Slipping into Fall- 7 Keys to Reduce the Likelihood of Falling

I want to tell you a story about a woman in her upper 70’s who was commuting when her SUV broke down on the highway. Once the tow truck arrived on the scene, they determined her vehicle needed to be towed. The driver used a winch to pull her vehicle onto the upper portion of the sloped truck bed when the cable suddenly broke sending the vehicle rolling toward the woman. Being a trained Feldenkrais practitioner and martial artist, she had trained herself to be able to respond at a moment’s notice. She instinctively flattened herself to the ground just in time for the vehicle to roll over her without hitting her.

How comfortably and efficiently can you move to and from the ground? How prepared are you to take a fall? September is National Fall Prevention month and slip/trip accidents are consistently one of the most common sources of accidental injuries, sending approximately nine-million people to the emergency room every year. 

As an outdoor athlete, I've had a lot of practice taking falls. Sometimes gracefully, and as my friends can attest to sometimes not so gracefully. Even walking on Seattle sidewalks can be dangerous! With a slightly bruised ego, I will admit falling on more than one occasion tripping on an elevated sidewalk panel on a dark sidewalk and walking away otherwise unharmed. 

So what's the key to building up your inner resilience to prevent a fall or respond if you're already past the point of no return.

1. Situational and Spatial Awareness. How aware are you of your surroundings? Oftentimes, people trip/slip on things they don’t see. Do I even need to bring up texting while walking? If I’m walking on a sidewalk and see large trees covering the sidewalk ahead, I might want to pay more attention to the levelness of the sidewalk. Spatial awareness increases in importance when considering activities like mountain biking or skiing when you are moving at high velocity. Having the situational awareness of the dangers around you keeps you alert and processing your safety. Also, knowing if I were to fall, which direction is safest to fall.

2. Good posture- which I define as the state from where a person can move in any direction, at any time, without hesitation or preparation. It is the absence of unnecessary muscular contraction. When well organized, a person is free of parasitic muscular contraction which can inhibit their ability to react to a changing environment. 

3. Balance/Counterbalance- Improved balance is achieved when the center of body mass is clearly organized above the base of support. I oftentimes see clients standing with their center of mass shifted to one side or another. When you perform a movement how clearly do you use the whole of yourself? As you move do you create a counterbalance within your body to clearly maintain your center of mass over the support of the surface you’re on?

4. Variation- being able to meet the demands of a changing environment through the ability to quickly adapt one’s self to novel conditions. How do you prepare yourself for this? You Train!!! The more potential pathways to the ground you’ve practiced the more prepared you’ll be to bring yourself to the ground versus fall to the ground. 

5. Structural Integrity- How clearly can you translate force through your body? What parts of yourself fall into the ground as you move? How do you organize yourself to have the clearest and most efficient way to move away from the ground without engaging unnecessary musculature? When you’re well organized and using the support from the surface you’re on you can maintain a sense of lightness as your skeleton provides clear support.

6. Suppleness- how fluidly can you respond to the environment around you? If you have a very rigid stance and someone pushes your chest you will likely fall back. However, if you are fluid you may be able to absorb the force without falling. If you have a rigid sole, you may not be able to feel the rock you stepped on before you roll your ankle and fall which brings me to my last point. 

7. Sensible Footwear- Please! When has it ever been a good idea to wear high heels when it’s icy out? Of flip flops in a construction site? Wearing the correct footwear in the right environment keeps you safer. 

Falling is a reality of life and it happens to all of us. Why not put the odds in your favor by building your inner resilience and training yourself to more effectively come to and from the ground with the least effort and the most efficient path? The main point is to train yourself. You can have conceptual knowledge of what to do in the case of a fall, but if you haven’t developed your brain’s motor mapping and spatial awareness, conceptual knowledge doesn’t translate into better functional outcomes. 

If you’re interested in developing these capacities within yourself my new movement workshop on “Developing your Inner Resilience” is the perfect place to begin. I hope to see you there!

For the Love of Your Back

For the love of your back stop what you’re doing and pay attention! This is tremendously important for everyone young and old with or without pain. This knowledge is something I try to impart on all my clients, and it's better to start this practice now than wait for back pain to occur!

The low back is one of the most chronic areas of pain in our society. In a recent article on NPR title, “To Fix That Pain In Your Back, You Might Have To Change The Way You Sit” it goes into some of the current statistics on sitting. The article states that the average US citizen sits between 9-13 hours a day and only gets about 2.5 hours of exercise per week. This article states that some indigenous communities sit roughly as much as we do. However, the way they sit is significantly different, and they don't suffer from the same back ailments we do. So what’s the difference? The key is skeletal alignment and organizing your sit bones!

When you sit having an emphasis on organizing the pelvis is incredibly important.

1. Hinging at the hips is very important. Most people sit on the back of their sit bones in the "C" shape the article mentions. Sitting on the inferior tip of the sit bones and pulling the gluteus maximus tissue posterior provides the additional skeletal support to maintain this posture over long periods of time. This creates a neutral pelvis and allows you to be more on top of the sit bones versus sitting on the softer butt tissue, which will eventually lead to the dreaded "C" curve.

2. Creating a base of support with your legs. Having your feet flat and legs slightly wider than your hips creates a basis of support from the ground up and through you. Additionally, having the pelvis slightly higher than the knees oftentimes helps people with tight hamstrings and gluts. This is where some Structural Medicine work can be helpful to create more length, space, and body awareness of where your sit bones actually are in space.

3. The article also didn't mention that most people sitting at work are focused on a computer. Typically, reading and typing on a computer pulls people's attention forward and most keyboards are set up so you're arms are internally rotated and the shoulders are rounded. We literally get pulled into our work and oftentimes the stress of deadlines only reinforces this pattern. Creating a desk set up with proper ergonomics will help keep the upper end of the spine aligned as well as the shoulders.

One of the last concepts that I’ll leave you with is something Moshe Feldenkrais said, “Good posture is the absence of muscular tension”. If you have to exert yourself to “hold” a good posture you’re doing something wrong. This will only lead to creating a new layer of holding on top of an already unorganized structure. You only get one back and most back pain is caused by long-term poor organization and movement. You’re in the driver’s seat so use the steps above to create a life-long healthy back while sitting.

Surfing

Summer is a great time of year to get out and try something new. Two weeks ago, my girlfriend and I had the opportunity to go surfing and we couldn't pass up the offer. It was a humbling experience getting thrashed by the cold waves of the Pacific and there were many unfamiliar elements to deal with. It initially left me feeling very awkward as I struggled to find a sense of balance on my board. However, I stuck it out and persevered. By the end of the first session had gotten up and rode out a couple of waves! Thank you Karen and Phong for some excellent pointers!

When learning a new movement or sport it's easy to get intimidated by feeling uncoordinated, uncomfortable and clumsy. This is natural and something I've dealt with in Yoga, Dance, etc., and now surfing. However, the good news is that the more variety of things you try the easier it becomes to pick up new movement skills. In addition, when trying new movements it creates a rich learning environment for your brain and body to develop new nerve pathways that enhance your motor skills and proprioception. When learning new sports it's also an excellent time to get some coaching to speed up your learning curve and maximize your enjoyment!

Arms in Motion

How do you use your arms in walking? Take a moment next time you are walking to observe how your arms are moving.

1. Do they move freely?
2. Does one arm swing more freely than the other?
3. Do your arms reach out forward more than they extend back?
4. Do they primarily move from below the elbow or move freely from the shoulders?

There are three primary roles of the arms in walking: They're Thrusters, Sensors, and Balancers. When used properly the arms are free to float and should naturally pendulum back and forth when you're walking. However, many of us unconsciously hold our arms increasing tension which can lead to tight shoulders, neck pain or more serious conditions like thoracic outlet syndrome. 

Next time you go for a walk see if you can shake out your arms and let them begin to swing more freely. One image that I sometimes use with clients is to imagine using your arms to swim through the air. This can help to get you started in developing more freedom in your swing and this would be an example of using your arms as thrusters to move you forward. Eventually you want the arms to naturally swing on their own, but this is a great way to bring some more awareness to get them moving again. 

Starting next week I'll be offering weekly movement classes to explore human movement potential and develop greater awareness of areas such as the arms that could benefit from more conscious movement!

6 Ways to Enhance the Body’s Response to Exercise

Many of us work hard to maintain a level of health and fitness. However, in today’s world of time crunched society many of us are not getting the other needs met to enhance our body’s recovery from our training. Here are 6 things to consider when ramping up your training this year.

1. Clear Intention- What is it that you want to accomplish? Creating a training plan keeps you accountable and on target. It allows you to train for specific objectives and track progress. Depending on your sport you might have a training cycle to address areas such as base fitness, strength, power, a performance phase and a recovery phase. There will be times when you need to make adjustments due to work/life balance or injuries. So keeping flexible is important to keep the rest of you in balance as well.

2. R&R (Rest & Recovery)- How well did you sleep? Did you get adequate rest? Are you exhausted from yesterday’s workout or in pain? If so, maybe today would be better for a light spin on the bicycle to flush out the toxins and do some active recovery.

3. Nutrition- Have you eaten enough nutrients to perform the prescribe activity with the correct amount of focus and intensity? If you go in hungry to a workout, you will not have the reserves to get the most out of an intense training session. Are you getting enough to eat during the activity (especially for endurance sports)? Have you replenished the reserves post exercise?

4. Hydration- Our bodies are roughly 65% water which is vital to regulating body temperature, blood pressure and the movement and transport of nutrients. Being a Structural Medicine Specialist I also know that decreased hydration equates to decreased elasticity in the fascial network. Fascial “stretch” is actually the glide between the fibers in a substrate of water absorbing proteins called GAGs, glycoaminoglycans. Without hydration our tissues are resistant to stretching potentially increasing the likelihood of injury.

5. Mental State- How calm, stressed or frustrated are you? People often use exercise to blow off steam, which can be very helpful emotionally. However, if you’re supposed to have a lighter workout day and you come in over stressed and angry and charge at 120% you might end up over doing it.

6. Mobility and Movement- Is your body moving well? Are there areas that are feeling limited? How much have you moved in the last 24 hours? If you’ve been sitting at a desk for the last 16 hours it would not be advisable to go straight into a high intensity heavy lifting workout. First, take the necessary time to open your body up doing mobility routines until you have the active range to do the prescribed workout and or modify the workout.

I know firsthand that it’s tough to monitor all these areas, but they all play a vital role in keeping you healthy and performing your best. If you’re not getting the proper hydration, rest, nutrition, or movement you are probably better backing off the intensity and volume of a workout until you are better prepared to perform.

3 Tips to Train Smarter this Spring

Want to run a marathon, climb Mt. Rainier, or bike a century? This time of year many of us are ramping up our training and we are full of hopes and aspirations for physical accomplished this summer. I'm one of those people hoping to continue to push my limits conquering harder rock climbing routes. Once the warmth and sunshine arrives (typically much later here in Seattle) we dust off our running shoes, bikes, etc and go full steam ahead. However, going out too fast leaves many of us susceptible to injury.

As research has now shown, the majority of athletes problems are most often neither in the musculature nor the skeleton.  Rather, it’s in the structure of the connective tissue including the fascia, ligaments, tendons, and joint capsules that have been loaded beyond their prepared capacity (Renstrom and Johnson, 1985, Hyaman and Roeo, 2000; Counsel and Breidahl, 2010). This typically occurs for a variety of reasons, but I’ll outline a few for you here:

1. Abrupt changes in training intensity or volume- As I’ve heard others say in the past, it’s all about the dosage. If you add in too much volume or intensity too quickly you will find yourself on the injured list, oftentimes because of a connective tissue injury. You see muscles respond faster and recover more easily than tendons and ligaments because muscles receive more blood flow, while connective tissue receive less blood flow. In fact, fascia can take 6-24 months to rebuild fascial elasticity.  Thus when returning to a sport or starting a new sport you must ease into training to avoid getting injured.

2. Changes in technique- I see this frequently with runner’s going from a heal strike to barefoot style of running. If you’ve been training for years in one style and then just switch to a new technique without a reduction in volume and intensity you are setting yourself up for failure.

3. A Change in the types of equipment being used- Cyclists changing bikes, shoes, or seat height. Rowers changing the type of boat or set up. Runners changing their footwear. All of these require adaptations for your body so ease into the new equipment.

Injuries take away huge gains in training and create a great deal of frustration. It's best to take a proactive approach to your training. Make sure to plan for the appropriate amount of volume and intensity that will continue to push you forward without getting into the zone of injury and overuse. When in doubt about an area that is painful be proactive and get it checked out. Oftentimes, injuries heal themselves much quicker if given time heal rather than pushing through pain and creating a chronic condition.

Build Habits First to Get to Your End Goal

Soon enough New Year’s will be right around the corner and many of us will set a big lofty goal for the New Year. Some of us might want to lose weight, others might want to qualify for the Boston Marathon, complete a big backpacking traverse or start a new hobby. These are all great ideas and one of the best ways to meet your lofty goal is to focus on developing habits rather than setting a specific goal.

Why not just focus on the goal? There are a couple challenges with goal setting. One, oftentimes a goal is a lofty vision of where you want to be in the future and without any real data points that the goal is based on. It’s really easy to say I want to lose 50lbs in the next 4 months, but how did you come up with that number. Secondly, many people pin their success and happiness to a lofting distant future state and it doesn’t acknowledge that you successful and whole now. Third, goals often create a yo-yo effect where you train really hard, meet your goal, and then fall off the bandwagon.

 Here are 5 Steps to creating Habits that can Transform You

1.    Tie it to an existing habit. For example, let’s say you want to start a daily mediation practice. One habit that just about everyone does and if you don’t you should really start doing is brushing your teeth! You can start by cutting out a two minute chunk of time each morning right after brushing your teeth to sit and mediate.

2.    Make it a Daily Routine and Your Identity. It’s much easier to be more consistent and cut out any decisions making by creating a daily habit out of you new goal. If weight loss is your goal make sure you set aside a daily exercise routine that will keep you on task and consistent. You can still have rest days but make it active recovery such as a light spin around the lake. This will develop your identity as a person that is active and healthy.

3.    Ease Into Intensity and Volume. Let’s face it we all have crazy busy lives. Oftentimes, we add too much too quickly and overwhelm ourselves or get injured. Sometimes, it’s hard to build up slow because we are excited about our new endeavor, but it’s important to maintain steady progress so we don’t overdo it.

4.    Start Before You’re Ready. Learn to accept and embrace the fact that you will never be fully ready to start anything new. We are really good at making excuses and telling ourselves that I’ll start training once I get this house project done or once the kids go back to school. However, the plate will never be clear enough so we need to just commit to starting now.

5.    Do it with a buddy! Starting a habit with a new friend creates accountability and you have a personal cheerleader to keep you motivated when you feel tired or when the weather is crappy. It’s always more fun when you have someone to share success with too!

4 Ideas to Fight Text Neck!

I’m pretty sure most of us have experienced a sore neck from tilting our head forward too long staring into the endless barrage of text messages, emails and Facebook updates on our smartphones. According to the research firm Flurry, we are now spending an average of 2 hours and 57 minutes on our phones and tablets each day and dedicated users are spending 3 hours and 45 minutes per day. This is leading to an epidemic of chronic pain in both the older and younger population. Neck pain is now the third most common form of chronic pain impacting more than a quarter of US Citizens.

Humans were designed to stand upright. When our body is well organized our skeleton is providing a great deal of the structural support to keep us upright in gravity and our muscles are free to respond to any necessary actions. However, when we slump or bend forward our muscles are now constantly engaged to keep us upright against the gravitational force pulling us forward. This can reap havoc on your neck.

The average adult head weights between 10-12lbs and when stacked properly over the cervical spine the gravitational force is equal to its weight. However, as you begin to bend your neck forward it increases the amount of force that is being applied to your neck and back. According to Dr. Kenneth Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine, with a 15 degree curve in the neck the head is equivalent to 27lbs and by the time the neck is bent to 60 degrees it’s equivalent to 60lbs.

Try this to get a feel. Hold a 10lbs weight next to your body for 15 seconds. Now, hold it at arm’s length in front of you for 15 seconds. It’s still 10lbs but you have to work significantly harder to hold it up. Your neck has to respond the same way each time you flex your head forward to check out the next text message.

So what’s the big deal? Well, you might at first experience some soreness and stiffness. This typically will go away on its own. However, if this patterning persists you’ll be prone to early wear, tear and degeneration of your cervical spine. You may develop bone spurs, ligament strains, spine degeneration and thickening of the tissue around the back of your neck in order to support the weight of your forward head. Luckily there are some steps you can take to reduce the impacts of using your phone.

Things you can do!

1.       When talking on your phone use the speaker or a hand free device

2.       Try holding your phone more upright in front of your eyes to reduce the amount of neck bend.

3.       Take frequent breaks and don’t spend prolonged amounts of time staring down at your phone.

4.       Do the stretches below to open up your neck, chest and shoulders.

a.       Shoulder Pass Through- Use a PVC pipe or broom stick. Hold the bar in front of you with your hands wrapped around the bar with a pretty wide grip. Now keeping your spine neutral bring your arms up over your head and pass them behind you or as far as you can take it.

b.      Neck Extension over a foam roller- Laying on your back place the foam roller underneath your mid back. Roll your body down the foam roller so that the roller is getting closer to your neck. Pinpoint areas on your neck that feel locked up and allow yourself to breath and let you neck extend backwards over the foam roller.

c.       Back/Neck Extension with Exercise ball. Sit on the ball and then lay back. Bring your legs out from the ball with a wide stance to improve stability. Now release your neck and upper back into extension over the ball. You can bring your hands out in front of you to open up your shoulders and pecs as well. Breathe deeply and relax your muscles over the ball on the exhale. 

Sprained Ankle? Forget About Rest!

It is estimated that there are 23,000 ankle injuries per day in the United States (Kannus, Pekka). Ankle injuries are most common among athletes, especially in sports such as basketball, soccer, and football. Up until recently the standard treatment protocol for acute ankle sprains has been RICE- Rest, Ice, Compress, and Elevate. However, there still lacks clinical evidence of the effectiveness of the RICE method. In fact, many clinicians in the last decade have moved away from the old regimen of RICE and now are stressing other treatment protocols such as POLICE- Protection, Optimal Loading, ICE, Compression, and Elevation and even more alternative approaches such as MEAT- Movement, Exercise, Analgesics, and Treatment.

Currently, there are no conclusive studies that determine whether RICE, POLICE, or MEAT is the most effective approach to soft tissue rehab. Yet, there appears to be a growing consensus that mobilization and optimal loading is the best strategy for improving injured ligaments and joints. When an injured ankle is immobilized, scar tissue forms in an unorganized pattern and tighter weave causing a stiffer joint and longer recovery time. In addition, when ligaments scar excessively, the ankle joint becomes more prone to future sprains since the ankle is more rigid and there is less give in the system.

Therefore, many practitioners are now recommending treatment protocols with pain free movement or optimal loading. An article in the British Journal of Sports Medicine by CM Bleakly defines optimal loading as, “replacing rest with a balanced and incremental rehabilitation program where early activity encourages early recovery. Injuries vary so there is no single one size fits all strategy or dosage. A loading strategy should reflect the unique mechanical stresses placed upon the injured tissue during functional activities, which varies across tissue type and anatomical region.”

Many people that suffer from sprains often times have to wait several days to be seen by an expert. Here are some steps you can take immediately to help reduce the amount of scar tissue build up while you are waiting for professional assistance.

1. Elevate the injured ankle and if swelling is significant ice, but only for short periods of time, no more than 5 minutes. You can reapply after 10 minutes if the ankle is still hurting. As I said in my last blog post, there is a lack of conclusive evidence of the benefits of icing injuries other than the reduction of pain, making it challenging to provide clinical suggestions for the appropriate use of ice. Based on the severity and type of injury, icing may still be appropriate for controlling excessive swelling and reducing pain.
2. Protect the joint from further damage by not loading it in painful positions. If you choose to use compression only use it for the first day or two to help control bleeding and prevent further damage.
3. Optimal Loading- start moving the joint with muscle pumping to reduce the amount of swelling and keep scare tissue from developing. Only muscle pump within a pain-free range of motion

In addition to movement, Structural Medicine can greatly increase the rate of recovery and restore proper structure and function to a joint after the acute phase of healing by addressing any remaining adhesions, scar tissue, and fascial restrictions. To reach the full potential of healing it is imperative to take the tensional strain off the injured soft tissue. Often times trigger points will result from the stress placed on the muscles surrounding the injured site causing an imbalance of tension around the joint.

Structural Medicine works to restore the tensegrity between the fascia and connective tissues surrounding the injured joint and introduces pain free movement which begins to re-establish mobility at the site of the injury. This movement will also set in effect Wolff’s Law which states connective tissue will arrange itself according to the stress placed on it. Therefore, through joint movement the body signals new connective tissue to establish proper strength, length, and elasticity needed at the joint.

Bodies heal with movement not immobilization and the quickest way to increase mobility of a particular restriction is through hands on manipulation of the soft tissue by a trained expert. By restoring the ankle’s proper structure and function through Structural Medicine you will heal faster and be less prone to future ankle injuries!

The Cold Truth About Icing Injuries

Ask any athlete what you should do if you sprain a joint or tear a muscle and they will respond with RICE (Rest, Ice, Compress, and Elevate). While icing may reduce pain, there is little evidence of its effectiveness in enhancing recovery. For example, research from the Emergency Medicine Journal concluded that there is “insufficient evidence to suggest that cryotherapy improves clinical outcomes in the management of soft tissue injuries.” In addition, researchers Hubbard and Denegar concluded “Despite the general acceptance of cryotherapy as an effective intervention, evidence on which to base these conclusions is limited.”

Icing can actually lead to the potential for increased injury since it decreases nerve conduction diminishing motor function (i.e. agility). In addition, icing numbs the injured tissue allowing athletes to push through unnoticed pain when they begin to exert themselves after icing. The article Why Ice May be Bad for Sore Muscles by Gretchen Reynolds discusses these points in greater detail.

One of the biggest potential negative impacts of icing was found in research released from the FASEB Journal suggesting that “muscle inflammation after acute muscle injury is essential to muscle repair by means of insulin-like growth factor-1 (IGF-1). The study found that the presence of inflammatory cells or macrophages in acute muscle injury create elevated levels of IGF-1 which significantly increases the rate of muscle regeneration (see press release).” To summarize, the body naturally responds to injured tissue by releasing cells that restore damaged muscles, tendons, and ligaments. Icing causes local vasoconstriction, or decreased blood flow, which could negatively impact the effects of inflammatory cells slowing the process of muscle regeneration and ultimately the speed of recovery.

This topic of discussion lacks conclusive evidence thus making it challenging to provide clinical suggestions for the appropriate use of ice.  Based on the severity and type of injury, icing may still be appropriate for controlling excessive swelling. Ultimately, every injury is different and needs to be assessed and monitored to determine the severity of swelling and the rate of recovery. Based on the fact that there is little evidence that icing improve recovery outcomes, and new research suggesting that icing may inhibit recovery, you may want to think twice about icing an injury with only limited or moderate swelling.