23 January 2010

Preemptive rehabilitation

Call it 'prehabilitation' since it seems that having a catchy new word for your idea is important in doing health and fitness writing.  This is an idea of mine, about something to do before or concurrently with the start of your aerobic or weight-bearing exercise program.  The idea is, most of us live our regular life without exercising our bodies much.  Especially, without challenging them much.  In my routine work day, for instance, the heaviest thing I life is a book or maybe 2 books.  Desk jobs are good for that reason, and they're bad for that reason.

If you don't use muscles, they get weaker.  If you're several years past the last time you exercised regularly (and not just some sort of exercise, but exercise that challenged your arms, and legs, and abdominals, and ... on down the list), then I think you are liable to have some areas that are not currently in good shape.  What that means, as I've coached beginning runners, is that you're liable to start your exercise program and have some real complaints from your body about it.  You can ignore real complaints, for a while.  The 'while' is however long it takes your body to make an injury out of the complaint.  The easy conclusion -- that you're "just not cut out to run" (or swim, or walk, or ...) -- is the wrong one.  The better conclusion is that your shoulders were used to not having to work, so when you made them do so in the pool, for the first time in 15 years, they complained.  The swimming itself is not a problem, but having let your arms get used to the idea that they only needed to lift a book or two every so often, and then ask them to pull you through the water, was the problem.  Same sort of thing for many other sorts of pains beginners encounter.  (There are also many that have nothing to do with this.  This is, alas, not a cure-all, even if it does work at what it tries to.)

Hence, prehabilitation.  I have had to do rehabilitation, at one time or another in my life, on my knees, shoulders, and back.  These seem also to be three major areas where people encounter problems.  Since they are such common areas for problems, I suggest that doing rehabilitation style exercises is a good idea -- even before you're injured.  Especially before you're injured.

As always, check any exercise advice out with your doctor, or, at the very least, a certified trainer in the sort of exercise you are trying to do.  I'm serious about this warning.  



This is an idea of mine about exercise -- not about sea ice.  If it's about ice, there's a fair chance that I'm right, even if I'm disagreeing with a sea ice expert.  On exercise, well, I've tried to read a lot and listen to people's experiences.  So I've got a fair number of ideas, and they're probably not too bad.  Usually.  But I'm not an expert here.  The fact that I've never seen this suggestion in any of the books I've read, or heard it from another coach or trainer concerns me that the reason is that it isn't actually a good idea, rather than I happened to have been creative and thought of a good new idea.

In terms of which exercises to do, I can't provide much guidance myself.  So, again, check with your doctor, letting them know that this is the line of thought.  For shoulders, for instance, one of the exercises is to take a weight (start with 1 lb, a can of veggies works fine for this purpose) in your hand and arm straight down at your side.  Lift your arm straight out to the side, up to the point that your hand is shoulder level -- no higher.  I've you're recovering from a torn rotator cuff, as I was, this is challenging.  Complete the set of 10-15.  If you haven't torn your rotator cuff, and this is hard -- you need some serious prehabilitation.  Work to the point of being comfortable with 10-15 lbs (5-7 kg).  It'll take time.  And, note, this is not the only exercise you should do for your shoulders.  There are several more, just of this sort.

A simpler exercise that anyone and everyone can do, pretty much anytime and anywhere (ok, might look a little funny in the wedding party), is to stand on one foot.  Just that -- stand on one foot.  If you're not positive about your balance, be near something stable you can grab on to if you need to stop from falling over.  You want to be able to do this for 60 seconds, easily, without having to grab anything.  When I started it up again most recently, I could make about 15.  Work on both legs.  One is probably much more stable than the other.  But you want to be getting 60 seconds with each.  Once you've made progress on that, try it with your eyes closed.  (I get 3-5 seconds this way at the moment.)  What you're working on here is your awareness of where your body is, and what your balance is.  Apparently, since I did it, you can be really lousy at this and still walk/run/swim/....  But it's easier to do those things if you have better balance. 

A different reason I like this idea is a problem many beginning runners have.  They're fired up and want to go run every day, now that they've committed to doing exercise.   And then I (and most coaches, especially anyone certified by the RRCA) tell them to start with running only every other day.  There goes some momentum on making their change.

So I'll suggest that the thing to do on your non-running day is some other sort of good exercise.  Maybe prehabilitation is a good idea for you, maybe it's the weight room, maybe yoga, ....  There are many options here.  But in terms of setting your schedule and getting habitual about your exercise, there is a big plus to having a particular exercise time.  And then you decide which exercise it is that you're doing for that day. 

I'll invite contributions of sites that give good prehabilitation-oriented exercises.  We're not aiming at the 'how to put on 30 pounds of muscle in 30 days' or 'how to lose 30 pounds in 30 days', but some basic, conservative exercises that people with injured shoulders/knees/back/... could benefit from, and that someone who isn't injured could also do and benefit from.

26 comments:

Hank Roberts said...

Thank you for this. More please, any time.

thingsbreak said...

Somewhat related:

http://www.youtube.com/watch?v=7jrnj-7YKZE

http://www.nature.com/nature/journal/vaop/ncurrent/full/nature08740.html

Penguindreams said...

Hank:
Thanks. I was wondering if anyone was interested. I'll take you as proxy for a legion of interested folks :-)

I figure to the sports/exercise articles always be on weekends. Call it the weekend warrior series.

thingsbreak:
The video, I could see the relevance of. The nature article, though, was about the color of dinosaurs. Not sure how they get in to the act.

The video, though is definitely interesting. When healthy, I'm a forefoot striker, as described in the video. Right now, with my calf and achilles injury, I'm keeping it easy on those points by being more of a heel striker. (The drawback, which was not mentioned, to forefoot striking is increased stress in the calf and achilles. Proper exercise to condition those areas makes up for the extra stresses. That, and the greatly reduced stresses on the foot and knee, lead to the net plus.) These get to be very fine distinctions when, as I do, your landing is squarely under your hip. The video shows the heel strikers as landing with the heel ahead of their hip, which I always advise against. It's called 'overstriding', one of the few things that is a strong predictor of injury.

I do run barefoot sometimes in recent years (and often in the summers in childhood). Having worn shoes most of the time for (mumble) years, though, a quick transition to full-time barefoot running is a recipe for injury. So, for now, it's just been a matter of a hundred meters here or there, repeated a few times.

gravityloss said...

I'm quite young still (around 30) and see it how, if I haven't really moved in a while, when I do sports (play soccer or floorball, I hate running aimlessly, weight lifting or aerobics), everything gets a little hurting after that. No injuries but muscles don't function well for a day or two.

Even vigorous walking (dunno what's the minimum, perhaps for a week) helps prehabilitate the body for that hugely and the whole experience is much more enjoyable. You can just go places by walking, no need to do special training. Bicycling is another. It feels so heavy in the spring (and your butt hurts after the first few times), but in the fall when you're back in shape, all the spring's uphills feel like downhills and you can just think of it as a pretty effortless way to move around.

I assume when I get older, the things that now manifest as muscle pain change into actual injuries.

I find walking also to be a special time to think and get ideas, and it's pretty hard to get injured in that. We have a really cold winter right now and lots of snow so it's beautiful to walk and also somewhat slippery at places. I hear some southern foreigners have trouble walking in their first winters here since they're used to a firm footing. So perhaps because of that, at the moment my one foot eyes closed balance time is "until I get bored / have to go to the bathroom".

Prehabilitation. Important and useful. Good post, if a bit odd with the specialized training perspective, from my view.

gravityloss said...

Watched the barefoot video. I predict a new fad.

Having lived with many flatmates I can say that some people thump rather than walk. Heel striking. I don't understand how their ankles and knees don't break. Well, they actually do. It's also annoying if you're sleeping and they thump around the apartment. (People don't wear shoes indoors here.) So it seems there's a need for not only running training but even walking.

Thomas Palm said...

I have had problems with my knees trying to run, and then I found "Running Fast and Injury Free" by Gordon Pirie on the net. Like the Nature article it suggested landing on your toes rather than the more usual heel style, and for me it worked at least to some extent. (I'm afraid I haven't been very good at getting into the habit of running again, though)

A similar suggestion when walking is to get shoes with a thin sole. Having well padded shoes protects the heel and encourage you to set it down heavily, but the impact still has to go somewhere so your knee gets punished instead. A thin shoe force you to walk a bit more carefully.

thingsbreak said...

The nature article, though, was about the color of dinosaurs. Not sure how they get in to the act.

D'oh!

http://www.nature.com/nature/journal/v463/n7280/full/nature08723.html

Hank Roberts said...

http://www.vibramfivefingers.com/products/products_kso_trek_m.cfm
has me wondering.

----
I'd sure like to meet the AI behind the word verification system. The word for this posting is:
bushmet

Hank Roberts said...

Chuckle. Every time I come look at your blog now, I'm standing on one foot (I've always had the computer set up for standing not sitting, for the little extra exercise that gives).

No 'toe shoes' yet but I've been using the 'toe socks' since they came out with a calf-high compression version, and they seem to help balance by encouraging me to spread my toes.

Agreeing with the earlier suggestion too about thin flat shoes
(and slippers) helping.

Hank Roberts said...

Ok, since I'm standing in for a legion of others, no doubt wondering the same thing -- does anyone know of a good simple timer device that can be set for Robert's run/walk pacing?

I find repeately taking the time staring at my old analog watch, to find the second hand, then do the addition, to work out how long til the next change of pace is doable on a boring track, but it'd be fatal on a street/sidewalk or trail. And a digital watch won't help, I'm not sure I can run, count, and do addition all at the same time.

Wanted: some wrist-portable gadget I can set in advance for the alternating run/walk times, that will alternate between them, with maybe a light flash or a beep signaling to change pace?

I'd be happy with circuit diagram and parts list, if anyone knows a design I can solder it up as a little project box on my belt.

Hank Roberts said...

I went looking for watches, and
Yeek!
http://www.runnersworld.com/article/0,7120,s6-240-321--13216-4-1X2X3X4X5X6X7X8-9,00.html

Hank Roberts said...

Brief excerpt from that article, because this bit actually seems topical

"....Within a week, her new watch starts spitting out a surprisingly insightful plan. On its postage-stamp screen, it suggests workouts in three zones—light, moderate, and hard. It assigns a quota of 5.5 total hours of weekly exercise, with the majority in the easy bucket. The light workout pace is a revelation to Parker; it was the speed she usually jogged alongside her aging dog. "Now that I'm not running full steam at every workout, I have more energy," she says.

... Parker begins to think of it as an adult Tamagotchi, needing constant attention or it'll die. In the morning she runs four miles, and in the afternoon she bikes to her son's school just to feed the watch. ... a dinky wristwatch assessing your general fitness is strange, one that tells your future is even stranger. Polar claims that its fitness test can predict VO2max, the upper limit of an athlete's oxygen intake. Many physiologists consider VO2max an important indicator of innate talent in runners....
... we ask Patty Freedson, chair of the kinesiology department at the University of Massachusetts, to measure Parker's VO2max ....
... Freedson comes back with the news: a VO2max of 51.2, a high number for women her age. The watch was right; in fact its calculations had slightly shortchanged Parker. "I guess I have more potential than I thought," she says. ..."

Penguindreams said...

Hank:
You can get watches far less involved than the one from that article. For about $30 you can get one that has 2 or more interval timers, which will do for your immediate question. I use a Timex Ironman Triathlon (100 lap memory being the main feature for me -- I like tracks, so rack up the laps pretty fast, and sometimes like to keep multiple workouts or races on it). If I remember right, that was about $60 when I got it 4-6 years ago.

Your later quote alludes to something important -- most people do most of their running too fast. The main benefit of the technology (heart rate monitors, in this case) is to help you run slowly enough on the days -- most of them -- you should be running easily. A lower tech version is to try talking. If you can get 3-5 words out at a time, you're ok. If it's full sentences, you're not running hard enough. If it's only a word or two, you're running too hard. Keep in the conversational range for all your training until you're running 30 minutes straight. And then stay conversational most workouts, and most of the time.

Health benefits, I'll mention, pay little attention to how fast you're running. Getting out and covering ground regularly is more important.

Hank Roberts said...

> 2 or more interval timers, which
> will do for your immediate question.

Thanks. Never underestimate my ignorance, I did not know what "interval timer" meant while wishing.

"An Interval Timer ... is a sequence of timers running in sequence. Once one timer has run its course, the next timer .. begins ..."

So I want: two interval timers, and a setting that will alternate between them a specifiable number of times, then stop. Dey do dat?

Or perhaps I want: ten interval timers, and manually set each of them?

I hate comparison shopping, that's why I have always bought ten dollar analog Timexes (grin) and ask dumb questions. Okay, off to the new millenium I go ...

Hank Roberts said...

nevermind, all I needed was to know "interval timer" and I'm finding, of course, everything I needed to know ...

Penguindreams said...

Hank: Sorry about the lack of description. But at least it put you on the right track. I see that my watch can be set for 9 intervals. I'm not sure why, since the most involved workout I know of in this respect requires only 3. Mostly I just use 2 -- one for how long to run, and one for how long to walk. At the moment it's 4 minutes run, 1 minute walk. If the rehabilitation continues to go well, in 2-3 weeks I'll be running my 30-40 minutes straight through, and need no interval timer. At least not for several more weeks to months -- when I then take up doing speed work one day a week.

Hank Roberts said...

Ok, something called 'Gymboss' (all over the web, sigh) seems to do this for about $20.

Saw my first set of toe-shoes in use at the track this morning, worn by a fellow markedly skinner and healthier-looking than Steve Jobs who was running, fast, the whole half hour I was there doing my alternations.

Hank Roberts said...

How quickly do you move from one stage to the next, Robert?

I feel impatient (having gotten back up to Stage 2 for the third time since last fall); the interval timer will catch my temptation to keep running longer between walks, which is intense.

Speed work? OMG as the kids say; I hope you'll post another set of stages for that when you get there. Maaaaaybe I can do it too.

Penguindreams said...

Hank:
You hit on my usual problem. It's a bigger issue when you still remember, and so do your legs, the paces and endurance you once had.

If you mean stage 2 injury status, and this is your third time in a few months:
a) it's past time to back off.
b) Stage 3 could be the next time you run. Stage 4 the time after that if you don't take the warning.
c) you need to find a way to slow down how fast you're increasing your exercise load.

Trust me, stage 3 is no fun. Stage 4 is seriously un-fun.

One help I've found for avoiding overly rapid increases in my running is to do other activities as well. So 2-3 days running, but also a day in the gym on a bike, and a day in the pool. Swimming and biking will also help your aerobic conditioning, and biking will help some running-related muscles.

I'm also discovering (erv will be happy) that strength training is a good idea as well. Particularly to do strength work on the abdominals and upper body that running doesn't do much for.

To the extent that you (like me) like to look at numbers progress, you're safer with the bike and pool. Use those to take your attention off the running progression and just let that happen in its own time. It won't be as fast as you want (certainly mine isn't) but it'll happen, and probably be faster than you're afraid it might be.

Something else you need to do is figure out why you're already in stage 2 injury and fix the cause (which could just be the usual 'too much, too fast, too soon'). Email me with details if you'd like. No guarantees, and as you progress up the injury stage list, doctors become more important.

Hank Roberts said...

fortunately, I meant I'd reached stage 2 in the stepwise increase timing for running, several times, then gotten interrupted and started over. Medically, nothing special going on. So those cautions can be for the silent horde reading along who haven't spoken up yet (grin).

I'm following 'erv' too, thanks for the reminder. For others, that's a reference to

"a blag-wide fitness event-- lets all talk about our personal 'fitness'. What we do, why we do it, mistakes we made along the way, even though we are totally amateurs :P"

http://scienceblogs.com/erv/2010/01/in_just_seven_days_oh_baby.php

Hank Roberts said...

Echoing Robert's introduction, to

"invite contributions of sites that give good prehabilitation-oriented exercises."

Please, fellow readers, more!

I've got the standing on one foot for a minute down. I'd try it with my eyes closed but my typing goes all to heck.

I've been thinking I need another 'gyro' wireless mouse, like I used to use in the old old Mac OS 7 days. Lovely little toy it was.

Oh, wait, i guess it's possible to exercise while _not_ reading online.
But what fun is that?

Penguindreams said...

Hank:
Yes, erv was my prompter here.

For the standing ... haven't you learned touch typing yet?

Hank Roberts said...

Well, this merits a cautionary aside

My touch typing was great for decades (100wpm without errors). But I worked a decade with pain misdiagnosed as "tendinitis"; belatedly a non-workers-comp doctor identified carpal tunnel, but too late, surgery didn't help; touch/pressure is unreliable now.

Ancient Mariner caution: kids, if you find you're starting to drop little things -- paperclips, stamps, Post-It notes -- see a neurologist. It's not old age/ clumsiness, it's nerve damage.

-----

Robert, thanks for the pointer to the heart rate calculators! Very useful.

Hank Roberts said...

I can now endorse the cheap little 'Gymboss' interval timer, based on one day's use. Beeps, vibrates, or both after each interval, and counts down the intervals.

(I'm at your Stage 3 0:30/4:30 x6).

Question--how do you decide when move up to next stage?

I fight the urge to check the display a lot during the walk time.

Question -- how fast do you walk? Heart rate target? I tend to walk about as fast as I can (but I always do).

LOTS of prehabilitation.

Is there a list of science/exercise bloggers somewhere?

Penguindreams said...

Glad the tool is working for you.

For the walking part, whatever is comfortable. A brisker pace -- one that keeps your pulse in the 60-75% training zone -- is a good thing if you can do it naturally. Don't worry about trying to get there, though, if it turns out that your walking isn't fast enough, or your recovery is too good, to keep your pulse up there. (Odd thing for me: If I'm only walking, it's hard to get my pulse over 120. If I run a little first, the pulse will stay over 140 for a long time even if I'm walking slowly.)

Going up to the next level is something that doesn't need to be done soon. With a heart rate monitor, I'd be recording what the heart rate was and how I felt. That's the more reliable indicator than the formulae. Before going up a full level, I'd want to see my heart rate at the end of the workout move down. Say that the first time I tried a new level, my pulse was 175 on the end of the last running stretch. I'd like to see it down at 165 or so before I moved up.

The principle is, as you get in better shape, you'll be able to do a given workout with less effort. So, as you improve, your heart rate will drop for a given workout. That doesn't apply as much if you're perfect about maintaining your effort level at conversational, but few of us are that good. Certainly I'm not.

But, whether by heart rate or by how I feel (see Borg perceived effort scale), I prefer to stay at a level until it starts to feel noticeably more comfortable. Conversely, if I step up and go from feeling fairly ok to 'oh my gosh, will this workout ever end!', it's also a sign that it isn't time to move up yet, at least not for the whole week.

No list of science/exercise bloggers that I know of. As you recall, that was one of ERV's complaints. One running resource I'll mention is Janet Hamilton's blog Ask the Coach. (Most recent question is from me :-)

Hank Roberts said...

Still at it, still grateful for the topic! A neighbor convinced me (with a 3-week-free-pass) to try a local "lite" franchise of the "24-hour" fitness chain (and to get membership from Costco for about half the over-the-counter cost). I'd never used machinery to exercise before! (aside from scythes, saws, shovels and ladders). The franchise is set up for interval training, and this convinced me to start that in between my running days: http://www.happyhealthylonglife.com/happy_healthy_long_life/2010/04/fujioka.html

Your main point, Robert, is still the big one -- don't push too hard, it's _so_ easy to overdo. (Some of their gear has heart rate detection, which helps)