Archive for exercise – Page 2

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

Relaxation of Effort

Proper Practice

In all training we are guided by certain principles.  The Yoga Community often places proper emphasis on proper practice.  One of the keys to skillfully practice is to relax ones effort.  Today we are often mindless doing and exercising.  Often the accumulated tensions of the day and life are held during our practices.  Therefore it would seem proper to point out this dis-stressful style.  Lets look at when you would emphasize this “relaxation of effort” in your practice.  Your practice could be Yoga asanas, Meditation or any movement endeavor/exercise or performance.

Enjoy It

When we start practicing an asana (again it could be a musical instrument or learning to run hurdles), we start doing something.  Often in the context of yoga asana, people are taught to do a form and then  learn to relax into it and enjoy it.  That sounds just fine.  In practice for most of us, it obviates the basics that need to be established primarily.

Sometimes a student is working at performing a particular asana (again think exercise or your choice or other skill).  If they have difficulty with it, they may stop working on it.  They no longer feel like they are enjoying it.  It just isn’t fun anymore.  This Yoga stuff isn’t really right for me.  I try something else.

Trying to perform something and then being unable to do it can be frustrating.  If the emphasis at the beginning is to enjoy it and relax and one doesn’t, then do you give up?  The whole act of practicing is not to perform something perfectly, nor to necessarily find it enjoyable and be so relaxed at the beginning.  (If you are a high level person that can hold a perspective truly of joy in the mind, then this article is not for you).

Practicing is about developing ways of sensing and doing that were not available at the beginning.  It is a journey filled with lots of work.  Perfecting this work/practice will give enjoyment and you will develop over time this “relaxation of effort”.

Hard work

Notice that a gymnast that is able to effortless perform a routine on the rings or balance bar does not start with trying to relax their effort as the primary practice.  It is only after much sweat, extreme focus/sacrifice and over a long time that they can look so beautiful and effortless.

Yoga Sutras

This classic text by Patanjali has 4 chapters/padas.  The second pada, 47th sutra starts out talking on how the posture is made perfect.  The first part in sutra 47 states that it is through loosening the effort or relaxing the effort, that then the posture/asana becomes perfected in it’s steadiness  and easefulness.

Note that the sutra before, that is sutra 46 states that a posture is that which is steady and easeful/comfortable.  Again this steady and comfortable is not what you do.  It is what happens as you WORK in asana.  Often people are teaching to become something at the beginning that we are not at the moment.  Once again, practice is needed which will provide these qualities as almost side effects of proper practice.

Now in looking at the first part of the definition of asana (in sutra 46), steadiness in Sanskrit is called sthira.  One of the first places in the Yoga Sutras that speak about sthira is in the first pada, sutra 13.  Loosely restating the Sanskrit (via Swami Veda Bharati)–…this effort towards sthiti/steadiness is called practice.

The next sutra in the first pada, sutra 14, then pretty much lists the qualities for ones practice to become solid.  (The beauty and depth of the Yoga Sutras are not being communicated here–just an introduction to some guiding principles and how they can guide this relaxation of effort in our practice).

Firm practice when:

  • Practice is done for a long time
  • Practice is done without an interruption (think long term here)
  • Practice that is done right and proper (details are 4 and beautiful, but will not be discussed here)
  • Practice is done fully, completely (not haphazard or partial)

Relaxation of Effort

So one can be guided by such a profound text like the Yoga Sutras.  In this case, one is practicing not to perform something perfectly.  One is practicing to create a steadiness and stability of their asana (again think dance performance, faster sprinter, etc).  This control of that which is not under control, is achieved through practice (only in part, see YS 1.12).

This effort to becoming steady and stable is our practice.  This steadiness is not rigidly still.  This steadiness is the absolute control of the mind and sensory motor system.  It is that which provides  the direction to correct practice.  This practice then takes time–often long hours of practice, done in the way outlined above.  It is not something that just happens without these focuses.

Then as our practice develops in these ways of becoming stable and easeful, we automatically find that there is a loosening of our effort.  Relaxation of effort is not prescribed first as a primary methodology here.  Of course practically you work and relax and repeat.  Just do not underestimate the primacy of working as outlined in the first and second padas of the Yoga Sutras.

Continuing Practice

Steady practicing leads to relaxation of effort.  It begins to flow.  (Practicing means you have a goal.  This goal is that which you focus your mind, body and effort on.)

Relaxing is always easier after working fully, completely.  There is a rhythm to relaxing.  It alternates with hard and skillful work.  Later it becomes not hard, but no less work.  One begins only later to appreciate the lessening of struggle of working FULLY.  One then moves into the  joy of “hard work.”  It is no longer an effort.  One starts noticing that they are just more relaxed.  This richness of practicing is worth the work.

Again if there is anyway I can be of service, please feel free to contact me here.

Effective Exercise

Strong Mind and Body

Do we get the best results from our exercise selections?  How do we select which exercise to perform?  Besides matching the proper exercise for the problem we have, what else is important?

Is being effective due to:

  • The proper selection of the correct exercise?  or
  • How we do that exercise/movement?

Effective Exercise

First we must congratulate ourselves because we are doing exercises.  Next we have usually identified some reason for putting down the remote and/or getting out of bed.  Now let’s move quickly on to someone who wants to perform their particular task or skilled movement better.  It could be that they want to jump higher, cut quicker on the field, get into better shape/condition or simple perform a yoga posture that is particularly challenging.  Let’s take the latter case to illustrate several of these points on how to effectively exercise.  (We are expanding the definition of exercise and bending the definition of yoga asana here to make some points, knowing that the purists may start off disagreeing too early here)

Yoga Asana–Chakrasana

This is not a complete description of how to do Chakrasana.  We are using this posture/asana as an example of some one who wishes to do an exercise or asana effectively.  (This example could be extrapolated into many of the “corrective exercises” being given and performed today.

Let’s start with looking at a typical example of someone wanting to be more flexible.  They have taken up Yoga asanas in a class.  At some point the teacher has progressed to this pose called Chakrasana or wheel.  It is fairly vigorous for many, as can be seen by the picture above.  Again this could be an example of someone wanting to jump higher and get stronger in their legs who at some point starts doing one leg squats.  It really doesn’t matter the movement activity by itself.  It is again looking at how to exercise effectively.

Truly in exercise/movements it would be best if we knew ourselves well.  (Know thyself–OK, end of philosophy).

  • Where do we move well–actually where and in which directions do we have ease and dis-ease
  • What movements are strong/stable/powerful and have endurance (both in mobility and in stability)
  • Which tasks and/or skills do we prefer and which ones do we stay away from
  • Do we move smoothly and in a coordinated fashion
  • Do we breathe or frequently hold the breath with frequent efforting
  • Can we stay focused and pleasant in our mind or just the opposite

These are just some of the aspects or questions to ask in order to get to know HOW we move and therefore better know ourselves.  Knowing ourselves better will allow us to move better.  We can take full advantage then of the exercises or movements being selected.

Maybe Chakrasana (or single leg squats) are not the best exercise at the moment.  Maybe the way in which we do them is not allowing the benefits of those movements to create the tremendous results that await us.

Where (location and direction) and how do we move well (and where/how we don’t)

We need to look at large patterns of movement.  We want to see and feel how the body moves in all directions from the major areas of the body while performing a variety of movement patterns/tasks/skills.

  • Bending and reaching
  • Twisting
  • Pushing and pulling
  • Squatting and kneeling
  • Rolling and crawling
  • Sitting and standing
  • Walking, running, hopping and jumping

Where in the body do we move a lot and where are we stiffer.  Often this inquiry stops here.  It is insufficient.  The shoulders may be tight in lifting them above our head but have a lot of movement in the opposite direction.  Especially important is to notice difference from side to side and up to down.  Maybe our hips are able to extend (backward bend) well but our shoulders cannot open in that same direction.  Maybe one shoulder does more opening that the other–do you see that in Chakrasana then you would create a rotation of the trunk.

Look at the picture again and you see that the hips are opening well in backward bending.  The lower back spine is bending a lot.  The rib spine or thoracic spine is not backward bending at all in the mid to upper back.  The shoulders are also tight in this same direction.

Isn’t it interesting to note that this person is doing the general direction of this Wheel pose.  It is just HOW they are doing it that is of note here.  Therefore they will be over using hips and low back (and neck) and under using shoulders and mid-upper back (and wrists).

What if we knew where we moved and didn’t.  This might totally change what we do and how we do it.  Of course the results would be vastly different.  Our learning then and what we pay attention to would be expanded.  The changes across many different systems could be facilitated (musculoskeletal, fascial, nervous system, respiratory, immune, etc)

What movements are strong/stable/powerful

Again looking at this picture, we can ask several questions.  I know it would be better if we actually had a video.  Then truly we could appreciate the movement qualities better.  This picture and discussion will at least highlight the points of this article.

Looking at the two ends of this Wheel pose–which end, the leg or arm end, looks most stable?  You can see how the weight of the body is carried behind the arms.  Are the shoulders weak or only stiff?  or both?  Address whatever is involved with a more appropriate regression of this pose first.  Identify weakness and lack of stability of the shoulder complex with the arm above the shoulder level.  There are many ways of doing these tests/movement regressions.  We will not go into that detail here.

Looking at the middle of the body and seeing how the front of the lower back (the belly) over lengthens.  The lower back  over shortens.  How much of this over extension of the low back is a mobility problem of the thoracic spine in extension?  (or/and does it involve lack of stabilization of the anterior belly region.)

First you would have to decrease the challenge of this activity.  Take them out of trying to do this asana.  Place them on the floor and have them roll from belly to back with only the arms and head.  Do they activate their belly enough to transmit the rolling through the trunk from the arms.  Could their shoulders and thoracic spine be so stiff as to even impede this movement. Further investigation would be warranted.  This again is just to highlight a perspective of looking and asking questions.

By looking at more of these larger movement patterns, it will become clearer.

Which tasks and/or skills do we prefer and which ones do we stay away from

I wonder if this person loves to do backward bending movements where the shoulders are not flexed near their end ranges (that is over head position, above shoulder level).  So let’s make up a scenario that I see frequently in the clinic.  They would do  easily cobra or lying on their stomachs with arms by their sides.  Even Camel pose (tall kneeling and bending backwards to place hands on heels) would be available.  Any superman type position or boat pose would be done with substitution and difficulty.  They would never practice hand stand as it is too tiring.

If this lack of using the extremities over the head (in Chakrasana) causes such stress, then it may need to be regressed or made easier.

This easier movement may allow the proper awareness and adjustments to overusing and underusing that is being outlined here.

Do we move smoothly and in a coordinated fashion

This examination of coordination and agility reinforces many of the above observations.  Again whatever we move well and strongly, those are things we do.  We always use what we have even when trying to do something else.

Let me digress from this example to talk more of our preferences and avoidance’s in general movement.  We use the same patterns of movements and habits even in opposite directions.  It is not unusual to see someone who is trying to sit on the floor and has a lot of left knee pain (for example–in a cross leg, sukhasana pose).  Sometimes in looking at them you see their weight shifted to their left hip, although they are leaning a bit to their right.  You find they are in right sidebending of their trunk.  When you ask them to sit on a chair and turn right and left they still have most of their weight on their left sit bone.  In other words they do their movements of rotation and still maintain their right side bending of their trunk.  Their coordination remains dysfunctional even though you would give them a movement to change it.

This latter dysfunction a very important point to discover.  Our movement habits often remain and don’t change just because we are doing some corrective asana or exercise.  The WAY we move becomes also very important.

Do we breathe or frequently hold the breath

OK, breathing is so important.  It is a barometer of our mind and nervous system.  Sure at the beginning one may fine this breath rhythm disturbed.  The habitual and repetitive nature of an interrupted breath is very detrimental to our learning and proper response to the exercise.  A jerky breath relates to a jerky focus of the mind and all the other negative effects in all systems.

Try moving only so far as the breath can flow well.  This does not mean that you can’t cause strain.  That is ridiculous.  As one continues to do repetitions or hold the pose, the breath should be noted to start to flow well.  Otherwise there is not practice.  One is just violently stimulating the system.  Of course you have some changes even with the breath always being strained.  This abnormal breath rhythm though is very limiting and over the long term is detrimental to health and well being.

Can we stay focused and pleasant in our mind

Alright, take off the music headphones.  Pay attention to what you are doing and what you are feeling.  A good barometer like the breath is to ask whether you are pleasant in your mind.  GEEZ, you mean we have to be smiling all the time.  OK, less drama here.  Just note what happens to your overall sense of tensing and effort when you notice that your mind is not pleasant.  Whenever I ask this question in class or to individuals, I never fail to see an easing of tension, even a  : o )

Also when the mind is more pleasant–often you will notice an ease in the movements.  Try it just like you would try breathing with more awareness and ease.

Whew

So now when you exercise, you can ask more questions.  Effective exercise is creating the proper effect you want and/or that is available in the stimulation of the movement done well.  Effective exercise involves BOTH the selection of the right exercise the proper way of moving–

  • The Body
  • The Breath
  • The Mind

So before and during your next exercise session, take time to pay attention.  Use the movements to create opportunities to sense and breath.  Train hard up to your capacities.  To know your capacities, you must practice a lot.  You would benefit by coaching or skilled guidance.  Try using these principles–pick one, like having a pleasant mind.  Then go find a skilled coach/teacher and get some quality feedback.

Best of luck in your effective exercise.

Feel free to comment or contact me directly for a consultation.