Should rehabilitation exercises be painful?

There seems to be two, somewhat group-specific although not equally wrong – general opinions on this:

The “Crossfit”-group, for the people who proudly wear the “No Pain No Gain”- tshirts and think that it has to hurt to work. All that nonsense; you are either one of those or you have heard it. The former is obviously worse and this view undoubtedly represents the “most wrong” opinion.

The “Personal Trainer”-group, for the people who have attended at least one expensive course/workshop/coffee meeting. Mantras such as “do not move into pain” and “pain is bad, mkay” rule the atmosphere of beliefs, and – not unlike the CF-group, they take pride in being part of this… better-knowing group of educated individuals. Once upon a time I too probably belonged somewhat to this group, so – because of social “reasoning” – that makes it okay for me to say it.


If you noticed the SP-ref and the sarcasm at the end there, there might be hope for you yet.


Now to the point. Both groups are most likely wrong.
Here´s why:

A 2017 meta-analysis titled “Should exercises be painful in the management of chronic musculoskeletal pain?” looked at both the acute and long-term effect of exercises where pain is allowed/encouraged compared with non-painful exercises. Based on the conclusion shown below, it would appear that both groups are wrong and that a moderate and controlled (in time) level of pain during (rehabilitation) exercises is okay, and perhaps even something to strive for. Good news for the sadists and masochists out there.

Conclusion: Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. In the medium and long term there is no clear superiority of one treatment over another. Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.


Are vegans getting enough protein?

Are vegetarians? Are fish-eaters?

Obviously there are individual differences within each group, so safe yourself the trouble of going down this line of thought thinking you are all that.


A newly-published cross-sectional analysis investigated the differences in plasma concentrations (mass spectrometry) and in intakes (food frequency questionnaire) of amino acids between 392 male meat-eaters, fish-eaters, vegetarians and vegans.
Results as follows:

Intakes of all 18 dietary amino acids differed by diet group; for the majority of these, intake was highest in meat-eaters followed by fish-eaters, then vegetarians and lowest in vegans (up to 47% lower than in meat-eaters).


All in all, concentrations differed between groups; each group was high in some amino acids and low in others. However, a pattern – as indicated in the quote – appeared, indicating that vegetarians and vegans, on the whole, might be consuming insufficient amounts of protein. Even though the long-term health of people on a plant-based diet is quite good and possible superior to comparable omnivores, it is wellknown that it can be difficult to consume sufficient amounts of all the different amino acids when on a vegetarian/vegan diet, so for the majority the results from this study should come as no surprise. It should, however, serve as a reminder that – unless you are eating meat on a regular basis – you should take steps to ensure that you are getting enough protein from other sources.

Low-carb or low-fat for weight loss?


Ah yes, the most asked question in all weight loss-groups known to man. The equivalent of to crossfit or not to crossfit, and the closest most nutrition people come to being part of a science-denying cult. For some reason, there is no middle way on this one; you´re either for or against, and if you are too smart/chickenshit not to choose, you know nothing.

Luckily, a newly published meta-analysis of 32 controlled feeding studies seems to have settled the case. This effectively means that, in 5-10 years, the majority of people in the fitness/nutrition industry will know and talk proudly about this.

In short, low-fat diets showed to elicit the greatest increases in fat loss.

Below is the abstract and a forest-plot of the included studies and their results.


Weight changes are accompanied by imbalances between calorie intake and expenditure. This fact is often misinterpreted to suggest that obesity is caused by gluttony and sloth and can be treated by simply advising people to eat less and move more. Rather various components of energy balance are dynamically interrelated and weight loss is resisted by counterbalancing physiological processes. While low-carbohydrate diets have been suggested to partially subvert these processes by increasing energy expenditure and promoting fat loss, our meta-analysis of 32 controlled feeding studies with isocaloric substitution of carbohydrate for fat found that both energy expenditure (26 kcal/d; P <.0001) and fat loss (16 g/d; P <.0001) were greater with lower fat diets. We review the components of energy balance and the mechanisms acting to resist weight loss in the context of static, settling point, and set-point models of body weight regulation, with the set-point model being most commensurate with current data.



Blue-light blocking glasses for better sleep


A study very fancy titled “Attenuation of short wavelengths alters sleep and the ipRGC pupil response” was recently (June 2017) published in OPO.

Luckily, the practical applications of said study are more down to earth: In short, participants were asked to wear blue-light blocking glasses every night before bedtime for 2 weeks. Night-time melatonin-concentration, sleep duration and sleep quality were measured. Subjects wore the glasses 3:57 ±1:03h each night.


Night time melatonin increased from 16.1 ± 7.5 pg mL−1 to 25.5 ± 10.7 pg mL−1 (P < 0.01). Objectively measured sleep duration increased 24 min, from 408.7 ± 44.9 to 431.5 ± 42.9 min (P < 0.001). Mean PSQI score [measures sleep quality] improved from 5.6 ± 2.9 to 3.0 ± 2.2.


Less blue-light before bedtime; better and longer sleep. Good stuff.

TV in the bedroom? Bad idea

TV in bedroom increases obesity risk – even in youth athletes.

Yes, this means it most likely has an even larger negative effect on you. If you absolutely have to sleep less, at least do something worthwhile in the bedroom.

Athletes with a TV in their room of sleep had higher BMI (22.73 vs. 20.54; P<0.001), slept less hours/week (7.65 vs. 8.12; P=0.003), and were more likely to be overweight/obese (40.32% vs. 25.52%; P=0.022). Athletes with unrestricted, unmonitored internet access in the room of sleep had a higher BMI (21.68 vs. 19.83; P<0.001), slept fewer hours/week (7.58 vs. 8.60; P<0.001) and per/weekend (9.00 vs. 9.37; P<0.001). After adjusting for age and gender, having a TV in the room of sleep remained significantly associated with BMI and WHO criteria for overweight/obesity.


Stracciolini et al., 2017.

What makes your pain better/worse?


It is now well established in the literature that factors like poor sleep (Schuh-Hofer et al. 2013), negative expectations (Bingel et al. 2011; Kessner et al. 2014), worry, anxiety, depression (Ligthart et al. 2013; 2014), fear (Crombez et al. 2012) , stress (Chen et al. 2011; Fagundes et al. 2013; Scott et al. 2013) and negative beliefs about the injury (Wiech et al. 2008; Wertli et al. 2014) all have the capacity to amplify the danger messages. Therefore the brain is alerted to more “danger” than there actually is and the pain response may not reflect the degree of tissue injury.

- Running Physio.


How much sleep do you really need?

The National Sleep Foundation gathered a 18 person- multidisciplinary expert panel to evaluate scientific literature regarding sleep requirements for different age groups. The evaluation is published in the journal “Sleep Health” and nicely illustrated in the infographic below.

Of note, the conclude that individual sleep requirements should be considered, but that these (should) rarely deviate far from the normal range. If done so consistently, over time this will most likely compromise health and well-being.

Alongside the CF-idoms/nonsense-phrases that somehow became popular due to plain stupidity, the “you can sleep when you are old”- phrase should be disregarded and the person stating it publicly ridiculed. That is, of course, only if you are interested in optimising health, memory, mental and physical performance, recovery, lean body mass, pain reduction etc etc.*




* (Thomas et al., 2000; Alhola et al., 2007; Taheri et al., 2004; Knutson et al., 2007; Afflect et al., 1996; Kundermann et al., 2004; Moldofsky et al., 2001)

The “surprising” problem with calorie counting – part 2

As promised, here is part 2 of the nice little two-story infographic on calorie counting by Precision Nutrition.

Whereas the first one nicely illustrated 5 reasons as to why trying to count the calories that goes in is a waste of time, the one below shows why “calories out” also is close- to- impossible to determine somewhat precisely.

In short; you’re not your neighbour!



The “surprising” problem with calorie counting – part 1

Another nice infographic by Precision Nutrition.

In short, you should know that you have absolutely no idea about how many calories you are really absorbing; mainly because of individuality, imprecise calorie-descriptions and food preparation. That is good news! If anything, it´s an argument to save you the never-ending trouble of counting and weighing your food.

Part 2 is a nice read as well!


Neurocounseling – bridging the gap between brain and behavior

The following is a guest-post by Tim Wayne, sharing an interesting infographic from Bradley University. In the very least it should remind us of the importance of a choosing a good therapist.


In a nutshell, a counselor’s role is to help clients rewire themselves to avoid undesired behaviors while promoting positive ones. However, one emerging field of counseling takes the idea one step further. This field is called neurocounseling, and it is founded on the principle that our brains are always developing to help us retain and use information — a principle called neuroplasticity.

By using knowledge of how the brain works, counselors are now able to better help clients reshape their brains to produce new neurons and neural connections. By reshaping our brains through neurocounseling, counselors are exploring how these techniques can help those suffering from depression, addiction, and even brain injuries.

In the infographic below, created for Bradley University’s Online Counseling Programs, you can learn more about what neurocounseling is and how these techniques can be used to serve those with mental disorders and conditions.