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Although frequent and sometimes debilitating, exercise associated muscle cramps (EAMC) have been poorly understood by the scientific and medical community for years. Many of the theories about EAMC have been from anecdotal evidence, not controlled studies.

Dehydration-Electrolyte Imbalance Theory
The dehydration-electrolyte imbalance theory is most commonly cited as the causes of cramps. During exercise fluid is lost though sweat. Along with water you are also losing electrolytes (sodium, potassium, magnesium and calcium) all of which are essential nutrients for proper muscle function.

Unfortunately, the data does not support this theory. Martin Schwellnus at the University of Cape Town reviewed the literature and found "the 'electrolyte depletion' and 'dehydration' hypotheses do not offer plausible pathophysiological mechanisms with supporting scientific evidence that could adequately explain the clinical presentation and management of EAMC."

Numerous studies cited showed no significant difference between blood volume (an indicator of dehydration) between cramping and non cramping athletes. Additionally, the theory does not address cold weather exercise when dehydration is less of a factor. 

Furthermore, if dehydration and electrolyte imbalance are the causes of EAMC simply ingesting adequate amounts of a correctly balanced sports drink should alleviate the problem. To test this, scientists had athletes drink carbohydrate-electrolyte fluids in equal amounts to fluid lost though sweat. Nearly 2/3 of the athletes still cramped! In addition, stretching, not fluid intake is the recommended relief for EAMC.  

Altered Neuromuscular Control Hypothesis
A new idea is emerging to explain EAMC, the  "altered neuromuscular control" hypothesis. This theory suggests that as muscles tire, neuromuscular coordination and control become impaired.

Muscles act in pairs, and smooth muscle action requires one muscle receiving a signal to contract and shorten while the opposite muscle receives a signal to lengthen. When muscle fatigue sets in these signals become faulty. The muscle continues to be simulated to fire without an equal inhibitory signal being sent to the opposing muscle. It is this imbalance in the neuromuscular signals that cause EAMC.

Although evidence from cat studies has supported this theory, Schwellnus states "Scientific evidence for the "altered neuromuscular control" hypothesis is based on evidence from research studies in human models of muscle cramping, epidemiological studies in cramping athletes, and animal experimental data. Whilst it is clear that further evidence to support the "altered neuromuscular control" hypothesis is also required, research data are accumulating that support this as the principal pathophysiological mechanism for the aetiology of EAMC."

My Experience
My experience teaching clients posture exercises leads me to believe there must be a neuromuscular component to EAMC. Clients will cramp trying to do a new exercise which is awaking muscles that have not been used in a long time. I also see consistent patterns of cramping when activating specific muscles. The cramping does reduce as clients repeat the exercises and gain more strength and function.

Prevention is the Best Medicine!
While the cause of EAMC is still under investigation the best prevention is:

• Stay hydrated

• Warm-up before and cool-down following exercise

• Fuel your muscles with adequate carbohydrates and electrolytes

• During exercise ingest an electrolyte drink for efforts over an hour

• Increase training duration and intensity gradually

• Stretch to improve flexibility to attain a healthy range of motion in your joints

• Properly fit your equipment (e.g. bicycle geometry)

• Massage your muscles regularly

Please enjoy this re-print of an article I wrote for mountain flyer magazine a few years back, original article (pdf).

Lying on the couch with fresh stitches in my thigh, as the ice pack begins to drip, my head is spinning from the pain medication. The sun is shining and I can see the mountains from my window. I haven’t ridden my bike for four months and couldn’t walk without a limp before surgery. Last summer, I was training for the Leadville 100 mountain bike race. This summer, I am reading, reconnecting with friends, resting, developing my upper body strength and enjoying more of my husband’s gourmet meals.

Injuries happen. When you push your body year after year with more miles, harder intervals and longer workouts, it’s hard to avoid a physical setback once in a while. In my 10 years as a competitive mountain biker with a pro license since 2004, this was my fourth surgery and the second season I missed due to injury.

Fortunately, success in cycling requires much more than bike training alone. As a cycling coach, I have advised several athletes on coping with injuries and alternate workouts. For my clients and myself, I have found that keeping a positive attitude, definitely difficult at times, and embracing time off as an opportunity can facilitate recovery and enhance future sports performance.

When I was laid up, it was important for me to concentrate on what I could do and not dwell on what I couldn’t. If you find yourself unable to ride and out of your training routine, try some of the following suggestions to help your cycling and your sanity.

MAINTAIN YOUR GEAR
When is the last time your bike was overhauled? Tired of the chain skipping a gear as you shift? Use your downtime to tune up your equipment. Perhaps you have always wanted to learn how to re-cable your bike but never had the time, well here it is. Order any parts that need replacing and other things just for a fun: a new saddlebag, colorful grip tape, loud bell, streaming tassels, whatever makes you smile. I was given a red saddlebag with dog prints that I’m looking forward to using this season. If you’re not inclined to work on your bike, take it to the shop or ask your husband to do the work like I did. Removing the temptation to ride and the constant reminder of your injured state may help ease your guilt and anxiety.

LEARN YOUR TRAINING AIDS
What do all those buttons control on your heart rate monitor? Heart rate monitors, bike computers and power meters offer vast amounts of data about your training. Odds are these technological devices provide more information than you’re currently using. Find out what what’s available and how you can best use these records to enhance your workouts.

STUDY TECHNIQUE AND STRATEGY
Regardless of whether you prefer dirt or asphalt, you can still learn more bike handling techniques and race strategy from watching videos and reading books and articles. I bought “Mastering Mountain Bike Skills” to learn what I could use personally and also in teaching mountain bike clinics.

PLAN FOR YOUR RECOVERY
Start with an honest evaluation of your strengths and weakness and where you need to improve to attain the results you desire. Determine what types of workouts will target the skills and abilities that are limiting your success. Make preparations to include this training in your future sessions by documenting it in your training log.

STRETCH AND STRENGTHEN
A forward flexed cycling posture tightens hamstrings and can lead to lower back pain. If your injury allows, try regular stretching, particularly lower body stretches, and strengthen your core with resistance exercise. The stronger your core, the more efficiently power is transferred to the pedals. Since my injury was to the hip, which is difficult to isolate, and central to movement of the body, I was very limited in what I could do initially, restricted to upper body movements only.

GET MENTAL
Do you ever psych yourself out on a familiar section of trail before you even get there? Our minds have a large impact on cycling performance, and the influence only increases with higher levels of competition. Is mental training part of your plan? If not, this is the time to include it.

Deep Breathing: Learning to control race anxiety by developing a deep breathing practice that you can use quickly in any setting, like the start line, can mean the difference between winning and not placing. During my downtime, I had weekly biofeedback sessions where I learned how to reach a clam, relaxed state of mind.

Self-Talk: We all talk to ourselves. Tune into the mes- sages you hear. Learn to recognize your inner dialogue
and work to restructure any negatives into the positives. This strategy can assist your recovery process and will also be helpful on the bike. Instead of thinking how much farther, think instead how every pedal stroke is bringing you closer to the top.

Goals: Set goals for your recovery, for the upcoming sea- son, for the month, for the week and for each workout.

PAMPER YOURSELF
Consistent riding and training requires extreme dedication and sacrifice. What are the things you skipped or didn’t make time for because you had to ride? I recently saw my first opera, attended a wine tasting seminar, enjoyed outdoor concerts and spent time at a spa enjoying luxurious hot water soaks and deep tissue massages. To get outside more, I played golf using a cart. I developed a greater appreciation for food cooking new recipes with my husband, such as spicy fried fish with homemade tartar sauce and farfalle with carbonara and spring peas. I also bought myself new clothes, began writing, played board games and spent more time with my friends, my family and my dogs.

Cycling is an important part of life but it’s not the only thing. Relax, accept your injury and view it not as a burden but an extended rest period. Use your time and energy on other aspects of your sport and your life that you’ve neglected because of long training hours, regular racing and frequent travel. My time off has helped me become a stronger mental athlete and a more knowledgeable cycling coach. I’m even starting to take my own advice.

Use your time in the gym to improve your structural alignment, not ingrain poor posture and compensated movement patterns.

Starting Position

• A staggered stance (1-2 feet apart) accommodates wider hips and larger dumbbells.

• The head, shoulders and hips are vertically aligned with the belly relaxed.

• Dumbbell heads are facing forward to keep the weights close to the body, creating a straight arm line from the shoulder to the wrist.

Movement

• Prior to initiating the shrug the shoulder blades are pulled down and together into retraction. The shoulder blades remain pinched together throughout the entire exercise.

• Shoulders are raised directly up towards the ears. Watch in a mirror to make sure the shoulders are level with each other at the top of the range of motion.

• The head and neck remain relaxed and neutral as the shoulders raise. Commonly, the neck will tense and the head goes forward.

• Upon reaching the top of the range of motion, keep the shoulder blades together and depress the scapula down towards the feet. Feel the muscles below the shoulder blades tighten to draw the bones down.

• The movement of the shoulders is synchronous, both raising and lowering at the same speed together.

• At the bottom of the range of motion hold the contraction for 1-2 seconds then relax the shoulders back to the neutral starting position.

In case you missed my article in The Weekly Sun of the Wood River Valley (pdf) or the Los Alamos Daily Post it is reprinted below.

Have you noticed changes in your skeletal structure when looking in the mirror or viewing pictures of yourself? Rounded shoulders? Increased or decreased arch in the lower back? One hip or shoulder higher than the other? These postural changes may be due to loss of function in your muscles.

Remember mom's words, “sit up straight!” Go ahead – adjust your body into a better position now. What changes did you make to achieve this enhanced posture? Did you increase the arch in your lower back to move the shoulders backwards without changing the curve in your upper back? Perhaps you leaned your upper body back behind your hips? If your rib cage remains perpendicular to the floor you likely achieved the posture using your muscles as designed. If your rib cage is pointing upward, there is a good chance you used a compensatory movement in your spine and pelvis to achieve your straightened posture.

Our brain, through the nervous system, directs the muscles to move the bones. If the muscles are too tight or weak, however, they will not be able to respond appropriately to preform the requested action and compensatory movements may occur. Additionally, the deep postural muscles are generally not under our conscious control. Changing the position of your vertebrae or the arrangement of how the upper arm bone is situated in the shoulder joint has a limited response to mental commands.

Form follows function! Good posture (form) is the result of an balanced skeleton. The position of the bones is dictated by the muscles that hold them. To achieve a strong, aligned skeleton the muscles must be at the correct length and tension preforming the appropriate movements. When correct muscle function is gained, your form/posture will naturally improve.

Your thoughts and internal dialogue creates your reality and influences your attitude, behavior, and outcomes. Take a moment to notice what is going through your mind right now as you start reading this article. You might be saying … I really should be working and not reading this … I don’t talk to myself … this sounds interesting, tell me more … where is she going with this and how does it apply to me?

Athletes use positive self-talk in the form of affirmations to develop trust in a desired actuality. "I am strong and exceptionally prepared to reach my potential and be on the podium this race."

Repeating self-empowering, confidence building, focusing and guiding statements of what you want and who you want to be will lead to achieving your vision. "I will be a successful solopreneur with work-life balance."

This technique proven in sports can also be applied to healthy lifestyle modifications. Whatever change you are undertaking – losing weight, improving nutrition, taking time for yourself, altering your exercise routine, reducing stress – can benefit from devising supportive affirmations. When developing affirmations always use positive words in the present tense that are personal to only you.

In my experience I have seen affirmations successful in modifying snacking behavior. Where once a chocolate was eaten now a confirming declaration is consumed. "I am lean, energetic and beautiful."

A bad day can be turned around with an uplifting affirmation. "I am grateful for all that is going well in my life - loving husband, good health, flourishing business, close friends and family, helpful neighbors..."

What you say silently to yourself has a powerful impact on your mood and actions – listen intently, take note, and where needed transform negative statements into positive words and recite often.

• I will have aches and pains
• My body will decay, fall apart and become decrepit
• I will become weak, fat and limited in my physical abilities
• My joints will become stiff, painful and may need to be replaced
• Walking will become a challenge and I may need assistance
• My energy will be diminished
• Sports participation and competition will be reduced or eliminated
• My posture will deteriorate and I will need orthotics
• I will depend on pain relievers to move 
• My balance will decline and there is a good chance I will fall, break a hip and never recover
• I will hurt when I wake up and have trouble getting out of bed

Use your time in the gym to improve your structural alignment, not ingrain poor posture and compensated movement patterns.

Starting Position

• Hand position on the bar is wide enough to create a 90 degree angle from the wrist to the elbow to the shoulder at the top of the exercise.

• Linear line from the hands to the knees with the spine in neutral alignment.

• Arms extended, elbows straight and a slight stretch in the lat muscles.

Movement

• Depress the shoulder blades down before beginning the upward movement. Depressing the scapula first stabilizes the scapula and secures the rotator cuff and shoulder joint, protecting it from injury. Additionally, depressing the shoulder blades puts the latissimus dorsi muscle (lats) in the proper alignment to be trained effectively.

• Evenly pull your body up engaging your back muscles to do the work until your chin is near level with your hands.

• Lower slowly, allow the lats to stretch at the bottom then depress the scapula to start the next repetition.

In case you missed my article in The Weekly Sun of the Wood River Valley (pdf) or the Los Alamos Daily Post it is reprinted below.

Sports and exercise shouldn't hurt. For many of us, though, moving our bodies creates symptoms of pain. Consequently, the circle of activities available to us shrinks and we move less. And the less we move, the harder it is to move, and the more it hurts when we try. A downward spiral for our musculoskeletal health and function.

It is common to blame the activity for the pain. Running is the most common culprit. I recall my doctor telling me to never run again after my first knee surgery, “It's too hard on the body and bad for your knees.” Could it be that the human body is so fragile that running will inevitably result in injury? If you've read Born to Run by Christopher McDougall you may recall that the human body is ideally adapted to run and early bush men actually hunted by running down their dinner.

Has our sedentary lifestyle and the conveniences made possible by the Industrial Revolution changed our bodies so rapidly that we should not run? No, our physical structure does not evolve through so few generations and we are still optimally designed for running. From a postural perspective running best simulates ideal joint alignment and has the additional benefit of impact which promotes joint stability and bone growth.

If it isn't the activity, what's causing the pain? Your body! If you go to run with a body like I had with one hip high, knees pointing inward, feet pointing outward and a rounded upper back and shoulders you can bet that your movement is compromised and in time you will hurt and in my case end up in surgery.

It is not the sport but the body you bring to the activity that makes you hurt. To help you improve your body position and keep playing, I'm offering free posture alignment exercises for many sports on my website, http://www.thepfathlete.com/. Enter your information in the upper right hand corner of the page to sign-up for my newsletter and receive your complimentary sports specific routine.

The Stress-Response and Relaxation Response are opposite pathways of our autonomic nervous system. When one is engaged the other is inhibited. The Stress-Response activates the sympathetic nervous system while the Relaxation Response empowers the parasympathetic nervous system. The table below shows a few of the contrary physiological reactions of each nervous system.

Harvard physician, Herbert Benson M.D. introduced the Relaxation Response over 30 years ago. According to Benson, Western society devalues the importance of relaxation and idealizes work. Consequently, the norm is to be stressed. Relaxation takes awareness and deliberate attention.

In his words...

"Unlike the flight-or-fight response, which is repeatedly brought forth as a response to our everyday situations and is elicited without conscious effort, the relaxation response can be evoked only if time is set aside and conscious effort is made."

Four Basic Elements to Invoke the Relaxation Response

1. Quiet Environment
2. Mental Device
3. Passive Attitude
4. Comfortable Position

Although a quiet environment and comfortable position are self explanatory the other two elements, mental device and passive attitude need more explanation. Additionally, these two elements are also the most important and essential. The Relaxation Response has been achieved while moving and in busy, noisy settings.

Mental Device

To keep your mind on the present moment a sound, word or phrase can be repeated silently or aloud. This helps to keep thoughts from distracting your attention. Having your eyes closed assists focus by eliminating visual stimuli. Your mental device may also be an object, in which case your eyes are open and you hold the item in a constant gaze. Natural deep breathing can be incorporated with using your mental device and will assist in relaxation.

Passive Attitude

Don't judge yourself on how well you are doing the Relaxation Response or worry that you're not doing it right. This may prevent you from achieving your goal. Benson advises to just "let it happen." It is common for unwanted thoughts to surface while trying to relax. When they do simply let them go and return to using your mental device.

Benson recommends practicing the Relaxation Response for 10-20 minutes once or twice daily. I am still working up to this level. Since I don't yet have a good personal story about using the Relaxation Response I'll leave you with a testimonial from Benson's book.

"The Relaxation Response has contributed to many changes in my life. Not only has it made me more relaxed physically and mentally, but also it has contributed to changes to my personality and way of life. I seem to have become calmer, more open and receptive especially to ideas which either have been unknown to me or very different from my past way of life. I like the way I am becoming; more patient, overcoming some fears especially around my physical health and stamina. I feel stronger physically and mentally. I take better care of myself. I am more committed to my daily exercise and see it as an integral part of my life. I really enjoy it too! I drink less alcohol, take less medication. ... I feel happier, content, and generally well when I use the Relaxation Response."

Flow is the state of optimal experience when the body and mind are pushed to the limit to complete a difficult task. It is these moments that bring us happiness and fulfillment in our lives.

Flow is an intrinsic experience of our own making that is not dependent on outside factors. It is a source of mental energy, motivating action and focusing attention. This state involves complete concentration, creativity, and deep enjoyment. When applied to sports it is often referred to as being in the zone.

Hungarian Psychology Professor, Mihaly Csikszentmihalyi, developed the idea of of flow through his extensive research in positive psychology during the 1970s. He describes flow as "being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you're using your skills to the utmost."

The Four Criteria for a Flow Experience

1. The presence of a challenging activity.
2. The perception that skills match the challenge.
3. Clear goals.
4. The availability of instant feedback concerning performance.

Compare the criteria for a Flow experience with the seven characteristics of the Zone and you'll find it is essentially the same thing. When an athlete says they were in the Zone they are describing a Flow experience.

The Seven Characteristics of the Zone

1. Being totally absorbed and focused on the activity.
2. Experience of an inner clarity and understanding exactly what is required, knowing that their skills are matched to the task.
3. A sense of ecstasy - being outside everyday reality.
4. 'Being in the moment,' focusing completely on the present. Unaware of time passing - a sense of time slowing down.
5. A deep passion for the activity leading to higher levels of performance.
6. Sense of serenity - no anxiety, no ego so no worries about the outcome of action.
7. No sense of effort. The activity becomes easy.

Enter the Flow State - balance challenge and skill

Flow is reached when both the challenge and skill required are high, top right in the diagram (source: Wikipedia). On the opposite end is apathy where the challenge and skill level are low. Anxiety results if the challenge is high and skills are low. Flow is a dynamic state. As skills increase the challenge must also increase and vice versa to prevent boredom.

Flow Creating Activities

According to Csikszentmihalyi's studies flow is easier to produce and more often experienced at work. A job has the built in criteria for flow - goals, feedback, challenge and skill. Of course the right combination of these are necessary to reach this optimal state of performance!

Free time activity can also bring about flow though some are better than others. In a study with US teens flow was observed 13% of the time while watching TV, 34% of the time while engaged in hobbies (music, reading, movies, social interactions), and 44% of the time while playing sports and games.

My Experience

I love classic style cross-country ski marathon races. Although this story is from my 2010 race which I hoped to repeat this year, I can say I had moments of being in the Zone during my ski last weekend. When asked why I race, it is for these experiences...

 

A few weeks before the race I had set mt goal, a top three finish. As the race neared I re-set my goal to win. At the start of the 45 km event I quickly went to the front of the field. I was skiing hard and focusing on each stride - kick, glide, pole. I could hear my competitors breathing hard behind me. I felt good and kept up the strong pace for the first mostly flat 15 km. My opponents and I came into the feed station together at the base of the first challenging climb. I was determined. I skied away in the lead and pushed on towards the steep slopes. Passing skiers as I worked my way up the snow covered hill I felt great! Although others seemed to be suffering, stopping and walking, I didn't notice my effort. I just keep going faster and faster towards the top. It felt as though I was skiing outside myself as I increased the gap from my pursuers. At the summit I was alone and I realized I had pulled away! I plummeted down the other side of the mountain never again to see or hear the other women in my race.

I reached Flow because I had a goal, my skills and the challenge were matched and I had immediate feedback about my performance. Use this same Flow criteria to create more moments of joy in your life!

In case you missed my article in The Weekly Sun of the Wood River Valley (pdf) or the Los Alamos Daily Post it is reprinted below.

Transitioning from skis to running shoes can be painful. When skiing our foot is connected to a long board and never makes contact with the ground. In running, the foot is free to move on its own and comes in direct contact with the earth. How the foot interacts with this surface can make the difference between a pain full or pain less run.

The functional design of the foot is to strike the ground on the center of the heel, roll to mid-stance and push off over all fives toes. The big toe performs approximately 60% of the push followed by 10% on each of the outer toes.

Take off your shoes and walk barefoot on a hard surface. Feel how your body is striking the ground. In addition to the pressure on heel strike and toe push off also be aware of the sideways movement of the foot. Do you feel more contact with the inner or outer edge of your foot? I have been told I pronate and corrective shoes were recommended for this improper foot strike where the foot rotates inward onto the inner edge. Supination is the opposite, rotating outward onto the outer edge. A common improper foot strike is to hit on the lateral side of the heel and cross though the mid foot to the big toe. Do you feel this as you walk?

Many painful lower leg conditions begin with an faulty foot strike including shin splints. An unbalanced foot strike creates additional stress on the soft tissues of the foot and ankle. As the foot supinates or pronates the the lower leg bones twist and the surrounding soft tissue is strained. In the case of shin splints minute tears are forming that can cause pain, swelling and tenderness on the inner lower leg.

Posture alignment exercises improve foot strike. On my website: http://thepfathlete.com/shin-splints you can sign-up to receive a free menu of exercises specifically designed to prevent and alleviate shin splint pain. I gave these to my neighbor and she has been able to stop icing her shins after every run. Before and after you do these exercises perform the foot strike test or do a balance test. Stand in a natural posture and feel how your weight is distributed throughout your feet – left to right, front to back and side to side. These exercises have a cumulative effect, your balance improves as you do them regularly.

Although this book review is of the women's version of the book it is applicable to men as well. Men will enjoy the first book, Younger Next Year.

Co-written by internist Dr. Henry (Harry) S. Lodge, M.D. and his patient, 73 year old Chris Crowley, Younger Next Year for Women is grounded in seven rules.

Harry's Rules

1. Exercise six days a week for the rest of your life.

2. Do serious aerobic exercise four days a week for the rest of your life.

3. Do serious strength training, with weights, two days a week for the rest of your life.

4. Spend less than you make.

5. Quit eating crap!

6. Care.

7. Connect and commit.

Harry makes an important distinction between aging and decay. There are biological changes that happen as you age - hair grays, maximum heart rate declines and skin deteriorates. However, he argues that many of the other feared signs of aging – obesity, joint pain, weakness, disease, falls, apathy and on and on are decay, and are due to our lifestyle choices and are optional.

It is about balancing growth and decay in your body. By nature, you are programmed to decay and as the years go by you need to do more to tip the scale towards growth. Exercise, and not just walking causally around the block, signals your body to grow. You may remember my blog: Exercise Makes You Smarter. Exercise also makes you younger!

What I found unique in Harry's rules was #2. Of course moderate exercise (rule #1) and strength training (rule #3) have been recommended for years but this was the first time I recall seeing high intensity aerobic exercise encouraged for the mature population. The required warning of see your doctor and build up slowly is given but after that – go for it!

I have to say I agree with this advice. Living part-time in Sun Valley I am regularly in awe of the fitness of the older women in the area, especially as they are beating me... it's never too late to get younger and stronger!

Although more than half of the book is dedicated to exercise there is also general advice on nutrition, staying connected with others and maintaining meaning in your life. This inspiring book outlines the steps you can take to feel functionally younger despite your chronological age. If you want to make the most of your later years I recommend you read this book and start implementing Harry's rules NOW!

In case you missed my article in The Weekly Sun of the Wood River Valley (pdf) or the Los Alamos Daily Post it is reprinted below.

Lifting weights is a great way to increase strength. Unfortunately, it can also engrain postural disparities and movement compensations. This reality has spawned the term, dysfunctional fitness, whereby we are doing our bodies more harm than good in the weight room.

Real strength comes from a stable and aligned posture. Joints that are out of alignment are weak. The position of the joints is dictated by the muscles that are attached to them. When our skeleton is in a symmetrical position, our bones support us and the muscles do minimal work. The key to aligned posture then, is keeping the muscles in good shape.

The postural muscles are the foundation of our skeletal structure. Visualize the muscles around your trunk in layers. The deepest layer consists of your postural muscles. Since dysfunction, lost musculoskeletal function, happens from the inside out, muscles at this most inner layer become weak and ineffective first. Once this support base is lost the outer muscles take over for the defunct underlying tissues, thus starting the process of compensation, muscles doing jobs for which they are not intended, resulting in postural deviations.

Traditional strength training targets these large, superficial muscles. Without first putting the body in a more ideal alignment – straightening – these compensating muscles will become – strengthened – in their accessory roles and faulty positions, further accelerating the atrophy of the postural muscles and skeletal misalignments.

A balanced strength training program will include exercises to counteract your postural deviations. Although these exercises may seem simple and remedial they are essential in the process of restoring muscle balance to your body. Lost body symmetry is the first step towards musculoskeletal injury and pain. Once your body is in an improved postural position you are ready to add resistance to your routine.

Here are some positioning tips for your next workout that will help you build strength in a good posture.

General Guidelines for All Exercises

• Align the feet straight forward and hip-width apart.
• Pinch the shoulder blades down and together.
• Use light weights to avoid compensated movements, train the muscles you intend.

Bench Exercises – Relax your lower back without pushing it flat or over aching.

Sitting Exercises – Roll your pelvis forward to a neutral position with your sit bones pointed straight down and your lower back slightly arched.

Abdominal Crunches

• Place your hands behind the head with your fingers interlaced. Pull and hold your elbows and shoulders back to reduce the pressure on your head and neck.
• Look straight up or slightly back, keeping your chin off your chest.
• Allow natural pelvic movement, do not flatten and hold your back down.

"What looks like laziness may actually be exhaustion."

This was one of the lessons from the book Switch: How to Change Things When Change is Hard. I listened to this book last year and recently attended a Wellcoaches class on the book which prompted me to write this blog.

In an experiment scientists put a group of people in a room with a plate piled high with freshly baked, mouth watering chocolate chip cookies (my favorite!) and radishes. Half the people were told they could eat as many cookies as they wanted but couldn't have any radishes, no problem! The other half of the people were told they couldn't have any cookies but could eat as many radishes as they wanted, yuck!

Amazingly everyone followed the instructions given. After some time the people were separated into their respective cookie or radish eater groups and lead into other rooms with no cookies or radishes. Self control having been challenged for the radish eaters the real experiment began.

Both groups were given a difficult puzzle to solve. The radish eating group who's self control had already been tested soon tired of working on the puzzle and quickly gave up. The cookie eaters, however, persevered and attempted to solve the puzzle for a much longer time. The conclusion being that self control is exhaustible.

How often do you do this to yourself everyday? You walk by the candy jar, vending machine, refrigerator, bowl of nuts or snack bar countless times a day. Initially you are able to resist but with repeated exposure it becomes harder and harder and you eventually give in, maybe not today or tomorrow but next week. Or, like with the puzzle solvers you'll surrender to the next enticement which may be sitting on the couch instead of exercising that evening because your self control is exhausted. Notice how this can become a rapidly moving snowball plowing over your good intentions and leaving your health shattered on the mountain slope.

The authors of Switch refer to our environment and behaviors as the path. We need to shape our path. Reduce the drain on your self control! Walk a different route avoiding the temptations, remove the treats, etc. This is the final step in the behavior change process preceded by the more pressing tasks of directing the riding and motivating the elephant.

The rider is your logical/rational brain and the elephant is your emotional/impulsive brain. Can you see which one is bigger... An elephant can easily squash the rider. You know you should so something yet you don't and do the opposite. That is the disconnect between your logical and emotional brains. Sounds like self sabotage doesn't it? And that's what happens when both brain systems are not in synch. Your rider and elephant are at odds and the elephant usually wins. It is not enough to intellectually know something but you need to create the desire, the emotional pull to make the change.

Aligning your rational and impulsive brains is the key to quick, easy and lasting behavior change.

Motivate your elephant! Read my previous blog: Motivation Trumps Willpower for Changing Behaviors.

In case you missed my article in The Weekly Sun of the Wood River Valley (pdf) or the Los Alamos Daily Post it is reprinted below.

Contrary to popular belief your knee is not a fragile joint. It is designed to run, jump, ski and perform all the activities you ask of it. The knee is actually a simple joint with a complex job. Acting as a hinge joint, the knee flexes and extends the lower leg. The complexity of the joint lies in it's role in coordinating and synchronizing the movement between the hip and ankle.

Your body is linked together in a kinetic chain and works as a unit. No joint or muscle works in isolation. Just try to bend or extend your knee without involvement from the hip, ankle or pelvis. It's not possible. The muscles and tendons that move the knee cross these anatomical structures.

In the kinetic chain of the leg the hip, at the top, is the largest joint with the greatest mobility. The ankle, at the base, is also very mobile. The knee sits between trying to stabilize the actions of these joints. If there is dysfunction in either the hip or ankle the knee can take on tasks for which it is not designed and become misaligned and injured.

The knee joint is the junction of the femur bone reaching from the hip to the knee and the tibia bone extending from the knee to the ankle. So, the position of the knee is dependent on the alignment of these bones above and below in addition to the tension, strength and health of the surrounding soft tissues (muscles, fascia, tendons and ligaments). Ideal knee posture is when the femur and tibia bones are in a neutral position with the knee cap centered and pointing straight ahead.

The two most common knee misalignments are internal or external rotation. This is evident through the knee caps, instead of facing straight ahead they point inward, towards each other or outward, away from each other. It is also possible to have only one knee rotated or the knees rotated in opposite directions.

It is said that the knees are the windows to the hips. If a knee is internally rotated, so is the hip above and likewise, if the knee is externally rotated the same is true of the hip above. Often, rotated knees are paired with rotated feet increasing the twist and stress on the knee joint which can lead to injury of the soft, protective tissue within the joint. Repetitive bending of a misaligned knee can damage cartlidge and the meniscus.

To realign the knee, imbalances in the pelvis, hip and ankle need to be addressed. An internally rotated knee may be caused by weak pelvic girdle muscles while an externally rotated knee may be caused by tight pelvic girdle muscles.

Guest Column: by Lynn Bjorklund

I started Egoscue® with Jessica in 2010 when I was in a downward spiral with numerous injuries. Each year I tried harder and could do less. Most people chalk it up to just getting older and that is what is normal to expect. I didn't want to believe that, so I spent considerable time and energy trying to understand why my body wouldn't heal up.

I had heard of Egoscue® even before meeting Jessica and signing up as a client. I had read the book, tried the exercises and felt like I could do most of them pretty well already. So I wasn't sure that it could really do much for me.

I started Egoscue® with the classic "no pain no gain" attitude of needing to work as hard as possible to get any better. After several months, it got frustrating. It was really tough for me to do the exercises where you just hang out in a stable, lined up position for extended periods of time. It was boring and didn't seem hard enough to do any good. The exercises that required movement, I would force with years of practiced gusto. The thought was that if you pushed through 5 sets of 50 rather than 3 sets of 30, improvement would be even better, and never mind what set of muscles were used to get there.

I was slow to catch on to the concept of gently reshaping your posture, while training those less obvious and under used muscles. Years of patterns and habits are not easily or quickly changed. Inconsistency and forcing movements probably slowed my recovery like it did in every other thing that I have tried over the years. A predisposition to a sort of compulsive, obsessive, all out attitude towards achieving goals can be an asset if channeled properly, or it can be a means to self destruction if not.

My recovery looks a lot like a stock market profile line, but the good news is that it is slowing trending for the better. Often due to my over zealous approach to training, racing, and exercise in general, I have had some dips and back sliding in my quest for an injury free, well functioning anatomy. There is huge value in honest discussions about the how and why things are going as they are.

Having someone to bounce ideas, help plan a program of success, motivate during the set backs, channel energy to the most helpful exercises, and focus on the appropriate goals while keeping life well balanced are all valuable benefits of working with a coach/therapist. Jessica is wonderful coach. I now look back and see tremendous progress thanks to her incredible patience and perseverance with me.

Here are some key points that have changed for me while having Jessica as a coach.

I have a better attitude about pain and injuries that may come about. I used to get very frustrated and/or depressed, as though something unfair had happened and the Pain Fairy broke into my home in the middle of the night and sprinkled pain dust on some unsuspecting joint.

Now I am seeing an injury as the warning sign that it is and that something needs to change. There has been an overload on some part of the system, and it has been slowly building up over time until one day I finally have to admit to a real injury. Something is out of balance, a change of some sort is needed, and it can be a challenge to figure out just what that might be. That is where working with a coach like Jessica can be so helpful. Having an injury doesn't mean stop moving and exercising, it means redirecting that energy. You can learn to "train the injury" back into healing.

I've realized I need to start where I am, not where I want to be. Rather than forcing through pain, the trick is to understand why I am hurting and redirect my energy to doing realignment exercises and slowly start building back with movements that are within the capability and tolerance of the injury. Training is rarely a steady state improvement the way I would love to see it happen. The weakest link will often break down, and then you do have to step back and do some restorative work before going forward again.

Instead of endless frustration with seemingly endless injuries, healing and realignment with Egoscue® can be a challenge that creates a better understanding of your body and how to work with it and not against it. Training becomes more balanced, healthful, and fun, and in the long run, that it is really what it is all about.

Starting Position

• Hand position on the bar is determined by abducting the arms to the side, bending at the elbows, rotating upwards and reaching straight up to grab the bar.

• The thumb wraps around the bar with the other fingers forming a hook. This reduces tension on the forearms and allows for better engagement of the lats.

• Linear line from the hands to the hips.

• Arms extended, elbows straight and a slight stretch in the lat muscles.

• Lower body is in a 90 degree angle with the feet flat on the floor.

Movement

• Depress the shoulder blades down and hold for ~1 second before beginning the movement.

• Slowly lower the bar down keeping the shoulders level and elbows even. There is a 90 degree angle with the shoulder, wrist and elbow.

• As the bar is lowered lean back from the hip allowing the lower back to arch and look up.

• Hold the position on the bottom for 1-2 seconds before raising the bar.

• As the bar returns to the starting position the body comes forward back into linear alignment.

   

Exercise Notes

This is a more advanced exercise. In order to perform it correctly you must have functional shoulders with the ability to extend the arms straight overhead without pain or compensation. If you are not able to do this I recommend starting with back rows.

Starting Position

• Lie down on a bench with your knees bent and feet flat on the bench.

• Distance between your heels and butt is ~ 6".

• Arms extended directly above the chest.

• Weights are facing each other with the palms down.

• Lower back has a natural curve, relax your abdominals and do not flatten your back to the bench.

• 3-5 degrees of bend in the elbow to provide shock absorption.

• Hands are slightly inside the elbows, 80 degree bend at the elbow to maximally engage the triceps.

Movement

• With the weights extended above the chest retract the shoulder blades down and together. This will move the weights apart 6"-1'.

• Slowly lower the weights down until the elbows are even with the body, a 90 degree angle with the shoulder, wrist and elbow. Any lower will put excessive stress on the front of the shoulder joint.

• The upper arm is held slightly below shoulder height, at 65-80 degrees of abduction.

• Hold the position on the bottom for 1-2 seconds before pushing the weights straight up.

Resistance Machine Notes

I purposely did not show this exercise on a resistance machine. Being of smaller stature I was not able to set the machine to fit my body at the correct angles to execute this exercise in good posture. If you do use a resistance machine for the chest press please follow these set-up guidelines and perform the exercise as described above.

• Make sure your upper arm is slightly below your shoulders. You may need to adjust the seat height to attain the correct angle.

• The angle between the elbow joint and the hand should be 80 degrees. Most machines have multiple grips that can be used.

• Sit with the lower body at a 90 degree angle from the ankle through the knee to the hip.

The month of January is a time of natural transition where we say goodbye to the previous year and excitedly enter into the new year. It is the one time on our calendar that as a society we vow to make positive changes and take action.

If the timing is right and motivation is high, then why do so many fail to achieve their New Year's Resolutions?

I believe the reason is because people jump right to making changes without an appreciation for the transition that is required first. In his book "Managing Transitions" William Bridges makes a clear distinction between a transition and a change. "Change is situational... Transition is the psychological process people go through to come to terms with the new situation. Change is external, transition is internal."

Transitions precede long-term change. And the beginning of a transition starts with an ending. Yes, initiating a change starts with letting go of the past. Before the desired outcome can be achieved the old way of doing things has to be released.

What will you need to give up to change?

Is the result worth the sacrifice?

After you determine what must be given up, the next step towards rewarding change is what Bridges calls the neutral zone. "The neutral zone is both a dangerous and an opportune place, and it is the very core or the transition process. It's the place and time when the old habits that are no longer adaptive to the situation are extinguished and new, better-adapted patterns of habit begin to take place."

The neutral zone is a difficult place. When desire is not strong and the first step of the transition has not been made it can be very easy to revert back to previous unsupportive behaviors. The length of the neutral zone varies. Upon its completion, a new beginning will emerge. This is the final phase of the transition when outward change is apparent.

The transition process: "endings - neutral zone - new beginnings."

Personal Story
2013 stated with me moving my parents from the house where I grew up in Carmichael, CA to an apartment in Encinitas, CA close to my sister. The house is pictured below.
This was not an easy move and it started over five years ago. Of course the housing crash didn't help but I believe one of the reasons it took so long was that my parents were stuck in the neutral zone wrestling with the psychological issues of the transition. It wasn't until those mental issues were sorted out and the inner decision made to move that action could happen to change their situation. It was very difficult for my parents to let go and end that chapter of their lives.

Their new beginning in the San Diego area has finally begun! My sister and I have been planning and hoping for this day for a long time. The apartment, shown right, is smaller but very clean with lots of natural light, community activities and conveniently located to shopping and important to my dad the YMCA.

I wish you a transformative year full of growth and change!

Reference: Managing Transitions Making the Most of Change, William Bridges