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Back pain

Chronic Pain

 

Hey! Did you know that all pain is all in your head?  It doesn’t mean you don’t have real pain when something to cause pain happens, or that chronic pain is not real.  Feelings of pain are very real and are initiated by the brain for a very important basic reason…to keep you safe.

The study of the neuroscience of pain has changed considerably in the past 10 years.  It is now believed that the sensation of pain is a necessary function that warns the body of potential pain or of actual injury.  The process starts with the nociceptor detecting a potentially painful stimulus from the skin or an internal organ. Neurotransmitters (chemical messengers) transmit the signals through the nervous system and spinal cord to the brain. In essence, how the brain processes the signals causes an appropriate or inappropriate pain response.

One example is a child falling and skinning his knees.  He gets up and continues to play as if nothing happened.  Then another child or adult reacts to the blood running down his legs, he looks, his brain responds differently to the neurological stimulus, and suddenly there is pain.  Initially the brain did not register the experience as painful, however the next time the child falls, he will probably immediately register the skinned knees as painful. Experience plays a role in the pain response.

The pain response can also be overridden by the brain in circumstances that are life threatening.  For example, a soldier who runs to safety with a serious gun-shot wound. The brain, due to past experience, can conversely register the event as much more painful or life threatening than necessary. For example, someone who was bitten by a poisonous snake may brush it off as being scratched by a stick, until they realize they have a life-threatening injury. But the next time they get scratched by a stick, they may respond as if they were bitten by a poisonous snake.

According to Elliot Krane in his Ted Talk “The Mystery of Chronic Pain,” after an injury or surgery, the nervous system can sometimes get what is going on wrong.  Approximately ten percent of the time, the nerves and glial cells (play a vital role in modulation, amplification, and distortion of sensory experiences) that interact in the pain response develop into a feedback loop that can become distorted. This altered feedback can make chronic pain become its own disease.

Dr. Maria Sykorova-Pritz in her course “Application of Water Exercise for Pain Management” describes how chronic pain is not simple, but very complicated.  The body, mind, emotions, and behavior can become entwined in the chronic pain cycle. Pain medication is often prescribed for chronic pain. Rampant prescription of pain medication is believed to play a large role in the opioid epidemic in the United States.  Although pain medication is often prescribed for chronic pain, it does nothing to unravel the combination of physical, emotional, and behavioral factors that are now believed to cause chronic pain.

There is growing evidence that chronic pain is caused by multiple factors including cognitive, physiological, and behavioral factors. If you are working with clients or interacting with a family member with chronic pain, it is important to understand that it is not just simply a physiological response to pain. It is important to effectively influence a client’s attitude, cultural background and belief system-which influences social norms and perceived behavioral control.  To achieve the highest positive health/fitness results among the chronic pain population, it is important to know and understand your client as a whole person.

As we start to look for alternative ways to deal with chronic pain and its aftermath, a combination of physical therapy/exercise and emotional/behavioral counseling is emerging as the tools of choice.  Using the practice of yoga and water therapy/exercise to relieve and even cure chronic pain are proving to be viable and more effective alternatives than pain medication. Statistics from the Institute of Medicine indicate that more than 100 million Americans suffer with chronic pain, thus creating a viable niche for those wishing to work with clients with chronic pain. Now that more is known about chronic pain, its potential causes, the chronic pain cycle, and how to treat it effectively, education is key to working with this population in need.  Proper treatment and compassion for chronic pain sufferers can help end the opioid crisis and help people beat chronic pain to live pain free lives without addiction and suffering.

For more information about the psychology and treatment of chronic pain management, see Dr. Maria Sykorova-Pritz’s continuing education course “Application of Water Exercise for Pain Management.


Compiled by June Chewning. June M. Chewning BS, MA has been in the fitness industry since 1978 serving as a physical education teacher, group fitness instructor, personal trainer, gym owner, master trainer, adjunct college professor, curriculum formatter and developer, and education consultant. She is the education specialist at Fitness Learning Systems, a continuing education company.

References

ahtlete running

Sports Nutrition Questions

Athletes have many questions about how to fuel for top performance. The Internet abounds with answers—but how do you what’s valid? Here are some trust-worthy answers, based on research presented at the American College of Sports Medicine’s Annual Meeting (May 2018; www.ACSM.org).

FUELING DURING 

Do elite athletes, such as professional soccer players, consume the recommended 30 to 60 g carb (120 to 240 calories) per hour during moderate/high intensity training?

Likely not. A soccer study indicates the players barely consumed half that amount (17 g carb (~70 calories)/hour of moderate intensity training and only 14 g (~55 calories) per hour during high intensity training). Soccer players—and other athletes in stop-and-start sports—want to experiment with consuming the recommended amount of fuel. They’ll likely learn they can have greater stamina and endurance at the end of their games—and that can be their winning edge.

FUELING AFTER 

Does enjoying a recovery snack after training actually impact on the next day’s exercise session?

Yes, according to 8 female collegiate tennis players who enjoyed 680 calories of recovery food (an apple, a banana, 2 tablespoons peanut butter, and a bagel) daily for 4 weeks after high intensity strength and power training. They reported being able to train hard the next day with 10% less perceived effort compared to sessions without the recovery snack. No one “got fat”; there were no differences in body composition. Knowing that the food was available contributed to better-quality training sessions. Whether psychological or physiological, eating within an hour post-exercise made a positive difference. Perhaps you want to make refueling a consistent habit?

HYDRATION

When training in summer heat, what’s best to drink?

In a simulated heat wave study, trained athletes exercised lightly for 3 hours in each of 4 trials. They drank either 1) room temp water (20 degrees C) as desired, 2) cold water (4 degrees c) as desired, 3) no fluid replacement, or 4) full replacement of sweat losses with programmed drinking. Obviously, those who drink nothing suffered the most heat strain. Those who drank ad libitum (as desired) consumed enough to prevent dangerous levels of dehydration. The athletes drank more of the room-temperature water. Preliminary findings suggest the cold 4°C water blunted thirst. Be careful about how much ice you put in your water bottle?

I’m afraid of becoming dehydrated when I train hard in the heat. I plan to push fluids. How much is too much to drink?

While drinking an extra-large volume of fluid before endurance exercise might seem advantageous, the question arises: would doing so actually trigger a diuretic effect and, thus, not provide the desired benefit (hyper-hydration). To test that theory, subjects drank 5, 10, 15 or 20 ml/kg of a sodium-containing beverageThat’s  about 12 to 50 ounces (350 ml to 1,400 ml) for a 155-lb (70 kg) athlete. The data suggest that the athletes retained about half of what they drank, regardless of the volume consumed. Thus, if you will be exercising in the heat, tank up as tolerated.

ALTITUDE  

How much harder do you need to work when exercising in the summer heat at altitude?

In order to meet the combined demands of increased blood flow to the skin (to dissipate body heat) plus transport of adequate oxygen to the exercising muscles, the heart has to work about 17% harder than at sea level during 30 min of moderate intensity exercise. If you are a fit, healthy person who is just exercising at altitude or just exercising in the heat, the heart works about 10% harder. No wonder exercising at altitude and/or in the heat is tiring! Programmed eating and drinking can help provide the extra energy and fluids needed to support the extra effort. Hikers and skiers, plan ahead…

CONCUSSIONS

As a soccer player, I am fearful of getting a concussion. Can I do anything with my diet to help protect my brain from damage?

An effective way to reduce the harmful response to traumatic brain injuries is to routinely consume oily fish (omega-3 fats) during training. Unfortunately, a study with 112 football players (none of whom took fish oil supplements) indicates only 1% of them consumed adequate dietary omega-3s. They would be wise to enjoy more tuna sandwiches, grilled salmon, and other oily fish, as well as take fish oil supplements.

INJURIES   

What can I do to reduce my risk of getting injured?

You want to eat well on a daily basis and stay in peak physical condition. Fit individuals have a lower injury risk. A study with Navy SEALs suggests having good knee strength and flexible hamstrings, as well as strong leg muscles, are important factors to reduce the risk of lower-leg muscle & bone injuries.

You also want to maintain an appropriate body weight—not too thin! Among female collegiate athletes, those with components of the Female Athlete Triad (amenorrhea, stress fractures, and/or restrictive eating) experienced more injuries than those who ate enough calories to support normal menses and strong bones. Eat enough!

WEIGHT

I eat less than my teammates but I am not losing weight. How can that be???

The less you eat, the more the body down-regulates to conserve energy. A study with collegiate female athletes reported those eating ~1,600 calories a day, as compared to their peers who ate 2,100 calories, conserved energy via a lower resting metabolic rate and reduced thyroid (T3) level. Try getting out of “hibernation” by eating a bit more and enjoy better energy? Consulting with a sports dietitian can help guide this process. To find your local sports nutrition professional, use the referral network at www.SCANdpg.org.

NITRATES  

I’ve heard that beets, arugula and nitric oxide supplements can enhance athletic performance by improving blood flow to muscles. Could they also help my grandpa who gets tired when walking?

Likely yes. A promising pilot study in older adults (average age, 78 years) showed that chronic nitric oxide supplementation (40 mg, 3 times/day) was well tolerated and associated with increased ability to walk more efficiently. We need more research to better understand the impact of dietary nitrates and nitric oxide supplements on physical activity and health among elderly people. Till then, we can all enjoy more beets, arugula, celery, and other foods rich in dietary nitrates. They help youthful athletes as well as their grandparents.


Nancy Clark, MS, RD counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her best selling Sports Nutrition Guidebook and food guides for marathoners, cyclists and soccer players offer additional information. They are available at www.NancyClarkRD.com. For her popular online workshop, visit www.NutritionSportsExerciseCEUs.com.

Senior Couple Cooking In The Kitchen

7 Tips to Avoid Obesity as You Age

As humans age, we are prone to obesity, which can cause a variety of other health problems and make it difficult to live a healthy and active life overall. Luckily, there are many things you can do to prevent obesity in old age, even if you haven’t always been healthy in the past. If you’re transitioning into retirement or living in senior communities, now is the perfect time to start living a more healthful lifestyle.

1. See your doctor regularly

As you age, it becomes absolutely crucial that you attend regular doctor’s appointments. Working with a doctor to manage your health is one of the best ways to prevent obesity. Your doctor can assess your own personal health challenges, as well as existing positive health practices, to help you develop a routine. Doctors can also help you develop a health management plan that is rooted in science and the latest technological developments, as opposed to the fad diets and exercise plans you might hear about online and in magazines. Additionally, doctors can help you catch any health problems you may encounter early on, so you can treat them and get back to health quickly.

2. Find an exercise routine you like.

It’s very important to exercise regularly, but for many people, it’s hard to find the motivation to exercise because they just don’t enjoy it. A good way to combat this is to take the time to find a form of exercise you really enjoy. There are so many different types of exercise to choose from, so if you don’t enjoy running or going to the gym, don’t worry – there are plenty of other ways you can stay fit. Look into local workout studios to see what types of classes they offer, and you can also check to see if there are any senior sports teams in your area. Even just going for a walk outside in an area you love can be a great way to stay healthy. Exercise burns calories and keeps the muscles and bones strong, so it prevents obesity from setting in. Additionally, exercising regularly will boost your mood and lower your likelihood of developing a serious health problem in the long run.

3. Drink water

Drinking water is one of the best ways to prevent weight gain, no matter what you like to eat. Water flushes out your system, so it helps you process the food you’re eating efficiently. If you’re exercising, drinking water can also help you lose weight more quickly than drinking sugary energy drinks. Water is a great way to quench your thirst without the calories that come with soda, coffee, or tea. It’s also very easy and cost-effective to drink. If you struggle to remember to drink water, carrying a water bottle around with you is an easy way to make it into a habit.

4. Eat a healthy breakfast.

Eating breakfast is crucial to jump-starting your metabolism for the day, so the body can burn calories effectively later into the afternoon and evening. If you don’t eat breakfast, your body gets hungry and starts storing the calories you consume, making it difficult for you to burn them off later. Keeping healthy, easy breakfast options on hand is a good way to ensure that you include this meal in your routine for the day. Examples of good breakfast options include fortified cereal, fruit and greek yogurt, or scrambled eggs, just to name a few.

4. Make it difficult to be lazy.

You’ll find that you’re more motivated to stay active and participate in healthy activities, such as exercising or spending time with friends, when you don’t have easier, more tempting options in front of you. For example, not having a TV in your home is a good way to ensure you don’t watch too much of it, and you won’t spend too much time relaxing on the couch. Figure out what your own personal weaknesses are and just make it hard for you to access them.

If you have a senior in your life that’s transitioning into retirement living, you can work with them to make sure that they have plenty of healthy activities accessible to them. Encouraging your senior to live a healthful lifestyle will ensure that they feel supported during this potentially challenging transition.

6. Keep track of what you’re eating.

You don’t necessarily have to count calories, but keeping a record of everything you eat every day is a great way to live healthier. Keeping a food journal forces you to be aware of everything you’re eating, and typically results in making healthier decisions. It also psychologically reinforces your positive decisions, encouraging you to stick to a healthy diet in the long term. Additionally, keeping a food journal makes it easy to talk to your doctor about your diet so you can make changes if necessary.

7. Keep your stress levels in check.

High stress levels will increase your chances of becoming obese, so it’s important to keep a handle on your stress levels as you transition into old age and retirement living. There are many things you can do to reduce stress levels – be sure you’re getting enough sleep, take time to relax and participate in hobbies, and socialize with friends and family. Actively managing your stress levels will make it more difficult for you to gain excess weight, and it’ll also help you stay healthy in other aspects of your life as well.

It’s very important for anyone to manage their weight, but it’s particularly important for seniors to do what they can to prevent obesity. Obesity can result in a variety of other health problems, and an older body won’t be able to fight off illness or injury as well as it once might have. It’s very important to work with a health professional to prevent obesity.


Holly Klamer is a connector with Senior Guidance and Senior Living Help that help provides comprehensive resources on various senior living options. She loves working in the ever-changing world of digital and is fascinated by the role content plays in today’s marketing.

group of happy pregnant women talking in gym

Pelvic Floor Dysfunction in Pregnant Women and New Mothers, Preventable & Treatable

 

Pelvic floor dysfunction, or PFD, is a broad term used to describe several physical conditions that occur mainly as a result from pregnancy and childbirth. As a pre and postnatal fitness specialist for over 20 years, almost every one of my clients has had some form of PFD. What does this mean and why is it relevant to women’s fitness? I will further define PFD in detail and explain how it changes the way we as exercise professionals program design for this clientele.

First, let’s look at the pelvic floor muscles. The pelvic floor looks like a sling or hammock that forms the floor of the bony pelvis and it serves several important functions in our bodies.  The internal layer or “pelvic diaphragm” work with the external muscles of the pelvic floor to support our internal organs, stabilize our bodies, allow for sexual function, urinary and bowel movements and assist in contracting and pushing in the birthing process. These muscles are prone to trauma from the various functions they perform.  The stress of the growing uterus in the body during pregnancy coupled with the changing gravity, posture and production of the hormone Relaxin all contribute to weakening the pelvic floor muscles.

Second, consider the whole Neuromuscular Core system. Pelvic floor muscles connect to the Transverse Abdominus (TVA) and they work together in harmony essentially hold the body upright. It is almost impossible to engage one without the other. Tightness in the hips combined with weak pelvic floor muscles creates PFD.

Diastasis Recti, Symphosis Pubis Dysfunction (SPD), Urinary and or fecal incontinence, pelvic pain, chronic lower back pain, Piraformis syndrome, sciatic pain, pelvic organ prolapse are all conditions under the pelvic floor dysfunction umbrella.  Below these conditions are listed and defined in more detail.

Diastasis Recti: This is a separation of the right and left side of the Rectus Adbdominus in the Linea Alba connective tissue more than 2 cm in width

Pubic Symposis Disorder: A separation of the pubic bones, which often occurs during birth but sometimes during the third trimester.

Urinary incontinence: Uncontrollable leakage from bladder.

Fecal incontinence: Uncontrollable leakage of fecal matter from colon. Usually as a result from severe tearing during birth.

Pelvic pain: This type of pain can be during sex or when performing a movement that is irritating or uncomfortable, many possible underlying issues.

Chronic lower back pain: Unexplainable chronic lower back pain

Sciatica: Pain that radiates from lower back down one leg along the sciatic nerve as a result of compression of the sciatic nerve

Piraformis syndrome: Also a result of an inflamed sciatic nerve but more localized

Pelvic organ prolaps: When organs of the pelvis fall as a result of weak pelvic floor muscles.

These conditions can be limiting for many women and go untreated because they are embarrassed or told that they are normal “experiences” after giving birth. Until recently, very few fitness programs existed to help women strengthen pelvic floor muscles. It is my opinion that every pregnant woman and new mother should be automatically screened for PFD and treated right away. If women do not learn proper strengthening exercises of pelvic floor muscles they can potentially live in discomfort for years. The sooner preventative care is offered the better the quality of life for these women.

As mentioned earlier, many of these conditions are preventable and remedied through a combination of functional strength with corrective, posture-based range of motion exercises. When a woman becomes pregnant there is an immediate increase in pressure to the pelvic floor muscles. The body begins to produce relaxin which affects the joints throughout the body, especially the pelvis as it prepares to accommodate the growing uterus and eventually for birth. If treatment begins to help women continue strengthening the muscles surrounding the hips immediately, the pressure on the pelvic floor muscles will be reduced.

It was common practice until recently that women were advised to learn and perform Kegel Contractions. We understand more now as movement therapists that Kegel contractions are very hard to teach, very isolated, and in most cases, when examined internally by a women’s healthcare PT, women are not performing them correctly.  A more effective approach to strengthening the pelvic floor muscles is to treat the entire hip complex as “one”– or a “global approach” — as described in applied functional science.

So, how do fitness professionals help create beneficial, safe and effective exercise programming for pregnant clients and new mothers that hone in on the core and pelvic floor? We must start by helping our clients improve their posture first and foremost, then work on proper breathing techniques and lastly incorporate larger exercises that do not isolate, but recruit many muscles from the hip complex and surrounding muscles groups. By incorporating all three planes of motion instead of working primarily in the sagittal plane (forward and backward) when performing even the most basic of exercises (i.e., the squat), you must change the movement by foot placement, arm placement, direction, tempo, range of motion etc. The variety in actions creates good stress to the pelvic floor and core muscles. Additionally, increasing the adduction and abduction action simultaneously while performing various exercises will help activate and recruit pelvic floor muscles subconsciously. Anatomically speaking, everything is connected in the body. Understanding that big global movements of the upper body and lower body together affect the position and strengthen of pelvic floor and core muscles is essential. The body is most efficient at strengthening the small muscles when big muscle groups are stimulated in combination. Throughout my years, I have seen much success with clients that incorporated these types of movements into their workout regimen and were safe and conscientious not to perform exercises that added bad stress to the external abdominal muscle group or impact exercises.

Each woman is different on how quickly it takes her to recover from PFD. The most important rule of thumb is to be reassuring and provide support and remember the time line is different for everyone depending on severity of PFD, the fitness level of the client, if the client is breast feeding and prior injuries that could prolong healing time.


Danielle Spangler, C.PT, has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com

Personal Trainer At The Gym

Body Language, Self-Awareness and The Client Experience

As a trainer, you wear many different hats during a typical work week. In turn, you are pulled in many different directions among family, friends and clients.  If you are focusing on too many topics at once you cannot be in the moment, which can lead to a lack of client retention.

Being in the moment.

There is a lot of competition in the studio market and potential members/clients like to belong to a gym – and stay with a gym – where they feel comfortable.  That puts the limelight on personal trainers to generate the positive client experience that is so important to retention.

This is why being in the moment is vital to gaining new clients and retaining current ones. If trainers are distracted this may be apparent through body language. Members may perceive being distracted as receiving bad customer service.

Members decipher up to 93% of what is said through body language.

When you think of excellent customer service, which companies come to mind? What makes them stand out from their competition? The employees that work for these companies are mindful and in the moment. They anticipate the needs of the client and help them accordingly.  Being in the moment means that your body language and what you say conveys the same message. This is important to note for customer service and member retention.

The importance of not ‘zoning out.’

Members are constantly making decisions on how they want to spend their money. When trainers work with clients they should be mentally and physically present for each session. If a trainer zones out the trainer leaves their client wondering if the session is important to them. Trainers also miss out on potential new clients who may have wanted their services.

Clients will typically get your attention first by asking if there is “something else you need to do”. This should be a clue that they know you are not in the moment.  You want to fix this quickly before the client stops training at your facility. Potential clients also watch to see how focused and attentive you are.  I once had a member watch my training sessions for 5 months before deciding that he wanted to hire me. He said that he was looking at my training style, personality and attentiveness. He passed up two other trainers because they seemed uninterested.

When you and/or your staff have better self-awareness you are able to anticipate the needs of your members easier.  You will also notice that more clients would like to train with you. By being in the moment every day your clients feel like they had an experience that they want to share with friends and family.

Do you know what message you’re conveying?

Nonverbal communication involves facial expressions, gestures, eye contact, posture, voice, and touch -and is actually more important then what is said verbally. Trainers are communicating non–verbally with clients and members all of the time and when mixed signals are sent, clients have to try to figure out how you actually feel.  You may be speaking to your client and sound present and in the moment but is your body language  communicating otherwise?


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References

http://www.helpguide.org/articles/relationships/nonverbal-communication.htm

http://www.statisticbrain.com/gym-membership-statistics/

 

Breast Cancer Survivor

Breast Cancer and Exercise

The most common issues that plague post-mastectomy patients are upper-crossed syndrome and range of motion limitations in the affected shoulder. Upper cross syndrome is the combination of protracted (rounded) shoulders, forward head, cervical lordosis, winged-scapula, and thoracic kyphosis. As a result of these postural deviations, mastectomy, lymph node dissection, and/or radiation, the chest muscles may become tight, shortened and spastic. This not only exacerbates the postural deviations, but may limit the ability of the patient to move their arm/shoulder through flexion, extension, abduction, and external rotation. While this is a general statement, the majority of patients will present with these symptoms. This is compounded even more if the woman undergoes reconstructive surgery. Not only with it further exacerbate upper-crossed syndrome, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis or latissimus muscle are used for reconstruction.

a trainer helping a senior woman doing fitnessThe most important factor in the safety and efficacy of the exercise program is the initial assessment. At the very least this should include a comprehensive postural assessment as well as shoulder range of motion measurements taken with a goniometer. The well-trained fitness professional will be able to deduce, from the results, which muscles need to be stretched and which need to be strengthened. By selecting the wrong combinations of exercises, the results may not only be undesirable, they may in fact be detrimental. For example, if a client presents with moderate to severe upper-crossed syndrome, performing any kind of “pushing” exercise that would involve the chest muscles (chest press), could make the syndrome even more pronounced by causing the pectoral muscles to tighten and contract. Instead, the goal need to be on stretching the chest wall and strengthening the opposing muscles in the back; particularly the scapular stabilizers.

Prior to adding a load (resistance) of any kind, the patient should have close to full range of motion through the particular plane of motion. Without correcting the range of motion first, the patient will reinforce the negative movement pattern by performing strength training exercises throughout a limited pattern of movement. Therefore, initially the focus should be on range of motion exercises. These may include very basic exercises that the patient can do on their own; front wall walks, side wall walks, pendulum swings, and corner stretch, or active isolated stretching that can be executed with the assistance of a professional. The combination of both will increase the speed of improvement in most cases.

Once close to full range of motion is achieved, the emphasis can be on strength training. Not only will this help to correct the postural and range of motion deviations, it will help increase bone density and lean muscle mass. Many women will either be of menopausal age, or thrown into menopause from their cancer treatment. With estrogen no longer being produced, the risk of osteoporosis increases. To make things even more complicated, the long-term side-effects of chemotherapy include osteoporosis, diabetes, and damage to the heart and lungs; all of which can be avoided or improved through proper exercise recommendations.

The last part of the equation is the risk of lymphedema of the affected arm/shoulder. Lymphedema is the swelling of the extremity following the removal of, or radiation to the lymph nodes on that side. Even if someone has undergone a sentinel node biopsy, and only had one node removed, they can still get lymphedema. Lymphedema is progressive if untreated and can be very painful and disfiguring. It can happen at ANY time after surgery; one hour or fifty years. The risk doesn’t increase or decrease with time, however a higher percentage of body fat, infection, age, and poor nutrition can all increase the risk once someone is at risk. In my sixteen years of working with cancer patients, I would say this is the number one “overlooked” issue amongst cancer patients. More often than not, they will not even be told about lymphedema. Following lymph node dissection and/or radiation, the lymphatic pathways do not operate with the same efficacy that they did previously. Therefore, we no longer know what the individuals exercise threshold is. It is critical to START and PROGRESS SLOWLY. This allows for a gradual increase in frequency, intensity, and duration of the exercise program. If at any point there is swelling, the patient should be advised to stop exercising and see their doctor immediately to determine if, in fact, they do have the onset of lymphedema. They should come back with a medical clearance form and the exercise instructor should take a step back with the frequency, intensity, and duration to the point prior to the onset of swelling.

Putting all of these pieces together is very much like solving a mathematical equation. If you are missing any of the information, you will never solve the problem. A typical exercise session should begin with cardiovascular exercise. This too should be gradually increased at a rate that the client is comfortable with and their body responds favorably to. They should stay well-hydrated, they should not wear tight-fitting or restrictive clothing on their upper body, and they should not overheat (all of these factors can increase the risk of lymphedema). Following the warm-up they should be instructed to do a series of lymph drainage exercise to open up the lymphatic pathways and prepare the body for exercise. I reference these exercises in CETI’s Cancer Exercise Specialist Handbook and Breast Cancer Recovery with the BOSU® Balance Trainer Book.

Meta Slider - HTML Overlay - Women wearing pink tops and ribbons for breast cancer on white backgroundFollowing the warm-up and lymph drainage exercises, the exercise specialist should determine what the areas of “need” are for the client. Remember to begin with stretching and range of motion exercises until they have close to “normal” range of motion. At that point the goal becomes strength training and choosing exercises that will strengthen the weaker muscles and stretch the tight and shortened muscles. Weight/resistance should also be very gradually increased and attention paid to any potential swelling of the extremity. Typically I chose exercises that will stretch the chest (chest fly, corner or door stretch, assisted stretching) and will strengthen the back (low/high rows, reverse flies, lat pulldown). They often [present with winged scapula following a node dissection. If this is the case, I will incorporate exercises that will strengthen the serratus anterior. If they have undergone an abdominal TRAM procedure, core work will be of the greatest importance in preventing, or minimizing, low back pain.

Because every muscle in the body works synergistically, an imbalance in the shoulder can lead to a multitude of imbalances from the hips to the knees to the ankles etc… Choose your exercises carefully. Put emphasis on the areas of need. This is not and can never be a cookie-cutter workout. No two breast cancer patients are the same. Not only are you taking into consideration their surgery, reconstruction, and treatment, you have to also factor in the remainder of their health history and any additional orthopedic concerns. I urge anyone who wants to work with cancer patients to undergo specialized training. It is very complex and the untrained professional can end up doing more harm than good.


Andrea Leonard is the Founder and President of the Cancer Exercise Training Institute. She is a certified as a corrective exercise specialist by The National Academy of Sports Medicine (NASM), as a personal trainer by The American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the American Council on Exercise (ACE), and as a Special Populations Expert by The Cooper Institute. She is also a continuing education provider for the National Academy of Sports Medicine and The American Council on Exercise.

man in window

Could Emotional Patterns Make Us More Susceptible To Cancer?

There is a lot of research, clinical data and statistics related to cancer – types, causes, and treatments – available to anyone interested in looking them up. There are, of course, the usual suspects /causes of cancer (more on that later). But there could be a case made out to look beyond the obvious. Scratch deeply and look below the surface. There is another omnipresent trigger we lug around and don’t give this Machiavellian it’s due. It coexists as both cause and effect, feeds off us, is often suppressed, and is usually the last to be addressed, if at all.

‘Unaddressed and unresolved emotions’.

The source of these could be singular, or more likely, multiple. Cracking or crumbling relationships, pressures of work (often tied up with a sense of ‘worth’ & ‘success’), irritants at home (from the mundane to the serious), overwhelming sense of responsibilities as a spouse, parent, child, maintaining a lifestyle, etc. come to mind easily. This tangle slowly and silently claws away at body, mind and soul. Some may immediately label it ‘Stress’. But this emotional web can manifest in other physio-psychological avatars too. It is silent and deadly. It attacks all systems- skeletal, muscular, nervous, circulatory, etc. All organ systems on one hand, and cognitive and emotional on the other, interfering with and impairing our quality of living and coping abilities. While one needs to clearly distinguish and recognize medical reasons for what they are, the truth is, this silent trigger is omnipotent. Abstract though it may seem, emotions wield the power to mess with our tangible systems. They have the capability of producing unwanted, negative, and damaging results in the human body. Sometimes, drastically so.

SHOULD WE BE LOOKING MORE SERIOUSLY AT OUR EMOTIONAL HEALTH IN OUR BATTLE AGAINST CANCER?

A long, relaxed conversation with a cancer survivor friend brought this aspect to the fore yet again. He has overcome cancer twice and tried all treatments – mainstream and alternate, including adopting a complete lifestyle change which most of us can only aspire to. But there remains an unaddressed issue. After years spent on this journey of cancer, getting on and off track, he calmly mentioned this point in relation to his experience of it. It was interesting to hear him analyze his own life experiences. Aware of what’s impacting him (acknowledging the source of his emotional drain), he recognizes the need let it go, and admits that he hasn’t been able to yet. Driven by his emotional moorings, he hasn’t been able to sever this source of recurring negativity in his life despite nudging by family, friends, healers and a few doctors.

He further went on to calmly say that till such time as he lets go, he is not fighting the root causes of cancer completely. (I say ’causes’ so as not to make an oversimplified case of cancer triggers, especially in relation to emotional health, nor is it my intention to present this as a thought in conflict with medical advice or challenge it.) He intends to seriously weigh the worthiness of continuing with this emotional baggage and its impact on his body.

DOES THIS MATTER?

He isn’t the first person – or the last – to have mentioned this connection. There is something more than pure abstraction at play here. And it’s worth acknowledging the elephant in the room. We are, after all, feeding it and it is rolling its weight all over us. Emotions impact us and negative emotions more so. Our bodies respond in myriad ways trying to combat it. Labored breathing, racing/irregular heart beat (cardiovascular), tight muscles (muscular), tingling in fingers/toes (neural), aches and pains (skeletal and muscular), compromised digestion, high/low blood pressure (other body systems)… these are just some common perceptible symptoms and responses to our altered emotional states. We have all experienced them to varying degrees and at different points in our lives. Not to mention what happens to our (emotional) responses and thought process.
It becomes a cause of concern when this altered state continues for a longer period of time. The body appears to adapt and these symptoms become silent and internal in nature. The impact, meanwhile, continues on a wider, cellular level, and various manifestations of this silent aggressor may emerge over a period of time, including possibly, as cancer.

SHOULD WE EMPOWER OURSELVES BETTER?

Does it mean all cancers are somehow the result of negative emotions or negative emotions will always lead to cancer? There is no definite, categorical ‘Yes’ as an answer. But, it could prove helpful investigating and addressing how our underlying emotive states may be leaving us exposed to greater possibility of serious health conditions, including cancer, along with all other clinical causes. As a precautionary tool, I reckon paying attention to emotional health plays a rather important role. We know that a healthy and fit lifestyle has so many advantages in serving as prevention for many health conditions. ‘Fitness’ needs to encompass emotional and mental health (strength and fortitude) too, by constantly sieving out the negative and enhancing the positive. It requires acknowledgement and working upon, with a conscious approach. As a cancer coping mechanism, focusing on positive emotional health and reducing negative (draining/sapping/unhappy/stressful/fearful) emotions plays a powerful role.

Emotions have the power to alter the human state at the conscious and subconscious levels. They can be an ally or a foe in our battle against ill health. They have the ability to align internal systems/processes to either facilitate or hinder external efforts.

So while one may refrain from an outright ‘yes’ to the question raised above, one cannot say an outright ‘no’ either. As science discovers deeper working of the human ecosystem, it is increasingly revealing the intertwining of our emotive state with our physical one.

Humans are emotional beings.

We cannot challenge it nor ignore the fabric that differentiates us. When one goes against the basic grain it creates friction. Prioritizing striving for a residual state of positive emotional health needs a deliberate plan and push. It is not easy. But neither is cancer nor its treatment. Using different techniques to spot and train our emotions, create emotional alchemy, makes sense now more than ever before, with different types of cancers spiraling and affecting all age groups, sometimes with the known triggers missing.

“Until you make the unconscious conscious, it will direct your life and you will call it fate.” –C. G. Jung

Originally printed on bodyinmotion.in. Reprinted with permission.


Vani Pahwa is a Functional Fitness specialist with over fifteen years of experience, and cutting-edge certifications from leading internationally-accredited and globally recognized fitness institutes. She is also a Cancer Exercise Specialist (perhaps one of the first in the country). Sought after for her multi-disciplinary fitness modules and expertise, Vani has conducted fitness workshops for leading corporate houses, conditioning and training camps for various sports communities, training programs for coaches, personal training programs for CEOs of multi-nationals, athletes, junior and senior sports professionals among others. Her combination of specialties, client profile and range, and extensive work experience makes her unique in the country. She is the founder of Body in Motion.

** If interested in further research on the topic you may read up related links including:

pain frustration

Chronic Pain – Healing with Release

Healing with release is based on the fundamental idea, backed by research, that stress, tension and trauma are both psychological and physical. Twentieth-century science is moving forward to a better understanding of the body’s deterioration. Hans Selye recognized that physiological disease could arise from psychological causes, such as stress (Somatic viewpoint). The pathology of chronic pain is associated with numerous losses such as a decline in physical fitness, disturbance of sleep, strained relationships, loss of energy and fatigue. Social isolation, loneliness and anger are often evident in people suffering from chronic pain. These negative emotions exacerbate pain and increase suffering. An estimated 33 to 35 million U.S. adults are likely to experience depression at some point during their lives.  

In 2011 in USA alone hundred million Americans suffer with chronic pain and the cost of lost wages translated to $ 600 billion due to employees with chronic pain calling in sick because of a pain–related condition such as:

  • Headache—$14 billion, only $1 billion of which consists of health care costs (Hu et al., 1999), partly because most people with migraine stop seeking medical care for the condition (Silberstein, 2010)
  • Arthritis—$189 billion, less than half ($81 billion) of which is for health care costs (Yelin et al., 2007)
  • Spine problems—$2,500 average in incremental medical costs (Martin et al., 2008); and low back problems—$30 billion (Soni, 2010) Opioid pain medication use presents serious risks, including overdose and opioid use disorder
  • Between 1999 and 2015, more than 183,000 people in USA died from overdoses related to opioids.

By having a flexible spine with strong hips and thighs, the human body is ideally designed for movement such as walking, running, squatting, and claiming- throwing objects and swimming.  Unfortunately, during the course of a person’s life, the sensory-motor nervous system continually responds to daily stresses and traumas with specific muscular reflexes. These reflexes, triggered repeatedly, create habitual muscular contractions which cannot be relaxed–at least not voluntarily.

If stressed, traumatized, overused and repetitively used muscles are required to continue to work, the muscle begins to tighten. Once this happens the contraction of the muscle constricts the blood vessels. This reduction of blood flow reduces the oxygen to the tissue. Once a tissue is oxygen deprived, it will shut down and tighten more. This creates a negative pattern of tension, oxygen deprivation, and more tension that ultimately results in rigid muscle tone. This results in one’s postural misalignment and muscular asymmetry with symptoms such as:

  • Chronically hard, tight muscles
  • Chronic tightness or chronic inflammation of a tendon(tendinosis)
  • Chronic joint tension or chronic inflammation
  • Limited range of motion in a joint
  • Impingement of a nerve resulting in numbness or a tingling sensation
  • Compression of a disc resulting in neck or back pain
  • Muscle weakness in one area especially if the muscle feels tight
  • Consistent muscle cramping
  • Joint instability while performing daily tasks
  • Recurring muscle strain or injury to the same muscles

Muscles needed to perform regular, daily tasks (such as sitting and standing) are what we call “functional muscles”.  It is more important in daily life to have functional muscles than it is to have big, hard muscles.  Functional muscles require more endurance than pure strength.  The focus of restoring to maintain a healthy body is to increase the endurance of those muscles which are needed to function throughout the day.

The exercises which safely activate a natural reflex mechanism calming down the nervous system which releases muscular tension are based on restoring blood flow and oxygen to tissue.

Muscular tension release can be done by manual pressure that is applied to the most superficial layer of tissue where dysfunction appears (pain, tension or rigidity). Once the tight tissue is stimulated, blood flow to the area increases and the tight tissue will become suppler. This allows the therapist to access the next layer of tissue without applying excessive pressure.  This pattern is repeated until all layers of dysfunctional tissue are restored and the tight, rigid tissue is replaced with supple and mobile tissue.  Supple and mobile tissue will be free of pain and have a greater range of motion.

The ability to release muscular tension independently one must learn how to align their body and mind while experiencing an alert but relax state of awareness. The SykorovaSynchro Method℠ is a phenomenal educational tool with positive impacts to patients mentally, physically and emotionally and has three stages/ progressive levels:

  1. To balance function of sensory-motor cortex via sensory stimulation mental imagery (sometimes called visualization, guided imagery), progressive muscular relaxation and control breathing. Result is relaxed but alert state of awareness.
  2. To enhance sensory integration/ awareness of somatic movement (movement regulated by feeling, mental imagery, sensation). Result is ability to perform somatic/ intuitive movement.
  3. Ability to perform conscious exercises – via mental imagery, sensation. Positive result is in neuro muscular conditioning/ function – postural improvement, balance, coordination, flexibility and agility.

Research has shown that when we imagine an experience, we often have similar mental and physical responses to those we have when the event actually happens. For example, if one recalls an upsetting or frightening experience, she/he may feel their heart beating faster, may begin to sweat, and hands may become cold and clammy.

In life it is very important to minimize the negative effects and maximize the healthy, healing aspects of the mind–body connection. Each person has a unique capacity for getting better, healthier, achieving peak performance and recovering from injury.

The mind-body connection means that one can learn to use his/her thoughts to positively influence the body’s physical responses, to create abilities to be aware of their own thoughts and actions in the present, without judging them self.

Physical activity has the potential to be not just an activity of the body, but a whole body-mind-spirit system. Exercise can create a unique, beneficial mental state; and the positive mental state can enhance the benefit of exercise as a part of muscular release tension plan, which reinforces the perception that exercise is just an out of body experience.  We have to remember, that our bodies are made to feel good and has abilities to heal.

A unique water exercise program based and structured on those principles will teach you to release tension, increase mobility and build endurance in muscles, tendons and joints. Those physical exercises are performed with an intense focus to utilize four principles such as breathing, proper form, control and concentration.

  • Exercise is performed with controlled breathing that utilizes full inhalations and full exhalations that follow a specific number of counts or rhythm. The goal is to learn how to breathe at a pace of 6 breaths a minute, about 3 or 4 seconds inhaling and 6 or 7 seconds exhaling. Once we have the slow, deep breathing accomplished, we don’t have to worry about counting and imagine breathing out any tension in the body or thoughts that get in the way of comfort and relaxation. The benefit of the water environment is tremendous. Hydraulic pressure increases human vital capacity in shoulder depth immersion 7x more than air, which promotes deep breathing and natural relaxation.
  • Exercise is performed with proper form or in precision. Quality of movement counts more than quantity in a mind-body exercise. Precision requires mental control. The mind has to be wholly focused on the purpose of the exercises as you perform them. The sensation of water on the skin is enhancing biofeedback’s, which helps with proper form greatly.
  • Neuromuscular exercise always involves the control and balance of your own body-weight. In water exercise we have interplay between gravity and buoyancy, weight and weightlessness. Control of the body can become challenging and at the same time very beneficial for overall success. By implementing movement patterns in a variety of directions, we stimulate and enhance balance, coordination, and flexibility, and inspire the neuromuscular system to become more expansive and creative. Moving in different speeds is an aspect of our physical capabilities that must be practiced in order to maintain a sense of health and well-being.
  • Releasing Movement is performed with intense concentration on yourself, in the present moment. The mind-body exerciser is focusing on his/her body rather than on the instructor, or on other participants. One should never be day dreaming about other things. The point-of-focus in a self- sensing exercise will differ from most other forms of physical exercise. One should be thinking about stabilizing, or anchoring, the area of the body that is NOT in motion. This is contrary to the usual Western method of trying to isolate the muscles that we perceive to be performing the movement.

Working as a health-fitness professional for the past 30 years, I am sensitive to the overall health of students/clients, and I continue to put research developments into practice. The focus in fitness these days for “Active Aging”, “Athletic Recovery”, “Chronic Pain Management”, “Healing with Release” are functional exercises – exercises that simultaneously use multiple muscles and joints to improve muscular endurance, overall strength, coordination, balance, posture and agility – to get a challenging, effective and fun full-body functional workout as well as prepare the body for every day, real world activities.

Reprinted with permission from Dr. Maria Sykorova Pritz and the Aquatic Exercise Association (AEA). The AEA is the leading educational agency in water fitness and is reaching health-fitness professionals in aquatic field. This article first appeared in the August/September 2018 issue of their AKWA magazine. 


Dr. Maria Sykorova Pritz Ed.D earned her doctorate in education (specialty in Physical Education and Sports) from University Comenius in Bratislava, Slovakia. Maria is an ATRI faculty member, member of AEA Research Council, author of health fitness articles and FLS CE class, presenter for national and international fitness conferences. In her 32 years of professional career Maria is combining academic knowledge with hands on experience in functional fitness, pain management via land based and aquatic fitness. Maria’s unique training method (SykorovaSynchro Method℠) involves integration of multidisplinery techniques to achieve overall health and optimized performance. Maria is an ATRI faculty member, member of the AEA Research Committee, FLS continuing education developer, author and presenter.

Resources:

  1. BURDENKO I, MILLER J. (2001) Defying Gravity. www.Burdenko.com.
  2. GREGOR T., SYKOROVA PRITZ M.: (2008) Pain management and psychophysical     conditioning through water exercise. Revue Mediciny v praxi, Bratislava, MAURO Slovakia s.r.o. Rocnik 6, cislo 1, 2008, s.29, 30, 38 ISSN 1336-202X
  3. Discovery writers. (2013): Mind – Body Exercise Connection. Discovery Fit &Health; http://health.howstuffworks.com/wellness/diet-fitness/information/mind-body-exercise-connection.htm
  4. INSTITUTE of MEDICINE (2011): Relieving Pain in America. A Blueprint for Transforming Prevention, Care, Education, and Research
  5. JOHNSON, L.S.(2009):”Therapist’s Guide to Posttraumatic Stress Disorder Intervention”, Academic Press is an imprint of Elsevier, San Diego, California, USA.Page146-148, ISBN:978-0-12-374851-5
  6. RAMSEY L. (2018): As America fights opioid addiction, the healthcare system is failing people who live with chronic pain: http://www.businessinsider.com/people-with-chronic-pain-during-opioid-crisis-2018-1
  7. SYKOROVA PRITZ, M. (2007):” The effect of water exercise on selected aspects of overall health on a fibromyalgia population”. Aquatic Fitness Research Journal, October 2007, Volume 4, Issue 2, Nokomis, Florida, USA: Aquatic Exercise Association. page. 6-13
  8. SYKOROVA PRITZ, M. (2018):” Healing with Release” AKWA: Volume 32, No 2;  Brunswick GA. USA; Aquatic Exercise Association, page 31-33,ISSN: 1536-5549
  9. STOLNICK, D.:  (2000-2008) Looking for joint pain relief. Vilage Inc.
  10. VAN HOUDENHOVE, B, – EGLE, U, – LUYTEN, P. (2005): “The role of life stress in fibromyalgia”, Curr Rheumatol Rep. 2005 Oct; 7(5):365-70.
  11. THEARMAN, B.H.: (2007) Simple solutions to Chronic Pain. New Habringer Publication, Inc. ISBN-13: 978-1-57224-482-5.

NOTE: To learn more about SykorovaSynchro Method, it is recommended that you take the course “Application of Water Exercise for Health Fitness Professionals Specializing in Pain Management.” to increase your knowledge and skills.  For more information, log on to www.FitnessLearningSystems.com.