E-mails have been coming in how readers quickly fixed their own pain and got better strengthening using the simple principle here on Fitness Fixer and my website.
Last week's post Each One Teach One showed how reader Ivy from New Zealand fixed a neighbors back pain.
This week is an e-mail from KMLash who quickly stopped 15 years of knee pain:
"Your paper on how to fix your knee pain is by far the most important thing that I've done for my knee since I injured it 15 years ago. I've tried every supplement that has good statistical results behind it (e.g. ASU), custom orthotics, physical therapy, message, leg strengthening, weight loss and any other cure that I read about and still I've been suffering with knee pain for years - especially when standing in 1 spot. It's put a damper on countless vacations, social engagements, etc.
"I read How to Fix Your Own Knee Pain and within a few days of implementing the techniques for both walking and standing I got results in my knee and surrounding muscles that I have not been able to get in 15 years. The first day I began using the techniques in your paper I began to experience relief and the second day it was obvious to me that I had come upon something that would do for me what nothing else did in 15 years of trying. I have never come across the concept of proper leg posture and its potential to relieve knee pain until I came across your paper. But the minute I read it and took a walk to try the techniques it became obvious to me that my leg posture was terrible and that all my weight was being placed on my knees with minimal support from my leg muscles. The concept of using my heels has been especially helpful. Additionally, keeping my body weight slightly backward from where it use to be during walking and standing has allowed me to place my weight on my heal and maintain proper posture. With that I immediately felt my leg muscles begin to spring into action and my body weight taken off my knees. The relief to my knee and surrounding muscles that has ached for years was very noticeable.
"Thanks for sharing this paper on the internet. It's a major find for me that's relieved knee pain that's hampered my life for 15 years. I really appreciate it." KMLash
"One other point worth mentioning - In becoming aware of my leg posture, I became conscious of the position of my feet when standing. The foot on my "bad knee leg" pointed outward a good 15-20 degrees. The foot on my "good knee leg" pointed outward less than 5 degrees. I have consciously been pointing the foot on my bad knee leg straighter and it has allowed me to stand in one spot for long periods of time without my knee and the connective tissue above the knee hurting. So, just becoming aware of the concept of leg posture has made me conscious of various aspects of my posture including my feet. Thanks again. " KMLash
More Fitness Fixer to help get your knees in shape:
Healthy Knees shows how to easily use your leg muscles when landing from jumps, to prevent inward knee sagging that gradually grinds the joint. Easily apply this to descending stairs, walking, running, and regular daily life activities.
Fix Your Own Pain Without Drugs or Surgery and Health & Fitness THIRD ed (How to be Healthy Happy and Fit for the Rest of Your Life). Good books at www.DrBookspan.com/books.
It can be easy. You can get better use of your muscles during all your regular activities without stopping your day to "do exercise."
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy.
We're just back from teaching the medical school elective in wilderness medicine. Each year I teach there, working over my birthday. Same food as last year. But the creek was thinly iced - good for ice swimming.
Before lecturing, I worried that my information on health - stand up straight, eat right, exercise, "and all that," would be so known and obvious to the bright young medical students that it would bore them. Instead, it was called, "Out of the box." When did health become out of the box?
I spent years of my career in a lab as a serious, intensely number-checking research scientist. I worked to ensure that we knew what truly worked, and what was hype, unrelated, or just wrong. I made certain that what I discovered and developed for patients was squarely right, practical, and in the best interest of the patient (and fun too, which is health). All I pursued was The Truth. Matt Cartmill once said, "As a youth I craved factual certainty, and I thirsted for a meaningful vision of human life. So I became a scientist. This is like becoming an archbishop so you can meet women."
Why is bypass surgery, angioplasty, stents, obesity, diabetes, and medications with uncomfortable, unhealthful side effects considered normal, while eating a vegetarian diet is labeled wacky and extreme when it is medically documented to stop and prevent heart disease, diabetes, high blood pressure, and other prevalent conditions that rob people of joy in life?
In my diving medicine lectures, I wanted students to see how the information worked and how it relates to many things in and out of diving, not just dictate lists of conditions to memorize. I showed slides, asking them to identify why an accident would happen on the way down versus up and why. I told them that if they understood, they would not have to memorize. I just wanted them to think. As my father once enlightened me, "Jolie, you're asking a lot!"
In the orthopedic lectures, I taught the same principles I tell in this Fitness Fixer blog of gaining great physical improvements without making pain and injury in the first place. After one of my lectures, students scattered for personal time, while a few stayed in the lecture hall, bent over laptops. They sat hunched, rubbing sore shoulders. Eventually one nudged the other, "Get the doc, she's right here." After some indecision, one student asked me to give him stretches to fix the pain of working at the computer. I told him you can sit and work without getting pain in the first place, and why didn't I show him that, instead of a stretch as an "antidote." He protested that the computer made his neck hurt. I agreed that the way he was sitting would do that, and repeated that you can easily sit and work in a way that doesn't cause the pain in the first place. More protests came, that as students they had to work on the computer long hours.
Medicine is not supposed to consist of allowing bad things to happen so that you can do a cool procedure to try to reverse it. Readers, do you want to try what I showed him and get a free house-call right now?
I moved his chair in close to the table where he was working. Move yours in close now.
Standing behind him with my hands on his shoulders, I gently pulled his upper body up and back to rest against the chair back. At home you can feel me guide your shoulders and upper body back.
Next, keep the chin gently in, not jutting forward.
We moved his computer back from the front edge of the table to make room to rest his forearms while using the keyboard. If you use a "below-desk" keyboard tray, it is often better to move the keyboard back to the desk. Don't crane your wrists, making a new problem. Relax and breathe.
I told them that at my own desks, I raise computer on a shelf, block, or book about 10 inches higher than desk level, and use a cheap external keyboard. Even without these helpful changes, you don't have to round forward over a laptop.
The seat back of the lecture chairs were concave - shaped to curve like the letter "C" so that you sat rounded forward. This is a common problem in many chairs, even some called ergonomic chairs. Another of the students mentioned he had a commercial lumbar roll at home. It was expensive and he didn't use it much because it was uncomfortable. I showed them how to use a small soft roll, which can be your gloves or light sweater, nothing fancy or expensive. Nestle it in the small inward curve of the lower back, then press your upper back, not lower back, against the chair back so that you can sit straight and lean back, instead of rounding forward. Pressing the lower back against the lumbar roll is a common way to make it useless and uncomfortable.
It turned out that most of the young, active, outdoorsy, academically talented medical students had muscle and joint pain. So did many of the top ranked physician faculty. Several told me they thought their pain was normal from their activities, from studying, their fallen arches, or body structure. They regularly took anti-inflammatory medicines and thought they needed special shoes.
You probably heard not to slouch since you were a child. That easy medicine hasn't changed. You heard to eat vegetables for health and an apple a day to keep the doctor away. I think only a few of the medical students I was teaching caught on, and will help others with what they learned. It can be so easy. As for the rest? Who is the one who is out of the box?
Are you doing unhealthy sitting without realizing it, during work, play, and exercise?:
All-in-one resources for healthier pain free life:
Fix Your Own Pain Without Drugs or Surgery. Chapters on fixing each kind of pain plus patient stories in every chapter tell how things work, why, and why not.
Health & Fitness THIRD ed - How to Be Healthy Happy and Fit For The Rest of Your Life. Exercise, food, health, fixing pain, functional built-in healthy life, family, mental, it's all here.
Healthy Martial Arts. Top level book for any athlete or those who would like to be.
--- Questions come in by hundreds. I make posts from fun mail. Before asking more, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Why not try fun stuff, then contribute! Read success stories of these methods and send your own. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certified - DrBookspan.com/Academy. ---
The previous article showed how the best ankle support comes from your own ankle, leg, and foot muscles. Pronation (flat, sagging arches) is rarely just the way your feet are made, or something you can't prevent. Usually it is a slouching posture, where the ankles are allowed to sag. You can prevent sagging, and can hold your ankles in healthy position, no differently than not letting your posture sag anywhere else.
It is commonly taught in gyms, medical schools, aerobics certification programs, and footwear stores all over the US, that shoes or orthotics are necessary to hold your arches in position. "Supportive" shoes change how you move naturally and are hard on your knees. The needed support can come from your own foot muscles. How do you do this?
Stand up with both feet parallel, pointing straight ahead.
See if your arch slumps downward, pressing your arches against the floor (left photo). In most cases, there is nothing wrong with your arches, but because you allowed it to slouch.
If you use the muscles on the outsides of your ankles and legs, you can gently shift your weight more evenly to neutral ankle (right photo) and stand straight. Don't tilt completely to the side or stand on the sides of your feet, just shift enough to lift your arches from the floor.
Don't yank just from the ankle, causing strain to the next segment. See where the slouch is coming from and make the entire leg positioning healthy.
Having arch support from your leg and foot muscles is the same as using your upper body muscles to stop neck and shoulder slouching. Are you are slouching right now reading this? Straighten your upper body in healthy manner to remind yourself you can use your own muscles to be healthy.
If it hurts, it's wrong. Don't force.
All you are doing is learning how to stand neutral, instead of tilted too much inward or too much outward. Both can compress joints and soft tissue. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater learns to hold their skates straight at the ankle, not angled.
Engineered running shoes are not necessary to prevent lower leg pain. Some even add to knee and ankle pain - more in other articles. Support your own feet by holding position using your own muscles, not a shoe 'straight jacket' that lets ankles atrophy and doesn't let toes move, stretch, and straighten.
My web site page Inspiring Patient Stories for a first-hand account of a patient who fixed a lifetime of pain and pronation by stopping the cause - letting ankles and feet sag. By holding healthy positions during your normal day, you can get free, built- in exercise for your feet and ankles, and better health.
It shouldn't hurt, or require commercial products or machinery to just stand up straight.
--- Read success stories of these methods and send your own. See if your answers are already here by clicking Fitness FIxer labels, links, archives at right, and Index. Subscribe free, "updates via e-mail" upper right. For personal medical questions - Replies to Medical Questions. Limited Class space for personal feedback. Top students may earn certification,DrBookspan.com/Academy. Get more in Dr. Bookspan's Books.
Which Shoes Help Exercise, Fall Prevention, and Ankles?
Tuesday, February 20, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
We are in the cold, damp Tennessee mountains for the rest of the week, teaching at a medical school program of wilderness medicine. It should be warmer than home in the Northeast US where it's snowing, and the Schuylkill River, and water bottle on my bicycle are frozen. I won't have Internet or phone access at the wilderness camp. Unflagging Healthline staffer Carrie Locke is posting the blogs for me all week. Thank you Carrie, once again.
For wilderness treks and hikes, and everyday walking, you need to walk on uneven surfaces without stumbling or spraining your ankles. Expensive shoes, inserts, arch supports, braces, ankle supports, and orthotics are sold on the belief that they are needed to hold your foot and ankle in position. However, this is an expensive fallacy.
You are the one who can hold your ankles in healthy position or let them sag into foot pronation. You don't need, or even want, shoes that hold your ankles straight for you. Without use, your ankle muscles weaken. With shoe support, your ankle doesn't have to work to hold itself. It gets weaker. It forgets how. "Supportive" hard shoes without flexibility are a common source of hip and knee pain. It is the opposite of what is needed.
It is not high top shoes or ace bandages or taping or orthotics that prevent falls and ankle sprains, or prevent ankles from sagging outward (supination) or inward (pronation.) The most important thing you can do for healthy ankles and preventing sprains is to use your own leg muscles, and simply hold your ankles without sagging, the same as any other posture. Think of a beginning skater. At first, they let their ankles bend and sag inward. They do not know how to hold their legs using their own muscles. Eventually, they learn to hold straight, healthful positioning.
Letting your ankles sag inward can press the joints of your arches, ankles, knees, even hips. In most instances, supportive shoes and inserts are no more needed than putting your mouth in a sling to keep it from falling open when you walk around. Thinking that you need supportive shoes to brace uninjured ankles for hiking and walking is a common myth that perpetuates weak, unstable ankles. Many people who use arch supports never learn how to use their own muscles, and are told to never go barefoot. This is an unfortunate and unnecessary restriction to their health.
The post Healthy Knees shows what inward-sagging knee positioning looks like and how to fix it. It is easy to do and makes an immediate and important improvement to your joint health.
Often in wilderness settings, I see hikers in expensive boots. The native mountain guides and pack-bearers are wearing flip-flops or old soft sneakers. This is not just a salary inequality. It is not that the guides don't know ankle and leg health. They know something crucial - the health of your ankles and knees comes from your own muscles. You will save much money by not getting footwear and products that prevent your foot and ankle muscles from working. You will save your knees and hip from the shock and extra loading of hard supportive shoes. Without them, you will get free, built-in foot stretch and leg and foot exercise with every step.
--- Read and contribute your own success stories of these methods. Before asking questions, see if your answers are already here - click labels under posts, links in posts, archives at right, and the Fitness Fixer Index. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. For answers to personal medical questions - Replies to Medical Questions. Limited Class spaces for personal evaluation. Top students may apply to certify throughDrBookspan.com/Academy.See Dr. Bookspan's Books. ---
Early tomorrow we're traveling to the Great Smokey Mountains of Tennessee to teach for a week at the Wilderness Medical Society medicine elective. I posted about the elective in December.
Last year we brought flashlights but no phone, as no cell signal got through there. Before arriving last year, I asked the medical director if we should pack in food. He said, "Not at all, the camp has its own chef." He told us there was plentiful vegetarian food. When we arrived, the breakfasts were sugared, packaged cereal, or sugared processed oatmeal packages, lunchmeats with greasy gloppy potato salad and fruit salad for lunch, meat loaf or other meat for dinner with small sides of vegetables soaked in fat. This is more than innutritious, it is harmful to health. There were many unfermented soy loafs and products. Unfermented soy, popular in protein powders, drinks, bars, and meat substitutes, is not turning out to be healthy as previously thought, and does not have the benefits of fermented soy products. Two previous posts, Is Your Health Food Unhealthy and Exercise is More Important Than Calcium Supplements for Bones explained that unfermented soy is known to slow the thyroid and has estrogen-promoting qualities - increasingly documented to contribute to estrogen-dependent tumors like fibroids, cystic ovary, breast cysts, and endometriosis. Hundreds of thousands of women annually have needless, serious, and painful surgery for conditions they might alleviate by avoiding estrogenic foods and the numerous "women's" supplements sold in "health" food stores. There were plenty of cookies, cakes, and muffins, coffee, and, in fairness, a bowl of fruit.
We were surprised that a medical education program would serve unwholesome food. Should we have been surprised? At the several medical conferences I attend every year, the breakfasts and meals at functions and meetings are bacon or sausage (these are not helpful protein sources; they do more damage than good), cheese Danish, and other junk food. The fruit is served covered with sugar and cream or as a small side. The only vegetables are the decorations. "Break-out" snacks are confections, candy bars, and ice cream. I was once on a committee that decided and promoted national health policy. The box lunches were ham, cheese, and mayonnaise sandwiches on white bread (or processed flour wraps) with a wisp of something green sticking to it, a bag of potato chips, a package of cookies, and a can of soda. I inquired one time about it and was told by the people in charge that it was "perfectly healthy and contained greens." At another conference, I was told they once tried to have healthful food, but were threatened by their physician members with reduced enrollments if they did. These are the physicians and health providers you go to, to safeguard your health. But, they are of the old generation and times have changed, haven't they?
At the Wilderness elective last year, I went believing that the young, "hip," privileged medical students had grown up with all the right information. I queried one student there about the food, and he replied without hesitation that it was no different from what he ate at home because healthy eating, "was too expensive and too time consuming and you need too many special pots and pans to cook that weird healthy stuff." I was taken aback by his misinformation. Several medical students agreed that they couldn't be expected to eat right with their difficult schedules, and that healthful food tastes terrible. Most had candy bars and bags of chips in their packs, or fancy "energy bars," which truthfully, are little more than candy (with unfermented soy and some synthetic vitamins) not the health products that advertising wants us to believe. I always thought that people know what is bad and would be embarrassed if anyone knew they did bad things. But the students didn't know it was unhealthy and flaunted their bad habit. These are the next generation of doctors who will make decisions about your health? Or prescribe drugs and surgery for things they don't know are from bad eating habits?
Our job there as their teachers is to give them information and open doors of insight. But their mind was set, and they did not want to hear how to have easy, inexpensive, and good-tasting healthful food (without needing special pots and pans).
I went to the director, a friend and sensible man, with the great idea to teach a healthful eating course at the next elective. He told me the students wouldn't be interested. I offered the idea to just change the menus to beneficial food at each meal, to live what they learn. The director smiled and told me they had a hard enough time getting enrollments and didn't want anything to decrease numbers. I said, "Don't tell them it's healthy food ahead of time." He winked, "Word would get out!"
I will let you know what happens this year with the students. We're bringing vegetables, fruit, onions, and spices for ourselves. If you're interested in how to make easy, inexpensive, fast, and good-tasting food, see the book Healthy Martial Arts. The interesting information I will be lecturing about this week on diving physiology and hyperbarics, is also on web site books page.
The New Year is beginning in many places around the world. Happy Lunar New Year on Feb 18th - Sheng Dan Kuai Le Xin Nian Yu Kuai. To my friends who prefer Cantonese Chinese - Sing Dan Fae Lok. Gung Hai Fat Choi. To family, readers, and friends in Thailand, Suk san wan pee mai.
In India, the Maha Shivaratri fell on the night of February 16th this year. 'Ratri' is Sanskrit for night, and Shivarati is the night Shiva performed the Tandava Nrityathe, the dance of primordial creation.
In the first photo above, friends are sitting in full squat to light Sai Lanterns, that float slowly overhead by the hundreds like ethereal jellyfish.
Happy bending, lifting, dancing, stretching, and reaching for exercise as a lifestyle. Follow this Fitness Fixer health column regularly for simple things, new with each article, to easily make this new year a year of health.
Fun Fitness Fixers showing why squatting is part of Fitness as a Lifestyle:
Stand back-to-back, as in the photo, arms outstretched, hands comfortably linked, thumbs face upward.
Don't lean back, arch your back, or jut your neck forward. Stand straight.
One partner gently pulls arms forward, while the second partner allows their arms to stretch backward, letting the chest muscles stretch (left-hand photo).
The idea is not to yank the second partner's shoulder at the joint. Allow the front chest muscles to lengthen. It should only feel good.
Hold for a few seconds while breathing easily, then switch so the second partner who just stretched arms backward, pulls arms forward to stretch the first partner (right hand photo).
Valentine's day doesn't have to be one day, then forgotten about. It can be the start of healthy interaction between any people and for yourself, for every day, which is the idea of "Fitness as a Lifestyle."
I have grandchildren - my patients are using what I taught them, to fix pain for others.
Monday's post on Partner Leg Press began the Valentine's week Fitness Fixer posts on sharing health with a friend. Today on Valentine's Day I have a post that best shows this. This story is from one of our own Healthline Fitness Fixer readers, Ivy Griffiths of New Zealand. Ivy writes,
"On Thursday night my neighbour was taken to hospital as she was experiencing pain in her hip which in turn went down her leg. I told her that I thought it was sciatica. X-rays showed that there was degeneration of the spine and that she had a pinched nerve. They gave her the usual drugs and she returned home yesterday afternoon. Her son told them at the hospital that they knew someone who would help that person being ME. Dr. Jolie I just about freaked out so I told them that I could help with the cause but not fix the pain. I went on to show her how to lift herself up on her elbows (face down) before getting out of bed, how to sit straight and squatting instead of bending over and all the advice that I have received from you over the past year. I took her for little walks around the village so that she wasn't sitting all the time. Around 5pm this evening (Saturday) I went to see how she was. To my amazement, she told me that she had been reading your book "Fix Your Own Pain Without Drugs or Surgery" which I had lent her. She had thrown away the drugs and the pain had gone. Believe me when I say that I was blown away."
Ivy, thank you. The world is better because of you.
Readers, keep the intelligent comments coming in reply to posts. Send me your stories and (small file size) fun photos of your progress. Prizes for the best ones. Use a photo sharing service so I can upload directly from your photo link.
Happy Valentine's Day, a day of being good and healthy to yourself and others. That's health and love.
"Appreciation is a wonderful thing: It makes what is excellent in others belong to us as well" - Voltaire (French Philosopher and author)
Thank you to Jenni at Chronic Babe. Jenni collected medical blogs from this past week to compose Grand Rounds 3.21 on the theme of Valentine sweetness in many forms.
Jenni included my posts on Thai Massage as "how to properly - and safely - massage your partner."
It's Valentine week. Each Fitness Fixer this week will show a fun way to improve health with a friend.
The Partner Leg Press strengthens your legs, hips, and posture muscles, and practices balance and good body position. It can be safely done with children too.
Partner 1 lies face up on the floor with both feet raised.
Partner 2 is facing down holding their body straight, with Partner 1's feet on their chest or abdomen (photo 1).
Partner 1, on the floor, bends knees to lower and pushes legs almost straight, in a leg-press action.
Repeat leg pressing many times, trying for at least 10 presses, then switch places.
Be careful. This one is so much fun that Partner 2 may drool on, or fall on, Partner 1 by accident (or purpose). Have fun on Valentine's Day.
Then try the Partner Leg Press with Partner 2 face up (photo 2 below). Start by partially sitting with Partner 1's feet on your back, and "walk" your feet away for straight positioning. Do several presses, then switch places.
As you do the fun Partner Leg Press, adjust your balance and positioning for the other person. Working with a partner practices cooperation and empathy - important and often ignored aspects of health.
Why tell a loved one or child you can't spend time with them because you need to go exercise? Instead of making exercise isolating and separating, and something you have to stop your life and disrupt your family to do, make it unifying, friendly, and fun. That is health.
Often the simple act of breathing is made into a complicated ritual. People take classes to learn how to breathe in this nostril and out that nostril and four times slowly this way, and eight hundred times quickly that way. All you need is to remain simple. In. Out. Try a nice breath now. This is often more than many people do. Check yourself when at work, opening mail, putting things away. Do you hunch your shoulders and hold your breath, straining or breathing shallowly and quickly, just to hurry through and get it done? Keep breathing normally in and out.
It was previously thought that lung function declined steadily with each passing year after age 30. It also used to be thought by some in exercise science that respiratory muscles could not be trained, or that the highest amount of air moving in and out with exercise would not change except to diminish with aging. Now it is established that the breathing muscles of the chest and abdomen are muscles like any other. You need to exercise them. You can improve function at any age.
Exercising your respiratory system through healthy breathing is important to reduce many respiratory problems, and is part of staying in shape and able to do normal activities without getting out of breath. How do you do this? To exercise your respiratory system, following are three main things to try:
1. Exercise your whole body with biking, skating, skiing, running, skipping, hiking, dancing, and other fun ways to move.
2. You can exercise your breathing right now while sitting or standing:
Close or purse your lips loosely (draw them together at the sides) and breathe in against the resistance.
Breathe out slowly without resistance. Repeat several times.
Try the above, breathing in more and more quickly.
Allow enough time (a few seconds) between each resisted breath so that you do not become dizzy.
As you get better at this over time, increase resistance by how firmly you close your lips together.
You can buy expensive respiratory muscle trainers in fitness catalogs to provide resistance for breathing muscle training. You can also get the same effect yourself by breathing in through pursed lips or trying to breathe through your sleeve (pressing your mouth against your forearm). Resistance breathing exercises have been long practiced in the martial arts in exercises of "sanchin," yoga, and some forms of chi kung breathing, which tighten the throat (or hold the nose) for resistance instead of the lips. Some scuba-divers and breath-hold free divers practice various techniques, hoping to increase breathholding endurance and underwater time. Not all of these practices are a good idea for divers, to be covered in future posts.
3. Periodically see how much air you can breathe in and out in one breath, both with and without resistance:
See how quickly you can inhale fully.
Then how fast you can exhale fully.
Regularly exercise heavily so that you need to breathe hard for extended periods.
Don't "overbreathe" (hyperventilate) by taking huge breaths in and out while at rest. That changes your body chemistry, which can make you dizzy or cause temporary limb tingling. The dizziness from hyperventilation is often taught in yoga, martial arts, and meditation breathing classes as something healthful. However, it is not physically beneficial.
Healthful breathing patterns are important when not doing strenuous exercise. When chopping vegetables for dinner, do you hunch your shoulders and hold your breath during the knife stroke? Instead, make the rhythmic chopping a meditation and an easy exercise with healthful body positioning. When you hang up laundry or put away groceries, notice if you tense up and hold your breath? When you move during any action, check to see if you tighten muscles and hold your breath trying to get it done. Lower your shoulders. Untense your muscles. Enjoy the task. Breathe.
For healthful breathing during life activities, remember to let your belly expand to breathe in. Don't just raise your shoulders and chest. Don't pull your belly inward when breathing in; let it come outward as air fills your lungs. Take a full breath in now and try it. Relax and feel good.
More on breathing for daily life and athletics is in the book Healthy Martial Arts.
--- Read success stories of these methods and send your own. Before asking questions, see if your answers are already here by clicking labels under posts, links in posts, archives at right, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail"(under trumpet) upper right. For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
We are on our way to the United States. It will be several days of trains, ferries, buses, and flights. I won’t have phone, mail, or internet to be able to post for a few days, but I will keep trying the drumming, magic spells, and carrier pigeons that have delivered some of my posts over the past month to Carrie, wonderful Healthline Staff member, who got them uploaded for you. Thank you Carrie.
Enjoy the photo, at left, of young tourists on the ferry. I will post soon on comfortable, healthful sitting for long travel. Until then, start with
Continue posting your comments, questions, and ideas, and keep e-mailing me your stories and photos for posting. You have all been writing great things that I will reply to as soon as I can.
Keeping Thai Massage Healthy Part III - Should You Do "The Blood Stop?"
Wednesday, February 07, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
The previous three posts have started telling about Thai Massage. Thai massage is done lying comfortably on a soft mat on the ground. No table is needed. It is done clothed, except for bare feet. Most places in Thailand have Thai massage going on in the stores, on street corners, in the internet cafes, at restaurants, on the beaches, and other organized or impromptu sites. Southern Thai Massage style concentrates more on pressure points. Northern style adds wonderful stretches.
Thai massage is generally helpful, but there are a few moves to avoid. One is the "blood–stop." There is much discussion about this maneuver, both for and against. It helps to understand what is really going on to be able to decide.
The practitioner may press their palms, knees, elbows, forearms, shins, or feet over the big blood vessels that bring blood to your legs, or over the arteries that conduct blood to your arms. They press enough to slow or stop blood from flowing to your legs or arms as long as 30 seconds, a minute, sometimes more, depending on the style and school where they learned. When they release the pressure that was restricting the blood, blood flows back down the limbs in a warm rush that some people enjoy. Thai massage practitioners are taught to never do the blood stop on anyone with high blood pressure, varicose veins, heart or circulatory problems, or pregnancy. But it turns out that it is also not healthy for others.
It is often taught in massage schools that the blood stop helps unplug clogged arteries. The theory is that if there were deposits that block the artery, the rush of blood returning would "unplug" the blockage and carry it away, like cleaning a clogged plumbing pipe. This does not work for several reasons. First, the rise in blood pressure from stopping (or slowing) blood flow is small and not enough to dislodge anything when flow is released. You increase your own blood pressure more from ordinary walking and exercise. Next, even if it could dislodge anything, anything that dislodges from your big blood vessels can travel to a smaller place to become a foreign clog there - in the same way that damage occurs from a brain clot or heart attack or phlebitis.
Another idea taught is that slowing arterial blood helps draw away "stagnant" venous blood from the limbs. This is not how circulation works, even if it sounds good. Even though the blood stop will not help, you can easily do exercise that improves circulation both arterial and venous. When you exercise, the contracting muscles squeeze your limb vessels and push blood that pools in the limbs. The post Collapsing Astronaut Gives Healthy Reminder explains more on blood pooling and what exercise does for circulation.
Another of the theories of the blood stop sometimes taught in massage schools is that it helps counter the phenomenon of "legs falling asleep" during long sitting or meditation. The belief is that "legs falling asleep" is caused by lack of blood flow, and the blood stop will strengthen or increase circulation to alleviate that problem in the future. A little knowledge of physiology shows why neither is true. Compressing arteries to slow or stop blood does not cause any increase in the number or size of blood vessels, or ability to pump blood, any more than having clogged arteries improves circulation. The blood stop does not reroute the blood or encourage the body to find new pathways which give circulatory benefit. Exercise will increase all these good things, but doing the blood stop does not, even if we wish it does, or were taught that it does. Next, when a limb "falls asleep" it is not lack of blood flow, but nerve compression. There is no reduction in blood flow when you get the tingling and the "pins and needles" feeling of a limb falling asleep. The tingling is called neuropraxia, which just means a temporary interruption of sending nerve signals resulting in pins and needles feeling. During the blood stop maneuver, there is no pins and needles feeling, and when you stand up after your legs "fall asleep" there is no warm rush of blood as after the blood stop. They are two different things.
The next problem is an interesting phenomenon. When you stop blood to an area, it is not healthy for the area. Cells starve. Nerve cells are the most sensitive to lack of oxygen. Thai massage practitioners are sometimes taught that it is not stopping blood but "opening the wind" to release stagnant blood or energy. Still, no matter what you call it, lack of blood flow is not great for the area. Then the interesting paradox occurs. When blood flow, called perfusion, is restored to any body area that was deprived, oxygen flows back into the area. That would sound helpful, but the oxygen itself causes a second injury. It floods the area with a kind of oxygen that is not healthy along with other harmful products. It causes a serious injury called a reperfusion injury. This same kind of injury occurs with heart attack or in a limb that may have been crushed or caught under something, depriving it of blood. First, areas of the heart or the limb that are shut off from oxygen begin to die. When blood flow is restored, oxygen flows back into the area and with it, and a cascade of oxygen damage.
You may have heard of anti-oxidant compounds in foods. Many processes can damage your cells by oxidizing them. Oxidation is a natural process and needed for many things. But too much is not healthy. Free radicals were thought to be involved in oxidative damage. Your body naturally produces anti-oxidants to balance this and other oxidative stress from other sources. Many people take anti-oxidant vitamins hoping that more is better, which is not always the case, and only works to sell products. Separately, anti-oxidant vitamins and your own body's defenses can't do enough to protect you against a sudden reperfusion injury. Much interesting work in high-pressure oxygen science deals with trying to understand and avoid the paradox of the reperfusion injury.
There is more, but in short, none of this means that Thai massage is not good, just that it is best to avoid the blood stop move. It is easy to avoid the pitfalls and hype of massage, and use Thai massage and other kinds of massage for the benefits.
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Making Thai Massage Healthier Part II - Avoid Snapping Elbows or Knees Backward
Tuesday, February 06, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
The previous two posts told a little about Thai massage, and some of the benefits and pitfalls.
Some massage practioners say that Thai massage is an "energy-based" system, not a physical one. However, there are direct physical moves that bring direct physical change, both good and bad.
Many of the Southern Thai massage styles consist mostly of pressing, without many stretches. Northern style Thai massage adds many stretches. Stretches can be helpful to restore length to tight muscles so that you can restore healthy body positioning. For example, in the photo at left, the legs are lifted so that the front of the hip is gently stretched. The practitioner (man doing the lift) puts his foot on the back of the person's hip, to safely keep the lower back from being overly-arched by the stretch. The stretch concentrates on the front hip muscles where it is needed. This is a beneficial stretch because the front of the hip is often tight from long sitting and faulty standing positioning. This Thai massage stretch, done right, can restore length to the front hip muscles. In the photo above left, the knees bend the normal way the knee joint moves and the hip gets a nice stretch.
There are a few moves that are usually better to skip. Some practitioners may straighten your elbow or knee too much - photo of knee hyperextension at right, below. They may push your elbow or knee backward to assist the overly extended position, even sometimes adding a forceful snap.They may bend your knee toward your chest, then hold your heel and let the leg drop straight, letting the force snap the knee. The elbow and knee joints are not shaped to hyper-extend. Hyperextension means to go more than a normally straight position. Hyperextending the knee or elbow can wear at the joint and strain the cartilage.
It is not usually healthful to snap a joint, especially repeatedly over time, to reach the end of its range of motion. Although many of us learned to do this in massage school, and were taught that the snapping and hyperextending motion has benefits, it is better to skip joint snapping, and do other moves that have benefit without harm.
Changing Thai Massage to Be Healthier Part I - Avoid Pressuring Lower Back Discs
Sunday, February 04, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
In the previous post, What is Thai Massage? I explained that many moves in Thai massage are beneficial, with a few to avoid. One of these less than healthy moves involves the practitioner pushing your back and neck forward into a stretch.
The post Disc Pain - Not a Mystery, Easy to Fix explains why sitting and bending over eventually breaks down the discs of your lower back. In one of the pushing stretches, the practitioner sits behind you to push your back forward, leaning their weight to assist your forward movement, as in the drawing at left.
In another move they add putting their arm under your arm and around the back of your neck. In wrestling, this move is called a half-Nelson. This move is used to bend your neck forward. From there, they push your back and neck forward, leaning their weight to assist your forward movement
Don't let people push your back or neck to round forward, whether to stretch or to make a cracking noise. Avoid treatments that include manipulation to the neck, which has been found to sometimes tear the blood vessels leading to the brain. There have been deaths and even Western chiropractors have been cautioned not to crack the neck with these moves.
A second assisted stretch to avoid is similar to the move above. The practitioner may sit behind you or to the side, and put one or both of their arms under your arms then around the back of your neck, in a move that in the West are called a "half Nelson" and "full-Nelson." From there they may swing you slightly to the side, then again with a wider swing, then a third time with force. This sometimes makes a cracking noise in your back. Anatomically, the greatest force you can put on your discs and low back is bending forward with a twist. Politely decline anyone who would do this to you.
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There are many claims for massage, some real and some exaggerated or false. I searched for methods that provide real benefit. I studied sports massage in India and Nepal, and in certification programs of Shiatsu in Japan, TuiNa in China, and Nuad Borarn, (which is Thai for "ancient massage") in programs in the United States and Thailand. We are here in Thailand now, working on many projects.
Thai massage has been called "Yoga Done For You." You rest comfortably on the floor on a soft mat, clothed, except for bare feet. There is no rubbing as in Swedish massage, but pressing and wonderful stretches.
The person associated with founding or codifying Thai Massage was Shivaga (or Jivaka) Komalaboat. Some practitioners in the United States call him Dr. Zhivago, like the main character Yuri Andreyevich Zhivago in the Russian epic by Boris Pasternak. But that is just a funny mispronunciation.
The "Father Doctor" or "Hermit Doctor" Jivaka is reported to have been born in northern India, and became a doctor of traditional medicine. According to some sources, he was a contemporary, even advisor, of The Buddha and great kings. He moved to what is now Tibet. His teachings came to Thailand and Burma over a thousand years ago. Father Jivaka is so important to traditional medicine throughout all these areas that he is also called the "Thrice Crowned King of Tibetan medicine." Drawings and statues of him, many with small shrines, are common in massage and medicine schools and pharmacies.
Many Thai massage stretches and movements are used in traditional Western sports medicine to reset resting muscle length, and find and relieve unhealthy muscle and joint tensions. I learned these techniques in school in the United States when I studied orthopedics. When I first came to Thailand to train and compete in martial arts, I was surprised to find they were established techniques for massage, and helpful for boxers recovering from injuries and strenuous training and matches. The photo, to the left, shows a nice stretch for the front of the hip. Several past posts explained how important it is to stretch the anterior hip. Most people keep the hip bent forward in a shortened position all day for sitting, then only bend forward more to exercise with crunches, pilates moves, toe touches, and others. A tight, shortened anterior hip contributes to many pain syndromes, and results in not being able to use hip and leg muscles properly when walking and exercising.
Many Thai massage moves are helpful. There are a few Thai massage moves that can be unhealthy. When I give or teach Thai massage, I omit the unhealthy moves. When I get Thai massage at home in Thailand, it is an art to politely manage to stop the tiny practitioners from holding you in an iron grip as they apply these moves.
