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What a pain in the neck!

If you are one of the millions of people who suffer with neck pain, YOU ARE NOT ALONE!  Do you spend hours hunched over your laptop? Are you constantly staring down at your phone? Is your stress level out of control? Do you lack self-care in the form of exercise and nutrition?

Forest with Stream

Forest Therapy

Whether we realize it or not, humans and trees have an organic connection with each other. We exhale the carbon dioxide that trees absorb. Trees emit the oxygen that humans need to live. Many cultures – both ancient and modern – have recognized this interdependency. Nearly every pre-industrial people group has had traditions, ceremonies, and medical practices tied to trees.


Diaphragmatic Breathing and Cardiovascular Exercise Performance 

Diaphragmatic breathing is a technique that involves engaging the diaphragm muscle while breathing, allowing for more efficient oxygen exchange in the body. This type of breathing can be beneficial for cardiovascular exercise performance, as it helps to increase the amount of oxygen that that is taken in with each breath. By doing so, diaphragmatic breathing can improve aerobic capacity, endurance, energy levels during exercise, as well as reduced feelings of fatigue and improve lung function.

One study conducted in 2016 found that diaphragmatic breathing improved exercise performance in trained male cyclists. The study participants perform a maximal cycling test, during which they practiced diaphragmatic breathing. The results show that the cyclists who used diaphragmatic breathing had a significant improvement in their VO2 Max (the maximum amount of oxygen used during exercise), and power output compared to those who did not use diaphragmatic breathing. Another study conducted in 2015 found that diaphragmatic breathing improved respiratory muscle function and reduce breathing effort during exercise in both trained and untrained individuals. Diaphragmatic breathing can also help to reduce stress and anxiety, which can have a positive impact on exercise performance. Stress and anxiety can lead to increased heart rate, shallow breathing, and decreased oxygen uptake, which can negatively impact exercise performance. By practicing diaphragmatic breathing, individuals can reduce stress, anxiety levels and improve their ability to handle the psychological demands of exercise.

In addition to its benefits for exercise performance, diaphragmatic breathing can also have other health benefits. It has been shown to reduce blood pressure, improve lung function, and enhance overall relaxation and well-being. For individuals with respiratory conditions such as asthma, COPD, or bronchitis, diaphragmatic breathing can be a helpful technique for managing symptoms and improving respiratory function.

It is important to note that diaphragmatic breathing should not be relied upon as a sole method for improving cardiovascular exercise performance. It is best used in combination with other techniques, such as proper warm up and cool down, a balanced intense exercise program, adequate nutrition, rest, and recovery. In addition, it is important to consult with a healthcare professional before incorporating diaphragmatic breathing into any exercise routine, especially if an individual has any pre-existing health conditions.

In conclusion, diaphragmatic breathing can be a useful technique for improving cardiovascular exercise performance. By increasing oxygen uptake, reducing stress, anxiety, and improving lung function, diaphragmatic breathing can help individuals to perform better during exercise and enhance overall health and well-being. However, it should be used in combination with other techniques and under the guidance of a health care professional for maximum benefit.

Reprinted with permission from author.

Mike Rickett MS, CSCS*D, CSPS*D, RCPT*E is a nationally recognized health and fitness trainer of the trainers, fitness motivator, author, certifier, educator, and the 2017 NSCA Personal Trainer of the Year.  He has been a fitness trainer for more than 35 years. With Cheri Lamperes, he co-directs BetterHealthBreathing.com, a conscious breathing educational program focusing on the diaphragmatic technique to enhance overall wellness.  In addition, he also directs the personal training site ApplicationInMotion.com.  


Understanding the Causes of Recurring Musculoskeletal Pain and Injuries

Musculoskeletal injuries from trauma, repeated activities, or overused joints or muscles are very common — in fact, almost every one of us will get injured at some point in our lives. Most of the time, it will reoccur and become more serious when left unattended or untreated. When repeated injuries happen, it is very likely not due to a one-off fluke.

So why do we constantly get hurt at a specific joint or muscle? And why does the pain seem to travel elsewhere after?

The human body is complex and designed to move in countless movement patterns. When we move, kinetic energy travels from our feet to our neck and head. This concept is called the Human Body Kinetic Chain Movement. Our skeletal system consists of various joints linked in a chain, each with specific purpose and function.

Stability and Mobility at the Joints

When our joint is not functioning as it is intended to, our body will adopt a dysfunctional movement, which can lead to acute pain in our joints or muscles. If not corrected, chronic pain can happen. A sedentary lifestyle, past injuries, poor posture and misalignment, stress, health conditions, diseases, and other factors can lead to the development of dysfunctional movement.

Here’s an example of a common dysfunctional movement at the lower proximity. If your ankle (which is supposed to be mobile) is stiff, your body will seek mobility at the knee which is supposed to act as a stable hinge. A painful knee typically develops as a result. In another scenario, if you spend extended periods of time sitting and experience restricted mobility at your hips, your body may compensate by seeking mobility at your knee or lumbar spine. This reversal of joint roles can lead to injury or pain in the affected joint or muscle.

Continuing to compensate for the long term can cause a cascading effect such as muscle imbalances, poor neuromuscular function and muscle atrophy or hypertonicity.

One of the common mistakes we make is to only address the symptom (pain) with the use of NSAIDs, massage, chiropractic therapy and other non-invasive or invasive treatments, rather than addressing the underlying cause of the problem.

Another widespread misunderstanding is the idea that simply strengthening the muscle at a joint can solve the problem, without considering its kinetic chain relationship. For example, strengthening the quadriceps to alleviate knee pain, without taking into account the mobility of the ankles and hips or the stability of the lumbopelvic area.

That’s why it’s crucial to have a comprehensive understanding of how our bodies are designed to move, and to identify any weak links in our body’s kinetic chain to ensure optimal recovery through appropriate rehabilitation measures, and not view the problem in isolation.

Typically, it is advisable to conduct an assessment initially to pinpoint the root of the problem. However, when a patient presents to my clinic in pain, they often exhibit compensatory movement patterns that can yield false positives/negatives results. For this reason, my approach is to first identify the type of pain or injury they are experiencing and address their pain as a priority. To reduce their pain levels, I utilize methods such as soft tissue manipulation and other therapies that are appropriate for their condition.

Soft tissue manipulation and manual therapy, such as massage has been proven to:

  • alter pain signal at the central nervous system,
  • manage inflammation,
  • inhibit muscle spasm and reduce muscle tonicity,
  • improve blood circulation and oxygenation to the injured tissue,
  • and improve mobility and flexibility at the joint.

It is best to engage a practitioner who is trained or skilled in this field, or perform self myofascial massage by using a foam roller or trigger point massage ball under guidance.

Once the pain has been adequately managed, I will proceed with a thorough assessment to identify any potential weak links in the person’s kinetic chain. After that, they will begin an active treatment program that includes targeted stretches, mobility drills, and muscle reactivation exercises through a set of neuromuscular exercises. The rehabilitation program also emphasizes teaching the person to disassociate their movements and joints through specific exercise drills, which re-trains their brain to use their muscles and joints as it is supposed to. As soon as they are able to correct their dysfunctional movement, it is highly recommended to strengthen the entire structure based on function, rather than relying solely on brute strength.

Understanding the concept of our body’s biomechanics and how kinetic chain work can help you better manage or even resolve musculoskeletal injuries holistically, and not just detaching the problem to a specific joint or muscle.

Do take note that different types of musculoskeletal injuries may require different forms of therapy or approach. It is extremely important to seek a professional’s help to determine the appropriate care for your musculoskeletal pain or injury.

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.


Field, T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice.

Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological Bulletin.

Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine.

American Council of Exercise (ACE)

National Academy of Sports Medicine (NASM)

walking shoes

Gait Speed… Chase It!

Walking is our freedom to GO anywhere, anytime, automatically, to get somewhere ‘on our own’ without fear or assistance.

It is the antithesis to the slipper shuffle and a key player in fall resistance, that is, staying UP. A shorter, wider stride, stiffer ankles and feet, and a hunched posture are not a function of aging per se. We CAN be spry, walk tall, with spring in our step, well into our 80’s and 90’s.


Functional Movement Patterns in Exercise For MS

You’ve heard the terms functional exercise, functional movement or functional movement patterns… but what do these terms actually mean?

The term “functional movement patterns” is confusing because it is really not a specific term. Trainers, especially those putting MSers on exercise programs, will usually take them through a program of upper and lower body exercises incorporating compound movements that ask your body to do several things at once. They tell you this is a functional exercise routine and that it’s the best way to help you with your MS limitations. Every exercise is NOT considered a functional one. So what’s the difference?

Functional, by definition, means, “of or having a special activity, purpose, or task; relating to the way in which something works or operates”.  In this case, the task is being a functional MSer with the ability to use your body to do what you’d like it to do like you did before your MS diagnosis.

And even though being “functional” is different from one person to the next—for instance, a triathlete needs to be able to run, bike, and swim without limitation or pain, while a homemaker (male or female) needs to be able to do household chores such as lifting groceries out of a car, moving a vacuum cleaner and loading and unloading a dishwasher without limitation or pain—the actual movement patterns required for these activities aren’t really that different.

When you think of functional movement patterns, you should see them as movements that engage your whole body in a variety of different active ways that involve coordinating your upper and lower body with areas that alternate from being steady to moving, and back again.

So where exercises like squats are considered functional because they require full-body coordination, strength, and stability exercises like biceps curls aren’t considered functional because they lack the full-body mental and physical engagement that comes into play with basic motion.

The main difference between functional training and other exercises that work each muscle is that exercises such as biceps curls or leg extensions attempt to isolate that muscle. When doing these movements we’re working individual body parts as separate from the others creating stimulus within those parts. Functional movements put the emphasis on using your whole body at once. 

The focus on functional movement patterns, in theory, is to train your body to move effectively as a fully connected single unit so it is able to sit, stand, bend or change direction effectively when you need it to.  Some of the functional exercises I use are squats, lunges, and pushups. These movements effectively engage the whole body in the exercise although they emphasize specific muscles as the main force of action.

I believe in functional movement patterns and agree there is a place for them in MS training BUT without the individual muscle-specific training it would be impossible to do a functional movement. If your legs are so weak from MS limitations how are you going to perform a proper squat that uses all the muscles in your legs?!  You won’t be able to. This is why specific muscle training is so important. And the only way to get muscle-specific strength is through resistance training. But it doesn’t end there…

You must strength train each major muscle group, individually and specifically to gain the ability to “function”.  I know you keep hearing about functional exercise for MS and how important it is. You are told that you MUST be in a program using functional movement patterns to help your MS limitations.  I HAVE MS and I have been a fitness expert for more than 40 years. The real FACT is that functional movement patterns are secondary to strength training. They are important but more important to your physical abilities are training methods that incorporate resistance exercises with principles that cause “thought-based training” ™ which create muscle fiber activation, neuroplasticity, and brain to muscle reconnection. 

So where am I going with all this?

Please be careful with who and what you take in as being the right fitness information for MS, especially coming from fitness “experts” who do not understand MS.  There is much more to proper exercise for MS than jumping into the next repetitive functional program.  And any trainer who says he/she is teaching you how to place mental attention on your workouts but only tells you to concentrate on what you are doing does not understand the significance of proper focus. It is not just a simple matter of paying attention to your exercises and form. It is the training methods you use that force that focus and concentration that is of key importance in your MS exercise program.  Exercise programs pushing functional pattern movements with no focus driven process or training method behind them other than the standard and cookie-cutter, “do 10 reps of 3 sets”, are of little value in bringing results to our MS bodies.

Continued Education for Fit Pros

Learn what you need to help MSers… check out the Multiple Sclerosis Fitness Specialist online course for fitness and health professionals!

David Lyons, BS, CPT, is the founder of OptimalBody, which touches the lives of fitness enthusiasts of all kinds. OptimalBody has been named The Most Comprehensive MS Fitness Program worldwide since its release. His book, Everyday Health & Fitness with Multiple Sclerosis, was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.