Diastases Recti, What It Is and What To Do

Reader Fun Steve previously wrote with his success losing weight and getting in shape with Fitness Fixer. Then he moved from Thailand to Japan. What happened next?

Steve writes:

"I 'done did' something to my stomach. Without having visited any doctors here, my own diagnosis is/are hiatal hernia or tearing of the linea alba area of my stomach muscles.

"No 'pain' but constant discomfort. Constant but mild indigestion. Shortness of breath. Here is the real kicker... If I do leg lifts while doing 'slight' crunches, I have a 2-2.5 inch vertical band of 'something' that reaches from my xiphoid process down to below my belly button. Feels like a strip of weak muscle. I normally don't do full crunches. Perhaps I lift my shoulders 2-3 inches at most.

"My rectus abs are solid. Rock hard .. but the area between left and right side is soft now. This odd strip of 'something' doesn't protrude unless I do leg raises and crunches (so I'm not doing them!) but if I use my hands to press it inward, I can do the crunches or leg raises without that strip pressing up. It's as if the rectus abs, once contracted, hold it in.

"So... what have I done to myself? Besides not doing any crunches and leg lifts, what shall I do to heal myself?"

I answered that (using my e-mail x-ray machine) it sounded like a diastasis, full name Diastasis Recti.

The vertical muscle fibers pull apart, leaving an area between them. This is popular in pregnant women and men with bellies. The 'rock hard' belly is often the large amount of fat (or pregnancy) pushing against the covering muscle, stretching it tightly. Weight loss will let it rejoin and heal. It's not surgical, meaning it can heal if you lose the belly.

I reminded Steve that crunches are not functional exercises, meaning they do not use your abdominal muscles the way you need them to function during any real activity in your daily life. Crunches repeat the bent forward posture that people already spend too much daily time in, and that he already new I had developed a method called The Ab Revolution™ that solves the counterproductive nature of crunches and leg lifts. For the time needed to heal, he could stop belly stretches - back bends, yoga cobra, and updog, and stretching the belly with too much food and weight gain. Continuing to do crunches and leg raises using hands as manual splinting has turned out to make things worse - since the muscles atrophy more.

Steve replied:

"How could I be pregnant?!? Actually, I have 6-pack abs! (Well, really two 3-packs right now. Unfortunately there is a thick layer of blubber covering them.) Under them too.
">>Dr. Bookspan wrote: Sorry to hear.
"Yes... me too. I came back from Thailand having lost almost 20 kilos, and due to McDonald's introduction of the 'Double Quarter Pounder with Cheese' into Japan and a side of trans-fat potatoes, I put it all back on."

I reminded Steve that weight loss will let the split area rejoin and heal, and that a diastasis was not surgical, meaning it can heal if you lose the belly and stop pulling it open with Pilates style leg lifts and crunches.

Steve wrote:

"Lose the belly. Lose the belly. That's all anybody says. Lose the belly. Hey, Buddha had a big belly and he didn't have this problem!?! Humpty Dumpty had a big belly and all that happened to him was that he fell off a wall. Well I don't sit on no walls!!! No sir! Not me. I sit on a couch doing bicep curls with the TV remote! I do full presses with bags of Doritos! Pectoral presses crushing my beer cans! Lose the belly?!? Oh well... I guess I gotta..."

I had developed The Ab Revolution™ to solve one common source of lower back pain - a slouching posture of too much inward curve in the lower spine. The Ab Revolution™ retrains function. Conventional ab exercises are often mistakenly prescribed for back pain. Conventional strengthening does not make people stop the actual cause, the slouch. They are just stronger people who slouch. Doing crunches also perpetuates another cause of back pain. It is an irony of pop fitness that without understanding causes, counter productive exercises are prescribed, then repeated by reporters then repeated by trainers and so on. The same is true for hamstring stretches, covered separately. What was interesting was all the documentation I received from people with diastasis and hernias who could use The Ab Revolution™ without pain and with benefit to build abdominal wall strength without pushing things out further with crunches. It made sense. I am looking into it further.

Steve wrote again:

"I follow the the Ab Revolution™. That's what's made my back feel so much better. I haven't had so much as a twinge in my back in the past year or so! It's been your work that made the difference. I'm not worried... now :o) Just PO'd. Thanks for the info about my (larger than necessary) stomach."

Steve followed up that he was back to healthier eating and was easily losing weight by following the healthier traditional Japanese diet without fast food.


Related Fitness Fixer:

• Fun Steve Loses Weight With Fitness Fixer
• Reader Ivy shows why Good Life Works Better Than Bad Ab Exercise
• If Better Abdominal Muscles Are Your New Year's Resolution, Try This
• Innovation in Abdominal Muscles
• Back Pain in Pregnancy - and Why Men Can Get It
• Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch
  

My Web Site information on how abdominal muscles work:

• DrBookspan.com/AbsArticle

Random Fitness Fixer:

• Extremes, Survival, Injuries, Faster Higher Stronger - Fitness Fixer

Labels: abdominal muscles, fix pain, injury, pregnancy, readers inspiring story, weight loss

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Supportive Hard Shoes Linked to Knee Loading and Arthritis

A Rush University Medical Center study has found that supportive, stable shoes increases the load on the knee joints compared with flat, flexible footwear or going barefoot.

Researchers compared gait and knee joint loading of 31 patients with osteoarthritis while walking in flip-flops, barefoot, and wearing several types of popularly prescribed shoes. Clogs and stability shoes increased loads on the knee joints up to 15 percent over flat walking shoes, flip-flops or barefoot. Knee loading was roughly the same whether the subject wore flips-flops or walked barefoot.

Dr. Najia Shakoor, rheumatologist and lead author stated, "Stiffness is also a factor. We've shown in earlier studies that barefoot walking is associated with lower knee loads than walking with conventional footwear. It may be that the flexible movement of the bare foot is mechanically advantageous. The natural flex of the foot when it contacts the ground probably attenuates the impact on the joint, compared to the artificial 'stomping' movement created by a stiff-soled shoe."

"Clogs and stability shoes, conventionally believed to provide appropriate cushioning and support, actually increased the loading on the knee joints, as opposed to shoes with less 'support,' flatter heels and more flexibility."

The article stated, "A higher-than-normal load on the knees during walking is a hallmark of the disease, associated with both the severity of osteoarthritis and its progression."



Study authors felt they had to also issue a caution that people who will trip if they wear flip flops or have poor balance not to wear them, however it seems better to do simple function to improve balance and reduce cause of the falls rather than wrap people in shoe "straight-jackets" that are not good for them.

When I was small, I remember worrying that horses had to wear iron shoes. I asked the teachers in school if it hurt the horses' feet, and was told their feet don't feel anything (a myth). I asked if the metal increased the hard impact against paved streets and why didn't horses wear sneakers instead. I was told that sneakers were bad for you because they don't "support" (another myth). I asked why you needed anything to hold your own body up and why you couldn't have healthy feet without them. I asked if cavemen wore support shoes and incredibly, the teachers said that support shoes were important and barefoot was wrong and cavemen had to wear shoes or they would not be able to walk. Later I found that arthritis, lameness, and gait changes were higher in metal shod horses, and that new horseshoes were being made in urethane and other soft composites.

When I tell patients that hard supportive shoes are known to increase pain and problems, they say they wear them because their doctor told them to, their trainer, their aerobics instructor, and their physical therapist said they must. When I remind that hard shoes may be part of their knee and foot pain, they say that they got the shoes from their podiatrist or orthopedic shoe place. Doctors used to recommend smoking cigarettes for the several benefits they gave - calming nerves, better digestion. The two bad side effects (illness and death) were left out. It may be commonly repeated that you need hard supportive shoes however, untrue stories are common.


Related Fitness Fixer:

• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Healthy Knees
• Your Muscles Are Your Orthotics for Arches, Knock Knee, and Knee Pain
• How To Treat Ankle Sprains and Prevent Them
• Better Balance by Christmas
  

Random Fitness Fixer:

• Do Fun, Not Exercise

Labels: arthritis, feet, fix pain, injury, knee, shoes

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Surgery For Achilles Tendon May Not Improve Recovery

Readers have been asking about fixing Achilles tendon tears. They ask if tears can heal without surgery. Tears, even complete tears, can heal with the right rehab therapy even without surgery. A recent study of 92 patients made news when it concluded, "Surgical and nonsurgical treatment were equally effective for patients with acute rupture of the Achilles tendon."

Dr. Katarina Nilsson Helander, MD, of Kungsbacka Hospital in Sweden reported at the March 2010 American Academy of Orthopaedic Surgeons meeting, that outcomes and rates of re-rupture did not differ significantly through 12 months between patients getting surgery and those with physical rehab alone. Within 72 hours of injury, the 97 patients were randomized to surgery (48 patients) or no surgery (49 patients), followed by two weeks in a firm cast, then six weeks in an adjustable brace that allowed some movement of the foot. Both groups reported increased physical activity over time. All underwent identical rehabilitation programs. Complications in the surgical group included one contracture of the tendon, two wound infections (one deep and one superficial), and two nerve disturbances. Thirteen patients had concerns about the scar, 10 for cosmetic reasons and three for scar contracture and pain. Both groups were still below pre-injury levels at one year.



There is currently no consensus whether surgery plus physical rehab, or physical rehab alone is the favorable approach. That means, if you go to a doctor with your Achilles tear, you may be told that surgery is the only way, even though you may get the same results without the surgery. Many people hope to have surgery and be done with their problem, not knowing they will need the same physical therapy either way. Complications such as incision-healing difficulties, infection, contractures, re-rupture of the tendon, atrophy, complications and illness from anesthesia, bleeding, clots, scar pain, nerve pain, can arise from surgery. Drugs required during and after surgery can create new illnesses and further drug prescriptions. Surgical and healing outcomes vary with the skill, luck, and patient load of the operating team that day.

It is not new information that surgery may not always be required. Several studies conclude that non-surgical treatment yields similar results:
Soccer player David Beckham underwent surgery last week after tearing his left Achilles' tendon playing for AC Milan against Chievo. The news reported that the surgeon, Dr. Sakari Orava, said that, "The operation went smoothly and nicely" but that Beckham would not be able to play in this year's World Cup, saying "No,....healing (from the surgery) takes a long time."

You have choices if surgery is not right for you.


Fitness Fixers To Keep Your Achilles Healthy:

• Better Achilles Tendon Stretch
• Fast Fitness - Built In Functional Achilles Tendon Stretch
• Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch
• Functional Achilles Stretch
• Friday Fast Fitness - Partner Achilles Tendon Stretch
• Achilles Stretch in the Bathroom
• Plantar Fasciitis Part I
  

Supportive Shoes Increase Tightness and Problems

• Which Shoes Help Exercise, Fall Prevention, and Ankles?
• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• Why So Many Aerobics Injuries?
  

Fitness Fixers on Surgery:

• Knee Tracking Surgery - Tracking Outcomes
• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary
• What Works Better Than Knee Surgery?
• Another Reason to Avoid Surgery - Catching Fire "A Bigger Risk Than Thought"
• Prevent Back Surgery
• Fix Disc Pain Without Surgery
• Studies Say Back Surgery Not Needed

Labels: achilles stretch, drugs, injury, surgery

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Hospitalization Increases Fractures In Elders

A study of men and women over age 70 found two to three times more bone fractures occurred following a hospital admission compared to not being in a hospital. The risk of new fracture was greatest during the first year after hospitalization and increased with the number of times a patient was hospitalized. This included increased numbers of hip fracture, which leads to a fatality within the year in about 30% of people over 50.

Study authors stated, "Because the risk of fracture is greatest soon after hospital discharge, assessment and interventions to reduce risk should be started during the hospital stay or shortly after discharge. Evaluations should include measurement of bone mineral density, assessment of the risk of falling and vision testing." According to the authors, appropriate treatment for these patients include calcium and vitamin D supplements; bisphosphonate drug treatment, such as alendronate (Fosamax) or risedronate (Actonel); vision correction if needed; and physical therapy, including walking programs and exercises to improve flexibility, strength and balance.

1. Being in a hospital is often joked about as being unhealthy. It is also a reality:
2. When people are sick, it is not the time to keep them sedentary, indoors, eating institutional food, out of fresh air and sunlight, and taking medicines that reduce bone density and increase pain syndromes.
3. Lack of standing and activity quickly reduce bone density.
4. Several commonly prescribed medicines directly reduce bone density and cause stomach and body pain. Instead of stopping these medicines, others are given, which further depress health, and the mistake of further unneeded and unhealthful drugs.
   
5. It is a circular problem when people feel they must reduce activity to prevent falls and injury.
6. What is needed is the right, carefully supervised, healthy movement to give the physical skills that prevent falls, the stiffness that results in more pain and lack of function, and reduction in bone density, balance, strength, and mobility crucial for basic health.

Fitness Fixers For Healthier Options:

• Prescription Acid-Reducing Drugs Produce Heartburn and Dependency
• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others
• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Exercise is More Important Than Calcium Supplements for Bones
• Collapsing Astronaut Gives Healthy Reminder

Random Fun Fitness Fixer

• Fast Fitness - Open Your Eyes and World View

Labels: aging, balance, drugs, injury, osteoporosis, practice of medicine, strength, surgery

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Knee Pain When Running - Check Your Yoga

If your knee pain from running isn't getting better with fixing bad gait, physical therapy, and medical care, check your yoga. Several poses directly twist, overstretch, or pinch knee cartilage. Over time, injury builds that does not show much in people who do yoga and little else, until their knees encounter resisted motion for running and sports, or from a trip or fall.

Not long ago, people in yoga or sports did not intersect much. Now, the previously more sedentary yoga populations try running, aerobics, and sports. Athletes are being told that yoga will give them magic benefits. Knee injuries bloom when they go back to sports, making the staunch yoga camps claim sports are the culprit, when it was the knee damaging motions in yoga and other stretches.

The knee is a primarily a hinge joint, like the hinge on a door that only can open and close. The door swings toward you and away. If you lift up on the door, it twists the hinge and eventually loosens it. The door begins to creak and rub and make noise.

Think of sitting cross-legged (tailor style). Your knees are out to the side and your lower legs bend toward you. All is fine at that point. Now picture, as with lifting upward on a door, you lift the foot and lower leg to rest it on your thigh in Lotus position or lifting it in some pigeon poses as in the photo, at right. Unless you outwardly rotate the upper leg fully at the hip, the knee twists, overstretching the lateral (outside) ligament and pinching the medial meniscus and soft tissue.

Often people bend the ankle upwards too, also pictured at right, a separate problem - see Unhealthy Yoga Ankles.

How to picture rotation at the hip? Think of a stapler. Like the door just mentioned, the stapler has a hinge or knee joining two sections, like your upper and lower leg. It opens and closes on the hinge. If you pull the upper or lower part sideways, it twists or shears the hinge. To turn to staple sideways, you need to rotate the whole thing.

Hero pose, (Supta Virasana) begins sitting on bent knees, meditation style (left-hand photo below), which often is fine. The knee hinge closes, like closing a door, normal bending. Then the pose continues by pulling the feet outside of the upper legs, like pulling upward on the door hinge. If you do not inwardly rotate both upper legs at the hip fully, your knee twists at the hinge, overstretching the medial (inside- facing the other knee) ligament, pinching the lateral (outer) meniscus and soft tissue. Lying back, as in the right-hand photo adds prying of the joint to the rotation damage (often people overarch the lower spine too instead of stretch the muscles, an additonal problem). In "W" sitting, both feet face outward. Not a problem for the knee unless the hips do not fully rotate (whether relentless W sitting is eventually is too much at the hip is a separate question). Runner's hurdler stretch is the same issue, one leg at a time.

Even though yoga may call for "doing both sides" and following each motion in one direction with one in the other, twisting both the medial and lateral sides of the knee cartilage by doing both Lotus and Hero will not cancel each other, but can overstretch and degenerate both sides.


Warrior poses 1 and 2 are like a lunge. Check your front knee:
- Is it inside the line of your foot?
- Do your foot and knee face the same direction?

Sagging inward unequally loads the knee and when the foot and knee face differently, the knee twists under body weight (blue center model, photo at right).

Keep your knee above your foot, both facing directly forward.



Mighty Chair pose - watch for, and change overly-stylized artificial position, not valuable for any functional motion (photo right and lower drawing left).

For chair pose, use outer thigh muscles to hold straight and prevent knees from sinking inward. Use neutral spine instead of overly-arched to practice movement the way it is needed all day for real life. Right-hand drawing below shows fixing.

Make yoga something that benefits your real life movement habits, not trains artificial, damaging, motion you don't even need.

Check that you don't crane the neck while raising arms, impinging rotator cuff and shearing neck vertebrae and greatly overarch (hyperlordose) the lower spine, see Prevent Back Surgery.

For a functional exercise, instead of straining in chair pose a few moments a week, use healthy half squats (right figure on drawing at left) for daily bending and get hundreds of healthy bends - Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending.


Hindu squats and one-legged heel-up deep bends may not twist the knee as much as pry it. Picture a tool to crack nuts - two handles joined at a hinge, like your upper and lower leg joined at the knee. Imagine putting an object (for example, a soccer ball) between the upper and lower leg and try to close the heel toward the upper leg - if the ball does not compress, the hinge (knee) pries open. That happens with low squats on the toes (heels up) if you have large or heavy legs. If you have slender legs, the heels can come closely, like bending your elbow so that your lower arm rests along your upper arm. Slender legs do this, while muscular athletes may destabilize their knees, leaving them venerable to future injury.

The beginning of one of the pigeon poses is pictured at right. The person pictured is sitting to the side, instead of keeping the back knee and leg rotated to face straight downward. Sitting to the side greatly reduces the stretch, especially to the rear hip's front muscles that need the stretch, but usually no big problem to the knee. When the pose continues to lift the back foot for King Pigeon, if you lift the foot up without facing the knee downward, you twist the knee joint. By turning the whole leg downward, you get a better anterior hip stretch, and when you lift the foot, the knee can bend like a hinge, not twist.

One Legged King Pigeon kneels on the rear knee with that knee bent so only the kneecap bears your weight. To reduce compression, and get a better stretch for your hip, move your back leg further back so that your weight rests on the thigh, not kneecap.

I have taken several yoga teacher certifications. Each gives different, plausible-sounding rationale why knee twist poses help, but the anatomy is just off enough to come to wrong conclusions. In one, they taught to deliberately twist the lower leg on the upper "to protect the meniscus." Twisting does not protect, but twist in a damaging way. There are two bones in the lower leg, allowing some rotation, but twisting injures other structures. Another teacher training stressed extreme knee twisting as a stretch in itself, stating that any increase in motion is beneficial, especially from joints. Knee laxity results. Without much muscle and positioning training, you predispose yourself to instability when giving the knee challenge, like going back to sports, or from a fall or blow. Another certification teacher training taught that knee twisting is beneficial since it allows great range of motion in case you fall down with your knee twisted backward. Sounds plausible for that one fall (unless you fall differently), but for every other day in your life, so much extra space can result that the joint 'rattles' and wears prematurely. In another class we were made to sit in Lotus, then, still folded in Lotus, rise to knees and swivel from knee to knee to waddle around the room, compounding damage with body weight on the twisted strained joints.

In each yoga teacher training and class I take, I hear teachers tell about their knee pain and surgeries. They don't know why. They think they need more yoga and do more injurious poses, getting relief or distraction for the moment, then pain comes back. Movement in general often relieves pain for the moment. No need to repeatedly add injury to get temporary relief. Stop the causes and the pain stops.

There are assertions that many people do these stretches and not everyone gets knee pain, so they must be fine. Smoking and unsafe sex also do not have a one-to-one association with immediately bad consequences every time. Some stretches and movements twist the knee and overstretch cartilage. If you do these stretches and have pain, or just sit or stand with your knees hyper-extended (locked back) even if you think it is unrelated, it is one place to think about.

There is more. For another time.

Related Fun Fitness Fixer:

• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• Hamstring to Quadriceps Ratios Not the Answer in Knee Injury
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Free Exercise and Free Back and Knee Pain Prevention - Healthy Bending
• Fixing Leg Numbness, Back Pain, Flank Pain, Knee Pain, Nerve Pain, Three Unhealthy Surgeries, Part II
• Prevent Knee Pain When Rowing
• Strengthen Legs Without Knee Pain - Standing Lunge
• Daughter's Love Saves Parent's Knees
• See all Fitness Fixer articles about yoga by clicking the label yoga, below
  

Random Fun Fitness Fixer:

• Trainers Don't Exercise Enough?

Labels: fix pain, injury, knee, running, stretch, walking, yoga

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Fast Fitness - New Understanding of Hyperlordosis and Disc Injury

Here is Friday Fast Fitness - a new possible contributor to vertebral disc injury, and how to avoid it:

1. In my previous studies, I found that overdoing the inward lower spine curve (hyperlordosis) pinches the lower spine like a soda straw. It forces the spine joints, called facets, backward against each other, eventually wearing them, and compresses surrounding soft tissue. After long periods of standing, exercise, and lifting with too much inward curve, lower back pain is not a big surprise or mysterious to fix.


2. Hyperlordosis was not previously thought of as a direct herniating force on discs. The major factor was and still is too much forward bending. Weighted flexion (bending forward bearing your body weight) opens the space between vertebrae in back, and over years of slouched sitting and bad bending and lifting forward, presses discs outward through that space creating herniated discs (an injury, not a disease). In my previous work I found that for someone with a disc already herniated, hyperlordosis pinches it, adding pain to the separate problem of the disc. Showing people how to stop standing in hyperlordosis greatly reduced their disc pain. In recent work, I found that hyperlordosis exacerbates, and possibly initiates disc herniation itself.


3. My new work is showing that hyperlordosis is a probable mechanism to directly shift disc position. I made a diagram showing the disc injury coming from overarching/ hyperlordosis/ hyperextending the spine that is so common in pop fitness.

Hyperlordosis (overarching the lower spine) is a spine damaging posture. Hyperlordosis and the pain from it can be changed as easily as moving your spine to a smaller, healthier degree of arch (neutral spine). It is not tightening your abs, just moving your spine, as simply as bending your elbow. Links below tell more.

Related Fun Fitness Fixer:

• I wrote of this in May 2009 when I was on the way to present my work at a medical conference - Comments, A Medical Conference, New Findings on Discs
• How To Spot and Stop Damage from Hyperlordosis - Prevent Back Surgery
• Damage from the opposite problem of injuriously done forward bending - The Cause of Disc and Back Pain and Disc Pain - Not a Mystery, Easy to Fix

Random Fun Fitness Fixer:

• Down the Stairs

Labels: disc, facet joints, facets, fast fitness, fix pain, injury, lordosis, lower back, posture

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Knee Tracking Surgery - Tracking Outcomes

In the article Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better, I listed common reasons knee pain doesn't resolve, including common bad stretches, bad shoes, treating the wrong thing, treating the right thing but returning to pronated, duckfoot or pigeon-toe gait (letting arches flatten or knees sag inward, and/or walking toe out or in), and omitting functional exercise and use. Fancy "supportive" running shoes, no matter how expensive or engineered often add to knee pain. I wrote that surgery for a tight lateral area isn't needed when you can stretch it. Readers wrote asking why stretch when you can just have surgery and cut it?

One common surgical procedures is an arthroscopic lateral release - surgical cutting of the lateral muscles from the patella (kneecap). The idea of the surgery is to decrease pull and pressure on the underside of the patella.

Studies following up people undergoing the surgery show, "The results are not always predictable or successful and in some cases, the surgery may have no effect on the patient's problem." http://www.arthroscopy.com/sp05032.htm

Another study from the Netherlands confirmed previous studies showing exercise therapy for patellofemoral pain was more effective to reduce pain and increase function than the often used "rest, wait and see." Science Daily.

Surgery often is made to sound like a quick way to get ahead, but numbers now confirm that you are restricted from full activity for enough time that your physical conditioning, flexibility, bone density, aerobic capacity, strength, and enthusiasm diminish. You will often be further behind, rather than quickly fixing a cause and going forward. Often, as much physical therapy is needed for full recovery after surgery as if you didn't go for the surgery. Stories are told of someone who had the surgery then went right back to skiing. I am the one who many of these people come to a year later. They say they are fine, but they still use pain medicine, still can't bend their knee enough to stretch enough to get relief of other tight areas and so on, and often haven't gotten back to previous benchmarks. To me, that is not "fine" enough. They slowly diminish in key areas of their life. They get new pain they don't recognize as related to compensating movement from the old ones. By the time they see me, they are often on several pain medicines, anti-depression medicines, and others that make new problems.

Surgical risks are also becoming better reported. Blood clot incidence is far higher after surgery than previous released. A study of nearly 1 million women tracked for an average of 6.2 years after surgery, showed risk continues for 12 weeks and includes minimally invasive procedures.

Not all patellofemoral pain is a tracking problem. Tracking pain is in the patellorfemoral area (where kneecap and top leg bone meet). However, other conditions besides tracking make patellofemoral pain. People with patellofemoral knee pain may be sent for tracking therapy even surgery, without needing it. Standing and moving allowing the knee to sag or rotate inward can also make rubbing. Surgery and tracking exercises do not address this. They may be done but yield no result. It is not a mystery.


Check For Reasons For Pain And Address Them:

• Kneecap Tracking - Don't Miss These Reasons It Doesn't Get Better
• What Works Better Than Knee Surgery?
• Arch Support Is Not From Shoes
  

Related Fitness Fixer On Knee Surgery:

• Knee Surgery - Arthroscopy Results No Better than Pretend Surgery
• Surgery for Knee Arthritis, Meniscus, Unnecessary
• Anterior Cruciate Ligament (ACL) Surgery Unnecessary
• Another Reason to Avoid Surgery - Catching Fire "A Bigger Risk Than Thought"

Random Fun Fitness Fixer:

• All the More Reason To Try - Exercise to Overcome Each Difficulty

Labels: fix pain, gait, injury, knee, practice of medicine, shoes, surgery

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Black Belt Hall of Fame 2009

This weekend we will attend the Black Belt Hall of Fame event hosted by the Eastern USA Martial Arts Association. Paul and I are honored to be invited back this year, and receive awards for Instructor of the Year. I will teach a workshop on Stretching Smarter for Martial Artists.

Why stretch smarter? Many standard stretches work to increase flexibility but don't improve martial arts or other sports, and aren't good for the joints.

Martial artists and other athletes often develop injuries from years of bad stretches. It's understandable to put yourself in harm's way to carry children and elders from a burning building, or suffer cold and hypoxia rescuing a stranded mountaineer. It's silly to injure yourself doing stretches and exercises you think are for your health. In martial arts you can harden your body to withstand blows through difficult and uncomfortable training, but it isn't the point of martial arts or other sports and activities to beat up yourself. I cover the difference between toughening the body and injuring it in the seminar and in my book Healthy Martial Arts.

My workshop teaches functional flexibility - changing your body to work better in real ways needed for daily life and fighting arts.

Functional exercise and medicine is an exciting change in fitness and health. My Academy page explains more - Academy of Functional Exercise Medicine AFEM.

I won't have Internet or mail for the week.

The hall of Fame event is by invitation only. Contact:

Executive Director Soke Kanzler Eastern
U.S.A. International Martial Arts Association
1 (800) 456-3872
EUSAIMAA@aol.com
P.O. Box 9642
Pittsburgh Pennsylvania 15226 USA

If you can't attend the lecture, get the book:

• Stretching Smarter Stretching Healthier

Related Fitness Fixer:

• Black Belt Hall of Fame 2008
• Black Belt Hall of Fame
• Black Belt Hall of Fame - Black Belts and Black Tie
• International Martial Arts Association - Weekend Event Nov 10-12
• What Does Stretching Do?
• Throw a Stronger Punch (or Push a Car or Stroller) Using This Back Pain Reduction Technique

Random Fun Article:

• All the More Reason To Try - Exercise to Overcome Each Difficulty

Labels: fix pain, injury, International Academy of Functional Sports Medicine, martial arts, stretch

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Healthy Aging Starts Now

Robert Davis, frequent Fitness Fixer success story contributor, wrote to me with observations that will encourage, educate, and help many -

"I am beginning to see an almost "plague" in our society. That plague is auto-assumption that age automatically will start to equal degradation of your body."

Mr. Davis, a young lifter, had first left a comment to a Fitness Fixer article last year asking about fixing his back injury from weight lifting. His success stories came in frequently from there, telling how he gained better health and ability than before his injury. In a recent update letter to me, he sent these insights:

" I have not mailed in a few months. However I did not want to forget what got me back to what I love. I have had no issues with my back for months now. It went from dreadful to move, to better then ever.

" It is all so simple once it becomes ingrained. At first it does seem to be a chore learning to (bend right with a lunge and) squat and all the other things to correct bad habits. However these things, with conscious repetition, become habits. No longer do I have to think about healthy movement!

" This has been beneficial not only for my back, but for all areas that were troublesome. The more I loosed up, bent correctly, and used movement correctly, the more minor problems just seem to fade away!

" I have a new mantra when I workout with weight. It is called "on the muscle" chant. Every exercise I perform I say this in my mind and concentrate all weight on the muscles (instead of making it easier by shifting weight to joints). If I feel it is too heavy and I am doing some joint crushing, I back off the weight. I do not lose anything backing off. I gain something. More strength to do the same "on the muscle". In sum, I have really really chosen healthy movement over getting in an extra few pounds with "joint/arch or whatever" assistance. It is not worth it. You will get it eventually "on the muscle!"

" One sad thing I am noticing though lately after going thru stuff myself is this. I am beginning to see an almost "plague" in our society. That plague is auto assumption that age automatically will start to equal degradation of your body. I grew up as a pre-teen/teen in the late 80s and into the 90s. I never remembered regarding people who were much older as limited. I think this phenomenon is a cultural condition based on no facts, and the massive influx of pharmaceuticals. I could be wrong but that is what I see.

" I am amazed at all the people I run across in the gym who are told to "not do this or that". I often think of my grandfather and the time period he grew up in. He was very active and working under cars and whatnot till a few months before he passed away. No one told him his age would hamper that.

" I could go on and on about this but I think particularly in America, we are in a self created plague where age is a bad thing and something to postpone. What little do people know is that healthy movement, awareness, and lifestyle help one get thru all this without having to stop what they love.

" Look at me. From a debilitating back injury to returning to what I love to do - "lift weights in the gym." I was skeptical I would have ever made it back when I got hurt. However I am kinda glad now I did get hurt as sometimes there is a gem inside what otherwise would seem problematic. That Gem was learning (from you) how to do what I love to do without worry of age or injury ever detouring me from that. I am in my mid 30s now and plan to stay on top of myself with your methods for as long as I have a passion for this(and I feel that is a very long time). After all I see the body builders in the 70s and am truly inspired to keep going.

" Thank you! I also wanted to just check in and give a little insight of what I was doing and my thoughts on things =P
"Robert Davis"

Related Fitness Fixer:

• Exercise and Aging - Don't Limit the Patient to Limit the Pain
• Autumn Yard Work - Limiting the Person Instead of the Injury Again?
• What I Learned at the Aging Conference
• 91 Year Old Decides to Run and Sets Record
• Are You Stronger Than A 67 Year Old Lady?
  
• Mr. America Urges Goodness and Responsibility
• Secret To Get Better and Fitter
• All the More Reason To Try - Exercise to Overcome Each Difficulty

Some of Mr. Davis' Success Stories, Videos, and Photos:

• Cardiovascular Cleanup
• Fixed Injuries, Got Strong, With Functional Exercise
• Fast Fitness - Better Legs and Pain Relief Comes From You Not The Exercise Ball
• Fast Fitness - Add Balance, Stability, and Portability to Military Press - Handstand Pushups
• Fast Fitness - Double Arm Strength, Endurance, Balance, Stability, and Free Inversion Table

Unrelated Random Fitness Fixer:

• Want Weightlifting? Plant A Food Garden

More from Mr. Davis next week, plus why he couldn't send us a photo this time - Healthy Aging Starts Now - Part II.

Labels: aging, fix pain, injury, lower back, readers inspiring story

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Prescription Acid-Reducing Drugs Produce Heartburn and Dependency

In a study of acid-suppression drugs, healthy adults with no previous symptoms developed

"heartburn, acid regurgitation and dyspepsia" after a course of the drugs. Forty percent of 120 volunteers taking anti-heartburn drugs called proton pump inhibitors (PPIs) had a rebound increase in gastric acid secretion, resulting in acid levels above their starting levels.


Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute. A comment appearing in the Journal stated there is, "Evidence that proton-pump inhibitor therapy induces the symptoms it is used to treat." Gastroenterology. 2009 Jul;137(1):80-7, 87. McColl KE, Gillen D.

PPI drugs for gastrointestinal symptoms are highly prescribed. Study authors stated, "This might lead to PPI dependency and thus have important implications."

In the previous Thank You to Grand Rounds, I noted that several prescriptions drugs are known to cause increased symptoms, rebound, even the original problem - Thank You Grand Rounds 5.50, Medicine & Technology.

It is becoming known that PPI drugs do not prevent the source of the problem, so may not be needed in the first place. It does not seem necessary to start a course of drugs that perpetuates your symptoms, even causes the problem itself. The Fitness Fixer article Stomach Acid Drugs Increase Osteoporosis and Hip Fractures explains more.


Related Fitness Fixer:

• Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Exercise is More Important Than Calcium Supplements for Bones
• Common, Missed Cause of MusculoSkeletal Pain - Your Drugs
• FDA Orders Suicide Risk Warning for Common Back Pain and Migraine Drugs, and Others
• Forensic Anthropology and Bone Density

Unrelated Random Fitness Fixer:

• Married 63 Years With Good Balance

Labels: digestion, drugs, fix pain, injury, practice of medicine

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Diver Down Flags - Boating, Swimming, SCUBA Safer and Smarter

My father, some of my brothers, and I loved swimming together in a cold river in the northern United States. We enjoyed fun discussions treading water at the turn-around points. One day, a speedboat left the boating lanes and came at us. I stared dumbly at the fast-approaching boat, because why would anyone run right over you when he could plainly see you? Everyone knew that people swim in the water. The prow churned the water right over us. We corkscrewed underwater like five clams in a row snapping shut, to clear the propellers. It is an acoustics fact that words attempted underwater are distorted. Humor columnist Dave Barry once wrote that anything said underwater sounds like "b-mmoogle" but Dad's blue stream was pretty clear through the roil of bubbles

We listened underwater until the propeller sound deepened, showing it was going away. We surfaced, and looked, and saw the boat turn around and head straight back for us. I thought it might be checking if we were all right, but Dad pushed all our heads back under. The boat smashed the water directly overhead again. Maybe the boat came to "finish us" but with the benefit of the doubt, maybe he just wasn't looking where we he was going again.

We dodged trouble. We are divers and have and use diver down flags. Boats not observing them is another problem. Every year, boats hit swimmers and scuba divers, and injure, disfigure, dismember, and kill them. Know your flags and prevent tragedies:

The Diver Down flag has a red background with diagonal white bar. It is notice to boaters that scuba divers are in the area and to keep clear. It was designed in the late 1950's so that boaters would not suddenly find themselves running over divers surfacing in their path. The "Diver-Down Flag" may be attached to a floating surface buoy and dragged around by a diving group if they will be ranging far from the entry point, or used as a stationary line for descents and ascents. It may also be flown by a boat used for divers. Some states prohibit flying the diver-down flag if divers are not in the water at the time. In that case, the dive boat will (is supposed to) raise the flag during dive activity then lower after all divers and swimmers are back onboard

Labels: injury, scuba, swimming

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Exercise in the Heat

Labels: aerobic, aging, circulation, heat, heat shock protein, injury, myths, perceived exertion, performance enhancing modality

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Fast Fitness - Hidden Source of Groin Pulls

An old sports medicine joke says that if you pull a groin muscle, make sure it is someone else's. Here is less known info for Friday Fast Fitness - do you stretch in a way that groin pulls are more likely to happen to you?

When you lift one leg to kick, stretch, or step up, you can get the needed range from the upper leg muscles, or you can just round your back. Many people round the spine and roll the hip under (tuck too much) to make the stretch easier. They don't get the stretch from the muscles high in the leg, leaving the area tight.

In event of large or sudden kick, step, or slip, high forces pull on tight groin muscles. Varying degrees of injury can occur, or the tight area yanks the standing leg out from under and the person falls backward suddenly - seen in aerobics and martial arts classes, and funny video shows. Then the person hobbles around saying they don't understand it since they do their stretching, and articles get published that stretching doesn't work and no one know why.

Being so tight that your other leg comes forward with the lifted one, comes from bad stretching habits that allow hip and pelvis to round and tuck under too much:

1. When you stand on one leg and lift the other, don't bend at the knee and hip, pictured at left. Straighten your back with chin loosely in, not rounded forward. Hold pelvis upright without letting it tilt and round under you, pictured right.
2. Keep the standing leg normally straight (not locked straight, but not bent more than normal standing). Stand straight and relaxed (both at once). Don't force or strain. Breathe.
3. Feel more stretch in the front thigh and groin of the standing leg.

Check your stretching, kicking, and stepping. Check if you round your back and hip when taking the stairs, stretching while standing, and stretching lying on your back.

When lying on your back to stretch by lifting one leg, keep the other leg flat on the floor, not bent at the knee and hip. It is a myth that you must bend your knees when stretching legs to protect your back. If you must bend your knees to protect your back, how are you supposed to stand normally and move?


Prevent Stretch And Exercise Habits Promoting Tight Anterior Hip:

Fast Fitness - Don't Shorten Hip When Stretching Hamstring
Fast Fitness - Hip Stretch and Spine Stability Training When Stretching Legs
Is Bad Martial Arts Good Exercise?
Fast Fitness - Better Standing Hamstring, Achilles, and Inside Leg Stretch
Common Exercises Teach Hip Tightness When Kicking, Stretching, and on the Stairs

Labels: fast fitness, fix pain, hip stretch, injury, leg stretch, martial arts

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How To Stay Underwater For A Month

Human beings have gotten all the way to the moon, but can't get far under the sea. In space we can wear special suits to decrease effects of pressure change and deliver air to breathe, but (in brief) the farther you go down underwater, the more these same conditions constantly change in difficult ways.

For ordinary scuba diving, divers wear a tank of regular air. A compressor squeezes ordinary filtered air into the tank, so that several times more air fits. For more time underwater than a tank allows, a diver can breathe from a special long hose from the surface. How far you can go depends on the length of the hose and the power to compress the air to the right pressure. With other specific training, you can wear a rebreather. A rebreather scrubs and reuses exhaled air instead of losing the exhale into the water (shortest description). In all these cases, the deeper and the longer you stay, the more nitrogen in the air you breathe dissolves all over your body.

When a diver starts back to the surface, pressure reduces all the way up, letting nitrogen back out. You need to come up slowly enough and not have stayed too long to be able to go directly to the surface without the nitrogen forming bubbles inside your body, part of the diving injury called decompression sickness or The Bends. Decompression sickness, and bubble formation, transit, and medical effects was a passion of my career work in physiology for many years. Still is.

On deeper dives, it works better to breathe less nitrogen. You can't substitute more oxygen at deep depths, because oxygen becomes increasingly toxic. You need a gas that doesn't make as much trouble during each depth and time. One choice is helium to replace some or all nitrogen, and part of the oxygen.

If you have lots of dissolved nitrogen or helium or other gases chosen for a long and/or deep dive, you need to stop on the way up, called a decompression stop. Where and when and for how long to stop is interesting, and the subject of research and arguments (discussions) among scientist and divers. Different Navies and commercial companies use different protocols, some known well, some closely guarded as company secrets.

For extreme depth diving for research, commercial work like oil drilling, mining, and communications, military surveillance, espionage, and "proprietary commercial interests," divers can spend time on "deco" stops, but for long dives, many stops are needed, some more than 10 hours. Doesn't work to do that, then go back to work the next day and repeat. One solution is to stay down inside the rig or habitat or other enclosure designed for that. I wrote a little of my work doing that in Living Under The Sea.

At each depth, you can only absorb a certain amount of gas. After that, no more fits. It doesn't matter how long you stay past a certain point, you have the same decompression obligation on the way up. Staying down until you are full of gas is called saturation diving. You can stay down a week or a month, then decompress once. Decompression can be done in the water, but there are problems of cold, darkness, bathroom needs, and gas supply. Another solution is inside a vehicle designed for that purpose. The decompression vehicle can be raised and removed from the water, and the divers inside slowly decompress safely. It was also experimented, to drag divers straight to the surface and throw them as fast as possible into a surface chamber to quickly compress them back to pressures at depth, then slowly release according to algorithms people back then decided were right. Tragically, some regular scuba divers heard about these two kinds of "surface decompression" and thinking it meant the water surface, managed to publish articles in diving magazines, and give lectures at dive shows, with that misinformation being widely repeated, that one could come straight to the surface after deep dives and float around in an inner tube and read dirty magazines, as the guys in the special recompression chambers did to pass the couple days they'd spend.

You wouldn't turn inside out from the huge pressure differential produced, as depicted in some science fiction movies, but it might kill you as effectively. That is a sample of what happens when reporters don't read what scientists write in their research articles, just repeat some sentences taken out of context, conclusions in the abstracts, or what someone else wrote.

Tomorrow - a fun story about NASA Astronaut Scott Carpenter in 1965. He lived 30 days underwater in SEALAB II, in the US Navy’s Man-in the-Sea Project off the coast of California. Commander Carpenter was breathing a helium mix during his surface decompression in a chamber. In tomorrow's post, hear a recording of what happens when he makes a pre-arranged phone call while breathing helium in the chamber to President Lyndon Johnson - Helium Speech - An Astronaut Calls the President of the United States.

Related stories:

• Space Walks
• Indiana Jones Rocket Sled
• Exercise and Medicine Underwater and at High Pressure
• Exercise and Fitness in Decompression Sickness Risk
• Living Under The Sea

Labels: aerospace, breathing, hyperbaric, injury, myths, scuba

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