Month: September 2017

Won’t you help me sober up

Growing up it made me numb

Some people will tell you of the far reaching, extremely beneficial effects of floating in body-temperature saltwater in a sound controlled tank allows the body to be completely comfortable. This sensory deprivation, of course, supports the immune system, promotes relaxation, better recovery, pain suppression, releases beneficial parasympathetic (relaxation) hormones, and unlocks the doors of perception to expand consciousness itself.

So, what we should all be doing for better health and performance is periodically depriving the body of all sensory input.

Some people will tell you of the far reaching, extremely beneficial effects of cold water immersion.  There’s even a cold guru who runs barefoot marathons through the snow and sits in ice for nearly two hours. This total body confrontation with the cold, of course, supports the immune system, promotes circulation, better recovery, pain suppression, and releases beneficial sympathetic habituation, and your mindset.

So, what we should be doing for better health and performance is periodically embrace the discomfort, exposing  ourselves to incremental amounts of specific stress.

… … …

Ok. So which one is it?

What the literature says:

Despite much funding in product design and marketing, there is very little on the benefit of sensory deprivation beyond what would be expected from placebo effect. The mind is powerful, and we tend to believe what we WANT to believe.  Sure, it feels good to chill out for a while and not attend to anything.

On the other hand, the literature points to legitimate beneficial effects on the immune system (by measuring various “antioxidative defenses” such as T lymphocytes and red blood cells). Full body cold water immersion and cold air chambers also resulted in increased metabolic rate (caloric demands just to maintain body temperature). It reliably produces a sustained increase in norepinephrine, which substantiates the long-term pain relief touted by cold gurus. Cold has also shown promise for those with chronic fatigue syndrome, chronic heart failure, and even some types of cancers.

What I think:

In the grand scheme of things, most of this is -probably- nonsense. Most of us these days are indeed far too comfortable for too long. Do not get me wrong. We should be supremely thankful when we do not have to endure slavery in exile, long and barren winters or marches through the snow to achieve independence from tyranny. But for many modern American lives, I think that comfort, and our quest for it, is killing us at worst and making us numb at best. Some NEED their air conditioners while others complain when the temperature drops one centigrade below what we’re comfortable with.  But really…

We. Are. Fine.

Or we would be if we weren’t accustomed to so much comfort.

We work and live and drive in climate controlled environments. For many of us, even our time exercising involves machines/crutches and televisions and not even a little bit of dirt. We should not wonder why life stress, physical and mental, perturbs us.

What we should do about it:

There is nothing “natural” about complete sensory deprivation. Unless, of course, we’re talking about the miracle of sleep, which is free. And yet we seldom take enough advantage of that offer.

Extreme discomfort is unnecessary at best. It’s life threatening at worst; a classic example of how trying to be extremely fit and healthy can kill you. We do know that ice therapy immediately after intense training limits the beneficial adaptations involved with inflammation and recovery. If you did not hear that, please know that ICING AFTER A WORKOUT ACTUALLY RESTRICTS YOUR GAINS. 

But I think that an intentional dose of discomfort is Juuussst Right, precisely what’s required to help keep us healthy with immune system blah blah blah and mentally sober. I mean, look at typical children. They play and laugh and don’t feel the weather and go all day. I want to hang on to some of that vitamin Don’t Grow Up for as long as possible. Even if the benefit is a package deal of keeping a youthful mindset, or plain placebo, so be it!

Prescription:

One moderately extreme discomfort per month and one moderately fair discomfort per week…yeah, that seems about right.

-That’s why I jump into the lake or stream when I get a chance. Even moderately cold water feels like a shock treatment to me. But I still do it. This is called “Getting The Month In” and it does wonders for your mind. **Know your limits and systematically apply the stress. You’re not setting any world records, so always error on the side of caution.

-That’s why I try to train (and train others) outside once or twice per week if possible, rain or shine, so long as conditions are not dangerous. An hour outside in the beautiful and the ugly weather. The discomfort itself is the benefit…getting the full dose of your exercise session. Breath in those gnats for extra gains.

Floating may feel relaxing for a while. There are certainly worse things that you could do with your time. But in the end, I really do not think that our own health, wellness and fulfillment can be found inward. Sensory deprivation offers practically nothing in terms of loving God and others. Even moderate discomfort makes the mind and body more resilient, capable, and even grateful.

This is obviously an opinion piece. Please do share your perspective.

…in which I justify all the jumping on and over picnic tables, which are far better than standard gym plyo boxes, but that’s another story. 

Most people think that running, jumping, and agility training all necessarily go together. Around here it’s common to hear it as one word.

“We’re doing speednagility.”

But they are not all one in the same. I mean, go ahead and look up the internet’s definition of agility.

“The quality or state of being agile. Nimbleness and dexterity.” 

Getting in shape for the season, getting faster at sprinting, and improving agility are related, but are in fact fairly different pursuits with different training methods. For example, it is entirely possible (and common) to have an athlete with  favorable conditioning and footwork on an agility ladder, but with very average acceleration and top speed sprinting ability.

Likewise, activities like P90X circuit style jumping and intensely jogging a mile (for conditioning) do very little to improve an athletes ability to achieve faster sprinting and change of direction (unless he/she is very out of shape to begin with). Skipping through an agility ladder or over cones will improve brain coordination to the feet in those precise drills. I like these type of activities done briefly as a warm-up. But they will do little to improve sprint and change of direction abilities.

So why do I call my own training “Plyo Friday” rather than “Speed and Agility Friday?” What’s with all the jumping when most athletes are NOT primarily interested in basketball or high jump?

I’ve written a few entries on what does actually improve a given athletes peak speed and change of direction, these being

1. Good static and dynamic alignment (all moving segments stacked optimally to work together to produce movement).
2. Adequate range of motion (controlled mobility means not being too tight, but not too flexible either).
3. The ability to quickly generate a lot of force into the ground (per body weight).

Athletes should work on developing these and then, THEN work on being agile in the demands of their sport. I’ve seen kids who can hardly walk and chew gum at the same time get on a BMX bike and demonstrate extravagant nimbleness and dexterity. The point is that “good agility” is fairly event specific.

The best way to work on alignment, controlled mobility, and force generation capability is through specific targeted resistance training. You could say that we are getting the athlete stronger. But you could also say that we’re using resistance and specific cues as a tool to literally change how the athlete  interacts with the environment. Once they are on track toward improvement in the three points above, we have to practice application. The best way to apply these attributes to athletics is through sprinting, plyometrics (think jumping type drills), and working on lateral movements and change of direction yes, agility). So that’s exactly what we do on Plyo Fridays. Here is the anatomy of a Plyo Friday:

1. We warm up (I’m attempting to do a better job of not skimping on functional mobility warm ups).
2. We perform a series of plyometric jumps: tuck jumps, bounding, lateral hops, and depth jumps on one and two legs. Jumps are not just for basketball players. They make excellent use of GRAVITY, one of our greatest and most overlooked tools for truly improving speed and agility. A large part of being fast and agile has to do with synchronization and timing of body segments to control landing forces, achieve a controlled stretch of muscle and tendon (called SSC, short for stretch-shortening-cycle) and efficiently roll that SSC into the next powerful movement up and out, in various directions.
3. We sprint with work on form, starts and stops, and peak speed with plenty of rest between sprints.
4. We run some grinding intervals, push the car, or do an obstacle course for general athleticism, conditioning, and/or plain fun.

Next we break each of these down further:

-Warm-up includes activities to work on dynamic alignment, balance, and basic movement patterns (such as single leg hip hinge, deep squat, skipping, lateral and rotational lunging, etc).

-Jumps! Tuck jumps and box jumps are great because they require a powerful and synchronized total body effort. The ankles, knees and hips perform powerful triple extension while the arms are being thrown up, the trunk is extended, and a fraction of a second later the anterior muscles must perform a rapid folding together of the torso. Tuck jumps are done forward and laterally, on two legs and one at a time. They qualify as “functional core” movements far more than you think, making non-weight bearing abdominal exercise unnecessary.

Depth jumps (and practicing good quality on jumping and landing) are critical because they are a great way to overload the movement and train the brain for pre-activation.  Careful though, as these are fairly taxing and should only be performed after normal jumping and landing form is achieved.

It is difficult to achieve quick and forceful  (powerful!) interaction with the ground  if the athlete has weakness of the trunk and legs or has a reactionary strategy of ground impact. By the time the athlete reacts to hitting the ground, it’s too late. Learning pre-activation is critical! That is, anticipating the next foot impact/interaction with the ground, activating the appropriate muscles and movement patterns while they’re still in the air.

Here is a good example of a depth jump, and series of broad jumps for pre-activation strategy.

First, notice how Ryan is able to easily tuck jump onto the table. Very impressive for an 11 year-old. Next, when he drops down to the ground, he is challenged to control his body mass and immediately explode up into the next jump. He does a great job making it over the “hurdles.” But I’d like to see him, in time, float and have a faster and softer interaction with the ground. This is not easy, and should not be done for hi repetitions in any athletic population.

A good verbal cue for depth jumps is “When you’re in the air, you know the ground is coming. Get ready for it. Reach for it and control the landing rather than crashing into a heap.”

Pre activation is absolutely a learned skill, and the fastest, most powerful athletes are able to do it subconsciously.

-Sprinting usually involves a little work on starts and change of direction. We do a few warm-ups and then timed sprints. There is NOTHING that gets a human to run with absolute full effort more than drawing a “line in the sand” and breaking out the stop watch. Week in and week out, athletes get to witness the fruit of their labors through observing their sprint times fall. Did you know that doing a handful of ~60-yard repeats at absolute max effort can be fatiguing and adequate for “conditioning?”

-Lastly, the conditioning portion depends largely on whether or not the individual has intense games or practices coming up in the next day or two. We keep the craziness and fun/showboating within tight limits when the athlete is in-season or making a run at something outside of Plyo Friday ; )

Everyone leaves Plyo Friday feeling tired but outstanding, sensing the gains to the depth of their Awesome Bucket.

And the Bonny Lane picnic table, tire, small stretch of grass, and dead-end roadway keep churning out top performer after top performer…

———————

Here is Cort and I at work a few years ago.

**WARNING: Most of the moves illustrated in the video are moderate- to high impact. Going at them without a proper build-up and form is likely to result in joint sprain or muscle strain.

I see an awful lot of ads for physical therapy companies and their services. It’s no surprise that I would take notice and be a bit sensitive about it.

Some of the ads are great. They’re interesting, informative, or plain entertaining. I stand behind most of how my employer markets our services. Follow us here to easily see what we’re doing.

Other physical therapy marketing techniques are either ‘meh or plain embarrassing. They’re clearly under the influence of Dale Carnegie and his contrived ways to fake friendship and manipulate people. I’m far more Wendell Berry than Dale Carnegie, but that’s another essay. These days, many PT marketing techniques make me feel like when you have new guests over for dinner and the dog drags it rear end across the living room rug.

Yep, that’s my profession. My calling. I’m on of them…but not the same. We’re not selling pizzas. Most of us are not in it to build an empire. And we’re not magical beings that are your every answer in all circumstances.

– – – – – – – –

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.”
Wendell Berry, The Art of the Commonplace: The Agrarian Essays
So without further ado, here are 15 long, drawn-out, backwards and moderately successful techniques to market your physical therapy services.

***My parents and grandparents taught me very little business sense. But they had a role in teaching me every one of the principles listed below. Some of them I have miles to improve. Each point above is absolutely true in the sense that I’ve lived it. And yes, “got business” out of it.

1. First and foremost, find a geographical area and commit to it. Love the land. I have a hunch that this is especially rewarding (more than financially) if you settle on a place in the inner city or very rural countryside where nobody else wants to be.
2. Hire local help where you need it. Take the car to the small garage owned by the guy who lives nearby. Know the folks at the pizza shop by their first names. Not to make them feel important or to make you think that they think that you think that someone made an impression on someone. Do it to be a decent human. And it’s a lot more fun to share a story while you wait. Eventually, they will offer you a glass of wine and not mess up your order.
3. Go to your primary care physician and “represent.” By this I mean a consistent life of wellness, and NOT how much you know about physical therapy, medicine, or (especially) alternative medicine. They will hear about your abilities as a PT soon enough, and a sense of humility regarding the entire human body (not just the musculoskeletal system) will shine forth like the sun. Annual physicals will be awkward.
4. Don’t pick up golf in order to meet doctors and other big shots. Do what you love and be open to helping and learning from others who pursue similar interests. You’ll make a handful of lifelong friends this way.
5. Don’t try to be an interesting person. Try to be genuinely interested in the world and in others.
6. Practice your “elevator speech,” sure. But perfect the art of active listening.
7. Have an on-line presence. Talk about your work and business, but not exclusively. Be a friend, throw your hat in the ring. Don’t be a jerk or get overly involved in divisive subjects.
8. Serve the community without an agenda. Before five minutes have passed, people will ask where you live and what you do for work. In five months or years, they will be coming to you with medical questions. Some of them you’re unfit to address, but you know that your trusted.
9. Spend time learning about that activity or sport that seems to keep popping up in the clinic, whether or not you like it. Pretty soon you will probably learn to like it or at least appreciate it. Who knows, one day you may spend most of your weekends actually glad to be driving your children to it.
10. Show up at your clients competition or event. Not with a handful of business cards, Dale Carnegie, but because you’re interested in seeing them in action. Your performance in Netflix Marathons and Fantasy Football will definitely suffer.
11. You MUST be a perpetual student and enjoy it. If not, you’re either inexperienced or obsolete. Take the courses because you want to learn, not just to fulfill CEU requirements. Read the books by day and the articles by night, again because you want to. Process what you study and filter it through your unique real life experience. Where and when you can, put that into writing or speaking.
12. Know that the customer is not always right. But you do need to learn something from every single criticism received. On the one hand, you need to closely watch for patterns. They are a clear indication for some serious course correction on your end. But on the other hand, do not try to please every person every time. Doing so may be good for business, but it will leave you with sleepless nights, an ulcer, or worse.
13. Go for the assist. When it comes to marketing, getting an assist is even better than scoring the goal. So establish a handful of trusted complimentary services. MDs, pain management specialists, personal trainers, massage therapists, etc. Make those connections, fitting the right person to the right service. Call them. Do tell your clients to mention who sent them. It’s a genuine win-win-win.
14. Deliver the goods. At the end of the day, you must provide a service that is worth the time and cost involved with peoples lives. You may have an advanced CNP (Certified Nice Person), but there’s absolutely no substitute for competency. Do not mistake this for “Get everyone better” because that’s not realistic. Sure, most people will achieve drastically improved function and less pain with physical therapy. But even those who do not ultimately fulfill their goals can and should have a great experience. At the very least, they should have learned a lot…about what may be ruled out as the cause of the problem, ways they can help manage the problem (if not successfully address it), or connections to others (#12 above).
15. Did I mention that this marketing model is not scalable? There are no pathways or sales funnels. This is probably no way to build a corporation. These marketing methods will not provide a huge salary, especially given today’s healthcare environment.
    Student loans will suck the life out of you. But you will be part of a community of people you care about and who care about you, and you will lean on each other for help. In the end, you will have many interesting stories and laughs to remember, and some joy as well. It will work out. Well, it should. I mean, who knows. My story unfolds. You’re listening to a guy who doesn’t mind driving an ’04 Honda to work or eating peanut butter and Jelly twice a day.

“The world has room for many people who are content to live as humans, but only for a relative few intent upon living as giants or as gods.”
Wendell Berry, The Unsettling of America: Culture & Agriculture
“The difference between a path and a road is not only the obvious one. A path is little more than a habit that comes with knowledge of a place. It is a sort of ritual of familiarity. As a form, it is a form of contact with a known landscape. It is not destructive. It is the perfect adaptation, through experience and familiarity, of movement to place; it obeys the natural contours; such obstacles as it meets it goes around.”
Wendell Berry, The Art of the Commonplace: The Agrarian Essays

Yesterday I noticed a spectacular machine racing across the front interior of my van. It functioned something like a small hovercraft drone.

This essay also known as, “Hey Bob can you write a program to get my dead lift up?” 

What makes me an expert at dead lifts, other than liking deadlifts?

I wrote this because being a strong dude plus personally experiencing my unscientific study of N=1 means that I know everything there is to know about dead lifting :). But really, there are more than a few good dead lifting resources out there. I don’t claim expertise in power lifting. My forte is more in the realm of using weight training to stay healthy and be awesome outside of the gym (sports performance and rehabilitation). But since more than a few people have asked the question…

I never lifted with an official bar (better grip and spring), wearing an official belt (assistance), in an official meet (strength culture and context). But even without these small but important advantages, I have managed to accrue these dead lift credentials, most of them with video proof:

600 lbs X 1, while weighing slightly under 200 lbs (> triple bodyweight is pretty rare).

500 lbs X 10 continuous reps

405 X 20 continuous reps

315 pounds for over 100 reps in about 30 minutes.

Yes, this is surely part of the reason why my injured right hip has suffered additional wear and tear.

I’ve also coached many folks through dead lifting over double body weight.

Presently, I’m not at peak strength but can probably manage 80% or better of the numbers listed above. Last week, at the age of 41, I easily dead lifted 405 X 10 reps.

There are six things the physical therapist hates,

seven that are detestable to him:
inflexible hips,
       worn out shoes,

a recliner chair that encourages kyphotic posture,
       a forward head with no recourse

a person with poor balance
          yet goes to the gym and sits on machines.

Humans are generally poor at risk assessment. We tend to over emphasize areas with strong emotional connection whether or not harm is probable. For example, 30,000 Americans die per year in car accidents. But we fear shark attacks. The early death rate and costs associated with metabolic diseases (obesity, high blood pressure, and diabetes) are astronomical, with many of the causes being modifiable behaviors. But we fret about the opposing political party “taking over” healthcare.  Falls are the most common cause of visits to the emergency room. The 8 million fall-related visits per year compromise 1/3rd of all visits to the emergency room. Yet we spend hours debating whether we should be drinking coffee or tea.

Here are a few more statistics:

Every year there are 115 falls per 1000 adults over the age of 65 (and these are only the ones reported).
Forty percent of people over age 65 fall once per year, with ten percent of those landing in the hospital. Fifty percent of those admitted to the hospital are still alive one year later.
Most falls occur in the home and in older individuals with chronic illness or failing senses.

We should think more about having a resilient body. We should remember that age-related decline is inevitable. Avoiding falls is not only an issue of being careful. Ironically, there is good evidence that being too careful makes us more likely to become frail and suffer a severe fall-related injury.

As we age, we typically move less. A little at a time, over many seasons, we lose flexibility, strength, and sense of balance. We get banged up and the old injuries catch up with us. We usually do not think about losing our movement quality until very late in the game. Improving our ability to move well should be a top priority. What are the best ways to recoup what we can, and make our bodies more resilient for the inevitable fall?

Preparation is good. But I want you to exercise smarter. Here are the top 5 concerns for fall prevention and body maintenance.

1. Make it happen.  Do something. The most commonly cited barriers to maintaining a regular exercise program is time and cost. But you’re not going to use those excuses, because this does not require a lot of time or special equipment! But it does require consistent effort and a willingness to be uncomfortable. So write 15 or 30-minutes into your schedule and treat it like an important meeting that your life depends on.
2. Get off the exercise machines. Most gyms are packed full of various machines that have you sitting and guiding the movement for you. There is a time for these. But the far majority of us sit for too long, too often. Driving to the gym to sit on various exercise contraptions seems quite misguided, especially in light of the typical excuses (time and cost) for not exercising. Instead, try to perform exercises and activities that demand that you control the movement. Start with small movements and light resistance, and progress gradually. A little resistance and gravity is all it takes! We have all the gizmos and gadgets and apps, but at the end of the day we’re always still dealing with gravity, load, distance and time. You truly need knowledge more than fancy gadgets!
3. Limit “dumb” exercise. By dumb exercise, I’m referring to activities that do not demand your attention and focus. Dumb exercise is sitting on a recumbent bike while reading a magazine, or using an elliptical trainer for an hour while watching television. These activities do have some benefit to our cardiovascular system, but they are limited in the extent that they help us train our balance sense, reactive abilities, strength and range of motion required in everyday living. So instead of 40 minutes churning away on an elliptical trainer, try 20 minutes with 20 more of total body strengthening and balance exercise. Sign up for yoga, tai chi, or a recreational sport or activity that demands body control, balance, and careful attention to learning something new.
4. Don’t hide from your problems. If you are strong and stiff, you may want to find a safe and effective stretching program. If you are flexible and thin but frail, hit the weights or at least bodyweight calisthenics. If you have shoulder, back, knee or foot pain, don’t push through. But don’t quit! Find a professional who can evaluate and guide you through the problems before they get worse, limiting your function even more.
5. Try this balance “sampler”. Here are a few of our favorite simple but effective beginner exercises that will help improve range of motion, balance, and functional strength. I did these in my home in order to show that they do not require a lot of equipment!

“Step-to balance” Stand a few feet from a wall or counter top, feet side by side. Practice stepping out and stopping, maintaining your balance on one leg. Try to stay tall and keep your hands near a wall or counter-top to “spot” yourself. Step back, feet together, then step out with the other foot. Repeat 5 to 10 repetitions stepping out onto each leg.

March march down and back near a wall our counter top, focus on driving one leg high and keeping the “down leg” hip straight and heel pressed into the ground. Pause with each step, front knee up and back heel down. When this is easy, try marching backwards or while holding some weight in each hand.

Nose Lean  Balance on one foot, approximately 8″ from a wall. Stay tall but lean your nose out toward the wall. Spot yourself with your hands near but not touching the wall. Reach your nose “out and up” but don’t face-plant! Return to tall standing on one leg. Do 5 to 10 repetitions on each leg.

Single leg hip hinge Stand on one leg near a bench or chair. Stay on one leg as you push both hips back, folding at the waist but not rounding our back, to lightly touch the surface in front of you, then return to the tall posture (still on one leg). Progress this exercise by holding a light resistance in your hands to touch the surface in front of you, or reach to a lower target such as an 8″ step.

Side step over and under fence Step sideways down a hallway or along a countertop (somewhere that you can touch to lightly spot yourself from falling). As you step sideways, imagine that you literally have to pick up both feet over a fence, then step sideways while ducking under a fence. With each step you go over the fence, then the next step duck under the fence. Repeat this 5 to 10 times stepping to the right, then back to the left.

Poor balance and falling are usually not something that just happen, but comes from unaddressed injuries and years of accumulated loss of flexibility, strength, body awareness. So do not neglect the maintenance and repair of your body. Get to it. Feel free to email me if you have any questions or suggestions.

References:

Fall Risk Awareness and Safety Precautions Taken by Older Community-Dwelling Women and Men: A Qualitative Study Using Focus Group Discussions/core/jig/1.14.8/js/jig.min.js

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363490/

National Council on Aging Fall Prevention Facts

http://ncoa.org/news/fall-prevention-facts

Falls in the Elderly by American Family Physicians

http://www.aafp.org/afp/2000/0401/p2159.html

Falls among Adult Patients Hospitalized in the United States: Prevalence and Trends

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572247/