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Increase Core Strength by Improving Your Breathing

“Core strength” is a popular fitness buzz term, but what’s the big deal all about? Core strength is essential for all our movements. The core is a collection of muscles that stabilizes the central muscles in our torso and spine. As our body’s center, our core has the big task of holding us upright. A strong core makes everyday activities easier to do.

You might think core training is all about lying on a yoga mat doing interminable “crunches.” But there’s way more to core training than aiming for a flat tummy or a “six-pack.”.

Importantly, you use your core when you put on shoes and when turning to look behind you. Likewise, reaching that box on your top kitchen shelf, or sitting in a chair are activities rely on a strong core. In fact, you might not notice a weak core until these activities become difficult or painful. Significantly, a strong core is also how you avoid back pain as you get older.

Breathing Helps Build Core Strength

The key to building core strength is by employing stomach-based, diaphragmatic breaths, so that our torso and ribcage expand forward, back, and to the sides. Breathing in is bodyweight exercise that lengthens the transverse abdominis muscles and obliques, which helps build core strength. Breathing correctly can increase flexibility and lower the risk of exercise-related injury. Also, a strong core helps with things like balance, and, oh yeah… it makes you look thinner.

4 Common Breathing Problems

1.Your neck, chest, and shoulder muscles feel tight. If you carry a lot of tension in the muscles around and under your neck, those muscles may feel painful or tender. Poor diaphragmatic control can cause neck and shoulder muscles to become short and tight. Slouching means you’re not activating your diaphragm when you breathe.

2. You sigh, or yawn frequently. If you must take a deep breath, sigh, or yawn every few minutes, it’s a sign that your body isn’t getting enough oxygen when you breathe.

3. You breathe with your mouth open. Unless you have a sinus infection or congestion that prevents you from breathing through your nose, your mouth should be closed as you breathe.

4. Your resting breath rate is too fast. A normal, resting breath rate should be about 12-20 breaths per minute. If the number of times you breathe each minute is too fast, your breathing is probably shallow. A normal respiratory rate keeps the balance of oxygen and carbon dioxide even in the body.

4 Ways to Practice Correct Breathing

1. Keep your shoulders still. Sit in a chair that has arms on the side. Support your arms and elbows by the arms of the chair. As you inhale through your nose, push down onto the arms of the chair. Exhale while you purse your lips and release any pressure on the arms of the chair. The purpose of this exercise is to keep you from elevating your shoulders as you inhale, which can cause upper chest breathing.

2. Slow your breath. Pursing your lips forces you breathe more slowly. Start by creating as small an opening as possible in your mouth when you breathe. Imagining you’re blowing through a straw or blowing at a candle only hard enough for it to flicker, but not blow it out. Breathe in through your nose for 2-4 seconds, then breathe out for 4-8 seconds, keeping your lips pursed. Repeat this for about 3-5 minutes.

3. Use upper chest resistance. Lie on your back, place a hand on your upper chest, apply slight downward pressure to the hard bone (your sternum) in the middle of your chest and maintain that pressure while you inhale and exhale. This will force you to “bypass” your chest while breathing and start to breathe from deep within your belly.

4. Blow up a balloon. When you blow up a balloon, you activate your abdominal muscles, align your spine and pelvis, and contract your diaphragm. Blowing up a balloon works your deep core muscles. It also requires all your mid-section muscles to work together. Sit on a chair with a straight back, or the floor against a wall, with your knees bent and your feet flat on the ground without leaning against the chair back or wall. Inhale deeply from your nose with your mouth closed, pushing your belly out. Then exhale by blowing slowly into the balloon, exhaling as much air as you can. Your deep abdominal muscles activate as you blow into the balloon.

Jacqueline Gikow, whose holistic, health and wellness practice centers on pain relief through better movement, is the owner of Audacious Living NYC™. She is certified through the National Association of Sports Medicine (NASM), the National Board of Medical Examiners (NBCHWC), the Functional Aging Institute (FAI), Medfit (MFN), and the Arthritis Foundation (AFAP/AFEP). Her fitness practice includes in-home and remote, one-on-one fitness training and coaching in New York City. Visit Jacqueline’s website at audaciouslivingnyc.com, or on Facebook.



creatine (2)

The Benefits of Creatine Supplementation for Active Older Women

Loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population. As ovarian estrogen declines during the menopausal transition, muscle and bone undergo significant changes.

Muscle mass and strength decline and loss of bone density accelerates after the onset of menopause. When these losses become severe, there is an increased risk of disabling falls and fractures and associated higher rates of medical comorbidities including high blood pressure, type 2 diabetes, depression, and cardiopulmonary disease.

Previously, in Athletic Aging, I posted about this very issue. Grip Strength as a Marker of Vitality in Mid-Life Women and Body Composition and Hormone Therapy – Truth and Tales are two articles that discuss the interplay among female reproductive hormones, muscle mass and function, body composition, and metabolism.

But it’s not just about muscles and bones! Mid-life women also struggle with sleep deprivation, brain fog, depression, and mood lability.

Today we continue this important conversation and take a deep dive into the science that explores the potential benefits of creatine supplementation in mid-life women that go beyond our muscles and bones!

How Does Creatine Work?

Creatine is a naturally occurring compound that is synthesized in the Human body by the kidneys and liver from the amino acids glycine and arginine. It is stored as phosphocreatine which supplies the energy that fuels muscle movement. Creatine is also found in animal proteins such as red meat, fish, poultry, and organ meats.

The phospho in phosphocreatine is a critical component for the production of adenosine tri-phosphate (ATP) found in tiny cell components called “mitochondria” that exist in every type of cell throughout the body. Think of the mitochondria as the “batteries” that power the cells within our tissues, and ATP as the “charge”. The “T” stands for tri -or 3 phosphates which is like 3 “bars” on your cell phone. When energy is used, ATP is converted to ADP – the “D” is for di- or 2 bars on your phone. So to recharge your phone to 3 bars (ATP), you need to plug it into the electrical outlet. Creatine serves as the source of energy to fully charge the mitochondria and replenish the stores of ATP.

What the Science Tells Us

Athletes have effectively used creatine supplementation for decades to support performance. Creatine is among the safest and most well-studied supplements in the sports industry.

Most of what we know about creatine was learned through the study of young, male athletes. Creatine has been shown to be effective in enhancing muscle strength, mass, and performance in strength-based activities. Because the aging population is particularly vulnerable to loss of muscle mass and function, attention has been turned toward investigating the potential use of creatine supplementation for preserving muscle mass and function in older individuals – particularly menopausal women.

A review of several randomized control trials and meta-analysis of studies investigating creatine supplementation in older female adults has discovered the following:

  • Women have 70-80% lower creatine stores and consume lower dietary amounts of creatine compared to men.
  • Declining estrogen levels are associated with increased inflammation and oxidative stress and may contribute to the reduction in protein synthesis and response to anabolic stimuli. Creatine supplementation has been proposed as a counter-measure to the inflammatory effects of declining estrogen.
  • Creatine supplementation with a high-dose load and maintenance of 3-5g daily in the absence of resistance training had minimal impact on muscle mass, strength, function, and bone density parameters in menopausal women.
  • Although studies have shown mixed results, the vast majority of research shows improvement of muscle strength, function, and bone density parameters with supplementation of 5g of creatine daily when combined with a consistent, long-term strength-training program of 3 months or more in menopausal women ages 50-65+.
  • There were no significant adverse effects of creatine supplementation in menopausal women across multiple studies.
  • Clinical evidence has reported positive effects of creatine supplementation on mood by restoring brain energy levels and balance. Evidence also suggests that creatine supplementation may favorably impact the dopamine and serotonin systems.
  • Creatine supplementation has consistently demonstrated improved cognitive performance and brain function, particularly in cases of sleep deprivation and mental fatigue. This is important given many mid-life women struggle with vasomotor symptoms (hot flashes) and disrupted sleep.

Summary of Recommendations for Mid-Life Women

  • Engage in a program of consistent (at least 2-3 times weekly) resistance/strength training as a permanent part of your long-term workout program.
  • Daily supplementation of creatine monohydrate may improve muscle strength, mass, function, bone density parameters, and body composition when combined with a consistent resistance/strength training regimen.
  • Dosing: Many experts agree a loading dose is not necessary. A daily dose of 5g/day (ideally in a shake, beverage, or with food) over time will achieve appropriate tissue saturation levels. *Vegetarians may require a dose of 5-10g daily.
  • Check out this podcast featuring Dr. Darren Candow, one of the leading creatine researchers for an incredibly informative review of how creatine works and the potential benefits of supplementation.
  • If you have chronic conditions involving your kidneys or liver, check with your doctor before incorporating creatine into your nutrition plan.

Article reprinted from Athletic Aging with author permission.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.



Smith-Ryan, AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective; Nutrients 2021, 13, 877. https://doi.org/10.3390/nu13030877Ellem

Pinheiro dos Santos, E et al. Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis; Nutrients 2021, 13, 3757. https://doi.org/10.3390/nu13113757


Watch Your Step

Because I’m a lifelong advocate of fitness walking and injury-free walking, I’m always trying to come up with the simplest way to get walkers to move along the ground in a way that produces the least amount of impact to the feet, knees, hips and lower back. The answer to this dilemma is different depending on whether you’re walking or running. I’ll begin with you walkers.


Taking Fear from Foe to Friend

Step One: Acknowledge and Accept Fear  

Acknowledging and accepting your fear is the first step toward limiting its power over you. Acknowledgement requires you to admit that you have fears, and acceptance requires you to realize their power. Congratulations, you are human! We all have fears, but the ways they affect our lives depends on the relationship we choose to create with them.  

  • Don’t be a Denier. Deniers bury their fears so deeply that the fears often go unrealized, gaining an unknown power over the Denier. The danger is that at any moment, the Denier may be confronted by their formerly hidden fears, which seem to come out of nowhere, overwhelming the person’s thoughts, decisions, and actions. Just because you  deny them doesn’t mean they don’t exist. 
  • Don’t be a Pretender. Pretenders admit their fear, but rely on their ability to vanquish, destroy, eliminate, and ultimately control it. They live under the misguided belief that they can make fears disappear. The problem arises when the fear the Pretender thought was destroyed comes back with a vengeance at an inopportune time. As with the Denier, that re-emerged fear can affect thoughts, decisions, and actions, potentially  placing the person on the pathway to unwittingly forfeit their dreams.  

Once you acknowledge the existence of your fear and learn how to address it productively instead of fighting it, you reclaim some of your power over it.  

Step Two: Find Your Fear’s Origins  

  • Determine where your fear originates and gain a deeper understanding of yourself. Knowing “the why” is a power diffuser. Is your fear based in lack of self-worth, self-love, self-doubt, rejection, or feelings of failure, or trepidation of success? If so, where did  this emotional trigger come from? Examine the negative assumptions you are making  and determine their source. This could be a childhood experience, something someone  said that you internalized, or some other event that created a negative self-assessment, which in turn is creating a fear. Knowledge is power, and it places you on the pathway toward healing.  
  • Take action to heal your fears’ origins. Healing comes through loving yourself and  seeking a deeper and richer understand of your authentic core. In my book, Yes! Commit. Do. Live, I explain, your “passions, loves, talents, gifts, and desires, along with  your character values, all inform and empower you.” These elements form your inner core. So let your fears reveal more of this inner core and show you something important that you may not have recognized. For example, if you have a fear of public speaking, a deep dive into your inner core could unearth your talent for storytelling, listening, and  using empathy to connect with others. Nurturing those talents, which are all  components of a great public speaker, would empower you to meet your public  speaking fear. So, use that inner core power to meet and ultimately tame your fears.

Step Three: Focus on the Positive  

  • First, ask yourself what opportunities and adventures are now presented due to the fear  that has arisen. What possibilities for building new talents and skills are now open that were previously closed to you? Write them down and celebrate them as “what can be,” and then start envisioning them as “what is.” For example, that fear of public speaking could be preventing you from experiencing new opportunities in your career, family,  and friendships that could change your life. By focusing on the positive aspects of what  can be and the emotions that flow from that positive outlook, you shift your mindset away from negative thinking.  
  • Second, remember that negative thinking is often at the core of our fears. Without facts or evidence, we allow negative thoughts to paralyze us and convince us that  defeat/disaster is inevitable. By choosing to focus on the positive outcomes we can gain from facing the challenge, we gain power over negative thinking.  

As a state and federal prosecutor, I was afraid at the beginning of every trial. What if I didn’t succeed? What if I made a mistake? However, none of these fears were based on facts. By focusing on creating a positive outcome for the victim and empowering them through the trial  process, I could move forward through my fear. According to Andrew Newberg, M.D., and Mark  Robert Waldman in Words Can Change Your Brain: 12 Conversations Strategies to Build Trust,  Resolve Conflict, and Increase Intimacy, a single positive or negative word can actually alter our brains. There is neurological power in positive thinking, so the time is now to live in the  positive.  

Step Four: Transform the Feelings  

  • You can use your body’s responses to gain more control of your fears. What happens to you when fear arises? According to MedicalNewsToday, for some people, their limbs shake, their breathing becomes shallow, their mouths get dry, and their hearts race. While these reactions may on the surface seem negative, those physical manifestations  are tied to the excitement of the moment.  
  • Once you are aware of your fear responses, redefine them. Remember, there is power in positive-thought realignment. When I left the practice of law to begin a singing career, during my early musical auditions, I was confronted with the physical manifestations of fear. I had a choice. I could allow those manifestations to derail my singing career, or I could retrain my brain and body to create a new understanding of  what those manifestations represented. I chose the latter—and you can, too. Here’s  how: 

Redefine those manifestations and repeat the new definition continuously until they feel real.  Repeatedly tell yourself this new positive understanding:  

  • My body’s shake is the energy surge that fuels my excitement. 
    • My shallow breathing is my body’s signal to slow down and take in rich oxygen.
    • My rapid heart rate is my body’s preparation on a cellular level to ready me to  step into my excellence.

Visualize your success over your fear and allow the positive emotions that flow from that  success to flood your body, head to toe.  

Find your calm and peace the “DDB” way—engage in deep diaphragmatic breathing. At each fearful moment, use the 5-5-5-5 breathing pattern: Inhale for a count of five, hold for five, exhale for five, and repeat for five. This practice allowed me to stay present and focus on the beauty of the moment.  

Reset those feelings further by recording your successes and focusing on each time you were able to feel the fear and do it anyway. I allowed every positive audition to reinforce my new positive understanding of my body’s response to each exciting opportunity. This process of transference turns negative thinking positive.  

Step 5: Look at Fear as Your Friend and Celebrate It!  

Fear is an extension of ourselves. It moves us. It represents a chance for a beautiful life transition. Fear offers an opportunity for immense growth and introduces us to new and wonderful challenges. It can be a gateway to the most beautiful, exciting opportunities, helping  you to unleash talents and unearth new passions.  

By taking the preceding steps, you are able to tame your fears. Remember, fear is not a villain, so there is no need for an epic battle. Instead, fear requires a relationship with yourself. It is a welcomed companion, a catalyst for change to constantly challenge your status quo. So, the next time you feel fear, ask, “What opportunity lies on the other side?” Challenge yourself to live through it. Do what makes you shake! Do what makes you shy away! It may not  be easy, but it’s essential for continued breakthrough as you journey to your highest state of  excellence.  

When you’re willing to feel the fear and move forward anyway, you position yourself to truly  write your story, live your purpose, elevate your thoughts, visualize your success, and live a life  without regret and with passion, laughter, self-determination, and endless optimism.  

Join Lisa for her webinar, How to Take Your Fears from For to Friend

Lisa Charles is a federal prosecutor turned singer/actress, wellness expert, certified health coach/consultant, and an acclaimed speaker. She served as the Fitness/Wellness Research Coordinator for the Rutgers University Aging & Brain Health Alliance, and is the CEO of Embrace Your Fitness, LLC, and the Author of YES! COMMIT. DO. LIVE.

  • Join my email list at yescoachlisa.com
  • lisa@yescoachlisa.com
  • IG: @lisaembracefitness

10 Keys to Planning for Your Health and Fitness Needs

Being proactive beats reacting every time. With our nation’s level of fitness deteriorating with each passing year, I thought it important to highlight these 10 keys. I am evaluating what it is that I may want to change in my own world and by sharing these thoughts with you hopefully move you to such a review as well.

1.  Get a physical

As a nation we are not being proactive when it comes to our health and as a result we are over medicating ourselves and creating other significant health related problems as a result. Being on drugs is not an effective way to maintain our health – making healthy choices instead is a far better strategy for preventing illness and disease in the long run.

2.  Get “real”

Being “real” with yourself starts with an honest evaluation of where you ARE in your physical and mental – and emotional life. Dumping old behaviors – and attitudes – that are no longer serving you is a place to start. Another step we can take is to get moving – doing whatever you can to positively move in the direction of what I call “your highest good”. We all have something we are here to do in life so get going and don’t waste a single day. Writing these articles is part of what I am to do so I am writing them!

3.  Get moving

By way of reminder – we are meant to be active beings – not sitting beings. Find out what it is you enjoy doing and get moving. Your body will thank you every day you do this. I know how I feel after I run and lift weights and it is in one word — happy.

4.  Get a handle on your stress

We are all stressed at some point during our day so why don’t we start working on strategies for dealing with the stresses – and stressors – in our lives BEFORE they happen. Being proactive in stress management means knowing we are going to have to deal with stress in our lives so why don’t we practice before the event or stress occurs? I have passed on some of my strategies in prior articles: Meditation, prayer, visualization work, focused breathing, running, quiet reflection, etc. These and other techniques are readily available and can be learned through classes and other forums.

5.  Get excited

Getting excited about life fuels our imagination and creativity. The more I think about my potential to make a difference in the world the more excited I become about each day of my life. The same experience can happen to you if you are open and receptive to what your subconscious is trying to tell you. The world of technology is taking away our ability to “go into the silence” and discover what life has in store for us. The “noise” we face every day is keeping us from hearing anything that could be of help to us in planning for it is we may want to do – and accomplish. Take a moment and ask yourself “am I living up to my full potential and if not what can I do about it?”

6.  Get clear on your purpose

Purpose driven people are happy people and they are self-actualized – meaning they don’t need someone to tell them what to do, think, feel, say, or do. They approach life from a position of “real power” and at the same time are able to acknowledge the uniqueness of each one of us. I got an email today from a reader telling me I would go to hell if I didn’t believe what he did and my response is – “it’s a free country and we get to live our lives the way we choose”.  I am empowered and energized by this thought. I am free – as are you – to live a purpose driven life or stay on the path you are on. We are ALWAYS “at choice” so CHOOSE YOURSELF TODAY!

7.  Get close to “real” people

This key is important in today’s world. “Friends” are NOT on the internet – they are in our REAL lives. Be aware that we need each other. Make it a point to be kind to others – smile, acknowledge them when you can, call people by their names and look them in the eyes when you speak to them. People are what make life worth living – not the cyber world of “fake” experiences and relationships.

8.  Get close to your family

My daughter is going through a difficult time in her life right now. She is facing challenges that are most uncommon and have her living “on edge” every day. She has a 7 year old son who needs her and a career in business to re-establish and beyond. I spoke with her last night and told her “I am here for you – whatever you need”.  As a father I sometimes feel helpless because she is a grown woman but she is still my daughter and I love her. It is my job now to just be her father and love her – tough as that may be for me. Take this step in your own life in the coming year and see what happens – you might surprise yourself at how your family responds to you.

9.  Get serious about your own health and fitness

Time has a way of marching on and to the degree that you acknowledge the passage of time you begin to appreciate what you have been given – and have in life. I am grateful everyday for my passion for training and running because I know it can be taken from me at any time. I live in the present when I am running or lifting weights and it is a practice I hope to continue until the end. I am serious about my fitness program because it gives me the energy and strength to do my work – teaching, speaking and writing on matters of healthy aging, fitness and exercise. Are your energy levels low? Get moving!

10.  Get to know yourself

This is perhaps the best thing we could do to prepare for the year ahead. Get to know yourself and start appreciating the magnificence that is you. Getting to know your self is a lifelong pursuit. The journey never ends.  I have learned during the course of my 66 years that I DID NOT appreciate myself at all – I had to learn the hard way through difficult and painful experiences that until I could love myself – and appreciate what it is I am here to do – that no one would ever appreciate – or love – me either. I spend time (each day) thinking about my life – and my contribution to life itself – and ask myself “is there more that I can learn or do today?” You should do this too – it will help immeasurably improve the quality of your life now and in the years ahead.

Final Thoughts

Why not take the time between now and the end of the year to see what you might want to work on in the year ahead and see how you can live more fully and completely.  Can you make a more expansive contribution to your own life and the lives of others as well? Of course you can! Isn’t this what the fitness lifestyle enables us to do in the first place? So get moving, be willing, be open, and appreciate who you ARE right now because you have only scratched the surface of your potential!

Reprinted with permission from Nicholas Prukop.

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His passion for health and fitness comes from his boyhood in Hawaii, where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.


Leg Length Discrepancy: Is it Causing Your Pain and Dysfunction?

In order to design effective corrective exercise programs that both alleviate pain and improve function, fitness professionals must understand their clients’ strengths, limitations, and weaknesses.[1] This includes having an awareness of common structural imbalances such as leg length discrepancies (i.e., when one leg is shorter than the other). While it is not within a fitness professional’s scope of practice to diagnose a leg length discrepancy (LLD), it is extremely important that personal trainers and fitness instructors understand the ramifications of this imbalance and how it can affect a client’s musculoskeletal system.

Types and Prevalence of LLD

There are two types of leg length discrepancies: functional and anatomical. A functional leg length discrepancy refers to a musculoskeletal imbalance where any number of structures (or muscles) in the body are not working as they should. This results in parts of the skeleton being pulled out of alignment making it appear as though one leg is shorter than the other. Alternatively, an anatomical leg length discrepancy occurs when the bone(s) in one leg are actually shorter/longer than those in the other.[2] As the possible cause(s) of a functional leg length discrepancy are wide and varied, this article will focus on anatomical leg length discrepancies and how they affect your client’s body.

Anatomical, also known as true, leg length discrepancies have been found in as much as 95% of the population.[3] However, significant leg length discrepancies of more than one centimeter are found in about 1 out of 4 people.2 True leg length discrepancies affect the entire musculoskeletal system and play a substantial role in the health, function and experiences of pain for your clients.[4]

How LLDs Affect the Body

The body is designed to be dynamic and can adjust incredibly well to varying movements and positions. However, a true leg length discrepancy (that is left untreated) causes bones and joints to shift out of alignment, soft tissue structures like muscles, tendons, ligaments and fascia to compensate/overwork and can lead to pain and injury over time.[5] Some major areas of the body that are affected by a LLD discrepancy are the lower back, hips, feet and ankles.

LLD and the Lower Back

The pelvis forms the base of support for the spine. Therefore, a level and well-balanced pelvis is critical for spine health and optimal lower back function. In order to comprehend how an LLD can affect the spine and lower back, it is imperative to understand the structural anatomy of this area. Either side of the pelvis is made up of three bones (i.e., the ilium, ischium and pubis) that are fused together.[6] However, independent movement of each side of the pelvis is possible due to two important joints located in the pelvis. One of these joints is called the sacroiliac joint (SI joint). The SI joints are located on either side of the back of the pelvis where the top of the pelvis (i.e., the ilium) meets the base of the spine (i.e., the sacrum). The other joint is located on the front of the pelvis where the pubic bones (i.e., pubis) meet (i.e., the pubic symphysis) (see picture below).[6] Since the base of the spine articulates with each side of the pelvis via the sacroiliac joint, movement of the pelvis affects movement and function of the spine.

In addition to interacting with the spine, each side of the pelvis also articulates with the corresponding leg via the hip socket. From a skeletal point of view, the height of each side of the pelvis is governed, in part, by the length of the leg on that side of the body. If one leg is longer than the other then the pelvis will likely also be higher than that same side (see picture below).[2]

If the left side of the pelvis is higher due to a leg length discrepancy, then the base of the spine (i.e., the sacrum and coccyx) will shift toward that side also causing a compensatory shift in the rest of the spine all of the way up to the neck and head.[2] Therefore, a leg length discrepancy can cause pain and irritation to the joints of the pelvis, the intervertebral discs of the spine and the muscles and other soft tissues that help stabilize and mobilize these areas.

LLD and the Hips

The relative length of each leg also affects the position and function of the hip socket. As one side of the pelvis elevates in compensation for a longer leg, the hip socket shifts laterally toward the longer side.[2] Consequently, the hip of the longer leg will shift to a position outside of the foot/leg (see picture below).

These compensation patterns in the hip/leg can cause various aliments for clients such as greater trochanteric bursitis, iliotibial band syndrome, tracking problems of the knee, and sacroiliac joint dysfunction.

LLD and the Feet/Ankles

Leg length discrepancies can also affect the function of the feet and ankles. Pronation, or a flattening out of the arch of the foot, is a common compensation for clients with an LLD to effectively shorten a longer leg by reducing the height of the arch. Conversely, supination effectively lengthens a shorter leg by increasing the height of the arch. As such, a common compensation pattern for someone who presents with a LLD is to overpronate on the side with the longer leg and over supinate on the shorter side. These imbalances in the feet typically display with compensatory shifts in the ankles as well. Overpronation is usually accompanied by an ankle that rotates in too much, while a supinated foot is accompanied by an ankle that rotates out too much.[5] These misalignment issues in the feet and ankles can lead to ankle sprains, Achilles tendinitis, plantar fasciitis, ankle impingement and a whole host of other painful problems.

How to Help a Client with a Suspected LLD

Being aware of the signs and symptoms of a suspected LLD will help you know when to make appropriate referrals to a licensed medical professional who can diagnose a client’s condition with the help of advanced imaging techniques (i.e., x-rays and CT scans). Developing a professional referral network that you can turn to for help with issues that fall out of your scope of practice allows you to provide a more comprehensive service for your clients. It also enables you to create long-lasting relationships with like-minded professionals who will act as a referral stream for your business.[7]

Once the appropriate referral and LLD diagnosis has been made, your allied medical professional will develop a treatment plan that may include a shoe lift. Your role, as an expert in muscles and movement, is to design corrective exercise strategies that help your client adapt to the shoe lift and the resultant new position of their head, neck, pelvis, spine, hips, feet and ankles. The golden rule of any exercise program – gradual progression – should govern every aspect of your client’s LLD treatment. Encourage clients to introduce their lift gradually when acclimatizing to their new leg length and follow the underlying doctrines of corrective exercise program design: utilize self-myofascial release strategies in the initial stages of adapting to the lift; progress to stretching and only conservatively add strengthening exercises after the client has had at least six months to a year to get used to their new leg length.

Justin Price is one of the world’s foremost experts in musculoskeletal assessment and corrective exercise and creator of The BioMechanics Method Corrective Exercise Specialist certification (TBMM-CES).  The BioMechanics Method is the fitness industry’s highest-rated CES credential with trained professionals in over 70 countries. Justin is also the author of several books including The BioMechanics Method for Corrective Exercise academic textbook, a former IDEA Personal Trainer of the Year, and a subject matter expert for The American Council on Exercise, Human Kinetics, PTA Global, PTontheNET, TRX, BOSU, Arthritis Today, BBC, Discovery Health, Los Angeles Times, Men’s Health, MSNBC, New York Times, Newsweek, Time, Wall Street Journal, WebMD and Tennis Magazine. 


  1. Bryant, C. X., & Green, D. J. (2010). ACE Personal trainer manual: The ultimate resource for fitness professionals (4th ed.). San Diego, CA: American Council on Exercise.
  2. Knutson, G. A. (2005, July 20). Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy, 13(11). doi:10.1186/1746-1340-13-11
  3. Pappas, A. M., & Nehme, A. E. (1979). Leg Length Discrepancy Associated with Hypertrophy. Clinical Orthopaedics and Related Research, &NA;(144). doi:10.1097/00003086-197910000-00034
  4. McCarthy, J. J., MD, & MacEwen, G. D., MD. (2001). Management of Leg Length Inequality. Journal of the Southern Orthopaedic Association, 10(2). Retrieved July 01, 2016, from http://www.medscape.com/viewarticle/423194
  5. Price, J. (2020). The BioMechanics Method Advanced Corrective Exercise Mentorship. The Biomechanics.
  6. Gray, H., Williams, P. L., & Bannister, L. H. (1995). Gray’s anatomy: The anatomical basis of medicine and surgery. New York: Churchill Livingstone.
  7. Price, J. (2018). The BioMechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.
Beer Glass Alcohol

Alcohol & Athletes: The good, the bad and the ugly

When asked, Is beer good for runners? Running legend Jim Fixx’s answer was, “Sure, if it’s the other guy drinking it!” By abstaining from alcohol, you can indeed gain an advantage over your competitor’s poor judgment. Just how bad is alcohol for athletes? Does it have any health benefits, too? Let’s look at some of the good, the bad, and the ugly regarding alcohol and athletes.

The Good

Socializing with a glass of wine, a beer, or a cocktail can add a nice touch to the end of the day for those who like to relax with an alcoholic beverage. Raising a glass to celebrate a victory is a fond tradition. But we know surprisingly little about possible health benefits of drinking in moderation because almost all studies are based on self-reported information that gets tangled up with lifestyle. Do adults who do moderate social drinking enjoy a healthier lifestyle than non- or heavy-drinkers? Does alcohol make them healthier—or do social connections make the difference? While moderate alcohol intake has been linked to reduced risk of heart disease, so has eating a healthy diet and being physically active.

The Bad

Alcohol has a negative reputation regarding athletics, be it heavy beer consumption after a hard work-out, or teams enmeshed in a culture of binge drinking. Student-athletes binge-drink more than non-athletes. Male athletes binge-drink more than female athletes. And all athletes drink more than non-athletes. The higher alcohol intake of athletes can be attributed to stress and anxiety associated with being a competitive athlete, increased muscle pain and soreness, socializing or bonding with teammates, and the belief the athlete “earned” the drink—a reward for having completed the hard effort.

The Ugly

Alcohol is the 3rd leading preventable cause of death in the US. (Tobacco is Number One. A poor diet with inactive lifestyle is Number Two.) Any level of alcohol intake can contribute to several types of cancer

How do you know if you have a drinking problem?

Moderate drinkers typically sip (not gulp) their drinks, stop drinking before they get drunk, and do not drive after drinking. Problem drinkers commonly drink to get drunk and to solve their problems. They drink at inappropriate times (such as before going to work) and may become loud/angry or silent/reclusive. People addicted to alcohol start drinking with no plan, deny drinking, hide bottles, and miss work or school because of hangovers.

Alcohol management

Despite the bad and the ugly, alcohol is an undeniable part of our sports culture. The following tips offer suggestions for helping athletes manage alcohol.

• Don’t drink excessive alcohol before an event—especially in the summer heat! Drinking too much the night before an event will hurt your performance the next day. You’ll notice a slower reaction time and reduced eye-hand coordination and balance. Research with Australian rugby players who consumed on average 9 beers post-game (with a range of <1 to 22 beers) indicates—no surprise— their high alcohol intake impaired their performance. Other studies report athletes are less able to do repeated sprints (think soccer, hockey) and jumps (volleyball, basketball). Among heat-stricken summer runners, a common denominator was booze the night before the race.

• If you are going to drink the night before or after an event, plan to also consume a proper sports meal with extra water. While excessive drinking is obviously problematic, a modest amount of alcohol consumed along with a balanced meal will unlikely have a negative impact. Yes, alcohol impairs glycogen resynthesis a bit. But in the real world of sports drinking, athletes who are heavy drinkers tend to make high fat food choices (nachos, burgers, etc.). The lack of healthful grains, fruits and veggies (carbohydrates) more significantly hinders glycogen replacement!

• First quench your post-exercise thirst with water, then enjoy alcohol, if desired. Alcohol is a diuretic; it stimulates the formation of excess urine. Whiskey and other spirits with a high alcohol content will dehydrate (not rehydrate) you. If you “must” drink spirits, ask for extra ice with the cocktail. Beer would be the better choice, given the alcohol content of beer is lower and the water content is higher. Yes, dehydrated adult athletes can rehydrate with a beer or two. Low-alcohol beer is the wiser choice, and no-alcohol beer the wisest beer choice.

• Heavy alcohol intake is not on the list of Best Recovery Practices for athletes to follow! Remember: bad things happen during exercise and good things happen during recovery. Wisely chosen recovery fluids and foods help you rehydrate, refuel, and repair your muscles. Adding alcohol to the mix slows down muscle repair, protein synthesis and adaptation processes. Yet a glass or two of wine or beer, along with plenty of water and food, is permissible.

• Alcohol is a source of calories that can quickly add up. Add in the calories in the pizza, nachos or munchies that you can easily overeat when alcohol lowers your inhibitions, and you can easily succeed in gaining body fat. Just five Heineken Light Beers add 500 calories. A goblet of wine can easily add 200 calories. Be wary of drinks that come with umbrellas! (400-800 calories/10-ounces)!

• Beware of drinks in a can, such as White Claw Surge with 8% Alcohol By Volume. (ABV). You can end up drinking more alcohol than you intended. You might want to stick with the original White Claw—hard seltzer with 5% ABV—similar to most canned beers, though some craft beers have a higher alcohol content.

• Don’t drink alcohol if you want a good night’s sleep. Alcohol might help you fall asleep faster, but it disrupts your sleep cycle. You’ll get less restorative sleep. Alcohol alters body temperature, which can affect how well you sleep. It also aggravates snoring (due to relaxed muscles and a lower breathing rate), so your bed partner becomes sleep deprived and grumpy. Plus, you’ll need to go to the bathroom more often in the middle of the night. None of this enhances athletic performance.

• If you don’t want to drink, be prepared to quickly say “No thanks” in a polite but convincing voice. If the person keeps insisting, respond again: “Î don’t want to drink today. I’d appreciate if you’d help me out.” Instead, be pleased that you will enjoy the natural high of exercise.

Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (Newton; 617-795-1875). Her best-selling Sports Nutrition Guidebook is a popular resource, as is her online workshop. Visit NancyClarkRD.com for more info.


Breathing Fun Facts

It’s hard to believe that something we do from the second we come out of the womb to our deaths is so frequently overlooked. Very few know the nuances of breathing. For example, breathing slow actually gets more air into the body than breathing fast! Why? More time to allow for oxygen transport and carbon dioxide to be eliminated.  Athletes have just recently been taking advantage of this. 

Here is something to ponder, breathing through your nose is much more efficient, healthy and is related to curing many disease states including obesity.

With that in mind, here are a few other interesting facts about breathing. 

  • The average person breathes 17 times a minute. That equates to almost 25,000 breathes a day! On the contrary, athletes breathe on average 5 to 6 times a minute. That means they breathe only around 8500 times a day. Considerably more efficient! The diaphragm is one of the most used muscles in the body, next to the eyes and heart. Treat it with care
  • Depending on the situation, you breathe more through one nostril! The right nostril is tied more to the Sympathetic Nervous System and dominate in situations where the fight or flight response is necessary. Also, in the morning when waking up! The left nostril is related to the Parasympathetic Nervous System, which controls the rest and recovery response and therefore is more dominate when you are winding down or going to sleep.
  • Want to think big? Alveoli, where O2  – CO2 transition occurs, covering a surface measuring more than 1,076.4 square feet or about 100 square meters. Equivalent to half a tennis court! The next time you breathe in think about all the places that breath must go!  
  • Think about this… a blue whales’ lungs in total have a combined capacity of over 1,300 gallons of air! That’s a big breath!
  • Laughing matters! Normal inhalation fills just 25% (tidal volume) of the total lung capacity. The remaining 75% (residual volume held in the lower 2/3’s of our lungs) remains filled with old stale air. Respiration becomes even shallower when compounded by stress.
  • Laughter helps to provide longer exhalations, thus ridding the lungs of residual air and enriching the blood with ample supplies of oxygen! It is the only time everyone uses the diaphragm efficiently. Have you ever laughed so hard that your stomach hurt? Case in point.

Once we pay attention to breathing, our lives can be enhanced beyond what you can imagine! From health to athletic performance, you will be giving your body every chance to be all it can be!

Stay healthy!

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.  



Friendly therapist supporting red-haired woman

The What, the How and the Why of Lifestyle Improvement

Health and wellness folks are sometimes confused about the role each professional might play in helping individuals to live their best life possible. Our clients are seeking to be healthier by losing weight, managing stress, stopping smoking, becoming less isolated, and often, managing a health challenge of some kind. To do so they need excellent wellness information, great treatment (if that is called for) and a way to make lifestyle changes that will ensure lasting success.  So, who is responsible for what?

Fitness trainers, rehabilitation therapists, physical therapists, dietitians, various treatment professionals and health educators can help their clients/patients to know what lifestyle behavioral changes will move them towards improved health and wellbeing. What we often hear from these medical and wellness pros is frustration with a lack of success on their client’s part in making the recommended changes and making them last. The reality is, most people simply don’t know that much about how to change the ingrained habits of a lifetime.  

The physical therapist works with their client in their session and sends them home with exercises that must be done every day. The dietitian creates a fantastic meal plan that their client must put into practice. The fitness professional creates a tailor-made workout plan, but their client needs to exercise on their own, not just in front of their trainer.

Health educators, treatment professionals, etc. provide the
Health and Wellness Coaches provide the
Our Clients find their

Everyone’s challenge is the how. It takes more than willpower and motivation.  What is often lacking is an actual well-thought-out plan that the client has co-created with the help of someone who can provide support, accountability and a well-developed behavioral change methodology. Translating the lifestyle prescription into action and fitting it into an already busy life is often where, despite good intentions, our clients struggle. This is where having a trusted ally in the cause of one’s wellness pays off.

As the field of health and wellness coaching grows, the challenge coaches sometimes face is clarity about their own role. Sometimes the confusion is all about the what and the how. For coaches to be proficient at “writing” the lifestyle prescription they need additional qualifications. It becomes a question of Scope of Practice.

To guide coaches, the National Board for Health and Wellness Coaches (NBHWC) has developed a Scope of Practice Statement. Here is the part most relevant to our question:

While health and wellness coaches per se do not diagnose conditions, prescribe treatments, or provide psychological therapeutic interventions, they may provide expert guidance in areas in which they hold active, nationally recognized credentials, and may offer resources from nationally recognized authorities such as those referenced in NBHWC’s Content Outline with Resources.”  (NBHWC)

If coaches can “wear two hats” professionally they can combine the what and the how. Otherwise, the key is to coordinate with other wellness professionals or work with the lifestyle prescription that their client already has.

Beyond the what and the how is the why.  The “why” of behavior is all about motivation – initiating and sustaining behavioral change efforts by drawing upon the energy and desire to do so. The key here once again is the question of who is responsible for supplying this. People may initiate behavior based upon external motivation – the urging and cheering on of others, the fear of negative outcomes. In order to sustain that motivation, it has to come from within. The challenge here for all wellness professionals is to help our clients to discover their own unique sources of motivation. Seasoned wellness professionals realize they can’t convince or persuade anyone to be well. However, when we help our clients discover their own important sources of what motivates them, they discover their why.  Motivation is fuel. Now with the aid of a coach our clients can find the vehicle to put in. They know what they need to change. Now they have a way to know how to change and grow, and they know themselves, why.

Webinar with Dr. Arloski

Join Dr. Arloski for The Behavioral Side of Health: Bringing Coaching Skills Into Your Wellness Work.

All wellness professionals want their clients to succeed at becoming as healthy and well as possible. For them to do so requires the expertise your bring from your profession as a fitness trainer, dietician, therapist, etc., and a way for your clients to follow through on your recommendations and live a wellness lifestyle. That’s where the skills of coaching come in.

Michael Arloski, Ph.D., PCC, NBC-HWC is CEO and Founder of Real Balance Global Wellness Services, Inc. Dr. Arloski is a pioneering architect of the field of health and wellness coaching.  He and his company have trained thousands of coaches around the world.