is strongly correlated to one’s commitment to being supported by the right people at the right time. Quite simply, the harder you want to push yourself, the more likely it is that little cracks will appear. And these need to be well managed, and managed early, to avoid significant set-backs down the track.

So, moral of today’s story: Get the right team around you… in every area of life. To run a successful business we use business coaches, marketing consultants, financial planners, accountants, etc. So why should your body and active pursuits be any different?? If you want or need more guidance on this, drop me a line, as helping our clients manage these teams is one of the key things we do!

RIDING UPDATE

As I mentioned earlier, these last couple of weeks have seen my riding increase a bit! In fact, on Saturday we had our first ride as a group with some of the Ride As One group! It was great to meet some of the people I’ll be sharing these journey with, and we did a nice 60km loop around Adelaide! The downside of the last couple of weeks has been a bit of a dichotomy between having been swooped a few times by magpies who seem to be out in full force at the moment with the coming of spring; but also, a lot of rain which makes it feel like winter is holding on for as long as possible! To help deal with the weather side of things (any advice welcome on how to deal with the magpies! Other than being told to toughen up!) I’ve logged a couple of long mountain bike loops that are looking after the strength in the legs just nicely!!

This is a nice segway to next week’s topic – one of the key principles towards avoiding injury and enhancing training longevity and enjoyment: Variety!

And don’t forget to sponsor the ride at http://my.leukaemiafoundation.org.au/iNformMaxMartin17

High Intensity Interval Training: So why all the hype?

Workout trends come and go, and one of these that is getting a lot of attention is High Intensity Training (HIT). The attention, such as that in television shows like Catalyst and Michael Mosely’s ‘The truth about exercise’ (claiming that 6 minutes of exercise per week is all that we need) is largely well deserved, but as with anything, there are always two sides to the story. Let’s start with some definitions and then make sure we end up with a balanced and informed perspective!

A senior woman and a mature man riding stationary bikes

HIT (High Intensity Training)

High Intensity Training (HIT) is the umbrella term given to a number of different high intensity training modalities. The measures used to determine the level of intensity are typically Heart Rate, or a Rating of Perceived Exertion (RPE). To qualify as high intensity, Heart Rate needs to be be over 70% of maximum heart rate (if you don’t know what yours is from personally testing it, it can be calculated by substracting your age (in yrs) from 220); and the exercise needs to be considered to be ‘hard’, or around 5-6 on an RPE scale, where 1 is “very, very easy”, and 10 is “maximal”.

HIIT (High Intensity Interval Training)

HIIT involves alternating short periods (Intervals) of work and rest over the duration of a session. The intervals can be programmed in different ways, with their length and actual intensities varying to meet the desired demands. For example, the lengths and intensities of the ‘work’ intervals can range very widely, to address either the anaerobic threshold, or maximal anaerobic power. Similarly, the rest period can be performed as active or passive rest.

HIRT (High Intensity Resistance Training)

A close member of the family, HIRT is based on the well researched varieties of cardiovascular based HIT training, but is performed largely with ‘weights’. So the work intervals may be made up of exercises that you may be more used to seeing in a gym floor, such as squats, lunges, presses, kettlebell swings, etc.

So, why would we bother with these types of training, and how do they compare to more traditional training methods?

Studies consistently show that HIIT improves metabolic health markers and fitness measures. For example Irving et al. (2008, Med Sci Sport Exerc) found that after 16 weeks of exercise, women with Metabolic Syndrome lost twice the amount of weight and fat mass, and four times the amount of fat around the abdomen when compared to those who did the same amount (isocaloric) of low intensity training. These type of studies strongly show that when it comes to energy in, or out, the amount of calories (or kilojoules) themselves are less important than the hormonal response that is created; with suggested mechanisms to explain this difference including improved insulin sensitivity and cortisol levels. More on the hormonal effect on energy in and out on weight management on a blog coming out soon!

High intensity training has been shown to reduce the risk of dying prematurely by up to 17% compared to those who do no HIT (Tanasescu et al, 2002, J Am Med Assoc), and after only one training session a week! Other often cited benefits include: reduce subcutaneous fat; improved insulin sensitivity; total body mass; aerobic fitness; blood pressure and glucose regulation; improved lipid profiles; and greater tolerance to stress! phew, great list!!

In addition, different varieties of HIT may be seen as more attractive exercise options, due to the opportunity to gain greater health benefits in less time. For those who lack motivation it may be a more enticing option than the prospect of continuously exercising for an extended period of time.

Bartlett (et al. 2011) found that the ratings of perceived enjoyment (yes, “enjoyment”) after HIIT were higher when compared to moderate intensity training. Considering that ‘lack of time’ remains the most commonly cited barrier to regular exercise participation, this seems too good to be real, right?! Well, perhaps.

There’s certainly some things that we need to be aware of:
While the physiological  effects are evident, the duration of most studies is very short, with very short follow-ups, and largely in unhealthy populations. The long-term effect of has not been well established and if I was to take a guess I would say that eventually there would be a decreased return on investment.  A yet to be published (large scale) study looking at physical activity trends in Australia shows that more Australians are performing vigorous physical activity; but less low-moderate physical activity; and the amount of sedentary time continues to increase. It appears that while HIIT is certainly more time efficient, the less time we spend moving the more opportunity we allow for sedentary time. This might help explain the increasing rates of Type II diabetes and Cardiovascular Disease, as it is well accepted that the negative physiological effects of sedentary time can cancel out and even outweigh the physiological benefits of exercise.

In addition, by its very nature, high intensity exercise carries a greater risk of injury, particularly for those new to exercise, so careful and guided progressions are recommended!

To conclude, other than the imbalance that is created between active and sedentary time, by shortening exercise time, I believe there is another significant issue with the way that research on HIT training is communicated to the public. The type of reporting seen in the media only reinforces the mindset that exercise is like some nasty medicine that we need to take, so we are best off pinching our nose and getting it over and done with as fast as possible! Surely the message should rather be one of promoting an active lifestyle, and that HIIT training can be a fantastic adjunct to that?  Our body is the machinery that we have to go out and experience the world in and with, and the broader and deeper our physical capabilities, the wider the range of experiences  we can potentially have. While High Intensity Training can certainly help us improve some specific health measures, does it help us live our lives more fully?

Written By Max Martin

The importance of goal setting!

Life can be chaotic, unpredictable and at times overwhelming. We can often get consumed in our own routines and a little bit lost. The simplest task can seem like sending flowers to the moon.

So how do we make a bit of sense out of our own world and make sure we are progressing and right direction? Goal setting has been shown to be one of the most effective ways to motivate us to achieve a certain task. Goals help us stay focused, allow us to place value on a task and provide us with a sense of accomplishment and satisfaction.

Evidence has shown that act of just writing down a goal increases the success rate of achieving them and this exponentially increases when we regularly re-evaluate them. It seems like a very simple task, however not a lot of us actually follow this structure and we wonder time after time why we are not reaching our goals?

“The trouble with not having a goal is that you can spend your life running up and down the field and never score. Bill Copeland

The first step in goal setting is understanding the importance of them, so here are a few important reasons:

  1. What do you truly want? Goals help us break down the what and why behind our actions and behaviours. For example we may want to lose weight; but why do we want to be a few kilograms lighter?
  2. Be accountable for your own happiness and expand on failure. Success and failure is a part of life. Take control of these circumstances by making a plan of action! Goals help you stay on track and move forward in the right direction. There is something humbling about looking back and reflecting on things you have achieved no matter how large or small; if you are progressing forward is still a step in the right direction!
  3. Live life to the fullest! When you take the time to set some goals you increase your ability to make the most out of every situation and moment of your life. There is too much to experience in life to push our aspirations to aside. Forming good goals will help you achieve and live the best life you can!

Goals setting can be applied to every aspect in your life whether in your career, what you want to achieve in your personal life or simply what you would like to do in your spare time. We often have these very generalised thoughts such as losing weight, but struggle to clarify how we will go about it.  Goal setting is usually always the first step.

Let yourself dream a little!

Goals help us believe in ourselves, they can be used to fuel your ambition! Make your aspirations a  goal and work towards them everyday. If it is not a goal it is a vague notion of the imagination that will most likely be un achieved.

Have a think! What would I like to achieve? What is getting in my way?  How am I going to achieve it?

Stay tuned for’ How to be SMART about it’ and start forming some ideas today!

Author: Lisa Golder

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