Decoding Pain: I3 Model

Pain, an all-too-familiar sensation for many, often leads us down a path of frustration and quick fixes. However, what if we were to interpret pain not as a mere inconvenience, but as a critical message about our body's mechanics and movement? Instead of resigning ourselves to discomfort, understanding what pain signifies can transform our approach to physical well-being. This is where the I3 Model, a concept borrowed from engineering and adapted by the physical therapy genius Kelly Starrett, comes into play.  This model offers a blueprint for navigating, and ultimately overcoming pain. 

Understanding the IModel 

At its core, the I3 Model simplifies the complexity of pain and injury into three interconnected stages: 

I1: Incomplete Mechanics 

The first stage, Incomplete Mechanics, highlights the root of most pain: poor movement patterns, limited range of motion, and inadequate strength. These deficiencies lead to suboptimal body mechanics and compensations, setting the stage for strain and over-tension in our tissues. Most of us are blissfully unaware of these issues until they escalate. 

Key Insight: Ignorance might be bliss, but not in the realm of body mechanics. Addressing Incomplete Mechanics early can prevent the downward spiral into chronic pain. Check out our Shapes series on YouTube to learn how to move efficiently. 

I2: Incidents 

Progressing to the second stage, pain becomes apparent and is usually triggered by specific activities (e.g., running, squatting, reaching overhead). Incidents are the aches and pains that seem to come out of the blue and there is no identifiable trauma. To tie in last month’s content, imaging is NOT indicated or helpful for I2 issues. This stage is a stark indicator that our body is no longer able to cope with the stressors imposed by our persistent mechanical or loading errors.  

Key Insight: Pain at this stage is a lagging indicator, a cry for help from our body urging us to reassess and adjust our movement patterns and training before it's too late. 

I3: Injury 

The final stage, Injury, brings activity to a halt, signifies that the damage has been done and forcing a confrontation with the reality of our neglect. The cumulative effect of ignoring our body's warnings and chewing through enough I1 and I2 cycles is that your tissues failed and you are dealing with lasting pain and possible disability for several weeks. Nobody likes I3. The unplanned (and hard to avoid) slips, trips, and falls land in this category too. That’s where imaging can be helpful if we fell off a ladder and can’t lift our arm, or our knee is buckling after that big ski wreck. 

Key Insight: Injury is not just a physical setback; it's a wake-up call to prioritize our movement health to avoid future debilitations. 

The Path Forward 

So, what's the takeaway? Pain should serve as a catalyst for change.  Often vilified and misunderstood, pain is actually a sophisticated messaging system designed to protect and inform us. By decoding its messages through the lens of the I3 Model, we can preemptively address the root causes of discomfort and avoid the pitfalls of injury. Embrace pain as a teacher, guiding you toward a more informed and intentional approach to your physical health. Remember, pain is not the end but the beginning of understanding your body better and unlocking its full potential. 

                              - Written by Team GSM


Your Body is NOT a Machine

One of my family members dealt with right knee pain for years. Eventually, she got an x-ray, which showed bone-on-bone arthritis. Shocked, she was considering a knee replacement. Her daughter, who was with her, asked if they could see her OTHER knee to compare. The left knee’s x-ray was identical, showing bone-on-bone arthritis. But she had zero left knee pain, and never had dealt with pain on the left side before. 

This example leads us to challenge conventional wisdom: medical imaging (x-rays, MRIs, etc), often hailed as the gold standard, are not as reliable as we once thought.  Many people “qualify” for surgery based on two things: imaging results, and the presence of pain.  But what if we’re missing something? Why doesn’t she have pain in her left knee, even though arthritis is present?  

It turns out that so-called “abnormal” imaging findings are not so abnormal at all. In pain-free 40-year-olds, up to 85% of knee x-rays showed arthritis. That’s the VAST majority of people who are FREE of pain!  Similarly, around 30% of pain-free people have a meniscal tear in their knee.  In pain-free collegiate basketball players, 35% showed significant abnormalities on their knee imaging.  

And it holds true for other body parts too.  MRIs show disc degeneration in the spine in 68% of pain-free 40-year-olds and similarly, 29% of pain-free 20-year-olds have disc protrusions.  For the shoulder, 55-72% of pain-free 45–60-year-olds have labral (cartilage) tears. Full-thickness (complete) rotator cuff tears are present without pain or loss of function in 28% of 60-year-olds, and 50% of 70-year-olds. 

So, what gives? Why are so many people pain-free when they have these abnormal imaging results? 

Medical images can’t assess strength! They can’t tell if a person is training at a level that prepares them for their activities. They can’t discuss with a person how their stress level impacts their pain experience. Imaging takes the human complexity out of it. 

Back when I applied to PT school, my personal statement included “The human body is the ultimate machine. I want to be a mechanic of it as a physical therapist.” Boy howdy, I could not have been more wrong. The human body is not a machine at all – it is infinitely more adaptable and dynamic, changing in response to the environment it is placed in.  This means our so-called “broken” parts don’t slow us down.  And they shouldn’t! 

It's time to challenge the status quo and question the reliance on imaging results as a primary determinant for needing surgery. The narrative of abnormal findings on scans coexisting with a pain-free and active life challenges us to rethink the way we perceive our bodies. 

You are a complex human. A one-size-fits-all MRI does not honor or capture your complexity. Our so-called "broken" or “abnormal” parts don't necessarily impede our progress – and they shouldn't. The abnormal, pain-free group is not only surviving, but THRIVING. Why can’t YOU be part of it? 

                  - Written by Lexi Klawitter, PT, DPT


10 Minutes to Wellness

The New Year is here, and the desire for change and betterment is taking center stage. Amidst the resolutions and aspirations, the quest for sustainable habits remains a challenge. What if the key to lasting wellness and behavior change lies in something as simple as dedicating 10 minutes a day? 

It’s easy to get bogged down by WHAT new habit we are starting: i.e., Which online workout program do I pick? Should I take in person classes? Should I buy a new pair of running shoes before I get started?  Instead, we know that WHAT we do doesn’t matter nearly as much as actually DOING it. Consistency is the cornerstone of behavior change. Short, regular activities create a consistent routine, fostering habits that are more likely to stick.  Once we have proved to ourselves that we can do it, then we can tackle the nuance of getting the most bang for our buck (spoiler alert: it’s not 2 hours on the treadmill)! 

More so, 10 minutes of some activities is actually enough time to make a measurable change. Check your heart rate, then perform 10 minutes of deep breathing.  Check your heart rate after, and in addition to feeling more grounded, you’ll see that you have power over your body in just 10 minutes too!  Similarly, 10-minutes of sprint cycles on the fan bike (10 seconds fast, 50 seconds slow) is enough to get that endorphin boost and get your blood moving. 

The beauty of 10-minute activities lies in their sustainability. Unlike drastic changes that often fizzle out, integrating small, manageable actions into daily life establishes a foundation for sustainable behavior change. Over time, these actions become ingrained as habits, forming a solid base for continued growth. 

As we step into 2024, let's approach wellness and behavior change with a new perspective. Embrace 10-minute activities! Start small, stay consistent, and watch as these incremental changes pave the way for a healthier, more balanced life. 

Are you ready to unlock the power of 10 minutes a day? Follow us on Instagram and Facebook and subscribe to our YouTube channel to start your journey to wellness and sustainable change in the New Year! 

                     - Written by Team GSM 


Beyond the Barbell

Beyond the Barbell 

Here at Granite, we get pretty hyped about strength training for improved quality and quantity of life, because the data is clear; muscle mass and muscle strength matter.  I could write a love letter to the barbell.  But it turns out there are even more reasons to exercise!  With this December weather, my body would rather go into hibernation mode under a pile of blankets, but reminding myself of the benefits of exercise can be a humbling and powerful motivator.  

  • Cancer Risk Reduction: Regular exercise has shown promise in reducing the risk of certain cancers, including breast, colon, and lung cancers. It's not a guaranteed shield, but studies consistently highlight the correlation between physical activity and lowered cancer risks, often in the 20-40% range!  

  • Coronary Artery Disease: We all know exercise is a boost for heart health. The key here is that intensity matters.  Instead of committing to a 2-hour walk for heart health, try hitting your maximum heart rate once per week.  Pick your cardio machine of choice (assault bike, rower, etc) and go as hard and fast as you can until you have to tap out. Typically, this will occur within 1-4 minutes!  Hitting full fatigue is actually more reliable than most heart rate monitors on watches to make sure you’re getting the full benefit. 

  • Alzheimer's and Dementia: Physical activity has been linked to a decreased risk of cognitive decline and we like to think about it exercise as a bubble bath for your brain! While it may not prevent Alzheimer's or dementia entirely, it can certainly delay their onset and potentially mitigate the severity. To me, this one is a no-brainer (pun intended)!  My typical mid-workout hype involves, “Do it for your brain!” 

  • Sleep Quality and Stress Reduction: Exercise can significantly impact sleep quality by promoting deeper and more restorative sleep.This time of year, the lack of sunlight can mess with our sleep cycles. Increasing activity, especially earlier in the day, can help offset the darkness and improve sleep. 

  • Mental Health and Depression: When you exercise, your body releases endorphins, neurotransmitters that act as natural mood lifters. This 'feel-good' sensation after a workout can help combat feelings of sadness and stress. It also aids in reducing cortisol levels, the stress hormone, leading to a better overall sense of well-being.  Studies suggest that regular exercise can be as effective as medication or therapy in alleviating symptoms of mild to moderate depression. It's a natural, accessible way to boost mood and overall mental health. 

Although we may still run into challenging health issues, exercise can help us stay healthy AND recover faster.  Aging well is not the absence of sickness or disease; it’s how well we weather it. 

                                  - Lexi Klawitter, PT, DPT


Giving Gratitude

Gratitude has long been recognized as a fundamental virtue in human society. What many people don’t realize, however, is the profound impact it can have on your physical well-being. Scientifically speaking, practicing gratitude can significantly enhance your overall health. When you express gratitude, your brain releases dopamine and serotonin, which are neurotransmitters responsible for making you feel good. These chemicals not only boost your mood but also play a crucial role in reducing stress and anxiety. Moreover, gratitude has been linked to improved immune function, better sleep, and reduced symptoms of depression. But the wonders of gratitude don’t stop there; its effects can also be observed in your body’s physical resilience and strength. 

  

My Journey: Nurturing Strength Amidst Challenges 

  

Eight months postpartum, I find myself on a challenging, yet transformative journey. Recovery from pregnancy and an unplanned cesarean section has not been easy, especially coupled with orthopedic injuries caused by hormone changes during pregnancy. Torn plantar fascia, a recent ankle sprain, and persistent back pain due to nursing and sleep deprivation have posed significant hurdles. The looming ski season fills me with both excitement and trepidation. 

  

Amidst these challenges, I hold onto gratitude like a lifeline. Every day, I marvel at my body's ability to nurture and sustain life, providing nourishment for my child and partaking in daily activities. While I might not be where I want to be in terms of strength and athleticism, I am profoundly thankful for the progress I’ve made. I cherish the moments spent outdoors, relishing walks and bike rides with my family during this beautiful fall season. These small victories remind me that my body, despite its setbacks, is still capable of joy, movement, and love. 

  

In the face of physical trials, I continue to cultivate gratitude. I am thankful for the support of my family, the healing power of nature, and the strength within me that propels me forward. Every day, I strive to be present in the moment, appreciating the simple joys of life, and celebrating the progress I make, no matter how small. I might not be sprinting down slopes this ski season, but I am embracing the opportunity to strengthen my body, mind, and spirit. With gratitude as my guiding light, I am confident that I will overcome these challenges and emerge stronger, both physically and mentally, ready to conquer whatever lies ahead. 

  

Moreover, the landscape of healthcare has undergone a profound transformation. No longer limited to the traditional biomedical model, contemporary research emphasizes the vital connection between mental and emotional well-being and overall physical health. Healthcare professionals now recognize the significance of factors like sleep hygiene, diet, exercise, meditation, breathwork, and emotional intelligence. These elements, crucial in promoting mental and physical resilience, are no longer viewed as complementary but rather integral components of a proactive healthcare strategy. This paradigm shift acknowledges the interconnectedness of mind, body, and spirit, therefore paving the way for a more balanced and fulfilling life. 

         - Written by Alison Shannon-Lier, PT, DPT


There's a better way to live!

October is Physical Therapy month and I want to jump up on my soap box and proselytize about how amazing our profession is.  Our healthcare model is slowly but surely shifting and PT is coming out on top as the provider of choice to restore and improve tissue capacity, improve pain, and push back on aging.    Sure, we can help you heal quickly after injury, but we can also make you a more resilient, happier human with an improved life span (how long you live) AND health span (period of time you are free of disability and disease).  Who doesn’t want that?   

When I first started practicing physical therapy over two decades ago (yikes!), we were a reactive profession.  Patients often entered into the healthcare system through an injury, and after bumping down a murky road of imaging, pain medication and too often surgery, they would end up at a physical therapy clinic.  

Luckily over the past 10 years, we have become the provider of choice for injuries.  We couldn’t be more thrilled to have our patients seek care with us first when they get hurt because we KNOW that we can accurately diagnose their injury, get them better faster and be less costly than any other medical provider.   

While this shift is both encouraging and necessary, Team GSM has bigger aspirations than just getting you back on your feet again and returning you to a pre-injury baseline.  Our team also has a more proactive approach to physical therapy and is helping folks get upstream of injury by seeing folks before a sport or recreational season, helping our patients avoid overuse injuries and keeping our elderly folks living independently.    We want to coach you towards being a more resilient human who is less likely to get hurt in the future.   

What really gets me fired up is that in the past several years there has been a tremendous amount of data looking at our ability to push back on metabolic diseases (the biggest causes of death.)  I’m pumped that PT is the top provider to help with this.  When we look at our ability to improve our life spans, health spans and “trick” our genetics, skilled exercise prescription is the most effective lever we can pull.  Appropriate strength and conditioning is more than going for a walk or jumping into a yoga class, it’s understanding our energy systems and how challenging them correctly pushes back on most systemic, chronic disease.  Since PTs are the experts on movement, exercise and the skeletal system, we are the best providers to step into this space.  

14 years ago, I started my Workshops For Workers in Yellowstone NP which are geared towards reducing injuries and improving overall quality of life. That data is strong, we are making a difference, and the word is spreading!  We wanted to reach an even wider audience with this data and created the Move Better Series to help folks get more fit and healthier.  Awesome, right?  

When Team GSM looks to the future, we see a much bigger goal than waiting for you to get hurt and then getting you back to your pre-injury baseline.  We want to raise the bar, give you the opportunity to decrease your risk of metabolic disease while crushing the trail miles well into your older years.  If there’s one recommendation I can make, it’s don’t be reactive and accept “age related decline” but get proactive about your health and wellness.   Find a fitness forward PT who understands how intelligent strength and conditioning is truly the elixir of youth, and get after it! 

Written by Darcy Cook, MSPT 


It's money in your bank!

Needing to have surgery stinks, and while it’s widely known that people usually end up doing some PT after they have a joint surgery, many people don’t think about doing a course of PT beforehand. There are a lot of great reasons to do some pre-op PT: it can help you feel prepared for your surgery and fully understand your surgical protocol and precautions, establish your pre-operative functional abilities to help set post-operative goals, understand healing timelines, as well as educate you on how to stay as fit and strong as possible while you heal. PTs can measure strength and functional capacity before you lose muscle while you are stuck being sedentary after surgery so your readiness to go back to sports and higher-level activities can be accurately assessed.  

What will the day of surgery and days immediately after surgery look like? Do I need any equipment? Patients have questions and we have a ton of experience helping patients through the process and have the time to go through your protocol and restrictions (before you are loopy on pain meds!). We can make sure you are clear on any activity restrictions therefore eliminating any surprises after the surgery. 

Even though you might not be able to do everything you are used to, surgery doesn’t mean you need to stay in bed for 6 weeks until you heal. In fact, post-op healing is better AND faster if you stay strong and active during your recovery. Loss of muscle mass and activity capacity can happen extremely quickly during a period of inactivity. We lose strength fastest in the first week of inactivity, and we lose fast twitch muscle fibers more quickly than slow twitch. PT can help you learn how to adapt your favorite exercises so you can still get your heart rate up, lift heavy stuff, and stay strong even if you must leave a leg or an arm out of the equation for a while. There’s no reason to sacrifice your whole body’s fitness because your knee or shoulder is out of the game!  

Another important aspect of staying strong is knowing where you started. Because surgery can keep you from working at your normal capacity, your overall strength (not just the knee or shoulder you got patched up) decreases. While we can test strength to compare limb symmetry during post-op recovery, if we don’t have a measure of that prior to surgery, we cannot truly know if you are back to where you were prior to surgery.   

If you are facing an orthopedic surgery, consider doing a pre-op appointment (or a few!) to make sure you are ready to take control of the operative experience and go into surgery with money in your fitness bank. 

-Written by Sydney Williams, DPT 


Old and Broken

With my 49th birthday right around the corner, my peer group is looking midlife squarely in the face.  This phase of life has a lot of built in acceptance.  Accepting the grey hairs, the wrinkles, the utter lack of time, and the need to hold the wine bottle at arm’s length to read the label, to name a few. Unfortunately, I also hear folks accepting that weakness and loss of function is just an unavoidable part of aging.  The good news is that simply isn’t true.  The bad news is you gotta work for it.  

The data doesn’t support that our body parts “wear out” with activity.  In fact, the opposite is true.  The more we move and load our joints, the healthier they become.   The healthier they are, the less they hurt. Even after old injuries, playing or working hard, or being told you have an arthritic joint (all of us old folks do!) you do not have to feel old and broken.  The data is clear that joint pain and tendon issues are resolved with appropriate strengthening. 

We have strong data that looks at longevity, injury risk, and general wellness.   For example, if you can do 10-15 pushups from the floor, we consider that good strength for a horizontal press (think pushing the lawnmower, pushing a stroller, etc).   On a good day, I can knock out 10 but I know that 15 would put me in the “great” category for shoulder strength and stability which reduces my likelihood of strains and sprains down the road.  Doing a push up off the floor may seem completely inaccessible, so start by doing them off your counter top while you wait for your coffee to brew, 30-45 sec total.   Check out the video blog for ideas! 

Next up, the ability to do 28 calf raises in 30 secs is normal for under 40 years old (I can nail this one!) and 12 raises if you are over 60.  Not only do your calves drive you up to the summit or up the ladder, calf strength also reduces likelihood of injuries like plantar fasciitis or Achilles issues.  Most importantly, calf strength is connected to fall risk as you get older.   Your calf muscles propel you forward making you less likely to stumble.  Try holding onto the countertop and knock out a handful while you brush your teeth.  Goal might be 15-20 on each side, depending how it feels.  

You know the GSM crew is ALL about appropriate strength and conditioning to not only maintain but to improve our quality of life and our longevity.  I can’t emphasize enough that weakness and loss of function is not age related, it’s due to a lack of appropriate strength and conditioning.  With plummeting hormones, poor work-life balance, and just so many time demands, it’s no wonder we feel discouraged and we just can’t seem to find the time.  I get it.  Start small with some calf raises and counter top push ups, be consistent with a few minutes a day and you might be surprised how good it feels to PUSH back on aging.  

- Written by Darcy Cook, MSPT 


Work Hard to Play Harder

The last several months have involved solid training and even more solid recovery for team GSM, and these efforts have paid off for PLAY.   From stiff, creaky knees in the morning, to irritable necks, to recovering from the delivery of a baby girl, our team is not without the challenges life throws at us!  Fortunately, we are equipped with the knowledge and motivation to push back on soreness and build tissue capacity. Our team knows that we have to work hard to play harder and we put in the squats, lifts, and cardio so our resilient bodies can reap the benefits! 

Last summer, I had just moved home from the Midwest, where the most vertical I could gain at a time was about 600 feet.  Stoked to be back in the Montana wilderness, I dove right in with a 3000 foot elevation gain on my first hike of the season. My knees had *quite* the wake-up call.  This year, consistent, progressive weightlifting through the Move Better Series (and beyond into General Physical Preparedness – GPP) led to zero knee crankiness after my inaugural hike.  I also made a better choice about building up a little tolerance to the trail mileage, avoiding the dreaded “Boom/Bust” cycle.  Wondering how you can build up tolerance to continue doing the things you love?  Come see us for a consult and we can create a custom workout program to meet your fitness goals AND time constraints.   

While my goal is to prioritize outdoor time, I’m still getting in my heavy squats and lunges.  It’s actually easier for me to stay motivated to continue lifting this time of year when I can end a hike with minimal soreness in my knees.  The relationship is clear and direct.  And it’s extremely rewarding to feel the hard work pay off!  

The WHY behind the workouts is so apparent this time of year. We’re getting after it with everything from bagging peaks to enduring house renovation to spending hours in the garden without having to pay for it.  Being able to play hard is worth the work.  Get out and enjoy living your WHY! Let’s get after it!   

                                                                                                                                                                  -Written by Lexi Klawitter, DPT 


And I'm feeling good!

I don’t know about you, but I am so elated to have sun on my face, beautiful blooming trees to enjoy, blue sky overhead, birds singing, and the smell of lilacs filling the streets around town.  The summer solstice is just around the corner and those few random smokey days are behind us.  June is here and it feels GOOD!  This got me thinking about how I was feeling physically, especially taking note of my lack of joint stiffness and pain and increase in energy.  Why are my knees feeling better?  Why now?  Sunlight plays a huge role in both our physical and mental health.  The sun helps us synthesize vitamin D which can improve joint and muscle pain and fight off depression.  The earlier sunrise also improves circadian rhythm which sets us up for a good night’s sleep. 

Also, we do tend to get more exercise this time of year.  We see more walkers, bikers, and runners popping up around town.  The outside tennis courts are filling up with all ages and the soccer fields are bustling with activity.  Motion is lotion and the increased activity helps decrease our soreness.  With the longer days, we are apt to take longer walks or runs, stay for an extra pick-up basketball game, or spend one more hour in the garden or mowing the lawn.  This increase in activity also helps with our sleep and allows our bodies to reboot more effectively overnight.   

What about the physical benefits of being out in nature?  Spending just 10 minutes a day outside can improve your mood.  Whether it’s taking a walk on your lunch break and sitting by the Yellowstone or hitting the newly thawed trail to get in the mountains, you can tap into better brain chemistry.  And if you want to level up your mindfulness, practice noting what you smell, see, hear, and feel while on your outside adventures.  This small noting exercise has been connected to people experiencing less pain and more calmness.  Take in those awe-inspiring views! 

If we introspect into the benefits of June, it can give us a roadmap for weathering the next long, dark winter with better brain chemistry, less soreness, and better sleep.  This is an easy season for sitting back and enjoying the ride but try digging a little deeper and identifying the reasons WHY this time of year is so dang good and how we can capitalize on these benefits year-round! 


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