Pain, the Brain and ACL Recovery

A few weeks ago I had a very interesting experience regarding my ACL rehabilitation. It’s very similar to an experience I had with Achilles tendon and heel pain. Here it is.

A perceived setback

I had ACL reconstruction on May 1, 2014. I have been very aggressive with my rehabilitation and I felt it was going very well. My PT and I agreed on a strategy and he approved of the process in general. I knew that sitting and resting was not the right way to go if I wanted to regain full function. For people like me, laziness wasn’t a problem; an overly aggressive approach might be though.

I knew that I could be in trouble if I did too much work too fast and stressed the knee too much. I worried that I’d drifted into this territory when at almost nine months I experienced more pain than I expected. I had a final appointment with my surgeon and she expressed some concern at my symptoms. We agreed that I should back off my activity and rest a bit. Seems perhaps I had reached the point of “too much of a good thing.”

I backed off lifting, running a cycling. I didn’t stop my activity completely but I cut it back significantly. After a couple of weeks I realized the knee wasn’t feeling much better. I continued to experience frequent pain; not debilitating but somewhat worrisome. I decided a visit to the PT was in order. I wanted to get some guidance and make sure I hadn’t damaged the graft.

The long and the short of the visit was this: The graft and my knee were fine. I needed more strength in the leg and around the knee. I needed to do more work, not less! Eureka! (My previous PT had moved on to another position and I had to meet with a new one. Unfortunately, the “bedside manner” of this PT left much to be desired. Right off the bat she was rude, dismissive and she interrupted my answers to her questions. I became very frustrated and it was work to keep my yapper shut and listen to what I needed to. Fortunately I got the information I needed.)

From here, I was ready to rock ‘n’ roll.

Goodbye fear. Hello confidence!

My experience was a very clear experience of what modern pain science has been finding recently. Here are some important points:

1) Pain doesn’t equal injury: In Reconceptualising Pain According to Modern Pain Science, neuroscience researcher Dr. Lorimer Moseley has made several points about pain. Two are pertinent here:

pain does not provide a measure of the state of the tissues
The relationship between pain and the state of the tissues becomes weaker as pain persists.

Yes I had an injured knee and yes I had surgery in which part of my patellar tendon was cut out in order to make a new ACL. This was all very disruptive to parts of the knee and was clearly part of the pain I was feeling. It takes about six weeks for the graft to heal. The reconstructed ACL is pretty much healed at six months which would’ve been October for me. In other words, my knee was/is healed and any pain wasn’t from tissue damage.

2) Fear is a significant obstacle that must be addressed: Fear is a powerful part of our pain. Overcoming that fear is major part of a successful rehab and return to activity. The pain in my knee caused me to worry that I’d re-injured it and it led me to avoid a lot of activity that I enjoyed. This condition is known as fear-avoidance. The International Association for the Study of Pain (IASP) describes fear-avoidance this way:

Psychological factors play a key role in the development of chronic musculoskeletal pain, in particular dysfunctional beliefs about pain and fear of pain. Fear of pain leads to avoidance of activities (physical, social, and professional) that patients associate with the occurrence or exacerbation of pain, even after they may have physically recovered. Whereas this response is adaptive in the acute phase—rest promotes recovery—it leads to disability and distress when avoidance behavior is continued after the injury has healed.

“Fear-avoidance model” by LittleT889 – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons – http://commons.wikimedia.org/wiki/File:Fear-avoidance_model.jpg#mediaviewer/File:Fear-avoidance_model.jpg

When I learned that my parts were solid and strong and that I wasn’t broken, I felt the fear drain away like water down a toilet. I was a happy dude!

Another of Moseley’s points is important here: that pain can be conceptualised as a conscious correlate of the implicit perception that tissue is in danger.

Big words. What does that statement mean? I’ll let Moseley explain (emphasis is mine):

“First, there are other central nervous system outputs that occur when tissue is perceived to be under threat, and second, that it is the implicit perception of threat that determines the outputs, not the state of the tissues, nor the actual threat to the tissues.“

In even simpler terms, we may feel pain absent any damage but we feel pain when our brain perceives a threat–even when there is no threat. I compare this to a car alarm that is set off by the wind. There’s no break-in occurring yet the alarm signal is going off due to the alarm sensing a threat.

3) Patient education is vital: Very interestingly, an effective strategy in treating chronic pain is patient education. This strategy of patient education is supported in several studies that are discussed in a review in the Archives of Physical Medicine and Rehabilitation, and it’s further discussed in an article titled Can Pain Neuroscience Education Improve Endogenous Pain Inhibition? Literally, knowledge of pain processes can reduce pain. (Pain is weird!) I believe that my experience supports this phenomena.

(To be clear, it’s not that I received education on how pain works. I received the message that my knee was solid, not injured and that it could be worked very hard.)

Keep this in mind.

Dr. Moseley discusses pain education in Pain really is in the mind, but not in the way that you think. I like what he says here:

“The idea that an inaccurate understanding of chronic pain increases chronic pain begs the question – what happens if we correct that inaccurate piece of knowledge?

We’ve been researching the answer to this for over a decade, and here’s some of what we’ve found:

(i) Pain and disability reduce, not by much and not very quickly but they do;

(ii) Activity-based treatments have better effects;

(iii) Flare-ups reduce in their frequency and magnitude;

(iv) Long-term outcomes of activity-based treatments are vast improvements.”

Most of us outside the medical community probably still equate pain to damage. Many inside the medical community still think that way too. (Blame Rene Descartes.) We now know better. Rather than address pain from a strictly biomechanical approach, therapists would be well advised to study and adopt what’s known as the biopsychosocial model for pain. This model is explained very well here and discussed in-depth here. We patients will be well armed in a fight against pain if we understand this model too.

What I’ve Learned: Principles of Movement & FASTER Global – Part IV

I’ve been discussing movement, exercise and how to make traditional exercises more applicable to real-life and athletic activities. I’ve discussed going from two feet to stepping. From there we can progress to a variety of hops and jumps.

Progressions

2 feet to 1 foot
stationary to stepping to jumping
jumping from two feet to two feet
jumping from two feet to one foot
jumping from one foot to one foot
stepping and jumping may occur in saggital, frontal or transverse planes
add weight

Other things to think about

We could focus on “sticking” the landing and maintaining perfect balance and control or we might focus on moving very quickly from one hop/jump to the next.

We might emphasize a very long or very high jump/hop or we might emphasize short and fast hops/jumps.

Here are some videos featuring tri-plane jumping and hopping with all sorts of arm driver activity. These are in no particular order and I’m not showing a progression. These are just a few combinations.

There is a nearly endless galaxy of these types of exercises. Any number of implements can be used (Core Momentum Trainer, dumbbells, sandbags, kettlebells, nothing at all). Trainees can either stay stationary or move in any direction.

I’m in the advanced stages of ACL rehabilitation and I’m using a lot of these types of exercises in my own workouts. I’m using them with a lot of my clients who are athletes as well as clients who don’t consider themselves athletes. These exercises can be a lot of fun, feel very challenging and are useful in stimulating the metabolism for those wanting to lose weight.

Good Words from Steve Magness at Science of Running

“Which brings me to the point. You can’t force things. In life or in running. You’ve got to let them come to you.”

– Steve Magness, Science of Running

I’m a big fan of Steve Magness’ work. He is both a researcher and an in-the-trenches running coach. His site the Science of Running is full of excellent information. His book (also titled The Science of Running) is a must-read for running coaches and any serious runner.

Under pressure

I greatly appreciate his latest blog post titled New Year’s Reflections and Anti-resolutions. He discusses resolutions and the high failure rate experienced by those undertaking them. He observes that a lot of us feel forced to make decisions and when that happens, we make bad decisions. When we feel cornered and pressured to accomplish or achieve something then we often don’t get the results we want. He says:

“Today, with social media, an ability to instantly compare ourselves to any of our peers, and a high premium placed on accomplishments and ‘success’, it’s hard to escape the feeling that we have to do something. We have to accomplish some goal, take some job, marry some guy or gal, all on some set time line or else we’re perceived as a failure. Society and culture put us in a place of ‘forcing’ us to do something.”

I can definitely relate to this scenario. I sometimes feel pressure when I observe the accomplishments of others in my field, or when I look at the athletic feats of men my age. It’s easy to feel like I don’t measure up, that I’m not “enough.” Later in this post I’ll give some evidence that by letting my mind wander to others’ achievements, I’m probably undermining my contentment in life.

Here is more from Magness:

“Which brings me to the point. You can’t force things. In life or in running. You’ve got to let them come to you.

In running, big breakthroughs occur when you let them happen. You’re more relaxed while still driven and focused during the race versus tense and pressing in which you are trying to force a new Personal Record. Ask any sprint coach if people run faster relaxed versus tensed and you will find your answer to why forcing a race does not work.”

There is power in being mentally engaged in the here-and-now rather than longing for the end product. Most of us have probably experienced this when we try really hard at almost anything. From a golf swing to trying to impress a date or a boss, if we bear down too much and try to force it we rarely get the results we want.

Flow

In contrast to forcing things, we would ideally relax and perhaps just react to events. Psychology researcher Dr. Mihaly Csikszentmihalyi calls this the “flow” state:

“These are moments in which your mind becomes entirely absorbed in the activity so that you ‘forget yourself’ and begin to act effortlessly, with a heightened sense of awareness of the here and now (athletes often describe this as ‘being in the zone’). You may be surprised to learn, however, that in recent years this experience has become the focus of much research by positive psychologists. Indeed, the psychologist Mihaly Csikszentmihalyi has even given it a name for an objective condition — ‘flow.'”

I’ve been fortunate enough to experience flow on the ski slopes–though not nearly as often as I’d like! Everything works. I turn effortlessly. I’m in total control. I move but I’m not aware of how it’s happening. I often feel this way when I trail run, mountain bike, lift heavy weights or when reading a great book. Life is best when I feel this “flow.”

Process, oh how I love the!

I recall conversations about training I’ve had with a friend. Much of his life is devoted to triathlon specifically and intense physical activity generally. We both love physical exertion of a sometimes extreme degree, and we both agree that we dearly love the process. Lifting weights. A track workout. A long bike ride. Learning a new exercise. We love every step towards the end goal. We love the beginning when we feel good, the middle when we’re tired and questioning why we’re doing it, and the glorious end when we feel a sense of accomplishment. In loving the process the end goal comes to us.

Magness speaks to loving the process:

“The key though is not simply thinking ‘it will all work out’ but instead acknowledging the first portion which is if you work hard at things you enjoy, love the process, then eventually things will work out. Perhaps not always in the direction you want them to, but for the most part they will.”

(Additionally, it’s during intense training that we are wholly focused on the task at hand. More on that in a moment.)

Chasing a mirage

I like Magness’s analysis of being process-focused rather than outcome-focused:

“We get caught in the rat race of trying to chase success, satisfaction, happiness, and outcomes. The reality is that this is simply an evolutionary mechanism designed to keep us engaged. Researchers have found that it’s not the actual reward that gives us the most bang for our buck in terms of the wonderful feel good hormone of Dopamine. Instead, it’s the chase that gives us the huge bump in Dopamine.

We’re designed for the process, but we focus on the outcome. It’s this nice little trick of mother nature that makes us follow through and get things done. It’s why we suffer from this nice fallacy of ‘If only I had X, I’d be happy/satisfied/whatever…’ We then chase X, feeling pretty good about ourselves as we chase it, but then are torn down by the feeling of discontentment when we finally reached our goal and while the payoff was nice, it most certainly doesn’t meet pre-conceived expectations. So we are left with the inevitable ‘so what now…’ that predictably follows.”

He says, “If I only had X, I’d be happy…” I believe a lot of us go through life this way, basing our contentment on external things: a race outcome, a flat stomach, a girlfriend/boyfriend/spouse, money, a house in a certain neighborhood… In other words, we’re looking for the perfect circumstance when everything goes right–then we’ll be happy!

In this scenario, we’re looking outside ourselves for contentment, fulfillment and happiness. We’re looking for affirmation of ourselves via things that we may not control. Interestingly, when we achieve one of these things (say hitting a PR in the deadlift, taking 2 minutes off your marathon time or making X amount of money) have we actually found happiness? Maybe…. But often we’ve simply obtained one of these things and we’re not actually any happier, so we keep looking for the next magic thing that will fulfill us.

(In my experience, by chasing happiness that we believe lives outside us, we’re really chasing a mirage. The external thing that we covet so much rarely if ever lives up to expectations.)

Happiness through focus

A 2010 study called A Wandering Mind Is an Unhappy Mind seems relevant to some of these ideas. The research was done by psychologists Matthew A. Killingsworth and Daniel T. Gilbert of Harvard University. Here are some paragraphs that deserve consideration, starting with what I think is the big picture on wandering minds:

“A human mind is a wandering mind, and a wandering mind is an unhappy mind,” Killingsworth and Gilbert write. “The ability to think about what is not happening is a cognitive achievement that comes at an emotional cost.”

“Mind-wandering is an excellent predictor of people’s happiness,” Killingsworth says. “In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged.”

When are we happiest?

Killingsworth and Gilbert found that people were happiest when making love, exercising, or engaging in conversation. They were least happy when resting, working, or using a home computer.

(Hey! Wow! Exercise!)

Finally,

“Time-lag analyses conducted by the researchers suggested that their subjects’ mind-wandering was generally the cause, not the consequence, of their unhappiness.”

What am I saying?

I believe that I’m advocating for finding activities that demand our full mental engagement. The phrase “live in the moment,” seems appropriate (even though it sounds cliche and a bit too cute for my taste–it happens to encapsulate a great concept!) There is a subtle, sublime state of mind that can’t be found by multi-tasking (possibly the ultimate non-focused happiness killer) or keeping up with the Joneses. Further, the focus on the process keeps us “in the moment.” If we can find a love for the process–rather than a fixation on the outcome–then I believe we can find a healthy dose of happiness.

What I’ve Learned: Principles of Movement & FASTER Global – Part III – Lunge and Reach

In the previous two posts, (here and here) I discussed what I’ve learned by going through the FASTER Global coursework. (If you’re a fitness professional who wants to truly become an expert at movement, then you need to do this course. This has been the most comprehensive movement education I’ve had in nearly 20 years of working in the fitness field.)

I believe I’ve made the case for why we should train with tri-plane movement. Further I believe that I’ve illustrated why traditional gym exercises like squats and deadlifts may not be the best way to develop all-around movement skills or strength. (For the record, I’m not saying traditional squats and deadlifts are bad. I use them in my own workouts and with my clients. To be clear, I believe that there are infinite variations that can and should be used to condition people in the most comprehensive way.)

In the previous post I showed a bunch of lunge and squat variations. Here are some more lunge variations this time with arm reaches.

Lunging and reaching

While lunging, we can drive motion from the upper body by reaching up, down, across, overhead, etc. We can reach with one or both arms. The way in which the trainee steps drives motion from the upper body up through the rest of the body. As he or she reaches, motion is driven down through the body toward the ground. The reaching affects balance and creates a wide range of slightly different body positions which look a lot like any number of athletic activities, for example, look at the baseball pitcher and basketball players.

Lower body motion plus upper body motion.

Saggital plane anterior lunge with same-side posterior arm reach… Or something like that. Lots of stuff happening.

Kobe executes a type of lunge and reach down.

Resistance can be added to these in numerous ways: weight vest, dumbbell(s), sandbags, kettlebells, etc. Cables or tubing positioned at any number of angles can speed up or slow down the lunge.

Remember though, if someone can’t control these exercises then he or she should be regressed to something that is controllable, safe and manageable.

Here are a few examples of lunges combined with reaches in various directions. I’ve shown an anterior lunge and a lateral lunge but we could add any of these reaches to any type of lunge. The combinations are nearly infinite.

Next we can progress to jumps and hops, all done in any number of directions, all with feet and arms in any number of positions. I’ll show some of those in the next post.

What I’ve Learned: Principles of Movement & FASTER Global – Part II

From gym work to “real life.”

Athletic endeavors and typical daily movements are rarely symmetrical. We’re often stepping from one foot to the other in any of several directions, swiveling and/or bending our bodies, reaching, moving with a load on one side of our body–all potentially at the same time. If we think of the SAID Principle (discussed very thoroughly here by Todd Hargrove of Better Movement) then it stands to reason that some of our training ought to resemble our chosen athletic or leisure activity, both in movement pattern and energy system usage.

A squat by any other name…

A lot of conventional exercises–squats and
deadlifts for instance–keep the feet planted against the ground in a symmetrical stance. Fine, but how much should we expect those exercises to translate to something like skiing? Yes skiing uses two legs and it sort of looks like a squat but there’s a lot more going on during a ski turn than just moving the body down and up.

We could say something similar about basketball where there’s a lot of jumping,

landing and movement into positions which look a good bit like a deadlift–but clearly doesn’t look like the standard deadlift.

Here’s a very interesting video on how to take a squat and add some flavor to it:

These are the types of movements that more closely resemble many sports and recreational activities. These can be used as part of a warm-up for a workout or they can be used as the workout itself.

Ground reaction forces

At some point we need to consider ground reaction forces. A foot or feet hitting the ground creates a whole different set of circumstances compared to planted feet. Enter the lunge.

A lunge creates a ground reaction force (GRF) as the foot hits the ground. A series of events should ideally take place in a certain sequence at the following joints: mid-tarsal joint, subtalar joint, talocrural joint, knee, hip and on up through the spine and even out to the shoulders and beyond!

(BTW, a lunge can be any distance or depth. If someone can’t lunge far and deep then it’s completely appropriate to simply take a step. I often ask my clients to go as far and/or deep as they can only so long as they can maintain control of the movement.)

There are a lot of variations on the lunge. We can step in any number of directions. Our world is a three-dimensional place so we can step forward or backwards, side to side, or in a circular or twisting type of motion.The purpose in doing this is to allow us to experience a wide range of joint angles and different ground impact scenarios. We can see if an athlete is able to move into his or her sport position. We might be able to expose a movement pattern that is unstable and which the athlete may want to improve for performance and safety.

Lunges for all occasions

Here are a collection of lunges done in an assortment of directions. Each type of lunge creates a different reaction throughout the limbs and joints.

Not pictured are lunges in which the trainee steps up or down off of a step. Any of these lunges can be done in this way. It’s a good way train for something like a hike (if for some reason a hike can’t be undertaken) or to simply add variety and new skills to the workout. Next you’ll see lunging in conjunction with reaching.

What I’ve Learned: Principles of Movement & FASTER Global – Part I

I spent much of the Summer and Fall going through the FASTER Global Specialist in Functional Performance and Specialist in Functional Therapy courses. It’s been a fantastic experience. At times it was incredibly challenging but such is life with anything worth learning and doing. I’ve come away from the experience with a tremendous movement analysis skill set, and a systematic way of thinking that I didn’t have before.

Sometimes I think I know something, that I’m a fairly knowledgeable trainer. Then I’m exposed to new information and I think, “I don’t know anything!” Whenever I dig into something new I have my old beliefs challenged by new concepts. That’s very much my experience with FASTER.

In this post I’m going to cover a few things I’ve learned. I’m going to try and keep it concise. I could meander all over the place….

The Specific Adaptation to Imposed Demand (SAID) principle is always at the top of the FASTER thought process. We consider the client’s or athlete’s goal(s) and then we build a program that very closely resembles that goal. If we’re working with a skier then joint motions and body position should look a lot like skiing. Similarly with a bowler, kayaker, runner, rock climber, pitcher, someone who has trouble waking up and down stairs–whatever. So with that we start with some questions.

Two big questions & another question:

Can the athlete get into the position required by the activity?
Asked another way: Does the athlete have the range of motion for the task?
If yes, can the athlete control that ROM?The above two are big. If we get two yeses then we ask:
Can the athlete control the ROM at the speed required of the sport?

Look at these activities. Lots of interesting poses here. Notice how the bodies are positioned. Notice the knees, hips, trunk, arms and head. Take note of all the angles between the joints. Here’s a question: Do any of the exercises you see or do in the gym look anything like any of these? How much of what you do in the gym puts you in an athletic or “real life” position? Does a standard squat, deadlift, kettlebell swing, sit-up or any type of machine exercise fit the bill?

In my exercise toolbox I now have the observational skills and knowledge to address those previous there questions with my clients and athletes. I know how to progress people from very simple movements to far more aggressive movements. I feel confident in my ability to help my clients solve their own movement problems via what I hope are fun, challenging and safe exercises.

(BTW, this also applies to anyone who “just wants to work out.” If he or she has no athletic goals but wants to feel like they’ve worked hard, I can instruct them on exercises that will be both challenging and safe. If I think a squat is the type of exercise that will satisfy his or her requirement to “feel” a workout, then I still will ask those questions.)

In following posts I’ll discuss progressions and variations on traditional exercises. By playing with joint angles, foot positions and hand/arm positions, and by employing impact (stepping, hopping, jumping) we can create an infinite number of exercises that closely resemble sporting activities. With this process we can probably better prepare for sports than if we simply employ traditional exercises like squats, bench presses and deadlifts. Don’t worry if you don’t consider yourself an “athlete.” These exercises tweaks can be a lot of fun, very challenging and never boring.

Colon Cancer & Sitting

The New York Times Well Blog discusses an alarming trend:

Incidences of colorectal cancer have been decreasing by about 1 percent a year since the mid 1980s, but incidences among people under 50 — the recommended screening age — has been increasing sharply, and these younger patients are more likely to present with advanced disease.

The article discusses findings published in JAMA. This information strikes close to my wife and I. Someone in her professional world has been diagnosed with advanced colon cancer. He is relatively young, not overweight and he has been moderately active. This has been a shock to a lot of people and we’re very sad for him and his family.

This situation makes me think about the research on sitting. Prolonged Sitting May Increase Risk of Certain Cancers is an article in Scientific American. The article states:

“The more time people spend sitting, the higher their risk of certain types of cancer, according to a new review of previous studies.

Researchers found that, with each 2-hour increase in people’s sitting time per day, their risk of colon cancer increased by 8 percent, and women’s risk of endometrial cancer increased by 10 percent.”

The person we know with colon cancer is a successful computer guy and he is very passionate and dedicated to his field of expertise and that’s dictated that he sits a lot. (I’m not placing blame on him, simply noting my observations as they relate to this data.) The Scientific American article also says,

“The results were independent of physical activity, showing that sedentary behavior represents a potential cancer risk factor, distinct from physical inactivity,” study author Dr. Daniela Schmid, of the University of Regensburg in Germany, told Live Science in an email.

So it seems that we can’t out-exercise our sitting habit. Sitting is a hazardous activity in and of itself. I am morbidly fascinated that modern humans have virtually eliminated threats such as animal predators and infectious disease from our lives, only to replace them with something like sitting. To me that’s solid proof that the creator of the universe is possessed of a real wacko sense of humor.

I have one question about the sitting-causes-cancer factor: What about bicycling? Is it literally putting my butt on a solid object that increases my risk or is it the staying still for hours on end? What if desk-bound workers were to somehow lay down for their work. Would the cancer risk also rise? My guess is that it’s being sedentary for hours and hours that’s the problem and that riding a bike is not carcinogenic. I’m also betting that someone is researching all of this and we’ll get some sort of answer soon.

Tracking Weaknesses: An Efficient Way to Monitor Progress (or Lack Thereof)

I’ve been deeply immersed the FASTER Global curriculum over the past several months. Efficiency (getting to your movement, physique and performance goals as fast as possible) is the key focus of FASTER. To this point I was given a great idea by my FASTER instructor Mike Terborg. I became of what seems to be a very useful and efficient way to monitor whether or not you’re doing what you need to be doing to achieve your goals.

Self-monitoring

Most of us know that if we want to lose weight then we need to do things like eat differently, exercise more and sleep more. Research (here, here and here) has shown that self-monitoring of metrics such as body weight, physical activity and food consumption is a significant component of weight loss. By tracking these things we become mindful and more aware of our habits which is exactly what we must do if we want to change our behavior. If we don’t track some data then a) we won’t know if we’re making progress and b) we’re less likely to focus on the necessities.

Track only what’s needed.

A lot of us have experience tracking all of our food, every mile we run/bike, every weight lifted on every exercise etc. This can become tedious and I know that in my experience I end up with a bunch of information that I never use. I don’t meet many people who are in love with tracking their activity. (Some people do enjoy the meticulous tracking of data. I wish I did.)

With a mind toward efficiency, maybe we don’t need to track everything. Maybe we can track and focus on only the things we need to improve–our weaknesses. Here are some examples:

One client of mine likes to drink a few beers. She started using a Google calendar to track a) the days on which she drinks and b) what quantity she drank. She shared that calendar with me so we can both be mindful of what’s going on. Fantastic!
If you eat well and work out consistently but you typically go to bed too late (1 a.m. let’s say) and don’t sleep enough then track every night of the week you get to bed by say midnight or 11 pm.
If you binge on sweets several nights a week then track every night that you don’t binge. You should be able to answer the question, “How many times did I eat sweets this week?”
If you exercise sporadically then think of tracking every day that you do something called “exercise.” If you’re a beginner then you will see fairly impressive benefits from simply starting to exercise regularly, no matter if it’s weights, cardio, (if you delineate exercise according to those terms) or whatever.
Maybe you’re an aggressive go-getter, and you’re not resting and recovering enough. You’re overtrained perhaps. Maybe you need a couple of dedicated rest days. Now you might actually track the days that you don’t work out. Or maybe you track every day that you take a nap.

It’s all about awareness.

I continue to believe that awareness is maybe the most powerful concept to anyone wanting to lose weight, get in shape and increase performance. The purpose of tracking (some of) what you’re doing is to contribute to your awareness. Monitoring some part of your activity is essential to see if you’re doing what you should be doing.

At the same time, it’s a good idea to be efficient and monitor only what’s needed. Too much information is… well… too much. It takes away from something else that’s important. Rather than monitor your strengths think of monitoring only your weaknesses.

Motivation vs. Willpower

I mentioned in the last post that I was reading and enjoying Matt Fitzgerald’s Diet Cults. Chapter five of his book contains some information that I found very thought provoking. This chapter discusses the process and details of those who’ve successfully maintained weight-loss. The National Weight Control Registry observed several key behaviors in those who lost weight and kept it off.

Weighing: If weight-loss is your goal then looking at a scale will tell you if it’s happening.
Monotonous eating: Eating very similar meals repeatedly makes it easy to track caloric intake. Further successful weight-losers to vary their eating less during the weekends and holidays. (“Monotonous” may imply boring. I don’t believe it has to be that way.)
Exercise: What we eat (and don’t eat) is absolutely vital for weight-loss. It seems that exercise is absolutely vital for maintaining weight-loss

(Interestingly, subjects do report eating healthier eating as part of the weight-loss process, no specific diet was identified as being best.)

More important than habits is the motivation that underlies these habits. Motivation is different from willpower. Fitzgerald suggests that motivation activates will power, sort of like computer software (motivation) activates the hardware (willpower). He says that “evidence suggests that most people have all the willpower they need to lose weight and that what separates the successful losers from the failures is motivation.

The NWCR study found that 90% of members reported having failed in previous weight loss attempts. In other words, these people failed a lot. It seems the people who succeeded kept on trying due to motivation. This got me thinking about my own views on willpower vs. motivation.

It seems that we often talk about willpower as a negative thing. We criticize ourselves because we don’t have enough of it and we wind up eating a bunch of cake. Or else we see overweight people, drug addicts or smokers and we say they don’t have the willpower to lose weight or quit. The word willpower mostly seems to come up when there’s something negative drawing us towards it and we know we’ll succumb to this evil thing, and then we’ll hate ourselves afterward. The practice of willpower seems a cold, Spartan type of undertaking.

In contrast, something that motivates us is a positive thing that we want. It’s something that makes us look past the temptations, triggers and roadblocks to our success. We may not be perfect in our eating and exercise habits but the motivating factor makes us keep trying. I think in a lot of cases motivation actually makes us want to undertake the healthy behaviors that lead us to our goals. As noted in Diet Cults, it’s motivation that makes for successful willpower.

Not that everything about our motivation is positive. Fear may be a great motivator. For instance, a doctor says, “If you don’t lose weight you’ll have a heart attack in five years.” For a lot of people, that may be the type of revelation that motivates them to lose weight. A similar scenario may play out if we lose a loved one to a preventable illness like diabetes.

Maybe shame motivates us. I recall a client who stepped on a scale, saw the numbers and said, “That’s it! I can’t do this anymore. I HAVE GOT TO LOSE WEIGHT.” And he did.

Money is one of the best, most popular motivators out there. Look at participants on the Biggest Loser. They go through an especially ugly hell to win fame and fortune. (I’ve seen all of about 3 minutes of that show. It scared me.)

I was speaking to a very wise friend about all of this and he said that inherent in this motivation to change is a genuine belief that a change for the better is possible. Beyond the fear mentioned above, we must see and believe in a better life for ourselves. A living belief in a better future sustains motivation. Without this belief motivation withers and dies.

From what I know, motivation must come from within. I’m not sure how to impose motivation on someone. I think perhaps I can draw motivation out of a client by asking the right questions. This is a challenging prospect! This involves a developing a fairly intimate relationship with a client and asking some nuanced, sensitive questions. This has given me a lot to think about.

What motivates you in your fitness endeavors? Surely something must motivate you to wake up early or carve out time in your busy day to grunt, groan, sweat and lift heavy objects. Most of you aren’t pro athletes or models. So why do you do it? I’d like to know. What makes you keep on keeping on?

Thoughts on “Diet Cults”

I’m about to finish Matt Fitzgerald’s Diet Cults and I’m enjoying it a lot. He discusses the extent to which we identify ourselves by how we eat. Many of us proudly and loudly claim the label of Paleo, Vegan, Raw Food, High-Protein, Low-carb and similar type things. Food gurus try to convince us that there is as Fitzgerald calls it The One True Way to eat, a way that guarantees long life and good health. The various diet gurus tell us that the One True Way exists, but science tells us something different.

(I’ve noticed that there aren’t many other products or practices that incite such near-religious devotion. We don’t identify ourselves by the color of our car, the material our shoes are made out of or what type of carpet we have in our house. Dietary habits however are a major part of our identity. Fitzgerald goes into some history and possible reasons why.)

Mainly what we learn is that humans seem to be very flexible in our ability to not just live but thrive on all sorts of different eating patterns. Diet cults however tend to rigidly forbid various foods (grains, gluten, dairy, animal flesh, alcohol, even cooked foods are a few examples) with the threat that you will surely fall ill and possibly die from any number of ugly conditions.

Here are a few other interesting points I’ve gotten from the book:

Motivation (different from willpower) is far more predictive of long-term weight loss than any type of diet or eating pattern. Here’s the study from the National Weight Control Registry.
Fitzgerald profiles various individuals who have lost weight and improved or maintained their health on all sorts of diets: Paleo, raw food, Weight Watchers, high-protein are a few examples. He even discusses researchers who maintained very good health while eating nothing but white potatoes for a month! The point? There doesn’t seem to be any One True Way to eat.
He discusses chocolate, wine and coffee, three things that are often demonized and forbidden in various diets. (Our paleo ancestors definitely didn’t even have them.) Yet there is evidence that they can confer good health on us when consumed in reasonable amounts. I like that he brings up the joy and pleasure we often have when consuming them. Spiritual health is something to consider alongside the strictly “physical” health components of our eating habits.
He provides a very interesting discussion on autoimmune issues, GI tract issues, gluten (and the fear of gluten), trauma and stress. Specifically what I found most interesting were the studies on trauma, stress and autoimmune diseases. (Celiac disease is one of many autoimmune diseases.) A study from King’s College London “concluded that more than one in ten cases of low-grade systemic inflammation in adults may be attributable to childhood trauma. And there’s more. A study by the Centers of Disease Control found this:

“Four years later, Shanta Dube and her colleagues at the Centers for Disease Control went a step further. They gathered information about “adverse childhood experiences” from more than 15,000 adults. The categories of adverse childhood experiences were physical, emotional, or sexual abuse; witnessing domestic violence; and growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. These data were used to create cumulative childhood stress scores for each subject. Dube and her colleagues then collected information from the subjects on hospitalizations for twenty-one selected autoimmune diseases in three categories. When the researchers crunched the numbers, they discovered that subjects were between 70 and 100 percent more likely to have developed an autoimmune disease than were subjects who had suffered no adverse childhood experiences.

The point? Food isn’t the only cause for our illnesses. Our emotions and the stress of modern living seems to have a very powerful influence on whether or not we’re “sick.” Thus, going on some sort of absolutist diet may have no effect whatsoever on such things.

So there are a few thoughts. Fitzgerald doesn’t give us license to eat all the garbage that we want but rather he illustrates that we can very comfortably attain excellent health through a wide variety of foods. (In my view, giving a damn at all about what you eat is probably the vast majority of what will get you where you want to be. Thinking about your food is a great starting place.) If you’re confused about all the mixed nutritional messages around you and some of the wild claims made by diet gurus then Diet Cults may deliver much welcome information.

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach