Posts Tagged ‘Certification Exam’

Least I seem like a simple pied piper for exercise, oblivious to any potential harm or risk, this blog should help lessen that perception.  Exercise has wonderful therapeutic qualities to help manage pain and increase your brain functioning.  It’s not without a price.  That price comes in the form of pain – some of it is soreness as shared previously.  There is pain that can not be ignored,  It varies by type of exercise.  I’ll share a bit of the “soreness” versus “pain to get checked”.

Running – the #1 culprit in aerobic exercise pain. So simple to do.  So simple to get injured from.  The amount of force that hits the ground with each little pitter patter is profound.  Each foot strike can be a bit like a right jab from Mike Tyson in his prime x 20.  Not pretty.  There are some technique flaws that contribute to potential running injury – the top is, ironically, the way modern running shoes force the foot into a heel to toe strike.   While good for walking it’s biomechanically inefficient and awkward for running.  Related to this is the more spent on a running shoe the lesser the benefit – if the human foot is coddled it becomes miserable and aggressively shares its misery with the knee and lower back.  See the article below from Wired for more.

Pain not to ignore in running – chronic pain indicator:

  • Plantar Fasciitis – more than just a mild sore arch, plantar fasciitis is a slight to major tear or fracture of the tendon and connecting tissue in your foot.  It’s truly a runner’s plague.  Rehab can take months.  Best prevention is to ensure a strong arch (alas where most running shoes coddle too much and weaken) and cold soaks of the foot before the pain starts. I had a nasty bout of this in 1996 and went from a semi-curved last shoe to a straight shoe (new balance, mizuno and saucony are good brands for the straight last).  It did linger for five months.
  • Knee – all sorts of knee pain can be aggravated by running.  Some is transitional soreness.  Others in terms of ligament or knee cap stress should not be ignored.  Efficient running can help avoid this.  Another preventive measure is avoiding 100% of running on concrete surfaces (mix in trails, asphalt and cinder).  You can run on weak knees and see improvement in those knees.  A good friend of mine, after reconstructive knee surgery in one knee and a cocktail of treatments in another, has been able to regroup and resume his cycling / running combination as well as his pursuit of a marathon in every state.

Pain that is typically transitional soreness

  • Shin splints.  When I first began running, post high school running in 1992, one of my pain companions was a good old shin splint.  Shin splints occur as muscle and joints are stressed and strengthen along the calf / shin.  These typically grow and heal as consistent running occurs.  A simple way to strengthen your shin is to take can old paint bucket (empty), place a small brick in it (about 2-3 lbs max) and then place over your foot.  Lift your foot up and ease down slowly 12 to 15 times.
  • Sprained ankles, oh my.  Sprains travel in pairs.  Sprain one ankle and another one follows.  There are some good stretching exercises – a primary one is to simply flex your ankle in every possible direction.  Strength training for ankles (and other aliments) is important as well.  Check this article out for some good tips
  • Sore shoulders, quads, buns, etc.  Soreness in those areas is just that – soreness.  Typically chronic pain will not ensue.  It’s just your body’s way of saying “hey, was pretty comfy all of these years, why are you changing now?”

To Run Better, Start by Ditching Your Nikes | Wired Science |

Strong evidence shows that thickly cushioned running shoes have done nothing to prevent injury in the 30-odd years since Nike founder Bill Bowerman invented them, researchers say. Some smaller, earlier studies suggest that running in shoes may increase the risk of ankle sprains, plantar fasciitis and other injuries. Runners who wear cheap running shoes have fewer injuries than those wearing expensive trainers. Meanwhile, injuries plague 20 to 80 percent of regular runners every year.But the jury’s still out on whether going barefoot is actually an improvement.

“The running shoe right now is doing nothing for preventing injuries,” said Reed Ferber, director of the Running Injury Clinic at the University of Calgary’s Faculty of Kinesiology. But, he adds, going barefoot has downsides too, and the research so far is still inconclusive. “It’s a total tradeoff.”

Chris McDougall, author of the recent book Born to Run, goes further. “If this were a drug, it would be yanked off the market,” he said of running shoes. McDougall says his own persistent problems with plantar fasciitis cleared up after he started running in Vibram FiveFingers.

On a scale of 1 to 5 with 5 being the highest I’m probably a 5 on institutional running pain knowledge.  For two other aerobic exercises, swimming and cycling, my pain savvy is lower (4 for swimming and 2 for cycling).  I do want to share some about each in terms of chronic pain and touch on strength training.  Avid cyclists please add your insights as well.

First and foremost cycling and swimming are considering healing aerobic exercises – they do not impose nearly the force on the body that running does.  There are some longer term, chronic pain issues.

Cycling – there should be minimal chronic pain, if done with proper technique (not grinding the pedal with your legs but smooth stroke cadence) and proper equipment (clip shoes, right bike for right road, right size and seat placement).  The potential for a crash at high speeds does ratchet up the pain potential (remember your helmet).  Beyond that, knees can be stressed by cycling – though as shared this is due more to improper technique or gear.  Buns also take awhile to adapt.

Swimming – even more than cycling, swimming is considered a healing exercise.  Your body endures no impact in terms of gravity.  You’re buoyant in water.  You learn to move well.  There are some chronic pain problems associated with adapting to water (swimmers eye or ear). The butterfly is the number stroke culprit in terms of strained shoulders.  Then again butterfly is not a staple for endurance swimming. Its a great change up stroke for simulating anaerobic debt for workouts.  I have yet to see someone crank out a 1,500 meter fly in the open water and doubt I will.  Also if piling up swim laps is on your agenda, give your body some rest (24 hours) between swimming and strength training – some strength training during a swim is a great idea!

Strength Training – truly no pain, no gain is NOT the right mindset.  The benefit of strength training is for longer term muscle and joint strength.  Keep weights light and reps high as your body adapts.  There’s no benefit from trying to slam down 8, 45lb plates on your squats or 4 plates on your bench to compete in the weight room.  Most serious weight lifters are very helpful in terms of explaining proper technique and weight.  I’m a bit beyond caring whether someone uses my bench press weight for their curls – the person that does can be a great resource.  Absent a physical trainer (recommend you do find a good physical trainer) you can pick up some solid advice.

An overall pain prevention technique is to blend and weave in multiple exercises – tie in the ones listed here with Aerobics, Spinning, Indoor machines (elliptical, stair step), Martial Arts, etc.  Ongoing repetition limits improvement and reinforces the “pain side” of the exercise force.

Next up on the Exercise – Brain Connection is Goal Setting.  Whether at our TAPU blog or via Facebook/Twitter/LinkedIn – please do share your experience and opinion with exercise and chronic pain.

Exercise and pain – two blogs have been devoted to it and a third one is presented here.  Maybe there’s a connection?  Even back to our brains. This blog addresses chronic pain from three prevalent health issues and the benefit of exercise to each.  The next blog will address managing long term pain from exercise – pain not to be ignored whether associated with knees, plantar fasciitis or achilles tendons.  Call this a sort of ying and yang of exercise.  This blog addresses the ying once again.

Benefits of Exercise – Take 2 – Multiple Sclerosis, Fibromyalgia and Chronic Back Pain.

I’ve shared that exercise provides benefit to a person of any age.  Can it help with significant pain diseases / issues?  The research indicates yes!  As with any exercise consult your physician first.  Also, as with the entire series on the Exercise – Brain connection, exercise is not offered a singular, exclusive solution that’s accomplished in four simple steps – it’s meant for a life long commitment that weaves and supports other treatments and activities. This ain’t an  informercial.

Multiple Sclerosis (MS) – I’ve seen the debilitating effects of progressive MS on my oldest brother.  Formal confirmation and diagnosis was provided in 2004/05.  His is not a relapse form of MS – it’s a downhill slope.  He is still active, aided by an iron will,  tremendous family support, treatment and moderate exercise.  While a marathon is not in the cards, he can be there at then end laughing at me trying to hold off the winner of the 80 and older age group.  That’s what brotherly love is all about.  Swimming and moderate strength training are his two primary forms of exercise.   The following video from WebMD provides some insights on how exercise can help manage the symptoms from MS


A disease which has exercise intolerance as a root symptom might seem an unlikely candidate to benefit from exercise.  Research does indicate that, in moderate and careful doses, exercise can provide invaluable support.  The following is from the Arthritis Foundation, Research Update, March / April 2008.

Exercise and Education for Fibromyalgia

The authors conclude in their article published in the Archives of Internal Medicine, “The present study suggests that progressive walking, simple strength training movements, and stretching activities are effective at improving physical, emotional and social function, key symptoms, and self-efficacy in women with fibromyalgia who are being actively treated with medication. Furthermore, the benefits of exercise are enhanced when combined with targeted self-management education.”

Back Pain

Back Pain is a common discomfort for most everyone at some point in their life.   For a some though chronic back pain is a life long issues.  President Kennedy’s struggle with back pain following his WW2 service is widely documented.  What is not as widely known is that the best relief was not provided by six daily pain treatment shots, rather it was after that approach was abandoned for moderate, back strengthening exercises.  The National Pain Foundation chronicles the work of Dr. Kraus in the following article:

Muscles, Back Pain and Exercise

Dr. Kraus, who originally was an orthopedic surgeon, actually established the first multidisciplinary pain center in the world in the late 1950s and early 1960s, which very few people know. It was at the Columbia University School of Medicine in the department of orthopedic surgery. There were psychiatrists, social workers, psychologists, physical therapists, physiatrists, and orthopedic surgeons researching at back pain and trying to understand it.
They found that about 80% of patients presented with nothing that could be demonstrated on an x-ray or physical exam that suggested there was something significant pathologically, so they tried to understand it from the perspective of conditioning since that was Dr. Kraus background. They studied about 3,700 patients for 4.5 years and created a test – called the Kraus-Weber test – and an exercise program to go along with the test to deal with what they thought were the types of functional muscle pain that exist

The following article from WebMD helps and encourages anyone beginning an exercise program or anyone who’s been in their program for years.  Sore muscles will occur – call it the acute pain of overcoming inertia.  I was thinking of this very topic during a 20 mile run today – which was relatively pain free.  There will be some pain from exercise.  That’s OK.  The key is to determine what is normal soreness and what may be an indicator of a more serious problem.  This blog concerns normal soreness.

Two Types of Soreness that are good

acute, immediate– this is the type of soreness that occurs during or very soon after you’re done exercising.  It can happen to newbees or experts.  There’s also some characteristics of soreness from different activities – here are some that bubble up high on the list

Running:  shins, quads, hamstrings, knee, feet and shoulders, oh my!  Each of those will be pushed.  Depending on current fitness level and body composition, your soreness in any one area will vary.  Here is one big hint. Learn to run on the balls of your feet (I’ll have an entire blog on fore foot running).  For now let me just say that our bodies are meant to run toe to toe or on the ball of the foot (walking is heel to toe).  The downside is most running shoes cater to heel to toe strike.  Test this yourself – run barefoot for 200 meters and see how your foot falls.  Its natural fall is on the balls of your foot right before your toes.

Cycling:  buns, quads, shoulders and back.  Lots of bending over on top of a bike.  Proper technique (smooth and fast rotation instead of straining or chopping your stroke) helps.  For the buns aka “saddle sore” a cycling or triathlon pair of shorts  is well worth the investment.

Swimming: a wonderful healing aerobic activity swimming can strain the shoulders and back depending on type of stroke and, more importantly, your efficiency with each stroke.  Other irritations include swimmer’s ear and even the dreaded google imprint on the nose.  Compared to running there’s far less soreness involved. 

Lifting: more related to DOMS and discussed below, the soreness from weight lifting is typically 30-48 hours after.  This is the old “bench pressed 205 yesterday and can’t lift my toothbrush today” syndrome.

Sore Muscles? Don’t Stop Exercising
After participating in some kind of strenuous physical activity, particularly something new to your body, it is common to experience muscle soreness, say experts.

“Muscles go through quite a bit of physical stress when we exercise,” says Rick Sharp, professor of exercise physiology at Iowa State University in Ames.
 “Mild soreness just a natural outcome of any kind of physical activity,” he says. “And they’re most prevalent in beginning stages of a program.
delayed onset soreness (DOMS)   Ah, the joy of the two days after a marathon, triathlon or 100 mile bike ride.  Walking around with a little hitch in your giddy up.  I’ve included a link to a fun video about the day after a marathon.  This type of soreness will lessen.  It’s a profound how our bodies are wired to deal with pain.  It’s associated with the muscle tear down and recovery cycle.  Read more about why DOMS happens in the WebMD article referenced above. 

To overcome DOMS the most powerful and frequently overlooked treatment is the cold soak – within 15 minutes of ending your session.  This runs counter intuitive to what our body tells us (a message of let’s soak in a hot tub and grab a massage is much more inviting than lets sit in a tub for 20 minutes with ice and shiver like a Titanic survivor).  But it’s the best way to reduce inflammation and quasi secret method for Olympic and professional athletes to treat DOMS.  Another good method is to stretch, warm up, cool down and stretch – call this more of a preventive technique.

In the next Exercise – Brain blog we will share a bit about what to do about chronic soreness or pain that indicates a deeper issue.  Additionally some ideas on how to manage that pain will be provided.


The day after the Marathon

“Delayed onset muscle soreness (DOMS) is a common result of physical activity that stresses the muscle tissue beyond what it is accustomed to,” says David O. Draper, professor and director of the graduate program in sports medicine/athletic training at Brigham Young University in Provo, Utah.To be more specific, says Draper, who’s also a member of the heat-responsive pain council, delayed onset muscle soreness occurs when the muscle is performing an eccentric or a lengthening contraction. Examples of this would be running downhill or the lengthening portion of a bicep curl.

So you thought exercise meant pain? 

While there’s some pain that results from exercise (either during or after – called delayed onset) the pain relief benefit from exercise greatly outweighs the pain creation.  This article provides a nice summary of what’s involved and I’ll shout and echo the sentiment that “Moving is what the human body is designed to do”…

Mixing aerobic, strength (anaerobic) and flexibility are the key – one type alone will not accomplish it. 

  • Aerobic exercise from running or cycling or aerobics classes help fuel that authentic wonder working tonic called endorphins.  From “Endorphins are manufactured in the brain, spinal cord, and many other parts of the body. They are released in response to neurotransmitters and bind to certain neuron receptors (the same ones that bind opiate medicines). Endorphins act as analgesics (diminishing the perception of pain) and as sedatives”
  • Flexibility helps your body correct itself from a generally sedentary lifestyle we have.  If you think about it, sitting at a computer or standing all day on your feet are the most punishing things you can do to your body.  So stretching, yoga and Pilate’s help increase your range of motion
  • Strength training does not mean “you’ll get pumped up” in the “governator” sense.  It does mean you’ll build muscles first and then over time (3-6 months later) your joint strength.Consider strength training your body’s natural ibuprofen. 

I’ve seen the benefits of exercise increase as I age or struggle with some minor chronic pain issues.  I have a flaky almost non existent thyroid that presented itself in 2001.  A 2 mile run felt like I was at mile 20.  It didn’t add up.  After a diagnosis and proper meds – Levoxyl rocks – I was back on my way.  However by focusing too much on running I would find myself fatiguing.  As I’ve mixed in a heavy triathlon dose and kept my strength training year round, I’ve noticed a much greater improvement in pain management.  Again, my pain management is very minor and I empathize with those who have arthritis or fybromyalgia or Lyme disease.  I’ve also seen that blending in healing aerobic activity of swimming and cycling helps with the body pounding nature of running (in a future blog I’ll share some secrets on how to make it less body pounding beginning with “get off your heals and onto the balls of your feet”).  My next step is improving my flexibility. 

Now further testifying to the benefit of exercise, I’ve felt the old body aches more if I’m away from some serious workouts for 4-5 days (lets say traveling).  The lower back creaks, feet hurt, etc. 

Please do share what you’ve found – whether you’ve exercised all your life, its been a few months or you’re just beginning.

Next up – overcoming the Pain from Exercise.


Getting started – often the first step is the most difficult.   It’s also the most important step.   I remember listening to John “The Penguin” Ingram, contributing editor for Runner’s World and self effacing ‘slow runner’, share at the prerace dinner for the Tulsa Marathon in 2003 that the “miracle wasn’t that I finished, the miracle was that I had the courage to start”.  At the time he began running he was considerably overweight and had a myriad of health issues.  So that first step was a good leap for mankind (giant leap belongs nobly to Neil Armstrong).

I’m not presuming that running is the only exercise to begin with.   It is a lower cost and simple way to begin – go out and run.  There are other equally effective ways.  There’s also some good advice from the Mayo Clinic on what to consider for any exercise program

  1. Assess current fitness level
  2. Design your program
  3. Assemble your equipment
  4. Get started (Penguin’s miracle)
  5. Monitor your progress

for our Six Sigma fans this resembles the DMAIC process a bit… but I digress

A good program should include both aerobic and anaerobic conditioning.

Here’s a quick list of lower cost entry aerobic exercises to begin with:

  1. Walking
  2. Running
  3. Cycling
  4. Swimming
  5. Dancing (ah, not slow, you need to move)
  6. Others – may require some investment
    1. Skiing – downhill or cross country
    2. Indoor passions – elliptical, stair climber, treadmill – at a local club, Y or home
    3. Soccer
    4. Roller Blading

Anaerobic exercises includes

  1. Circuit training (health club)
  2. Free weights (can be done at home)
  3. the “ups” – push, pull, chin and modified sit ups.

How often should you do it each week?  The traditional wisdom is 3 times a week for 20 to 30 minutes to begin.  My observation and one shared by the “Younger Next Year” authors Chris Cowley and Dr. Harry Lodge http://www.youngernextyear.comis more than that – at least 4 aerobic sessions for 45 minutes each week and 2 to 3 anaerobic / strength training programs.  Why?  Am I harsh?  Old School?  Grumpy? 

Maybe, but the deeper reason is our bodies were made for movement every single day and not just 2 or 3 days a week.  While 3 days a week for 20 minutes is a start, your body actually craves a bit more .  As we share more on heart rates and endorphins, 45 minutes is when you begin receiving the “thank you” from your body.

Now that 45 minutes is NOT at break neck pace.  If your goal is to run, then begin with a walk/jog combination – a 50/50 mix over those 45 minutes.  If cycling, then a mix of 8-12 mph with occasional bursts to 15.  The idea is to extend your session, reasonable.   How long should you stay at this “introduction” phase – the simple answer, as long as it takes for you to feel comfortable to add time to each session or increase intensity or both.  That may mean weeks or months or even a year. 

Next up are blogs on Anaerobic exercises, “Pain”, Extending your Performance and psychological benefits from exercise.  For now venture out and make the exercise stuff happen!