April 21, 2015

Wellness Prescription

I recently blogged that I retained the services of a life coach. His name is George. I love George! When I hear the name George, I'm always reminded of the abominable snowman from the cartoon days of my youth. "Oh look, my very own bunny rabbit! I want to hug him and squeeze him and pet him and name him George!" But I digress.

I wanted to elaborate upon the wellness prescription that George has given me.

1) Exercise: I endeavor to run 2 miles, 3x/week in order to improve my cardiovascular endurance without beating up my body. On difficult days, I use a mantra while I'm running: "change your physiology, change your mind." On odd days I alternate between core stabilization therex, yoga stretching, and the 7-minute workout.

2) Meditation: 5 minutes a day, combined with deep breathing: 4 seconds in, 6 seconds out, 2 second hold. Thoughts move into the mental field, are acknowledged, and released.

3) Mindfulness (living in the now): George wants me to get into the habit of "checking in." Program your phone to chime every 15 minutes and ask yourself: "How am I feeling right now?" If you don't like what you feel, do something to change it: Eat if you're hungry, empty your bladder if you've gotta go, deep breathe if you're agitated, drink water if you're fatigued. If you're happy: Celebrate!

4) Gratitude: Part of staying present is being grateful for every little thing every day. Why is gratitude so hard? Because we get busy and stressed and forget to notice all the little miracles that occur around us all the time. Gratitude is the gift that is coupled with being present. Often, I have heard that people who pray are better at gratitude because prayer is all about saying thanks rather than asking for something. Thanksgiving can be celebrated every day when remember to incorporate gratitude into our daily routine.

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April 11, 2015

Weekend Warrior?

I love to run on Saturday mornings. I see so many more people running than on weekdays. And I say "hi" to all of them. Some of them, bless their hearts, look like they're laboring hard to get their workout in (probably like me!). And others are as cool and poised as can be, like they do this all the time....

I want to be like that some day.

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April 4, 2015

Pathfinders Study at Duke

I was watching TV the other night, anticipating the 3 part series titled: Cancer, The Emperor of all Maladies, when another show preceded that one. Having recently worked a temporary position at a Duke Hospital, I was interested to hear about a pioneering study being done there called Pathfinders.

The Pathfinders program is designed to address the mind, body and spiritual needs of each individual patient.

Not only did this study explore the psychosocial aspects of living with a cancer diagnosis, they have holistic approach which puts the humanity back into medicine, that is often lost when a person becomes someone with a cancer to treat.

Included with the Pathfinders Program are the 7 pillars to personal recovery: hope, balance, inner strengths, self care, support, spirit, life review. And it occurred to me by watching this show, that the pillars could be applied not only to illness, but to addiction, injury, divorce, loss of a child or job, or any number of life crisis.

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April 2, 2015

Getting a Life Coach

It's so easy to get off track of wellness goals. All we need in life is a major distraction and the new habits we're trying to establish get side-lined. In my job, I act as a cheerleader, of sorts, in order to get patients to move so that they do not lose function. In my life, I found I needed a cheerleader or guide so that I too could accomplish goals. I'm actually pretty good at the practicalities of life: I am able to feed myself, clothe myself, work a job and pay my bills. But living life is about more than surviving. How do we make our life the stuff that our wildest dreams are made of. In the context of a major life transition, I found I'd forgotten how to dream about what I wanted my life to be.

My solution: George, a life coach. Why not? Even elite athletes need a coach to shape them toward their professional goals. It is no different for the rest of us. And for me to reach my full potential, I need to replace old, outdated coping mechanisms with new, updated skills for emotional regulation. George says, "you can't change habits, you can only replace them." Exercise is part of my prescription, along with meditation, mindfulness (living in the now), and gratitude. "If you can change your physiology, you can change your mind."

So, last week, when I was distracted with life chores: getting a job, preparing income taxes, and finding a car, I began to lose focus on my new habits. I'd say to myself, "meh, I don't feel like running today." or "I'll do the 7 minute workout or 5 minutes of meditation this afternoon." It wasn't long before I was dishing myself a heaping helping of "miserably overwhelmed!" I felt so terrible and discouraged for losing momentum in the right direction. But it was George who kicked my butt back into gear with the following statement: "You know this stuff works for you. If you don't stick with the program, then I can't help you."

It sounds amazingly similar to the messages I tell my patients: "you must do the work or nothing will improve." Thank you, George, for redirecting my focus. I know that it will take time, but once I can catch and redirect myself to use those new habits, I will no longer need a coach to remind me.

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March 31, 2015

Another Reason to Take D Vitamins

First there were articles about the importance of Vitamin D for building healthy bones. Then later articles drew a link between Vitamin D deficiency and age-related decline. Now there seems to be a link between low Vitamin D levels and depression in healthy individuals.

The connection between sunlight exposure and production of Vitamin D is well documented. During winter months, especially in northern latitudes, sun exposure is decreased and often associated with seasonal affective disorder (SAD). So the it's easy to jump to conclusions that this explains the relationship.

However, in this new study:
After taking into account season, body mass index, race/ethnicity, diet, exercise, and time outside, the researchers found that lower vitamin D3 levels across the study period predicted clinically significant depressive symptoms (P < .05).

Taking a Vitamin D supplement is a low cost, low risk solution for people who may be at risk for depression. I like the 1000 IU, which are 1000IU per gel. However, other supplements offer
5000 IU per tablet. Talk with your doctor to find out if Vitamin D supplementation is right for you and how much you should take.

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March 23, 2015

Dance is Exercise

I've always loved to dance. There is nothing more joyful than moving your body to a song with a beat that moves the heart and soul. Most of my dancing has been free-style at clubs in my youth. It was the 80s, everybody was doing it!

A dance that I've always thought looks like a lot of fun is swing dancing. So I looked for local lessons and found an affordable venue at our local Elks Lodge. For $10 I got a beginners dance lesson, followed by two hours of dance which was open to a local dance club. Ages 17 to 75 are welcome and the dancers really reflected the spectrum of skill levels. I made a mental note to dance with every single person who asked.

I had a blast. Dancing, even at my limited skill level, is a great aerobic exercise. I danced 90% of the time and was sweating up a storm. I drank 3 bottles of water in 2 hours! My partners were kind and patient, giving me tips and pointers, which helped me gain confidence and reinforce the new dance steps that I learned at the beginning of the evening.

So if getting off the sofa and going for a run or working out at the gym is not your thing, sign up for a dance class. It's a whole lot of fun, good exercise, and helps you meet new people. BTW, the example video links above are "west coast style" swing dancing. There is also an "east coast style" which I am learning.

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March 20, 2015

Stymied By Re-injury

I've been training for a half marathon, and worked my way into an overuse injury of the adductor muscles on the inner thigh. After following instructions for rest, ice, stretching, and massage, I've started feeling better. I also began to incorporate strengthening exercises and everything seemed to going on track and I was ready to begin some easy running.

But first, I had errands to run, because, after all, life gets in the way. And it was in the supermarket, lifting a 26 lb box of cat litter into a shopping cart, that my right psoas went into spasm. I usually find cat litter in 20 lb boxes - what a difference 6 lbs can make! If I had been forced to lift the box from the floor rather than from a hip-height shelf, I probably would have squared my body better.

So rather than begin a light running program and return to training, I continued to rest. And I continued to stretch. And I used my foam roller to continue to work out my hamstrings, and IT band, and quads. And I continued my pelvic strengthening exercises. What I noticed was the sore spots were different on both sides of my body, like I was stretching and strengthening two different people. My pelvis remained out of alignment, and the last thing I needed to do was strengthen my body to reinforce and aberrant and out-of-balance pattern of support.

So I sought the help of a chiropractor. Why would a PT utilize the services of a chiropractor?? Why would an orthopedic surgeon I know recommend chiropractic for his back patients? Because chiropractic care has it's place in spectrum of health and wellness. If soft tissue manipulation and exercise do not correct a bony misalignment, then a chiropractor or well-trained PT are indicated. Frankly, a chiropractor may be quicker and cheaper. And if a patient is contemplating back surgery, wouldn't it make sense to exhaust all non-invasive options (with the blessings of your surgeon)?

So, lo and behold, it took 2 sessions, and my pelvis is back into alignment enough that I can do the pelvic stabilization test with increased steadiness. And I can perform my strengthening exercise with equal exertion on both sides of my body. And my muscles exhibit tension and tenderness in consistent locations on the left and right sides. And light running no longer hurts.

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March 18, 2015

Exercise and Depression

I'm between jobs right now, and frankly, the situation has me feeling depressed. But rather than moping around, I've decided to focus on things in my life that I can control, such as my health. I also have a hefty "to do" list: you know the kind, all those things you know need to get done, but you put them off .... How often in our lives do we get a block of time to get around to nagging projects without having to take personal time from work, or spend precious weekends attending to them? But when people are depressed, motivation can be hard to come by. The solution: exercise.

Mental health experts have long been aware that even mild, repeated stress can contribute to the development of depression and other mood disorders in animals and people. Scientists have also known that exercise seems to cushion against depression. Working out somehow makes people and animals emotionally resilient, studies have shown.

The evidence is clear that exercise helps with depression. From professional medical sites such as WebMD and Mayo Clinic, to psychology sources to the Cochrane Research Database, ample literature supports the benefits of exercise in warding off and preventing depression. And we're not talking about just depressed mood, but major depression. The one thing an individual can do to improve their mental health is to exercise.

What is Mental health:
“State of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope
with adversity.”—USHDDS, 1994, p. 4

I have to admit, getting out and running has helped to lift me out of the doldrums. Being side-lined from training put me back in temporarily because I was not able to engage in exercise at the level I needed to combat depression. But now that I'm back in the game, my motivation has improved again. Heck, I've even been motivated to resurrect this blog! And I feel good about myself for taking charge of my health and getting moving. The success of exercise builds on itself - the better you feel, the more you want to do to keep feeling better.

Exercise does not require special equipment or expense. You can simply use the weight of your body for adequate resistance training. Walking to get the blood moving is the safest, most effective cardiovascular exercise. And stretching, especially after a workout, is helpful in recuperating following an exercise routine and maintains flexibility. To reduce depression, follow general public health guidelines, which recommend at least 30 minutes of moderately intense exercise five days a week as well as two days of strength training each week. Of course, if you have any medical conditions, it is always a good idea to consult with your doctor before starting any exercise program so that you can do so safely.

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March 16, 2015

Exercise as a Conduit to Wholeness

In today's topic, I want to reach back to my alternative medicine roots and talk about wholeness. I'm going to use myself as an example, simply because it's the most immediate one on hand. I've mentioned in earlier posts that I have an SI joint instability, which allows too much movement in the foundational support systems in my body: my pelvis. It does not give me problems all the time, but simply moves in and out of episodes of stability and dysfunction. Under duress, such as training for a half marathon, the compromise in this system of support has revealed itself.

Metaphorically, I can apply the compromise of my foundational support system to my life situation. I have recently undergone a major life transition, where I feel like "the rug has been pulled out from under me," so I can attest to moving in and out of periods of strength and instability mentally, emotionally, and spiritually. Stepping out of my comfort zones and into novel situations serves to test my resilience and point out areas in life where I need to underpin compensatory behaviors with real strength.

Energetically/spiritually, the pelvis houses the root and sacral chakras, represented in red and orange. The first or root chakra is the seat of physical vitality and the fundamental urge to survive. It regulates those mechanism which keep the physical body alive. The second or sacral chakra is the center for creating relationships of all kinds. It is where we develop an inward sense of self and an outward awareness of others, ego, sexuality, and family. So if I have a physical compromise to the joint connecting the sacrum to the pelvic bones, then energetically, I have some work to do on my sacral chakra and my sense of self in the context of a major life transition.

I believe exercise is a perfect conduit to accessing the mental/emotional/spiritual parts of the self. What a helpful insight I have that the foundation of myself has become compromised. So I now have an opportunity to shore up that weak foundation, one that has relied on compensations outside of the self for stability. After all, you cannot build a house (or a life) on a weak foundation. As needed, I will utilize professional help from several sources.

I read recently that exercise is the one thing we can do for ourselves to address a whole host of illnesses without having to fork over a co-pay, add anything toxic to our systems, and has few side-effects when taken correctly. Ample research shows that exercise has multiple benefits for the mind, body, and spirit.

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March 13, 2015

Rehabilitating Adductor Magnus Strain

In a prior post, I mentioned that I developed an overuse injury while training for a half marathon. Specifically, the adductor muscles of the inner thigh, which act to stabilize the lower extremity during walking or running, got overworked and inflamed.

Luckily, researching to pinpoint exactly where the problem lay, I came across a wonderful resource that every runner should have in their arsenal of care. The Running Injury Oracle was able to identify the type of injury, and basic self care of the injury, such as rest, ice, stretching and massage (which just reinforced information and skills I already have at hand.)

Most importantly, they also give advise about safe return your sport, including exercises to prepare in order to avoid re-injury. And for a newbie to any sport, these same exercises, specifically core stabilization, should be mastered before the feet even hit the pavement. Thankfully, I did not have any trouble accomplishing this exercise. As a physical therapist, I teach this concept to my patients all the time, especially the low functioning ones. The theory is, that if your armature (yes, that's an artists term) is not firm or stable, basic movement is difficult or impossible. Our bodies are designed to stabilize through the torso before we attempt to move our arms and legs. Once you have awareness of core stabilization, you'll be able to feel it happening, even if you're simply reaching into the cabinet for a coffee cup.

The other test and exercise that is so important for runners, is pelvic stabilization. And here is where I was in for a shock. Upon performing the test, I could not manage it without either a handhold or putting my foot down. My supporting knee wobbles all over the place on both sides. It is no surprise, I was able to accomplish this test easier on the left side than the right. Given my history of compromise through the right SI joint, it makes sense that I don't have good pelvic stabilization. Without mastering those pelvic exercises (which basically is the pelvic stabilization test repeated) I have no business running or else I'll just re-injure myself. So even though I didn't plan to run the half-marathon, my training for it is over and a new training program has taken its place.

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March 12, 2015

Marathon Training and Overuse Injury

When I started training for a half marathon, I expected pain. And I've been proud of myself that I've been able to accomplish as much of the training as I have without too much difficulty. However, now I've been temporarily side-lined from training due to an inflamed adductor syndrome called Gilmore's Groin. I've never heard of Gilmore's Groin but I am familiar with overuse injuries which did no abate with continued activity. Luckily, there seems to be no rupture, so with rest, ice, stretching, and massage, I can rehab this injury myself.

While I'm disappointed to not be able to continue training, the silver lining on this event is the opportunity to research and review the biomechanics of lower extremity function and rehabilitation. I've always used this blog, not only as a resource to my massage therapy clients, but also a way to educated myself about a variety of conditions that massage therapy and now physical therapy can address. You might be thinking, "but you're a physical therapist, you should know all of this already." The bulk of my physical therapy experience is hospital-based, where I assist patients out of bed following a surgery or stroke. Out-patient physical therapists work more with ambulatory patients and those who are injured due to sports.

So, this is a good review of some education that is already 5 years old!! Not only that, it is one thing to know information didactically, and completely another to know it when applied. Experiencing a sport, and having pain inside your own body, is a different kind of learning yet again. Movement, and how it aggravates pain, and how you must compensate to avoid that pain, is information I can use to make me a better therapist.

One thing I will admit that I should have known, and I didn't listen, is to start slow. By pushing myself too quickly in order to adhere to a truncated training schedule, I could have predicted this. However, there were other things at play here. Remember, in a prior post on this topic, I gave a run-down of muscle soreness? It turns out that long-standing SI joint instability set me up for this kind of strain. And this is where the real learning about lower body biomechanics is useful for me as a therapist.

If the SI joint acts as a shock absorber for the forces that are transmitted between the upper and lower body, than it is crucial that joint be healthy. Having an adhesion where the psoas is stuck down on the iliacus, means that the pelvic stabilization needed in order to have optimal biomechanics for running, is compromised. The body has to compensate somewhere and that area of compensation occurred for me in the antagonist muscles to the gluteus medius and gluteus minimus. Those two muscles are responsible for balance in standing and hip extension that occurs in the lengthened position of running when the foot is out behind. Remember, too that gluteus maximus is a big strong muscle driving the body forward. The adductors work against all of those muscles, especially the adductor magnus, to act as stabilizers against hip extension and external rotation. Instability in that system logically indicates weakness somewhere, meaning muscles within that dynamic complex will be asked to work overtime or engage in activity they were not primarily intended to do, and an overuse injury occurs.

PT peers, please feel free to chime in here and enhance my education if there is a piece of the biomechanical puzzle I've missed. Knowing how muscles are supposed to act in one or two planes is a different than when we begin to examine how they work dynamically within a complex during weight-bearing and movement.

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March 11, 2015

Half Marathon Training: How Do You Feel?

Day 4 of my half marathon training is my first rest day. Thank goodness. I've been looking forward to my day of rest because everything is sore!

Right off the bat, about 1/3 of the way into my first run, I felt my right SI joint and then my right psoas muscle begin a back and forth conversation. I have a long history of SI joint instability, since before I started massage therapy school. Fixing the SI joint became an area of expertise while I was a massage therapist, but I've never been able to fix my own and keep it fixed. Healer, heal thyself! So when I got home, I went to work on myself, freeing a small lesion where my right psoas was stuck down onto the underlying iliacus muscle. Once the muscles, which act together for pelvic stabilization, could slide smoothly across each other, I had no more SI joint discomfort during my runs.

Running down hills (which was easiest for me on day 1 of training) is known to be hard on the knees. Thankfully, my knees feel fine. But my quadriceps, those big muscles on the front of the thigh, are sending me hate mail. Going down stairs lately requires a handrail for safety. And sitting down ... well, lets just say that investing in highboy toilets may be a good idea in future house renovation.

Tensor fascia latae, the muscle on the outside of the hips that give tautness and support to the iliotibial band of the legs, are complaining too. Lots of stretching and range of motion exercise helped to calm them down. Following the second run, they did not complain nearly as much.

The adductor muscles run all the way down the inner thigh of the leg. Because of the pattern of discomfort, I thought my sartorious was complaining, but sartorious is a weak muscle and plays little role in pelvic stabilization during activity. The adductor muscles line up perpendicularly right underneath sartorious. So, once I took my third run (another 5 miler) I realized it was ALL the inner thigh muscles that were complaining. Unlike tensor fascia latae above, they did not calm down with additional running, which means there is a problem Houston!

My next post: Investigating why my inner thigh muscles hurt so much and what I should do about that.

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