Overdoing: To Do or Not To Do?

We live in a culture that is “go go go”, where we prioritize doing far more than not doing. Many of us juggle excessive work hours, family and household responsibilities, hobbies, fitness and wellness practice, social lives, errands, appointments, and more. We are often left with little to no down time, and when we do have this down time, we may spend it in ways that are less than ideal for restoring balance and peace back into our lives. This constant rush can be stressful and taxing on our bodies and minds, and due to time constraints we begin to have to pick and choose what we do. Self-care and sleep may be underprioritized, setting us up for burnout.

Think about yourself as a tea kettle: a 100% full tea kettle means you are in a state of optimal health, energy, comfort, peace, happiness, and overall well-being. The less tea you have in the kettle, the less bandwidth you have, which can manifest in irritability, exhaustion, reduced performance, as well as mental and physical health challenges if this continues over time.

If our goal with the “go go go” mentality is to achieve and succeed, but this mentality actually can set us up for failure over the long term, isn’t this entirely counter productive?

Think about what sources in your life are draining your tea kettle, and what sources are helping to fill up your kettle. Consider both external and internal factors. External may be people, situations, and activities, whereas internal may be thoughts, beliefs, behaviors, emotional reactivity, and movement patterns. What changes can you make in your life to ensure you have a full kettle? After all, an empty kettle serves no one!

Coming Next Time: Some useful strategies for avoiding “overdoing” based on neuroscience and principles of mindfulness.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Unlearning Fear of Movement

Kinesiophobia, or fear of movement, is an issue that affects far too many of us. Often
times, people with chronic pain or a history of injury to a particular body area will develop a fear of movement. Kinesiophobia can exist on a macro or micro level, affecting both overall physical activity levels, as well as movement of specific joints and patterns of muscular activation. Kinesiophobia is often outside of our conscious control, as the fear circuits of our brain (e.g. the amygdala) are involuntary and affect our movement without us necessarily being aware.

How does this happen? Individuals with kinesiophobia may associate certain activities with pain, as this activity may have caused pain in the past. An activity that is a common trigger is bending down towards the ground, perhaps because this movement may have led to an injury in the past. The internalized association between movement and pain will contribute to fear-avoidant behavior, and the individual will continue to avoid this activity due to fear of pain or re-injury. Over time, even after the original injury heals, the individual will still have this same fear embedded in them and will avoid bending down. Now the motor pathways, muscles, and joints responsible for bending down will atrophy, and it will be far more likely to cause injury if the individual were to bend down in the future! The irony is that the fear is what contributes more so to the dysfunction, rather than an issue in the physical tissues of the body.

What can we do about this?

Because fear is a learned behavior, we must "unlearn" the fear, as well as create new neural pathways that teach us that movement can be safe, easy, and pleasurable. Your physical therapist at the Wellness Station will quickly identify what is contributing to your kinesiophobia. Along with providing education about anatomy, biomechanics, and pain neuroscience, your therapist will teach you how to gradually engage in safe movement patterns that will help you gently progress towards your functional goals. It is important that this process is done slowly and gently, as our brains will not be receptive to learning if fear is still present. The tissues of your body will slowly adapt, and your nervous system will gradually learn that previously feared movement patterns can be safe and even easy.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Enhancing the Therapeutic Alliance

In seeking physical therapy for an issue such as chronic pain, there are many factors that can influence the outcomes. Of course, it is important that your physical therapist is knowledgeable, is able to communicate clearly, and is able to provide interventions that fit your unique needs. However, successful therapy outcomes also rely on one more very important factor... the relationship between the patient and the clinician, known as the therapeutic alliance.

By definition, therapeutic alliance is

"the sense of collaboration, warmth, and support between client and therapist."1

Features of a strong therapeutic alliance include mutual agreement on goals and interventions, empathy, compassion, and mutual respect. A positive therapeutic alliance involves bi-directional open communication and kindness between the two. It is the therapist's job to create a safe space for healing, and to actively listen and respond to the needs of the client without judgment. It is the client's job to strive to believe in and implement the recommendations of the therapist, while being open and honest about their needs, as well as response to therapy.

Think back to the teachers you had while in school. Does any teacher stand out that you remember liking a whole lot? You likely have fond memories of this person, and can even recall many of the things you learned from them. They were probably kind and empathetic, and valued creating a safe space for learning. In return, it is likely that you put in effort to respect their wishes, listen to and incorporate their recommendations and lessons, which resulted in a positive learning experience.

Think back to a teacher you might not have liked so much... the results were probably much different! Being in therapy is very similar. A good therapist is like a teacher- we teach anatomy, movements, education about pain and dysfunction, as well as lessons to help you get to know your body better from the inside out. The better your relationship with your teacher, the more you will get out of the experience.

At the Wellness Station, your therapist will always strive to create a supportive healing environment by enhancing the therapeutic alliance. Here are some tangible methods that can enhance this alliance:
• "We" statements
• Open body language
• Eye contact
• Statements of reflection/summary
• Non-threatening touch

What are some behaviors to look out for that can detract from the therapeutic alliance?
• Talking down
• Interrupting
• Speaking for someone
• Lecturing
• Shaming
• Looking away, avoiding eye contact

Here is a quote from one of our clients who understood the importance of a strong
therapeutic alliance:

"I have been working with Jacob for several months on my hip bursitis, and shoulder arthritis. He has a wealth of knowledge, both about traditional physical therapy and Feldenkrais. He was careful to work within the home program that I felt I could manage, and went with the flow when I just wanted to come in and mellow out! Jacob carefully stayed in communication with me, when we had a misunderstanding, which actually improved our communication. I now have a workable home program which helps me relax around the discomfort I have had."

The relationship between the client and therapist can prove to be even more important than the therapy itself. Consider the importance of your therapeutic alliance as you continue on your healing journey in order to get the very most out of this experience.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:
1) https://dptcapstone.web.unc.edu/2020/04/15/enhancing-the-therapeutic-alliance-for- patients-with-chronic-pain/

Seeking Nature for Inner Healing

In our modern lives, there is often a degree of disconnect between us and the natural world.

Many people consider themselves as separate from nature, as if nature is this thing or activity that may or may not be part of one's life. It can be easy to fall into this kind of lifestyle, as so many of our lives are lived primarily inside, contained within boxes that separate us from plants, wildlife, fresh air, and sunshine. By living life in this way, we are depriving ourselves of beauty, novel experiences for our minds and bodies, functional exercise, and even vitamin D from the sun.

Without nature, we lose the balance in our lives, which can lead to very undesirable consequences.

In fact, the word "disease" can be related to loss of balance- "dis" meaning "apart" or "away", and "ease" meaning "undisturbed state", "comfort", or "well-being". Putting these words together describes a departure from the undisturbed state, a loss of balance and harmony.1

How can nature lead us back into balance? We have an innate human instinct to connect with the natural world. Many of us seek nature when we are not feeling well, or may realize we feel much better after disconnecting with screens and reconnecting with what is real in the world around us. Our bodies know how to heal themselves, but sometimes we may be preventing this process by disconnecting with the world around us.

Nature is our teacher, the divine force that can help guide us towards a path of healing.

We look to nature to learn how to solve problems naturally, whether we may be inspired by the supportive community of a forest, the love of a mother bird caring for her young, the dynamic energy of a rushing river, or the geological masterpieces of mountains, canyons, and glaciers.

Connecting with nature and time spent outdoors has measurable health benefits for the mind and body. In fact, many doctors are recommending "forest bathing", which is an ancient Japanese practice that involves immersing oneself in nature using all of the senses. Regular time spent in nature can improve emotional well-being, decrease blood pressure, increase energy levels, and lower stress hormones such as cortisol.2

The eclectic blend of sights, sounds, smells, and feelings can help calm our nervous system. The constantly varying terrain of walking outdoors stimulates our minds and bodies in new ways. This can help to improve balance, strength, reaction time, and will help us avoid loss of mobility and repetitive stress injuries that we get as a result of only interacting with flat, human-made environments. Spending time connecting with nature also helps us internalize the crucial connection between taking care of our planet and taking care of our own bodies, as we are not separate from nature.

Time with nature is our reminder that we evolved with nature, and chronic separation from the natural world is ultimately incongruent with the way our biological systems function.

At the Wellness Station, we encourage our clients to spend more time outdoors whenever possible. What are some easy ways to get more nature in one's life?

1. Make going on a walk a daily practice. Consider walking on a trail away from busy roads, where there may be many trees, flowers, and creeks.

2. Do exercise outside! Take a yoga mat or a blanket to a flat surface outdoors and move your body.

3. Meditate outside. Pay attention to all of your senses.

4. Keep the windows open for more fresh air.

5. Plan a trip or social event with outdoor activities planned, which may include hiking, sight-seeing, swimming, or any other enjoyable activity.

6. Get into gardening!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1)    https://www.semanticscholar.org/paper/The-Wisdom-of-Biophilia%E2%80%94Nature-in-Healing-Huelat/08e18ab071a4a468a3aa820aa2d797e168fe0c59

2)    https://www.nytimes.com/2018/07/12/well/take-a-walk-in-the-woods-doctors-orders.html

Moving in Three Dimensions

All movement occurs in some combination of the three dimensions. This includes the sagittal plane, frontal plane, and transverse plane.

Movement in the sagittal plane, which involves flexion and extension of the body, is the most common movement that is trained, and tends to be the most familiar in our daily lives. Sagittal plane movements include squatting, walking, climbing stairs, bicep curls, and interacting with objects that are in front of us.

Sagittal Plane

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Frontal plane movements relate to lateral, or side to side movements, and may include side stepping, side bending, and lateral arm or leg raises.

Frontal Plane

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The transverse plane is the third dimension of movement, and includes rotational movements such as turning the spine from left to right, or rotating the hips or shoulders in or out.

Traverse Plane

Movements in the sagittal plane tend to be overemphasized in people's lives, whereas the latter two planes of movements may be more unfamiliar.

We must be able to move with agility and efficiency in all three dimensions in order to respond to the unpredictable demands of daily life without strain. Limiting movement to only one dimensions can put more stress on particular tissues of the body, which can contribute to pain and pathology, particularly of our joints. For example, walking has the potential to be very beneficial for our whole bodies, but the way we walk can also contribute to excessive strain on certain joints. If we only ever walked on flat, invariable terrain (think concrete or a treadmill), and tend to keep our spines very rigid while we walk, this would limit our movement to primarily the sagittal plane. This may put extra stress on certain regions of our weight-bearing joints, particularly our hips and knees.

If we can vary the way we walk as well as the terrain we walk on, we can move in all three dimensions which will spread the movement over a greater area of our bodies. Imagine adding a little “dance” to your walk by allowing the pelvis to glide from side to side with each step, as well as allowing the arms to swing and the chest to turn. This will allow the body to move more fluidly by including side-bending and rotational movements in our gait. Combine this with regularly walking on different terrains (e.g. inclines/declines, twists and turns, grass, dirt, stones, etc.), and we will stimulate our bodies in constantly varying ways to minimize repetitive strain on isolated areas.

As part of a comprehensive treatment plan, your Wellness Station therapist will ensure your program includes balanced movements in all three dimensions. It is our mission to address the root of issues, rather than treating symptoms, an unfortunate tendency that is often found in more traditional therapeutic approaches. We strive to see the bigger picture, and will help you develop strategies to bring greater balance and ease into all dimensions of life.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team