Where To Continue with Fitness Fixer During Health... Stuart's Community Health As A Lifestyle Thank You Grand Rounds 6.31 Academy Developmental Ability and Special Olympics... Fast Fitness - Eighth Group Functional Training: S... Dr. Jolie Bookspan Earns Humanitarian Prize Shihan Chong Breaks 10 Blocks of Ice At Age 70 Arthritis, Hip Pain, and Success With Running Fast Fitness - Seventh Group Functional Training: ... Prevent Pain From Returning - Readers Successes August 2006 September 2006 October 2006 November 2006 December 2006 January 2007 February 2007 March 2007 April 2007 May 2007 June 2007 July 2007 August 2007 September 2007 October 2007 November 2007 December 2007 January 2008 February 2008 March 2008 April 2008 May 2008 June 2008 July 2008 August 2008 September 2008 October 2008 November 2008 December 2008 January 2009 February 2009 March 2009 April 2009 May 2009 June 2009 July 2009 August 2009 September 2009 October 2009 November 2009 December 2009 January 2010 February 2010 March 2010 April 2010

Fast Fitness - Using Perceived Exertion

Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - Perceived Exertion!

What is it?
  1. Perceived exertion is your own description of how hard you are exercising
  2. Perceived exertion is usually described on a scale of 1 to 10 (very, very easy to extremely hard).
  3. Until recently, perceived exertion was found to correlate with actual oxygen consumption, meaning your body is actually working medium hard with medium oxygen consumption when the effort feels medium hard. Perceived exertion scales are becoming ineffective as young people become increasingly unused to exercise and rate almost any minor effort as extremely hard.


It is not an injury when you exercise hard enough to have sore muscles over the next three to four days. It is not an injury when you use your body enough to feel aching effort in your muscles. It is not a respiratory problem when you are out of breath from hard exercise. It is not a medical problem when you are tired at the end of the day. If you have worked hard, being tired enough to sleep is right and needed, and avoids the need for taking medicines to sleep.

Work to increase the effort it takes to become out of breath and feel hard muscular effort. Work to increase the amount of work it takes for you to feel something is moderately hard.

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Knee Pain When Running - Check Your Yoga

Jolie Bookspan, M.Ed, PhD, FAWM
If your knee pain from running isn't getting better with fixing bad gait, physical therapy, and medical care, check your yoga. Several poses directly twist, overstretch, or pinch knee cartilage. Over time, injury builds that does not show much in people who do yoga and little else, until their knees encounter resisted motion for running and sports, or from a trip or fall.

Not long ago, people in yoga or sports did not intersect much. Now, the previously more sedentary yoga populations try running, aerobics, and sports. Athletes are being told that yoga will give them magic benefits. Knee injuries bloom when they go back to sports, making the staunch yoga camps claim sports are the culprit, when it was the knee damaging motions in yoga and other stretches.

The knee is a primarily a hinge joint, like the hinge on a door that only can open and close. The door swings toward you and away. If you lift up on the door, it twists the hinge and eventually loosens it. The door begins to creak and rub and make noise.

Think of sitting cross-legged (tailor style). Your knees are out to the side and your lower legs bend toward you. All is fine at that point. Now picture, as with lifting upward on a door, you lift the foot and lower leg to rest it on your thigh in Lotus position or lifting it in some pigeon poses as in the photo, at right. Unless you outwardly rotate the upper leg fully at the hip, the knee twists, overstretching the lateral (outside) ligament and pinching the medial meniscus and soft tissue.

Often people bend the ankle upwards too, also pictured at right, a separate problem - see Unhealthy Yoga Ankles.

How to picture rotation at the hip? Think of a stapler. Like the door just mentioned, the stapler has a hinge or knee joining two sections, like your upper and lower leg. It opens and closes on the hinge. If you pull the upper or lower part sideways, it twists or shears the hinge. To turn to staple sideways, you need to rotate the whole thing.

Hero pose, (Supta Virasana) begins sitting on bent knees, meditation style (left-hand photo below), which often is fine. The knee hinge closes, like closing a door, normal bending. Then the pose continues by pulling the feet outside of the upper legs, like pulling upward on the door hinge. If you do not inwardly rotate both upper legs at the hip fully, your knee twists at the hinge, overstretching the medial (inside- facing the other knee) ligament, pinching the lateral (outer) meniscus and soft tissue. Lying back, as in the right-hand photo adds prying of the joint to the rotation damage (often people overarch the lower spine too instead of stretch the muscles, an additonal problem). In "W" sitting, both feet face outward. Not a problem for the knee unless the hips do not fully rotate (whether relentless W sitting is eventually is too much at the hip is a separate question). Runner's hurdler stretch is the same issue, one leg at a time.

Even though yoga may call for "doing both sides" and following each motion in one direction with one in the other, twisting both the medial and lateral sides of the knee cartilage by doing both Lotus and Hero will not cancel each other, but can overstretch and degenerate both sides.


Warrior poses 1 and 2 are like a lunge. Check your front knee:
- Is it inside the line of your foot?
- Do your foot and knee face the same direction?

Sagging inward unequally loads the knee and when the foot and knee face differently, the knee twists under body weight (blue center model, photo at right).

Keep your knee above your foot, both facing directly forward.



Mighty Chair pose - watch for, and change overly-stylized artificial position, not valuable for any functional motion (photo right and lower drawing left).

For chair pose, use outer thigh muscles to hold straight and prevent knees from sinking inward. Use neutral spine instead of overly-arched to practice movement the way it is needed all day for real life. Right-hand drawing below shows fixing.

Make yoga something that benefits your real life movement habits, not trains artificial, damaging, motion you don't even need.

Check that you don't crane the neck while raising arms, impinging rotator cuff and shearing neck vertebrae and greatly overarch (hyperlordose) the lower spine, see Prevent Back Surgery.

For a functional exercise, instead of straining in chair pose a few moments a week, use healthy half squats (right figure on drawing at left) for daily bending and get hundreds of healthy bends - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.


Hindu squats and one-legged heel-up deep bends may not twist the knee as much as pry it. Picture a tool to crack nuts - two handles joined at a hinge, like your upper and lower leg joined at the knee. Imagine putting an object (for example, a soccer ball) between the upper and lower leg and try to close the heel toward the upper leg - if the ball does not compress, the hinge (knee) pries open. That happens with low squats on the toes (heels up) if you have large or heavy legs. If you have slender legs, the heels can come closely, like bending your elbow so that your lower arm rests along your upper arm. Slender legs do this, while muscular athletes may destabilize their knees, leaving them venerable to future injury.

The beginning of one of the pigeon poses is pictured at right. The person pictured is sitting to the side, instead of keeping the back knee and leg rotated to face straight downward. Sitting to the side greatly reduces the stretch, especially to the rear hip's front muscles that need the stretch, but usually no big problem to the knee. When the pose continues to lift the back foot for King Pigeon, if you lift the foot up without facing the knee downward, you twist the knee joint. By turning the whole leg downward, you get a better anterior hip stretch, and when you lift the foot, the knee can bend like a hinge, not twist.

One Legged King Pigeon kneels on the rear knee with that knee bent so only the kneecap bears your weight. To reduce compression, and get a better stretch for your hip, move your back leg further back so that your weight rests on the thigh, not kneecap.

I have taken several yoga teacher certifications. Each gives different, plausible-sounding rationale why knee twist poses help, but the anatomy is just off enough to come to wrong conclusions. In one, they taught to deliberately twist the lower leg on the upper "to protect the meniscus." Twisting does not protect, but twist in a damaging way. There are two bones in the lower leg, allowing some rotation, but twisting injures other structures. Another teacher training stressed extreme knee twisting as a stretch in itself, stating that any increase in motion is beneficial, especially from joints. Knee laxity results. Without much muscle and positioning training, you predispose yourself to instability when giving the knee challenge, like going back to sports, or from a fall or blow. Another certification teacher training taught that knee twisting is beneficial since it allows great range of motion in case you fall down with your knee twisted backward. Sounds plausible for that one fall (unless you fall differently), but for every other day in your life, so much extra space can result that the joint 'rattles' and wears prematurely. In another class we were made to sit in Lotus, then, still folded in Lotus, rise to knees and swivel from knee to knee to waddle around the room, compounding damage with body weight on the twisted strained joints.

In each yoga teacher training and class I take, I hear teachers tell about their knee pain and surgeries. They don't know why. They think they need more yoga and do more injurious poses, getting relief or distraction for the moment, then pain comes back. Movement in general often relieves pain for the moment. No need to repeatedly add injury to get temporary relief. Stop the causes and the pain stops.

There are assertions that many people do these stretches and not everyone gets knee pain, so they must be fine. Smoking and unsafe sex also do not have a one-to-one association with immediately bad consequences every time. Some stretches and movements twist the knee and overstretch cartilage. If you do these stretches and have pain, or just sit or stand with your knees hyper-extended (locked back) even if you think it is unrelated, it is one place to think about.

There is more. For another time.

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Stapler photo, Some rights reserved by www.bossbahamas.com
Hero pose, Some rights reserved by www.fitsugar.com
Warrior knee, Some rights reserved by lululemon
Chair pose, Some rights reserved by lululemon
Drawings of Backman!™ © copyright All Rights Reserved by Dr. Bookspan
Pigeon sitting sideways, Some rights reserved by www.ehow.com

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Working In An Underwater Lab

Jolie Bookspan, M.Ed, PhD, FAWM
I am a scientist in human physiology. I study how the body works in extremes of environments. I lived on mountains and underwater. I slept outdoors in snow to study cold adaptation. I spun pilots in centrifuges until their faces looked like shar pei puppies. I make grown men cry.

Readers asked for stories of when I lived the extremes myself.


Here is a story when I worked and lived in an underwater lab.

I didn't have a camera then, and have few photos from those years, so at right is a photo of an underwater lab found on the Internet using a search of the terms "underwater lab."

You live many meters underwater in a metal structure that keeps out the water. It is an air pocket the size of a big room and the air you breathe is under pressure equal to the surrounding water depth. Since you live there for days, or weeks, the lab has a kitchen. Cooking and using the bathroom in the higher pressure is for another story.

To get to the lab you need to dive down underwater. You can wear scuba gear or use a long surface supplied hose. Occasionally a reporter would come visit the facility and want to stay in the underwater lab for a day to get a story. We, the staff, would teach them enough to use the air supply safely to get them down and back up after their stay, and transport their sometimes large and unwieldy suitcases for them in watertight containers.

One day, another staff member and I helped a reporter dive down to the lab, helped her inside, all nice and dry, and left here there to set up her typewriter (this was a long time ago before laptops and wireless devices). We returned to the surface and put the air hoses away. Shortly later, we decided to free dive back down to check on her.

We took a deep breath, held our breath and dived
down down down

We thumped on the big tempered glass portholes trying to get her attention.

thump thump!
(holding breath)

thump thump thump!
(holding breath longer)

thump!
longer... oooooooh!

She noticed us. She was delighted to see two mer-people swimming in the blue depths outside. She waived at us gaily. We hovered swimming weightlessly outside in the blue, holding our breath.

She raised her two hands, making a camera gesture.
She clicked a finger in air and then pointed it to tell us - "Wait!"

Through the porthole we watched her pawing around for her suitcase to find her camera.
(still holding our breath, outside in the deep blue water)

She looked and looked. She scattered clothes and bags.

The other staff and I used a swallowing technique to extend breath-hold time -uuuuuuuuuuuMH

Finally, a camera waved at the view port.

She positioned the camera to take our photo.

(Still holding our breath waiting, waiting).

She held up the camera .... She leaned back, ... She stopped and oriented the camera the other way, ..... She leaned to the side

She gestured WAIT!! She gestured, "I have to get it just right! Just a moment longer just WAIT."

CLICK!!

She got the photo. We saw the flash bounce off the glass, knowing the photo would never come out. She didn't seem fazed.

She held up one finger and pantomimed through the glass - "Wait - one more!"



"The cure for everything is salt water — sweat, tears or the sea."
— Isak Dinesen



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Underwater lab photo by Michael Rupert
Photo of me free diving © copyright Dr. Jolie Bookspan


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Fast Fitness - New Understanding of Hyperlordosis and Disc Injury

Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - a new possible contributor to vertebral disc injury, and how to avoid it:
  1. In my previous studies, I found that overdoing the inward lower spine curve (hyperlordosis) pinches the lower spine like a soda straw. It forces the spine joints, called facets, backward against each other, eventually wearing them, and compresses surrounding soft tissue. After long periods of standing, exercise, and lifting with too much inward curve, lower back pain is not a big surprise or mysterious to fix.

  2. Hyperlordosis was not previously thought of as a direct herniating force on discs. The major factor was and still is too much forward bending. Weighted flexion (bending forward bearing your body weight) opens the space between vertebrae in back, and over years of slouched sitting and bad bending and lifting forward, presses discs outward through that space creating herniated discs (an injury, not a disease). In my previous work I found that for someone with a disc already herniated, hyperlordosis pinches it, adding pain to the separate problem of the disc. Showing people how to stop standing in hyperlordosis greatly reduced their disc pain. In recent work, I found that hyperlordosis exacerbates, and possibly initiates disc herniation itself.

  3. My new work is showing that hyperlordosis is a probable mechanism to directly shift disc position. I made a diagram showing the disc injury coming from overarching/ hyperlordosis/ hyperextending the spine that is so common in pop fitness.
Above, Left and center - Drawings of two ways you can stand in hyperlordosis, and the results over time, on the discs.
Above, Right - Actual MRI, comparable to center drawing, shows disc herniation and pinching between
lower vertebrae.


Hyperlordosis in both walkers, easily seen at right. Damaging sloppy posture.


Hyperlordosis (overarching the lower spine) is a spine damaging posture. Hyperlordosis and the pain from it can be changed as easily as moving your spine to a smaller, healthier degree of arch (neutral spine). It is not tightening your abs, just moving your spine, as simply as bending your elbow. Links below tell more.

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Drawing © copyright Dr. Jolie Bookspan. MRI courtesy of ChiroGeek
Walking hyperlordosis photo © by mikebaird

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Thank You Grand Rounds 6.17 - Food as Medicine

Jolie Bookspan, M.Ed, PhD, FAWM
Thank you Dr. LaPuma at Let Food Be Your Medicine Too for hosting Grand Rounds 6.17 and including my article Fast Fitness - Happy New Year of Fitness in the Grand Rounds collection of best medical writing of the week.

The theme of Grand Rounds this week was Food as Medicine. Many posts talked about buying and eating food for yourself. I wrote of food for others too.

Dr. LaPuma writes, "Fitness Fixer’s Dr Bookspan, bless her heart, takes pleasure in the rhythm of cooking and giving and gardening."

Thank you Dr. LaPuma for good words and all your hard work for Grand Rounds.

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High Fat Diet Reduces Endurance

Jolie Bookspan, M.Ed, PhD, FAWM
Racers eat all sorts of things hoping to extend endurance. A long history of drugs and supplements have been used from illegal to unhealthy to useless to good common sense nutrition.

Some racers load on unhealthful simple sugars hoping that will maximize needed carbohydrate stores called glycogen in the muscles. Others shun carbohydrates, even healthy needed nutrition in fruit and vegetables because they want to lose weight. A main effect of low carbohydrate diets is loss of muscle glycogen, quickly reducing size and water weight, giving the illusion of weight loss, and reducing exercise ability.

Another factor was identified in a study at Oxford University looking at using a high-fat diet. They found "stark reduction in physical endurance and a decline in cognitive ability after just nine days." Researcher found increased levels of a protein called the 'uncoupling protein' in the muscle and heart cells of rats on the high-fat diet. This protein 'uncouples' the process of burning food stuffs for energy in the cells, reducing the efficiency of the heart and muscles.

The study used rats, which have different nutritional needs than people. Previous rat nutrition studies led to higher than needed protein estimations, still believed by body builders hoping to build muscle through eating. This rat study seems to be in line with longitudinal dietary studies of human athletes who could not run as long on a treadmill or navigate as well through a maze. Dr Andrew Murray led the work at Oxford University. He stated, "We found that rats, when switched to a high-fat diet from their standard low-fat feed, showed a surprisingly quick reduction in their physical performance."

Primary Source: 'Deterioration of physical performance and cognitive function in rats with short-term high-fat feeding' by Andrew J Murray and colleagues. The FASEB Journal, 2009; DOI: 10.1096/fj.09-139691.
Copy of the paper: http://www.fasebj.org/cgi/rapidpdf/fj.09-139691v1.pdf


What they called a high fat diet was 55 per cent of the calories from fat. This may be less total fat than what I observe many people eating with fast food and junk food. Patients come to me proudly showing a food diary that they think is balanced because it lowers the total fat percentage of a recipe with lard by adding sugar. That is still the same high fat amount. Reduce your total fat, and keep your head not to avoid vegetables because they have a high percentage of carbohydrate. The percentage is high, not the total. If you have a one-dollar bill in your pocket and that's all, your pocket has 100% dollar bills, but not a lot of them.

In American Samoa, 93.5% of the people are estimated to be overweight since changing traditional complex carbohydrate low fat meals to Western imports of fatty food, junk sugar, and processed meat like Spam. In the Republic of Kiribati, another tropical island nation of the central Pacific, 81.5% are estimated overweight for the same reasons. Egypt began an increase of obesity when they began importing fast food. In the United States, over 65% of the people are considered overweight, related to considerable fat and high simple sugar from processed food with corn oil and high fructose corn syrup.

If your body chemistry, your temperament, medications you take, or economic situation pushes you to gain body fat from eating too much unhealthful food, eating less of it is still key to reducing overweight. I am not a nutrient biochemistry specialist, just a physiologist. For health and sports success over the long term, a working generality is to stop eating the fat and refined sugar of junk food, fast, food, and processed food, and many so-called "health-foods" which are expensive candy or over-processed products. Try an apple or favorite fruit and some walnuts for healthy exercise and endurance.

There are many components of health covered in the hundreds of Fitness Fixer articles already here, including how to fix injuries, stop pain, and improve sports and life abilities without expensive unhealthful sports food or drugs and medicines that reduce overall health.


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Photo of enduring SEALs by Rennett Stowe

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Natural Hard Exercise - Stuart's Community Health Stewardship Continues

Jolie Bookspan, M.Ed, PhD, FAWM
Reader Stuart Wood did a magnificent thing. He took charge and started teaching my work to reduce the high rate of strain-related injuries in his community for projects ranging from school health to senior health to water harvesting in his arid city of Tucson.

Stuart writes:
"The second group of pictures in the set are from a water harvesting project run by the Water Management Group here in Tucson. We spent 5 hours digging and bending and planting. The structures make use of street run-off in a way that reduces road and water pollution while at the same time "greening" the street by providing the plants with water which will eventually shade the side-walk and street and reduce the "heat-island" created by all the asphalt and concrete that attracts and absorbs sunlight/heat.

"This was my first time volunteering with them and I didn't get a chance to teach but I did figure out how to dig and bend correctly myself. It was a work-out and felt really good. I have dug in the past for long hours with improper bending and what it a difference it makes! Soon I hope to teach the other volunteers so that in addition to being good stewards of the community they can also be good stewards of their health.

"The watershed admin is thinking the best thing for me to do would be to teach the various instructors so that they could then oversee the volunteers throughout the city.

Stuart will retrain participants' bending so that their exercise is healthy for themselves and the community


"I was looking at your website (DrBookspan.com/Academy) and seeing the part about scholarships for Native Americans and the elderly, that intrigued me a lot. There is a large reservation just south of town for the Tohono O'odahm Indians, I have been thinking about how neat it would be to teach some of them.

"Recently there has been a wellness program implemented by the City of Tucson to reduce work-related strains and injuries. They have not been exposed to your work yet but they have been exposed to stretches that are potentially damaging at worst and ineffective at best! My friend spoke kindly of me and how your blog and my advice had helped him so, when I talked to his supervisor, he was more than helpful in suggesting ways in which I might be able to teach city workers in various settings and occupations."

More work is in progress. Reports to come.

"Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
It is our light, not our darkness, that most frightens us.
We ask ourselves, who am I to be brilliant, gorgeous, talented and fabulous?
Actually, who are you not to be?
Your playing small doesn't serve the world.
There's nothing enlightened about shrinking so that
other people won't feel insecure about you.
We were born to manifest the glory that is within us.
It's not just in some of us; it's in everyone.
As we let our light shine, we unconsciously give other people
permission to do the same.
As we are liberated from our own fear,
our presence automatically liberates others."

- Nelson Mandela
1994 Inaugural speech


How Stuart Started All This:
See Stuart's Work Teaching School Kids and Instructors:
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Fast Fitness - Fifth Group Functional Training: Ankle and Knee Safety With Lateral Movement

Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - fifth in the series of Functional Fitness Training (FFT) to teach your group, teams, classes, students, kids, battalions…

In this FFT, learn to be ready for changing direction, cutting, lateral movement, landing to the side from jumps, slips and missteps, and more. It builds on the Third Functional Training exercise where you learned to jump with good lower body mechanics.

Assemble your group in neat rows. Stand in front in view of all. Tell them this is a basic, functional physical skill to learn how to reduce lower body injuries during sideways jumps. Remind them they use the previously learned principles from the Third FFT of vertical jumps.
  1. Have everyone crouch using good bending (knees do not sway inward or slide forward, taught in the first FFT skill), then rise to toes with stable neutral ankle (not bowing outward at the side, taught in the second skill). Remind them that when they land from a jump they use the same neutral ankle.
  2. Next, have everyone to leap sideways at once, off one leg onto the other foot, landing softly with good knee bending and neutral ankle. On landing, the knee is already above the foot, not bent inward. Foot is neutral, not flattened inward (pronated) or turning outward like a sprain (inversion and supination).
  3. Leap back to starting place onto the other foot. On landing, the knee is already above the foot. Repeat leaping sideways from foot to foot. With each landing, watch the knee of the landing leg. Make sure the knee doesn't sway inward of foot.
Improve by jumping increasingly fast, and far, for longer periods of time.

Each new Functional Training exercise shows how to teach your groups (or self) how to prevent common musculoskeletal problems during the team season or operational theater. Learn this one to be ready for the fourth one coming next, needed for cutting, changing direction, lateral movement, more.

Trainers, Drill Instructors, readers, send in your stories of how you use these in your program.

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Photo by Wouter Verhelst

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Thank You Grand Rounds 6.13

Jolie Bookspan, M.Ed, PhD, FAWM
Thank you to The Covert Rationing Blog for hosting this week's edition of Grand Rounds Vol 6, Number 13, and including my article StuartShip - How To Start Healthy Movement Programs in the list of best medical articles of the week. Fitness Fixer reader Stuart used my work to integrate healthy movement into community projects in his town. Click StuartShip to read about it.

DrRich, host of Grand Rounds this week, says he has been thinking about starting his own healthy movement program.

Thank you Dr. Rich. Congratulations Stuart.

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Knee Tracking Surgery - Tracking Outcomes

Jolie Bookspan, M.Ed, PhD, FAWM

In the article Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better, I listed common reasons knee pain doesn't resolve, including common bad stretches, bad shoes, treating the wrong thing, treating the right thing but returning to pronated, duckfoot or pigeon-toe gait (letting arches flatten or knees sag inward, and/or walking toe out or in), and omitting functional exercise and use. Fancy "supportive" running shoes, no matter how expensive or engineered often add to knee pain. I wrote that surgery for a tight lateral area isn't needed when you can stretch it. Readers wrote asking why stretch when you can just have surgery and cut it?

One common surgical procedures is an arthroscopic lateral release - surgical cutting of the lateral muscles from the patella (kneecap). The idea of the surgery is to decrease pull and pressure on the underside of the patella.

Studies following up people undergoing the surgery show, "The results are not always predictable or successful and in some cases, the surgery may have no effect on the patient's problem." http://www.arthroscopy.com/sp05032.htm

Another study from the Netherlands confirmed previous studies showing exercise therapy for patellofemoral pain was more effective to reduce pain and increase function than the often used "rest, wait and see." Science Daily.

Surgery often is made to sound like a quick way to get ahead, but numbers now confirm that you are restricted from full activity for enough time that your physical conditioning, flexibility, bone density, aerobic capacity, strength, and enthusiasm diminish. You will often be further behind, rather than quickly fixing a cause and going forward. Often, as much physical therapy is needed for full recovery after surgery as if you didn't go for the surgery. Stories are told of someone who had the surgery then went right back to skiing. I am the one who many of these people come to a year later. They say they are fine, but they still use pain medicine, still can't bend their knee enough to stretch enough to get relief of other tight areas and so on, and often haven't gotten back to previous benchmarks. To me, that is not "fine" enough. They slowly diminish in key areas of their life. They get new pain they don't recognize as related to compensating movement from the old ones. By the time they see me, they are often on several pain medicines, anti-depression medicines, and others that make new problems.

Surgical risks are also becoming better reported. Blood clot incidence is far higher after surgery than previous released. A study of nearly 1 million women tracked for an average of 6.2 years after surgery, showed risk continues for 12 weeks and includes minimally invasive procedures.
http://www.nlm.nih.gov/medlineplus/news/fullstory_92610.html

Not all patellofemoral pain is a tracking problem. Tracking pain is in the patellorfemoral area (where kneecap and top leg bone meet). However, other conditions besides tracking make patellofemoral pain. People with patellofemoral knee pain may be sent for tracking therapy even surgery, without needing it. Standing and moving allowing the knee to sag or rotate inward can also make rubbing. Surgery and tracking exercises do not address this. They may be done but yield no result. It is not a mystery.

Coming later this month - Knee Pain From Yoga.

Check For Reasons For Pain And Address Them:
Related Fitness Fixer On Knee Surgery:
Random Fun Fitness Fixer:

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Photo of making your knee sad by goatling

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Winner - Contest to Name The Illustration

Jolie Bookspan, M.Ed, PhD, FAWM

Reader Paul J has been named Winner of the contest to name the figure who illustrates many of my books, articles in Fitness Fixer, web site articles, and Academy teaching materials.

The comic figure who educates about healthy movement continues from one I had an artist design for me. The artist moved away and could no longer work for me. I am no artist, and had to learn to draw him - not great like the original artist's, but what I could figure out for myself.

When I hired the talented young medical graphics artist, I told him I envisioned an image that was not man or woman, not black or white, not young or old, but everyone. He drew me a white guy, with a big western nose. Still it was a funny warm character that people say they can identify with as he figures out life.

Runner-up was reader JayaKrishna who gave him the name, Dr. Goodback. I like that, and that remains his formal professional name. The rest of the time, thanks to Paul J, his name is Backman!

When you see Fitness Fixer posts with this character, you should see the trademark symbol and his copyrighted name.

The name also reminded me of a SuperHero name. I wrote to thank Paul J, saying "I am BACKman! POW! splat! take that Joker!"

He wrote back, "Do you mean Jock-err...the steroid using muscle man that does bad bending?"


Backman!™
wins again with functional exercise.


More Dr. Goodback, otherwise known as Backman!™
More Fun - Participate and Win
See Backman!™ in Action

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See if your answers are already here by clicking labels, links in posts, archives, and The Fitness Fixer Index. Subscribe to The Fitness Fixer, click "updates via e-mail" upper right.
For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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Drawing of Backman!™ © copyright Dr. Jolie Bookspan

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Fast Fitness - How To Be An Inspiring Success and Send In Your Story

Jolie Bookspan, M.Ed, PhD, FAWM
Here is Friday Fast Fitness - How to Be in the Fitness Fixer Hall of Fame.

The 2009 Fitness Fixer Hall of Fame listed readers who fixed their fitness and sent their stories. How can you be in the Hall of Fame 2010?

Send in your reader inspiring success story. If you have read Fitness Fixer for any time, you probably are smart and would use it, and by now, be better at some aspect of your life:
  1. Large or small, write what you did and why and how. It can be one small improvement like sitting in healthy position at your desk or bending right so that you no longer hurt. It can be that you stopped pain and now can do activities you used to love, or wanted to try for the first time. It can be how you taught a family member or friend to stop their pain.
  2. If you don't have something, choose a fun and easy Fitness Fixer - close to 700 so far. Labels under each article gives all articles in that category, for example all Fast Fitness, or all reader inspiring stories. Or use the Fitness Fixer Index.
  3. Take photos and short movies if you can, of small file-size. Send me your story with your link to your photos on a photo-sharing site like Flickr, MyPhotoTown, Picassa, or other you prefer. If you don't know how to do that, it may be fun to learn. At last resort, e-mail me the photos.
Ivy from New Zealand had to borrow a film camera, wait for developing, and mail me the photos from overseas, which I scanned and uploaded. Her efforts with her 86 year old neighbor who took the photos are on Inspirational Ivy. Reader Robert Davis propped his camera phone on a paperclip, put the camera on timer, and ran into place. For smart Fitness Fixer readers, there is always a way. On my professional website www.DrBookspan.com, the academy page and the BOOKS page have contact links to be used for Sending Good. Separate pages and contact links exist for asking questions and professional help.

A telling observation is when I search photo databases for examples for the hundreds of articles for all of you, searches using keywords of "exercise," "health" and "fitness," or searches of fitness sites yield only bad, unhealthful positioning. Often, unless I take the photo myself of a student or patient, or a reader sends one in, there is no "good" example. Come be one.


Double Benefit:
Enter the Fitness Fixer contests. If you show how you do it yourself, and why this is a positive change in your life, you can have two successes - contest winner and success story.
Fitness Fixer Reader Hall of Fame:
More How To Do It:

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Photo of winner by kyz's photostream

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91 Year Old Water Skier

Jolie Bookspan, M.Ed, PhD, FAWM
Edith McAllister was born in 1918 and lives in San Antonio. Here is a video of her water skiing at the age of 91.

Click the > arrow to play this short movie:


If video does not load, click
http://www.youtube.com/watch?v=T-OzZppi1kw

Ms. McAllister swims and water-skis every day. She says the key is you have to keep going, don't quit.

My father was also an avid water skier. I have photos of him slalom-skiing, long silver hair flying. In water-ski vocabulary, "slalom" means only one ski. I also have a photo of him high diving from the Mexican cliffs with the real cliff divers - for another story. I have photos of my grandmother lifting weights in her 90's with her hip-length hair still black, but she said she doesn't like the photos because she looks old.

Stay active, no matter what your age. It is the key to being mobile and independent

Related Fun Fitness Fixer:
Random Fun Fitness Fixer:


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For personal medical questions - Replies to Medical Questions. Limited Class spaces for personal feedback. Top students may apply for certification through DrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
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Thank You Grand Rounds 6.15

Jolie Bookspan, M.Ed, PhD, FAWM


Thank You Dr. Nick Genes for hosting Grand Rounds Volume 6, Number 15, the first of the New Year and including my Fitness Fixer Reader Hall Of Fame 2009 in the list of best medical writing of the week.


Congratulations to all Fitness Fixer readers who earned a place in the 2009 Hall of Fame.

Click to see them here.

On the web, Grand Rounds is a collection of the best on-line medical posts from the past week. A different host works hard each week to find and list the articles. This is different from the Grand Rounds in a hospital, which is a lecture for doctors about a patient or topic.

Thank you to Dr. Genes, this week's host for doing the hard work of collecting and featuring our posts.


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Are You Always Colder With Exercise In Cold Water?

Jolie Bookspan, M.Ed, PhD, FAWM
It is winter in the northern hemisphere. Outdoor swimming and boating waters range from chilly to frozen. A widespread assumption is that exercise in cold water always makes you colder. Some scuba diving textbooks assert that cold water will cause heat loss and therefore you will always chill in cold water. Some survival protocols may say you must never try to swim to safety if you find yourself unexpectedly in cold water. Are these true?

Although you lose a high amount of body heat to moving water, it is also true that you gain heat from being alive and from moving. The more heat you can generate, the more it is likely to meet or exceed the amount you lose. Losing heat by itself does not mean that you are chilling. If you generate more than you lose, you do not chill, you can stay warm when swimming and diving, even overheat. If not, of course, you can get very cold.

In general, it is easier to chill than overheat in cold water. However, in some cases, you can generate enough heat through exercise to match or surpass the heat you lose, even moreso if you are well insulated with muscle and fat. Swimmers doing laps in pools and divers sweating into their masks during hard finning against currents can tell you that. During Desert Storm, some divers in the Persian Gulf needed to wear ice vests for heat extraction to prevent overheating.


Many factors are involved including your fitness (ability to exercise hard enough to make enough heat), your build, your clothing, medicines you may be taking, how far it is to safety, your health, how warm you were when you started, the weather, water current and conditions. You can have net loss and gain back and forth during the same swim. Much to know.

When I competed in swimming, we swam miles each day. In winter, after finishing pool training, I walked home, hair still dripping. A fun thing was to see how fast it would freeze. When I'd pat the top of my head, the frozen hair crackled humorously. You could hold locks out to freeze in shapes. Teammates and I experimented informally, running various speeds to see if the wind froze the hair more or our rising body heat could melt it. Some of us were able to generate a literal head of steam. Most of my training was pool swimming (wimpy) but I have tried ice swimming in no more than a bathing suit. My family were Russian Ice swimmers and my Grandfather was the oldest member of the Iceberg club, who swam in the ocean every day, including New Year's Day. I am trying to find any photos that may have been taken. I know the club and my Grandfather were pictured in an issue of Strength and Health magazine.

In my military work in cold survival, we used computer models to compare heat loss in critically cold water scenarios for downed pilots and combat swimmers, to our real experiments putting volunteers in cold water with lots of forced convection - waves, wind, overhead spray, and my little toy wind-up sharks and penguins. You can become incapacitated by cold before becoming hypothermic. You can die from cold incapacitation in the water without ever reaching a hypothermic state. In informal conversation, the terms hypothermia and chilling are often used interchangeably, but that is not correct, and they are not the same. I made t-shirts for "my guys" the military volunteers in each extreme experimental protocol. The cold immersion trial shirts were inspired by the verse "Many are called but few are chosen" to become, "Many are cold but few are frozen."

More On Surviving Cold:
Healthy Swimming and Scuba:
Random Fitness Fixer:

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See if your answers are already here by clicking labels, links in posts, archives, and The Fitness Fixer Index. Subscribe free, click "updates via e-mail" upper right.
For personal medical questions - Replies to Medical Questions. Limited Class space for personal feedback. Top students may apply for certification through DrBookspan.com/Academy. Get more in Dr. Bookspan's Books.
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Ice swimming photo by farlane
Iceskiing photo by pdbreen


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Good Bending Strengthens Legs and Lifting Ability

Jolie Bookspan, M.Ed, PhD, FAWM
BikaBill, one of the winners of the How To Sit Up Straight Contest, writes,
"Ahhh, so good to be a winna!!!

"Another recent success:

"I'd bought a steel fire pit that weighs about 50 lbs, and when I got it last November I could barely move it more than a few feet and that was with some pain. I was going to ask someone to help me move it for use on New Years Eve. But I've been really watching and correcting my posture for the last couple months, and when I picked it up New Years Eve, it seemed really light. I just whisked it out to the front yard like it weighed nothing, and there was no pain!!!

Left drawing shows neutral spine and hip. Center and Right show two kinds of swayback (hyperlordosis) a slouching posture you can easily change to stop pain.



"I was amazed. I would never have guessed that good posture makes one so much stronger, but it does! I've also noticed a difference in my poise -- like forcing yourself to smile makes you feel happier, so does good posture make you feel more self confident. No surgeon could ever have given me that!

"Thanks, Dr. J.

"Happy 2010!
-Bill"

Good body mechanics are a powerful performance enhancing aid.

How To Do This Too


Good Bending:

Lifting Overhead:


Better Ergonomics for Carrying Loads:


Great Technique for Pushing and Punching
Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

What Is Neutral Spine?

Another Reader Applies Good Bending:


Random Fun Fitness Fixer
:

Drawings of Backman!™ © copyright by Dr. Jolie Bookspan




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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 through
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