Achillies Tendon Rupture: Post Surgery Week 1-2

On Dec 2 in a Cyclocross race my left achllies tendon ruptured.  On Dec 5th I had surgery to repair it.  I took that week of work off between doctors appointments and surgery and used the guidance of elevatation to help to control swelling.  I went back to work the following Monday and worked a regular schedule with the help of a knee scooter.

The doctor told me it was the worst achillies rupture he had ever repaired.  In his words there must have been a previous tear in there.  Because of the extensive damage he decided to put me in a cast for 12 days instead of the normal 3-5.  Being in a cast wasn't that bad until a week in and the itching started.  Nothing you can do about it.  Those were some sleepless nights.

I got on an air dyne that evening after surgery to help try to get whatever residual anesthesia may be in my system and get some blood flowing.  I used a Marc Pro a minimum of 2-3x a day for 1-2 hours each for the first week.  I continue to do that at least once a day.  Here is a timeline of modalities used and why.

Day 0 surgery.
Introduced air dyne.  10-20 min easy effort.
Marc Pro 3 sets of > 60 minutes
Kept the foot elevated
Wrapped blood flow restriction band (BFR) around upper thigh and did bodyweight leg extensions.
Did Glute ISOmetric holds for time.  Both sides.
Hip Flexion, knee rotation CARS
Side planks with Active Movement

Day 1-3
Pretty much did the exact same protocols.  But did this 3x a day.
I added in bone both with gelatin and 3-5 grams vitamin C in a drink that I slugged down 30-60 min before I rehabbed.  Who knows if this will help, but it can't hurt.
Reverse Hyper without any weight with Slingshot around my knees.  My thought process is that I was getting some type of stimulation into the calf perhaps.
Regular GYM work for what I would do for upper body, lots of extra pulling work.

Day 4-7
Started pushing through the heel of my cast into the air dyne pedals.  This felt good.
Extra seated work at the SkiERG
Light band resisted knee extensions with BFR on upper thigh.
Stopped taking the Ibuprofen they recommended.  I felt like I was controlling inflammation well with exercise and the research seems to say NSAIDS delay tendon healing.
Still taking baby Aspirin morning and night to help prevent any clotting issues.

Day 8-12
Lack of showering under my cast is starting to feel it.  Itching.  Nothing you can do about it.
Kept up all the same work as previous days.
Got the cast off!

My doctor walked in looks at me and states,  "You tore the shit out of it."  But it looks like it's healing well."

I was shocked at how swollen my foot looked.  I thought I had been doing a pretty decent job of elevating and movement when I wasn't working.  Now I'm in whats called a CAM boot now.  Locked in Plantar flexion of 20 degrees for 2 weeks and then 10 degrees for two weeks and then at a month at neutral or 90 degrees.  It just feels awesome to be able to take it off.  I've found that If I put half a deck of cards in my Timberland boots it makes for a secure workout bike riding boot.  I can ride much more aggressively and really drive through the foot with no pain.  Thats big.

Day 14
Holding ISOmetric lunges with the left leg forward for repeated sets of 20-30 seconds.  I can raise up out of it for 2-3 inches with minimal pain.  Going to start doing LOTS of this.

The next few days, I'm going to feel out, band assisted bodyweight box squats, hip thrusts loaded,  Seated calf raises and some alactic/aerobic work like 10/50 work to rest for blocks of time.

There is nothing like skin in the game to start really reading and applying something to your life.  All injuries have reasons.  Do we ever figure them out is another story.  But, I've come to accept that this one is 90 percent my fault and 10 percent shit happens.  This achillies has a history of bothering me.  I would do some eccentric calf
raises for a few months, bring back some jump roping and by fall it would be feeling pretty good again.  Winter comes, I don't do a much of that stuff and I think my tendon, which had a small tear in it apparently already, would get cranky from "spring enthusiasm" and be sore in the summer, start to rehab it, be good by fall.  Cycle starts again.  This year I got more into biking and spent most of my time biking.  After chasing a 1/2 mile time I wanted to beat, it got sore, but instead of rehabbing, I just biked more and avoided it, I believe without the loading, my tendon got weaker.

I didn't do the work.  Tendons need load, not rest.  Things I knew, but didn't apply.

"Knowledge without application is simply knowledge.  Applying knowledge to ones life is wisdom, and that is the ultimate virtue."  Kasi Kaye

Achilles Tendon Rupture: Pre Surgery Day 1-3

When it comes to injuries, hindsight is 20/20.  It's easy to look back in time and create the why.  It's also easy to chalk up injuries to bad luck.   As a Strength coach and Chiropractor/therapist I want to know the why's.  I don't believe in bad luck.  There are reasons.  I don't know all of them, but we do our best to learn and move on.  We also have to be careful to not just create reasons because it fits with our need to have answers.

Sunday morning I had a complete rupture of my left achillies tendon.  I somehow saved my bike from a slide out, I must have used my leg as a kickstand and I felt someone run into or kick my calf.  I looked behind me to see who was there, and in that matrix like moment, time slowed, I saw no one, dropped an f bomb and knew.  I knew instantly when I didn't see anyone behind me.  In the seconds that processed through my brain I thought, here comes the next year of my life.

I've had on and off pain in this achillies tendon for over 10 years.  So chances are there are some decent amount of degeneration in the fibers before the rupture.  From a mechanics stand put, this ankle has lacked as much dorsiflexion in it since a pretty bad ankle sprain that limited life for about 6 months as a freshman in college, jumping over a wall and landing on a parking berm.

Take Care of Your Joints.

It would come and go the inflammation around the achillies.  One thing I've neglected is dynamic loading when I was feeling good.  We know you need to use the qualities you want to keep.  Healthy tendons need load, eccentric strength and must go through stretch shortening cycle.  This had started to fade over the years.

Variable Loads Are Needed.

I normally take my HRV every morning, but I had just finished getting over a weird cold that seemed to last 18 days and had gotten out of the habit.  It had left me with good power in terms of strength, but anything over 160 heart rate I was wiped out.  Part of me thinks I was still fighting something, had extra inflammation in my system when this all when caput.

When I got home from the ER, that Sunday reached out to a bunch of friends and got some surgeons names that were recommended.  I was able to see my Doc Monday morning and he stated it was a bit higher then normal.  I said, great more blood flow!  He said yes, but less tendon to work with.  (here's hoping I'm right)

A good friend sent me to the website of Dr. Amol Saxena, one of the leading foot/calf guys in the world.  He performs lots of achillies surgeries on athletes who's livelihood depends on it.  He lays out a great rehab protocol.  Week by week.  Post Op Rehab Achillies

Nutritionally I'm going to do a very high protein, high fat, low carb diet for at least a month.  Essentially eat no junk and try to limit inflammation.  Bought a bunch of high quality bone broth to drink multiple times a day to see if I can maximize connective tissue health.

Have a Plan

ALTIS just posted a nice recap of their Coaching program and one thing that stuck out was this from Matt Jordan.  1.  Know what matters.  2.  Measure what matters.  3.  Change what matters.  Dr. Saxena has seen hundreds through to the return to running and 3 things matter.  1.  Perform 5x25 single leg raises with 15 seconds rest between sets.  2.  Have a post operative limb within 5mm of the good leg.  This is tricky as mine was already 1.5-2 cm smaller from when I had a back injury to the left.  My goal will be to get as close to the size pre surgery.  3.  Have ankle dorsiflexion and plantarflexion of 5 degrees of the good limb.  If access to an AlterG run 85% bodyweight for 10 minutes.

Be Abel to Measure Your Plan

Surgery is in the morning.  Then the fight begins.  It's been humbling to feel and hear all kinds of support from family and friends.  My wife has been amazing.  Funny, after my first thought of oh shit I tore my achillies, my 2nd thought was, Kelly is going to kill me!  lol

Instagram @drjasonross

Developing a Template and Momentum for 2018

When you watch a lot of sports you get a sense of the power of momentum.  It's a very weird thing to witness.  One team seemingly has control, but one play later and things can change.  That one play leads to another.  Everyone can feel it.  Players that weren't making plays, start making spectacular plays.  The ball starts bouncing their way.   Momentum is powerful.

"Momentum solves 80% of your problems. "  John Maxwell

This is about building some momentum going into the new year 2018.  People want to think that a new year is a new you.  There hoping that some extra magic happens because they watched a glittery ball drop.  

Instead of starting from scratch, prepare, get it going.  Preparation is the key to getting where you want to go.  Most peoples new year resolutions revolve around being more healthy.  That is hard to define.  So take the time to define it.  Perhaps it means losing 15 pounds.  Getting your blood pressure low enough to get off medications.  Complete a 100 mile bike race.  Do your first 5k.  Walk a 12 minute mile.  Eat 3 servings of vegetables a day.  The list is endless. 

 

Step 1.  Define in very specific details what you want to accomplish.  

This needs to be written down.  Research has shown that what gets written by hand is a much more powerful way of doing things.  Buy a journal/writing pad that can be used daily for a year.  Get a pen with blue ink.  Research says we remember blue ink better then black ink.  (It can't hurt!)

Now, one can have more then one goal, but it's hard to have 3 or 4 specific and different goals.  But, some goals become very similar when you break them down.  I'll have several people tell me they want to get to the gym more, eat better, lose some weight.  At the end of the day, they are all kind of the same goal.  Write a book, lose weight, attend all my kids games, make more money.  These are all very different goals.  So choose wisely.  

Step 2.  Figure out what you are going to give up.  This is the power of negativity.  Example is giving up smoking.  Your not doing anything extra, but your stopping doing something that isn't healthy.  Perhaps it's giving up your happy hour with friends or one night out a week.  Giving up TV, cable.  Giving up buying a treat with your coffee.  Make some time for what your trying to do.  At the very least, by examining your week/day hour by hour, you will be much more conscious on how you are spending your time.  

"How we spend our days, if of course how we spend our lives.  What we do with this hour and that one is what we are doing."  Annie Dillard 

Step 3.  Make a list of all the Micro things it takes to accomplish your goal.  

Take the Micro and make it Macro for awhile.  I call this the consistency beats intensity.  We all know the person that is gung ho for a few weeks and then fades like a shooting star 3 weeks in.  They stuff every possible new habit into the day.  Wake up early, eat a crazy smoothie, hit the gym, run, cook every meal, do yoga, no TV, go to bed early, read that book.  3 weeks later, they are stressed out and burned out.  

Take what you envision to be your ideal day and mold that day into a week.  Instead of cooking every day, pick one dinner out of 7 and cook that one.  Get that one meal down.  What to buy for it, what to keep in your fridge to make it.  Did you cook that one meal one time in the week.  That is a check mark in your journal.  

Instead of hitting the gym everyday.  Get to the gym one time. (Gym is just a word for lifting weights)  Work out for 45 min doing something you enjoy.  Did you do that one time this week.  Check it off in your journal.

Did you floss your teeth one time this week?  Did you elevate your heart rate for 30 min one time this week (aerobic stuff).  Check those boxes off.  Wake up early one day, go to bed early one day.  Check those boxes. 

The idea is to make a checklist of what your vision of a perfect day is.  Then expand your day to a week.  So it's not about burning out day to day, it's about building slow growth over the course of that week.  Get momentum, (there's that word again).  Create consistency with smaller commitments that will most likely bleed into bigger ones.  Also check those boxes, for real.  Are brains are wired to achieve pleasure in marking off things done.  They are victories after all.  

Step 4.  Remove Restraints

Listening to Freakanomics Podcast on Behavior Change and they interviewed Daniel Kahneman.  He had a great idea that he credited to Kurt Lewin, that peoples behavior is driven by two main forces.  Restraining and Driving and our behavior is the equilibrium between these two.  There are two ways of going about influencing behavior.  Get rid of the restraining forces or increase the driving forces.  Increasing the driving forces is a poor choice, getting rid of the restraining forces is the key.  

Instead of trying to figure out how you can eat more vegetables, figure out why you aren't doing it in the first place.  This goes for everything.  At the end of the day, we all have more then enough information.  We need more application.  One by one address the answers that pop up with the question why not.  Remove the restraints to make moving forward easier.

I never have vegetable in my fridge when I get home from work.  (Every Sunday I'll buy vegetables)

I go to make them and they have gone bad.  (Ask the groceries or Google what are the best vegetables that last a full week or how to store vegetables.  

They taste bad.  (two recipes on google with spices that create an enjoyable eating experience)

Clean up is annoying and tiring (aluminum foil on a cookie sheet)

Step 5.  Create Discipline

Look at your week and write down when you are going to do what.  Obviously make sure that it's a real time commitment.  Can't hit the gym at 530 if you routinely get out of work at 545.  No matter what, commit to what you put in writing no matter what you "feel."

Feelings at the end of the day are irrelevant.  I don't feel great, so I'm going to skip the gym today.  I feel tired, so I'm not going to cook tonight.  We have all said that and done that.  How many of us have said I'm still tired I'm going to lay in bed and not show up to work?  My kid is really bothering me today, I don't think I'll take the time and get dinner for him.  Can you see how silly that sounds.  We can keep commitments when they are obvious.  Just eliminate feelings as a choice. This is how discipline is created.  Doing what you said you would do.

"Discipline Equals Freedom"  Jocko Willinck

Get started now, create momentum to hit the ground running in 2018.  Don't wait for the glittery ball to drop.  

Patience in 2.5 Unit Increments

There are a lot of quotes on patience.  A quick google search will brings hundreds of memes that extol patience.  We all know we need it, very few of us want to use it, even fewer of us want to be in situations that require it.  I speak from experience.

 We all know it's useful but unless there are concrete actionable steps to take, be patient becomes just another saying.  Want to be successful, early bird gets the worm.  Cool.  Wake up early and then what?  See what I mean, memes and saying look nice on a quote board, but unless a plan is in place, sayings are just poems.

I came across an article about a man learning to use the 2.5 minute rule with his kids.  Every task, partition an extra 2.5 minutes because kids are slow, less dexterous, and some things aren't memorized motor tasks.  Ask them to put their shoes on, extra 2.5 minutes.  We can slip our shoes on literally in a few seconds.  Not so much for young kids.  Tasks like this.  Give yourself and your kids this leeway.

I learned early on that you need to partition extra time when you are taking your kids somewhere.  I learned it so well almost 6 years in with kids, that I'm only late like 3 out of 5 times.  Of those 3 times, I'm sure I was a bit stressed and I'm sure I stressed them as well.

There was no plan.  If you don't have a plan, you ultimately don't succeed often, when you do, it's probably by luck.  Give your self "extra" time is just arbitrary.  2.5 minutes is concrete.

When I first started lifting weights.  The only principle I understood was that if I put more weight on the bar then the last weeks effort, I was getting stronger.  If I kept doing this, I'd get to where I wanted to go.  So I used those small 2.5 pound weights every single time for my last set.  If I beat my last weeks effort, I'd go up 2.5 pounds on each side the following week.  If I didn't I stayed there.

Those 2.5 pound weights got me where I wanted to go.  They also taught patience.  You don't go from squatting 135 pounds to 405 pounds in big increments.  Your body needs time to build up connective tissue, motor unit recruitment, cross sectional muscle development, vascular networks and loads of other physiological adaptations.

One of the things I've noticed with myself is the lack of patience with some of my bigger lifts in the last few years.  I've also noticed lack of progress.  Part of it, is just being content at staying at a certain weight.  Part of it, was just lack of patience.  Wanting to just get
in get a lift in, but not having the patience to commit to slow progress.

With winter coming, patience in 2.5 unit increments is becoming a concrete goal.

"The two most powerful warriors are Patience and Time."  Leo Tolstoy

The MOBI Is A LifeStyle Tool for Better Movement and Recovery

We know that information doesn't lead to change.  Facts are not enough to convince us to do something or change a habit.  Would anyone still smoke if facts were enough?  We all know some very basic health facts, that not all of us do.  Do we all floss?  Do we all eat 3-5 servings of vegetables a day?  Do we all wear a seatbelt?

So if facts don't change our habits, what does?

Charles Duhiggs book the Power of Habit is one of my all time favorites.  In it he outlines a habit loop that consists of 3 parts.  Cue, Routine and Reward.  

1.  Cue.  Some call it the trigger or reminder.  This is usually visual.  I see it, so I'm reminded to do it.

2.  Routine.  Because of the cue, you proceed to do what has been determined to be correct action.

3.  Reward.  Because of the action taken, we usually have a burst of dopamine that reinforces good behavior.  For example, floss tonight and you will feel accomplished.  I took positive steps towards my goal.  

We created the MOBI to be a musculoskeletal tool for your connective tissue.  Part recovery tool, part mobility tool, but 100% lifestyle tool.  What does that mean?

Our goal was to create a visually appealing, aesthetically sound device that feels natural to have around.  It feels good to hold in your hands.  It doesn't look weird to be laying flat on your desk at work.  It travels well regardless if its a backpack, computer bag, yoga mat or gym bag.  

We wanted something that was around.  Visual cues.  I'm an out of sight out of mind type of person.  If I see, I do.  I keep post it's on my computer of things I have to do.  If I see the book I'm reading on the couch, I pick it up and read it.  If my kids knock it under the couch, I tend to almost forget about that book.  The biggest benefit to MOBI in my eye is the greatest asset any athlete can possess,  availability.  If an athlete is not available, they are not helpful to their team.  If something can help you, but you don't have it with you, in the end it's not helpful.   MOBI is designed to be "available."

If your foot has pain with walking, of course you will be reminded about trying to do something for your foot.  But, why wait for pain.  We have been taught at a young age to brush our teeth morning and night, not because they hurt, but because they keep our teeth healthy.  

What did your parents, coaches or health practitioner teach you about the rest of your body.  Do you have a physical practice or routine that helps the muscles, fascia and joints to move and feel better?  

Do you do something daily that helps with how your body recovers or moves?  

I want MOBI to be that tool that becomes your cue.  We have created videos that show routines to help create small 60 second actionable steps to form your own personal movement and recovery routines.  It doesn't matter if you are sitting at your desk, finished a bike ride, starting a session at the gym, or hanging in your living room.  If there is something in your hands, you will use it.  You will have a routine to help areas move and feel better.

It's the small stuff that adds up over a lifetime.  One minute, 10 times a day is 10 minutes a day of being better.  It wouldn't help to brush your teeth once a week for 10 min.  But, one minute, 2x a day can be the difference between healthy teeth and dental nightmares.  The body responds the same way.  Frequency trumps intensity.  

Every time you use your MOBI your brain will elicit the reward to do it again.  Not because the MOBI is magic, (it's just a tool) but because you took a positive action towards better health, recovery and movement.   We know that if we do that daily, over months we will have created a positive habit.  I think spending 5-10 minutes a day working on moving and recovering the musculoskeletal system can be an amazing health habit, that everyone needs.  

We are few weeks out from our Kickstarter goal.  Check out the video of the MOBI in action.  If you know of someone that you think this may help, please share.  MOBI on KICKSTARTER.

Thanks!

DRJASONROSS on Instagram for some MOBI videos, pictures of coffee, kids, bikes, occasional workout ideas, craft beer and more coffee.

Becoming A Performance Therapist

Performance therapy is a term that has become more mainstream in the last decade.  When I was in school, the term Sports Chiropractor was probably more common.  I can only give this article the viewpoint from the lens of a chiropractor as I have not walked the road of other professions even though I interact with them frequently.

I've been an athlete my whole life and because I was a fairly good, I was able to make a National Team in the sport of bobsled.  I had just graduated chiropractic school, so the first people I worked on were high level powerful folks.  In my world, this was the norm.  It took me almost a full year to get used to a more passive mindset in clients when I left to work in the private sector.

I've had the good fortune of working an Olympic Games, traveling the world with some really fast guys and taking part in big meets and events.  I've been able to work with lots of different sports and teams and had some amazing memories from them.

This article isn't about getting to do that.  Some of it was luck and some of it was knowing the right people, and some was the classic right place at the right time.  Sure, if the door opened and you aren't that good, you don't get asked back.  This article is about being good enough to get asked back.

Performance therapy by my definition, is therapy that perpetuates better performance.  It can be on a spectrum.  Hurt on the left.  Increased performance on the right.  Someone will present somewhere between those two points.  While performance therapy can be used to overcome injury, it is by definition treating someone not injured and looking to make that session or that race optimal.  I think the best work is done in a heavy training block and therapy is used to help recover and allow more training volume and better training sessions to happen.  I stress that not injured doesn't mean optimal.  Think of someone that is running well, but the lower back get sore after every sprint session.  Perhaps the big toe doesn't have enough motion to allow full ROM on push off at high speeds so the athlete arches their back to compensate.  Still training well, but not as fast as they could progress and are getting increased lumbar soreness.  

First a few points to remember.  This is my opinion.  Ask someone else and they may disagree on everything I'm about to tell you.  Don't ever get into the mindset that because someone works for someone or some team that they are amazing.  Just like someone driving an expensive car doesn't mean they are rich.  The outline I'm going to talk about is also not the path I took.  Many of the courses and people I've met along the way, weren't around when I was in school or on my graduation.  So in a way, even though I've taken these courses it wasn't my path.  This should tell you there are many paths, but the following path is what I tell kids when they email me asking advice on how to become a performance therapist.

Get a huge base.  You need a big base if your ever going to build a big pyramid.  Your base is what your going to spend most of your time with and it will take up most of your treatment.  All other things become less effective if you don't master the basics.  How many times have we been told, master the basics,  build a solid base, don't skip ahead.  The best course hands down for building this base is the Functional Range Release (FR).  You get very good at finding anatomy and feeling anatomy.  Locating tension and then addressing tension and tone, also differentiating mechanical tension from neural.  (This was one of my biggest mistakes on leaving school) If you develop this base well, you will be able to help a lot of people even if you never went any further with your training.  I plan on taking one every year or so, until I feel like I'm not getting anything out of it.  I'll bleed this one dry.  Get good at knowing what structure you are feeling and if what you are feeling is normal.

Get good at loading the tissue. 
Things get better when we load them.  Things get worse when we load them wrong.  Things don't improve very much or as quick if we don't load them at all.  Become a master of understanding load.  The best course is Functional Range Conditioning.  You may think I'm biased, but it probably worked out this way for a reason.  The FR originators understood that to get great results required load and the conditioning course was born.  This course goes deep into that understanding.  I mean deep.  It made me go back and read histology and cell physiology and truly enjoy it.  I will retake this course in the future.

Get good at Being Part of a Team.
A performance therapist should know about physical training.   Understand strength and conditioning.  You probably won't be the primary coach for that person or athlete, but to understand what exactly is happening during training is extremely important.  The body adapts to training, understand how your therapy can be synergistic to that.  Being able to have a competent conversation with the athlete and coach is so undervalued it's criminal.  If you end up working in a team setting, this may be the difference in being asked back.  Are you competent in being part of the triangle of performance, athlete, coach and therapist.  The best course is being offered by ALTIS, another hands down.  It's the only thing really like it that I know of.  You get to experience the triangle in action.  You can ask a therapist why they pulled an athlete after watching them in their warm up to treat X.  Then see how that treatment changed the movement or drill.  You can watch and learn as treatment, coaching and athletes response feed of each other and determine the daily dose of training.

Get good at Regression and Lateralization.
This is a term I learned from Charlie Weingroff.  Regression is taking an exercise and making it available to that athlete that can't quite do it as prescribed.  They lack hip mobility so you take a deadlift from the floor to a deadlift off blocks, this is an example of a regression.   Lateralization is a side step.  If you don't have dorsiflexion to get into a great squat position, substitute the squat for a trap bar.  Still being able to train a heavy load with out putting the athlete at risk while working on getting them dorsiflexion.  Charlies Training=Rehab series of DVD's are a tremendous resource.

Get good at Energy Systems.
Not understanding the impact that the physiology of the energy systems plays, is one of the biggest mistakes in therapy.  Getting in great aerobic shape can help the healing response and position the athlete to have better tissue quality, less prone to colds and allow more training volume.  Blood flow brings healing, build more ways for that blood to flow!  I'm currently taking Joel Jamieson's Bioforce Conditioning Coach course.  It's very good.  His book is also a tremendous resource.

Get good at Nerve Flossing.
How to address neural tension or nerves that are causing the major course of dysfunction.  Michael Shacklocks Neurodynamics course is amazing.  4 days of of insane amount of information.  Great anatomy tie ins and superb blend of teaching and hands on.  I will retake this course in the future.

Get good at Knowing What You Don't Know.
This category exists to understand when you need help.  For me, this category is stuff I want to get better at, but am currently inefficient in to give guidance at an elite level.  For example, the everyday person, I can give blood work advice on some basic stuff.  Throw in an autoimmune problem, or fluctuating patterns that I'm not confident with, I'm not going to risk their health.  Some of the systemic monitoring like HRV and omega wave and using technology like EMS are one of the pools I'm learning to swim in, but again, I don't feel confident in giving advice.

Get good at Waking Up.
I think this is a small percentage, and to be honest I'm still figuring out where it belongs in the big scheme of things. But I do think it belongs somewhere.  I put the courses fascial manipulation and Reflex Performance Reset in these.  I give RPR the nod, as it's like 1500 dollars cheaper.  I think there is an appropriate time to "wake up" tissue, like post surgery or when body awareness is low.  I currently am using it mostly in the untrained individual.  I'm finding they  have a hard time "feeling" a muscle work/contract.  Even if it is!  The body awareness is so poor that when you do exercises with them, they start biasing into what they can feel.  RPR has allowed them to have better body awareness.

Get good at Competition
I think therapists should compete in something.  I think you should understand what being at a start line, waiting for the whistle to blow, or waiting for the green light is like.  What it feels like to know your ready to compete, to also know what it feels like to know your under prepared.  To fully know the frustration of being hurt.  To know what bonking is.  To know what heat/cold feel like.  To know the highs and lows of training.  To know that most days are just showing up and putting in work and your therapy is a part of that.  Nothing special, just a part of their day.  You don't have to be good, but you have to work at something and put yourself out there.  I think athletes appreciate when they know you may know a little about their world.  It also helps from an esoteric level.  If your at a big meet/event and you can feel the energy and nervousness that is around, it helps you give a more calming, positive presence in your treatment.  If you have never felt the nerves yourself, you may get caught up in the situation and put out nervousness and feed forward that to your athlete.  So join a lifting club, enter a 5k, register for a local cyclocross race and put yourself out there.

Get good at Reading
Every talented therapist I ever met has been a voracious reader.  It's not just therapy books either.  Although you should have some solid anatomy books.  (I like Stecco's stuff)  The bigger the library the more you start to see how things fit together or intertwine and overlap.  I think this helps you start to recognize patterns and process information at a higher rate.  The more that is in your understanding the faster you can start to process information.  In a private clinic that might mean you get to see 3 people in an hour instead of 2.  At the track it may mean you get to solve a potential problem in warm up instead of interrupting the practice.  Figuring stuff out faster is important.  Train your brain to learn and be creative.  Read more and read from a broad spectrum.  Variability is a good thing for joints, heart and your reading.

This is my recommended path when kids email me.  Now I can just send them to this blog post instead of just listing some courses.  Like I said, this was my opinion.  I'm sure others would have other recommendations.  If you are a therapist that works with sports or athletes, what course have you found instrumental in your learning?

Random Thoughts From Unicorns to Invisible Casts

I was listening to the Joe Rogan Podcast with Andy Galpin and since then a few ideas I had been thinking about, I'm thinking about more.  Heres a few.

The Fallacy of The Unicorn

Unicorns are by definitions, mythical animals that despite my 5 year olds deep desire, don't exist.  Yet many of us in the fitness/health field and a lot of our patients or athletes can fall for the unicorn.  The unicorn is something that is the panacea, the answer.  The One Thing.  When I was in high school, I thought if I found the "perfect" workout plan I'd be sure to get bigger/faster.  I was up for the latest supplement that was sure to put all the muscle on.

Even today, I'll find myself slipping into this train of thinking.  Wow, beet root supplement increased the performance by 6% on the bike.  I MUST HAVE!  But then I calm down and I think it through. Usually it goes something like this, hmm...I didn't even eat any vegetables today, lets hold off on the 50 dollar beets.  

The Unicorns strength is that it can be used to be that one thing you need that is sure to put you over the top.  It can be almost anything.  Oh, If I go Keto, I'm sure to be (insert superlatives)  If I do this magic exercise I'll never strain my muscle again.  This supplement will make me lose all the weight I've ever wanted.  

Just remember, Unicorns don't exist the next time you start getting super geeked for...

Adapting or Optimizing

While the concept isn't new, how I've thought about it has changed since the podcast.  Adapting means your training session for that day is designed to adapt to something.  Perhaps it's learning to do a harder workout with less carbs, less sleep, or even less water.  Optimizing is making things as perfect as possible to create the best environment to perform your best for that particular workout on that particular day.  Now I find myself deliberately doing both.  Adapt to get better, optimize to express your better-ness.  

Sticking with the adapt and optimize theme, Asker Jeukendrup puts out some great information.  This article "Intestinal Absorption," was about getting your body used to using carbs for a race.  You train your stomach/guts to use carbs.  If you go to long without carbs, you are teaching yourself to run on fats, which is great if you don't plan on optimizing race day.  But, if you do, start increasing your carb intake 3 days prior to your race.  It's essentially a solid article pointing us to the concept of Metabolic Flexibility.  

How To Eat

Most people that aren't in a diseased state benefit from metabolic flexibility.  Mike T Nelson is one of the leading authorities on this, if you want to dive deep into this.  Metabolic flexibility is teaching the body to run on carbs and fats.  Training in both environments.  Getting the body capable of thriving in multiple conditions.  One of the points made in the mentioned podcast was that you would never say this is the one way I'm going to train for all my goals for the rest of my life.  How boring.  Why do we do this with nutrition?  

Patient Dialogue 

As a clinician/manual therapists I've had a few incidences when the patient didn't need manual therapy, but a friend that called them out on their misguided notions.  This takes tact, because you run a good chance of losing the patient.  I don't do it often, but every now and then I just feel like I have to.  My record in these instances aren't good.   

My mentor once told me whatever you are, be that, every day.  Be consistent.  If your ornery, be that, if your quite, be that.  If your boisterous, be that.  But, don't be someone new every day.  I've always tried to do that.  He also said, you don't get to have bad days.  People are paying you to help them, not listen to your struggles, or feel your negativity.  Every now and then I've found myself losing my patience, I always feel like I've let him down, when that happens.  Be better.  

Patients that are in the most pain, are also usually the most scared.  I always try to remember that.  The ones that are the most scared are the ones that had been in pain, got better and then for some reason it came back again.  Falls, time, accident, you name it.  One of the reasons, I always try to get my patients to view themselves as athletes, is because everyone knows athletes have highs and lows, but you wake up and try to get better and better isn't usually a straight line.  

BECOME YOUR OWN ADVOCATE

Recently a patient of mine got diagnosed with stomach cancer.  It's never a great day when this news hits your ears.  He was being prepped for chemotherapy and was advised to take a protein shake to try to mitigate the muscle loss.  He asked what to take and was given something.  My patient did their own research and realized it was complete garbage and asked if I could recommend something better.  Of course.  You have to control what you get to control.  Don't leave your health to someone else. 

FUTURE OF RESEARCH

So where do you go for information?  This day and age, we are inundated with so much stuff.  It's hard to filter when you are not trained.   I can tell you the future of research is in supporting people you find doing awesome stuff and supporting them.  Patreon is a way of crowd funding people you want to help out.  I currently support a few people, Dr. Ben House a functional medical doc that consistently writes outstanding information.   Dr Rhonda Patrick that puts on very informational videos and podcast and Bill Lagakos that writes on health topics I have an interest in.  Patreon is a way of basically saying your doing great work keep it up and hopefully enough people support you to keep it going full time.  

ENDURANCE IS MIND AND BODY

This past year I've gained a new found appreciation for the endurance athletes mental game.  To be honest, I've always known the life of an endurance athlete was hard just from the amount of lonely hours practicing their sport.  Endurance often comes down to willing to suffer.  Pushing the brains impulse to let up.  Until recently I've never been "fit enough" to race though.   Recently, I've gained enough of an aerobic base where I can actually worry about racing instead of just riding.  All of a sudden a new found mental game is being played that I never had to worry about before.  Strategy, boredom, watching the competitors, going with racers, letting racers go, hydration, nutrition.  I found myself mentally tired half way into a race.  I found myself coasting instead of racing, even though my legs could go faster.  It was a very interesting realization.  Always be racing...

KOBE WAS ALWAYS TRAINING

In this video Kobe talks about losing focus in a game in high school and losing the game and the next day realizing he was letting his mind wander in Geometry class, just like he let his mind wander when he lost that game.  So teaching himself to focus in geometry was actually teaching him to stay focused, which was training him to be a better basketball player. Great lesson from one of the all time greats.

Wise words from @kobebryant​.

Check out excerpts from his speech to us at #ChargersCamp. pic.twitter.com/bM5EedKx8O

— #LACvsSF (@Chargers) July 30, 2017

INVISIBLE CASTS IN OUR LIVES

Katie Bowman writes a lot about living in a more natural state and that we are often limited in our health of our human bodies by the "casts" we have built into our lives.  If we don't do things that help off set the casts, then we are slowly becoming less healthy as a human.  Often the casts are so inundated with our life, that we don't even think of them as "blocking," our health.  They are invisible. Shoes are a cast for the feet, go barefoot.  Chairs are casts for the hips, get down on the floor.  Modern stuff (computers, phones, walls) are casts for the eyes, focus far away through out the day.  Cars are casts for the heart.  Walk more.  In a way, casts can be quite a few things, sometimes its beneficial to do things the hard way to wake up our physiology to provide a different stimulus.  

Have a great Labor Day Weekend!

Commitment Can Be That One "Thing"

I'm a big fan of bike riding.  I can't actually remember a time when I couldn't ride my bike.  One of my first memories as a kid is my older brother taking my training wheels off and telling me I didn't need them.  Ever since, biking has been a part of my active lifestyle.  This last year has brought not only more time on my bike, but a little more commitment to training and getting more aerobically fit.

It's probably not coincidental that this was the first Tour de France I had payed attention to since Lance did his thing, then Floyd did his thing and on and on and on.  This years Tour was highly entertaining and by way of watching more I ended up reading a book about cycling by Phil Gaimon called "Pro Cycling on $10 A Day."


It was a really enjoyable read and I learned quite a bit about the subculture, the lack of money, the struggle and sacrifices that pro cyclists deal with daily.  It was far from my notion of signing a pro contract with a healthy salary.  It was more like the namesake.  I highly recommend the read as his sarcasm and literary wit comes through.

There was a page and half of writing that really resonated with me in terms of key principles.  In this one section of the book Phil describes future Cyclocross National Champion Jeremy Powers coming to see where Phil was living.  Jeremy was described as angry that his friend was not living like a pro athlete should.  "What is this?  You don't have any food.  All you eat is deli meat, sandwiches and rice cakes.  You've got to eat real food!  You don't live like an athlete!  

"You can sit here and half ass this thing, and you'll always make $20,000 a year, or you could do it right, invest in yourself, and make 10 times that.  You know you have the talent, so stop being scared!"

Phil goes on to say that it finally made sense to kick in the last 1% of commitment, in his own words..."otherwise, my sacrifices would be for nothing."

"I turned the thermostat up, bought a few bags of organic groceries, and made a weekly massage appointment.  I treated every training ride like a race, timing my breakfast to maximize my energy, with a recovery meal when I finished and as much sleep as I could get. ...If I was going to be a pro athlete, it was time to embrace it."

Those few pages speak volumes to what I think is missing in a lot of athletes lives, but even going further what is missing in a lot of peoples lives.  That 1%.  A lot of time it might be embracing what we don't like or think is that important.  Perhaps it is your cool down, you may have heard of its importance but have never paid much attention to it.  Perhaps it was sleep, one more 30 min late night talkshow won't hurt will it?  My doctor told me to walk, but walking can't really be that beneficial right? Perhaps it is the boring aerobic rowing class that your coach tells you would benefit you.  Being more aerobically fit will help out a lot with your recovery in your sport, but it meets at 6am on a Saturday and that means choosing it over a late Friday night.

Committing to the 1% will always mean different things to different people.  Whatever it is, I hope you learn to embrace it.

Providing a Measurement for Aging Well

How are you Aging?

It's not often a question you hear, but at a certain age, you will begin to think about it if you haven't already.  I've often heard the quote, "You are as old as your joint's feel."  I've often joked my back feels 50, my elbows feels 80, my neck is 20 but my right ankle is 16, so I'm not to bad when you average it all out.  Joking aside, feelings are subjective.  At the clinic, I try to promote objective measures to know if we are doing better and making progress.  A poor question is how did your back feel this morning.  A good question is, were you able to sleep though the night without the back waking you up.  The first is subjective and the later is objective.  One gives clear information that can't be misinterpreted.  If the past week has been waking up twice a night with lower back pain and last night you were able to sleep through the night, progress is being made.

How do we measure Aging?

How do we go about answering the question, are you Aging well?  I think the best way is to scour the literature and put together some agreed upon measures that have shown a correlation with all cause mortality.  Essentially, researchers go over a bunch of studies and correlate stuff.  For example, this group ate 5 fruits and vegetables every day for 15 years and they had a 38% less chance of dying from heart disease.  So, in no particular order, here are a few things to start doing and tracking.

1.  Drink coffee.  Hooray.  2-5 cups of coffee have shown to be brain protective.  This means you are less likely to derive Alzheimers and Parkinsons if you drink caffeinated coffee every day.  It has shown to perhaps be a protector of stroke in women.  This is straight black caffeinated coffee.  Leave the spoonfuls of sugar.  In two very large meta-analysis studies Parkinsons was decreased by up to 31 %.  Coffee and Parkinsons.  There are also some strong correlations with drinking coffee and keeping Alzheimers at bay.  They believe the caffeine and the antioxidants in coffee play a protective roll of some kind.

2.  Get Up!  The simple get down and get back up test has some strong corrections with lifespan as it challenges a few important things, strength, balance and flexibility.  Simply sit down on the floor without your hands or knees and get back up without your hands or knees.  If you need to use an elbow or a hand you subtract a point.  Each point subtracted corresponds to less life span.  This article explains the point system.  Sitting Test.  I think it's a nice marker.  Everyday you do it and if for some reason it starts to get hard, you figure out why.  Every day, get on the floor and get up.  Practice different ways of getting up.

3.  Grip It.  Grip is a surprising thing that has a very strong correlation with health and life.  The loss of it has been shown to be even a better predictor of all cause mortality then even systolic blood pressure.  In these studies a hand dynamometer was used and for every 5KG loss, cardio vascular, Myocardial Infarction and non CV mortality went up.  Averaging 51kg per squeeze for men and 31 for females, both around 40 years old in this STUDY.  There was a corresponding decline as we age. This was one of the few studies I found that gave data.  Now this is great, but I'm the only one of my friends with a Dynamometer.  Two suggestions.  Hang from a pull up bar and time it.  That becomes your marker.  If every couple months you time it you will have a measurement of your grip.  2nd option is purchase a 20 dollar Iron Mind Captains of Crush gripper.  If you close the "trainer" that is 60lbs of pressure.  Count how many times you can close it.  If you can get 10.  There you go, you have your data to measure against.  (Cool thing, training your grip can lower your blood pressure as well)

(84 year old Canadian man deadlifted 440LB...more then me.)

4.  Be a Stork.  Can you stand on one leg?  When I first started looking into this I thought this would be more for the risk of falls.  Falling and fracturing a hip results in 1 out of 5 dying within one year.  But this study showed that the ability to stand on one leg with your eyes closed for less then two seconds to be more of a brain health marker.  Those that couldn't after repeated trying showed a correlation with small "Silent Strokes"  View eyes closed as more of brain marker and eyes open as balance and muscle coordination marker.  Shooting for 20 seconds eyes open and more then 5 with eyes closed.

5.  Chair Squats.  Stand up and sit down 35x in a minute.  This makes sense as it takes a lot of strength and endurance to do it.  The test was done on 53 years and older.  Those that could only do the test 22x or less in the minute were twice as likely to die in the next 13 years.  If you fail it, work on getting stronger.

6.  Walk On.  Walking may be the most underrated health and fitness activity you can do.  With the plethora of pedometers and fitness trackers available these days, there is no excuse to not know how many steps you get in.  If you need some extra motivation, adopt a dog, then you have to walk him 2x a day!  The research has almost shown a linear relationship to mortality,  The more you walk the less chance you have of dying.  But, when you get over 10,000 steps a day there is a jump and you have 40% decrease in mortality.  I read an article earlier this year that showed that 15,000 steps had an amazingly correlation with health.

7.  Know Your Numbers.  High blood pressure of 140/90 is considered high.  Dropping each by 5 points correlates to 7% less mortality.  Vitamin D levels below 20nG/ML  were associated with 2.37 increased mortality rate.  Resting heart rate is another easy measurement that has some correlation with increased mortality.  After 90 beats per minute, the risk for CVD is significant.  Shoot for 70 or less.

8.  Sleep Zone.  When it comes to sleep, Goldilocks had it right, not to little, and not to much.  Under 6 hours and over 9 hours were both predictors of death.  If either is in your life, get some help to figure out why.

9.  Make Some Friends In Your Community.  One of the best and healthy things a human can do is be involved in their community.  What that means to each individual will be highly different.  Whether it is church, a gym, a bike club, a book club or anything were you get involved and share some type of bond has proven to be a highly healthy trait that is ingrained in the human soul.  It has as much evidence for lifespan as quitting smoking.  I recently just finished Sebastion Jungers great book "Tribes," in it he describes why we gravitate towards things like Crossfit gyms and why we are the most content after natural disasters when we are forced to band together to endure hardships.  In fact, during wars, mental depression and suicide go down.

10.  Keep Your Joints Healthy.  Does your shoulder move in 360 degrees of motion?  Does your hip act like a hip?  Can you laterally bend your spine?  Joints are designed for motion.  If they can't, you tend to not move as much.  As you can see, a lot of these healthy aging markers will be improved if you can keep moving.  Functional Range Conditioning was designed to keep your joints acting like joints.  Every morning moving your joints and explore their motion, this is called your Daily CARS.  Controlled Articular Rotations.  Your asking each joint, hey can you move in a circle without much discomfort.  If not, figure out why.

All these ten steps give you markers to check in on.  Some daily, some weekly some every few months.  But, like any athlete, they give you guidelines on what to work on, what to put in maintenance and what to make a high priority.  

For those over 65, I wouldn't let anything go more then a month without getting actual help. Don't let a painful knee or hip stay painful 3-4 months.  That's a significant amount of time to lose conditioning  and lose valuable muscle mass and fitness.  In fact, it is worthwhile to check in with a quality Chiropractor, PT or Strength Coach to get what legendary track coach Dan Pfaff calls a Plan B.  If an athlete is injured they don't sit it out, they work just as hard on whats called Plan B to keep them in shape and ready to compete when they are ready to return to sport.  While you work on what is bothering you with your therapist, you work on Aging well with your plan B.

In a society that seems to fear aging, perhaps it's because we have looked around and seen so many older individuals struggling with any of the dementia's, the fragility of their bodies and the inability to care for themselves.  Perhaps it is because we have been told we have the "genetics" for certain ailments.  Perhaps it's because we have this fear we will become a burden for those we love.  At the end of the day our choices our some of the main factors we have that help with these fears.  I see it every day in the clinic, vibrant 80 year olds, hanging out with their grand kids and struggling 60 years old that fear what the future holds.

These 10 choices will give you an outline or map to help bring about measurable change.  So when someone asks how you are doing you can say, "I'm aging well my friend."

PS.  Please pass this along if you know someone you want to Age Well.  Thanks!

20 Tips for After the Big Race

For many people in Grand Rapids, the Riverbank is either a yearly tradition or a one time bucket list, check that box type of race.

The 25k is a unique race in that it iss 2 miles longer then the 1/2 marathon.  On paper, that doesn’t seem like a lot, but I’m guessing come mile 13, 2 miles and some change seems significant.  This race often represents a first time dipping the toes in this long of races for many people .    Hopefully, it all went well.  This is about the aftermath.  

NOW WHAT?

The last few years I’ve seen some pretty banged up people that all started with finishing the Riverbank.  They either jumped back to quick or didn’t address some issues that cropped up during the race.  Here are some guidelines to navigate the next two weeks following you crossing that finish line.

1.  Congrats you made it.  Hug the people that mean something, slap some high fives and get something to drink.  Try to walk a bit.  Resist the urge to just collapse and not move for 30 min.  Your job right now if you don’t need the medical tent is some movement.  You don’t want to go from racing to sitting.  You might not have the energy to do a “proper cool down” but even walking will have some big time benefits to help flush the body from racing to recovery.  

2.  Get some calories in you.  Often times your stomach is still jostling around so something heavy like a cheeseburger probably won’t be the best idea, but something simple like a banana might seem delicious.  

3.  Get more calories in you.  An hour to two hours later, you might get struck with a famished feeling.  Eat what you want, after you choose some high quality protein.  Protein helps the body recover, let’s start right off the bat.  30-50 grams.  That usually means something the size of your palm. Then eat what you want.  :)

4.  Contrast shower. You can switch 3 or 4 if you want to shower before you eat lunch.  It’s permitted.  Warm/hot shower for a minute, colder shower for as long as you can (cooler will work).  Try to go back and forth a few cycles.  This is to help speed up some flushing of your system and promote a more parasympathetic state.

5. Take a nap.  

6.  Wake up and eat some more protein and drink some more water.  

7.  Bust out that foam roller and do some rolling.  Cap it at 5 minutes.  Work the quads, hips, and calves.  Roll the bottom of the feet with a lacrosse ball.  

8.  Before bed do some gentle stretching with a rope or towel.  The purpose of this is more for relaxation then actually stretching to improve range of motion.  Something just nice and easy and focus on your breathing.  Inhale through the nose, exhale through the mouth.

9.  Sleep an extra hour if you can.  Sleep is our biggest recovery option available.  

10.  Wake up and drink some extra coffee.  I’m biased, but I think it helps.  

11.  The day after is 10 min of elevated heart rate that isn’t on your feet.  This can be a bike, a pool, weight lifting or even rolling on the ground with your foam roller.  Just get some blood moving.  No more then 20 minutes.  Nothing that makes you lose your breath.

12.  Keep on top of protein and hydration the next few days.  

13.  Hang out.  Literally.  Hang from a pull up bar or a tree branch for as long as you can.  Try to do this 2-3x a day.  If you don’t have access, hanging from a study door with feet on the floor can work.  Here were bringing in some traction to the lower back.  If you go to the gym, hang off the back extension machine for about 20 sec a repetition.  Hanging this way you need to be careful for eye pressure.  

14.  3 days later your going to foam roll for 10 minutes focusing on quads, hips, calves and feet.  Then follow that with a 15 min walk.  We are looking for an asymmetrical soreness.  For example, your left knee or left quad was the only thing that hurt more then the right.  It’s OK to be sore, we are looking for one thing that is more sore then the others.  

15.  Treat yourself to a massage.  I’d suggest at least 4 days post race.  

16.  During day 3-6 you can add 10 min a day to activity.  So day 6 you can be at an hour of pretty light to medium activity.  Again, nothing that is strenuous and nothing on your feet.  

17.  Keep checking in with your body through foam rolling the key areas and walking.  Paying a little more attention to the areas that remain sore that is asymmetrical.  

18.  No running for 7 days post race.  First runs between week 1-2 post race are kept under 5-6 miles.  This is only cleared when there is no asymmetrical soreness, for example, I feel real good except for my left foot, that still hurts.  Figure it out before you jump the gun.  

19.  Get help from a professional is your asymmetrical soreness doesn’t go away in 7-10 days.

20.  20 deep breaths before you go to bed every night starting day one.  Inhale through the nose.  Gentle long exhale.  Repeat and make this a habit.  

Congrats, you made it 10 days since your big race.  You should feel like your old self again.  Time to choose your next goal and start pursuing it.  

This is designed for the person that is doing a one time race.  You trained specifically for this race and not using this race as just a long run for a later race such as Bayshore marathon.  There is a huge difference in racing and running.  This is also guidelines for someone that is new to this distance.  This is the first time hitting these long runs.  With that said, hope it helps you recover and not become that person on my table that regretted their race.  

Nutrition From a Programming Perspective

Sticking to the theme of things I've changed my mind about, nutrition is one of them.  I was a big believer in the following statement, if it can't be sustained, it is not a real solution.  It is not healthy.

A respected coach posted something about how humans are supposed to be an undulating organism.  To say this one way is how you eat for the rest of your life is silly.  It  made me rethink and admit my thinking was a little short sighted.

Lets take biking as an example.  People that bike enjoy biking. They may bike everyday.  Then they decide to enter a 200 mile gravel race like the Dirty Kanza.  They are going to have to do some serious specialized training.  When the race is done, they won't sustain the volume and intensity of biking they needed to prepare for the race.  It is also doubtful that they will say, well I did the race, I'm done biking.  They are still going to ride.  A few months pass and they decide to do a mountain bike time trial.  A 60 min all out redline zone 5 race.  It's going to require much different preparation then the 200 mile race.  They train for that race and when its done they aren't going to keep the same training even though they will still ride their bike.

This is an analogy for nutrition. While there are some basics, it's going to come down to personal goals as well.  If you are trying to lose weight, attacking that goal for 3 months and then taking some time off (a set time) and not being as strict.  You are still going to eat well,  (your still riding your bike) but not as intensely.  Then go at it again with renewed discipline but also with a metabolism that isn't ground to a halt. 

Taking it a little deeper into the periodized analogy.  Humans that are healthiest have the greatest variability in their physiology.  The HRV is a score of your heart rate variability.  It is the healthiest when it's the most variable.  Most peoples joints are healthiest when they have the greatest motion that they can control.  Varying your caloric needs, varying your macro nutrition all can be healthy and help break through psychological barriers that may come from feeling you are depriving yourself of something.  

My thinking is that do the basics well consistently.  Protein, veggies, water.   Ride that bike.  Then attack something aggressively.  Most people lose weight if they cut all sugar/breads/dairy.  I think most people can do this with a lot of discipline for like 4-6 weeks.  Train hard for that crazy bike race.  Then I'd back off to not limiting stuff and going back to making sure you got the basics covered.  Go back to riding that bike.  During that 4-6 weeks phase I'd have days of low calories and day of higher calories. 

Variability in the human has been shown to be healthy, I'm starting to think nutrition is no different.  When you want a change, attack it aggressively and then return to moderation.  Keep doing this.  

Plan for Addressing High Blood Pressure

High Blood Pressure is called the silent killer because one can have a high blood pressure and lead a pretty normal life, it doesn't have great warning signs.  For this reason, everyone should have their blood pressure checked regularly.  Most grocery stores now offer a little station you can sit, relax and get it read.  Try to do it at the same time of day every time.  Don't do it after strenuous workout out or with caffeine in your system.

Blood pressure is the measure of systolic pressure and diastolic pressure.  Systolic is how much pressure it takes to pump the blood when the heart muscle contracts.  Diastolic is how much pressure is present when the heart is relaxed.  Generally speaking 120/80 is considered normal.  130/90 is prehypertensive and 140/100 or higher is Hypertensive.

Hypertension can lead to a lot of different issue so it's very important to get this addressed.  One is essentially asked the heart to work harder all the time.  This can lead to a heart attack.  You are pushing it harder through vessels, the vessels essentially are not as pliable.  This can lead to strokes or aneurisms.  Other organs are also at risk.  One that is commonly damaged with uncontrolled HBP is the kidneys.  The kidneys filter the blood through lots of small arteries that lead to the nephron.  These arteries can became narrow, harden and weaken.  This becomes a negative feedback loop and this will cause an increase in BP as well.

1. Start getting a few relaxing walks in per day.  Then shoot for a minimum of 20 minutes.  Heart rate should be elevated but you should be able to hold a conversation without losing breath.

1a.  Once walking has been established, start going slightly more brisk walk for a goal of 30 minutes. Stairs make an excellent choice for training the bigger leg muscles.  Biking is excellent low impact choice.  Weights can be beneficial, just don't hold the breath.  The ultimate goal is 150 min of exercise a week.  It takes 1-3 months to drop systolic pressure up to 10 points.  It only lasts for as long as exercise stays apart of your daily life.

2. Work your grip strength.  This has been shown to be a really cool exercise with proven results.  It was discovered by fighter pilots in the 60's.  Those that gripped the control the strongest pumped more blood to the brain and passed out less during high G forces.   Find a gripper that you can grip that you would consider medium in difficulty.  You want to be able to hold the grip in the closed position for 5 seconds. Relax for 10 seconds.  Get as many reps as you can for 2 minutes.  Repeat the other hand.  It has been shown to drop the diastolic by up to 15 points.  (quite large)  It seems to work because it makes the walls of the carotid artery and other blood vessels more pliable.

3.  Electrolyte balance.  I would recommend getting blood work done to see your potassium and sodium balance.  The standard advice of lowering sodium is not a given.  It is known now that it is the balance of sodium/potasium that is crucial to heart health.  Most sodium isn't from table salt added to food but is snuck in prepackaged foods.  Most potassium comes from fresh fruits and vegetables, so the advice of cut out food that comes in a box or package and eat more fruits and vegetable is good advice.

4.  Drink lots of water, hydrate like it's medicine.  Dehydration can raise high blood pressure.  Your body will hold onto sodium more.  If you find you are never thirsty for your bodyweight, perhaps upping your protein will be of value.  Shooting for a minimum of 1/2 your bodyweight in ounces.

5.  Maximize Nitric Oxide.   NO is a key signaling molecule throughout the body.  It is produced by the endothelial cells in the arteries and acts to relax the arterial walls.  It is produced when we exercise.  (Step 1)  It is only available for a few seconds after it is produced, so we are constantly making it.  Exercise/Food/Supplement for Nitric oxide production.

6.  Supplement.  Garlic and Other Nitric Oxide supplements.  Garlic has a strong backing as a viable option for reducing HBP up to 10%.  Not eating it raw but supplementing it.  You need the allicin in the garlic.  It seems to work by stimulating the production of NO.  Some companies are making specific NO supplements.  I'm currently testing out the APEX Nitric Oxide and will report on it in a few months.

7.  Add specific foods to your diet.  The amino acids L- arginine and L-citruline are crucial in the formation of Nitric Oxide.   Turkey and pumpkin seeds are two of the highest suggest sources of arginine.  Walnuts are an excellent source for arginine and has been studied on its own to lower blood pressure.  Watermelon, cucumber and other melons are great sources of citruline.   Beets are being studied a ton lately for its high level of nitrate.  Seems to be enough research to suggest adding them to the diet will be of benefit.   Beet, Watermelon, cucumber, walnut, honey (a little research for HBP) sounds like a nice NO shake to me!

7.  Be around animals.  Going to zoos or being around dogs, petting dogs.  It seems odd, but they have measured BP in zoos and it's lower.  Then have measured it petting dogs and it's lower.  We are meant to be around animals in my opinion.

8.  Volunteer.  People that volunteer tend to have a LBP then those that don't.  Feel good perhaps?  I'd bet volunteering at an animal shelter would be quite beneficial for BP.

9.  Become a Nasal Breather.  By breathing through the nose you are able to capture more Nitric Oxide with each breath from the sinus cavities.   Breathing through the mouth doesn't do this.  It takes dedicated practice and it can be used as almost a meditative practice.  Which coincidentally, also has been shown to lower blood pressure.  Taking a few minutes a few times a day and practice nasal breathing.  I think walking is a great place to do this.  It keeps the walk at an aerobic level and you get to practice only inhaling through the nose.

10. Drink less alcohol and don't smoke.  The uptake of one glass for women and 2 for men seem to raise the blood pressure slightly.  Smoking is just bad for everything related to health.  

All of these options will have individual results.  Not one by itself will probably bring you down into the normal range, but all of them combined and working them into your lifestyle will go a big way  into helping control them and perhaps need less medication or perhaps get off or not get on any.  Always have a way to monitor your blood pressure if you are on a medication and start to implement these lifestyle changes as it will hopefully require different dosages.

Random Spring Review Thoughts

A lot of thinking has been going on in this head of mind the last few months.  The old saying is if want to know what you think, write it out.

I'm excited to continue to learn more and more about reading and interpreting blood work.  From a personal curiosity for my own health questions to taking the Apex Mastering Functional Blood Chemistry and a bunch of books in between.  It's been an exciting chance to delve back into pure learning mode.  I've already started to work with a few patients on the lifestyle, food and supplementation strategies to start changing their health.

One of the most fun and aha moments I have is when two somewhat separate events/ideas cross over and you are able to see the connection.  I've been on a year long mission to understand the aspects of breathing and performance.  It started a few years ago in taking the PRI courses and realizing the importance of the diaphragm.  It escalated with Wim Hoff and continues with some more of the acute training affects with books like "The Oxygen Advantage," by Patrick McKeown.  Delving into the Buteyko breathing and hearing the CO2 and breath hold techniques from Kasper van der Meulen for increasing athletic ability.

From this information you learn how Co2 can have an effect on something called the Anion Gap.  Anion Gap is the difference in the measurement of cations Sodium/potassium (+) and the anions Chloride and bicarbonate (-) in your body.   Learning about the importance of the anion gap from the blood work perspective and having functional medicine say that brain injuries have a much harder time healing when the gap is 22 or larger.  For the healthy, you would want to be under 15.  With simple strategies to decrease this from breath holding and from nutrition/supplementation.

Young practitioners or students, start your day and finish your day with patients that you truly love working with.  It can change the whole outlook of your day or the next day, when you start and finish with someone that is truly fun to work with.  If you have ever been the first or last patient of mine...congrats...haha.

I was asked what are the biggest changes in my thought patterns for strength and conditioning I've had in the last few years.
1.  Aerobic training is highly beneficial when you are not an aerobic athlete and it has immediate effects on your health and isn't a downfall for pure strength.  Smart programming can keep your "gains."  Alex Viada from the Hybrid Athlete was the first to start to change my thinking.  I do recommend his eBook.  Biggest takeaway for me, I recover faster from training and from things like the common cold.
2.  Maximal strength isn't worth chasing at the expense of other strength choices.  I just don't see the payoff anymore in sports unless you are a powerlifter/oly lifter.  For track/field, field sports, health/performance I'm not seeing the carryover after a certain amount of strength.  Which leads to #3.
3.  Learning to integrate movements is more important.  Coordination. Isometrics.
4.  Hypertrophy as you age is important.  Don't knock machines or single joint activities.  Bodybuilding has a place.  My former self would have said they are useless.
5.  Abdominal work should have a direct place.  Deadlifts and squats are not enough.

I've been playing around with a few things in terms of nutrition and products the last 4-5 months.  I gave the nose pieces from Turbine a very fair go.  My wife said the sleep ones didn't help my snoring.  Fail on that.  The yellow performance ones,  I didn't notice an improvement in performance with a stated 38% increase in air flow.  Anyone that has been on a bike understands the term snot rocket.  With these in, it's impossible to do.  So you lose the 10 dollars nose piece.  Not worth it for me.

This has been my preride/ride/post ride combo.

I really enjoy the Organo Gold mushroom coffee before I ride.  It gets a bad rap for being MLM, but I  like it before riding and definitely with traveling.   UCAN is just legit.  Developed for people that have diabetes,  this is an outstanding product that has trickled down into the endurance world.  It's built for sustained energy and stable blood glucose levels.  I haven't bonked, just sustained energy.  No stomach issues.  The craziest thing post ride is normally I'd finish a big ride and have the appetite to crush a whole pizza, now I finish and I'm not famished.  Caloric intake after a big exertion is just normal.  

The hard thing about business is knowing when to spend money and when to just wait and figuring out which leads to growth and what and when to invest in the business.  They don't teach that in school.  Sometimes decisions are just as weird as I need two more parking spots.  Not something your thinking about studying for board exams.  

Health>Time>Money:  This has been an ongoing debate for sometime on Facebook with a friend of mine.  Which 3 do you value most.  The thinking is that if you had money you could have all the time in the world, but this just states you value time the most.  If you value time more then health, well you could be to sick to actually enjoy it.  If your sick you could be forced out of work, money.  Time is meaningless.  If your healthy, you have the ability to still enjoy everything.  So take the time and money and invest in your health.  By default you create time and money.  

Had my first DNA tests done.  Was pleasantly surprised how accurate it really seemed to be.  I was pretty much 70% fast twitch 30% slow twitch and advised me into sports like American football and weight lifting.  I'm glad I figured that out when I was like 10. haha.

Some more of the interesting was the lack of folic acid and poor absorption of B vitamins.  The B vitamins I had figured out in the last few months from blood work.  An interesting aside was that I lack a certain variant that helps you process alcohol.  (Bummer as I like craft beer and live in Beer City USA.)

I started to read stuff that has nothing to do with health, training or business again.  It always surprises me why I get out of that habit as I enjoy it so much.  It makes you wonder what else you forget to do for enjoyment simply because it doesn't fit into your work or practical column.