The BBC news reported this week that, Kickboxing 'causes brain damage.' The news story stated that a recent study showed: "Kickboxing can cause damage to the part of the brain which controls hormone production." However, it is not kickboxing, but receiving blows to the head.
Recently I posted about the fun exercise training in the movie Rocky IV - Rocky IV and Healthier Exercise. After training to become healthier and stronger, the movie depicts Rocky sustaining severe head strikes as a symbol of determination or disciplined fighting ability. It is higher fighting skill not to receive these hits. It is hopefully not a surprise that it is also healthier not to get hit in the head.
The Turkish study that the above news item was based upon compared pituitary hormone function in twenty-two kickboxers who had boxed in national and international championships (16 men, 6 women) compared to controls of the same age who did not box. Levels were lower in the kickboxers (Tanriverdi F, Unluhizarci K, Coksevim B, Selcuklu A, Casanueva FF, Kelestimur F. Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism. Clin Endocrinol (Oxf). 2007 Mar;66(3):360-6). A previous study by the same group found the same results in eleven actively competing or retired male boxers (Kelestimur F, Tanriverdi F, Atmaca H, Unluhizarci K, Selcuklu A, Casanueva FF. Boxing as a sport activity associated with isolated GH deficiency. J Endocrinol Invest. 2004 Dec;27(11):RC28-32).
Studies like these, that compare groups, cannot tell if boxing lowered the hormone levels without measuring a "before and after" or including number and severity of head strikes sustained. Without more information, these studies would not be able to conclude if the boxing caused the low levels, head strikes caused the injury, or it was the case that the people started out with low levels then became successful competitive boxers. However, it is documented in the literature that head blows that lead to traumatic brain injury produce anterior pituitary dysfunction (Agha A, Rogers B, Sherlock M, O'Kelly P, Tormey W, Phillips J, Thompson CJ. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab. 2004 Oct;89(10):4929-36). The previously mentioned Turkish researchers had earlier reported on a case study where they observed a boxer who received a head strike then suffered specific anterior hormonal effects (Tanriverdi F, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F. Transient hypogonadotropic hypogonadism in an amateur kickboxer after head trauma. J Endocrinol Invest. 2007 Feb;30(2):150-2).
Previous studies looked at neurophysiologic and neuropsychologic function and did not find long term damage in these areas (Haglund Y, Eriksson E. Does amateur boxing lead to chronic brain damage? A review of some recent investigations. Am J Sports Med. 1993 Jan-Feb;21(1):97-109) so it is new and helpful to localize that hormonal damage may be occurring from head blows.
Growth hormone is one of the hormones affected. The post Human Growth Hormone shows how it works and how to boost your own levels naturally and safely.
Aerobic kickboxing is not the kind of kickboxing where the studies are finding brain damage. The issue is strikes to the head and subsequent brain damage. Blows to the head can happen in any contact-style martial art, not just kickboxing. Head injury is also an in issue in motor vehicle accidents, falls, and domestic violence to family members of any age.
I will write soon about avoiding head injury in boxing and fighting arts, and other exercise. I am glad that the top competitors I faced in the ring didn't manage to land any head blows during my own full-contact martial arts and kickboxing bouts (or none I remember :-). To their credit, they managed other worthy hits. It is still not known what damage choke holds may produce, and is a topic of ongoing investigation.
The idea of the martial arts is to get out of a fight not into one. Fighting arts, as sport or entertainment, can be done, and won, without permanent damage to the other person, if all understand and fight for a greater good.
"To win one hundred victories in one hundred battles is not the highest skill. To subdue the enemy without fighting is the highest skill." - Sun Tsu, The Art of War
Scorn, anger, name-calling. Not good for the heart. The best warrior wins without hurting others or himself.
The Thais call it "jai yen" - cool heart. The secret is to not make anger a negative force. They keep kindness in their voice. Jai yen is central to Thai social and business interaction. It illustrates the mind and body of the experienced warrior. Jai yen is part of Muay Thai boxing training. In Thai martial arts, respecting teachers and elders is foremost. Every fight begins with the Ram Muay, a spirit dance to show respect and thanks to parents, and ask blessings from the Kruu Muay Thai - the teachers. In Japan it is "fudoshin" - unchanging heart. A person with fudoshin is more stable and light-hearted when things happen that they don't agree with.
How do you get good at being heart-healthy? Practice it like exercise. Unlikable things happen every day, so we all have the good luck to get much chance to practice. It's healthy exercise. In the novel Shogun, James Clavell, wrote:
"To think bad thoughts is really the easiest thing in the world. If you leave your mind to itself it will spiral down into ever increasing unhappiness. To think good thoughts, however, requires effort. This is one of the things that discipline - training is about."
Discipline is the mental exercise of self-control to direct your behaviors. With discipline you brush your teeth everyday, and do exercise, and refrain from bad habits, and breathe and smile when someone is rude. The other person may continue injuring their own health with negative behavior, but you won't sadden yourself and injure your body with the unhealthy chemicals generated that can hurt your health and heart. If your kindness and understanding calms and comforts the other person, that is twice healthy. Breathe. Get outside in the sunshine every day. Be happy.
Thank you to Dr. Stuart Henochowicz, M.D., M.B.A., F.A.C.P. for hosting Grand Rounds 3.27 this week on his blog MedViews.
Grand Rounds is a collection of selected medical blogs of the week.
Dr. Henochowicz included my post Muay Thai Monks on Horseback, calling it, "a fascinating piece about Thai monks who use their Buddhist faith to fight drug addiction."
Here is a quick stretch, helpful after long sitting or working. Done right, it stretches the neck, upper body, and side of the body, helping restore muscle length to tight muscles:
Put one hand behind you, as if in an opposite back pocket (photo at right).
Slide the other hand down your leg toward your knee. Breathe. Don't go so far, or strain so that it hurts.
Tilt your head toward your shoulder, gently stretching the entire side of your neck and body. Don't go so far, or strain so that it hurts.
For best stretch to the side of the neck, look forward, rather than up or down.
Don't lean your head or body forward or you will lose the stretch. Stand straight.
Hold for a few seconds.
Change sides and repeat on the other side. Smile. Keep breathing.
To tell if you are standing straight, stretch with your back against a wall. Keep the back of your head against the wall for the entire stretch. If it is not comfortable to stand against a wall with your shoulders, backside, and the back of your head all touching at once, do the pectoral stretch in Fixing Upper Back and Neck Pain. Check for the upper body tightness that makes it uncomfortable to stand straight - Thumbs Can Show Tightness That Leads to Upper Back Pain. If it hurts, it's not right.
More:
Use this stretch, called the trapezius stretch, with the pectoral stretch and the Better Shoulder and Triceps Stretch to restore healthy positioning to the upper body.
Rounded upper body position while lifting contributes to shoulder trouble, explained in Upper Back Exercise and Neck Pain Prevention Too. With good positioning, you can lift more and avoid injury.
E-mails have come in since I posted that we were on our way to the Monks on Horseback in the northern Thai mountains. Readers wanted to hear about our stay.
We live in Asia part of each year. We traveled north to visit our friends and teachers who are relatives and former teachers of the Phra (monk) Kru Ba Neua Chai who heads the monastery. Our friends live in the village of Baan Mai Kom, not far from there, close to the Burmese border. We took the bus north to there. There is no station - the driver dropped us on the road after dark, and we walked into the cool night to the mountain.
Nearby in Myanmar (Burma), drug traffickers from ethnic and government groups move vast amounts of opium and heroin, and more recently, methamphetamine, into Thailand for local and world distribution. For generations they have torn through villages, murdering adults and forcibly recruiting children into their militias. Drug use in the area further damages and destabilizes families and lives through drug illnesses, kidnapping, prostitution, and land control.
Drug wars, shooting, bombings, terror, international involvement and dollars have not stopped the destruction. The Thai monarchy, caring for the welfare of all involved, started a program for poppy growers to have income from other crops and industries beside opium. Thai soldiers in the region asked local monks to combat the drug menace by taking dharma (duty to behave righteously) to the hilltribe villagers. One monk was Kru Ba, a former soldier and Muay Thai (Thailand style martial arts) champion, known to boxing fans as Samerchai, and graduate of Ramkamhaeng University in Bangkok. To serve his land better, he became a monk. Another Thai man who wanted to do good gave the monastery a horse. Kru Ba took in more horses and orphaned hilltribe boys, and ordained the boys as nen (novice monks). Many of the nen had seen their families murdered by drug guerillas. Kru Ba taught the nen discipline, calisthenics, caring for the horses and other living things, the life of doing and saying good, and Muay Thai martial arts. Soon more fully ordained monks and nuns became part of the monastery. Then Kru Ba started new monasteries. Today he has 10 monasteries in the northern hills. Except during periods when monks observe certain restrictions, they train Muay Thai outdoors, in the jungle, or in their thatched boxing ring each early morning and night.
Khru Ba and the monks and nen ride through local areas to show traffickers and locals they can stop contributing to drug addiction. Khru Ba says, "When we meet the Wa (one ethnic group involved), I try to engage them in dialogue, 'Why do you do this?' I ask them. 'How would you feel if these drugs were being consumed by your own sons and daughters?'" On occasion, Kru Ba has used his Muay Thai to protect his nen and the monastery. As daily training, they incorporate the discipline of doing good into the physical discipline of their training. Kru Ba says, "Boxing for me is something which frees the body and releases the soul from barbarianism. When I box I use every single part of my body and my mind. Buddhism teaches you not to harm or take advantage of people which some may find to be in direct opposition to an aggressive looking sport like boxing. For me, boxing helps me to become a better Buddhist. I learn to control my emotions. I find beauty and peace and stillness in boxing. I get rid of my animal instincts and control them to the point that they become beautiful, an art form for sport, for education, for the discovery of truth. The word "Thai" means freedom and when I practice Muay Thai I feel free - free from my emotions, from anger."
A documentary made on the lives of Kru Ba and the nen has been called, "a heroic undertaking to create a better world." See more on www.BuddhasLostChildren.com. I will post more in the future about our part there.
When you take your shoes off and stand up, do your toes turn upward by themselves, as in the photo at right? That is usually from tightness in the top of the foot. You can often see the tight, string-like tendons on the top of the foot pulling the toes back. Do your toes face outward (toward the little toes) when your foot is facing straight forward (same photo). A sideways -shift is common, not only from tight shoes, but can be produced from how you walk, step after step, year after year.
Toes deform into unhealthful positions in common ways:
Shoes: Tight shoes fold and shift toes out of place. Heeled shoes push toes upward. When toes are held in one position too much, the muscles tighten and don't go back to normal length.
How You Use Foot Muscles: Many people do not use muscles in their feet or toes when they walk. They just clomp. The muscles that normally work to pull toes and forefoot downward during the weight-bearing phase never engage properly. The toes stretch upward during push-off, but not downward.
Positioning: If you walk with feet facing outward, the "push-off" phase is on the side of the big toe instead of the bottom of the foot. After years of being pushed toward the other toes, the big toe eventually tightens into the new shifted position.
Good reasons to stretch toes:
Healthy spacing avoids fungus like Athlete's foot, calluses and other injuries from rubbing, and improves needed movement.
Toes need to move through a full range up and down, and independently from each other, for balance, preventing several causes of foot pain, and for quicker, healthier movement ability. Feet are not just blocks to clomp around on.
You can avoid toes that curl, hook, hammer, face different directions, or push sideways into bunions.
Try these easy stretches:
Take your toes in your hands and bend them all downward, to stretch the top of your foot.
Take your toes in your hands and bend them all upward, enough to feel a nice stretch in the bottom of your foot, not just the toes.
Pull each toe apart from the next.
Pull the little and big toes away from each other at once, restoring healthy width to the front of the foot.
Pull any toes that are bent-up until they are back downward. Pull bent-down areas gently straight, and pull curled toes straight out to restore straight length.
Stretch deformed, squashed toes with your hands several times every day, or at least at night and in the morning, or when exercising or stretching. Reduce the need to stretch them back to health in the first place. Walk with feet (and knees) facing straight ahead. Wear shoes with room in the toes. Tight shoes are not healthy. Unhealthy shoes are not beautiful.
It is often taught that tight or snug shoes are needed for "support." However, tight shoes are not healthy for many reasons, or even needed. Tight or supportive shoes are a common source of tightness of the toes, foot, and Achilles tendon, and pain of the toes, feet, ankle, and knees. The posts Arch Support Is Not From Shoes and Which Shoes Help Exercise, Fall Prevention, and Ankles? explain more about the myth that support is from shoes.
Shoes worn snugly "for support" cause frequent problems. If your toes fit together like puzzle pieces or do not face straight ahead, as in the photo at left, it is likely that you frequently wear shoes that are too tight.
There should be space between each toe, and each toe should face straight forward, not turned toward either side (photo below right).
If you need toe separators (a soft foam device for separating toes) to paint your toenails, your toes are too tight and bunched together. Toes that are bunched together need regular stretching to separate them. Take your toes in your hands and gently pull them apart. Some of my patients use those toe separators to wear to bed. That is all right to start, but instead of only treating the result of a tightness problem, it is best to correct the problem with simple stretching before deformity progresses to the point where it is difficult to fix:
Pull your toes away from each other with your hands.
Straighten each toe gently.
Make sure all toes separate and can wiggle.
Practice wiggling your toes.
Don't wear shoes that push your toes together or keep them from moving.
Avoid tight socks and stockings - "tight" is anything that presses your toes together.
When standing, don't tighten or clench your toes against the floor or each other. Don't press toes into the ground to balance so much that they buckle and bend. Keep your weight distributed over your entire foot, including your heel. Notice if you rock forward to the ball of your foot when standing.
Take off shoes and all hosiery every day and let toes get sunlight and air.
When you exercise and walk, make sure you do not walk "toe-out." Turning the feet outward, sometimes called "duck-foot" used to be thought the normal direction of the fibers and muscles. Now it is known that both feet should be able to comfortably face straight ahead.
Toes do many wonderful things for balance, walking, ability to jump and move quickly, for the shock absorption important to your hip, and more. See the post Healthy Toe Stretches for foot stretches. The next article will give fun stretches specifically for tight toes.
Even before Actor Sylvester Stallone made news this week for stating he used the performance-enhancing drug growth hormone, I was preparing a post about him. His movie Rocky IV was on television. Not long after this movie came out in late 1985, I saw it in the theater when I moved to the U.S. to study another graduate exercise physiology degree. It was the first Rocky movie I saw. I loved it for poking fun at exercise science, all the artificial movement used for training popularized in the 80s, and at my own Soviet Russian heritage (and our interactions with Americans). In the movie, the supposed stereotypes were personally familiar - Russians were stunningly physiqued, disciplined, straight-postured, stern, and humor-challenged. The Americans were comically rude, indulgent, hostile to foreigners, and flamboyant.
Dolph Lundgren (born Hans Lundgren in Sweden) played Soviet boxer Ivan Drago. The movie spotlights Drago and Rocky's training for their epic match in Russia. Drago has teams of lab-coated trainers pushing him on dozens of beeping machines with blinky lights, and hints of performance enhancing drugs. He runs on motorized treadmills and uses shiny equipment to simulate activity. Rocky runs through deep Russian country snow and clambers up freezing mountain slopes. He rescues horse carts stuck in ditches, heaves rocks, and chops wood. These activities train his muscles and outlook in the real ways he needs for fighting, while Drago is made to simulate movement in artificial conditions that did not directly prepare him, and lead to his on-screen loss of confidence and the match itself.
In real life, Lundgren knows real training. He was a full-contact karate champion, and looks it. He holds a 3rd Degree Black Belt in Kyokushin Karate. Lundgren also has a master's degree in chemical engineering and attended the Massachusetts Institute of Technology (MIT) on a Fulbright Scholarship. Mind and body.
I received an e-mail asking why the previous post was named Human Growth Hormone even though the injectable form is not human growth hormone (made from humans), but synthetic which has a different name. Human growth hormone for medical use was originally extracted from human pituitary glands (from cadavers), and abbreviated "hGH." By 1985, concerns about transmitting incurable fatal brain diseases like Creutzfeldt-Jakob Disease led to replacing pituitary-derived hGH with synthetic growth hormone. Human growth hormone (hGH) is no longer used in medicine or sport doping. Instead, biosynthetic human growth hormone is used, called recombinant human growth hormone (rhGH), somatropin, somatotropin, or somatotrophin, to remind of the pituitary cells called somatotrophs where the human form is made. If products are marked "HGH" they would contain no growth hormone (and you would not want them to). Also know that the underground market of performance enhancing drugs is known for having many fake (counterfeit) drugs for sale, including fake growth hormone.
The post was named Human Growth Hormone because the point was that you can make your own Human Growth Hormone in your own body, safely, easily, and cheaply. You can be younger, leaner, and stronger without injections, through the three main things that stimulate human growth hormone - healthy exercise, sleep, and eating right, described throughout this Fitness Fixer blog.
Rocky IV was one of the highest-grossing sports movies ever. At the end, Rocky spoke to the crowd, saying that fighting in the ring was better than war between countries, and stressed respect over animosity. Remember to use the message of real training through real activity, not artificial movements in a gym. The crowd, including Politburo, stood and cheered when he declared, "If I can change and you can change, then everybody can change!"
Effective, fun exercise, stretch, and improvement for body and mind, performance enhancing foods and drugs, avoiding injuries: Healthy Martial Arts.
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Actor Sylvester Stallone made news this week for being found with the drug Jintropin. Jintropin is a brand name for the drug growth hormone (GH).
Growth hormone is naturally made in the pituitary gland of your brain. It does several things, including stimulating protein to make muscle. Various bodybuilders and athletes get injections of synthetic growth hormone hoping to get bigger. Actors and models use growth hormone injections to look more muscular and lean, and some cosmetic procedure doctors promote it as a drug against various signs of aging. Growth hormone use is not yet detectable by drug testing.
In children, one function of growth hormone is to stimulate bone lengthening. When the pituitary doesn't produce enough, children don't grow enough, causing one form of dwarfism. Occasionally, with too much, a child can grow to a giant. An adult taking growth hormone will not increase long bone length, so cannot get taller. Instead the forehead, hands, feet, and jaw may elongate.
Growth hormone "doping" is expensive, and must be done for a long time before results occur. For bigger results, some bodybuilders and athletes combine, or "stack," growth hormones with anabolic steroids (body building hormones). Some users add the dangerous practice of injecting insulin in combination with growth hormone (and/or steroids) for bigger muscles, more veins showing, and the appearance of exceptionally thin skin, looking as if shrink-wrapped over the muscle (believed a desirable look by some). Insulin doping can cause serious, long-term illnesses.
Growth hormone use does not seem to cause the serious health problems produced by steroids (as far as known). Problems from GH can include joint pain, wrist pain, carpal tunnel syndrome, joint swelling, facial swelling, facial elongation, and increased blood pressure. Using large doses can decrease thyroid function and increase risk of diabetes. Sadly, users may think these are signs of aging, so they take more growth hormone believing it will stop this "aging." If the user already has cancer, it can increase growth of the tumor. Growth is what this hormone does. There is no need for too much of it.
Growth hormone is naturally produced in your body all your life. Older people produce less growth hormone, but they still produce it. Some advertising for GH tries to persuade that older people are somehow at a disadvantage without a lot. Remember that older people (above the age range of puberty) need less because they are not growing, although they still need enough for strength and tissue repair.
Aging alone is not what makes you not have enough growth hormone. Four main practices reduce your body's levels:
Lack of exercise. That makes sense, because without exercise your muscles, bones, and other tissues have no reason to rebuild; you aren't using them, after all.
High blood sugar from dietary sources - such as eating too much and eating junk food.
Already high levels. Your body reduces its growth hormone levels if it already has too much. Growth hormone stimulates your liver and other tissues to secrete "insulin-like growth factor-I" (IGF-I), which is the real factor behind most of the effects of growth hormone. Having high blood levels of IGF-I decreases secretion of growth hormone as a normal regulatory function.
Anti-inflammatory and immune-suppressive medicines called glucocorticoids (such as prednisone, dexamethasone, and hydrocortisone). Ongoing dosage with these can lead to osteoporosis, muscle weakness, delayed wound healing, and increased infection risk. This should be kept in mind by people taking them for injuries and pain.
How do you get more natural growth hormone in healthy amounts without side effects? Three main agents stimulate GH secretion:
Exercise. Getting exercise in healthful ways, described throughout Fitness Fixer blog posts, boosts GH at all ages.
Deep sleep. With good exercise, you will sleep well at night too.
Low levels of sugar in your blood. It is shown that both high fat and high refined-sugar diets increase blood sugar. It is not rocket science to eat less junk and more fruit and vegetables to be healthier and to lower high blood sugar.
Related Fitness Fixer: There is more to growth, metabolizing fat, or building muscle than taking hormones. Click these posts on safe "natural" training for a healthy muscular body:
My book Healthy Martial Arts has a chapter on performance enhancing foods and substances, good and bad, and chapters on effective fun exercise, stretch, and improvement for body and mind. Not just for martial artists, it is for everyone who wants to move in healthier ways.
Nagyon köszönöm (thank you very much) to Hungarian medical student Bertalan Meskó who hosted Grand Rounds this week, the electronic gathering of the best medical blog posts of the week.
How many times do you get in and out of a chair everyday? It could be enough for a fair amount of exercise, if you use muscles instead of leaning forward (photo shows terrible sitting) and flopping down.
At a medical conference last year, a speaker droned endlessly about back surgery (even though Studies Say Back Surgery Not Needed, and you can Fix Disc Pain Without Surgery) and the usual tedious exercises that people must do three times a week (then they do unhealthy movement all day that causes the pain in the first place, or do their exercises in back damaging ways - Common Exercises Teach Bad Bending). An obese physician arriving late plodded to a chair next to me. She laboriously bent over, bending wrong to put her bag on the floor. She slowly bent over forward, bending wrong again to retrieve two cushions from the bag. She bent over wrong again to place one cushion on the chair seat, then again for the second cushion for the chair back. She turned her back to the chair, bent far forward, bent her knees a small amount, so slowly, then slammed her backside down to the chair with a WHUMP. She sat rounded for the rest of the lecture about surgery for disc herniation. Sitting and bending rounded forward is the major cause of disc "disease." To easily avoid disc pain and surgery see Disc Pain - Not a Mystery, Easy to Fix.
What to do instead? Any time you start to sit, check if you lean forward and stick your backside out. You shouldn't need to lean far forward to sit, or rise from sitting. If you have to lean, it is usually a sign of weak legs. If your heels come up as you bend your knees, your Achilles tendons are tight (or you have functional bad Achilles habits). You shouldn't (ordinarily) need to use your hands to sit or rise. Your balance and legs should do the work. Do you sit down heavily, not using leg and hip muscles to decelerate? Why jolt your spine and give up free calorie burning at the same time? Try this now to see:
Stand up, ready to sit -
Start to sit, keeping both heels down on the floor.
Don't lean forward. If you lean, correct it by tilting your hip under and raising your upper body to be straighter.
Keep both knees back over your heels. Don't let knees slide forward.
Keep knees parallel over your heels. Don't let knees sway inward.
Notice how you have to use far more leg and hip muscle, and the pressure of holding your body weight comes off the lower back and knee joints.
Notice if you reach for the arm rests, or other support, out of habit. Use your leg muscles instead.
Sit down lightly.
Start to rise from sitting -
Notice if you lean far forward or raise your heels or jut your chin forward.
Notice if you need to push off your hands.
Notice if your knees comes together. Don't let them.
Change how you rise to put both heels down on the floor, push off your whole foot including heels, and use your leg muscles to rise while holding your upper body more upright without jutting your neck and chin forward.
This is not a bunch of strange rules for sitting, or a weird, contrived exercise, it is just basic concepts for normal healthful daily movement.
The previous post explains why it is not healthy for your back or the best exercise to lean and stick out in back - Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats? It covered good knee placement too, so check that if you avoid healthy movement because of knee pain.
Exercise is still thought of as something you go and "do" instead of moving in real life. It's silly to do 10 squats in a gym or using your chair and then go back to unhealthy movement each time you sit or bend during the day. Have comfortable healthful movement all day. Sit and rise easily. That is exercise as a lifestyle.
Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats?
Monday, March 12, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
A commonly repeated phrase in fitness training and programs is "neutral spine" and "tuck the tail" for healthier lower spine posture. Many people know this, repeat this, teach this, write articles about it, then jut their hip too far out in back and overly-arch their lower spine, doing just the opposite, when they squat, bend to pick things up, sit in a chair, and exercise (photo at left).
Tilting the hip too far outward in back overly-arches and hyperextends the lower spine - photo at left and left drawing below.
Hyperextrending the spine, creating too much lordosis (hyperlordosis) can result in unhealthful compression on the spine joints called facets, and on surrounding soft tissue.
Overarching shifts your body weight onto the spine joints and compresses them in a bent-backward position, eventually increasing back pain and joint damage.
Another issue is that if you cannot squat without sticking out in back or leaning your upper body far forward, it is a sign that your thighs are weak, your Achilles tendons are tight, you are not using your ab muscles, your balance is poor, or all four.
Why do so many programs teach to stick far out in back? It is well known that the opposite problem of tucking too much and rounding forward (lumbar flexion) contributes to back pain. People hear this and assume that the opposite, over-arching backward, will counteract that. They exaggerate the arch.
Overarching often initially seems to "work" because you can lift more since you shift some of the work from the muscles onto the lower spine (and sometimes knees).
The muscles do less, so it seems easier. Competition lifters use it to lift more, regardless of the pain and injuries it causes later on.
It is trend-breaking news to say don't stick your backside out too much to squat, and instead use neutral spine, shown in the right-hand drawing. I know. It goes against what fitness organizations and pop-science exercise books teach. I know. Try this to see for yourself:
Stand upright with feet side-by-side, comfortably apart.
Face both feet in the same direction as your knees.
Bend both knees, keeping both heels down on the floor and over your feet, not sinking inward or bowing outward.
Look down and see if your knees cover the sight of your toes.
If you can't see your toes because your knees are forward blocking the view, pull your knees back (keeping them bent) until you are still squatting but can see your toes.
Keep your upper body as upright as you can.
Now, here is the point about the lower back - notice if you tilt too far out in back, pinching your lower spine backward like a straw. Overarching may be habit, or that you don't have the leg strength or balance, or your Achilles tendon is so tight that your heels come up from the floor. Instead, tuck the bottom of the hip under, just enough to bring the spine to "neutral." A small inward curve remains when you have neutral spine, but not a large one - Right-hand drawing.
Raise your upper body to be more vertical, while staying in the squat.
Notice how you have to use far more leg and hip muscle, and the pressure of holding your body weight comes off the lower back and knee joints.
Use healthy bending for all bending. Neutral spine helps squats for exercise, to pick up clothes from the floor, to get pet dishes, look in the refrigerator, get the laundry, pick up the kids, to sit down in a chair, and so on. You will get a far better workout for your thighs, keep weight off the joints of your knees and spine. It is healthier to squat upright than bending over forward to pick things up. It is not healthier to cause the opposite problem by overly-arching and pinching the spine back (increasing swayback).
Another point in spine health and exercise is not to "tighten" or clench your abdominal muscles to squat or lift. It is not healthy or useful to tighten muscles for movement. It is trend-breaking news to say "don't tighten." I know. It goes against what fitness organizations and pop-science exercise books have been teaching. I know. Tightening is not what supports your back. Moving your spine out of unhealthy over-arched position, explained in this post, to a more neutral position is what "supports" (you hold your spine in place) preventing pain and injury. Using the muscles to stop unhealthy position, and hold healthful position is how you support your back - not by tightening.
Have fun being part of this big and healthy change in fitness.
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Using Abdominal Muscles is Not Tightening or Pressing Navel to Spine
Thursday, March 08, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
Tighten your neck! Sound comfortable? Tighten your legs and walk around! Sound sensible? Yet, many popular exercise programs have insisted on the erroneous practice of tightening abs. I have written articles, posts, and books on why this is not beneficial and what works your abs better. At last, it is making headline news. A big name in spine research, Dr. Stuart McGill, published that "drawing in" the abdominal muscles, also described as "press the navel to spine" is detrimental to health of the lower back, and that tightening the abs impedes normal movement. In Arch Phys Med Rehabil. 2007 Jan;88(1):54-62, authors Grenier and McGill conclude, "There seems to be no mechanical rationale for using an abdominal hollow, or the transversus abdominis, to enhance stability."
This week the headline news of British newspaper "The Daily Mail" followed up with inquiry into the incidence of back pain and injuries using the "drawing in" technique: Is Pilates bad for your back? (A minor note - they accompanied the otherwise good article with an incorrect photo depicting the opposite concept of back extension, not the unnecessary contracted abdominal tightening, which was the point of the article.) Pressing and tightening the abdominals has been an incorrect assumption made into ritual in the fitness industry for many years. However it is not the way your abdominal muscles work to do anything helpful to you.
When you bend your arm, you don't tighten your muscles to do it. In fact, you shouldn't want to. You just move your arm bones using your arm muscles. Abdominal muscles work the same way. You use them to move the body parts they attach to. Voluntarily. Strengthening or tightening won't make them move automatically. You may have a strong arm, but it isn't held up in the air automatically - only when you move it there. Strong, or even tight, abdominal muscles will not automatically support your back. Moving your spine into healthful position is the support.
Note how the belt line tips down in front in the left-hand photo and the inward curve is exaggerated. This is hyperlordosis.
Ab muscles attach from hips to ribs. When you don't use your abdominal muscles, your ribs lift up and the front of your hip tips down. The inward curve (or arch) in your lower spine increases (left-hand photo of the pair). Too much inward curve is called hyperlordosis, over-arching, and swayback.
With over-arching, the lower back pinches and aches after long standing because you are letting the weight of your upper body press down on your lower spine. People with the bad habit of overarching often feel they need to lean over forward or sit to relieve the pain.
To correct the source of the pain, tuck the bottom of the hip under (not push it forward) to lift up the belt-line in front and lower the ribs to level (right-hand photo). The action is like a pelvic tilt or crunch standing up. The large inward curve reduces to a smaller one. Upper body remains upright, not rounding forward.
The muscles that move the ribs and hip to neutral spine and out of hyperlordosis are your abdominal muscles. Changing to neutral (right photo) gives a free built-in ab workout, with no tightening and no forward bending; just functional use of the abdominal muscles to hold your spine in healthy position during all you do.
Moving your spine to neutral should invoke no more tightening than bending your elbow or finger. Tightening prevents relaxed belly breathing.You should be able to inhale fully, expanding the abdomen even when moving to and maintaining neutral spine.
Using your abdominal muscles to move your spine to neutral and out of injurious over-arched position during all you do is good exercise - without tightening.
This week for electronic Grand Rounds, "Grunt Doc" did a smart job of gathering a variety of helpful medical posts to make Grand Rounds 3.24 in the clear organized way of the good former Marine that he is.
The previous post How To Treat Ankle Sprains and Prevent Them promised another effective technique on the missing link in preventing and rehabbing ankle sprains in today's post. It follows below. First, it made news yesterday that a well known name in spine research, Stuart McGill, found what I have been saying for nearly 30 years of my research career - that tightening the abs and "sucking them in" inhibits healthful movement, and using the popular "draw in the abs" technique is making yoga and Pilates classes the sources of more back pain and problems. The post What Abdominal Muscles Don't Do - The Missing Link shows why crunches and Pilates are not the best exercises for core muscles, and the comment replies to Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain give more links on how abs really work. The next post will cover the news from Dr. McGill and my years of research of what works the abdominal muscles in healthier ways instead.
So today you get two breakthrough fitness posts in one. Now the promised second fun thing to do for more stable ankles. Maybe you never sprained your ankle but wear supportive shoes thinking that will keep you from sprains. Maybe you've sprained your ankle in the past, and rested it and keep it braced during activity thinking that will help, and did ankle exercises, usually consisting of "spelling the alphabet" in the air with your foot or using resistance bands. The "exercises" often do not prevent repeat sprains, leading people to think that exercise will not help and only bracing will "support" an ankle. Rest and bracing often make things worse - the numbers show many repeat sprains in people following this method. Why?
The missing link is receptors in your ankle that sense if you are standing straight on your ankle or if your ankle is bending outward, a movement called inversion. In an inversion sprain, the bottom of your foot turns toward the other leg and your ankle bends too much, overstretching or tearing the connective ligaments. Inversion is the most common source of sprains. There are two common beliefs in medicine - that strengthening will help prevent sprains, and that strengthening will not help. Both points of view are missing that preventing sprains requires something else - training the receptors that tell you if you are about to invert. This sense is called proprioception. Without it, the ankle does not send signals to your leg muscles to prevent you from turning it. With proprioception training, you learn how to sense ankle position and balance to keep it from inverting. Allowing inversion when stepping up or down is surprisingly common, even in people who exercise frequently. No wonder they get sprains. The last post showed the interesting proprioception drill of rising to toes while not allowing your ankle to invert. Try that first, then try this next step:
Rise to tiptoe and lower to full foot, keeping your ankles straight without allowing your weight to shift over your small toes. Keep weight over your big and second toe. Repeat at least 10 times.
Work up to rising to toe and lowering on just one foot (good for balance).
Work up to careful jumps, first coming down on both feet, then on one foot. Each time, land with your weight centered over your big and second toe, not turning your ankle outward, then roll gently down until the whole foot is one the floor.
Use the above stabilization technique each time you step up or down from anything, including stairs and curbs.
With this practice, you can train your ankles to deliberately hold healthy position with each foot-fall, reducing your risk of sprains, instead of letting the ankle turn outward.
--- 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. For answers to personal medical questions - Replies to Medical Questions. Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
The Fitness Fixer article Which Shoes Help Exercise, Fall Prevention, and Ankles? showed why you don't need high top shoes, or arch supports, or orthotics to prevent your arches and ankles from sagging inward (pronation, arch flattening, or flat feet). You can train your ankles and feet to hold straight stable position using your own sense of positioning that comes from receptors in the muscles and connective tissue around your ankle and foot. The article Arch Support Is Not From Shoes gives a simple retraining to restore healthy comfortable arches and prevent the pronation that can cause knee, hip, ankle and foot pain. It's easy, built-in exercise-as-a-lifestyle.
What about feet and ankles that turn the other way - bending outward, not inward, at the ankle so that you may turn your ankle causing a fall, break, or sprain? What if you already have sprained your ankle and want to get back to activities and prevent future turns and sprains? The same simple principle applies. Using direct positioning training, you can teach your ankles to sense when they are turning too much to the outside, and quickly send signals to your ankle, foot, and leg muscles to straighten your ankle and prevent a sprain. This works well, even with damaged and overstretched ankle ligaments, and is key to rehabbing a sprain.
Wearing supportive shoes, an air cast, splints, taping, and elastic bands to brace an injured ankles is a common practice that perpetuates weak, unstable ankles because these devices prevent sense of balance and positioning. Wearing these things to "support" non-injured ankles for hiking and walking is as bad. Within only one day of wearing an ankle brace, whether you have a sprain or not, balance is quickly diminished. You can put a healthy person in an ankle brace and test their ability to stand on that foot without the brace at the end of one day and find they are less able to balance and more likely to tip over. This problem compounds each day a brace is worn. Hard inflexible "supportive" shoes are a common contributor to increase hip and knee loading and pain.
The missing link in ankle rehab and the reason for so many repeat sprains is staying in the bracing and not doing enough balance and positioning retraining after the last sprain. This is why resting an ankle, bracing it, and reducing activity can make things worse. It is also the reason why the usual ankle strengthening exercises have not been working, and people keep spraining their ankles despite strengthening exercises. The issue in ankle sprains is not as much strength as sense of positioning, called proprioception. You need simple and easy-to-do proprioception exercises. Would you like to try one?
Stand up. Keep both feet facing straight ahead, not turned out.
Rise up on tiptoe. Notice if you allow your weight to teeter over the small toes, tipping your feet and ankles outward. That is the poor positioning and lack of the stabilization that allows your ankle to turn in the outward direction that allows sprains. You don't want this bad positioning to occur any time you are walking, hiking, jumping, dancing, or moving in any way. Not even when sitting.
Shift your body weight more toward your big toe and second toe, without grinding your weight onto the bones. Don't let your ankles sag inward or outward. Hold ankles straight.
Hold standing up on tiptoe with straight, good positioning as long as you can. You can practice this on the phone, or when doing dishes or laundry. Make sure you use it in real life activities whenever standing on your toes to reach and lift.
Next: More fun ankle proprioception retraining to rehab ankle sprains, stop reliance on supportive devices, and learn to prevent future sprains - No More Ankle Sprains Part II.
"#1 Dinosaur" is the name of the family doctor who hosted Grand Rounds 3.23 this week, illustrating a theme of how things have changed, and not changed, in medicine.
A recent New York Times article quotes aerobics teachers and devotees saying they now have painful, chronic injuries from years of aerobics classes. Why did this happen?
I receive frequent e-mails from aerobics instructors, many only in their 20s and 30s, saying they are too old to continue teaching because of pain and injuries from teaching. I am older than their parents. At the schools and clubs where I teach classes, teachers and trainers are often absent, or replaced, because of herniated discs.
The Times article quotes major aerobics spokespeople, attributing the injuries to jumping on "concrete floors in bad tennis shoes," and related how former well-known-names in the aerobics industry now teach low impact classes. The article continued, "A lot of people doing aerobics back then can no longer do any jumping whatsoever. They have problems with their backs, feet and hips."
Conventional "impact activities" are not the problem.
In the years I spent in the lab studying injuries, seeing patients, and teaching students, I have found that the problem is not that impact must be avoided. I see patients who are instructors of Pilates, stretch, yoga, rowing, martial arts, and Alexander technique for degenerating joints. It is simple misuse.
It is not that people are doing the exercises "wrong" but the movements themselves.
If you saw someone bend over at the waist or hips to hoist a suitcase or child, you know it is bad bending and it hurts the back. The same people will bend over the same way to lift weights in a gym or do yoga stretches. It is the same disc-injuring bending in all cases.
The post CommonExercises Teach Bad Bending gives interesting examples from a class that is "low-impact." Wear occurs on the lower back and neck discs regardless of how expensive and engineered the aerobics shoes.
The post Are You Making Your Exercise Unhealthy? shows you how to put the knowledge of bad positioning together in your mind with how people are exercising, to realize it is not rocket science when people have pain, even though they "do their exercises."
You can run, jump, walk without jarring impact
Many people walk with higher impact than a good martial artist will kickbox.
Many people are unnecessarily restricted from favorite sports and told to walk instead, based on the fallacy that running or tennis is necessarily higher impact, instead of looking at how heavily they clomp around letting spine, hips, knees, and ankles sag and grind.
Many of my obese patients with knee pain stand and walk with their knees in sagging positions. This is not a consequence of their body weight.
When I show them to simply hold their knee from knocking inward (or outward) by using their own muscles to hold straight, the pain quickly goes away. They say that they can then, for the first time, *do* any real exercise to lose weight.
Lightweight people can have the same knee and other pain. They may move heavily without good shock absorption or hold joints in angled painful ways.
What About Shoes?
Common myth are that you must wear "supportive" shoes, and that flexible soft shoes cause injuries.
Hard shoes increase shock and load on your ankles and knees.
Supportive shoes reduce or prevent the natural stretch on the plantar fascia and Achilles tendon that you ordinarily get with bare feet or soft flexible shoes. Tightness and risk of injury rises.
Supportive shoes decrease your need to balance and stabilize yourself, reducing your own abilities.
The post When Did Health Become Thinking Out of The Box? explains more of why you don't have to have pain from exercising or even long sitting while studying (or watching TV). I don't take people away from their favorite activities when injured. I even use their sport as rehab, showing them how to do it in healthier ways so that they can do more, lift more, and run more than before, not less. Health care should not be "Limit to the patient to limit the pain."
Read Inspiring Patient Stories on my web site - how patients fixed their own pain and could do more than before.
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Read success stories of these methods and contribute your own. 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. For personal medical questions - Replies to Medical Questions.
Subscribe to The Fitness Fixer, free. Click "updates via e-mail"(under trumpet) upper right. See Dr. Bookspan's Books, take a Class, get certifiedDrBookspan.com/Academy.
