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Muscle Specificity versus Confusion
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[What I use to swim]
I recently went to the gym, NOT to swim this time but to use their elliptical and incline machines (I am not good at the gym equipment's terminologies - sorry) as a diversion from my usual swim or run routines. I was intending to run at the park after working in the hospital but something happened to me two days ago, this is not worth re-telling but it might benefit others with regards to new shoes, training and fasciitis.
First I decided to replace my old worn-out running shoes. I usually buy Mizuno which I think fit my feet the best. My first mistake was that I assumed certain things. I thought I could just go on with my usual running routine even with new shoes. I did an interval training. Big mistake. My left heel was burning the following morning. I pretty much knew that shoes need 'breaking in' but for some reason I thought having the same brand would not make any difference. Wrong!
Being a PT I knew that off-pounding will be the next step to avoid this from getting full blown. I decided to use these new shoes at work place for now, just to 'break' them in. I might use them for slow jogging until they conform to the contour of my feet. Meanwhile I will stick to the old shoes for speed training.
So my next move was to replace my running with something similar but has less stress on the heels. Well, here comes the elliptical and incline. I deferred my swimming today due to some other issues (that will require another article later). And it worked just fine. The elliptical provided the challenge much similar to running without the extreme impact.
Which brings me to a topic that is not really new and perhaps everybody knows about already: Muscle Specificity versus Muscle Confusion. There are so many terminologies that sports enthusiasts have been coming up with lately that they can get confusing at times. Pacing, Intervals, LSDR, Aerobic, Anaerobic, VMax, Lactic, sub-lactic threshold, cross-training - these are just a few. Lately, every time I turn on the TV, people talk about intervals and muscle confusion. It is claimed that muscles work the best when they are not routinized or in layman's parlance, they are surprised. Some TV gurus claim it to be 'the secret' to maximal work-out benefits.
In PT, we have been working on a similar concept for decades now, it's called PNF. (Proprioceptive Neuromuscular Facilitation) which basically applies the concept of working on all groups of muscles with one stroke called 'pattern' which usually is diagonal in direction. It's really good when you want to 'involve as many muscles as you can given a limited time or session' or if you want to increase 'proprioception' which is basically an 'awareness' of the limb or muscles in terms of position, movement or direction. But there were studies that had concluded it's not much different from the regular active ROM exercises. Perhaps there are current trends in PNF that I am not much familiar with but the main reason I mention it (on account of muscle confusion) is because for me the most important aspect of exercise is exercise itself no matter the form, technique or rationale.
When people ask me what is the best exercise, I say, 'Exercise'. In my years as a PT, what matters is not much about what exercise a person does, but 'how compliant' the person is with his or her exercise. I can give you the best exercise program in the world but if you go home to sit it out and lay on the couch and eat anything you want and get driven wherever you go, really, what's the point of those wonderfully, scientifically proven effective exercises I just handed to you? This is one of the biggest frustrations of PTs like me: Lack of Motivation and Poor Compliance.
The Importance of Being Ordinary
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Well, before you start wondering where I have been all this time, I was back to work and the last few weeks were extremely busy even with my capacity as per diem PT. Summer is usually the season of vacations for many Therapists and as per diem, I was assigned to cover for them. As I found out, I am still attracted and highly confident in areas of Acute care especially in Trauma, so, I was all over the place taking care of anything trauma-related: MVA, MCA, GSW, Assaults and add to that are some Limb Lengthening procedures and lots of back surgeries. So there, what I thought would be a light duty became the same old same old, until this week when all them Therapists returned to work and I got canceled. That's ok, I am preparing to return to the university anyway to resume my quest for my second Bachelor's degree in IT. And by the last week of August I might need as much free time as I could. This goes without saying that I might be slower in updating my blogs again (depending on the severity of the courses and assignments) so right now, I am trying to finish what I promised myself to finish before school resumes.
I was able to complete my Healthysport Questionnaire and will try to finish the food types and servings table. I also need to populate my sister's Knitstore and by the end of August I should have all done what I wanted to do as far as this website is concerned. Obviously I won't be 'disappearing' but I may from time to time blog the things I want to share with people. The good thing about this blogging and web designing as far as PT is concerned is, it gives me an impetus to study my profession. There was a time I treated my profession as a simple job necessary to pay my bills. Now with my current interests, I keep on studying about this field because I find a reason to do so.
I am in love with sharing information, this much I know. And though my information can be inadequate and raw at times, it is still information. I am not about to lie about my qualifications and would not pretend to be an expert. I know I have taken care of PT patients, mostly in hospitals for the last twenty years and my experience might complement my lack of specialty. This I also wish to tell you: I have used my body constantly in learning about health. I can easily get you out of the bed via hoyer or sliding board; I can easily pick you up in between parallel bars and make you shift weight in preparation for walking; oh yes, I can even clean your wounds in the whirlpool or lavage depending on the need, and I can even tell and show you all your back precautions, knee precautions, hip precautions after surgery - but I won't be able to teach you how to become above the ordinary. My role in life had always been to return anyone as close as possible to their level prior to getting sick. Now to teach you how to become an athlete for the Olympics or how to acquire a sexy body to land you on the cover of GQ magazine is something I'd rather refer to the athletic/sports specialists or personal trainers. That is not my job.
Everyday I deal with patients who lost something, mainly a function. Everyday, I deal with patients afraid to lose their abilities to work, be involved, be productive. Everyday, I deal with old men and women whose lives are constantly reminded of deterioration, weakness and perhaps departures from this earth. Do they come to me asking how to be an athlete? No. Do they ask me how to look good? No. All they ask is to be normal and ordinary.
Believe it or not, becoming normal and ordinary is such a big challenge after you are visited by an accident or a disease. Ask a person who recently had a stroke or a heart attack or has been paralyzed by spinal injury. That single step, that single standing, that single getting out of bed or even a single small twitch in a leg muscle is so much of a big deal they start screaming in celebration and joy once it is accomplished. dealing with these patients has been my world for the last twenty years.
I too am going through what my patients have gone through. As I approach the mid-century mark I am beginning to understand many of my patients complaints: The mornings are such a hassle when you deal with pain. We can no longer rekindle the sexual fire we used to possess. We are slowly getting isolated from old friends who are moving farther and farther away. The kids we thought belonged to us are now gone belonging to their own independence. The speed we used to brag about is gone. We could no longer keep up with the sports team mates who are much younger. Our taste for fun is radically changed and deviated from what used to be. Suddenly we ask people to repeat themselves because we missed a phrase or two while talking to us. Some of us pause a while to recall where we placed our keys or did we turn off the stove before we left the house? Some of us look a little closer at objects or people or places because our eyes fail us at times.
At age forty I changed my lifestyle because I was one of those young people who thought they knew everything. I thought, being in health care rendered me free and immune from the ailments attacking my patients. Until the painful truth struck me: My cholesterol was high. My triglycerides were critical. My BP was high. My sugar was high. And I was stupid that I smoked. I was only 39 years old. Frightened by this truth I embarked on a journey that I still pursue even today. I started training for half marathons, I rekindled my love for swimming and when given extra time I went on cycling. Later on my MD proclaimed I was diabetic. So I changed my eating habits that I lost 25 pounds and kept it. And now, I am a 49 year old fit man, but I am no extra-ordinary.
Being fit is what Nature intended man to be. Ordinary people are not designed to run 26 miles, swim 2 miles, or bike 120 miles but some are gifted to do those. Ordinary people like me do not belong to that elite athletic crowd. Many of us dream to be but we can't. Many of us assume we can but really, that's why people collapse and die while in a race or while training. To be active doesn't have to mean we can beat every Tom, Dick and Harry that cross our path. Being fit alone should be enough to cause us to celebrate. There is nothing more triumphant than acquiring a normal BP, normal pulse, normal sugar, healthy readings of blood tests, having a normal healthy weight after being diagnosed abnormal with them. After so many years of constant work-out and dieting and discipline, all my readings have finally normalized. I did it all without medications. And that is what I want to share with anyone that cross my way. Will I be ordinary for the rest of my life? I doubt it. But right now, I celebrate about my fitness and regaining of my ordinary self.
Reminders about my recent work-outs:
08/04 - swim for 1 hour
08/02- interval training x 5 miles total
08/01 - swim for 1 hour
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