Urinary incontinence, the pelvis, and training

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A client came in recently, slightly irritated. “Jenn, you aren’t going to believe the commercial I recently saw. You are going to be upset.”

Intrigued, because this client knows me well and she knows very few things phase me, I went ahead and bit. “What?”

“One of the feminine hygiene companies is making incontinence products targeted towards younger women. Just what women need—to be told they need to spend more money on products when they could get stronger and save themselves the money and the embarrassment of peeing themselves.”

A little background. This client had two children via C-section. One of her main goals when she started seeing me was not to pee herself when she got older. We work on things. No leaking has happened in the 13 years she has worked with me. In the last two years, she found out both her stepmom and her sister struggle with urinary incontinence (UI). When she asked me what they should do, I told her they should both get referrals from their doctors to a pelvic floor physical therapist. I also told her I don’t think it’s a topic that’s talked about often enough. I train a lot of women who have had children, and I care about their total body strength, including the strength of their pelvic floors.

At some point, she looked at me and said, “I am beginning to think you’re right about why women take so long in the bathroom—they are cleaning themselves up as discreetly as possible.” (Women in the bathroom used to perplex me until I started realizing the sheer number of women struggling with incontinence. I have become more patient and understanding in recent years when waiting several minutes for a stall.)

After our session, which involved a lengthy discussion about the importance of strength and some challenging deeper abdominal exercises (for her), I began a search of urinary incontinence and exercise on my lunch break. What I found was interesting and (in my opinion, anyway), article worthy. Let’s start with the obvious.

Vaginal birth and UI:

One of the risk factors for UI is denervation of the pelvic floor muscles. Denervation means there has been a loss of nerve supply to a specific area. Nerves provide sensory and motor information to a body part—if you can’t feel an area, it’s more difficult to control that area. One of the things associated with denervation to the pelvic floor is vaginal birth, so it shouldn’t come as a surprise that statistics show up to 37.9% of women experience UI, even after 12 years of child birth. Hence, UI products.

It’s not that cesarean delivery guarantees you won’t have UI, but the odds are less. Risk of pelvic organ prolapse is also less during a cesarean delivery; however, it is surgery, and there are a host of other factors that increase following C-sections.

As an aside, I have found training women post c-section is related to different concerns than working with women post vaginal birth. I will speak more about this in a later post.

Female athletes:

It’s a problem that extends beyond vaginal births. An observational study published in the European Journal of Sports Science found the prevalence of UI in high impact sports athletes was 70%. At the risk of stating the obvious, Chances are low the 82 out of 118 women surveyed reporting had given birth, which makes this number seem really high.

A meta-analysis examining the prevalence of urinary incontinence in female athletes found female athletes had a 177% increase of presenting with UI when compared to sedentary women. The researchers suggest physical exercise places women at higher UI risk because of increased intra-abdominal pressure that’s generated during high-impact activities, but aren’t we designed to run and jump and climb? And if we are designed to do those things, shouldn’t our pelvic floors respond by getting stronger?

Curiously, a literature review by Steenstrup et.al, (2018), found that while data is limited, sedentary lifestyle also appears to be a risk factor for UI. It appears it is difficult to escape UI risk if you are a female.

Menopause:

Lest you think the issue disappears with age, in China, more than 20% of women between the ages 45-59 experience stress urinary incontinence (SUI). SUI refers to leaking during elevated abdominal pressure, which happens when you cough and sneeze.

Data collected from a questionnaire given to women between 1995-2005 found that of 1339 women reporting UI, 61% did not seek treatment because 73% believed the UI wasn’t “bad enough,” and 53% believed UI was “a normal part of aging.” This begs the question: how many women struggle with UI and don’t report it? Hence, products aimed at women specifically for UI.

And don’t forget about the men…

Prostrate cancer happens. One of the treatments for prostrate cancer is a radical prostatectomy (removal of the prostate). When the prostrate is removed, risk of UI increases.

And maybe UI just happens. A survey of 23,240 Danish men found 1657 reported various forms of UI. Granted, this is a lot lower than the numbers reported for women, (7% as opposed to 20% or more reported in the sections above), but it’s not insignificant.

Implications for movement professionals and personal trainers:

So at this point I think we can all agree UI is a bit of an issue, probably one that’s bigger than many of us realize. What can movement professionals do?

As always, creating a line of open communication is key. If any of your clients shy away from a higher impact exercise without offering an explanation, respect there might an underlying issue she/he doesn’t want to discuss. If, at some point, if someone does share with you she’s struggling with leaking, encourage her to get a referral to a pelvic floor physical therapist.

Here’s what we know: pelvic floor muscle training has a positive effect on UI in women. In men with UI following a prostatectomy, research showed improvement in UI following a strengthening program that included kegals, squats, supermans, and bridging; interestingly, hip extensor strength and endurance was significantly higher in the continent group. Women who regularly exercise have stronger pelvic floor muscles mid-pregnancy than women who are sedentary. Ankle position facilitates greater contraction of the pelvic floor muscles.

Let’s look at this another way. Getting strong will effect the entire body, all of the way down to the skeleton. Your pelvic floor muscles are no exception; if you load the pelvis in a variety of ways, the muscles that support the pelvis will get stronger.

A brief note about the physiology and anatomy:

Muscle tone and strength maintain your structural integrity. When the muscles of the pelvic floor are stiff and/or stretched out, the muscles fibers are less able to generate power. The majority of the muscles that comprise the pelvic floor are made up of slow twitch muscle fibers, so contraction during urination is initiated by a small number of fast twitch fibers. These muscles are affected during denervation, but with the appropriate exercise and pelvic floor training stimulus, can be strengthened. Kegels are a low level activity, and while they may be appropriate to begin to improve coordination and awareness of the pelvic floor, in a movement and strength setting, the structure of the pelvis should be challenged in a way that stimulates strength and mobility.

*Please note: I opted not to discuss breathing, but breathing is also a low level activity that can improve awareness of pelvic floor contraction and relaxation.

The muscles that support the pelvis should be trained in different positions. If someone doesn’t have the ability to move the pelvis in isolation, chances are slim the pelvis is going to participate in an integrated way during movement. From a practical perspective, it’s less about anterior or posterior pelvic tilt being bad, and more about the ability to being able to move the pelvis both directions, as well as laterally and rotationally. Basically, if you can channel your inner burlesque dancer, you have good access to mobility in the pelvic region.

Putting theory into practice:

How many positions can you perform a pelvic tilt? Can you do it in supine? Quadruped? Tall kneeling? Half kneeling? A squat? A lunge position? A plank? Seated? Long sitting? You own the movement when you can translate it into a wide variety of positions.

External rotation:

Strengthening external rotation of the hip may increase pelvic floor muscle strength, possibly because of the orientation of muscles such as the obturator internus and piriformis. The piriformis is actually one of the muscles of the pelvic floor; it’s also one of the rotator cuff muscles of the hip, so it stabilizes the femur in the socket during movement. It’s not only implicated in UI, it’s also implicated in non relaxing pelvic floor dysfunction, which can involve pain during urination and sexual intercourse (different topic for a different day, but worth noting).

Putting theory into practice:

External rotation should be strengthened progressively. There is so much value in ground work and different floor transitions; I frequently use the floor work from the MovNat system and squat variations from the GMB elements program to work on external rotation. I also using breathing techniques and isometric holds to feel movement in the pelvic floor. If someone struggles with external rotation, teaching the basic clam shell exercise creates awareness and the ability to isolate the movement of external rotation. Like Kegels, these are a low level movement and clients/students should be progressed to more dynamic movements fairly quickly.

The shin box/seated 90/90 exercise is an excellent way to teach external and internal rotation at the hip. A wide number of variations and transitions can be implemented from this position once basic points are covered. Prone frogger is also an excellent exercise for isolating external rotation at the hip joint. Both the seated 90/90 and the prone frogger are ways to build awareness and strength in the muscles of the pelvis and the pelvic floor.

Ankle position:

How you use your feet and ankles affects how you experience work in your pelvis and hips. Have you ever cued someone to push through the heel when stepping on to a step in order to get the person to feel the gluteal muscles more? Or maybe you’ve cued the pressing of the big toe and arch into the floor while staying centered in the heel in order to help someone feel the adductors. Your feet and your hips works together to create movement; it shouldn’t come as a surprise that ankle position impacts pelvic floor activity.

Think about what happens when women wear high heels. What position does their pelvis naturally move to accommodate the motion? Anteriorly, right? Again, this isn’t about anterior or posterior pelvic tilt being better or worse, but it should make sense that ankle dorsiflexion or a neutral ankle improves resting activity in the pelvic floor muscles. Try this: come into standing on the balls of your feet. Try and contract your pelvic floor on your exhale. Now, lower your feet to the ground. Try and contract your pelvic floor on the exhale. Which was easier?

Now, in a standing position, move your pelvis into an anterior pelvic tilt. Contract your pelvic floor. Move your pelvis into a posterior pelvic tilt. Contract your pelvic floor. Which variation was easier?

Putting theory into practice:

Our pelvis should be able to move anteriorly and posteriorly. Our ankle should be able to plantar flex and dorsiflex. If you are working with someone who struggles with UI, early on in the programming, work on ankle mobility and create awareness from the feet to the pelvis by utilizing a variety of positions while working on the feet in a flat position. Conveniently, squats, squat walks, and low lunge variations strengthen the hips and pelvis while also improving ankle dorsiflexion. You can also spend time simply working on foot exercises barefoot in order to create more mobility in these areas.

A brief note about the female athlete and UI:

I noted earlier female athletes appear to have a higher incidence of UI than their sedentary counterparts. This is probably (like all things), multi-faceted, but I do wonder if more restorative, mindful interventions surrounding the pelvis and the feet would help? Slowing down a little bit and paying attention to feeling how different areas move can create awareness, down regulate the nervous system, and improve overall coordination. While gravity, force, and pressure all play a role in the function of the pelvic floor, so does having access to a variety of positions and balanced strength. I couldn’t find any meta-analyses that looked at these types of interventions, and it’s an area I think that deserves further study. Strength happens from the inside out.

Urinary incontinence is a topic that’s considered taboo. It affects men and women of all ages and athletic capabilities. Creating programs that strengthen and mobilize the pelvis, hips, ankles, and feet in a variety of ways, utilizing isometric holds, and knowing who the pelvic floor physical therapists are in your area so you can refer out are all excellent ways to help clients deal with an issue that can decrease overall quality of life.

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The trunk: mobility, stability, or balance?

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What do you consider your core? Is it different than the trunk? And what, exactly, is its role during specific movements, like walking?

From an anatomical point of you, the trunk is the structure that consists of the neck, thorax, abdomen, and pelvis. The spine, structural component of the trunk, serves as a connecting point for the head and the pelvis. The ribs, another structural component of the trunk, protect the vital organs necessary for life and connect to the thoracic portion of the spine.

The architecture of the spine with its four curves, is designed to withstand axial stress. Axial stress is a stress that changes the length of the body. The four curves allow you to remain upright even though compressive forces (like gravity) are constantly exerting a downward pull.

The muscles of the spine keep the spine upright during day to day life by continually making small adjustments to hold the body seemingly still. They are also involved in breathing and voluntary movement.

The spinal muscles are often divided into two systems for discussion purposes: global and local. The global system is the one that enables voluntary movement. If you want to roll yourself up into a little ball? That’s the global system. Move into a deep back bend? Also the global system.

The local system, on the other hand, maintains stability, for lack of a better word. If you were to be hooked up to an EMG all day, the muscles that comprise the local system would show low level activity, always. That’s because these muscles keep you upright. Without them, you would be like the Wicked Witch at the end of the Wizard of Oz—a big puddle.

If you were to place pressure mats that measure force underneath your feet during quiet standing, you would see that the pressure doesn’t remain constant. This is because of a concept called postural sway. The body is kind of like a pendulum, with micro adjustments happening at the ankles and hips that cause a ripple effect up the body. In fact, when rigidity sets in, like in Parkinson’s, at least one research study shows an absence of postural sway.

Postural sway, then, is predicated upon both stability and mobility of the spine (as well as other factors, which I won’t discuss today). In fact, some studies show increased postural sway during dynamic tasks in subjects with chronic neck pain. This makes sense when you consider the suboccipital muscles are sensory rich, sending lots of information to the central nervous system about the position of the head; the cervical receptors also have reflexive connections to the visual and vestibular systems. If the spine has a lot of extra movement (i.e., doesn’t have good stability), the neck may feel like it’s doing far more work to keep the head stable than it would if the spine were quieter (i.e., had more strength).

This is also consistent to what I have experienced when working with clients with non-specific neck pain. Once they gain a little bit of strength, the neck pain dissipates.

Three of the muscles of the local system, the transversus abdominis, the multifidus, and the psoas have been accused of being “off,” or not firing properly, or having a delayed activation time, or being chronically tight. I do not work in a laboratory setting, nor am I an anatomist, but if local stabilizers keep you upright, it would stand to reason these individual muscles aren’t really the sole contributors to low back pain/pelvis positions/lumbar lordosis. Instead, what those of us who work with people in a movement setting can say is a lot of muscles keep us upright. Our experience of feeling unstable/tight/discomfort is multifaceted. Learning how to control movement in a variety of positions will help all of the muscles get stronger, even the ones that make up the local system because load causes changes in the ability to withstand force all the way down to the skeletal level.

The muscles of the global system include the pectoralis major, latissimus dorsi, rectus abdominis, external oblique, rectus femoris, and gluteus maximis. These muscles cover large areas, are capable of producing high amounts of torque, and are the first line of defense against extrinsic load. Remember, extrinsic load can come in a variety of forms, so someone like Matthew Fraser, the Crossfit Games winner the last three years, has a very different external physique than Alex Hannold, the free climber who soloed El Capitan. Both, however, have visibly strong lats and abs, just different sizes to meet the demands of the external loads regularly placed upon them. They both also have high amounts of mobility to get into the positions their respective sports demand.

If you are a movement practitioner, why should you care about the different core muscles and how things work together? Understanding that the spine is designed to be both stable and mobile is key for helping people of all ages and abilities feel better in their bodies. Let’s look at this a little bit closer.

One way to quickly assess the mobility of the spine is to observe a person’s ability to receive the floor. People who struggle with feeling sensation when they are lying down and need cushions and blankets to create a barrier between them and the floor are a) not used to the feeling of a hard surface, kind of like the princess and the pea or b) not distributing pressure well across the points of the back that are in contact with the floor. In either situation, spending a little time down on the ground and mobilizing the muscles that move the trunk will probably make the person feel less sensation when he or she lies down. It will also decrease the amount of stiffness the person likely feels and almost certainly demonstrates during movement.

Additionally, just the act of getting up and down from the floor requires the spine to bend and be mobile. Helping people explore different ways to get up and down from the ground can create more mobility and adaptability of the trunk and torso.

Here’s what interesting about the muscles of the global system (at least to me, and it could very well be argued that what I find interesting veers towards unusual). They are the very muscles that are frequently considered the culprits for “tightness” when it comes to things like decreased shoulder flexion and a tendency towards an anterior pelvic tilt. Maybe the problem is less that specific muscles are tight and more that the trunk isn’t able to move in a variety of ways. “Aren’t those the same thing?” you might be wondering?

Not necessarily.

The ability to rotate the spine during walking allows the arms to swing. You don’t have to force an arm swing, they just do it because the trunk is rotating. If the arms don’t swing, there is a very high chance the thoracic spine doesn’t rotate, and when muscles aren’t used for basic, everyday motions, range of motion decreases. Again, another example of how the torso and shoulder girdle are connected.

The isolated view that’s often taken when it comes to something like improving shoulder mobility typically ignores whether the spine can flex, bend, extend, and rotate. So maybe when addressing shoulder mobility it makes sense to work on spine mobility as well. Maybe.

So what about stability? How does that work?

Well, it’s two fold. As we’ve already discussed, basic strength is helpful for gaining a sense of stability.

When I say sense, that’s really what stability is. Research shows posture isn’t indicative of pain or dysfunction, so you can’t say looking a certain way is problematic, and I have met people over the years who are active, have posture many movement professionals would consider less than optimal, but don’t have any pain (and these are people in their 70s and early 80s). Whatever they are doing is enough to create a sense of security. Stability means you feel strong enough to support your structure and external load and that you have a sense of control in your spine, so if you are knocked off balance, you can catch yourself. Basic strength creates stability.

The other way to help people feel more stable is to train…balance. That’s right, the best way to improve postural control is through balance training. In fact, a systematic review and meta-analysis showed balance exercise training improves postural control in older adults, while strength and multi-component exercise interventions don’t.

Let me guess, you threw the BOSU away and the stability balls are sitting in an exercise closet somewhere because of the 2008 article in the Journal of Strength and Conditioning Research that showed using unstable surface training did not increase muscle activation in “highly resistance-trained individuals.” There are a number of ways to train balance. Unstable surface training isn’t necessary. You can use single leg variations, eyes closed conditions, split stance positions, heel to toe variations, obstacle course variations, ball throwing options and more to challenge balance. Dynamic balance training feels and looks a lot like play, which makes it enjoyable for both the practitioner and the student. And if you sort of liked using unstable surface training, but you are embarrassed to use any of it because you are afraid your co-worker will judge you for your lack of an evidence based approach, pull the unstable surfaces back out and let your general population clients walk on, . Their balance will improve and they will have fun doing it—just know that standing on a stability and doing squats probably won’t improve anyone’s golf game.

Unless you are working with a very specific population, most people can benefit from a movement or exercise program that incorporates a little bit of mobility, a little bit of strength, and a little bit of balance. If someone is more strong than mobile, work on a little more mobility, and if a person is mobile, but lacks balance, work on more dynamic balance. If you address a person’s needs while maintaining his strengths and keep it at least a little bit fun, the entire process is a lot more enjoyable. Plus, you get the added benefit of the global and local systems working in a balanced way.

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Balance, context, and anxiety: balance beams, part 2

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We are a nation that’s plagued by anxiety. We worry about what’s going to happen tomorrow, we worry about what others think, we worry about the state of the world. 

The worry can be incessant, and for some, the worry feels overwhelming. Another way to think of anxiety is that it’s fear- fear of what will be. 

Fear works in a very specific part of the brain, the amygdala. The amygdala, a small portion of the brain located in the mid temporal lobe sends out all of the appropriate physiological signals when fear is present, including elevated heart rate, elevated breathing, and a change in muscle tone. Fear also sharpens our memory and increases perception- it’s probably no surprise that obsessive compulsive disorder is related to anxiety

Living in a state of constant worry or fear is exhausting, It affects our relationship with our body and makes the perception of pain more present. As Robert Sapolsky notes in the book “Behave,” “The amygdala receives news of that reliable trigger of fear and aggression, namely pain. This is mediated by projections from an ancient, core brain structure, the “periaqueductal gray” (PAG); stimulation of the PAG can evoke panic attacks, and it is enlarged in people with chronic pain attacks. Reflecting the amygdala’s roles in vigilance, uncertainty, anxiety, and fear, it’s unpredictable pain, rather than pain itself, that activates the amygdala. Pain (and the amygdala’s response to it) is all about context.” 

There is also a correlation between hyper mobility syndrome and anxiety (and pain), perhaps partially because individuals with hyper mobility have decreased proprioception due to their joint laxity. Basically, the brain doesn’t quite know where the joints are located in space because the information it’s getting from the joint’s internal GPS is a little off, so we could also say the state of the body affects the state of the mind. 

What does this have to do with balance beams? One of the most intriguing research articles I have happened across in the last year examines rats that are bred specifically to exhibit anxiousness. One group was placed in a contextually rich environment, filled with balance beams, things to hang from, and obstacles to maneuver. The control group was placed in an environment without obstacles. The rats in the first group exhibited a reduction in anxiety, despite the fact they were born anxious.

If rats can reduce anxiety through interacting with their environment, it stands to reason humans should be able to do the same. (Or maybe it doesn’t, but you can obviously see where I am going with this). 

A few things happen when you figure out how to use your body to balance, climb, and maneuver over and around things. First, you become stronger and feel more capable in a way that promotes adaptability and problem solving. Those of you who have read previous blogs know I am all for mindfulness and improving awareness—in fact, it’s a large part of what I do. I also strongly believe in giving the body and the brain a chance to learn through doing, with less input from me. It gives people a chance to self organize and, if they don’t succeed the first time, their neuromuscular system works to figure out a new way to try based on its available options. I feel like this is valuable. I step in and offer suggestions when people are stuck, but learning by doing, I think, is empowering.

It could be argued that being able to figure things out gives an individual back a sense of control. People exhibiting traits of anxiety often don’t feel in control, so the context of controlling an outcome, such as successfully maneuvering the body through space, potentially increases a sense of resilience.

Additionally, when you move in a novel environment, if you are successful at least some of the time, dopamine, your brain’s reward chemical, is released, making you feel good. It’s difficult to feel anxious when you feel happy. Plus, according to neuroscientist Daniel Wolpert, our brains evolved for movement, so maybe incorporating this type of contextual problem solving calms us down simply because we are using our brains in the way they were intended: to produce complex motor coordination.

Finally, moving your body and interacting with the environment directs attention, so you are no longer thinking about whatever you were feeling anxious about and it improves your sense of physical self. Motor control research suggests simply by interacting with something you find challenging, in a variety of ways, you will become more efficient, indicating a reduction in motor noise. Noise can be thought of as the awkwardness you experience when you are trying something new. Whatever you are trying doesn’t look pretty—it looks disjointed as your neuromuscular system figures out the best way to accomplish the task, throwing everything it has at it, even if your right elbow has nothing to do with your ability to land on your right foot, or your jaw doesn’t really help you turn around on a narrow surface.

With practice, things get smoother and more efficient Another way to look at this is maybe by working on a physical challenge and reducing the noise it takes to do the task, you also reduce the noise in your head. Maybe.

Plus, when you use your physical self, you begin to feel the body parts and muscles that are required to navigate the obstacle. The more of yourself you feel, the more complete picture you have of yourself. 

I am not suggesting walking on balance beams will cure anxiety, but I do think it might very well help. Clients differ from baby rats in a number of ways, and one of the most important thing to take into account is current skill level and fear.

Fear activates the sympathetic nervous system and makes it harder to perform certain physical tasks. If someone doesn’t feel secure on his feet and you ask him to walk across a slightly elevated surface, heel to toe, it will probably make his anxiety worse because he is afraid of falling. It’s important to make sure whatever obstacle you are giving someone is appropriately challenging and isn’t going to send the person’s sympathetic nervous system into overdrive.

How can you tell whether or not an obstacle is appropriate? If the likelihood of the person trying and succeeding is about 80% and the risk of injury is extremely low, then you are on the right track. Let’s look at two examples.

I have a client I will call Ron. Ron has had 6 open heart surgeries and several little strokes. He has neuropathy in his feet and his peripheral vision is poor. How can Ron be challenged in a way that is appropriate?

Ron is scared of falling and doesn’t have very good balance because of the neuropathy and lack of vision. However, I can challenge Ron by having him by doing things like walking around obstacles, walking through spaces that are narrow for him, and walking over very low obstacles like dowels.

Ron struggles with these tasks, but feels safe doing them and gives 110 percent. He is (usually) successful, and the risk of him falling is very low--I spot him so he feels safe. He often tells me that he feels like he gets his money’s worth from these types of activities because they make him feel more confident in navigating his environment during every day life. Confidence reduces overall anxiety (and he does have a bit of anxiety), so it’s a win/win.

Let’s contrast this with a client I will call Megan. Megan is in her mid 30s and is also prone to feelings of anxiousness. She has a lot of natural mobility and had a lot of pain when I first began training her from a stint of bed rest during her most recent pregnancy. Megan quickly progressed to balancing on 2x4s, walking side ways, and moving between 2x4s. She often jokes that I am training her for the circus, but in addition to her pain completely resolving, her husband tells me she is the most confident and calm she has ever been—a change he credits to the confidence she has gained through physical training.

The less capable we feel when interacting with the outside world, the smaller our world becomes. Fear comes from so many things, not the least of which is not feeling confident in our physical abilities. Physical challenges that don’t require much instruction and give the client an opportunity to figure things out using his body and his brain closely resembles play; play is something children need in order to thrive, so wouldn’t it make sense that adults who use some form of play training would thrive physically and emotionally as well?

 

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2x4s, balance, and hip mobility

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Five years ago, while I was training for my MovNat level I certification, I purchased an 8 foot long 2x4 to practice the balance skills of walking forwards, backwards, and sideways. Sideways was challenging for me, so I set it up in my living room and practiced every time I walked through the house. (Side note: our house at the time was tiny, and our living was literally open space so we could move around on the floor. The 2x4 was the only piece of “furniture” I had).

Walking on the 2x4 intuitively made sense, and clients found it to be a fun challenge. I noticed foot and hip mobility were often better after a few passes, which I found interesting, but I wasn’t quite ready to dive into the potential aspects of why.

Five years have passed and I have read and thought a lot about the feet and gait mechanics. I have a few theories about what happens when you walk across a 2x4 and what might be happening, but first, let’s look at how the foot responds to the ground during regular walking.

When you take a step, a foot stays in contact with the ground while your body passes over it. There are a few things that happen when the foot absorbs the impact from the ground and transmits load up the leg before it propels the leg forward. Think about it for a second- your foot is responding to the ground. Would it make more sense for the foot to stay stiff or for it soften a bit?

Soften, right? Otherwise, it’s like hitting a steel beam with a rigid arm- it doesn’t feel very good or result in an elastic response.. 

The technical term for the absorption phase of the foot is pronation. The technical phrase for the stiffening phase of the foot that happens to propel the foot forward is supination. Before we get too bogged down with technicalities, let’s focus on the pronation phase and what else needs to happen for all of the joints to play happily together.

Walking is a series of rotations that results in a forward looking trajectory. From the ground up, rotation occurs as the arch comes closer to the ground, pronating to attenuate the force of the ground. The ankle responds a little bit as well; the inner edge of the heel comes just a little bit closer to the ground, moving into eversion.

The next bone in the chain is the tibia, the shin bone in the front of the leg. If the arch is coming closer to the ground, what way is the tibia moving? Is it rotating in or out?

If you guessed (or logically processed), that the tibia rotates inward, you are correct. The tibia responds to the movement at the foot by internally rotating.

Above the knee joint (which responds like the ankle by moving slightly inward during the stance phase, a fancy way of saying the stage of walking when the foot is on the ground), is the femur, the long thigh bone. If everything below the femur is moving in, how would the femur respond to best absorb the load?

Yes! You are right- it would move inward, internally rotating. The pelvis internally rotates as well, allowing the foot to pull the pelvis over it.

The whole situation reverses to propel the leg forward and push the foot off of the ground- the foot becomes rigid and the arch moves away from the floor, the ankle inverts just a little bit, the tibia externally rotates, the femur externally rotates, and the pelvis externally rotates. It’s like a chain- one thing moves, affecting the next above (or below) it until at some point, the whole system reverses. If the goal was to define neutral, it would be the point where everything is balanced- right before the foot moved from stance to propulsion. 

Another way to think of it is pushing is associated with externally rotating and pulling is associated with internally rotating. When the foot lands, it’s pulling the pelvis over it, and at just the right moment, the foot pushes off of the ground. 

You can feel this entire situation in a squat, if you think about pulling yourself down- you will notice an internal movement of your tibia and femur. When you decide to push the floor away from you and return to an upright position, there is a shift and the bones move into external rotation.

So what about the balance beam? Why does this improve balance and general mobility in the hip for some people?

Imagine you do the pushing off aspect of walking really well. Your foot supinates, your tibia externally rotates, and your femur externally rotates, but when the foot lands to absorb forces, the bones don’t change position very much and internal rotation is limited. What would that do to your balance and basic mobility in the hip joint?

If the foot has a tendency to be rigid, you are going to spend a lot of time using the outside of the foot and not very much time using the arch area, the center of the heel, or the big toe side of the of the ball of the foot. That’s a lot of surface area that you aren’t using when you balance and that’s a lot of information you aren’t receiving from the pressure of the foot against the ground- there are mechanoreceptors that respond to change in position and pressure in the bottom of the feet. Those mechanoreceptors let the brain know where the body is located in space and help inform which options are available for movement. If they don’t detect a change in position or pressure, they have no information for the nervous system- a bit of a conundrum when it comes to motor planning and execution, and a problem when it comes to balance.

If the foot is rigid and the femur responds to the position of the foot by remaining mostly in external rotation, how would that feel in the hip joint? Imagine you sat on the ground, knees out to the side and feet crossed at the ankles for three hours and then tried to sit in a chair with your knees touching and your feet moving away from each other. How would that feel?

Probably not great and you would more than likely experience a sensation of stiffness. So if, day and day out, your femur remained mostly in one position, it probably would feel a bit stiff when you tried to move it in a different way.

Okay, so what does a 2x4, possibly the world’s least expensive piece of fitness equipment, have to do with all of this?

Now is a good time to do a (brief) review of basic motor control terms. When you go to perform any physical task, there are an infinite number of ways the task can be done. The amount of options you have at any given joint is the degrees of freedom available at the joint to perform the task. Think about the act of walking: you could walk with your knees high or your knees low. You could walk with your feet wide or narrow. You could walk with your feet landing in front of your or behind you. You could walk with your knees really straight or with your knees really bent. You get the idea. 

What’s interesting is that even with all of these options available, you probably walk in a very consistent way. Movement is funny like that- unless you practice doing things differently, your neuromuscular system decides which way it prefers to do things based on past experiences and sticks to it, even if there are more efficient ways to do the same task.

A constraint reduces the amount of options you have to perform a task- it lessens the degrees of freedom available. Task constraints can be used to introduce a different way of doing a well established skill or improve coordination.

A 2x4 introduces a constraint to the activity of walking. If your habit is to avoid internal rotation, it’s going to be difficult to balance on the 2x4. 

Why? The nature of being slightly off the ground on a surface that requires walking with one foot exactly in front of the other and having a board that dictates your feet point (mostly) straight ahead means that if your tendency is to spend the majority of your time on the outside of the foot without moving into pronation, you won’t have good contact with the 2x4 when you transition from the back foot to the forward foot. The lack of stability you experience means you will try and figure out a way to stay stable, This can include less efficient strategies such as clenching your jaw, holding your breath, and tightening your fists. If your coach (or the voice inside your head that is serving as your coach), notices you are doing these things and asks you not to, you will figure out how to get across the board another way. If you are moving slowly and given repeated exposure to the task, your foot (or feet, depending upon the situation), will do this by moving into pronation. Assuming your lower limb functions in a coordinated fashion, the other parts will follow. 

Since walking across the 2x4 is dynamic, once the nervous system realizes it’s safe, it’s a way to repeatedly expose yourself to a position you aren’t used to being in and since that position is a natural part of an efficient gait cycle, there tends to be a transference of neuromuscular coordination. Your balance will improve, your hips will feel less tight because they have more options, and things will feel a little more coordinated, all because you walked in a constrained way. Kind of interesting, isn’t it?

Obviously, this won’t be the case for everyone, because not everyone has a habit of avoiding pronation and internal rotation, but for those it does help, it’s a pretty simple exercise to implement.

The other way I use a 2x4 for working on gait mechanics is to teach big toe loading during plantar flexion. Plantar flexion is a movement that is synergistic with supination (meaning they often occur together during coordinated movements). Remember how I mentioned supination goes with tibial external rotation during gait? It also goes with big toe dorsiflexion- the big toe bends up when you toe off. Except when it doesn’t because you are avoiding placing load in that area, a common occurrence in a society that often neglects toe and foot health. If you don’t load the big toe during gait, your foot travels less smoothly through the area. 

Think about it. The big toe has more surface area to push off of than the other toes. If you aren’t pushing off of the big toe, the neuromuscular system gets creative to propel the foot forward. Creativity doesn’t always equal efficiency.

Back to the 2x4. If you stand so the 2x4 is horizontally in front of you and you place the toes/ball of the feet on to the 2x4, you have a constraint that orients your toes straight ahead. If you lift your heels off of the ground so they are above the balls of the feet, if the weight moves into the little toe side of the foot, you won’t feel secure. The nervous system prefers feeling safe, so if you have the mobility, your neuromuscular system will change your strategy so the load is on the big toe side of the foot. If you start to move sideways, every time the weight moves to the outer edge of the foot, you will feel unbalanced. As a result, there will be a continual correction towards the big toe side of the foot, teaching efficient loading of the big toe.

Aside from the mechanics of what is going on, balance work is fun. People enjoy it and when they struggle, they become curious, trying over and over again until they succeed. Introducing variability, challenge, and novelty into anyone’s program is a good thing. Using simple tools and understanding how to use constraints can provide an element of play and have a profound impact on someone’s movement.

Part II will discuss how balance training can decrease anxiety, a subject I’ve written about before, but focusing more on the practical application.

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The shoulder and the hip: how are they connected?

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*I wrote a blog three years about the connection between the shoulder and hip during movement. It’s one of my most viewed articles. Time has marched on, I continue to study and read, and have a more full understanding of the relationship between these two body parts. Read on for an updated look at how these areas function together.

The musculoskeletal system is comprised of a variety of tissue, including muscles, ligaments, tendons, fascia and bones. The place where two bones meet, the joint, is an opportunity for force to be passed from one place to the next. The muscular tissue supports the dispersal of force up the skeleton; the ability to do this efficiently enables coordinated movement. 

How well our musculoskeletal system does this simple job is predicated upon a number of factors, including strength, the degrees of freedom available at each individual joint, and how coordinated we are. Our coordination is a reflection of how often we move on a regular basis, in a variety of ways. 

One of the most basic coordinated movement we perform is walking. When you walk, one of the legs swings forward, while one foot remains back, on the ground absorbing the ground reactive forces so it can be propelled forward. If the right foot is swinging forward, the left arm is swinging forward, while the right arm is back.

Think of the words that are used to describe the forward arm and leg- they are swinging, easily, using the elastic properties of the fascial system so no effort is required. It’s an amazing system, one that is taken for granted until it’s not working as well as it used to.

How well the arms and the legs swing is partially dependent on the rotation that happens at the torso and pelvis. As the right foot swings forward, the thoracic spine rotates and laterally flexes to the right. The shoulder girdle is neatly located on and around the thoracic spine- as a result, the swinging forward of the foot and the rotation at the thoracic spine allow the right arm to swing backwards.

On the left hand side of the body, the opposite is occurring. The body is moving over the left leg, so the left leg is behind the pelvis, while the left arm swings forward. All of this occurs in a very dynamic, spring-like way. It’s elastic in nature, and results in basic walking feeling almost effortless.

What happens when one side of the pelvis doesn’t move when the leg is supposed to be propelled forward? Or when the thoracic spine doesn’t rotate to one side? How does this change things?

We’ve all seen it, the walking gait that looks a little bit funny, but you aren’t sure why. How does this affect general mechanics and why does it matter?

Walking, crawling, and even throwing are movements that are based on the idea that as one leg moves forward, the opposite arm moves forward to propel something (the body, an object), through space. In fact, the large amounts of internal rotation at the humerus that occurs during the throwing motion is the fastest motion the human body produces- but it isn’t the reason an object can travel a large distance. Shoulder rotation contributes at most to 1/2 of the power produced during the throw. The rest comes from the contribution of the torso and hips. And, while other mammals can and do throw objects, none do so with as much force or power as humans. With bipedalism came rotational power.

Crawling, of course, is often the prerequisite to walking, and is consistently performed in a diagonal pattern, with the right hand and the left knee moving forward, followed by the left hand and the right knee moving forward. Think about what is required for this movement to take place. The right hand bears load through the right shoulder while the left knee bears load through the left hemi-pelvis when those two limbs are on the ground. The thoracic spine rotates a little bit to the left to accommodate the movement.

Throwing and crawling illustrate how connected the shoulder, torso, and hip are in providing stability and creating power. During the walking gait, the arms swing passively, requiring little effort. In fact, experiments that reduce or prevent arm swinging result in an increase in energy required to walk and an increase in ground reaction force, signifying a reduction in overall efficiency.

From a movement perspective, why does this matter? Because it’s a reminder that if movement is only viewed in isolation, the ability of the system to work together, like it’s designed, is being ignored. 

For the arm to swing freely during, there needs to be movement at the glenohumeral joint, with subtle movement at the scapula, acromioclavicular joint, and thoracic spine.  For the leg to move from providing support to swinging through the air requires movement at the rearfoot, forefoot, tibia, femur, hemipelvis, and lumbar spine. If the arm can’t move freely, or the leg can’t transition from providing support to swinging, there will be a loss of efficiency. Here is the tricky part- the loss of efficiency is occurring across a system, not across one joint.

If you work with people in any sort of setting that involves movement, whether it’s yoga, personal training, strength and conditioning, or Pilates, if you observe an arm that doesn’t swing during walking, do your eyes stop there? Or do they look further? Hopefully, they make their way to the shoulder girdle and rib cage, but what about to the pelvis and opposite hip? 

For things to regain a sense of elasticity, you are probably going to need to consider how things work together. What happens at the right shoulder? What happens at the left hip? What way do the ribs like to turn? Can they rotate the opposite way? 

Another question to ask yourself is do you put people into positions where rotation has to occur? And if so, where do you cue the movement from? The hip that’s moving forward? The shoulder that’s moving forward? How the hip and the shoulder move together? Or maybe you cue it from the shoulder and hip that are moving back? Or from the thoracic spine? Each option will lead to a different experience for the client, and hopefully help reinforce the way different parts of the body work together during the natural act of rotation.

The body is designed to move and attenuate forces in a variety of ways. The cross patterning that occurs during gait is one of the most fundamental movement patterns, and translates into larger force production during throwing and stability in quadrupedal positions. If you only look at what’s happening in one place, you are missing, perhaps, the most important part- how things work together.

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July newsletter:

July Newsletter, 2018: on business and growth

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While I was up recently in the middle of the night, pondering deep things like which size kettlebell rack I should purchase and the best storage solution for yoga mats, medicine balls, and Jenga pieces, I left behind the world of fitness storage to read something- anything, that might help me fall back asleep.

The first descent into sleep is never a problem for me, but when something is on my mind, like storage solutions, my brain gets busy and I find myself wide awake at midnight. Even though I rationally know I can’t solve my organizational problems for my new studio in the middle of the night, it’s sometimes hard to quiet that part of the mind down once it gets going. 

I also recognize there are far bigger issues at hand in the world, and that my “problems” don’t exactly warrant sleeplessness.

My workspace transition is on my mind nonetheless, and in an effort to distract myself with something non-studio related I found a short, but potent, piece on Elephant Journal about the importance of connecting with your audience outside of social media. The author’s argument was social media sites trend; e-mail subscribers are the people who truly deserve your energy.

It re-routed my brain from focusing on how to organize the perfect training studio space to pondering how I could provide better information using my newsletter. I decided to recalibrate my energy and provide short tutorials for those of you that allow my newsletter to sit in your inbox once a month. 



If you have any ideas for a tutorial you would like to see, drop me a line. If it’s not in my wheelhouse, I will reach out to my network of professional colleagues and see if anyone can get you the information you are looking for, like the upcoming webinar I am doing with Trina Altman on how to effectively market yourself to find private clients + fill your schedule.
Someone reached out after the last webinar to ask if I would consider doing a webinar on building your business of private clients. Though I have had a full schedule for years, my path to get there was slow (you are probably noticing a theme- I am the consummate turtle). 

Trina and I have different backgrounds and skill sets. In addition to being an experienced movement teacher, Trina also has an extensive background in sales from her first career, which involved working on commission selling high end clothing, and later promoting her own jewelry line at Barney’s and other retail stores.

In this webinar, we’ll show you how to:

    •    Convert people who are taking your group classes into private clients
    •    Cultivate a social media presence to build local visibility and fill your schedule
    •    Describe what you do in a way that builds interest in your work and creates more referrals
    •    Balance the need between creating a thriving business while also taking care of yourself

If my last two webinars are any indication, this will fill up. If you would like to join, just reply “yes” to this e-mail and I will make sure you receive the registration link as soon as it’s up. 

Happiest of summer days!

Upcoming events:
Saturday, June 23: The art of cueing, a free online webinar FULL. If you would like the recording of this, please respond to this e-mail and let me know- I will send it to you the next day.

Saturday, July 28: Getting Private Clients: a one hour, free webinar with Trina Altman. Info above.

August 5-25: The art of cueing- an online course. This 3 week course is limited to 10 participants and includes homework, tutorials, and feedback. If you want an opportunity to think about and improve your cueing skills, registration link is here: Cost for three weeks: $129 To register: http://www.bewellpt.com/events/2018/8/5/the-art-of-cueing-a-three-week-online-course

 September 3-29: mentorship group
Do you want to take your skills as an exercise and movement professional to the next level? 
Join me for an in-depth, 1 month online course on a deep dive of how the spine relates to movement. We will cover trouble shooting abilities, understanding how to design and apply corrective exercise interventions using a variety of methods and modalities, and how to work with special populations. Maximum participants in session: 5. In addition to guided course material, I will work with you via e-mail and video chat to provide support and answer questions.

Cost: $399

Goals:
Support professional growth of fitness and movement professionals through online coaching. Topics that can be covered include:
Troubleshooting/problem solving specific client issues such as working with clients with low back pain, knee pain, shoulder pain, post partum, or hyper mobility
Deepening your understanding of specific areas and how they integrate into movement and exercise
Establishing a niche
(This course is partially full. If you would like to be considered, please view registration here: http://www.bewellpt.com/events/2018/9/3/september-2018-mentorship-group

Saturday, 10/20/18: Free your neck, and the rest will follow (LA workshop)
Registration opening soon. More info: http://www.bewellpt.com/events/2018/10/20/free-the-head-and-the-rest-will-follow

Proprioception: updated thoughts

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How do you sense where you are located in space? Not just, “my arm is by the side of my body,” but “my arm is within grasping distance of the object located to my right.” If you were to close your eyes and try and touch right index finger to your left nostril, could you? What about your right foot to your left knee? If you are standing, that’s probably a little bit harder, but why? Is it “just” that your balance is off? Why is your balance off?

Proprioception, or our awareness of where our body is located in space, is often considered our sixth sense, arguably as important as our other five senses (touch, sight, smell, hearing, and taste). It’s our innate knowledge of our physical self, and it reduces the separation between the mind and the body. Just like a sommelier has a heightened sense of taste and smell compared to, say, me, the person who spends time practicing physical tasks moves in a way that is more coordinated, balanced, and integrated than his less movement practiced cousin.

Proprioception is determined not only by our level of physical activity, but also by things like previous physical trauma and genetics. Our ligaments, the cartilaginous tissue that connects bones other bones, are filled with mechanoreceptors that determine joint position. Joint sprains/injuries and genetic predisposition to laxity can affect proprioception- where you think you are located in space doesn’t always match where you are actually located in space.

Habituated patterns can also affect proprioception. Take the person who habitually stands at attention, with his shoulders thrown back, his chest puffed out, and hips thrust forward. His perception is he is standing up straight when, in actuality, he is standing arched back. When asked to soften the ribs so they move down, broaden his shoulder blades so his arms hang loosely by his sides, and stand in the middle of his feet instead of his heels he feels like he is slouching. If you were to take a picture of him from the sides, he would look more straight in the second scenario, but this contradicts the internal image of he has of himself. 

Patterns:

Proprioception isn’t just a matter of how we perceive our resting position. It is also our sense of how we maneuver through space. It enables us to step off curbs without looking down and allows us to reach back for the water glass and “just know” where it is. We interact with the world largely through this relationship between how our body moves and where things around us are located. Our response to the world is predicated on our ability to just know how to move.

Pretend you have a job that requires a lot of screen time and your favorite form of physical activity is lifting weights. You like the traditional lifts, so you do things like bench press and rows, lat pull downs and shoulder presses. Your life doesn’t require your arm to move behind you very much, if at all.

Time passes, and it’s been months since you have reached your arm behind you, let alone placed any body weight on your arm when it’s in that position. Is it any surprise that when, on whim, you decide to teach yourself the Turkish Get-up, it goes a bit disastrously and your shoulders and arms are sore for several days?

There are a number of reasons for this (the muscles are de-conditioned at that joint angle, it’s a move you have never done before), but I think it’s worthwhile to remember that if you haven’t recognized that part of yourself for months, or even years, it shouldn’t be a surprise that the neuromuscular system overcompensates in the form of excess sensation. 

Stretch:

The same thing happens when a person first approaches a joint angle that hasn’t been used in a while. The sensation of stretch is high. Again, multiple factors cause this, but if you stretch, walk away to perform another exercise, and return to the same stretch, the sensation will be less. Why?

The mechanoreceptors that determine stretch are a little less loud the second time around because the “new” joint angle is no longer novel- it’s not scary or threatening, and the memory of the position is still fresh. Your brain is learning to access a part of your body that was previously, in a sense, unrecognizable. Repeated exposure to the new joint angle will eventually quiet the sensation of stretch, partially because there has been an increase in proprioception. The outline of your internal view of what you look like begins to look a little more complete.

Scientists have identified a gene specifically related to the ability to sense force, a key aspect of proprioception, named PIEZO2. Examinations of two subjects born with variants in the PIEZO2 that rendered it essentially ineffective found both subjects had difficulty reaching and had shallow breathing as babies. They could not feel light touch or detect vibration against the skin, and they were unable to perform touching tasks with their eyes closed. Their movements were bigger and less coordinated than their fully PIEZO2 functioning counterparts. Though they were still able to feel pain and had normal strength and cognitive function, their ability to maneuver through the world in a way that felt safe and secure was diminished.

Have you ever climbed up on something just a little too high, only to look down and feel a wave of insecurity (and maybe a touch of nausea) as you realize you aren’t sure how you are going to get down? You don’t trust your body to know how to scale the tree/counter/rock that you just climbed and the fear you are experiencing is almost paralyzing. 

Short of channeling your inner Alex Hannold, what do you do? You probably suck it up, cross your fingers and hope that no imminent harm is done as you figure it out.

Once you are on solid ground with no expansive drop beneath you, your heart rate will be elevated, your breathing rate a little bit quickened, and an alternating sense of tension and relief will wash over you. People living without PIEZO2 feel this way regularly while performing tasks many of us take for granted. A sense of safety is necessary to perform a movement skill in a coordinated way; lack of safety results in both over-efforting and a heightened focus of the other senses as you work to maintain self preservation.

Force:

Perhaps one of the most interesting aspects of proprioception is the innate awareness of how much force is needed for a particular task. Someone whose proprioception is finely tuned knows how to dial force up and down to match task demands. 

Whenever you are exposed to a movement skill for the first time, or when you are asked to do a skill you’ve done many times in a new way, the level of force used will be high. Just like when you are asked to place your limb at a joint position that is novel and the sensation of stretch is high, new movements require the neuromuscular system to figure out how much effort is necessary. Motor unit recruitment (which allows for the appropriate contraction to occur), appears to be modulated by the information received from proprioception

Let’s say you are being instructed to take your right knee behind you without arching your back. You are struggling, since this is the first time you can remember doing the movement this way, and the instructor has you come into a 1/2 kneeling position with the right knee behind you so you can “feel” the position a little bit better. While there, he has you perform some pelvis tilts to feel the pelvis move around the femur. At some point, he stops you with your pelvis in a very slight posterior pelvis tilt and asks you to feel like your left hip bone is moving back while your right hip bone moves forward. He stops you again in what feels to you like your right hip bone is far past your left hip bone, but when you look down you see they are even, and asks you to breathe. As you breathe, you feel your right glute and abdominals in a way that is both intense and completely foreign. When you are told to relax, you happily come out of it, surprised that such a simple looking movement could result in the sensation of so much work. What just happened?

You were asked to perform a familiar movement in a new way. The new way resulted in lots of motor units being recruited, while the nervous system figured out what was required. If you were to do the same exact position a second time, the sensation of effort would be a little bit less- your neuromuscular system would begin to figure out exactly how much effort was needed to be in that position.

With repeated exposure, the position would still feel like work, but not as much work as the very first time you did it. You could turn the volume knob up if you wanted and make the sensation of work higher, or, as your strength increased, you could turn the knob down and make the movement feel easy, especially if given the right cues. You begin to regulate the effort to meet the demands of the entire goal- what are you trying to do? How much force is needed to do it?

Proprioception is a critical aspect to moving well. Take the time to feel where your body is in space and how it moves through space. How do you interact with the environment? How much force are you using to perform a specific skill? Is it appropriate for the demands of the task? If not, why not? Can you adapt to different surfaces, different grips, different textures? Body awareness improves not just through moving a variety of ways, but in a variety of environments. Practice adaptability and variability to improve resilience and, ultimately, strength.

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Weekly musings, 6/25/18: on sensing movement and sensing position

Weekly musings, 6/25/18: on sensing movement and sensing position
Proprioception, our innate awareness of where our bodies are located in space, is often considered our sixth sense. It allows us to do things like close our eyes and touch our right index finger to our left ear, it enables us to just know where our limbs are without looking at them. People in tune with their proprioception tend to be more sure footed and a little more balanced than their less aware counterparts.

A review of proprioception in the “The Scientist,” explains proprioception is both awareness of the limbs at rest and when they are moving. This awareness is accomplished through an interplay between the brain, neurons, and muscles. Information is constantly being relayed to determine things like how much force is needed to perform a specific task, or what path the arm should take so the finger can touch the ear. It’s a balancing act, one which we often take for granted.

When an injury occurs, or pain becomes chronic, or we stop using our bodies regularly, this carefully regulated information loop can become a little less accurate. The good news is, like all things, you can improve your proprioception, but it takes a little practice. Slowing down, feeling where your body is located in space, and feeling how your limbs move are ways to tune up rusty signals. The more of yourself you can feel, the more options you have to navigate the world.

*Article can be found here: https://www.the-scientist.com/?articles.view/articleNo/46796/title/Proprioception--The-Sense-Within/

Weekly musings, 6/17/18: backs and standing up

I was recently watching someone whose back was acting up move. She looked uncomfortable transitioning from sitting to standing, and it took a few steps for her walking gait to even out. She’s athletic, and didn’t seem overly concerned about- it was obvious she saw it as a nuisance, not a permanent situation.

Back pain happens. Professional organizations estimate that up to 80% of the population will have back pain at some point in their lives. Usually it’s temporary, like a cold, and disappears quietly without fanfare. If you wake up with a back ache, there are a few things you can do to try and ease the discomfort during the healing process.

Move. Walking usually helps. So does gentle mobility work in other places. (I usually stay away from the spine for the first few days, and then introduce easy movement in the parts of the spine that aren’t painful).

If it hurts to do a certain movement, like standing up out of a chair, see if you can figure out a way to load your skeleton a little bit differently. Instead of standing with your feet parallel, for instance, try staggering your feet a little bit. You can also shift your perspective and see if you can feel your abdominals and your legs supporting you when you transition. This tends to help.

Make sure you breathe. Long exhales occasionally will help calm the nervous system down and change the position of your thoracic spine. Inhaling into different places can change how you are loading the skeleton.

Do something relaxing. Massage, acupuncture, floating… Anything that you enjoy that takes your mind off of the discomfort can be beneficial. 

Give it time to heal. Your body is intelligent. If you move in a way that hurts, don’t repeatedly move in that way. And when you are healed, if you aren’t already doing some form of general exercise, either aerobic exercise or strength training, consider implementing a consistent exercise program. While nothing is a guarantee against low back pain, research does show that aerobic and resistance training improve outcomes in people with chronic low back pain that doesn’t appear to have a specific cause.*

https://www.ncbi.nlm.nih.gov/pubmed/29889056

Weekly musings, 6/10/18: Synergistic movement

Weekly musings, 6/10/18: Synergistic movement
In the book, “Human Motor Control, second edition,” by David Rosenbaum, he writes, “Simultaneous flexion of the wrist and elbow is easier than flexion of the wrist and extension of the elbow, or extension of the wrist and flexion of the elbow.” Simply put, it is more natural to bend the elbow while the wrist bends the fingers towards the upper arm than it is to bend the elbow while the wrist extends the fingers away from the upper arm.

You are structured to move via a series of synergistic movements. When you step, as the body moves over the foot, the foot flattens a little bit, the lower leg rotates in, and the upper leg rotates in. As you prepare to toe off and propel your body forward, the situation reverses. It happens automatically, without you thinking about it. 

Sometimes, traumatic injuries happen, or we are told to hold ourselves a specific way, or we stop doing specific movements and our bodies lose touch with these synergistic patterns. These patterns allow efficiency for things like walking and reaching, but moving the uncoordinated way occasionally is okay, too. It’s just that when the uncoordinated way becomes the default pattern, efficiency is lost, making basic activities a little more challenging. 

How can you determine whether you are moving in ways that are synergistic or not? Try doing the opposite of what you normally do once in a while. How does it feel? When you straighten your elbow and bend your wrist, what happens? What about when you straighten your elbow and extend your wrist? How does it feel to let your weight be in the outsides of your feet when you are standing? What happens if you place the weight on the insides of your feet? How does your lower leg rotate when you place weight on the outside of your feet? What happens if you move your lower leg the other direction? How does that feel?

Slowing down and feeling the different ways the bones can organize during movement tasks gives your nervous system options. It helps the nervous system determine what the most efficient way to perform different skills actually is, and it reminds you, the participant, that there is more than one way to perform a task. 

Weekly musings, 6/3/18: expert, chunking, and patterns


In the book, “The Athletic Brain,” Amit Katwala explores what makes professional athletes more proficient at sport than amateur athletes. Two key ways professional athletes are able to react more quickly and more efficiently than the rest of us are their ability to chunk information and their ability to recognize patterns.

When you look at a Parkour athlete moving with ease through the urban environment, what do you see? Probably a flurry of movement, with parts that don’t look distinct. If you were asked to repeat back what you watched, you would be able to pick out one or two moves, (“he vaulted over something,” “I think he somersaulted at some point”). The Parkour athlete, on the other hand, would probably be able to repeat back the whole sequence, but not because he sees individual moves strung together- instead, he sees sequences within the sequence, chunks of skills strung together.

Chunking is frequently taught as a memorization trick. If I asked you to look at the following sequence of numbers for a few seconds, cover it up, and repeat it back, you might struggle: 741031214116

If, on the other hand, I asked you to remember the following dates, it might be easier for you: 7/4 10/31 2/14 11/6

Why? The numbers are the same, but the context is suddenly different. Chances are high those dates have some meaning to you if you live in the US (Fourth of July, Halloween, Valentine’s Day, election day). That wasn’t always the case. First, you had to learn your numbers, then you had to learn about dates, and eventually, through repeated exposure, you learned to associate those days with different things.

The experienced athlete begins by learning individual parts, really, really well. For instance, the Parkour athlete works on the pieces of the precision jump by working on landings and small short target landings. He learns the components of a forward roll, progressing to a somersault by practicing, slowly at first, and then faster, over and over again. Eventually, he learns to perform a precision jump to a somersault. The individual parts becomes a sequence of movements. He still practices the parts individually, but he no longer sees them as individual entities.

Chunking allows a practitioner of any discipline to take in information at a faster rate. Skills blur, because the individual parts simply become a way to create a bigger picture. However, even the most advanced practitioners are always refining the basics, becoming smoother, and looking at the smallest parts with curiosity. 

For a little morning Parkour inspiration: https://youtu.be/NX7QNWEGcNI

Weekly musings, 5/20/18: the shoulder, proprioception, and co-contraction

Weekly musings, 5/20/18: the shoulder, proprioception, and co-contraction
During a webinar I hosted recently, an attendee wrote afterwards and asked me to further explain why proprioception seems to be diminished in people with hyper mobility. (Hyper mobility refers to the ability to move the joints in extreme ranges of motion. One of the causes is ligaments, which provide stability to joints, are stretched, potentially leaving the individual with a sense of instability). Research shows a correlation between hyper mobility and poor sense of where your body is located in space, but the reasons why that occurs isn’t fully understood.

A paper by Scott Lephart and Rajesh Jari* suggests the ligamentous structures of the shoulder may provide sensory feedback to the brain about joint position, which causes a reflexive contraction of the muscles that stabilize the shoulder. Proprioception, or accurate sense of joint position, is required for the brain to tell the muscles to contract- it’s a feedback loop.

When you take hold of something heavy, like a kettlebell, barbell, or suitcase, before you grasp the item, the brain is figuring out how much strength you need to hold on to the weight. Otherwise, the shoulder wouldn’t stay in place- the weight would pull the arm down out of the shoulder socket. I wonder if strength training tunes the feedback mechanism, making the output a little more accurate based on the input? Regardless, strength matters and having a sense of stability can make many things in life a little bit easier.

*https://www.sciencedirect.com/science/article/pii/1060187202800120

Weekly musings, 5/20/18: Fitness for a living versus fitness as a part of life

Weekly musings, 5/20/18: Fitness for a living versus fitness as a part of life
Last night, I finished watching “The Redeemed and Dominant,” the documentary covering the 2017 Crossfit games. Regardless of what you think of Crossfit, the athletes competing at the highest levels are incredibly versed in a huge variety of events, making them the ultimate generalists. They were required to swim, run, cyclocross, lift heavy weights, jump over bales of hay, carry, do handstand push-ups, pull-up, use hammers, and jump rope, among other things.

As they were highlighting various athletes, my husband looked at me and said, “they really aren’t very interesting as people. All they do is train.”

People whose livelihoods depend upon on fitness spend their days fitness-ing. They train, they eat, they recover, and they train. This isn’t just limited to professional Crossfit athletes. It extends to people who have built brands around fitness. In order to be taken seriously, you have to look the part. Looking the part involves training. A lot.

Training all day is unrealistic for most people and it takes away from the rest of life, which, again, for most people involves more than fitness, especially if it’s not your career. Instead of setting unreasonably high expectations based on a fitness professional’s abilities, take a realistic assessment of where you are today and ask yourself how you can move things around to make fitness a part of your life without it taking over your life. Most people can devote 20-60 minutes daily to some sort of practice and still have time for work, family, and other hobbies. 

The amazing thing is 20-60 minutes daily is enough to improve strength, mobility, and skills. You can become more fit by training in a smart, progressive way that will enhance the overall quality of your life without impeding upon it. Your fitness is one small piece of you.

Newsletter, June 2018: disconnecting

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In late April, I attended the Movement Exploration Retreat in Costa Rica for the second time. It was a wonderful experience, filled with movement, great people, nature, and a bit of work.

I arrived on Saturday, but it took me until Wednesday to fully relax and be in tune with my environment. Though I felt present during the movement sessions, the thrum of my to-do list in California prevented me from disengaging with my work life before then. However, once I finally finished the thing that was hanging over my head, I was able to embrace not doing anything work related, other than moving and learning.

It’s hard to disconnect. There is always something that can be done, a newsletter to write, a website to update, an e-mail to respond to… It is remarkably easy to create work when you are self-employed. 

However, disconnecting leads to a brief sense of calm. I was often without my phone while I walked the beach or ate lunch with my fellow attendees and, while I missed an incredible picture of an iguana, I felt more free than I had in a very long time. 

Be productive, but remember, balance is created when there are moments of no productivity. I came back more focused and with more enthusiasm for my work. The key to preventing burnout, I’ve been told, is to step away once in a while. 

Wishing everyone a wonderful June!

Yours in health and wellness,
Jenn

Upcoming events:
World Virtual Posture Summit, May 24-27. I was invited to present on movement, along with several other movement people whose names you might recognize. The basic lectures are free. To register: https://world-posture-month.app.virtualsummits.com

The Psychology of Mobility Training, May 26. A free online webinar. This 45 minute webinar will cover why mobility training can impact more than just the physical experience. We will discuss the impact increasing mobility has on proprioception and overall sense of self. We will also cover how to determine the appropriate mobility intervention for the individual in front of you. To register: https://pilottij.yondo.com/webinar/the-psychology-of-mobility-training/4402

Unlocking the Power of the Hips through the Feet and Ankles Saturday June 2, 10:30-2:30, Carmel. $90 until 5/20; $100 after. Register here: http://www.bewellpt.com/events/2018/6/2/unlocking-the-power-of-the-hips-through-the-feet-and-ankles

Unlocking the Power of the Hips through the Feet and Ankles Saturday, June 16, 1-5, Move-SF, San Francisco. $90 before June 1; $100 after. Register here: http://www.bewellpt.com/events/2018/6/16/unlocking-the-power-of-the-hips-through-the-ankles-and-feet

Recommended reading:
I promise, this list will get back to its former glory next month (I haven’t been keeping very good track of the articles and books I have read lately). However, Walter Isaacson’s biography on Leonardo Da Vinci is wonderful. If you don’t want to read the 500+ pages, The Guardian gives a good overview here: https://www.theguardian.com/books/2017/dec/16/leonardo-da-vinci-the-biography-walter-isaacson-review

 

Weekly musings, 5/13/18: Change and posture

Weekly musings, 5/13/18: Change and posture
I was working with a client recently, watching him as he rested supine on the floor. His mid-back was flat against the ground, his head looked comfortable on the small blanket. His knees pointed straight up towards the ceiling, parallel.

This wasn’t always the case. When I first began working with him, just bending his knees was enough to cause the his left hamstring to send twinges of pain. His feet would angle in, and his weight would primarily be on his right side. His middle back, near the junction of the thoracic and lumbar vertebrae, would hover off of the ground. His neck would appear strained, no matter how much I propped him up. 

Slowly, with consistency, strength, and awareness, his resting posture changed. It didn’t just change in supine, but in standing as well. As he felt more of himself and became aware of his patterns, he learned to shift to places that were more comfortable. 

The curious thing is I never once told him to hold himself a certain way at rest, or during movement, for that matter. Instead, I made suggestions, asking him to feel certain parts of himself or place load in different aspects. It started with feeling his ribs when he breathed and when he reached, and moved quickly to how he used his feet. 

When you shift awareness and try loading your limbs a little bit bit differently, you feel different parts of yourself. The sensation usually shows up as muscular work, since you are suddenly placing a demand on your musculoskeletal system that is different. The sensation reminds you there are options for moving.

What if you stopped trying to sit or stand a certain way and instead just let yourself be in a comfortable place? What if instead of trying to correct resting posture, you acknowledged that improving your general awareness of your body and your habits during movement were enough to change your physical self, including your resting positions? Let go of managing your resting posture and see what happens- you might be surprised.

Weekly musings, 5/6/18: pain and tomorrow

Weekly musings, 5/6/18: pain and tomorrow
I was chatting with a friend recently that I hadn’t seen in a while. He asked me if I was still running. I responded yes, and as our conversation continued, he looked at me and said, “you don’t ever have anything wrong with you, do you?”

I paused, unsure how to fully answer. “No, but I have a lot of tools.”

Later, I thought about my response and wondered if I should have told him that I had pain issues for years. That at one point I thought I would have to give up running because my joints used to ache afterwards. That I struggled to reconcile the fact that movement was my work, but the pain I felt on a daily basis made me feel fraudulent, as though I were selling something that didn’t really work. 

I also could have told him that these issues sent my on a quest that has enabled me to help many people, including myself. That I learned it doesn’t have to be hard to feel good in your body, but it does require work and patience. That moving in ways that are gentle and feel good is just as important as gaining strength and mobility. That yoga, or strength training, or Pilates might not be the answer if you aren’t in a good place mentally. That how you feel today doesn’t have to reflect how you feel six months from now. That I feel far better today than I did ten years ago.

Pain is real. It affects every aspect of your life and can make you feel unsure about your future. Regardless of the physical cause, you will not be the same person you are in a year that you are today, and that includes how you use your body and what you experience physically. You can make progress towards a pain free existence, filled with movement, strength, and mobility if you are willing to look at your relationship with exercise and life a little bit differently.

Weekly musings, 4/29/18: driving and moving

Weekly musings, 4/29/18: expertise
As I was sitting on a bus up the airport last week, at one of the stops a man got on who was acquainted with the bus driver. He sat up front, next to him (it was one of those small shuttle buses), and they chatted about driving. They both talked about driving the same way I talk about  movement- with a sense of genuine interest that made it obvious they were more than competent at the skill of maneuvering large vehicles at high speeds.

I use a car on a daily basis, in a pretty minimal way. My commute is about 9 minutes, sometimes 20 if traffic is heavy coming home. I am definitely not an expert driver. If someone asked me to drive a bus of any size, I would struggle with how much space was required to navigate the vehicle safely from one point to another. This doesn’t mean I couldn’t learn how to be more proficient at driving, but I would need a bit of training and a lot of practice to learn how to be better.

Movement skills are kind of like this. Everyone has a body that they use to some degree, every day. Some people use their bodies a lot. In fact, they regularly study movement skills with a teacher and practice regularly in an effort to improve their ability to navigate how their bodies move in space. These individuals are akin to professional drivers- they have a level of competency the average person hasn’t developed. However, this doesn’t mean the average person can’t learn how to be more proficient at using his body. It will take study, time, and maybe even a little bit of training with a teacher to become better acquainted with specific skills and the internal sense of feeling that allows movement to be strong and capable. 

Weekly musings, 4/22/18: the princess and the pea

In the old children’s tale, The Princess and the Pea, a prince determines whether a young woman is actually a princess by placing a pea underneath several mattresses and featherbeds. When the young woman is unable to sleep because something hard is in the bed, the prince knows he has found his partner- only a princess would be sensitive enough to feel the pea.

I found myself thinking about the princess and the pea yesterday while I walked, barefoot, across the rocks along the ocean’s edge. I didn’t feel any discomfort, and my feet shifted over the ridges to disperse the pressure from the rocks across the soles. 

I regularly have new clients roll their feet out on the bottom of a very small ball. I don’t do this to break up fascial adhesions, or to roll out trigger points, but to have them feel their feet. The sensitivity the first time is often uncomfortable; with repeated exposure, the sensitivity lessens. 

If you aren’t used to feeling a specific area, the first time pressure is applied to that place, it’s like information overload to the nervous system. The brain senses the change in pressure in this unusual place and sends lots of information in the way of sensation back to the area. You are left feeling like you want to pull your foot away from the ball, or for the princess, her back away from the mattress. 

However, with repeated exposure, the sensation lessens. Eventually, sensation of the uneven ground against your feet is no longer deemed a foreign threat by your nervous system. The benefit of this is when you can feel more of yourself, you begin to use the area during everyday movement. It’s like your brain is filling in the lines of a picture, showing which parts of yourself are available for activity.

So maybe the goal is to not be like the princess in the children’s tale. Expose yourself once in a while to different surfaces and fine tune your sense of self.

Newsletter May, 2018: the sum of the parts

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I recently posted a video of me doing a depth jump to a forward roll on Instagram. My philosophy with Instagram is if I post something that either teaches someone something or inspires someone to look at movement in a slightly different way, I am (hopefully) providing a useful service. Someone commented that she didn’t know anyone else who would try that particular move.

I replied that what she didn’t see was the work that went into doing that. I did drills for my depth jump. I practiced forward rolls. I practiced a depth jump to an all fours landing. I worked all of these pieces, until eventually I could jump down to an all fours position and go right into a forward roll, ultimately eliminating the all fours position. It took months of working the basic pieces, over and over again. I posted the finish product because I feel like if someone like me, who has no high school or college athletic career, isn’t naturally flexible, and spends hours each week practicing alone, can learn how to use my body in an interesting way at age 38, anyone can with the right amount of dedication and practice. 

Not everyone wants to put in that amount of work, and that’s completely okay. Not everyone has to be an aspiring Parkour enthusiast to appreciate novel movements; practicing physical skills once or twice a week in a class setting can bring a person’s ability to perform specific skills to a new level. 

The crux of all of this is the basic components of the skills that are being sequenced together need to be practiced, over and over until the student doesn’t need to think about it anymore. So if you want someone to actually be able to perform higher level skills, they can’t be introduced to the basic pieces once on a Monday in February and once more on a Thursday in April with the expectation that the student will have adequately learned the necessary parts to perform that thing. 

I have a client in his early 60s who isn’t naturally flexible. The first time I had him come into a tall kneeling position, he struggled. When I had him try and sit back on his heels, he could barely go down.

Over time and with repetitions, he was able to lower to his heels, but only with the foot perpendicular to the floor. Any other position caused cramping or discomfort. We practiced every time I saw him, which is about twice a week. I added in standing ankle work to improve his ability to flex his foot and get the top of the ankle moving down, towards the ground. We practiced this regularly for a month.

Today, he sat back on his feet, toes pointing behind him. He looked surprised and excited as he realized he could do this elusive movement for the first time in his life. 

The total amount of time each session devoted to this is probably less than four minutes. But moving in and out of positions with control, and allowing pauses enables the nervous system to adapt to new positions. And while the position itself doesn’t matter, he realized a new way to sit on the floor which, arguably, is a good thing. It also highlights the fact that, at 62, he is able to gain flexibility and control that he has never had before. Learning happens throughout life, and using the physical practice to reinforce this fact can have a positive impact on the client.

Upcoming events:
May 23-25:
World Posture Virtual Summit
In addition to 11 other professionals in movement disciplines, I will be speaking (albeit, virtually), at the World Posture Virtual Summit on what it means to move well. For a limited time, access is free with registration. Link here.

End of May: Studio location change! I will be moving into my new space sometime at the end of the month. It’s exciting, and worth noting.

June 2:
Unlocking the power of the hips through the ankles and feet. Location: Be Well Personal Training Studio, The Barnyard, Carmel CA. 
Information and registration:

June 16:
Unlocking the power of the hips through the ankles and feet. Location: Move-SF, 2863 California Street, San Francisco, CA 94115, time and registration: TBA. 

Learn how the feet and ankles influence what is experienced in the hips and glutes and how pelvis position influences the feet. We will discuss proprioception from the ground up, and still utilize sensing, isolating, and integrating as a framework for improving movement efficiency and creating a deeper sense of embodiment. Gait mechanics will be touched upon, as well as how the feet influence common foundational movements such as the squat and hip hinge. This workshop is appropriate for movement teachers, personal trainers, and those interested in deepening their knowledge of how this area works. Class format will be lecture, practical application, and partner work. Please bring a notebook and dressed to move around. 

“Please download all your information into our brains!! The clients are loving the exercises we did at the workshop and they all say their feet feel stretched out/flatter/more grounded and they are fascinated by it!” A.G., recent workshop attendee.

July:
Learning Opportunity
I am looking for three curious movement/fitness professionals that are interested in honing their assessment skills, deepening their knowledge of movement and how to work with individuals with injury or pre-existing conditions, and are curious about how to combine strength, somatic work, and mobility work in an individualized setting.

I am launching an online mentorship/coaching program. The beta test group will consist of one month of weekly web chats, homework, and a dive into spine mechanics, proprioception, assessing what you see, and breathing. We will also how to address specific client needs or questions around programming and troubleshooting. (Future programs will be longer, but I am keeping this short and small to get a sense of how it feels for everyone). Cost is $100 for this group only. If you are interested or know someone that might be interested, please e-mail me with a bio or resume, why you think this might be a good fit for you, and career goals. pilottij@gmail.com

August:
Open House! If you are local, celebrate the opening of the new studio space with us August 4 from 11-2. 

A slight change in location, a much bigger space, and an opportunity to take classes, look around, consume refreshments, and ask questions. Join Jenn in celebrating the new studio location, still in The Barnyard, located upstairs, directly above Patrick James and next to Yolanda's Hair Salon facing the courtyard. 
12:00-12:45: Mobility and game play
1:00-1:30: Restorative
Cost: Free!

Saturday, October 20:
Free your neck and the rest will follow
Location: 36o FitHaus, 1400 Colorado Blvd. Suite C., Los Angeles, CA 90041. Details and registration coming soon.

Happy days!
Jenn

Weekly musings, 4/15/18: Rigidity and posture

Weekly musings, 4/15/18: Rigidity and posture
Have you ever been told you “should” hold yourself a certain way because it’s better for you? Or that if you round your spine, you are loading the discs too much and you are certain to cause imminent damage?

The spine is designed to move in order to respond to perturbations, or outside forces that act upon it. Rigidity during movement doesn’t allow for any sort of response and it doesn’t feel good. Think about a metal rod. When you hit it, how does it feel? Now imagine that you are hitting a water balloon that doesn’t burst with the same amount of force. How does that feel and which object do you think is more stable? A spine that works well is one that is strong enough to return to its resting position, but supple enough to give when there is outside force that acts upon it.

In fact, in a 2013 study, researchers examined how well subjects were able to recover from an unexpected perturbation when their lumbar spines were in a corset that held them rigidly. This was contrasted with how well they recovered from the same unexpected jolt without the corset. The corset hindered the subjects’ abilities to recover their balance; without the corset, the subjects recovered more efficiently and in less time.*

A client came in recently who struggles with low back pain. She has made dramatic improvements, but still struggles with occasional bouts of discomfort. We were discussing her tendency to hold herself rigidly and her fear of moving her lower back. “I was told I should keep my lower back a little bit arched at all times and never let it round because of my disc extrusion,” she told me. 

“Does it hurt when you let your back round a little bit when you bend over or does it cause your symptoms to flare up?” I asked.

“No, it feels really good.”

“Then it’s okay to do occasionally,” I responded.

Fearing movement isn’t helpful, just like always moving the same way limits mobility and strength going the other direction. If it hurts, don’t do it, but while strength is one of the best things you can do for your body, rigidity and strength aren’t necessarily the same thing.

*https://www.ncbi.nlm.nih.gov/pubmed/24036601