Archive for exercise

Restoring Movement to the Neck

The Neck

The neck is about one of our most used connections of the spine (and well used in our lexicon)  It is designed to be mobile and capable of great feats of movement and stability.  Just remember the days you’ve arisen out of bed–even before getting up–you notice how stiff you became over night.   Sometimes we say life is a pain in the neck.  Some folks even still neck around a little.

The neck is just not an anatomical structure to be described of bones and soft tissues.  It is a highly functioning arm of the nervous system and ourselves.  Here I am concerned with looking at how to restore movement in the lower neck (in a particular direction).

Mechanical problems

In my practice of Physical Therapy, many people who come in with shoulder and neck problems usually have a problem in moving their lower neck and upper back spine.  This area seems to become easily rigid.  We often see degenerative changes of the spinal segments at the segments just above this juncture of neck and upper back.  We often label seven neck segments with the top one starting as number one.  So the fifth and sixth segment are very popular in showing these degenerative changes.  To me this means that the area below is not participating in allowing movement to continue through these lower segments.  By the way, we don’t just move our necks.  Our bodies don’t move the neck.  Our movements take place in the spine.  Our patho-anatomical  medical approach (getting a diagnosis of a problem based soley on the anatomy that has a dis-ease vs including a functional evaluation or how it is working in daily usage) can distort our perspective of how we look at how what is going on ie the problem.

Of course, the  direction of mobility problem can be different for different causes and different people.  Here I wish to share my observations of the problem at moving through this juncture of the neck (cervical spine) and upper back (upper thoracic spine).  This junction is easily referred to as the cervical-thoracic junction or C/T junction.

What I find is that many people do not have very good side bending of the lower neck.  They often over move in the segments above.  Also when you observe those with pain and dysfunction of the neck and shoulder complex, it is worth evaluating how well they are side bending at this lower neck to C/T area.

Of course there are problems of stability in the mid neck and also upper neck.  There are sometimes mobility problems of the upper cervical region as well.  Note the junctional areas of the spine are very important in transmitting forces THROUGH the area (versus into the area).

Example of Moving the Lower Neck Spine

Here is a short video I did in working with someone.  I hope it will explain a bit about how you might start to work on learning to move this area.  Note it spends most of the time trying to coach one to move the lower area while learning to stabilize the above area.  It seems un-natural for many who have a movement deficit in this area.

Remember the learning is not just about correcting and moving better.  Ideally one must spend a good amount of time feeling and practicing these directions.  Often it takes some coaching.  A mirror can be invaluable in this type of training.

Conclusion

Enjoy the practice.  Those who don’t move this lower neck area well will be rewarded with proper practice.  You will find that once you can create some movement here sometimes your shoulder and neck problems become less.

Try it out and let me know what you find.

Holidays and Travels

Greetings All

The Holidays are upon us.  Hoping you and yours are planning on much celebration.

We have been very busy here, just like many of you.  I was in SRSG, Rishikesh India for the month of November.

What a great time teaching and learning from everyone.

 

Met some fantastic people from Delhi.

 

 

 

 

 

We had over 65 students from all over the world.

 

Now back in USA, California.

 

 

 

Wishing you all the best of the Holidays.  May it be filled with much love and laughter.

…and remember:  Many times bring the mind to itself–just watch your breath.

See you in the New Year–Shantih, Shantih, Shantih–peter

 

Spartan Training Regimen Using Yogic Breathing Technique

In July of 2011, I attended a yoga retreat in St. Paul, Minnesota, at the University of St. Thomas.  It was an opportunity to reconnect with friends, meet new people and experience multiple treasures from the Himalayan Tradition.  One of the interesting things I learned was from a friend (CW) who had discovered how to use Ujjayi Pranayama in treating his painful chronically swollen glands underneath the jaw.  This account completely captivated my attention.  It is an amazing account of diligent practice assiduously applied over a nine month period.  At the end, autoregulation of the his heart rate rhythm was mastered.  The accomplishment is quite laudable.  The great lesson to be learned is about what was done, not about who did it.  The great lesson was doing a practice with an iron determination that bore such amazing fruit.  It is a path of practice that is open to many of us.  It was such an amazing systematic effort made day after day over many months  that impressed me greatly.  I think once again, that it is the strengthening of ones will to focus ones effort at arriving at a place that is talked about, but few examples are given in today’s communities.  Here is one such example that invites us all to re-focus our efforts in our practice.

I remember Swami Rama of the Himalayas speaking about the Science of Breath.  He stated that there were basically two ways to have conscious control over our autonomic nervous system.  One way was to control the motion of the lungs.  The other was through our will power.  The following contains an example that combines both methods.

This gentleman is a long time yoga practitioner who is quite active.  Stating that he is active is a slight understatement.  There is a daily  30 mile (total) bicycle trip to and from work over a rigorous Mountain range.  He hikes and mountain climbs (above 6000 feet) on the weekends.  Also he works as a Mountain Rescue Team Leader with high levels of peak stresses.  The large manufacturing company where he is a senior manager keeps him away from his family a bit too.

Over a year ago he noticed that his glands underneath his jaw would become swollen and painful.  He found no exertional trigger that would set off his symptoms.  There were times that certain foods and periods of increased stress would be associated with more swelling.  Otherwise it did not seem to be clear what was causing this condition.

CW did consult with his regular local medical doctor.  A follow up blood panel revealed elevated cortisol levels.  It was recommended that he try a course of oral steroids.

Later he looked into finding an Ayurvedic doctor, as his travels to India made this a knowable option.  The following is a description of his Ayurvedic (USA) evaluation and subsequent very interesting and intense training regimen.

His initial Ayurvedic appointment consisted of evaluation and instructions in a specific protocol to deal with these elevated cortisol levels.  His doctor started with a pulse diagnosis for two minutes.  No other verbal interview was conducted before this reading.  His doctor then proceeded to write a two page list of notes that quite accurately described many of his habits and preferences.  These included food preference, when he arose in the morning, his sleep habits, etc.  He was also able to accurately relate much of his prior medical history with only this pulse diagnosis.  This is amazing but they say not atypical for a good Ayurvedic practitioner.

The doctor then listened to his athletic history as described above.  This person was using a Polar wrist Heart Rate (HR) monitor often.  He often used 2:1 breathing during his training.  This pattern is breathing twice as long on the exhalation as on the inhalation.

They then went outside for a simple walking course of about a 1/2 mile.  He wore a HR monitor to record his rate and rhythm.  During this time, CW was instructed to keep his heart rate as level as possible during a normal pace of walk.

Returning back to the clinic, the HR monitor information was downloaded into a computer program for simple analysis.  The graphic analysis showed that his HR was around 180 beats per minute (bpm), without any unnecessary exertion.  The doctor mentioned that this is typically seen in overtrained athletes.

Next, time was taken to teach him a particular breathing pattern called Ujjayi.  Ujjayi breath here was done very vigorously both on the inhale and exhale phase.  If CW had not been accomplished in diaphragmatic breathing, he would have needed several weeks to train it first.  Please follow the above hyperlink for more detailed information on this “pranayama” or breath regulation method of the Yoga Tradition

Then they repeated the same monitored walking course of a 1/2 mile.  During this time he was instructed to maintain a steady 1:1 breathing pattern and use the Ujjayi technique.  A repeated analysis of the graphic HR rhythm showed his HR was at 130 now.  Pretty impressive change with this traditional yogic method of breathing!

His doctor briefly explained that his adrenals had become overactive.  They were producing excessive cortisol.  The body can become fixated at these higher levels of cortisol production during an abnormal stress response.  If he could train during his physical activity with this Ujjayi technique, he would be able to retrain his system.  He would learn how to autoregulate his HR under physical stress.  (Even emotional stressors that elevated his HR would be controlled subsequently).  WOW!  The following  will describe an outline of his training regimen from the first month to his final Ayurvedic consult in the ninth month.

First and Second Month:
His normal bicycle route was elevating his HR too quickly with the hills.  Therefore a 15 minute warmup period on the flats while doing Ujjayi was initiated.  Then continue on his route with slightly less hills.  This new route added 60 minutes/day to his previous time of commute.  Therefore he had to arise 30 minutes earlier every day (4:30 am, whew!)

He had to try to maintain his HR always at 120 or less during the ride.  A Polar HR monitor was used daily.  The first week of doing this very strong and forceful Ujjayi made his throat very sore and raw feeling.  There were lots of episodes of choking, coughing and breaks in the technique while continuing to pedal to work.  Just try it yourself right now for those who have an idea of the technique–remember it is “vigorous”.   Ok, once you stop coughing, please continue reading.

Also during this exertional effort of riding and restricted breathing style there were other strong symptoms.  One feels as though they are deprived of oxygen.  When you just don’t feel you are getting enough oxygen it can be fairly alarming.  Oh, I’m suppose to relax also during this physical effort–oh, oh the ole HR is hitting above 120 again.  Ok just try to do the Ujjayi, keep pedaling and stay here.  Many times the thought of quitting crossed his mind this first week.  Egads this sounds like tremendous focus and dedication at these challenging times.

The second week was a little better.  He was getting used to the Ujjayi and the sore throat problem was subsiding.  Still this tremendous fear of not be able to breathe was right there.  Thoughts of quitting were never far from his mind.

By the third week he was able to perform the Ujjayi breath 100% of the time, except not in the hills.  He was not in Nirvana to say the least.  It was an effort still but doable.

Third and Fourth Month:
He now returned to his original mountain route.  A five minute warmup on the flats were his only preparation.  The Ujjayi was full and loud.  He still had to maintain the HR of 120, but only on the flats.  During the hills he was no longer restricted to maintain the 120 bpm.  He was just to observe the HR response during the hill work.  It was noted that he wasn’t hitting his previous peak of 180 bpm as quickly as before.

It was still a struggle to do 1:1 Ujjayi breathing in the hills.  Occasionally he would have to slow the pace.  Realize that his work load was so high and his breathing so restrictive that he noted symptoms of exertional intolerance.  He referred to these symptoms as spinnies and stars.  (equilibrium and visual disturbances).   In this third month, the hill work frequently interrupted the Ujjayi breathing simply because of ventilatory insufficiency (lack of oxygen).  He therefore had to reduce the speed of his ride.  Therefore again he extended his commute time.  (Oh boy, gotta love those early mornings).

It might be hard for us mere mortals to imagine this type of effort.  Certainly the discipline of this level of training could be unknown to many of us.  Remember that he is actually operating at a high level of athletic function.  Even several high level athletes that tried this regimen, still ended up stopping before completion.  His level of sankalpa (resolution) was demonstrated day after every day.  Both his mind and his body were being strengthened.

By the beginning of the fourth month he was able to breathe with Ujjayi 100% of the time in the hills.  Realize too that he was hiking and mountain climbing on weekends above 6250 feet, still using the Ujjayi breath.  Again it was done with great difficulty and tremendous discipline.  He had his ole familiar symptoms of spinnies and stars for company.

Fifth and Sixth Month:

During the fifth and sixth month he now consciously tried to not let his HR peak above 120.  His focus now was to relax and do the Ujjayi breathing.  During this time, he would internally focus on keeping the HR steady and eliminate the prior peaks.

His cycling pace had to be slowed down the first couple weeks of this training period.  Again his focus was not to be thinking about the mechanics of pushing and pulling on the pedals, etc.  His focus was breathing and internally making the HR steady without any accelerations of this internal rhythm.  He kept relaxing and doing the Ujjayi breath.  This feedback of his internal state was the regulator of his training work load.  He became very connected internally to the sensations of what it felt like when his heart rate would elevate.  He built up both conscious and subconscious feedback for the auto regulation of his pulse during high levels of exertion.

By the end of the 6th month he was able to maintain his HR below 120.  There was much less effort needed to do the Ujjayi and maintain his HR at his prescribed target.  Still there were times during the strenuous ride when his heart rate would peak above 140 bpm.  At these times he was able to easily restore it to the proper training levels.

He was noting in general that over these past six months of training, he was feeling progressively less fatigued.  Realize that during this time he was still quite busy in the organizational and administrative duties of his job and avocational pursuits.  Remember he continued to pursue vigorous hill and mountain work/rescue activities while still practicing the above regimen.

Seventh and Eighth Month:

Now he was gradually reducing his use of the Ujjayi breathing.  This means it was less vigorous and less loud.  Within the 7th month, he introduced only doing the Ujjayi on exhalation, not on the inhalation phase.  He still practiced on consciously maintaining his HR at or below his 120 bpm target during exertion.  He stated that he was now finding it much easier to do this autoregulation of the HR without needing to use the Ujjayi breath.

At the end of his 8th month, he was able to completely stop the use of Ujjayi and still consciously and proficiently autoregulate his HR response.  He was now using his original bicycle commuter route of 30 miles round trip.

Ninth Month:

He was now scheduled to have his final check in with his Ayurvedic doctor.  During these previous months he had phone consults with this doctor.  They were just progress checks.  No real changes in his program were made at these times.

Now he and his doctor noticed several improvements.  There were no longer any tender swollen glands.  There had been a gradual reduction of these signs over the first 6 months.   He could not say that he had any real increase in energy, as he was always energetic.  The bicycle commute though was made with less exertion and effort now.  He now had to reduce his caloric intake because he was much more calorically efficient.   Fats and starchy carbohydrates were reduced at this time.

Also at this time he started using a single speed bicycle (geared at 42/18).  Starting this single speed bike on the hills and mountain passes was tremendously difficult even now.  He had not turned into Superman yet.  You have no idea how difficult it is to pedal a single geared bike over mountain passes.  Tears fill your eyes, not because of emotions but because of shear severe maximal efforts required here.  He just felt that his prior rigorous training made it doable.

Now listen closely to this next sentence.  He was able to still keep his HR at 120 even when initially adapting in the first couple of months to this new endeavor.  This response is just a demonstration of an amazing adaptive capacity that is trainable.

He found that he could mentally regulate his heart rate under many conditions of physical and emotional stressors.  Listening to his inner sense of his cardiac function became second nature.  He was able to accurately sense and autoregulate it’s rate under biking, hiking, climbing, kayaking and skiing.  As mentioned before, even under emotionally stressful situations, he could sense an elevation in his HR and again begin to autoregulate it,  thereby modulating his emotional response in these situations.

It has been a year now after the intense training period.  He still finds the effects of sensing and autoregulation to be an intimate part of the way he lives.  Everything that he did has been done by others.  Of course some who have attempted it have dropped out.  As you can see it is a rigorous training regimen.

Realize what you want.  Design a proper program.  Engage in it and shape your mind with your determination.  The body will follow.  Realize that there are no short cuts.  It is a lot of work if you wish to achieve something other than the ordinary.  You can be extraordinary through such as is encouraged here.  Now go and train.

Fitness is a Lie

The Great Lie

  • Get fit and loose fat
  • Fitness improves your health
  • Increase your longevity with exercise

Give Me a Break

We put our hopes and dreams into ideas.  Fitness can become just an idea.  These supposed lies of fitness could be true as well as not.  There are parts to each of the above that are true and other parts that are misconstrued.  Let’s take a break from whether it is true.  The discussion is specious.  Does this mean we shouldn’t strive to be fit.  Again there is this aspect of talking about it vs getting it done.   The key at this moment is “go” not talk about it.  (now before you leave for your workout…)

Next Step

Best thing to do is stop discussing this idea and start practicing it.  There is a ton of information out there on different programs to help you achieve your goals in becoming better at moving.  This is what fitness does.  It helps you move better.

Everything in our physiology is movement related.  We send signals of back and forth within our body, both chemical, electrical and mechanical.  We push and pull air and fluids throughout our vessels and channels.  We move things inside and outside.  Our thoughts and emotions move into and out of our awareness.  We are a constant complex marvel of an internal and external ballet of choreographed movements.

All this internal movement is summoned up in our expression and dance of movement with our outside ecology.  These exercises we do and the functions we perform in our daily lives and the kinds of relationships we have or don’t have are the final expressions of our symphony of movements.

Fitness Guidelines

  1. Start a regular practice involving large body movements.
    1. Spinal movements
    2. Shoulder girdle movements including the whole shoulder complex
    3. Hip girdle movements including the lower extremities
  2. Include a systematic variety of different types of movements
    1. Endurance both aerobic and anaerobic forms
    2. Stability and strength
    3. Flexible and fluid
    4. Power
    5. Agility and balance
    6. Coordination and motor control
    7. Skill and FUN aspects
  3. Yoga
    1. Develop a philosophy of life
    2. Live both the life of the inner worlds WITH the life of the outer worlds
    3. Be truly happy and know yourself
    4. Skill set of practices
      1. Meditation and concentration practices
      2. Breath training
      3. Internal dialogue
  4. Diet and nutrition
    1. Develop regular eating habits
    2. Proper food selection and supplementation
    3. Proper elimination
  5. Sleep
    1. Regular
    2. Sufficient amount
  6. Sex
    1. Healthy expression
    2. Significant indicator of hormonal balance
  7. Etc
    1. In case I left out anything, please add here

Now What

Do some of you remember Jim Fixx.  Back in 1984, he was on the popular front of running and getting fit.  He had a 2 pack/day cigarette habit and was out of shape.  He stopped smoking, ate better and took up running.  He was the iconic symbol of a fit man when suddenly he died of a heart attack while jogging.  I remember this incident well.  I had bought his book and thought what a great thing for fitness that he was doing.   After his death there was a whip lash effect on this fitness craze of the day.  Some of course used this sad story to incorrectly label the efforts of fitness.

Being fit does not protect you from disease or life.  It does allow you to move better through life, no matter what you have to deal with.  The key again is movement.  Fitness isn’t something that you can hold in your hand as this or that.  But if you have done your practices regularly, then you will be able to live above most that do not.

We all will have some of today’s diseases for a variety of reasons.  Some of us will be heavier.  Some us will be skinnier.  Etc.  Being able to move our minds and bodies well will allow recovery and return to our lives with greater ease.

Look closely at what you want in your life.  Develop a practice to reach those goals.

What you can train, you can attain!

If you are involved in training, congratulations!  Consider reviewing your program.  Look at the above guidelines.  Which areas are you doing well in.  Are there areas that you leave out?  Maybe you don’t even consider them.  It would be another article to speak more directly about using some of these guidelines that may be under utilized (or mis-used) by some in the fitness arena.  Leave a comment about this topic.

If you haven’t started training regularly, then re-evaluate where you are in relation to your goals.  Maybe get some goals and/or redefine them.  Start with a simple plan and then take action on it.

Expect to train and practice for a long time.   Many fitness gurus and research speak of short term training programs.  There is value to including short term effects.   The real value in practice and training is over the long term.  It is always surprising to me how much change happens from year to year.  Most are familiar with the change of degradation from year to year.  The changes I find that are most sustainable and profound actually take place over many, many years.

Now for some, a longer view is a kin to a prison sentence, at least emotionally.  OK, that isn’t uncommon.  It is just unproductive.  This evaluation of the value of long term training actually allows for all of us to attain whatever it is that we are training.  This statement kind of reminds me of a money back guarantee.

Just don’t be planting carrot seeds and expecting apple blossoms.  I’m not kidding.  Many people say this type of training just doesn’t work.  Often these critics do not even participate.  They are the arm chair quarterbacks or the box seat critics.  You have to be moving and doing (before you re-hang around being).

But again the main point is that what ever we do, what ever we eat, what ever we think/feel becomes what we are.  If we have a particular result, it is due to all that we have done or not done that leads up to this result.  Again this can become a challenge to survive/manage/overcome or an obstacle that seems insurmountable.

Develop the fitness of the mind and body.  Engage fully in life.  Practice!

Best of the best in your endeavors–peter

Shoulder Stabilization in Asana/Posture and Movement

Shoulder Stabilization in Posture and Movement

In Yoga and many times in athletics/sports, we are often looking at physical flexibility.  This is great in the proper context.  Flexibility which is certainly stressed in yoga asanas has it’s compliment in stability.  We often talk a good line about balancing the body.  Often in practice we don’t notice what kind of balance we are creating or have created.  Since I often hear instructors in yoga class repetitively encouraging a student to go farther into the asana, I wish to focus on this incomplete perspective.

We will look at a case example from my Physical Therapy clinic.  Before moving into looking at this specific example of shoulder instability, let’s speak more of this flexibility vs instability issue.  Is it that one is better than another.  (of course it is and of course it is not)

Posture or Asana Guidelines

This is old material for many who know it, but a brief review will be stated.  The first of the three Yoga Sutras of Patanjali on asana starts out as:

Sthira-sukham asanam

Asana or posture is steady/stable and easeful/comfortable.  I don’t know how many teachers and students who can recite this and more, still persist in having someone focus over and over again in trying to stretch further.  Many people will look at a picture of someone who has tremendous physical flexibility, and they will effort to accomplish more range of movement.  (Just like in the picture of their mind)

This perspective of overdoing the flexibility aspect of asana is not being balanced out by proper training of the needed stability.  There must be good reasons why such an authoritative text like the Yoga Sutras has started out with stability and not about flexibility per se.  (I know the context is stability of the mind–but we are starting with the body part of the mind here)

Developmental Guidelines

When babies start to move around, what is the first thing they do?  In one way they start just moving.  They seem to come equipped with great flexibility, right? (Wouldn’t some of us love to have that now days.)  Well they don’t get very far until they develop significant stability.  They do a ton of core work on their backs while seemingly flaying around their limbs for example.  I will not get into the large amount of work they do sucking and orienting their eyes and head, etc.  I just want to focus on this idea and observation–they don’t get up and get around until they develop their stability.

So if someone has the proper mobility then stability comes in conjunction to complete many of the functional movement patterns or exercise/sport  patterns that we are involved in.  What if we don’t have the flexibility, let’s say for the a particular asana.

We need to have movement.  What is the relationship with movement and stability?  Does one come before another?  Well—it depends.  (great words of wisdom : ))

Flexibility Problems and Of Course Stability Problems

Flexibility and Stability are both needed.  It is the prescription of how, when, and where–including dosage amounts and timings.

For the past several weeks I have been seeing a client for shoulder and neck pain.  Basically when he raised his arm above shoulder level in abduction, he has a painful arc of movement from about 110-150 degrees.  Also this is his limit of movement on first examination.  He can stretch it farther into the ends of range to 160, but it is just more painful in this case (not a true painful arc, per se).  His neck movements were slightly limited in rotation and side bending away from the affected side.  Mainly stiff lower cervical segments as a group.  Also his thoracic spine rotation was markedly restricted bilaterally.

All his movements demonstrated poor sequencing of the scapular component.  He was very weak in scapular retraction against resisted rowing movements, especially on his affected side.   (The gleno-humeral joint was  also anteriorly subluxed slightly)  He was unable to retract or move his scapula’s together with resisted pulling movements when his forearms were more vertical.

I often use a mini band at this point to see if they can maintain their forearms in more of a vertical position as they pull the band apart and try to retract the shoulders.

Often they are grabbing this mini-band with their hands vs just wrapped around their wrists.  You can see here that the band is at the top of the chest level.  If you try to have them start at their nose level and then try to pull it apart–you will often see them only able to pull it while allowing it to come to their chest level again.  Their scapular stabilizers with abduction of the arms are quite weak.  The classic testing of shoulder stability with the elbows at the sides of the trunk are for very weak folks.  Much of compromised work is with the hands/arms raised over his head.

Flexibility and Stability Retesting

Once I found both a flexibility and a stability problem, I will start to stimulate one area like the above scapular retraction with the mini bands.  (As this scapular component could be at the base of his flexibility problem–as the shoulder blade is literally the base of the arm AND it was the most asymmetrical problem).   Then I will retest their original complaint.  In this case, he had pain with limited shoulder abduction.  He immediately showed improvement.  So then just for an experiment in his case, I tried doing some gleno-humeral (shoulder ball and socket) mobilization and mobility exercises.  He didn’t respond as well upon retesting.  I  also tried improving his thoracic rotation.  We used combined active movements of rotation and side bending of his trunk in sitting.  He improved in shoulder abduction a few degrees, but not nearly the improvement as seen with the direct scapular resistance.

This particular fellow is rock climber and surfer, etc.  He is very active and very strong in other ways.  In other words, when I asked him to do a push up, he just dropped to the floor and pushed away with no problem.  Please note that in this push up position, he locked his upper arms in close to his side.  His scapula’s were quite stable, with no winging or instability.  Very impressive.

Note that his instability (and seemingly inflexibility) is when his arm and hand are above his head.

Stability Rehab

This client case is just to emphasize that some people will have a lack of movement.  Their lack of movement does not always respond to stretching.  In this particular case it made no difference, except it was actually more uncomfortable with end range stretching.

He has responded well to starting with side plank positions.  He is fairly unstable and has very weak endurance in this side plank position.  The forward plank did not demonstrate enough change.  The bulk of his program that has proved most helpful has been with these pulling movements at different angles.  We often focus on holding the pulling movement and then working on eccentric/concentric contractions of this movement pattern.  We change the angles over time, trying to find the weakest and most unstable position.  We back away from it slightly and work before that place and after that place and then through that place that is difficult.  He still uses thoracic mobility exercise to his advantage too.

Limitation of Yoga Asana

He has done very well.  It is interesting to note that in traditional Yoga Asanas:

…most asanas develop forward pressure movements involving the upper body

He was originally trying stretch it out for weeks and weeks.  There wasn’t much change.  All forward pressure movements did not significantly help him either.

Summary

Realize this is a case example–speaking to the importance of assessing both mobility and stability.  Certain protocols/sports/movement paradigms are biased in direction of movements and particular activities.  These are constraints that can lead to significant imbalances.  It is not that something is bad or good for you directly.  There has to be an evaluation of what are your weaknesses and strengths.  Often we are involved in activities that strengthen our strengths and do not do much for our weaknesses.

I know that in other people, they have more of a mobility restriction in their particular case.  Therefore work more on mobility.  Remember it is identifying the problem(s) and then a key is to RETEST.  This retest provides the feedback.  It isn’t this paradigm vs that paradigm.  These topics of controversy, if they truly are, only should lead to examination not to reverential following.

Strengthening your ability to observe is paramount.  Also you must ask a lot of questions.  Be systematic in your focus of questions and answers–(most really are not–their mind immediately jumps away to a more familiar aspect of their inquiry–more to say about this in another post)

OK, make some comments.  Share what you find works.  Let’s build a community together.

Strong Mind and Body–Peter


 

 

Myth of Maximum Heart Rate

Question

What should my target heart rate be for safe exercise now that I’m reaching into my 60′s? or now that I’m ….?

Answer Part 1

There has been a consensus from people in medicine and in the various fields of exercise training that your maximum heart is determined by the following formula:

220 minus your age =’s Maximum Heart Rate

Then you take a percentage of that to arrive at your target heart rate for training.  Let’s first look at this formula stated above.

Background

This formula has been too casually utilized.  It has been promulgated as being scientific and over time has become the erroneous guideline for many in determining individual training levels.

It was founded in 1970 by Dr William Haskell.  There is a very good article in the New York Times that challenges this myth of maximum heart rate.  Below are excerpts from it:

The common formula was devised in 1970 by Dr. William Haskell, then a young physician in the federal Public Health Service and his mentor, Dr. Samuel Fox, who led the service’s program on heart disease. They were trying to determine how strenuously heart disease patients could exercise…

The subjects were never meant to be a representative sample of the population, said Dr. Haskell, who is now a professor of medicine at Stanford. Most were under 55 and some were smokers or had heart disease…

…At that point, Dr. Fox suggested a formula: maximum heart rate equals 220 minus age.

But the formula quickly entered the medical literature. Even though it was almost always presented as an average maximum rate, the absolute numbers took on an air of received wisdom in part, medical scientists said, because the time was right.

Answer Part 2

The American College of Cardiologists and the American College of Sports Medicine have come out with different guidelines.  I have seen that the American Heart Association used in the past the old formula.  I don’t know if they are still recommending this 220 minus age, equals your maximum heart rate.

Many have used the Karvonen Formula–See this link for an easy and quick calculation (and calculator)

Heart rate = ((Max HR-Resting HR)*%X/100)+Resting HR. (where %X =%MAX)

There is a great summary on a Wiki page here.  It provides more information than many would want.  It has other measurements and of course you can find the cited references.  Nice job.

So where does that leave us.

Answer Part 3

OK, whenever there are at least three answers proposed, be careful.  That means here, be careful!  I think that we don’t have a simple answer.  Also, we just don’t really know.  So in light of doing a treadmill test or similar at a human performance testing laboratory–what do we do?

We could use our common sense (or uncommon sense, as the case may be).  Take measure of who is asking.  What kind of condition are they in, any medical concerns–use a doctor to rule out medical problems.  What is their exercise history both recent and past composed of. Etc.

I personally like the Karvonen Formula or one of the other similar ones (they seem to differ in the range of standard deviations allowed).  In addition, I also like the Scale of Perceived Exertion.  This scale has shown good reliability with different groups of people–but it has doubt for some populations (caveat emptor).  Many people have derived their own modified Borg Scale.  Different groups have assigned different numbers meaning different levels of exertion.  (here and here for example)  Most importantly find your own subjective report that you can use consistently to gauge your work effort.  Be smart and be aware always.  Don’t use scales of any kind without retesting.

This retesting is important.  By retesting I mean how do you feel after exercising at your level of exertion.  How long does it take for you to recover–both in immediate heart rate (and breathing rate) and in the following days.  How you are sleeping and waking are always good barometers to pay attention to in determining how stressed you have become or not.  Also consider your mood swings and general level of energy.  This evaluation is always seen in our relationships with both are family/friends and in difficult situations especially.

Summary

Training is never done in isolation to how ones heart rate only is responding.  One needs to pay attention.  This attention would benefit by having a check list (hmmm another article someday)

Hopefully some of you will read this article and add what you have found to be important in determining your level of work.  Add your comments below.

Good training–may our hearts expand and receive the benefits of training beyond the base physiological parameters of regular exercise prescription.

 


 

Shoulder Pain: Case Example Using Mini-Bands

Background

Shoulder problems are one of the big money makers for people in the medical field.  As with many problems there are many factors and different categories of these problems.  This statement of shoulder pain is a very poor title for discussion.  It is the common moniker that many of us use for a wide variety of different problems.  In other words, shoulder pain does not even describe the problem, only the symptom.  Only subsequent questioning and discussions can bring clarity to what is the problem.  Shoulder pain can be referred pain from other sources like the neck, ribs, heart and lungs and many other problems.  These origins of the shoulder pain don’t even have to be in the neighborhood of the shoulder.

Here I just wish to talk about a particular case illustrating some basic principles of movement and stability of the shoulder complex and using mini bands.   If you are experiencing painful shoulders, please do not limit your assessment to what is given below.  Remember what is said in the above paragraph.  First ask other questions.  If there is any doubt in your mind have your doctor clear you first before embarking on trying out a musculoskeletal approach only.

Case Example

This young man who works a sedentary job and participates in weekly yoga class had been noticing increasing discomfort  of both shoulders but especially the left one.  Simple lifting the arms above the head would reproduce his symptoms.  They would get better on the right with continued movements but not on the left.

A brief assessment showed the following.  His posture looked casually very erect.  (Although is head was slightly forward and his thoraco-lumbar area was over extended, and his scapula’s winged bilaterally).  His neck demonstrated limited rotation and sidebending bilaterally especially to the left, his more affected side.  His lower neck spinal mobility was more restricted in these movements.  His shoulder mobility was with a flexion deviation in abduction. End ranges in abduction and external or outward rotation were slightly limited.   Resisted testing was weaker in extension and external rotation with arm above the head.

His mid to lower thoracic mobility was restricted in rotation–his mid to upper thoracic  was restricted more in extension.

In all his shoulder mobility testing, he demonstrated poor initiation of the scapula, especially on his affected, left side

Basic Approach

We worked on basic joints and glands (calisthenic type) exercises and foam roller to help restore some of his spinal mobility.  He improved so that his mobility was more normalized in his spine and shoulder.  His most provocative test now was his resistance to external rotation of his left shoulder when his hand was above his head.

It is interesting to note that in the classic muscle test position of external rotation with his elbow at his side, he had no problem.  I find it always helpful to hunt around to see if different positions will provoke his symptoms.  Also during these movements the scapula had a lag or latency in it’s sequential recruitment.

Mini Bands

Since he was essentially not activating his scapula enough in order to move his arm, work on this provided the changes he needed.  By working on basic pulling activities and cueing the scapula to perform better he was able to complete his recovery.

One problem I find in recommending exercises is compliance.  The simpler and easier the exercise the more compliance you will have.  This is a real struggle for me as there are so many areas that a person needs to learn about to move effectively.  If you can start the movement and break it into pieces, you can sometimes deal with this compliance issue effectively over several sessions of training.

This photo shows the 9 inch long loop called the mini band in action.  Here we started with simple setting of the posterior shoulder muscles.  We can emphasize scapular retraction while loading more of the external rotators to act as stabilizers.  This movement reminds me of the ole chest expanders we used as kids.  (Hoping to become like Charles Atlas and rule on the beaches).

Mini bands are great.  I constantly refer my clients to an online store called Perform Better.com.  Here is the link to their mini-bands.  They are a closed loop and give you what thera-band still gives (sans the knot, tying the ends together).   I just find I use these a lot more and they are so easy, portable and just fit the bill so well.  (no I don’t have any financial relationship with this company–except when I give them my money for their products)

We used a variation of this set up that is shown in the above photo.  What you see here is the mini-band looped around his wrists while pulling on another band (monster band, listed under mini-bands in the above link)–this monster band is 20 inches vs 9 inches in the mini-band.  You can use them separately or together as shown here.

One of the advantages of using a closed loop to do any type of rowing movement is that you can develop two directions at once.  This combined movement is very good for activating the stabilizers in this case.  You see on regular rowing you work on mainly retraction/extension of the shoulder.  Here with a closed loop (and the addition of the mini band) you emphasize this external rotation with a variation of horizontal abduction.  Turning on multiple planes of movement will really drive the shoulder complex to be more stable with proper cueing.

Another advantage to this arrangement is that it is very simple to set up and take down.  Space and equipment considerations are minimal.  Just get in there and do the work.

Progressions

The mini bands come in a variety of resistance.  I often have my clients purchase the yellow, green and blue mini bands.  Also buying the 20 inch loop (called a monster band with in the mini band section), will give you a large variety to try many different things.

  1. First I will start with a yellow or green band in the upper body for sedentary folks
  2. Next I will add the two bands as in the second photo
  3. For people who have issues in grip–whether arthritic hands or other problems, you can easily use the loops around the forearms
  4. Also the loops placed more proximal will reduce the force needed–this makes it very doable for anyone–I even use these ideas with a 93 yo woman who is progressive working just with the mini bands and also a 40 inch loop.
  5. This rowing movement for those who have issues of rotatory instability with the arms above their heads need to further progress.
    1. We start from simple rowing movements where the elbows are pulled closer to the sides while the forearms are more parallel to the floor
    2. Next we work into getting around a 90/90 degree position of shoulder abduction with external rotation while the elbows are around 90 degrees
    3. I’m not too strict here about the 90/90, just having them move towards this position and have their forearms more vertical works quite well

Summary

Retesting will clearly show if we are in the right direction.  I will immediately retest their provocative movement pattern.  If it is better, that is stronger, better movement of the scapula/humerus and thoracic spine–I know this has been a good choice.

There are of course many ways to deal with this problem of instability.  Try out this variation if you haven’t.  Let me know what you find.

Best in training.

As always, contact me if I can be of further assistance–Peter