Craig Liebenson

Dodgers ask feds to leave; team delays initiatives

Still the biggest factors that send people to the clinic.

This doesn’t just apply to people starting programmes or novices, we can all be susceptible to these easily made mistakes.

As races draw nearer, keep an eye on the big picture.

Highlighting a physical inactivity crisis & failure of both HCPs & public health measures to promote lifestyle modifications (sleep, substances, stress, diet/weight, PA, social participation) & behavioral change.

Our rapidly aging population faces a rising tides of NCDs - CVD, OA, LBP, falls, fractures & frailty. These are not merely due to people living longer, but to escalating levels of obesity & T2D - a metabolic storm.

MSK episodes are generally recurrent or persistent. Over-detection, nocebic labeling & various conservative & interventionost treatments are promoted, but none have robust effect sizes for effectiveness. While self-management is all but ignored.

There is a growing evidence-practice gap in the MSK pain field - termed a "super winked crisis". Most PT & DC curriculums & practitioners are slow to de-implement evidence-discordant or low-value MSK approaches.

Proper exercise can reverse damage from heart aging Exercise can reverse damage to sedentary, aging hearts and help prevent risk of future heart failure – if it’s enough exercise, and if it’s begun in time, according to a new study by cardiologists at ...

www.utsouthwestern.edu/newsroom/art...

Offline: Making obesity matter “None of us were entirely right, none of us were entirely wrong.” That was Francesco Rubino's wry comment on his Commission, published by The Lancet Diabetes and Endocrinology on Jan 14, 2025, and lau...

Making obesity matter - The Lancet

www.thelancet.com/journals/lan...

This is a helpful summary of the Rubino et al commission on redefining obesity

Relationship between Physical Activity and Pain in U.S.... : Medicine & Science in Sports & Exercise gical cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hyp...

Meeting the aerobic-only and strength-only criteria also demonstrated a large increase in odds of reporting less frequent pain, 52% and 31% res bunny. I’m gonna go in the office and my goal for Friday canceled Wednesday

journals.lww.com/acsm-msse/ab...

“Individuals engaging in physical activity—strength and aerobic—demonstrated two-times lower odds of reporting pain when compared with those not meeting the physical activity guidelines.

“PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating 2 times lower odds of reporting pain when compared to those not meeting the PA guidelines.”

“There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain.

People considering exercise to prevent low back pain recurrence prefer exercise programs that differ from programs known to be effective: a discrete choice experiment Do program and participant characteristics influence people's willingness to undertake exercise programs to prevent recurrence of low back pain?Discre…

“People who experience low back pain commonly have a recurrence within one year. Exercise is the only intervention known to be effective for preventing recurrence of low back pain.” www.sciencedirect.com/science/arti...

including health system-level barriers such as unavailability of effective services within the local healthcare system and failure of clinicians to deliver or prescribe exercise to prevent recurrence of LBP.”

“future research should explore how to engage those who are unwilling to exercise to prevent recurrence of LBP. This includes mapping and addressing barriers to participation in preventive exercise programs,

Harmful Marketing: An Overlooked Social Determinant of Health - Prevention Science This paper reviews evidence about the impact of marketing on ill health. We summarize evidence that marketing practices in six industries (tobacco, alcohol, pharmaceutical, processed food, firearm, an...

Harmful Marketing

link.springer.com/article/10.1...

This is sooooo good

1. Obscuring Goals & Impact
2. Efforts to Conceal Impact
3. Efforts to Protect Its Investments (through advertising, and thus shaping our views and attitudes)

And many issues beyond

Recommendations for shaping the future of low back pain prevention research Prevention is a fundamental tenet of medicine but has been largely ignored in low back pain (LBP), where clinical care and research have focused on the treatment of those currently experiencing an epi...

“Recurrences are very common 70%of people will have at least 1 recurrence w/in 12 months &40% will experience activity limitation or seek care as a consequence of recurrence.Thus,the benefits of even moderately effective secondary prevention interventions could be large bjsm.bmj.com/content/earl...

4) Plan that ⬇️ risk of non-communicable diseases (NCDs)

Measurables: negative health outcomes (OA, CV disease, falls, fractures, frailty)

3) ⬆️ metabolic-physiological health
Measurables: ⬇️ inflammation (DXA, waist circumference, Blood biomarkers)

2) ⬆️ psychological resilence - ie self-efficacy

Measurables: Subjective scales - confidence, fear-avoidance beliefs

1) Empowering people to meet the PAGs - keystone health behavior w: max impact
Measurables: daily steps, weekly aerobic time, weekly strength training sessions)

Signs & measurables of a high value approach:
1) Empowering people to meet the PAGs
2) ⬆️ psychological resilence
3) ⬆️ metabolic-physiological health
4) Plan that ⬇️ risk of NCDs

It shouldn’t matter what methods are deployed so long as they serve preventive (positive) health care goals.

Health is more than the absence of disease.

Changing lifestyle & behavior is the key & it requires a team

How can you tell the difference between high & low-value MSK care?

Do people who buy e-bikes cycle more? Previous research shows that e-bike owners use private cars less than other transport user groups, and also report to have changed from motorised to n…

Do people who buy e-bikes cycle more
www.sciencedirect.com/science/arti...
Yes
⬆️ their bicycle use from 2.1 km to 9.2 km on average per day; a 340% ⬆️.
The e-bike's share of all their transportation increased dramatically - 17% to 49%, where they e-biked instead of walking, public transit, & driving

Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy? A randomised controlled trial - Baraa Alsulaimani, Luke Perraton, Patr... Objectives To investigate the efficacy of adding radial extracorporeal shockwave therapy or sham to exercise for people with insertional Achilles tendinopathy. ...

“The addition of radial extracorporeal shockwave therapy to exercise and education did not lead to improvements in pain, function or other outcomes compared to sham at 6 or 12 weeks among people with insertional Achilles tendinopathy.”

journals.sagepub.com/doi/10.1177/...

My next book is on Sustainable Athleticism & Healthy Longevity and this is also the main course topic I teach.

Yet lifestyle change to improve healthy longevity w/ our aging population became a real possibility & simultaneously this maintained quality of life & function in those with pain.

Making health span last one’s lifespan is my mission. My practice began pivoting from MSK pain to NCD prevention about 5-7 years ago as the literature confirmed the low effect sizes for any treatments benefits for MSK pain became apparent.

We don't discuss an end of cars and hence we stand no chance re #microplastics
jacksondamian.substack.com/p/driven-mad

Resistance exercise has an antihypertensive effect comparable to that of aerobic exercise in hypertensive patients: a meta-analysis of randomized controlled trials - Hypertension Research These authors contributed equally to this work:

www.nature.com/articles/s41...