When One Door Closes, Another Opens…

Often when clients consult me for advice or physiotherapy treatment, they are frustrated that they have had to stop their usual sport or exercise. They will usually add that they have put on weight and need to get back to it! At this point I routinely ask them if they have tried another form of exercise that doesn’t involve the injured body part? Frequently, a look of surprise ensues “I didn’t think of that!” Sometimes it’s a guilty look “I’ve been lazy…I’ve used it (my injury) as an excuse.” On other occasions it’s just a blank expression “I didn’t know what I could do?” When I tell them that in fact, there are quite a few things they can still do, their eyes light up with excitement at the prospect of resuming some form of physical activity.

I remember treating a triathlete several years ago. He came to see me because of a calf problem that was preventing him from running. Running was his favorite part of the triathlon and so predictably, it had a prominent place in his training regime. Initially I asked him to stop running and focus instead on swimming and upper body strengthening…he actually started enjoying swimming which in the past had been a chore. He would come in excitedly and tell me how his technique was improving. When he returned to competition he was surprised to see that his times had improved dramatically! By allowing him to focus on his weaknesses, his injury turned out to be a blessing in disguise.

Alexander Graham Bell said “When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.” So true, we are constantly surrounded by opportunity but it takes a positive outlook and a flexible attitude to seize it!

The Effects Of Smoking On Musculoskeletal Health

It’s common knowledge that smoking is bad for health. In the UK, according to the NHS, 114,000 people die each year of smoking related illnesses. In the US, the figure is 443,000 and as reported by Centers for Disease Control and Prevention, smoking is the cause of one out of every five deaths. Smoking damages the lungs and causes conditions such as bronchitis, emphysema, pneumonia and 90% of lung cancers…in addition to several other types of cancer. It also damages the heart and circulatory system and increases the risk of getting coronary heart disease, heart attacks and strokes…but we know all that, what we’re less familiar with are the effects on the musculoskeletal system.

Lets take a closer look at some of the harmful constituents of cigarette smoke: nicotine, carbon monoxide and hydrogen cyanide. Nicotine causes a narrowing of blood vessels and thus decreases blood flow to tissues. Nicotine also increases the risk of blood clots by increasing platelet stickiness. Carbon monoxide and hydrogen cyanide both hinder oxygen metabolism and transport. In summary, smoking decreases the blood flow and transport of oxygen to tissues. The supply of nutrients, minerals and oxygen via blood flow is vital for the development and regeneration of cells.

Some of the numerous documented musculoskeletal risk factors associated with tobacco use are:

  • poor wound healing and increased rates of postoperative complications such as infections, haematoma, tissue death and skin graft loss
  • delayed or deficient ligament healing (in mice)
  • shoulder rotator cuff disease
  • the development of osteoporosis and osteoporosis related hip fractures
  • an extensive body of evidence shows that smoking delays mineralization during the bone healing process, decreases the strength of regenerating bones and increases the incidence of non-union (failure to heal). In one study on wrist fractures, non-smokers took 4.1 months to heal whereas smokers took 7.1 months…almost twice as long! Smokers have been estimated as having 2.5 times more risk of ensuing complications.
  • an increase in the incidence of rheumatoid arthritis
  • a greater likelihood of developing systemic lupus erythematosus (an inflammatory autoimmune disease affecting connective tissue)

In order to enhance soft tissue healing and fracture healing, as well as for general musculoskeletal health, it’s definitely advisable to stop smoking!

The Obesity Paradox

According to research, obesity is to a certain extent genetically determined. The pandemic now affects a billion people and has gradually grown over the last 150 years. Interestingly, our genes have not changed over that period. So how could obesity, which is genetically determined, have appeared over a time when our genes have remained unchanged? What has changed?

Well, over 150 years ago 90% of the population lived an agricultural lifestyle. They walked to work, performed active physical work, walked home after work. Water had to be carried and clothes washed by hand. Our lifestyles were much more similar to those of our distant ancestors in that, we stood and walked for most of the day.

With the advent of industrialisation and urbanisation 50% of the world’s population moved to the cities. This figure is even higher in developed countries. Factory work became prevalent and chair-based work replaced standing just like machine operation replaced tool use. The biggest change has taken place over the last 25 years…over half the population in the developed world now sits in front of a computer for 8 hours a day. As a result of these changes, our occupational energy expenditure could have decreased by as much as 1200 kcal/day.

At home most of us have a personal computer and we spend a few more hours banking, shopping, browsing and even socialising (Facebook, Twitter, MySpace, etc)! Oh, and if we’re not sitting in front of the computer it’s probably the television…another brilliant invention that appeared in the last century. Sales of labour-saving devices like washing machines, dishwashers and cars track obesity rates and it’s estimated that mechanisation saves  around 111 kcal/day.

Obviously food has become more available (in industrialised countries) and one could assume that our intake has increased. Surprisingly, in the UK since the 1980s, energy intake seems to have decreased whereas obesity rates have doubled! Statistics in the US show that intake hasn’t changed but obesity has skyrocketed…

Here’s a quick thermodynamics refresher…when energy is added to a system it’s either used to perform work or stored…if the energy intake is greater than the energy expenditure, the excess is stored as fat…if the energy imbalance continues over several months or years it leads to obesity. It’s becoming clear that it’s the decrease in our activity that has lead to the weight gain.

How come we haven’t all been affected by this? This is where the genetics plays it’s part. Those of us that are genetically programmed to conserve energy have blossomed in this new modern environment, the rest have found other ways to replace their need for movement: walking or cycling to work, pacing about at work, getting involved in DIY at home, going to the gym or taking part in sports or active hobbies. Crucial research shows that lean sedentary people stand and walk for about 2.5 hrs/day more than obese people. If obese individuals were to stand and walk 2.5 hrs more each day it would equate to an expenditure of 350 kcal/day which is exactly the figure that was identified in a different study to determine the amount of exercise that obese people had to undertake to help weight loss.

Why should we care about obesity? Perhaps because it’s been linked to type 2 diabetes, hypertension, stroke, arthritis, sleep apnea and cancer…maybe because obesity related medical expenses are out of control and  in the US they reached $75 billion in 2003!

What’s the best way to lose weight? Is it through exercise or non-exercise activity? Or both? According to Dr Levine, the majority of people who exercise for just under 2 hours a week expend an average of about 100 kcal/day. This is a drop in the ocean compared to what it’s possible to achieve by increasing non-exercise activity. Granted, we can’t all change our jobs and become lumberjacks or tree surgeons but we can become more active both at work and at home. Our muscles are almost completely silent when seated and as a consequence, our energy expenditure is negligible…our expenditure goes up 15% when standing and doubles when ambling…purposeful walking can double or triple it! So, spending less time sitting seems to be the key to burning up more calories.

Prolonged sitting time has been linked to metabolic syndrome, type 2 diabetes, obesity and cardiovascular disease. This is thought to be the result of poor fat metabolism due to the decreased production of lipoprotein lipase in muscles when seated. Non-exercise activity reverses this process.

It appears our technological innovations have had insidious effects on our health. The antidote lies in freeing ourselves from the chair…can we afford to wait for governments and corporations to reengineer our workplaces? Probably not…we must all take responsibility for our health and those among us that have a predisposition towards energy conservation need to take active measures by simply standing and walking about more often and for longer periods during the day.

Most of the information in this post is inspired from the work of Dr James Levine, Professor in the Department of Endocrinology at the Mayo Clinic in Rochester MN

Half Full Or Half Empty?

Have you ever had a spell where nothing is going the way you want it to…in fact everything seems to be going wrong in the worst possible way? Of course you have, we all get those spells…but did you know that the way we think influences the extent to which we’re affected by those periods of bad fortune. More specifically it’s our thinking in relation to the 3 Ps…personal, pervasive and permanent that make the real difference. Pessimists will tend to view problems as being personal (“It’s my fault”), pervasive (“I can’t do anything correctly”) and permanent (“It will never change”) whereas optimists view problems as situational, specific and transient. Martin Seligman’s work demonstrated that a pessimistic explanatory style can cause learned helplessness (inaction and passivity) and depression. Further research has shown that it can also lead to a weakened immune system and an increased vulnerability to minor ailments and major illnesses.

Probability ensures that life brings us a bit of everything: the good, the bad and the in between. Our challenge during the bad times is to keep our resolve and focus, and perhaps even learn from the experience. Our task during the good times is to take full advantage of the opportunities, celebrate and really relish the moment.

So if you happen to be going through a rough patch…it’s not your fault, it happens to us all…notice how it doesn’t affect every aspect of you life…and rejoice in the knowledge that good times are just around the corner!

Feeling Sad?

Have you been experiencing any of the following symptoms:

  • Feeling down or depressed
  • Less interested in doing things or procrastinating
  • Loss of libido
  • Over eating
  • Waking up in the night
  • Waking up too early
  • More tired than usual, heavy limbs, aching muscles or headaches
  • Stomach problems, sweating, cramps, having to urinate frequently, dry mouth, sighing, heart palpitations, hyperventilating
  • Feeling tense, irritable, worrying too much about little things
  • Slow thoughts or speech
  • Fidgety, restless, difficulty concentrating
  • Paranoid and suspicious

If you have, you’re not alone. About 25% of the population is affected each year, particularly during the months of December, January and February. For 7% of people the symptoms can actually become debilitating. It’s like a form of winter depression called SAD (Seasonal Affective Disorder). A reduction in daylight hours and a lack of sunlight disrupt our body clocks and may lead to an imbalance in the neurotransmitters serotonin and melatonin.

Winter is characterised by a relative scarcity of food and some animals take the opportunity to hibernate. Their metabolism decreases in order to conserve energy. Although we’ve never hibernated, before the advent of electricity and in particular the light bulb in the 1800s, our activity and sleep was dictated by sunlight. As the number of sunlight hours decreased during the winter months, so did our activity. Our body clocks followed a marked seasonal rhythm.

The artificial light produced by electricity has allowed us to become more productive by helping us keep the same working hours throughout the year. Even though artificial lighting is strong enough to allow us to work and live, it’s much weaker than natural sunlight. As a result, it lacks the strength to regulate our body clocks in the same way that natural sunlight does. We’re now forcing our bodies to awaken when they would naturally be asleep. This burden hasn’t been tolerated well.

Read my next post for some useful tips to help you beat the winter blues.

Injury Blues

Last week I injured my shoulder whilst training in martial arts. Yeah, I know…if I’m going to play silly games I should expect things like that to happen! My first emotion was anger. Anger about the way it happened, who was to blame, “I should have known better”, etc. This got me thinking about the mental aspects of injury.

In 1969, Elisabeth Kubler-Ross released a groundbreaking  book called “On Death and Dying”. It included a model which described the process by which people coped and dealt with grief and tragedy. Tragedies such as being diagnosed with a terminal illness. She defined 5 stages:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Interestingly, she later discovered that this process also applied to other forms of loss such as; the loss of a job, the end of a relationship, injury, etc. Although there are 5 stages, not everyone goes through all of them. Also, the order is not necessarily as shown above and people can dip in and out of a particular stage.

Athina Markou and Karen Wager-Smith have recently postulated that severe stress and adverse life events can lead to neurobiological processes that physically alter the brain. They believe this is an adaptive response and that it is accompanied by wound healing mechanisms such as inflammation. Certain neurons die, others sprout, change shape and make new connections as the brain rewires itself.

With injuries, the sooner we reach acceptance, the sooner we can start to work on the road to physical recovery. Fortunately for me, my injury isn”t serious and so, it didn’t take long to “get my head around it” and reach acceptance. I’d like to share with you something that really helped me. It’s a video documentary of Brazilian Jiu-Jitsu master Braulio Estima.

Braulio Estima Road to ADCC Episode 4 – YouTube

It’s a wonderful illustration of how adversity can be faced with courage…and the miracles that can be achieved with belief, determination and perseverance.

Welcome to Healing in Motion

I guess I should start from the beginning. Why ‘Healing in Motion’? ‘Healing’ obviously relates to health, something that a lot of us take for granted…until it goes awry. Our health must be continuously cultivated through our actions and our behaviour. Good health is something to be cherished surely?

The word ‘Motion’ has a dual significance. It expresses physical movement. Our bodies are built for movement and thrive on it. When combined with ‘Healing’, it represents a process. I love the word process! It can be defined as a series of changes taking place in a definite manner…and that is exactly what ‘Healing in Motion’ is about…a series of physical, mental and/or emotional changes taking place in a definite manner and steadily moving you towards better health.

What will I write about in this blog? Well, I will include research, news, exercises, tips, quotes, musings and anything else that I think may be of interest and benefit in helping you achieve great health. Welcome!