Thoughts

THE ABDOMINAL WALL: STRUCTURE & FUNCTION OF WOUND HEALING

THE ABDOMINAL WALL: STRUCTURE & FUNCTION OF WOUND HEALING

Incision and closure of the abdominal wall is one of the most frequently performed; yet least discussed, of surgical procedures. Another often over looked topic is; understanding the rehabilitation process and post surgical care. Placing the power in the clients hands and arming them with the knowledge to self manage the healing process can significantly reduce movement dysfunction caused by scar tissue or change in posture habits and inactivity; as well as, a basic understanding of the timeline for wound healing and wound health.

The structural integrity of the anterior abdominal wall depends upon the rectus abdominis muscles, the muscles of the flank, and the conjoined tendons of the flank muscles that combine to form the rectus sheath. These terms, the anatomy and function were introduced in length in my last article. The rectus abdominis muscle is found on either side of the midline with the pyramidalis muscle lying superficial to the rectus muscle just above the pubis.

Factoring in connective tissue; we mentioned the rectus sheath also forms and intertwines with the superfiscial front line and the deep front lines of the fascia matrix. However, two notable structures are often overlooked when discussing abdominal wall surgery and post surgical care. They are the pyramidalis and the transversalis fasica.

 

abdominal wall 1

The Pyramidalis:

One important muscular structure that is often not discussed in re training/ re patterning post-surgical rehabilitation is the pyramidalis.

The pyramidalis muscles arise from the pubic bones and insert into the linea alba in an area several centimeters above the symphysis pubis. Normally, the precise function of the pyramidalis muscle is unclear and considered to be of no value in the human structure. That is until abdominal incisions are made along the linea alba and near the umbilicus. The function this muscle acts to contact the linea alba, as well as stabilize the pelvis.

Therefore, if scar tissue or adhesion builds up, as it naturally will due to cutting through the abdominal wall and connective tissue, the innervation and nerve response could be diminished. In many patients, I have worked with I have seen Si joint dysfunction and low back pain that was not present prior to surgery. Something to consider in rehabilitation.

Transversalis Fascia 

Deep to the muscular layers, and superficial to the peritoneum, lies a layer of fibrous tissue called the transversalis fascia, which lines the abdominal cavity. It is visible during abdominal incisions as the layer just underneath the rectus abdominis muscles.

It’s importance lies in the nature of it’s structure. The transversalis fascia in its entirety is second in importance perhaps only to the peritoneum as an encasing membrane of the abdominal contents. It acts to reinforce and stabilize the spine, as well as regulate intra abdominal pressure. Where function demands, it thickens and develops its strong elastic fibers to a protective perfection. When there are multiple incisions necessary for surgery, like a laparoscopic appendectomy this wall is perforated and comprised for several weeks to months. Tissue strength is a integral concern and factor in corrective rehabilitation; as well as wound healing.

WOUND HEALING:

Understanding the fundamental processes that are responsible for these functions is necessary to best create and close an abdominal incision and limit the risk of inflection, as well as to understand the complex process of healing post surgery.

Inflection is the first major risk; or failure of the healing process to synthesize adequate quantities of collagen to restore abdominal wall strength.

Psychoneuroimmunology (PNI):  (Pyschological + Neurological + Immunology)

The wound-healing process is a balance between the amount of damage done to the tissue during an operation, and the ability of the body to decontaminate and repair its function.

With any incision, there is exposure of blood and platelets to connective tissue; which ultimately begins the inflammatory response that will sterilize and heal the wound. Psychoneuroimmunology (PNI) plays a critical role in both healing and immune function at the biological and biochemical levels. PNI is the study of the interaction between psychological processes,  the nervous and immune systems of the human body.  Recent work in psychoneuroimmunology (PNI) has demonstrated that stress delays wound healing; which is directly related to the pre and post surgical anxiety and nervousness a patient will ultimately feel.

Greater fear or distress prior to surgery is associated with a slower and more complicated postoperative recovery because anxiety presumably interferes with recuperation through both behavioral and physiological mechanisms. Seems logical enough.

Listening to mindful music for an hour every day can reduce chronic pain by up to 21% and depression by up to 25%, but I will leave that stat for another article.

Our body’s nature inflammatory response

During the initial phases of this process, the small vessels in the region of the injury become permeable to both molecular and cellular mediators of the inflammatory response. First, healing is under the direction of the inflammatory response, as this is essential to eliminating bacteria; as well as immunology. Every person has a unique biological and biochemical healing process; which should be taken into account.

After this initial phase, the polymorphonuclear neutrophils (PMNNs) and wandering tissue macrophages begin their work of digesting damaged tissue, killing bacteria, and synthesizing the chemotactic factors that direct wound repair. These cells lay the groundwork for the later appearance of the fibroblast that will reestablish wound strength.

The next critical factor in proper healing is the amount of necrotic tissue created. Actual repair must begin from healthy tissue. Healing must then begin from the uninjured tissue behind the area of damage.

Collagen & Tissue Strength

The re-establishment of abdominal wall strength depends upon the synthesis of new connective tissue. This is accomplished by fibroblasts and requires, not only the protein precursors for collagen synthesis, but also occurs most rapidly in a normally oxygenated environment where the enzymes and cofactors needed for collagen synthesis are present.

Collagen, the primary structural protein of the body, is synthesized by the fibroblast. It begins to appear in the wound on the second day, as an amorphous gel devoid of strength. Maximum collagen synthesis occurs around the fifth day. It depends especially upon the presence of oxygen, vitamin C, and amino acid precursors.

Maximum strength development does not occur for several months and depends upon the interconnection of the collagen subunits. Approximately 80% of original strength is reached in about 6 weeks; therefore it is recommended that light activity building up to moderate activity are only encouraged after 6 weeks and as long as there is no pain or discomfort.

It is important to recognize that perfusion of the wound is the most important factor in wound healing. Integrity of the microvasculature and flow is responsible for the oxygenation needed for cellular metabolism. Damage to tissue that impairs the delivery of oxygen to the wound increases the number of wound infections and the likelihood of herniation or infection. Which could complicate and impair movement quality in the future.

CONCLUSION:

Empower the patient is first and foremost. Education each client on the complex healing process and concerns moving forward with post surgical care is crucial to not only the healing process but self management on behalf of the client. Understanding tissue strength and the body’s healing process from the inside out is of equal importance when re entering sport, play and or professionals that require manual labor.

Sources:

  • Milloy FJ, Anson BJ, McAfee DK: The rectus abdominus muscle and the epigastric arteries. Surg Gynecol Obstet 110: 293, 1960
  • Cruse PJE, Ford R: The epidemiology of wound infection: A 10-year prospective study of 62,939 wounds. Surg Clin North Am 60: 27, 1980
  • Cherney LS: A modified transverse incision for low abdominal operations. Surg Gynecol Obstet 72: 92, 1941
  • Surgical anatomy of the transversus abdominis and transversalis fascia. Ann Surg. Jan 1971; 173(1): 1–5.

 

 

Sleep, Chronic Pain and Our Biological Clock

Sleep, Chronic Pain and Our Biological Clock

 

SleepDeprivation_0Pain and sleep are integrally connected. A person’s quality of life and health can be disrupted due to many different reasons; like diet, activity level, and stress. However, one important, yet underestimated cause of a person’s reduction in quality of life, can be contributed to sleep loss or not enough restorative recovery.

Over the course of the last several decades, the modern worlds working hours have been consistently increased, along with an emphasis on active leisure, and “more” is typically seen as being better.

Depending on your profession, in some designations, people face sleep restriction. Professions; such as health care, emergency response and security and transportation require working varied shifts and often rounds of night work. In these fields, the effect of acute total sleep deprivation (SD) on performance is crucial and possibly life threatening. Furthermore, on average, in almost every profession, people tend to stretch their capacity and compromise their nightly sleep, thus becoming chronically sleep deprived. On a neurological level, this changes a persons biochemical, biological and psychological health. Thus, increasing risk for mental illness, chronic pain and disease.

What The Stats Tell Us:

In the adult population, about 15% of those surveyed report experiencing chronic pain. Nearly 50% of older adults have insomnia, have difficulty in getting to sleep, early awakening, and/or feeling unrefreshed upon waking. As we age, several changes occur that can place one at risk for insomnia, and less than restorative sleep; including age-related changes in various circadian rhythms, environmental and lifestyle changes, and decreased nutrients intake, absorption, retention, and utilization.

In all age groups, those who suffer from insomnia and consistently achieve less than restorative sleep show memory weakness, increased reaction time, decreased fine motor skills, short-term memory problems, and lowered efficacy levels.

A lack of sleep and restorative recovery can be more problematic in elderly subjects, because it puts them at higher risk for falling, cognitive impairments, weak physical function, and mortality. Not to mention, not getting enough sleep takes time off our life span. There’s a reason, our body tells us when it needs a time out to re boot, filter and process daily existence.

Minerals Count:

In order to have a restorative sleep, we must have the right percentage of calcium and magnesium present in our system. This directly relates to cell formation and re generation, as well as key processes in our body.

Magnesium: Plays an essential role in ion channels conductivity, such as N-Methyl-D-aspartic acid (NMDA) receptor, and unilateral entrance of potassium channels. Therefore, magnesium as a natural antagonist of NMDA and agonist of GABA is critical in sleep regulation.

Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It is involved in more than 300 biochemical reactions of the body.  Magnesium is an essential cofactor for many enzymatic reactions, especially those that are involved in energy metabolism and neurotransmitter synthesis. It contributes to teeth and bones as well as activating enzymes, contributing to energy production, and helps regulate calcium, copper, zinc, potassium, vitamin D, and other important nutrients.

Calcium: Does not work alone in your body. It requires vitamin D, parathyroid hormone and healthy saturated fat in order to be utilized for strong bones, teeth and muscles. Nerve cells have calcium channels that act like gates in their membranes, regulating calcium flow in and out, triggering each cell to take action.

Bone health not only requires calcium, but an array of other vitamins, minerals and hormones to complete that process.  Another notable amino acid in sleep regulation is Tryptophan; which your brain uses to make serotonin and melatonin. These two substances are neurotransmitters that slow down nerve transmissions, relaxing your brain and body and encouraging deep sleep.

sleep_wake

Sleep & Chronic Pain

Pain triggers poor sleep; we shift around, can’t get comfortable, and thus can’t fall or stay asleep. For instance, someone experiencing lower back pain may experience several intense microarousals (a change in the sleep state to a lighter stage of sleep) per each hour of sleep, which lead to awakenings.

Pain is a serious intrusion to sleep. Charles Bae, MD, a neurologist in the Sleep Disorders Center at the Cleveland Clinic in Ohio, puts it this way: “Pain can be the main reason that someone wakes up multiple times a night, and this results in a decrease in sleep quantity and quality, and on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.”

The body’s has a built-in circadian clock, which is located at the center in the hypothalamus in the brain. This is the main mechanism that controls the timing of sleep, and is independent of the amount of preceding sleep or wakefulness. Therefore, it is no wonder that people who experience chronic pain, adrenal fatigue or other auto immune diseases have trouble sleeping. The Hypothalamus is one of the most important organs related to regulation of body systems and re generation of cell formation.

Circadian Rhythm & Sleep:

When considering the effects of sleep loss, the distinction between total and partial SD is important. The need for sleep varies considerably between individuals; averaging sleep length is between 7 and 8.5 h per day. Sleep is regulated by a two-part process that adjusts to the body’s needs every day. This two-part process is known as the homeostatic debt and the phase of your circadian rhythm.

The homeostatic process depends on sleep and wakefulness; the need for sleep increases as wakefulness continues. This homeostatic debt increases as a function of how long you have been awake and decreases as you sleep.

The second process that greatly influences the onset, of sleep and the duration, and quality of your sleep is the phase of your circadian rhythm. This phase is governed by your biological clock, whose rhythm is endogenous but is reset regularly by daylight, but deeply affected with inadequate amount of sleep. Studies show, that the circadian rhythm dips and rises at different times of the day. In adults, the strongest sleep drive generally occurs between 2:00-4:00 am and in the afternoon between 1:00-3:00 pm

The interaction of these two processes determines the sleep/wake cycle of a person and can be used to describe fluctuations in alertness, performance, energy levels and cognitive functions.

To perform at your best, achieve your dreams and reach your goals, ensure sleep is restorative recovery is part of your daily optimal well being plan.

Mobility vs. Flexibility

Mobility vs. Flexibility

 joints

Mobility training seems to be all the rage these days and has been widely accepted by both ends of the movement, sport and performance spectrum. However, as a growing trend, the word “mobility” is more and more often being used interchangeably with terms, such as; “flexibility,” and “stretching.”

For instance, many clients come to me and say they have been told they are tight, and need to stretch. Some of these clients have been prescribed Yoga classes or been given “stretching” exercises, but isolated stretching or classes that encourage improved flexibility will not address, nor fix a mobility dysfunction problem.

Understanding the “why” we prescribe and the “how” are key to, not only a client’s success, but in their understanding of how to self manage their health. Let’s start by defining the three terms:

Flexibility is the ability of a muscle or group of muscles to lengthen passively through a range of motion. It is specific to that particular “part or parts.” Notice the word passively. During screening, one must assess tissue extensibility and length to determine if the dysfunction is a true muscle tissue issue, or, a joint issue.

Mobility is the ability to move a joint actively through a range of motion. Mobility is all encompassing and takes into account the joint, the joint capsule (ligaments), the muscles crossing the joint and the nervous system (motor control). This requires movement can control. Notice the word actively. This speaks to a clients ability to control movement. Screening mobility should also address mobility dysfunctions and or tissue extensibility dysfunctions.

 

Joints vs. Tissues:

As an industry too often we merely think of “flexibility” or “mobility” as being solely just tissue related, but what about the joints? Mobility dysfunctions are seldom differentiated appropriately because we need to screen them separately. We need to determine patterns vs. parts. This should be a two pronged process to differentiate mobility dysfunctions; further into either joint mobility or tissue extensibility dysfunctions. Joint pain, unlike muscle soreness, is a legitimate, bonified red flag, much like tight and overly toned tissue restrictions is a legitimate yellow flag. I say yellow because even if there is no pain yet, if not addressed, there could be.

Patterns vs. Parts:

In corrective movement, we focus much of our attention to “training patterns,” not parts.” This means that when a client is prescribed an exercise, it needs to address a pattern of movement, not just a part of the body. If there is an action to one part, there will be an equal reaction to surrounding parts AND to the pattern. As part of my overall screening I ensure “mobility (patterns) is optimal first,” which includes screening “tissue length” (parts) if needed, so that I can address and identify risk, but also ensure I am not just treating the symptom of a larger problem.

After screening or assessment, stretching may be one tool needed if there is a true flexibility issue; but even the word “stretching” has a vast spectrum of meaning. Stretching could apply to, passive, active, dynamic, facilitated, contract/relax etc. As a coach, clarity to the client is key.

Stretching is a form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately flexed or stretched in order to improve the muscle’s felt elasticity and achieve comfortable muscle tone. The result is a feeling of increased muscle control, flexibility and range of motion. Stretching is also used therapeutically to alleviate cramps.

Here’s an example of screening both for mobility and tissue extensibility (aka flexibility):

In the active straight leg raise screen, we are looking to identify the active mobility of the flexed hip, but also addressing the available hip extension on the alternate hip. We can also add in addressing lumbar and core/trunk stability.

In this screen, we ask a client to actively flex at the hip and raise the leg up straight (no bend in the knee). If the client cannot reach adequate flexion with a straight leg (which is around 70 degrees for leg flexion in this particular screen) we then move into screening the flexed hip through passive range. If the client still cannot reach optimal range, we could define this as requiring more “flexibility” in the hamstring group.

Does the screening process stop here? No…

If a client has movement dysfunction, the tissue length of the hamstring is merely one piece of the overall puzzle. When I screen, I also take into account the mobility of the joints at the hip, knee and ankle. Therefore, breaking this down to include screening the muscles in hip extension; as well as internal and external rotation at the hip, along with screening dorsi flexion at the ankle, would be next on my list to determine the full pattern. And down the rabbit hole we go. If I find other limitations I may take the client to seated and standing and further screen their toe touch to ensure this is a bonified “hip mobility” dysfunction. For the sake of this article, I merely wish to point out the difference between “flexibility” and “mobility” related to both screening and program exercise selection.

Prescribing Flexibility:

Soft Tissue release, we addressed in our 2 part series on myo fascia release. . Muscle soreness, tightness or tone usually changes when an appropriate warm-up, myo fascia release techniques are administered and or flexibility efforts are performed. This is where styles of stretching can be beneficial. Movement is the best remedy for maintaining both adequate flexibility of tissue, and adequate mobility of the surrounding joints.

Static stretching and proprioceptive neuromuscular facilitation (PNF) stretching are the two most common ways to stretch short, tight muscles. Static stretching usually involves using stretches that hold the target muscle in a lengthened position. Through autogenic inhibition, this method allows for increases in passive range of motion. Once we have achieved this, we can then move onto active range, and joint disassociation drills.

Prescribing Mobility:

Mobility should always be addressed proactively, rather than on a reactionary basis. Do not wait until there is problem, dysfunction will manifest if compensation is present. If you see compensatory movement – address it right away. Mobility comes before stability and stability comes before strength.

Tight tissues are red flags for risk. Mobility drills address the elements that limit movement and performance; they take into account short and tight tissue, soft tissue restrictions, joint capsule limitations, joint range and motor control faults – the pattern, not just the part. Mobility includes, flexibility if needed, but for instance, if a client has a tight chest, tight shoulders, and a tight upper neck, I would look to screen their thoracic spine. Most often mobility exercises; like the rib pull or trunk rotations can clear up limitations in the shoulder, neck and upper girdle. Merely stretching the pecs or lats will not clear up dysfunction.

Mobility should be performed by globally addressing movement above and below the limitation to help weed out performance and movement problems.

Just keep in mind that when you add mobility to a joint, you also increase risk. Stability needs to be earned and applied before you apply strength. Movement and control are the key when mobility is added to a client’s program.

321 Method: A List Training for Body, Mind and Spirit Comes to Vancouver May 4th, 2014

321 Method: A List Training for Body, Mind and Spirit Comes to Vancouver May 4th, 2014

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Most people know Ramona Braganza as a global fitness expert and celebrity trainer. Her client roster and list of Hollywood clients have included (and are not limited to) Jessica Alba, Halle Berry, Kate Beckinsale, Anne Hathaway, Amanda Seyfried, Scarlett Johansson, Eva Mendez, Dania Ramirez, Zac Efron, Ryan Reynolds, Tom Welling, Michael Weatherly, along with the entire cast of the movie “The A Team” – Jessica Biel, Bradley Cooper, Liam Neeson and Sharlto Copley.

And that’s a big part of who she is and what she’s does, but that’s only a small portion of her story and her success.

I met Ramona in 2005; while working at Stude55, a boutique style health club located in the beautiful downtown city of Vancouver. Upon our first meeting, tit was obvious to me that this woman was a leader, and more importantly, a woman who defied all odds; born in Germany and growing up in Ontario, the Canadian native left home, around the same time most young adults contemplate which University to go to, to make a name for herself in the big city of LA. A city that is no short of trainers, health club owners – all trying to climb the corporate ladder in industry success. That did not deter her from her dream; and that drive and determination has been the direct result of who she is and what she loves to do.

Ramona has spent a lifetime in fitness; not just coaching and training clients, but she speaks from a place of experience. Her accomplishments are many, such as; a competitive gymnast, NFL cheerleader, fitness contestant, model and wellness coach. Her true passion is guiding all walks of people toward a better life – body, mind and spirit.

The 321 Philosophy

The same training philosophy and methods she uses with her Hollywood clients can be found here. Originally designed for movie shoots on location where time and equipment were limited, 321 Training Method contains the proven combination of core, cardio and circuit exercises to get you in the best shape of your life.

The 321 Philosophy focuses on the integration of body, mind and spirit, where people can tackle anything life throws at them because they’ll have wellness for the mind, fitness for the body, and peace for the spirit. It’s design is focused on the ability to get you ready mentally, get set physically and go forward emotionally to reach your goals.

There are hundreds of videos and products out there; but very few that actually result in improving one’s lifestyle. Ramona’s products are not your regular run of the mill products! After sitting down with Ramona, I was able to get a deeper perspective on the operating system of 321 works and why I believe it has great potential in our industry for the niche market of weight-loss, body sculpting and those who want to train like the stars do – it’s simple – it is well rounded. It takes into account the biopsychosocial model of a client’s well-being; their physical, mental and emotional well-being. It also ensures that any trainer who wants to add onto their current scope of practice the ability to not only learn the program design and exercises, but the business model itself, and how to improve your own business.

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Take The Workshop or Get Certified: The 321 Training Method in Vancouver May 4

As a newly accredited course (with canfitpro), this program gives you the opportunity to become a qualified instructor in Canada so that you too can follow and enjoy the same workout as the top LA celebrities.

The 321 Training Method Level 1 is a workshop and is suitable for gym instructors and personal trainers who want to learn new ways to help clients achieve great results. This massively successful programme, now available in Canada, is accredited by canfitpro and will earn you 2 CEC credits towards your annual CEC quota.

Once you have completed Level 1, you can register for the Level 2 certification course, as this will also earn you 2 CEC credits. Register for both in the same day and save!

In just a couple weeks, Ramona teaches this revolutionary workshop and certification course here in Vancouver, at APT South in Kits (4255 Arbutus Village) for more information on how to register please visit her website here: http://ramonabraganza.com/instructor-training/

Ramona Goes Global:

 

mobile_appAt your fingertips, with minimal to no equipment, wherever you are, her 321 Method is ready when you are. This highly effective combination of 3 Cardio, 2 Circuits of Strength training and 1 Core segment will get you burning fat fast, losing the weight and building lean muscle tissue immediately!

It come with a 12 week transformational program that progresses you safely through beginner, to intermediate then advanced. Unlike other programs that give you the same workout everyday the 3-2-1 Training Method includes a variety of exercises, daily workouts and top training techniques she uses with her stars to keep motivation high and the body challenged!

There’s even a built in calendar, with bi-weekly fitness assessments and the ability to customize the length of your daily training sessions, whether you have 20, 30, 45 or 60 minutes, will keep you on track! Download it from iTunes today!

So what are you waiting for!

Find her here:

Twitter:@ramonabraganza  / Facebook Page / Website 

A Corrective Approach to the Turkish Get Up

A Corrective Approach to the Turkish Get Up

The TGU is a flow state drill that targets 7 specific movements and requires not only mobility and stability, but strength and endurance, built from the ground up; which makes it an effective drill for strength and corrective coaches alike.  We can classify it as; corrective, functional and a competent way to lift. It can help restore movement patterns and build strength. As a corrective tool, I most often use the half get up to improve shoulder or thoracic spine dysfunction and I use the half get down to improve hip and thoracic stability, as well as rotational compensation.

The 7 Stages in the Get Up:

Much like neurodevelopment, the TGU is built from the ground up, moving the human structure through primitive postures, to foundational ones. Breaking down the stages will ensure your client’s success, as well as understanding of the benefits the TGU can provide.

(1) Fetal Position to Press, (2) Press to Elbow Position (3) Elbow Post to Hand Post (4) Post to High Pelvis (5) High Pelvis to Hip Hinge Bend (6) Hip Hinge Bend to Half Kneeling, (7) Half Kneeling to Standing.

From the Agatsu E Book Series

From the Agatsu E Book Series

From Movement to Mastery, the benefits include:

  • Improved shoulder stabilization and neuromuscular control
  • Improved thoracic mobility
  • Improved multi segmental stabilization of the spine
  • Improved hip stability , in supine, half kneeling and standing neurodevelopment postures
  • Improved reflexive lumbo pelvic control
  • Improves balanced symmetry between right and left sides, as well as upper and lower quadrants
  • The TGU can be used for critical postural feedback and mechanical awareness

Screening:

Remembering that a screen is not an assessment, always use your best judgement; if there is pain or a red flag for potential risk, the client is not ready to perform the TGU. We know that from the joint by joint approach, problems with the neck could mean problems stemming from a different area of the body altogether. Problems in the shoulders, could mean sloppiness in the cervical spine or stiffness in the thoracic spine.

Let’s presume you have already performed the full FMS screen and have been working on your clients prerequisites for the TGU. This would include soft rolling upper and lower body patterns, and ensuring that you re screen that major patterns within the complex make up of the Turkish get up or get down. This would include:

From the Functional Movement Screen:

  • The shoulder mobility screen – which we know showcases not only the shoulders, but active flexion and extension in the thoracic spine.
  • The active straight leg raise screen – as this will showcase a client’s ability to perform flexion and extension at the hips, as well as lumbo pelvic control and hip disassociation.

Selective Screens:

  • Screen breathing patterns in both unloaded/relaxed, and performance breath – breathing patterns places emphasis on the diaphragm and significant load to the thorax.
  • Thoracic Spine Screen– screening the thoracic spine is critical, as this is required for proper packing of the shoulders and rotational stability coming from standing to half kneeling, as well as getting up to half kneeling with load. You can perform this right after the breathing. If you have not screen the prone press up and TSPU you can move into this easily through this sequenced screen.
  • Cervical Spine screen – to ensure there are no pre risks in the upper neck or tissue supporting the head.
  • Screen your client’s grip.  Grip strength can determine neurological restrictions in the hand related to the shoulder and ability to pack and move around the load in the get up.

brett-gray

A Corrective Approach to the TGU:

As movement prep, I warm my clients up with a little foam rolling to rehydrate and warm tissue. From there we review upper and lower body rolling patterns, working in biofeedback tools where necessary. From there a set of open and closed chain joint mobility sequences to help promote flow state movement and breath. The tool or type of equipment also matters. A dumbbell or power block doesn’t can wobble; whereas using a kettlbell will offer you more because of the nature of its design. The handle and offset center of gravity helps to pull the body into vertical, because of the placement of load. When the weight hangs from your hand, within that vector of gravity means less risk and more stabilization.   Reviewing where needed; the hip hinge, coassack lunge or shibox progressions depending on which style if TGU I may use (RKC vs EKG).

The Arm Bar & Ceiling Reach:

When we look at the structural anatomy and physiology of the shoulder we can deduce that it does two things; (1) compresses (as in the arm bar and TGU) and (2) it distracts (as in a single arm deadlift or snatch). The TGU focuses on compression of the joints. Both of these drills ask us to practice vertical placement of weight through the shoulder blade. Shoulder packing requires the shoulder girdle, the breath and the body to support load. Getting the joint stable and centered, so the client can work on the proprioceptive vertical. One addition to this drill to ask the client to rotate the load in the ceiling reach until they find a spot that feels stable. Adding onto this, we can then ask the cline, still in supine to rotate the head (cervical spine) from side to side; which helps build their ability to disassociate between their neck and shoulders, while at the same time improving movement and proprioception. Moving onto the hip drive in the arm bar,  you can teach the client to connect the vertical compression and shoulder packing to the initial hip drive required to start distributing load in the first stage of the get up. Teaching the client to drive from the hip, transferring that load to the shoulders encouraged clients to understand the connection between the shoulders and the hips. Practice stacking the shoulders in the finish position and driving the floor away (turning on as much tissue as they can). This is a whole body exercise right from the beginning, to the end.

Half Get Up:

The half Get-Up is an excellent exercise for those who have dysfunction or compensatory movement in the shoulders, and thoracic spine. For those who require motor control and stability in the upper quadrant, this drill can be incorporated with neck and shoulder rotations, just like we performed in the arm bar and ceiling reach; which require total body engagement.  Learning this first part of the Get-Up places a high priority on breathing, as opposed to powering through the movement; therefore, cues like “bringing the sternum forward, driving out of the posted elbow will all help the client connect to the ability to expand in breath.  The aid of the kettle bell intertwines the grip, breathing, and core to pack the shoulder and display balance under a load. It is at this point you, as the coach, can further explore restrictions that can then be cleaned up as you slow this process down. One cue I use often for clients to “move your body around the kettlbell,” when you start keep your eye on the bell, move your body around the bell vs moving the bell to match your body. This prevents the athlete from pushing the bell forward, when they move from underneath the bell, it becomes an extension of their body. The half get up down slowly, allows us to provide the structure with a sensory rich environment to explore greater awareness and stabilization.

Pay attention to the Grip:

Most often the grip is practically ignored in today’s training. Yet, we know from primitive patterning; strong hands lead to a strong body.  The hands also fire neurons to the brain, when you make a fist and your body recognizes fight or flight and will naturally pack the shoulder. The hands tie into the neurological system, as do our feet. They are the two most neglected sensory feedback tools we own and are a central nervous fatigue marker.  Practice exercises in the vertical and horizontal positions to strengthen your grip. Once you have mastered this, then move into practicing static holds, bottoms up in half kneeling, as this will also start to improve more hip stability needed to hinge in the half way position prior to loading into standing.

Leaders in the evolution of the TGU:

The Turkish Get Up is one of the oldest known lifts, which requires a great deal of both mobility in the joints, extensibility in the tissues and stability in movement to endure moving from the ground up. I have found that a hybrid between the traditional TGU and the integration of the shin box bridge in the Evolution Kettlebell Groundwork series, as well as the attention to mobility and preparing tissue to move in Agatsu Kettle bell Trainings can significantly increase a client’s success and awareness towards the flow of this movement. It connect each stage as well as the breath. The links to these can be found below.

Next week we look at the other half of the TGU from the perspective of top down, vs ground up.

Sources:

Part 2: Foam Rolling FOR “Tissue” Release! Say What?!

Part 2: Foam Rolling FOR “Tissue” Release! Say What?!

fasciaLast week,  we featured “Part 1: Foam Rolling NOT Myo Fascia Release” where we looked one end of the debate regarding foam rolling for myo fascia release; where our focus was to look who foam rolling should be applied based on a client’s particual tissue make up. Meaning, the difference between tissue tone or muscle knots vs tissue fibrosis and scar tissue.

Foam rolling is a form of self-myofascial release that is commonly used by fitness and health professionals across the globe. However, it is still a relatively new field of research.  The study of  the areas of fascia, myofascial release, self-myofascial release and myofascial trigger points are also still young and quickly developing; therefore depending on how, what, when and where you apply these techniques are up for discussion. As I mentioned in my previous post, it really boils down to the the understanding of both tissue composition and the “WHY.”

Why are you prescribing these tools? Do you understand the difference between tone, tightness, tension and fibrotic tissue/scar tissue? Have you considered manual therapy over self release techniques? If a client has tone and you are looking to prepare the clients tissue for movement, the roller can be effective, but has temporary lasting effects. If the client has significant mobility and tissue adhesions the roller will not be enough to break down fibrotic tissue and thus you will get the results you want, nor will your client.

Any discussion of self-myofascial release first has to present some background to research into fascia and the vast interconnected matrix.  The purpose of today’s post is to look at how foam rolling, can indeed by beneficial to a client’s tissue health, when used appropriately.

First, let’s jus review the fascia system; fascia is connective tissue that wraps around all of our muscles and is heavily interconnected with muscular function, communication and our nervous system. It has 3 integral layers (visceral, deep and superficial) putting it in it’s simplest terms.  It is also a continuous sheet all around the body, which means when we alter it’s composition in one area, it can effect movement in other areas of the body.

Tight fascia  and fibrotic tissue affects the whole organism. Structural imbalance causes overall and specific increased rates of nervous stimulation. These cause increased muscle tonicity, trigger points and somatic-visceral referrals into the organs.

Myofascial trigger points are more usually defined as “tender spots in discrete, taut bands of hardened muscle that produce local and referred pain” (Bron, 2012). A commonly-held hypothesis about myofascial trigger points is that they are caused when motor endplates release excessive acetylcholine, leading to localized sarcomere shortening and consequently very short muscle fibers in one particular area (e.g. Hong, 1998).

fascai 2

According to the standard definition provided by the Journal of Bodywork and Movement Therapies (LeMoon, 2008), fascia is responsible for:

  • Maintaining structural integrity
  • Providing support and protection
  • Acting as a shock absorber
  • Plays a role in hemodynamic and biochemical processes
  • Provides the matrix permitting intercellular communication
  • Functions as the body’s first line of defense against pathogenic agents and infections
  • Creates an environment for tissue repair post-injury

How Can Self Myo Fascial Release(SMR) Benefit Tissue:

In general, a myofascial release technique is intended to address localized tension and tone , but most people describe it as “fascia rlease” when in actuality a better way to educate clients, is to use “tissue release,” because we are affecting more than just the fascia itself.  SMR traditionally focuses on the neural and fascial systems in the body that can be negatively influenced by poor posture, repetitive motions, or dysfunctional movements.

There is research that explains that these mechanically stressful actions are recognized as an injury by the body, initiating a repair process called the Cumulative Injury Cycle. This cycle follows a path of inflammation, muscle spasm, and the development of soft tissue adhesions that can lead to altered neuromuscular control and muscle imbalance. The adhesions reduce the elasticity of the soft tissues and can eventually cause a permanent change in the soft tissue structure, referred to as Davis’s Law. SMR focuses on alleviating these adhesions (also known as “trigger points” or “knots”) to restore optimal muscle motion and function.

Literature often seems to me to be slightly confusing regarding whether muscle tissue, fascia itself or a combination of both is being treated by the various techniques. I tend to lean towards “tissue release,” vs “fascia release.”  Most often we prescribe these tools not only to “release fascia,” but to prep muscles to improve mobility in a joint, or perhaps extensibility in muscle tissue (called tightness).

fascia01

Let’s Talk Hydration:

Outside of blood, connective tissue houses the majority of our fluid state. Other, more intricate and vastly important systems (nervous, vascular, and circulatory, etc…) rely on the fluid in this system to function efficiently. If the Extracellular Matrix (ECM), which is the fluids and it’s components of connective tissue that support, protect, and connect all of the cells it surrounds loses even 2% of its water content, it would cause every cell, structure, and system it surrounds to lose efficiency. This exhausts the body, makes it work harder daily and ultimately taps out your energy, ages you faster, and is the catalyst for most chronic pain.If we become dehydrated the body will prioritorize so that essential organs will remain hydrated.

Connective tissue (fascia) will be one of the first to dehydrate leading to adhesions and fixotrophia. For example, researchers have noted that since 67% of the volume of fascial tissues is made up of water and that the application of load squeezes water out of the structures, fascia may therefore lack water in certain areas. The application of external force may therefore be required in order to redistribute water and rehydrate the tissues. Using tools like the roller , the magic stick and slow, application of pressure can improve translation of nutrients and water into and out of tissue.  

James Oshman Phd. in his book ‘Energy Medicine’ cites research which shows that a 10% increase in hydration will result in a million -fold increase in conduction of impulses through the tissues such as collagen. This means our work could potentially be a whole lot more effective if we could get our clients more hydrated.

Gil Hedley, who is renowned for his work with cadavers and fascia mentions quite frequently in his Integral Anatomy Series,  that using myo fascia tools and manual therapy are important to movement and the pliability of tissue to maintain the sliding properties of fascia and muscle.

My Conclusion:

The discussion is new, our fields of research in these areas are new, and there still so much we do not know about the fascia, tissue and this interconnected matrix.

KISS Principle: Keep it simple…

  • SMR & Foam Rolling Techniques: good for reduces tone, improving hydration and temporary release of tense “tissue.” (notice I did not say just fasica, let’s think tissue – fascia and muscle)
  • For Fibrotic Tissue, Scar Tissue and Acute Adhesions: for best results, seek hands on professional treatment for long-term sustainable effects.  Offer client’s self management tools to empower them to manage their health, but ensure they recognize the difference and benefits, to both used together.

 

Sources:

  •  The Concise Book of Neuromuscular Therapy: A Trigger Point Manual – By John Sharkey
  •  NASM Essentials of Corrective Exercise Training – edited by Micheal Clark, Scott Lucett, National Academy of Sports Medicine
  •  Integral Anatomy Series – Gil Hedley
  • MELT Method – http://www.meltmethod.com/category/tags/connective-tissue
  • Energy Medicine – by  James Oshman Phd
  • John Forsyth – RMT, Central Lonsdale Massage Therapy Clinic & Massage and Therapy Center Vancouver
Part 1: Foam Rolling NOT Myo Fascia Release? Say What!

Part 1: Foam Rolling NOT Myo Fascia Release? Say What!

self-myofascial-release-collection

Human life involves movement. Movement is behaviour and it is communication. From the moment, we wake up to the moment we go to bed we are moving. It’a an endless array of activity expressed from our nervous system to our neuromusculoskeletal system to order to produce movement ongoing all day long.

Movement can also be a stressor, when we push too hard, when we create injury or just from poor habits, this is why in corrective movement we prepare the body FOR movement and FOR our daily activities, not just exercise. Not doing so can result in an inability for the tissues to efficiently accept, communicate and properly adapt for the load in which we apply, which can result in injury and pain. Most often this includes elements of “self soft tissue rolling.”

This 2 part series was spawned by a recent video circulated earlier this month called “Foam Rolling is NOT Myo Fascia Release,” by Dr. Andreo Sipna, Sports Specialist Chiropractor and Medical Acupuncturist and Manual Therapist out of Ontario, Canada. His findings and approach are valuable to our industry in understanding the difference between rolling for release and actually changing myofascia structure.

In the health and wellness industry we speak of health first, before fitness. Part of this health model is ensuring the layers of our skin, muscle, fascia – all tissue, are ready for life’s movement.  One of the trends we have seen over the course of the last few years, has been that of “self myo fascia release,” using rollers, trigger point balls, magic sticks and knobby things of all shapes and sizes.

Research is starting to show that even though self foam rolling and other tools works for movement preparation, and for those who require a little tone reduction, but  it may not be the best tool for breaking up scar tissue or for those with significant structure concerns and have excessive mobility issues.  Scar tissue that causes adhesion, contractures, and tissue fibrosis, cannot be changed through self means (self administered techniques).

Most often, clients are asked to preform “rolling” before their workout as a warm up, but what is rolling good for? And do they perform it properly? Do they know why they are asked to roll? Is it the right prescription for a client?  And is it enough? These are questions that circulate  in our industry, where many health professionals have differencing views on whether or not foam rolling can benefit the body. 

As is with any debate I look at rolling and how it will benefit movement, it’s two pronged (1)  rolling is only as effective as the coach who provides the tool and educates the client  (2) are you using these tools to reduce tone, or are using these tools to reduce pain and break down scar tissue? Both of these questions ask you to know the difference between tone/tension and scar tissue/fibrosis.

My place in the debate is this: There is scientific data that foam rolling or “self” myofascia release does indeed,  warm the system, release surface tension, and reduce tone, but it is temporary and if a client suffers from chronic pain, has scar tissue or adhesions, it most likely will not be enough to truly break up fibrotic tissue, as a stand alone method.  There is also scientific data to say that rollers and trigger points can’t break up scar tissue, it compresses vs laterally shear and therefore, the more effective approach would be hands on treatment. Again, tis is client specific.

Perhaps the best place to start is building from the inside out – a brief look at the fascia and at how scar tissue forms.

Brief Overview of Fascia Layers:

We have the outer skin covering the muscular skin and tissue and between the muscular skin and tissue we have a layer a connective tissue layer, which has been known as the subcutaneous fat layer. However, upon closer examination of this layer we can see that the is made of the scaffolding of fascial tissue, where pockets of fat live. It adheres the skin and the the underlining tissue.  This is known as the Superficial Fascia layer.

The complexity of fascial tissue can be simplified into three divisions: fascia superficialis (superficial layer), fascia profunda (middle layer) and deepest fascia (deepest layer). Since fascia is a contiguous interconnected soft tissue, each layer smoothly transitions from one layer to the next. Thus there is no “clear” division between layers.

There is a movement between these layers, which can be seen merely be touching your skin and feeling the bouncy, a gliding effect between these layers of connective tissue and muscle tissue. However, with age, previous trauma or injury or even lack of movement and a sedentary lifestyle, the connective tissue layers can start to become fibrotic or abnormal.

Recently, a video has circulated by Dr. Andreo Sipna outlining that rolling, in fact, is not myo fascia release. Now before we get into that debate, take a quick read below on his findings related to the difference between surface tension and inside tissue tension, in it’s relationship to scar tissue development.

fascia

Fibrosis & Scar Tissue:

When the fascial tissue becomes more mature, more dense or restricts normal movement, it becomes stiffer and can form fibrosis of tissue or scar tissue.

This can happen on two levels:

1. Inter layer restriction (via the Inter Sliding : the restriction of movement of the skin, on top of the muscles and fascia themselves.

2. Intra layer restriction: the restriction between the layers of the fascia and profunda within the same bundle, meaning within the same particular layer.

Fibrosis occurs anywhere in the fasica, and it will adhere to different structures and bind them together creating adhesions, contractures, and scar tissue. This limits joint range and mobility, can cause compensation and pain and movement dysfunction.

The tag ling “Rolling is NOT myo fascia release,” has spawned the debate on how we classify myo fascia release and whether or not rolling is a tool to administer for fascia release. Dr. Sipna believes it is not, while others believe it is. There is research on both ends of the spectrum,  pro and con. My ideology is to never take sides, but to appreciate both conversations. For the sanctity of this post we will look more at Dr. Sipna’s side of the debate.

The Myo Fascia Release Debate: Continues

When we talk in relative terms, most people will interchangeably use the words “myo fascia release” and “foam rolling or trigger pointing” as soft tissue release techniques. When we discuss soft tissue release, we need to understand that what we need to establish is relative tissue motion between the two layers that are bound together from the scarring or fibrotic change in tissue. The only way to achieve this is not merely through compressing the tissue, but by adding in relative tension and relative movement and in doing so establish afferent motion to start the process of breaking up fibrotic tissue.

In the recent video, circulating social media by Dr.Andreo Spina; his approach outlines the various processes that cause soft tissue injury, in his article written for Canadian Chiropractic, titled “Targeting Fascia.” I have noted his findings below.

“Each fibre, bundle and muscle is encased by fascia. The goal of soft-tissue therapies has never been to tear muscle proteins apart. It has been to remove restrictive scar tissue, or fibrosis. But where does this fibrosis form? Here is a list of the various processes that are known to follow soft-tissue injury:

  • Remodelling of connective tissue with lower tensile stiffness and lower ultimate strength;
  • Randomized collagen fibre direction and deposition (i.e., fibrosis);
  • Inability of collagen bundles to slide easily past one another due to cross-linking;
  • Substitution of collagen types with those of lesser strength.”

Compression + Tension + Movement

In other words we must be able to slide these layers over the other, or create motion between two fascia planes we are able to break down fibrosis through afferent motion.  Rolling can support better movement in tissue, but it cannot fully break down scar tissue or fibrotic tissue on its own.  A great explanation of this can be found in the video titled “Why foam rolling is NOT myo fascia release” by Andreo Spina (Functional Anatomy Video) to conceptualize this, he speaks of the inability for rollers and soft tissue tools are unable to create that relative tissue motion because they cannot grab onto muscle and hold them as muscles and tissue slide past one another and are usually held to trigger point without movement, either passive or active.

His conclusion is that research now shows that when it comes to foam rolling, alternating fascia composition requires a lot longer that simply a stroke or roll over the tissue or skin. Studies show that it requires 2 minutes minimum of tension/load or imparted load in order to cause a fascia release to occur. He goes onto say that these tools are still useful if we want to increase soft tissue healing by causing small amounts of tension, they can have a temporary relief in pin pointed pain, but we cannot consider these tools to take the place of hands on treatment and we cannot have long term changes in fascia composition or release adhesion or fibrosis using rollers or tools of this nature.

My conclusion, after watching this video is that soft tissue release is a very subjective term. He makes great points about the lateral shearing needed to break up fibrotic tissue, but to rule out foam rolling as a technique entirely, I am more on the position of keeping an open mind and giving clients tools they can self manage. Research shows significant progress for reducing tone uses these tools, but again it’s client dependant and how the unique make up of, injuries, past history and current biomechanical factors for make up that client.

When there is significant history with combative sports, structural traumas, high stress and mobility restriction I usually refer clients to an RMT, KMI structural integration specialist or other professionals engaging in applications of hands on treatment. Rolling will only make some temporary gains.

Next week we will look at some great responses to the video  post and offer insight into the other side of the debate, which is rolling and self managed myo fascia release tools can be of great benefit.

Food for Fascia thought!

Sources:

Dr. Andreo Spina, Sport Specialist Chiropractor, Inter. Speaker, Mobility & Movement specialist -creator/instructor- Functional Anatomy Seminars including the FR® & FRC® systems – Video – https://www.youtube.com/watch?v=BnYdzaoMyQ8#aid=P–lv2vjPlQ 

“Targeting Fascia,” article at Canadian Chiropractor  – http://www.canadianchiropractor.ca/index

Corrective Breathing Un Covered

Corrective Breathing Un Covered

Breathing is one of the most complex things we do all day. It is both a conscious and subconscious task. Proper breathing is the root of all healthy and functional movement. Think about the current popularity of muscle activation, meaning simply just because you create activity in a temporary isolated situation,  does that re setting carry over into other things, after the corrective exercise?

As coaches we spend most of our day “activating tissue,” we work on getting the glutes to fire, or the core to engage, but what about breathing. Do you consider breathing as part of someone’s health and fitness?

The same is true for a breathing exercise, we can use it to activate the breathing mechanics, but it too has to relate back to function’ which means carrying over improved movement or breath to other tasks; not just the one you are currently working on. The FMS screen can be used as a tool to look at opportunities to re-coordinate or reconnect breathing to improve health.  As a healthcare professional my first responsibility is to start with health, not necessarily performance or fitness.

First things first, assess risk and catch the red flags; this can be done 2 fold;  (1) identify if poor breathing is structural or (2) identify if poor breathing is situational. This directly relates back to the biopsychosocial model we looked at in as well as understanding the different kinds of BPD (breathing pattern disorders).

respiratory-muscles

Structural:

Identifying if there is a structural problem, an obstructed airway, a deviated septum, a closure of some kind thus can alter breathing and will be key in your program design and standard operating system for screening.  When people have horrible postures, rounded shoulders, forward head carry it could be because of an anatomical dysfunction. This can increase anxiety, cortisol levels, reduce adrenal function and increase likelihood of paradoxical breathing. Often called “reverse” breathing, occurs when the abdomen contracts during inhalation and expands on exhalation. Paradoxical breathing associates with the expectation of exertion, sustained effort, and resistance to flow, and stress. Clients with chronic airways obstruction also show in drawing of the lower ribs during inspiration, due to the distorted action of a depressed and flattened diaphragm As a result, this pattern causes very rapid fatigue.

Now what if that posture is where the airway is the largest and by telling our client to stand up straight reduces the client’s airway? If your airway is compromised… the body will resort to the path of least resistance – compensation.

Did you know: Three out of four Canadians report sleep apnea (75%) were 45 years and older. On average, these pauses in breath during sleep can last for 10 to 30 seconds, until the brain reacts to overcome the problem. With each episode of apnea, blood oxygen levels are reduced (hypoxia), and sleep is disturbed as the sleeper must wake briefly to resume breathing. In daily life, the person is restless, anxious and usually very fatigued.

Let’s take the airway out of the equation and move onto situational.

Situational:

The first place to start is assess the risk. During my consultations I will ask clients the following questions to gain a deeper understanding if altered breathing is a concern. Then I move onto the FMS screen.

Pre-screen questions for risk:

  • Do you have seasonal allergies?
  • Do you cough often?
  • Do you have episodes of bronchitis or chest congestion?
  • At higher threshold training do you resort to hyperventilation breathing?
  • How is your sleep? Do you have problems staying asleep? Do you have problems falling asleep?
  • Do you feel anxious or fatigued?
  • How much stress would you say you have in a week?

Before you prescribe an exercise – you must know the WHY!

Breathing changes movement; but lack of movement can also change breathing; therefore, take mobility off the table first. Key points you should consider; mobility, then stability or motor control. Remove the negatives and mobility restrictions, this frees up space for the mechanics of breath to work efficiently.

When looking at breathing, look at the mobility of the neck, the shoulder girdle, the thoracic spine, or how about the hips? When performing the FMS screen I can usually pick up breathing red flags  because the first two things we look at in the Functional Movement Screen for their influence on breathing are shoulder mobility and the active straight-leg raise. Both of these restrictions can help restrict authentic breathing.

Shoulder mobility is more than just looking at the shoulders; it addresses thoracic extension and flexion. Can you actively extend your spine?

The active straight leg raise showcases active symmetry and the ability to lift one leg in an unloaded position and it tells us a lot about a person’s hip and core function.

If mobility restrictions are taken off the table and there is no risk of structural concern, then some of the below breathing coordination exercises can encourage the resetting of authentic breathing.

Breathing Corrective Exercises:

Seesaw breathing: Reversal breathing (paradoxical breathing). see-saw breathing is a way to de-emphasize chest breathing and improve abdominal breathing. Start by identifying the 2 main cavities of your upper body, your chest cavity and your abdominal cavity. Find and settle into a comfortable breathing rhythm. Observe where your breath naturally goes, and which cavity naturally changes shape. Just observe. Now, as you inhale, allow the abdominal cavity to change shape and expand while keeping the chest cavity still. Exhale. On the next inhale, allow the abdominal cavity/belly to remain still while allowing the shape change to occur in the chest cavity. Exhale. And repeat for 5 mins.

Crocodile Breathing: Crocodile breathing is another way to illicit bio feedback, it gives a different sense of feedback than seesaw breathing where the belly expands both side-to-side and pushes into the floor, lifting the low back. Lie face down with your forehead on your hands. Breathe into your stomach. Of course, the air doesn’t go into your stomach, but the idea is to breathe deeply enough so that a person standing beside you would see your lower back rise. Keep your neck and shoulders relaxed.

Check out this video from Barefoot Running, Charlie Reid:

In the FMS level 2 courses we look at crocodile breath as a great example of screening the breathing. As a corrective movement coach, corrective exercises should be a temporary measure of re setting and re-educating your clients, but also so you can pull the new thing you gained into other activities, so that it becomes functional. You’ll breathe better the next time you run. You’ll breathe better the next time you lift and you’ll breath better when you sleep and recover.

Dysfunctional Breathing Patterns: Breath Changes Movement

Breathing is the primer to all human movement. When breathing is altered due to stress or prolonged periods of stress, the cycle of anxiety and poor breathing can significantly alter a person’s well-being.

BPD – Breathing Pattern Disorders:

Breathing pattern disorders (BPD) – the most extreme of which is hyperventilation – are surprisingly common in the general population. Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms that can impede performance and optimal movement. Most often it is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction; which can be further broken down into specific dysfunctions.

Diagnosed dysfunctional breathing affects 10% of the general population. However, we see a high number of the general public with altered breathing patterns due to stress, poor postural habits and pain. Despite decades of research BPDs, together with a range of the resulting pathophysiological biochemical, psychological and biomechanical effects, remain commonly under-recognized and under addressed by health care professionals as contributing to pain, fatigue and movement dysfunction in general. The physiological consequences of unbalanced breathing can be profound. The body starts to adapt both structurally with a range of systemic symptoms (raised shoulders,  upper chest breathing, jaw tension, headaches, chest tightness and reduction in thorax expansion); as well as physiologically (the body struggles to maintain chemical balance, deep sighing, restless sleep, exercise induced breathlessness, frequent yawning and hyperventilation, and fight or flight reactivity).  Both mind and body are affected by ‘poor breathing’.

Some of the most common dysfunctional breathing patterns are hyperventilatory, apical, thoracic, paradoxical, periodic, respiratory alkalosis, hypocapnia and hypoxic.  These may appear exclusively or in combination depending upon the state and level of the individual’s respiratory dysfunction.

  1. Hyperventilatory: is the state in which breathing occurs in excess of metabolic requirements, leading to an acute reduction in partial pressure of carbon-dioxide (PaCO2) and a predictable set of physiologic changes. This rapid-breath pattern uses accessory muscles and restricts diaphragmatic movement being predominantly situated at the thorax.
  2. Apical Breathing:  It refers to a pattern of breath that contains most movement to the upper chest. Breathing plays a major role in both posture and spinal stabilization. Some of the symptoms with this pattern can exhibit chest-raising that elevates the collarbones while drawing in the abdomen and raising up the diaphragm. Those who are “open-mouth breathers” attempt to increase intake by breathing through the mouth vs nose, but this provides minimal pulmonary ventilation resulting in the accessory muscles used in this pattern consume more oxygen than it provides. In exercise, these individuals fatigue quickly. Bio mechanical compensations can include rib head fixations or classic lower/upper crossed patterns of muscular imbalances.
  3. Thoracic: Closely related to apical breathing, these “chest-breathers” typify aggressiveness. This pattern lacks significant abdominal movement, being shallow and costal. Enlarging thoracic cavity creates a partial vacuum by lifting the rib cage up and out through external intercostals muscles. When our breathing movement is kept to only part of the chest or thorax, fewer muscles are engaged. Those muscles that are used have to undergo more stress and more movement to facilitate breathing rhythms. This reduces pulmonary ventilation, since the lower lobes receive the greatest blood volume due to gravity.
  4. Paradoxical: Often called “reverse” breathing, occurs when the abdomen contracts during inhalation and expands on exhalation. Paradoxical breathing associates with the expectation of exertion, sustained effort, and resistance to flow, and stress. Patients with chronic airways obstruction also show in drawing of the lower ribs during inspiration, due to the distorted action of a depressed and flattened diaphragm As a result, this pattern causes very rapid fatigue.
  5. Respiratory alkalosis: This involves a rise in pH of the blood, from its normal levels of ~7.4 due to excessive CO2 exhalation during rapid breathing. An immediate effect is smooth muscle constriction, narrowing of blood vessels, the gut etc, as well as reduced pain threshold and feelings of anxiety, apprehension (Leon Chow 2014)
  6. Periodic: This pattern demonstrates rapid-shallow breathing, followed by a holding of breath, followed by a heavy sigh. It is an over-responsiveness to CO2 concentrations in the bloodstream. This “airy” panting “blows off” or flushes out the CO from the bloodstream, which causes the brain’s autonomic system to shutdown respiration until the CO2 level raises to appropriate gas mixture. In the Periodic pattern, this cycle perpetuates. This pattern can be created through sustained anxiety, or by post-traumatic stress syndrome (Sonnon 2014).
  7. Hypoxic: Otherwise known as breath holding. This is often seen in swimmers, as well as clients who push too hard and cannot control breathing through exertion. This results in a reduction of oxygen (O2) supply to tissue, below physiological levels. Preparation of perceived exertion, this pattern comprises an inhalation, withholding of exhalation (breath retention) until the perceived exertion concludes. Holding the breath dramatically increases intra-thoracic and intra-abdominal pressure, causing health risks such as, fainting associated with Vagal nerve stimulation, increase in blood pressure, and hypoxia (lack of oxygen). (Sonnon 2014)
  8. Hypocapnia: Deficiency of Carbon dioxide (CO2) in the blood resulting from over-breathing/hyperventilation (HVS), resulting in increased pH, respiratory alkalosis (Naschitz et al 2006). (Leon Chow 2014)

Changes in Breathing, Causes Changes in Movement:

As a clinician or doctor diagnosing this would be your specialty, but as a movement coach, this is outside our scope of practice. However, most often through screening breathing techniques, I can most often determine if someone’s is an apical breather, if their diaphragm is dysfunctional, and or most often, using more of one side of the rib cage or the other. In association with this there are two major areas affected by dysfunctional breathing; they are optimal thoracic spine mobility, and optimal lumbo-pelvic control. In BDP the thorax and hips most often becomes stiff. Why?

Stiffness and sloppiness alternate when we consider the joint by joint approach. It is a present and observable phenomenon producing many common movement pattern problems. Often if you don’t have the necessary core stability, the T-spine will get stiff and this also works in reverse. If the T-spine is too stiff, the core stability will be compromised. Logically we must make sure these areas are mobile, because if the hips and T-spine aren’t mobile, the lumbar stability we create is synthetic and it will not stick outside the session. Most of us make the mistake by assuming sloppy knee, stiff ankle, stiff T-spine without considering the potential problems above and ­below.

How about the diaphragm? How often do you assess breathing? If the posterior aspect of my diaphragm attaches to my pelvis and I do not breath well, or I apical breathe… my hips and lower back can become tight, thus, my hip flexors can become tight because they transverse through my diaphragm. Or how about blood flow to my lower limbs? The aorta also transverse’s through the diaphragm. Breath is critical to well-being.

It can work either way. It’s not about finding what came first, the chicken or the egg—you have to catch both or you can’t manage either.

Corrective Strategy:

I always start by addressing and screening a client’s breathing, as well as addressing their stress. Most often clients are told to breath deeper or practice deep diaphragmatic breathing, and in some cases this can improve proper breathing mechanics as it does encourage the biochemical release of relaxation hormones. However, most often this can result in a client feeling anxious, dizzy, nauseous etc.

Why? We often incorrectly attribute this to O2 saturation, when actually the ratio of CO2 to O2 permits the release or retention of O2 from the blood (Sonnon 2014).

Changing your breathing pattern is critical to optimal health and wellness.  Increasing CO2 retention, can utilize more O2 from each breath, which in turn leads to better circulation and oxidation for tissue health, as well as prevention of disease and injury.

Screen the breath first I usually will screen in standing, supine or prone,

Supine: have the client lay on their back, knees bent and if possible, place your hands on either side of the ribcage. Ask them to breathe normally, and then into your hands. This a great way to see if a client breathes more with one side vs the other.

Prone (crocodile breath): Client lays on the floor on their stomach. Place one hand on their lower back and upper back and ask them to breathe into your hands. Watch for rises in just the chest, both hands should move together.

Standing: I ask the client to close their eyes and breathe normally. I place on hand on the upper chest and one hand on the back. As the client breathes I lower the hand in the back to the mid back and then lower back to determine if they breathe fully. Then I place one hand on the belly to see if the client can belly breath.

I use all of these when screening, especially if I feel breathing is compromised.

In the first early stages of coaching, address exertion and watch a client’s physiological adaptations. With the help of a team, working with other health practitioners, below is a list of suggestions for re training proper breathing mechanics:

1.     Reduce the synergistic inputs to the pain process (i.e. modify adaptive demands)

2.     Deactivate trigger (or tender) points

3.     Remove noxious input from scars

4.     Enhance spinal and general joint functionality

5.     Improve muscle recruitment, strength, flexibility

6.     Pay attention to exacerbating factors in diet, lifestyle and habits (sleep, exercise, posture, balance, breathing)

7.     Consider emotional/psychological factors and lifestyle stressors

8. Your corrective strategy should include breathing techniques and corrective exercises to help strengthen the diaphragm and re pattern/re train the ribcage for adequate activation of breathing mechanics.

 

Additional Sources:

Gray Cook – http://graycook.com/?p=35

FMS – Functional Movement Systems – http://www.functionalmovement.com/

Scott Sonnon – 6 Dysfunctional Breathing Patterns – http://www.rmaxinternational.com/flowcoach/?p=443

 

Health vs. Fitness: Are They The Same Thing?

Health vs. Fitness: Are They The Same Thing?

Health and fitness are words that become interchangeable in our industry, but they actually aren’t the same thing at all. These two words are most often used incorrectly and can get lost in industry jargon.

So what’s the difference? In order to answer this question effectively I would like to introduce the term the “biopyschosoical model,” fist before we get into defining them.  This model takes into account the spheres of one’s overall well-being.  Notice I did not say “health” or “fitness,” here either, I said “well-being.”

The Biopsychosoical Model:

Tis model is best understood in terms of a combination of biological, psychological, and social contextual factors rather than purely in biological terms of the human structure (our physical body).  Many clients come to us because they want to “feel better,” “get fitter,” “be less stressed.” Yet, most often this in related to the physical body only, and as we know the physical structure of a human is merely one proponent of someone’s “well-being.”  When we use the words like health and fitness  we need to identify the pre-requisites. After that address the systematic activities that need to be established to prevent or rehabilitate health problems that allow for greater fitness gains and ultimately promote optimal well-being.

untitled (10)Take pain for example, or movement dysfunction This model is used most often in the clinical practice, but as a Movement Coach is a very critical piece of analysis we can use as a reminder that health and fitness are not the same.

What’s the Difference?

Let me ask you this?  If there is pain, does this mean a person needs better health or better fitness? Do they just need to move more? Have we identified what kind of stressors  they exposed to at their work, lifestyle etc ? What’s their nutrition like, do they fuel their body for proper health or proper fitness?

Let’s outline a simple framework for not only defining these separately, but let’s breakdown an easy operating system towards acceptable transition from health to fitness.

What is health? Health can be considered the level of functional or metabolic efficiency of a living organism. Therefore, in humans, it is the general condition of a person’s mind and body, usually meaning to be free from illness, injury or pain.

What is fitness? Fitness is a general state of health and well-being or specifically the ability to perform aspects of sports or occupations. Physical fitness is generally achieved through correct nutrition, exercise, hygiene and rest.

Can you see the difference?

I want to bring your attention to the phrase ‘free of pain.” If a person has pain, their health is at risk. Not just physically, but biochemically, neurologically and psychologically.. Pain changes movement. Pain changes our chemical reactions and it changes breathing ; which can lead to dysfunction, limiting their ability to perform fitness related tasks. 50% of patients with chronic pain will increase their chances by 50% towards having a mental health problem; like depression, anxiety or sleep related disorders.

Why? because pain changes and affects your health. If there is pain, then improved health is first and foremost. Fitness cannot even be considered until the pain is at a manageable level where the client can feel confident in movement.

How to Screen Health vs Fitness:

Every person on our planet, no matter how athletic you are, or how many organic fruits or veggies you consume or super foods you add to your recovery shakes – when we look under the hood we can always find asymmetries or dysfunction – and this can cause pain. We all have them at some point in our lives, your coaches, your health practitioners – all of us, because we are all human and because our external environment is in constant state of flux  and when our external environment changes, so does out internal environment.

The goal is minimizing risk  and pain is by addressing movement dysfunction early on and ensuring early intervention with injury.  Look closely and you will often find that a tight muscle is limiting a movement pattern where motor control or stability is poor and vice versa, too much mobility can cause inhibition of tissue and instability of the joint.  Look at your profession; every profession has its physical and biopyschosocial risks that has the potential to lead to injury. Pain not only changes movement, it changes your bio chemical reactions, secretions and operating systems of your organs. Most affected by this is your breathing and cardiovascular health – dysfunctional movement = dysfunctional breathing patterns. This increases anxiety in the body; which in turn creates tonic, tense tissue!

Prevention is key and what you choose to do should make it move better, and that’s dependent on the tools in your coach’s toolbox. The FMS Movement Systems is one of those tools, along with the SFMA (selective functional movement assessment). Both are baselines for  health (the SFMA – when there is pain) and fitness (the FMS – movement and transition to performance).The SFMA protocol and top tier breakouts are a guideline from which you can see from the figure 1 that help to triage the impairment so you can know the direction to take the client’s health. This is for the clinician, not the coach. So if you are a coach, having someone to refer to with SFMA experience is key. Now, this is not the only assessment out there, but it is one of few that use language that is easy for any coach or client to understand. Using a language that is common to all, allows for greater intra-disciplinary support – working together as a team.

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Your Gateway to Fitness:

The FMS Systems is merely one tool in your toolbox towards screening a client for health concerns and or fitness readiness. Apart from the FMS and proponents of musculoskeletal testing, I also use a postural poise screen and certain strength benchmarks once a client has been cleared from pain..

If you flunk a movement screen due to pain or movement-pattern incompetency, the best coaching in the world most likely will not help much. As a coach, my job is to correct mechanics, improve movement and empower clients to live an optimal lifestyle. Even with a major movement restriction, compensation or limitation, we can always find positions where you can still encourage movement competency and increased load, but there must be pre requisites for applying load. These pre requisites start with mobility, then stability and then strength. The reality is we want a moving, dynamic evolving and adaptable human being, not someone who knows how to program a treadmill well.

When you pass a movement screen, you can undergo further load-focused testing and you are now ready to look at corrective strategies and transitional training.  Thus you can now move into fitness. Test and retest for much-needed bio feedback on how to improve performance and skill sets.

This is why the patterns of the FMS movement screen, the SFMA and the corrective models are so important. As Gray Cook says “acceptable movement patterns under appropriate loads usually improve, but we must first agree on situational definitions of acceptable and appropriate.” Much like agreeing upon acceptable definitions of health vs fitness. Understanding the vast difference can help you, as a coach systemically change your client’s life – not just physically, but improving their own biopyschosocial approach.

Empower Women & Girls Globally: Join Walk In Her Shoes Vancouver

Empower Women & Girls Globally: Join Walk In Her Shoes Vancouver

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On Sunday March 9th, 2014 WALK IN HER SHOES 103 KM RELAY Celebrates 

103 years of International Women’s Day

Vancouver’s Sarah Jamieson, founder of RUN4ACAUSE joins forces once again with CARE Canada for the annual Walk In Her Shoes campaign. An annual run event, that aims to empower women and girls globally.

Vancouver, February 1, 2014 – To help break the cycle of poverty and in celebration of the 103 years of international women’s day (IWD), Sarah Jamieson  of RUN4ACAUSE & CARE Canada want to empower Vancouverites to join a Walk In Her Shoes 103km relay team.

Who is CARE?

CARE focuses on global issues such as maternal and child health, education, economic empowerment, adaptation to climate change and emergency relief. The necessities to empowering women, children and whole communities through the ability to live, learn and earn.

CARE Canada’s staff, many of whom are citizens of the countries in which CARE works, help strengthen communities through an array of programs that work to create lasting solutions to root causes of poverty.

What is Walk In Her Shoes?

She needs to walk an average of 6km per day to gather the things she needs to keep her family alive. CARE & RUN4ACAUSE are challenging you to try and experience what this is like. On Sunday March 9th, join thousands of Canadians in celebration of International Women’s Day to empower women and girls to fight global poverty – Join Walk In Her Shoes.

How Can You Help?

RUN4ACAUSE & CARE are challenging Vancouverites to participate in our 2014 Walk in Her Shoes campaign. This 103km relay is divided into 8 relay legs ranging from 10km – 12km in length and each supports a specific CARE project. You can join as part of a team and run or walk at your own pace or become a run ambassador. As a run ambassador, participant or volunteer you inspire your community to help CARE empower women and girls in the developing world.

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Here’s how you can get involved:

  • Sign up to be a Run Ambassador and build a team for your relay leg, supporting a specific CARE project.
  • Join a relay team, walk or run at your own pace.
  • Raise funds to help women and girls fight global poverty.
  • Donate to our cause here and see how your support can impact below

This is your chance to…

  • Learn more about global issues.
  • Become physically active.
  • Inspire girls around the globe.

What Impact Can you Make:

Your support and donation is then leveraged at 3:1 ratios by our Canadian Government; thereby increasing the impact! All projects are instrumental towards empowering women and girls around the world.

How does your donation impact these families?
  • $10 can purchase schoolbooks in a child’s native language for a year.
  • $25 can purchase life saving vaccinations, treatment and micronutrients which prevent a child from diseases like malaria, anemia, and diarrhea.
  • $26 can provide a week long leadership training course to an adolescent girl to help her understand her legal rights at home, work and in the community.
  • $60 can purchase clean water for a family and help build a well.
  • $100 can help a woman start a business.

What The Numbers Tell Us:

  • When women earn an income, they reinvest 90 percent of it in their families.
  • For every year a girl spends in school she raises her family income by up to 20 percent.
  • Educated girls grow into educated women, who have healthier babies and are more likely to educate their children.
  • When a girl in the developing world receives seven years of education, she marries four years later and has 2.2 fewer children.
  • Engaging men, boys, girls, and women can transform gender roles and increase gender equality.

Join today…

To register contact Sarah Jamieson @ 604 789 0203 or Email: [email protected].

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Why Compensate: The 4 Types of Tissue Compensation

Why Compensate: The 4 Types of Tissue Compensation

imagesCAK79GHC1.       Tissue Tightness, Tension & Tone:

The four corners of the dreaded “T.” Tightness, tension and tone often become interchangeable when discussing a lack of mobility in tissue, yet they are vastly different things bio mechanically.

  • Tension: Whenever you train a movement pattern, the tissue (muscles and fascia) retains the tension generated by the degree, direction, range and load and is specific to the tissues used.
  • Tightness is usually determined by a lack of tissue length. Take the hamstrings for instance; during the (ASLR) active straight leg raise screen if a person scores a 1 or 2 actively, we then check the muscle length through the passive range. If the client till cannot straighten their leg or score higher; we can assume the hamstring tissue is tight.
  • Tone: However, if the client has improved range in the passive hamstring test, and can indeed reach the optimal 70 degrees, then this is most likely not a muscle length issue, but one of too

much tone in the tissue (tightness in the resting state of muscle) and a lack of motor control.

2.       Myofascial Restriction/ Density:

Deep fascia are layers of dense fibrous connective tissue that interpenetrates and surrounds muscles, bone, nerves and blood vessels of the human body. It provides connection and communication in the form of tendons, ligaments, aponeuroses, retinacula, septa, and joint capsules. It encompasses bones and nerves and is the nervous systems transportation highway.

Our fascia also has the capability to initiate relaxation. Deep fascia can relax rapidly in response to sudden muscular reaction or rapid movement, this ensures that the tissue does not tear and limitis end range response. When we neglect to release residual tension from our fascia, the pre-tense tissue lays down collagenous fibers to make it easier to maintain, which substitutes for muscle activation. It is this collagen which gives it it’s strength and integrity, but when there is an increase in tension the fascia bag increases in thickness as a counter measure to limit movement and effort. Thus resulting in compensation. This diminishes mobility.

3.       Sensory Motor Amnesia/ Motor Control:

Sensory Motor Amnesia (“SMA”) is a term introduced by Thomas Hanna, the inventor of Somatics.  SMA occurs when inefficient patterns of muscular activation become so habitual you can’t sense or control them due to the nature of habit. For example, those who have desk jobs or spend many hours seated often struggle with neck and shoulder pain. Part of this is because of the nature of their job and thus have forgotten how to relax tissue such as the neck, low back and shoulders, and thus we often see a concurrent concern with the inactivity of engagement or how to activate muscles like the glutes or “core.”

This leads to weakness, inefficiency, poor coordination and eventually pain.When tissue can’t move through a particular range or degree of direction, our connective tissue/ fascia web adapts and reacts by reducing biofeedback and innervation of the tissue. This means less of the muscle is activated and less of the nervous systems signals make it to the desired tissue to result in the desired movement pattern. If left dormant too long, the tissue can start to develop protective mechanisms to avoid any and all movement. This can result in bio mechanical compensations and dysfunction, which can lead to injury.

Somatic Yoga and Corrective Movement are two modes of rehabilitation which have showed significant success and are designed take your body goes through all the subtle little movements you have unconsciously avoided for years. It takes precise concentration and attention to recover them without “cheating” or deviating into a compensatory pattern.  After the movement is recovered, it is integrated back into your movement patterns, leading to increases in performance and reductions in pain.

4.       Fear – Reactivity:

This is a great term, which I first came across in Scott Sonnon’s TacFit course. It relates to the tissue’s inability to recover and recoordinate itself to its true resting and activation state. It’s defensive in nature, where muscles and tissue develop measures to protect itself from moving into an unknown, dormant capacity. Tissue will react by bracing, shaking, flinching or freezing because of the fear associated with long term forgotten movement potential. Our muscles can then start to atrophy, adipose tissue can accumulate and our fascia can thicken. Compensation can come in the form of pain, injury, increased tone or inability to move as you once could. This fear then becomes embedded in the muscle memory system and can be more than just a physical issue, but then a mental and emotional one as well, which could lead you to not pursue your goals or aspirations.

All 4 of these compensations must be carefully monitored. We must stay under the radar of the signs so that we can counter balance and not reinforce compensatory patterns. The more we move, the better we feel and the more we see not just our gym time, but our profession, our daily activities as “movement” as well the easier it will be to provide functional balance to our integrated system.

The Power of A Story: How to Build Shame Resilience

The Power of A Story: How to Build Shame Resilience

“Shame derives its power from being unspeakable. That’s why it loves perfectionists – it’s so easy to keep us quiet. If we cultivate enough awareness about shame to name it and speak to it, we’ve basically cut it off at the knees. Shame hates having words wrapped around it. If we speak shame, it begins to wither. Just the way exposure to light was deadly for gremlins, language and story bring light to shame and destroy it. “ – Daring Greatly be Brene Brown

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Yesterday I was given the opportunity to speak to an amazing group in Vancouver; The Twenty Ten Group. Invited by my good friend, fellow ultra marathoner and adventure seeker Graham Snowden.  One of my opening snippets of any presentation or talk always starts with the importance of telling one’s story. Telling our story can be a very powerful and profound thing. It can connect. It can inspire and it can heal. When telling my own story of triumph over adversity I am always reminded by Brene Brown’s work in vulnerability and more importantly “resilience tool” called “Gremlin Ninja Warrior Training.” I wanted to share a few of my thoughts on telling ones story of challenge, adversity and the long road to understanding and healing.  It all starts with shame vs guilt.

Shame:

Shame is something we all have, but don’t want to talk about. It’s that little voice in the back of your head that tells you no, or can’t, or don’t. Shame is lethal.  Brene Brown’s distinction between shame and guilt is equivalent to an epiphany. Understanding the distinction between the two can make or break your resilience to fear and achieving greatness. It boils down to our self-talk.

Shame = “I am bad”

Guilt is “I did something bad.”

Brown’s Gremlin Ninja Warrior Training offers real and raw guidelines, with a step by step approach towards better understanding this human paradox, while at the same time building shame resilience.

Gremlin Ninja Warrior Training

We all have feelings of in-adequacy or failure from time to time, but without this there would be no feelings of success, joy and elation. There would be no evolution. The human race would become stagnant.  It is through our mistakes, we learn the path of righteousness and experience what it feels like to get back up and stand tall after being knocked over by life’s unpredictability’s and nuances.

Each of us at some point has come face to face with our enemy or have come to face to face with what hinders us, and in doing so we must prepare effectively to properly manage the situation and come out victorious. This is no easy feat and most often we are unprepared and wind up stumbling around in the dark searching for strategies.

In the book Daring Greatly, Brown uses the metaphors of masks and armor as examples of how we have learned to build walls in self-protection against the dark arts of discomfort of vulnerability, and a world where scarcity, fear, criticism, shame and never enough dominate our very existence.  Yet, we must contend that we cannot live an authentic and wholehearted life without removing the armor and letting go, so that we can let in.

That’s the thing about walls. We may protect ourselves from the outside, but we also shut ourselves, opportunities and people out as well.  Viking (fight) or victim (flight), are not viable options for dealing with vulnerability.  She offers practical daring greatly strategies to help us embrace vulnerability and courage; using the way of the warrior or the Ninja as opportunities to fear and shame resilience.

The Way of the Warrior and the Ninja: Combat Warfare

Ninja: The historical accounts of the Ninja are scarce, yet the early 15th century holds glimpses of emerging “spies” whose functions were espionage, sabotage, infiltration and assassination and open combat with a high degree of honor and valor.

Warrior: A warrior can be defined as a person skilled in combat and warfare.

Gremlin: a mythological creature commonly depicted as a mischievous creature who sabotages or dismantles.

What do all of these things have in common?

They have duality. They have a Ying side; where they act in accordance with their values; which are integrity, honor, discipline and trust in the system. Yet, they also have a Yang side; when we connect these definitions we can see that there is an opportunity for not construction of greatness, but de construction as well. Each one has a quality of sabotage and when it comes to fear, shame and guilt the mind has an amazing ability to mask these as “protectors.”

“You don’t have to do that, let someone else.”

“Why do you fix, what ain’t broken.”

warrior understands that most often the greatest enemy, or foe, we face, is usually ourselves. As humans we have a propensity to self-sabotage our best efforts through a masked villain called fear. This fear can be veiled in emotions like anger, dis trust, sadness, helplessness, bitterness, shame and guilt, but they all stem from one word, and that’s fear.

The ability to own and engaged with our vulnerability determines the depth of our courage and the clarity of our purpose; the level to which we protect ourselves from being vulnerable is a measure of our own fear, resistance and disconnection. Humans are not perfect. Humans are imperfect, and that is what makes us authentic. Vulnerability is at the heart of being authentic.

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Ask yourself these questions:

  • What drives our fear of being vulnerable?
  • How do you protect yourself from vulnerability?
  • What meaning do you place on the word “protection”?
  • What do you gain or lose when you build up walls and disengage for fear of failure?
  • How could you own and engage with your vulnerability/ your gremlins, so you can start transforming the way you live, love and bring about change?
  • Are you a leader in your own life? If not why?

Brown dares us to have the courage to be vulnerable, to show up and be seen, to ask for what we need, to talk about our feelings and have the hard conversations. She asks us to tell our own personal story of both trials and tribulations in an effort to live a life of courage and authenticity.  As the book cover articulates it is about transforming the way we live, love, parent, teach, and lead.

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