Wednesday, September 28, 2011

An ounce of prevention> pound of cure

I had a long conversation last night with an athlete about a long standing ankle injury she had recently re-aggravated. We were talking about strategies to mitigate her injury, and she quoted her doctor who said "We've been through this a few times, I don't think another 12 weeks of PT are going to help you that much." With which I totally agreed. What the doc was implying was that this woman should get operated on, with which I disagree.
Some folks have issues, joints, muscles, tendons, levers that just don't hold up. They have to be constantly maintained (assuming one doesn't just want to sit on the couch and watch Simpsons re-runs) some folks have accumulated a very high number of small injuries that have broken down joints or tissues, others have had a single catastrophic event that has created a long standing issue.. a lucky few (like me) have a combination of all of the above.
If any or all of these describe you, then you will probably need to manage and maintain your injury for as long as you intend on being active and pain free. You don't ever get to stop PT/corrective exercise if you don't want to hurt. It's just a fact of being you, sorry, suck it up buttercup. The good news is, if you stay on top of your maintenance you can continue to be awesome.
Similarly if you have significant dysfunction from your lifestyle (sit at a desk all day perhaps.. wear high heeled shoes all the time? ect) Unless you make significant changes to that aforementioned lifestyle not only do you have to do corrective exercise to get you out of a dysfunctional movement pattern or posture, you're going to have to keep doing some small amount of corrective exercise to keep you from returning to that dysfunction. To simplify, if your posture is terrible because you sit at a desk all day, you won't be "cured." Especially if you continue to sit at a desk all day. You are going to have to continue to do soft tissue/mobility/stability work to counteract the effects of what you do and how you sit those 40-60 hours per week.
Too often people want to be 'fixed' to be 'cured' with these types of movement and postural issues it's not that simple. You are fixed by keeping up on your preventative maintenance and making sure your dysfunction becomes and stays functional, and never becomes injury. If you have been injured, then making sure you keep that in the past tense will probably always be a part of your training. The up side is you get to keep training, and for 10-15 minutes of prevention will save you the pain and cost of a surgery or worse.

Mahalo.

Tuesday, September 20, 2011

Spin to win..

When I was a Product Engineer (Guy who designs stuff) the sales guys loved to take me along when things were broken. Invariably there would be three or four vendors sitting around a conference table with the customer "suggesting" that it was broken because it was someone else's fault. They were being what I like to call "congress polite" (this is where I call you the distinguished gentleman, but also explain that you don't know your back pocket from a hole in the ground). I am analytical. I tend to listen to everyone's arguments before speaking, and not just to shoot holes in them. Generally speaking, in those situations I figured out what really was wrong, we’d get it fixed and the customer would be happy. What everyone forgets in those situations is the customer just wants their stuff to work. They don't care (really) whose fault it was.
Conversely, I was terrible at pre-sales meetings. If the customer could get away with buying a cheaper product, I'd suggest they do just that. Drove the sales guys nuts, but what they didn't see was: the truth gets you the sale, and generally several others. A fib only gets you one sale. It makes no sense to lie, particularly when the truth will ultimately work out for everyone.
So what does that have to do with fitness? Product endorsement.
I have endorsed several products in the many years I have run this blog, but those were products I purchased. There was no need for disclosure. The kind folks at Lemond have loaned us a spin bike to use in Kate's rehab. This post is to tell you folks why I jumped at the chance to add the bike to our tool kit. I am getting access to an amazing piece of equipment for free. I would not use anything I do not believe in on one of my athletes in general, an injured one particularly, and on my wife specifically. If you doubt that, then I worry that you spend too much time on the internet.
When we are dealing with an injured client the first thing we want to do is get a training effect systemically while maintaining the integrity of the injured area. The simplest way to do that is to keep it stable. The spin bike is great for this as you can condition around most injuries. You can position the seat and bars such that there is very little pressure on the upper body for shoulder and neck issues. Athletes with extremity injuries can rest on their elbows, and folks with lumbar spine issues can be positioned in a neutral alignment, and fixed there. All of this is while training any or all three energy systems.
A secondary advantage of the bike is the load that can be applied to the flywheel.
If applied correctly a client can work very hard with either very little speed: high load-low cadence (keeping them very stable) or very low load-high cadence (high work rate with very little tension) this is a huge benefit for working the anaerobic system while keeping the injured area fixed and the physical impact at zero.
For uninjured athletes the two tools I like are the spin bike and sleds like the prowler both allow the athlete to condition on 'off' days with little wear, and very controlled fatigue. There is no eccentric load on either so the athlete doesn't get sore. The major drawbacks to the sleds are: they take a lot of space.. a lot. People training out of small gyms it's not an option (unless you want to dodge traffic while behind a loaded sled in a hypoxic fog.)
For athletes who don't move very well, the push sled can be problematic as it requires spinal loading and it's difficult to coach people when they're moving all over the place.
The bike works great in both of these instances; you can load it up, or keep it quick and fast. You don't have to worry about space or movement quality as you can fix them in the correct position with the seat and bars and they don't move so if you need to correct as you go it’s easy enough just to give a poke, a prod and adjust how they're moving.
Finally doing longer pieces that train the aerobic system is nigh on impossible with the sled. Unless you have several miles of space to push the thing, it's just not plausible. I am not a fan of long slow distance work for fat loss, or power athletes, but those are not the only reasons why people train. Sometimes you do need to be aerobically fit.
For those reasons; when Matt offered the bike up for us to use I jumped all over it. I knew the product, and I knew exactly how I was going to use it. It was a slam dunk. Is it appropriate for everyone? No. There is not a single tool in fitness that is; anyone who tells you otherwise is probably selling something.
Mahalo.

Monday, September 12, 2011

Kate's log 9/12/11

I am now 9 weeks out of surgery, and I¹ve had a bit of a rough week. I have been experiencing some residual pain for several weeks; it seems to come and go with no noticeable pattern. Usually, the pain seems like a reminder that something is going on back there; it¹s not physically hindering me, but is worrisome nonetheless. This week, after Tuesday¹s workout, that pain increased significantly, to the point that both John and I were concerned.
Knowing that I have an appointment with my physical therapist on Monday morning, we decided to take Wednesday off, take Thursday easy, and reevaluate on Friday.

Monday, I did 3 x 10¹ on the bike.

Tuesday, I lifted at the boathouse, and stuck strictly to the workout prescribed by John.

Wednesday, I took off.

Thursday, I felt pretty good and decided to attack my 10 x 2¹ on the bike aggressively. My heart rate stayed in the low 150¹s for most of the intervals, and I quickly learned that I have a lot of work to do.

Friday, I felt great; probably better than I¹ve felt in weeks. I did not have a lot of time at the gym, though, as John had to attend a seminar later that evening. I did my physical therapy exercises first, and then did push ups, step ups, IYT¹s, static lunges, planks, bridges, and x-walks with my bands.

Saturday, I did 10 x 30² on / 1¹30² off on the bike. Heart rate was in the 150¹s. I have lots of work to do҆ still.

Sunday, I lifted at the gym. I completed the entire workout as prescribed though I subbed chin-ups for IYT¹s, plus my physical therapy exercises. This was, by far, my best workout since the surgery. I felt like I could move freely and I could work hard.

For a week that began with a pit in my stomach, the end leaves excited for the next. My goals for this week are to begin feeling more comfortable and confident on the bike.

-Kate

Friday, September 9, 2011

Success.

I had a completely different topic to write about, but THIS has been bugging me to no end. Let me start of by prefacing this with I don't know Nick Diaz. Never met him, so I cannot say what his motivations are so the following observations come more from my experiences as a coach and an athlete than from my understanding of Mr. Diaz specifically. Let me also say that I think the guy is a world class talent, he works his guts out, and on fight day is mentally very tough. He could be one of the top fighters in the world.. but we'll probably never know because he keeps getting in his own way. The first time he was set to fight for a title (in Strikeforce agains Jay Hieron) he no-showed for his drug test. He got his stuff together and blew through everyone in Strikeforce and got the strap. This week he was on the precipice yet again, he was going to step to the next level: a title shot in the UFC, a chance to make the kind of money he feels that his talents and all of his work are worth, and he ghosts again.
He's been a professional fighter for 10 years. He knows he has to go take his drug test. He has 9 fights in the UFC. He knows he has to go to the pressers. It's the price of being a professional fighter. I don't think anyone enjoys that stuff. So if he knows all this, why did he miss those events? It's not that he's afraid of GSP or Hieron. I don't think Nick Diaz is afraid of any man. I think he's afraid of success.
Most people are. How many people do you see in life that work the same job they complain about daily? They have the same body when they know what to eat, and how to train? They live the same life because it's what they've always done. Moving forward is scary. Sometimes it requires a big leap, sometimes a small step.. but it's hard to tell the difference when you're fairly comfortable where you are.
I've not only seen it, I've been that person. I am taking steps right now to move my life forward, to do the things that I've wanted, dreamed, and planned for years, but it's scary. I only have a limited time on this earth, how do I want to spend those? What example do I want to provide for my friends, my readers, my son?
What are you missing out on? How often have you peeked over the ledge and not jumped?
I hope Nick Diaz figures it out. I was looking forward to the GSP fight. I'm still looking forward to Diaz vs. Penn which looks like it's now on.
Likewise if you're in that position.. jump.

Everyone thinks of changing the world, but no one thinks of changing himself.
Leo Tolstoy

Mahalo

Sunday, September 4, 2011

Kate's Log 9/4/2011

Following John’s post, I, too, wanted to publicly thank our friend Matt at Lemond who lent us this awesome bike. I am nervous for lots of reasons, but having first-class equipment at my disposal and a first-class trainer to map my recovery seems to be making this endeavor much less stressful.

I had a micro-discectomy on Monday, July 11th. The previous Saturday, after having suffered increased leg pain throughout the week, I found myself on the floor unable to get back up. Fortuitously, a friend was visiting and John had just arrived home. It was quickly decided that Emily would bring me to the ER, where I underwent several X-rays and an MRI. Late that night, the surgeons suggested that surgical repair was most definitely in my best interest. As they put it, my disc was in the 80th percentile of herniations. It was capital-B bad. They said that I could go home and go through months of physical therapy, epidural injections, chiro, and acupuncture, and for at least the first two of those months, I would not be able to pick up Wyatt. Or, they could operate, and for two months I would not be able to pick up Wyatt… but after that, I would be fine. The thought of what this would do to all the plans I’d made for my first summer home with Wyatt weighed heavily on me, but ultimately John and I saw no other option. I’ve rehabbed one herniated disc already; it was a long, arduous journey and I didn’t see myself successfully doing so again, at least, not with an active toddler at home.

A short history: The surgeon blames my issues on genetics (thanks for the crappy collagen, Mom) and our very large baby. In 2008, I herniated L4-L5 and L5-S1, but was healthy seven months later and, until this spring, remained mostly pain-free. I was able to row and lift, though I’ve known since the first injury that I would never squat or deadlift again. I had no issues through my pregnancy and only a slightly nagging pain in my left thigh through the spring of 2011, which naturally, I largely ignored until it rendered me helplessly wailing on the living room floor. The surgery in July was easy; it took only 45 minutes and I was able to leave the hospital that afternoon. I was sore for about a week, and then resumed life as normal, minus lifting Wyatt and working out. At three weeks, the doctor allowed me to see my physical therapist. They both agreed that I could use my TRX to do presses and rows, as well as a short list of PT exercises. By six weeks, I was cleared for “normal” activity by the surgeon.

This is what threw me for a loop, though. I kept asking him what “normal” meant for me, and he had no answers. MOST people who get a microdiscectomy never herniate again. In fact, there is only a 7% chance of re-injury in the first year; after that, it goes down to 3%. But knowing that I’d already done this to myself once, I asked him for reassurance that these numbers really did apply to me as well… am I normal? “Not likely,” he answered, “but I don’t think that should really affect your lifestyle. You have a bad back and while you need to be careful and mindful of how you exercise, it may happen again or it may not.” Uh, thanks. He told me that he would not be at all surprised to perform a fusion on me sometime in the future, nor would he be surprised to never hear from me again. And, adding to my frustration, both the surgeon and my physical therapists are confident that this is not an issue of core strength or poor technique, so while both of those things are crucial to a healthy back, I feel like fixing one or both of them would be much easier than simply knowing that I have a “bad” back.


I should note that I really do like this surgeon, but left his office after my 6-week check-up feeling as scared as I did when I went in. I am afraid of lots of things. The most basic of these fears is never wanting to feel that kind of pain again. I’m a pretty physically strong person, and people who know me (and love me) would agree that I’m fairly headstrong as well. So, not being able to get myself off the floor was more than a little disconcerting. It hurt. A lot. But there’s also a fear of the future: how many more times will this happen to me? (No one knows). How can I prevent re-injury? (Be careful, though it may not even be possible). How can I be a strong role model for my son, for my students, and for the women who look to me for fitness guidance? (Get back on the horse!) How can I continue to challenge myself in fitness with all these fears nagging? (And that is what the husband is for!).

I’m looking forward to getting on this new bike and to feeling competitive again, even if – at least for the near future—that means competing with myself. I’m also excited to do some boxing and to work with a plan that has been tailor-made for me to accommodate both my fears and my physical limitations.


-Kate

Friday, September 2, 2011

Of Wife and men.

Sorry for the long delay in posting folks, I have been off the computer and off of work for a week. I am feeling very refreshed and recharged.
I've been working on some projects around the house this week and one of the biggest ones was putting together a training plan for the wife. As of last week she was cleared to train as she sees fit (with some obvious prohibitions for someone who has had disc. We've worked out a basic training plan, and will post the programming and her impressions for your reading pleasure. The 'we' in that sentence is very important. This is very much a collaboration. For several reasons: the first is the wife is an experienced athlete and coach. She has considerable knowledge of training in general as well as to what her limits are and how hard and far she can push.
The second is in this first stage of training after a serious injury the biggest hurdles are mental. Fear of re-injury is a major factor, and one often overlooked by the texts. We're going to do several things to assuage those fears. First,I'm going to listen to her and acknowledge those fears; this seems like a small thing, but many poor trainers ignore this step, and their clients suffer for it. Then we're going to avoid spinal loading and flexion totally and completely. The third thing is the idea of novelty. I have some boxing gear, and we're going to use it for some light recovery work once a week. Similarly,once she gets some basic strength back we are going to keep the work in the weight room novel and fun. The final key is comfort. If a trainee is comfortable with a type of training, then she will be more apt to push herself; this leads to more confidence. Programs applied with confidence and effort will always be more effective.
For the wife this means more conditioning work than I would normally prescribe for a post-op trainee. As a rower/endurance athlete she is more comfortable with this type of training than strength training, and she is happiest when she is training every day. Considering the nature of her injury, rowing (in a boat, or on the ergometer) is well out. Too unstable, too much shearing force on the spine, too much association with the injury.
Since Kate has talked about competing in a couple modes of cycling there was a natural progression, but she isn't quite ready to wheel the streets and trails of Western Washington just yet. We are very lucky to have a good friend at Lemond fitness who has loaned us one of their pro spin bikes. Very stable, super adjustable, and an absolute heavy-duty beast. The flywheel itself has to weigh 20 lbs. I damn near killed myself carrying it from the car. I set Kate up in a vertical position with the saddle very close to the bars to eliminate as much flexion as possible. The bars are very comfortable in her current vertical position, and will remain so as she progresses. The bike will allow her to get into a more realistic riding/racing position depending on where she decides to go.
Some people are down on spin bikes as a mode of training, but I think they're great for a number of reasons: very stable, very easy to increase load/resistance/intensity, zero impact.. but more on that later.
So that's the thought process. The training plan looks like this:
Monday:
Bike 3x10 minutes just below AT.
Tuesday:
Lift. starting with 3x12-15 reps
Rear foot elevated split squats
TRX squats
Step-ups
Chins
TRX rows
DB bench
Calf raises (to counteract some of the innervation issues from the surgery)
Wednesday:
light boxing workout (mostly at recovery intensity)
Thursday:
Intervals on the Slideboard or using the prowler (pulling, strapped to her hips)
and a 5 minute "free" interval.
Friday:
Lift. same as above.
Saturday:
Bike short intervals 10x30:60 above AT
Sunday:
Lift.

Tuesday, Friday and Sunday she will also do exercises prescribed by her PT.
This program starts Monday the 29th and will go for 4 weeks.
From there we will access and adjust.

Continuing with the collaborative nature of this project on this site we will be posting weekly updates from the wife herself. How she likes the programing, the new equipment, what her mental state is, and the truth about her journey. I think this is an interesting story. I will continue to write about technical aspects of training and the wife will focus on her personal story.
Mahalo.