Guest Post: Three Ghosts, Four Injuries, Five Adaptations (Part 1)

One of the unexpected benefits of our fitness journey has been all of the incredible people we have gotten to know along the way. Doctors, nutritionists, and trainers have all shared their knowledge and support. But the most inspirational, by far, have been fellow "lay fitness" people that have come even farther and made even greater transformations than we have.

One of our favorites is, David, a man who dubs himself "Watchnerd" on Fitocracy. David lives in

the San Francisco Bay Area, works for a software company, did some sports in high school and college, was pretty sedentary in his 30s, and decided to get serious about his health again in his 40's. He's also one of the pithiest writers I've had the pleasure of reading in some time. Today, David shares the first part of the story of his own transformation in a series I know you're going to find both entertaining and inspiring.

"NEW RULE #9 • Everyone is injured. But not every injury hurts." 

Lou Schuler, "The New Rules of Lifting for Life." 

Prelude:

DOCTOR Z: "So you went to the emergency room on Thursday? Tell me what happened."
ME: "Shall I give the whole narrative?"
DOCTOR Z: "Yes please."

ME: "I injured myself on Saturday. I was deadlifting and --"
DOCTOR Z: "Wait, what? You were what?"
ME: "Deadlifting, a weightlifting exercise you do with a barbell, starting on the floor. Looks like this." [show motion]

DOCTOR Z: "How much were you lifting?"
ME: "135 lbs"
DOCTOR Z: "That sounds like a lot!"
ME: "It's not, really. Not among people who lift. You could probably do it with some practice."

DOCTOR Z: "So what happened?"

ME: "I was generally tired that day and had just done of bunch of exercises before the deadlift. It was last on my list. I got sloppy, started using bad form. Lifted ugly. And strained or pulled something. My initial assessment based on my symptoms was strained hip flexors on my left side. It hurts when I go through the act of standing up from a chair, but not once standing, or sitting, or lying down. It was pretty excruciating up through Monday, but it's getting better now."

DOCTOR Z: "But you didn't go to ER right away, you waited until Thursday. Why?"

ME: "After I used the toilet on Thursday, I had pretty severe pain in the affected area, but also back pain and tingling and numbness in my extremities. It was enough to make me concerned that my initial self-diagnosis was wrong and that I might have a hernia, instead. So I went to the ER."

DOCTOR Z: "Says here the ER doc checked you for hernia, didn't find any symptoms. Suspects strained abdominals or hip flexors lead to muscle spasm or splinting in the lumbar region, which might have caused tingling extremities."

ME: "Yes, although I may have been leading the witness for the last bit."

DOCTOR Z: "So, um….what would you like me to do? Would you like me to also check you for a hernia?"

ME: "I guess if you want to. But I don't think it's necessary at this point."

DOCTOR Z: "Well, keep an eye on it, let me know if the symptoms worsen, and, you know, take it easy..."

ME: "Thanks, will do…."


And that's when I knew: the process of improving my health, renovating my middle-aged body, buttressing the weak spots, strengthening the foundations, and patching the holes would be pretty much 

          All...

                  On...

                           Me.

- - - - 

It was an epiphany to realize that I was going to have to take on the primary duty of navigating my way through the health issues associated with tackling a serious fitness routine in my 40's. But it really shouldn't have been.

I should have known I didn't fall into any pre-existing medical practice bucket. I'm not a child, so don't need a pediatrician. I'm not yet truly old, so don't need a geriatric specialist. I don't have (thank heavens) a serious condition that would require an oncologist or cardiologist. I don't have diabetes and, thankfully due to diet and exercise, have managed to avoid taking medications for blood pressure or cholesterol.

I didn't fall into one of the buckets that would allow me to say: "I'm sick. Give me a pill or a surgery to fix it." The kind of categorization that our modern medical system is geared towards.

So I had a drink with a college friend, now a doctor. But not MY doctor.

Soft Tissues:

ME: "...so, that's the ER story."
DOCTOR Y: "So that's your third injury in 3 months, right?"
ME: "Well, yeah, but --"
DOCTOR Y: "You need to recognize that you're 'An Old' now."

ME: "What's that supposed to mean? I'm just supposed to throw in the towel and get decrepit?"

DOCTOR Y: "Just accept your limits. Don't push the boundaries and you won't get hurt. You're not 20 any more. You should, you know, act your age."

ME: "Did you hear what you just said? I'm just supposed to give in to creeping atrophy?"

DOCTOR Y: "No, you should definitely be active, we all know the blahblah minutes of daily exercise that the AMA says, et cetera. But you don't have to be THAT active. Just --"

ME: "It's too late, anyway. I'm already doing barbell squats. You're not going to talk me out of it. I use the power rack at my gym more than the 20-somethings. I love it."

DOCTOR Y: "Damn…I uh get winded just doing body weight squats. Heaving my daughter around leaves me winded. I haven't even worn a sports bra since I had a kid."

ME: "Huh, really? You used to be pretty fit."

DOCTOR Y: "Hey, you have a kid, you get married, you -- wait, this is supposed to be about you, not me!"

ME: "Maybe it's really about both of us, doc." [smile smile]

DOCTOR Y: "Ok, look, maybe I have sample selection bias. I just see so many torn labrums and ripped ACLs, and half of them are from guys your age who think that now that erectile drugs can give them the rigidity of a teenager with the staying power of mature guy, that they can just wake up and go Rambo at gym. It's not that simple."

ME: "Was your sample selection bias comment referring to the torn labrums or the erectile drugs?"

DOCTOR Y: "Hush, you! Look, you're not that old yet. You've probably regained strength quickly and your cardio is --"

ME: "Surpassed. I'm stronger now than I was in my 20's. Or at least I'm lifting heavier weights."

DOCTOR Y: "Exactly. And your cardio improved probably even quicker than that. But your joints and soft tissues will lag. And by lag I mean severely lag. Like months behind."

ME: "What do you mean?"

DOCTOR Y: "Think about middle aged athletes. They almost never retire because they've lost skill, strength, or endurance. It's almost always injuries, and often those are joints injuries. And these are among guys who are active for a living. They've got pretty beefed up cartilaginous tissues, so it's usually something major like a tendon or a ligament. In a way, you're lucky."

ME: "How so?"

DOCTOR Y: "Well, no offense, but you're not a pro athlete. Before you ever get to the point of blowing a ligament, you're far more likely to succumb to repetitive strain injuries before you even get to that point."

Which brings us to…

GHOST 1: Osgood–Schlatter disease

Ghosts don’t stay buried. They like to haunt you. Surprise you and scare you.

If you’re like me, you had some physical issues in your (reasonably) athletic youth. Issues that went away when you stopped being so active. Issues that disappeared when you stopped pushing your body’s limits.

You thought you outgrew them. After all, you hadn’t had symptoms in decades. But they’re still there, lurking in the background, waiting to pop out and get you. You know - like that monster-in-the-tv in “The Ring”.

Early teens through high school, I participated in a number of running sports, including soccer, cross country, and middle-distance track (400m & 800m). At the time, I developed Osgood-Schlatter disease, a fairly common knee ailment among teens. According to Wikipedia:

“Osgood–Schlatter disease generally occurs in boys and girls aged 9–16[2] coinciding with periods of growth spurts….symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity”

I hadn’t had knee problems in decades. So when I decided to get active again, I did so with gusto.

My instrument of choice was the elliptical trainer. The latest studies seemed to indicate that I needed to get 45-60 minutes of “steady state cardio” in a day if I wanted to get real improvement, so that’s what I did. Every day. 6-7 days a week.

[I won’t get into why this approach to cardio is wrong-headed just now, but it is common consensus.]

And as I got into better shape, I had to increase the intensity in order to get that addictive runner’s high. I would set the machine to a low resistance, put on some 150 bpm music, and thrash round like the Tasmanian Devil until I got my heart rate above 140 and kept it there for a minimum of 45 min.

Until I woke up one morning and couldn’t walk because my knee was on fire..

INJURY 2: Patellofemoral syndrome.

DOCTOR Z: “Well, it looks like you have patellofemoral syndrome.”

ME: “So nothing acute, that’s good, no torn ACL. I assume that’s a repetitive strain injury?”

DOCTOR Z: “Yes. Treat it with anti-inflammatories and ice. And on this paper are some supplemental exercises you can do to help strengthen your quads, which seems to help.”

ME: [look at sheet] “Wall squats? Seriously? But I’m doing barbell squats.”

DOCTOR Z: “Well maybe you shouldn’t do those for a while.”

ME: “But you said I need to strengthen my quads.”

DOCTOR Z: “Yes, that’s right. Stronger quads help keep your patella in the right place.”

ME: “Right, I get that. But if I’m already doing barbell squats, how are wall squats supposed to make my quads stronger? It won’t be challenging enough to build strength.”

DOCTOR Z: “Well, um…just don’t do them for a couple of days. Then start again if it feels okay, I guess. But you should limit your cardio to something lighter, like maybe 30 min of walking.”

ME: “30 min of walking? I’m already way past that. I’m not an 80 year old healing from a broken hip. That’s going to decrease my cardio performance, not even hold it steady.”

DOCTOR Z: “I understand that, but I’m trying to help you avoid injury.”

ME: “Every sport has injuries. Part of the training process is finding out where the boundaries are between not enough training to produce positive change, and too much that causes injury. I have to go through this discovery process with my own body.”

DOCTOR Z: “We tell people to be more active, then they come back with patellofemoral syndrome. Number one complaint among the recently active.”

ME: “Well, you can’t have it both ways. You can’t tell people to be more active to improve their health, complain when they get injured and then ask them to stop being active.”

DOCTOR Z: “Hmmm.”

ME: “What do you do for cardio?”
DOCTOR Z: “Treadmill. Easy pace.”
ME: “And does it ever hurt? And what do you do about it?”
DOCTOR Z: “I just stop. Usually after 20 minutes.”

ME: “You took my blood pressure 15 minutes ago. You saw my resting heart rate. We’re similar age. How does it compare to yours?”

DOCTOR Z: …..”yours is better.”

ME: “QED, right?”
DOCTOR Z: “Huh?”
ME: “It’s Latin. Quo Erat Demonstrandum. Used at the end of math proofs. Means ‘it has thus been demonstrated.’”

DOCTOR Z: “You are one of my more….challenging....patients.”

ME: “Hope that’s a good thing! Look, if this is related to RSI and impact, I think I can switch to using a rowing machine. I’ve been playing with it a little bit and from what I can tell it should be even lower impact than the elliptical trainer, but with even greater cardio intensity.”
DOCTOR Z: “Okay…just, you know, take it easy.”

ME: “I’m sure I’ll have to at first. I’m not very good at it yet. And if I have any early RSI symptoms, I’ll treat it with RICE.”

DOCTOR Z: “Huh? Like white rice?”

ME: [silent facepalm] “No, Rest Ice Compression Elevation...”

DOCTOR Z: [sheepish] “Oh…okay, see you later. Don’t push too hard!”

And thus began my transition from the never-ended slog of the elliptical trainers, to…

ADAPTATION 1 - Competitive Indoor Rowing:

What’s low impact, a full body workout, extremely taxing on the cardio system, can be done indoors, burns over 600 calories an hour, has competitive worldwide rankings, and doesn’t involve getting hit in the face?

Indoor rowing! AKA ergometer rowing.

After a few weeks of horrible torture, burning lungs, gassed out muscles, and just slumped over exhaustion, I was finally getting to the point where I could row the standard distances without quitting. My times were getting into the range of “respectable”, although far from competitive.

I was in a groove, tracking every distance, time, 500m split, strokes per minute, and ranking myself against other rowers around the world.

It was so much more satisfying than just punching the clock on the elliptical next to banks of people who didn’t want to be there, either, immersing themselves in magazines and books, anything to take their minds off the goal-less drudgery, the “WHRRRWHRRRWHRRR” droning of endless banks of cardio machines. Like pods in the Matrix filled with human slaves.

And I was making rapid progress. My full-body barbell workouts seemed to carry over nicely for both the lower and upper body pulling strength needed to be a good rower. I was dreaming of competing in the indoor regattas next spring.

But then it all came crashing down with one bad bench press.

[to be continued]

Five Things You Need to Know About Joint Health

With posture like this, no wonder he didn't get away with it.
Darn meddling kids!

There are a few things that clearly mark "older" people in our society: demanding that loud rock and roll music be turned down, random shouting at neighborhood children to get off the lawn, and inexplicable and unwelcome aches and pains cropping up in various parts of our body.

Today, I'm going to cover an issue that is near and dear to those of us who are north of 40: our joints. Specifically, how to keep them healthy and pain free. Because the last thing we want is to get fired up to get back into the gym and, three days later, limp home defeated.

For me, I've dealt with lower back pain, some cranky hip flexors, and a right shoulder that reminds me every so often that I've got to check my ego on the bench press. But, the truth is, joint pain is not an inevitable and natural accompaniment to aging, as many of us have come to accept. Instead, it's the price we pay for extended bouts of inactivity and insufficient nutrition.

A few words about pain

Before we get into the heart of the post, let's talk about dealing with pain. Training involves pushing your body, making it adapt to new conditions. Some pain goes along with that, most notably Delayed Onset Muscle Soreness (or DOMS). DOMS is that sweet, sweet pain you get when you overdo it or when attempting something that your body hasn't been conditioned to do.  The only real way to treat it is to keep moving.  But it's important to recognize when you're dealing with ordinary pain and when you're facing a potential injury.

If your pain is very specifically localized and sharp and/or is accompanied by numbness or tingling, see a doctor or chiropractor before continuing your training program. Muscle strains and sprains don't have to keep you out of the gym entirely. Just throttle the weight back and lift carefully. Some exercises may need to be dropped for a while until the pain goes away, but in many cases, the combination of regular icing and lighter weight will get you through.

If you are feeling pain after a workout, treat with ice, not heat. Ice will reduce inflammation and swelling, which takes pressure off the joint.

1. Joint Health Basics

I'm going to focus on the "big three" - shoulders, knees, and hips, as these seem to be the most common problem areas that crop up.

The health of your joints is based on four basic elements: bone, cartilage, synovial fluid, and supporting tissue (tendons and muscles). In the joint itself, the bones are "capped" with a thin layer of cartilage that is the first line of friction protection in the system. Between the two bone surfaces is a thin layer of highly viscous fluid that functions much the same way as motor oil does in an engine cylinder, keeping the two bone and cartilage surfaces from coming into direct contact with each other.

Around your joints are systems of muscles and tendons that keep the bones in the proper position to each other.

2. Warming Up

Warming up seems to have become a bit passé in many circles. If you're squeezing in a training session before work or over lunch, it may seem like a no-brainer to skip it all together. But warm-ups play a very important role in preventing injury and reducing pain. The way your joint systems work, the act of movement itself causes a "splashing" effect of the synovial fluid, improving the coating quality on the joint surfaces. This is what is commonly referred to as "lubricating the joints." A light run at low to moderate pace for five minutes or some light calisthenics like jumping jacks will provide the kind of movement needed to get things going. Warmed up muscles are also less likely to strain or cramp during exercise.

Please note that this is not about stretching. Stretching before lifting actually reduces your ability to lift. Think about it: the act of lifting itself centers on contracting your muscle fibers. Why would you pull them further apart? Stretching itself is also not a long-term answer to improved range of motion. Practicing the motion often with proper form and manageable weight is your key to increased range.

3. Eating for Happy Joints

I don't know why I'm still surprised when my research continually leads me back to the same themes. But, yet again, our Standard American Diet as recommended by the ADHA has yielded some unfortunate consequences.  As a result, coaches, trainers, and medical professionals also recommend a nutritional component to support joint health.

Joint fluid and cartilage health is dependent on two primary macronutrients: sufficient protein and fat intake. Omega-3s are critical to the generation and replenishment of the essential synovial fluid. So, the low/no-fat, high carbohydrate diet pushed for decades hasn't done us any favors in the joint department.

Additionally, one of the main coincident symptoms of metabolic syndrome (the precursor to type II Diabetes, estimated to affect some 25-30% of adult Americans) is chronic inflammation throughout the body's systems. And the primary culprit in metabolic syndrome: a chronic overload of refined, processed carbohydrates in the form of white flour and sugars. Metabolic syndrome is characterized by insulin resistance, and one of the most important treatments decreasing insulin resistance is regular exercise, resistance/weight training in particular.

So, as with so many things associated with the chronic health conditions of our times, you are either subject to a self-perpetuating spiral or, if you turn it around, a synergistic set of factors that will slow and even reverse the damage we have done to ourselves. Your joints hurt because they are inflamed and they are inflamed because you haven't been fueling your body correctly, and you don't want to exercise because you don't have the energy and the pain is unpleasant. But - get on a training program and correct your nutrition plan, and the issues will likely resolve themselves.

Finally, proper hydration is essential for producing and replenishing synovial fluid, along with just about every other function the body performs. I know it's simple, but it bears repeating all the same. Drink lots of water.

4. Improving Supporting Muscles

For many of us that have either forgone exercise entirely or gone for the American Heart Association's universal prescription of light to moderate cardio three times a week, we haven't used our muscles for much. As I said earlier, strong muscles and connective tissue are a critical element in healthy joints. This involves a number of smaller supporting muscle groups that we don't normally think about. The best thing you can do is to work to make these muscles stronger.

For the shoulders, specialized "prehab" exercises will help build the necessary strength and support. They're not sexy, but neither is wincing when you put your shirt on. Here are a few that are simple to perform with light dumbbells or resistance bands:

• Internal Shoulder Rotation: Lie on your back on a bench or balance ball (for dumbbells) or standing with a resistance band anchored at the midpoint to create tension. Keeping your elbows fixed at your sides and your lower arms at a 90 degree angle from your body, slowly rotate the arm from the side to the front.  The only thing that should be moving is your shoulder joint.  Return to the side and repeat for 15-20 reps on each side.
• External Shoulder Rotation: This is the same as internal rotation, only reversed.  Lie face down or place the resistance band so it crosses your body from its anchor point.  Slowly rotate the arm from in front of you to the side and return.
• The Halo:  Performed with a kettle bell or exercise plate, the key to this exercise is the range of motion you can accomplish, not the amount of weight you can support. Raise the weight overhead with two hands and the elbows bent, move the weight in a circular motion around your head, mimicking a halo. Try to make as big a circle as possible. Do 20 reps and switch direction. You can also do one repetition in one direction, and then do the next repetition in the opposite direction.

For the knees, barbell squats are a fantastic way to build strength. If you're not ready for the squat rack yet, then the leg extension machine and lunges are good bets too, but they're no substitute for the kind of motion and stability involved in squats, even light weight ones.

The hip flexors are a special case. Most of us that have spent hours upon hours in front of a computer or at a desk have lulled our hips into a virtual immobilized stupor. For me, this translated in some chronic lower back pain right around my tailbone, which took an hour or two every morning to loosen up. Learning how to move and engage them takes a little practice. My recommendation here: take some yoga classes. There is no quicker way to learn how to engage muscles you didn't know you had than a basic yoga class.

And, last but not least, form, form, and form. There are so many poor examples of lifting out there that can really set you up for some major pain, particularly as you move to heavier weights. Keeping your elbows in tight during bench press or push-ups, making sure your grip is the proper width for shoulder presses, and keeping your knees lined up during squats are just a few. Get a trainer or review a reputable program and have a spotter to make sure you're getting it right.

5. Joint Supplements

Glucosamine and Chondroitin:  According to an article by the American Association of Orthopedic Surgeons, "One meta-analysis of randomized, placebo-controlled clinical trials from January 1980 to March 2002 found glucosamine to have “highly significant efficacy” for all outcomes, including joint space narrowing and Western Ontario MacMaster University Osteoarthritis Index (WOMAC)."  Chondroitin, has not had the same level of clinical success, but users still report a reduction in pain associated with joint movement after taking the supplement.

Omega 3 supplements:  As already mentioned in the nutrition section, fatty acids such as Omega 3s are essential to joint health.  If you're not getting enough through your diet (most of us aren't) then a high quality supplement isn't a bad idea for a number of reasons.  Just remember, it's fish oil, so if you're allergic to seafood, you need to stay away.

So, let's recap:
Warming up, eating the right components to support your joints, doing some prehab work for trouble areas, and, if needed, supplementing with glucosamine and/or Omega 3s are your best prescription to keep your pain down and your training on track.  When you're not sure if it's "normal" pain, see a doctor (which we are not). But if it's just plain ol' DOMS, get back on the horse; it will get better.

Now, get off my lawn!