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.
In a previous post I discussed my version of the Perfect Workout, which consisted of eight steps. The first step is to deal with soft tissue abnormalities that lead to pain and/or poor movement patterns. Here, I discuss this further.
Unless you are a newborn, when you walk into a gym — quite a feat for a newborn — you are going to have some muscular tightness…some tension or “knots” in muscles that occur from chronic movement patterns that are less than ideal. We all have less than ideal movement patterns. This is not a judgment…it’s just a fact.
Those of us with chronic coughs especially develop tightness and tension in the thoracic spine, and neck. Those who sit at work or at home at a computer for many hours a day can also develop muscular tension in the neck and back, as well as tightness in hip flexor muscles and hamstrings. A good way to think about this is that over a long time sitting in a chair, your body tends to become “chair-shaped,” i.e. short and tight hamstrings and hips. If that’s not scary enough to imagine (a chair-body), the ugly truth is that muscles don’t live in isolation from their neighbor muscles. The entire soft tissue system (muscles, ligament, tendons and fascia) is all interconnected. So a tight, knotted muscle in one area very definitely affects muscles, tendons, etc. both upstream and downstream from it.
This is why a knot in the middle of your back can cause pain all the way up into the back of your head. Or in my case, this explains why spending a few minutes rolling the bottom of my foot around on a lacrosse ball can help me loosen up my ankles and calves.
So why do we care? We care because it isn’t just that pain in one area leads to pain in another, but muscular weakness (resulting from those painful knotted tissues) leads to imbalance and weakness elsewhere, which leads to improper movement. Somebody famous once said, “The body does what it does perfectly.” So if the body moves imperfectly, it then perfectly continues to move imperfectly. And if we, for instance, go for a walk or add resistance to imperfect movement, we solidify that pattern in our brains, and become nicely set up for injury…and more pain!
So what’s a (tight and knotted up) body to do? Well, before asking the body to work, it is nice to do whatever you can to lengthen and unknot the muscles that need attention. This does not have to be a long process, and you don’t need to spend 30 minutes on your foam roller, thus using up your workout time allotment.
I have three favorite tools that I use for this purpose. First, the aforementioned lacrosse ball is a must for my feet, and occasionally for very tight knots in my back. If a lacrosse ball is too hard (and you will definitely know this), you can start with a tennis ball and move to a harder ball as your tissue gets more pliable and your nerve endings get used to the process. For my feet, I simply stand up and put one foot on top of the ball and roll it around. You will automatically gage how much weight to put on the rolling foot (by how much pain you can tolerate). When I started this process, I could barely tolerate any pressure—I have very tight feet. But I persisted, 5 minutes every day. After a couple of weeks, I didn’t mind it at all. Now this actually feels good. I don’t usually do this at the gym. Instead, I have found that the easiest time to do it is when I do my treatment every morning. It’s like giving myself a foot massage! I also keep a lacrosse ball in the bathroom. You figure it out.
The second tool I use is the foam roller. You’ve probably seen these around. Most are about six inches in diameter and about three feet long. They are made of Styrofoam, and have lived in the gym scene for years now as a favorite instrument of torture. I say this because they are used for “self-myofascial release,” a process that is slightly uncomfortable, especially when it is really needed. I roll my calves, hamstrings, gluteals, and if I’m really feeling masochistic, my quadriceps over such a roller. You will know what you need to roll by how painful it is. The more it hurts, the more you need it. You simply modify the move to a tolerable level of pain by taking some of the weight off the body part being rolled. I generally spend five minutes or so rolling as the very first part of my workout.
Tool number three is a very expensive, intricate and complicated instrument. Kidding. It’s called a “peanut,” and is comprised of two tennis balls duct taped together to form a peanut-shaped duo. This handy little tool sets my thoracic spine back to where it’s supposed to live every single day. The maneuver is simply to place the peanut on the floor under your lower ribcage, and lay back on it so that the groove in the peanut is directly under your spine. This places each ball of the peanut perfectly under the bundle of muscles that lie adjacent to your spinal column. You simply roll back and forth on the peanut several times in the position, then move it up the spine about an inch and repeat. Moving this way all the way up to the level of the big protuberant bone at the bottom of your neck takes only a couple of minutes, and is one of the best things you can do for knots along the spine as well as mobility of the spine (to be discussed in a later post).
That’s it! Soft tissue rolled out…now it’s time to move on to mobility work.
There is good news and bad news about getting old with cystic fibrosis. The good news is that I am getting old with CF! How great is that? Although it is happening to more and more people as medical care gets better and the median age of survival creeps upward, it still surprises me every time I have a birthday. I laugh at my wrinkles, chuckle at hot flashes, and marvel at the fact that I look, well, middle aged.
Living with an unpredictable illness is not all mirth and laughter, though. Some aspects of getting older are a bit more frustrating, at least for me. This is where Tonic, a new iPhone/iPad app, enters my story. As you probably know, staying healthy with CF requires more and more effort with age. There are more medications to take, more treatments to do, more effort is required to stay fit, to eat well, to manage CFRD, to get enough sleep, enough water, to do whatever it takes to make the plumbing system work well, remember appointments for the doctors and port flushes, to do…pretty much everything. Yet, just as the “CF care complication” factor increases, the ability of the mind (mine, at least) to keep track of it all begins its downward descent. This is poor design, but it is what it is.
I noticed it first with Advair. I can never remember if I have taken it. I don’t know… I seem to have a mental block. The block then spread to enzymes, vitamins, children’s names, books I’ve read, etc. While it’s much cheaper to be able to read the same book (and be entertained) multiple times, too many shots of ProAir or too many Pancrelipase capsules can be problematic.
I have officially dubbed this past winter, “the winter from hell.” For some reason, I had three episodes of pneumonia with resulting rounds of home IV antibiotics over the span of eight months. If this wasn’t enough, I cultured MRSA recently, so each round of IV’s included three different medications, all through IV access. IV meds must be refrigerated of course, and when they come in Entermates (as two of mine did), they need to be removed from the refrigerator a few hours before being used. When you forget to do this, 1) brrrr, and, 2) the infusion takes forever. Not to mention that during exacerbations, I do three treatments per day, try to sleep, try to remember to eat (when I have no appetite), and take the usual oral meds, supplements, and vitamins. I also have follow up appointments with doctors and need to get to the lab for blood draws three times each week. Did I mention the port dressing changes? I literally needed a flow chart to traverse through my day, or I would forget an essential item. Of course, most people get admitted to the hospital for this rather intensive treatment time, where, at least in theory, they keep track of these things. Wink. But I hate hospitals, and only go in if it is absolutely mandatory.
Enter Tonic. As luck would have it, I was able to beta test Tonic this “winter from hell.” Tonic is an app that helps you to remember and track whatever you need to track. Setting up Tonic is a simple task. You simply make a list of all that you want to remember and track. It took me about 30 minutes because my list of “tonics” was enormous. When it was done, though, my trusty little iPad would bleep whenever I had to do something. Take out med (bleep). Infuse this (bleep). Take this (bleep). Eat (bleep). Weigh yourself (bleep). Eat more (bleep). Trust me, the thing was bleeping all day, every day of each exacerbation. But I was so completely on track! I missed nothing. Nor did I do or take anything more than I was supposed to, because you check off each “tonic” as you do or take it. This is a very satisfying property of Tonic for anal compulsive people who like checking things off lists (like me).
Second, remember that the idea is to make your life easier, not to add another chore to your day. When my life is so complicated that I really need help, I use Tonic. But other times (like now) when things are pretty good, I let Tonic fade somewhat into the background. It still reminds me, but I turn off the “bleep” alarm and don’t always check off all the activities or enter a lot of data. You will find your own balance.
In summary, Tonic is just what I needed at just the right time. I would recommend it to anyone, whether you have a complicated regimen like mine, or just want to track a few things. If you decide to give Tonic a try, let me give you two hints. First, use it for all of the things you do for your health. Everything. Really. Meds, sleep, exercise, nutrition, water intake, everything you can think of that you know you want to do to be at the top of your game. For instance, Tonic even reminds me to journal, to stretch my hamstring muscles, and to meditate.
You can find Tonic on the web at .
I decided today that this Boot Camp posting thing has to be postponed, for now. I know when I am avoiding writing because I don’t want to face my blog that I need to change subjects. Perhaps this is because I don’t feel like writing about how to “come back” from being sick in the midst of being sick. Instead, I feel like ranting. So here goes:
I’m in a bad mood. I hate this disease. I hate the fact that this is my third bout of pneumonia in less than eight months. I just had this “cute” blog post idea of listing my seventeen-part day (with each part being a picture of each CF medical regimen item in my current plan to stay alive). But I don’t feel like being cute. I’m mad. I know this shouldn’t be a blog topic on a site called “Sick And Happy.” It’s only 50% appropriate. But let’s face it, happy is only one side of a coin. There is no happy without sad…or mad…or afraid.
This is when I wish I could call up my sister, Kathy and see how she did it. Or my brother, Tom, and ask what his secret was. But I can’t. I have to find my own course of action. For now, it is to write until the tears stop flowing and the dog gives up on trying to console me to go back to the couch and sleep.
There is nothing fair about a disease that consumes your entire day…and night. That, no matter what you do to keep it at bay, never leaves you alone. There is no one to do it for you.
If this were really a blog about how positive psychology techniques can help you cope with chronic illness, I would now do something like count my blessings…or appreciate the fact that at least four lobes of lung tissue are relatively clear…or that, somehow, I have not lost any weight this time around. Perhaps I would write a letter of gratitude to someone. Or maybe I would write about my “best possible life” to cultivate some optimism. No, not this time. Instead, I am going to practice a mindfulness technique. I am going to be aware of every f’ing thing I hate about this disease, in list form. Maybe I’ll come up with seventeen.
1) I hate that I can’t call up Kathy or Tom.
2) I hate that it is 11:09 in the morning, and I have yet to have time to eat breakfast because my entire day has been treatment and IV infusion focused.
3) I hate that I have to set an alarm in the middle of the night to stop my IV and flush my port.
4) I hate that I have a port, a week before a trip to Hawaii, where I will try to cover it up so other people won’t wonder what is wrong with me.
5) I hate that I can’t seem to gain any weight no matter how many milkshakes, Jack in the Box Grilled Bourbon BBQ Steak Sandwiches, and Boost Plus that I consume.
6) I hate that when my sons come home from school with a friend, they are embarrassed to find their mother lying on the floor, doing the Vest Boogie while infusing antibiotics. “Oh that? My mom’s sick, that’s all.” Unspoken is the fact that “other mom” is the picture of health and has more friends than God, and probably cooks hot meals every night. Unfair.
7) I hate that I feel guilty that I want company at the same time that I don’t want anyone to see me at my lowest of lows.
8) I hate my lungs…every last lobe…down to every single alveolus. I don’t know why this came out as a smiley. Maybe God is talking to me.
9) I hate spending enough time on the toilet to count the tiles on the floor, wondering how painful it is going to be to conclude this particular event.
10) I hate worrying about traveling now, wondering if something bad is going to happen far, far away from my CF clinic.
11) I hate not being able to hug my father, who once-upon-a-time had a MRSA skin infection.
12) I hate the fact that I am paranoid about even visiting him at his home in a retirement center, because such places are havens for resistant bacteria.
13) I hate that I have to get mad at my oldest son for not covering his mouth and nose at any slight eruption of air. And he never remembers, so…I get mad a lot.
14) I hate wondering when the inevitable downslide is going to really get going, and how I am going to cope, and what my kids will think.
15) I hate that every time I get sick now, I need an entire team of specialists (or House) to figure out what to do with my lungs, my liver, my kidneys, my psyche.
16) I hate needing so many people so much of the time…doctors, partner, friends that I don’t want to ask for help, siblings.
17) I hate that today is a great day for Little League baseball, and it doesn’t even sound fun.
I’d better stop. Seventeen hates…seventeen self-care items per day. Sounds balanced. Tomorrow will be a better day, and maybe I’ll feel like being cute.