technically inferior

Less is more when it comes to technology for exercise. Gadgets may help you be informed and design programs and track progress. But for the part where you have to physically do something, there's no app for that.

Take strength training. Most major gyms offer a line-up of resistance machines. Train your low back with torso rotation and extension machines. Choose one of many crunch machines for the abs. Use leg extension machines for the front thigh muscles and leg curl machines for the hamstrings. Hit the hip adductors and abductors with those inner and outer thigh machines that should be reserved for the obstetrician.

No wonder people are bored and don't have time for strength training.

And then there are lunges. The hip and quadricep (front thigh) muscles must generate force with most of the weight on one leg. Controlling momentum of the body (plus any additional loading like dumbbells) requires the abdominal and back muscles to stabilize the pelvis. The hip adductors (inner thigh muscles) and abductors (outer thigh/butt muscles) balance the leg so that you don’t tip over.

Lunges require no equipment and work all of these muscles functionally, rather than isolated along fixed lines of motion. Proper lunges help prevent problems and improve balance, walking, and running efficiency. 

Why use five machines to train in a less efficient, less functional manner when better results can be had with just one exercise? Do you really think that a giant "seated bicep curl" machine that's been specifically engineered to match the leverage of the elbow offers your tiny biceps something that some heavy iron can't?

Lunges and rows and chin-ups and pretty much anything that involves simple you and gravity and a maybe a little iron are uncomfortable. And plain better.

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pain and your three knees

One of my first anatomy lessons came from a rodeo clown yelling to an announcer.

Aaaauuuugghhh! He got my knee. That bull got me in the knee.

He what?

My knee!

Oh. You're walking kind of funny. Did he hit your left knee?


Your right knee?


What? Well then which knee did he get ya?

It was my HIGH knee.

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That heiney bit was hilarious when I was a kid. A recent experiment here at home has confirmed its continued effectiveness in young populations. But it's no wonder that many older folks groan and roll their eyes. The twenty seven million Americans suffering knee osteoarthritis (OA) are in no mood for dumb knee jokes. It has been estimated that of all joints, the knee is most frequently affected by OA and leads to the greatest loss in function.

The role of physical activity in causing and treating osteoarthritis has been studied and reviewed. What we know is what you could have guessed.

-High impact activities and traumatic injuries to the knee are bad.

-There's a downward spiral of pain, decreased activity, and generally poor health.

-Low impact exercise and not being overweight are helpful, so those with knee pain should walk and stretch and quit doing anything fun like tennis and skiing and mountain biking.

King hippo probably had bad knees.

-If you still have debilitating pain after you've quit doing anything fun and tried conservative treatments like anti-inflammatory medications and injections of corticosteroids and lubrication, then you're a good candidate for knee replacement.

-Knee replacements do reliably reduce pain and improve self-reported quality of life in 90% of patients. Yay.

-Knee replacement is a major ordeal. D'oh. You can expect about three days in the hospital, unless the new joint gets infected. Then you go home and have at least a month of increased crabbing around and depression due to pain, constipation, restless nights, and thrice-weekly trips to your  choice of rehabilitation specialist.

And here are a few bits of evidence that we probably wouldn't have guessed:

-Patients generally plateau in their recovery by about six months after surgery, and function begins to decline at about two years after surgery. A new knee won't keep you from getting older. Sorry.

-Although most patients have much less pain and recover to preoperative levels of strength and range of motion by about six months after surgery, they still exhibit the EXACT same level of functional limitations.

-"Preoperative level" does not imply good strength. People are painful and weak in the legs going into surgery, and pain free and STILL VERY WEAK well after surgery. It is thought that this strength deficit holds the key to the unfortunate stats below. 

-Compared to adults without significant knee pain, those who have had knee replacement surgery exhibit 18% slower walking speed, 51% slower stair-climbing speed, and a 40% leg strength deficit. They report having greater difficulty kneeling, squatting, moving laterally, carrying loads like groceries, exercising and playing light sports, dancing, gardening, and participating in sexual activity.

Don't ask me, that's just what the literature says.

I'm unsure what else we can gather from all this. Knee replacement surgery helps with pain but not with function. Some people are content with that. But I can add just a few points of personal observation for those of you kneeling on the brink of a trip to the orthopedic doc.

-Despite your neighbors friends uncle who experienced Job level devastation after having his knee replaced, the orthopedic docs are great at selecting appropriate candidates for surgery. In the clinic at three weeks after surgery, almost everyone regrets having gone through with it. On a scale of zero to ten, their pain is rated right around "you-know-where-you-can-shove-your-scale." And by about two or three months, those same folks very rarely regret having surgery.

-There's definitely an x factor here, an unknown. The x may have to do with expectations and other deep psychology that's hard to quantify. It may have to do with other unmeasurables involving blood chemistry and inflammatory response.

You may be a fit, active, and otherwise healthy adult. But that won't make an ounce of difference in how your body handles the pain, swelling, and other miseries due to the controlled trauma of orthopedic surgery. Some knowledgeable dude just subluxed your kneecap, hacked off the ends of your femur and tibia with a fancy saw, jammed a peg into the marrow, added some glue to hold everything together, and stitched it back up. Your morning green tea and years on the elliptical probably has little to do with all that (though your omega-3 fatty acids might).

Take ginseng in order to...do more pirouettes on the beach?

-Why is it that with or without surgery, those with knee OA function about half as well as people without significant knee pain? Is it ginseng? I truly don't know, but the literature indicates that it's NOT just the pain.

There are other, mechanical factors that do exist and can help, though they're extremely difficult to quantify. Are there nuances to your habits and how your body moves? What chewed up your knees to begin with? I bet there are imbalances in strength or flexibility or motor control of your ankles and hips and core. I bet you walk with increased transverse plane (torquing) motion at the knee and/or move with a knee dominant pattern that doesn't allow the strong hip and pelvic muscles to perform their stabilizing roles. It may not be the case. But if I were a bettin' man...

-Pretty much everyone with knee pain has to sit on the sidelines far more than they would like, and this sitting has propitiated poor balance and an "I can't" mentality. That's one of many reasons it's probably not a great idea to give grandma a new knee and then send her back home without a lot of ongoing work.

-Surgery or no surgery, it's worthwhile to explore these things. It's important not to expect a pain free existence. I've seen some people who have worked on their functional strength and balance and movement patterns, and despite a pretty bad x-ray, were able to manage quite well without knee surgery. And I would certainly think that even if the effort doesn't save you from surgery, it holds value for gaining peak recovery, so you're not functioning at half capacity like the literature reports.

-On a final note, us rehab folks focus a lot on getting that knee flexibility back. You need to get the knee straight to allow a grossly symmetrical gait pattern. You need at least 110 degrees of bending to allow stairs, stooping and such. But the literature suggests that the most important factor for improved function is not flexibility, but strength.
Get up and working on your feet, a.s.a.p.

"Successful" knee replacements with little pain and adequate flexibility still show limited strength, and strength dictates function more than anything else. So the latest thought is that really pushing the strength training is critical, especially in that first month after surgery when strength plummets the most. That means pushing 20 pounds instead of 2 pounds on that exercise where you sit and kick the leg out. It means challenging your limits in balance and doing lunge variations and steps-ups if you can, rather than 3 sets of 100 leg raises and heiney squeezes.

So there you have it. Osteoarthritis is a pain in the knees. I got lazy bones typing here at the end, but references are available upon request. Except for the heiney part. I refer you to the expert testimony of rodeo clowns.

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Coming this weekend, for a limited time only, while supplies last.

Increase growth hormone, blast fat, rev the immune system, extinguish inflammation, focus-in mental acuity, stave off emotional collapse, and increase your day by 4.1%!

No side effects!
Any one product or service that promises everything-and-the-kitchen-sink is probably pretty worthless. That's usually a good rule of thumb.

But not Z-Rx. Z-Rx is not a sleep aid, but sleep, clinically tested and proven in the kitchen sink, and more. And for a limited time this weekend, it's FREE.

Behold DAYLIGHT SAVINGS DAY, where 60 minutes magically appear from thin air. It's the one day of the year when nobody can throw up their hands saying, "if only there were more than 24 hours in a day." It's the one gift you will receive while unconscious at 2:00 a.m.

You will be sleeping, right? You can't afford to administer this gift any other way.

Seriously. Just go to bed.

When it comes to improving health and fitness, people spend hours planning and implementing exercise routines, nit-picking their diet, and searching (and shelling out for) the next big performance-boosting supplement. This can paradoxically serve to take them further from what's needed most: time to chill.

Do you imagine it's healthier to discipline yourself to chill or to wash down your gingko and vitamin B pills with another shot of 5-Hour Energy?

If what the National Sleep Foundation has to say is even the least bit accurate, most of us could use nothing more than some restful quiet. I would like to think we should pay more respect to sleep.

Before we diet hard.
Before we consider pretty much any supplement.
Before we start getting up at 4:30 a.m. in order to fit in a morning workout.
Before we start making major overhauls aimed at increasing creativity and productivity at work.
Before we stay up reading blogs of questionable content and quality.

It would take many moons to sight reference upon reference dealing with the ill effects of sleep deprivation. Sleep deprived athletes show decreased measures of mental and physical performance. High cortisol interferes with optimal repair, recovery, and growth from a number of angles. Even a single night of deprived sleep has people feeling hungrier and actually eating significantly more than those coming off eight good hours of rest.

Researchers suggest that changes in insulin resistance, as well as the hormones ghrelin and leptin, explain why higher rates of obesity, heart disease, diabetes, and high blood pressure occur in chronically sleepy folks.

You don't exactly feel up to the task of working hard when you're mentally exhausted. And it's difficult to be like Jesus when you're staggering around like a tired and irritable zombie bundle of hell because you were up all night goofing off on your bike.


Clinical sleep disorders are complex and really do have a wide grip on our health. But there are many who need to JUST GO TO BED. For those of us who stay up too late reading and typing and watching re-runs of House, fine, we've made our decision. But there's no room for complaining and puzzled looks when we're sick and crabby and making little progress toward our fitness goals.

This weekend really is the most wonderful time of the year, especially for parents with pre-school aged kids who love a good 6 a.m. cry fest right in their siblings ear.

Merry Day Light Savings Day to all, and to all a good, 60-minute longer night. 

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