Stop Lower Back Pain From Swimming and SCUBA Part II

Yesterday's post explained the most common hidden cause of lower backache after swimming and scuba diving. Swimmers and divers who get this chronic pain are often misdiagnosed with SI (sacroiliac) joint dysfunction, arthritis, disc injury or various "catch-all" terms for back pain with unknown origin. Scans may show damage to the facet joints, which can occur from spinal overarching. Injections and surgeries and various anti-inflammatories are often prescribed. No shots, medicines, or surgeries are needed. You do not need physical therapy or strengthening programs. All you need to do is stop overarching and maintain neutral spine when walking, running, swimming, and diving. It is easy, and is a healthy and normal spine position. You do not tighten any muscles to do it. It is just learning a normal posture.

Check yourself to see if you stand in hyperlordosis:

1. Stand up and look sideways in a mirror. Your belt should be level, as in the left drawing of neutral spine. The side seam in dress or trousers should be vertical from leg to waist, as in left drawing, not tilted forward at the hip (middle drawing).
   
   
2. Back up slowly and gently into a wall. If your backside touches first, it may be an indicator that you lean forward at the hip. If your upper back touches first, it often is a good indicator that you lean the upper body backward (right drawing).
   
   
3. Stand with your back against a wall, with heels, hips, upper back and back of your head touching. There should be a small space between your lower back and the wall, but not a large space. Then raise both arms overhead to touch fingers to the wall behind you to simulate swimming with arms outstretched. See if the lumbar curve increases. You should be able to stand with the back of your head touching the wall without increasing your normal curve, and be able to raise your arms without increasing it.

If you have a large space between lower back and the wall, try this:

1. Press the lower back toward the wall to feel how to decrease the space. There is a short movie of this on Fast Fitness - How to Feel Change to Neutral Spine.
   
2. If you can't figure how to do that, put your hands on your hips, thumbs facing the back, and roll your hip under so that your thumbs come downward in back.
3. Feel the large space between lower back and the wall become a smaller space.

Lower back pain that is caused by hyperlordosis should ease right away. Learn how to easily, gently do this while walking, running, swimming, or whatever you do. This is done without tightening or clenching any muscles.

Keep the good new neutral spine when you walk away from the wall, and all the time. Apply it to when you are swimming and scuba diving.

Muscle Use is Not Automatic
The muscles that hold neutral spine are your abdominal muscles. They do not do this automatically, which is why strengthening programs do little to stop back pain. Someone may have strong abs but stand and swim in arched posture, with continuing lower back pain.

Heavy scuba tanks don't make you arch your back or have bad posture. Not using your ab muscles to counter the pull, and allowing your back to arch is the problem.

When you are standing up wearing tanks, straighten your body against the pull of the load and maintain neutral spine. Do not tighten your abs, just move your pelvis. If you notice yourself arching while wearing tanks, straighten your body as if starting to do a crunch but don't curl forward. Only straighten to neutral spine. Don't tuck so much that you lean back or push your hips forward.

No More Lower Back Pain From Overarching
Transfer this neutral spine skill to your daily life for carrying gear, putting cargo up on racks, heavy packages on counters, and whenever you lift and reach. Use neutral spine when standing, walking, running, reaching overhead, swimming, and scuba diving.

Labels: facet joints, lordosis, lower back, neutral spine, scuba, swimming

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Lower Back Pain From Swimming and SCUBA

Lifting and carrying heavy dive gear with good lifting mechanics is good and functional exercise. With bad lifting habits, it is a common and obvious cause of lower back pain in scuba divers. A second major cause of lower back pain after SCUBA and swimming is often overlooked and can occur after scuba diving and after swimming laps with no gear lifting.

Hyperlordosis
When swimming or finning face down and horizontally through the water, many divers allow their lower back to increase in arch. They look like they are face down in a hammock - shown by the figurine below:


A small inward curve belongs in the lower back. When you allow the normal inward curve, (normal lordosis) to increase, it becomes hyperlordosis or overarching (swayback).

For most people, hyperlordosis is most common when upright, such as standing, walking, and running. Swimmers and divers who allow their back to overarch when swimming face down often notice the pain after swims and dives:


How Hyperlordosis Causes Lower Back Pain
Hyperlordosis pinches the joints of the vertebrae called facets and the surrounding soft tissue. When swimming and diving in hyperlordosis, the fulcrum of the kick becomes the facets instead of the muscles of the abs and hip. When standing upright with a hyperlordotic lower spine instead of neutral spine, the weight of the upper body presses down on the overly pinched-backward lower back. Running in hyperlordosis causes more of the banging and pressing.

People with lower back pain from hyperlordosis usually feel they need to bend over forward, or sit, or raise one leg to relieve it. Often nothing shows up on x-rays and scans. Eventually, hyperlordosis can damage structures enough to show. Until then it just aches a great deal.

The cause of this kind of pain is often unrecognized and people may be told they have a condition called sacroiliac, or SI joint dysfunction, or nonspecific back pain, or other names.

Next - Part II, How to Stop Lower Back Pain From Swimming and SCUBA

Labels: facet joints, lordosis, lower back, neutral spine, scuba, swimming

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A Reader Asks About Osteoporosis and Walking Lightly

One good question launched many answers. The post Walk Lightly - Shock Absorption for Happier Joints explained a light step prevents joint, soft tissue, and plantar fasciitis pain. In the comments, Carol asked if there were, "a connection between walking lightly and oesteopenia?" This is interesting, since osteopenia is lower than normal bone density, lack of enough pulling or tension on the bones reduces bone density, and a certain amount of vibration may help bones. The simple answer seems to be, that walking lightly should not be enough to reduce bone density, by itself.

Walking, running, and jumping lightly is good exercise to load the bones, while being better for your ankles, knees, hips, and spine than jarring with each step. The post Why So Many Aerobics Injuries? cited news accounts attributing joint pain and injury to high impact activities, with examples of popular aerobics personalities of the 1980s who now say they are too crippled to exercise. Their injuries were avoidable, but not by avoiding impact exercises. Impact activities can be done safely by not stomping down hard. Even repeated jumps from a height can be done with soft landings. Good athletes run, jump, and box with far less impact than most people walk, and have good strong bones. Exercise, done right, is crucial for your bones - Exercise is More Important Than Calcium Supplements for Bones.

When muscles pull your bones during walking, running, and other exercise, the pulling increases bone density. Adding external weight loads bones further. That is a major way weight-bearing and weight lifting exercise increases bone density. The effect of muscles contracting to provide good shock absorption when moving also pulls on the bones,which should be good. The post Forensic Anthropology and Bone Density looked at influencing the shape of our bones by how we move.

The reader went on to comment, "I have always been very light on my feet, and now in my 50s I have found out I have low bone density. I have a cousin who shakes the house when she walks who has been told that she doesn't ever have to worry about her bone mass." Walking lightly alone should not have caused the osteopenia. Questions would be, what other exercise the reader does, and what things might be decreasing her bone density? For the cousin, "shaking the house" by itself may not be enough bone stimulus that anyone could tell her that she "doesn't ever have to worry." Has the cousin taken a bone density test and was found to be high (for whatever reason)? Then you can say there is lowered risk of fracture. Is this cousin is very heavy, which helps load bone? Does this cousin do regular exercise to increase her bone density? It is not likely to be a valid prediction that someone never has to worry about bone density just because they walk badly.

The reader went on to ask, "I went to a bones for life class and was taught to do heel bouncing to stimulate bone growth. i.e. dropping repeatedly from toes onto heels while standing in proper alignment. Do you agree with that exercise?" I did a few searches on the bones for life class and found that the class uses many exercises, not bouncing on the heels alone. Bouncing for a few minutes would not be enough to undo sedentary life style, and the various things people do that actively take away from bone density. You need to do all the other exercises. How much the shock wave of the impact may additionally load or stimulate the bone is still an open question.

There are studies looking at effects of vibration and tapping on bone building. Mechanisms have been studied from the effect on cat bones of their purring, to various machines that bang or vibrate. Some advertising for vibration machines goes as far as making claims that they will increase bone density. So far, none have been found to have as much bone building effect as muscular activity (exercise). Too much occupational vibration, like jack-hammer, helicopter and similar environments produces joint pain, injuries to the spine, eyes, ear, nervous, and other systems. That was one of the topics I was looking into when I did aviation medicine research. A news article that came out on last year's fitness fad of vibration plates promising weight loss and fitness building, mentioned a few of the problems with too much vibration, and, ironically had an accompanying photograph showing severely hyperlordotic (overarched) lower spine positioning by a person listed as the trainer. Hyperlordotic spine posture, by itself, damages the facet joints of the spine over time. It seems safe to say that the jolting of the vertebral joints against each other in this overly arched position would only be worsened by vibration. The post Prevent Back Surgery shows examples of overarched lower spine and why it causes so many injuries in fitness.

It would be interesting to know if low levels of vibration, through tap dancing, Flamenco dancing, pogo stick jumping, and similar activities, would change bone compared to the same amount of exercise without the impact. Some studies claim that swimmers or cyclists do not have as high bone density as runners, while others do not find that when they control for the direct muscle work applied to the area. There are even studies showing that Tai Chi, a most mild form movement with almost no foot-falls at all, can increase bone density in older people, just from the movement.

Along with walking or running, and weight lifting to build bone density, and using your muscles to stop stomping which can hurt the joints, you can prevent bone loss by avoiding things that reduce bone density:

• Smoking
• Drugs that are known to greatly increase risk of bone fracture: stomach acid drugs and steroid anti-inflammatory drugs, regular use of SSRI antidepressants such as Prozac and Paxil. Numerous medications used to treat different cancers may produce osteopenia (bone shortage) and osteoporosis in long-term cancer survivors. See Stomach Acid Drugs Increase Osteoporosis and Hip Fractures
• Lack of sunlight. Calcium cannot be absorbed or do its job without enough sunlight
  
• High consumption of meat and dairy products
• Drinking alcohol too often
  
• Lack of fruit and vegetables, and vegetable calcium sources
• Eating wheat and related grains by people with celiac
  

Osteoporosis and osteopenia cause major problems for men, not only women. More on this to come. Move, walk, lift weights, stand on your hands, and jump for fun, exercise, and bone building. You do not need to ooze around on tiptoe to avoid impact injuries. Jump and dance and stamp your feet for fun, without jarring your joints and retinas loose. Have fun.

Carol ended her comment to me with, "Thanks for your site - I've learned a lot about alignment, which has helped in many ways." Thank you Carol for writing so many helpful questions for our benefit.

Labels: aerospace, biking, facet joints, fix pain, impact, injury, osteoporosis, plantar fasciitis, swimming

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Can We Teach Young Doctors to Be Healthy?

We have been traveling for the past 2 months in Asia and are on the way to the chilly Smokey Mountains of Tennessee USA to teach medical students for a week during their rotation elective in Wilderness Medicine. This is the third year I will teach there.

I will teach the entire curriculum of diving medicine and physiology, plus a workshop on why commonly prescribed stretches are not healthful, and what to do instead. Several members of the Knox County Sheriff's Office from Knoxville TN have requested to attend my lectures, and several readers made the effort to find the class information on my web site and make arrangements to travel to the camp to attend.

As a physiologist, I design the techniques that physicians use. I spent many years as a military and university researcher in environmental physiology, which is how the body functions in the heat and cold, at altitude and underwater, breathing different mixtures of gases, doing different forms and intensities of exercise. It's important to understand why things work. If you don't understand, then you can't think for yourself, and all you can do is repeat the mistakes of the generation before you, who also were just repeating what they learned in a book from teachers who just were repeating what they had heard.

This problem occurs with some of the exercises and stretches given as physical therapy. An introduction to the problem is in the post What Does Stretching Do? In the past two years teaching at the camp, we encountered young students who were not interested to change bad stretches, and made a point of showing me after my lectures that they will keep doing their rounded bent forward toe touches, since "everyone knows" that is how it is done. However, Sitting Badly Isn't Magically Healthy by Calling It a Hamstring Stretch.

The problem occurs with nutrition. The medical school food at the wilderness camp is not healthy, and students have defended eating candy and junk food as reasonable, even saying that what they eat is not unhealthful - What Medical Students Told Me About Nutrition and When Did Health Become Thinking Out Of The Box?

The problem can occur with medical treatments that are in the books, even though wrong. In my diving physiology lectures, I try to show that if you understand the physiology, you will know why certain treatments do not work or are not needed. Immersion in water, for example, creates many interesting effects such as distributing blood volume more out of the limbs to the body. This is similar to the effect that occurs in space, described in Collapsing Astronaut Gives Healthy Reminder. Recently, during our travels, Paul wound up in the hospital with a swollen leg. The doctor who was Chief of Medicine of the hospital, announced that the treatment was bed rest. Paul was told he must lie flat in bed for at least three to fours days with the leg elevated to drain the fluid. We understand that bed rest is often listed in books as a treatment for this, but it is wrong. I asked the doctor if going in the water could help. The doctor said that standing in the water meant the leg would be "hanging down" and the leg needed to be elevated to drain. If you understand immersion, then you know why immersion can more effectively treat limb edema and water retention than medicines and lying in bed. Extended bed rest is unhealthy, and reduces muscle and bone health so much that it is used to study the damage to the body from floating around during space travel. We escaped the medical care and went into the water. I will post more on immersion, edema, and health soon.

I will not have Internet access for the next week to read or reply to comments. Enjoy the posts. Start taking and sending in fun photos of your successes using all the fun techniques.

Labels: education, injury, scuba, swimming

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Swimming and Pulmonary Edema Part II

In Monday's post, Katharine, an Ironman Triathlete, told of having pulmonary edema of swimming twice this year and asked if warm up or fluids were involved. US Open Water Swimming also interviewed me about pulmonary edema. Here are some things they asked.


1. What is pulmonary edema and why should swimmers know or be concerned about it?

Edema means too much fluid accumulation. Fluid suddenly fills the lungs. The left side of the heart is not pumping properly. It can cause you to have to stop a race. It can sometimes cause serious illness and death.

2. Is it more likely to occur in cold water?

It seems to be more likely in cold water. It has occurred in surface swimmers and scuba divers in both cold and warm water. Cold is only one of the several proposed causes.

Causes or contributors seem to be things that increase cardiac preload and afterload, including immersion in water, cold water, heavy exercise, negative pressure breathing (like breathing with a snorkel, and swimming with the chest below the surface and even the slight elevation of the head to breathe in), and drinking too much water or other fluids before swimming. Don't drink lots of water before swimming.

3. What are the signs and symptoms?

Unusually shortness of breath (not just fatigue) and coughing bloody froth. No chest pain.

With a stethoscope you can hear rales, an abnormal rattling breathing sound. Chest x-rays show the classic pattern of pulmonary edema. When blood oxygen in the arteries is checked, arterial O2 may be lowered.

4. Do wet suits provide any measure of protection against PE?

Difficult to say since it has occurred in people with and without wet suits. I haven't seen charts where the numbers of each predisposing possibility, like protective garments and temperature, were compared.

5. Can medical personnel easily detect PE?

Pulmonary edema is not subtle. The person is usually gasping and spitting pink froth, and asking for help with a worried look.

A swimmer who develops shortness of breath and cough in a race may have something else like exercise induced asthma.

6. What is the first aid if PE is suspected?

Get them out of the water. Sit them up to elevate the head, if conscious. Give them 100% oxygen by mask, and get them to the emergency facility.

7. If PE is untreated and the athlete continues to the race/swim, what could happen?

Depends how serious. Symptoms can resolve on their own or they can get worse. I wish I knew the future for them, but it's like other injuries. There have been deaths. We wonder how many people who suddenly went under were not drowning but developed pulmonary edema. We have no way yet to tell. Drowning also produces pulmonary edema (after the fact). Repeat cases of pulmonary edema can occur in the same person.

Interestingly, the frothing pulmonary edema occurs in racehorses after hard races. They are blowing bloody nose froth all over, but veterinarians have reassured me that the horses are fine. Any readers who are veterinarians, please tell me more. If a person is frothing, get help.

Labels: circulation, cold, fix pain, injury, pulmonary edema/oedema, swimming

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Swimming and Pulmonary Edema Part I

Reader Katharine asked:

"I am an Ironman Triathlete and have recently experienced symptoms of swimming induced pulmonary edema on two occasions this year and am trying to find as much information about this condition as possible. I have a background in swimming and have not experience this phenomena until recently. In both instances, my breathing became labored and fluid built up in my lungs during the early stages of a competitive triathlon swim.

"The most recent instance of what I suspect was 'SIPE' (Swimming Induced Pulmonary Edema) was on July 22nd at Ironman USA in Lake Placid. After the swim portion of the event, I had to be taken to the hospital as I was unable to breathe and was coughing up a 'pink frothy foam.' I felt normal within 24 hours and have still been able to continue to train as normal –initial ECG and Echo tests of my heart are normal, as well as a lung scan and x-rays of my lungs, throat and sinuses.

"The problem has only occurred in 2 out of 4 triathlon’s I have been in this year – and both instances occurred at approx. the 750m mark of an open water swim.

"It doesn't seem to be a common ailment so I’m trying to gather as much information on SIPE as possible from anyone who has studied it. I'm primarily trying to find out how to prevent it from happening. I am fine in training in the same 'open' cold water as I race it, so why is it happening on race day... Perhaps not enough of a swim 'warm-up' and an immediate elevation in HR... that along with added fluids in the days leading up to a long distance event such as an Ironman."

Warming up does not seem to be related to developing pulmonary edema. Why pulmonary edema can happen with swimming, what fluids have to do with it, and what to do, follow on Wednesday.

Labels: circulation, cold, injury, pulmonary edema/oedema, swimming

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Fast Fitness - Healthier Sports Shake

A New Zealand swimmer asked for more sports nutrition. Here is Friday Fast Fitness - quick, good tasting sports shakes - cheaper and healthier than store-bought.

My father and grandfather, (and great-grandfather+) were Ice Swimmers. We all swam all year in open water including several over 20 miles (32km). My grandfather's sure-power recipe was an oily mixture (for future posts). When I raced competitively, I swam 5-7 miles a day, 35-40 miles a week (up to 64km/week). The coach pushed the common fad of eating Jello powder. As a vegetarian I skipped it, and watched other vogue sports food assumptions come and go. Best is real food.

Throw in a blender or other mixer:

• Clean water
• Peeled banana
• Peeled orange with the seeds
• Some of the well-washed orange peel
• Raw walnuts or other favorite
• Some cooked brown rice left from a meal
• Sweeten with raisins or a prune softened in clean water. Molasses optional. Adds many minerals.
• Cinnamon powder to level blood sugar

Tips:

• For the day of the event, you can substitute tea for the water.
• Experiment with amounts to get preferred consistency
• If you want a chocolate shake, add a scoop of unsweetened cocoa powder (unsweetened non-dutched baking cocoa). People with migraine can leave out the cocoa.
• Don't junk it up with milk, sugar, artificial sweeteners, commercial sports powders.
• If you use a juicer, put the solids and pulp back in, or you will be drinking sugar water and throwing away the point and the nutrition.
• Try different fruit - Persimmons, mangosteen, pineapple, melon, berries, your favorite. Raw red beets are an overlooked sweet fitness food good in shakes.
  
• For flavors, add a small slice of unpeeled ginger root, washed mint leaves.

Labels: cold, endurance, fast fitness, nutrition, performance enhancing modality, swimming

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Nutrition for Endurance Swim Training

"Dr. Ernie" is training to swim the Cook Strait of New Zealand. We met him in May in Sixteen Miles of Cold Water, learned about cold acclimatization with him in Getting Fitter in 50 Degrees, and did Better Stretches for Swimming with him in Cook Strait Update.

Dr.Ernie (blog name) writes,

"The water temp now (has risen to) 14 degrees Celsius (57F) and I had a robust swim this afternoon in Wellington Harbour (photo below right). Interestingly enough there was virtually no shivering. I'd swum for about an hour and a half in the pool earlier today.

"I was struck by the difference between pool and ocean swimming... technically I've improved tremendously in the pool over the past few weeks and my times have improved greatly. In the ocean it's much harder -- but I felt faster nonetheless.

"I am not a fast swimmer -- in fact, at this point I am still too slow to pass Phil's test -- but I can feel I'm making progress. I've been able to hold a pace of 2.5 km/hour for a few hours, and this has been an improvement from a measly 2 km/hour not very long ago. And I'll be up to 25 km/week by the end of this month (about 15.5 miles a week - longer and generally more work swimming than running).

"My plan is to increase weekly mileage to 40 km (approx 25 miles) per week by the end of November and then to make a push through to 50 km/week (about 31 miles) by the end of December -- the 'crunch' month. I'll attempt to renter the open waters by mid-November and begin reacclimatization to the cold. With luck and persistence, I'll be granted the privilege of attempting the Cook Strait swim.

"I met with Phil Rush -- the man who has crossed the Strait seven times (including a double-crossing) and who holds the world's record for a triple crossing of the English Channel. He will be piloting the support boat for my attempt, which will hopefully be in February 2008. His advice: swim, swim, swim… then be ready to take a 6-hour test in early January. In the test I will have to demonstrate that I can sustain at least a 3 km/hour pace for the 6 hours. He told me I'd have to figure out the kind of sustenance I'd need on my own, and he recommended that I not try to gain too much weight -- though he cautioned not to lose any from this point on. He also suggested that I procure the skills of a swim coach to refine technique (Fitness Fixer posts in progress on faster healthier stroke mechanics for swimming).

"Any advice on nutrition or cross-training would be appreciated. Because I also have a full-time job, time is tight and hours in the water are limited. I've experimented with a commercial product (name deleted) for multi-hour endurance activities that's easy on the stomach."

I am not a nutrient biochemistry or epidemiology researcher, so I can only report what I have read from others, which can inadvertently repeat and perpetuate wrong information incestuously (we all say so, it must be true). Following is a summary of what I believe and have seen from working with my patients and athletes:

• In general, good nutrition all year will give more benefit than eating special foods for an event, race, or hike.


• Processed packaged sports supplement foods cost far more than the ingredients, and you can get healthier ingredients, cheaper, and just as easily without commercial sports powders, bars, drinks, and other preparations.


• Many nutrients need to work in the original food containing other components that make each part work better. Some do not work, or have even been found to increase health risks when concentrated in vitamin and mineral supplements.
  


• In general, no commercial processed "sports food," no matter how engineered or marketed as effective for training, will give you the health of healthful real food. Whole foods, for example, a simple apple with the skin, contain combinations of nutritional and disease fighting chemicals that are not available in supplements.


• "Energy food" technically means it has calories. Extra calories alone will not enable you to build muscle or win a race.


• Increasingly, some "energy food" and drinks contain stimulant compounds. This practice is a foolhardy one to become accustomed to, building cycles of inability to focus, exercise, or feel well without them, and varying degrees of agitation with them, sleep difficulties, and various cardiovascular risks.


• Products with soy are usually unfermented soy. Unfermented soy contains enzyme inhibitors which block digestion, goitrogens which inhibit thyroid function, phytic acid, which blocks minerals like zinc and calcium, and estrogen-promoting compounds. Anyone with tendency to estrogen-dependent tumors or cancer, fibroids, cystic ovary and breast, or endometriosis will be better to avoid unfermented soy.


• Even if sugar water will extend endurance, it is still junk food, not healthy for the long term. Science Daily reports "Sports drinks face junk food label"


• Protein and carbohydrate together work better for training than sugar alone, however commercial processed powdered mixtures are still not the healthy choice over the long term.

This is all good news. You can eat good tasting food, that is quick to make, and cheaper and better for you than expensive commercial "sports food." Click the nutrition label under this post for suggestions, with more to come in future Fitness Fixer posts.

Don't worry that you have to eat engineered products to be able to win. You will win better in the long run without them.

Recipe follows in Fast Fitness - Healthier Sports Shake.

More on all these issues plus some Halloween treat suggestions - Is Your Health Food Unhealthful?

Labels: cold, endurance, nutrition, performance enhancing modality, readers inspiring story, swimming

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Better Stretches for Swimming - Cook Strait Update

The September equinox was this weekend. At the moment of the equinox, the center of the disk of the sun crosses the equator. The northern hemisphere comes into Fall while the southern hemisphere begins Spring. For the day before and after that moment, the entire apparent disk of the sun passes the equator, and night and day are approximately equal length all over the world.

Japan celebrates three days before and after the equinox as a time for life reflection, looking forward and back. A Mid-Autumn Festival of the second of three fall harvests is celebrated in many East Asian communities around this time on a varying lunar calendar. The full moon closest to the Autumn equinox is the Harvest Moon, lighting long evenings of harvest work. The moon all during the month of the Autumn equinox is the Wine Moon, a good time for grape harvest, occurring (usually) around September in the northern hemisphere and March in the southern hemisphere.

With this equinox, the weather is warming in the Southern Hemisphere, meaning increased swim training for New Zealander 'Dr. Ernie' (blog name).

He is training to swim the 16 miles of the Cook Straight, introduced in May's post Sixteen Miles of Cold Water and updated in Getting Fitter in 50 Degrees.

Dr. Ernie sent the photo at left and wrote,

"This phase has been one of knuckling down. So here goes:
"Cook Strait Swim: Phase II
"Now it gets serious.....

"On June 6 I completed my last open water swim in Wellington Harbour in water temps of about 14 C: It felt really cold, the coldest I've experienced. The swim lasted 45 minutes and I noted that afterwards I didn't shiver at all -- a clear sign of acclimatization. I was advised by all to start serious swim technique and endurance preparation in the pool.

"I met with Phil Rush -- the man who has crossed the Strait seven times (including a double-crossing) and who holds the world's record for a triple crossing of the English Channel. He will be piloting the support boat for my attempt, which will hopefully be in February 2008. His advice: swim, swim, swim -- get up to 40 km/week by December (approx 25 statute miles or 21.6 nautical miles), and then be ready to take a 6-hour test in early January. In the test I will have to demonstrate that I can sustain at least a 3 km/hour pace for the 6 hours (a little under 2 miles per hour, a mid-training pace).

"Since July, I've been meeting with my coach, a former Olympian (I'll not mention his name until I've made it successfully across the Strait) and it's been hard going. But very necessary. What I assumed I could do on my own proved to be incorrect. For one, basic aspects of technique have been clarified and my entire stroke has been reworked in the past two months -- a good thing because I don't have a competitive swimming background and I've been doing lots of stuff to create drag. If' I' m to make it across the Strait I'll have to be extremely efficient. And I'll have to be able to keep up pace to stay warm. So my coach had done several important things: first, he's forced me to realign my body position, stressing posture, line and balance; second, he's pushed high-intensity sprint and interval training in addition to long distance swims. I plan to continue weekly lessons through the end of the year."

One of the things Dr. Ernie and I have been working on is better swim stretches. Good shoulder range of motion helps swimming. Some experts regard the extra range as always destabilizing for the shoulder joints.

I investigated this and found that much of the problem is unhealthful stretches, not the range achieved. You can have a mobile strong shoulder without developing instability or injuring the shoulder joints and surrounding cartilage and soft tissue.

Pulling one arm across the front of your body, left hand drawing, is The Stretch You Need The Least. Click the link for more about why.

The best way to stretch your shoulders is to stop doing this unhealthful stretch and do two healthier ones:

1. Front chest (pectoral) muscles, taught in Fixing Upper Back and Neck Pain
2. and Nice Neck Stretch. To make sure you get the stretch as intended and not lean or round forward, do the Nice Neck Stretch (trapezius stretch pictured at right) with your back and the back of your head against a wall so that you do not bring your head forward of the wall as you slide down to the side.

- Fast Fitness Friday this week will add a third stretch that is more effective than the common practice of pulling the elbow overhead with the other hand.
- Dr. Ernie's story will continue next week with more about nutrition for exercise training.
- Post from last year's equinox - Is Bad Martial Arts Good Exercise?

Labels: arm, holiday, readers inspiring story, shoulder, stretch, swimming

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Respiratory Muscle Training for Swimming, Diving, and Running

The previous post on training breathing muscles -
Respiratory Muscle Training for Better Health and Exercise - covered how breathing exercises have been found to help increase respiratory capacity in people with various diseases, and more recently, to help physical training in athletes. At the diving and hyperbaric conference three weeks ago, I attended sessions on respiratory muscle training for underwater operations. It is a topic of interest for those in charge of combat swimmers.

In one study, Researchers at the State University of Buffalo at New York found that respiratory muscle training improves swimming and respiratory performance at depth. As you go deeper, the work of breathing can increase, even using high performance breathing devices, because of higher gas density and other factors. They tested the effect of resistance respiratory muscle training on respiratory function and swimming endurance in divers at 55 fsw (~16 m). They found that respiratory muscles were less fatigued following training, breathing rate was lower during the swims, and that the training increased the duration they could swim by about 60%. They concluded that respiratory muscle fatigue limits swimming endurance at depth, and the increase in swimming endurance may result from reduced work of breathing or improved respiratory muscle ability.

The second study by the same group looked at the different benefits of training the endurance and strength of the respiratory muscles. Eighteen SCUBA-certified swimmers were randomly assigned to a placebo group who didn't train their breathing muscles, a respiratory endurance training group, or a respiratory strength training group. Each group used a breathing resistance device five days a week for 30 min over four weeks. The endurance trained group decreased heart rate and ventilation during underwater swims. Both the endurance and strength groups improved fin swimming endurance. The placebo group experienced no changes.

The researchers concluded that respiratory muscle training is effective in improving swimming endurance. They told me they found it is also effective for endurance running, but perhaps not as effective. They are working on finding out why. My friends who do long stints in submarines mentioned they like to use respiratory muscle training to help keep them in shape since they can't go out for a run while on sub duty.

The post Do Breathing Exercises Work? shows ways to try breathing training. The book Healthy Martial Arts gives more.

Labels: aerobic, breathing, endurance, hyperbaric, performance enhancing modality, scuba, strength, swimming

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Respiratory Muscle Training for Better Health and Exercise

At the American College of Sports Medicine conference last month, I attended an entire session on effects of training respiratory muscle function. Back when I was in school, we learned that the ability to breathe harder, better, faster, could not be trained with exercise or other modality, that it was fixed from person to person, like eye color, except that it got worse with aging, and that it didn't matter much, since ventilation did not do much to limit exercise potential anyway.

Even though the lungs don't have any muscles of their own, it didn't seem right to me, as the diaphragm and muscles that move the rib cage to voluntarily breath in and out are muscles like any other. What if there are people whose respiratory muscles are not trained to work hard enough and add to the metabolic cost of exercise, increasing fatigue and so, limit exercise? It is also true that many people are not in good enough shape to use more oxygen, so breathe most of the oxygen back out with each breath, even when exercising strenuously. What about someone in great athletic shape who could use that oxygen. Why couldn't they be trained to move more air faster if they needed some?

Exercising the muscles that you use to breath in (inspiratory muscle training) is known to improve the endurance of the respiratory muscles in people with spinal cord injury and cystic fibrosis, and is shown to improve exercise capacity in patients with heart failure. What about for people without these conditions or for athletes?

There is some published literature that does not show improved work capacity (J Sports Sci. 1991 Spring;9(1):43-52.) and some that show high-intensity training increases exercise capacity in people who are healthy (Phys Ther. 2006 Mar;86(3):345-54.).

The diving medicine conference two weeks ago had several studies that showed interesting and promising results with breathing training. Combat swimmers have long used various breathing training to get in shape for swims and other strenuous work. The next post covering respiratory exercises - Respiratory Muscle Training for Swimming, Diving, and Running - tells about it.

Respiratory muscle training in the above studies did not involve popping corks from your lips, as in the accompanying photo. To improve your breathing capacity and do training at home without respiratory training devices, see the post Do Breathing Exercises Work? and the book Healthy Martial Arts.

Labels: aerobic, breathing, circulation, endurance, performance enhancing modality, scuba, strength, swimming

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Getting Fitter in 50 Degrees

The Cook Strait, separating the north and south islands of New Zealand, is cold. Reader Dr. Ernie, 52 years old, is training to swim the 26 kilometers across the strait next February. Sixteen Miles of Cold Water started telling about it.

Cold water can be uncomfortable, even incapacitating. Scuba divers wear wet suits in cold water, and dry suits in very cold water, not only for comfort, but safety. According to International Swimming Federation rules (Fédération Internationale de Natation (FINA), marathon swimmers cannot use wet suits to stay warm. English Channel swimmer Ted Erikson is reported to have said that "wearing a wet suit in a marathon swim is like completing the Tour de France on a moped."

Unofficial swimmers can wear whatever they want, but the idea of training in the cold is to improve your fitness by training several body systems so you can generate more heat and better prevent heat loss. The process of increasing resistance to cold injury through regular cold exposure during real conditions is called cold acclimatization. The International Union of Physiological Sciences distinguishes acclimatization in actual conditions, from acclimation, which is change produced in a laboratory.

To be able to swim in the cold, you need to train in the cold water, not just swim in a pool. The idea is not supposed to be to make yourself sick and weak from cold, but to train to become healthier. Dr. Ernie writes:

"Last Saturday I did an 8 km swim: two and a half hours total, out to Somes Island in the middle of the harbour, fortunately dodging the big and small ships with the help of friends in an accompanying dinghy. It was a most gorgeous day. And though tired on the following Sunday, I felt ready to start up again on Monday. It was a tremendous confidence and stamina builder. Today (Sat) after about half an hour in the pool I ventured out and swam about 40 minutes -- water colder, rainy.... but exhilarating. Pretty much a sprint all the way (I have to stay warm enough). We are in our autumn here and will be easing into winter in a few months.

"I feel as if my best chance to make it across Cook Strait is not going to involve miles and miles in the pool, but lots of time in the ocean, hence I'm trying to maximize that, trying to become more and more familiar with its changing moods. I love it and am reaching a tremendous comfort with it even in rough conditions (as this past week). I'd really like to keep up sea swimming through winter without a wetsuit -- the water might get as low as 10 Celsius (50 degrees F).... we'll see."

Read more on cold immersion and cold tolerance in "Diving Physiology in Plain English."

Labels: cold, performance enhancing modality, readers inspiring story, swimming

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Sixteen Miles of Cold Water

A physician in New Zealand wrote that he is preparing to swim Cook Strait, the body of water separating the north and south islands of New Zealand, next February. The Strait is 26 km wide (16 statute miles). It may take him anywhere from 8 to 15 hours to swim, depending on tides and other factors. Temperatures range from 14 to 19 degrees Celsius (52-66 F). Body grease is allowed for the crossing, but no wetsuit, just a regular bathing suit. He asked me to call him "Ernie."

Dr. Ernie is 6'2", approx. 190 lbs, on the lean side. He shivers easily. He asked for suggestions about acclimatizing to cold water swimming.

Cold acclimatization means increasing your ability to tolerate cold. Cold acclimatization occurs through regular exposure to cold. People developing cold acclimatization don't need to shiver so soon, and generate more heat without shivering. They may develop ability to both increase and decrease skin temperatures. In some circumstances, skin blood flow increases to keep extremities warm. In other cases, it decreases to reduce heat loss.

Tolerance to cold improves with physical conditioning. A fit person can tolerate a colder external environment and lower internal body temperature than an unfit person before shivering begins, and they can generate more internal heat through shivering. Increased muscle through physical training increases their ability to produce and store heat. Being physically fitter allows you to exercise at a higher intensity to generate more heat. Cold tolerance increases more with exercise in the cold than from exercise alone. For that reason, you need to get out and exercise in the cold.

Dr. Ernie writes, "I've kept up my schedule of working on technique in the pool and have been in Wellington Harbour at least 4 times weekly for 30 minute swims: the temp is about 14-15 Celsius and I can feel myself slowly able to tolerate the cold better -- much less shivering after I'm finished."

A nice fat layer helps maintain warmth and buoyancy for cold water swims. You don't want so much fat that you are slower or unhealthy. I mentioned to Dr. Ernie, that maybe he can stay lean to make the training more effective (difficult) now, then gain the fat closer to time of the crossing when he will want an easier ride.

Ideas? Encouragement? Comment below.

Information on cold immersion and cold tolerance is in "Diving Physiology in Plain English." Read the next update of Dr. Ernie's training for the Cook Straight in Getting Fitter in 50 Degrees.

Labels: cold, performance enhancing modality, readers inspiring story, swimming

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The Story of the Black Belt

My Tuesday night martial arts class students continued transformation to healthy behaviour. Instead of chatting noisily, they sat quietly straight and relaxed. They sat down on the floor without needing to use their hands. Their equipment was neatly arranged. Instead of sitting glumly or chatting idly on cell phones about the usual annoyances from the day, they mentally put them away and were breathing calmly, focusing on what we were going to do in class. Last week we worked on elbow strikes, blocking, and double kicks. This week was triple kicks, faster footwork, and spinning backfist. Each week at the start of class we have a sitting Zen called the zesa or zazen. We kneel and concentrate on a story or parable, a historical lesson, or an inspiration to live life.

This week's story told the story of the black belt. Who wears one? Why? What does it mean? First, who doesn't wear one? Boxers don't. Kickboxers don't. Wrestlers don't. Chinese Kung Fu practitioners wear a black sash from the first lesson, not only when they become accomplished. Some aerobics instructors purchase one to wear like a chef's hat as a costume to look cool for boxaerobics. Anyone can buy one. What does it mean to earn one?

Color belts were not part of ancient martial arts. Dr. Jigoro Kano, founder of modern Judo, applied a system of belt colors in the early 1900's at his school, the Kodokan, in Tokyo. Some say that part of the inspiration was the ranking by color of swimmers in the Japanese military. Dr. Kano wanted to encourage and recognize his different rank martial arts students. The belt color system spread to other martial disciplines. Who wears belts now? Mostly the Japanese arts of Judo, Aikido, and Karate, the several Okinawan Karates, and the Korean Karates like Tae Kwon Do, Hapkido, Tang So Do, and others.

The symbolism for transforming from novice to black belt comes from starting white - blank - with nothing. In old Asia, you would not wear white to a wedding, but to a funeral. White is the emptiness. Black is the fullness. We all start with nothing, represented in our belt. As you work and learn and train, your belt turns yellow with sweat, red with blood, brown with your toil in the earth, and eventually black with the richness and fullness of your learning. Then you know enough to begin. You continue your dedication as your belt begins to fray and grey with age and wisdom, eventually turning white again, full circle. Zen.

I told my students that a black belt is much like a college degree. In many cases, it does not mean anything. It can show you passed time, but does it mean you learned? In some schools, some upper students bully instead of help those learning. They smoke and eat unhealthy food after class. In some schools, students advance belts by ritual exercises not sparring. In other schools, students fight continuously to subdue others, never taming their own mind.

The Founder of Aikido, Morihei Ueshiba, envisioned a martial art that would reject destruction and show strength through compassion. His revelation reversed thousands of years of harsh tradition. He named his art "Aikido," or "the art of peace." Honorably doing right is what all martial arts strive for, and is the true black belt.



Photo from when we lived and trained in Japan. See more photos and stories of how to change exercise to health in Healthy Martial Arts

Labels: martial arts, sitting, spirit, stress, swimming

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