Fixing Your Achy Wrists

Do you experience pain in your wrists while doing exercises like bench presses or planks? If so, then read on!

As I've mentioned 1,000 times (and you're probably sick of me saying it already), we always have to look distally (farther away) from the area in question. Think of your entire arms as a train. If the shoulder isn't working properly, you bet that you're gonna have elbow and wrist problems too. Take a look at the photo on the right from Thomas Myers' Anatomy Trains. You can see here that the pecs of the chest will influence the structures all of the way down to the fingers.

The number one complaint I hear from clients when doing the front squat is that their wrists hurt them. While the wrist pain is the symptom, the cause typically arises with poor shoulder mobility. If your front rack position is sub-par, your wrists now have to bear the brunt of that load. The lower your elbows are, the more wrist extension you need to compensate. In this instance, you need to work on opening up the pecs and lats to ease the stress on your wrists.

Because of this horrendous shoulder mobility, his wrists suffer.

I see similar problems arise in pressing movements. In the bench press or the overhead press, clients occasionally lack the necessary strength in their forearm flexors, so they fall into a hyperextended wrist position throughout the lift. A more "neutral" wrist position can save them a lot of discomfort. In these cases, the problem might not be mobility, but grip strength. I would have these people do exercises like hangs from the pull-up bar, plate pinches, or farmer walks to combat this. Sometimes, cueing alone can also go a long way to correct this issue.

This image from Liftbigeatbig explains different wrist positions. We never
want significant extension in pressing movements.

Ultimately, if you feel pain in your wrists you have to check out how your shoulders are moving to properly assess the issue. Shoulder instability can manifest itself in a variety of different ways. Continuing to address your wrist alone will have little to no effect. I see a lot of people working to stretch their forearms to alleviate wrist pain, but rarely do they address other possible contributing factors like shoulder stability or grip strength. Global corrections will stimulate an entire chain reaction of positive effects.

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The 4 Exercises that Your Shoulders Hate

It is common for a lifter to seek boulder shoulder status. While having protruding, rounded shoulders certainly looks nice, the shoulders are very vulnerable to injury. The demands of a sedentary, desk-ridden society already makes our shoulders unhappy, and if you translate this dysfunction into the gym, you're gonna have a bad time.

I have dealt with my own shoulder issues in the past, and I know just how aggravating it can be to have to modify workouts or avoid certain movements. Ultimately, I had to learn the hard way what exercises provoked my shoulder pain. Many common-place shoulder exercises can be effective for deltoid and pectoralis hypertrophy, but they also promote instability and compensation. For both myself and my clients, there are four main exercises that I avoid for the sake of sparing their shoulders:

1. Pec flies. Regardless of whether you're using cables, dumbbells, or even the pec-deck machine, you're most likely better off without them. With this movement, many lifters tend to go well beyond the necessary range of motion to isolate the pectoralis muscles in transverse shoulder flexion. You also run the risk of sufficiently irritating your biceps tendons. Instead, they end up stretching the hell out of their anterior deltoids and forcing their shoulders into a yucky internally rotated position that makes me cringe. For chest development, I prefer to have clients do reverse grip bench press, neutral grip dumbbell bench press (with a slow eccentric focus), and Spoon presses. If you're hell-bent on keeping pec flies in your workout routine, try to minimize the range of motion so that your arms only go slightly above parallel, and make sure you maintain a slight bend in your elbows.
2. Behind-the-neck lat pull-downs. I've addressed my feelings about behind-the-neck exercises previously, so to save you from a redundant rant, I'll give you the abridged version: these movements (especially in lat pull-downs) encourage you into flexed cervical spine and often reinforce poor shoulder movement. Very few people possess adequate shoulder and thoracic mobility to perform these. If you really want wings, stay away from these. Instead, try rowing variations, pull-ups (you add weight or go chest-to-bar if you want a greater challenge), straight arm pull-downs, and maybe the occasional Red Bull. (I couldn't resist...)

   

   Yikes!

3. Box dips. In a recent Instagram video, I mentioned that I stray away from programming dips on a bench or a box. Effectively, this variation places unnecessary stress on the anterior capsule and tendons of the shoulder. To perform these, a client must flare the elbows out excessively, while the shoulder again shifts into a precarious position. You will see this as well on bar dips, but to a lesser degree, because the athlete's shoulder and elbows are closer to his center of mass. The ideal way to do dips, in my opinion, though, is on the rings. The rings force the athlete to properly adduct his shoulder, and his arms are closest to his center of mass (thus resulting in a more mechanically advantageous position. If you're currently unable to do ring dips, stick to push-ups on the rings, and then slowly progress to a full ring dip.
4. Upright rows. I'm sure you've heard trainers shun this exercise before. While I think it can be helpful for developing the shoulders for the right client, there are always other options. I've found that they cause more harm than good for most people, as usually the anterior deltoids are the strongest part of the shoulder. Instead, many people would benefit from training the posterior or rear deltoids with back flies to balance out the omnipresent imbalance from front to back.

In general, gym goers can benefit from fewer pushing exercises and more pulling exercises. I usually propose a 2:1 ratio for upper body pulling:pushing days. By this, I mean that you should only spend about one day per week doing bench press, push press, etc. (or at least with those movements as your primary focus), and two days with a pulling/rowing focus. The anterior deltoids and pectoralis tend to run the show (especially in men), and, thus, can cause a lot of pathologies and mobility restrictions. Your rhomboids, rear deltoids, lats, and lower trapezius can always benefit from some more love and attention.

There are plenty of safe and effective exercises that will still give you strong shoulders, such as those that I've listed in this article. You can be smart about your upper body training and avoid nagging injuries that will keep you sidelined for weeks at-a-time. Make these changes to your routine, and your shoulders will be happier in the long run!

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Debunking the Myth of the Vastus Medialis

The quadriceps complex is comprised of four main muscles: the rectus femoris, the vastus intermedius, the vastus lateralis, and the vastus medialis (which seems to have become the most buzzworthy muscle of the four). The vastus medialis obliquus (commonly referred to as the VMO) is the middle “tear drop” shaped muscle of the quadriceps complex. Both personal trainers and physical therapists often blame generic knee pain on this guy being weak, but the literature just does not seem to substantiate that concept. If a doctor or physiotherapist has ever told you that you need to strengthen your vastus medialis, then he or she is spouting off outdated and false information.

I have seen many an article claiming that one can “isolate” the vastus medialis, or emphasize its activation, by raising the heels in a squat, by narrowing one’s squat stance, or by doing some wild exercises. These exercises are frequently prescribed to individuals with patellar tendinopathy, patellar tracking, or post-op ACL tear patients. While these concepts sound excellent in theory, the data has shown that those ideas are effectively no more than broscience. The vastus medialis and lateralis muscles contract together, and no amount of heel raise, hip external rotation, or close-stance squats will change that.

Do decline squats increase VMO activation?

The first exercise myth about the VMO is that raising the heels will increase its activation in the squat. While using Olympic lifting shoes or standing on a board will undoubtedly increase total quadriceps recruitment, as your torso will be more upright, the vastus medialis receives no preferential treatment. Rather, the vastus lateralis and medialis simultaneously work harder to squat when the heels are elevated. Similarly, the high bar squat is more quad-dominant than a powerlifting low-bar squat, and a front squat is the most quad-dominant of the three.

Does squat depth influence VMO activation?

When analyzing the angles at which the vastus medialis and lateralis are most active, Lee et. al. found that 90° or less of knee flexion was optimal. Essentially, deeper squats allow for greater vastus medialis and vastus lateralis contraction. Again, both muscles are being targeted in this instance, so the VMO is working harder, but so too is the vastus lateralis.

The other take home here is that if you want quads of the Gods, you can’t skimp on your depth. If you have to ask someone if you’re going low enough, you’re probably not! If mobility is an issue for you, then you should seek the advice of a qualified professional and dedicate time at the end of your sessions to improving your bottom position.

What about narrow-stance squats?

None of the research to date indicates that squatting with a narrow stance impacts the vastus medialis to a higher degree. In fact, it doesn’t appear that it changes the activation in any of the quadriceps muscles at all. I’m not quite sure where this myth arose, but it seems to be contradicted by the literature.

Squatting with your feet close together won't increase VMO activation,
but it may result in faulty mechanics and potential for hip impingement.

One study with Paoli et. al. looked at the EMG in 8 different thigh muscles, measuring activity in three different squatting widths and three different intensities (no load, 30% of 1 RM, and 70% of 1 RM). They tested both quadriceps and hamstrings muscles, and there was effectively no statistical difference in any of the muscles except for the gluteus maximus. No matter how close the lifters stances, their quadriceps muscles (vastus medialis included) were no more or less active at any intensity.

Surely foot position matters?

This is one that I have heard for years, and even believed myself for a while: trainers boast that externally rotating the feet will preferentially recruit the VMO, whereas a parallel foot position would lead to more evenly divided muscular recruitment. Unfortunately, no studies to date have confirmed this concept.

Murray et. al. tested twenty physically active adults in 4 different foot positions during a partial squat on the Power Tower machine. They found no real differences in EMG amplitude in differing levels of external/internal rotation. Similarly, Ninos and colleagues tested two varying foot positions (externally rotated and neutral) in the Olympic squat, and there was no noteworthy difference in vastus medialis activation.

The take home? If you have strong quads, you have a strong VMO.

Trainers have managed to come up with many creative circus-trick exercises for targeting the vastus medialis muscle, but while they might look exciting to try in videos, the basic foundational leg movements are all you need; squats, lunges, step-ups, and split squats will help you build strong quadriceps muscles, and, in turn, strong vastus medialis muscles. You can perform your leg extensions with your feet externally rotated all day, and you still won’t be able to isolate your medial quadriceps. Instead, just stick to those previously mentioned core movements and reap the benefits of your tree trunk legs!

Works Cited:

1. Caterisano, A., Moss, R. E., Pellinger, T. K., Woodruff, K., Lewis, V. C., Booth, W., & Khadra, T. (2002). The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. The Journal of Strength & Conditioning Research, 16(3), 428-432.
2. Dionisio, V. C., Azevedo, B. M. S., & Siqueira, D. A. (2013). Horizontal and Declined Squats in Healthy Individuals: A Study of Kinematic and Muscle Patterns. ISRN Rehabilitation, 2013. Chicago
3. Murray, N. G., Cipriani, D., O’Rand, D., & Reed-Jones, R. (2014). Effects of Foot Position during Squatting on the Quadriceps Femoris: An Electromyographic Study. International Journal of Exercise Science, 6(2).
4. Paoli, A., Marcolin, G., & Petrone, N. (2009). The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. The Journal of Strength & Conditioning Research, 23(1), 246-250.

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Why Does Your XYZ Hurt? (Your Pain Explained)

Often times, pain in the body is associated with injury or illness of the patient. Pain is not, however, as straight forward as it may seem. There are quite a few misconceptions about what pain means, or what causes pain itself. Here are a couple facts about pain:

I want to start off by saying, just because you’re in pain, does not necessarily mean you’re injured or ill. Pain can be your body’s way of telling you that a dysfunctional pattern needs to stop. When you overuse a muscle, it’s gonna say, "hey, give me a break." As Lorimer Moseley puts it, "100% of the time, pain is a construct of the brain." Basically, this means that it is the brain sending messages of pain, not the muscles. A lot of people seek out temporary cures like cortisone shots, NSAIDs, ice baths, etc., when what they really need is some corrective exercise. This will stop the pain response in the long term by treating muscular imbalances, rather than temporarily treating the symptoms.

Mirror therapy tricks your brain to believe that the
missing limb is still attached to your body.

• Similarly, you can feel pain on a limb that's not even yours. Yes, you read that correctly. Take, for example, the case of phantom limb pain. Patients often report feeling shooting pains in an appendage that was removed years ago. A technique called "mirror therapy" has been very effective in treating this phenomenon: "a procedure utilizing the visual recreation of movement of a lost limb by moving the intact limb in front of a mirror, has been shown to be effective in reducing [phantom limb pain]. However, the neural correlates of this effect are not known." While the exact science of phantom limb pain and its treatment is still widely a mystery, this just goes to show that pain is multifactorial and complex.

Conversely, if you’re injured, you might not necessarily experience pain. Not every torn ligament, disc herniation, etc. is symptomatic. There are people with disk herniations who experience 0 pain, and they're able to continue on with their daily activities: "On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions... Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental," noted a study executed by Jensen et. al.

Your body remembers previous traumas, and “pain” pathways form in your brain. So, if you suffered from an injury a few years ago, you may experience pain in that same area without having re-injured it. Let's say, for example, you fell while you were ice skating and sprained your wrist two years ago. Now, your brain forms a negative association with ice skating. You may notice your symptoms reappearing every time you go back to the rink, even though you've long since healed.

Emotions can influence your symptoms. We can physically manifest stress in certain areas of the body. If something in your body is bothering you more than usual, consider other environmental stressors that could be contributing to the pain. Did you lose your job? Are you fighting with a friend? Neuroscientist Dr. V.S. Ramachandran puts it succinctly: "Pain is an opinion on the organism’s state of heath rather than a mere reflexive response to injury … Pain is an illusion.” This can mean that if you're upset about something, or you've convinced yourself into thinking there's something wrong, then your brain will respond accordingly by sending a pain response to the area.

Treating the pain symptoms (i.e. taking NSAIDs, icing, etc.) does not necessarily treat the cause of the problem. These will work as short-term solutions. See a doctor, physical therapist, or a chiropractor to figure out the source of the pain before you try to treat it on your own.
There are a million different factors that contribute to pain. Here are a few listed by Dr. Kathy Dooley:

1. Environment
2. Memory programming of pain (i.e., cerebral programming)
3. Systemic inflammation
4. Pain receptor irritation
5. Heightened awareness, due to neurotransmitter activity/inactivity (i.e., drug exposure, depression)
6. Circulatory issues (i.e., blood stasis)
7. Fatigue and energy deficiency
8. Improper hydration/dehydration
9. Psycho-social components (i.e., your back hurts because you hate your job)

The moral of this article is thus: don’t just lump “pain” into one category. Pain does not necessarily mean something is horribly wrong, but you do need to look at why the pain is occurring in the first place, if you want to eliminate it in the long term. Be your own detective.


Works Cited:

1. Brinjikji, W., P. H. Luetmer, B. Comstock, B. W. Bresnahan, L. E. Chen, R. A. Deyo, S. Halabi, J. A. Turner, A. L. Avins, K. James, J. T. Wald, D. F. Kallmes, and J. G. Jarvik. "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations." American Journal of Neuroradiology 36.4 (2014): 811-16. Web.
2. Doidge, Norman. The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity. 1st ed. N.p.: Viking, 2015. Print.
3. Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York: Viking, 2007. Print.
4. Foell, J., R. Bekrater-Bodmann, M. Diers, and H. Flor. "Mirror Therapy for Phantom Limb Pain: Brain Changes and the Role of Body Representation." EJP European Journal of Pain 18.5 (2013): 729-39. Web.
5. Jensen, Maureen C., Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross. "Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain." New England Journal of Medicine N Engl J Med 331.2 (1994): 69-73. Web.
6. Moseley, Lorimer. "TEDxAdelaide - Why Things Hurt." TEDx. YouTube, 21 Nov. 2011. Web. 10 May 2016.

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You're Injured–Now What?

At some point in nearly every athlete or active person's career, he or she will experience some injury, either major or minor. Whether you've torn a tendon or ligament, sprained a muscle, or you just have a nagging painful area that won't seem to go away, you understand how frustrating it can be when you're making a lot of progress and your body forces you to a screeching halt.

She does not look like she's having a good time.

Unless it is a traumatic injury (broken bone or a complete muscle tear), many people will just bite their tongues through the pain and continue to train normally. Perhaps they'll rest for a few days, or they'll avoid painful movements.

If you're currently suffering from some sort of issue, you're probably trying to figure out what the safest approach is that will allow you to continue to make progress towards your goals.

Injury (or pain) can be a slippery slope. Often times, people will approach me saying "my XYZ hurts. What should I do about it?" First, let me start by saying that I'm not an Orthopedist, a physical therapist or a chiropractor. I simply work in an environment in which people have a pretty high injury risk if they're not being careful, and I've had the opportunity to rack the brains of some very intelligent people who are much more qualified in this area than I am.

Here are some safe approaches to dealing with a painful or injured area without losing your precious gains that you've worked so hard to achieve:

1. Get assessed! This is the number one, without a doubt, biggest priority. So many people put off going to a physical therapist or chiropractor for one reasons or another. Perhaps they're afraid of what a doctor will say, or they're just too stubborn. Alternatively, they'd prefer to deal with the pain on their own, and they exacerbate their symptoms. Often times, problem areas are a pretty quick fix, assuming you see the right therapist. Finding out what muscles are weak or under-active will be helpful in preventing other similar injuries down the line.
2. Prioritize corrective exercise. I hear so many people complaining about pain, but yet no one wants to do anything to fix it. Instead, they will pop a couple Aspirin and hope it'll disappear on its own. Sorry to rain on your parade, but that won't work in the long term. Where there is pain, there is dysfunction. Injuries are very rarely caused by one isolated incident, but, rather, the culmination of months (or years) of bad movement patterns. Pain happens when your body says "Whoa, something needs to change. I can't keep working like this." Breathing drills are absolutely important to bring your body back to the parasympathetic nervous system. Correcting your posture will improve your mechanics. Strengthening weak muscles will lead to more optimal movement patterns. Do your shoulder stability work, core strengthening, and hip stability exercises. Without consistency, your symptoms will persist.
3. Only lift with perfect technique. This goes hand-in-hand with number two. Don't put more weight on the bar than your body is ready to handle. Injuries happen when you compensate.
4. Don't train painful movements. Figure out a way to work around the pain. If squats are painful when you pass parallel (full knee flexion), try doing box squats or lunges for a while. Are front squats bothering your wrists? Stick with back squats. When a movement causes you pain, you will, subconsciously and consciously, move differently. Your body is going to reflexively shift weight away from a painful area, so you might place more weight on one side of your body than the other, or recruit muscles you shouldn't be recruiting.
5. Focus on other areas of your body. While your ankle is bothering you, you may use this time to work on your pull-ups and your bench press. Try adding some gymnastics movements into your routine. If your shoulder is injured, now's the time to improve your sprints and increase your back squat. Spend time strengthening the uninjured areas, so that you can still stay on top of your game.

Injuries are frustrating, but they're not the end of the world. If you take all of the proper measures to treat them, you can be back to training normally in just a few weeks.

With an injury, the worst thing you could possibly do would be to ignore it and just hope it gets better on its own. Be proactive and help yourself! Remember, we all experience injury at one point or another, and you can still make progress while you're injured. Always listen to your body and train safely.

Works Cited:

1. Cook, Gray. "The Three Rs." Gray Cook Physical Therapist Lecturer Author. N.p., n.d. Web. 31 July 2015.
2. Myers, Thomas W. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Churchill Livingstone, 2001. Print.
3. Nickelston, Perry. "10 Things Breathing Patterns Tell Me About Your Body." Stop Chasing Pain. N.p., 8 Mar. 2012. Web. 31 July 2015.

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Where Does Your Knee Pain Really Come From?

The knees are the largest joints in the human body. Unfortunately, these large joints also seem to be an even bigger area for pain and injury. In the U.S. alone, surgeons perform around 700,000 knee replacements annually--that's a lot of bionic knees! Other knee-related injuries include ACL tears, MCL tears, patellar tendon tears, patellar tendonitis, dislocated patellas and osteoarthritis. In my opinion, many of these surgeries or injuries are easily preventable. With the proper training protocol, you can avoid knee pain and inevitable surgery down the line.

We use our knees for a lot of different activities from walking and running to jumping, squatting and lunging, and therefore they withstand a lot of impact. It is incredibly important to prioritize solid movement patterns to avoid any further stress.

I should warn you, that this post will be fairly heavy in anatomical jargon. Brace yourself.

The "knee" covers an area of four bones: the femur, the fibula, the tibia, and the patella. As a hinge joint, the knee can only flex and extend. Though its actions are simple, the muscles around it are vast and complex. Some of the important muscles that directly help the movement of this joint are the hamstrings complex (semimembranosus, semitendinosus, and biceps femoris), the quadriceps complex (vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris), the calf muscles (gastrocnemius, popliteus, tibialis anterior, and the peroneals). If you feel overwhelmed with the laundry list of muscles I just mentioned, fear not! I will elaborate.

Now, we need to remember that the body acts as a chain. One part of the body reacts to the feedback of another part. What are the two major joints near the knee? If you guessed the hip and the ankle, high five! We cannot just consider the knee in the case of knee pain, but rather, we must think about how the surrounding joints are compromising the integrity of the knee. If you have poor hip or ankle stability, the knee is going to work a lot harder to compensate for the lack of stability elsewhere.

Let's start from the ground up, at the ankle. The ankle can plantarflex (point), dorsiflex (flex upwards), invert/supinate, or evert/pronate. Check your feet. Are your arches exceedingly high or collapsed? What happens to them as you squat or jump? Ideally, we want to strive for a perfect balance between pronation and supination when standing. Both of these two movements are completely natural ankle movements when walking or running, but we do not want either in excess.

If, for example, you squat and your ankle collapses (pronates) completely, you will likely experience some collapse of the knee with it. The muscles on the inside of your leg (adductors) are over-active or tight, while the antagonists (abductors) will be lengthened. Do you often feel pain in your IT bands? Well, you may fit into this category of people. Your IT bands may be tense because they're working really hard for some other guys. Think about how this position is going to effect the ligaments and tendons in your knee!

Look at the relationship between his knees and ankles in the squat.

Conversely, if you drive your knees out too much and shift your weight laterally (supinate) your feet, the opposite will happen. Your adductors are going to be lengthened while your abductors will work over time. I was one of these people. The lateral areas of my knee always caused me pain, because I was nearly rolling my ankles as I squatted.

Obviously, the ankle position will effect the knee and hip mechanics, and vice versa.

If one lacks sufficient strength in the gluteus medius and the peroneals, the lifter will, again, revert to a valgus (collapse) of the knees. Weak gluteus maximus will result in an abuse of the quadriceps complex, which is going to pull onto the patellar tendon for dear life. Put more simply, if your glutes aren't strong enough, your knees are going to pay the price.

As I said, we want to maintain a balance in how we shift our weight as we move. Too much outward shifting of the hip or ankle is just as counter-productive as shifting too much weight inward. True strength comes from a balance.

Some of these inefficiencies may be a matter of learning. You might not understand what a proper squat should look like, and there for cueing and repetition will go a long way. If cueing has not helped, then you need to follow a strengthening and mobility routine. The exercises I've listed below will be tremendously helpful.

Now that we've made it through the meat of this article, it's time to learn how to correct these faults. Figure out where you lie on this spectrum of movement dysfunction, and correct your mechanics as necessary.

Here are some great ways to mobilize the hips and the ankles:

• Subtalar eversion and inversion
• Resisted half-kneeling ankle mobility
• Soleus and gastrocnemius release
• Gluteus medius release
• Plantar fascia mobilization

Once you've mobilized, the next step is to strengthen the targeted muscles:

• Single leg RDL
• Banded squats
• Ankle step downs
• Squat off of box
• Banded eversion
• Banded inversion
• Barbell hip thrusters

Where there is pain, there is weakness and dysfunction. You don't have to "accept" being in pain. Strengthening the hip and ankle muscles are vital in perfecting your mechanics and preventing unnecessary stresses on the soft tissues of the knee. Pay attention to those stabilizers and you will save your knees for many years of heavy lifting to come.

Works Cited:

1. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 06 Jan. 2015. Web. 29 June 2015.
2. Myers, Thomas W. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Churchill Livingstone, 2001. Print.
3. Weinstock, David. "Neurokinetic Therapy®." Neurokinetic Therapy. N.p., 22 Apr. 2012. Web. 29 June 2015.

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A Broken, Shattered Heart

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İngilizce ' de pain kelimesiyle hangi anlamlar türetilebilir ?

İngilizce ‘ de pain ( peyn ) kelimesi dert , sızı ,ağrı ,acı gibi anlamlara gelir . Pain , fiil olduğunda ağrı veya acı vermek ; üzüntüye sokmak anlamlarına gelir .  

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A Colonoscopy Can Be Difficult and Painful

It has taken me a while to write about having a traumatic experience with a colonoscopy.

I shared on my Facebook and Instagram that I was turning 50 and would be experiencing my first colonoscopy.

I took my husband a few years ago and all went very well. I understood the prep for the process as the worst part and the rest would be a breeze.

Sadly, this was not my experience.

Let me share that I have a very high pain threshold. I had both of my children without drugs or epidurals, and it takes a great deal of discomfort for me to complain.

Colonoscopy Prep 

The prep for the colonoscopy was horrible, and I nearly vomited up the Moviprep solution each time I had to drink it. I expected that so I was prepared that this was not going to be fun. Within an hour of drinking the solution, my frequent bathroom visits began.

It felt like self-induced stomach flu of the worst kind. I retreated under several blankets after each run to the commode. I had to drink more solution at 3:30am and continue the toilet runs up to the time of leaving for the hospital at 7:30am. Needless to say by the time I was done, my poo looked like pee, and I lost 5lbs literally overnight. This is not the recommended or safe way to lose weight, but understand it needs to happen prior to this type of procedure.

I went into the colonoscopy thinking after the toilet trauma was complete, the rest would be smooth sailing. I was ready for my short nap and waking to an all-clear report.  

The Procedure

The doctor was great and explained everything thoroughly and the nurses took really good care of me. I was covered with warm blankets, IV in place ready to move to the procedure room. Once the IV anesthesia was administered, I fell asleep quickly but what happened next was like an excerpt from a horror movie. 

Extreme pain in my stomach began and I felt myself screaming like in a dream - it hurts, it hurts, it hurts, and to stop, stop, stop. The anesthesia kept me trapped in my mind and body as I  endured unbelievable pain. It was like having a nightmare and not being able to move.

In the distance, I did hear a loud voice say “do you want us to stop” and I do remember saying “wait a minute, wait a minute, wait a minute.”  I was thinking if they stop, I would have to do this again. There was no way that was going to happen. I don't know what I sounded like or how I moved during this process of extreme pain under IV sedation but was hoping someone would help me.

It could be more pain relief was placed in my IV, but I don't know that. What I do know is that the pain was unbearable. My colonoscopy was far from a breeze and I felt traumatized by the event.

The doctor did explain in my haze state upon check out that my colon is very compact with many bends. This was diagnosed as a tortuous colon. It caused a rigid application of the scope and caused pain similar to childbirth during the procedure. His recommendation was that I go under general anesthesia for my next colonoscopy. 

Recovery

It took my body a couple of days to recover from the anesthesia. I didn't feel good physically or emotionally about what happened to me. I had to know if other people experienced extreme pain during a colonoscopy so began online research to discover I was not alone. 

What a relief that I could read forums of so many individuals sharing my same story. I think what bothers me the most is not being properly informed. I went into my colonoscopy with a positive attitude and came out with post-traumatic stress about the event.

I believe that the medical paperwork prior to the procedure should outline extreme pain with colonoscopy can be experienced. And, in this case, measures will be taken to make the patient comfortable during the procedure.

Preventative Medicine is Important  

I'm not writing this to say I am now against having a colonoscopy because I do believe in preventative medicine. I am happy to report that my colon is clear for ten years. I will be investigating different colon screening methods the next time.

I am writing this blog to inform people that extreme pain can be experienced, and it's not always a breeze for everyone. I'm in the small percentage of those who don't respond well to traditional colonoscopy methods. 

I was shocked but also relieved to discover my diagnosis of a tortuous colon. However, it was unfortunate to undergo such discomfort to find out.

I felt an obligation to inform you about my personal experience as a voice of information about health-related subjects.

Being your own healthcare advocate is important. I am hopeful the documents pre-colonoscopy will be revised to include a thorough statement of colonoscopy procedure expectations.

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My Desperation for a New Beginning

Back in the early summer my life-- perhaps that is the wrong word to use... my mental and physical health took a detrimental turn for the worse. I was in such a deep depression that took nearly a month to even slightly improve. Slowly but surely, I progress significantly for about a month. August was a content month for me. Unfortunately it was short lived, and at the beginning of September, my depression and anxiety were back and increasing daily.

Last Sunday was probably the worst "episode" I have experienced throughout this whole ordeal. I was in agony the entire day; so damn trapped inside of myself. It felt like my soul was desperately clawing trying to escape my body. I could not stand myself. It was an inner war. I tried to journal and write my feelings to calm myself down. I went to a movie. I took a bubble bath.

Those attempts helped slightly, but the second my head hit the pillow  to go to sleep, my anxiety completely took over and I stayed up the entire night. I tossed and turned, transitioned from the bed to the couch countless times, took 10 mg of melatonin (usually 2 1/2 mg's knocks me out), and nothing worked. By 4:30 in the morning I was sick of it so I took and shower and got ready for work, and was in my office at 5:30 AM. I stayed awake for a day and a half. My sleep has been horrid lately. I have trouble every single night, I toss and turn nonstop, and my leg pain due to RLS has surfaced a lot more than normal.

Aside from last weeks episodes, there have been a plethora of other problems; mainly the same ones I experienced back in June and early July. My skin is awful around my chin and jawline, my moods are so up and down and constantly changing, motivation comes in short bursts and never lasts, concentration is unheard of, and at any given moment, I can lose control of my emotions and cry. Most days I dread getting out of bed and it is all I can do to make it through the day. 

I try to hide these issues to the best of my ability and most days, I do a wonderful job. I do this because no one wants to read a blog from a woman who is miserable. No one wants to be friends with a woman who depressed. Most days I cannot stand me; how could anyone else?

Everyday I feel myself breaking inside; as if a piece of me dies at every moment. I am sick of it. I am so tired of being tortured by my pain. I do not live my life this way; I never have. I am such a positive person who works hard and believes in the beauty of life. I am a person who believes that our destiny is up to us, and what we are willing to do for what we want.

I have worked so hard to make myself live by these philosophies. Ever since I started writing deeply from my heart on this blog nearly a year ago and started my novel, I have wanted nothing more than to grow and live my dreams of writing full time, while simultaneously help other men and women live their happiest and healthiest life. I just want my words to help. However, none of that is even slightly plausible if I keep living my life the way I am now. I am so miserable inside most days now, that writing motivational posts would be a complete lie. That scares me immensely because I do not want to miss out on my dreams-- I do not want to miss opportunities. I am terrified that I am going to lose everything I have been trying so hard to accomplish for myself because of how sad I have been.

My weight loss has been stagnant for a little over 2 months because of all of this and that admittedly makes this entire thing worse. Most of my pain is from my breakup 11 months ago with my doormat weight loss journey closely trailing.

It is embarrassing for me to admit that I am hurting so extremely over a breakup that happened nearly a year ago. However, what I went through with him for 2 1/2 years is indescribable. I felt everything with him. I went through so many intense and personal things with this person. I finally knew what people meant by feeling like one with someone you love. I had never given my heart to someone until I was 21 years old and went on my first date with him. I still remember that night like it happened yesterday; the weather. the outfits. the atmosphere. the smells. 

The worst part is that I did not leave because I wanted too. I left because I had too. That may not make any sense, but it was a situation where the relationship had gotten so bad, but neither one of us could let go. Just because our relationship had gotten so bad, the love was still there and we were both so desperately clinging to it. I worked until I bled to try and make it last; always compromising, being supportive, adoring him, putting forth every effort I could, and I did it alone. It was never good enough either.

After the breakup, I spent months having my heart thrown around like trash; which is partly my fault because I allowed it. He quickly moved on to a new relationship, but after that ended, the empty promises and constant hope and let down cycle continued. There is no other way to describe being put through that by someone you love, cherish, and adore, other than burning in the flames of hell. I have never crashed and burned so much in my life. Overtime even that slowed down. Not completely, but significantly-- enough to where I was wise enough to realize the comments were not real, but a condiluted statement from consuming a mind altering substance. That did not make any hurt any less though.

Now I understand he does not love me anymore. He does not want me. All of our memories, all of our plans, and everything we built together-- two and a half years are gone. It is desperately time for me to realize this and move on. It is just unbelievably hard for me to accept because I decided that once I gave my heart to someone, I would do anything possible to make it work; and I did. I tried so damn hard. After all of the horrendous examples of love and marriage I have witnessed throughout my life, I was going to take my relationship just as serious as my health and my career. But it takes two. I could not do it alone.

In true Liz Taylor, Fitness Blondie fashion, I am not going to write about my pain and invite everyone to my pity party without a plan of action.

There is one thing I have needed to do for a long time, but it breaks my heart to do it.

I am leaving my gym.

One is maybe scratching their head after that statement not understanding why that is a big deal, but with fitness being the biggest passion of my life, my gym means so much to me. For 4 years, I have been to that place 5-6 days a week. I love my gym. It is home to me. Home is where the heart is, and that gym is my home.

Since I moved to Charlotte 4 1/2 years ago, it is the one place that has been my rock. I remember when that gym was nothing but a concrete foundation. I watched it turn from nothing to a 3-story fitness facility, as I lived right beside of it. I joined there before it opened and I was there training the day it did. I worked there for 6 months. I made tons and tons of friends. I met my ex there. Even the worst of days improved to me when I stepped into that place. I lost myself there. I discovered myself there. I lost 65 pounds there. That gym means so damn much to me, and yesterday I had to let go. Though it is right beside of my apartment - across the parking lot and I am in a contract, I cancelled my membership.

The reason is because since my breakup nearly a year ago, I have had to see my ex almost every single day. I have had to see a person who I used to sleep beside of every night pretend like I do not exist... and like he could not care less. I tried to stay strong; but I can't. It has eaten away at my soul and my joy more than I ever thought possible. I have cried during my workouts more times than I care to admit, Saturday at the gym I lost it so bad that it carried on the rest of the day and throughout my evening out, I knew I was reaching a breaking point and I had to make this change. I know he would never leave the gym because he loves it so much, nor would I want him too.

The positive side to leaving my gym is I am going to be adding a lot more variety to my training ;which I think will really kick start my weight loss again. I only have 30 more pounds to go. I bought a two week pass to a boxing facility; once that expires, I have a two week pass for hot yoga, I am trying a Pure Barre class, I am going to continue hiking, jog more on the beautiful greenway behind my home, and do my "Hot Mess Express" workout more - that plyometric, full body workout, works me harder than anything. Luckily, the gym at my apartment is very nice and I will do my weight circuits there until I decide on a new gym to lift.

I hope-- I desperately hope implementing those changes will help me get over the bulk of my anxiety and depression. There are still quite a few other issues going on in my life, but I feel if I can get over this pain and heartache, my mind and emotional state will improve significantly which will give me the strength to get through the other problems.

I desperately want a new beginning. I want to feel free again. I want to feel like myself. My heart has been in chains for so long. I need strength to keep pursuing my dreams, I need hope, I need joy. I need faith. I am so low in all of those essential feelings. Back in the summer when I wrote the post "Lost Within Myself", so many of you sent the most heartfelt and inspirational stories about moving on from heartache. They helped me a lot, and I pray that one day I will the same story to tell the world. I want to pull through this and be a better and stronger woman that I ever felt possible. Right now it feels like I am going to sulk in this sorrow for the rest of my days. I feel like such a broken person. It is time for me to once a for all move on and close this chapter.

"If don't catch my breath, I may never breathe again, so just know this:
I've never been so torn up in all of my life, I can't believe I let myself break down.
I've never been so torn up in all of my life,I should have seen this coming.I've never felt so hopeless,Than I do tonight.I don't wanna do this anymore...
I've never been so torn up in all of my life,I should have seen this coming.I've never felt so hopeless,Than I do tonight.No I don't wanna do this anymore, I'm moving on."

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Lost Within Myself

How do I write this; how do I even begin?
I have never felt this way in my entire life. I have not been feeling good lately. It is just that simple. I have not been feeling good mentally, emotionally, and physically. I think this is when it started and the pain has grown from there. This is new to me and it is completely out of my character. I'm in a bad, bad place. I felt it coming it for a while and tried to fight it to the best of my ability, but for the past week and half, I have let it engulf me. I am normally very good at hiding it.
I am not a complainer. Every once in a while I write from my heart on here to explain pain or problems going on in my life, or sometimes simply to give thanks and talk about happiness. Writing is my outlet and therapy, and my friends who read this blog really help me get through tough times. I am slightly embarrassed to even write this post, but I am at the point where I can use any prayers or help you may have because I don't know what to do anymore.
I think I finally burned myself out completely. The type of burned out that not just a day of laziness can resolve. This burn out comes within my soul. Am I depressed? I don't know... it feels so weird to even affiliate that word with myself because I try so hard to always solve problems, make things happen, make the best out of life, and be thankful for what I have. But I am not perfect.
I do know that I am exhausted. I'm tired. I'm tired of working so damn much. All of this hard work is not paying off yet. It could (keyword is could) pay off one day, but maybe not. Because of that uncertainty I am constantly self-doubting my ability to achieve success. I am constantly telling myself that I am not going to achieve my dreams. Because some people work their entire life and success never comes. 
I have a multitude of other issues going on that no one wants to hear about and a very, very broken heart. All of these problems combined have been killing me. I can't focus on the positive anymore. I can't really focus on anything. I can't stay optimistic... because for a long time, I did because I believed things would get better, and they really haven't. Actually, nothing has changed. I am just unable to hide anymore. I constantly pray for strength, guidance, and help to get through these hard times, and most of the time I feel abandoned and empty. 
What is most surreal to me the physical symptoms this stress and pain is causing me to have. I am having the worst night sweats, even though I am freezing most of the night. It is literally like the second a negative thought enters my mind, my body starts to go crazy and I sweat like I'm working out at the gym. My hands stay ice cold. My joints are hurting, especially my knees. My RLS has surfaced with a vengeance after months of being controlled. My body aches every single morning when I wake up. Panic attacks come out of nowhere. I stay exhausted. I am always on the verge of tears. I rarely have the strength to text or call anyone back because I have nothing to say. I have nothing to offer. I can't concentrate on anything. This is HELL. I am so damn lonely, even around my friends and family. My heart is so empty and I do not know what to do right now to fix this.  I feel dead inside. This is not me. This is not how I live my life. This is not my personality. 
What I feel right now goes against everything I stand for in life. It goes against helping other men and women learn to love themselves and live the best life possible. It goes again my #BeFearless project. It goes against my book. It goes against everything I am working so hard to build for myself.

Writing this is so hard, but I am the point where I need someone to tell me they have had a heart so broken that it tore their world apart. I need to know that someone out there has been exhausted, and hurt like I am. 

I have had this blog post written and saved for about a week now, but have not wanted to publish it. But somehow, someway, I have got to pull through this, and I am going to remember this moment. I don't know how because I so damn miserable inside and the only time I have peace is when my mind and body are so exhausted that I go numb. Here is where I am right now.

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Why You Need to Have a Big Butt

Having a big butt is certainly preferable for models twerking in rap videos, but it's also extremely important in athletic performance. Weather you're a soccer player, a running back or just simply working out to maintain a healthy lifestyle, you need to make sure you're giving your butt the attention it deserves.

I know what you're thinking: "But Arianna! I can squat 250 pounds. My glutes are really strong!" In a perfect world, you would achieve glute activation in the back squat, but many of the back squats I see people execute in the gym make use of the anterior quadriceps muscle and recruit minimal activation from their posterior chain. The truth is, if you are a predominantly sedentary person (meaning you sit for 4+ hours a day at home or at work), you probably don't know how to correctly activate your glutes because you're not using them for the majority of the day. Fear not--you are part of the American majority who sits at a desk job all day. It's no wonder that we don't know how to activate the right muscle groups considering we don't use them as often as we should.

Underactive or weak glutes can cause a ton of problems, including lower back pain, knee pain, IT band syndrome, and a whole slew of other maladies. Your quadriceps may be strong enough to squat 250 lbs, but guess what? If you learned how to activate your glutes properly, you would easily squat over 300 lbs.

The gluteus maximus (one of three muscles that make up what we collectively call the "glutes") is the biggest muscle in your body. Now, if we learn how to properly employ the strength of this tremendous group of muscles, we are going to see some real magic happen. Whether we're doing a deadlift, a squat, a box jump or a clean and jerk, we need to learn to properly harness the power from our glutes in order to move the most amount of weight and avoid injury.

In order to utilize the strength of the ever-powerful gluteal muscles, we must focus on activating them. Some great exercises can be found in my previous article about warm-ups, but I'll list a few more that I really like here:

• Single leg or weighted glute bridges
• Banded walks
• Reverse hyper extensions
• Single leg Romanian deadlifts
• GHD raise
• Bulgarian split squats
• Reverse lunges
• Side plank with abduction

Once you learn to properly engage your posterior chain, you will see tremendous gains in strength while simultaneously protecting your body from injury. If you have humongous quadriceps and a small butt, that should be a red flag to you that your glutes needs some more attention. Channel your inner Nicki Minaj and start building a bigger booty!

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Range of Motion and Mobility

In athletes and deconditioned clients alike, range of motion restrictions are an ever-prevalent issue. Either the individual is not using a full range of motion in a given exercise because he/she wast taught to perform the movement as such, or he/she has severe mobility restrictions.

If you have the ability to train through a full range of motion and neglect to do so, you are doing yourself a disservice. Movements like the pull-up, squat or push-up are the most frequent examples I see in the gym. Men and women alike bust out a quick and sloppy set of push-ups without their chest touching the ground or their elbows fully extending. By using the full range of motion for these exercises, you are not only stimulating more muscle fibers (and therefore getting stronger), but you are also ingraining proper movement patterns into your brain that will be applied across the board.

Training through a full range of motion is extremely important in both injury prevention and treatment and developing strength to your maximum potential. As the famous Kelly Starett, doctor of Physical Therapy and owner of CrossFit San Francisco, warns us:

"If you have ankle pain, chances are good that your calves are tight and are pulling on your ankle, limiting your range of motion. If you have knee pain, chances are good that your quads, hips, hamstrings and calves (all of the musculature that connects to your knee) are brutally tight. It's no mystery why you have pain: You can't get into the correct positions or move with good form because you're missing key ranges of motion. Mitigating overtensioned systems using mobilization techniques feeds 'slack' to the 'injured' site, reducing localized joint pain by improving the efficiency of the system"

In a nutshell, if you're experiencing pain in any given joint, it's probably because you have some tight muscles and are therefore missing full range of motion in that area.

A good percentage of the people I've met have difficulty getting into a full squat because they lack the proper hip and ankle mobility. Before you can even think about putting a barbell on your back, you have to address your poor squat mechanics.

Fortunately for you all, there are many ways of correcting movement dysfunctions and restrictions in mobility. Tools like a foam roller, lacrosse ball, or bands are all useful tools in getting rid of tightness and other movement restrictions.

For more information on specific exercises to mobilize any given area, check out www.mobilityWOD.com.


Sources:

1. Starrett, Kelly. "Home." MobilityWOD. N.p., n.d. Web. 10 Sept. 2013.
2. Starrett, Kelly, and Glen Cordoza. Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance. Las Vegas: Victory Belt Pub., 2013. Print.

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