Operational Breakdown

I recently picked up a brochure on relationship breakdown (planning to pass it to a mate who is going through some tough times) and took a moment to read it.

There was a list of  ’10 Sure Ways to Breakdown’ and I realised much of the list applies to managing people in the workplace.  So, borrowing from Shirley Cornish in Maroochydore, I offer the:

7 Sure Ways to Mismanage Your Staff

  1. Think ‘It’s my way, or no way’
  2. Blame or criticise the other
  3. Be intolerant or inflexible
  4. Behave in a hurtful manner
  5. React before you think
  6. Dismiss or oppose the others viewpoint
  7. Give up

These 7 items are pretty obvious when you read them now while your emotions and ego are in check.  Avoiding them in the heat of battle when dealing with situations or pe0ple is indicative of a strong leader. Managing others always begins with managing ourselves, this list might help you identify where to focus your improvements.

Diseases of Lifestyle – choosing to be sick

At a UN gathering of NGOs and Public Health Organizations a consensus ‘Statement of Concern’ has been released asking the United Nations (UN), to hold accountable those in the food and beverage industry “whose products and marketing contribute substantially to the development of non-communicable diseases (NCDs) that kill 36 million people every year.” They are talking about lifestyle diseases such as diabetes, obesity, many cancers, cardiovascular disease and other diseases predisposed by consumption of alcohol, tobacco and foods high in salt, sugar and/or fat.
This is a fantastic idea but only strikes at the supply side of the market.  Until individuals are held accountable for the actual consumption of these products and prepared to foot their bills for healthcare costs and the lost social capital due to illness and death of parents, breadwinners and producers little will change.
Excessive consumption of these products, combined with an inactive lifestyle, often results in disease and associated costs of care.  The decisions made and actions taken on a daily basis by individuals exert market pressure on suppliers – we just need a critical mass of people changing the way they think, shop, consume and live to back up the Statement of Concern.
It starts with each of us.

Health – Taking It For Granted

Once again I am reminded of how our personal productivity is determined by our energy and health status.  Just prior to boarding a long haul international flight home recently, I got an upper respiratory tract infection.  Almost forty hours of transit (complete with two delays) is not a tonic for recovery.  Once home I deteriorated further and it has taken another ten days to start to feel well again. 

During this time I tried to continue some level of productivity but both the quality and quantity were very ordinary.  Household chores, gardening duties, errands and shopping for food were all just too difficult.  Let alone any activity requiring brain power.  Sleep was poor quality and appetite was likewise.  The only plus was managing to lose about 2kg in body weight, but not a healthy strategy to achieve this.

Two take home messages for self:

  1. be more proactive in health management when my immune system is under threat due to stress (travel, sleep deprivation, poor nutrition, whatever);
  2. be more reactive in terms of recovery strategies (turn off computer and emails, give permission to sleep more, don’t deplete energy reserves and accept any help and advice from those around you).

Message for all of us:

  • make sure your personal productivity goals have inbuilt contingency or reserve capacity in case of illness or some other factor. Packing you schedule with expectations and tasks will result in a cascade of complications when things don’t go so well, let alone being one of the reasons you get crook in the first place!

Now, must make a recurring diary note to self about this idea as when you are well it just seems logical that you will continue to be well – a default state we tend to take for granted until fate intervenes.

How Many Hats?

My fabulous and usually tolerant wife Mary has declared ‘no more hats’.  She is referring to my proclivity to wearing, and therefore acquiring, hats. I just love hats.  I believe it is time men reclaimed the hat as a personal statement of masculine fashion.  I am talking about proper hats – trilbies, fedoras, snappy brims, wide brims, stingy brim jazz hats, even pork pie and cloth caps.  Pretty much anything except baseball type hats.

Anyway, Mary has suggested (wife speak for ‘this is really important, pay attention and no one will be harmed’) I purchase no further hats until I have another hat rack to accommodate them.  Yes, another hat rack.  I have filled the first one.  Fair enough, I thought, these hats deserve their own position and care. So no more hats unless I retire one. 

We blokes wear a lot of hats.  Not necessarily the actual hats of which I speak, but the many ‘hats’ associated with our many roles.  Husband, son, uncle, father, sports coach, employee, boss and so on.  The idea of ‘putting on a hat’ in regards of assuming a particular role to play.  The way you conduct yourself changes according to the hat you are wearing at the time.  Your Dad hat makes you a different bloke to your Sports Coach hat, or your boss hat.  Same person, different role to play.

I wonder if Mary was hinting in a cunning subliminal female way that I had too many of these other hats.  Too many roles in my life that may be diluting my effectiveness in all of them.  I have my Dad and wife hats of course, but also my professional speaking hat, my author hat, my chamber of commerce board member hat, my business coaching hat and quite a few others.  Perhaps she was suggesting (see above) that I should not take on any further roles, tasks, jobs or projects until I have cleared some space on my ‘hat rack’. 

It is very easy to add stuff to your life, to find corners of time and enthusiasm to tackle a new project or activity.  Obviously the time must come from somewhere else and your current hat collection may suffer.  Pretty good advice, really. 

So when a new opportunity to get busy, to take on a new project or activity appears or is thrust upon you – before putting on the new hat take a good hard look at the hats you already have on the rack decide if there is space on the rack.  If not, retire one hat before you put on the new one.  Then all your hats will get a chance to be worn with style and success.

How Passive is Passive?

Passive shouder movement is a common early rehab option for patients who have undergone recent rotator cuff repair surgery.  This treatment is to maintain joint mobility while avoiding active loading of the repaired tendon.  However recent research suggests passive may not be as passive as we thought. 

In research published by Uhl, Muir and Lawson (2010) they found that when performing passive range of motion there was still slight electrical EMG activity in the rotator cuff muscles.  They also found that the transition from passive movement to active-assisted exercises involved only ‘insignificant increases’ in EMG activity in the muscles measured. The increase in activity rose from below 10% of MVC to around 20% of MVC.  

My take on this is two-fold – firstly be very cautious with ‘passive’ range of motion exercises because there is still some active assistance being offered by the musculo-tendinous unit.  Secondly, the transition to active-assisted exercise could probably be made earlier in rehab depending on the fragility of the repair, the number of tendons repaired, the pain levels reported and the confidence of both physio and patient. 

Ref: Uhl TL, Muir TA, Lawson L. 2010. Electromyographical assessment of passive, active assistive and active shoulder rehabilitation exercises. Phys Med & Rehab Feb 2(2):132.41.

Frozen Shoulder – Sick not Injured

 When I graduated I knew everything about treating every condition.  I was on fire!  Three days into my new career I had crisis of confidence – not only did I not know everything, I pretty much knew 10% of very little.  And this was in the days when there wasn’t much to actually know!
One thing I was pretty sure about was that if a joint was stiff it was my job to make it move.  To jiggle it, lean on it, twist it and then do all three at once.  And reassess. There are many women out there who now believe physiotherapy is a satanic pain ritual practiced by young men with more muscle than brains.  These are the women who came to see me with a Frozen Shoulder – Stage II.  Let me now apologise to them: ‘I am so sorry that I caused you immense pain in the pursuit of a five degree gain in shoulder flexion or a zillionth of a degree of external rotation’.  Why you returned for futher appointments speaks more for my postive attitude rather than any actual improvement.

Yet, they DID improve.  If I treated them long enough they all responded to my brilliant therapy skills.  Sometimes it took three or four months, sometimes a year or more.  But they all got better.

So did the clients who stopped treatment – they also got better.  Some took three or four months, others a year or more.  But they all got better.
So I rethought my approach to treating frozen shoulders (adhesive capsulitis).  This condition is thought to be an auto-immune disorder where the lining of the shoulder joint becomes acutely inflamed (capsulitis) with lots of pain, then goes haywire and starts to weld up it’s collagen fibres (adhesion) and become incredibly stiff.  These two stages (I and II) I call ‘freezing’ and ‘frozen’.  Then later the shoulder goes into stage III – thawing – and the movement starts to return without the previous pain.

Identifying a client in Stage I is difficult. Often they have been through the doctor/X-ray/Blood Test/Specialist visit cycle during which the shoulder moved into Stage II and arrived at physiotherapy ready for rehab.  Too late.  Here are a couple of ideas for identifying shoulders that may be in Stage I:

  • Pain is out of proportion to any recent trauma
  • Significant loss of external rotation first, then later elevation
  • Investigations for structural pathology are negative
  • Pain is not direction specific when testing movement or strength
  • Look for signs of immune system stress, for example recent illness or surgery (not necessarily shoulder), big life events (moving, parent or partner death/illness, family or financial troubles)
  • Over the age of 40
  • Left shoulder
  • Diabetes or it’s precursor Metabolic Syndrome
  • Female

None of these is diagnostic in it’s own right, but when they co-exist my index of suspicion zooms up and I can better navigate the optimal care plan

If you believe a shoulder is freezing, there may still be a chance to prevent it progressing to frozen.  Pain control is vital as is inflammatory control   Mild cases may respond to oral pharmacology, others may need intra-articular cortisone.  Non-stressful joint mobilising to adhesions and modification of aggravating activity will help.  As will a clear explanation to the client. A supportive physician or rheumatologist is a great partner in the care of these clients.

In fact, I find the education aspect of the treatment to be the most important.  I am careful with my words and tell them their shoulder is sick, not injured.  Patients understand ‘sickness’ has a course to run, and are more likely to ride with the slow progress if they get the difference.  You can then put the ‘sick shoulder’ into the context of their general health issues, the immune system struggling to cope and the internal battle now being waged.

For those patients in Stage II (frozen), I believe it is critical to keep them active and healthy.  The ongoing pain is distressing and combined with the lack of short term improvement can predispose to depression and anxiety.  Which doesn’t help their immune system resilience.  I try to keep them active (total body) with walking, cycling or modified aquarobics.  This is a positive approach mentally and may help prevent weight gain during this period of restricted activity.  I also try to reduce sources of inflammation (activity, stress, nutrition) and check them every four to six weeks to monitor their maintenance exercises, encourage them to stay active and patient,  and to identify when Stage III begins.  This is the stage when I can enhance their recovery with more frequent joint therapy, massage, exercise and functional activities within the limits of their inflammation threshold.

And I get the credit!

This is the secret to getting all the credit for the patient’s recovery:  make sure you are treating them when they get to Stage III.  Because whoever is treating them at this time gets ALL the credit!  Physio, Chiro, masseur, astrologer, aura therapist – it doesn’t matter because it is all in the timing!

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The Conquest of Space

Have you ever had trouble getting started on a project?  A project that you really want to do, one that gets you excited whenever you talk about it at a Chamber meeting or out to dinner with real friends, a project that pushes all your buttons: but you just can’t get it started.  This is my story…..

My project is to turn my speaking topics on productivity, longevity and fun for men (also known as men’s health) into an absolutely riveting, entertaining and useful book for men.   I intend to write the first ever book on men’s health that men actually read, and maybe even act on.  But I haven’t.  And more importantly I couldn’t work out what was stopping me. 

I finally realised it was space.  I had some, but it was the wrong type.  It was my ‘busy’ space – the desk where phones rang, emails demanded action, payments were made, meetings were arranged, business correspondence written and financial records were processed.  Whenever I sat down to start my project any attempts at creativity and planning were invaded by all this busy work.  And so was my mind: I was trying to do creative work in my admin space, but my mind would not be tricked.  It promptly switched from right side activity to left side activity and I got busy.  So there was my barrier: my external and internal spaces were neither suitable nor ready for the task at hand.

I realised progress depended on a different quality of physical space and discipline of my mental space.  So I did the unthinkable: I sought help! This goes against all the programming of the male mind and was quite a breakthrough.  I did a ‘paper flow workshop’ (Kikki K, Maroochydore) to learn how to manage all the pits of paper, bills, invoices, letters, notes, appointments, etc that come over my desk. Then amazingly, I actually implemented the plan and noticed an immediate change in the appearance of my workspace and the feel of sitting down to a clear work top instead of a clutter of horizontally filed paper where priority had been overwhelmed by arrival date. 

Next was my head space.  No convenient workshop for that one!  It required some coaching from a fellow speaker and author to help me identify what my ideal head space should be, and how to retain it against constant invasions from external and internal sources. 

Now I am ready – title done. Web domain? Done.  Chapter concepts? Done.  Outlines? Next.  But that’s me, what is the message for you?  Who cares?  I’m underway!  No, that’s a bit harsh – the questions I would like to pass on are simple: what is stopping you from your next leap to greatness?  What simple steps can you take that will allow you to achieve your next success in business or life?  And are you prepared to ask for help?  Is your workspace or headspace holding you back, because if it is and you can conquer it, the universe beyond is beckoning.

 Cheers for now,

Craig

Shoulder Rehab: Activity, Exercise or Training?

At the Queensland Physiotherapy Symposium  on Saturday May 15, I presented  a short talk on the difference between slow twitch muscle fibre rehab and fast twitch muscle fibre rehab in regards to the shoulder.   Sounds boring, but several people told me they really enjoyed it and learned a lot.  The core message was for us not to be satisfied with basic rehab which trains our clients to be very good at slow twitch activities (posture, low load movement, balance, control) but instead seek to to train them to a higher level of function in preparation for the unexpected loads that are associated with injury.  Yes, shoulder injury occurs at speed and with unexpected loading so training the fast twitch systems in the shoulder muscles and movements will help build in a greater level of performance and protection. 

To access the slide presentation and cover notes click on the appropriate link below:

I was at the APA Symposium and know the password – show me the slides

I was not at the APA Symposium but would like to purchase the presentation for $10.00.

Feedback is welcomed.

Living Longer – I want it earlier!

A few years back, a couple of authors (Evans and Rosenberg) came up with the 10 biomarkers of ageing. These were 10 physiological characteristics which changed with the passing of the years.  Their list comprised muscle mass, strength, basal metabolic rate, body fat percentage, aerobic capacity, glucose tolerance, cholesterol/HDL ratio, blood pressure, bone density and temperature regulation.

Two things are interesting about this list

  1. The biomarkers of disuse make up the same 10 factors
  2. Nine of the ten markers can be improved by working out in the gym (not sure about temperture reg.)

In other words, you can hasten your physiological deterioration by inactivity, and slow the (currently) inevitable changes by doing resistance training and remaining active. The anti-ageing pill is actually PHYSICAL ACTIVITY!

Our chromosomes are built to survive for about 120 years.  This is the potential life span we are each born with.  These tiny strands of information will reproduce themselves and maintain our body and brain for up to 120 years before their batteries run out.  Obviously we don’t all live to such a great age.  From conception, when our genetic makeup is established, begins a process of subtracting seconds, minutes, days and years from that 120 year potential lifespan.  Our fragile internal ecosystem that is constantly trying to rebuild and maintain its structure and function battles against all sorts of factors that progressively shorten our lives.

Factors such as maternal nutrition while still in the uterus, infant diseases, nutritional excesses (sugar and fat) and nutritional deficiencies (vitamins, minerals, anti-oxidants), exercise or lack of it, stress, smoking, toxic environments or relationships and the list goes on.

Every day your body is rebuilding and replacing it’s entire substance.  Cells are being retired, dismantled and rebuilt every breath you take.  Your heart muscle is replaced, your bone structure is updated, your skin shed and rebuilt.  The raw materials for this project comprise whatever goes into your mouth.  Your body is rebuilt using what you eat and drink!  Your choice is whether to go with the budget or convenience materials (sugar, fat, fast foods, processed foods, refined products) OR to select the premium ingredients (fresh fruit, vegetables, lean meat, nuts, legumes, pulses, water and all freshly prepared) to build your new cells.  I think many of us spend more time and energy researching our electronic equipment or vehicles and making the best decision than we do on how to rebuild our bodies with the healthiest and strongest cells and DNA possible.  

Scientists (bless their cotton socks) are working to extend the duration of human life.  To increase longevity toward our potential 120 years.  Obviously they are having success – more of us are living too 100 years old.  Improvements to public health and hygiene and eradication or control of some nasty diseases have already produced results.  But I think they are going down the wrong path.

If I was looking to extend my life span, I wouldn’t be tacking on 10 or 20 years at the end.  I want my extension much earlier than that.  I want another 5 years of childhood.  And another 15 or so years between 30 and 35 please.  That’s where I want my extra twenty years: during the free and fun years of childhood and the years I missed and messed by concentrating on work, status and money instead of enjoying my kids growing up and savouring every moment with my older parents. 

But in the mean time, I’ll just keep replenishing my DNA with high quality nutrition, get a bit of exercise, try not to get too stressed and enjoy whatever extra time comes my way.  As my mum always said, ‘Eat your vegetables, go out and play.’

Who needs scientists?

The Pain, in the Main, is Completely in the Brain.

Benedict Spinoza, a centuries old philosopher, described pain as ‘a localised form of sorrow’, and in just a few words summed up the physical and emotional components of pain. 

I heard Dr. Lorimer Moseley, esteemed pain researcher, speak at a conference some weeks ago and he made the point that all pain is perceived in the brain.  There is no pain in your leg, or shoulder or chin until your brain collects the signals and assembles them into a pattern you then label as pain.

Why am I writing on pain?  Because I can’t sleep. I have had surgery on an arthritic toe and my brain is paying particular attention to it.  In fact it has told me to interpret the sensations as pain.  And to stay awake to keep an eye on it.  In fact, I suspect my brain has allocated a larger ‘toe pain’ monitoring area to make sure it doesn’t miss a thing. 

This is what the brain does.  If something is deemed more important it will allocate more resources to monitoring.  It is particularly good at this in regards to pain.  It happens at other times too, for example if you are learning a new language, or a musical instrument or a new skill the brain will find some underused nerve cells and press-gang them into service to provide more computing power for the new activity. 

This is phenomenal, but it gets more interesting. As you gradually master the task the brain makes wiring efficiency changes and dismantles the extra zone bringing control back to as few nerve cells as needed.  Freeing up the extra computing power for another adventure!

That is not what I wanted to discuss, however.  Back to pain.  In my previous career as a physiotherapist I treated clients with new, fresh painful injuries and also those poor souls with long-term, chronic, persistent pain.  This second group initially had an injury, but their pain had not disappeared as the injury recovered.  Their back, or whiplash, or tennis elbow had healed but the pain remained in the brain. 

I loved treating these patients, perhaps because I had nothing to lose.  Their expectations of successful treatment were poor as many practitioners had failed before me!  However, for some we had great success.  They returned to work and sport, they resumed gardening and other yard work and they started a fitness program.

Sounds great, but not one of them got rid of their pain.  But it was OK, because I told them on day one that I would never cure their pain but I could offer other life improving enhancements.  Simply put I told each of them, ‘Today is the day you choose between two lives.  A life of pain and disability, or a life of pain and living life to the full.  Your choice.’

Most were stunned, having come in to get pain relief, many were disappointed, and some were really pissed.  Many of these clients went away, thought about my offer and never returned.  I was sad for them but not surprised, they were just not ready for my approach.  The clients who took a leap into the unknown and decided to give it a try were fantastic.  They were courageous, frightened, anxious and desparate.

We had some great outcomes,  and some didn’t complete the journey.  I wished them well and hoped they would find their answer elsewhere.  For the stayers, I set about reprogramming their brain using activity, words, gestures, encouragement and leadership.  But not much empathy!  When ever they tried to tell me about their pain I pointed out that I wasn’t really interested, and couldn’t treat their pain.  And refocused them on to getting fit and healthy. 

Know what? As the brain allocated more resources to learning new exercises and skills, as it got the occasional dopamine shot (your pleasure chemical in the brain) with success, it paid less attention to the signals previously interpreted as pain.  The brain stopped listening intently for pain,  and instead got excited about doing things again.

And it has worked again.  After writing this post, my toe pain has all but disappeared.  Time to go back ..to…… bed…… and ……..sle….