Reflecting on the past year and some of the things I learned.
Whatever you are, be a good one. – Abraham Lincoln
1. Learning takes place much more rapidly when you have to teach or perform.
This is one of those things that seems so obvious, but I find myself continually reminded and humbled by this. I also find myself continuing to learn about the learning process and how a person becomes good at something.
At a certain point in the learning process we need accountability, and we need pressure to continue to advance. It’s why tests are important. It’s why having to perform and compete gives us experience and growth that we just can’t get from practice. It’s why having to teach someone often makes us learn more than the person we’re teaching.
Learning a field is like putting together a puzzle, a puzzle for which you don’t even have the box cover to know what it’s supposed to be. With a puzzle piece, you will pick it up and scan for its place. Sometimes you find it, but often times you don’t. So you put it down for the time being and move on to another piece that you feel confident you can find a place for. As you place more and more pieces in the correct place, it gets easier and easier to place pieces in their spot or at least easier to see the general area where the piece goes.
I used to think that a person who was smart should be able to read something once and gain the necessary knowledge and understanding contained in it. With complicated material this often doesn’t happen, at least for me. As I increase the number of texts, research papers, webinars, etc, that I have consumed, I often revisit many of them as I can better “place” the information with each revisit. Keeping to the analogy, I used to be so much more easily swayed and confused by charismatic hyper-confident individuals who claim to have the “secret” answers, but the more the picture emerges, the easier it is to place those “pieces” into the scrap pile.
I have personally found Crossfit to be an extraordinary lab to put learned concepts into useable knowledge. When I used to hear practitioners talk about or read about not treating the site of pain but rather the site of dysfunction, (the site of pain is usually not the site of the problem) it sounded great, but how do you really solve those problems? It all makes much more sense now, and it’s usually very easy to see – if you know what you’re looking for.
2. Motor Control – the most important factor in the movement game .
When it comes to pain and dysfunction and movement, we hear words thrown around like, mobility, stability, flexibility, strength, movement patterns, etc.
Most people tend to think that we all just need more mobility – that we need to spend more time stretching. Plenty of people have more mobility than they can even control – they would be better off with less.
Lots of people also think that strengthening things is the key to injury prevention and feeling good. If muscles have strength then they will do their job, and everything will be fine. Unfortunately, strength doesn’t automatically create coordination or good motor control.
Motor control is knowing how to move. It’s both conscious and unconscious. It involves using your body as a system and not as individual muscle groups. It informs you to the limitations of your mobility and keeps you safe in predictable and controllable environments. It won’t, however, protect you against a submission hold geared towards dislocating your shoulder.
Good motor control is the foundation that mobility should be built on and the foundation for establishing strength. Strength without motor control becomes a liability for hurting yourself.
A common error is that people think that motor control will be automatic if we increase mobility or strengthen the right muscle. Unfortunately, that rarely happens.
This is why assessing movement is so crucial – the only way to get a glimpse into motor control is through MOVEMENT.
Can you see why static postural screenings are not very helpful?
3. Shoulder Pain – The topic that never goes away
In my post last year on things I learned (link), I talked about learning a lot about the shoulder and dealing with my own shoulder issues. While I quite successfully was able to deal with most of my own shoulder pain and dysfunction, I had one lingering issue. For most of 2013, I was unable to perform the Olympic jerk without feeling like I was getting punched in my shoulders.
In some ways, I wasn’t very concerned about this because you can have a very healthy shoulder and not be able to perform this movement. In the movement hierarchy, the jerk is one of the most challenging movements for the shoulder. You need to have instantaneous stability while changing directions very quickly under high load demands.
In other ways, I was very concerned about this because I knew that being able to perform the jerk without pain was necessary for my continued learning of shoulder and general movement functioning as well as to further increase my own performance.
Various mobilizations and strengthening exercises didn’t do the trick, and it turns out that the issue was one of MOTOR CONTROL. A slight change to my motor pattern, and my shoulders felt 100% pain-free in this very dynamic movement.
4. Chronic Pain
I will be learning about this topic for many more years but spent some considerable time learning about it this year.
First, pain is in your brain – it’s not in your tissues. No one ever really believes this at first; it seems so silly. But think about phantom limb pain – where a person feels pain in an extremity that’s not even there.
(picture of phantom limb pain)
What happens is that your tissues have receptors that sense various stimuli, like temperature, pressure, vibration, etc. When these are stimulated to various degrees, they send a signal to your brain where your brain processes the degree to which it finds the stimulus threatening. To a large extent, the more threatening – the more pain. These stimuli are processed through several areas in your brain, some of which include memory and emotion centers where a lot of other factors have an influence on your pain experience- things like your beliefs, emotions, stress levels, past experiences, etc.
Physiologically, tissues are supposed to heal over a certain period of time but what about when pain lingers for an excessive amount of time? What happens in many many cases is that the tissues are healed, but they’ve become sensitized to stimulus due to things like the memory of that painful tissue and feeling more vulnerable to pain and injury.
We’re all more aware of some of this neurology than we realize. As I said, phantom limb pain and another common one – the placebo effect.
One way that a placebo can work is by reducing a person’s feelings of threat. By reducing a person’s feelings of threat, we can “turn down” the sensitivity of the nervous system and subsequently the feelings of pain.
The mere intervention of a doctor or professional that a person “believes in” or has confidence in can greatly affect this aspect of the nervous system.
This is a fascinating TedTalks on the power of the placebo, how colored pills are more powerful than white. Pills with lettering are more powerful yet. And the needle is more powerful still. Skip to 3:35.
As a responsible clinician, we have to realize this factor and not be so quick to think that our meds, surgical tools, or manual therapy skills are all there is to the story.
This is a major method by which many techniques and interventions have spread and are able to claim some degree of success and why the success of those techniques usually require a significant degree of clinician charisma and confidence. It’s important that the patient “believes in” the methods and to get people to believe in some of the crazy methods out there takes some pretty good charismatic convincing.
On the flip side, many clinicians give their patients nocebos. They use a language that educates or reinforces that the patient is “broken” and/or has significant problems. Most do this unintentionally but plenty do it to manipulate for their own gain.
5. Soft Tissue, Fascia, Graston, Active Release Technique, Foam Rolling, Kinesio Tape, etc
No, I’m not just rambling off words. These nouns have a lot of overlap even though they are often trying to differentiate themselves as “different”, “special”, and “advanced”. The more we learn, the more we find that they are quite similar and probably work in very similar ways.
These techniques have shown to be quite successful, but we’re still largely trying to figure out how exactly they work.
What we’re pretty sure of though is that we’re not getting rid of or breaking up scar tissue or lengthening or making much of a mechanical change to the fascia.
Very likely, the pain science gives us a lot of insight into the powerful neurological components that many of the soft tissue techniques share.
If we look at Active Release Technique (ART™). We have a technique that has strived to differentiate itself from other soft tissue techniques by self-proclaimed specificity, advanced training, specific protocols, and of course, better results. What we know is that it’s very unlikely that we’re “breaking up” scar tissue or remodeling it as the technique claims, but that doesn’t mean the technique is any less effective at decreasing pain and restoring function.
What we really get with ART is a technique that combines a myriad of other techniques, such as:
–Ischemic compression (trigger point therapy) – reperfusing tissues
–Nerve Flossing – a part of what probably happens with many if not all of the movements with ART.
–Stretching – involves elements of taking joints to end-range, possible elements of PNF stretching and mechanoreceptor stimulation.
-Active Movement – All kinds of good things come from this from decreased tissue congestion and lymphatic circulation to desensitizing the nervous system by guiding people safely through ranges of motion that their brain may have previously decided were dangerous.
6. Mobility training should be Movement Specific
What does that mean?
I’m not going to completely spell this out as I plan to write more about this in the future and do it more justice than a couple paragraphs.
This train of thought stems from a somewhat mobility/flexibility obsessed society. Obsessed is probably too strong of a word, but there is a pervasive general thought that the more mobility and flexibility a person has, the better.
It’s hard to know where to start when addressing this notion of mobility=good.
It’s such an incomplete thought and really just misses the mark.
I see and work with people all the time who have TOO MUCH mobility. Sometimes it just in an area or two and other times it’s essentially everywhere.
Mobility is a liability and can create more risk as we move.
Mobility should be worked on and trained in regards to specific movement patterns.
So, instead of working on being able to touch your toes – which for most people reinforces a faulty pattern of bending over with a rounded lumbar spine – work on mobilizing your squat pattern and being able to hang out at full depth without much strain and effort and being able to breathe normally. In real life, what does being able to touch your toes really do for you? I’m not saying it’s a bad thing, and I’m pretty sure it probably stems from flexibility tests all being based on the sit and reach test.
7. Choosing a Direction
I think a fair amount about the topic of how to use my time. What should I learn next? Should I spend time marketing or spend time learning more about conditions and treatment? Should I spend more time on relationships or various other things?
And just because you figure out what you want to spend your time doing doesn’t mean that it won’t still be wasted by sifting through misinformation.
A lesson that I’ve been learning over the last several years is how to move in the right direction sooner and get side-tracked less. I used to be much more gullible and gather as much information as I could before choosing a direction. I spent close to $1,000 dollars in chiropractic school pursuing additional education and training in upper cervical specific techniques and education. This basically amounted to learning about an out-dated philosophy, guru worship, and people presenting their opinions as facts. I was enticed by the mystique, the charisma of those who “believed” in the philosophy, and the power that false over-confidence seems to have over me.
I tried out another club back in school, called something like the Maximized Living Club. I thought it was kind of like a business club that I thought might help me better understand how to operate a business after graduating. It turned out to be like a big pep talk for those that wanted to hear that they could easily make millions in practice. It worshipped practitioners who see hundreds of patients per day (yeah, do the math on that one), and had at least one organizational leader that claimed to be able to bring the dead back to life with an adjustment.
The lesson I learned was to look around me and significantly decrease the weight that words hold and to more strongly question charisma and confidence. So if you are pursuing something or thinking about pursuing something, look at the type of people pursuing and involved in that endeavor – their personalities, their priorities. Do they share your values? Does there appear to be a high level of hypocrisy?
If you align yourself with genuine, intelligent, ethical, responsible people it’s hard to get too far off track. This doesn’t mean you shouldn’t do a little exploring; just stick to solid principles and maintain some level of skepticism.
