Happy start to theNew Year Dear Friends!
This is a time when we frequently make resolutions or changes to our daily routines.
This year, I am hoping to continue to reduce watering the seeds of anger, fear and dualism and continue to water the seeds of happiness and love
I also want to continue my work in preventative orthopedic medicine, and really work on my ability to distill impactful information.
Here at the top of the year, I have come up with a short list of what I wish everyone (Jane Q public, medical doctors and nurses, physical therapists, pilates/ yoga/ strength and conditioning teachers) knew about movement, our musculoskeletal bodies and our sensory reality. I don't see our medical community (even my field of physical therapy) communicating these concepts. We know so much more than we did, and this information feels so important and even sometimes, urgent.
Downloads From an ortho PT Brain- Things I Wish Everyone Knew About Movement:
1)Every cell in our body is bioplastic- and therefore capable of change. This is important when you consider what part of biology is genetically mediated (such as the genes that create dystrophin or myelin), and what part of your biology is your own making (your spinal curves and your bone loading).
2) Skeletal muscle fibers are capable of differentiating into 3 different types of fibers, based on how you train. Type IIb muscle fibers are the most important to protect as we age so we can continue to perform functional transfers (e.g. get up and down off the ground, get in and out of a chair)
2) Bones and muscle can become more robust throughout our lifetime (see above), and they require the right exposure to consistent resistance training (see ACSM guidelines).
Safe, graded resistance training is far and away the least practiced movement that I see female patients/ female members of the public performing. This is a huge detriment to our health outcomes as we age.
3) Good biomechanics and spinal curves are acquired, not inherited, and can be improved and changed at any age (see point #1 re: bioplasticity)
4) Neutral spine is the safest position to protect muscle, tendon, ligament, bone and IV discs. In order for a back injury to heal, loading in neutral must proceed first prior to loading in other positions.
Our spinal alignment and curves co-created daily by the cross sectional area (the size and force capacity) of the muscles on our back and back of our hips, our ability to sense our spinal alignment, and our motor (movement and postural) habits. Curves are not inherited, and they are not something someone can give you passively. You must actively protect and create them.
5) That being said, most spines can get back to most motions after a time of protection following injury
6) Tissue is somewhat limited (this seems at odds with point #1). We can grow (type II b muscle fibers, bone density), and our growth is limited. We must also offer conservation and protection strategies (such as protecting articular cartilage through not performing movements we are not strong enough for). Striking a balance between building tissue resilience and protecting tissues is important across a lifetime of movement.
7) Most of the activities we do daily (lift grocery bags, hike, travel and lift luggage) require the navigation of thousands of pounds of pressure (by our active tissues- muscle, tendon and bone). In order to be strong enough to continue our function, every person must participate in safe strength training life long.
8) Though cartilage cannot regenerate, proteoglycan aggregates and collagen can turn over more rapidly (repair and replenish themselves) when their owner loads them through safe resistance training> High Intensity Interval Training (HIIT), is one of the best ways to build better cartilage.
9) Each person can learn and know a knee strategy and hip strategy in a squat and lunge, and have a great hip strategy in both. This can protect hips, knees and low backs from wear and tear as folks age.
10) Joint stability, rather than mobility, is the most crucial element of joint protection.
Most wear and tear at joints that winds up causing osteoarthritis occurs from 5 million small slips across the joint surfaces, when movements are performed that the mover is not strong enough for (see #7).
Mobility through a functional range is extremely important for cartilage health. Excessive motion can reduce the stability of a joint, and break it down more quickly.
11) The toughest part of designing a workout isn’t coming up with new movement ideas, but keeping a movement practice safe.
12) Safety is equally as important as participation (movement) in gaining and protecting the body tissues
13) Interoception (the report resulting from sensory neurons) is only reflecting back what you have designated as your homeostasis. (e.g. I have thalassemia so my body -in this case my chemoreceptors- perceive low hemoglobin/ hematocrit as fine and normal)
Your interoceptors cannot give you feedback (about a knee strategy, flattened spine or low hemoglobin) if they do not detect a deviation from normal. If a flat spine is your normal, interoceptors will process that as “everything is fine here”
14) Pain needs a biopsychosocial model to process causal conditions.
The biomedical model of pain (a disc is herniated, therefore there is back pain) is not a successful model for explaining pain, yet it is the model most often employed by clinicians/ movement teachers.
15) Instead, pain (and sensation in general) is a complex part of our consciousness. We must use a more complex model (the biopsychosocial model) to understand how our biology (inherited and created), our thoughts and beliefs, and our social and cultural conditioning influence how we feel in our bodies.
I hope to revise this list at the start of 2025, and I am curious to see how my insights change/ remain over the course of the year.
Wishing you and your loved one meaningful movements and joy in 2024!
A wintery morning in Joshua Tree