Getting back in the game

Over the last few months, I’ve written about how I help clients manage their medical conditions with exercise. Professionally, it’s been a great way to educate and bring hope to those feeling overwhelmed by their circumstances. The majority of people that contact me do so with a certain level of frustration. We have more health and fitness information available than at any other time in history, but people are more confused than ever.

On a personal level, my experience with fitness solutions has been deeply satisfying. In this short time, I’ve had people cry, laugh and celebrate with me as they’ve begun to take back their lives. When someone is finally able to shift their mindset from overwhelm to clarity and then to focus, something magical happens. As hard as it is to “just get going,” it’s even harder to stop when you start noticing changes and sense that you are moving in a new direction.

All of this has been happening at an interesting time for me. I’ve been managing torn rotator cuffs and shoulder pain for a few years and decided to have surgery in 2016. On April 12, I underwent a pretty extensive operation for my right shoulder. Torn rotator cuffs were sutured, my “frayed” bicep tendon was reattached, the damaged bursa was removed and the joint itself was cleaned out of arthritic changes. A lifetime of contact sports and heavy weight training had really taken its toll on my shoulder.

Leading up to the operation, I considered my situation just like I would any client with this challenge. There were many times when I felt overwhelmed and frustrated. Pain and disability can lead to fatigue and depression, and I definitely had my moments. My tipping point came when I had to throw the ball underhand at the annual parent/kid baseball game in our park. I knew things had to change!

Setting a surgery date gave me the clarity I needed to develop a plan of action to get things moving just like I would do with anyone who came to see me. “>The program that I came up with consisted of four parts and would take me far beyond the date of my operation. Here are the phases that I created for myself.

“Pre-habilitation”

Most people have heard of doing rehabilitation after an injury or operation. There is evidence, however, that doing strength and conditioning exercise before undergoing a procedure can improve the odds of a favourable outcome and reduce the time it takes to recover following surgery. It’s important to note that this is different than working on the injury itself. In my case, this meant working around my injured shoulder to build as much supportive muscle as possible to stabilize the joint. I worked with rubber resistance bands and free weights to strengthen my upper back around the shoulder blades and the rotator cuffs. A big part of this phase is to enhance posture which can help decrease pain and minimize further damage to the joint.

Rehabilitation

The goal of rehab is to bring the repaired area back to full function as efficiently as possible. For me, this meant doing a range of motion exercises less than 24 hours after leaving the operating room. It’s no small feat to raise your arm when it is sore and swollen and you’re just starting to come out of the fog of anesthetic! Hats off to my surgeon who urged me to get moving as quickly as possible. It helped me to feel like I had some control over my situation. Currently, I am working with a physiotherapist on strengthening exercises that she designs for me. This phase can last up to 16 weeks and I am at the 10-week mark.

Reconditioning

Rehab and physiotherapy last for 16 weeks and reconditioning picks up at that point. Once my shoulder is back to full function, it will be weak and lacking in endurance. The goal of the reconditioning period is to build the strength and endurance that I’ve lost throughout my entire body. I haven’t had a proper workout in months! Another common side-effect of surgery is weight gain. The combination of no exercise and “comfort eating” have resulted in me gaining 12 pounds of unwanted body fat that I am determined to lose as soon as possible.

Possibility

To keep people really engaged throughout this process, I would suggest that “possibility” might be the most important phase of all. Rather than simply “getting better” and then working on maintenance, possibility explores what exactly you’d like to do once you are no longer in pain and injured. For me, it means that I will be mountain biking in the fall and playing hockey in the winter. My full return to sport should be in October, which is the six-month mark post-surgery.

Obviously, a plan like this would be modified depending on someone’s personal situation, but, the point is that clarity, focus and planning are the best tools for getting beyond overwhelm and frustration and moving on to rehabilitation and possibility.

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Finding your balance, part 2

In last week’s Fitness Solutions Column, I wrote about the importance of balance and how to assess it. (Visit thespec.com and search “Schramayr” if you missed it.) This week, I’d like to give you an idea of how you can improve your balance and include some of the exercises and tips that have most benefitted my clients.

To recap; I wrote about how balance and stability are related to your “functional capacity.” This is your ability to do different things such as housework, yard work, child care and the demands of your job. It also determines how and what you can do in the way of recreation, travel, hobbies and sports. As we age, maintaining our functional capacity also becomes a matter of safety. Falls are a very serious problem among the older population and improved balance, stability and co-ordination can decrease the risk of serious falls.

The 6 assessments that I described last week were broken down into two areas. The first measured whether you could hold yourself stable while balancing and the second was more active, where clients were not only balancing, but also moving their bodies in a variety of ways.

Once you have a good baseline score from the assessments, it’s time to get to work. After a few weeks of incorporating these moves into your fitness plan, I would recommend retesting yourself to see if you’ve improved and by how much. As your scores improve, you can move onto the more challenging assessments that I described.

Here are 5 of my favourite balance building moves to add to your weekly regimen.

1. Single leg hold during active rest. When you exercise, there are natural breaks after sets or at the end of a round of circuit exercises. Rather than resting, get up on your feet and do a 30 second Single Leg Hold while you recover. Experiment with different leg positions. You can simply lift one foot off of the ground, or raise your knee up to waist height for a more dynamic move. You can also hold the “floating” leg straight out to the side of your body for an added challenge.

2. Use resistance bands and experiment with different foot positions. I love incorporating resistance bands into client’s workouts for exercises like chest presses or for rowing moves. As you move further away from the spot where the band is anchored, there will be more resistance and your core will have to flex to stabilize your body. You can alter your foot position from wide to narrow and from staggered to parallel for a variety of balance and stability challenges. An added bonus is that these moves really work your core muscles.

3. Uneven weight distribution. My favourite way to do this is to hold a dumbbell in one hand only while doing squats. With an uneven load, your body will have to work hard to stabilize itself and to co-ordinate movement. Imagine the effort it takes to hold a bag of groceries or a baby in one arm while bending to pick up a dropped set of keys.

4. Do single leg hold exercises progressing from very stable to very unstable. You can do this by wearing shoes on a hard floor, progressing to no shoes, then moving to a soft surface, like a carpet or a lawn, and finally to a very unstable surface like a pillow or on sand. Always make sure you have a chair or partner nearby who can help you if you stumble during this exercise.

5. Walk the Plank! Find a line on the floor or stick a piece of masking tape on the ground. Walk the length of the line “heel to toe” with your arms out if you are unsteady. With my clients, I have them progress to “Walking the Plank” along a 2 X 4 on the floor. It’s challenging to say the least.

My favourite thing about these 5 moves is that they can be modified for all fitness levels. They can be super easy or made to challenge even the most elite athletes. Start slowly and make sure you always have something you can grab onto if you feel uneasy or awkward.

This past weekend was a milestone for me in my return to health and fitness since having shoulder surgery 9 weeks ago. I had a great Father’s Day on Sunday that included my first bicycle ride of the year. It was a gorgeous, sunny day and I rode 30 kilometres from Hamilton over to the lift bridge in Burlington and back. Today, it’s back to physiotherapy and more strengthening and stretching exercises.

Tools to help you find your balance

When someone’s fitness level is assessed, we tend to measure strength, endurance and flexibility. In my practice, I also like to look at someone’s functional capacity. My clients are usually with me because a loss of balance and/or stability make it very difficult for them to do things they love, like hitting a golf ball, riding a bike or even just going for a walk.

Losing balance can occur from a number of factors. Diseases like Parkinson’s, MS, stroke and arthritis interfere with the body’s ability to maintain balance and stability due to dysfunction of the muscular and nervous systems. Even in healthy individuals, the cells in the part of the brain that help us to stay upright begin to die off as we age. When this happens, it gets harder to correct the body as it moves through space and has to navigate things like curbs, stones or uneven surfaces. Vision and hearing problems make it difficult to channel information and the use of some medications and/or blood pressure issues can result in dizziness.

Loss of muscle strength, power, co-ordination and reflexes can play a massive role in someone’s ability to balance and stabilize themselves in their everyday lives and in their extracurricular activities. Fortunately, this is the area where we have the most control and where I am most able to help people.

As part of a two-part series on assessing and improving balance, here are my favourite ways to judge the balance and stability of my clients.

1. Single Leg Hold

Stand on one foot and time how long it takes before you touch your opposite foot to the ground. Record your score and repeat with the other foot. If you have serious balance issues, stay near a wall or chair that you can grab in case you wobble.

2. Abdominal Plank

Balance yourself on the floor from your toes and your elbows for as long as you are able to hold, pain free. Do not hold your breath in this position! This is a great measure of core strength and stability.

3. Single Leg Chair Touch

This is a much more advanced version of the Single Leg Hold. Balance on your left foot in front of a chair. Bend at the left knee and touch the chair as many times as you can with your right hand. If you stumble and have to touch the floor with your opposite foot, continue where you left off without restarting the timer and record how many touches you get in 30 seconds.

4. Standing to Lying to Standing

This test should not be performed by people with low blood pressure, back pain or problems with dizziness. Stand in front of an exercise mat and start a timer for 60 seconds. Lie down on the mat on your back and then stand back up. Record how many times you can go from standing to lying to standing in 60 seconds.

5. Modified Standing to Lying to Standing

I came up with a modified version of this test for seniors or others that find it challenging to simply get on the floor. Rather than repeating for 60 seconds, I have the client lie down and stand up only once and then record the time it takes.

6. Timed Up and Go “TUG” Test

This test is very useful for people with conditions like MS, Parkinson’s and Arthritis or post-stroke. The client sits in a straight back chair and a spot is identified 3 metres away. At a signal, the client will rise (using assisting devices if necessary) and walk to the 3 metre mark, turn, return to the chair and sit down. Their time is recorded for retesting later on.

I’ll pick and choose from the tests outlined above depending on a client’s current fitness level and or level of impairment. When I get a score, we’ll use it to compare to a retest every few weeks. Recently, I had a client improve on the Stand to Lie to Stand from 4 to 8 ½ repetitions in just 4 weeks and another client decrease his Modified Stand to Lie to Stand score from 105 seconds to 28 in the first month. These improvements are significant and will have a huge impact on their daily lives.

Next week, I’ll let you in on some of the exercises that my clients use to get the kind of improvements that carry over to their lives in meaningful ways.

I’ve started physiotherapy for my surgically repaired shoulder in the past week. This means that I’m working on strengthening and moving it more these days. I’m a little sore today, but I was able to shovel top soil into the garden on the weekend, play a game of pool and even strummed my guitar for the first time in two months. Slowly, but, surely I’m getting back in the game.

Tweak your workout for life changing results

I’ve been in Collingwood for the past several days with my family for my daughter’s dance competition. We decided to make it a bit of a vacation and take in the scenery at Blue Mountain where the event is being held. The views here are absolutely gorgeous and inspiring.

Our road trip coincided with the fact that I was moving into a new phase of recovery following rotator cuff surgery. Aside from daily mobility stretches, my arm has been completely immobilized for five weeks to allow it to heal properly. While in Collingwood I was able to remove my arm from its sling, so I decided to do my first workout in six weeks in the hotel gym.

My workout started with “body weight only” arm movements before moving on to leg and core exercises and then about 30 minutes of cardiovascular work.

While I was in the gym at the hotel, I got to observe a nice, older gentleman come in for his own workout. He looked to be about 72 years old and looked like he had been sitting, hunched over a desk for at least 40 of those years. His posture was terrible with his head jutting forward, his shoulders rounded and his lower back flattened. Nevertheless, I was impressed that he was making the effort to work out while on vacation!

While I was riding the stationary bike, I watched him go through his routine with great efficiency. He had clearly done this before. As I watched him, it occurred to me that he was doing exactly opposite of what I would have assigned him for a workout if he were my client!

A common mistake that many exercisers make is to only work on the parts of the body that they can “see in the mirror.” This man was doing exactly that. He started by riding the recumbent bicycle for 15 minutes, pushed up close to the handlebars. While the cycling might have elevated his heart rate, it put him in a position that made his postural problems worse and did nothing to warm up his joints and muscles.

After his warmup, he moved on to strength exercises. Chest presses, abdominal crunches, leg extensions and finally bicep curls. Every one of these moves strengthens a muscle group at the front of the body, which in his case was already too tight. He ignored the muscles that he couldn’t see which could help him stand up straighter.

To make matters worse, he performed his entire routine sitting down, slouching forward.

So … to reiterate, I admire this man for going to the workout room and putting in the effort. I feel for him, knowing that his diligence could be moving him in the wrong direction. He’s not just wasting his time; he might actually be making himself worse!

The good news is that his workout routine could be fixed very easily. Here is what I would do if he were my client.

First, I would get him out of his seat! Sitting, slouched over a recumbent cycle is the wrong way for him to warm up. I would have him perform a series of chopping movements with a medicine ball or a light dumbbell, standing up, and emphasizing proper posture and alignment of the spine.

For strength training, he could continue with the exercises that he is comfortable with, but, rather than sitting and resting between sets, he would perform at least two exercises for the back of the body. Rather than doing a set of Chest Presses and then resting, he would do the presses followed immediately by a rowing exercise and then by a back extension. He would rest, standing up, before starting the cycle of three exercises over again. This “superset” method could be applied for each of the exercises he was already doing.

After strength training, he would perform up to 12 minutes of aerobic exercise, on his feet, using the elliptical trainer or the treadmill. Every three minutes, he would speed up for a 20 second burst of effort for the duration of the 12 minute session.

A great way for this gentleman to complete his workout would be with some static stretches, specifically for the tight muscles at the front of his body while he was cooling down.

With just a few tweaks, a disastrous workout can become a routine that can be life changing for an exerciser that is well intentioned and disciplined, but, lacking in direction.

How to keep your joints strong and mobile

When I started writing Fitness Solutions, I introduced readers to the “7 most common conditions that I help people manage with exercise.” It’s important to reinforce that the job of a medical exercise specialist is never to diagnose or to treat a condition. Diagnosis is left to medical doctors and treatment is the domain of physiotherapists. What I do is help people manage their conditions with exercise.

One of the most common problems that I help people overcome are joint disorders related to osteoarthritis (OA).

Osteoarthritis refers to the arthritic changes that happen in a joint due to age, injury, overuse or just daily wear and tear. It involves inflammation and can start in the cartilage before spreading to the opposing bones. Cartilage is the tissue in a joint that provides “shock absorption” so when inflammation happens, the joint loses its integrity and bony surfaces become rough and don’t slide over each other as well as they used to. Pain and instability are common and if the joint affected is for weight-bearing like the knee, ankle or hip, and loss of function can be expected.

If you have arthritis and are starting an exercise program, it is important to go slow, modify your plan through trial and error and develop a balanced program. Balance means doing a combination of strength training, flexibility exercise and endurance activity. Balance also means working at a level that is challenging enough to stimulate the body to get stronger while not so difficult that you can’t recover between sessions. My favourite way to do this is to use several different training modalities. Some workouts are for times when you may not feel your best and others for when you really want to push yourself.

Here are my three favourite workouts for people dealing with joint problems due to osteoarthritis.

1. Aquatic exercise. The thing that I love about working in the water is that it is so adaptable to all fitness levels and is so low impact. If you are sore and tired, just walking and stretching in a warm pool can do wonders for your recovery. On the other hand using things like deep water vests and water dumbbells can allow you to do a workout similar to being in a gym for when you want to really push things.

2. Weight training. For building supportive muscle around an arthritic joint, there is nothing that works as well as weight lifting. Whether you use free weights, machines or rubber resistance bands, the key is to work in a pain-free range of motion and to build muscle equally on all sides of the joint.

3. Static stretching. Joints that are affected by OA become stiff. Stretching the muscles around that joint can help restore proper range of motion and even decrease pain as function is restored. Like weight lifting, you should only ever stretch within a pain-free range of motion. My recommendation is to spend some time warming up, either in a hot shower or by doing some cardiovascular work before doing a stretching routine.

When you do get into a routine of strengthening, stretching and building endurance, it’s important to monitor how you feel. I always tell my clients that it’s OK to feel muscle soreness, but, it is never OK to experience joint pain. OA sufferers may require more time between sessions due to pain, swelling or fatigue and having alternatives to an all out workout is crucial. Arthritis pain shouldn’t be worked “through,” but, it can often be worked “around.”

My own rehabilitation after rotator cuff surgery is entering a new phase this week. The first was to immobilize the joint to allow it to heal. This was done by staying in a sling at all times other than when doing mobility stretches.

On Thursday, I will be out of the sling and will start to use my muscles to lift my arm in several planes of motion against gravity. I’ll also be working with a physiotherapist who will start to actively mobilize my shoulder. Thinking of this, it occurred to me that, other than walking and staying active, for the first time in my life I haven’t actually exercised in 6 weeks!

With summer approaching, I’m really excited to get moving again, with a plan, as my shoulder gets stronger. I’ll work on losing the eight pounds I’ve gained since my operation as well as getting back to mountain biking and then back to men’s hockey in the fall.

Here’s help managing your energy level

When you think of the different pieces of the puzzle that make up someone’s health and fitness, there are three things that jump out at you: Strength, endurance and flexibility. There’s no doubt that these three are critical, but, I would suggest that a fourth might be just as important … if not more so. The fourth key to real, long-term fitness I would suggest we consider is energy.

We live in a world that is increasingly connected and that never shuts down and as a result, we have a population that is tired, stressed and lacking in vitality. The reality is that this isn’t going to change any time soon, so it becomes even more important to learn how to manage your energy levels while you navigate your daily life.

On most days, I have a client that tells me that they are sick and tired of … feeling sick and tired. When they come to me, they’re frustrated because they think they’re doing all of the right things and still not seeing a payoff. The good news is that, with a few tweaks, increasing your energy levels can happen almost overnight.

When I meet someone who says they have “no energy,” I discover they are usually missing out on one of the four key elements that provide the kind of endurance that gets people out of bed in the morning and feeling alert and awake long into the afternoon and evening.

These four key elements are:

• Blood sugar stabilization through nutrition

• Efficient oxygen transportation from fitness training

• Balance and recovery via sleep and stress management

• Mental renewal through hobbies and play

I can think of one client in particular who felt like her whole life was a struggle just to make it to the end of the day and then go home to crash. She thought that she was eating “healthy” and she was walking a couple of times per week. After getting to know her, she handed me her food journal. Her diet was, indeed, quite healthy. Mostly homemade and very few empty calories. What really stood out were the long gaps between meals or snacks. She ate breakfast before going to work and then usually had nothing to eat until dinner 12 to 14 hours later! Her blood sugar levels would drop to nothing and she would be so tired that she sometimes felt dizzy. She started packing a lunch and an afternoon snack that included some protein and, as her blood sugar levels stayed consistent throughout the day, her mid-afternoon slump disappeared.

The walks she was taking were leisurely at best and mostly on weekends. It became a priority for us to design a quick, efficient workout she could do at home three times per week to build her strength and aerobic capacity. While not long, her workouts included higher intensity exercise “bursts” to make her better at moving oxygen rich blood throughout her body.

An interesting thing happened as her vitality increased. Her days became more productive, so she got more done at work and did more at home after work. When it was time for bed, she slept more soundly then she did in years, meaning that she didn’t feel like she was dragging the moment she got up in the morning.

One of the things that she started to do with her new-found energy after work was to get back to her hobbies, which included doing arts and crafts. The importance of this can’t be overstated. Most adults lose the ability to “play” or just do things for the fun of it. Playing and participating in hobbies helps us to relax and brings our stress levels down. The benefits can be similar to those you receive after a vacation. It helps bring perspective back into our lives and even gives us a sense of control when our days might feel like they are controlled by everyone else. It’s the reason your doctor plays golf every Wednesday! For you, it can mean learning guitar in the evening, growing tomatoes in your backyard or colouring in an adult colouring book. When you feel renewed, you are given a new beginning with a full tank.

Last week, I had my surgical followup for my shoulder. I’m happy to say that I seem to be right on schedule. My range of motion is a little bit better than average and I will be adding a fourth set to my stretches during the day. Other than that, I am still in a sling for the next three weeks and learning to live with one arm. My pain level is still extremely low and I haven’t taken a pain pill since the third night after the operation. Basically, my instructions are to protect my shoulder, keep it close to my body and let it heal. Easier said than done!

5 keys to managing back pain

Back pain affects a large segment of our population. For some it pops up occasionally, while others live with it continually. It can affect the upper, middle or low back area and can be caused by a one-time event or by long-term overuse and poor lifestyle behaviours.

When you suffer from back pain, it seems like it’s the only thing you can think about. It saps your energy and makes it hard to focus on anything other than managing it. There are three main reasons that back pain occurs in the general population: disc bulges or herniations, muscle or ligament strains, and arthritis.

Whether the pain comes as a result of a one-time event, like an accident, from long term overuse or from poor lifestyle choices, there are ways to manage it.

After years of working with people who suffer from back pain to different degrees, I have identified 5 keys to managing back pain.

1. Build strength and stability in your core. The muscles of the “core” include the abdominals, the lumbar extensors, the hips and the buttocks. The best strength moves for the core require little or no equipment and include moves such as abdominal crunches, planks, hip bridges, back extensions and resistance band rotation exercises.

2. Decrease, as much as possible, the amount of time that you sit. If you have a desk job, take your breaks standing or walking. If you must be on the phone, use that as a chance to move around and walk during your lunch hour. If possible, consider using a standing desk.

3. Exercise in ways that counteract what you do all day at work. If you are on your feet all day, sit down to exercise using machines. If you sit all day, try circuit training and functional exercise where you are mostly on your feet. In today’s world almost all activities involve being in a flexed forward (hunched over) position. This makes it crucial to spend time focusing on the muscles that hold you upright. These include the muscles that pull your shoulder blades back, hold your head up and help you to sit up straight.

4. Decrease your stress levels. Use tools such as daily check lists to reduce the feelings of being overwhelmed that come from being pulled in too many directions. Working from a list allows you to focus on one task at a time before moving on to the next. People who feel stressed will ignore pain signals and continue working through them. If you feel chronically stressed, try activities like yoga or meditation or simply go for a walk outside.

5. Examine how you sleep and choose the right bed for you. Generally, a firm mattress that provides support will be best for a healthy back. Some people with back pain find relief using body pillows to support their knees, hips and spine in different positions. This is a way to keep your spine in proper alignment while sleeping, which reduces tension on the muscles, ligaments and even on the discs.

If you have back pain that lasts for great lengths of time or causes numbness, tingling or shooting pain into a limb, it’s important to seek attention from a medical doctor, physiotherapist or chiropractor. They will assess you and will help you to plot out the best course of action to find relief.

While medical exercise specialists and personal trainers can help you tremendously to manage your injury, it is outside of their scope of practice to diagnose a problem or to “treat” a problem where these symptoms exist. If you have the symptoms listed above, get to your doctor!

As I write this, I am five days post-op after my shoulder surgery. Two rotator cuffs were sutured, my shoulder joint was cleaned and smoothed and my bicep muscle was reattached to a new location on my upper arm bone. These procedures required drilling, sewing and filing. Incredibly, however, I have no pain. My surgeon insisted that I begin stretching exercises the day after the operation and I think this has made a big difference. I’ll be using my strong arm to move my operated arm three times per day for the next couple of weeks (You can see a video on my YouTube channel demonstrating the moves) and then we’ll assess whether I can move onto strength exercises. Above all, consistency is the key to success and I plan to be diligent with the homework that I’ve been assigned.