Emptying out the mailbag and clearing the history #4

Posted on December 22, 2014

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Other mailbags can be found hereKeep in mind a lot of this is email conversations, comment replies, or some random interesting things I’ve found. By their nature they are not as thorough or complete as a post on one topic.

Here’s what’s covered in this installment (click to be taken to the section):

Rise and fall of smoking in America

This is an amazing graph:

Rise and fall of smoking

Anyone who works with people in a behavioral change manner should be very encouraged by this image. I see many out there who are too cynical when it comes to changing people’s behavior. As if getting people to change how they eat, getting them to exercise, or whatever, is impossible.

“People just do what’s easy, or what feels good. You can’t change people.”

This chart proves you can change human behavior on a massive scale. And we’re talking changing an incredibly strong habit.

“We don’t sell Tic Tacs for Christ’s sake. We sell cigarettes. And they’re cool and available and *addictive*. The job is almost done for us!”

From Thank You For Smoking

Looking at the graph above, even after the surgeon’s general warning it took ten years for things to start really dropping. Be more optimistic. Some things just take a lot of time and effort.

Body in Mind Pain Conference Write-ups

BodyInMind.org has a series of posts regarding the recent World Congress on Pain conference. I thoroughly enjoy their site. I’ve found a lot of useful stuff on there. However, I nearly fell off my chair laughing when I read this sentence in this post on Complex Regional Pain Syndrome:

“In the world of chronic pain syndromes CRPS is different.”

My laughter is not aimed at the writer or BodyInMind. At least not directly. It’s more-so at all the people going crazy about applying people like Lorimer Moseley’s work to knee pain, shoulder pain, just regular, everyday aches and such.

A huge amount of BodyInMind’s research, and the pain science research, is on CRPS and phantom limb pain. (More is being done on the lower back. Virtually zero has been elsewhere.) I’d venture to say those at BodyInMind would make this statement as well:

“In the world of chronic pain syndromes phantom limb pain is different.”

Those such as Moseley and BodyInMind have diligently discussed the limitations of their research. (Small sample sizes being a common one.) Those who are running off with their research applying it to every scenario are not taking the same degree of diligence.

In one scenario you have one of the only chronic pain syndromes that you can see, CRPS, such as being able to see inflammation or sweating changes. Contrast this with most chronic musculoskeletal issues where the issue is not inflammation, such as tendinitis, but degradation, such as tendinosis.

In another scenario, phantom limb pain, you have a painful area that doesn’t exist anymore. Contrast this with most chronic musculoskeletal issues where, you know, the structure is still present!

These are, as one of my clients put it, “pretty fucking extraordinary circumstances.” There’s no doubt there is application to be had. There’s also no doubt there isn’t.

Holding onto the treadmill and burning calories

I use walking on an inclined treadmill as an exercise quite a bit. My clients are always wanting to hold on to the handrails, especially when tired. This study caught my attention:

The Reduction of Metabolic Cost While Using Handrail Support During Inclined Treadmill Walking is Dependent on the Handrail-use Instruction

From the abstract (edited for easier reading):

“Energy expenditure was quantified while each subject walked in four conditions:

  • 5% incline unsupported
  • 10% incline unsupported
  • 10% incline holding the handrails while maintaining an upright posture
  • 10% incline holding the handrails while leaning backward.

Energy expenditure (kcal min-1) was significantly higher for 10% unsupported (8.83) and 10% upright (7.77) relative to 5% unsupported (6.32).

No significant difference was found between 10% leaning backward (6.02) and 5% unsupported.

Altering posture with respect to the inclined walking surface by holding the handrails and leaning backward significantly reduces metabolic cost; however, utilizing the handrails and remaining upright does not result in a significant reduction at a 10% incline.”

I was pretty surprised to see such a small difference between not holding on and holding on. 8.83 kcal per minute versus 7.77 kcal per minute. One usually feels quite a difference when grabbing. Looks as long as someone isn’t leaning back though, what I’d call “really holding on,” there’s a difference not worth worrying about. At least from a calorie standpoint. Good to know.

Another benefit of coffee

Want clean teeth? Drink strong coffee.

Coffee and caffeine is oddly something many people constantly go, “I need to give that up.” Whenever I have a client who says, “Yeah, I’m trying to give up coffee / caffeine.” I immediately go, “Don’t!”

Coffee has been associated with innumerable benefits. Some off the top of my head:

  • Increased mental acuity
  • Increased calorie burning (particularly for fat)
  • Decreased appetite
  • Increased physical performance
  • Potential benefits after a night of drinking (liver benefits)
  • Heart benefits

This list goes on for a while. Now, it’s not like you would say, “Just drink coffee to help X.” There doesn’t seem to be that strong of a benefit. It’s more like, “It doesn’t hurt anything, and it very well may help things.” So why stop drinking it?

-The

Some femoral retroversion and glute questions

From an email:

“I wanted to ask you a hip question (i’ll try to keep it brief but it will take me a few words to describe it).  I found your post on retroversion.  My hips are definitely retroverted, something I’ve known (but didn’t know the term for) for a long time.  Physical therapists are often telling me to “squeeze my butt” during different movements, and, depending on the exercise, sometimes it makes perfect sense to me and I am able to do it, and other times it makes no intuitive sense whatsoever, and feels physiologically impossible (for me).

My left hip is less retroverted than my right, and it’s also easier to squeeze my butt on that side.  But with both hips, it seems I can’t squeeze my butt unless my femur is somewhat externally rotated (and squeezing it causes a little bit more rotation).  I try to explain this to them and they don’t listen (or maybe don’t get it), and just tell me to keep try to squeeze my butt.  This leaves me frustrated, but also concerned that maybe I am doing something wrong.

Based on this experience, I’m wondering if “normal” hips use the glutes a bit more, and retroverted hips recruit more on the upper hamstrings for certain hip extensions (specifically when the leg is in a neutral position, i.e. vs externally rotated).  But, I don’t know enough about the anatomy (origins, insertions, etc) to know if that is true or not.  For example, if I’m doing a simple bridging exercise on the floor, in order to really get my glutes involved my legs need to be somewhat abducted and externally rotated.  If I bridge with my legs neutral (no rotation, shoulder-width apart), my glutes do work some but my hamstrings work a lot too, possibly more than my glutes (and this is more exaggerated on my right, more retroverted, hip).

So, does that make anatomical sense to you?    If so, should I just continue to do what feels natural and let my hamstrings do their share of the work sometimes?  Or, am I dead wrong, and instead I actually do have some sort of glute activation issue, and need to somehow train them to contribute more, even from a neutral position.

Another example is I’ve been told to squeeze my butt just before my heel strikes when walking, to stabilize my hip.  This feels unnatural, but I can force myself to do it, though much more easily on my left than on my right.  In order to do it on my right leg, I feel like I have to externally rotate my right leg a little, which isn’t how I would naturally walk.

Thanks in advance for any light that you can shed on this issue.

 -Jon”

My response:

-To start off with, I’m not a fan of squeezing the glutes during so many activities. I know this is quite common in the PT world, but, for the most part, I never recommend doing this. It’s something I’ve gone more and more away from throughout the years.

-It is common when squeezing the glutes for the leg to externally rotate. Glutes, particularly when the leg is straight, have a strong external rotation aspect to them. It makes sense when squeezing them for 1) The femur to want to rotate and or 2) It be easier to squeeze them when the femur is already a bit externallly rotated.

-The hamstrings don’t have any role in femoral rotation. (Only tibial rotation.) So I don’t believe that would be the case with a retroverted hip. The lateral rotators of the hip are going to be somewhat shortened in a retroverted hip (usually anyways), but that doesn’t necessarily dictate how they will function.

-This gets a bit complicated regarding what you feel during the bridging. You could simply have some glutes that don’t fire as well as they should / some hip flexors that are stiff, such as the TFL. When you aDDuct the femur, the TFL gets put on a greater stretch, if it doesn’t like that (it’s stiff), it can make it so it’s harder to squeeze your glutes. This is a common thing with people and has nothing to do with retroversion. It’s usually worth working on, although bridging isn’t how I prefer to do this.

(One example of how I do this sometimes: https://b-reddy.org/2012/06/01/standing-version-of-the-best-damn-it-band-stretch/ )

That said, the hamstrings do extend the hip. To feel some work in them is normal. It’s more you don’t want to feel zero work in the glutes.

-I rarely use the glute squeezing during walking anymore. I prefer to focus on the ankle, if needed. More on this here: https://b-reddy.org/2013/06/13/relieving-hip-pain-while-walking/

The never ending whining doctors

Since I work with some doctors, I should say there are many doctors I like. This certainly doesn’t apply to all of them. And I very much respect how hard medicine and human health is, i.e. harder than any other discipline. The following is a pet peeve of mine though when it comes to the economics of healthcare.

On the science page of reddit, this link came up: Patients don’t understand the risks of unnecessary antibiotics, study says.

As predictably as ever, all the doctors started chiming in.

“Waaaaaa, our patients don’t listen to us.”

-> That can be the doctor’s fault, too.

“Waaaaaa, we only have 15 minutes per patient.”

-> I love this one. It’s ALWAYS tossed out by doctors. Beyond the fact this is partially a choice by the doctor, what’s one of the biggest complaints people have about their doctors? The waiting time. Doctors are so compressed time wise, 15 minutes then right to the next person (they claim), yet they are NEVER on time for their appointments. And we all know it’s not like 5 minutes late. It’s often 30 minutes or more.

“Waaaaaa, our salaries are tied to patient satisfaction.”

This, by far, was my favorite -made me the most infuriated- comment:

Reddit healthcare comment

That last sentence is priceless. Doctors have had a huge influence in making the healthcare business run like the business it currently is. When it comes to lobbying organizations, the American Medical Association spends the second most amount of money. They spend more than any health insurance company, hell, they even spend more than Exxon. A whopping $110 million more.

Top spenders lobbying lobbyists

Too many doctors want to be let free to charge by the procedure, charge whatever they want -what “they’re worth,” have a joke of a medical malpractice lawsuit limit -one that doesn’t even increase with inflation (such as here in California), not be judged by what patients think of them, etc. etc. But, they don’t want to be judged how other businesses are judged.

Many doctors commented how some of their reviews done by patients complained about things having nothing to do with them. Things like the parking. Newsflash: A business is judged by A LOT of factors beyond say, the coffee. If the parking sucks where your coffee shop, or whatever business is, guess what, you lose money, you get shit on Yelp, you get shit at the cash register. If you’re the owner of the shop, and your cashier is having a bad day and treats customers poorly, you lose business. Just like if you’re a doctor and your secretary’s ongoing divorce affects their patient interaction.

Or, I saw people on that reddit thread whining patients complained it was loud at night and they couldn’t sleep.

“But that shouldn’t matter. It’s a hospital, not a spa.”

What if a hotel owner went “I’m sorry, we can’t control the fact your neighbor is snoring so loudly you can hear him through your wall.” You wouldn’t stay at that hotel next time.

If you’re a waitress and you do a flawless job tending a table, but the food comes out overcooked, you probably don’t get tipped as well.

You have a hospital that has great staff, but makes people feel like a mouse trying to get through a maze? You’re going to get complaints.

“But I didn’t build the hospital.”

Waaaaa.

I recently went to Las Vegas with a friend. The last time I was there I went to this great bar with some buddies. It was easily the highlight of our trip. I wanted to take this friend there. I asked a bartender at a nearby bar exactly where it was, as I couldn’t quite remember.

“Oh, that place closed.”

“Really? Some friends and I loved it there. What happened?”

“A ton of places have tried that location. They all have had to leave within a year or two. Doesn’t matter what approach the place takes. There’s just not enough foot traffic at that spot. People don’t know anything is there. It’s awkward to get to.”

For anyone who has been to Vegas, this is a bar that served pitchers for $14. I couldn’t remember exactly where this bar was, but I remember that price clear as day, as typically a single beer can be around $13 in Vegas. Meaning this was not only an awesome place, it had great prices. It was doing everything right, except one thing. Out of business in a year.

I can’t remember where I saw this quote. But it went along the lines of:

“Anybody who says they don’t want to deal with the business aspect of things, that “I just want to focus on my craft,” gets what they deserve.”

In other words,

shut-up1 (pivot)

Doctors really need to learn to pivot.

 

One of the best Friends moments:

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