The View from Sports Center

Humbled by Hall of Famers

Each year, we hold a party to honor our clients who have "banged the gong" at Sports Center. "Banging the Gong" is a ritual that symbolizes a transition from illness, pain, and limitation to wellness and freedom (and, we really do have a gong that hangs in our lab). Once you've banged the gong, you are automatically inducted into our Hall of Fame. Since 2004, we have welcomed close to 500 people into the Sports Center Hall of Fame.  Last night, 2/26/09, was our 2009 Hall of Fame party and like every other one, it was a great night. Good food, drinks, fun, laughs, stories of triumph.

But, not everyone who becomes a client at Sports Center makes it to the Hall of Fame. Some people quit. Give up. Sometimes, it's too hard, takes too much time. Or, they don't want to give up something now to gain something later. Maybe the progress is too slow or sometimes they're looking for a quick fix. Rebuilding your body takes much more mental and emotional strength than it does physical strength. Injuries or surgeries or diseases force you to become patient, to be persistent; to accept set backs and still keep moving forward. It's not easy.

Physical therapy is a practice; one you get better at over time and from a variety of experiences. Sometimes the reason someone doesn't make it to the Hall of Fame is our fault. We might miss something or might not have a clear enough picture of what needs to be done and then the client gets frustrated and leaves.  It doesn't happen often and when it does, we do our best to learn from it and reduce the chance of it happening again.

Physicians sometimes make the decision about discontinuing physical therapy without ever discussing it with us. The client goes back to their family doctor or orthopedist or neurologist, etc., and the doctor basically says, "You don't need any more therapy. You can do this on you own." Most of the time, we never see the client again. We only find out after the fact by calling the client. Sometimes we hear that all is well but a lot of the time we never find out. I often wonder what happened to all of those folks.

That's why people in the Sports Center Hall of Fame are such a special group. They never quit on themselves. Sometimes they've even had to argue with their doctors or insurance companies so they can keep working on getting better. And, some of the stories, are, well, amazing. Last night, one woman shared with us that she was told by her doctor that at 69 she was too old to get any healthier and she should just get both of her knees replaced. She decided to get a second opinion, went through rehab at Sports Center and is now dancing every week with her husband. Another gentleman had herniated discs in his spine and, even though he couldn't stand for more than about a minute at a time without excruciating pain, his surgeon told him his condition wasn't bad enough to operate. He told his surgeon, "But, I can't do anything! I can't really walk or play golf or do anything I like to do!" He got a referral to us, completed his rehab and is playing golf again.

There are a lot more stories like these and every year I am so humbled by what people have done to get back their life and the things they love. They are an inspiring group of people.

We had a few surprises for our Hall of Famers. We had three drawings. One for a Starbucks gift card, one for a night at the Alamo Drafthouse and one for dinner at TruLucks. But, no one left emptied handed because we gave everyone a copy of my new book, The Little Book of Sparks.

Oh, and my friends Ryan and Christine surprised me by formally inducting me into the Hall of Fame. I banged the gong (again!), received my graduation certificate, and my t-shirt that you can only earn; not buy. I had my picture take with the entire group. It was completely unexpected and if I were an extrovert, I probably would have cried (we introverts cry a lot on the inside).

To all my new friends in the Hall of Fame, I'm proud to be part of the tribe. Proud and humbled.

Let's do it again next year.

DK

P.S.- If you're a physical therapist and would like a job where you can learn how we help people reach the Hall of Fame, send your resume to jobs@sportscenteraustin.com. We're always looking for great talent.

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For the latest on PROJECT SKI: MY QUEST TO RETURN TO SNOW SKIING, click here .

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New to the View? Consider subscribing to my RSS feed: Subscribe to this blog's feed. Or sign up to get email updates in the box at the top left hand corner of my blog and then share this blog with your friends.

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Do you have a copy of my new book, "The Little Book of Sparks"? Here's what one reader had to say about it. "This was great reading. "The Little Book of Sparks" inspired me to live a healthier lifestyle. Each chapter in the book motivates me to do something daily to keep my mind and body healthy and active. This is a book that's entertaining, and filled with simple suggestions that when applied to our daily routines make a positive difference in our health and happiness - David."

You can read a sample and order it here.

Where's Project Ski?

Some people wanted to know what happened to my updates on Project Ski. You can find them here (and in the future, go to the View, look of the right hand side of the page for Project Ski and click on the link).

When I write a new article, I'll include a link to the page. Check frequently as I update the page every couple of days.

DK

Freedom

According to Jungian analyst James Hollis, freedom is being able to say, “I am not what happened to me; I am what I choose to become. I am not my roles; I am my journey. I am not my limiting experience; I am the creative power of my potential.”

I thought this was a great way to start off the week. We all have a lot of reasons to feel trapped or imprisoned by current events. A sour economy, an injury or disease, loss of a loved one, whatever the challenge might be, remember the creative power of your potential and choose what you will become.

Be well.
DK

Three Things That Make Work and Recovering From Injuries Meaningful

I'm reading Malcom Gladwell's book, Outliers (worth reading). It's about why some people succeed, go on to live very productive and sometimes extraordinary lives, while others miss the opportunity.  About half way into the book, he points out three things that, from his perspective, go into making work meaningful. If something is meaningful, you tend to work at it harder; longer. So, your chances of success are better. As I read it, I noticed the parallels to recovering from an injury or surgery.

Gladwell thinks that you need a certain amount of autonomy in your job; that you need some freedom to direct your self, make decisions, and be out from under too much scrutiny. When a physician, untrained and completely inexperienced in my profession, told me to do something very specific for a very specific amount of time regarding a client, such as "hot packs, ultrasound, and massage only, once per week for three weeks," I wanted to scream. Well, what I did was refuse to do what he (or she) said and that of course is a really good way to ruin a professional relationship. I didn't care. For my work to be meaningful, let me do my thing. I want autonomy, thank you very much. Gladwell is right.

This issue of autonomy is true in rehab when it comes to your involvement. If you're passive in the process or don't have any say in the decisions, not only is the rehab less effective but you may end up doing things that just don't make sense, or that hurt, or are boring. And you won't learn anything. You might spend 3 to 5 hours a week in therapy. If you just do what you're told and you're not making some of the decisions, at some point, your recovery will be short lived once you leave rehab. Of course, there's a period of time where you're not in control but even then you should still have some input into the process.

Complexity is next on the list. Gladwell makes his point by suggesting that if you were offered $100,000 to sit in a toll booth and make change all day versus $75,000 as a lawyer, that most people would choose to be a lawyer. I think what he means is that the work needs to have a certain amount of challenge. You can only do quad sets and straight leg raises for just so long before parts of your brain turn to mush. You need to be challenged; pushed. I refer to this as "edging". Push until you find the edge and then push a little more. Your body will not change on it's own. Sorry but every body is inherently lazy; always seeking the path of least resistance; spending the least amount of energy possible. Edge, edge, edge.

But, if you take responsibility, have some autonomy, work hard, are challenged but the reward is insufficient, you're more apt to be burn out than lit up. There needs to be a link between your effort and what you get in return. It doesn't have to be a huge sum of money necessarily. Sometimes it could be recognition. A promotion. Or even just a thank you.  It just needs to make you feel that the work you're doing is worth it. In rehab, sometimes it feels like you just bust your butt and get nowhere. You need something that can show you that all the work you're doing is worth it. In rehab, one way we create that link is by using metrics. Data. Knowing where you started, where you need to go, and where you are at regular intervals creates the link between effort and reward. Other ways are simpler. Like telling you how awesome you really are (and I mean that. People amaze me with their dedication and patience.).

To increase your chances of success in recovering from an injury or surgery, remember, you need these three things:

1. Autonomy
2. Challenge
3. A link between effort and reward

Get these in place and rehab will be a lot better.

DK

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New to the View? Consider subscribing to my RSS feed: Subscribe to this blog's feed. Or sign up to get email updates in the box at the top left hand corner of my blog and then share this blog with your friends.

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Do you have a copy of my new book, "The Little Book of Sparks"? Here's what one reader had to say about it. "This was great reading. "The Little Book of Sparks" inspired me to live a healthier lifestyle. Each chapter in the book motivates me to do something daily to keep my mind and body healthy and active. This is a book that's entertaining, and filled with simple suggestions that when applied to our daily routines make a positive difference in our health and happiness - David."

You can read a sample and order it here.

Speed Got Me in Trouble

From Omar (a Sports Center Hall of Famer):

Yo Kelsey!

The speed test was what got me in trouble in the first place. Having discussed this issue with a few marathoners, the consensus seems to be that, while training for speed is important, it should only be done after a certain level of fitness has been achieved. I think this would also apply to doing any sort of speed test.

While a person of good fitness and young age can go out and bang out 100m on a track, I found myself doing this at age 35 and then booking time to see you!
I did a winter climb on Mt. Rainier last year….lots of training for that. It’s a step on the way to Denali!  But, now I take a step back. In 3 weeks we’re expecting our first child! I’m spending less time on the streets/trails and more time with a hammer/nails! Also, I’m working on recording some music I’ve written.

Hope this note makes it to you!

I seem to keep missing the HOF invitations!  Got my new address?

Omar

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Omar -

Always great to hear from a Hall of Famer!

You raised a good point.

A couple of points though from me. I'm an advocate of getting fit to run not running to get fit, first of all, and I said that the speed test is a jogging, running, walking, or whatever combination you can do. And, as with my other posts on lifting weights as fast as you can, that means within your limits.

So, I'll be clearer because I know you're not unusual (well, mostly :-).

If you have not exercised (meaning strength trained) and have not done any jogging, do nothing more than a fast walk for 100 meters.

If you jog two or three times a week and do not do any strength training, but have jogged consistently for at least a year, jog a little faster for the 100 meter test.

If you strength train at least three days per week, jog or run one to two days per week and have been doing this for at least a year consistently, you can likely run fast.

Consensus is sometimes not terribly helpful. After all, that's how we ended up in a war in Iraq. Age is not the issue. It's the strength of your tissue. I'm a pretty good example. I'm 52 recovered from a lumbar disc herniation, have multiple level spine disease, bilateral knee joint osteoarthritis, and left ankle osteoarthritis and I can sprint. I can hop and jump. I don't do it a lot but it's part of my training. And, I worked my way up to it. I worked on my fitness first (remembering that being fit is being well suited for the physical demand). If we define what we can do only by how old we are, we'll quit doing stuff at 30 or 40.

Thanks for your comments and I'm very glad to hear you're doing so well.
DK

How Fast Can You Run?

When I read this story about a woman, 72 years of age, who ran after a teenage thief who stole her handbag, it reminded me of the importance of working on speed as you age. Most of us won't need to run down a thief but we may need to get out of the way of someone or something or just catch our balance after missing a step. It's speed that helps you to those things.

Speed comes from fast twitch muscle fiber which you lose at an alarming rate as you age unless you combat it with specific physical training and even then, you're going to lose some. Between the age of 25 and 70, you can lose up to 30% of your lean muscle mass with a 40% loss in strength. As you lose strength, you lose speed.

Some of the decline is associated with a drop in testosterone and growth hormone - two hormones that help you repair tissue damage and promote muscle growth. Training can boost the production of both of these hormones but the training has to be intense. You'll get little to no improvement in muscle strength from running long distances for example or swimming. Long distance running and swimming has its benefits on the cardiovascular system but it does nothing for strength and, as you age, you really need strength. The type of training you need to slow the aging train is high intensity, short duration training (look at the drill sets I've been doing for Project Ski and you'll get an idea of what I mean).

But, this type of training can also get you injured if you're not careful. Crossfit is known in the fitness world for their high-intensity training and they even have a special t-shirt, "I met Pukey", for clients who throw-up after a session. That's just stupid. But, Crossfit can work for people  provided the intensity of the session matches the capacity of the person. It's risky business though for a 50, 60 year old man or woman who hasn't exercised in years to jump into such a hardcore "workout".

The things to be thinking about are these:

• Are you exercising regularly? If so, examine the type of training you're doing.
• How much of your training is high-intensity?
• If you can't perform high-intensity training, why is that? Maybe you need some assistance to heal an injury or get some instruction?

A simple speed test is to time your self for 100 yards (or meters). Cover it as fast as you can whether that's running, jogging, walking, or some combination. Write it down. Test your self again in a few weeks after you've been training. It's a simple way to measure your speed. You'll get faster.

Strength is speed. Speed slows the aging train.

Get stronger. Get faster.

DK

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New to the View? Consider subscribing to my RSS feed: Subscribe to this blog's feed. Or sign up to get email updates in the box at the top left hand corner of my blog and then share this blog with your friends.

**

Do you have a copy of my new book, "The Little Book of Sparks"? Here's what one reader had to say about it. "This was great reading. "The Little Book of Sparks" inspired me to live a healthier lifestyle. Each chapter in the book motivates me to do something daily to keep my mind and body healthy and active. This is a book that's entertaining, and filled with simple suggestions that when applied to our daily routines make a positive difference in our health and happiness - David."

You can read a sample and order it here.

Bang the Gong

"Well, I think you look great. Really great. Your reflexes are normal now and all of your strength tests are normal. You don't have the plantarflexion weakness you had a few months ago. At this point, I don't think we need to set a follow up but if something changes, just call me and come in," said Dr. White.

When I arrived, I felt good. When I left, I felt great. So, as I walked toward the stairwell, I had this idea float into my head. "You know, Sports Center is just downstairs. I should just walk in, go right to the Gong, and bang it good and hard."

So, I did.

And, in that moment, as the vibrations from the gong sailed through the room, I felt that I was well. Free to be well. And, that's what I said.

"Yes! I am now free to be well!"

Banging the Gong at Sports Center is a big deal. We established this ritual a few years ago as a way to publicly celebrate a client's victory: achieving the goals he or she set out to achieve. And, when you bang the gong, you enter the Sports Center Hall of Fame. Overcoming an injury or surgery or a disease is tough. And usually, it takes longer than a few weeks or even months. The act of banging the gong is a manifestation of persistence, courage, and patience. You then join a special tribe of people.

I'm honored to be in the tribe. There are a lot of very impressive people with great victories in the Hall of Fame.

So, on February 26, 2008, I not only will be attending the Annual Sports Center Hall of Fame Gala as a member of the SC team, but also as a member of the Hall of Fame. It's a great feeling.

DK

Promoting Our Profession: IDEA

Here's an email I just received from a reader who also is a physical therapist. He makes a great observation at how good pharmaceutical companies are at marketing and how we, physical therapists, need a "new subject in the journey to promote our profession." My thoughts follow his email.

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To: Sports Center
Subject: Re: [The View from Sports Center] There is 1 new post in "The View from Sports Center"

 Doug

 As always you hit ten on the target. Pharma companies seem to use psychology and marketing with advertisment the way we DO NOT as Physical Therapists despite we are the experts in exercises and their natural way of healing and promotion of good health. I like how you approach the medical problems and how physical therapy misses all the opportunities to promote itself. I agree with you that Aleve could and probably is helping people with various pain but this is only assistive factor in promotion of functional and active life.

I am looking forward for a new subject in the journey to promote our profession.

Peter 

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The problem is that drug companies know that what most people want is the blue pill; not the red pill. They want something that will give them the dream ("Hey, I can play softball as long as I take Aleve!") and keep them immersed in blissful ignorance without the hassle reality often brings with it.  I just love the Matrix.

Promote movement as medicine. Sometimes, the right movement is just as fast or faster than a pill, but more importantly, it empowers the client / patient. What people are really after isn't pain relief. It's control or at least the illusion of control. I know what it's like to feel like your life just took a dive off a cliff and you're not sure if there's a bottom coming up or how long a fall it will be and what you'll be like after it's done. Drugs offer control. Sometimes, you have to use them but physical therapists should be talking about and promoting what people really want not what they say they want and not how great physical therapy is for this or that.

Move it or lose it.
DK

My Anniversary and Where to find Project Ski

I've created a new page on The View for my updates on training routines for Project Ski. For those of you who are interested in following my training routines, you'll have all of them on one page. I'll post a notice when I've added something new to the page. For those who aren't interested, you'll no longer get a detailed article - only a notice that something new was added.

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I just recently passed the one year mark of my skiing accident and subsequent L4-5 disc herniation. And, I'm feeling very good about where I am and how far I've come especially when you consider that about 40% of people with a disc herniation at the one year mark are either no better or worse and about 80% continue to struggle with intermittent leg pain.

So, a lot of people can't do the things they enjoy.

I'm tempted to add that I was lucky to end up in the other 60% but I don't really think it was luck. I did a lot of stuff to recover and rebuild and now, one year later, I'm in better overall physical condition than I was before my injury.

What I'm tempted to say is that if I can do it, you likely can too.

DK

*Nykvist F, et al. "A prospective 5-year follow-up study of 276 patients hospitalized because of suspected lumbar disc herniation" Int. Disabil. Studies - 1989; 11(2):61-67

Do You Believe Aleve?

The full page color ad for Aleve suggested that if you wanted to be able to do the things you love and be free from joint pain, all you had to do was take Aleve. Just two pills will wipe away arthritis pain for a whole day. Life will be grand.

But, in very small print in the bottom left hand corner that no one who actually uses this stuff can read was a disclaimer: "Use as directed for minor arthritis pain."

So, what exactly is "minor" pain? And, if you have minor pain, why are you taking a pain reliever? The people I've met who take over-the-counter non-steroidal anti-inflammatory (NSAID) drugs regularly, like Aleve or Motrin or Advil, hurt doing things like walking, climbing stairs, or lifting a bag of groceries so much that they avoid the activity. That's not minor pain. Minor pain is a nuisance; annoying but it doesn't interfere with your function. It doesn't alter your movement. And, minor pain goes away on its own so you don't need any help from drugs.

"Use as directed...." is one pill every 8-12 hours for no longer than 10 days. Few people I've met actually do that. Some have been taking NSAIDs for years. Here's what's really happening. People with joint pain hurt enough that they can't do the things they need to or want to so they turn to an over-the counter drug like Aleve because the advertising is non-stop, everywhere you go, in nearly every magazine, on radio stations, TV, and online. It's a massive onslaught of misinformation aimed directly at the heart of the unsuspecting and vulnerable. But you don't know that it's misleading because you don't know why you hurt nor do you know what drugs like Aleve actually are doing for you. You just trust the ad implicitly. Afterall, companies can't actually lie to you, right? They can't run a TV ad that misleads you, right? The government makes sure of that so it must be ok. Right. Where have you been living?

I don't believe Aleve. They're not being honest with us.

What's the truth about drugs like Aleve?

These drugs may relieve pain. The research on this is mixed. But, even if they do relieve joint pain you still haven't addressed why you had the pain in the first place and you're not one bit healthier or stronger or more capable of doing the very thing that forced you to pop a couple of pills to begin with. And in fact, there's some research that suggests you could make your self much worse. The joint may get weaker even as you feel better. Oh, and I forgot to mention the myriad of gastrointestinal side effects from it.

I'm not saying you should not take Aleve. If you have to, you have to. I have. If taking a drug like Aleve is the difference between you getting on a cycle or an elliptical machine and sitting on your butt, the upside of the exercise is greater than the potential downside of doing a bit too much because you feel better than you actually are. But, keep in mind that NSAIDs may make you feel like you're ready to run or play tennis or hit the gym but your body has a protective armor like the outside of an M & M. It seems pretty tough but tap on it and the whole thing caves in. So, proceed with caution.

I know many of you want to know what to do. I've written some articles (below) on dealing with joint pain. Maybe these will help.

• A New Supplement for Chronic Joint Pain
• How to Use Supplements to Rebuild Your Joints
• How to Cut Your Risk of Getting Osteoarthritis
• When Less is More
• Knee Pain in Wisconsin

In the meantime, this issue weighs on me. I think about it a lot, have dealt with it myself, have several friends who struggle with joint pain and I've decided to do something about it. Many of you have asked me to compile information rather than dig through a large website. So, here's what I'm doing: working on a book all about joint pain, injuries and how to deal with them and then adding more detailed information to Exercise:ology. As that happens, I'll let you know.

Onward....
DK