Craig Liebenson+ Your Authors @CraigLiebenson Encouraging sustainable, healthy lifestyles so health span = life span [email protected] Feb. 08, 2020 3 min read + Your Authors

I hope PTs will stop managing people away from load & DCs will stop promoting dependency.

It causes #overprotection & #underpreparation

Beginning in our 30s focusing on nocebos is iatrogenic as it brings us towards a tipping point since most people are a) not meeting physical activity guidelines & b) muscle atrophy is a natural aging process. #biologicalage

Why would we scare people into assuming activity is harmful or every hurt = harm? “Hurt is an alarm, but not every hurt = harm” @benedsmith @Prof_Littlewood @JanHartvigsen @GLAD_Denmark @GLADCanada @GLAD_Australia @GLADSwitzerland

Ideally we will stop scaring people away from activity. Instead give evidence-based MSP care by offering reassurance & reactivation advice. We’ve known this since the 1980s but #knowledgetranslation is too slow @jeubanksMD @CGMMaher @MaryOKeeffe007 @RachelleBuchbin @jpcaneiro

“It’s not the load that breaks you down but the load you’re not prepared for” @TimGabbett

By finding a person’s floor we can measure & then manage the landmarks associated w/ sustainable resilence. This is regardless of not knowing the exact timelines. @PfaffSC @StuartMcMillan1 It’s about finding the low hanging fruit of poor programming & movement foundation gaps.

Regardless of the tissue bridge the gap from current to required capacity. @ProfJillCook @KThorborg While avoiding sudden spikes.

Too often we focus on negative, reactive, “fix it” approaches rather than sustainable, resilence upstream factors.

Disability & lifestyle go hand in hand. Motivating, reassuring & reactivating people rather than “fixing” them is the keystone. @PeteOSullivanPT @_Tyson_Beach

Education is a big part of it. @RodWhiteley Not only of our patients, but ourselves too.

MSP can be a gift of injury waking people up to the value of lifestyle change for #healthylongevity & prevention of #ncds @WHO #getmoving

Changing you’re #healthspan requires addressing the natural atrophy process of aging. Unfortunately this takes time. Most people want immediate symptom relief & they chase the latest “fix it” hype of #vestedinterests @OsteloR

The problem is right in front of us. A worldwide #inactivitycrisis But how many HCPs are aware of or giving safety messages rather than danger ones about activity? @PainRevolution

Structure is rarely the sole or even main cause of pain. Yet patients feel if we don’t image them we can pinpoint the cause of their pain.

The #socialdeterminantsofhealth are upstream of the Bio & Psycho. But the culture of heath care & patient expectations drives #overdetection ➡️. #overdiagnosis ➡️ #interventionism @MaryOKeeffe007

Wear & tear is one of the silliest labels & biggest nocebos in sedentary people.

The #vestedinterests bias decision making. The information overload is no excuse for HCPs not being up to date. @GregLehman

It’s simple gradually increase capacity so it exceeds the greatest anticipated demand. @fysioviis @JeremyLewisPT @ProfJillCook @KThorborg @TimGabbett

But just because it’s simple doesn’t mean it’s easy! Precision N=1 requires we appreciate the social environment & context, not just the bio & psycho. @Peter_Stilwell @_Tyson_Beach @MattLowPT

A big mistake is ignoring #behaviorialeconomics or how people’s behavior can be nudged. @Ekkekakis @upstream_team

These other non-clinical factors may be the most important @ZacharyRethorn @_Tyson_Beach @jeubanksMD

Often the clinic can participate in what is called “the tyranny of the visit” because of patient expectations surrounding us “fixing it”. Reducing dependency & showing people what they can do for themselves is 🔑 #firstprinciplesofmovement

This requires we de-implement the status quo. @JanHartvigsen @ewa_roos @DrChrisBarton @kieranosull

It starts w/ realizing its time to #LevelUp Learn the value & safety of activity & how to change behavior. @ClinicalAthlete Give a positive experience w: movement. Tangible hope & an achievable plan. Find the hardest thing a person does well to trigger adaptation & self-efficacy

The HCP needs scalable principles rather than a rigid system or protocol to finding a precision, relatable solution for each person. Every environment is unique. The expert is more generalist than specialist & as a result agile in chaos.

❇️ Know the person 1st then make suggestions
❇️ Keep an open mind that you could be wrong
❇️ Listen w/ empathy
❇️ Guide w/ compassion
❇️ Humility to handle uncertainty & pivot to Plan B. @_Tyson_Beach @PainRevolution Daniela Vaz person-centered paradigm 

You can follow @CraigLiebenson.


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