Being in the healthcare industry and seeing a diverse array of clientele, I see something new every day. This is what makes healthcare fun, dynamic, challenging, frustrating, and even sometimes outright whacky. There are, however, some things that are just tried and true constants. The more I age the more I appreciate constants in life. The constants I'm writing about today, however, are nonesuch the case.
Below you will find a list of things PTs across the board experience on a routine basis. This is a collection of phrases patients and practitioners use, beliefs people have about their bodies, and myths about exercise. Hopefully you will find both humor and enlightenment in this list!
“I’m jacked up” OR “my [insert practitioner] says [insert body part] is jacked up”
This is something we hear almost every day. This statement is confusing/frustrating to me for two reasons:
-1) What does this actually mean? 🡪 does that mean that trauma has occurred?
Let’s define “jacked up” 🡪 when I hear “jacked up,” what I actually hear is someone trying to assign language to a painful area in their body and don’t know how to make sense of it. This is often said playfully or with a smile, perhaps they are trying to make brevity of their current situation. But, ultimately this means there is a fundamental lack of understanding as to why they might be hurting.
-2) Do you actually believe that? I believe that language matters and that if we hear/say something enough times we begin to believe it. If we have a body part that is “jacked up,” we begin to believe that there is no solution for this issue. Somehow this idea got into the head of the “jacked up” person, and unfortunately this often comes from practitioners who A) don’t know what they're talking about and/or B) too lazy to educate their patients OR C) think that this language somehow creates meaning. It doesn’t. It’s harmful. It’s not helpful. It creates dependency and you’re making things harder for yourself!
“I’ve got a very high pain tolerance”
Nope! If ever there was a way to identify someone who does not cope well with pain, this would be the secret password. A dead giveaway.
-What does this mean? (I’m going to ask that a lot) 🡪 Does this mean you’ve been in pain for a very long time and have learned to live with it?
-Also, how does one objectively know this to say with such confidence? Have they won the blue ribbon at a pain competition? What an entertaining show that would be… Step aside, “America’s Got Talent,” “America’s Got Pain” coming this fall! Unfortunately, this is true. We’ve got a lot of pain.
-All joking aside, in an interesting article by Assa et al (2018) in European Journal of Pain, they wanted to know who was “tougher”: endurance athletes or strength athletes. They found that “both strength and endurance athletes have higher pain tolerance and lower pain sensitivity to non athletes,” AND that strength athletes have higher pain thresholds than endurance athletes and non athletes. BUT- endurance athletes have a higher pain tolerance than both strength athletes and nonathletes. Concluding that different types of sports affect the perception of pain differently, but ALL sports expose an individual to pain, making them more resilient to it.
Moral of the story: lift heavy things and get your heart rate up.
CITATION: Assa T, Geva N, Zarkh Y, Defrin R. The type of sport matters; pain perception of endurance athletes vs. strength athletes. Eur J Pain Lond Engl. 2018; pmid:30379385
“How am I supposed to burn calories if I cannot run [bike/swim/walk]?”
The myth that cardio is the best and/or only way to burn calories is one that frustrates many people trying to lose or maintain weight.
-While cardiovascular training makes our hearts efficient and allows our muscles to endure sustained workloads, it DOES NOT increase our metabolism. Meaning you’ll burn calories to an extent, yes, but the body will only burn a certain amount of calories doing cardiovascular work until it goes into “safety” mode, physically slowing the caloric burn. The ONLY way to influence metabolism is to increase muscle mass. Muscle mass has a higher metabolic demand and requires more calories to sustain itself.
AND for all you science nerds here is a scientific article explain this:
-CITATION: McPherron AC, Guo T, Bond ND, Gavrilova O. Increasing muscle mass to improve metabolism. Adipocyte. 2013;2(2):92–98. doi:10.4161/adip.22500
"You should never let your knees go over your toes on a squat"
Somehow, someway in dingy gyms across the country between the years 1980-2000, this myth began to permeate the PE class. At least, that’s what I’ve concluded from very scientifically gathered information from my clients when we talk about squatting. They say, “I was told my knees should not go over my toes when I squat,” I ask them “when were you in middle school?”
The answer is always between 1980-2000.
-This is hogwash and it makes ZERO sense. If you want to be able to squat there is no way you can properly squat with a perpendicular tibia to the ground. There is not a human strong enough in the world who can do this well.
-Fry et al (2003) in the Journal of Strength and Conditioning Research studied the effect of knee translation during squatting. They found that when your knees translate forward stress increases by 28%. They also found that when the knee was held straight stress at the hip increased by more than 1000%. The conclusion was that “appropriate joint loading during this exercise may require the knees to move slightly past the toes.”
Can we FINALLY put this myth to rest?
Don’t even get me started on not deep squatting!
CITATION: Fry, AC, Smith, JC, and Schilling, BK. Effect of knee position on hip and knee torques during the barbell squat. J Strength Cond Res 17: 629-633, 2003.
“I should not have to be in pain”
You’re right, you SHOULD not. However, that’s not reality. Reality is that death, taxes, and pain are absolute guarantees in life. Instead of chasing symptoms and trying to rid ourselves of pain entirely why not try and understand pain? Become more resilient to pain? Learn how to manage symptoms? Influence things you have some control over – like strength, mobility, cardiovascular fitness, emotional responses to pain, nutrition, sleep, stress, education. These are the things that matter, and these are the things that are ultimately the ‘”fix” for our symptoms. This takes proactiveness, gratitude, determination, consistency, patience, courage. No room for apathy, blame, helplessness, or dependence.
“My [body region] is out of alignment”
This is one that broadly speaking is very misunderstood and overly encouraged by healthcare providers. Hand up! We are to blame for this.
-Last time I checked there are 7.7 billion people currently living. Does that mean that 7.7 billion people all need to be in perfect alignment to function? That’s an insane thought, because the fact is that the human race has thrived on not being “aligned.” Anatomy is widely multivariate. There is not one single “prime specimen,” everyone has limitations and variation in their anatomy. So the idea that there is one perfect way to be aligned it very harmful from a psyche standpoint.
-Should certain joints and muscles and nerves function in generally the same way? Yes! And for the most part, they do. Sometimes through developmental changes, learned patterns, injuries, and age related changes, our anatomy may change over time. Sometimes our nervous systems may feel unsafe because of anatomical changes that should be address through strength training, mobility, manual therapy, activity and behavioral modifications, graded exposure, and understanding.
This is obvious and is what most healthcare providers actually provide. The idea that we are all Jenga towers and with one false move we come tumbling down because “my big toe is too restricted” or “I have a scoliosis” is exceedingly harmful to someone who is trying to thrive as this creates dependency on the people that can “fix” them or “realign” them. That’s NOT good medicine.
In the animal kingdom the most basic level of parenting is what? Preparation for survival. If an animal rears a young to dependent on them the whole system falls apart. While humans more complex emotionally and spiritually, they do still require the same tactics. As rehabilitation experts our job is to help people become more resilient and more fit to face the world and the challenges it brings. Using dependency driven language only sets people further back.
Thanks for reading!
Jake Reynolds, PT, DPT, OCS