Takeaways from Glucose Revolution

For anyone who has not yet read Glucose Revolution: The life-changing power of balancing your blood sugar, it is most definitely worth the read. It was written by a French biochemist, Jessie Inchauspé, and is the holy grail for anyone hoping to learn a little more about nutritional biochemistry.

Inchauspé provides background information about how what we eat and when we eat it can trigger glucose spikes, in which the amount of sugar in our blood goes up very quickly. Over time, many glucose spikes can be taxing on our organs, our mental and physical health, and can put us on the road towards serious health issues. Even if we have not been diagnosed with diabetes or prediabetes, chronic spiking of glucose can negatively impact our health, well-being and our waistlines.

The chronic spiking of glucose can lead to insulin resistance, chronic inflammation, atherosclerosis (and related heart events), as well as weight gain.

The book does not suggest dieting, as going on diets is often unsustainable. If we choose to restrict what we eat, we will often experience the “yo-yo effect”, in which we temporarily deprive ourselves only to drain our will-power and eventually return to our old ways.

Rather than dieting, if we are hoping to improve our health for the long-term, we must change the relationship we have with nutrition and exercise to be evidence-based, more enjoyable, and strategic.

How does this relate to physical therapy?

More glucose spikes means more inflammation. More inflammation means more irritated tissues, which leads to more pain. Excess weight also leads to inflammation, as well as increased biomechanical forces on joints, both of which contribute to pain. So, by improving our relationship to nutrition, we decrease inflammation, maintain a healthy weight, thereby making us less vulnerable to pain and unwanted strain on our tissues.

Takeaways

Here are the four takeaways that have stuck with me the most, and that I tend to recommend most often to clients who are hoping to enhance their blood sugar regulation.

Don’t “Diet”

If you’re on a “diet”, it is likely unsustainable. Consider asking yourself the following question: “Is the way I’m eating now sustainable?” Or “Could I see myself eating like this for the rest of my life?” If the answer is no, you probably would benefit from adjusting your mindset relative to what you are eating. Restricting calories or certain foods is likely temporary, and as soon as you stop doing it, your weight will likely bounce back to what it was before the restriction.

It is helpful to consider more the relationship you have to food and nutrition. To learn how to make decisions about food based on the best available information. To not deprive yourself of calories, but rather focus on nourishing your body with healthy, whole foods. Move away from counting calories, and towards counting how many different fruits and vegetables you eat in a week.

Seriously, try it. Over the course of a week, write down every single fruit and vegetable you eat. If you eat a banana seven times, this only counts as one, as I am referring to different fruits and veggies. At the end of the week, what is your number? Aiming for 20-30 per week is a great place to be. If you’re nowhere close to that, no worries! Try again next week.

“Dress” your Carbs

Ever wonder why taking medicine on an empty stomach might not be a great thing? Or perhaps drinking alcohol? When the stomach is empty, there is no buffer, and whatever you ingest has a quicker, stronger effect on your cells. Same thing with carbs: if you eat something that is high in carbs, particularly refined carbs (e.g. white bread, pasta, rice) or sugar (desserts) on an empty stomach, this will lead to a very high glucose spike.

Consider a green starter to each meal, which means having a vegetable before the carb. Or “dress” your carbs with fats, proteins, and fiber. The glucose spike from eating two pieces of white bread would be far higher than a sandwich with two pieces of white bread with avocado, greens, tomatoes, and a protein source in between. Better yet, choose whole wheat bread, as the fiber will also slow down the glucose spike.

Move After Eating

In the post-meal state, when the glucose is first starting to spike, your body is trying to figure out what to do with it. Is it going to go to the liver for long term storage? Is it going to go into the fat cells? How about the muscles? If you move a bit after eating, your muscles will start to soak up the sugar to use as energy, rather than going into fat cells. 

This doesn’t have to be intense exercise. Simply walking for five or ten minutes after a meal will help to decrease the glucose spike by sending the glucose into the muscles instead of the fat, which can be very helpful for weight management over time.

Apple Cider Vinegar (ACV) is your Friend

Vinegar can help decrease glucose spikes. This is particularly helpful if the vinegar is taken about 20 minutes before consuming something that could potentially spike glucose. It is important to only have a small amount, 1 - 2 tablespoons, and to dilute it.

As the taste of vinegar can be vile, I like to make an ACV tonic, which I drink a couple times per week. Here is the recipe:

• 1 - 2 tablespoons organic raw ACV (maybe start with 1)

• Liquid stevia to taste, or other natural zero-calorie sweetener (no sugar, as this will negate the effects!)

• 1/4 tsp cinnamon (or keep cinnamon sticks in the bottle of ACV)

• Big squeeze of lemon

• 8 oz water

• Mix it up, apple sliced and/or lemon wedge optional for garnish

Enjoy!

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Befriending Your Unwanted Habits

If we didn’t have habits, life would be really difficult. All of us have developed patterns of moving, thinking, and behaving that become deeply ingrained in our nervous systems, like well-carved out ski slopes during peak season. These patterns are represented in our brains as neural networks, or interconnected brain cells that fire together to create our ways of being. The brain creates these networks to ensure efficiency. Without these networks, we would have to start from scratch every single day with clean slates, no skills, and no purposeful movements available to us, like a newborn baby.

As we go through our development, we learn a heck of a lot. In fact, by the time we are adults, our 100 billion neurons can form over 100 trillion synaptic connections! We continue to learn as we grow older, although our brain does go through certain critical periods, making it more or less responsive to learning certain types of information throughout various parts of our lives. This is why it is so much easier to learn a new language as a child, as early childhood is the critical period for language development. Our youth is also a time where we develop many of the neurological patterns that define who we are, what we do, and how we think.

When it comes to movement, our repertoire tends to shrink as we grow older, and we are more likely to move in a less variable, more confined way, which gives rise to challenges with mobility in our later years. We are more likely to fall back on the same patterns again and again, and less likely to expand our horizons.

While the learning process is extremely adaptive and helpful for our ability to engage in life, our learning can also lead to undesirable habits and patterns. For example, imagine that you grew up in the north with a very questionable heating system. Whenever winter would come along, you might bundle up in a few coats, and find yourself shivering and hiking your shoulders up towards your ears more often than you might like.

The more time you spend generating tension in your shoulders, the more of a habit it might become. So later on, even if you move down south, you might have the learned habit of tensing up the shoulders, particularly during times of increased stress. This can impede the natural movement and flow of your body, and might contribute to strain on the tissues and chronic discomfort.

We all have our bodily habits. Whether it’s hiking up the shoulders, clenching the jaw, craning our necks forward during computer work, tensing the pelvic floor, holding our breath during exercise, only crossing the same leg on top while sitting, or countless others. What these habits have in common are that they are learned, persistent, and undesirable- and, they may have served us some helpful purpose in the past. That’s why they exist.

Sometimes we don’t even notice these habits until someone else points them out- a family member, a friend, a physical therapist. Sometimes the habit is completely innocuous and may or may not be associated with something undesirable. If in fact the habit is truly undesirable, e.g. it relates to unwanted strain on a tissue, is associated with discomfort, etc., then we are likely trying to change the habit. How do we do this?

Building Awareness

The first step of creating change is awareness. If you do the habitual behavior 100 times per day, and only notice it one time, this is not enough. Performing mind-body practices regularly such as Feldenkrais lessons, yoga, tai-chi, mindfulness meditation, etc. will help to develop the ability to become more aware.

In everyday life, a reminder system must be developed. One must become aware of the situations and environments in which the undesired habit is most likely. Does the habit show up the most frequently at the computer? While driving? In the kitchen? Wherever the habit is likely to show up, consider bringing a visual cue into the area, such as a brightly colored sticky note. The sticky note could be blank, have a small symbol to remind you to cease the habit, or a few words or short phrase, such as “exhale”, “relax your shoulders”, “smile”, etc.

During the activities that are most likely to trigger the habit, consider a very short body scan, perhaps right before starting the activity, sometime during, and immediately after. Say that you are going to do desk work for one hour. Right before you begin, sit down, get comfortable. Close your eyes. Ask yourself if you are comfortable. Ensure that your breathing is nice and relaxed. Scan your attention throughout your whole body, particularly the area where the habit might show up. Maybe this takes 15-30 seconds. Continue on with your task, but do the same thing half way through, and again after finishing the task.

Respond with Kindness

When you inevitably notice that the habit is happening, change how you respond to it. It is very easy to become frustrated with yourself- “What’s wrong with you, why can’t you stop doing that!”. This is an unhelpful strategy, as it creates unnecessary frustration and suffering around the habit. Instead, have a chuckle. “There you go, tensing your shoulders again like it’s freezing! No need- you are safe and comfortable.” This is making friends with your habit. Your habit is there for a reason, and by being kind to yourself, you are more likely to develop a better relationship with it.

Purposefully Move the Involved Tissues

And finally, when you notice the habit arising, perform some movement that helps to relax and change the tension in the area. For example, if the habit is hiking your shoulders up, here is a movement sequence you can try. Start by raising and lowering both shoulders, towards and away from your ears, as if your shoulders are two rising elevators. Then, let one shoulder shrug up as the other goes down, like two elevators going in opposite directions. Finally, begin to circle both shoulders up, back, down and around. This can become both shoulders making circles, but at opposite phases of the circle, so as one shoulder is up the other is down (like two ferris wheels going side by side). Perhaps you spend no more than a minute on these movements, and then return to whatever task you were engaging in.

By implementing these you will begin to create more instances of noticing the habit, and changing how you respond to it to be that of kindness, as well as an active movement-based strategy to change how your nervous system communicates with the involved muscles.

These strategies can greatly decrease the frequency and impact of the habit, and can facilitate the creation of new habits! The nervous system will begin to choose less stressful and more efficient movement patterns, which can eventually replace or minimize the influence of long-term, inefficient movement patterns. Over time, the new patterns can become automatic. While the old habits may never disappear completely, you will find it comes up less often, you will notice when it happens more often, and it will lead to overall less distress and discomfort.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

https://online-learning-college.com/wp-content/uploads/2022/04/Neurons-and-synapses-scaled.jpg 

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Embracing the Gray Area

Many of us want a definitive answer. We feel there is some “correct” answer to every question. We are either doing things right, or wrong. Considering the gray area can help us change our thinking into more of a spectrum, recognizing there is rarely a right and a wrong, but rather a multitude of options. Some of these options may be better for us at that moment, and some not so much.

This way of thinking might stem from our educational system. We all might remember a time where we raised our hand in class, and were embarrassed that we gave the “wrong” answer. Perhaps we stopped raising our hands so much after this. Or, perhaps we still remember the sinking feeling in our stomach when getting a test back and seeing the red X’s by some of our answers.

Binary thinking gets buried deep into us. And it shows up in how we move, exercise, care for our bodies, and respond to pain and injuries. If we are more concerned about whether we are doing something right or wrong, it blocks our ability to explore, experience, and learn.

Think about a well-known exercise, like a squat. Is there a part of you that feels like there is a “correct” and an “incorrect” way to do a squat? Say someone was taught that the correct way to do a squat was to have the heels 12 inches apart, toes turned out to 30 degrees, to sit down until the bottom is the same height as the knees while keeping the chest pointing forward, and then stand back up. If this person internalizes these instructions as the correct way, any variation from this will be perceived as “wrong”.

What about the variability in anatomy? Everyone has different angles at which their hips naturally turn out or in, which will certainly impact how one might place their feet on the ground while squatting. There are also countless variations in types of squats, and none of them are correct or incorrect! Narrow squats, wide legged squats, single leg squats, sissy squats, goblet squats, front squats, back squats, plié squats, kitchen sink squats… to name a few! There is no right or wrong, only options.

If someone is dealing with pain or an injury, it is far more important for them to listen to their own sensations than someone else telling them how they are supposed to do something. Many people with knee pain say “they cannot squat”, and therefore avoid any type of squatting. This can weaken the body and greatly impact mobility. If instead this person were able to modify the squatting pattern in a way that worked for them, they could gradually improve their squatting and end the cycle of avoidance.

By limiting our construct to a correct and incorrect way to squat, we are denying ourselves the ability to explore variations, as well as to respect that our bodies are all different. What is an efficient squat for one person may be an inefficient pattern for someone else, which could set them up for injury or impair their performance.

A great first step to comfortable squatting is the kitchen sink squat: hold on to the kitchen sink or a counter, and slowly sit the bottom back, as if sitting into a chair. Allow chest to lean forward a bit. Choose how low to go down based on your own ability and comfort. Stand back up by driving hips forward and up towards the counter. Repeat as desired.

At the Wellness Station, we are sure to stay far away from using words like right, wrong, correct, and incorrect. Instead, we teach people to match the intention with the action. In other words, we provide an intention (such as the instructions above), and teach people tools to monitor their own actions while moving. That way, the individual can observe whether their action matches their intention, and make adjustments as necessary.

We aim to empower our clientele by providing movement options, which help people become aware of variables that are in the individual’s control. The variables for a squat might include the following: distance between feet, turn out angle of the toes on each foot, depth of the squat, time taken to go down and to come back up, pauses and rests in between repetitions or sets, pauses within a repetition, reversals (changing direction of the movement), alignment/angles of ankles, knees, hips, and trunk, and much more.

Stay posted for our next blog, in which we will provide video examples exploring three-dimensional variations of squats.

It can feel easy and simple to learn a correct and incorrect way to do something. However, thinking in this way is extremely biased, and takes away one’s agency and ability to trust in one’s own experience. By embracing the gray area, we can open our minds and our bodies to a depth of possibilities.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Jill’s Journey Through Back Pain: A Case Study Part II

In the previous blog post, we introduced Jill and described her journey with back pain. Now we will discuss more specifically the approach we used to help her navigate this complex situation. 

As the Wellness Station is a holistic practice, Jill’s plan of care was based on the biopsychosocial approach. This means that our care integrates factors related to biological/tissue structure and function, as well as psychological and social factors. Our approach is inspired by the Feldenkrais Method of somatic education, as well as therapeutic yoga, mindfulness, and traditional physical therapy.

(For further understanding of the biopsychosocial approach to pain, check out the following two previous blog posts: Does How You Think About Your Pain Affect Your Pain? & A Holistic Approach to Pain Science)

Bio

In collaboration with Jill’s referring provider, we made sure that Jill was managing pain most effectively with the lowest possible therapeutic doses of medications with the least potential for adverse effects. Jill’s goal was to get off medications for good, as she did not want to rely on them over the long term for pain management. 

We also ensured that Jill was consuming a nutritious, whole-food diet to support an internal environment conducive to healing (she adopted an anti-inflammatory diet similar to the Mediterranean diet). 

The bulk of our treatment approach focused on movement patterns that were likely putting additional strain on the injured tissues. Jill was extremely sensitive to bending movements, as well as prolonged sitting. Using biomechanical principles, we broke down patterns of spinal flexion and extension necessary to bending and lifting, and provided opportunities for neuromuscular learning- new strategies of bending that felt more comfortable, efficient, and less stressful on Jill’s back. This generally involved keeping Jill’s center of gravity over her base of support, sending her hips back to counterbalance her reach, and lifting objects with the strongest muscles of her core and legs.

Jill began to practice picking objects up in her daily life using new techniques, and eventually picked up her two year-old granddaughter in her new and improved way! 

We also provided education about posture and the importance of changing position throughout the day, especially during prolonged sitting. Jill found that a children’s ball placed behind her back in her chair was incredibly helpful for back support, as well as performing small, regular movements of her pelvis, hips, and spine known as the pelvic clock. 

See How Your Spine Moves Part I and How Your Spine Moves Part II for some ideas on what Jill learned here.

Psycho

Psychologically-informed care was necessary for Jill’s treatment approach. The grief from the loss of her husband was affecting her more than she cared to admit. She also recognized that a fear of aging and loss of confidence in her own body’s resilience contributed to a sense of hopelessness. Addressing these factors allowed Jill to further align with her goals, and she was able to instill a sense of self-compassion into the rhythms of her day. Combined with education on the psychology and neuroscience of chronic pain, as well as a daily practice of mindfulness meditation, Jill was able to insert a mindful influence on her pain. She recognized that by shifting the way she thought about her pain, her back, and the active role she could have in her own healing, she was able to take control of the situation more effectively. This helped her body and mind to begin to function more as one.

See Mindfulness and Movement for more of an idea on how we integrated mindfulness and self-compassion into Jill’s therapeutic care.

Social

Without others, we are lost. By creating a strong therapeutic alliance, Jill and I were able to work together on an even playing field. Unlike previous therapies she had been to in which an authoritarian figure prescribed what she should do for her back, Jill and I collaborated as a team, along with her physician. This feeling of support improved Jill’s confidence in her providers, as well as in herself as a necessary member of the team.

See Enhancing the Therapeutic Alliance for more information on the importance of the relationship between the patient and the provider.

We also addressed Jill’s social life and relationships with others. We encouraged her to seek support from her daughters and her friends. Jill began to feel more comfortable asking for help. She also began to go on regular walks with her friends, which she realized was very helpful for her back and much more enjoyable than walking alone. 

A Whole New Jill

Clearly, Jill’s issues were not just in the tissues. The tissues in the back are part of a living, breathing, thinking, feeling, moving organism. Any persistent pain or mobility challenge is multifactorial. Throughout the healing process, the biopsychosocial approach was taken in order to holistically Jill’s issues.

As mentioned previously, Jill is now back to rowing, walking with her friends, strength training with weights, and playing on the floor with her grandchildren!  This has further motivated her to continue to stay active and improve her life and her movement capabilities. She feels that she has gotten her life back!

“In the last eight months, I have shared my experiences with friends and shown them some of the simple movements. I have traveled, concerned I would re-herniate a disc. Not. That truly felt like success. I now know that this process takes time and patience but it is well worth the investment.”

Jill will occasionally experience instances of increased pain. However, these instances are drastically different from the flare ups of the past. They are far less frequent and less severe, and do not bother Jill as much emotionally. She also has much more clarity as to why the flare ups are happening, based on what she has or has not been doing.

Jill no longer sees pain as the enemy, but rather as an informant that helps to guide her actions. She recognizes that pain is inevitable for us all, but how we believe and behave relative to our pain can make all the difference.

Jill has the tools to manage and diagnose how to treat her pain, and she still does a monthly check in at The Wellness Station for support and for a review of movements and techniques.

Jill had an extremely active role in her healing journey, which will be a gift that keeps on giving for the rest of her life.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images: 

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Jill’s Journey Through Back Pain: A Case Study Part I

Who Is Jill?

When Jill first presented to the Wellness Station, she described her life as “a mess” and felt skeptical that another attempt at physical therapy would make any kind of difference. Jill is 75 years old and had stayed generally active with outdoor rowing and exercising with weights. However, Jill has experienced recurrent bouts of debilitating back pain over the last 15 years, which tended to set her back for quite some time. She had been to physical therapy several times, which never made any long-lasting difference for her.

Jill was having an extremely challenging year. She had become more sedentary during the pandemic, as she did not feel as comfortable working out with her personal trainer. She lost her husband, her lifelong best friend. On top of this, her sister also lost her husband around the same time.

While at her sister’s house to support her both emotionally and physically and to re-organize their house, Jill suffered a severe back injury. A herniated disc in her lumbar spine became sequestered, and the sequestered disc fragment led to nerve compression. Jill began to experience severe back and leg pain, which was constant and severe. She had herniated several discs in the past, and she described this pain as far worse.

Jill went through a course of traditional physical therapy and described it as follows:

““It was very modest stuff. I felt like there wasn’t much of a progression, and it wasn’t as individualized as I would have hoped. They might have used the same printable exercises as any other old lady with back pain!” ”

Jill Finds The Wellness Station

Jill was referred to the Wellness Station four months after her sequestration injury, and was still experiencing constant, debilitating pain. In coming to the Wellness Station, Jill hoped for improvement but wasn’t sure what to expect. Her goals were to improve her fitness and build her core strength in order to be active, independent, and play with her grandchildren- however, she was beginning to lose hope that any of this would be possible.

““In the first session, I found Jacob Tyson to be an exceptional listener as I outlined my back pain history, the recent event and goals. The room was calm as was his demeanor that set a relaxed tone.””

““I still was puzzled in the first few sessions that focused on just a few movements or exercises to establish what is called the pelvic clock. But at each weekly session, the new movements built on the previous week, a method I could appreciate as a former newswriting instructor, teaching the basic journalism language and incorporating more concepts and practices as students learned newswriting style.” ”

Jill Turns the Corner, & Beyond! 

As we worked together over the course of weeks to months to a year, we gradually progressed Jill’s home exercise program by introducing new movements, slightly more challenging than the week before. We continued to layer on educational and lifestyle components that were related to Jill’s life, including concepts of biomechanics, anatomy, exercise physiology, psychology, mindfulness, pain neuroscience, and more.  As Jill continued to learn and build her strength and confidence, she has been able to do more demanding physical tasks without any increase of pain.

“ “Through the sessions, I learned how to stand up and walk in new ways, to use my legs and tailbone to shift weight, to improve the flexibility of my entire spine—all aimed at relieving the pressure and weight on the lumbar part of my spine. We also did relaxation and simple meditation to promote mind-body connection. After each session, I received an email, summarizing our activity. I have compiled all those exercises and support into a file that I can use to refresh my memory of exercises—and to see my progress.” ”

““The knowledge and movements I learned gave me a feeling of accomplishment and control over the mechanics of my body. Usually an exercise or stretch would relieve the pain, and I did not take any medication. A triumph!” ”

Jill is doing much better today, and feels that she has gotten her life back. She no longer feels limited by her pain, and feels empowered to stay active and engaged in life. She is now back to rowing (weather-permitting!), going to the gym twice per week, and having no trouble lifting her quickly growing grandchildren!

Jill also improved on the Modified Oswestry Disability Index (a survey used to measure the impact that back pain has on quality of life) from a 58% to a 12% over a period of six months, which is over four times the threshold of clinically significant improvement. 

Stay tuned in to see our next blog post, which will break down more specifically what we addressed with Jill biologically, psychologically, and socially.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images:

https://www.safetyandhealthmagazine.com/ext/resources/images/2019/10-oct/back-pain.jpg?t=1568903562&width=768

http://balanced-movement.com/2019/02/17/controlling-pelvis-hips/

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