Got Chronic Pain? S.N.A.P. It!

 

Got Chronic Pain? S.N.A.P. It!

As a parent, one of the worst feelings in the world is to see my daughter in pain. While I fight a losing battle to protect Amelie from all the world’s perils (uneven sidewalks be damned), I have found boo boos to be my nemesis!

Fortunately, Amelie is my best teacher, and informs me - “Daniel! It’s okay. Boo Boos heal.”

Yes, my daughter calls me Daniel, and it makes me smile every time.

Amelie provides sage advice, but what happens in the case of chronic pain and why is it becoming such a significant problem in our society?

Chronic Pain… The Elephant in the Room

At a recent continuing education course, Therapeutic Neuroscience Education1, I came across some sobering statistics:

• In the United States, 25.3 million adults suffer from daily chronic pain and, of those, 10.5 million individuals’ state that they have a lot of pain every day.

• It is estimated that 126.1 million adults in the United States experience some pain over a 3-month reporting period, which means that more adults in the United States experience pain than those who do not.

• Within these staggering prevalence numbers is the associated cost of persistent pain in the United States, which adds an economic burden of $560 to $635 billion dollars annually.

• The Centers for Disease Control (CDC) in the US have reported that prescription opioids for pain cause three times the number of annual deaths in the US than cocaine and heroin addiction combined.

Chronic Pain, Oh S.N.A.P.

It is against this backdrop, that Fred Gilbert and I had the opportunity to participate in a Chronic Pain Townhall Discussion with Northern Virginia Family Practice, in September 2022. Here is a recording from this event. Take a look, and please share this with friends and family:

SNAP Up Chronic Pain

Conclusion

If you need any help navigating the world of chronic pain, come work with me!

References

1.       Adriaan Louw - Therapeutic Neuroscience Education – 2022

2.      Vlaeyen, J. W. S. and S. J. Linton (2000). “Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.” Pain 85: 317-322.

 

3.     Moseley, L. (2002). “Combined physiotherapy and education is efficacious for chronic low back pain.” Aust J Physiother 48(4):297-302

4.     Sloan, T. J. and D. A. Walsh (2010). “Explanatory and diagnostic labels and perceived prognosis in chronic low back pain.” Spine (Phila Pa 1976) 35(21): E1120-1125.

 

5.     Kjaer, P., C. Leboeuf-Yde, et al. (2005). “Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women.” Spine 30(10): 1173- 1180

 

6.     Milgrom, C., M. Schaffler, et al. (1995).“Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender.” The Journal of bone and joint surgery. British volume 77(2):296-298

 

7.     Reilly, P., I. Macleod, et al. (2006). “Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.” Annals of the Royal College of Surgeons of England 88(2): 116-121

The Secret to Living Well? Start with “Why”

In 2009, the inspirational speaker & author Simon Sinek wrote Start with Why: how great leaders inspire

everyone to take action. The central premise of Start with Why, is that “why” is our purpose/cause/belief,

and it must be the foundation of our daily existence. The foundation of “why” informs our daily habits and

choices. As a physical therapist, my “why” is to improve people’s confidence through movement. More

recently, as a father, my “why” has grown to include living a long, healthy life to support my family. I

want to be a healthy role model for my children and their children, and my great-grandchildren, as well!

A Physical Therapist/Father’s Wake-up Call

As a result of my evolving “why”, I decided to formally pursue a Precision Medicine Health Coaching Fellowship 

to better understand how my daily habits and choices impact my ability to live long and live healthily.

My physical therapy/health coaching journey has opened my eyes to the fact that our society is currently

facing a number of health challenges, such as heart disease, obesity, and diabetes, all of which can impact

our ability to live long, healthy lives.

According to the Centers for Disease Control and Prevention (CDC):

* Heart disease is the leading cause of death for men, women, and people of most racial and ethnic

groups in the United States

* The US obesity prevalence was 41.9% in 2017 – March 2020. This number has increased from 30.5%

in 1999-2000

* More than 37 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them

have type 2 diabetes

In the face of these challenges, what is your “health why”? Maybe you are a parent or grandparent that

wants to keep up with the munchkins in your life? Maybe you have faced a recent illness that has temporarily

hampered your health? Whatever it is, the health journey starts with identifying your “why.” Finding your

“health why,” will help you stay the course. Healthy living is a mindset, a practice, and a commitment to

make daily choices that align with your response to the question: “Why do I choose to be healthy?”

The path to healthy living can be windy, uncertain, and steep. Who better to help you navigate the path than

a sherpa?

Hello! I would like to be your sherpa!

 

What Can I Expect to Focus on with Health Coaching?

We will focus on four pillars of health – each of these pillars is crucial in the journey towards optimizing health.

1.) Movement

What better place to start than with the pillar that is at the heart of my company?

* Daily, purposeful movement. Add more frequency and variety to your movement profile. Channel your inner child.

What does this look like? Every 20 minutes, take a 20 second break from your workstation to move. Move as much of

your body, through as large a range of motion, as possible.

*Fitness related movement practice– improve your body’s stress resilience through a comprehensive fitness practice –

mobility, stability, strength, power, endurance training.

2.) Nutrition

Personalized coaching with the intention of bringing awareness to your daily nutrition practice and restoring the

enjoyment of eating. Areas of focus:

* What to eat? Selection of high quality foods that match your needs and social/cultural/religious practices

* Nutrition journaling – This allows for a snapshot of our daily eating habits and also gives us time to reflect on how our

bodies respond to what/when/how much we eat.

3.) Sleep Hygiene

Sleep quality is the linchpin of health and wellness. We will discuss daily habits and rituals that start from the moment

you wake up, to improve your sleep quality.

* Review of daily habits – discuss how daily activities (such as sun exposure, physical activity, caffeine intake) impact

sleep quality

*Create a plan to maximize your sleep quality through daily habits

*Track sleep through wearables (such as Oura ring, Apple Watch)

4.) Emotional Wellness

Purposeful reflection, practicing gratitude, and leaning into a support system to strengthen your wellness journey

* What is stress? How does it impact our emotional wellness and the other 3 pillars of health?

* Review of daily habits – discuss activities that lead to a disproportionate increase in daily stress.

* Reflect on how personal stressors impact your emotional wellness.

*Develop a daily practice to reduce stress, in the moment, using practices such as deep breathing, meditation, time with

loved ones.

*Track with a journaling practice

 

What Does the Health Coaching Plan Look Like?

How long? 6 months

How often do we meet? Twice per month

How long is each session? 4 “Pillar of Wellness Introductory Sessions” are 60 minutes in length, and the 8 follow up

sessions are 30 minutes in length

Session Focus? At least two sessions per each pillar (8 sessions); Remaining sessions will focus on individual client needs

(4 sessions)

Cost? $1500

How Can I Get Started?

Click here to sign up online

Follow the steps to request a session with “Dan.”  From there, you can coordinate directly with Dan to schedule a 10

minute introductory phone call to get started.

References:

1. Sinek S. Start with Why: how great leaders inspire everyone to take action (2009). *** His subsequent TED talk on this topic has been viewed over 59 million times!

2. https://www.cdc.gov/heartdisease/facts.htm

3. https://www.cdc.gov/diabetes/basics/type2.html#:~:text=More%20than%2037%20million%20Americans,adults%20are%20also%20developing%20it

4. https://www.cdc.gov/obesity/data/adult.html

Better Backs, Stronger Shoulders

As a physical therapist and upper extremity fellow, I have spent countless hours working in the “shoulder pain trenches,” scraping and clawing to help get patients out of the hole and back to stable ground. During this time, I have found that the role of the scapula has been widely studied as it relates to shoulder health (or the absence thereof). Many of these studies highlight the impact of a poorly functioning scapula on shoulder pain, due in large part to the scapula’s role as the base upon which the shoulder and arm functions 1-5.

 

Image credit – Scapular Problems and Disorders – American Academy of Orthopedic Surgeons

 

Armed (see what I did there) with this knowledge of shoulder “sickness,” what if we take a proactive approach to the scapula/back in training and our daily movement practices to move towards the fitness end of the spectrum? When I think about optimizing the fitness potential for the upper body, I always have the back at the forefront of my thinking!

Image Credit - https://www.drgordongroh.com/orthopaedic-injuries-treatment/shoulder/scapula-disorders-and-snapping-scapula/

 

***Disclaimer – I am using scapula and back interchangeably. As you can see from the above image, many of the major back muscles have portions of their attachments along the borders of the scapula.

With regards to upper body fitness, we will focus on the following pillars:

1. Mobility – the ability to move your body freely and easily, through as large a range of motion as possible

2. Stability – demonstrating body control through the motions in the mobility section (especially in end ranges)

3. Strength – the capacity to generate force through large ranges of motions

4. Power – the rate at which work is done; or trying to simultaneously maximize speed and force production

5. Endurance – the ability to sustain your activity

 

Mobility is a prerequisite to the other four pillars, as you cannot demonstrate proficiency in a movement or position that you cannot physically achieve. As such, mobility comes first. Keep in mind, mobility is a dish best served with frequency and variety. Channel your inner child and move! Here are a couple of examples to express mobility in the upper body:

Wall Shoulder Flexion:

Hand Release:

Prescription: We have discussed in previous blog posts the “20/20 principle.” Every 20 minutes, take a 20 second break from your workstation to move. If you follow this approach, the body will adapt. The body adapts to the movements we perform most frequently.

 

Stability is of utmost importance to the shoulder, as it is structurally built for mobility. The shoulder joint is a ball and socket joint – meaning it moves in every which way. A joint that is very mobile sacrifices some structural stability. As a result, we must be purposeful with training stability of the shoulder, especially at the extreme positions of the joint (i.e. fully overhead and arms behind the body). Start training stability of the following positions by increasing the time in each position or the weight you must control in each position:

 

Pull up hang:

 

Crab Lift:

Ring Row Hold: 

Barbell OH walk:

Prescription: Start with 5 rounds: 10 seconds work with 50 seconds of rest. Increase stability demands through longer sets or increased weight.

 

Back/shoulder strength is a topic near and dear to my heart. Take a look at this previous blog post, where I dive into the specifics of pulling and pushing strength:

https://drdansclinicalcorner.blogspot.com/2018/07/

Power is the ultimate expression of your upper body fitness, as it requires the marriage of speed and strength. **For reference, maximum power is expressed at 1/3 to ½ of maximal strength and is typically trained with resistance just slightly heavier than that6. We can train for power with any of the movements discussed in the strength blog, but I will highlight the ski erg, as it tracks power production for you (Watts measurement).

Ski erg: 

*An inspirational video demonstrating that power can be expressed at any age

Prescription: Power training = sets of low reps with generous breaks (2:00-5:00). 6 x 20 seconds maximal effort ski erg. Rest 2:00 between each set.

 

Endurance can be trained through long duration bouts of exercise (i.e. hop on the rower for a 5000 m row) or repeated intervals. Both approaches have been validated to improve our maximal endurance. When it comes to back endurance, try repeated efforts of the following:

Ring rows:

Prescription: 3 x 15 seconds maximum reps. Rest 45 seconds between each set.

 

The Take Home: Train your back and improve your shoulder health! Take a balanced approach by training each of the 5 pillars of fitness in your weekly routine. If you need help, Come train with me!

References:                                                          

1. ​Ellenbecker, et al. Current Concepts of Orthopedic Physical Therapy: The Shoulder. 4th edition – 2016 

2. Reinold, M. Clinical Examination of the Shoulder Joint Complex (2015)

3. Kibler, WB. Understanding Scapular Dyskinesis. ASSET 2018

4. Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: The 2013 consensus statement from the ‘scapular summit’. Br J Sports Med. 2013;47:877-476 885.

5. Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90-104

6. Greenfield B. Beyond Training: Mastering Endurance, Health, and Life. 2014.

7. Tsatsouline P. The Quick and the Dead. 2019.

 

 

Sled Push to Longevity

As a physical therapist, my mission is to improve people’s confidence through movement.

More recently, as a father, my “why” has grown to include supporting movement through lifestyle choices that maximize my chances for longevity. I have developed a passion for enhancing the genetic hand we are dealt with lifestyle choices – nutrition, movement, sleep hygiene, mental/emotional wellness, and social support. I feel that these lifestyle choices are the true foundation for living well (and moving well).

Plus, I want to stick around a long time for this little munchkin…

 

While these pillars of wellness are integral components of my child-rearing philosophy, it is never too late to start implementing them at any age to boost wellness. Let’s start with my mission: Confidence Through Movement.

How is Movement Essential for Longevity?

Back in 2014, the American Physical Therapy Association (APTA) published a position paper to clinicians and patients, alike, in order to bring awareness to outdated approaches to physical therapy¹. One of the areas that piqued my interests was the following:

Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals¹.

I am a firm believer that we age because we slow down (not, the other way around). In fact, a 2020 study published in the European Journal of Clinical Nutrition, supported this notion, with the following findings: Adults > 60 years old with sarcopenia** and slower gait speed possessed a greater mortality risk than their age-mates, with normal muscle mass and walking speed².

**Sidebar – sarcopenia is defined as a progressive and generalized skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality³.

The APTA supports these studies with the claims: 

1. Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls¹.

And…

2. A carefully developed and individualized strength training program may have significant health benefits for older adults¹.

This advice is music to my Movement-Loving ears! Put simply – train the inner child within the older adult.

Unleash the munchkins within!

Finally, to tie a big bow on this Movement-Lover’s present, a 2018 Journal of the American Medical Association (JAMA) article found that: Cardiorespiratory fitness [endurance] is protective against all-cause mortality. This JAMA article found that the higher the aerobic fitness [endurance], the greater survival against all-cause mortality, and this finding was associated with benefit in older patients⁴.

Put simply: Strength + Speed + Endurance = Longevity

My Favorite Longevity Movement?

The Sled Push!

Anyone who has worked with me knows that I love the sled push!

Shoulder pain? Let’s push the sled!

Back pain? Let’s push the sled!

Performance training? Let’s push the sled!

 

**Disclosure – I have no financial ties to any sled company, although I would gladly become a brand ambassador to any that would have me 😊.

 

And now…

Longevity equation? Let’s push the sled!

Why do I love the sled? Specifically for the population of adults > 60 years old? The sled push allows us to train the entire body in one movement. Efficiency! The sled push reinforces taking bigger steps and adopting a forward lean with gait - both of these skills are frequently lost in this population. The sled push lends itself to effective form without requiring much coaching, which means you can start training for performance on the first day. The sled push has very little eccentric loading (lengthening of muscle-tendon complexes under load), which means less soreness after you complete the movement. I could keep going, but I have been given a word count restriction for this post!

The Prescription: Hit each movement pillar of longevity 1-2 x weekly.

1. Sled push strength? Load that sled with some weight! Push 3 sets of 8-10 steps on each leg

2. Sled push speed? Sprint that sled as far as you can: 4 sets of 20 seconds. Rest 2 minutes between sets.

3. Sled push endurance? Push that sled as far as you can in 4 minutes. Rest 4 minutes. Repeat for 3 sets.

 

The Take Home:

We want our kids to run fast, run long, and be strong and healthy. We owe it to them embody these tenets and to be movement and wellness role models.

Want to Learn More? Check out my blog, where I dive deep into all things strength, speed, and endurance. Want to Do More? Come train with me!

 

References:

1. APTA – Choosing Wisely - Five Things Physical Therapists and Patients Should Question. 2014.

2. Bachettini NP, Bielemann RM, Barbosa-Silva TG, Baptista Menezes AM, Tomasi E, Gonzalez MC. Sarcopenia as a mortality predictor in community-dwelling older adults: a comparison of the diagnostic criteria of the European Working Group on Sarcopenia in Older People. European Journal of Clinical Nutrition volume 74, pages 573–580 (2020).

3. Cruz-Jentoft A, Sayer AA. Sarcopenia. The Lancet. Volume 393, Issue 10191. Pages 2636-2646. June 2019.

4. Mandsager K, Harb S, Cremer P. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Network Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605