Author Archives: Ray

Applying Physical Therapy to Tai Chi – Part 3: Range of Movement

Improving the range of movement (ROM) of a joint is arguably one of the primary functions of a physical therapist. Physical therapists employ many techniques to improve the ROM of a patient’s joint, including stretching, active and passive exercises, and direct mobilisation and manipulation of the joint. Tai Chi also have techniques involved in achieving optimal use of the joints of the body. One of these is peng jin; in simplest terms, the ability to ‘open’ the joints to assist free flow of qi (energy) through the body. Understanding and being able to apply peng jin could assist physical therapists improve ROM in their patients.

What is ‘Normal’ Range of Movement and Why is it Important?

Normal ROM is considered to be the standard acceptable range a joint can move through in a given plane of direction given normal anatomical considerations. For example, normal active ROM for a knee is generally considered to be 0 (extended) to 140 degrees (flexed). Maintaining normal ROM of joints is essential to preserving normal functional capacity; when the joints don’t move the way they’re supposed to, we are no longer able to do the things we want to do.

Injuries, diseases, deformities, foreign bodies, and limitations of soft tissues can all restrict the ROM of a given joint, resulting in reduced function, pain, and disability. A good example of this is the reduced ROM seen in osteoarthritis of the knee. As the disease progresses, many people demonstrate reduced knee extension (ability to straighten the knee). This is often observed as a tendency for the person to stand or walk with the knee bent. This starts as response to pain and the person’s attempt to reduce weight-bearing on the joint especially when walking.  In time and with progression of the disease it can produce physiological changes, such as tears or deterioration of the cartilage and abnormal surface changes to the bone resulting in decreased joint space, as well as shortening of (primarily) the hamstring tendons. It is a self-perpetuating process: the more time a person spends walking on a bent knee, the more damage and changes are done, the more the person tries not to straighten the knee because of pain.

How Can Tai Chi Help?

There have been a number of clinical studies have demonstrated that practicing Tai Chi can be beneficial in improving physical function of people with osteoarthritis (for example, see the meta-analysis published by Yan and colleagues). However, not all patients seen by physical therapists are able to integrate Tai Chi forms into their rehabilitation, especially in its earliest stages (for example, post-joint replacement therapy). There are however concepts within Tai Chi, such as peng jin, which could be utilised early within the rehabilitation process to facilitate a patient’s progress.

A simplified way of understanding peng jin is to think of it as opening the space between the joints of the body, thereby extending the limbs and trunk. In the early stages of learning, students often use mental imagery to conceptualise the opening of the joints as they practice their forms. A skilled practitioner is able to demonstrate a physical change when applying peng jin to a specific part of the body.

Consider what happens to the knee in the case of osteoarthritis, as demonstrated in an x-ray image below:

The loss of joint space in the affected knee results in a decrease in ROM, both from the narrowing of the joint space, and the subsequent pain resulting from bone-on-bone contact. If the principle of peng jin is to ‘open’ the joint – effectively open the joint space – then it stands to reason that the application of peng jin could result in increasing the joint space, thereby relieving both the physical restriction and pain-producing factors which limit ROM.

Applying Tai Chi to Physical Therapy: Recovery from Joint Replacement Surgery

A common acute limitation to ROM after total knee replacement surgery is the inability to fully extend the knee. Improving extension range in the acute phase of rehabilitation can be challenging, as the patient is often limited by pain and swelling, as well as being preconditioned to not fully extend the knee. Improving extension ROM at this stage often comprises passive and gentle active techniques as more aggressive techniques – for example, manual therapy techniques – are contraindicated while the patient recovers from surgery.

One such past patient of mine had considerable difficulty improving their range of knee extension post-surgery. Using traditional physical therapy techniques, over ten days the patient was able to demonstrate an improvement in knee extension from -10 degrees to -4 degrees extension (the negative indicating the shortfall from a neutral 0 degrees position). However, despite rigorous adherence to their home exercise program and employment of available techniques during appointments, the patient seemed unable to make further progress beyond -4 degrees.

Based on the principle of peng jin, I taught the patient a visualisation technique of ‘opening the joint’ and ‘extending the limb’ while performing a seated knee extension exercise. Within four repetitions the patient demonstrated improved extension range, and by the completion of ten repetitions was able to demonstrate 0 degrees (neutral) knee extension. At the next appointment the patient demonstrated that they had maintained some improvement, measured at -2 degrees knee extension, and by the following appointment demonstrated consistent ability to achieve 0 degrees extension in all positions.

Again, this is at best observational evidence of a specific application of Tai Chi principles to physical therapy. However, it does support the increasing body of evidence-based research advocating  Tai Chi as a means of improving function and mobility, and in my opinion, is worth further investigation as an adjunct to physical therapy.

Know Your Value. Know Your Worth.

If you’re anything like me you’ve probably had to learn at least a few things ‘the hard way’. The most recent lesson for me has been about knowing my value, and knowing my worth. Though I have considered these things before, the importance of understanding them has become very apparent in terms of seeking return on investment – specifically, the return I get on investing myself into various aspects of my life.

Though they sound the same, there is a subtle difference between your value and your worth. I think of it in terms for what you offer, versus what you receive.

Know Your Value

Your value is what you bring to the table. It includes your knowledge, experience, skill set, level of expertise, as well as things like your attitude, disposition and approach to things. It is both a quantitative and qualitative measure – not just what you can do, but how you do it and how well you can do it. It can be both objective and subjective as well. For example, my value as a physical therapist can be measured against other physical therapists by looking at objective measures, such as my knowledge and proficiency of a treatment technique, as well as subjective measures, such as my rapport with patients and co-workers.

We all have different levels of value in different areas of our lives. My value as a physical therapist is far greater than that of my value as a carpenter; my value as a Tai Chi instructor greater than that of my value as a marathon coach. Knowing your value requires a great deal of critical self-reflection. It requires us to self-evaluate our strengths and weaknesses, a process which requires us to be very honest with ourselves. Not always an easy thing.

Knowing your value has a number of benefits. First, it serves as a point of reference for making decisions that are going to be favourable to you. Using my above example, I know that I’m going to be much more successful seeking and retaining employment as a physical therapist than I will as a carpenter. I could further say that as a physical therapist, I have much more experience working in the home health setting than I do in intensive care, so when it comes to looking for work, I probably have a much higher chance at success in the home care setting than a specialised hospital setting.

It also helps you identify opportunities for growth and improvement. More than that, it can help you prioritise and focus your efforts towards growth and improvement. For example, I know that my value as a carpenter is probably comparable to my value as an artist – that is, relatively low. While I would like to improve in both these areas, improving my ability to draw represents much more of a personal challenge to me than carpentry, so at this point in life I’m more inclined to focus on improving my artistic ability than my wood working skills.

Knowing your value also enables you to understand your worth: to an employer, to your relationships, and to society in general.

Know Your Worth

Your worth is what your value entitles you to; it’s your reward for what you bring to the table. Worth is also objective and subjective, though I would argue far more of the latter. For example, your salary is an objective measure, however, exactly what that salary should be will differ between you, your employer, and the marketplace.

Knowing your worth is important for two main reasons. First, it enables you to determine what you feel is fair compensation for your efforts. Again, in terms of salary, you would probably expect it fair to be paid at a higher rate if you have specialised skills and years of experience than you would if you were new to the position and still learning on-the-job.  You would also expect to be paid at a rate that is similar to what others are getting in the same position, particularly if their knowledge and experience is similar to yours.

This leads to understanding what degree of leverage you have in a given situation, which enables you to be able to negotiate more effectively. This further empowers you to make decisions about what is and isn’t acceptable to you. Using salary as the example again, knowing your worth could equally help you negotiate a higher rate of pay, as it could help you determine whether other benefits (better work-life balance, less stress, etc.) in lieu of a higher rate is just as favourable.

My three tips for discovering your worth are:

  1. Be realistic: there’s no point in me expecting to be hired as a master builder because I can assemble flat-pack furniture. This is where knowing your value is important, and will save you a lot of frustration and embarrassment.
  2. Be self-critical: understand your limitations, but also give yourself credit where it’s due. No one is great at everything, but all of us are good at something. Also identify those things about you that are static versus those that are dynamic. Being willing to change and grow can increase your worth, but it’s also important to understand what aspects of yourself you’re not willing to change lest you lose the essence of you.
  3. Do your research: what you think you are worth can be different to what someone else thinks you are worth. The more you understand someone’s needs, the more you can determine your level of worth to them, and what they are worth to you.

If you want to experience more positive interactions in your work, your relationships, your community, and even your self-image, knowing your value and your worth is a great place to start.

Towards Reconciliation: Is Forgiveness the Next Step?

As National Reconciliation Week begins and we celebrate twenty years since the Bringing Them Home report was tabled in Federal Parliament, and over ten years since former Prime Minister Kevin Rudd made The Apology to Australia’s Aboriginal and Torres Strait Islander peoples, my thoughts turn to a question which has been burning within me since The Apology was made: why haven’t we achieved Reconciliation?

It’s a question to which there are as many answers as there are those willing to answer it. Fingers can be pointed in all directions: Government, institutions, mainstream society, even back at Aboriginal and Torres Strait Islander communities. Ironically, the majority of all these groups seem to want Reconciliation. So what’s the hold-up?

In his Apology to Aboriginal and Torres Strait Islander peoples, former Prime Minister Kevin Rudd stated:

“The time has now come for the nation to turn a new page in Australia’s history by righting the wrongs of the past and so moving forward with confidence to the future.”

One of the main criticisms of the Australian Government it that it has not done enough to improve – or facilitate the improvement of – the lives of Aboriginal and Torres Strait Islander peoples. The updated Bringing Them Home 20 Years On report provides a classic example: twenty years after the original report and we see little progress, yet the same rhetoric, the same arguments, and the same recommendations. Stop and think about that for a moment. Twenty years, and we’re still talking about the same things! Forget “moving forward with confidence to the future” – we’re stuck in neutral. Or maybe even up on blocks!

On that premise it could be argued that Reconciliation cannot proceed until the Government makes substantial reparations to Aboriginal and Torres Strait Islander peoples. While I believe that many Aboriginal and Torres Strait Islander peoples would agree with that, I also believe that there is (or should be) enough evidence to suggest that unless there is a major shift in the Government’s priorities, that degree of change is unlikely to happen.

Does that mean we should give up on Reconciliation? Not at all. However, it does mean that we may need to alter our approach to Reconciliation, and consider the sequence of events that need to occur in order for us to start moving forward.

Former Prime Minister Kevin Rudd said:

“We the Parliament of Australia respectfully request that this apology be received in the spirit in which it is offered as part of the healing of the nation.”

At the time it seemed that Aboriginal and Torres Strait Islander peoples – in general – had received the Government’s apology, in that it was both welcomed and valued, and seen as a huge step to improving race relations in Australia. However, I think what may have been lost over time is that Mr Rudd was not just asking for the apology to be received or accepted: he was asking for forgiveness. Maybe that’s what’s been missing from the Reconciliation process to date?

When two people have an argument, once it’s determined who is in the wrong there is usually an apology, a promise to make amends, and then forgiveness. Forgiving conveys an understanding that the apology and proposed correction have been accepted, and that things can move forward. It is not ‘forgive and forget’, and does not imply that the receiving party must ‘get over it’. If anything, it is important to recognise and recall past faults in order to facilitate current and future correction.

While I believe Aboriginal and Torres Strait Islander peoples welcomed the Apology, I’m not convinced that, as a majority, we have expressed forgiveness. Further, I believe this is recognised, perhaps on a subconscious or unexpressed level, by broader Australian society, and inhibits the Reconciliation process. Not because non-Indigenous Australia doesn’t want Reconciliation, but because it’s waiting for us to say, “it’s okay, we forgive you, let’s work out how we move forward from here.”

The idea of forgiveness without prior reparations might be inconceivable to some Aboriginal and Torres Strait Islander peoples. For many – arguably all – the sins of the past still affect present-day lives. Many wounds are still open, and being stuck in the status quo does little to help them heal. We’re now fifty years on from the Referendum, twenty years on from Bringing Them Home, and almost ten years from The Apology: there is nothing to suggest those wounds will heal unless we do something different to what we’ve done in the past.

I’m not going to tell anyone that we ‘have to’ forgive broader Australia for the past – that’s not my place to say. What I will do is encourage all Aboriginal and Torres Strait Islander peoples to consider whether forgiveness is the next step towards Reconciliation. We need to have this discussion in our families, our communities, and our organisations. We need to ask ourselves, can we forgive? Are we ready to forgive? Is forgiveness what we need to do in order to strengthen the relationship between Indigenous and non-Indigenous Australia, and in doing so, make Reconciliation – and all the factors that are included in achieving Reconciliation – a national priority for all Australians.

How else can we move forward?

Please feel free to share your thoughts in the comments section below.

Learn About Aboriginal Australia – Ask an Aboriginal Person!

In the spirit of National Reconciliation Week (27 May to 3 June) I’m inviting anyone and everyone who would like to learn more about Aboriginal peoples to go ahead and ask – me!

I’m not claiming to be an expert, but as an Aboriginal person with a diverse range of knowledge and experiences, I’m more than willing to share what I know with all who would like to know more. And if there’s anything I can’t answer (and I’m sure there will be) I’ll do my best to find someone who can.

I see this as an opportunity to promote Reconciliation between Aboriginal and non-Aboriginal peoples through sharing knowledge, promoting understanding, and removing fears. Reconciliation begins by coming together at the same table and engaging in open discussion.

Please post any questions in the comments section below – I will respond to each as quickly and best as I’m able!

Happy National Reconciliation Week!

5 Reasons Tai Chi is the Most Accessible Form of Exercise

Photo courtesy of Gold Coast Tai Chi Academy

Tai Chi – or taiji ch’uan – is a popular form of exercise well recognised for its health benefits. One of the great things about Tai Chi is that it is readily accessible to everyone. It doesn’t matter how old you are, how fit you are, how much time you have, or whether you have any previous experience in sports, martial arts, or fitness: if you can breathe, you can do Tai Chi.

Here are five great reasons why Tai Chi is the most accessible form of exercise for everyone.

Tai Chi is appropriate for all ages.

You are never too young or too old to practice Tai Chi. Due to its low-impact nature, This is an important consideration when choosing exercise for both the pre-adult and the older adult. Excess forces on the body can be counter-productive for both these age groups. In the pre-adult, the developing musculoskeletal system generally responds well to the forces that various exercises place on it. However, excessive forces can alter or damage critical components – such as growth plates – which can lead to developmental problems. In the older adult, many tissues simply will not take the strain of excessive force, which ultimately leads to injury. Tai Chi movements improve strength and balance without putting a lot of strain or force through the body.

Tai Chi is suitable for all fitness levels.

Tai Chi has no prerequisite level of strength, balance, or cardiovascular fitness level in order to start practicing it. In fact, you don’t even need to be able to stand or walk in order to practice Tai Chi. However, if you have already achieved a moderate or even high level of athleticism, Tai Chi will still offer challenges to you that will benefit your existing health and fitness. The two key reasons for this are Tai Chi’s progressive nature – that is, starting with very basic movements and concepts, and advancing over time to whatever end your mind and body can achieve; and it’s adaptability – a knowledgable Tai Chi instructor will be able to recognise a person’s strengths and limitations, and adapt their training accordingly so they can participate and advance at their own pace.

Tai Chi is gender neutral.

While all forms of exercise are (or should be) equally accessible to women and men, many are developed for, targeted towards, or tend to attract, one gender in greater numbers than the other. Tai Chi is one form of exercise that is truly gender neutral. While some may stereotype the ‘soft’ nature of Tai Chi to be  more suited to females, or its martial aspects to be more appropriate for males, the very nature of Tai Chi is to strike a balance between feminine and masculine aspects. A good Tai Chi class will make women and men feel equally at ease practicing their Tai Chi with each other.

Photo courtesy of Gold Coast Tai Chi Academy

Tai Chi requires no special clothing or equipment.

Whatever you are wearing right now, you are dressed for Tai Chi. Wherever you are, you can do Tai Chi. In addition, many of Tai Chi’s forms are practiced ’empty-handed’, meaning there is no need for special equipment. Ideally you will be wearing loose, comfortable clothing, and have enough space to be able to move through the form you are doing, but neither of those are essential to being able to practice Tai Chi. You can do literally do Tai Chi anywhere. They even do Tai Chi in space!

Tai Chi is easy to learn.

Tai Chi is something that anyone, of any background or ability, can jump straight into. Quality instructors introduce new people to Tai Chi in such a way that they have something they can go home and practice right after their first lesson. It is often said of Tai Chi that it is easy to learn, difficult to master, and with good reason. Yet I’ve seen so many people who are introduced to Tai Chi so pleasantly surprised that they can walk in to a class and just join in right from the start. It’s one of the few forms of exercising that, for the beginner, holds no intimidation.

Tai Chi is easily one of, if not the, most accessible forms of exercise available to everyone. Why not give it a try for yourself?

Indigenous Issues: Are We Targeting the Right People?

interracial_hands1Most of us have heard that wonderful saying about stepping back and taking a look a the big picture, however when we’re so deeply involved in something, we often don’t get the insight, much less the opportunity to do so. Since moving abroad I haven’t been as actively involved in Indigenous issues as I have been in the past. While not my ideal situation, it has given me the opportunity to be more of an ‘observer’ and examine not just what other people are doing, but also reflect on what I have done, from a more objective perspective. When I look at the efforts I and so many others have put into pursuing issues relevant to their peoples, I see the same issues, the same arguments, the same discussions happening over and over again.

Why? Why is it that we keep saying the same things, but little to nothing changes?

Lately, I’ve been thinking: maybe it’s because we’re taking our message to the wrong people.

In my experience, when it comes to advocating for Indigenous issues there are three main groups we take our message to: Indigenous peoples, the Government, and representative bodies (which includes professional associations, educational institutions, and other, usually not-for-profit organisations, that are themselves representative of, or advocates for, subsets of broader society). The rationale for this is simple. We talk to our own people to identify issues, educate on what we’re planning to do about them, and seek support for our cause. We talk to Government because they are the law- and policy makers of the land, and have the ability to affect change. We talk to other representative bodies because they too have the ability to facilitate change, both directly (through their policies and programs) and indirectly (through their advocacy efforts).

It seems that we have the key players identified and have been working with them for far greater than the twenty years I’ve been involved. It would seem reasonable to expect that the situation for Indigenous peoples should be far better than what it is, right?

Here’s the problem.

Talking with Indigenous peoples about Indigenous issues is a classic case of, “preaching to the converted”. Indigenous peoples know what the issues are, they know what needs to be done to change the situation, and in many cases they’ve been consulted about it to the point where they are tired of repeating themselves. We must keep Indigenous peoples the main part of the conversation, however we need to change the topic of conversation from, “what is the problem?” to “what are we doing to make things better?”

Talking to Government is always going to be crucial because they are the ones who can make laws, and develop policies and programs, that have the ability to create real change. The issue with Government is that it tends to support the views of those that keep them in power. There are two basic groups that Government draws it support from: its constituents, or those who vote for them, and its endorsers, or those who provide the most tangible (mostly financial) support to them. Indigenous peoples are often a severely under-represented segment of both of these groups, and so have a relatively low-level of influence. This could be indicative of why many Governments outwardly appear to support the cause of Indigenous peoples, and yet only actively engage at a minimal level to affect change.

It’s a similar situation when talking with other groups and organisations who have the ability to affect change for Indigenous peoples, however are not solely dedicated to Indigenous issues. The people who direct and manage these organisations are usually serving two masters. On one side, the Government, who provides the underlying laws and, in many cases, funding, on which these organisations are based. On the other are their own constituents: their members and/or the population they either represent or provide services too. Again, Indigenous peoples, through sheer lack of numbers, or often under-represented in these groups, and so their voice is relatively small. Ironically, many of these organisations are very ‘pro-Indigenous’, and could be doing a lot to help Indigenous peoples change their situation. Many boards and managers even “want to do more” to help Indigenous peoples, but claim their hands are tied because their views are not supported by their members, their constituents, and/or the Government of the day.

Obviously we don’t want to exclude any of these groups from dealing with Indigenous issues because they all have critical roles to play. yet we cannot go on rehashing the same rhetoric with the same people only to get the same results. We need to start engaging people who have the power to influence Governments and organisations who can affect change.

We need to start targeting the non-Indigenous population in order to address Indigenous issues.

In most countries where there is inequity between Indigenous and non-Indigenous peoples, non-Indigenous peoples represent the overwhelming majority of the population. While we like to think that the basis of our societies are morals, ethics, and social justice, the fact is that our lives are directed by one simple, time-tested rule: majority rules. It is also a fact that Indigenous peoples are unlikely to ever regain majority status in countries where the population is made up of Indigenous and non-Indigenous peoples. If we’re going to see change, real change, we need to be the majority, and our only hope of achieving that is if we have non-Indigenous peoples on our side.

This is not just a matter of bringing Indigenous issues to the attention of non-Indigenous peoples. In fact, in the age of digital and social media, we could argue that today’s society is the most informed of any previous. Many non-Indigenous people are supportive of Indigenous peoples and addressing Indigenous issues, but this support is passive. If we’re going to garner support of non-Indigenous people to address Indigenous issues, we have to make those issues important to them. It has to become not just something they feel, but something they believe. Something they want. When it becomes important to them, it will become important to those that represent them, namely Governments and other key stakeholders. Remember: the majority have to ability to keep those people in power. Or take that power away.

Changing the lives of Indigenous peoples is not just a numbers game; there are many things that need to change in order for us to see real equity between Indigenous and non-Indigenous peoples. Many Indigenous – and to be fair many non-Indigenous – peoples have been trying to create change for many years. However, they still represent only a minority of society, and society favours the majority. If we’re going to see real change, we need non-Indigenous peoples to want to improve the lives of Indigenous peoples. As we move into 2017, maybe those of us involved in advocating for Indigenous issues need to rethink our target audience?

Indigenous Issues: When Will We See REAL Change?

I love NAIDOC week. Not only is it a great time to celebrate my Aboriginality, it’s great to see other Aboriginal and Torres Strait Islander peoples being recognised for their achievements. It makes me very proud, and makes me think that in many ways Aboriginal and Torres Strait Islander peoples are advancing our status in the modern world.

Yet having been out of the country – and by consequence, out of direct involvement in Indigenous issues – for almost 2 years now, I’ve had the opportunity to be more of an observer than a direct participant, and I’ve got big concerns over what I’m seeing.

The Indigenous community is full of success stories across all fields: health, education, social justice, business, politics, sports, the arts, advocacy, and almost any other field you would care to mention. Yet when you step back and look at the big, big picture, little, if anything, has changed. The statistics are much the same, the reports are much the same, the discussions are much the same – even when I look back at my own contributions over the last 20 or so years, the things I’ve been saying are essentially the same.

So if we’re doing more, and things are getting better, and we’re achieving our goals, and raising ourselves up from the depths of our past, where is the change that we’ve been looking for? Why are we having the same conversations that we’ve been having for years and years and years? Why are we not seeing more tangible results for our efforts?

This is not to discount the amazing things that people are doing in their respective fields, and we should continue to nurture and support all those who are devoting themselves to the betterment of all our peoples. However, maybe we need to step back for a moment and take in the bigger picture again. Maybe instead of focussing our little piece of the puzzle, we need to start thinking about how we make all the pieces fit together so that we get to the big picture. Maybe we need to be a little more self-critical of ourselves – to step back and look at what we’re doing and ask, “what difference are we really making?”

Because after 20 some years of addressing Indigenous issues, I don’t want to be having the same conversations, reading the same reports and social commentary, nor be part of the same statistics for the next 20. I want results. And I would hope that anyone reading this would want that too.

“Be the change you wish to see in the world.” – Mahatma Ghandi

What do you think needs to happen for us to see REAL change in Indigenous issues? Please feel free to share your thoughts in the comments below.

Reconciling Australia: We Need Acknowledgement More Than Apology

984a1b0af5d47f5f81d26ace274913bdIt’s National Reconciliation Week in Australia, a time intended to build relationships between Aboriginal and non-Aboriginal Australians. The last time I spoke about Reconciliation I called for reconciliation between Aboriginal peoples. Yet as I skim through the posts, tweets, memes, and videos posted in commemoration of this week, a sad irony presents itself: there is still so much bitterness, so much anger, so much hurt, and so much division between Aboriginal and non-Aboriginal Australians. Reconciliation in Australia seems less likely than ever.

National Reconciliation Week arrives just after National Sorry Day, a day commonly misunderstood to be recognition of the Apology to Australia’s Indigenous Peoples by former Prime Minister Kevin Rudd. While the two are inextricably linked, National Sorry Day commemorates the tabling of the Bringing them Home report on Australia’s Stolen Generation, and is held to both recognise the injustices of the past, and hold the Australian Government accountable for repairing the damage caused by those injustices. It is a day of mourning and remembrance, in much the same way that ANZAC Day is a day of mourning and remembrance.

However, it’s the ‘sorry’ part that seems to be the sticking point. Many Aboriginal peoples feel that ‘sorry’ isn’t enough; that without reparations ‘sorry’ is just a word non-Indigenous people use to absolve themselves of guilt. On the other hand, many non-Aboriginal Australians do not see the point of continuously saying ‘sorry’; at best they feel their remorse is not being accepted as genuine, and at worst, that an apology isn’t necessary for something they personally have not done – that “the past is in the past”. Could it be that the demand for ‘sorry’ is actually driving a wedge between Aboriginal and non-Aboriginal peoples, rather than bringing us together?

Perhaps the way towards achieving Reconciliation involves acknowledgement more so than apology. Acknowledgement on both sides of the cultural divide.

The first thing to acknowledge is that Aboriginal peoples are still suffering, in every sense of the word, from the injustices of the past. This does not mean that Aboriginal peoples are “still living in the past”; rather it means that the effects of those injustices are still very much the present, and the immediate foreseeable future, for Aboriginal peoples. It is not the past because Aboriginal peoples are still living it. Non-Aboriginal people don’t need to understand that – in fact it is arguable that anyone not living through that could not truly understand it anyway – but they do need to acknowledge that the suffering experienced by Aboriginal peoples is real, and part of the reason things are the way they are.

By the same token, Aboriginal peoples also need to acknowledge that we are still suffering as well, and this suffering can skew our perceptions of the attitudes of non-Aboriginal peoples towards us. I have seen and heard too many Aboriginal peoples use their suffering as justification for their mistrust of non-Aboriginal people. Sadly, there are still enough non-Aboriginal people whose intolerance and racist attitudes fuel this mistrust, but it is not representative of all – or in my personal belief, even the majority – of non-Aboriginal Australians. Many non-Aboriginal support, or at least want to support, the betterment and empowerment of Aboriginal peoples. We need to acknowledge that, and in doing so let them support us.

There also needs to be acknowledgement on both sides that the disparity between Aboriginal and non-Aboriginal peoples in relation to health, education, social justice, and a whole host of other issues, from a moral and ethical viewpoint, is wrong. Everyone knows about these disparities, however what is becoming increasingly obvious is that many have come to believe that these disparities are unavoidable, even normal or expected. It is in no way normal, and should not be expected, much less accepted. Acknowledging the wrongness of this attitude is not just a task for non-Aboriginal peoples: Aboriginal peoples also need to acknowledge that living with these disparities is not part of Aboriginal identity (read my previous article for more discussion on this topic). Betterment is not about assimilation. It’s about levelling the playing field. No one would expect that non-Aboriginal people should lower their standards of health, education, and so on to the level of Aboriginal peoples. Why should there be any resistance on either side to raising those same standards for Aboriginal peoples to those of the greater Australian society?

We don’t need more apologies to achieve true Reconciliation between Aboriginal and non-Aboriginal Australians, we need more acknowledgement.  We need to acknowledge the need for remorse, and the need for forgiveness. We need to acknowledge the problems, and the need to find solutions. We need to acknowledge that our differences can be used to unify rather than divide. And we need to acknowledge that we – all of us – are the only ones who can make Reconciliation happen.

Do you believe in Reconciliation? What do you think we need to make Reconciliation happen? More acknowledgement? More apologies? Please feel free to share your thoughts in the comments below.

Applying Tai Chi to Physical Therapy – Part 2: Gait Training

Walking is a skill that many of us take for granted – let’s face it, when was the last time you actually thought about the way you walk? Yet it is still a skill, and when your ability to walk is suddenly impeded, or lost altogether, you realise just how important it is to your life. Even with disease or injury, many of us find a way to maintain our ability to walk, however any deviation from ‘normal’ gait (the medical term for walking) can often result in the development or compounding of other problems: pain, muscle imbalance, and arthritis being some of the more common, not to mention the difficulty in attending to day-to-day activities.

What is ‘Normal’ Gait and Why is it Important?

I often explain gait as a “controlled fall”. In order to walk, we shift our center of mass (CoM – see Part 1 for an understanding of the importance of CoM) forwards so that our body starts to move forwards. If we allowed this shift in CoM to continue unchecked, we would fall flat on our face. To avoid this, we use a complex pattern of movements to support ourselves on one leg while we place the other one in front of us to arrest our fall. If we keep our CoM moving forward, we have to repeat the pattern again: the leg in front now becomes the supporting leg, and the leg that was supporting us must now swing forward to save us. Repeat over and over again and you are walking.

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The way our limbs and body produce this – not just the movements themselves, but the way they are coordinated – is referred to biomechanically as a ‘gait pattern’. A ‘normal’ gait pattern is a complex, ideal version of these coordinated movements that result in a stable and efficient means of locomotion which has minimal impact on our musculoskeletal system. It is defined by a number of different factors, including joint angles, distribution of mass (ie: the location of CoM), forces applied to the body, and synergy of movements. For a more in-depth explanation of normal gait, check out this article on Physiopedia.

Anything that doesn’t comply to a ‘normal’ gait pattern is considered to be an ‘abnormal’ gait pattern. This is not to say that it is wrong as such, merely that it does not conform to the ideal that is normal gait. Physical Therapists strive to teach people to walk with a normal gait pattern, or as close to a normal pattern as is achievable. For some people this might not be possible, for example, due to anatomical differences, muscle weakness, imbalances, or tightness, neurological changes or deficits, pain and/or injury, disease, aging, or some combination of these factors. However, while the ‘perfect’ gait pattern might not always be achievable, many people who experience problems with walking can be assisted through Physical Therapy to improve their gait pattern, and in doing so their overall functional capacity.

How Can Tai Chi Help?

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Photo courtesy of Gold Coast Tai Chi Academy

Students of Tai Chi spend a lot of time learning to walk correctly. One main example of this is the technique known as mao xing, or ‘cat walking’. In mao xing, the Tai Chi practitioner shifts weight into one leg while stepping forward with the other. The stepping leg has no weight in it right up to the point the heel makes contact with the ground. The practitioner completes the step by gradually transferring weight from the supporting leg to the stepping leg, involving a shift from side-to-side and back-to-front. As the stepping leg is loaded it becomes the supporting leg, eventually freeing up the other leg to take another step forward.

This sounds very similar to normal gait, however a key difference is the location of the person’s CoM. As already described, normal gait requires the CoM to be displaced forwards outside the person’s base of support BoS), providing momentum. In mao xing, however, the CoM is maintained within the BoS while weight is shifted from one limb into the other, effectively eliminating the “falling” part of walking. To do this successfully, the Tai Chi student must develop a deeper understanding and awareness of how their body moves, in terms of coordination, weight shift, loading and unloading of the limbs, and placement of the feet. As a Physical Therapist, if I could have all my patients mao xing I wouldn’t have to worry about any of them having falls!

Applying Tai Chi to Physical Therapy: Recovery from Joint Replacement Surgery

Recently I’ve been applying the principles of mao xing in retraining normal gait patterns in patients who’ve undergone total hip or knee replacements. In the first weeks after surgery, many joint replacement patients demonstrate a very “stiff-legged” gait pattern: they tend to hold the operated leg very stiff when attempting to mobilise, and limit the amount of time they bear weight through the limb. In some cases the patient will circumduct or swing their leg around rather than bend their hip and knee in order to take a step forwards. Some patients may also have been walking like this for sometime prior to their surgery due to the nature of the condition that required joint replacement.

It can be quite challenging to retrain patients to walk with a normal gait pattern again, and often requires very precise practice. This has been particularly true in patients who have had bilateral joint replacements, who don’t have a ‘good’ leg to support themselves on and so are very guarded with attempting to walk.Though I haven’t been trying to teach my patients mao xing as such (though I often think I would like to), I’ve found that incorporating a number of the principles of mao xing – stepping onto the heel, rolling through the foot to come up onto the toes and push-off – as well as instructing the patient in a similar manner to how I would teach the technique to a Tai Chi student, provides a much more correct and consistent result than other methods I’ve tried. I’ve also found in practice that focusing on the principles related to the foot (heel strike, weight shift, stance, toe off) produce a subsequent improvement in the pattern of movement at the knee and hip – that is, an increase in the amount of flexion at the hip and knee during swing phase – and tolerance to weight-bearing during stance phase. When I apply these principles to gait training, I seldom have to draw attention to or correct movements at the hip, knee, or lumbo-pelvic area as these seem to correct themselves when the patient is applying the principles to their feet.

Lastly, and in some ways the most exciting part, is that I’ve found that patients are more likely to practice this “creeping” (as several patients have referred to it) way of walking as part of their home exercise program than they are other techniques or exercises designed to improve their gait. The exact reason why is unclear, however I would suggest it is because it is easier for the patient to conceptualise, understand, and apply, than other techniques that are more detailed and require a higher level of cognitive processing. In practice this apparent increase in compliance and attendance to exercises between therapy sessions does appear to translate – in general – into a more timely improvement in gait and physical function.

Again, this is at best observational evidence of a specific application of Tai Chi principles to physical therapy. However, it does support the increasing body of evidence-based research advocating  Tai Chi as a means of improving balance and mobility, and in my opinion, is worth further investigation as an adjunct to physical therapy.

Recognising the Modern Aboriginal

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When I was a student at the University of Canberra I spent a lot of time hanging out at the Ngunnawal Centre, a drop-in/support centre for Aboriginal and Torres Strait Islander students. It was a great place, not just because of the services and support it provided, but because we had such diversity of students, from all over Australia, all different backgrounds, all different ideas and experiences. It was, generally speaking, a place of acceptance, and my time there and the people I met there certainly helped strengthen my identity as an Aboriginal person.

I remember once walking into the common room into a very passionate discussion about maintaining culture. One guy was making his opinions known about the evils of materialism and how we were all becoming “white fellas” and how he wanted to get back to “traditional life”. It was a stirring speech that many of us could identify with, especially those who had limited exposure to a ‘traditional’ cultural upbringing. That is, until someone said, “watchya on about? You’re not gonna give up your Nikes and your mobile phone for a spear and a lap-lap!” Which, needless to say, we all had a good laugh at.

Since then I have often thought about the challenge many Aboriginal peoples face with regards to living a modern life in a modern world while attempting to live up to cultural values and beliefs that are considered the definition of ‘being Aboriginal’. It is truly a case of walking in two worlds, a walk that would be much easier were those worlds allowed to merge into one.

Adaptation is a key component of evolution; a marker of whether a species thrives or dies. If there is one thing I’ve learned about my Aboriginal culture, it’s that we have survived for so long because of our ability to adapt. We have adapted to the environment, to the availability – or scarcity – of resources, to contact with other cultures, and even to invasion. Yet despite this ability, it seems there is an unwillingness to allow Aboriginal peoples to ‘evolve’ into the 21st century. That to be ‘Aboriginal’ is to remain in a pre-invasion state of existence, and any deviation from this somehow makes us less Aboriginal.

Adaptation is not assimilation. Yet that seems to be the view that many Aboriginal and non-Aboriginal people take when Aboriginal peoples take advantage of the modern world, the modern conveniences, or even the modern ideas that exist today. Drive a nice car, live in a nice house, in a nice suburb, have an advanced education, a career, a desire for nice things like clothing, furniture, or lifestyle, and suddenly you’re assimilated, a sell-out, a big-noter, a coconut. You’re no longer a ‘real’ Aboriginal, because ‘real’ Aboriginal peoples don’t have, nor want, those things.

Yet think about some of the things that we wouldn’t have if Aboriginal peoples hadn’t adapted the the changes that surrounded them. There would be no repeal of the various Aborigines Protection Acts. There would be no Freedom Ride. No 1967 Referendum. No NAIDOC. No Aboriginal flag. No Aboriginal doctors, nurses, lawyers, teachers, police, soldiers, politicians, sport stars, business owners, writers, musicians, actors, tradespersons, or journalists. You would not be reading this article. Aboriginal peoples would still be considered part of the Australian ‘fauna’. If we existed at all.

Most, if not all, Aboriginal peoples have already lost so much of their culture and heritage. It is critical to our survival and our identity that we preserve as much as we can. Yet if we are to thrive – not just survive – we must allow ourselves to embrace those elements of 21st century life that can be used to our advantage and for the betterment of our peoples.  We need to understand and accept that an Aboriginal person today is not the same as an Aboriginal person 250 years ago, or even 25 years ago, and recognise that can be a good, even desirable, thing.

Yes, we must value, retain, and give to future generations as much of our cultural heritage as we can. However, we must also live in the modern world, take advantage of it, adapt it to our needs, and use it for the betterment – the empowerment – of our peoples and communities.

How else can we expect to progress?


What is your take on what a modern Aboriginal person is, or should be? Please share your thoughts in the comments section below.