Stuart Wood has been teaching my work in his Tucson community to retrain healthy movement to reduce the high rate of strain-related injuries. Instead of doing rehab exercises after you strain yourself doing your work, you use healthy movement for your work - the real fitness as a lifestyle.
Here is an update on his water harvesting training - a needed program in arid Arizona:
"Hi Dr. Bookspan, I trained the staff for the Watershed Management Group today it was a lot of fun and they were eager and receptive to learn. Training in this formal setting assuaged some of my fears and gave me confidence. Thanks for your confidence in me it is great to hear.
"I could answer their questions and they just kept coming with more. I encouraged them to keep in touch with me so I could direct them to specific Fitness Fixer entries and support their efforts. Everyone was eager to take the handouts you sent me in the mail and were asking about help for friends (to prevent) back surgeries, etc.
"I took some good pictures and am doing a little photo editing on them. I was very happy afterwards and look forward to doing more of these. I have posted the photos from my training:
"I am going to develop a survey that I can get feedback with using a cool online tool.
"I felt very professional in my AFEM shirt. They were also excited by the prospect of completing modules. Just wanted to send you a short note. I have to go watch dogs now but I'll prepare a complete e-mail and upload the pictures soon for a suitable blog entry. I'm keeping my chin up But not squashing vertebrae :)
Stuart, of course I have confidence in you - you are my Jedi. Keep doing great things.
Fast Fitness - Eighth Group Functional Training: Spine and Shoulder Stability With Overhead Motions
Friday, April 23, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - eighth in the series of Functional Fitness Training (Bookspan Basics) to teach your group, teams, classes, students, kids, battalions, or self. In this Bookspan Basic Training, you train positioning and muscle skills to reach overhead with healthy mechanics for the shoulder and lower back.
Assemble your group in neat rows. Stand in front in view of all. Tell them this is a basic, functional physical skill to learn to prevent injurious positioning during overhead motions.
Everyone reaches up. Have everyone notice if they lean their upper body backward to raise their arms. See if their tilt their beltline downward in front or push the hip/pelvis forward. See examples in both photos above and below. Explain that leaning back and increasing the lower spine arch are not a healthy ways to raise arms and that upright neutral spine is a stronger base for their arm movement and uses abdominal muscles.
Have everyone bring their ribs back down to level, pull upper body to upright, and tuck the hip under to straighten the pelvis to vertical and neutral. The motion is like doing an abdominal crunch standing up, without curling forward. You crunch enough to bring yourself to straight and upright. See our short movie of fixing this on Overhead Lifting, Reaching, and Throwing Part II - Lower Back.
Have everyone hold their upper body upright and vertical and notice where their shoulder is and try it again with healthy position.
Leaning back when raising arms increases the inward curve of the lower back, causing a swayback, hyper-lordotic posture. Hyperlordosis is a common source of "mystery" back pain. It comes when you over-arch - usually during long standing, walking, running, reaching, then goes away. People are mystified. Look at both photos again. It is easily prevented by stopping the injurious position then and there. Send your success photos to me at DrBookspan.com.
Make sure everyone breathes. A bad habit promoted by much popular fitness is tightening the abdominal and backside muscles to do minor movements. People hold their breath. Make sure all can do full relaxed belly breathing while holding neutral spine and reaching both arms overhead. Remind all to keep their shoulders down and not raise the shoulders when they raise the arms.
Ted loves to run. We previously fixed his back pain from running. We kept in touch about all his successes with pain free running. A few years later he wrote, worried that his hip x-rays showed severe hip arthritis and an old hip injury hurt. We again got him back to pain free running. That is what we do at Fitness Fixer. In the New York Times, an article quoted a physician who always had pain after running and said he "had no idea why." More about that follows with what Ted and I did to fix his hip pain from running.
Four years ago, Ted came to me with back pain from running. He had been running with too much inward curve in the lower back, which is a common cause of lower back pain while standing, walking, and running. We stopped his back pain from running by teaching him to reduce the too-large inward curve to neutral spine during running and daily life - Back Pain From Running.
A year later, he wrote back saying that since his back pain was completely gone (plus a few other things we fixed in the interim), he noticed some hip pain. He had been running with the foot turned out (duck-foot) and wrote, "A straight push off after the foot-strike made the pain go away - Runner Fixes More Pain With Straighter Push-Off.
Earlier this year Ted wrote that his doctor said his x-rays showed arthritis in both hips. I told Ted not to let doctors scare him into anything rash (surgery, giving up running, taking medicines that cause other problems, and so on). Often the arthritis or other abnormality that shows up on an x-ray is not the cause, or only cause, of pain.
The New York Times recently ran an article quoting the President of the American College of Sports Medicine (ACSM) as saying he (the president) "Has no idea why his knees are sore after each time he runs." The article also quoted several prominent physicians saying, "Most folks should not go (to doctors), because most general doctors don’t know a lot about running injuries. Most docs, often even the good sports docs, will just tell you to stop running anyway, so the first thing is to stop running yourself. In fact, because you probably will have to make a co-payment if you see a doctor, you will be adding insult -the fee - to your injury."
In a study reported at a recent meeting of the American Orthopedic Society, Dr. Matthew Silvis did MRI scans of the hips of 21 professional hockey players and 21 college players. Results showed 70 percent of the athletes had abnormalities, More than half had labral tears, which are scary looking rips in the cartilage that holds the leg in place in the hip bone. None had pain, or only minimal discomfort that did not affect their playing. The same is true for rotator-cuff tears. Studies have demonstrated that about half of all middle-age people with no shoulder pain have these rotator-cuff tears that show on scans but they have no pain or symptoms.
I wrote to Ted with several things for him to check and fix about his body mechanics. He replied:
"I used your ''Better Exercise on Stairs'' article to go Pain Free up stairs (which I had not been able to do for 8-months)
"Thus Encouraged, I ''flattened'' it out, and used the Same Mechanics to do AN EXTREMELY Slow Jog on my 20-min Sunday Walk/Jogs. which have been PAIN FREE.
"The doc looked at my x-rays, told me he had NO idea how I could run on my arthritic hips, had me demonstrate the Flattened Better Exercise on Stairs Method, I explained my 41 year Love of Running....and he said ''You've already figured it out, keep doing what works and YOU call ME if you need to come back.''"
Ted didn't need to go back to the Doc, but he did write to me:
"Sorry to bother you Dr. Bookspan, "In my running you helped me with my back, then you helped me with my knee, (and shoulder).
"I may be pushing my luck here, But NOW my hip flexor (psoas) is inflamed and essentially my thigh is swollen. By paying attention, I found the pain in the hip is in front, about where a tendon would attach to the hip (not the ball joint as I had feared).
"QUESTION--is there an isolation exercise for this tendon??? assuming there is one (I didn't pay much attention to Anatomy in Pharmacy School). What would be some good re-hab exercise/stretches?? This is an old injury from catching my foot on the upswing while running across a tarp spread over the track."
I gave him a nice stretch for the front of the hip where the leg meets the body (anterior hip).
Ted wrote: "Thanks for the quick response
"I went out this morning and did 40-minutes (ohboyohboy) PainFree
"I'm game for any other techniques (and am reading all your web site info…)
"This has added literally YEARS to my running starting 4 years ago when you helped me fix my Back Pain."
Then Ted went walking around downtown on concrete surfaces. He wrote that he was in pain again. I sent him to all the anterior stretches in my book Stretching Smarter Stretching Healthier. Ted replied:
"Dr Bookspan,
"......WOW.....
".....I just got the book last night, "was hurting from a lousy 20-min run, "looked up ''quad'' and ''hip flexor'' stretches and was Pain Free this morning.
"Like I told my running buddy this is like a CookBook for Pain Relief,,,,,,,
"I cannot wait to go out and hurt something else."
Readers have sent in their success stories on understanding how some of the most common musculoskeletal pain occurs so that they can keep it from coming back.
Here are just four letters of success:
1. From Monica in Montana last November:
"Hi Dr. Bookpan, "I've been reading your articles again. It seems reminders were in need. My back seems well (thanks to you!) but when I started having pain on both sides of my hips, I realized I was returning to walking with duck feet to a certain extent - an old habit. It's just enough to cause me problems. I'm working at watching this very much and it is better.
"I thought I was using all of the good bending to pick things up rather than using my back. When (my) knees gave me some issues, I came back to re-read your knee article too. I'm found that I was so tight that I can't get my heels to stay on the floor when I bend, so I wasn't doing good bending. I am getting a plan together of your stretching and strengthening exercises. I'll probably end up with all of your books, with not only now in mind : ). Your information makes me up lifted when it comes to aging, not that I'm old, 43. I spent so much of my youth in pain, so now I try hard to take care of myself in healthy ways and stay out of pain. "Thank You! Monica "
I wrote back with things to do and Monica replied:
"Dear Dr. Bookspan, "Thank you for the reply. "I received your book. I've been taking it in and implementing the methods. I can say it's only been a couple of days and my hip is improving. With this experience of really helping myself I knew I would no longer rely on other people solely for help and thank you for making available tools to very common obviously misunderstood health issues. What you are doing is making a difference. Please do not concern yourself with a reply. I know you will read this and that is good enough for me. Warmest Regards, Monica (Montana)
In April, Monica sent this follow-up:
"I hope you are doing well! With your help I have lost 8 1/2 pounds! For years I've wanted to lose at least 10 minimum. I'm almost there and it's been so easy I have a feeling all that can go, will go. I use to be heavily into bodybuilding. It set up a mentality about getting enough protein. As I grew older and did not work out like I use to I still kept up the protein. Due to reading your book Health & Fitness in Plain English, it put my fears of dwindling muscle due to not enough protein to rest and put them in reality.
The consumption of grains and protein took a dramatic decrease. I have a lot of energy and my body is getting leaner and leaner. Life is so much easier. My back is still doing great. When I hurt my back I looked at all the things that may have contributed to the injury. I am humbly grateful for being able to see (all this)…I am better. I am sleeping again. "
2. Laraine first wrote that her same pain had returned. I replied and asked her to check if she had gone back to the same habits that caused the first pain, and gave her ways to check.
Laraine replied: "Good Morning Dr. Bookspan: "I e-mailed you several times regarding the extrusion in my lower spine (L1 S1) & you were kind enough to respond to each & every e-mail. I know you are busy & you still took the time to answer. I am practicing the body mechanics daily & doing the exercises & I am improving - thank you so much again for your support....
"You replied back asking if I was not just doing the exercises but using them to live and move correctly. Sometimes I didn't. I try to do them exactly the way the book has instructed --- and as you said not to do them as a regiment but incorporate them in daily life.
"I wanted to let you know that I did do the wall test at home yesterday & I noticed that my shoulders were slouching. I guess for the past couple of weeks after I was making progress I went back into the habit of bending forward a little with my shoulders & didn't realize it. Yesterday, you mentioned to check your posture with the wall after the three extension exercises, I concentrated on neutral spine & noticed the pain subsided & I was much better.
"Thank you again for the reinforcement - sometimes after using poor body mechanics for so long, it takes time to change that - we simply find it easy to go back to the old habits of poor posture without realizing & can get discouraged thinking we are not going to get better. I really believe in your book & if I keep doing things the correct way & maintain that, I will eventually heal.
"As I said in my previous e-mails last month, this is the most logical & sensible way to maintain a healthy back. I know it will take time - but as long as I make progress, I will be patient. I guess I lost my moral yesterday & thought I was going backwards. Keep up the good work - you are wonderful... You are an inspiration to all that have pain. Also, thank you for your persistence in making sure that I am doing the stretches & exercise correctly...."
"This back injury had sure been challenging for me. Now I'm better. I'm glad that I found your website." Laraine P"
3. Our own Inspirational Ivy from New Zealand made gains:
"It is now four years since I discovered your website. With your help and advice I was able to overcome debilitating sciatica in my right leg plus foot drop. Since then I have carried on using your methods to keep free of pain.
"In the early hours of Friday morning, I awoke to excruciating sciatic pain down my left leg. I asked myself as to why this has happened, telling myself that I had not been doing any bad bending or similar. OR so I thought. Yes, these past few days I have been rushing here and rushing there which has resulted in me being lax about my movements, in particular, standing at he bench while cooking etc. I always put my spine into the neutral position. Always!!!!!!! I am asking myself. It would appear - not so.
"Yesterday and today, I have stopped rushing about and telling myself every time I move "Think Ivy, think before you do anything." I seem to remember using those very same words four years ago."
I wrote back, to Ivy that I hoped it took more than "a little rushing" to cause such pain. It may sound odd, but I hope it took a lot of bad bending and standing. No one should have so little margin - you need the strength for leeway for unexpected events and still not cause pain. No one should need to live "on eggshells" or reduce activities to prevent pain.
Ivy replied:
"Thank you for you kind words. I have now fully recovered thanks to your help and advice. I could not understand as to why I was not recovering as I THOUGHT I was doing everything correctly. I referred to your book "Fix Your Own Pain Without Drugs or Surgery" and the penny dropped - because I was experiencing pain, I was leaning forward as I walked. Once I rectified my posture, the pain went immediately. Silly me, I was aware of the pain but not of my posture.
"Yesterday, I was watching one of the residents here watering her garden. She is experiencing a severe attack of sciatica. I noted that she not only bent to the side she was also leaning forward. Her back was arched so her butt stuck out. I made a few suggestions in the nicest possible way and this was her reply. Mind you, you have probably heard this one before "It sounds like too much work to me." Needless to say, I walked away.)
"I am now free of pain thanks to your wonderful advice. Thank you Dr Jolie, what would I do without you. "Love and hugs Ivy"
Ivy wrote with several follow-ups that all continued fine. She went on to use good bending after her cataract surgery where bending over is harmful to the recovering surgical site (as well as the back).
4. A special e-mail came in from JayaKrishna (Kris):
"Dear Dr. Jolee ( I am the Indian guy from Jersey who attended one of your seminars in person).
"It has been almost 5 years since I first read your article in the December of 2004.
"After 5 pain free years, it is was only last week when I suddenly felt my lower back tightening up again for the first time. Almost predictably I started feeling severe shoulder pain. But this time I was fully prepared. I went back to the basics. Whom else to seek for help other than St.Jude of the Joints. I pulled all the articles written by you and read them one by one. Thanks to your principles, I then did some deep soul searching and found out that cause was violating of the golden principles outlined by you due to the pressure of work or the strange feeling of invincibility that comes from enjoying good health.
"It is very strange that when we recover and start enjoying life again, we sometime forget and start thinking ourselves to be invincible. Bad habits creep in again.
"As an atonement for my violations I ordered two more books by you from Amazon: which is Healthy Martial Arts, and Stretching Smarter. I took my new year resolution to be always mindful of these golden principles from you. I promised myself a one day sabbatical every year when I would re read your articles and reiterate these golden points.
"I once got this little nugget of wisdom in a party (Most unlikely place). Nursing drinks in our hands, we were all discussing on the secrets success and happiness when one of the drunks said the most profound statement: The one who is punished the most in a particular endeavor or area and is still standing will have the secret to success and knowledge.
"Looking at your life, your education, experiences it is no wonder that you have been chosen to share your treasure trove of knowledge on healthy living. I cant tell you how much I am grateful for your acquaintance. "Regards, Kris Jayakrishnan"
Here is Fast Friday Fitness - learn healthy floor-sitting, mobilize your pelvis, and use your core muscles and brains at the same time to move out of painful position to healthy comfortable sitting.
Here is a technique to identify if you sit in a way that is associated with lower back pain, and a technique to move out of unhealthful position:
1. Sit on the floor cross legged. 2. Notice your pelvis. Does it tilt backward at the top, so that the lower back rounds outward. This is too much tuck, demonstrated by my student Yash in photo 1 below:
3. Put your hands on the floor right behind your hips. Push against your hands to lift your back upright. Can you feel your hip tilt forward to upright position demonstrated in photo 2 below?
(In the photo above, hands are not behind the hip, to provide unobstructed view of the hip/pelvis corrected from tilted back to vertical)
Sit well and you can sit without back pain.
If your hip is too tight to move out of unhealthful tilted position, then it is likely that you are sitting with your back in painful rounded position.
If you are tight, or do not know how to move your pelvis while sitting, it is often easier to learn to mobilize your pelvis standing or lying down. The pelvic tilt is misused in therapy settings. It is mistakenly thought of as a strengthener or a back pain fix. The muscle work (to strengthen) is minimal. The idea is to learn *how* to move the pelvis so that you can voluntarily move to the needed position, then hold it.
Reader Fun Steve previously wrote with his success losing weight and getting in shape with Fitness Fixer. Then he moved from Thailand to Japan. What happened next?
Steve writes:
"I 'done did' something to my stomach. Without having visited any doctors here, my own diagnosis is/are hiatal hernia or tearing of the linea alba area of my stomach muscles.
"No 'pain' but constant discomfort. Constant but mild indigestion. Shortness of breath. Here is the real kicker... If I do leg lifts while doing 'slight' crunches, I have a 2-2.5 inch vertical band of 'something' that reaches from my xiphoid process down to below my belly button. Feels like a strip of weak muscle. I normally don't do full crunches. Perhaps I lift my shoulders 2-3 inches at most.
"My rectus abs are solid. Rock hard .. but the area between left and right side is soft now. This odd strip of 'something' doesn't protrude unless I do leg raises and crunches (so I'm not doing them!) but if I use my hands to press it inward, I can do the crunches or leg raises without that strip pressing up. It's as if the rectus abs, once contracted, hold it in.
"So... what have I done to myself? Besides not doing any crunches and leg lifts, what shall I do to heal myself?"
I answered that (using my e-mail x-ray machine) it sounded like a diastasis, full name Diastasis Recti.
The vertical muscle fibers pull apart, leaving an area between them. This is popular in pregnant women and men with bellies. The 'rock hard' belly is often the large amount of fat (or pregnancy) pushing against the covering muscle, stretching it tightly. Weight loss will let it rejoin and heal. It's not surgical, meaning it can heal if you lose the belly.
I reminded Steve that crunches are not functional exercises, meaning they do not use your abdominal muscles the way you need them to function during any real activity in your daily life. Crunches repeat the bent forward posture that people already spend too much daily time in, and that he already new I had developed a method called The Ab Revolution™ that solves the counterproductive nature of crunches and leg lifts. For the time needed to heal, he could stop belly stretches - back bends, yoga cobra, and updog, and stretching the belly with too much food and weight gain. Continuing to do crunches and leg raises using hands as manual splinting has turned out to make things worse - since the muscles atrophy more.
Steve replied:
"How could I be pregnant?!? Actually, I have 6-pack abs! (Well, really two 3-packs right now. Unfortunately there is a thick layer of blubber covering them.) Under them too. ">>Dr. Bookspan wrote: Sorry to hear. "Yes... me too. I came back from Thailand having lost almost 20 kilos, and due to McDonald's introduction of the 'Double Quarter Pounder with Cheese' into Japan and a side of trans-fat potatoes, I put it all back on."
I reminded Steve that weight loss will let the split area rejoin and heal, and that a diastasis was not surgical, meaning it can heal if you lose the belly and stop pulling it open with Pilates style leg lifts and crunches.
Steve wrote:
"Lose the belly. Lose the belly. That's all anybody says. Lose the belly. Hey, Buddha had a big belly and he didn't have this problem!?! Humpty Dumpty had a big belly and all that happened to him was that he fell off a wall. Well I don't sit on no walls!!! No sir! Not me. I sit on a couch doing bicep curls with the TV remote! I do full presses with bags of Doritos! Pectoral presses crushing my beer cans! Lose the belly?!? Oh well... I guess I gotta..."
I had developed The Ab Revolution™ to solve one common source of lower back pain - a slouching posture of too much inward curve in the lower spine. The Ab Revolution™ retrains function. Conventional ab exercises are often mistakenly prescribed for back pain. Conventional strengthening does not make people stop the actual cause, the slouch. They are just stronger people who slouch. Doing crunches also perpetuates another cause of back pain. It is an irony of pop fitness that without understanding causes, counter productive exercises are prescribed, then repeated by reporters then repeated by trainers and so on. The same is true for hamstring stretches, covered separately. What was interesting was all the documentation I received from people with diastasis and hernias who could use The Ab Revolution™ without pain and with benefit to build abdominal wall strength without pushing things out further with crunches. It made sense. I am looking into it further.
Steve wrote again:
"I follow the the Ab Revolution™. That's what's made my back feel so much better. I haven't had so much as a twinge in my back in the past year or so! It's been your work that made the difference. As my stomach gets smaller so does the diastasis. I'm not worried... now :o) Just PO'd. Thanks for the info about my (larger than necessary) stomach."
Steve went back to healthier eating and was easily losing weight following the healthier, smaller, traditional Japanese meals without fast food.
Supportive Hard Shoes Linked to Knee Loading and Arthritis
Tuesday, March 30, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
A Rush University Medical Center study has found that supportive, stable shoes increases the load on the knee joints compared with flat, flexible footwear or going barefoot.
Researchers compared gait and knee joint loading of 31 patients with osteoarthritis while walking in flip-flops, barefoot, and wearing several types of popularly prescribed shoes. Clogs and stability shoes increased loads on the knee joints up to 15 percent over flat walking shoes, flip-flops or barefoot. Knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.
Dr. Najia Shakoor, rheumatologist and lead author stated, "Stiffness is also a factor. We've shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial 'stomping' movement created by a stiff-soled shoe."
"Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less 'support,' flatter heels and more flexibility."
The article stated, "A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of osteoarthritis and its progression."
Primary Source -Najia Shakoor, Mondira Sengupta, Kharma C. Foucher, Markus A. Wimmer, Louis F. Fogg, Joel A. Block. The effects of common footwear on joint loading in osteoarthritis of the knee. Arthritis Care & Research, 2010; DOI: 10.1002/acr.20165
Study authors felt they had to also issue a caution that people who will trip if they wear flip flops or have poor balance not to wear them, however it seems better to do simple function to improve balance and reduce cause of the falls rather than wrap people in shoe "straight-jackets" that are not good for them.
When I was small, I remember worrying that horses had to wear iron shoes. I asked the teachers in school if it hurt the horses' feet, and was told their feet don't feel anything (a myth). I asked if the metal increased the hard impact against paved streets and why didn't horses wear sneakers instead. I was told that sneakers were bad for you because they don't "support" (another myth). I asked why you needed anything to hold your own body up and why you couldn't have healthy feet without them. I asked if cavemen wore support shoes and incredibly, the teachers said that support shoes were important and barefoot was wrong and cavemen had to wear shoes or they would not be able to walk. Later I found that arthritis, lameness, and gait changes were higher in metal shod horses, and that new horseshoes were being made in urethane and other soft composites.
When I tell patients that hard supportive shoes are known to increase pain and problems, they say they wear them because their doctor told them to, their trainer, their aerobics instructor, and their physical therapist said they must. When I remind that hard shoes may be part of their knee and foot pain, they say that they got the shoes from their podiatrist or orthopedic shoe place. Doctors used to recommend smoking cigarettes for the several benefits they gave - calming nerves, better digestion. The two bad side effects (illness and death) were left out. It may be commonly repeated that you need hard supportive shoes however, untrue stories are common.
Functional Fitness as a Lifestyle By Mail Room Workers
Monday, March 22, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
Peggy Santamaria wrote me that she was using my work, and my illustration Backman!™ to teach healthy movement to workers for a good day's work without injury and repetitive strain:
"Hi Dr. Bookspan, "Very excited to report that I met with the Appalachian Crossroads staff and the trainees of the Mail Room Service Unit. The goal is to connect developmentally disabled adults with a paycheck for good work done well.
"I had created some Backman!™ flash cards illustrating some of the daily work in the mail room. These were distributed to the trainees with explanations for the staff about our new program. Then I met with the trainees and talked more about functional fitness.
"We then practiced some of the healthy movements needed for their work day. We took pictures to document their great understanding of what we are working toward. I will make these photos into small posters that can hang in their workspace.
"They are all excited about what we are doing and are proud to be part of the Academy. "Peggy"
Here is Ms. Santamaria's update with the successful outcome plus great photos. I personally congratulate and thank each participant:
"Hi Dr. Bookspan:
"Here is an update on Academy activity. As you know, I am working with staff and trainees at Appalachian Crossroads, a private nonprofit human service agency that primarily serves developmentally disabled adults in Garrett County, Maryland.
"One of the Appalachian Crossroads work units provides a "mail room" service to local businesses. The trainees in the mailroom provide support, expertise, and manpower to process everything from daily statements to sales catalogs to monthly newsletters. More than 1.2 million pieces of mail go through the hands of 18 employees each year.
"As the Academy’s director of Developmental Abilities I set about creating a program using your work and Fitness Fixer to help the trainees work in a healthy way and be functionally fit. I met with staff and trainees of the unit to hand out instructional flash cards featuring Backman!™ going through the daily functions required in the mail room.
"The Appalachian Crossroads folks were super. They got right to it. With the help of staff they were ready to work and demonstrate their functional fitness skills. I took pictures that I am making into small posters for their work area.
"I will continue to work with these men and women as well as others in the custodial service unit, the grounds crew, supported employment, and the day program. It is a privilege to be working for the Academy and sharing your fitness message. "Peggy Santamaria"
This is a shining example of getting things done well, simply, and intelligently. Thank you Peggy! Thank you Appalachian Crossroads staff and mail room!
Readers, The Mail Room is teaching us how to keep things healthy and smart. They are role models and generous guides for all of us. Use what they have done, and send your stories of using this work for Good.
Here is Fast Friday Fitness - Strengthen your arms while learning to change a movement habit that is a common source of elbow pain:
Hold a pushup or plank position, handstand, or just lean on one or both arms.
Notice your elbows. Check if you lock them straight, or let them hyperextend (bend slightly backwards) shown in the photo below.
Instead, keep elbows slightly flexed (bent forward). You will feel an increase in arm muscle use.
The elbow joint is called a hinge joint. It is shaped to open and close like a door. Because of the shape of the bones, opening wider than a certain point - usually close to a straight line - is stopped by the bones, not muscle flexibility. You can try it yourself now, and feel the bony end point. Like a door, if you force the elbow joint open past maximum straight range, it yanks one side of the hinge and squashes the other. Don't try that yourself. That is a common injury in yoga because some forms of yoga teach to hyperextend the elbow under body weight.
People with flexible elbows, both men and women, have bones shaped to open slightly wider. They can hyper-extend the elbow so that it bends slightly backwards. That is not a disease or cause of pain by itself and does not preclude them from sports like archery as often repeated (will be covered separately). You can easily control elbow angle using your brain and muscles.
For leaning against a counter, bike handlebars, doing pushups, plank, yoga, and other leaning or arm balancing. Keep elbows slightly flexed instead of letting the joint open to or past maximum range.
Ivy from New Zealand continues making her community healthier, one neighbor at a time. What does she do that helps so many? Here are just a few stories from her many updates:
"Yesterday, I was talking to a 64 year old woman who is a new resident to this country and she told me that she was experiencing back pain. I told her that I could help her - she was most insistent that she hated exercise so I promised that I would not have her exercising that what I would show her would be what she could do as she went about her daily life. I showed her how to lie on the floor and lift herself up on her elbows. She marveled at the instant relief. I then showed her how to squat and do lunges which she was most receptive to. I showed her how to sit up straight, shoulders back and suggested that she lift her ribs (to learn to unround the upper back instead of forcing the straightening from the shoulders or neck). I was most amused she put her hands over her rather ample breasts and lifted them up. It looked so funny. It is the first time I have had someone do that to lift her ribs."
In January 2010, this update came:
"Just the other day when I spoke to Jean she remarked how young I look. (Jean is the lady who I helped re back pain) She said that she felt envious when she compared herself at 62 with me at 73. I remarked that I could not help but be surprised as all I see are the wrinkles when I look in the mirror. No, she replied, we all get wrinkles, it is your slim, fit body plus the fact that you walk so fast. So........., there is hope for me yet!!!!! Smile, "Hugs to you both "Ivy"
In January, Ivy sent me a happy e-mail. The large-chested neighbor who thought pain was due to her size was able to stop upper back pain with healthy techniques, and holding her weight in healthy positioning on her muscle, rather than letting shoulders round and slouch in painful position:
"Jean tells me that she is now free of back pain. She is lying down on her stomach lifting herself up on her elbows on a daily basis. Needless to say she is very happy with the results.
"Re the trapezius and pectoral stretch - she will be visiting me over the next few days (to check good positioning learned from it).
"Re: Merlene (Strengthen a Neighbor, Strengthen a Community) - I did not have to telephone Merlene, she called me to ask if I could vist her. She showed me how well she was doing re her balance. Also, she was delighted re her weight loss. I checked her posture and it was perfect. No longer any back pain.
"She asked if I could help re strengthening her legs. I showed her how to do lunges.
"Merlene is always a pleasure to work with. She is a delightful lady. Love and hugs to you both Ivy"
At the end of January Ivy wrote again:
"Jean: I visited her at home this morning to show her both the Pectoral and Trapezius stretch. She tells me that she no longer has any pain in her back and hip. She also tells me that she has shown her daughter the back stretch and she, too, no longer has any back pain. So.........two very happy women.
"Merlene: I also contacted Merlene this morning to see how her lunges are going. She, too, is happy with her progress.
"Jean did make a comment as to how much I could help people here in the village. I replied that I do try, however, the request has to come from them personally. It is all a matter of choices. Some choose to take medicines, others do not (and use healthy ways to fix the pain without needing medicines).
"Love and hugs to you both Ivy"
February brought this:
"Over the weekend, I received an e-mail from a friend who lives in Australia, telling me that she had back ache. She had had it for a week and had decided that once the weekend was over, she would go to the doctor to get some pain relief.
"I wrote back and told her to lie on the floor or bed and lift herself up on elbows. I have just received a reply saying that the pain has gone.
"Today while shopping in my local organic shop I got talking to a lady who had decided that she would shop for healthy foods instead of the usual junk food. She explained that her family had minor health problems and thought that perhaps if she changed their diet, the health of the family would improve. She noticed what I had in my shopping trolley so asked if I would mind helping her. Actually, I must admit that I did enjoy doing so. She could not believe the knowledge that I was able to pass on and was most grateful. One of the things she asked was how to make sprouts. Not a problem I replied and explained how I, personally, do sprouts. I hope I see her again soon so I can catch up on their progress.
"My shopping which usually takes 20-30 minutes took more like an hour and a half. I assure you, it was time not wasted.
"Hugs Ivy"
Does Ivy meet people who work against themselves? Last October she wrote me about one:
"Thank you for the post re helping oneself. I must have missed your post "Somebody Please Do My Personal Responsibility For Me." (my computer would have been out of action) To be honest, I could not help but burst out laughing at some of the excuses, as I, too, hear these same words time and time again.
"As an example, about 3 years ago, a lady approached me for help re her weight. I might add that she was morbidly obese.
"I wrote her out what I believed to be a balanced diet with plenty of food so that she would not feel hungry. She was thrilled to see that she had lost 16 lbs when I weighed her the following week. For the next few weeks there were no weight losses at all. I asked her if she was following the diet. No, was her reply, you allow me too much food, so I cut down on the quantities. I then get hungry and eat what I shouldn't. This went on for 6 weeks.
"Needless to say, I gave up on her.
"This same lady now lies in bed all day. She does no exercise what so ever. Her husband does everything for her. Once in awhile I see her go out with her husband in the car.
"It is so sad. I did but try. No doubt you can tell many similar stories.
"Have a great day "Hugs, Ivy"
Wisely, Ivy has focused her energy on others since.
New Healthy Employment Programs for Developmentally Disabled
Monday, March 08, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
Another reader has Fixed the Fitness for a community program so beneficial and potentially far-reaching that I have given her an Academy Appointment.
Peggy Santamaria is bringing my healthy daily life techniques to developmentally disabled adults. She has made a new program to transition developmental disability to Developmental Ability.
"Thanks. Cool to find that this morning on Fitness Fixer. I would like to work with job coaches at a local agency that trains and finds employment for developmentally disabled adults. Snow removal is one of their big programs. I hope I would have your permission to use Fitness Fixer techniques to help prevent injuries for these trainees. I am on the board of directors for the agency and really support the program. Thanks again. you rock!!!" peggy
I wrote back asking if she could start before the snow season ends, which was soon, and that when the snow season ends, what activities and healthy movement retraining could she bring to them?
Peggy replied:
"Just spoke with program director at Appalachian Crossroads. I will meet with his job coaches and staff on Monday afternoon to talk about healthier movements while on the job shoveling snow, landscaping, vacuuming, etc. This is their website if you want to check them out, www.appalachiancrossroads.com/"
I am pleased to announce her appointment through the Academy of Functional Exercise Medicine (AFEM) as Director of Developmental Ability. We are working on better names - write in your ideas in the comments for a good title for this program for the disabled to develop their abilities. Peggy has been working hard developing the program. She drew the shovels for me for the Backman!™ illustration, and has been drawing and developing more teaching tools.
Our plan is for participants to gain skills and healthy work, reduce injury and pain risk, and be proud role models. The community gains important improvements in ways that are healthy for all. We hope our program with Appalachian Crossroads becomes a model for programs all over the nation like it.
Peggy wrote back:
"WOW!!! That's all I can say. Off to teach a class. I have read a gazillion of your fitness fixers (they are like peanuts, you know). I just don't get any housework done. But I will be well-armed to begin this task.
"My daughters and grandchildren are very proud. (They) said it was "awesome" and "Go Grandma Peggy!""
Join TheFun - Join in this work, and do the same for your own local world. Send in your own ideas and stories. See my Academy page - www.DrBookspan.com/Academy.
Reader Peg S. put healthy bending to work in real life, wrote in with this success story, sent a title for it, took photos and sent them with captions. Thank you Peggy for great work:
"Dr. Bookspan, your emphasis on squats and lunges in place of unhealthy bending has saved my back during long hours of snow shoveling.
"Lots of snow has fallen in far western Maryland - over 265 inches so far this season - with three back-to-back blizzards (22 feet of snow, or 673.1 centimeters).
"All that snow needed to be moved. I avoided unhealthy bending and had no back discomfort after hours of lifting snow-laden shovels.
"When I took a break, I emailed my yoga class students reminding them of the healthy movements such as squat and lunge in their snow removal efforts. They later thanked me for the reminder.
"Thank you for the information on back health!!!" Peggy S
Peggy is teaching these and other healthy movement techniques to developmentally disabled adults to train useful work skills and prevent injuries. See the first results in Functional Fitness as a Lifestyle By Mail Room Workers Peggy, her colleague Patty, Reader Paul J, and I have been working on Peg and Patty's project of using human powered devices like bicycles, to make electricity. More on this to come. Contact me if you can offer real input to design or build.
Fast Fitness - Hip and Quadriceps Stretch Lying Down
Friday, February 05, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
Here is Fast Friday Fitness - The front of the leg and hip are helpful places to stretch. Here is another nice stretch for the front of your hip and thigh.
People often "do" a quadriceps stretch without getting a stretch. They keep the front of their hip bent forward at the crease where it meets the body, meaning the area is being shortened not stretched. This is opposite of the point of the stretch. To get the stretch and the idea of lengthening and extending at the hip:
Lie on one side with both knees bent in front of you. It is ok to round your body a bit. The spine is not rounding under compression. It's a nice stretch. Prop your head comfortably.
Keep the bottom knee still bent in front of your body.
Notice different stretch with raised and lowered top knee placement. Stretch the other leg too.
Prevent these reasons the top knee may hurt:
Don't pull back so hard that it pulls painfully at the knee.
Tight quads can feel like knee pain when they tightly pull where they attach at the knee. It is not a problem with the knee, but with tight thigh and quadriceps muscles. Tight people may feel sharp pulling or yanking around the knee when trying to put weight on a knee stretched behind them, as when ruining or lunging. The problem is tightness, so stretch gently and intelligently. The idea is to stretch the quads so you don't hurt, not yank so that you do.
Check that you are not twisting at the knee - generally you can tell this if your foot is facing a different direction than the front of your knee. One commonly missed reason for knee pain felt during running and walking is twisted stretching, including yoga poses like lotus and hero if you don't turn from the hip, and others, covered in Knee Pain When Running - Check Your Yoga.
--- Read success stories of these methods and send your own. See if your answers are already here by clicking labels, links in posts, archives, and The Fitness Fixer 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 throughDrBookspan.com/Academy. Getinfo all in one place in Dr. Bookspan's Books.
Doctors Don't Prescribe Effective Back and Neck Pain Therapy - Exercise
Wednesday, February 03, 2010
Jolie Bookspan, M.Ed, PhD, FAWM
Studies have confirmed that directed exercise is beneficial for chronic low back and neck pain. Is it being used? In a survey reported in Arthritis Care & Research, of 684 patients with chronic low back or neck pain, only 14.4% were prescribed exercise by their physicians. By contrast, 63.8% of those seeing a physical therapist and 33.1% of those who saw a chiropractor were prescribed exercise.
Other significant predictors of an exercise prescription were being female, having greater than a high school education, and being on workers' compensation.
Primary source: Freburger JK, et al "Exercise prescription for chronic back or neck pain: Who prescribes it? Who gets it? What is prescribed?" Arthritis Care Res 2009; 61(2): 192-200.
My colleague, family medicine physician Dr. Fabrice Czarnecki sent me this:
A study did a review "prospective controlled trials of interventions." These are studies that evaluated effectiveness of various interventions to prevent back pain (BP) in working age adults. In short, after all the math and big words were sifted through, they found that, "only exercise was found effective for preventing self-reported BPs in seven of eight trials. Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs."
Their conclusions: "Twenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals."
Bigos SJ, Holland J, Holland C, et al. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009 Feb;9(2):147-68. (Review) PMID: 19185272
Not all exercise fixes pain. Many exercises cause lower back pain, even those commonly used in rehab and PT programs. Prescribing random exercise is not effective.
--- Read success stories of these methods and send your own. 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 throughDrBookspan.com/Academy. Learn more in Dr. Bookspan's Books.
