Personal Training

My back issues started in earnest when I first started working out with a personal trainer (about 5 years ago). It was my first experience with a personal trainer ever. And I was out of shape (of course) but had never really exercised before. (I don't think P.E. in Jr. High really qualifies.) I was exercise adverse. I don't mean that I was/am against physical activity. I just was against the kind that involved a gym, equipment, looking stupid and sweating. I had several times in my life where I went to Jazzercise or Aerobics class (back in the day when we all wanted to look like Olivia Newton-John as she "Got Physical").  But I digress.

I had amazing health insurance at the time and it paid for a medical program that included a weekly nutritionist, 3X / week personal training and periodic check-ins with the doctor.  It was a one time program and I had to pay a portion, but I wouldn't have been able to afford it without the amazing health insurance plan. Anywho, the program expected dramatic results (which it achieved). And the personal trainer I was assigned to was a young man. I believe he felt pressure to be able to write down quick physical fitness improvements in my chart.  (The program was heavily monitored by a team of professionals that were evaluating the program as a whole as well as the results of individuals).

Lots of lessons AFTER I was hurt.

This seems obvious, I know.  But...there's this weird thing at work here. I'm paying this trainer to help me get into shape. I believe that what he is asking me to do will actually help me get into shape. I believe that he knows better than I and would not instruct me to do an exercise that I wasn't ready for. Whenever I wanted to say, "No, I don't like this", I wasn't sure if I just didn't like it OR if there was a reason I shouldn't do it.
Turns out, one of the reasons I got hurt was because my trainer DID have me doing exercises I was not ready for.  A big reason he didn't see that was because with each exercise he would show me, I would mimic fairly well. Because I was able to lift the weight or hold the pose I believed that I was actually seeing the results of my new workout routine. The trainer was happy because he could write down in the little chart that I was progressing.  I was happy because I thought I was progressing.

The things that were important were the things that were not visible to the eye. That is, I was doing the exercises by using the WRONG muscles. He said "Lift this", so I lifted it, period. What I learned in physical therapy was that all along I had been using my back muscles for every exercise. EVERY exercise. This whole exercise thing was new to me, so I had no idea how to identify that the correct muscles were working for each task.

This is exactly what I had to do. I had gone to the doctor with my hurt back and he sent me to the physical therapist. So I had to add physical therapy 2X / week on top of personal training 3X/week. I shared with the trainer that I was in PT and what I was instructed to change in my work out. But I had to really stay strong and confident because as I got physically stronger, he kept encouraging asking me to return to an exercise I had been doing before I was hurt.

Exercise is not supposed to cause actual pain. Discomfort maybe but not actual pain.

Oh My Aching Back

I am so appreciative of the comments on my last post. I planned on posting an update yesterday but was so sleepy that I went to bed super early instead. My back is better. Not great but better. I will tell you what I'm contemplating.

I had physical therapy for this very same back issue about 5 years ago. I learned a lot about why I was hurt and how to begin to heal. The main reason I was hurt? A weak CORE. --By the way, I grew to hate hearing about my core. Even now, I have to stop myself from giving a stink eye to anyone that says something about working to strengthen my core.

So, if I strengthen my core muscles (abdomen and back) I am less likely to have my back fall out of alignment. (Which is pretty much what I think I experienced this week.)  Sometimes it's the chicken versus the egg question. How do I exercise my abdomen and/or back when I am in pain? Don't I need to heal first?

Well, I've done a lot of reading this week, and all of the literature I found says NOT to stay in bed if you have back pain. Everything recommends movement.  For me, I could feel the vertebrae in my lower back just kind of lock up. I felt that if I could get them to loosen up and be flexible (again), that I would be on my way to not hurting.

When I was in PT, I had regular PT and then was sent to a Pilates physical therapist. She was a certified physical therapist that used Pilates techniques and equipment for PT. I got such a huge benefit from working with her. Each time we started with me on the table and I had to warm up my spine by sitting up and then rolling down to the table vertebra by vertebra. This was not easy for me as my lower back usually collapsed without releasing incrementally (vertebra by vertebra).  This was an indicator that my lower back vertebrae were tightly locked and wanted to act as one instead of moving separately as connected joints.  But with each day that I worked my back in these very slow deliberate motions, my back got looser and the pain eased.

We also discovered that one of my legs is shorter than the other. (Right leg). In fact, what we found in my non-Pilates PT is that my actual leg bones are the same length. Instead, my right hip torques into my pelvis (which has the effect of a shorter leg). Good news is that the leg can actually be pulled out of the pelvis and with some exercises I can help keep it out.

Sometime after graduating from PT, I re-injured myself. This injury was a little different and the PT was not as effective the second time around. Someone recommended a Chiropractor. I had previously been skeptical of Chiropractic care, but this time I was tired of hurting and tried it. Amazingly, working with him gave me tremendous relief. This practitioner was very gentle and believed in exercises for me to practice at home to help. The goal of the exercises? Strengthen my (wait for it) CORE.

Massage also helped.

So, now here I am again, and I live in a different town where I have to re-build my care team. I was sure I wanted to find a Chiropractor pronto. But truly, I'm not so sure this time. My reading shows that some practitioners still believe in thrusting to move vertebrae into place. And I'm just not sure I want to trust that.

We already know I need PT. I was supposed to get PT for my knee last April. My guess is that the knee problem and the back problem are inter-related. I found a physical therapist I want to use. The big question now is will insurance cover it. The second big question is how to schedule the appointments.

I fully expect that my future holds exercises that involve strengthening the (say it with me) core. Below are some of the things I remember from my prior PT and core work. I remember using foam rollers to help with back pain.  I'm almost looking forward to this.

Tomorrow I will tell you more about my personal training experience.

My Back Hurts

So, my back hurts. I've had lower back flare-ups for a while.  My body is telling me it wants me to take notice. So now I've got physical pain to go along with my guilt for not being a good steward with my body.

My mind keeps thinking that I’ve just been on a short hiatus from exercise and overall taking care of my body. Somehow I've convinced my mind that we are still physically fit...or at least getting that way. But, I hate to admit it, I've been lying to my mind.

You know, not that long ago I became a runner. Actually, I was trying to become a runner. I was working on the couch to 5K workout plan. But, I injured my knee and was told to stop (by a Doctor). The doctor gave a referral for physical therapy that is needed before resuming running.

I convinced my mind that this is why we aren’t at the gym or walking or anything. My mind has accepted the story that the knee injury was not long ago. It was APRIL! It was nine months ago. My knee is better. I haven't yet been to the physical therapist. Now, before you judge, there are two reasons for that.  One, my doctor wanted me to use a PT associated with his larger medical network. The PT department was supposed to call me to schedule. I never received a call.  (Really). And, two, timing. It is so difficult to schedule all these medical appointments during the workday. 

2X / year I have dental appointments. It looks like I really need to go to an endontist because one of my root canals has lingering nerve issues. (Weird, right?) I got the referral to the endodontist at my last dental appointment. I haven’t made the endodontist appointment yet, either. Of course, I have annual primary care appointments, Gyn. and mammals. That’s a doctor appointment every two months. PT will be/would be weekly. I struggle with the times.

So now, my back hurts. 

GOAL= Healthy Weight (?)

I was on a weight loss program that lasted an embarrassingly long time. The first 6 months I did great and lost an appropriate amount of weight. Then I plateaued for another 6 months. Flat. Each time I went to weigh in I comforted myself that "No Gain = No Gain", which is a WIN. But I really wanted to jump start to get that next 10 pounds off. That would not have put me at "goal", but it would have put me at a number I would be willing to have on my driver's license.

Running Has Been Placed on Hold

RUNNING! Why is it that when I want to do something "good for me" it turns against me? Last Saturday I ran eight two minute runs, with single minute walks in between.  --My right knee began to hurt a week ago along with my left ankle.  I believe that these aches and pains are related. I think one is compensating for the other, but not quite sure which came first...the ankle or the knee.  My knee is something I need to pay attention to.  I've had knee issues in the past, but thought that I could just work through this.

I purchased serious running shoes and was fitted by a serious local running shoe company.  They actually watch you run in shoes before selling them to you. --They seem to know their stuff. I'd been sort of fitted for shoes in the past but they've never watched me run.  Once I was fitted (can't remember if the first fitting was New Balance or Brooks), I just purchased similar shoes from then on. This new store I went to also want you to bring in your existing shoes so they can get clues about your walking/running patterns by the soles of your shoes. --I took in two pairs (two different brands, but similar in how they fit).  They could tell absolutely nothing from the soles of these shoes. I've worn them of course!  Just not run in them. And really the walking in them was minimal so that there was no wearing pattern. 

The second thing this store does after looking at your existing shoes they have you take off your shoes and socks! Then they have you sit down with your feet on the floor and look at how your feet plant themselves.  Then they have you stand up to see how your feet change with the weight of standing. My shoe person told me I have "fairly" flat feet.  And he took out a felt tip pen and made marks on the instep (arch).  He said he was measuring how the instep changes between sitting, standing and walking. He found it interesting that although I have fairly flat feet that the arch does not collapse when I stand or walk. He also said that the shoes I currently used are "stability" shoes, usually recommended for people with over-pronation.  He said that it is interesting that even though I have a flat foot it does not appear that I actually over-pronate and he felt that I should not wear stability shoes.

Stability shoes have extra support along the instep of the shoe to help stabilize your ankle and keep it from rolling too far inward.  He advised that I get a shoe for "normal" pronation with no additional stability built in.  The reason it is not good for someone with a "normal" gait/pronation to wear a shoe with stability added is that it can force your foot to move away from "normal" and roll your foot to the outside, which would cause different problems.  Confusing? Yes? 

Image by Bob Gavin
From the August 2004 issue of Runner's World

I just did additional research to confirm that I understood pronation correctly in the explanation above. So what have I learned?  I've learned, that my feet are flat.  Typically flat feet leads to over-pronation in running. This would mean needing a stabilizing running shoe. I was previously fitted with stabilizing running shoes. I learned that it is odd that although I have flat feet I don't overpronate. The shoe person recommended that I run in non-stabilizing shoes.  --Which I bought...and they are beautiful.

On the third day that I wore my new shoes, my ankle and knee began to hurt noticeably.  However, that was also the day that we increased our running from 1 minute per run to 1.5 minutes per run.  In addition, I am not in the best physical shape and I am not at my "optimal" weight.  So, it is hard to say what caused the pain.  The shoes? The additional running time? The fact that my muscles are weak? The fact that we are running on a trail in the woods with hills and uneven terrain. What could it be?

Some pain is expected with a new exercise.  So I ran again 3 times after noticing the pain.  I ran on Monday with my new shoes and still hurt.  On Wednesday I ran with my "old" shoes.  Still hurt...but maybe not so much? Hard to tell. But Wednesday was my best run to date. And I will tell you, I missed the arch support I got with my "old" shoes.  Saturday run was increasing the run to 2 full minutes. I ran in my old shoes.  It was absolutely my best run yet. I almost liked it. I didn't believe the Pacers when they yelled out "Walk" to indicate that the first run was complete. I felt two minutes could not have possibly passed.  I ran each two-minute interval without stopping. It was the first run I was able to complete without resorting to some walking during the running portion. I was elated.  But, after it was over, my knee and ankle hurt.

Sunday I went back to the shoe store to have my shoes re-evaluated. The manager took over from the initial shoe person.  My symptoms were something that needed more expertise.  So I had to run and walk and have him watch.  As I returned to the manager (after an embarrassing limpy walk/run), he said, "Well, I can tell you that these are the right shoes. But you also should not be running".  He suggested I see a physical therapist as soon as possible.  Tears actually came to my eyes. "No! You can't say that!" I wanted to shout. Not now that I decided I was going to enjoy it! I want to be fit. I want to lose weight.

I went home to research running gaits.  Perhaps it's not the shoe.  Perhaps it is the way I run.  I told the first shoe person that my natural tendency is to run sort of on my toes.  He watched me run my natural way (sort of on my toes) and the way I thought my Personal Trainer taught me to run: "Heel Toe, Heel Toe".  He said either way was fine, but that when I ran on my toes it was actually similar to the new movement barefoot running.

My running gait research told me that Heel Toe is not correct.  Landing on your heel (according to two of the articles and videos by running experts) means your foot is in front of you. This leads to your forward momentum being stopped like a brake, and all of your weight with that forward momentum lands on your heel which shoots pain straight up your leg and joints.  This sounds right to me.  I felt my leg pain in my knee.  The articles said you aren't supposed to land on your toes, per se, but on the balls of your feet and you are supposed to land softly.

I know for sure that the day I hurt myself I was not landing softly.  Even though I was somewhat enjoying my run, I was aware that I could hear and feel a heavy landing with each stride. Perhaps the landing was heavier on my right leg.

Armed with this new information regarding gait, I ran one more time in my new shoes. Saying to myself with each step "BALLs of your foot, not heel".  But with each step, my left ankle and right knee were yelling at me to stop.  Undaunted, I would not stop, though I ran so slowly I might as well been standing still.  I finished the run/walk. I had to, there's no other way out of the woods.  I went home, took Advil and put ice packs on my ankle and knee.  The knee is swollen.  It hurts now to walk even around the house. I feel stupid for trying again.

Have Dr. Appt scheduled..  Will most likely get physical therapy to strengthen the legs. I should have stopped sooner...I know that now. I can't sacrifice my knees. I need them. My husband says I should try biking.  Or swimming or walking... You know, there is probably a point to be made.  Perhaps I should have gotten my legs stronger before just jumping in.  Will have to re-evaluate.



Learning to Run

Last Saturday I completed my first group run. I joined the local running club: Carolina Godiva Running Club. Each Spring the club hosts a training program to help "couch potatoes" become runners.  Fittingly, the program is called "Running Start". 

I have never been an athlete.  I don't mean that I never considered myself to be athletic.  I mean I've never done anything athletic.  Actually, I may be a little wrong about that last statement.  When I was young (5 years or so) I L.O.V.E.D. to swing on swingsets.  I could swing for hours.  --This is a passive exercise, I think.  In elementary school, during recess, I was not one to play German Dodge Ball or jump rope.  Instead, I was playing jacks or a card game called "Spit". --Both games involved fairly good hand-eye coordination as well as a competitive element.  I was quite good at both. But physical exercise type play? Not really my thing.