DON'T Make This Mistake During Core Exercises (Know Your ABC's)

As a personal trainer in the early 1990's, it was pretty standard operating procedure to give people sit-ups or ab crunches as part of their routine. I don't use these exercises much anymore, but honestly if done right they do have some benefit. I would always emphasize the breathing as I showed them the exercise. Nonetheless, EVERY SINGLE PERSON would hold their breath at some point. Then I would remind them. "OK Mr. Smith. Your form looks good, but just don't forget to breathe." Of course they would start breathing again. And of course, about 3 or 4 repetitions later, they would start to hold their breath again. EVERY SINGLE PERSON!

Fast forward to today. I am still giving people "core" exercises. By my standards "the core" means any part of the torso that connects one limb to another, or a limb to the head. That covers a lot of ground. Needless to say it's not just the "abs" anymore. Nowadays I give patients exercises which they are going to do at home without me. I can't be there to say "Breathe!". So how can I ensure that they are breathing? They need to know their ABC's

Active Breathing Core (ABC) is system of exercises that I developed in which the person holds a position, and counts breaths. They do not count repetitions. But they have to be big audible breaths. Not so big that they are hyperventilating, but big enough to challenge the respirator muscles beyond the "rest phase". It's really not as complicated as it sounds. It is similar to yoga, but you just have to count your breaths.

At rest, our breath is controlled at a subsconcious level. It involves the diaphragm, the elastic recoil of the lungs, and some parts of the intercostal muscles (the muscles between the ribs). This process happens even though we are not consciously aware of it. Therefore I call it a passive breath pattern.

Active breathing occurs when our heart rate goes up and our demand for oxygen increases. Most anything beyond sitting and resting can do this. Light activities like walking, washing dishes, or cutting the grass are good examples. Our bodies need to increase the volume of air that is taken in, and begin to use different muscles to do just that. This includes muscles of the neck and shoulders (SCM, scalenes, pec minor) for the inhale, and abdominal and low back muscles for the exhale. These "active" exhaling muscles are rectus abdominis, external oblique, internal oblique and transversus abdominis, iliocostalis and longissimus, the serratus posterior inferior and quadratus lumborum. All of those muscles are "core". Those muscles, which are activated in elevated breath patterns, are also necessary to help stabilize and support the torso during the activity. Therefore, these muscles need to be taught to be able to COORDINATE their function of breathing with their function of stabilizing!

Try this test. Stand up. Then squat down as if you are about to pick up a pencil. Then stand back up. Go ahead and do it now.
Done? Chances are you just held your breath to complete this movement. Your body should not need to shut down the breathing process in order to do such simple tasks. Now think about running. Do you think you need some core muscles during this movement? Do you think you also need to breath? Bingo!

So for simplification, I now give these positional exercises and have the person count three big audible breaths. Then come out of the position and relax for a breath or two. This is repeated at least 5 times. Coming out of position is often necessary. The longer someone holds a position, the less likely they are to hold GOOD position. So the small break helps them "reset".

Don't worry, though. You won't have to go back to school to learn your ABC's. You can see them here on Youtube.

How to tell if your headache is really from sinus pressure

Many of my patients already know that they have allergies. For some it is new territory. The idea that allergies can increase or decrease through the course of one's life is still surprising to many. ("I've never had allergies before!") In addition, many people with allergies don't really know what they are allergic to. This makes them all more difficult to diagnose. Yet allergies can definitely combine with other factors and contribute to existing headaches. It may be often enough that people may become confused about where there usual headache ends and the sinus headache begins. Then add to the mix possible sinus infections? Even more confusing.! So here are a few distinguishing characteristics.

Most people will describe their headache as "pressure" when it is sinus related. Otherwise headaches are usually felt as dull aches or bands of tension. If the pain is around the eyes and cheeks and central forehead, it is likely sinus related. Pain or pressure in the teeth is also sinus related. When it is more around the temples, or a band around the head, it's a tension headache. Near or above one eye is usually a migraine. If this does not help, try this quick test. Bend forward or tilt your head forward. A sinus related pain will usually create more pressure and more pain. Most other headache variations do not worsen when you move this way. Lastly, migraines are the only headache to also cause nausea and/or vomiting. If you experience this, then it is usually a migraine.

Attributing the allergy to the allergen is helpful in figuring out the patterns. Seasonal allergies often play a large role. Depending on what season it is can help you determine what you are reacting to. Late winter/early spring is usually from snow mould. (This is actually a fungus). Mid to late spring is more often tree pollen. Late spring to mid summer is usually grass pollen. Mid to late summer is usually weed pollen. Late summer to fall is most often leaf mold. Some sources say winter is high in mold as well. This may be true, but keep in mind indoor allergies such as dust mites. Most people don't spend much time outdoors through the coldest months. In fact, using an air purifier in your bedroom can help cut down on all allergens, especially the indoor ones. You can also use weather apps or allergy specific apps to help track the allergens according to your specific climate.

To make things even more confusing, chronic allergies can weaken your immune system to make you more susceptible to getting a sinus infection. There are some general guidelines that can help regardless. Current research suggests that people suffering from chronic sinusitis often have poor gut flora. This is where the immune system starts. Probiotic supplementation therefore can go a long way to help one's immune system under these circumstances. Herbal remedies can also be helpful. I have seen the best success in allergies with feverfew, stinging nettles, and Vitamin C. Chronic infection seems to be better treated with oregano oil. Of course, if you have a fever or other symptoms in addition to sinus pressure headache, please consult your primary care physician.

Chronic knee pain: is it really arthritis?

There are few injuries that will slow you down as much as knee pain. In circumstances where there is trauma and /or accident, the diagnosis and treatment are fairly obvious. Think of someone being tackled from the side and their knee buckles in. This is likely a tear of one or more ligaments of the knee. Treatment depends upon the degree of damage, and surgical reconstruction may not be a bad idea. But more often the pain is more mysterious. It arises with no obvious cause. It comes and goes at seemingly random times. Many people conclude it must be arthritis.

If you follow this blog or my Facebook page you likely have likely read about how there is POOR CORRELATION of pain to joint damage and arthritis. Scientists have always assumed that x-rays, CT scans and MRI imaging were the "gold standard" for diagnosing musculoskeletal pain. What they are looking for is evidence of joint damage and/or arthritis. But recent studies have shown that MRIs of "normal" or "healthy" populations WITHOUT pain also show significant levels of damage and arthritis. So the question is- how can you be certain that it is the cause of YOUR pain, when there are so many other people with the same damage and NO PAIN?
So here is some perspective. The old way of thinking goes something like this:

In the old way of thinking, ALL damage was due to overuse and overactivity. The problem with this is that everything is considered "too much". Is it really "too much" when someone squats down to pick up a small child? What about going up or down stairs? Should an otherwise healthy 25 year old woman need to stop running 5k races because it is "too much" for her knee arthritis? I think not.

The new way of thinking looks something like this. It is a double feedback loop.

You can see how even if you surgically "fix" damage and arthritis, the pain is likely to continue. It's not that damage and arthritis are always completely unrelated to pain, it's just that it's not a direct one to one relationship as previously thought.

Too often in the past, we have been told to be "careful", and "don't overdo it". Unfortunately this has led to many of us being overly cautious and fearful of daily activities. We start to see our bodies and weak, and need to avoid pain at all costs. Opioid prescriptions are a good example. They don't heal you. Your body does the healing. We just need to optimize the heeling environment. How do we do this? MOTION! Gradually increasing the activity level is crucial. Muscular resistance exercise is necessary. Studies have shown that even in the presence of arthritis, training the surrounding muscle structures helps to improve function and decrease pain. So the first question is- does such training decrease the level of arthritis? No. Arthritis can't be undone. Then there is the second question. Is the pain really from arthritis?