The View from Sports Center

How to Improve Any Physical Performance

Eric Heiden was a phenomenal athlete. As a speed skater, he won five gold medals and set four Olympic records in the 1980 Winter Olympics. He trained relentlessly, was focused and disciplined. But, there's something he did nearly everyday that you can do too if you want to improve performance in your life.

He mentally rehearsed every race nearly every day. He closed his eyes and experienced the race: the sounds, the feeling of wind on his face, his competitors, his coaches. Every detail went into his mental practice. He saw himself winning.

Eric, now an orthopedic surgeon, does the same thing in his medical practice. He visualizes surgical techniques prior to entering the O.R. He's convinced that this technique improved his skating performance and has improved his performance as a surgeon (click here for the video to see Eric talk about this idea).

You can use this idea of mental rehearsal or visualization in your life too. The key is choosing something that you can clearly "see" your self doing and then taking the time to practice it in your mind. Research to support this idea comes mostly from sports performance - improving free throw shooting in basketball, for example - and experts disagree on how much improvement you can expect. But, practicing, mentally and physically, will no doubt improve your performance over not practicing at all.

Think about how you can apply visualization in your life and then do it. Just pick one thing and start seeing your self succeeding.

Ready?

Make today count.
Doug Kelsey

ref:  Grouios G,  Mousikou K,  Hatzinikolaou K,  Semoglou K,  Kabitsis C: The effect of a simulated mental practice technique on free throw shooting accuracy of highly skilled basketball players. J Hum Movem Studies 1997,  33:119-138

The Movement Fingerprint and How to Use It

I went to my first University of Texas football game this weekend (I know - hard to believe) and was stunned by the sheer size of it all. Over 90,000 people in one place with about 89,900 all screaming for Texas.

A great thing about crowds of that size is the buffet of walking styles. We all have the same bones, muscles, and joints and yet no one walks exactly the same way. It's sort of a movement fingerprint. Sure, you can make your self walk like someone else - for a while (someday maybe I'll post a You Tube video of me moon walking...maybe not) - but when you just get up and go, your style is unique to you. Fascinating.

Now, within families, you'll notice similarities in walking styles. Maybe your feet point out a bit and you have a bounce to your step. Or, maybe you swing your arms hard and fast like you're elbowing your way through a crowd. The next time you're at a family reunion, if you want to inject a little fun, line up your parents and aunts and uncles and cousins and have them walk all together. The similarities will jump out at you.

But, there is one thing that everyone should do when they walk that makes walking a really helpful exercise. Use the fall line.

When I learned to snow ski, my friends told me to lean into the fall line. That sounded a bit stupid to me. Why would I want to lean into that and fall? But, after they explained it to me, I finally understood that by leaning where gravity wanted to take me gave me better control.

The same is true for walking since walking is just controlled falling. Watch a toddler learning to walk and you'll see that it's more falling than not. As we become more coordinated, we become more graceful and walking no longer looks like falling (but, it still is). 

To walk into the fall line, you only need to do two things. Stand up as straight as possible and lean forward at the ankles - not the hips. Lean forward as if you're walking into a stiff breeze. It doesn't take much of a lean either. Avoid bending forward at the hips or in the back. Make the lean happen in the ankles. When you do it right, you'll notice an increase in walking speed and it will feel nearly effortless.

The benefits of walking into the fall line are that you will walk faster and make your anti-gravity muscles (mostly your butt and back) work like they are supposed to leading to better overall posture and improved muscle tone. Who doesn't want that?

Walk on.
Doug Kelsey

What Do We DO Now?

Sometimes you feel stuck, you can't get to where you want to go, but how often is the feeling of being stuck because of your perceptions of how things are supposed to work? Click here for the video.

Space Walk on Earth

Mechanical load (physical force) is the single, most important factor for maintaining and improving health. Without mechanical load, your lungs and heart will not work properly, your bones will soften, and muscles will wither away. Without regular and appropriate loading, you'll die sooner than you should.

Astronauts face this problem, insufficient loading, from being in zero gravity while in space. In fact, this is such a significant problem for astronauts, that NASA has spent millions of dollars building a special treadmill to simulate the effects of zero gravity on the body and as a potential training device to help astronauts stay healthy. Fortunately, you have lots of ways to keep your body working the way it should without having to run on a vertical treadmill.

Maybe It's Not the Surgery...

When scientific studies appear that denounce one treatment or another, the results tend to spread rapidly and then be misapplied by lots of people. My hope is that I can, in some way, stem the tide on this one.

In a study published today in the New England Journal of Medicine, the authors concluded that arthroscopic surgery for osteoarthritis of the knee is no more effective than medical and physical therapies.

The authors examined two groups of patients. One received surgery, medical therapy, and physical therapy and the other received medical and physical therapy only. They were followed over an eight year period. But, after reading the study, there is one flaw that also routinely shows up in almost any study that involves physical therapy. Physical therapy is viewed as a homogeneous treatment like a medication (Naprosyn is Naprosyn no matter where you get it or take it). A rose is a rose is a rose. But, it's not homogeneous and even the authors said so:

"Physical therapy was provided for 1 hour once a week for 12 consecutive weeks. The intervention was standardized and based on a review of the literature and a formal survey of university physical therapists. Information regarding a home exercise program that emphasized range-of-motion and strengthening exercises was provided to all patients. Individualized exercises were recommended on the basis of the severity of osteoarthritis, the patient’s age, and the patient’s specific needs. Instruction was also provided regarding activities of daily living, walking, use of stairs, and methods of treatment involving cold and heat. The patients were asked to perform the exercises twice daily and once on the day of a scheduled physical-therapy session. After the patients had completed 12 weeks of supervised activity, they continued an unsupervised exercise program at home for the duration of the study."

"Individualized exercises" means that what patients did was different from one to the next. Instead of comparing one treatment to another (Naprosyn to Celebrex for example or), it appears that the authors actually compared multiple treatments (different exercises, dosages, motions, etc.) to multiple treatments and when you mix treatments you end up with mixed results.

Physical therapy is not a treatment. It's a process that uses a variety of modalities (exercise, physical agents such as heat or cold or electricity, manual therapies such as mobilization, etc. ) to return the patient to the highest level of function possible. It should be customized to the individual and for that reason, it is difficult to study.

So, there's the first problem with the study: failure to use consistent interventions. And, here's another one. In this study, for the first three months following surgery, the surgical group demonstrated greater improvements than the non-surgical group. After the three month mark, the groups evened out.  Why then, did the authors conclude that surgery was ineffective rather than conclude that the medical and physical therapies failed to sustain the improvements afforded by surgery? Maybe the issue wasn't that the surgery was ineffective. Maybe, the therapies were detrimental to the surgery.

Here's the study if you would like to read it.

Make today count.
Doug Kelsey

Spencer's Status

Thank you to all of you who have expressed your concern about my buddy, Spencer. Here's what happened at the vet.

Dr. Reynolds, concerned that Spencer could have a bladder or kidney problem, poked and prodded Spencer's abdomen. If he had crystals in his bladder or if his kidney was inflamed, the pressure would hurt. Spencer just kept wagging his tail enjoying the attention. "So, he's eating, drinking, urinating ok? Yes? " asked Dr. Reynolds.

"Well, maybe not drinking as much water as usual but otherwise, I think so," I said.

Dr. Reynolds held Spencer's head looking at his face and palpating around his ears and neck. He turned to his assistant and said, "Let's go ahead and get a urinalysis just to make sure that he doesn't have any crystals in there." His assistant turned and walked out of the room.

He then tilted Spencer's head up and back. Spencer let out a loud, shrill yelp and assumed the head down, hunched position we had seen often the past few days. Dr. Reynolds opened the door and shouted,"Never mind. Cancel that. We don't need it."

The source of Spencer's symptoms, it seemed, was his neck. "So, is this joint or disc disease likely?" I asked.

"Yes, likely so. The trembling and hunched postures are pain responses. We'll start him on an oral steroid and some pain medicine and watch him closely over the next few days but I think this is it," answered Dr. Reynolds.

Well, that was good news. But, on the way home I realized how many different tools I had available for a human with cervical disc or joint disease and how few were available to animals: cervical traction, cervical rock n' roll, assisted arm motion exercise, load-controlled aerobic conditioning, taping techniques, how to modify positions and movements among others.

I know the medications will help him feel better quickly. Prednisone is the Attila the Hun of anti-inflammatories. As he starts to feel better (which he already has), we'll have to control his activity level (remembering that feeling better and being better are not always the same thing) but he needs some exercise, so we'll go for walks but start slowly. I've added a mixture of glucosamine and cetylmyristoleate to his diet to help manage his symptoms but also improve the strength of his collagen.

This morning, Spencer greeted us with his head up, tail wagging, smile on his face along with his usual vocal chorus of howls and barks. It was great to see him happy again. But, I wonder what will happen when we stop the meds?

Wait to worry. Wait to worry.

Spencer's in the Worry Bucket

Worrying is borrowing trouble from the future and I'm doing my best to not borrow any more.

On Saturday, I finally strung my 15 to 30 second jogging intervals together for a full 3 minute run. Run three walk two.  I felt light. My steps had a little bounce reminding me of my competitive athlete days and it felt good. My heart rate didn't take off like a fighter jet so the whole time I felt as if the effort was just a little harder than a fast walk.

I have spent several months working toward this goal. Not just to jog for the sake of jogging or health or fitness but to do it with Spencer, our Dalmatian.

Jogging with Spencer brings me joy (and his brother Cirque too!). Why? Well, maybe it's because he seems so happy and his excitement pulls me in or maybe it's because for 30 or 40 minutes, I'm just me and get lost in the delight of being. I know that may sound like I'm dining on ethereal cereal but I don't know how else to describe it. I love the time, the thing we're doing, being outdoors, the effort, and I love that he loves it too.

But, something's wrong with my buddy Spencer.

Dalmatians love to run and depending on the breed, they can run a long ways. But, on Sunday, Spencer quit running and slowed to a walk after just two rounds of jogging.  His head was down; not up and perky. His back was arched and his gait had a stiff, mechanical quality. He looked stressed as if he had just finished a marathon. I decided to head back to the house. I thought I might have to carry him.

Later that day, he seemed to improve but he was not normal. Low energy, ornery, the arched back and mechanical gait returned. He couldn't go down the stairs; I had to help him. We had just taken him to the vet last week for his check up and all was fine so what is this?

Spencer has had bladder problems - many Dalmatians do - in the past but his symptoms were different. He's had a fracture of his left leg so perhaps he's now arthritic? I found my self trying to diagnose him without enough information or knowledge. I found my mind scooping up buckets of worry. What if he has bladder disease? What if he's going into acute renal failure? What if it's too late? What if....what if...

I've counseled thousands of people over my career and now it's time to take my own advice. There's no amount of worry that will change the situation. Action might. There's no guarantee but you'll empty the worry bucket a lot faster if you take action. So, I called the vet and we're going today.

When you find your self worrying, try remembering that it doesn't help you at all. Instead, start thinking about what you can do and start doing it. Every time you scoop up some worry into the worry bucket, dump it out. It's an effort. You'll refill it a lot. But, just keep doing it. It's action and action is what you need.

Make today count.
Doug Kelsey

One Brace Fits All

I'm always there but sometimes hard to find; supportive but difficult to motivate. I can be very protective but if you ignore me, I will wither away.

Who am I?

Most will call me the "core" - a group of muscles that form a dynamic brace around the mid-section of the body.  Unfortunately, the term means different things to different people. Some think of the core as the abdominal muscles while others include trunk muscles and still others include abdominal, trunk, and hip muscles.

For our purposes, the "core" is the region of the body between the mid-chest and upper thigh.

In my last post, I talked about the internal and external bracing options for lower back pain. The muscles of the core act as the internal brace increasing the stability of the lower back. From injury, surgery, or disuse (from a largely sedentary lifestyle), these muscles atrophy in some cases fail to function at all leaving you spine without sufficient "mooring".

The spinal muscles, though, are not under your conscious control - you can't make them do their job which poses a problem. If these muscles need strengthening, will not fire on their own, and you can't make the fire,  how do you ever get them working again?

Like Ringo Starr once sang, "I'll get by with a little help from my friends". If you tighten certain muscles in the abdomen, the spinal muscles will contract as well. The abdominal muscle is the transverse abdominus (this muscle courses over the abdomen from side to side). You make this muscle contract by pulling in your stomach or bracing as if you're going to get punched in the stomach. When the muscle fires, it's like having a direct, high-speed connection to the spinal muscles.

I  think the contraction is better if you imagine being punched in the stomach rather than pulling the stomach in (although I taught that for some time). In either case, you need only a slight tightening of the muscle to fire up the spinal muscles. So, imagine that some one is about to really smack you in the stomach. Tighten up your abdominal wall as hard as you can and call that a "10" on a scale of 1 to 10. During the day, just moving about, you need a "2" or "3" level of force. This is a conscious effort on your part and is difficult to master at first. If you bend over to pick something up, increase the tightening to a "5" and if you pick up something from the floor or over head, move the level of tightening to "7". All day long, you slide the degree of tightening to match your effort in whatever task you're in. Even just sitting at a desk, you need a "2" or "3".

Like all muscles, your transverse abdominus will tire out from use. That's a good thing. When you notice that you can't seem to hold the contraction for very long or can't increase it, rest. Lean back in a chair, lie down, or lean against a wall and just let the muscle get a couple of minutes of rest.

In addition to the "punch in the stomach" imagery, you can use the plank exercise to help strengthen your core muscles. The goal is to hold the position for two minutes and you might want to start on knees and elbows if you've never done this before. Breathe normally during the exercise. I usually suggest doing one set for up to two minutes a few times a day.

There are a number of books, videos, websites, etc., promoting "core" exercises. Here's one that's fairly good but it includes "superman" - skip that drill (yes, even the famous Mayo Clinic suggests the superman drill).

For more information on abdominal muscles and the core, read:

• Stop Sit Ups and Save Your Spine

Make today count.
Doug Kelsey