Day 1: Pillars for Preggos an Addendum to What You Should Expect While Expecting

Approximately one year ago my father and I attended the 2009 functional training symposium for the NSCA. What followed was nothing short of inspiration for the work done at GCMC. It is no secret that the tide of health care is shifting towards prevention. Gone are the days of sick care, the kind of circular passive care that keeps on going, and going, and going, until your benefits are exhausted for the calendar year. GCMC is about supporting active lifestyles. It's the kind of health care facility that wont tell you to stop living. Juan Carols Santana, the representative for the NSCA at the symposium, provided us all with the vernacular to translate our heavy medical jargon into real words and concepts that everyone could understand. Thus was the birth of "pillar training" at GCMC and specialty classes like Pillars for Preggos.

It is all well and good that we should know proper lifting techniques; however, recent studies indicate that teaching proper lifting techniques does not simply translate into a world free of back pain. While the study did not answer why teaching proper lifting techniques did not prevent low back pain I have a theory of why and how that answer can lead to a better method of preventing low back pain in pregnant women and women with small children.

The answer is one of efficacy versus effectiveness. What I mean is that in theory and in ideal conditions, proper lifting techniques should help to prevent low back pain. However, we live in a less than ideal world and in less than ideal conditions. So while there may be some efficacy in lifting techniques, the advice has little to no effectiveness in the real world. And this is not a new concept; athletes do not train solely in ideal conditions. The distance runner does not adhere to only short sprints, on sunny days, with zero humidity, at zero elevation, and then go run a full marathon in Denver, Colorado in November.

This principle means a few things to the expecting mother. You can expect changes in the core musculature supporting your low back. Patterns of weak and tight muscles that will predispose you to certain aches and pains. You can also expect balance changes to come as your pregnancy progresses. Core strengthening exercises like the pelvic tilt, dead-bug, quadraped, and plank can help to recondition your core, while balance training can help prevent falls. However, you can also expect that your baby, once delivered, will put you in all kinds of precarious lifting situations, ones that making proper lifting techniques impossible.

As Juan Carlos Santana said at the Functional Training Symposium, "try to explain to a mother how to use proper squatting and reaching techniques while bending over across the back seat of a car to place a small child into a car seat or to take one out of it." It just is not possible. This is why Pillars for Preggos has the potential to be a success and help many new mothers. Life is movement, and bodies that move well, live well. It is important that you train for life. Being a mother is a full time job, 25 years later my own mother reminds me of this fact every day. So why not train your core in the positions it will be exposed to? We are all athletes of sorts. Some by vocation, some by recreation and some of us are industrial athletes. Consider yourself a domestic athlete, possibly one with the most physical demands.

Pillar Training for Preggos will be held every Saturday at 1:00pm. We had our first class today and it was a success. The group was small but there was a lot of learning and training, even for me. Of all the things I had accounted for, after all the training in classes and on my own, the one thing I did not anticipate was nausea. Needless to say we now have that under control. Today, some expecting mothers took their first steps to putting their pregnancy on a strong foundation and GCMC took their first steps towards fine tuning their first specialty group program. For more information about pillar training click here and to schedule online for the next Pillars for Preggos class click here.

I Think I can! I Think I can! Mind over low back pain.

Acute low back pain (LBP) is an interesting animal. Affecting 80% of the population and much more popular among the younger crowd, LBP is generally overwhelmingly harmless and in most cases resolves naturally within a couple of weeks. But sometimes this seemingly benign condition takes a turn for the worse. Two weeks turns into two months, two months turns into two years and now your harmless LBP has turned into a disability. LBP is the leading cause of work absenteeism in America for ages 19-45 and the second most common reason for seeing your primary care doctor. Are you curious as to why this happens? What if I told you its all in you mind?

One article in The New England Journal of Medicine compared medication, bed rest, mobilization exercises and simple reassurance and encouragement to continue normal activities in the treatment of LBP and found that simply advising people that it is safe to continue living life normally was more effective than the other options. In fact it has been shown that providing self-care advice and reassuring the patient that there is no need for fear or anxiety provided an nine-fold decrease in risk of LBP becoming chronic.

A fancy term used to describe this phenomenon is fear-avoidance beliefs (FAB). FAB turn acute pain into chronic by mentally disabling you. Vlaeyen stated that a misconception of pain being a threat can cause an individual to completely avoid physical activity and become deconditioned based on fear and anxiety. Deconditioning coupled with a feeling of hopelessness delays the recovery process.

The Agency for Health Care Policy and Research has properly stated that "the main goal for treatment of back pain has shifted from treatment of pain to treatment of activity intolerances related to pain." This means that your health care provider's job is to not simply treat your pain, but to strengthen your ability to live your life normally as quickly as you will let him or her. There is no problem with laying on a table while your health care provider attempts to decrease the pain for you, at least not initially. The problem arises when there is not a speedy transition from passive treatment to active treatment (ie full range of motion exercises).

No, chronic LBP is not purely mental. You can not just think happy thoughts and make it disappear. However, you can control how quickly you will recover. Happy thoughts can help get you pain free again. So be optimistic, the sky is not falling. Live your life, only bed rest could
truly hurt you.

Fear-Avoidance Beliefs Questionnaire

Arthritis Foundation's 2009 Women's Health Summit

I wanted to take a moment write about a first time experience I had on multiple levels. My father, Matt and myself were recently asked to give a presentation on the importance of exercise with arthritis for the Arthritis Foundation's 2009 Women's Health Summit. There were multiple speakers in different rooms with various background ranging from the Chief of Geriatrics at a nationally ranked hospital to the nutritional advice presented by an RD.

As I mentioned, this was my first of many: this was my first public presentation for GCMC, this was my first time speaking in front of an elderly population, this was my first time working with the Arthritis foundation, this was my first time presenting along side MD's and DO's, and this was my first time bring our message of "Life is Movement" to a larger, non-athletic audience. And for all of those reasons I was slightly nervous. We have conveyed our ideas to many types of athletes with great reception; however, I have never tried to communicate our message to those indifferent to exercise.

I thought that my biggest problem would be my message being lost in translation to an indifferent crowd, but the real challenge wound up being much more primitive. When given the choice of which presentation to attend, the vast majority was more interested in attending a lecture on which medication they could use to manage the pain then to listen to about how maintaining a quality of life is two-sided contract. As health professionals at a movement center, our end of the contract is to get them moving again and their end is to actually take responsibility for their health and not to accept a defeatist mentality. What I found was that people are much more inclined to wave the white flag then to fight for their quality of life.

It is sort of ironic in a way, I did include in my presentation how nearly a third of those with arthritis live completely sedentary lives. I knew that the problem was a misconception that movement was the problem and that exercise would only hurt them, when in fact even Harvard has recently published that one to two hours of moderate exercise can prevent pain from osteoarthritis all together.

So I guess that my point is we have more of an up hill battle than I expected. The good news is that those that chose to listen to our presentation were very receptive to our concepts. They very much understood what I said and felt that we understood their battles. Now what is left is for us to really push the concept of exercising to reduce or eliminate pain. We have lived in a sick care nation for a very long time. We have conditioned the aging population to accept defeat: loss of hearing, loss of memory, loss of vision, loss of balance, loss of strength, loss of driving, ect. It is time to take the focus away from pain and towards performance.

At GCMC we acknowledge that everyone has a goal and desired level of performance. That can mean you want to run an ultra-marathon or that could mean you want to walk pain-free around the mall. The point is we are all training for something and that, at the very least, we are training for life.