Ep 17: The year of the confident body – what does this mean?

Voiceover (00:02):

Welcome to the Confident Body, where experienced health professionals discuss how to get the most out of your body for the lifestyle you choose. We believe everyone can exercise and get the most out of life, regardless of your injuries or health issues. Now here’s your host, senior physiotherapist, Michael Dermansky.

Michael Dermansky (00:22):

Hi, everyone, and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. My name is Michael Dermansky, I’m a senior physiotherapist and managing director of MD Health. Today I’ve got a special guest, Josh Blenclowe. He’s our osteopaths at MD Health Carlton North. Welcome to the show, Josh.

Josh Blenclowe (00:42):

Thank you, Michael. Thanks for having me.

Michael Dermansky (00:44):

Well, you are the first guest of the first show for 2023, and we’re going to be talking about a topic really getting people started this year. I guess the whole point of the show is people having confidence in their body. So, I guess this topic this year is this year of building confidence in your body and what does that mean? So, Josh, I’ll get started from here. In your experience, what have you seen as the benefits of customers building strength and gaining confidence in their body?

Josh Blenclowe (01:16):

I think the key thing is just getting the body moving, being really active where someone might not be as active within their daily routine, whether they have quite a sedentary job. Yeah, just basically keeping that positive mindset and getting things moving is really essential. Yeah.

Michael Dermansky (01:41):

All right, and so I mean how have you seen people’s lives change over where they’ve come in and they’re not confident in what they can do, and then that you’ve seen that process change over a period of time?

Josh Blenclowe (01:53):

Yeah, well, it’s basically just getting things moving. So, someone might not have exercised or done any sort of movement patterns to what we do in the studio there to a degree. So, just giving them that reassurance that they can do it and they can get results, and whether it be something small, whether it be something quite large, just to have that increased quality of life within each client.

Michael Dermansky (02:27):

Do you have any specific examples, someone you can think of, from the top of your head?

Josh Blenclowe (02:32):

Someone I can think of off the top of my head would be, yeah, look, to be honest, a broad term, someone who’s a desk worker, who’s probably, I would say, yeah, in their late fifties, who has never played sport before in their life, and they enjoy walking and they have always wanted to run, and we build up their strength and build up their movement patterns to the point where they can walk very comfortably and then they can engage in that running activity. Doesn’t have to be a great distance at all, but just being able to run without getting injured and just to feel good.

Michael Dermansky (03:14):

That’s fantastic. So, I guess on the other end, there’s when people first start their exercise program, what are the major fears or worries that they have that you usually hear?

Josh Blenclowe (03:25):

Fears? Pain is a big one. “I’ve had this pain for,” let’s say, “over six months. I can’t do it. I’ve been to multiple different places before, similar results.” So, yeah, so there’s that moral anxiety and fear towards, “Oh, how is this going to be different?” But also, yeah, it’s just working through those intrinsic factors and doing the testing that we do here to really make them comfortable to build that patient rapport that we do here is super essential.

Michael Dermansky (04:08):

Okay. So, I mean when people are scared that they’re going to hurt themselves or that they’re anxious about the process of doing exercise because they’ve been and done this before and it hasn’t worked for them as well, how do you work on those fears with them? Is there a particular process that you guys go through a particular to manage that fear, or what are your thoughts on that?

Josh Blenclowe (04:34):

I make them feel super comfortable so there’s no pressure whatsoever. So, right from session one, outlining their potential weaknesses and the reason for that, educating them as to why that would be, and transitioning into certain simple movements, building up from there, getting into greater movements to reassure them that they can do it, and when they see the results and they feel just a bit smoother within their movements, they feel like they have a little bit more energy, then that really eliminates that fear factor within pain and their potential mild anxiety or fear towards their goal, basically.

Michael Dermansky (05:24):

I see. So, I guess it is almost a chicken in the egg scenario as well is that they want to do things, they’re scared of it too, but unless they do it, they don’t not scared of it too, and so once someone is able to do a task, even if it’s over time, then the fear is less, they know they can do it and it has a positive reinforcement effect.

Josh Blenclowe (05:46):

Correct. Yeah. That’s right.

Michael Dermansky (05:46):

So, I mean, in terms of you’ve seen people go start their journey and move through it, say, after about seven or even 13 weeks as well. Have you seen that change in their lives and when they first start they’re scared they can’t do their task and then seven, 13 weeks later, how have you seen those kind of transitions with people over time?

Josh Blenclowe (06:07):

It’s quite fascinating. Everyone is different. Some have quite a slow progression that it might take that 13 weeks for them to notice quite a change in their activation of muscles, et cetera. Some are really rapid, whether that four to six week period just by simply getting that body moving, engaging in all those important muscles, those intrinsic muscles that they might not have even felt or used before, which is super important, and I see that a lot as well. “Oh, wow, that’s a burn. I didn’t even know I had a muscle there,” et cetera. So, really important. Yeah.

Michael Dermansky (06:45):

So, what kind of muscles are you talking about? So the listeners know.

Josh Blenclowe (06:48):

Big one for me is gluteus medius which is a hip abductor and external rotator where we do a movement pushing out to the side on the reformer, and yeah, it will be predominantly weak on most people who are quite sedentary and sit too much. So, that’s quite a big one as well, and a few muscles around the shoulder and shoulder blades as well, which can have a large impact on the neck.

Michael Dermansky (07:19):

Okay. So, because not all of us just know that the gluteus medius and the minimus muscles are stabilized on the side of the hips. So, when you stand and you walk, you have to use those muscle groups to stop your hips dropping downwards as well, and when you are sitting for a long time, those muscles are on stretch and they’re compressed and they don’t love that and so they get weaker over time unless you are specifically working on it, they will be weakened, especially in women as well. Those muscles tend to be a bit weaker as well because of the way they’re designed. So, because women’s hips are wider and the angle of the hips comes in a bit more, that muscle is in a different position is with men. So, it’s under a different load and it’s often further weaker because of that reason. So, it’s super important to work on those areas.

(08:01):

When Josh was talking about shoulder blade control, he’s talking about the shoulder, the muscles, the controlled position and shoulder blades. So, to keep your upper body up straight and to get the best movement on your shoulder, those muscles need to work and be activated, and then not always working that well with a lot of people.

Josh Blenclowe (08:15):

Correct.

Michael Dermansky (08:19):

So, I mean, I guess from there, are there any really exciting stories that you’ve heard from clients who have been able to achieve what they’ve been able to achieve by getting a stronger and more confident in the body? Any specific stories that you’ve heard? I’ve heard heaps as well. I love those stories, but any ones that you’ve particularly heard?

Josh Blenclowe (08:38):

One to me, those classic disk bulge or disk related clients, especially within the lower back who have had a lot of hardship through that time, not being able to do simple activities as bending over, as going for a simple walk, and the things that they love that we take for granted each day as normal functioning humans. So, yeah, look back, transforming their lives to being able to do those simple tasks and therefore getting them on the barbell, doing things like dead lifts, doing things like barbell squats, doing a number of different lower limb activities where they did not think that was possible, whatsoever, and transitioning that into specific sports.

(09:35):

So, whether it be a cricket player being able to bowl again, the things that they love doing. Something as simple as a new father who can’t bend over and pick up his child without being in severe pain, getting [inaudible 00:09:50] down at the leg, et cetera. Being able to have more time with their children and family, to be able to do those movements is some of the great stories that I’ve heard, which is very close to me as well, which is fantastic. Some others would also be just simply being more productive at work. So, yes, they might have a sedentary job, but it’s being able to be more aware of their body and their posture at work to be able to be more productive within their job and to create success within their line of work as well. So, yeah, from whether it be a work setting, whether it be a family setting, I think I’ve heard a lot of different fantastic stories come from that.

Michael Dermansky (10:42):

Yeah, I mean it’s exactly the way it really should be, as in people come into an exercise program, be with us, anywhere else, it doesn’t really matter, and the whole point is not the exercise program itself, it’s a means to an end, or a means to a goal. So, as you said, a father who wants to look after their child and lift them up off the ground, lift him up off a crib and they can’t do that, that’s the whole point. I mean, I’ve got a great story at the moment where we’ve got a client who has, as you said, a disk bulge, that was the major reason why she came to see us, and she’s lifting, as you said, doing other exercises and then now doing lifting on quite reasonable weights on a barbell, doing dead lifts as well, and I’m noticing their notes a few weeks ago that she started taking BMX riding as well. Like, “Okay, really?” And go, “Yeah, I wanted to keep up with my son.” I’m like, “Okay, that’s great.”

(11:36):

I didn’t see that coming, she’s in the late 40s, she started taking up BMX bike riding in her late 40s. That’s fantastic. That’s just having that shared experience with her son was the whole point of it. She came in here for an exercise program to work on her back and she’s got a larger shared experience for her son, which is the whole point of it too, and then we got another, we’ve got a lady, she’s on one of our posters here too, and she does aerial yoga and it’s something she shares with her daughter as well. So, it’s another activity that she has in common with their daughter. That’s not why the reason she came here, but she’s ended up being there, and that that’s the whole point of the exercise programs is to be able to achieve those life goals and have those larger shared experiences.

Josh Blenclowe (12:24):

Correct. Yeah, that’s exactly right.

Michael Dermansky (12:26):

I mean, I guess going back to a step at what you said as well is that you’re doing deadlift, you’re doing lifting of people as well, that could be a very scary prospect for people when they haven’t done that before. Is that where you start people? Do they start lifting from day one?

Josh Blenclowe (12:40):

No, it won’t be from day one. As I said before, within the intrinsic muscle groups and all those large joints of the body, want to get those activated moving, and getting the patient super aware of those joints that are going to have a large effect on their presentation when they come in. So, the reformer Pilates is fantastic for that in it can be such a small simple movement and outlining the strength from the start and working their way up, to then transitioning that into a larger more compound movement such as dead lifting, squats, et cetera, where we can build them up even further from there. So, no, not straight from day one. It could be within the first four weeks, it could be in the first eight weeks, it could be even in the first 12 weeks. It’s very individualized.

(13:43):

That’s what I like about the reformer Pilates as well. We can build them up within each muscle group around each major joint of the body and transition them into a large movement that shouldn’t be scary, but is something like the deadlift has quite a bad wrap for giving sharp lower back pain where we transition those movements and break it down movement by movement and can replicate that on the reformer or even outside the reformer just with dumbbell work, et cetera, to then really transition them to doing it safely and getting that form a hundred percent correct or at least over 90% correct to then transition into adding further weight to that movement and progressing from that.

Michael Dermansky (14:33):

Yep. Okay. So, I mean, that’s what we usually see as well is that that’s not where people start, but we work on the stabilizing muscle first and when they’ve got good control then you add in the compound lifts as well and then they’re super effective. So, the right place at the right time when the control’s there.

Josh Blenclowe (14:50):

Correct.

Michael Dermansky (14:50):

So, let’s go to the other end of it too. What happens when things do go wrong, when people have a new injury during the program, what happens then? What do you do?

Josh Blenclowe (15:01):

Well, from an osteopathic perspective, just simply getting them in the room, going through a full assessment of that area that is problematic, and then tailoring the exercise regime from there, whether it be we do hands-on treatment for the majority of the session and doing a couple of stabilizing exercises, or you can really customize it through each session. That’s the beauty of doing both hands-on and reformer Pilates as well is that we can, if someone does have a flare up and is in quite a lot of pain and stiffness, we can therefore treat the area, whether it be consecutive sessions, however long it takes for us to get a result there, and then slowly transition and potentially change the way that we do their exercise regime in the studio.

Michael Dermansky (15:59):

Yeah, so when someone gets injured as well, you’ve assessed it, you’ve changed the program as well. Does it mean they have to stop the exercise program because often people feel is, “Oh, I’ve hurt myself, I better not do anything as well.” What are your thoughts about that?

Josh Blenclowe (16:12):

No, not at all. There’s always something we can do. As I said before, it can be a small, very simple movement to a very complex movement as well. So, we can definitely keep that exercise regime going and incorporate simply a little bit more hands-on techniques and also things that they can do at home as well, whether it’s foam roller use, massage ball use, simple stretching and patient education as well. So, something like if they have a flare up and they’re going to be quite sedentary at work, it’s getting them to be a little bit more active at work to prevent them from stiffening up into basically making those muscles quite lazy in the process. So, giving them tips that they can do within their own lives, not just in here, but yes, keeping them active is our number one priority.

Michael Dermansky (17:10):

So, that’s interesting you say keeping someone active as number one priority. I mean, going back to what we talked about about the fears and worries as well is that injuries will happen, they’re normal part of exercise, doesn’t mean people go backwards, it just means it’s a glitch in the program where the people are at, and getting the confidence really quickly that what things will happen, but it’s okay, it doesn’t mean the end of the world, it means you can go back and just adjust things to keep moving and exercising as well.

(17:38):

So, I mean, I guess there’s two people, there’s people that we see that stop and there’s people we see just, “Oh, no. I’ll just ignore this injury and pretend it doesn’t happen.” Neither of them are the right response. It’s adjusting things when people hurt themselves to the right response, but also not stopping and not having fear and anxiety be the reason why people don’t continue on the program as well. I mean, that’s one of the things you always have to work through is making sure that someone doesn’t let anxiety and being scared stop them from achieving the goals they can potentially achieve in their lives.

Josh Blenclowe (18:12):

Yeah, correct. Exactly right.

Michael Dermansky (18:16):

I guess moving on for similar lines as well, is it ever too late for someone to start to build strength and confidence in the body, that you’ve seen?

Josh Blenclowe (18:28):

Straight line answer is no. We have, I think, the oldest client that I have seen here at MD Health would be 85, and she is brilliant. I do not treat her like an 85 year old whatsoever. So, no, the answer is just flat no.

Michael Dermansky (18:51):

What are the major benefits? I mean, what do you know about if someone’s scared in their 70s and they’re just starting a program as well, what are the benefits? Why start at something at 70 years old?

Josh Blenclowe (19:03):

Look, as we get older, our joints, our muscles do naturally degrade, and a big thing for the elderly as well is that bone density in that bone mass, which will naturally decrease. So, resistance training and reformer Pilates training and simple any exercise whatsoever is really going to help that bone density and help their muscles to really just switch on. Activation is key. It doesn’t have to be doing big weights, it doesn’t have to be heavy necessarily, it’s just simply switching on all those important muscles to make their lives just that much better.

(19:47):

So, they might love walking, it might be a k of walking, it might be 10 minutes of walking, it doesn’t have to be anything too extravagant. But, then as they get older, they have that fear that, “Oh, okay, I’m just going to accept that I cannot walk again.” Or, “I can’t walk as far again.” We can change that. We can get them into an assessment, we can work with their bodies and we can enhance their activation to transform into doing the things that they love.

Michael Dermansky (20:21):

Yeah, so, I mean, as you just said, as you get older, when you start to get reduced muscle mass, people scared they can’t walk, they can’t do this, they change their lives and it’s a really ugly spiral where people feel scared of doing something, they do it less, they get further weaker, they do it less and it becomes a spiral of reduced confidence, and a lot of the times, I mean, there will be limiting factors too, but it’s becomes a self-fulfilling prophecy that we don’t want to see happen. It’s an unnecessary reduction in people’s quality of life that doesn’t need to be there. They can be stronger, they can do it, as their muscles get stronger, their confidence and their balance improves, so that it’s trial new things and it’s a virtuous cycle.

(21:04):

I mean, there is a degree of Sarcopenia, which is a reduction in muscle mass as people get over 65, that’s a normal degree, but that’s 80s, 90% of the reduction in muscle mass is due to lack of activity, not for due to that process, and so that’s a large amount that can be controlled, that’s unnecessary, and I like seeing people have the lives they deserve, not that they’ve boxed themselves into.

Josh Blenclowe (21:32):

Yeah, correct.

Michael Dermansky (21:33):

I guess on the other end as well, is it anything that you’ve noticed is too early to start? What is the youngest you see people working on getting the confidence in their body?

Josh Blenclowe (21:44):

Well, I’ve had a kid come in, he was 14. I know that’s the youngest that I’ve seen. I know there would definitely be younger than that for sure.

Michael Dermansky (21:57):

Yeah, we’ve done a few kids about six, seven years old as well, here.

Josh Blenclowe (22:00):

Yeah. I think obviously with the opposite end to the elderly being the young, their bodies are still growing, their bodies are still transforming in which if you get onto certain things early enough can make just that small change, which can really set them up for that growth coming into their later teens. So, that’s what I’ve got a great example of a 14 year old kid that we have here who is very tall. So, I’m about 6’1, I’m looking straight into his eyes, he’s a very tall individual, and he’s quite kyphotic through his thoracic, so he’s got very long limbs and he’s that classic… He feels too tall for himself and they’re all naturally slump.

(22:55):

So, we’ve really transformed his body just by doing all those right exercises for their posterior chain, and making him taller, basically making him stand up nice and straight and neutral. We’ve seen over the space of, I would say, six months, I’m looking up to him now because I just feel like that his posture has just changed dramatically, which is incredible, and he plays basketball and all those things, which he needs that proper postural strength to basically get the best out of his game.

Michael Dermansky (23:34):

Right. Excellent. I mean we’ve seen kids younger than that too as well, and at the end, when you go between six and say 12, our biggest aim is our agility coordination. Not a huge amount of muscle strength, but just getting people comfortable, kids comfortable exercising sport. So, where we tend to see is where these are shy, sort of low toned kids that just don’t participate, and we know we’ve done our job properly when the parents tell us, “Oh, how’s he feeling?” “Oh, similar, but he’s now just doing more things,” and that when they would cling on to the side of the rail when they’re going and swimming, now they’ll just go participate or just go play soccer with their friends. Where with the teenagers, like you’re talking about as well, you’ll start to add a bit more formal strength work in their program, particularly if they’re playing sport like basketball or football, is they’re going through this massive growth spurt, but their muscles aren’t necessarily strong enough to be able to cope with that too.

(24:29):

When they get things like… All viewers, might not all this stuff they know, there are things like Turkish ladders, and these are all where the load on the joint, the attachment from where the muscles attach onto the bone is the weakest part of it, and they tend to break down because you just can’t take the load, and so it’s really important to build up kids’ muscle strength. So, the young footballs where they’ve gone transition from under 12, under 14s, under 16s where the load and the speed’s gone up quite significantly as age groups, their bodies don’t always cope when they go through a growth spurt. So, they’re really important times to bring things back, make them strong again, so they can transition to the high level of sport.

Josh Blenclowe (25:15):

Okay. Yeah, a hundred percent. Yeah.

Michael Dermansky (25:17):

So, Josh, before we finish up, any other further things you want to add and tell listeners before we finish up today?

Josh Blenclowe (25:24):

I think it is, if you are thinking about getting into some form of exercise, then reformer Pilates and the things we do here at MD Health would be a fantastic start. As we’ve discussed today, you can be as no point being too young, there’s no point in time where you are too old to do anything. Every stage in your life is important. So, I would heavily encourage with our amazing team here and the guidance that we have from someone like yourself, Michael, being that senior physiotherapist is absolutely fantastic, is just to conduct our assessment. You might have weaknesses, you might have strengths that you didn’t know about. So, we can really inform you on that and really transform your life to get the best possible confident body that you can.

Michael Dermansky (26:25):

Excellent. Well, thank you very much for your time Josh, and I hope that all listeners got quite a bit out of today’s podcast and start building their confident body. Thank you very much and we’ll hear Adrien. Well, next up will be one of our other senior exercise physiologists, Adrien, who’ll be talking about getting started again this year. Thank you very much.

Voiceover (32:49):

Thank you for listening to The Confident Body. For practical articles to help you build a confident body, go to mdhealth.com.au/articles.