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 Danger of Knowing

I wonder if we ever really know as much as we think we do.   A recent article in Spine (1)  looked at GPs with a self described special interest in musculoskeletal or occupational health medicine and their management of patients with low back pain.  The conclusion drawn by the Australian investigators was, ‘A special interest in back pain is associated with back pain management beliefs contrary to the best available evidence. This has serious implications for management of back pain in the community.’  In other words, those GPs who believed they were more ‘expert’ were actually the opposite!

It got me wondering about the risk of ‘knowing’ something so well that we cease to refresh or challenge our knowledge base.
For example, I have a special interest  in shoulders.  I have written and taught about shoulders for over twenty years.  Yet, how many shoulder workshops have I attended that I didn’t actually lead?  Maybe one every couple of years.  Post-graduate university teaching and delivering at large conferences have obliged me to try and keep up with other work, but I am only human.  And one of our human limitations is the ability to blind ourselves to new information when it suits us.  To hold a strong position and then avoid, disregard, mis-interpret or bend new information so as not to rock the conviction already held.  I love finding research articles that support my clinical observations and the foundations on which I treat patients.  I share these papers,  use them in my reference lists and acknowledge the wisdom of the researchers.  Upon reflection I suspect I treat papers that don’t resonate with my beliefs and practices somewhat more cursorily.   Beyond that, I am sure many colleagues jump on the very papers I underestimate and embrace them enthusiastically because they experience a  resonance with them.  Academic rigor in research demands a review of relevant published work even those not supporting hypothesis.  To keep an open mind pending the outcome. Outside of the research environment there is no such imposed balance.

Knowing stuff can be dangerous.  You can retreat to a comfort zone of ‘well that’s that, I understand it now’ and cease to be open to new, different, complementary or even opposing views.

Knowing stuff is cognition.  Knowing that your knowing is incomplete and is subject to your attitudes, prejudices, bias, expectations and experience is meta-cognition –  the ability to rise above your ‘knowing’ and perceive that your knowledge base is a mere speck of sand on the wide beach of what you do not yet understand.  Maybe this is the difference between knowledge and wisdom.

Just like the GPs who believed their ‘special interest’ afforded their patients an advantage, I suspect any complacency in our information quest will impact on our patient care.

That said, I am now going to register for a shoulder workshop…


1.Buchbinder et al, Spine: 15 May 2009 – Volume 34 – Issue 11 – pp 1218-1226

Work Life Balance…..

I love motorcycle touring.  Today I met up with a bunch of like-minded mates and we took off for 300km around the hinterland of South Eastern Queensland, Australia. Stopping for ‘smoko’ and lunch gives us a chance to tell a few lies and laugh at a few stories.  Later this month I am combining motorcycling and work when I conduct my first workshop tour ‘on the road’.

Travelling south as far as Canberra, I will be delivering twelve “BizFizz’ workshops for private physiotherapists in rural New South Wales.  Four or five hours riding each day through some of the best motorcycling road in Oz, then after a walk, some exercises and a feed – four hours on the business of physiotherapy.  

Combining your passion with your work transforms the way you feel about your ‘job”.  Sometimes the links are obvious, sometimes it takes a little more innovative thinking.  See how you go.

The Red Sock System of Time Management

My wife, Mary,  says I have a ‘red sock obsessive-compulsive disorder’.  Something to do with my drawer full of red socks.  Have you any idea how much time you can save every day by not having to choose what colour socks to wear?  I reckon I must have saved (say) 60 sec per day for 20 years  PLUS the reduced sorting of socks in  the wash and pairing them afterwards!  This could add up to around 180 extra hours to pursue more important activities.   This is more than an extra week in my life. 

When looking to ‘manage time’ identifying trivial time wasters can turn small daily gains into leveraged cumulative results.