One of the first questions I ask clients after they have walked into the clinic is, how's the (insert body part/parts of choice) feeling?
I expect a variety of different responses every time, but the answer usually sets the course of treatment that day. Are we progressing exercises? Is today going to be an intense workout? Are we going to be focusing more on hands-on treatment?
One of the biggest frustrations I hear (and have experienced!) with pain and injury is that healing isn't an instant process. Unfortunately we are used to a medical system that has created a culture of 'quick' fixes. Have high blood pressure? Here's a pill. Aches and pains? Here is some Ibuprofen (or, sadly in many unnecessary cases, an Opioid). But even though symptoms have been masked, nothing has truly been fixed. If you are taking blood pressure medication, you still have high blood pressure! Take the pill away and you're back to square one.
Meaningful change to lower your blood pressure takes dedication and attention to exercise, nutrition, sleep quality, and stress levels.
In fact, as most of us have figured out, real change with anything in life be it relationships, finances, and quality of life, takes work. There are very few shortcuts. It's a grind, and success isn't measured in leaps and bounds it's measured in "Inches" (insert Al Pacino imitation here)
Recovery from an injury or chronic pain is no different. It's slow, it can be frustrating, but as that pain dissipates the results are even more meaningful and long lasting. It's not a linear progression, it's ups and downs along the way.
I remember when I was working on a large research project with a pretty tight deadline. As the frustration mounted, I was reminded of an African proverb which asks How do you eat an elephant? One bite at a time. The quote stuck with me and I still say it to myself every time the finish line of a project or my own rehab/fitness goals feel out of reach.
Pain and rehab is complicated and it can be overwhelming and confusing. If we just look to the finish line we miss those vital baby steps along the way. Are you sleeping a bit better? Did your morning shoulder pain disappear faster? Could you work at your desk for a bit longer? These are the markers we look for as clinicians and make us smile to ourselves knowing that a patient is on the right track. True change and achievement is an accumulation of small successes and failures, not leaps and bounds to the finish.
Yours in Movement,
Every time I log into Netflix I make a horrible mistake.
No, it's not binge-watching the latest TV show only to emerge from my home one week later, pale-faced, unshorn, and dishevelled. The mistake I make is navigating to the travel documentary section. My issue isn't confined to Netflix, my Instagram and Twitter feeds are flooded with travel photographers, adventurers, and sponsered athletes. I watch as people who are paid to do the activities I love frolic around the world while I sit in my onesie crying into my home made trail mix (maybe I'm exaggerating).
In all seriousness, a lot of us suffer from a sense that we are not getting the most out of life. We dream of travel and large scale adventures to remote locations and cultures. This 'travel bug' is intensified by beautiful vistas and beach scenes inundating us on social media and in movies. We often don't see that the number of people who live 'the lifestyle' are few. We also underestimate the amount of work it takes to maintain that way of life and to even attain it in the first place.
People who know me know about my sense of adventure, and that my activity, exercise, and time in the gym all revolve around my need to disappear into the backcountry and push my body to sometimes painful extremes. However, work, family, finances, and day to day routine get in the way of these pursuits. The amount of time daydreaming about these activities outweighs how much time is spent performing them. So what is an adventure driven person to do?
Enter the microadventure. The microadventure is a term popularized by Alastair Humphreys. The microadventure challenges the notion that adventure and travel need to be an all or nothing experience. The idea is encapsulated in the expression
"We are defined by the 9 to 5, but what about the 5 to 9"
We have constructed a life dominated by monotonous routine in which we live for our 3 weeks of vacation a year. Often that vacation is so hyped up and we spend so much time preparing for it that it doesn't live up to expectations.
The microadventure challenges us to explore the notion of adventure and travel on a small scale. This can be as simple as exploring a local forest. Maybe it's bringing a camera and exploring a new neighborhood in your city. Maybe it's as big as a Sunday 3am wakeup to drive 4 hours away for a day of exploration. It's amazing how thrilling new perspective can be even on a small scale.
Maybe you've always wanted to try a new activity, most outdoor stores offer cheap rentals. Canoe down a local river, learn to cross country ski or snowshoe. Will it be as magnificent as a surfing the waves in hawaii with diamondhead in the background? No. Will it allow you to appreciate the little things that surround you on a daily basis and help you spend more time in the present? Absolutely.
Here are some more ideas for beginner microadventuring and some great microadventure resources.
1) Go to a local museum and learn about the history of the region. Then go out and explore/photograph the birth of your city/province
2) Pick an activity you have always been too scared or busy to try, then go do it.
3) Take your local transit to the end of the line, explore the food, coffee, and sights of the new neighborhood.
4) Pick an exotic, multistep recipe you have never tried before. Even if it flops you will gain from the flavors, smells, and cooking process.
5) Keep a notebook and record your daydreams, then practice distilling them into meaningful and realistic microadventures.
"You need to exercise more."
"Sitting is the new smoking."
"Have you considered joining a gym?"
Many people who visit their healthcare professionals are familiar with these sayings. Very often physios, doctors, and personal trainers will repeat the same message over and over with little result. Many patients live with pain, poor health, fatigue, and other symptoms of a sedentary lifestyle and return year after year, visit after visit with no change. As healthcare professionals we get frustrated and patients become even more frustrated with their lack of progress.
We know the numbers on health and sedentary behaviour. In a study by the CDC in 2015, sedentary behaviour was responsible for 131 billion dollars in health care costs. A 2015 study by Dr. David Alter at the University of Toronto found that sitting for long periods can increase the risk of cardiovasular disease, cancer mortality, all cause mortality, and the risk of type 2 diabetes. So why aren't our patients changing?
A lot of people hear the quotes above and feel overwhelmed. It's easy to recommend exercise when you live an active lifestyle. But we forget that for those on the receiving end, who are not used to making activity a part of their day, the messages are dizzying. They want to move, they want to be pain free, they want health, but they don't know where to begin.
So here are few of principles to share with patients, and, if you are a patient, for you to internalize to make it easier to start the journey to better health and happiness.
1) Physical activity is anything that makes your body move
This can be: Gardening, walking, biking, pacing, jumping, swimming, yoga, household chores, recreational sports and the list goes on.
2) All you need is 150 minutes of moderate intensity movement per week
I know, I used the 'i' word. People hear the word intensity and want to run away. What is moderate intensity anyway?
It's as light and basic as: gardening, household chores, walking your pet, or carrying groceries (<20kg). There. That doesn't seem so bad right?
I know an office worker that managed to get his 150 minutes of moderate activity by printing documents on the farthest printing station from his desk, or pacing while on the phone. Any way you can sneak it in works. It does't have to be 150 minutes straight. It can be accumulated over 10 minute bouts. Just get your weekly minutes.
3) Movement shouldn't hurt
This is a big one. So many people are used to living with pain. They feel that it is their 'normal'. But movement shouldn't hurt. The no pain no gain principle is a dangerous one as all pain is not created equal. Find ways to move that are pain free. If you can't, or your pain is limiting your quality of life, go see your physiotherapist.
4) Less is more
Everyone knows that gym memberships and attendance increase in January. You know what else increases? Injuries. And the two are related. Some people are gung ho about becoming more active and take on more than their body is ready to handle. We have a fitness industry trying to convince us that fitness happens overnight. The ability to exercise, or, our work capacity, must be built up with time. When starting, start slow and increase duration, weight, distance, and speed carefully and gradually. Your physiotherapist is a movement expert and is a great place to start. The worst thing is someone ready to make a change having to wait due to an avoidable injury.
So there it is. Getting the health benefits of physical activity is easy. Ignore the people at the gym who seem like they slept in the squat rack, or the people you see jogging on the street. For many of them it is a lifestyle that they enjoy. Some people like woodworking, some people like movies, some people like running, cycling, and strength training.
Don't let the fitness industry fool you into thinking that the gymrats shall inherit the earth. If the goal is to be healthy and have less pain, start with the 150 minute principle, anything else is just gravy.