seasons and years

Most of us have little idea of how we arrived at the doorstep of the year we call 2015. I spent a few hours last Sunday night trying to figure it out, got carried away and missed much of the Steeler game. Sorry dad. And I still don't have a good handle on it. 

It would make sense if our 24-hour days divided up neatly into 28 days per month and 12 months per year. But of course we had to invent the idea of leap year to make up for our 365-day imposition on the sun. Did you know that the earth does not move at constant speed in its elliptical orbit? In the norther hemisphere, spring and summer are longer than fall and winter by about 3 to 4 days. Even our precious 60-minute hours and 24-hour days are in flux. Because of the gravitational forces of the moon and other planets, twenty four hours is only the average duration for the earth to complete a full rotation. We simply don't notice the routine occurrences when a day swings up to 8 minutes shorter or longer than a "day."

The Gregorian calendar was proposed to number our years from the day Jesus was born. Wouldn't it be nice if the year 1 actually occurred on the year Jesus was born? Speaking of Christmas, wouldn't it make sense if the pagan feasts on which it was piggybacked also took place on the first day of winter when the days start getting longer? Why wasn't the winter solstice, the longest night in the norther hemisphere, marked as the last day of the "old" year?

Sunrise at Stone Henge on the winter solstice.

Yes, I'm proposing that the winter solstice and Christmas and the first day of the new year should line up. But then again, the day of the solstice occurs in cycles between what we know as December 20th and the 24th. Still, I say we move January 1st to December 22nd and celebrate Christmas, winter festivals, and New Years day at the same time. That would make sense and save us the holiday fatigue.

Side note: Some scholars say that Christmas was assigned to December 25th a few hundred years AD, when some church leaders started teaching that Jesus resurrection and conception necessarily occurred on the same day (March 25th). From there they arrived at December 25th (9 months after conception) as his birthday.

At any rate, our years are labeled imprecisely from the year that Jesus was born, which itself has been imprecisely layered upon imprecise winter solstice festivals which are based upon the actual winter solstice, which varies by the day and hour. What does this have to do with my theme here at Mental Reps? It's a bit of a leap, but I'd like for you to consider the imprecision of our bodies.

What makes a formal exercise beneficial and unique to other types of formal exercise? In what ways is informal movement better? What is the best diet for fat loss or muscle gain? How many days per week should you train and allot to recovery? What's aerobic or anaerobic training? (Where, for example, does a typical Crossfit WOD or a hard set of 20 squats with high resistance fit into all this?) What's the correct movement tempo, rep, set, and resistance scheme to maximize health versus physical power, strength, or size?

The answers are definitely far less clear-cut and precise than we think. God is apparently no respecter of our man-made divisions, categories and labels. Neither are our bodies.

But I do know that we need to be paying attention to what we eat and how we feel and function. We need exercise and rest. We desperately need rhythm to our days far more than a precise measure of the time and many of things that we do desire.

Please question your sets, reps, timed splits and macros. Be critical of the health and wellness industry (my forte), with it's man-made categories and assumptions set in stone. The 7-minute abs, the 14-day detox, the organic kale flax diet. Some of these are fine and well, but they never exist in isolation. Quick fixes and one-size-fits-all formulas don't exist at all.

Drinking two Red Bulls in order to drag yourself to the gym or ball field is going to catch up with you. Trying to accomplish too many things at once is an easy recipe for failure. One way or another, those sharp abs will come at a cost. And they won't be worth it (or sustainable) when you're arthritic knees can't raise you from the couch. Is the control freak diet and exercise schedule really necessary? Will it be destroyed under the weight of a life that demands more than focusing on yourself? It should.

Us mortals need our categories, divisions, and labels. They're convenient, if not entirely accurate. Anything we do to the extreme is sooner or later going to cause the pendulum to swing back with force. You are not likely the exception. I'm preaching to myself as much as anyone reading.

However imprecise we understand and make use of it, we are given this blessing of time. May 2015 be a year you take inventory of what's important to you. May you move well, rest well, and serve others in honesty and humility. And have some fun!

Rotational Training for Baseball (Part 3).

Part One of this series included general observations and commentary on sport-specific training, with a brief introduction to the three planes of motion. 

Part Two highlighted 5 key points regarding strength training for baseball.

                               - - - - - - - - - - - - -

Here we tackle the fun stuff - sport-specific power training for baseball.

Power training for baseball should bridge the gap between (relatively) heavy load, controlled movements and actually throwing, hitting, and running like a beast. The perfect strength training program for any given individual is worth little in terms of performance if it doesn't translate to demonstrating high amounts of rotational force (Torque) QUICKLY.

How exactly do you develop power in the transverse plane? Are traditional plyometric power exercises safe and warranted for baseball players? Is power development plane-specific? Here are a few key points regarding power training for baseball.

1.Traditional plyos are warranted for baseball players.

"Why are you training a baseball player to jump? This isn't high jump or basketball." 

I will admit that I'm biased toward traditional power training with leaps, bounds, tuck jumps, hurdle jumps, depth jumps etc for a very bad reason. (I'm a good leaper, well, for an old man). Also, there are only a handful of lower body, transverse plane specific plyometric exercises to choose from. I think Eric Cressey would agree that lateral hops are a great baseball specific exercise, but they can only take you so far.



Although traditional plyos are predominately sagittal plane movements, they remain a great way to supercharge the nervous system. They are total body efforts that require the athlete to develop body control and optimize ground reaction force. They are by all means the best way to reach and develop fast twitch muscle fibers.

You could achieve much of the same effect with triple the injury risk and time invested by doing the Olympic Lifts. This backhanded compliment about Olympic lifting comes courtesy of this entry where I lay out why O-lifts are not the best choice for most athletes.

Plyo push-up variations...sure.

Traditional plyos should not receive the same emphasis as they would for, say, a long jumper. But there is definitely room for them. Plus, most athletes benefit greatly from leaping and bounding off one leg, and baseball players are no exception. Single leg launching and landing does require great transverse plane strength and stability.

2. A word of caution.

Please be aware that knees and feet are at risk for those who throw caution to the wind. The type of impact, total number of repetitions, form, and fatigue should be monitored and progressed gently. My clinic records prove that even strong athletes may suffer injuries from careless application of plyos.

Awesome-making, shin-eating machine.

Build up the impact gradually. Don't perform high power movements when in a state of extreme fatigue. Variations of single leg plyos are great, but don't perform repeated single leg bounds across cement or hardwood. Control the deceleration while landing your jumps. Only jump as far and as many times as you can land well. There are a handful of tricks to the trade that many trainers are apparently unaware of.





3. The total body whip.

I would argue that the most baseball-specific exercises are power/plyometric exercises that 1) incorporate the transverse plane, and 2) use everything between the ground and the hands. While traditional lower extremity plyos have their place in a baseball training program, the majority of plyometric training for baseball players should incorporate these two criteria. Our options are quite limited here. There are really only a handful of exercises to do and I think about 60% are worth the time.

Or stomach the thought of swinging an actual ax.

Baseball players should be on a steady diet of throwing the med ball, clubbing a tire (or something), and hitting with an over-weighted bat. "Battling ropes" may serve some purpose as well. How heavy should those items be? They should be heavy enough that the exercise is not replicating the exact mechanics of throwing and hitting. Baseball players take enough stress and strain with their repetitive tasks. On the other hand, the objects should not be so heavy as to hinder the athletes peak power production (i.e. the athlete can still move relatively quickly).

4. Intent precedes content.

Maybe it's just me, but it's irritating to see athletes doing 20-rep wall balls and box jumps with 60% effort. Using plyometric power exercises to hit your lactate threshold and determine your willingness to suffer is a great way to test the integrity of your connective tissue. This is not the time to drone through the motions as if the training effect you desire is magically going to happen. Instead, do what it takes to throw the med ball like you're trying to knock the wall down. Hit the tire like you're battling for your life. Feel the impulse, energy generated between your feet and dead earth, traveling through your hips, torso, shoulders and out of your hands.

There's something very satisfying about the thump of a tire or brick wall.

5. Work smarter and harder. 

Progress isn't always measures in duration and impacts. Just because you have 20 good jumps, throws, or tire hits in you now doesn't mean the goals should be 60 or 100. Hit it with more force. Tuck jump the hurdle, measure vertical- and long jump distances, and time the short sprints/agilities. Radar some med ball throws or measure the distance covered. The younger crowd at GoWags swings a standard (relatively) heavy wooden bat at pitched balls. Measuring ball exit speed gives good incentive for and objective measurement of full effort.

Apply these principles and there you have a comprehensive baseball - specific training program. Certainly comment if there are any additional considerations that you have found beneficial. I hope to unpack many of the ideas presented here into a series of short videos. Let us know if you have any questions that you would like to be addressed.

Rotational Training for Baseball (Part 2)

One of my favorite transverse plane weather systems

Part one of this series mentioned that throwing and hitting are total body movements that take place primarily in the transverse plane. Developing rotational power in this plane is essential to any training program that claims to be "sport specific" for baseball. Here are a few key points related to strength training for baseball.

1. Many traditional weight training exercises DO have their place in a baseball specific program.

Most athletes benefit greatly from doing time in some variation of the fundamental movement patterns. As power athletes, baseball players are no exception. We're talking about squat, dead lift, pressing and pulling variations. While the standard barbell lifts are not particularly transverse plane movements, they do offer many benefits.

Keep in mind that much of what we see in gained strength is neurological in nature. Here we will not get into the details of muscle unit synchronization, rate coding, and antagonist muscle disinhibition. Suffice to say that the brain learns to move the body more efficiently on macro- and microscopic levels. Well-renowned trainer Mike Robertson suggests that athletes master sagittal plane movements first because they are easier to learn and control but still provide the general benefits of loaded movement. 

NOT effective for gaining size

The traditional lifts are also critical for an athlete that desires to put on quality size. Obliqe crunches, cable "chops," and shoulder rotation against tubing are not going to cut it. The best way to gain muscle is to focus on the "big" multi-joint movements that demand high amounts of force output and a stable core. The idea of gaining muscle mass leads to the next point.

2. Thickness is uniquely important to the transverse plane.

Part one of the series also described how the structural differences between a fit basketball player and a fit baseball player are obvious, and this reflects different qualities of power (transverse- versus sagittal plane). The thickness of an individual joint, and of the athletes body as a whole, are of relatively little importance for sagittal- and frontal plane movements. But that's not the case when you analyze rotational movement in the transverse plane. It's a simple matter of physics that more muscle mass generating force further from the axis of rotation is going to produce more torque. 

3. The transverse plane hides out in unilateral exercise. 

Hopefully I have established that while traditional weight training exercises are not particularly transverse plane movements, they should be included in a baseball training program because they are a great way to engrain sound movement patterns and to gain efficiency, strength, and size. But now you may be wondering where the transverse plane strength exercises come in. What do they look like? Spinning with weights? Swinging around a barbell by one end? 

THE key for training the transverse plane is undoubtedly unilateral movements. Pushing, pulling, squatting, and lunging with one arm or leg at a time demands a lot of rotational force at the moving segment as well as rotational stability at the spine and other non-moving segments. The transverse plane demand is obvious in rotational movements like med ball throws and tubing work. But most of those are better classified as power exercises.  Examples of appropriate strength training exercises that make the transverse plane obvious include tubing twists, cable chops, and side lunges. But there is much more! The (relatively) heavy unilateral lifts should be the meat and potatoes of developing strength in the transverse plane. 

A poorly executed barbell lunge: making obvious the demands of frontal and transverse plane stability.

Try to perform a simple hip hinge on one leg. Touch both hands to the floor without rounding your spine or excessively flexing at the knee. Or try to maintain an upright torso and lunge while holding a modest weight at or above shoulder level. Try push-ups with one foot on the floor instead of two. Viola! You're training the transverse plane.

These three exercises are great examples, simple and effective, of training the transverse plane. You truly don't need the ridiculous theatrics on a BOSU ball to train stability and balance. You would be surprised at how many athletes cannot control even a light load. The knee and pelvis quiver or collapse, or the spine twists, folds, or side bends.

Training on machines with cables and columns that guide the movement steals all the transverse plane benefit. So get off the machines and control some iron where it's just the athlete v. gravity. Movements like lunges, split squats, step ups, "lawn mower" rows, and land mine presses truly should be a prime area of focus for most baseball players. Do not think of these as light accessory movements. When taken seriously and worked consistently, these unilateral exercises can also be good for stimulating more muscle mass.

4. You can't be a powerhouse in any plane if you're imbalanced or injured. 

Overhead squats not advised

Another reason why unilateral lifts should be emphasized in a baseball training program has to do with staying efficient and injury free. Hitting and throwing are both high intensity, asymmetrical efforts that baseball players routinely subject their bodies to. It should be no surprise that mobility and strength imbalances develop after hundreds and thousands of repetitions. Unilateral strength training will often reveal strength and stability imbalance and help as a corrective measure to offset the asymmetrical strain.

Lastly, baseball players do need to give special consideration to arm health. Over the years, most throwers acquire some degree of anterior shoulder capsular laxity, posterior stiffness, and a literal twisting of the humerus. There are typical changes at the thoracic spine and pelvis as well. There is very little room for some exercises such as overhead barbell presses and overhead squats in this population of athletes. Other exercises like traditional back squats and bench press are generally safe for most baseball players, but should be used with some caution. This is highly specific to the individual, but in all exercises, special attention should be given to the position and movement of the thoracic spine, humerus and the scapula.

5. A word on the Olympic Lifts.

Can you see why power cleans, clean and jerk, and snatch grip anything are probably not a good choice for baseball players? The olympic lifts are very powerful moves. But they're not great mass builders because they require very little time under tension. They make relatively little demand for mobility or stability in the transverse plane. Getting to intense but safe training with these requires a lot of time to learn them as a skill. Some strength coaches and trainers may say otherwise, but it is my opinion that they are just not worth it. I believe that power training can be accomplished more safely and effectively in other ways.

Power training for baseball will be the last installment in this overview of baseball-specific training. I do hope to unpack some of the ideas with a series of short video clips. Certainly let us know if you have anything in mind that we can address.

To Long Toss or Not To Long Toss

The debate continues as to whether or not a pitcher should be doing long toss. Each side has both sports medicine and coaches claiming how wonderful or terrible it is to throw on a high arc for maximal distance as apposed to direct line throws of shorter distance.

In my opinion it's a debate in minutia when there are other considerations of greater importance. As I mentioned here, we should consider the number of months of rest from throwing per year, total throws per game, innings pitched per year, and about 20 other factors. Intelligent training of the entire body is the best way to spare the throwing arm.

That being said, with 6 out of 10 pitchers sustaining a significant shoulder or elbow injury, giving attention to minutia is completely justified.

This study is still cited as pure and clean evidence against long toss. The study does show that mechanics of long tossing are different than throwing for shorter distances, and that long toss throws cause greater torque at the shoulder and elbow.

  [Different intent, different toss.]

From this I conclude, "Oh really? Long tossing, like, where the athlete takes a skip and a crow hop and reaches way back, orients his chest to the heavens, grits his teeth, and launches the ball out and up..." 

The real surprise is that egg heads like me need data proving that this is different than throwing down hill off a mound. Any T-baller could tell you that. Any Little Leaguer with 5-minutes of exposure to a radar gun will determine that velocity (and therefore arm speed and kinematic variables like torque) is greater when you are free to move your body as much as you want just prior to a throw.

In the context of rehab after an injury, it's pretty clear that you do need to be careful. This study did affirm that long toss is probably not a wise choice for rehab or early return to throwing. But lets talk about someone with a relatively healthy arm who wants to gain velocity and the total body rhythm that actually helps decrease strain on the arm.

The differences between long toss and pitching from a mound are exactly why long toss is a valuable component of training. Why don't we simply think of long toss as a form of over-speed training? It's a great way to create some sport specific strain that's a slight variation from the forces and trauma of actual pitching.

Also, throwing is a total body effort that should occur in three planes of motion {rotation, front to back, and side to side), not just linearly (front to back). I would think that long toss is a good way to "fix" pitchers who are constipated in their delivery, "arming" the ball with a linear pattern or with poor transfer of energy from their legs.

So I'm pro long toss. But now the word of caution because I'm sure it can be overdone and used inappropriately.

The common sense that you would apply to pretty much every other situation should cover it. When beginning a long toss program, plan to gradually and systematically build the intensity and number of efforts. You can't just add stress indefinitely. With pitching, even in the best case scenario, micro-trauma occurs throughout the entire upper extremity. The risk of injury certainly goes up if pitchers simply add any type of maximal effort throwing.




- - - - -
Do share your opinion on long toss!

Rotational Training for Baseball (1)

What I've seen of the ESPN 30 for 30 documentaries have been excellent, but I especially liked Jordan Rides the Bus. This episode details Michael Jordan's first retirement from professional basketball and foray into pro baseball.

Watching this, I thought about the fact that Jordon was arguably the greatest athlete in the world at that time. He had access to every resource imaginable and plenty of time to train and practice. He had experience, drive, athleticism, and loads of visibility. And yet he failed at high level baseball.

Lebron is jacked, but not for the transverse plane.

I admire Jordon for giving it an honest effort. At the same time it's laughable that he truly thought he could pull it off. The documentary didn't say this, but...

Jordan clearly didn't understand motor control theory and human development. He didn't understand that the mind and body are one and both adapt in stages over years not months. He had plenty of what we call "God-given" talent. But one look could tell you that he wasn't equipped as a baseball player.

The typical rotational powerhouse.

Even today, the typical high level basketball player is super muscular and fit, but they simply don't appear like the typical high level baseball player. The difference in structure that we readily see has everything to do with qualities of sport-specific power. Basketball players are powerhouses in the sagittal (front to back) plane but not the transverse (rotational) plane. Some baseball players are average sprinters and leapers but rotate like a tornado.

Don't get me wrong. You'll be hard pressed to find a high level athlete that's horrible in any one aspect. I'm sure Lebron, for example, can likely apply rotational force far better than the average Joe, but not the average baseball player.

So this brings me to the point of what a baseball player can do to develop rotational power. Throwing and hitting are short, powerful, asymmetrical, rotational movements, and THIS is the heart of sport-specific training for baseball.

Is sprinting and plyometric jump training in the sagittal plane justified for baseball players? You bet. But there needs to be more. Where do the traditional resistance training methods fit in, and how exactly do we train the transverse plane for strength and power?

Part 2 coming soon.

A Problem with Protocols

Rehabilitation protocols are an important part of physical therapy. They provide guidelines and standards of care to assure appropriate progression after injury or surgery. Protocols communicate expected time-frames for recovery and facilitate the most efficient, high quality healthcare. 

Reading a protocol gives me a sinking feeling. At such and such time, restore this and stop that, this is contraindicated and ensure that you get to that. It sounds so helpful and simple. In practice, protocols are a weight that one person, a mere physical therapist, cannot carry. It feels like juggling 5 bowling pins when your limit is 3.

I understand that "feeling it out" and "let's see how it goes" doesn't cut it when you want to standardize stress applied to surgically repaired tissue. It's no way to define and justify evidence-based practice. But during my 14-year PT career, there have been no ACL or rotator cuff tears or re-tears. There were no broken pins or loose screws. Zero joints have dislocated under my watch. And my offices have thrived as privately owned, independent businesses.

Protocols easily become mindless dictators. Don't answer. Don't ask. Don't try to make sense.

"Okay. Got it. Follow the protocol."

These days, protocol power comes not from surgeons or medical advisory panels, but from accounting departments. Calculated patient encounters, reimbursement rates, and discharge dates drive services rendered. Woe to the patient (and healthcare provider) who doesn't achieve the standard goals within the defined parameters. Protocols give the least credit for the resources invested in people who need care the most.

Protocols are no respecter of persons. There's no formula for our entire system and being. Protocols coldly march forward, day by day, paying no mind to unique body structure and function much less motivation and perspective on what it means to live well. Protocols don't care about your fibromyalgia, stressful workplace, leg length discrepancy, or recently deceased spouse.

And yet protocols are simply one small instance of the health care tail wagging the dog. It's happening everywhere and has effected you already.


As much as I hate what the Affordable Care Act is doing to health care and especially to small businesses, I will resist blaming protocols on President Obama. I know so little, just enough to be aware that the big picture is not so cut-and-dried.

Imagine a time when the patient and provider decide if, when, and how they can be treated. -Sigh-

Nah. That would never work. That would require honesty, transparency, and mass selflessness on behalf of all parties. It would require hope and change from the achievers, the lazy, and everyone in between. This country needs Jesus. No, really.

So this holiday season, encourage your diabetic uncle to find the time and support for an appropriate diet and exercise program. Tell your wayward niece that she really should get out of the house and get a job. And then wish them "Happy Holidays." I'm kidding, of course. Well, kind-a. 

Now where were we? I mean, according to the protocol...

Wall Sits for No One

Wall sits. 
Huh.
What are they good for? 
Absolutely nothing. 

Digging a hole and filling it up is more purposeful. A stroll down the driveway burns more calories. Getting up off the couch demands more flexibility. Jumping up and coming down is far more physically taxing. And brain training? Well, wall sits are like learning to write by pressing your face into a letter chart.

Do not confuse "difficult" with "worthwhile." 




Wall sits build endurance? Endurance at what? Okay - I'll give you down-hill skiing. But there are about a thousand more efficient and productive ways to gain strength and endurance for that. I'll also give wall sits "effort." While even the worst resistance training machines demand more strength, flexibility, and energy burn, none of them rival the misery of wall sits.

Wall sits are misery for the sake of misery. So if that's what your after...

Yeah, exactly. How do you progress wall sits? I mean, other than timing them until you collapse of boredom and muscle cramps. What you need is a creative, attention-getting way to increase the ineffectiveness of wall sits, piling on the misery with...even more lack of benefit. 

This? No. Oh - no.

When the lever arm is zero, torque is zero, no matter how large the force.

THIS is precisely why you should have actually learned your simple Newtonian physics instead of whining around and questioning why exercise science and athletic training majors have to take basic science courses. This is why you should always keep an eye out for applying those basic trigonometric functions and free body diagrams.

[Incidentally, it's also why a good trainer or PT is worth something.]

You can stack the weight of an entire hippo on someones thighs. I don't care if you have the Cat In The Hat himself come and balance on the person with a book on a ball with a fish and a rake. It's all the same to the wall sitter (well, until their patella dislocates or tibia splinters)

Instead, try some goblet squats or step-ups, side lunges or even burpees or pistol squats, suitcase lifts, jumping jacks, somersaults or pirouettes, or, or...

Trainer, coach, teacher, wellness coordinator, great uncle Jimmy... Please. You can do better than wall sits.

You are not strong

Don't tell me about your 5-day per week exercise routine. I don't care about your spinning, Zumba, your half marathon, or yoga. Your hundreds of poor quality squats and lunges during Insanity or BodyPump Class are probably making the problem worse. Your lower back, IT-band, knees, or feet are taking a beating for a reason.

You are not strong

Could it be that despite your lofty efforts, you are not strong? What's that? No, I'm not talking about anything close to Powerlifting or otherwise competitive fitness. You don't believe it? Allow me to show you.

Try lifting this modest weight off the ground without your spine bowing. Lift with your legs, not with your back? Well show me your version of what that actually looks like. Hold that same modest weight in front of you with both hands, and show me how you step up 12 or 16 inches. Show me even one good squat with chest tall, hips sitting back, heels on the ground, knees and trunk not buckling inward 

See?

Despite all the time and energy invested in exercise, you remain weak. Don't get me wrong, your routine is probably great for your heart, for burning calories, and for maintaining the blood flow to the brain that keeps you mentally sharp. Those benefits are truly priceless. But your bones and joints are suffering, and I'm pretty sure that I know why...

-- - - ---

The tone here is intentional. Yes, this is me from behind the barrier of these flickering pixels:



When I'm anywhere other than Internet Land, I'm learning to be careful how I say it. I've noticed that certain words can be quite offensive to someone who takes the time and effort to train, who takes pride in their body and exercise routine.

So then.

"Your hip abductors are not doing their job."

"You're not recruiting the core muscles."

"It's challenging to do it in that specific manner." 

"Your brain is not use to this movement pattern."

In the end, these are all gentle versions of the same statement. Yet the problem remains. There may be flexibility or structural issues. Less than optimal movement patterns are almost always implicated. And more often than not, you're plain...Well, ya'know.

There was a time when physical therapists and other health professionals were taught to test strength by attempting to isolate individual muscles. This book by Florence Kendall was (and still is?) the Bible of strength testing. I still use these when such isolating may provide pertinent information. But I've found it far more revealing and quickly obvious to both myself and the client to simply use a handful of functional tests.

Some functional tests involve jumping or acceleration type movements. I usually reserve these for a young or athletic population. But nearly everyone gets some variation of a functional squat test, lung test, and step up test. They reveal far more than manual muscle tests ala Kendall.

Try a few for yourself.

1. Deep Squat - described briefly above or look it up.

2. Lunge - There are many variations. I usually have clients hold a light weight and lunge backward, checking for the rhythm of hip and knee bending that allows the heel to stay down, the shin to stay vertical, and the torso to remain upright.

3. Pick things up - Pick something up from the ground without rounding your back, lifting your heels, or allowing your knees to jut together or far out in front. Hopefully you find your hip hinge!

Possibly why your lower back, hips,

or knees are hurting.

4. High Step-Up Test - hold a light load in front with both hands and step up 12 to 18" (depending on your body height) by pulling up with the lead leg and not pushing off the floor. There should be no side to side movement of the knee or side tilt of the pelvis.

White-collar problems: In defense of traditional sitting

Sitting is bad

I'm sure this is not the first time that you have heard about the danger under your bottom. Sitting Disease is a term coined by James Lavine, a medical doctor who has spent most of his career studying sitting at the Mayo Clinic in Rochester, Minnesota. Estimates on exactly how much we sit vary. But it's hard to deny that many white-collar workers are plagued with this diagnosis.

Consider the human behavior that we call sitting. Notice what's going on all around you. Sitting has been implicated in numerous orthopedic problems like headaches and disc herniations. You do not have to earn a PhD in biomechanics to confirm all the protruding heads, C-shaped spines, and extremities that have adapted to the chair position.

A recent study by the American Heart Association found that whether or not you exercise, long sedentary periods raise your risk of developing heart disease, diabetes, cancer, and obesity. In other words, a lunch time jog does not make up for a typical day of sitting at work or class, and in the car, and while eating and reading and watching TV.  In 2010, British experts linked prolonged periods of sitting to a greater likelihood of disease, and Australian researchers reported that each hour spent watching TV is associated with an 18% increase in the risk of dying from cardiovascular disease.

The chair's fault

In the United States, the science of ergonomics is generally considered to have originated during World War II. Since then, both the medical community and furniture companies have attempted to design safe chairs, desks, and anything else needed to perform repetitive sedentary work. 

Numerous ball-shaped chairs, kneeling chairs, and ultra adjustable chairs have been proposed. These are definite improvements with some degree of scientific and plenty of anecdotal evidence for effectiveness. Yet many ergonomic solutions spare one part of the body at the expense of another, don't fit properly at common table heights, or have an odd appearance that is unacceptable for a professional workplace. Other ergonomic chairs simply don't accomplished what most people still want: enabling us to sit still and comfortably accomplish work.

It is my opinion that we are asking far too much from our chairs. The research seems to indicate that a healthy chair is an oxymoron. We may as well be talking about designing a low-impact hammer or the best Oreo for weight loss.

At this point, the conversation on Sitting Disease warrants some perspective. 

Lesser of evils

I imagine ages past when people hoped for a time when less strenuous work would allow them or their children to lead happy and healthy lives. These days, we are far less optimistic about that idea. Only recently have we began to understand some of the risks of white-collar work.

Sitting is not the only thing that is taxing on the body. The far majority of humans throughout history have had to perform more or less repetitive physical labor, rarely by choice. In modern times, blue-collar workers of all ages are in worse health than white-collar workers, even after controlling for socioeconomic variables. Blue collar workers are more likely to suffer from arthritis and report 3.4 more musculoskeletal injuries per one hundred workers. At age 65, blue-collar men score a mortality rate 42 percent higher than white-collar men.


When the daily grind involves repetitive lifting, carrying, pushing, pulling, kneeling, and operating heavy machinery, a good sit is legitimately therapeutic.Who among us hasn't been there after even one Saturday afternoon of yard work?

"Ahhh. The chair."

Keep in mind that many of us have such things as gardens and yards to tend to outside of our employment. We all sprint through seasons of time-crunched mayhem, some of it self-induced. But overall, Americans have far more leisure time than ever. We have the time and freedom to choose whether or not we want to watch TV, exercise, or otherwise fight back against what ails us.

The problems

The problem isn't simply the chair or desk or sitting or being classified primarily as a blue- or white-collar worker. The real problem, of course, is that too much of anything is bad for us. Some of the studies listed above and many others like them have found that physical inactivity, and not necessarily just sitting, is the crime we commit against ourselves.


Sedentary living is undeniably linked with sitting, and white-collar work demands siting long and often. But the fact of the matter is that our bodies gradually break down and fail us. If not from sitting, we would likely suffer repercussions from months and years of farming, hanging drywall, sorting packages, standing on cement, or some other task.

Some occupational risks are less obvious than others. Despite a growing body of evidence, white-collar employees remain less aware of their risks. A national workplace survey sponsored by The Hartford Financial Services Group Inc. found that while the average blue-collar worker expects to suffer overuse and traumatic injuries on the job, far fewer of their white-collar peers recognize that possibility.

Some not-quite solutions

Be aware of the realities of sitting for the majority of the day. Do not take the threat of sitting down...sitting down. By all means get your work done. But fidget, stand, kneel, walk and move as if your life depended on it, because it does. Search some of the evidence on NEAT (Non-exercise activity thermogenesis). Fascinating evidence is emerging that every small movement does count.

If many of your waking hours involve sitting, for heaven's sake, don't sit during the time you allocate to exercise. For example, the seated leg extension machine, the bicep curl machine, and the recumbent bike are not your smartest choices at the gym. Don't let me catch you on these unless you have a specific disability or other good reason for using them. I'm an advocate of exercises like squat and lunge variations, step-ups, shoulder presses, and pretty much anything where you must practice good posture, balance, and control the movement of multiple body segments against gravity.

Yes, you should schedule breaks from sitting, stretch, and take the requisite time and effort to create an environment that enables you to work efficiently over the long haul. Remind employers that an ounce of prevention is indeed worth a pound of cure.

As a physical therapist it is my duty and obligation to lecture you about posture. If only you could see my hypocritical posture as I type this! Why is it so difficult not to slouch? Gravity, our ancient friend and foe, is relentless. Stretching, strength training, "adjustments" and ergonomic chairs all only provide the potential to sit and stand with good posture. In the end, the only way to actually achieve good posture is relentless attention to sitting and standing with good posture. 

Don't stay in any one positions for too long, and don't give up. Variety, the spice of life, is also good medicine!

Given this problem with no easy or complete solutions, one of the most powerful things we have is gratitude. If only we can choose to be thankful for the privileged time and place in which we live. We can at least envision a narrow road that lies between the broad paths of sedentary living and backbreaking manual labor. With the perspective and time we have been granted to learn and engage in activities that do not involve chairs, maybe we can even be thankful for our place to sit.

 - - - - -

Long duration of inactivity raises risk despite exercise habits: http://circ.ahajournals.org/content/107/1/e2.full

Long duration sitting linked to various disease: http://bjsm.bmj.com/content/43/2/81.extract

Television viewing time and mortality:  http://circ.ahajournals.org/content/121/3/384.long

There is no one correct posture, chair, or correct way to sit: http://www.knoll.com/media/477/936/wp_future_ergonomic_seating.pdf

Blue-collar workers of all ages are in worse health than white-collar:
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154222/

Blue collar workers 3.4 more musculoskeletal injuries per one hundred workers:
http://www.ncbi.nlm.nih.gov/pubmed/17314467

Mortality of blue-collar and white-collar men at age 65: http://jech.bmj.com/content/57/5/373.full

Americans have more leisure time than previous generations: 
http://www.bls.gov/news.release/atus.nr0.htm

Sedentary lifestyle, but not siting, linked to health-related costs: 
http://www.ncbi.nlm.nih.gov/pubmed/24512865

Every small movement counts: http://www.ncbi.nlm.nih.gov/pubmed/16439708

Cost effectiveness of occupational health intervention: http://www.ncbi.nlm.nih.gov/pubmed/16299706

The Health & Fitness Trump Card

This is not the time to explain or debate the finer points of why something works for me and the clients under my care, or what may work best for you.  But here I make the claim that physical health and fitness can be reduced to this: building and maintaining muscle and strength. This is indeed THE critical component of staying healthy and functioning well as you grow and age.

When you regularly perform total body resistance training primarily with free-weights with good form and appropriate progression, you remain fit and "balanced." You don't have to diet or do a lot of "cardio." Everywhere you go, 24-hours per day you carry around functional, good-looking muscle that burns energy and allows you to eat a reasonable amount of relatively normal food. More likely than not, you will have good blood profiles, low body fat, and far more strength and endurance than you need on a daily basis.

Or you can believe the prevailing notions about the pathways and barriers to health and fitness. You can spend hours per week on the elliptical, "tone up" with high reps on the Nautilus machines, wave around the 2-pound pink dumbbells, take the lemon balm extract and whatever other supplements Oprah and Dr. Oz are hawking, buy the low sugar ice cream, the organic smoothies, and the whole grain cookies, rub on the pain relieving creams and gels, and throw out your nutrient depleting microwave oven. I could go on...

Don't get me wrong. To be healthy and achieve aesthetic or performance related goals, you do have to exercise and be mindful of what you eat. But it's truly not complex and time-demanding. We're not talking about knock-down-drag-out blood-sweat-tears marathons.

Today I was tired. Completed a few quick errands after work, disassembled a treadmill, installed a new belt, and put it back together. With little time and energy for training, I trained. The lack of music and training partner increased the demand by 27%. After a "clean the basement floor" warm-up, the days work included only 3 sets of intense single leg squats, one set of 20-rep squats, a few bicep curls, and a "core" finisher which including wailing on a tree stump with a heavy ax.

So to summarize. If you want better health, less pain, and to look good with minimal time investment, do resistance exercise. Compliment the Zumba, golf, yoga, skiing or whatever activity that you enjoy with time under the weights.

Consistent (2 to 4 days per week)

total body (controlling multiple body segments against gravity - in good form)

resistance exercise (strength training and conditioning activities safe for you)

is what I'm selling.

And there's the trump card. - bam -

Rest enough, minimize processed food, try to manage stress and have some fun.

See where that gets you!

advice to an aspiring medical professional

After a few questions about student loans and the state of health care, the aspiring medical professional puts it out there:

"So if you could go back and do it again, what would you choose differently?"

I gave him a few platitudes. Most of this young mans questions are good. At 22-years old, he's thinking through scenarios that were off my radar at that age. Even now, in our everyday discussion I can readily sense that in many ways he's more mature than I, and in others less.

I attempted to answer the question; couldn't think of another career path (physical therapy with personal training on the side) that would be better suited for my talents and inclinations. Teaching would be nice, maybe some day.

The young man comes from a supportive family with kind and intelligent parents. He has the grades and the standardized test scores and the work ethic and the personality and the various experiential learning to impress ANY admissions board. Success is practically guaranteed. I'm sure he doesn't understands how blessed (some would say lucky) and talented he is. These more meaningful words should have been communicated.

Ahhh success. Doesn't everyone define it differently? Here are just a few other thoughts that of course came 8-hours late:

-Commit to a community. Fall in love with a geographical area like it's a person. Choose to serve that community well for all the days you are given to dwell it. Some areas are surely better than others, but they all have their strengths and weaknesses. Being needed and needing others is more important than you think, for them and for you.

-Do what you can to not spend a quarter of your life sitting around getting to and from work. Sure, books on tape are good but focused or relaxed reading on the couch or in the back yard is far better.

-Follow your passion? I'm not so sure Lady Gaga. Sometimes you're not going to feel passionate about what you must do to honor your commitments and pay the bills. The work (pain in the ass) parts of work are good for you. 

-Accept uncertainty. Doing your homework and walking forward with caution and care is no substitute for the fact there will always be relevant developments that we don't know or understand. The cost of things will go up and the car will need repairs. Other than that, change is constant and little is truly predictable. 

-Live below your means. If you want to even have a chance at a low stress, semi-sane  existence where you can find joy and see the beauty that's in front of you, find a way to live below your means. There will never be enough money or time. The shiny finer things will always get old and sooner than that they will be old to you.  

Take these for what you will, the thoughts of a 38-year old who does terrible with accepting uncertainty, but is content with weight training in his basement and roasting marshmallows with the various kids who end up in his backyard. In the finances game he wins small and loses small. He drives a '98 Subaru, for Pete's sake, and takes great pride in using an old car but because of other life choices couldn't do much about it if he didn't.

 - - - - -

Remove far from me vanity and lies; give me neither poverty nor riches; feed me with the bread of my daily need.

an exercise in perspective

I was beating the clock on a timed weightlifting interval in my backyard. Such things make for brief yet effective training if you're willing to push yourself. An appointed rest interval ended. The time to get moving quickly came and went, slipped away like a car speeding down the highway. Instead of starting the task at hand I kneeled and pulled a weed from the lawn.
- - - - -

1. Training: 

Training is select movement with a specific performance goal in mind. Variables like loading and reps, speed and rest are manipulated with intent. One session supports and builds upon the other, and the end goal is much too lofty and specialized for any single bout of effort. Training requires a chunk of time with structured progressions and regressions, recovery and peaking. This type of effort requires the greatest amount of discipline regarding what to do as well as what not to do.

Training culminates in astounding displays of nearly superhuman strength and speed and endurance. This is exercise.

2. Working out: 

Working out requires showing up, and it may require great effort and courage. This is what usually comes to mind when we talk about "getting in shape." You lunge or dance, kick or spin, or maybe follow what an instructor planned for the hour. You fit in a jog or brisk walk. You put in a DVD and repeat circuits of calisthenics. Working out may or may not have much structure. It's formal calorie burning, where you gasp and sweat and go on with your day.  

This too is exercise.

3. Corrective exercise and rehab:

This is highly specific and structured but less intense. You may sweat depending on your fitness base. The primary aim is to use movement as a means to gradually build tissue resiliency, improve joint stability or mobility, and ingrain more efficient movement patterns. You alter the mechanical forces on your bum knee by stretching the ankle in a specific way and building hip strength. This is physical therapy, gait and balance training, and I suppose some forms of yoga.

These count as exercise.

4. Work: 

Work involves a bazillion reps of moderate to low intensity. You lift and sort packages, mow the grass, pick green beans, build a shed, perform stretching and adjustments, wash windows, or pace hospital floors. Work is, well, work. It's the 40-plus hour per week grind that lasts for months and years. Work is also the weekend binge, like loading the barn with hay or painting the house.

A reminder of the obvious is warranted here. Work is awesome because at the end of the day you have achieved something beyond fitness. Your muscles tugged at your skeletal segments and your heart beat fast and it resulted in compensation or some other immediately tangible offering to the world.

Labor is definitely exercise. Every pile of split firewood warms you twice.

- - - - -

With this as a reminder, here are a few thoughts:

-The vast majority of human activity has always been in the realm of #4. Only in recent times have many of us needed #2 or had the time and means to take #1 very seriously. Most with a career that requires even moderate manual labor cannot comprehend why anyone would want to spend their limited leisure time and energy on #1 or #2. These days, the #1 and 2s just assume those folks are neglectful or lazy. Maybe they are. Or maybe they're just tired.

-On sports: Playing the game where winning is the primary intent is #1. Playing where the main goal is to have fun or exercise is #2. Pay heed to this and do not mix the two.

-The #1s often fail to realize that doing time with #3 will help them resist injury and achieve new levels of performance. It goes for #2 and 4 as well. In fact, excessive anything outside of #3, without attention to #3, will often result in taking you to #3. But as Ronnie Coleman would say, ain't no one wanna do no boring-ass corrective work.

-There is sometimes a fine line between #1 and #2, but often there is not. Currently there is a LOT of confusion between the two. Athletes who have a specific performance goal in mind are caught running around, giving their body too much variety, going through unnecessary random draining workouts, with all the effort serving to stifle their advancement in #1. On the other hand, those who aspire to simply be active and get in shape are isolating their muscles on resistance training machines or, even worse, performing relatively technical and heavy movements they don't need or want.

-The funny thing is when a person who is all about the workout and gym culture imagines their #2 is some kind of magical greatness when in fact almost any #4 would be a lot more demanding and beneficial for them. Pay someone to plow the snow so you can go to the gym and work bis and abs.

-Military personnel, police, and other public servants are the only true #1s. Or at least they should be. Where else in modern times may life and death truly depend on high level performance? Professional athletes are often impressive genetic freaks with sharp intellect and superhuman work ethic. But at the end of the day, win or lose, they go home and eat, sleep, and hang out with their friends and family.

-The point, I think, is to clarify exactly what you want out of your fitness program (and life). I will point you to the enjoyment of pursuing a purposeful #1 rather than merely suffering through workouts. Do not discount the myriad of psychological benefits that even a light #2 provides.

-Right now I waver between #1 and 4, and except for casual mountain biking, usually altogether avoid structured #2. There's no need for random energy burning with all the work, housework, children, semi-rec sport. I remain fascinated with the idea of being a serious athlete, the discipline and diligence, structure and progression of #1. But could this be fading? I did pull the dandelion when I could have set a PR.

Sucker didn't come easy.

Deconstructing the BOSU

I'm not sure what it is about the BOSU half-ball. By the looks of it, there are a LOT of athletes, average Janes and Joes, soccer moms, personal trainers, physical therapists, and other professionals who believe the BOSU has some kind of mighty mystical properties.

Is there something in the BOSU ball that I'm not aware of? Is it filled with a slurry of emu oil and electromagnetically charged ground up unicorn horns?

I think the far majority of exercises on the BOSU are simply, well...dumb. At best they are a waste of time relative to other aspects of performance and fitness that you could be working on during training. For the most part, they are a pointless test of your ability to remain uninjured.

Here's a case of high injury risk with little, if any benefit. Tuck jumps demand a lot of the legs and core. When many athletes have difficulty jumping and landing on flat ground with adequate control, this guy is having his clients do it on a BOSU.




Truly, there are so many dumb things you can do on a BOSU.

These are not going to improve your strength, stability, or mobility any more or less than pretty much any activity that does not involve you sitting in front of a TV or computer. These are not even going to improve your balance in a way that is relevant to functional athletic performance. The one thing that such BOSU exercises achieve is a fairly fast and drastic improvement in performing that BOSU exercise.

If you're going to load your muscles, bones, and joints with resistance, do it in a way that encourages your brain to practice proper control through a full range of motion. When that gets easy, make the exercise more difficult (and beneficial) by gradually increasing the load. The far majority of athletes desperately need to improve their functional mobility (stability and range of motion) on solid ground.

Whether your primary goal is weight loss, conditioning, strength gain, or what-have-you, most of us will stand to benefit the most from plain GETTING STRONGER, something that the BOSU inhibits relative to training on the flats.

Single leg squat on a BOSU? Single arm plank for time? I promise that you can do almost any of those ridiculous looking BOSU moves and poses if you have good strength and you practice that move.

I will grant that balance training on the BOSU and other unstable surfaces is indeed beneficial in the context of physical rehabilitation. The BOSU is a decent tool for when your primary interest is sending proprioceptive input to the brain. Here are a few examples of appropriate use of the BOSU.

 

But please understand that there is a relatively narrow window here. Once you establish good control of these type of movements, you're far better off gradually increasing the speed and/or resistance of movement on flat ground.

[I'm not listing references here, but certainly let me know if you want to see evidence for some of these claims. For the most part, they all say that unstable surface balance training is modestly helpful for rehab after injury or surgery but offers very little benefit in the area of sport performance].