Tagged: fitness
Case Study: Chris D
Often I have cases come into my practice where they stand out as a good example of what appropriate progression can accomplish. Also, frequently I get people asking me: what do you do with people? What is your secret to helping people get pain free and strong? I thought this case might be a good example of both and allow me to share some of the principles that have brought me success with people like Chris D. While this is an extreme example of a case, it might help give you insight as to what proper progression and intention can accomplish.
Chris started working with me ten weeks ago. He came to me through a referral described as a “back problem”, which I quickly found out was a bit of a loose description. I can’t obviously share what his scans MRI revealed but needless to say they were detailed and he had a lot of spinal issues stemming from a long career as a contractor. The biggest problem with our initial assessment was a pretty glaring one:
Chris couldn’t sit down. He couldn’t sleep for more than about an hour without waking. He couldn’t work without constant pain in his neck and shoulders and legs. Even driving his car was an exercise in pain management. Due to the pain in his neck, upper back, shoulders, lower back and legs after just sitting in my office for five minutes he was uncomfortable enough to have to stand up. No matter what I tried to do in order to check movements through his upper and lower body he was in pain, and it would flare up at the slightest bit of movement or force. Even isometrics, which is usually the most minimally irritating to most people was really irritating to Chris. I’ll share later what we have found out during the course of his treatment but needless to say it was a very daunting task.
For only the second time in my training career (and you can read about the first HERE) I was faced with a situation where I wasn’t 100% sure if I could help. Chris expressed that his previous physio experience left him feeling better, but of course things came back once he stopped because he didn’t have strategies to keep helping himself after he was done. This is all too common – physio can help to an extent, but then it takes getting stronger to really complete the rehabilitation process.
Initially Chris decided to give me a two week period to see if what I was doing would help a bit. Here’s a layout of how our first movement session worked (I keep notes on everything I do with every client so this is directly out of my notes):
- Priorities: Mobilize upper neck C5/6/7, upper trap, R side shoulder blade, strengthen L side upper quadrant. Standing mobility in L side hip com/glute com/lower back, strength in R side glute/hip coms and ankle on R side. (this was all based on what I could assess)
Release therapy was done on his upper trap areas on both sides to bring blood flow into the area and expose him to self myofascial release that we could do on his own with a ball. There are varying sizes of these and we used the largest one in order to have the largest surface area and the least access to deep tissue. Chris could not stretch conventionally because any movement would cause his pain to flare.
We started with a manual two legged hip hinging movement with about 20-30 degrees of hip and knee flexion (with a base for support that was 30 inches high as a guide) for control and teaching how to use his pelvis. My initial goal was to work on getting him sitting down (to help with work and being at home), then lying down (to help with sleep). We did some R side isometric engagement (while standing) for his glute and hamstring. We did some standing brace work to teach his inner unit how to engage properly and worked on his walking gait. One major discovery we did right away was that if he flexed his L shoulder 20 degrees forward while walking his pain diminished significantly through his neck and upper back.
After 35 minutes we had to stop because Chris was getting major irritation in his shoulders and neck.
Using proper microprogression and trial and error Chris was able to sit down in his car so that he could drive to his father’s place 1 hour away for Father’s Day in June, about five weeks after we started. His sleep was still an issue and his shoulders and neck would still get irritated quite easily, but through constant self therapy and working on movement patterns we had established on his own, things started to improve. Chris started to experience periods of time without neck/shoulder pain. Through more trial and error we found that if Chris rotated his shoulder blades a certain way he experienced relief. Being mindful of all of these things kept him encouraged and improving.
His lower back and legs started to improve significantly and we introduced compound movements. After the eight week point we discovered that his thoracic spine was likely twisted and began to work on that aspect, which helped quite a bit. Chris discovered that when driving (which he could do at all previously and now could do for extended periods) if he consciously kept his shoulder blades even he could eliminate pain in his neck. By now Chris could squat (with load), split squat, flex his shoulders almost to 90 degrees and even hold his spine against rotational torque.
After ten weeks Chris could deadlift 60 pounds with perfect form. I have a video of it but Chris asked that he remain relatively anonymous.
He has been getting proper nights’ sleep and been able to do more driving for work. He has been able to do work around his home that would have caused serious problems three months ago. Here’s a layout of our most recent workout:
- Alpha Ball warmup – mobility in rotator cuffs (both sides), one legged balance and thoracic spine mobility. Blood flow increase to VL/IT Band fascial line on R side (since doing more with his legs he started to experience some weakness through this area on his R side).
- Dead Lifts starting at 50 lbs and increasing to 60 (he holds the bar in external rotation because his shoulder is able to maintain in that position) for up to 9 repetitions.
- Lying position shoulder flexion with 3 lbs load on both sides maintaining position above 20 degrees from floor (through various positions we found that he is able to use front delt/pec/serratus in this position)
- Single Legged Leg press at 90 lbs of load (does not affect his lower back or hip complex any more)
- Eccentric loaded row in an incline position (I would have to take a picture of this for you to understand but think about lowering through a chest press focusing on the negative portion only)
Chris had made phenomenal progress over his time so far seeing me for only two hours per week. He also does a lot of work on his own, which is what I expect from my clients. He is aware of what he needs to do (and not do) and every time he comes in we have some new insight into a movement pattern that he experienced and we are able to build on that. One thing I constantly express to him is how I love the fact that he wants to understand what is going on and focuses constantly on moving properly. Chris has invested in his recovery, which is vital to any progress you want to make physically. It doesn’t happen slowly, it happens with careful application and time.
So here’s a good example of how a properly progressed strength program can help someone that has been in chronic pain for a long period of time. Many people walk around in situations that can easily be diminished or resolved through a properly progressed program with lots of intention and appropriateness. I’m hoping that Chris will continue to improve. One of our major goals was achieved last week when he actually slept properly, something he couldn’t remember doing for a very long time. These little things can make a huge difference to someone’s quality of life.
If you have any comments or questions about what I have been doing/have done with Chris please simply ask and I will share it (with his permission of course). Also, if you have any people who you think could benefit from the type of treatment Chris has gone through feel free to let me know.
Until next time – keep moving!
Is YouTube Making You Dumber?
Recently I was provided with several examples via clients and just various internet sources of people who are “fitness experts” on YouTube throwing up videos on various topics. Most of them centred around exercise and technique for the best possible application for whatever body part they are focusing on. I’m not even going to get into the amount of nutrition videos that exist (and have information that would make you laugh) because we would be here all day.
Just as an example, one was provided by an IFBB Figure Pro and was talking about changing the angle of the leg press in order to “isometrically” stimulate the glutes. Not only did she realize that isometric doesn’t mean isolation when it comes to exercise, but she also stated such gems as “this is all glute – no quad and hamstring at all” (hmm, I wonder what was helping your knee extend and flex during that press?) and also had you positioned on a leg press lying on your side – something that is not only risky, it could also be really harmful for somebody’s back if the load was high enough. A gimmick position designed to take a regular movement, and make it fresh and new – and potentially dangerous.
Another was a video about bicep curls. Very slick, very well produced and of course full of buzz words like “kinesiology” and “biomechanics” and “concentric” but at the end of the day, it was about bicep curls. Barbell bicep curls. And it was over 6 minutes long. The person who produced it used pretty much every buzz word they could pronounce, and made it seem like something as simple as using a barbell to perform elbow flexion was something that required a ton of attention from the average gym person.
Pretty much every YouTube fitness “expert” has videos of the “best [insert body part here] workout”. These videos will typically show you a circuit of exercises that you could find in any magazine on a shelf this month put in an order that isn’t anything new or different than has been said 100 million times previously. Movement is movement, and Arnold was talking about bicep curls about 40 years ago – surprisingly, the movement hasn’t changed. If anyone ever tells you can that they have come up with a brand new way to stimulate a joint, they are full of it. I’ve read papers written over 2000 years ago about human movement – odds are, things haven’t changed that much. Elbows are still flexing exactly the same way. Force is force. What changes is the way people try to repackage fundamentals so that they can sell it to unsuspecting people who don’t know any better.
Now, before people jump on me for being critical, I’m not saying that these videos are wrong or that they don’t provide some good information for exercise variety for the average person. I’m saying that there is a TON of inaccurate information out there, and you have to be aware of it in order to be able to sift through all of the crap. Just recently a study was done on Wikipedia articles that dealt with medical information and it was found that across 20,000 articles, 90% of them had false information in them that could potentially lead to misdiagnosing an illness. Since most people these days get their information via the internet this could be fairly serious. I’m sure that I can spot inaccuracies in over 90% of videos on YouTube as well, making it also a potentially dangerous source of knowledge, especially when you consider that people will hop on there, watch a video and then try a movement without any real coaching. Many of these videos also encourage people to run through a very challenging circuit that likely they have no business performing at that stage in their fitness evolution. I’ve written before about people who push way too hard way too soon, and YouTube is a great place to get ideas for that.
I know that when I have a client come in and they tell me about something they read on the internet, my answer usually is that it wasn’t wrong – it was misleading and not totally accurate. Part of my job is to provide accurate information to people and explain exactly how things work – then it is up to the person to make their own decisions. One of my mantras is that there is no “good” or “bad” – there are varying levels of appropriate and how things are applied to whom, where and why. Are leg presses sideways bad? Probably – but it depends on who is doing them. Is there a better, safer way to do almost exactly the same thing? Yes. Are bicep curls being done wrong in every gym across the country? I have no idea. It probably didn’t require a six minute video to explain, but obviously this person thought that it did and is using it to market themselves as a “fitness expert”.
You also have to consider the motivation behind the videos that you watch. Are they just marketing fodder, sponsored by a supplement company and starring an attractive figure model? Are they telling you that a “revolutionary” new technique is going to get your results to you even faster (especially if you take/wear/drink their product at the same time)? 98% of the time that person is there to market themselves or a product that they sponsor and the more hits they get, the more money they make. Some of the videos know that sex sells so their model is wearing next to nothing. Again, more hits = more money. And a lot more people who might just believe that lying sideways on a leg press is a great way to isometrically use your glutes.
With all of this information being thrown at you, it is really not easy to pick out the accurate information from the inaccurate without having someone to point out what the truth is. If you sit and watch videos long enough, suddenly you start to believe that if you just try this new technique that your results will change drastically and that you will vault into the stratosphere of fitness without putting in the appropriate time and effort. That’s what makes you dumber. I’ve had fellow trainers message me asking “is this right?”. The point is that this inaccurate information makes people question if what they are doing is actually what they should be doing. This applies to both trainers and people who are looking to get fitter. Then someone watches a video, gets on a leg press at a sideways angle and wrecks their back (or hip or both) and wonders why.
Here’s my suggestion – get off of the internet and start reading books. NOT Dr. Oz books. Textbooks, manuals, journals with published research, things written by people with track records and credentials to match their publishing history. Odds are they are going to be a TON more accurate than somebody who looks great in a pair of tight pants or tank top and is showing you a nice booty exercise. There are actual web sites where you can open source whole courses on anatomy, mechanics and movement or at least the textbooks for reference – for free (if you want to know some feel free to message me). Be a little more proactive about your knowledge. Read books on workout routines written by actual coaches and people who have been doing it for thousands of hours with hundreds of people. Not someone who only has a fitness following because they are on TV or look really hot in a set of tight pants. And if you have a question – find someone who knows the right answer and ASK THEM. I’m always happy to answer questions for people even if they aren’t my client, because part of my job is to help people, and to me that means providing accurate information to the best of my ability. And if I don’t know the answer I can direct you to someone or somewhere who does.
The fitness industry is full of marketing ploys and terrible information and it can all be found just a click away and make you dumber as a result. Please, don’t fall for this stuff and don’t allow the internet to dictate what you do or don’t do in a gym or to your body (yes I realize the irony of writing this on a blog). Find an expert, consult with them and get it right the first time. Don’t let anything that affects your body be as simple as believing someone with a slick video on the internet is anything close to an expert on the body and what it does. I’m happy to help if you need it.
Feel free to like, share, but please don’t publish it on YouTube.
Tuning Up – My Insights from Yoga Tune Up
For the past week here in Ottawa I was a participant in a great course called Yoga Tune Up teacher training, where I got to spend seven full days with a bunch of very dedicated professionals getting tuned in to the yoga world a bit more. While I’m still processing everything that happened during the week, I wanted to share my initial observations with my readers and clients because there were a few things that jumped out at me right away I wanted to share.
The people who attended this course with me were from several different corners of the fitness industry. There were yoga instructors, CrossFit trainers, powerlifters, dance instructors, and even just regular people who wanted to learn more about yoga or had taken the class and wanted to learn how to present it themselves. Why did I take it? It is very rare that courses come to Ottawa, and I have known one of the main instructors for a couple of years and have a lot of respect for his knowledge and what he brings to the fitness world with his intention. To be fair, the course was not entirely what I expected and I would not have taken it if I knew what the days were going to entail, as I have no intention of being a yoga instructor – but here’s some things that I took away that are valuable to me. Even if a course isn’t exactly what I’m looking for, my belief is that even if you just get one thing out of it, then it still has value.
The Concept of Sankalpa
On the first day we had to come up with a Sankalpa, or a basic statement that sets your intention around your yoga practice, or simply your life at that point. It is something you are supposed to repeat to yourself in order to guide your thoughts and what you intend to do. In business this could be called a mission statement (although they are usually a lot longer). In some meditation circles it could be a mantra. The great thing is, the simpler it is the better – one sentence can be enough. Sometimes it can be oriented around something you intend to improve personally or within your practice. It is well established that once you repeat something to yourself enough, your brain and body start to believe it. Coming up with a simple statement allows you to touch base with who you really want to be, even if you have to fake it until you make it for a bit.
I would suggest that everyone come up with something like this. Repeating it to yourself under times of stress or when you need to focus on your real intention can be really eye opening in the moment. I know it certainly was for me once I figured out what it is. If you want to know, just ask me.
People Need to Follow Their Inner Voice
When I was getting to know the other participants, a common theme came up constantly through the week very similar to my own. The people had a regular job that they hated, took a class and loved it and realized that they were doing the wrong thing and decided to do something that they liked instead of something that they hated. What a novel concept. I did the same thing almost 15 years ago when I left my high paced stress filled retail management job.
I’m a firm believer that if the universe is telling you something, then you need to go and do it if or when you can. If you can’t manage it right now because of other circumstances, then start planning to get there. I have a client right now who is already planning for her retirement and what she wants to do with her life, but she isn’t retiring for another five years. Even if it takes a few years, for the rest of your life at least you will be working on your authentic purpose rather than wasting away day by day doing something that you hate. Like Jim Carrey said in a recent clip that has been making the rounds of the internet: “you can fail at what you don’t want, so why not take a chance at doing something you love?”
Mobility and Strength aren’t Mutually Exclusive
With the group that we had in the room, it was a great mixture of both “flexy-bendies” and pure strength people, but the greater thing was that everyone was open minded and listened to all points of view without judgement. The thing that emerged (at least from my perspective) was that the really mobile people didn’t have a ton of strength, and the really strong people didn’t have a lot of mobility. It is almost like a large parabolic curve with the x axis being strength and the y axis being mobility and you should aspire to be somewhere in the middle – but it is really hard to get there. There is also a well known correlation between having too much range of motion and not being able to control your joints at end ranges, which can easily lead to injury (something I address constantly with my clients).
The point there is to have a balance – but the one thing that they reinforced during the course (and quite well) was that you can’t achieve a good position of strength if your position is faulty. This means when you are trying to achieve a strong movement or even just to walk properly it is important to begin with proper spinal alignment. So many of us walk around with massive forward head posture and bound up thoracic spines and externally rotated hips, and then we go to a place where we sit all day staring at computer screens lower than our eyes should be, get into cars where we cram ourselves into seats that push everything forward, and sleep with three pillows.
I came out of this course feeling much more mobile than I have been probably in years, and with a renewed sense of who I am and my purpose in the world. It reinforced my path to me and made me aware of things that I had let slip over the past while. Moving forward through life can only be done properly if you have a sense of where you want to be, so sometimes just getting a bit of a wake up call is really valuable, and that’s worth the cost of ten courses to me. I also had a great time and met some incredible caring knowledgeable people who I’m really happy to now be networked with as possible resources for my clients and colleagues.
If you want to know about Yoga Tune Up, visit www.yogatuneup.com and check out a class in the area, it might just be worth it for you.
A Tale of Three Runners
It was the best of times, it was the worst of times…if you understand that reference then you’re probably my age or older (or just enjoy reading). Actually, this weekend it was the best of times for three of my athletes.
Recently in my city of Ottawa we had our annual Ottawa Race Weekend. It is a fantastic weekend for runners where they hold a marathon, half marathon and a 10k and 5k and all events are well attended with over 30,000 people participating. Every year it is run flawlessly for the most part (although they had a bit of a screw up on the ½ marathon course this year) and attracts runners from all over the world. Since runner coaching is a part of my business I wanted to share a story about three of my athletes who all come from different aspects of fitness, but all achieved a level of success this weekend, even though they started in very different places.
RP is a gentleman who has been working with me for over two years, who although he just turned 40 still has the athletic ability of a gazelle and the sparkling wit to match. When he started working with me he had acute Achilles tendonitis and he had 8 weeks to his first marathon. He couldn’t run for more than about 10k without pain. I distinctly remember the look on his face when I told him his mileage was getting cut in half 8 weeks before a marathon, but he went with it and successfully ran his first marathon. Since then he has done several other races including two more full marathons, a half marathon PB and a 500 kilometer bike ride from London to Paris. Last weekend he beat his personal best on the marathon by over 30 minutes by staying consistent and running 4 times per week with a gradual buildup to 65-75k per week over time.
TW is a woman who came to me only a few months ago with another problem – this time ITBS, or iliotibial band syndrome and she couldn’t run at all, but still wanted to compete in the 10k with a restriction of only running 3 times per week (with a holiday mixed in for good measure). She had previously done marathon training so was used to volume, but had to have some adjustments to her speed (I actually sped her UP to give her a proper gait) and work on her IT band issues, which resolved fairly quickly. Her initial goal was to complete the 10k, but then a few weeks out we changed that to doing it in under an hour, which she had never done. She finished in 58:30 with a smile on her face and no IT band issues.
CM is a woman who I have been working with for about a year who came to me because she liked to walk long distances with a goal of completing another ½ marathon walk in another short time line. She is obese and has some other health issues that make it difficult for her to move. We got her through that race, however she continued to suffer from calf and ankle issues and had to restrict her volume so that she could stay consistent with her workouts. She completed another ½ marathon walk last weekend only about 10 minutes slower than the year previous – having never walked for more than an hour in training. For her a ½ marathon walk takes four hours but she got through it, even on a brutally hot day.
These three people all made significant accomplishments last weekend. The point I’m trying to make is that different people accomplish things differently. All three of these athletes came at their respective events from different places, skill levels and levels of progression. However, all had a successful result following a plan – and in CM’s case that plan was simply to get it done even though we both knew she was going to have a hard time. With all the athletes they did what they could to make consistent progress towards the goal they had set – and then those got modified when progress was either better or worse than expected.
Anyone can be successful given the right tools and progression, no matter what you want to do. Want to bench press 300 pounds? Want to run a marathon? Want to climb a mountain? Great. The idea is to set the goal and then work towards it carefully, mindfully towards what your body is capable of at that time and then just keeping moving forward. And you’re never going to get anywhere by trying to not listening and respecting your body when you try to push it too far too soon. The great thing is, it will tell you when you’re pushing too hard and try to stop you – you just have to listen.
Getting hurt doesn’t mean you have to stop – it means you have to learn what caused you to get hurt, and either stop doing it or modify what you’re doing in order to let it recover and not have it happen again down the road. Attack the problem, not the symptom. With a couple of these athletes it was a simple form adjustment and being mindful of what they were doing, which you should be doing anyway.
So today, tomorrow, whenever you start working towards something be smart, progress yourself within your tolerance limits and above all, listen to your body. Oh, and hire a good coach. I happen to know one, and he trains runners virtually as well if you’re interested. Maybe next year you can have the same success that all of these people did, even though they started from completely different places.
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Therapy and Exercise Refined 