Self-perception




I was standing in line at Starbuck's the other day, looking around at nothing in particular. I noticed a woman waiting for her drink with an adolescent daughter or niece. "Wow," I caught myself thinking, "it's hard to believe adults can really be so little." As I paid and went over to the same counter to wait, I realized she and I were the same size. If anything, she may have been a touch taller.

Self-perception is a funny thing. I noticed early in my training career that when I asked some of my female clients to place their feet hip distance apart, they would set up with their feet wider than their hips. Their perception of their hips and the reality were different (I have also had the opposite happen, with people setting up more narrow than their actual hips). Becofsky et.al, found in 401 individuals with osteoarthritis, perception of disability was more strongly correlated with depression than actual reduction of physical functioning; those with reduced functioning that didn't view their condition as a disability were actually in a better place psychologically than those with less reduced functioning, demonstrating that perception can affect both our physical and mental health. Our perception of our physical selves and abilities can be our biggest barrier (or our most powerful aid) in attaining our athletic potential. I often wonder how we get so out of touch with our physical bodies. Is it because we don't use them very much? Or that we are inundated with press about knee replacements, arthritis medication, and the obesity epidemic? Many of my clients that come to me as new exercisers don't trust their bodies to be strong. They wait for something to go wrong, assuming their bodies will fail them. It is my job to teach them their bodies are capable, and if they are patient, their body will perform feats far greater than they expected. The reverse is also true. Sometimes there is an expectation that "I should be able to do x because I could 30 years ago." While "x" might still be an attainable goal, if a person's body is different than it was 30 years ago, "x" might have to be achieved in a different way or on a different time schedule. A yoga teacher once said what we think we look like we while we are practicing yoga and what we actually look like are two different things. There are times where I think I must be in the deepest backbend ever, only to find my hands and my feet are miles apart. As a result, my perception of my ability to backbend is that I am not "good" at it and probably won't ever be able to do poses that require a lot of back mobility. This is in contrast with my perception of my ability to handstand. I know I can handstand in the middle of the room (I have accomplished this on several occasions, just not consistently); as a result, my perception is that eventually I will be able to always handstand in the middle of the room. My perception for handstands translates to confidence, while my perception of back bending borders on self deprecation ("I cannot currently backbend; therefore, I will never be able to backbend").

Perception also affects how people with chronic pain move and and their ability to perceive where their body actually is in space. Wand et.al, found 50 out of 51 patients with chronic low back pain endorsed items on a questionnaire suggesting distorted body perception. (Body-perception distortion was found to be infrequent in the healthy control group). Recently, I trained a gentleman that had suffered from bilateral sciatica in the past year. While he was feeling better, he still suffered from a bit of pain, particularly walking up and down stairs. The first time I had him come into a supine position with his knees bent and feet flat on the massage table, I noticed his right pelvis was pressing heavily into the bed while his left pelvis was barely in contact with the surface. "Which side of your pelvis feels like it is most in contact with the bed?" I asked, assuming he would say his right. "My left," he responded with certainty. "My right feels like it's barely touching it." Though I learned a long time ago not to assume anything about how a person feels or experiences movement, I was a little bit shocked that his perception of his body and the reality were so different. His perception wasn't wrong; it simply didn't resemble what my eyes saw, further demonstrating the importance of asking rather than assuming what a person is feeling or experiencing.

Something that I find interesting about self-perception is the ease with which it can change. The new exerciser that perceives movement as a potential threat to injury with the right guidance can begin to view her body as strong and able. Using imagery and focused attention over time has allowed my client with low back pain to begin to perceive both sides of his back and where they are in space. I doubt I will look at a person while waiting in line again and think about how little she is, knowing now that that is a more accurate representation of me. While I think about movement and how my body moves a bit obsessively, I don't think much else of my physical self. If someone asked about my self-perception, I would describe myself as strong, not short or little, though I would probably qualify it with, "stronger than average, but there are many that are stronger than I am." If asked about my flexibility, I would quickly say my flexibility leaves something to be desired. Perception is relative and largely depends on one's frame of reference. Watching women regularly perform incredible feats of athleticism on the yoga mat and in the weight room (thank you, Youtube) gives me a different frame of reference of strength and flexibility, leading me to feel that compared to my peers, both could be improved upon. However, it could probably be argued that my strength and flexibility are above average when compared to the normal population. It is impossible to know a person's frame of reference and one's perception of his physical self. The client who has always been told her hips are bigger than her torso will probably regularly set up with her feet a little too wide, while the client that has been told she is frail might balk if given heavy weights too soon. The value of asking, "how does that feel," shouldn't be overlooked, either as a trainer, or as self-reflective question. Conversely, our experience of proprioception and how we move might be impacted by pain, our movement vocabulary (how much or how little time we spend thinking about movement), or our current psychological state. Connecting with our physical selves and beginning to paint an accurate picture of our body in space can improve athletic performance, self-confidence, and overall well-being.

Yours in health and wellness,
Jenn






Becofsky, K., Baruth, M., & Wilcox, S., (2013). Physical functioning, perceived disability, and depressive symtoms in adults with arthritis. Arthritis, 2013.
Wand, B.M., James, M., Abbaszadeh, S., George, P.J., Formby, P.M., Smith, A.J., & O'Connell, N.E., (2014). Assessing self-perception in patients with chronic low back pain: development of a back-specific, body-perception questionnaire. Journal of Back and Musculoskeletal Rehabilitation.

What personal trainers could learn from mind body practices



I am taking an online yoga training right now on "The Art of Sequencing." The instructor, Jason Crandall, teaches in a clear, concise manner. Part of the course is to take themed yoga classes taught by him. The interesting thing that he does, which is very similar to how I train, is he takes an area, brings awareness to that area, and then threads that awareness through the class in different postures. What happens when classes are taught like this is when the class is over, the student is more in tune with holding patterns in that area and how that area responds and is affected by other movements. This is similar to some of the Feldenkrais ATM lessons- the participant is taken through a series of movements with an emphasis on a specific region of the body and how that region responds to a variety of conditions. It heightens the participant's awareness and in Feldenkrais lessons, usually results in a substantial increase in mobility due to improved motor control and better neuromuscular organization.

There are, of course, multiple ways to coach and many ways to cue exercises. I am not going to discuss word choice for cueing, though much has been written about this topic. Sam Leahy wrote a great blog reviewing the research and discussing the application of how to cue which can be found here: http://samleahey.com/science-of-coaching-cues/.  What I find works best for my clients is if I pick an area to emphasize during the warm-up, I start asking general association cues regarding that area, and I bring awareness to that area throughout the session. For instance, I am currently training a gentleman I will call Jim. Jim had significant sciatica in the past, and has done quite a bit of physical therapy. He is 69 and wants to be able to walk and play with his grandchildren. I quickly realized (after both assessing some general things and watching him move) that he was disconnected from a sense of center and I decided to start with improving his awareness of his inner thigh connection to the pelvis and abdominals. All of his warm-up activities included holding a foam block between his thighs, which I instructed him to imagine he was holding with his pelvis. I had him do some isometric adductor squeezes, just to bring a little more awareness to the area, and we moved on to standing exercises. For the remainder of the session, whenever he would set up for an exercise, I would ask him to pretend like he was holding the block with his pelvis. We had established what that meant earlier, giving him a movement vocabulary for that action. As the session progressed, I asked him to notice what the sensation of holding the block did to his abdominals (made him feel them) and what it did to his feet (made them less duck footed). Because this was foreign for Jim, I cued it often, though I always gave him the opportunity to set up before I said anything. About 30 minutes into his session, he was paying much more attention to foot placement and inner thigh engagement without feedback from me. The next time I saw him, he commented that he was much more aware of his general tendencies towards external rotation, and he was practicing keeping his knees straight ahead when he sat down. Jim had learned something during our session, done a little bit of homework and his own, and this allowed us to move forward to connecting the hip to the weight of the foot, which is where I went next.

People like Jim are a fairly common occurrence in my practice, though occasionally I get someone like Kate*. Kate danced when she was in college and is a Pilates teacher. Kate has a very large movement vocabulary, and if I help her make an association once, she will retain the cue and implement it without me asking. Kate has a strong bias towards internal rotation, which sometimes leads to stress underneath her knee. I started with teaching her how to engage her glutes and not let her thighs fall into internal rotation in various kneeling and 1/2 kneeling positions. When we moved into standing work, I found she had a difficult time maintaining a neutral calcaneus with hip external rotation. We have been working on keeping a neutral foot and a balanced hip in every exercise. She has a difficult time dissociating the hip from the foot, though as we explore it in a variety of ways, it is improving. She tells me she thinks about glute engagement during barre class, and she thinks about her position when she is demonstrating exercises on the reformer. Like Jim, she was able to make an association about how her body moves and is applying that general awareness to activities performed outside the gym.

Training in this way is powerful because it empowers the client and allows him to take ownership of movement patterns. Experienced yoga teachers do this naturally, though their emphasis is usually on improvement on a specific posture. However, the principles are the same. I am regularly told by clients that they leave sessions feeling like they learned something. I strongly believe that if I want to improve movement ability and increase everyday activity in my clients, it is necessary for them to begin to understand how their bodies work and how they have control over their movements.  I do think part of my job as a trainer is to educate and improve body awareness, one association at a time.

Yours in health and wellness,
Jenn

A balanced hip: Part I







The hip is a neatly designed joint, organized in a way to allow functional mobility, but still has proper constraints in place to maintain stability, including 3 ligaments (Nam et.al, 2011). These three ligaments are the ischiofemoral ligament, pubofemoral ligament, and iliofemoral ligament.

There are 6 deep muscles that stabilize the hip in the socket, followed by several layers of muscle that move the joint a variety of different directions, culminating with the gluteus maximus muscle which not only generates power and propels the body forward, but is also believed to be the point of load transfer from lower extremity to torso via the thoracolumbar fascia (Barker et.al. 2014). Directly opposing the lateral hip is the “groin” area. This area connects the abdomen and the lower limbs via the inguinal region, consisting of abdominal muscles (internal and external oblique, transverse abdominis, rectus abdominis, and the pyramidalis), the inguinal canal, and the femoral triangle (Valent et.al, 2012). During movement, the pubis symphysis is stabilized synergistically by the abdominals and the erector spinae, and the adductor muscles work in an opposing manner to provide stability to the area during load transfer. In the front of the hip are your “hip flexors,” which flex the femur in the sagittal plane. One of these muscles, the psoas, has attachment points on the lumbar vertebrae and is believed to play an important role in lumbar spine stability in an upright stance (Penning, 2000). It also shares fascial connections to the diaphragm and some believe it may play a role in overall trunk stability, along with the diaphragm, transverse abdominis, multifidus, and pelvis floor (Sajko & Stuber, 2009). A variety of issues can occur in and around the hip joint, including minor issues, such as tendon snapping, and more serious pathologies such as femoral acetabular impingement syndrome (Byrd, 2007). Interestingly, hip pathologies usually present as a “pain in the groin,” rather than pain in the more centralized hip joint area. Obviously, the cause for these pathologies are multi-faceted in nature, and it is worthwhile to note that the hip receives innervation from branches of L2-S1, with the L3 dermatome innervating much of the medial thigh, so if you or someone you work with has chronic groin pain, refer to an M.D. to rule out serious hip or lumbar spine pathology and make sure exercise is cleared.

Clearly, the hip and the muscles surrounding the hip play an important role in movement. It can be unclear how to train this area (do I focus on hip internal rotation or external rotation? Do I stretch the hip flexor or instead think about glute activation?) Each person is unique and what works for some might not work for all; however, hopefully we can begin to examine ways to move the body and integrate the hip in a balanced way. It is important to first bring awareness to the area and see if the hips are balanced, or if any asymmetries exist. An easy way to check this is to lie down on your back and begin noticing the weight of the pelvis on floor. As you begin thinking about this area, ask yourself if the weight of the pelvis on the floor feels even or if it feels unbalanced. If it feels unbalanced, ask yourself which side feels heavier against the floor. (If you have a difficult time identifying the contact of the pelvis with the floor, I strongly encourage you to work on some breathing exercises and learn how to engage your core using your breath. It is possible that by simply focusing on the sensation of your exhale, you will begin to feel a stronger sense of weight of the pelvis). If your pelvis feels like it isn’t quite balanced, chances are this asymmetry will be present during movement. Consider that your muscles are designed to work in a specific manner depending on their length-tension relationships. If you have a pelvic asymmetry, muscles on one side of the pelvis will be in a different position than the muscles on the other side of the pelvis. Unless you begin to correct the imbalance, your muscles will be working differently on the two sides. Now that you have assessed your pelvic position in a supine position, sit down on a bench or chair with your feet flat on the ground. Glance down at your feet. How did you naturally sit? Is one foot slightly in front of the other, or are your feet even? If your feet aren’t even, can you pull the hip of the foot that is forward back a touch to even out the feet? Now, notice the contact of your sitting bones on the bench. Are they both rooted evenly, or is one in better contact than the other? If you can’t find or feel either sitting bone, I highly recommend some breathing work with an emphasis on core integration (you might begin to notice a theme). If you feel one better than the other, can you begin to root the sitting bone that you can’t feel and then relax back to what feels “normal?” Do this a few times and relax. See if there is a difference. Now, come into a standing position. Once you are in a position that feels comfortable for you, glance down at your feet and see if they are even. If they aren’t, can you move the foot back that is forward with your hip? Now, take your hands on your hips and look down and see if one finger appears to be slightly forward or higher than the other, or if they look balanced. Observe the contact of your feet with the floor. Are your feet balanced on the floor, or are you standing more in your heels or toes? Where is your weight more loaded? Is it more on your left foot or your right, or is it even? Find balance. What happens when you spread your toes and lift your arch? Do your feel any activity in your hips? If you have a high arch, what happens when you engage the center of the foot and press the arch towards the floor? Do you feel any activity in your hips?

Before training the hips, it is important to understand there can be imbalances and asymmetries in our pelvis. This influences how we perform movements and which muscles are activated during movement. Bringing awareness to the area is often the first step in recognizing asymmetries that might exist. Asymmetries also affect the body’s ability to move in an efficient manner. Part II will focus more on actually training the hips and integrating the movement with the rest of the body.

Nam, D., Osabahr, D.C., Choi, D., Ranwat, A.S., Kelly, B.T., & Coleman, S.H., (2011). Defining the origins of the iliofemoral ischiofemoral, and pubofemoral ligaments of the hip capsuloligamentous complex utilizing computer navigation. HSS Journa, 7(3), 239-243.
Barker, P.J., Hapuarachchu, K.S., Ross, J.A., Sambaiew, S., Ranger, T.A., & Briggs, C.A., (2014). Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint. Clinical Anatomy, 27(2), pp. 234-240.
Valent, A., Frizziero, A., Bressan, S., Zanella, E., Giannotti, S., & Masiero, S., (2012). Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscles, Ligaments and Tendons Journal, 2(2), 142-148.
Penning, L., (2000). Psoas muscle and lumbar spine stability: a concept uniting existing controversies. Critical review and hypothesis. European Spine Journal, 9(6), 577-585.
Sajko, S., & Stuber, K., (2009). Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implication. Journal of Canadian Chiropractic Association, 53(4), 311-318.
Byrd, J.W.T., (2007). Evaluation of the hip: history and physical examination. North American Journal of Sports Physical Therapy 2(4), 231-240.

Meditation and exercise



Meditation has been showing up in my world a lot lately. It could be argued that as a yoga practitioner, meditation should show up daily, but it is easy to put that portion of the practice on hold for the physicality of asana. It could also be argued that yoga is moving meditation, and I definitely think that it can be, but first a brief explanation of what meditation actually is and how it can be applied to all realms of exercise, not just asana.

Lately, I have been a bit dissatisfied with the fitness industry, or more accurately, the air of negativity and self righteousness that permeates the online scene. Perhaps this is the downside of social media- often the ones with the loudest voices are also the ones with the strongest opinions. I study a variety of systems in an effort to find the most effective way to get people moving well, get them strong, and prepare them for the demands of life. The systems I study all provide aha moments, but I find them incomplete. Each one is missing something and so I am constantly searching for the answer, the one system that will help all of my clients lead pain free lives. I find many people in my profession like to make absolute claims regarding movement, (“Distance running will kill you!” “Yoga will make you weak!” "Kettlebells cure everything!") all while claiming a specific system/methodology/philosophy is the solution to movement dysfunction. This frustration led me to run away to a yoga festival in Boulder and study with several well respected teachers and turn off my phone. Meditation came up in two of the classes, and I found the teachers saying things that made sense. Jason Crandall said that meditation is really the observation of thoughts without judgement, and Maty Ezraty said her cues (which were given while we were shaking in deceptively simple postures) were meant to help focus our thoughts and move us towards a more meditative state. 

According to Wikipedia, “meditation is a practice in which an individual trains the mind or induces a mode of consciousness, either to realize some benefit or as an end in itself.” A meta-analysis performed by Morgan, et.al, (2014) found mind-body therapies are effective at reducing markers of inflammation, and it is well-accepted that meditation can be an effective way to reduce blood pressure, reduce anxiety, and decrease cortisol. The term meditation can indicate several different techniques. A fascinating paper Debarnot et.al (2014) examines the influence meditation can have on expertise (if you have any sort of interest in mastery, this is well-worth the read. The link can be found below). They categorized meditation into two different groups: focused attention and open monitoring. Focused attention is the concentration of a particular external stimulus while ignoring all other input. This was the type of meditative practice Maty was hoping we would achieve by listening to her cues rather than fixating on what our bodies were feeling or thoughts of “this is too hard.” This type of practice can develop sustained attention and enables the practitioner to redirect attention to the desired object, in my example, Maty’s voice. On the opposite end of the spectrum is open monitoring, which aims to enlarge focus to all incoming sensations, emotions, or thoughts without any judgement. This was what Jason was emphasizing during his arm balance class. He wanted us to notice what we felt and observe the thoughts associated with the asana without judging them (harder than it seems if you are at all type A). This type of practice is believed to develop awareness, and improve executive attention. John Ratey, Richard Manning, and David Perimutter point out in their book “Go Wild” there is a belief that meditation is about relaxation and bliss when it is actually about hyper attention and focus. From an evolution perspective, this makes sense. Hunter gatherers needed to use this hyper focus and awareness to both stalk their prey and perceive danger. This requires both focused attention and open monitoring, and the beauty of understanding meditation in this way is that it can be applied to several areas of motor learning and performance.

The easiest way to begin improving awareness is by leaving the cell phone at home or in the car prior to engaging in physical activity. This was one of the things I appreciated about my timel in Boulder. I am not someone that is necessarily tied to the phone; however leaving it at the hotel while I participated in 6 hours of yoga was freeing and allowed me to focus, not just on the yoga, but on my surroundings. While much of the technology built into the cell phones is great for data collection, I will argue that leaving the cell phone when one hikes or runs is a way to increase both open monitoring and focused attention. The ability to observe our surroundings and  thoughts without technology is powerful, and actually focusing on body sensing during movement allows us to recognize unnecessary tension and ease of movement (Danny Dreyer discusses this in depth in his book, “Chi Running”). What “mind-body” disciplines all have in common is they require the practitioner to focus on what is going on, a sort of focused attention to the task at hand. Not using electronics, minimizing music, and choosing movements that require focus are all ways to ensure a movement meditation. While this type of training is harder for the teacher or trainer, the mental benefits could be significant, and perhaps improve our overall health. I frequently cue clients to think about  the breath during “regular” exercise movements in an attempt to keep them focused on the task at hand and ask clients to notice how one part of the body responds when another is moving. Instead of viewing meditation as a separate activity, if we try and incorporate it into our everyday lives and particularly into our movement regimens, we might find an increase in performance, attention, empathy, and health.

Yours in health and wellness.
Jenn






Morgan. N., Irwin, M.R., Chung, M., & Wang, C., (2014). The effects of mind-body therapies on the immune system: a meta-analysis. PLoS One, 9(7). 
Debarnot, U., Sperduti, M., Di Rienzo, F., & Guillot, A., (2014). Experts bodies, experts minds: how physical and mental training shape the brain. Frontier of Human Neuroscience, 8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019873/

The stiff neck dilema



A large survey of 353,000 Americans revealed 31% of Americans reported experiencing chronic neck or back pain in 2011 (Brown, 2012). Interestingly, rates of individuals experiencing chronic pain increases until the late 50s, when numbers level out and slightly drop, possibly because of morbidity. I began working with a 15 year old basketball player 5 weeks ago specifically because of nagging neck pain. His neck had been an issue for months, and a running drill the team did with their hands overhead for 7 minutes caused a spasm that left him with discomfort in the following weeks.  He rested, avoided movements that bothered it, and asked his mom if he could see me so he could get strong without getting hurt. A quick assessment revealed asymmetries in his thorax and pelvis, as well as a tendency towards inefficient breathing. Research performed by Wirth et.al, suggests improving neck flexor muscle endurance, thoracic spine mobility, chest mobility, and respiratory muscle endurance training for individuals with chronic neck pain. Further, Dimitriadis et.al, compared respiratory strength in 45 individuals with chronic neck pain compared with 45 controls. The researchers found the chronic neck pain group had a statistically significant difference in their respiratory muscle strength and concluded this weakness impaired global and local muscle systems in the neck.

When you look at the anatomy, this makes sense. The primary muscles of inspiration are the intercostals and the diaphragm; the accessory muscles are the sternocleidomastoid, scalenes, and serratus posterior superior and inferior. During respiratory distress, the levator scapulae, pectoralis major and minor, rhomboids, serratus anterior, and latissimus dorsi are also involved (an easy to read chart can be found here: http://share.ehs.uen.org/system/files/0720024.pdf). If you glance at the picture above, you will see all of the accessory muscles of inspiration are have attachments at the neck and many of the muscles used during respiratory distress do as well. This, of course, might lead one to wonder if a breathing disorder is causing chronic neck pain or if the chronic neck pain is leading to inefficient breathings patterns? It depends on the person, and individuals that are referred to me because of chronic neck pain fall in the "cleared to exercise, everything else has been checked and is a non-issue" category. In the presence of breathing disorders such as asthma, it is useful to understand the effect this has on stabilization and potential increased activity in the accessory muscles of inspiration. This affects rib cage position and will lead to a decrease in overall stability. When clients are experiencing an increase in asthmatic symptoms because of weather or allergens, I am careful about position and load. Anecdotally, clients that have asthma have reported a decrease in symptoms after 4-6 weeks of regularly implementing breathing exercises into their program. I am not suggesting asthma can be cured by mindful, diaphragmatic breathing, but in my experience, it seems to help the severity of it. 

What I did with the basketball player consisted of three parts. I taught him how to breathe in a more parasympathetic (read, diaphragmatic) manner. This went hand in hand with improving his overall core stability with breathing exercises and bodyweight exercises done in an efficient position. I also made him aware of his shoulder position. He is preparing to participate in a pre-season strength and conditioning program involving olympic lifts. His natural, resting tendency is to have his shoulders up by his ears, which doesn't lead to efficient lifts. This pattern seems to be common in individuals with neck pain and goes along with anteriorly rotated shoulders (which he had). I taught him some techniques to notice where his shoulders were located, and I asked him to "make his neck as long as possible" in a variety of positions. When we first started, he consistently used the strategy of trying to find a way to use his neck to make his neck long. Once he because aware that his shoulder position influenced the length of his neck, he became better able to alter neck position with shoulder position. He was able to bring this increased awareness with him during his daily activities, and I can happily report he is currently participating in all of his pre-season activities (including hours each day of basketball), pain free. Many times, what we do outside the gym matters far more than what we do in the gym.

Yours in health and wellness,
Jenn



Brown, A., 2012. Chronic pain rates shoot up until Americans reach late 50s. Gallup Well-Being; http://www.gallup.com/poll/154169/chronic-pain-rates-shoot-until-americans-reach-late-50s.aspx
Wirth, B., Amstalden, M., Boutellier, U., & Humphries, B.K., (2014). Respiratory dysfunction in patients with chronic neck pain-influence of thoracic spine and chest mobility. Manual Therapy, [Epub ahead of print].
Dimitriadis, Z., Kapreli, E., Strimpakos, N., & Oldham, J., (2013). Respiratory weakness in patients with chronic pain. Manual Therapy, 18(3), pp. 248-53.

Calcaneus neutral- and why the ankle bone really is connected to the hip bone



If you read this blog on a somewhat regular basis, you are aware that I am fascinated by how the body works. This includes an interest with feet and how they impact our movement. Our feet are the first part of our body to receive feedback from the ground. As a result, they are full of mechanoreceptors which send feedback to the brain regarding body position with respect to supporting surface (Kennedy & Inglis, 2002). The ankles and knees provide proprioceptive feedback to the brain which are thought to provide information about joint angle relative to the trunk, linking what happens at the foot and ankle joint to what is happening in our body's center. Interestingly, reduced plantar support (position of the foot) appears to affect stepping reactions to postural perturbations (basically, how you respond to losing your balance). This matters because one of the jobs of the deep core musculature is to maintain stability during walking; this includes making sure the system can recover from large and small perturbations during gait (Stanek et.al, 2011). If our first line of contact with the ground isn't in a position to properly respond to disturbances, how can we expect our deep stability muscles to stabilize when needed? The reverse could also be stated: if the core stability muscles aren't in a good position to do their job, the foot isn't going to be able to do its job. Walking is important, and before we can perform well or move well, we have to be able to walk well and recover from slight changes in the environment that throw off our balance.

The first line of defense is a good offense (or so I'm told) so training the body in a position that addresses foot position is important. First and foremost, I think it is critical to have a spine that is well-organized/neutral/has proper rib cage to pelvis position. This gives the deep intrinsic muscles of the core a chance to do their job reflexively, without conscious activation (and this is what we want. If you miss a step, you do not want to have to actively think, "shoot! Fire transverse abdominis, internal and external obliques, serratus anterior, gluteus maximus!" By then, you will be neatly crumpled on the ground). Further, Moon et.al (2014) point out postural control is automatic and the balance of the body depends on how the center of gravity is maintained by the body's support base; this means small alterations in foot position can change the postural control of the entire body, indicating foot position is important. After the spine position is addressed, a good foot position can be established. I like to spend a little bit of time working with people barefoot, but it isn't necessary. Being barefoot helps a person more readily identify what a neutral position is because of the feedback from the floor, but this can be done in shoes as well. The first thing I like to do is have the person figure out where the center of the foot is located. This means observing normal standing position, rocking forward and back to feel the extremes a few times, and then settling on what feels like the center of the foot to that person. I also have the person rock from left to right and find what feels like 50 percent of the weight in the right foot and 50 percent of the weight in the left foot. This begins to move the person towards a more neutral calcaneus, which simply means the calcaneus on visual inspection will appear centered and you will be able to draw a straight line from the calcaneus up to the back of the knee. This position will allow the arch of the foot to gently lift (if the person has pronated feet) and/or the big toe to begin to engage with floor more actively. It is important to keep the tibialis anterior (the muscle in the front of the shin) relaxed and keep the toes from clawing at the ground. I find it useful to have the person observe how his hips felt in his "normal" standing position and observe any increase or decrease in awareness of the hips in the "new" position. If the person is having a really difficult time with both feet, I frequently use the 1/2 kneeling position demonstrated below to bring awareness to foot position. Doing 5 minutes of standing exercises helps reinforce the position and sensation of the foot and the hip working together. Once in a while, I am unable to improve foot position despite trying a variety of things; when this happens, I refer the client to someone specializing in foot mechanics, such as a podiatrist, for further evaluation. More often than not, I observe improvement in balance and core stability when I incorporate this type of training, and as stated above, walking efficiently is the first step I can take in getting my clients to move well.

Yours in health and wellness,
Jenn

Video Link: https://www.youtube.com/watch?v=hjVYmzPYv0I
P.S.- For more information about barefoot training, I highly recommend checking out www.evidencebasedfitnessacademy.com

Stanek, J.M., McLoda, T.A., Csiszer, V.J., & Hansen, A.J., (2011). Hip- and trunk-muscle activation patterns during perturbed gait. Journal of Sports Rehabilitation, 20(3), pp. 287-295.
Kennedy, P.M., & Inglis, J.T., (2002). Distribution and behavior of glabrous cutaneous receptors in the human foot sole. The Journal of Physiology, 538, pp. 995-1002


Goal setting for mindful movement and the asana in progress project


One of the things that I love about movement is there is always something to work on. Regardless of one's physical endeavors, there is always room for increased efficiency, improved performance, or simply moving to the next level. Over the years, I have had many different goals, some extremely specific ("I will run up this 2.5 mile hill without stopping to walk in the next month," "I will learn how to do the Turkish Get-up,"), others specific to what I viewed as weakness ("I will learn to fire my lateral hip stabilizers on my right side during single leg squats," "I will learn to use my adductors while arm balancing"). Perhaps the most challenging change in my movement that I implemented was last year when I realized my deep core stability as it related to my breathing was not just less than optimal- it was non-existent. I spent three months re-training my neurological system and did so much diaphragmatic breathing that I bruised a little muscle under my sternum called the triangularis sterni. I get bored easily, and setting a goal keeps me interested and moving towards something.

In my quest to learn about movement, I spend time on Youtube watching people move really well. There are the yogis, that float gracefully from one pose to another, the Ido Portals of the world, that could seemingly spend hours in handstand variations, and the Scott Sonnons and Erwan LeCorres that move seamlessly, fluidly, as though there is no effort required at all to lift a giant log or swing a club bell. This is wonderful, inspiring, and can be a great learning tool; however, it never showcases all of the work it takes to get there. I truly believe that almost anyone can achieve whatever movement task they desire, as long as they work mindfully and intelligently on that task. The task will not come overnight; it takes months, sometimes years to accomplish a movement task that poses a large challenge to an individual, and often requires addressing a specific weakness, looking at the task from several different angles, or dedicating specific time to practice the task daily. The way I finally made it up the 2.5 mile hill, for instance, was running it in the dark. Because I couldn't see how much longer I had, I was able to trick myself and just keep running.  In a world where movement tasks such as climbing trees for fruit, hunting down large prey for food, and carrying heavy logs to build shelter are no longer necessary, it is important to set movement goals periodically to keep the mind and body engaged and working together. The mind/body disconnect and lack of movement efficiency that exists in western society isn't healthy for our overall well-being. So, I invite you to join me. Pick a movement goal. It doesn't matter what it is, as long as it is something that you can't do currently. Examine it, practice it, figure out your sticking point, and get creative about moving past the sticking point. To measure your progress, once a month, either film yourself, time yourself, or have someone assess you, depending on what your goal is. My goal, as you will see below, it to link together some of these postures together on my yoga mat. I filmed myself in the middle of my practice, which is eventually where the task should be performed with ease. I will work on these tasks in a variety of ways, by performing some of my sticking points in isolation, in the gym after a strong core session, and in a less fatigued state. However, since the task is to be done during yoga, each month, I will film during a yoga practice and examine my progress. I am giving myself 12 months, and if I complete the task before then, I have two other asanas I am working on that I will devote my attention to. When I was debating graduate school, a client pointed out that in 24 months, I would be two years in the future, with or without the knowledge a master's degree would provide. Which version of myself did I want to be? The same is true with any challenge. Twelve months will pass regardless of whether I decide to improve my strength and mobility. I want to be a stronger me, and I hope you do too.

Yours in health and wellness,
Jenn

https://www.youtube.com/watch?v=es90vm7y8kU

Training the unstable client




I began training Amy* 8 years ago. She came to me because she wanted to build strength and prevent her osteoporosis from getting any worse. I was a much greener trainer at that point, and did my best to challenge Amy with heavier weight, dynamic movements, and body weight exercises. This didn’t go so well, and it became obvious that Amy was unable to support heavier weights, particularly in her upper body. Her shoulders were sloppy, and she didn’t have the ability to perform the movements in a technically proficient way. She also had some instability in her hips, and would occasionally get hip pain. 

My first three years with her was a lot of trial and error to figure out what wouldn’t bother her shoulders and her hips, but would still give her strength (some of my clients are amazingly patient people. Why she stuck with me, I will never know). It wasn’t until I began studying joint position and mechanics and actually understanding how that impacted function that I was able to help her. Instability is rampant in the yoga world; to be good at many of the advanced postures requires quite a bit of mobility. While this should be balanced with an equal amount of strength, it is not unusual for people that already possess a large amount of mobility to gravitate towards the practice. Unless they spend time focusing on finding strength in each asana, this can be detrimental and lead to a lack of cohesive movement. The body will move in a way that lacks underlying support- it’s like removing the foundation of the house and hoping that the beams are strong enough to hold up the roof.

To understand the importance of joint stability, it is important to have a brief understanding of how the nervous system works. When we want to lift our arm, for example, the brain sends information via motor neurons to the appropriate muscles required to both stabilize the body for the action and to the muscles that lift the arm. Inside the joints are sensory nerve fibers that provide information to the brain about forces exerted on the joint tissues, joint position, and whether or not the joint is moving (Grubb, 2004). The nerve fibers that provide this information are called proprioceptors, and are located in the joint ligaments. This poses a problem when a person has joint laxity, or ligaments that are overstretched. In the shoulder, for instance, it is believed dynamic ligament tension is involved in signaling how much force the rotator cuff muscles need to exert on the humeral head (Kelly, 2002). If the ligaments lack tension, this would alter the activity of the 4 muscles of the rotator cuff, as well as decrease the stability of the joint simply because the ligaments aren’t doing a very good job keeping the shoulder in the socket. In a healthy joint, full range of motion should be pain free, the person should know where his arm (or hip, or ankle) is in relation to his body, and there should not be a fear that something is going to “slip” or “fall out,” common descriptors when you work with hyper mobile clients. It has been my experience that when someone falls into the category of hyper-mobility, it is important to change the training strategy to give stability on the deepest level.

In the case of Amy, she returned one summer from travel with shoulders that were not in a very good position. They were painful, her neck was overactive, and she said she couldn’t figure out “where they [the shoulders] are supposed to be.” At this point, I suggested we back off the weights for a while and try and a different approach. She agreed, and while it was frustrating at times, (“why is this so hard? I am not doing anything”), we progressed slowly and steadily. I gave her things to be aware of when she wasn’t with me, such as how to move from the scapula rather than the shoulder to reach for things. We worked on other things as well, such as breathing and improving her thorax/pelvis integration, and eventually we got back to weights, though I don’t have her go very heavy (she is 64, and I find it is better to train smart with older clients, rather than harder). She said to me last week, “thank you. My shoulders haven’t given me trouble in a very long time, and I feel way more stable.” Sometimes, people need mobility, sometimes they need strength, and often they need a combination of the two. We tend to avoid the things we aren’t good at; these are frequently the things we need the most. Having a little patience and an overall plan can go a long way in improving function and well-being.

Yours in health and wellness,
Jenn

P.S.- For a glimpse of some of the things I use to enhance shoulder stability, view the link here: https://www.youtube.com/watch?v=pmY8J2EVxuM


Grubb, B.D., (2004). Activation of sensory neurons in the arthritic joint. Novartic Found Symposium, 260, pp. 28-36.
Kelly, I. The Loose Shoulder, Maitrise Orthopedique, 111.

The Integrated Systems Model, and evidence based practice




I recently listened to Diane Lee's lecture on the Integrated Systems Model, which she uses to classify her treatment strategy (more information can be found on her website here: http://dianelee.ca/the-classroom.php). I am quite fond of her presentation style- she has a good sense of humor, doesn't seem to take herself too seriously, and is passionate about her subject matter. If she allowed personal trainers to take her courses, I would figure out a way to get up to Canada and attend one of her 4 day workshops. She made a number of points in this particular lecture that resonated with me, and one thing she discussed rather extensively was evidence based practice.

Evidence based practice (EBP) has become a bit of a buzz word in the last 5 years. Practitioners want credibility, so they search out evidence (i.e., research) that demonstrates they are on the right path, while consumers want proof that what they are doing will help them become healthier/fitter/stronger/better. This is fair; the profession of exercise or movement science is quite young, and for every person that claims exercise helped, another says that exercise caused pain. It is muddy, and unclear, and everyone has an opinion. The term "evidence based medicine" was coined by Dr. David Sackett in 1996. He wrote, "...evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients," (http://en.wikipedia.org/wiki/Evidence-based_medicine). According to Ms. Lee, there are 3 components associated with this. The first (and the one most people attach to) is the research. For the research to be high quality, it should be a random control trial. Here is the thing with research when it comes to exercise- you can find a study supporting almost any view you want to take. In graduate school, I noticed over and over again during class discussions that people could take completely opposing views on something and there would be research to support both sides. By the time I was in my second year, I began to realize that sample sizes of things I was interested in were typically extremely small, the studies weren't always designed in a way that mimicked actual performance (who runs solely on a treadmill?), and not very much research on functional exercise or performance actually existed. I read through several studies last weekend examining deep core stabilization and how the intrinsic muscles of the core affect function. What I found was dismal. Saunders, Roth, and Hodges state, "despite the importance of the deep intrinsic spinal muscles for core control, few studies have investigated their activity during human locomotion or how this may change with speed and more of locomotion." This was in 2004, and not much has been done in the last decade to improve upon this.

The next component to the evidence based model is expertise. Experience comes from learning the material, practicing the material, and figuring out how to apply it. In the ISM, having a variety of tools is encouraged; the key is knowing when to apply those tools. It took me a while, but I eventually realized I am happiest in my career when I am learning. I find that what works best for me is learning a system fairly well, integrating it fully into my own workout/movement practice, and then using it with my clients. At this point, my tool box is diverse, and I feel comfortable using what I know. When I first learn something, I tend to use it on everyone; as the material becomes less foreign to me, I am able to more readily identify which tools fit best with each client. This is the final component to an evidence based model. The sample size that ultimately matters is when n=1. Not every modality works for every person. Some people respond really well to certain things, while others need a completely different approach. Working solely in an exercise setting, I can genuinely say I have experienced situations where 90 percent of clients do really well with one particular movement, while for the other 10 percent, that movement doesn't work at all. Experience comes largely into play, and over the years, I find I am able to figure out the best course of action with people a little more quickly.

Another note about EBP is a lot of the techniques that are out there are seriously lacking in research. Anecdotally, people will tell you "system x/y/z changed my life." Again, the sample size of n=1 is what matters. The beauty of this is that there is something out there that will work for everyone. It might take a while to find it, but patience and an open mind are key. From a consumer's perspective, I recommend trying something 4-6 times. This is enough time to let you know whether you a) hate it, b) don't really mind it, but aren't sure it's doing something for you, c) notice a little bit of difference, but maybe that's attributed to the 5 other things you changed at the same time or d) you know in your heart this is it. It's changing your life. As a practitioner, it is extremely important to learn things that resonate with you on some level. Maybe it's the material, maybe it's the teacher, but whatever it is, it needs to move you to learn it well and apply it in a manner that your passion for the material can be conveyed. This means that maybe not every workshop you go to will work for you, and maybe some things will work for you for a while, but then you might stumble upon something else that works a little better. Or maybe one specific system is your thing and you want to study that intensively for years. Find what works for you. Personally, I find that each system/teacher has strengths (and obviously, I haven't studied every system that is out there); the flip side, is they all have weaknesses. This is why I immerse my body into whatever it is I am learning about. I try it on, see how it fits, see how it makes me feel. Studying anatomy and physiology and reading a bit about the brain also allows me to better understand why things work (and I am very much a "why" person). Keeping an open mind when it comes to movement techniques and searching out quality, passionate instructors will help individuals find movement that they both enjoy and enhances their lives.

Yours in health and wellness,
Jenn

Some quick notes on the importance of the pelvic floor and why the body's second diaphragm should be addressed during movement

Over the last 8 months, I have become fascinated by the role pelvic position plays on the body's stability. More accurately, I discovered the importance of the pelvic floor on all things low back oriented. I train many people that suffer from low back pain. some of whom have had surgery, others that are trying to avoid surgery. While many of them have positional similarities, the most striking similarity I have found (now that I know to look for it), is the inability to maintain pelvic position with activation of muscles that work in the transverse plane, such as the transverse abdominis and internal rotators of the hip. Once this is cued correctly and the person knows how to "find" the proper engagement, stability increases dramatically (and people feel their "core." It's pretty amazing). While there are often other things that need to be addressed in these clients to improve function, this is an incredible starting point. The senior yoga people have been trying to explain this to me for years; however, rather than explain the anatomy, they use mystical terms such as mola bandha. I think many of the advanced pilates/gyrotonics people might know this, but I have never been fully immersed in that world, so I can't speak for sure.

The pelvic floor is often considered the body's second diaphragm. When there is a physiological change in the diaphragm, either during inhalation, exhalation, or coughing, there is a symmetrical change in the pelvic floor activation (Bordoni and Zanier, 2013). In order for proper intra-abdominal pressure to be maintained during respiration, support from the pelvic floor is required. This ensures trunk stability, and corresponds to activity in the transverse abdominis and internal obliques- therefore, if your pelvic floor isn't working properly, your deep abdominal muscles probably aren't working properly, causing an alternative (and less efficient) stabilizing strategy.

How does this relate to pelvis position? It is worthwhile to note that the pelvis is required to move in all three planes (sagittal, frontal, and transverse) during the gait cycle (Lee & Lee, 2011).  The sacrum, which attaches to the pelvis at the sacroiliac joint, needs to nutate and counter-nutate during various movements. For the purpose of this blog, think of the sacrum as something that moves slightly to handle load dispersal. If the sacrum is unable to move because the pelvis isn't able to move in all three planes, load will not travel well up the spine. If, for instance, someone remains in an extended posture most of the time, the anterior inlet spills forward and abducts, and the posterior inlet moves backward and adducts (see picture below). Think of what happens to the sacrum if the pelvis is stuck in this position- it can't move and the muscles on the back of the pelvis (specifically the piriformis) are going to be "gripping" to keep a person upright. Further, the muscles in the pelvic floor are long and loose- they aren't able to provide the support needed for the bottom of the canister to co-contract and provide stability. This is going to lead to movement inefficiencies (and possibly SI joint "tightness" or pain). In this example, to move the pelvis to neutral, we need to inhibit the piriformis by activating the internal rotators of the hip, activate the hamstrings to pull the pelvis down in the back, and activate the transverse abdominis and internal obliques to pull the pelvis up in front. In a sense, we are mobilizing the pelvis so it can move more freely during the gait cycle. (For some ideas on how to work with someone in an extension pattern on co-activation of the muscles in the pelvic floor, see the video: http://youtu.be/UtJnY0MhIPA).



(The anterior pelvic inlet is labeled in the picture above. You can see how when the pelvis tips forward, it will give the appearance that the top portion of that circle is widening. Conversely, the posterior pelvic inlet, which would be the view from the back and can be seen in the picture below, will appear to narrow when the pelvis is tipped forward. If you look at where the SI joint is located, you will notice that if you tilt the pelvis forward, the sacrum won't have much room to move).





As I have mentioned before, I view my job as a movement professional to help people move as efficiently as possible. This is directly related to the body's ability to stabilize on the deepest level, and really, it means having an understanding of what is required for the body to do that. If the pelvic floor and the engagement of the deep abdominal muscles is ignored, performance will be hindered. The crazy thing is I have watched efficiency (and movement quality) improve dramatically in yoga practitioners, golfers, and triathletes by simply improving the function of the deep stabilizing system. I have also seen grandparents pick up their grandchildren without pain, and low back pain lessen. Anatomy and physiology in the absence of disease is consistent- understanding how the body works dynamically is the most valuable tool a movement professional can have.

Your in health and wellness,
Jenn

P.S.- If you find this topic interesting and would like to study it further, I highly recommend Diane Lee's work (her website can be found at http://dianelee.ca/index.php) and/or the Postural Restoration Pelvis course (either home study or live).

Bordoni, B., & Zanier, E., (2013). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, pp. 281-291.
Lee, D., (2011). The Pelvic Girdle, Fourth Edition. Churchill Livingston Elsevier: Toronto.

The problem with SMART goals, pincha mayurasana, and why it's okay tofail






I read a lot of blogs. And research articles. And non-fiction books (I was interviewed recently about the personal training industry. I told the journalist I had a continuing education problem, but perhaps it's more of a curiosity problem). I always enjoy the writings this time of year because they tend to be reflective and/or hopeful, focusing on what was accomplished or where the author wants to go. An acronym that is thrown around frequently when people talk about resolutions is SMART goal setting. I wrote a blog on this years ago, when I was in the midst of a Wellcoach training program and convinced SMART goal setting was the only way. Needless to say, my views have changed a bit, although I think setting goals that are specific, measurable, attainable, realistic and timely are great for people that have daunting tasks ahead of them ("I will lose 5 pounds this month" is a much better goal for someone with 100 pounds to lose than "I will lose 50 pounds in 4 months." The person needs something within his grasp to experience success, rather than a seemingly insurmountable task). For some, the word "attainable" is synonymous with "safety," and this is where I think the acronym shouldn't always apply.

I have written before about the fact that I am stuck in PSP (primary series purgatory). This happens to individuals that are relatively inflexible Ashtanga yoga practitioners with limited access to a teacher. These individuals never get progressed because they aren't technically proficient at, say, supta kurmasana, so they remain in PSP for years. This leads to boredom and eventual exploration of other poses. I decided to work towards arm balances, because they look cool, and posed a physical challenge that I didn't think was impossible. I suppose it could be argued that this fact makes my goal attainable, but I never set a time limit on it, or even really had any other aspiration other than to do pincha mayurasana in the middle of the room. I started working on this two years ago (yes, you read that right. As I said, no time goals). My first attempt (done after several youtube tutorials and some floundering attempts against the wall), resulted in my falling. So did my second. And third. And when I tried again a couple of days later, I fell. I fell over, and over, and over again until one day, my legs were over my head and I was balancing on my forearms, almost certainly with a bowed back because I didn't have good shoulder girdle strength at the time (I know now), but the point was, I was up. I was able to repeat this pretty regularly, not always on my first attempt, but usually on my second or third attempt, until I felt like I could safely say I could sort of do the posture. Over the last year, I have rebuilt my practice with a neutral spinal position, the ability to engage my bandhas (it turns out, if you ask someone in an extended spine position to engage the bandhas, it's pretty close to impossible, but that is another blog), and a much better integration of the shoulder stabilizers. As a result, pincha mayurasana continued to feel steadier until one day, 4 weeks ago, when I kicked up with a fair amount of control and fell over. "No big deal," I thought, "I will try it again." And I did, 7,8,12 times until my arms were shaking, deep frustration had filled me, and I finally recognized my mind and body weren't going to cooperate, so I let it go and finished my practice.




This, of course, is the beauty of any sort of challenging, mindful movement practice. It teaches you to fail, walk away, and know that you can attempt it again tomorrow. It is also the reason we have to remember to set goals that are slightly out of our reach, maybe not attainable on the first try. When I was going through the process of opening my studio last summer, I found myself thinking at one point, "what if this doesn't work?" I had run numbers, looked at business trends, and consulted with someone I trust, but there is no way of knowing for sure whether or not a new business is going to fail. Opening my own space had been a long term goal of mine for years, and similar to my goal of forearm balance, I never set a timeline for myself. I simply put it out there as something I wanted to do (it was written on my regrigerator), and when the opportunity arose, I jumped with both feet. Rather than dwell on my negative thoughts, I acknowledged it, let it go, and instead directed that nervous energy at becoming an even better professional. Recently, while working with a client, coaching, cueing, and guiding, I realized, "I finally get it." All of those concepts I have struggled with over the last 13 years, watching people move, reading, listening to experts in various movement fields explain "how" to help someone move better, the systems that I have studied, all came together in this crazy way. This isn't to say I don't have more to learn, or that I know it all; I have only scratched the surface, but all of the time spent learning challenging concepts is allowing me to do my job better than I ever have before.

When I returned to my yoga practice a couple of days later, I lifted up into pincha mayurasana with ease. Each time I have practiced it since, I feel stronger and steadier than I ever have before. I have read about this with skill acquisition; often there is regression before there is progression. While I expect I will still fall, I am confident it will happen less and less. When setting New Year's resolutions, remember It's okay to fall, and it's okay to fail, as long as you pick yourself up and try again tomorrow. You will be better for it.

Wishing everyone a healthy, happy 2014.

Yours in health and wellness,
Jenn

The little muscle that could, or why the serratus anterior is important for stabilization




I have come to the realization that I don't like the way anatomy is traditionally taught.  During my undergrad, we went to the medical school at UC Davis, looked at prosections, and learned the muscles of each section- their actions, their origins, and their insertions.  We never looked at how the body as a whole functioned to move, or approached anatomy the way I like to think of it now- these chains of muscles provide postural stability, these chains of muscles provide the strength necessary for movement, and here is how they interact (more anatomy trains-esque, although I am finding that understanding how to walk well is key to athletic performance.  If you aren't walking efficiently, you aren't going to move efficiently during basketball, yoga, Crossfit, or whatever athletic endeavor you pursue).  Prior to starting my graduate studies, I spent a weekend studying yoga with Kino MacGregor.  She talked about "filling in the space between the shoulder blades" and activating the "serratus anterior." I was intrigued, both because it changed the way my plank felt and because it was a muscle I had heard of, but never given much thought to.

Fast forward four years: I have learned the serratus anterior is both critical for walking well, important for shoulder girdle stability, and begins the chain of muscles that stabilizes the core.  The serratus anterior has attachment points on the front side wall of ribs 1-8 and the front surface of the scapula (http://www.anatomyexpert.com/structure_detail/5505/151/).  It shares attachment points with the diaphragm, which has attachments at the xiphoid process, ribs, and lumbar spine.  The diaphragm crura blends with the crura from the transverse abdominis; the diaphragm fascia also intertwines with the fascia from the psoas (Hatley, 2006).  The serratus anterior (SA) protracts the shoulder blades and stabilizes the shoulder girdle and, like the transverse abdominimis, fires before you move to provide stability.  The diaphragm is a muscle of inspiration and aids in postural stabilization.  Its ability to properly dome up is based on the position of the rib cage (Hruska, 2005). This ultimately affects the ability of other muscles of the core to properly function, specifically the internal obliques and transverse abdominus. The transversus abdominus (TrA) is essentially the SA of the lumbar spine.  It creates intraabdominal pressure and provides stability before movement, acting on a feed forward loop.  The psoas flexes the hip and provides lumbar stability. Anteriorly and from a stability perspective, this links the shoulder to the hip in four steps.  The interesting thing about all of these muscles is their ability to properly stabilize is position dependent.  If you have scapula that are retracted in a resting position, your SA isn't in a good position.  This is going to limit the ability of both the diaphragm and the TrA to properly function.  If the scapulae are retracted, chances are high that during rest, the rib cage is in an inspiratory position, which will affect pelvis position.  The ability of the deep stabilizers to work together is necessary for efficient movement mechanics, so while this started as a discussion of the oft forgotten serratus anterior, it's really a discussion of one piece of the deep stabilizing system.

Diaphragm Image

So how do we make sure it is working and why do we care?  We care because if it's not stabilizing the shoulder girdle, something else has to, and usually that something else is the latissimus dorsi, rhomboids, and upper fibers of the trapezius.  These muscles affect resting position of the scapulae, which is problematic if you raise your arms overhead for any reason.  They also affect resting position of the pelvis, with an overactive latissimus tilting the pelvis anteriorly. This can also lead to a "pain in the neck," quite literally.  Breathing should not take place with the shoulders elevating each inhale; when this happens, the upper trapezius and scalenes are going to be working overtime, which can cause overuse.  This also means the diaphragm isn't working properly, which means the lumbar spine isn't being properly stabilized, which means the pelvic girdle isn't in an optimal position.  In order to improve efficiency, the SA needs to be addressed.


The next question is how?  First, we have to inhibit the overactive muscles and improve position, so the SA in a better position to do its job.  If the scapulae are pulling away from the back, the scapulae retractors are working in over time.  To stretch them, we are going to protract the scapulae and bring the rib cage back to meet the shoulder blades. Protraction also fires the SA, so we are killing two birds with one stone.  Once the thoracic spine is less locked up and the scapulae are resting on the back, we can work on position.  The medial borders of the scapula should be parallel to the spine at the level of T2-T7 and flush against the thorax (Osar, 2012).  I use a tactile cue, which is demonstrated in the video below, but the key is to get the sense that the upper back is broad and the scapulae are gently being pulled down and around the back. This will inhibit the upper trapezius and activate both SA and the lower fibers of the trapezius, which relaxes the overactive muscles in the neck in people that are neck breathers.  This needs to be done in order; skipping directly to lower trapezius/SA stability won't fix faulty shoulder position.  The goal of all movement direction and cueing should be efficiency- how can we get the body to move well with the least amount of effort?  This doesn't mean there won't be work; it simply means the body will work more cohesively, and ultimately perform better.

A quick side note- I find it is helpful to remember the shoulder girdle functions like the hip girdle.  If we can relate the function of the muscles in the shoulder girdle to those in the hips, it sometimes makes things a little less foreign.  I will be discussing this in an upcoming post.

Yours in health and wellness,
Jenn

Video link: http://youtu.be/KEqv3V9-htc

Hatley, S., (2006).  Anatomy and Asana: Preventing Yoga Injuries.  Eastland Press: Seattle
Hruska, R., (2005).  ZOA position & mechanical function. Postural Restoration Institute, viii-xi (http://www.posturalrestoration.com/resources/dyn/files/1051512z69443dbe/_fn/ZOA.pdf)
Osar, E., (2012).  Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.  On Target Publications: Aptos.

Four examples of how I use PRI and DNS during training sessions, plus a plank variation...


I often get asked by other fitness professionals that are studying neuromuscular techniques or are thinking about studying neuromuscular techniques if I use it.  "Yes," I always reply, "all of the time." The inevitable follow up question is how?  How is it implemented into sessions that are supposed to be strength and mobility based?  How do you find the time to test/re-test and actually use some of the correctives when really, our job as trainers is to get people strong? Below are four examples of clients that I use the techniques with often.  The principles of DNS/PRI are utilized in every session I perform; the depth to which I use it depends on both the client's goals and how the client wants to use the session.  I should caveat this with a little about my clientele.  I do not have individuals walk into my studio that have absolutely nothing wrong.  This just doesn't happen.  Even if the person says he has no musculoskeletal issues, after 30 minutes it isn't unusual for there to be references to car accidents, shoulder surgeries, migraines, and my favorite, open heart surgery (while not a musculoskeletal injury, it still seems something worth mentioning to your trainer at the initial intake, but apparently not everyone shares that sentiment).  And, despite what some might think, I do train people under the age of 60.  They have things going on as well (degenerative disc disease at 40?  I am totally your girl).  The take home message is many of my clients have tried traditional exercise programs and have either been injured or had the feeling they were going to get injured if they continued on that path.  And so they end up in my studio, looking to me for guidance, for a safe program that will make them strong and able to do the things they enjoy in the real world.

Kate* is a 70 year old former professional dancer.  She has had chronic neck pain for the last year (diagnosed OA), suffered from a bout of spondololythesis about 16 months ago, and wants to gain functional fitness. She walks regularly and has participated in a variety of fitness programs over the years (her dance career ended in her late 20s).  She is also missing something structural in each foot (fairly certain it is a bone, but not 100 percent).  As a result, she has never been stable standing on one foot.  The very first session, I used DNS techniques to activate her SA (supine and prone 3 month model).  I also taught her how to bring her ribs to her shoulder blades, drop her ribs down, and activate her IOs and TA using PRI breathing techniques.  I did run her through some of the PRI tests, and she has instability issues in her hips.  After we worked on those things, I taught her how to stabilize standing, using her "center." She was able to stand on one foot for the first time in decades without pain or unsteadiness.  We have since progressed to dynamic balance using stepping sequences.  We discussed breathing and I showed her a handful of breathing techniques to help shut off her neck.  I have learned the hard way not to load an overactive upper trapezius.  Bad things happen.  Fast forward 6 weeks.  She walked in for her weekly appointment and said to me, "before we start, I have to understand what we are doing."  "What do you mean?" I asked.  "For the first time in a year, my neck pain has subsided.  You haven't touched my neck.  What are you doing?" This is the power of beginning to understand reciprocal inhibition and facilitation, coupled with the client having the awareness to notice breathing patterns.  She has also told me repeatedly how excited she is to stand on one leg.  It's empowering to be able to do something that has alluded you for most of your life.  We are slowly progressing to a more strength based routine with an emphasis on proper alignment and breathing.

Pete* is a 58 year old executive.  He has been active his entire life and has a bit of a type A personality.  He had low back surgery 16 months ago (disc repair), and, unfortunately, a negative physical therapy experience.  He began seeing me 12 months ago to regain fitness and get back to the activities he enjoys.  We started with working on DNS principles of getting the rib cage more neutral and engaging the SA.  We also worked on the external rotators of the hips and on the integration of the foot and hip using DNS techniques.  We got a bit stuck (he was plateauing, and I wasn't really sure where to go), so a PRI physical therapist assessed him and gave me some ideas.  We had one more set back, involving a very bad adductor drop test that I didn't address at the end of the session and a back spasm the next day (pretty sure it was related to moving furniture, but I didn't tend to my details when I should have, so I placed much of the blame on myself), and are now working towards neutrality by testing at the beginning of the session, repositioning, emphasizing breathing during the core work between the circuits, and re-testing at the end.  He also has breathing homework that he might be doing sometimes (I am not really sure how often, but I know that he is at least more aware of his breathing and knows how to get his ribs down).  He began playing golf 4-6 months after we started working together, walks regularly, and says he is the most fit he has ever been.  He made an interesting comment recently.  He has been working out with trainers off and on for the last 30 years, and he said he noticed that while he got older and his needs changed, the techniques the trainers used stayed the same.  I am the first trainer he has had that approaches things differently.  While I think more and more trainers that are serious about training as a profession are starting to use different techniques, I thought it was a fascinating glimpse into an industry that is slow to adopt new ideas. I am hopeful that in the next 4 months I will be able to help Pete move even more efficiently and enable him to continue doing the things he enjoys.**

Jess* is a 33 year old professional.  She is extremely active and movement keeps her sane.  I have worked her off and on for about 5 years.  We have always done more traditional strength training sessions, using primarily body weight, suspension trainers, and some weights.  She e-mailed me 4 months ago before one of our sessions to ask if we could just spend the hour stretching.  She was experiencing a lot of pain in her mid back, her hips were killing her, and she was sure she was going to have to give up running, which was making her sad.  When she arrived the next morning, I told her I was happy to spend the hour stretching if she thought that's what she needed, but I suggested we try some other, out of the box, things first.  She said that would be okay, so I ran her through some of the PRI tests (which made it pretty apparent why her mid back was bothering her), and we spent the next hour working thoracic mobility with breathing, engaging her IOs and TA, and helping her shut off some the things that were in a state of overactivity.  I told her to not make any declarations regarding running yet; rather, see if she felt better after our session, and see how things went.  She e-mailed to say she felt much better, and over the next 4 months we worked on activation with breath and have recently begun working on balancing out her frontal plane.  She is feeling much better, her mid back pain is gone, her hips only bother her when she does too much and throws herself back into an extension pattern, and she is running pain free (not everyday, but every other day).  We are back to devoting most of our session to strength and mobility work, but spend time in the warm-up on activation/inhibition techniques, and I make sure position is encouraged throughout our workout.

Jenn is a 33 year old personal trainer.  She loves all things movement, and has been active for as long as she can remember.  She runs and bikes (often), swims (a little), practices yoga, and spends some time in the weight room working primarily on body weight drills with a little bit of kettlebell work thrown in.  She pulled her hamstring in the gym 5 years ago and while the pain went away, she never really addressed the root of the problem.  She re-injured it a year ago during a daily yoga regimen that wasn't really that mindful and coincided with running a trail 1/2 marathon.  She began implementing some of the DNS positioning techniques and also began using a regular DNS flow as part of her daily warm-up.  It began to heal, and she noticed things were feeling a little bit better, but than she got a bit stuck.  She began learning PRI and it became obvious that she needed to address some major extension issues if she wanted to continue playing hard.  She began doing PRI every day with DNS as part of her warm-up (about 10 minutes) and implemented some of the PRI exercises during her 3 days/week gym routine.  She utilized the philosophies of both DNS and PRI in her yoga practice, and noticed a change in how she moved and how she felt.  One day, while running herself through some self PRI tests, she discovered she was actually in a state of neutrality.  This made her want to jump for joy, but instead she used it as an opportunity to progress to learning some of the PRI standing exercises.  Her low back no longer feels any sense of compression in back bends, her shoulder blades don't feel a sense of "tightness," and her hamstring feels wonderful.  She strongly believes DNS and PRI together are powerful tools.

Below is a link to a plank sequence I use when I want to activate IOs and TA.  It emphasizes breath to activate the abdominals and focuses on the ribs being in a state of exhalation.
https://www.youtube.com/watch?v=BMqbT_Q2B9k

*All names have been changed except for the last one.  Jenn, as you probably guessed, is me.
**Two days after I published this blog, I received a phone call from Pete's doctor.  He was impressed by Pete's mobility, strength, and overall fitness, and was wondering if he could refer people to me.  He has been looking for a fitness professional that "gets it" and is able to work with more difficult conditions for some time.  I am grateful I found methodologies that make sense to me and have such a profound affect on people's wellbeing.

Yours in health and wellness,
Jenn

Lakshmi, PRI re-positioning, and the brilliance of DNS positions



I was at a yoga workshop last weekend where the teacher discussed some of the Hindu goddesses.  One of the goddesses, Lakshmi, is the goddess of wealth, both internal and external.  As the teacher explained Lakshmi's influence over fortune, she said that part of Lakshmi's power is that she tends to the details.  Tending to the details allows wealth to grow and will result in good fortune, not necessarily in the form of money, but in an internal sense.  It was one of those stories that stayed with me for the week and made me wish I had more patience for the Indian texts (I failed miserably at my one and only attempt at reading the Bhagahavad Gita.  I lasted half a page).

Fast forward 5 days.  I was training a lovely endurance athlete yesterday who has gone from pretty much bullet proof to having some things crop up.  This, unfortunately, happens to endurance athletes, and if they don't get a handle on the root of the problem, they end up spending the next 10 years of their careers "chasing pain" so they can participate in their respective sport.  I have worked with her off and on for a long time (4 years), and I decided yesterday to run her through some of the PRI tests to see what was going on and to give her a more directed, therapeutic program for the off season.  There was only one glaring issue (left AIC), so off to work we went.  After 10 minutes of re-positioning work, I re-tested her, tending to my details, found she was in a much better position, and we moved on with our session.  While we worked on the normal strength training stuff for her upper body, I used several DNS positions for her lower body to try and improve some of her firing patterns.  Her main issue seems to stem from an old ankle injury and her right glute max is taking a pretty intense vacation.  I started her in DNS side lying, couldn't really get any activity there, moved to 3 month supine mode, where I had much better success, and then skipped forward to tripod sit, which is far more developmentally advanced.  She is a crazy endurance athlete after all; I figured I should be able to get some activity going and add some challenge.

While I was moving her through the DNS positions, it occurred to me how brilliant the system really is.  The goal of PRI is reciprocal, alternating movement; DNS addresses movement dysfunction via developmental positions.  The goal of the baby ultimately is walking which is reciprocal, alternating movement.  The higher developmental positions do a wonderful job with pelvic orientation and  addressing strength and mobility needs specific to various stages in the gait cycle.  In many ways, it makes the job of the movement professional easier- make people walk well.  Only then are they going to be able to perform well athletically.  Tend to your details.

At the end of the session, I put her back on the table to re-test her position.  I do this with people when I begin working on improving position.  I want to make sure I am on the right track.  Her left leg didn't drop.  At all.  I had undone her position.  This has never happened to me before- my sessions always address the needs of the individual and I pay attention when there are significant imbalances.  But I had skipped steps.  When she couldn't activate in side lying, I moved her backwards, only to jump forward again.  The neurology wasn't ready for that.  I didn't tend to my details and instead of taking the proper steps, I tried to skip ahead.  I promptly re-positioned her using PRI techniques, re-tested, and she was back to the position I had attained at the beginning of the session.  The take away message: don't rush the process.  Systems exist for a reason and you cannot cheat the system when it is based on neurology.  And don't forget to tend to your details.

Yours in health and wellness,
Jenn

Some quick thoughts on high intensity exercise, breathing, and a potential philosophy shift



Let me start by saying I love hard exercise.  I always have- there is nothing quite like a hard workout, where all of your muscles are fatigued, you feel physically tired, and like you can conquer the world because nothing is quite as challenging as the 40 minutes you just spent killing yourself in the gym.  Whether it's circuit training, spinning, intervals of some sort, or HIIT, there are many different ways to effectively accomplish this, and I think it has a place.  However, what I have come to realize in the last two years is that if we can't shut our sympathetic nervous system off and bring it to a place of calm, we are inevitably setting ourselves up for injury.

We live in a high stress world.  We are always on the go, we multi-task, our brains are constantly being exposed to stimulation.  We don't get outside enough to enjoy our natural surroundings, we don't play enough, and we rarely relax and breathe.  In fact, our breathing often feeds into this inability to calm down.  We breathe into our chests, following a more "fight or flight" type of pattern, with our ribs up and our mouths open.  I ask clients to take a deep breath and I see their chests rise high towards the sky and their bellies not move, or sometimes cave in.  These same clients have upper trap tightness, "tight hips," and low back pain.  There is a general sense of fatigue that follows them, although they aren't sure why.  For these clients, I am going to argue that stimulating their sympathetic nervous more by having them perform high intensity exercise would be a mistake.  It would feed into this pattern of hyperactivity and chronic tightness.  These clients have to learn how to shut their superficial muscles off, find a state of calm, and learn how to breathe.  This is going to benefit them far more than further activating their sympathetic nervous system.  Once they learn how to come down, how to breathe, how to activate their deep stabilizers to keep them upright rather than hold on for dear life with their prime movers, then they can benefit from higher intensity exercise.  However, it is critical to make sure they have returned to a state of calm, with ribs that aren't flared, a sternum that's not lifted, and a breathing pattern that's not feeding into a hyperactive state, both mentally and physically before they walk out the door.  I strongly believe that people should be able to alternate from a state of hard physical work and physical ease seamlessly, with little fanfare.  If you watch the good movers move, you will notice this is what they do.  Watch Ido Portal or Erwan LeCorre, or Kino MacGregor, and you will see an easiness to their movements.  Continue to watch them move and you will see their breath is even, their mediastinum is open, their diaphragm is fully functional.  This is what we should want in our own movement practices and for our clients.  On occasion someone who has been doing lots of high intensity work shows up in my studio.  It could be someone practicing for TacFit, someone participating in Crossfit, or someone who loves HIIT classes at the gym.  All of the individuals want to get back to their respective activity and the one thing they have all had in common is faulty breathing patterns.  I encourage all of these individuals to practice breathing before and after their workouts in an effort to get them out of this pattern that is doing them harm.  I am not suggesting that learning how to breathe will prevent injuries; however, I believe it is a good place to start.

Yours in health and wellness,
Jenn

5 things I have learned studying neurologically based training methods (specifically, DNS and PRI)


Over the last 18 months I have become mildly obsessed with neurologically based training.  My accountant (who is also a client), claims it's because I am bored now that graduate school is finished and I need something to study.  This is partially true- there is something inherently rewarding about studying and implementing concepts that are somewhat challenging to grasp.  I am forced to think, try, and apply until I figure out how (and if) it works.  On a more basic level, neurologically based training simply makes sense to me.  It answers questions about things I have always noticed, but never really understood.  It examines patterns, and it supplies ways to correct patterns that might be inefficient.  It speaks to my yoga background, where I have trained with amazing individuals that have taught me effective techniques, but never fully explained "why" the techniques work.  However, this type of training isn't for everybody, and it definitely isn't the easiest way to approach human movement.  Outlined below are 5 lessons I have taken away during the last year and a half, and I am sure there are many more to come.


  1. Breathing is important.  Not just important, paramount to good movement patterns, decreased pain, good shoulder mobility, and good hip function.  If breathing is dysfunctional and isn't corrected, it can be very difficult (if not impossible) to get good quality movement.  I have sat through almost 40 hours of lecture on this topic, and am just beginning to sort of grasp it.
  2. Reciprocal inhibition is critical to good movement patterns.  Physical therapist and PRI instructor James Anderson says something along the lines of, "anyone can turn a muscle on.  An expert knows how to turn muscles off."  (This comes from the moykinematics home study course).  Certain things we see over and over again as fitness professionals- tight upper traps, overactive IT band, quad dominance, overactive lats...  The list goes on.  Over the years I have learned to train around things so that I don't flare something up.  A better solution is to turn things off so they aren't active, freeing up the proper stabilizers to do their job.
  3. There are many different ways to skin a cat (I think that's the saying.  I have always wondered where that phrase comes from- aren't cats pets?  And who wants to skin one?  But that's a different blog post).  Some people respond well to simply moving more.  Yoga works really well for some, probably because it activates several muscle chains, there is an element of focusing what you are doing and telling your body how to move (neuro training).  Pilates works well for others.  Primal movement, CST, NKT, z-health...  There are several acronyms that are effective at training the neuromuscular system.  DNS and PRI resonated with me.  This doesn't make them the end all, be all.  My clients are making very positive gains and many of my clients are suddenly practicing breathing when they aren't with me, moving better, and feeling better.  This is important to me.  As a result, I will continue to learn these two methodologies, but that doesn't mean I will discount other techniques or be unwilling to listen to experts discuss them.
  4. Just because you go to a workshop, you are not an expert in the topic.  These methodologies take time to learn.  And practice.  And a willingness to ask for help.  If you aren't willing to do these things, I recommend learning something else.  I not only do PRI and DNS regularly (it is not unusual to walk by my studio and see me with 2 or 3 manuals out, trying different things, figuring out how it all fits together), I attend workshops, ask questions of more advanced practitioners, and re-read informational material.  I am willing to sit through lectures multiple times in an effort to understand the material better, and am constantly practicing on my clients.  Again, this is hard, and more intensive than other training techniques I have studied.
  5. Test/Re-test is invaluable.  I know other methodologies use this philosophy. Prior to PRI in particular, and DNS to a lesser extent, I hadn't fully understood how valuable it is to know whether or not you are on the right track.  Watching someone improve in a matter of minutes is not only exciting to the practitioner; it boosts the client's confidence as well.  I don't test every session, but when someone has something going on or I am working on something specific, it is a good way to test progress.
Learning is a process, and I am hopeful that as I continue to deepen my understanding of human movement, I will be able to have positive impacts on my clients lives and share my knowledge and experiences with others in the human movement field.
"The secret to mastery in any field is to forever be a student." Martin Palmer

Yours in health and wellness,
Jenn



The handstand chronicles



I posted recently on Facebook that I had held my first handstand in the middle of the room.  Clearly, I was excited, slightly overjoyed actually, that I finally accomplished this and felt the need to share.  In the week following, I was surprised how many people asked me about it.  Some people wanted to know “how" I had accomplished this while others wanted to share why they “couldn’t" perform a handstand.
I have been intrigued by handstands for decades.  I used to try them when I was an adolescent, inspired by the gymnasts at the olympics who could lift up with control and hold the position for minutes on end.  I never managed to stay up for longer than a nanosecond, and the ceremonious flop that always resulted never deterred me.  Over and over again I would try, until I became bored and moved on to whatever I deemed more interesting.  Eventually, my interests grew away from handstands, as I moved into running and lifting weights, focusing on more of an external strength rather than an internal one.
When I took up yoga in 2004, my fascination with handstands returned.  I would watch with amazement as women in their 30s, 40s, and 50s would lift up in a controlled manner and hover with their feet in the air.  I was fixated, and after building a consistent practice, I found myself throwing them in on occasion against the wall.  There, I could work on refining the position, feet pressing up while supported, shoulder girdle finding the proper engagement.  
And so this went for years.  About a year ago, Kino MacGregor wrote a blog called “Let her fall," where she discussed her journey with Pincha Mayurasana.  When she began working on that posture, she was weak and fearful.  She realized that to build both the strength needed to conquer the pose and to overcome her fear of falling, she needed to get away from the wall and fall.  For some reason, this resonated with me.  Once a person knows how to fall and has the flexibility to go into a backbend, it’s really not a big deal to fall over.  I had both of these things, and after figuring out how to do pincha mayurasana in the middle of the room, I moved on to handstand.
And fall I did, though not as spectacularly as I expected.  There was frustration, as I figured out how much energy was needed to lift my legs up (I was used to purposely overshooting a little bit because the wall would catch me).  There were the times I ended up in backbend, only to quickly lower myself down and try again.  And then, just like I had always hoped to do, I found myself in it, not shaking, not unstable in any way, just holding.  After five breaths (I didn’t want to press my luck), I slowly lowered down, only to realize my relationship with handstand is a lot like my relationship to life.  Whenever there is a risk of failure, I explore my options at the wall first.  Once I have gained the confidence that I know how to fall and not get hurt, I move to the middle of the room.  Failure is really only a glorified backbend.  As long as I can get back up and try again, it will all be okay.

Hamstring strain, running, and prevention options





Hamstring injuries can be a real pain in the butt (literally).  Hamstring strain is a common injury in all sports that involve running, and in distance runners can be the cause of deep gluteal pain (White, 2011).  This is the one running related injury that shows up in my life occasionally, and I can attest to how irritating it is.  Perhaps more frustrating is the conflicting research showing how to "deal" with it.  Interestingly, the cause of the injury is often forceful eccentric contraction, which occurs during the swing phase of running gait, when the hip is flexed and the knee extended.  If the pelvis is in an anterior tilt, the hamstring is a lengthened position (see image below).  As Panayi (2010) points out, both anterior pelvic tilt and/or pelvic asymmetry puts increased demand on the biceps femoris origin and increases functional demand of the hamstring group because the synergist muscles (glute max) are inhibited.  I have had a number of clients suffer from hamstring strains, all have been female, and all have been prone to excessive anterior pelvic tilt.  The literature shows the best way to treat hamstring strain is using an eccentric approach to improve flexibility and strengthen the musculotendinous junction (White, 2010).  The rationale for this is that eccentric strength training might allow active tension to return to normal by restoring the musculotendon length (Heiderscheit, Sherry, Silder, Chumanov, & Thelen, 2010).  However, by ignoring the lumbo-pelvo-hip complex, the issue of why the hamstring was injured in the first place is being ignored.  Heiderschei et.al, cite a study by Sherry and Best that found a progressive agility and trunk stabilization program emphasizing neuromuscular control was more effective than a progressive stretching and strengthening program at reducing hamstring reinjury risk- after 1 year, 70% of the S&S group had been reinjured, while only 8% of the neuromuscular group had experienced reinjury.  This is more closely related to my experience; eccentrically training my hamstrings when they have been injured doesn't feel good.  I have always felt I needed a different approach to training my hamstrings, I just wasn't sure what it was.


Enter Eric Cressey's blog on hamstring strains and me learning some PRI techniques.  I have already written about how DNS had a positive impact on changing my thoracic position.  PRI takes it a step further and begins to address pelvic position, thoracic position, and thoracic and pelvic asymmetry.  Some of the lower body PRI exercises are specifically designed to integrate hamstring and glute function using a slight posterior pelvic tilt and proper thoracic positioning.  I was learning these when I read Eric's blog here: http://www.ericcressey.com/5-reasons-tight-hamstrings-strain.  Even though he works with baseball players and probably doesn't spend a lot of time assessing runners, I finally felt like someone was giving me permission to avoid end-range movements while trying to improve my hamstring strength and stability.  Up until this point, I was getting ART once every three or four months, which makes my hamstring feel fantastic, but (as is the case with most manual therapy work), wasn't "fixing" the problem.  I was fully aware that my movement patterns were causing the hamstring to flare up again (although to a lesser extent and in a different spot, oddly enough).  It's only been a month, but I can honestly say the hamstring feels like it's healing.  It doesn't bother me after riding (which seemed to be the biggest culprit, although I am sure running wasn't helping), and yoga no longer seems to aggravate it.  I am doing a lot of spinal mobility/breathing/PRI/DNS type work, and throwing in the occasional backwards stair walk.  The strengthening movements I am doing in the gym, such as deadlifts, are performed after some glute/hamstring integration work and no longer feel like they might be doing more harm than good.  The crazy thing is, training the hamstring in a shortened position with a posterior pelvic tilt feels really good- more how you expect something to feel when it is rehabbing an injured area.  I am all for a little mobility, but as Eric states in his blog, you have to assess the individual.  Not every rehab protocol will work for every person.  And sometimes, the research focuses a little too much on the site of pain rather than the source of pain.

Yours in health and wellness,
Jenn



White, K.E., (2011).  High hamstring tendinopathy in 3 female long distance runners.  Journal of Chiropractic Medicine, 10(2), pp. 93-99.
Panayi, S., (2010).  The need for lumbar-pelvic assessment in the resolution of chronic hamstring strain.  Journal of Bodywork and Movement Therapy, 14(3), pp. 294-298.
Heiderscheit, B.C., Sherry, M.A., Silder, A., Chumanov, E.S., Thelen, D.G., (2010).  Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention.


The real reason I can't squat, compliments of the PRI postural respiration workshop



My bodyweight squat leaves something to be desired.  I can squat all of the way down, heels remaining on the floor, and look pretty good once I am down there.  My knees stay straight ahead, my feet stay in good contact with the floor and don't rotate, and my pelvis remains level.  So, where is the problem, you ask?  My torso.  It folds neatly forward, with good alignment in the spine, rather than remaining upright and vertical with my tibia (proper squat form).  It kills me when I do videos of myself squatting because it is the one area I can't seem to improve.  I have elevated my heels on little risers to see if it's an ankle mobility restriction (it's not).  I have worked on my deep intrinsic core muscles, ala NASM's CES protocol, because according to NASM, it's an intrinsic core issue.  I thought maybe my regular DNS work would improve pelvic positioning, thus improving my squat pattern.  All of this has been to no avail.  Still, when I would squat in front of a mirror, I would watch with dismay as my torso folded forward.  The slightly analytical (and perhaps overly compulsive) part of me wanted to be able to squat well.  It's the signature of a good movement pattern, always the first thing people look at when they begin to understand how you move.  I began to feel resigned to the fact that maybe I would never squat well and my movement pattern would forever be less than perfect.

Enter the Postural Restoration Institute Postural Respiration workshop.  I went because a) Eric Cressey mentioned PRI in his blog, b) it was local (this never happens in Monterey) and c) it sounded neurologically based, which seems to resonate with me.  Something that should be understood about these types of workshops is no matter how well you think you move, you are going to discover you have areas you need to work on.  Like most people in the industry who spend oodles of time analyzing others movement patterns and helping them move better, I apply that same overzealousness to my own training and (with the exception of the squat) think I move pretty well.

It turns out, of course, that I was mistaken.  There were all kinds of things wrong with me, most notably my lack of thoracic curve.  When you are a short, athletic female, you spend a lot of time "standing up tall."  Part of that "standing up tall" means pulling the shoulders back and, prior to my DNS training, retracting the scapula.  (I have gotten completely away from that, and have noticed a HUGE improvement in my clients' shoulder function.  I now cringe when I either attend a class that encourage scapular retraction or read a blog/watch a youtube video that encourages this motion).  While scapular retraction is no longer part of my movement pattern, thoracic flexion is something I have never given much thought to, or, more appropriately, my complete lack of thoracic flexion in just about any movement.  I have very good hip flexion (probably to spare my lumbar spine), and because of that bending forward has never been an issue.  However, (and I couldn't find anything online to support this theory), if you take away one of the curves of the spinal column, it only makes sense that the balance of the spine would be thrown off during activities such as hip flexion.  Instead of being able to keep my spine parallel to my tibia during squatting, my lack of thoracic flexion caused me to fold forward to balance the weight of my hips.  In fact, when I hold a medicine ball or kettlebell in front me, I can suddenly stay more upright (again, makes sense.  I am counterbalancing with my upper torso superficially).  Once I realized I lacked sagittal plane mobility in the thoracic spine, I started playing around with things to improve it.  I also tried maintaining a more neutral spine (read: a little bit of thoracic flexion) during my bodyweight squat and low and behold, I could actually squat past 45 degrees with a more upright torso!  Now, I still can't get down to 90, but this has been a huge improvement.  It also led me to think about something that was mentioned during the workshop.  James, the instructor, noted many of us are in an extension dominant pattern,  I thought he was nuts.  With all of the sitting and screen time, how can this be the case?  However, after my squat discovery, I reflected on all of the women I have worked with over the years who have a very similar squat pattern as mine.  They all have a flat thoracic region and, like me, are "stuck" in a more extension dominant pattern.  Restoring flexion in the thoracic spine makes a lot of sense and will further improve lumbar spine and pelvis stability and position.

Yours in health and wellness,
Jenn

MovNat level I- a certification review



Last weekend, I was fortunate enough to attend the MovNat level I certification course in Monrovia, CA.  Kellen Milad and Jeff Kuhland were our coaches and people came from all over the western US to participate in either the certification or the Power & Agility workshop.  While there have been reviews written about the workshop, my goal is to offer a trainer's perspective of the certification portion of the weekend.

I wasn't sure what to expect.  I registered for it because my husband and I did the 4 weeks of MovNat workouts on Breaking Muscle and he wanted to do the workshop, so I figured if I was going to go to the workshop, I might as well get certified (I am a fitness professional, after all).  I had watched the crazy video of Erwan LeCorre moving in this incredibly fluid fashion years ago, after I read the first Outside Magazine article discussing Erwan and his fitness philosophy and was intrigued, to say the least.  I followed the evolution of the company over the years, and this opportunity seemed like a good time to take my curiosity to the next step.

My fellow certification attendees came from extremely varied backgrounds.  One was a successful personal training studio owner with a background in training fitness models.  Another was an acupuncturist with a background in Crossfit and Chinese medicine.  There was a rock climber, a recent college graduate with a genuine interest in bringing outside movement to people in Boulder, and a former chef making a career change.  There were also two people going through the certification simply to help their family and friends.  I work primarily one on one with people and my clientele is generally baby boomers with injuries or endurance athletes, so it was interesting to be in an environment with other fitness professionals that weren't necessarily so corrective exercise based.  Kellen and Jeff did an extremely good job dealing with the varied level of coaching experience and provided a very safe environment for us to learn and help each other.

The workshop portion of the event was physically challenging.  Because MovNat covers so many elements of fitness (strength, power, agility, endurance), it is almost impossible to excel in all areas, although there were a couple of attendees that came close (note to self.  Climbing rocks and trail running seems to improve overall fitness.  The trail running I already do.  The climbing rocks I started this week).  I received the best jump coaching I have ever received and can finally land somewhat quietly, although the height I can jump leaves something to be desired.  Swinging from bars is fun.  So is learning how to climb trees, which has become a small area of fixation (performing a handstand in the middle of the room is a slightly larger area of fixation.  Both should be accomplished by the end of the summer).  The lifting and throwing techniques were taught well, and the different crawls and rolls were fun to execute- however, I felt maybe a little more attention could have been given to bad crawling technique.  Maybe it's just my clientele, but it is not unusual for me to put a new client in a quadraped position and see scapular winging and an increase in spinal lordosis, which would have to be addressed before adding locomotion.  The highlight of the workshop came on Sunday, when we created our own combos in small groups and played outside for 3 hours.  Both activities cultivated a team environment and allowed us to put the skills learned over the weekend to use.

The certification portion of the weekend meant we started an hour earlier and ended an hour later than the workshop participants.  During that time, we discussed coaching and programming, were assessed on our proficiency in the movements, took a written exam, and were asked to design a small group program for participants of varying levels.  I was grateful I had been practicing some of the movements since early January (things like tuck swings can tear apart your hands if you don't have blisters), and I didn't find any one aspect overly challenging.  I actually enjoyed the practical portions of the certification- I have a number of certifications and with the exception of ACSM over a decade ago, I have never been asked to actually teach a movement and prove I have any level of coaching competency.  Jeff and Kellen gave excellent feedback, and they did a nice job with the diversity of professionals in attendance.

While I don't know if I will go on and get my level II and III certification, I definitely enjoyed the experience and would recommend it to anyone looking to have a more diverse movement background.  One of the things I really like about philosophies such as MovNat is they are fun; you get to lift some things, throw some things, maybe dynamically balance and swing from things, in a much less regimented way than most training.  If you work with the general population, performing these types of movements well are more functional than most open chained activities.  Overall, a very positive experience.

Yours in health and wellness,
Jenn