Faster, Higher, Stronger

Since the Olympic winter games are taking place as we speak in beautiful Vancouver, British Columbia, I thought it would be a great time to discuss a topic that does crop up every so often in my physiotherapy practice in Toronto.

While watching the Olympic games, we can see incredible feats of athletic prowess and extraordinary examples of the constantly evolving boundaries of human performance.

With the constant chant for “Citius, Altius, Fortius” reverberating in their minds, athletic limits are being tested and achievement records are being broken.

So this begs the question: Is performance really healthy?

Just perusing the biographies of almost any of the elite athletes that have qualified to represent their countries at the highest level of competition, one can see an almost infinite variety of minor to serious injuries that these extremely conditioned individuals have overcome to reach their personal achievements.

Multiple knee surgeries, broken bones, concussions, separated shoulders, sprains and strains.

The list is essentially endless.

Now going back to the question regarding performance and health, here’s my take in one word.

NO…

And here are a few more of my words…

Performance is very seldom healthy.

Olympic Weightlifting Injury

Before I get pilloried on the internet, let me qualify that preceding statement.

In the pursuit of extremes, in the pursuit of redefining the boundaries of human athletic performance, in the pursuit of winning medals at the highest levels of competition, athletes must be in peak physical and mental condition and must undertake rigorous training programs.

But in order to do what has not been done before, risks have to be taken.

This is where limits are pushed, where boundaries are stretched.

This is where that razor thin line between risk and reward is often crossed.

Nodar Kumaritashvili

This is where, as was witnessed just a few short days ago, a young Georgian luger by the name of Nodar Kumaritashvili, lost his life in a horrific crash while he was pursuing his dream of winning an Olympic medal for his country.

I’ve always believed that the human body is capable of incredible feats.

And that as time passes, as science and technology advance, we’ll be able to perform at even higher levels.

But for most people, are these levels of performance required?

Do most people need to test the limits of their bodies?

When these athletes train to extremes, they constantly put their bodies at risk.

Risk of injury, risk of over-training.

At what point does the average human being decide that the risk is not worth the reward?

Or, when does one decide that they are okay with being just average?

Yours in movement.

Dev Chengkalath

I’ve already spoken about the dangers of sitting in a quite a few of my previous physiotherapy blog posts, so I won’t belabour that point.

What I will say is that even for those who are fairly physically active, prolonged sitting will still cause problems, the same as it will for those who are more sedentary.

This is where NEPA comes into play.

NEPA or Non-Exercise Physical Activity (I’ve talked about it as NEAT or non-exercise activity thermogenesis previously) is all the other movement you do during your day that doesn’t count as exercise. The “everyday life activity”. This is where that leisurely stroll, the housework, and yes, even the fidgeting comes in to play.

Why is NEPA important?

Think of it this way…It’s a lot easier to get a few minutes of NEPA frequently throughout the day than it would be to set up an intense exercise activity regularly and consistently through your day.

If you can increase your non-exercise physical activity by 15-20 minutes a day in spurts of 1-2 minutes at a time, over the course of your week you will have added around 2 hours of increased movement. And most of you won’t even notice the added bouts of 1 minute movement.

It won’t interrupt your day.

It won’t cost you much in terms of time to take the stairs instead of the elevator, but the health benefits multiplied over a long period of time can be significant.

This takes me back to an article I was emailed some time ago.

According to that article, in the past 150 years non-exercise related calorie burning has dropped by about 2000 calories a day.

Yup.

2000.

That’s the same number that is used as the baseline total daily calories for calculating percentage of daily values for nutrient requirements in American food labeling.

150 years ago, we used to burn more calories with non-exercise related activities than we are supposed to take in daily today.

Now that’s something to think about.

Yours in movement.

Dev Chengkalath

In my humble opinion and using my knowledge as a physiotherapist, the solution to the above noted problem is quite simple.

But as I’ve stated many times before, simple does NOT mean easy.

To recap the previous blog post, there are two behaviours and their resulting effects that need to be addressed to stave off the dangers of prolonged sitting.

These are:

1. The benefits of regular moderate to vigorous intensity physical exercise

2. The risks of too much sitting and limited non-exercise everyday life activity

In today’s post, I’ll take a deeper look at the first point and offer what I believe are realistic actions you and any other reader of my blog can take immediately and without significant changes to your life.

It’s been proven over and over again that regular physical activity, typically undertaken at a moderate to vigorous intensity, as noted above, has numerous health benefits to the various body systems including the cardiovascular system, the neuromusculoskeletal system, the endocrine system, the neurological system etc.

Intense Physical Activity

Key words: moderate to vigorous intensity.

So taking a leisurely stroll around the block, walking to the corner store, going up some stairs, doing housework…just won’t cut it as exercise. These are typically not intense enough and don’t last long enough to stimulate the body the way a more focused exercise regimen would.

The thing with exercise is that you have to do it to get the benefits and you have to keep doing it to keep the benefits.

The other thing with exercise is that most people do it in one big burst (e.g. early morning before heading off to work) and then remain sedentary the rest of the day.

A better option may be to do smaller bursts of higher intensity physical activity, frequently throughout the day.

Here are some options of how you might be able to fit in multiple bouts of exercise-based physical activity:

-Early morning high intensity interval program combining resistance training and cardiovascular training for 30-45 minutes.

-Lunchtime body-weight workout for 15-20 minutes just doing lunges, squats, push ups, burpees or other equipment free movements.

-Post work exercise class for 30-45 minutes – just find one you enjoy!

-Join a recreational or competitive sports team for an activity that you love.

-Take your kids out to the park and play those games you used to love to play, have races, climb and jump around.

-Schedule it and respect it like you would any other appointment.

As you can see, with a little imagination, the physical activity possibilities are endless!

The objections:

I know many people will tell me that they don’t have time for the above amount of exercise in their day.

I don’t buy it.

It’s not that they don’t have time, it’s that they haven’t prioritized their health.

Cut out 1 or 2 television shows and you’ve just gifted yourself an extra half hour to an hour of exercise time. Or if you just can’t give up on the reality TV shows, do some exercise during the commercial breaks.

Want to find some more time in the morning? Stop pressing snooze 3 or 4 times in the morning and you’ve got another 15-20 minutes.

If you have kids and you take them to their various extra-curricular activities, use the time that you’re there to do some quick exercise. While watching little Timmy’s hockey practice, why not use that time to lunge around the rink?

It may look strange, but you’ll be the one improving your health. Plus that will probably also get you away from the pop and chips from the concession stand.

While this is by no means an exhaustive list of how you can find exercise time during your day, it should give you a place to start.

If you have any other ideas on how to fit in exercise drop a comment and let me know.

Yours in movement.

Dev Chengkalath

In my practice, there are three things I consider of utmost importance, my own golden triad if you will: my clients, my profession and my reputation. And I will endeavour to protect all three.

The following link will take you to one of the most prominent articles cutting down the physical therapy for injury rehabilitation.

“Treat me, but no tricks please”

After my first reading, I could feel my blood pressure bubble over and and those small hairs on the back of my neck rise in defensive posturing.

Within the first few lines of the article Gina Kolata wrote:

“But the letter the angry doctor had received from his insurer made me wonder whether physical therapy was different from the plasma treatment. Is there rigorous evidence showing it works?”

Here’s this journalist cutting up the profession which has given me so much and allowed me to help so many people.

Then it all made sense.

Therapeutic ultrasound

A few lines later, I realized that Ms. Kolata lumped all physiotherapists with what I refer to as “CHUM therapists” (Cold/Heat/Ultrasound/Massage):

“When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.”

It seems as though my profession had been boiled down to a few “modalities” of treatment that are typically used as quick time filler or that could or should otherwise be done at home.

Ice Pack: Not really physical therapy

It seemed as though the actual “physical” aspect had been forgotten.

Most importantly, the cerebral nature of our job description was completely omitted.

And this reminded me of something the esteemed Dr. Shirley Sahrmann, physiotherapist extraordinaire, spoke about at one of her movement impairment syndrome courses. I can’t recall her words verbatim, but in broad terms she lamented the fact that the way the industry is set up, we get paid for procedures, not to think.

Modalities are procedures. Actual physical therapy work such as progressive exercise programming requires thinking. And time.

As physiotherapists, we should be first and foremost educators. We should be teaching our clients what may be causing them pain. We should be teaching them what they can do to  get out of that pain. And we should certainly be teaching them how to stay out of that pain.

And we should be using movement as our medication of choice.

Yours in movement.

Dev Chengkalath

Toronto Physiotherapist

While many of their stories are unique, there are always certain similarities.

This holds true for not only back pain, but also shoulder pain, hip pain, knee pain or any other pain that you can imagine.

One of the most common questions I’m asked at the clinic is:

“How long will my low back pain last?”

And that, my friends, is a great question.

In some cases, my clients had low back issues resolved within days while others have taken months or longer.

But really, that just means I don’t know.

I wish I had a simple answer but since the actual mechanisms of low back pain are so varied and distinct for each sufferer, I wouldn’t honestly be able to answer that question with a blanket timeframe.

It just doesn’t exist.

There is no magic bullet, cure-all pill or results-guaranteed surgery. There is no exercise panacea.

Unfortunately.

However, in cases of mechanical low back pain, if you remove the root causes of the pain, the body has the incredible ability to heal itself.

While that task may appear simple, it’s not necessarily easy.

Fixing a bad back will take time and effort on your behalf. You will have to be consistent in working on improving your situation.

You’ll have to be willing to acquire the knowledge to learn what’s causing your pain or keeping you there.

You’ll have to be willing to break old habits, be aware of your postures and alter your positions.

You’ll have to be willing to do the work.

Basically,  you’ll have to give your body a chance to heal.

And that begs the question that has become the title of this blog post:

“How long will you let yourself suffer with lower back pain?”

What would you do to stop it?

What steps would you take?

What information would you need?

What price are you willing to pay?

What would you be willing to sacrifice?

These sound like hard questions to ask yourself, but they are absolutely necessary.

I’m looking forward to hearing your comments.

To your low back pain relief.

Dev Chengkalath