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

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  https://www.researchgate.net/publication/313470762_Towards_an_ecologically_grounded_functional_practice_in_rehabilitation 


You can follow @CraigLiebenson.



Bookmark

____
Tip: mention @threader_app on a Twitter thread with the keyword “compile” to get a link to it.

Enjoy Threader? Sign up.

Threader is an independent project created by only two developers. The site gets 700,000+ visits a month and our iOS Twitter client was featured as an App of the Day by Apple. Running this space is expensive and time consuming. If you find Threader useful, please consider supporting us to make it a sustainable project.