Relax to Move Better

Listening to a teleseminar with Dr. Evan Osar on my commute today, I was reminded of an important concept when it comes to optimizing function.  It has to do with learning to relax your musculoskeletal system, rather than creating tension.

I am sure that most of you have heard ad nauseum about the importance of engaging your core when performing functional activities.  While a well-trained core means having the ability to reflexively stabilize your spine under demand and in the presence of change, one should not aim to walk around perpetually "braced". By doing so, you may be impeding your function rather than enhancing it.  As much as it's important to be able to engage your stabilizing muscles at the appropriate times, it's also important to be able to relax your phasic (mover) muscles when not being called on to perform.  Muscles in a continual heightened state might inhibit your movement and may contribute to myofascial discomfort.

Try this simple drill.  When you're lying in bed tonight, close your eyes.  Then, starting with the crown of your head, focus on each area of your body, one segment at a time, working your way down to your toes.  Try to allow that section to completely relax and "melt" into the surface of your bed.  Spend about 30-60 seconds on each body area until you are completely relaxed in that segment.  What you will discover is that you are likely unintentionally holding tension in certain areas.  This is a simple yet effective drill to bring some awareness and control to your body. 

Remember, it's not always about firing things up to achieve optimal function and performance.  Sometimes it's about doing the exact opposite. 

No Absolutes in Exercise (Except This One)

"Is yoga good for me?"

I hear this question asked all the time by patients.  And my answer is always, "It depends."

This article in today's New York Times Week in Review section got me thinking about that frequent question.

http://www.nytimes.com/2013/11/03/sunday-review/womens-flexibility-is-a-liability-in-yoga.html?ref=opinion&_r=0

I may not agree with the author's somewhat declarative title that women's flexibility is a liability when it comes to yoga.  Everyone is different, and I wouldn't want women (or men) to be scared off from such a beneficial form of exercise based on this article alone.  But I do agree with the all-important message in the final two paragraphs.  You must listen to your body.

When answering my patients' queries regarding this or any other form of exercise, I always provide them with the caveat that they should not push through pain.  That is my main concern with group yoga, where an overzealous instructor coupled with a competitive and prideful student may result in injury.  If you are experiencing real pain during exercise, STOP!  Your body is telling you something.

When pain is present, it's usually (but not always) a sign that some bodily tissue is damaged or on its way to being damaged.  Barging ahead by "toughing it out" is not wise.  For one, you will likely stress that already "angry" tissue.  And two, your body may develop aberrant movement patterns to fight through the task.  It is very important to recognize that ANY given exercise may be either PROGRESSED or REGRESSED.  So rather than battling through pain, find an alternative method that will provide you with a similar benefit without injuring yourself. 

I'm not sure who coined the phrase, "No pain, no gain!"  But if your goal is to become stronger, more flexible, better balanced, more relaxed, and to move better, yoga is a great way to do it.  Just be sure to also exercise some common sense along the way. 

Being Grateful

Last week, I was talking with a patient named Rosalie who is coming to the clinic to work on improving her gait and balance.  She has been dealing with a neuropathy in her left leg that developed after taking a medication to fight her cancer.  Rosalie was first diagnosed with breast cancer in 1989 and has battled it courageously for the past 23 years as it has left and returned four times.  She had this to say as she lay on the table:

"You know, for all these years of dealing with my cancer, I never felt limited in my abilities.  I have always been a dynamic, active person.  This is the first time that I feel really impacted in a negative way, and I have to say, it's depressing.  But you know what, I have a wonderful daughter who I'm thankful to be here for.  I have a great job where I'm wanted and valued.  So, as much as I am frustrated, I am also grateful."

That's some pretty amazing perspective.  What are you grateful for?

Balance Like June

One of my favorite patients graduated from physical therapy today.  Her name is June, and she had come in originally to rehabilitate her replaced right knee. Unfortunately, she suffered an unrelated setback earlier in this year which necessitated a hospital stay.  This left June weakened, but she came back raring to go and as determined as ever.  This clip is from today's final visit:

June is 87 years old. 

Can you balance like June?  I have seen MANY people with fewer years, fewer hospital stays, and all their original joints flail all over the place while having their single limb balance assessed.  The thing that gets me is when the follow-up question is "So what if my balance isn't great?"

Balance is one of those things that is easily taken for granted when it isn't impaired.  But then all of a sudden, it can become an issue.  It's also trainable, just like strength and endurance.  It may not seen glamorous or exciting to perform balance training (after all, there aren't really balance muscles you can show off on the beach!).  But it's so important.  In the later years, falls and their detrimental effects can be devastating. 

One other reason you may want to pay attention to your balance abilities has less to do with injury risk from falls and more to do with athletic outcomes .  Asymmetries in left to right capabilities may be negatively impacting your performance.  In addition, asymmetrical balance has been identified  as a risk factor for potential athletic injury.

By the way, the above clip shows June demonstrating her operative leg balance.  She was also able to repeat the same time on her left leg.  It was one final test to send June off on her own, with all of her hard work and dedication having paid off.

Grab a minute and test yourself.  If you can't match or best June, ask yourself why?  Then get to work fixing it.

BMI......BM "Why?"

Last night we had a couple of friends over for some pizza and beers.  At one point, one of them returned to the table after using the bathroom.

"You guys have a scale?  I haven't seen one of those in a while!"

It was a good point.  We've had a bathroom scale lying on the floor for as long as I can remember, but I'm not so sure why.  Sure, it provides us instant feedback about how much we weigh any time we step aboard.  But in terms of providing a good measure of health, does it really matter?

My neighbor's comment lead to a brief discussion about the current measure of healthy body weight as it relates to height, and that's Body Mass Index (BMI).  This number uses two measures, height and weight, to compute your number.  That's it.  However, there are plenty of people walking around who are "skinny" and unhealthy, and many who would "fail" the BMI test but who are pictures of good health by all other measures.

For 10 straight years, I was required to have an annual physical while I worked at the New York City Department of Education.  Each year, I was given a thorough work-up, followed by a brief 5 minutes chat in my doctor's office to discuss results.  Every year, I'd hear the same warning:

"You are borderline overweight.  Something you should keep your eye on."

Finally, after years of the same speech, I said, "Look, my weight has been the same every year I've come to you, within 3-4 pounds.  In fact, I've been the same weight since college.  I honestly don't feel like I have to worry about a weight problem."

His response was, "I know, but the insurance companies like to use this straight forward measure to help determine outcomes."

What's my point?  Get comfortable questioning your health care providers.  It was always funny to me to hear anti-universal health care coverage folks decry, "I don't want anyone coming between my doctor and me!"  Well, unless you pay your doctor in cash (meaning you don't have private insurance), there has always been a hidden third party involved.  And that third party has a major financial incentive at stake that may be influencing decisions made in the office or clinic.

If insurance companies like tidy numbers like BMI, it should make you question things.  By this standard of health, your average NFL running back (5"11 and 215 lbs.) would have a BMI of 30.0.  That puts these athletes in the "obese" category.  Does this make sense?

Piggybacking on my last post, the take-home message is this:  be your own biggest advocate.  Don't accept your health care interventions at face value.  I'm not suggesting that you should tie yourself into a knot by becoming an online MD.  Rather, don't be afraid to ask, "Why?"  You may be surprised at the answers.

When It Comes to Pain, Be Your Own Strongest Advocate

I've heard of several incidences recently whereby a patient was given either injections or medication for their pain.  I assume most folks are looking for a "quick fix" to their physical ailments, which is understandable.  And we know that modern medicine and the pharmacological industry are all too ready to accommodate them.  However, this might not be the best long-term approach to treatment.

Take a look at this article from the New York Times Magazine:

http://well.blogs.nytimes.com/2013/07/18/looking-for-alternatives-for-back-pain-relief/?smid=pl-share

I am not saying that all medicine should be shunned when it comes to pain.  I AM saying that you should not just accept that as the first and only solution without question.  The alarming thing to me is when I hear that people are receiving medicinal treatments without having been properly evaluated first!  At the end of the day, neither imaging (x-rays and MRIs) nor medicine should trump a good old-fashioned subjective and objective evaluation.

So, if you are planning on seeing your doctor for a consultation, be sure that he or she thoroughly reviews your history, habits, subjective complaints, etc.  Then, be sure that you are assessed by a comprehensive physical examination that involves movements (active and passive), palpation (hands-on), and even functional tasks.  This is a time-honored standard that should not take a back seat to the fancy "bells and whistles" that modern medicine has to offer.

Health care is not cheap.  Neither is your time and effort to make an appointment and be seen.  Make sure you are getting what you deserve.  Be informed and be your own strongest advocate.

Neck Pain? Check Your Shoulders and Breathing

While listening to a teleseminar with the great Shirley Sahrmann and Gray Cook on my run this morning, I hear this quote:

"Don't let your shoulders destroy your neck."

What does that mean, you may ask?  Remember the old song, "The hand bone's connected to the arm bone, the arm bone's connected to the shoulder bone, etc."?  Well, it turns out that this is true.  If you find yourself in pain somewhere in your body, don't jump to the conclusion that the site and source are one and the same.

Back to the neck and shoulder.  There are some important muscles that help move the shoulder blades (scapulae) called the levator scapulae and the upper trapezii.  One end of their attachments (origins) are on various parts of the cervical (upper) spine.  So, if you are having neck issues and find it painful to rotate your head into various positions, try these simple steps to see if you can find some relief.  First, rotate your head from side to side and forward and backward in standing to find your range of motion capacity.  Then, try sitting in a chair with armrests and prop your forearms on them.  You are essentially "unweighting" your shoulders in this position.  Now, retest your head movements to see if you notice any improvement.  You can also take the shoulders out of play by lying on your back and assessing your rotation.  Gravity won't be tugging at your shoulders in this supine position.

If you notice an improvement in your available pain-free range of motion with your shoulders "out of the way" so to speak, next check your breathing patterns.  One of the reasons that those aforementioned muscles may be contributing to your neck pain is if they are working overtime to assist with your breathing.  Healthy breathing patterns, as I've written about in the past, involve the diaphragm, and shouldn't rely on these accessory muscles of respiration.  If you find that you're someone who holds their stress and tension in your upper back and shoulders, there's a good chance your breathing is out of whack.

So, next time you experience a problem with your neck, look further away from the site of your discomfort.  You may be surprised to learn what's actually driving your pain in the first place.

Can You Cat/Camel?

In twelve years as a physical therapist, I am always surprised to see how much folks struggle with this relatively basic exercise.  It seems pretty simple, but when people hit the floor to perform it, all sorts of things happen.

The benefit of the cat/camel is that it allows you to bring your spine and pelvis through a relatively unloaded range of motion.  Difficulty performing this exercise speaks to the fact that so many of us have lost awareness, feeling, and control of our core movements.  Without this kinesthetic awareness and control, how can one be expected to maintain a neutral spine in standing, sitting, or when safely picking something up from the floor?

Here's a demonstration of the cat/camel:

I recommend making the cat/camel one of the first exercises in a core stabilization program.  It is a good way to establish and master control of your spine before you layer on more complex movements.

Mind and Body, Withering on the Vine

"Please pardon any errors, typos, or brevity that may incur when I'm replying from my mobile or Tablet. "

This was the disclaimer on the bottom of the "cover" email accompanying a resume I received last week.  A preemptive excuse for the mistakes you may make?  Is this where technology has lead us? A progression, or a regression?

"Smart" phones are great.  I wouldn't want to live without mine.  But think about what the "smart" means.  The inventors and programmers of all the apps that make our lives easier are wicked (a nod to any Bostonians who may be reading this) smart.  But they sure as hell aren't making most of us users any smarter.  As long as we can "Google" something, we're all geniuses.  We don't even have to know how to type our searches, we can simply speak them.  Generations to follow will likely have atrophied brains with hypertrophied thumbs.  Instant access to mountains of information, with an inversely proportional effort required to attain it.  

"Yeah, so what's your point, preaching about how our smart phones/pads are dumbing us down?"

Simple.  The science is there to back up the fact that those who keep their minds engaged by such things as crossword puzzles and other "brain games" help stave off dementia.  Use it or lose it.  If we become so dependent on our technology that we no longer challenge our power of recall, then that function won't be there for us when we need it.  It would have dissipated from lack of mental exercise.  Or if we start to use technology as an excuse to be quick and lazy (as exemplified by the discarded resume at the bottom of my waste basket), we may slowly drift away from bothering to do things correctly all together.

Today, I had two separate interactions with patients that got me thinking about this concept of disuse atrophy.  One was with a Google programmer.  We were discussing Google glasses, which are sure to become ubiquitous in the near future.  He told me that they were doing away with the facial recognition feature due to privacy concerns.  This feature would have allowed us to walk down the street, look at a face, and attain instant identification on the glasses display.  Amazing technology, no doubt.  But also incredibly eerie.  Why do we have a need to recognize everybody, always, instantaneously?  Wouldn't it be better to practice the skill of stalling with small talk while scanning your mental Rolodex for the momentarily forgotten name?  

The other interaction that I had today was with a new patient.  He is a very "jacked up" (muscular) 56 year-old who has been lifting weights since he was seventeen.  He came to see me for help with some knee pain.  I put him through a movement screen which exposed multiple dysfunctions.  I'm sure this gentleman can press and pull a ton of weight, but he couldn't balance on either leg for more than 4-5 seconds without losing his balance.  He also had no prayer of performing a competent squat.  In the subjective part of the exam, he had told me that he lifts weights 4-5 times a week, but he said "no" when I asked him if he squats or dead lifts.  The reason, he explained, was that he has poor balance.  So instead, he prefers to sit on machines, where his stabilizing muscles can take a vacation as he wails away on his big movers, the "beach" muscles.  He asked me this very legitimate question:

"Why would I ever squat deeply if I never need to do that in my life?"

My reason was very similar to the one I have for giving Google an occasional breather and using your own brain power to recall information.  Use it or lose it.  I told him that I didn't want him to squat for squatting sake.  If he wants to continue to sculpt his quads and glutes on the leg press, go for it.  But I asked him to throw in some body weight (no load) squats on top.  I explained to him that being able to get fairly low in his squat demonstrates mobility of his ankles, knees, and hips, as well as control to get down there.  I further explained that that motion and control will serve him well in all facets of his life, not just squatting.  

All the work your younger self did in laying down movement patterns and learning and storing vast amounts of information shouldn't go to waste.  Rather than consistently choosing the easiest path, try challenging your mind and body.  That way, if your smart phone dies on you, or you're forced to move out of your comfort zone, your God given abilities will be there, ready to deliver.  

Growing Up And Acting Like a Baby

Last night I watched Zero Dark Thirty, a good movie that told a very compelling story that made me even prouder of our military men and women.  I doubt there is a more determined, well-trained, and brave group of people in the world.

But Americans don't do ALL things the best.  Several scenes in the movies depicted Pakistani men in a full crouch.  They were just sitting all the way down on their heels, and these were not young men.  Definite grey beards squatting comfortably like two year-olds.

When I ask my patients to demonstrate their squat, it's alarming to see the results.  Some look at me with a bemused look as if to ask, "Why would I ever do that?"  Then all sorts of compensations and strained expressions emerge as they labor to get their butt to the floor.  I'm not looking for power lifters here.  I simply want to see how their joints move and what level of control they can maintain in moving them.

I recently listed to a teleseminar with Shirley Sahrmann and Gray Cook, two heavyweights in the field of physical therapy.  Cook is co-founder of a movement screen called the Selective Functional Movement Assessment, with which a person's movement competency can be assessed.  The screen includes a deep overhead squat assessment.  The interviewer asked Ms. Sahrmann what she thought of the SFMA, and she sang it's praises, with one caveat.  She questioned the practicality of asking her older patients to squat, postulating that it would be beyond their physical capacity.  Gray countered, saying that with all due respect, Sahrmann was probably only thinking of screening Americans.  He asserted that in other parts of the world, people can squat well into their golden years without issue.

Performing a squat is about more than just executing the movement.  It is a great diagnostic indicator of potential physical problems.  Yes, we all are prone to slowing down as we age, our tissues becoming more obstinate in their willingness to bend, stretch, and compress.  But we CAN take some ownership in stemming the deleterious effects of the aging process by continuing to move the way we once did.  Rather than accepting a perceived inevitable slowing down of your movement capabilities, stand up, squat down, and fight back!

I'll refer back to one of my very first blogs, when I wrote of the "rubber band in the back of the drawer".  Keep those parts pliable and lubricated through motion, and they'll be more capable of responding when you need them most.  You don't have to be a Navy Seal.  You just have to move.

Sometimes, Simple is Best

Look at this ugly foot!!

Where is the arch?  Get this foot an orthotic, stat!!  How can this person even walk without knee, hip and back pain, let alone run??  That foot is disgusting!

That foot is mine, and it just took me for an 11 mile run.  My wife calls my feet "Barney Rubble" feet.  She is both amused and grossed out by what she affectionately calls my "slab" feet.  But they work for me, and I wouldn't change them for the world.  My run this morning prompted me to write this post.

Last night I swung by Dick's Sports Store and picked up some new running shoes.  Here they are below, flashy neon lime green:

It took me about 10 minutes to pick out my shoes.  I started with some of the less expensive (notice I didn't say cheaper) models, tried three pairs on, and went with the ones that felt the best.  I didn't spend time on the models that cost $125.  I've never spent close to that amount.  My new sneaks cost me $79.  Not bad.  I also didn't spend time looking at motion control vs. stability vs. neutral models.  I just went with the ones that felt the best.  That simple.

My point is, don't complicate something that should be relatively simple.  Walking and running should be natural pursuits.  I believe that when we try to tinker too much with the biomechanics, we run the risk of doing more harm than good.  It is one of the reasons why barefoot or minimalist running has become so in vogue recently.  All the great "technological" advances in footwear since running first gained popularity in the 70's are being re-examined.

A few years ago I was at a seminar on running and injury prevention.  The course covered complex mechanical breakdown of foot, knee, and hip angle measurements, force attenuation, and multiplanar analysis using a treadmill, video recorder, and a fancy computer program.  Interventions included recommendations for shoe changes, orthotics, and heel wedges, all with the intent to "fix" biomechanical faults.  This was pretty impressive stuff.  But at one point, I raised my hand and asked the following:

"If someone comes to you with a running injury, and they have been running for 10, 15 or 20 years, without prior injury, why are you now going to try to alter their mechanics?  If poor mechanics were truly driving the injury, then why didn't that person get injured when they initially laced up their shoes for the first time years ago?"

I don't recall receiving a satisfactory answer.

Now, I'm not saying that biomechanics should be completely discarded.  I just saying that I don't think that they're the be-all, end-all.  During the first two miles of my run this morning in my new flashy shoes, I noted some mild discomfort in parts of both feet.  But as I ran on, the pain dissipated and then completely disappeared.  I wasn't concerned.  I chalked it up to my feet getting accustomed to a slightly different (and newer) shoe.  I also credit the disappearance of pain to the body's INCREDIBLE abilities to adapt to change.  Within a few miles, my body "figured it out", and I was able to run on unencumbered by pain.  Truly amazing.

Getting back to my ugly feet.  I began running in college over 20 years ago (wow, that is tough to type!).  I haven't gone more than 5 days in a row without running since, I would guess.  If I were to be conservative, I would say that I've averaged 10 miles a week.  That's over 11,000 miles of running, or approximately 3.5 times back and forth across the country.  In that time I only recall sustaining one injury, which was a relatively easily managed calf strain while training for the 2006 ING Marathon.  And this was all done with my "Barney Rubble" slab feet.  If a podiatrist, physical therapist, running expert, or Foot Locker employee took a look at my wheels, they most likely would insist that I insert some sort of orthotic into my shoe based on my static foot mechanics.  But my personal experience tells me "Don't fix what ain't broken!"

My take home message here is the following.   Try not to get too hung up on the latest, greatest, most advanced, most technical, and usually most expensive products and advice.  Try to simplify.  Stick to what feels most natural for YOU!  The human body is the most amazing machine in the world.  But it doesn't come off an assembly line.  Every single body is unique.  Whatever your pursuit or endeavor, try starting with what feels most natural for you, and then go from there.  Expert opinion is great, but just remember that the most expert opinion you have is your own when it comes to how you feel.

Breathe Like a Baby

Often times teaching people some of the most basic movements can be the most challenging.  A case in point is breathing.

Movements that are so basic that they were mastered in the early stages of development can become dysfunctional for myriad reasons, including pain, injury, poor posture, and impaired movement.  The diaphragm is part of our core, whose main purpose is to help reflexively stabilize our spines so that we can function well without injury.  When the core isn't performing optimally, you may be setting yourself up for increased risk of injury.  But how do you know if you have issues with your core?  Let's start with the most essential movement, breathing.

Take a look at this clip of my 2 month old son, Bennett:

Notice how his belly flares out while his rib cage doesn't move very much.  Do you breathe like that?  Try this simple move.  Lie on your back and place one hand on your belly, the other on your chest.  Breathe by inhaling through your nose and exhaling through pursed lips, as if blowing up a balloon.  Focus on making your belly hand rise on inhalation while your chest hand remains relatively still.  Seems simple, right?  You'd be amazed at how folks struggle with this in the clinic.  And usually their first reaction is, "I had no idea how I was breathing in the first place!"

Those who come into my clinic with complaints of upper back, neck and shoulder pain often struggle with breathing correctly.  They're the "high anxiety" breathers who use muscles which are not intended to do the heavy lifting of breathing to compensate for their diaphragm.  They have a difficult time "quieting down" their ribcage during the above exercise.  But they are not the only ones who will benefit from re-learning how to breathe correctly.  Everything we do in life benefits from correct breathing.  And while simply breathing correctly isn't the cure-all for pain, it certainly plays a vital role in good functional movement.  In addition, an inability to breathe diaphragmatically can be an indication of impaired core motor control, which carries with it potentially broader implications.

Before you can begin to correct the way you move, you must first become aware of how you are moving in the first place.  So try this simple breathing exercise.  You may find that something "so easy that a baby can do it" is more challenging than you think.

What's Your Favorite Television Show?

I was having a conversation with a patient about the frequently heard excuse as to why people don't exercise on a regular basis, which is that they don't have the time.

"That's a bunch of crap," he said.  "I guarantee you I have a busier life than 90% of your patients."

My first thought was that that was a fairly bold and presumptuous statement for somebody to make. After all, how can he know what other people's lives are like?  But then he explained that in addition to being a partner at his law firm (time consuming), he was a single father of three (very time consuming), one of whom has special needs (unimaginably time consuming and emotionally exhausting).  Maybe he was right after all.

After sharing the details of his jam-packed life, he then said to me something that resonated and stuck with me:

"The next time one of your patients says to you that they don't have time to do their exercises, ask them 'What's your favorite T.V. show?'  If they have one, then the have time for exercise."

Look, I know that people don't want to be preached to about the importance of exercise.  It gets annoying.  But I DO think it's that important, and it's why I continue to write about it.  I'm also not sitting on some high-horse saying that I don't enjoy some good mindless television watching.  After all, I watch episodes of Seinfeld that I've already seen 8 times and still laugh (which also has value)!  I watch my fair share of Knick, Giant, and Yankee games.  I even watched American Idol with my wife until this year (yes, I admit it).  I'm simply saying that if we truly examined our days and were more honest with ourselves, squeezing in a little bit of exercise would suddenly seem a lot more feasible.

Not long ago I read a quote from a doctor who said that if an obese person comes into his office, the single best thing that he could do to help all of their impaired systems would be to take them for a walk.  But he can't, because that's not how our healthcare system works.  So instead he prescribes medication and performs reactionary procedures.  With that thought in mind, the next time you sit down to watch Dr. Oz's show about ways to stay healthy, try turning the set off, grab an apple, and go for a walk.  Rather than sitting for an hour watching a TV doctor talk about how to get healthy, you'll be using that newly discovered hour to actually DO SOMETHING to get healthy.  It's a notion to which Dr. Oz himself, if not his advertising sponsors, should surely agree.

Perfuse It or Lose It

We all know the physical benefits of regular exercise.  But what about what it does for our brains?

A few years ago when I was working for the New York City Department of Education, I attended a workshop on the topic of yoga for special needs students.  I recall a simple study that tested children's motor skills pre- and post-exercise.  The children had to draw as many marks as they could within a minute, keeping each mark within two lines spaced an inch apart.  Then they stood up and performed a simple form of exercise (I believe it was jumping jacks) for 60 seconds before sitting down and repeating the task.  The results showed that post-exercise, the children consistently performed better by drawing more lines with greater accuracy.

Last week I read an article entitled "Sitting is the New Smoking".  I found that statement to be a bit hyperobolic, but one thing that I completely agreed with was the author's newfound habit of conducting as many "walking" business meetings as possible.  I think that's a fantastic idea.  Who says that every meeting has to be around a conference table, with stale bagels and Danish off in he corner?  Why not go for a 30 minute walk around the neighborhood to discuss business matters?  One common reason why folks say they don't exercise on a regular basis is because they don't have time.  What better way to get it in than to work it into your regular day?  If I were the CEO of some company, I would strongly encourage my employees to take a two hour lunch to get some exercise (and food) in the middle of the day.  I KNOW they would be more productive in the afternoon.  After all, I'd rather have a clear-headed employee log three useful hours in the afternoon than a post-lunch groggy employee spend five sluggish hours warming their seat.  What good does that do anyone?  Employee moods, morale, and efficiency would all surely improve.  I'm even willing to bet that absenteeism would drop because people would be healthier overall.

Typically one of the first programs to get cut in schools on tight budgets are gym classes.  This is stupid and short sighted.  If we truly want our kids to be more alert, think more clearly, be more productive, and perform better in every other facet of their lives, we should be INCREASING opportunities to move, NOT DECREASING them!

Perfusing the brain with more blood, oxygen and nutrients helps us think better.  It's why we exercise to "clear our heads".  And it's what happened to me this morning on my run as this topic came to mind.  So, next time you go to break a sweat, think about the good you'll be doing for your head as well as your body.  Who knows, perhaps it will be the catalyst for your next million dollar idea.

THAT'S What It's About!

Today a patient whom I've been seeing for low back pain told me that she "tweaked" her back when she misstepped while shopping last week.  But then she added the following:

"You know, I didn't worry so much about it when I re-injured my back.  This time, I knew what to do and was able to calm the pain down with the things you taught me.  As a result, it's feeling so much better today."

That was music to my ears!!  In my opinion, that's what physical therapy is ALL about.  We're here to teach YOU how to take care of YOURSELF.  As soon as someone is able to shift the focus of their rehabilitation from one of dependency to one of central control, then true success can be achieved.  I consider myself first and foremost a teacher in many ways.  Yes, there are certainly passive techniques and interventions that I use to help people with painful dysfunction.  But for me, the best part of my job is when people learn to take ownership of their physical well-being.

In a weird way, I'm in the practice of putting myself out of business.  So are all health care practitioners.  After all, the fewer times that someone "needs" to come see me for my services, the less I get paid.  But I'm alright with that, as long as it means my patients are getting better faster, and staying healthy longer.  So when I hear a comment like the one above, my day is made, because that's what it's all about.

Learn to take your health into your own hands.  It's an incredibly powerful tool that will leave you relying less on medicines and health care practitioners, and more on yourself.  After all, who should care more about you than you?

It's Never Too Late

Today I was inspired, and here's why.

A few weeks ago I was sitting in my barber's chair.  We were talking about fitness and nutrition, and he mentioned another client of his who works as a trainer.  An 82 year-old trainer.

"There's someone I'd love to meet," I said.  So my barber walked over and grabbed a card from a stack across the room.  "Here you go.  Give him a call."

This morning, I finally got to meet and talk with this personal trainer after several brief phone conversations.  I caught about 15 minutes of his last client session for the day, and then we sat and talked for about 45 minutes.  In the brief time I got to see him in action, I witnessed him effortlessly squat down, pick up a 45 lb. plate, rack it on the leg press, and demonstrate the exercise.  I watched as he got down on the floor and worked on Supermans with his client.  After his session, I learned that he has been working as a personal trainer for 12 years.  This means that after a career in an unrelated industry, this man earned his training credentials and started a new career at 70 years old.  Wow!

I share this little story for a few reasons.  First, it's never too late to make a change.  Age does not matter.  If it's a commitment to get in shape, age does not matter.  If it's a commitment to reinvent yourself, age does not matter.  My Saturday morning meeting affirmed that for me.  Secondly, learning to move well now will allow you to move well later.  This trainer told me that he loves to travel with his wife.  If he can easily squat and rack a 45 lb. plate, lugging a suitcase should be a breeze.  And third, always be open to conversation and ideas with as many people as possible.  A chance conversation with my barber lead me to an inspirational meeting with someone twice my age, but with similar values to mine about living healthy and moving well for the long haul.

Next time you think doors are closed to opportunity, no matter what facet of your life, think of the 82 year-old trainer doing his thing.  You just might think again.

Tight Hammies? Maybe Not!

Are you someone who has long believed that your hamstrings (the three muscles in the back of your upper leg) are "tight" because you can't touch your toes?  Perhaps they truly are.  But maybe you've been barking up the wrong tree by stretching the heck out of them.  Here's why.

The hamstrings work to flex (bend) your knee and extend your hip.  But the big hip extensors are your glutes.  I like to refer to the glutes as the "lead singers" in hip extension production, with the hammies as the "back ups".  The hamstrings should work synergistically with the gluteals.  However, if the glutes are under performing, those back-ups will take the lead mic.  In effect, they're "singing" louder and longer than they ought to be.  They're "turned" on more than they should be.  This phenomenon may also be perceived at "tightness" in your hamstrings.  Your hamstrings have become synergistically dominant.  You want them to be manning those back-up mics, not leading the band.

Here are two quick ways to assess if you have truly tight hamstrings.  Try bending forward to touch your toes with your knees straight.  If you can't, now sit on the floor and reach out to touch your toes.  If you can, then perhaps those hammies aren't as tight as you thought.  After all, aren't these essentially the same movements?  The only difference is that the standing maneuver requires more spine-loaded motor control than the seated version.  Another key sign that your hamstrings may be working too hard is if they are prone to cramping.  Try this.  Lie on your back and perform a glute bridge.  Feet flat on the floor with your knees bent, lift your butt off the floor to make yourself straight through the thighs and trunk by driving your hips to the ceiling.  This SHOULD be a glute-dominant action. However, if you find that your hamstrings begin to cramp while doing this move, then it's a sign that your hamstrings are working overtime on that lead mic.

Here's a quick (if not high-quality) clip of my 5 and 3 year old doing an unsupported (arms in the air) glute bridge.  Maybe not perfect form, but if my kids can bust out a bridge on a Friday night (yes, this is what I do on the weekend these days), so too should you.

So, think again whether your hamstrings are truly tight or not.  And if you find that your hamstrings have been unfairly blamed all these years, and that your weak, under performing glutes are the real culprit, get to work.  Make sure these powerful hip extensors are up to the task.  Your low back will thank you for it!

James W. Horn, MSPT

Baby's Don't Lift Dumbbells

I took a great course last fall that changed the way I look at my patients.  In essence, it provided a system by which a person's basic movement capacity can by screened, revealing mobility and/or stability deficits.  With all the evaluative and treatment tools that I have accumulated over the years, this is the system that has organized the toolbox.  It's a work in progress, but I'm very excited about the ways that it will help me help YOU to get better, stay better, and move better.  That's why I love doing what I do every day.

Of all the great nuggets I took away from that weekend in Philadelphia, one particular line struck me the most.   "Baby's don't get strong by grabbing miniature dumbbells and doing 3 sets of 10."  Rather, an infant's motor development occurs naturally and intuitively.  They have to earn the right to to reach the next developmental milestone by laying down the wiring sequentially.  Think of the new Freedom Tower as it's going up down town.  Without the preceding floors, the higher ones couldn't be there.  This is the fundamental concept behind the movement assessment to which I'm referring.

As we get older, we do a million things to tangle those well-laid wires.  We assume habitually poor postures, stick to a single lane on the movement highway, and incur injuries for a variety of reasons.  These are just a few ways that we can mess up the software that drives our hardware.  Here's the thing though.  Whether we're rehabilitating ourselves from injury, or we're setting out to "get in shape" with a new year's resolution, odds are we're neglecting our wiring (neuromotor control) and focusing prematurely on the hardware (big, lean muscles!).  Well, if I ask someone to grab some weight and start pushing or pulling it without having some understanding of their basic movement capacity, then aren't I asking them to injure themselves worse?  Or at the very least, prolong their rehabilitation?  Or "get in shape" without actually doing a damn thing about learning how to move well for the long-haul?  The answer is "yes".

Baby's don't walk out of the womb.  The 80th floor of the Freedom Tower doesn't float in the air without support from 1-79.  Next time you want to get in shape or have to undergo rehabilitation, ask yourself if you've "earned the right" to grab that dumbbell.  Get assessed to see how well you REALLY MOVE (or don't for that matter).  You may be surprised.

I'll leave you with this quick example.  If you can't squat like this baby, ask yourself, "Why not?"

James W. Horn, MSPT
Chelsea Physical Therapy
& Rehabilitation
119 W. 23rd Street, Suite 1002
New York, NY 10011
(212) 675-3447

Good Posture....See it AND Feel it.

I had a 22 year old guy come into my clinic earlier this week with right shoulder pain.  He first hurt it a month ago while boxing, and then re-aggravated it playing basketball last week.  All he wanted to do was to "fix" it so that he could get back out onto the court.

I proceeded to perform my typical shoulder examination after taking his subjective history.  One of the things that really jumped out at me was his posture.  After putting him through a full movement screen, I told the eager hoops player that his shoulder issue was infinitely fixable, but that his bigger picture for good long-term shoulder, neck and back health was addressing his poor posture.  I'll explain why, and offer a quick tip on what you can do to assess your own posture.

For a young athletic person, this patient had what's known as a forward head, forward shoulder carriage.  In other words, when viewed from the side, his head protruded forward so that his ears were well in front of his shoulders.  His scapulae (wing bones in the back) were also riding upward and tilting forward, contributing to a "slouched" appearance.  This posture, SO typical of a desk jockey logging 8-10 daily hours staring at a computer screen, puts the shoulder complex in a poor mechanical position.  The results can include dysfunctional movement patterns, increased risk for impingement syndromes of the rotator cuff, impaired diaphragmatic breathing, and myofascial pain in the upper back, neck and shoulder regions, to name a few.

I would be doing this young patient a disservice if I only addressed his pain and didn't work to help him improve his posture, his movement patterns and by extension his shoulder function.  So, what did I do?

The thing that I tell people is the first step towards correcting posture is gaining AWARENESS.  So that's where we start.  Odds are, most of you have very little idea of what you look like in profile.  When you look into a mirror to check yourself out, you're only seeing one plane of symmetry.  If your shoulders are even, you probably feel that you are in good alignment.  A simple technique that I employ in the clinic is to grab a patient's cell phone camera and snap a picture of them in profile, without prior instruction.  I then ask them to back up against a wall so that their heels, butt, shoulder blades, and the back of their head are touching the surface.  I then ask, "How does that feel?"  Inevitably, the response is, "Weird!"

Next, I ask the person to stand in profile, retract their head (as if making a double chin, not tilting the head backwards into cervical extension), pull their shoulder blades down and back towards their spine, brace their belly, and squeeze their glutes.  It's basically the position that I had them assume against the wall.  I then snap another picture and compare the before and after.

The reason why I have found this simple drill to be of such value is that it allows people to SEE what good posture looks like immediately after FEELING what good posture feels like.  They have instant feedback that tells them, "No, I suppose I WON'T look like I'm marching in the military if I actually carry myself with correct posture."  The reason that it feels so strange initially is that their current posture is their sense of normal.  I want to teach people to learn a "new normal", and the visual feedback is a great first building block towards that crucial awareness that I mentioned.

So, I've provided you with one small anecdote as to why good posture is important (healthy shoulders!).  There are many more, including the simple fact that it looks better!  If you want to know what your posture looks like, grab a partner to snap some quick pictures and try these simple steps.  If you do indeed have an "aha" moment when you finally see what you look like, try this one last piece of advice.  Rather than to try to remember all those kinetic check points to keep in line, just think about "Getting Tall".  If you try to get the crown of your head as close as you can toward the ceiling, as if a string were attached and pulling you there, then everything else will fall in line. It may be a bit overly simplistic, but I have found that people are much more likely to remember to "Get Tall" and therefore remain compliant.  As I mentioned, attaining good posture always starts with awareness.

So start "Getting Tall" everybody, and watch as you eventually begin to feel and move better as a result!

Jim Horn, MSPT
Chelsea Physical Therapy
& Rehabilitation
(212) 675-3447