Monday, April 20, 2015

Am I Strong Yet?

My Roots

We all have to start somewhere.  My earliest experiences with strength training had to do with high school and was often connected to my love of wrestling.  Strength was a key element of the training and we worked really hard.  I was on a team in one school where almost the entire team consisted of state champions – no,  I was not one of them.
What was evident to me was that people who were stronger seemed to do better.  They were no pinned as easily and could often break holds.  I could see it’s importance but it was not something I particularly worked at unless the coach was making me do something like push-ups or sit-ups.  I do have to admit a more than passing interest in Charles Atlas and his dynamic tension.  I just never made enough money to buy his product.  It still sells for about $50!

And Then Came the Army…

I joined the Army to study Physical Therapy.  In my mind it is still one of the most important things that I have done.  I learned a good deal about the body and specifically about how therapy is done.  I was expecting to learn massage and exercise.  

What I actually learned was about 3 hours of massage and exercises for particular issues that are regularly seen in a military setting.  It was a very good foundation but it only emphasized the shortening aspect of exercise.  We specifically focused on strengthening muscles for the purpose of returning a soldier to duty in the shortest amount of time.  We were considered miracle workers by many due to the way we were able to get people out of the hospital so quickly.

One of the things that is burned into my mind is the amount of pain often experienced with our approach.  Many people told me that they really dreaded coming in for their treatment.  PT was said to stand for Physical Torture.  No Pain – No Gain was our slogan.

What I Learned as a Trigger Point Therapist

 I went to school to study Trigger Point Therapy.  It was not like today where one goes and learns to incorporate treating trigger points into a massage session.  This was actually studying Trigger Point Therapy as an actual discipline.  There are not many who actually do that.

One of my favorite memories is of a teach asking us periodically in class – with no time to think about an answer – How we were similar to and different from other specific disciplines.  She asked me about Physical Therapy.  My reply – PT sees a person in pain and asks, “How can I teach that person to exercise and increase their strength to get out of pain.”  A Trigger Point Therapist would ask, “How can I lengthen that person’s muscles to get them out of pain.”

Those 2 perspectives differ greatly.  In my experience I saw more people respond positively to pressing “Trigger Points” than I did to “Strengthening” muscles.  In fact, the strengthening approach often increased the pain so much that people often quit therapy before it was over.  The other really interesting thing is that I found people had more strength after the lengthening process and that it was an instantaneous improvement.  The patient did not have to exercise for weeks or moths to see the improvement!

The strengthening approach has grown in recent years into a movement in PT  Athletic Training that is called Core Strengthening.  It seems to make sense that if we strengthen the muscles most responsible for maintaining posture that we should be able to help more people.  The story about posture is pretty well debunked in my post, “Confessions of a Recovering Posture King.” There are numerous studies that actually show that core strengthening is now really effective at all and was implemented by good marketing instead of by good science.

 I really liked, taught, and used the lengthening approach for many years.  Now I think differently.  It’s time for the rest of the story.

The Rest of the Story

When a person is experiencing pain they learn to avoid it by not using the area.  Our brain, for some reason, has decided that it is safer to shut down and avoid movement in order to protect itself.  In long term pain we learn to guard or hold ourselves long after the injured tissue has actually healed.

This lack of activating the muscle shows up as weakness and we assume – often incorrectly that the body’s defense is actually a defect. This defect must be corrected by strengthening or lengthening – depending on the view adopted by your therapist.  

But……What happens if we simply remove the sense of threat?  What if we could convince the brain that there is nothing wrong with the tissue and that nothing bad is going to happen when we move it?  This is what modern pain science is indicating that we should actually do.

The there are those pesky 95 lb. weaklings with zero pain. They don’t need strengthening to avoid pain.  They may need help opening a ketchup bottle though!

You Can’t Replace Something with Nothing!

If the brain is experiencing a sense of threat when there is no actual threat – What can we do?  There are a number of specific things that we can do.  Here we are simply going to mention a few of them.

We can show the brain that it is safe.  This can be done in a number of ways.  I often do this by passively moving a joint to show the person that it is safe to do so.  I then explain that pain does not necessarily indicate damage to tissue.  If there is redness warmth and swelling – indicators of actual inflammation – there may well be a problem requiring actual medical intervention.  If it is an acute injury it is usually a good idea to have the injury checked out – just to be safe.

You can also move the area where you feel pain.  I encourage people to move the area to the edge of pain and to practice doing that.  With practice – the initial point of pain is passed and greater movement is accomplished.  This is illustrated here by a PT.  He calls it Edge Work.

I often touch the painful area and then stay there as I distract the skin from another location.  This actually fires of stretch receptors in the skin and tells the brain that it is sage.  You can do that with a medical tape such as kinesio tape that is sold in drug stores.
These things commonly lead to strength increases without exercise and without pain. They are things that you can do for yourself.  There is almost always something you can do to help pain.

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