It has been a very long time since I have written a word on this blog. I don’t know why. Sometimes, I just don’t have much to say. But now I do. Life is good. I am healthy and fit (for me), and I want to talk about why this might be true.
In brief, I have quit trying to kill myself with intensely hard workouts, day after day. You would think after living with cystic fibrosis for 51+ years, I might have embraced the wisdom of this before now, but alas…
What has caused this epiphany, you ask? After attending a four day Z Health course last month, I’ve begun to re-train my nervous system as part of my overall exercise program. By necessity, this means I am being nicer to myself. I’ve learned that my brain doesn’t like to be whipped into an endorphin frenzy every single day…and neither does my body. Oddly, I’m 1) in better shape than I’ve been in years, and 2) not injured.
“OMG,” I can hear you now. “First, I have to take a million medications, AND I have to do hours and hours of daily treatments, AND I have to wear a vibrating vest for an hour a day, AND I need to go outside and walk or lift weights every day, AND I need to get 8-9 hours of sleep, AND I need to eat 5-6 times a day (add more pills), AND I need to work, AND I need to raise kids and be a spouse or partner and dog mom, AND I have to fit in a few home (best case scenario) IV sessions each year, and NOW I HAVE TO RE-TRAIN MY NERVOUS SYSTEM, TOO???”
Only if you want to minimize pain and injury and maximize your movement excellence. I’ll write more about Z and what it is doing for me in subsequent posts. Oh, and just a side note: if you move well and without pain, you move more. When you move more, you increase your fitness. And when you have CF, it’s not fitness, it’s life.
It’s kinda crazy that it took four steps to get to “movement preparation,” but this is just what active stretching is called.
Remember back in the days when you would hold static stretches before you exercised? I still see people doing this…going straight from the locker room to the stretching mat and doing seated forward bends and holding calf and quad stretches before going to the elliptical machine or treadmill. We know better now. First, it’s not good to stretch cold muscles. If you must do static stretches, it’s much better to do five minutes of jumping rope or fast walking first, as the increased blood flow to the muscles helps to warm them up and may increase their elasticity. It also turns out that stretching a muscle statically (holding the stretch for 20-30 seconds) may actually decrease its ability to perform strength and power moves. So if you are intending to lift weights, it will benefit you to find better ways to stretch prior to your workout, and do the static stretches at the end.
A better way to stretch cold muscles and get them ready to work is to stretch them actively. This simply means to stretch your muscles while they are in the act of moving. This is a dynamic process. Nothing is held for time. You simply wake your muscles up by asking them to move into stretched positions. A great example of this is the “inchworm,” one of my favorites. Here is a great example of this. Notice that the hamstrings and calves get a great stretch as they are working.
Another great exercise for the upper body targets the front of the shoulders and the upper back. This is much harder than it looks, especially when you keep your butt, upper back, head, forearms, and wrists touching the wall the entire time. Check it out here:
Walking lunges are a great way to warm up for running or lower body weight lifting. To increase the stretch in the hip flexors, add a twist in the direction of the forward lunging leg. Check this out here:
These are some of my favorite movement preparation exercises. I will also do a few sets (if I am lifting weights) or a few minutes (if I am doing cardio) at a much lighter intensity level than what I do normally as more movement prep. After all, the best way to prepare to do something is to do it…with a very light load. This tells both your muscles and your brain to get ready for what is to come.
Now that you have rolled for five minutes (see here), and done ten minutes of mobility work (see here), you are well into your workout and have yet to do any “exercises!” It’s time to start working your muscles. Corrective exercises are best done now, while you’re fresh and sufficiently loosened up.
Corrective exercises are meant to do exactly what you would guess, namely to “correct” any structural imbalances which lead to vulnerable muscle groups. These types of exercises have also been termed “prehab,” with the idea that if you do them, you avoid injury, pain, and the need for “rehab.” Why would imbalance lead to injury? I’m glad you asked.
As I mentioned in the previous post, we all (and by “we” I mean those of us with CF) tend to develop a somewhat kyphotic (hunched forward) upper back, and usually the end result of this is an overarched, or “lordotic,” lower spine. This lordosis combined with hours and hours of sitting lead to tight hip flexors (the muscles that work to hinge your hips forward—think bringing your thighs to your belly-button). Tight hip flexors tend to go along with weak gluteal muscles. This stick figure here shows the problem. Tight low back and hip flexor muscles along with weak abdominals and gluteals. The picture of imbalance. This is a set up for low back pain.
These are the areas that I focus on in my “prehab” work. I do exercises to strengthen my gluteals and abdominal muscles, and work to stretch and strengthen my hip flexor group and low back extensors. In the YouTube video below, I go through a few of my favorite “glute” activators, and some good abdominal exercises using a stability ball. Try these, and let me know what you think.
In the next post, I’ll talk about some corrective exercises for that pesky hunchback.
After you have read “The Perfect Workout,” you will have a basic understanding of the eight steps, in the right order, to use as the backbone of your workout. Step One (discussed here) of your workout, involves rolling out soft tissue knots and tight areas with the foam roller, or a small ball (or pair of balls).
Now it is time to move on to Step Two, which is all about improving mobility. Mobility is becoming one of my favorite subjects lately, and I have been working diligently to improve my own. It is not a complex subject; mobility is simply the ability to move. As it relates to exercise, mobility is about the ability of every joint in your body to move through its natural range of motion. Now, there are many, many joints in your body…somewhere between the mid 200’s to mid 300’s (the definition of “joint” is a bit fuzzy). Most of those don’t need a lot of your attention. But before you stress your body with exercise, it is good to circulate a bit of synovial fluid (the stuff that lubricates joints) and wake up the millions of mechanoreceptors that live around your major joints…especially the ones you plan on taxing during your workout.
I have many tight and not so smoothly moving areas that I like to focus on, but the one area I’d like to talk about at length here, because I am certain that we all share this issue, is the thoracic spine.
Think about your posture. Adults with CF very commonly have poor posture, and most of us with poor posture know that it is a problem. The causes of the problem are many. First, we are getting older, and with age comes increasing reinforcement of poor movement patterns. The body adapts perfectly to what is asked of it. If you start slumping your shoulders when you sit at the computer, or drive, or breathe, the body decides this is the position it is to always assume. Second, with age comes bone loss (especially in CF), which can lead to osteoporosis and subsequent hunching of the upper spine (technically called kyphosis). Finally, as breathing mechanics change with increasing lung disease, there is consequential structural alteration of the thoracic cavity that worsens kyphosis.
Why is this? Because the body tries to offset or balance the increased hunching (kyphosis) of the thoracic spine with an over-pronounced swayback of the lumbar spine, also known as lordosis. This leads to pelvic and hip problems, and the result is a mess. Sounds bad, right? It is, and the worst part is that all of this leads to a very common problem in adults with CF, back pain. The picture below illustrates this problem.
The thoracic spine is actually supposed to be very flexible. It is supposed to flex, to extend and to rotate. In contrast, the lumbar spine is designed more for stability and less for flexibility. Sadly, most people have this backwards, and tend to use the lumbar spine more than the thoracic and hips for bending and rotating. This often leads to pain, and commonly to injury. Because the thoracic spine in CF tends to be even more “frozen” in place because of the above-mentioned issues, pain is extremely common.
But wait, there’s more. Pain is bad enough, but what is worse is that the combination of poor posture and pain leads to inhibited airway clearance, less expansion of lung tissue and deteriorating lung function. Stiff and unmoving thoracic vertebrae also increase the work of breathing (isn’t it hard enough?). None of this is good. Not good at all.
But here is the good news: Some of the postural problems in CF can be corrected. Those having to do with muscle and soft tissue tightness are reversible! Stiff joints can be mobilized with specific exercises and soft tissues can be stretched to allow for normal alignment and movement.
This is why at least 10 minutes of your workout should be spent waking up and moving your thoracic spine. If you are like me, you literally need to teach your brain exactly where this part of your back is, and how to move it because of something called sensory-motor amnesia. This is exactly what it sounds like: When you don’t move a body part much, the brain 1) forgets where it is, and 2) forgets how to move it.
I’m Convinced. What Should I Do?
First, take a breath and don’t panic. Then, check with your doctor and make sure these are safe for you, especially if you have osteoporosis. Next, to get a rough assessment of the amount of kyphosis in your upper spine, do this test.
Lie down on your back with your feet on the floor, knees bent to about 90 degrees. Now press your low back into the ground and keep it there as you do the following: bring your arms up and over your head, keeping them straight with your biceps muscles close to your ears. Don’t move into pain, but see if you can bring your wrists and back of hands to the ground above your head. If you have normal thoracic mobility, this is a breeze. If you can’t, you are like me and have some pretty stiff and sticky thoracic vertebrae. The following exercises are for you. If you can, and want to keep it this way, the following exercises are for you.
1)Spend quality time with your double tennis ball contraption (link) every day…before your workout as I discussed in the previous article, and also throughout the day, especially if you sit at a desk a lot. If you are bigger and have more muscle mass, you might graduate to double lacrosse balls. This is not in my future.
2) Roll your upper back with a foam roller. As you do this, bring your hands behind your head and keep your elbows close together (this gets your shoulder blades out of the way). Slowly roll up and down the spine, stopping at the neck above, and the lowest rib below. Try to “curl” yourself around the roll by aiming the top of your head to the ground. If you have tight spots that are slightly uncomfortable, spend some time there.
3) Get on hands and knees and push your butt slightly back toward your heels. Now take one hand (for example, the right) and place it behind your head by bending your elbow. Now, keeping your butt back, rotate your spine by reaching the right (bent) elbow toward your left knee. Come back up and do this several times, slowly. Repeat on the other side.
4) Stay on hands and knees, but this time sit all the way back onto your heels. Take right hand again behind your head, and now rotate it up, toward the ceiling, trying to open your chest to the ceiling as well. Don’t move your butt–this is keeping the lumbar from moving, thus isolating the upper back. Repeat on the other side.
The sensory-motor amnesia problem is a bit more complicated, but can also be remedied with some drills taken from a system called Z-health. I am currently immersed in learning Z-health and will write more about it in future posts, but these are some basic exercises that will begin waking up and mobilizing the spine. Try them and then retest with the “raising the hands over the head” exercise. My bet is that it will improve. I don’t start my workout until I can do this without discomfort (but it has taken awhile to get there). Start slowly, but be persistent and patient. Your spine and lungs (and posture) will thank you.