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My clinic deals largely with chronic injuries and acute flare-ups of chronic conditions.  Often, the advice to “rest” an injury is given, but the discomfort remains; other times rest helps the issue.  On other occasions, I have a client come in who has been “resting” for years and now lives in fear of doing anything physical to avoid a flare-up.  Years of rest however have caused their health and fitness to dramatically decline and now their risk of disease and acute injury (slips, falls, trips, etc) is greatly increased.  How are we to deal with all these situations?

I find it best to define the phases of injury in order to deal with with each phase in a slightly different manner.

INSULT: Every single day of our lives we do something physical, be it walk down the stairs, walk the dog, help a friend move, or run 10 miles.  Each and every physical activity creates some “insult” to our tissues.  Insult is a small amount of damage that goes un-noticed by us.  When we eat good food and go to sleep for sufficient time our body heals this damage.  The principle behind strength and conditioning is creating an exact amount of damage that our body heals “slightly” better.  This process is called super-compensation.

Irritation: When we have enough insult to our physical body our nerve endings start to send signals to our spinal cord that moves up into our conscious mind that allows us to be aware of it.  This is called an irritation.  Most often, a client will say “I feel my knee” when they do a certain movement or activity.  This can happen in one short time period.  A certain activity will cause enough insult for us to notice it and we have an irritation.  It isn’t enough to stop, but we “notice” it.

It can also happen chronically when we don’t heal from a “normal” amount of insult.  Remember that everything we do creates insult and our body heals it as we eat/sleep well.  BUT, if we fail to get enough proper food/sleep we don’t heal.  Now, we have two days of insult.  Continue this path and we have three days of insult and develop an irritation, continue further and we can develop a “chronic” irritation: days, weeks, months, years of pain in a certain region.  ”I always feel my back”.

Injury: When we have enough irritation to make us not want to continue an activity I term it an “Injury”.  Injuries can happen suddenly, like getting hit by a bus, but often happen chronically.  When a chronic injury begins one will say “I’m not sure how it began.  My shoulder usually feels tight, but then one day I just couldn’t do push-ups anymore. ”  This is an accumulation of insults causing tissue damage and eventual irritation and injury.  This is often when a healthcare practitioner will give the advice to “rest”.  However, I disagree on a case-by-case basis and you’ll see why later.

Pain: Pain is the emotional response to tissue insult, irritation, and injury.  However, the emotional response is not dose-dependent on the insult.  A huge insult can cause very little pain for someone; watch a Pro football game, those guys undergo a LOT of insult each game, but keep on rolling.  A small amount of insult can cause a big emotional response.  Watch a small toddler walk around and fall over.  They fall perhaps six inches (toddlers have pretty short legs) and land on their butt.  If alone they get up and keep moving, but if an adult sees them and rushes over asking if they’re ok (with fear in their voice) the child begins to cry uncontrollably.  Three minutes later they return to their activity.  The child underwent “pain” without much true insult.  They had an emotional response to the discomfort.

In chronic injury there is always an amount of pain involved.  The pain is derived from fear of always feeling discomfort, fear of not being able to return to their beloved activity, fear of surgical or medical intervention side-effects, and a whole host of other issues.

When dealing with chronic injury, we must always deal with the emotional pain aspects as well.  Developing a sense of confidence in one’s ability to perform an activity without creating insult is of absolute necessity.  I’ve dealt with a large number of back pain patients who are physically able to bend forward but have a great fear of doing it because it will create insult, irritation, and injury.  However, thru intelligent progressions I am able to get these individuals to lift hundreds of pounds off the ground without issue during nor afterward, a great thing for injury prevention in the future!

Framework for progress:

• Good movements: The human body was built to push, pull, lift, squat, jump, and run.  Insult to tissue occurs with every movement, good or bad; we heal at night and continue on.  However, incorrect movements create MORE insult and therefore require MORE healing. By ensuring that the way each person lifts, squats, pushes, pulls, jumps or runs is correct we can minimize the insult of those activities and allow for faster, further, and more consistent progress.
• Better healing: By education on timing of activities, timing/portion/volume/types of foods, and nightly habits/patterns/rituals nearing night-time that can affect sleep we can improve how fast someone heals.  This means a correct movement with minimal insult creates GREAT progress, and incorrect movements with more insult can still heal and leave us without irritation, injury, and pain.
• Intelligent work volume: Doing too much or too little of each movement can lead to greater insult.  It can also lessen the healing that occurs each night.  Our body heals with a reactive hormonal response to the activity we’ve done.  Too much lifting relative to squatting can create a lot of insult; too much “cardio” relative to strength training can limit the healing response.  AND doing more than your body is currently able to handle will create more insult, irritation, injury and pain.
• When to rest: Insult is damage that must be fixed.  However, it may fix improperly unless we give it the correct stimulus.  If a muscle partially tears, we have damaged a lot of little proteins called collagen.  These collagen fibers can be replaced.  If they are replaced in the right direction there is minimal remaining issue afterward.  If they are replaced in the wrong direction we can have longer lasting problems (lasting until they are signaled to line up in the correct direction).  How do we give them the signal?  By using them correctly.
  • If we insult our back by lifting something the wrong way, we can heal that insult by lifting it the correct way.  If we insult our shoulder by pushing the wrong way, we heal the injury by pushing the correct way.  Rest, or disuse, will only cause the healing to be incomplete and incorrect.
  • If we are doing something correctly but too much of it relative to other activities we can create damage that way and resting the over-used activity is a good idea, temporarily.
• Why not to rest: If we rest completely from any activity, our body fails to produce the hormones that allow us to heal as we sleep at night.  Complete rest will simply prevent the proper healing response from occurring as we sleep.  If we have an injury, irritation that prevents us from continuing an activity, we must find OTHER activities that allow the proper response of hormones to get us to heal.  Most often, strength training will produce a great healing hormone reponse and put healthy force through the damage to get it to heal correctly.  We must then create a calm in the mind to sleep deeply and allow the process to occur.

Every client I work with has their own unique combination of the above issues.  As such, it is my job to educate them on how to better balance their choices to create a healing environment and continue progressing towards better strength, fitness, health, and enjoyment of life!

Are you currently running too much for how strong you are while standing on one leg?  Is the amount you squat to the ground comparable to the amount you lift from it each day?  Is the flexibility of your ankles enough to allow a proper looking squat that keeps all of your joints safe?  Do you perform the proper amount of strength training, cardio-respiratory work, meditation, and focus to ensure you’re strong enough to lift heavy things but won’t tire if you have to help a friend move?  Do you eat foods that help you heal?  Do you allow your body to calm as the afternoon fades to evening to get deep sleep?  Are you comfortable with past choices leading to your present state, proud of your current position in life, and optimistic towards future progress?

Whenever you encounter your specific level of insult, irritation, injury, and pain you should ask yourself the above questions.  In there you shall find the answer and correct path to continued development!

I was asked a question by a client.  ”How does the strength training we’re doing differ from what I’ve done in the past with weights?”

Simply put, a majority of the issues I help people improve result from not being strong enough for their activity;

• Distance runners without enough leg strength for running
• New moms without enough arm strength to carry their child properly
• Weekend athletes not strong enough to participate in their activity pain-free
• Older women who want improved bone density

All of these things are improved through strength training and getting stronger.  When getting stronger there is a shift of brain power, hormones, and connective tissue health that reduces injury and chronic disease risk.

Common knowledge is “lifting weights make us stronger” but this is not necessarily true.  What movements do we perform?  What directions?  How many times?  How frequently?  If we answer these questions incorrectly, we don’t get stronger.

The act of lifting weights is different from “strength training”. Lifting weights is moving a weight through a range of motion. The focus is on the single act of moving the weight.  There is no thought given from workout to workout  to improve the ability of the individual.  Typically, one does not often lift more or less from workout to workout, they lift the same amounts each time just to “work the muscles”.  This does not allow progressive improvement.

Strength training is a process; multiple workouts strung together in a specific way to improve strength. To legitimately get stronger we must pay attention to how much someone is lifting, how often it is occurring, what various movements are performed so that we don’t get too strong or too weak in certain directions, and how you eat/sleep/live to maximize your recovery.  Strength training involves more thought, expertise, and focus than simply lifting weights.

Strength training is a process of improvement and weight lifting is a singular act.  Find an expert in your area to develop a strength training program instead of a weight-lifting routine.

Numerous injuries occur to the foot and lower leg.  Hammer toes, bunions, neuromas, ankle sprains, plantar fascitis, shin splints, stress fractures and many more!!  In the past 50 years, injury to the foot and ankle have risen significantly.

Shoe companies have tried many different products in that time to aid their clients.

1. At first, the belief was that pavement and stiff artificial surfaces were un-natural so we had to add extra cushioning to our feet (we still have it: think Nike Air, or Shox!!).  Injury levels rose.
2. Then the belief was too much cushioning allows too much movement of the foot.  Thus, motion-controlled shoes came about to slow, stop, or limit motion in certain directions.  Injury rates continued to rise.
3. Now there is an evolution towards barefoot and minimalist shoes to allow more motion of the lower leg.  Injury rates continue to rise… what gives?

All the above beliefs are correct.  Artificial surface, too much movement, and too little movement all stand the risk to create injury.  However, you can have the best fighter jet in the world, but if the pilot isn’t skilled at the controls it’s gonna crash and burn.  We need the right footwear, but first we need to get the pilot trained.

You weren’t strong ENOUGH: Injury occurs when we aren’t strong enough to do what we ask of our bodies.  This is different for everyone, it is relative to what you ask your body to do.  Walking on soft ground, running on pavement, sprinting barefoot on grass, and running 3 miles in minimalist shoes require different levels of strength.

Strength does NOT come from our footwear, it comes from our body.  All the little muscles around the lower part of the leg act like a marionette for the foot… tendons are the strings to work each little piece and part. If these muscles lack strength, the foot is a stiff clump of bones that slams into the ground… INJURY!! The muscles of the lower leg are very small, as such they are really good at positioning the joint but not absorbing impact.  We must ALSO have strong hips/knees to absorb the impact when the foot touches the ground.

Can I hear you running?  Does your foot smack the ground?  You need stronger knees/hips to absorb the ground softly and quietly.  We need strong ankles, knees, AND hips for a healthy foot!!

Being weak leads to being stiff: When a muscle is not strong enough for our activity but we use it anyway, our body starts to lay down extra connective tissue to stabilize and support the muscle/joint complex.  This extra connective tissue is also termed scar tissue or restricted soft-tissue.

Get mobile, free the past restrictions: Now that scar tissue was laid down, the muscles stay weaker and stiffer than their potential.  Read here for details on how scar tissue can make you weak and stiff.  Well applied manual therapy is often necessary to fully rehabilitate once an injury has occurred.  Manual therapy is included in most if not all of our rehabilitation protocols at Stay Active Clinic.

Get Strong: The muscles of the lower leg are great for positioning the foot and ankle.  Use the foot drills to strengthen these muscles.  The hip and knee are great at absorbing impact and creating movement of the body.  Make these strong by using squats, lifts, and single-leg strength moves with good technique to prevent future overload and scarring.  Stay Active Clinic uses these in most if not all rehabilitation and performance protocols.

Footwear: Now that you have a strong body and are ready to be active you MUST have the right footwear.  Talk to a footwear professional to find the best fit for your strong stable body that will support your activities!!

In conclusion, let’s rely less on footwear and more on our own body to be strong enough for our activity… be it weekend hikes, marathon training, or general health/fitness.

Local Trout over Mixed Greens with Avocado

Last Friday I went to watch the documentary “Forks Over Knives”.  It is a documentary on the tale of two careers headed in the same direction.  Drs. Colin Campbell and Caldwell Esselstyn, the former a nutritional biochemist and researcher, the latter an open heart surgeon, focus their careers on helping people improve their lives and health by advocating a whole-foods, vegetable-based diet.  The film was well done, entertaining, and I highly recommend all of you seeing it when it comes out in May of this year.

I would also recommend you pick up “Food Inc.” from the video store, a similar movie about eating locally produced, organic, whole-foods.  Focusing less on the health of you, “Food Inc” discusses the health of your food and allows you to draw correlation to how it impacts your own health.

“Forks Over Knives” repeatedly discusses how chronic diseases like cancer, stroke, diabetes, and heart disease can be avoided or even reversed with a change in your diet.  They advocate cutting out meats and processed foods and eating an entirely vegetable-based diet.  The linking of meats and processed foods made it difficult for me to engulf their whole message as the two are not entirely inter-dependent.

Nutrition labels show what science has learned about food so far, not the healthful properties of the food itself!

On whole foods:

Foods, plants and animals as they exist in nature, have millions of little chemicals, hormones, minerals, vitamins that help it all function correctly.  The human mind, and the scientific method, have worked centuries on understanding all of what is in there.  However, we still do not know everything there is in food.  As such, by breaking it down, processing it, removing those chemicals and then re-inserting them into the food we only know how to re-insert the ones we know exist.  Everything else is forgotten.

Health-food nutrition labels have gotten longer and longer to account for further research into the field.  Does it not make sense that we still don’t know EVERYTHING there is?  Therefore, we are unable to put EVERYTHING back into the food after we package it for long-term storage?

The idea of a whole-food diet is such that you don’t NEED to know everything that is in there, your body knows its there and takes out what it needs to work properly.  We don’t always need to know the nutritional content of our food, just eat the whole thing and it’ll work.

On avoiding animal-based products:

The film-makers of “Forks Over Knives” repeatedly flash pictures of McDonalds, Wendy’s, or sausage on the grill when the words “animal products” are heard.  Unfortunately, this instills the idea that ALL animal products are unhealthy.

As “Food Inc” shows clearly, the industrialized meat sector is NOT real food.  It is not a pig grown out in a sunny field.  It is not a chicken clucking around the yard until its time to lay an egg.  These animals are fed horrible foods, stuffed in cages, pumped full of hormones and chemicals to keep them “alive” until its time to process them in a mass killing.  This is NOT a whole-foods diet.  This is NOT avoiding processed foods.

Locally grown, organic farms that raise their animals humanely and responsibly, in my opinion, is supporting the notion of avoiding processed foods.

I believe that eating a diet of local, organic, whole foods is one piece of obtaining a healthy lifestyle.

“Forks Over Knives” discusses the cessation and reversal of chronic disease.  However, I found this to be a little pointed.  There are MANY factors that go into a healthy lifestyle and ALL must be addressed.  Future posts will discuss what chronic disease is and how our lifestyle, including what we eat, think, and do, will impact this.

God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference.

The book Exuberant Animal by Frank Forencich is a great book on creating change in the American, western, affluent lifestyle.

My pup Lloyd on the hunt in a fresh winter snow... Short-term, sympathetic, fight or flight in full force!

Many clients deal with chronic stress; be it physical, chemical, or mental stress our body deals the same way.  Our body produces neurological and hormonal changes to deal with short-term threats no matter the cause.  One section of the book discusses high contrast living.  The idea is that we need to have all out stress responses and then periods of total relaxation.  Just read the following excerpt:

We turn to the dog on the porch.  His baseline norm is relaxation; unless otherwise stimulated, he’ll stay in his long-term, anabolic, tissue-rebuilding phase as long as possible.  His norm is feed and breed physiology.  He’s content in this phase and will stay there until further notice.

But now suppose there’s an unfamiliar sound or odor at the front gate.  Alert!  An intruder!  Our friend’s short-term physiology kicks in instantly.  His amygdala sparks a danger response and a hormonal cascade that generates barking and a threat posture.  Within a second, he’s up and ready for action.  Heart rate up, blood pressure up, glucose levels up, digestion down.  Cortisol surges, doing its powerful work.

If the intruder turns out to actually be a hostile invader, our faithful friend is ready to leap, snarl, and repel.  But when the intruder turns out to be a friendly neighbor who’s been visiting your house every week for the last 10 years, the whole system changes polarity in an instant.  Short term physiology immediately shuts down, adrenals relax, blood pressure drops, vessels dilate, and our friend returns to the serious work of napping and rebuilding his body.  There’s no obsessing over the encounter, no second guessing his decision to “go-short-term”.  There no moment-by-moment review of the encournter.  No lingering rationalizations.  No, it’s all very simple.  Threat over, turn off the stress response.  Forget it; it’s done.

Analysis can show a  fantastic example of the human mind creating a stress response by having thought and memory.  How many of us would bark and snarl, realize it was someone we know, then be profoundly embarrassed and beat ourselves up for days.  We relive the same physiological response just remembering the incident.  By thinking about barking, “heart rate up, glucose up, digestion down.”  We think to ourselves, “I can’t believe I barked at my friend” and then relive the encounter 5 or 10 times in the next few days.

Chronic mental stress may be the most difficult to handle because changing your mind is a complex but workable issue.  However, remembering situations of the past that are now unchangeable are a needless stressor.  We must only utilize mental stress on something we can change and learn to live and let live the unchangeable.

We need to learn from our furry friends.  If there’s a problem, deal with it.  When it’s done it’s done.  Drop your thoughts, judgments, and memories of it and move on.  Back to digestion, tissue repair, and creating love for our community.

Photo courtesy of: http://www.nlm.nih.gov/

“Say wha!?!?!  I thought we were trying to REDUCE our belly fat!!”You’re right.  Reducing the amount of fat storage on your trunk is a GREAT way to improve your health.  Fat storage around the midsection has a significant correlation with risk of heart disease, stroke, cancer, and auto-immune disorder.  However, my statement is not in regard to actual fatty tissue.

“Get your belly fat” is a term I heard recently regarding spinal stabilization, i.e. a way to tighten your abdominal muscles to brace the spine and prevent it from buckling under load.  Unless we fall on our butts hard, a majority of injuries to the spine occur when it moves into an end-range… by keeping our spine neutral we can prevent excessive damage!

“A fat belly” refers to engaging your diaphragm, a giant muscle in your midsection that promotes correct breathing and is a potent stabilizer of the torso.  When standing, your diaphragm lies mostly parallel to the ground and divides the upper portion of your torso from the lower portion (separating rib cage from abdomen). As we properly breathe in, the diaphragm moves downward compressing our stomach, intestines, and other contents to make room for our lungs to expand and bring in more air. When we then hold our breath and place a heavy weight in our hands or on our shoulders we increase what is termed intra-abdominal pressure.  This means the pressure in our abdomen increases and helps prevent our spine from moving.

If we breathe in properly our belly will expand (making it appear “fat”) because of intestines getting pushed by the diaphragm.  If we then get “tight” when it is “fat” we can keep a deep breath which will stop our chest from dropping, give our shoulders a great platform to sit on and stop our low back from moving too much.  ”Wait, I thought I was supposed to suck my belly IN”… nope.  When we say “get tight” we don’t mean “suck in” (i.e. moving the belly button towards the spine).  We mean tight like you’re about to get punched in the gut.  Now, we might also say “get fat” or “get a big belly”.  This will help you visualize taking a deep breath in, engaging your belly to push outward, and then holding tight to prevent any motion.

This is part three of an educational series about active and passive connective tissues and their ability to move: your flexibility.  In Part I we addressed WHY flexibility was important, and the two factors limiting your flexibility.  In Part II, we discussed neurological restriction and a few basics ways to keep it at bay.  Today we will discuss WHEN to address neurological tension.

What do I stretch for an overhead squat?  I get this question more than “how much does this bar weigh?”  Here’s my answer: Whatever is tight.

Your body is an interconnected system that gives you options for certain movements.  Some of those options are better and less damaging than others.  An overhead squat requires the greatest range of motion of both hips and shoulders of any movement we have.  You’ve got to be strong, mobile, and co-ordinated.  So what do you stretch?

You stretch what’s tight.  Some of you have your problem areas and you MUST work those.  Others have an American range of motion… shoulders tied down, tight hips, and a stiff ribcage. When you no longer have a “problem area” you then a “training area” and have to deal with training stiffness.  This is the increased muscular tension after a tough workout, defined as one aspect of neurological tension from the previous post.

Sometimes, it’s more beneficial to stretch what’s been worked, not what’s ABOUT to work. Delayed onset muscle soreness (DOMS) is a phenomenon of the immune and nervous systems that causes tension and tenderness of a worked muscle.  When we work out, we damage muscle tissue.  The immune system sends in an inflammatory response to repair the damage.  This inflammation creates the tenderness we notice.  With the small damage, there is a small decrease in the strength of the muscle, thus your nervous system shortens the muscles to protect them from being damaged again.  Commonly, DOMS is most significant in the 24-72 hour range with a peak at 48 hours.

Tuesday had a load of deadlifts and kettlebell swings.  Both are POTENT exercises to strengthen the hips/hamstrings/low back (aka posterior chain).  As a result, that area will likely have the greatest DOMS today (two days later).  Increased tension in the hip/hamstring/low back region will limit hip flexion and thus limit depth of the squat.  As well, the lats cross the low back and tie into the gluteus maximus (butt muscle) on the opposite side (aka posterior functional sling).  When the gluteus gets DOMS from some deadlifts it can pull on the latissimus as you enter the squat and pull the shoulders down resulting in a drop of the bar forward.

This video explains the posterior functional sling, it’s ability to limit the overhead squat, and some foam rolling work to help mobilize this area.

*Disclaimer: Flexion and rotation are acceptable movements for foam rolling in a healthy spine.  You should feel more free and mobile after a brief foam rolling session like this.  If you feel tighter or more uncomfortable after foam rolling, you may have an unhealthy or symptomatic spine and need some professional assistance.  Be sure to let your coach know.

In conclusion, mobilize what is tight.  When you have problem areas, work them. When you’re generally fit and healthy, you’re going to have training areas that are undergoing DOMS from earlier workouts in the week.  Focus your mobilization on your DOMS areas with some foam rolling/lax ball work.  It’ll be a little uncomfortable, but you’ll survive.